Pneumonia and pulmonary abscess due to Legionella micdadei in an immunocompromised patient.

INTRODUCTION: Legionella micdadei are gram-negative bacilli living in soil and aquatic habitats. They are responsible for less than 10% of legionellosis, but have a propensity to affect people suffering from immunodeficiency. Lung cavitations may also occur in this population. Isolation of L. micdadei on clinical samples requires specific culture media that are not routinely used. Moreover, serologic methods and urinary assays are specific for Legionella pneumophila serogroup 1 (the most frequent serogroup isolated from clinical specimens), and lack sensitivity for diagnosing L. micdadei infection. As a consequence, this diagnosis is difficult to confirm. CASE REPORT: We report here a severe case of community-acquired legionellosis due to L. micdadei, in a patient under immunosuppressive medications and high-dose corticosteroids for rheumatoid arthritis. The source of his infection was hypothesized to be his continuous positive airway pressure device, which was regularly cleaned with tap water instead of sterile water, thus potentially resulting in Legionella contamination. CONCLUSIONS: L. micdadei must be considered as a possible cause of community-acquired severe pneumonia in case of immunodeficiency. For outpatients, advice concerning the cleaning of aerosols-generating devices at home must be emphasized.

Effects of L-Dopa on circadian rhythms of 6-OHDA striatal lesioned rats: a radiotelemetric study.

Temporal variation in the motor function of Parkinson's disease (PD) patients suggests the potential importance of a chronobiological and chronopharmacological approach in its clinical management. We previously documented the effects of striatal injection of 6-OHDA (as an animal model of PD) on the circadian rhythms of temperature (T), heart rate (HR), and locomotor activity (A). The present work assessed the possible influence of L-Dopa on these same rhythms in the 6-OHDA animal model of PD. The study began after a four-week recovery period following surgical implantation of telemetric devices to monitor the study variables and/or anaesthesia. The study was divided into an initial one-week control period (W1) for baseline measurement of T, HR, and A rhythms. Thereafter, stereotaxic 6-OHDA lesioning was done. and a second monitoring for two weeks followed (W2, W3). Rats were then randomly divided into two groups: eight control rats received, via a mini-osmotic pump implanted subcutaneously, the excipient saline; the other eight rats received L-Dopa (100 mg/kg SC/day). After a seven-day period (W4), the pumps were removed and the T, HR, and A rhythms were monitored for two weeks (W5 and W6). To control for 6-OHDA striatal dopamine-induced depletion, 12 other rats were injected by identical methods (eight rats with 6-OHDA and four controls with saline) and sacrificed at W1, W3, and W5 for dopamine striatal content determination. To verify the delivery of levodopa from the osmotic pumps, plasma levels of levodopa and its main metabolites 3-OMD, DOPAC, and HVA were determined on separate group of rats receiving the drug under the same experimental conditions (osmotic pumps delivering continuously 10 microl/h for seven days, 100 mg/kg/subcutaneously). Our results agree with previously reported rhythmic changes induced by 6-OHDA--loss of circadian rhythmicity or changes in the main parameters of the registered rhythms. When circadian rhythmicity was abolished, L-Dopa treatment improved or accelerated recovery of the circadian rhythms, the effect being more pronounced for the HR rhythm. When circadian rhythms were not abolished but perturbed, L-Dopa treatment did not improve the 6-OHDA-induced changes in the T and A mesor (24 h mean level), while a significant effect was observed for HR. It appears that constant-rate L-Dopa infusion is unable to totally balance dopamine depletion; taking into account the circadian pattern of many structures implicated in drug effect, a sinusoidal delivery of L-Dopa must be evaluated in future experiments.

Circadian rhythms of oxidative phosphorylation: effects of rotenone and melatonin on isolated rat brain mitochondria.

Mitochondrial experiments are of increasing interest in different fields of research. Inhibition of mitochondrian activities seems to play a role in Parkinson's disease and in this regard several animal models have used inhibitors of mitochondrial respiration such as rotenone or MPTP. Most of these experiments were done during the daytime. However, there is no reason for mitochondrial respiration to be constant during the 24 h. This study investigated the circadian variation of oxidative phosphorylation in isolated rat brain mitochondria and the administration-time-dependent effect of rotenone and melatonin. The respiratory control ratio, state 3 and state 4, displayed a circadian fluctuation. The highest respiratory control ratio value (3.01) occurred at 04:00 h, and the lowest value (2.63) at 08:00 h. The highest value of state 3 and state 4 oxidative respiration occurred at 12:00 h and the lowest one at 20:00 h. The 24 h mean decrease in the respiratory control ratio following incubation with melatonin and rotenone was 7 and 32%, respectively; however, the exact amount of the inhibition exerted by these agents varied according to the time of the mitochondria isolation. Our results show the time of mitochondrial isolation could lead to interindividual variability. When studies require mitochondrial isolation from several animals, the time between animal experiments has to be minimized. In oxidative phosphorylation studies, the time of mitochondria isolation must be taken into account, or at least specified in the methods section.

El climaterio: algunos aspéctos biosociales y su manejo terapéutico a nivel primario / Climateric: some biosocial aspects and it therapeutic management at primary level

Estudio descriptivo prospectivo en que se analizan las variables: edad, trastornos neurovegetativos y manifestaciones psicológicas más frecuentes; alteraciones de la dinámica familiar; porcentaje de mujeres que consultan a nivel primario y reciben tratamiento hormonal, de 82 mujeres seleccionadas accidentalmente sin patología crónica, durante el período comprendido entre el 23 de Noviembre y el 16 de Diciembre de 1994, en tres consultorios urbanos de Valparaíso: Plaza Justicia, Hospital de Niños y Barón. Al finalizar nuestro estudio podemos concluir que el mayor porcentaje de mujeres climatéricas se encuentra en el rango de edad de 45-49 años (33 porciento). El trastorno neurovegetativo más frecuente es el bochorno (83 porciento), sintomatología típica del climaterio, ocasionado por el desajuste hormonal, sin embargo, hay que destacar la cefalea en un porcentaje similar ( 82 porciento), pero dicho síntoma es multicausal, muchas veces de carácter subjetivo. La manifestación psicológica más frecuente que presenta la mujer climatérica es la irritabilidad (73 porciento), sin embargo es muy significativo el porcentaje de riesgo de depresión (70 porciento). La dinámica familiar no presenta alteración (60 porciento). En cuanto al porcentaje de mujeres que consultan a nivel primario es bajo ( 25 porciento) y el de las que la reciben tratamiento hormonal a nivel primario, es aún más bajo: sólo con un 4 porciento. Hay que destacar que hay un 19 porciento de las mujeres, que consultan médico particular y que la mayoría, un 16 porciento, reciben tratamiento hormonal