Spatiotemporal Parameters of Gait Among Adolescent Athletes with Concussion When Performing a Visuospatial Cognitive Task.

Background: Adolescent athletes aged 10 to 19 years are at the highest risk of experiencing sport-related concussions (SRCs). Despite the known deficits and battery of assessments following concussion, postural stability during dual-task gait remains understudied in this population. Purpose: The purpose of this study was to evaluate the dual-task cost (DTC) in adolescents with an acute or chronic SRC compared to reference values from healthy athlete peers for spatiotemporal parameters of gait during walking with and without a concurrent visuospatial memory task presented on a hand-held tablet. Researchers hypothesized that adolescents during the acute phase of concussion would be likely to experience a greater DTC compared to healthy peers in at least one spatiotemporal parameter of gait when walking within the dual-task paradigm. Study Design: Cross-sectional, observational cohort design. Methods: Adolescents with concussion were recruited to participate. Subjects were divided into acute and chronic categories based on significant differences in the neuropsychological function after a period of 28 days. They walked at a self-selected speed along the 5.186-meter GAITRite® Walkway System with and without a concurrent visuospatial cognitive task presented on a hand-held tablet. Outcomes included normalized velocity (m/s), step length (m), and double limb (DLS) and single limb support (SLS) (defined as the percent of a gait cycle [%GC]). The data were then compared to the previously published reference values established using the same methods in the healthy athlete participants for all spatiotemporal parameters of gait. Results: Data was collected on 29 adolescent athletes with SRC. Among males (15.53+/-1.12 years) with SRC, 20% of acute and 10% of chronic cases experienced a greater DTC compared to healthy athlete reference values. A similarly increased DTC was experienced by 83% of acute and 29% of chronic SRC cases for females (15.58+/-1.16 years). Conclusions: Adolescent athletes with concussion may continue demonstrating deficits in gait capabilities even in the chronic phase, and compensatory gait strategies were not the same between males and females. Dual-task cost assessment using the GAITRite® may be a valuable adjunct to comprehensive analysis of gait following SRC. Level of Evidence: 2.

Predictive factors for nephrectomy in renal trauma; assessment of a 6-point score.

PURPOSE: To evaluate predictive and associated risk factors for nephrectomy in renal trauma and assess a 6-point score for surgical decision-making. PATIENTS AND METHODS: This multicenter, retrospective, and observational study assessed 247 subjects with blunt or penetrating kidney trauma. Kidney injuries were classified according to the American Association for the Surgery of Trauma (AAST) Injury Scoring Scale. Renal trauma was classified as "low-grade" (Grades I-III), Grade IV, and Grade V. Subjects were compared according to conservative treatment (CTrt.) or nephrectomy. Predictive factors were evaluated with a multiple regression model. A 6-point score was evaluated with a ROC analysis. RESULTS: Patients requiring nephrectomy had a lower mean arterial pressure MAP compared to CTrt, 64.71 mmHg (SD ± 10.26) and 73.86 (SD ± 12.42), respectively (p = < 0.001). A response to IV solutions was observed in 90.2% of patients undergoing CTrt. (p = < 0.001, OR = 0.211, 95%CI = 0.101-0.442). Blood lactate ≥ 4 mmol/L was associated with nephrectomy (p = < 0.001). A hematoma ≥ 25 mm was observed in 41.5% of patients undergoing nephrectomy compared to 20.1% of CTrt. (p = 0.004, OR = 9.29, 95% CI = 1.37-5.58). A logistic regression analysis (p = < 0.001) showed that blood lactate ≥ 4 mmol/L (p = 0.043), an inadequate response to IV solutions (p = 0.041) and renal trauma grade IV-V (p = < 0.001), predicted nephrectomy. A 6-point score with a cut-off value ≥ 3 points showed 83% sensitivity and 87% specificity for nephrectomy with an AUC of 89.9% (p = < 0.001). CONCLUSIONS: An inadequate response to IV solutions, a lactate level ≥ 4 mmol/L, and grade IV-V renal trauma predict nephrectomy. A score ≥ 3 points showed a good performance in this population.

Static and Dynamic Balance Assessment in Healthy and Concussed Adolescent Athletes.

OBJECTIVE: The purpose of this study was to explore the utilization of the Y Balance Test (YBT) alongside the Balance Error Scoring System (BESS) during examination of healthy adolescent athletes (14-18 year old) as well as those with acute and chronic concussion. DESIGN: A repeated-measures study of balance in a cross-sectional convenience sample of adolescents participating in high-school athletics. SETTING: Data were collected on healthy athletes in their school setting for comparison purposes and on concussed athletes in the physical therapy rehabilitation center at the hospital. PARTICIPANTS: Participants were a convenience sample of male and female athletes between the ages of 14 to 18 year old [180 healthy (111 male, 69 female) and 44 (28 male, 16 female) with concussion]. ASSESSMENT OF RISK FACTORS: All participants were cleared for participation by preparticipation examination or by the treating sport medicine physician. MAIN OUTCOME MEASURES: Healthy athletes performed the YBT, a dynamic assessment of balance. Athletes with concussion also performed the BESS, a static assessment of balance. RESULTS: Means for each YBT reach direction were statistically different for both healthy males and females ( P < 0.05). Within both the acute and chronic subsets of the concussed sample, some participants performed over the median value for the BESS but not the YBT. CONCLUSIONS: These data may suggest that dynamic balance testing in conjunction with static balance testing could be valuable in both the acute and chronic phases of concussion to ensure a comprehensive assessment of the necessary balance skills for athletic play.

Tocilizumab reduces COVID-19 mortality and pathology in a dose and timing-dependent fashion: a multi-centric study.

Life-threatening COVID-19 is associated with strong inflammation, where an IL-6-driven cytokine storm appears to be a cornerstone for enhanced pathology. Nonetheless, the specific inhibition of such pathway has shown mixed outcomes. This could be due to variations in the dose of tocilizumab used, the stage in which the drug is administered or the severity of disease presentation. Thus, we performed a retrospective multicentric study in 140 patients with moderate to critical COVID-19, 79 of which received tocilizumab in variable standard doses (< 400 mg, 400-800 mg or > 800 mg), either at the viral (1-7 days post-symptom onset), early inflammatory (8-15) or late inflammatory (16 or more) stages, and compared it with standard treated patients. Mortality, reduced respiratory support requirements and pathology markers were measured. Tocilizumab significantly reduced the respiratory support requirements (OR 2.71, CI 1.37-4.85 at 95%) and inflammatory markers (OR 4.82, CI 1.4-15.8) of all patients, but mortality was only reduced (4.1% vs 25.7%, p = 0.03) when the drug was administered at the early inflammatory stage and in doses ranging 400-800 mg in severely-ill patients. Despite the apparent inability of Tocilizumab to prevent the progression of COVID-19 into a critical presentation, severely-ill patients may be benefited by its use in the early inflammatory stage and moderate doses.

Coxiella burnetii vascular graft infection.

Q fever, a zoonotic infection caused by Coxiella burnetii, can present with a wide spectrum of clinical manifestations. The organism is typically transmitted from sheep, goats, or cattle to humans via contaminated aerosols. On average, 1-5% of patients with acute Q fever will develop chronic infection months to decades after their primary infections. We report a case of a chronic vascular graft infection due to Coxiella burnetii in a 61-year-old man without direct exposure to animals who presented with recurrent fever. Indium-111-labeled white blood cell scan with single-emission positron computed tomography demonstrated findings suggesting a graft infection. C. burnetii phase I and phase II IgG antibody titers were > 1:32,768 and polymerase chain reaction performed on the explanted graft was positive for C. burnetii. Q fever should be considered in the differential diagnosis of vascular infections in patients who have a pre-existing lesion such as an aneurysm, or vascular prosthesis even in the absence of a history of direct animal exposure.

Prosthetic hip infection due to Salmonella enterica serovar Enteritidis.

Prosthetic joint infection (PJI) is a serious complication of prosthetic joint implantation with a prevalence of about 1-2 % of all prosthetic joint surgeries. While Staphylococcus spp. are the most common organisms isolated, Salmonella spp. are a rare cause of PJI (estimated prevalence < 0.3 %). We present a case of a 62-year-old patient with a history of previous joint trauma complicated by osteonecrosis, infection and chronic alcohol abuse with late hematogenous prosthetic hip infection due to Salmonella enterica serovar Enteritidis. PJI due to Salmonella spp. should be considered in the differential diagnosis when a patient has risk factors such as malignancy, hemoglobinopathies, diabetes mellitus, human immunodeficiency virus/acquired immunodeficiency syndrome, alcohol dependency or immunosuppressed state, even without significant preceding gastrointestinal symptoms. Our patient had a few of these risk factors and required surgical debridement in addition to antimicrobials for treatment of his PJI.

Both Chloroquine and Lopinavir/Ritonavir Are Ineffective for COVID-19 Treatment and Combined Worsen the Pathology: A Single-Center Experience with Severely Ill Patients.

The off-label use of antiviral and antimalarial drugs has been considered by many researchers as a fast and relatively safe alternative to provide therapeutic options to treat COVID-19, but the assessment of such drug-specific effectiveness in this regard is far from complete. Especially, the current body of knowledge about COVID-19 therapeutics needs more data regarding drug effectiveness and safety in the severely ill patients with comorbidities. In the present article, we retrospectively analyze data from 61 patients that received treatment with chloroquine, lopinavir/ritonavir, both drugs administered together, or a standard treatment with no antiviral drugs, and the study was carried in severely ill patients. We found that either drug is ineffective at treating COVID-19, as they are not able to reduce hospitalization length, mortality, C-reactive protein (CRP), lactate dehydrogenase (LDH), d-Dimer, or ferritin, or to enhance gasometric parameters, lymphocytes, total leukocytes, and neutrophil levels, whereas both drugs administered together decrease circulating lymphocytes, increase LDH and ferritin levels, and more importantly, enhance mortality. In this way, our results show that both drugs are ineffective and even potentially harmful alternatives against SARS-CoV-2.

Characteristics of pediatric patients operated of aortic coartation in the years 2009 to 2018 at the National Institute of Cardiology Ignacio Chávez. / Características de los pacientes pediátricos operados de coartación aórtica en los años 2009 a 2018 en el Instituto Nacional de Cardiología Ignacio Chávez

Objetivo: Determinar las características radiográficas, electrocardiográficas, angiográficas y quirúrgicas de los pacientes operados con coartación aórtica en el Instituto Nacional de Cardiología Ignacio Chávez entre los años 2009 y 2018. Métodos: Se recabaron del expediente electrónico las variables consideradas relevantes para el estudio y se registraron en la hoja de captura Excel previamente diseñada. Se analizaron diversas variables radiográficas, electrocardiográficas, angiográficas y quirúrgicas. Se valoró la evolución clínica posquirúrgica, complicaciones, requerimiento de procedimientos intervencionistas o quirúrgicos, y se valoró la respuesta a estos y también los diferentes desenlaces. Resultados: Se reportan 187 cirugías de pacientes desde los 2 días de vida hasta los 12 años, en donde se mencionan las características radiológicas, electrocardiográficas y edad de presentación. El total de fallecimientos en los 9 años fue de 17 casos, los cuales en su gran mayoría (94%) fueron antes del primer año de vida. La técnica quirúrgica más utilizada (90%) fue la coartectomía extendida con anastomosis terminoterminal. Las complicaciones posquirúrgicas registradas fueron en orden descendente: insuficiencia ventricular izquierda, hipertensión arterial sistémica, insuficiencia renal que requirió diálisis peritoneal, etc. Conclusiones: La población registrada que requirió una intervención quirúrgica en el Instituto Nacional de Cardiología fue en su mayoría «lactante menor¼, con una mediana de 3 meses de edad en el momento de la cirugía. Respecto a la técnica quirúrgica empleada, la que tuvo mejores resultados y que no demostró tener una asociación significativa con el número de defunciones fue la coartectomía extendida con anastomosis terminoterminal. Objective: To determine the radiographic, electrocardiographic, angiographic and surgical characteristics of the patients operated with aortic coarctation at the Ignacio Chavez National Institute of Cardiology between 2009 and 2018. Methods: The variables considered relevant for the study were collected from the electronic file, recorded in the previously designed Excel capture sheet. Various radiographic, electrocardiographic, angiographic and surgical variables were analyzed. Post-surgical clinical evolution, complications, requirements for interventional or surgical procedures were assessed, and the response to these as well as the different outcomes was assessed. Results: 187 patient surgeries are reported from 2 days of age to 12 years, where the radiological, electrocardiographic characteristics and presentation age are mentioned. The total number of deaths in the 9 years was 17 cases, which were mostly (94%) before the first year of life. The most commonly used surgical technique (90%) was extended coartectomy with term-terminal anastomosis. The recorded postoperative complications were in descending order: ventricular failure, systemic arterial hypertension, renal failure that required peritoneal dialysis, etc. Conclusions: The registered population that required surgical intervention at the National Institute of Cardiology was mostly a minor infant with a median of 3 months in their surgery age. In view of the surgical technique used, the one that had better results and that did not show a significant association with the number of deaths was the extended coartectomy with end-to-end anastomosis.

Nanoparticle-Based Devices in the Control of Antibiotic Resistant Bacteria.

Antimicrobial resistance (AR) is one of the most important public health challenges worldwide as it represents a serious complication that is able to increase the mortality, morbidity, disability, hospital stay and economic burden related to infectious diseases. As such, the spread of AR-pathogens must be considered as an emergency, and interdisciplinary approaches must be undertaken in order to develop not only drugs, but holistic strategies to undermine the epidemic and pathogenic potentials of multi-drug resistant (MDR) pathogens. One of such approaches has focused on the use of antimicrobial nanoparticles (ANPs), as they have demonstrated to possess strong antimicrobial effects on MDR pathogens. On the other hand, the ability of bacteria to develop resistance to such agents is minimal. In this way, ANPs may seem a good choice for the development of new drugs, but there is no certainty about their safety, which may delay its translation to the clinical setting. As MDR pathogens are quickly becoming more prevalent and drug development is slow and expensive, there is an increasing need for the rapid development of new strategies to control such agents. We hereby explore the possibility of designing ANP-based devices such as surgical masks and fabrics, wound dressings, catheters, prostheses, dentifrices, water filters, and nanoparticle-coated metals to exploit the potential of such materials in the combat of MDR pathogens, with a good potential for translation into the clinical setting.

Características de los pacientes pediátricos operados de coartación aórtica en los años 2009 a 2018 en el Instituto Nacional de Cardiología Ignacio Chávez / Characteristics of pediatric patients operated of aortic coartation in the years 2009 to 2018 at the National Institute of Cardiology Ignacio Chávez

Resumen Objetivo: Determinar las características radiográficas, electrocardiográficas, angiográficas y quirúrgicas de los pacientes operados con coartación aórtica en el Instituto Nacional de Cardiología Ignacio Chávez entre los años 2009 y 2018. Métodos: Se recabaron del expediente electrónico las variables consideradas relevantes para el estudio y se registraron en la hoja de captura Excel previamente diseñada. Se analizaron diversas variables radiográficas, electrocardiográficas, angiográficas y quirúrgicas. Se valoró la evolución clínica posquirúrgica, complicaciones, requerimiento de procedimientos intervencionistas o quirúrgicos, y se valoró la respuesta a estos y también los diferentes desenlaces. Resultados: Se reportan 187 cirugías de pacientes desde los 2 días de vida hasta los 12 años, en donde se mencionan las características radiológicas, electrocardiográficas y edad de presentación. El total de fallecimientos en los 9 años fue de 17 casos, los cuales en su gran mayoría (94%) fueron antes del primer año de vida. La técnica quirúrgica más utilizada (90%) fue la coartectomía extendida con anastomosis terminoterminal. Las complicaciones posquirúrgicas registradas fueron en orden descendente: insuficiencia ventricular izquierda, hipertensión arterial sistémica, insuficiencia renal que requirió diálisis peritoneal, etc. Conclusiones: La población registrada que requirió una intervención quirúrgica en el Instituto Nacional de Cardiología fue en su mayoría «lactante menor¼, con una mediana de 3 meses de edad en el momento de la cirugía. Respecto a la técnica quirúrgica empleada, la que tuvo mejores resultados y que no demostró tener una asociación significativa con el número de defunciones fue la coartectomía extendida con anastomosis terminoterminal.

Abstract Objective: To determine the radiographic, electrocardiographic, angiographic and surgical characteristics of the patients operated with aortic coarctation at the Ignacio Chavez National Institute of Cardiology between 2009 and 2018. Methods: The variables considered relevant for the study were collected from the electronic file, recorded in the previously designed Excel capture sheet. Various radiographic, electrocardiographic, angiographic and surgical variables were analyzed. Post-surgical clinical evolution, complications, requirements for interventional or surgical procedures were assessed, and the response to these as well as the different outcomes was assessed. Results: 187 patient surgeries are reported from 2 days of age to 12 years, where the radiological, electrocardiographic characteristics and presentation age are mentioned. The total number of deaths in the 9 years was 17 cases, which were mostly (94%) before the first year of life. The most commonly used surgical technique (90%) was extended coartectomy with term-terminal anastomosis. The recorded postoperative complications were in descending order: ventricular failure, systemic arterial hypertension, renal failure that required peritoneal dialysis, etc. Conclusions: The registered population that required surgical intervention at the National Institute of Cardiology was mostly a minor infant with a median of 3 months in their surgery age. In view of the surgical technique used, the one that had better results and that did not show a significant association with the number of deaths was the extended coartectomy with end-to-end anastomosis.

Chemical Profiling Provides Insights into the Metabolic Machinery of Hydrocarbon-Degrading Deep-Sea Microbes.

Marine microbes are known to degrade hydrocarbons; however, microbes inhabiting deep-sea sediments remain largely unexplored. Previous studies into the classical pathways of marine microbial metabolism reveal diverse chemistries; however, metabolic profiling of marine microbes cultured with hydrocarbons is limited. In this study, taxonomic (amplicon sequencing) profiles of two environmental deep-sea sediments (>1,200 m deep) were obtained, along with taxonomic and metabolomic (mass spectrometry-based metabolomics) profiles of microbes harbored in deep-sea sediments cultured with hydrocarbons as the sole energy source. Samples were collected from the Gulf of México (GM) and cultured for 28 days using simple (toluene, benzene, hexadecane, and naphthalene) and complex (petroleum API 40) hydrocarbon mixtures as the sole energy sources. The sediment samples harbored diverse microbial communities predominantly classified into Woeseiaceae and Kiloniellaceae families, whereas Pseudomonadaceae and Enterobacteriaceae families prevailed after sediments were cultured with hydrocarbons. Chemical profiling of microbial metabolomes revealed diverse chemical groups belonging primarily to the lipids and lipid-like molecules superclass, as well as the organoheterocyclic compound superclass (ClassyFire annotation). Metabolomic data and prediction of functional profiles indicated an increase in aromatic and alkane degradation in samples cultured with hydrocarbons. Previously unreported metabolites, identified as intermediates in the degradation of hydrocarbons, were annotated as hydroxylated polyunsaturated fatty acids and carboxylated benzene derivatives. In summary, this study used mass spectrometry-based metabolomics coupled to chemoinformatics to demonstrate how microbes from deep-sea sediments could be cultured in the presence of hydrocarbons. This study also highlights how this experimental approach can be used to increase the understanding of hydrocarbon degradation by deep-sea sediment microbes.IMPORTANCE High-throughput technologies and emerging informatics tools have significantly advanced knowledge of hydrocarbon metabolism by marine microbes. However, research into microbes inhabiting deep-sea sediments (>1,000 m) is limited compared to those found in shallow waters. In this study, a nontargeted and nonclassical approach was used to examine the diversity of bacterial taxa and the metabolic profiles of hydrocarbon-degrading deep-sea microbes. In conclusion, this study used metabolomics and chemoinformatics to demonstrate that microbes from deep-sea sediment origin thrive in the presence of toxic and difficult-to-metabolize hydrocarbons. Notably, this study provides evidence of previously unreported metabolites and the global chemical repertoire associated with the metabolism of hydrocarbons by deep-sea microbes.

Social networks as tools for the prevention and promotion of health among youth.

The emergence of information and communication technologies (ICT) has generated a number of research questions, related to their use and potential risk, but also potentials for prevention or health promotion. Online social networks have become an important source of information for users as well as a tool for social relations. As traditional social networks, they can act as vehicles to improve the health of adolescents and youth, as well as play a key role in an educational context. The aim of this work is then to explore the theoretical relevance of ICT, particularly on online social networks, on disease prevention and health promotion of communicable diseases. Literature review points out the role of online social networks, particularly in the field of sexual health, body image, especially eating habits and overweight, as well as smoking and alcohol dependence. Data allow us to understand how online social network behavior and interaction is related to their burden and interventions developed in sexual health and addiction show positive results. More efforts in body image are needed in order to use these tools for prevention and promotion of health from early age.

Venom components of the scorpion Centruroides limpidus modulate cytokine expression by T helper lymphocytes: Identification of ion channel-related toxins by mass spectrometry.

The study of the effector mechanisms of T helper cells has revealed different phenotypic characteristics that can be manipulated for designing new therapeutic schemes in different pathological scenarios. Ion channels are significant targets in T lymphocyte modulation since they are closely related to their effector activity. Remarkably, some toxins produced by scorpions specifically affect the function of these membrane proteins. For that reason, these toxins are important candidates in the search for new immunomodulators. Here, the effect of two venom fractions of the scorpion Centruroides limpidus was assessed on T lymphocyte proliferation and cytokine production. The venom fractions ClF8 and ClF9 were separated by reversed-phase high-performance liquid chromatography (RP-HPLC) and cultured at 25 and 35 µg/ml with murine T lymphocytes. The results indicate that the fraction ClF8 increased both production and secretion levels of IFN-γ, IL-4, IL-17A and IL-10 by CD4+ T cells at 24 h. In contrast, fraction ClF9 only promoted the secretion of IL-17A and IL-10 at its highest concentration (35 µg/ml). Both fractions did not show any effect on T cell proliferation. Subsequent analyses by liquid chromatography-tandem mass spectrometry (LC-MS/MS) revealed seventeen toxins in the fraction ClF8 and five toxins in the fraction ClF9, most of them with voltage-gated sodium (NaScTx) and potassium (KScTx) channels as molecular targets. These toxins might probably interact with ion channels involved in T lymphocyte activity. Our findings suggest that the difference in composition between the two fractions could be related to the observed effects, and the components identified could be isolated to search for possible immunomodulatory molecules.

Smart Nanoformulation Based on Stimuli-Responsive Nanogels and Curcumin: Promising Therapy against Colon Cancer.

Curcumin (CUR) has gained much attention for its widely reported anticancer effect; however, its clinical use is restricted due to its low water solubility and, consequently, its poor bioavailability. Here, we report on the use of a nanoformulation of CUR with cationic nanogels for colon cancer therapy. Cationic stimuli-sensitive nanogels were prepared using a scale-up polymerization methodology based on surfactant-free emulsion polymerization of N,N'-diethylaminoethyl methacrylate (DEAEM) and poly(ethyleneglycol) methacrylate (PEGMA). The obtained nanogels showed a homogeneous size distribution (from 51 to 162 nm, polydispersity index (PDI) < 0.138) and exhibited a spherical form and core-shell morphology as confirmed by dynamic light scattering and electron microscopy, respectively. Nanogels were responsive to and degradable by variations of pH, temperature, or the redox environment, depending on the cross-linker used in the synthesis. Nanogels cross-linked with bis(acryloyl)cystamine incubated in a buffer (pH 7.4) containing 3 mM glutathione degraded in 60 min, while nanogels cross-linked with a divinylacetal cross-linker degraded in 10 min (pH ≤ 6). Nanoformulations of nanogels with CUR were stable as tested up to 30 days at physiological conditions. In vitro studies of the human colon cancer cell line (HCT-116) showed a synergistic effect of CUR and the degradable nanogels. Further, in vivo acute cytotoxicity tests of empty nanogels in mice demonstrate their potential as CUR nanocarriers for colon-anticancer therapies.

Social networks as tools for the prevention and promotion of health among youth

Abstract The emergence of information and communication technologies (ICT) has generated a number of research questions, related to their use and potential risk, but also potentials for prevention or health promotion. Online social networks have become an important source of information for users as well as a tool for social relations. As traditional social networks, they can act as vehicles to improve the health of adolescents and youth, as well as play a key role in an educational context. The aim of this work is then to explore the theoretical relevance of ICT, particularly on online social networks, on disease prevention and health promotion of communicable diseases. Literature review points out the role of online social networks, particularly in the field of sexual health, body image, especially eating habits and overweight, as well as smoking and alcohol dependence. Data allow us to understand how online social network behavior and interaction is related to their burden and interventions developed in sexual health and addiction show positive results. More efforts in body image are needed in order to use these tools for prevention and promotion of health from early age.

Case report of Triumeq (abacavir/dolutegravir/lamivudine) associated rhabdomyolysis in a human immunodeficiency virus (HIV) infected patient.

RATIONALE: With the existence of the human immunodeficiency virus (HIV) infection as a chronic disease, more often adverse effects of its treatment with the various antiretroviral therapies (ARTs) available have been recognized. Going further, Triumeq has been associated with a myriad of adverse effects, of which rhabdomyolysis is rarely reported in the literature. PATIENT CONCERNS: The patient presented with muscle tenderness over the lower limbs and dark brown-to-red colored urine. DIAGNOSIS: Given the presenting symptoms, as well as the laboratory testing, including elevated serum creatine kinase and liver enzymes, the diagnosis of rhabdomyolysis was made. INTERVENTIONS: Improvement was achieved rapidly after starting intravenous fluid therapy and with discontinuation of Triumeq. OUTCOMES: After discharge, repeated creatine kinase levels in the clinic have been normal and decision was made to initiate another ART and until now, no further episodes of rhabdomyolysis have developed. Regular outpatient follow-up has been ongoing for over 1 year and no complications have been identified. LESSONS: This case aims to recognize rhabdomyolysis as a rare, but possible adverse effect associated with the use of Triumeq for HIV-infected patients and therefore clinicians prescribing this combination should be aware of this potential side effect and counsel their patients accordingly.

Meduloepitelioma de cuerpo ciliar. Reporte de un caso y revisión de la literatura / Ciliary body medulloepithelioma. Case report and literature review

Introducción: Se presenta el caso de un paciente de 10 años de edad a quien se le realizó el diagnóstico de meduloepitelioma de cuerpo ciliar con posterior enucleación. Objetivo: Presentar las principales características clínicas, abordaje diagnostico y terapéutico de un paciente con meduloepitelioma de cuerpo cilar, realizando una revisión de la literatura existente de esta patología. Diseño del estudio: Reporte de caso. Resumen del caso: Paciente masculino de 10 años de edad que presentó perdida de agudeza visual asociada a dolor ocular, al examen oftalmológico se encontró masa en cámara anterior. Se realizó biopsia de lesión iridiana diagnosticándose meduloepitelioma de cuerpo ciliar con posterior enucleación. Conclusión: Se presentó el caso de un niño con meduloepitelioma de cuerpo ciliar, exponiéndose las manifestaciones clínicas, su diagnóstico y tratamiento, así como la revisión de la literatura existente.

Background: We present the case of a 10-year-old patient who underwent a diagnosis of ciliary body medulloepithelioma with subsequent enucleation. Objective: To present the main clinical characteristics, diagnostic and therapeutic aproach of a patient with a ciliary body medulloepithelioma, carrying out a review of the existing literature of this pathology. Study design: Case report. Case summary: A 10-year-old male patient presented with loss of visual acuity associated with ocular pain. Ophthalmological examination revealed a mass in the anterior chamber. A biopsy of an iris lesion was made, diagnosing a ciliary body medulloepithelioma with subsequent enucleation. Conclusion: The case of a child with ciliary body medulloepithelioma was presented, exposing the clinical manifestations, their diagnosis and treatment, as well as the review of the existing literature.

Patterns of avian haemosporidian infections vary with time, but not habitat, in a fragmented Neotropical landscape.

Habitat loss has the potential to alter vertebrate host populations and their interactions with parasites. Theory predicts a decrease in parasite diversity due to the loss of hosts in such contexts. However, habitat loss could also increase parasite infections as a result of the arrival of new parasites or by decreasing host immune defenses. We investigated the effect of habitat loss and other habitat characteristics on avian haemosporidian infections in a community of birds within a fragmented landscape in northwest Ecuador. We estimated Plasmodium and Haemoproteus parasite infections in 504 individual birds belonging to 8 families and 18 species. We found differences in infection status among bird species, but no relationship between forest fragment characteristics and infection status was observed. We also found a temporal effect, with birds at the end of the five-month study (which ran from the end of the rainy season thru the dry season), being less infected by Plasmodium parasites than individuals sampled at the beginning. Moreover, we found a positive relationship between forest area and Culicoides abundance. Taken as a whole, these findings indicate little effect of fragment characteristics per se on infection, although additional sampling or higher infection rates would have offered more power to detect potential relationships.