Septicemia por Chromobacterium Violaceum en pediatría / Septicemia due to Chromobacterium Violaceum in pediatrics

Chromobacterium violaceum es una bacteria gram negativa anaerobia facultativa, que se encuentra ampliamente distribuida en el agua y el suelo en regiones tropicales y subtropicales, que se asocia con infecciones respiratorias, gastrointestinales, abscesos hepáticos, meningitis, endocarditis, síndrome hemofagocítico y sepsis fulminante. Se presentan 2 casos en niños: el primero es un varón de 8 años con lesiones en piel, fiebre y adenitis inguinal, que ingresó con un cuadro de sepsis severa, síndrome de distrés respiratorio agudo (SDRA) y falleció a las 3 h del ingreso. De los hemocultivos se aisló Chromobacterium violaceum. El segundo caso, es una niña de 12 años con antecedente de fiebre y adenopatía inguinal secundaria a herida cortopunzante en el pie homolateral, que ingresó con un cuadro de sepsis, con desarrollo de abscesos múltiples profundos. De la colección obtenida de piel y partes blandas y de un aspirado traqueal se aisló Chromobacterium violaceum. Recibió tratamiento antibiótico adecuado y posteriormente fue dada de alta. Se realizó una revisión bibliográfica de esta infección en niños y se encontraron 44 casos en todo el mundo. Algunos de éstos, se relacionaron con inmunodeficiencia de base, como la enfermedad granulomatosa crónica. La infección por esta bacteria es rara y se presenta como un cuadro grave que no responde a antibióticos habituales de uso empírico y tiene una alta tasa de mortalidad (AU)

Chromobacterium violaceum is a facultative anaerobic Gramnegative bacillus, widely distributed in water and soil in tropical and subtropical regions and associated with respiratory and gastrointestinal infections, liver abscesses, meningitis, endocarditis, hemophagocytic syndrome, and fulminant sepsis. Here two pediatric cases are presented: The first was an 8-year-old boy with skin lesions, fever, and inguinal adenitis, who was admitted with severe sepsis, acute respiratory distress syndrome (ARDS) and died three hours after. Chromobacterium violaceum was isolated from blood cultures. The second case was a 12-year-old girl with a history of fever and inguinal adenopathy secondary to a wound in the homolateral foot, who was admitted because of sepsis and multiple deep abscesses. From samples collected from the skin and soft tissues as well as tracheal aspirate Chromobacterium violaceum was isolated. Adequate antibiotic treatment was started and the patient was subsequently discharged. In a review of the literature, 44 cases worldwide were identified. Some of these cases were related to underlying immunodeficiency, such as chronic granulomatous disease. Infection with this bacterium is rare and presents with severe manifestations that do not respond to the common empirical antibiotics and are associated with a high mortality rate (AU)

Evolution of TKA design.

The use of Total Knee Arthroplasty (TKA) in treatment of chronic degenerative pathologies of the knee boasts of an experience of 50 years. During this period the collaboration between surgeons and engineers produced many developments in the design of the prosthesis. Today this procedure is safe and established even if in continuous development. The progress in technologies and the use of new materials let researches try again old-fashioned techniques from the past in order to be improved. This enthusiasm for those discovers is not always going hand to hand with scientific validation: many open questions remains Every different concept of the design tries to answer to special needs as the reach of the highest ROM, the reduction of pain and debris, articular geometry, the type of fixation, the modularity of augments and stems, the types of constraints,  knee kinematic and of course costs.

Manifestaciones neurológicas de endocarditis infecciosa en niños / Neurologic manifestations of infective endocarditis in children

Introducción. La endocarditis infecciosa (EI), es una patología poco frecuente en pediatría. Según diferentes series pediátricas reportadas, 15 a 25% de los casos, presentan una complicación neurológica como forma de presentación inicial. Las manifestaciones neurológicas más frecuentes son: accidente cerebro vascular (ACV), abscesos cerebrales, meningitis, encefalopatía, convulsiones. Estas manifestaciones son atribuidas a diferentes etiologías, sin tener en cuenta a la EI como causa probable de las mismas. Material y métodos. Se revisaron las EI del 2008 al 2011, estudio retrospectivo observacional, analizándose los datos en Epi-info versión 2008. Resultados. Se registraron 7 casos; 5 reunían los criterios de Duke, 2 asumidos como endocarditis posible. Media de edad: 73 meses (R 11-162 meses); media de fiebre: 10 días (R 2-19). Dentro de las características clínicas: 3 pacientes tenían cardiopatía congénita, 2 desarrollaron insuficiencia cardiaca, 4 eran desnutridos, 2 presentaron síndrome nefrítico y 3 insuficiencia renal. Tres pacientes desarrollaron fenómenos embólicos en SNC, uno debutó con ACV, otro con aneurismas micóticos en SNC y el 3º con absceso cerebral. Estos 3 últimos pacientes tenían síndrome parameníngeo con LCR alterado y cultivo negativo. En 5 casos la vegetación se localizó en cavidades cardiacas derechas; 3 requirieron cirugía (verrugectomía y recambio valvular). Se aisló germen de hemocultivos en 6 pacientes, siendo el Staphylococcus aureus el más frecuente. Dos pacientes fallecieron. Conclusiones. Tres de los pacientes debutaron con síntomas de SNC como forma de presentación de EI. Consideramos que ante un niño con síntomas neurológicos, como hemiplejia, debemos pensar en endocarditis como probable etiología.(AU)

Manifestaciones neurológicas de endocarditis infecciosa en niños / Neurologic manifestations of infective endocarditis in children

Introducción. La endocarditis infecciosa (EI), es una patología poco frecuente en pediatría. Según diferentes series pediátricas reportadas, 15 a 25% de los casos, presentan una complicación neurológica como forma de presentación inicial. Las manifestaciones neurológicas más frecuentes son: accidente cerebro vascular (ACV), abscesos cerebrales, meningitis, encefalopatía, convulsiones. Estas manifestaciones son atribuidas a diferentes etiologías, sin tener en cuenta a la EI como causa probable de las mismas. Material y métodos. Se revisaron las EI del 2008 al 2011, estudio retrospectivo observacional, analizándose los datos en Epi-info versión 2008. Resultados. Se registraron 7 casos; 5 reunían los criterios de Duke, 2 asumidos como endocarditis posible. Media de edad: 73 meses (R 11-162 meses); media de fiebre: 10 días (R 2-19). Dentro de las características clínicas: 3 pacientes tenían cardiopatía congénita, 2 desarrollaron insuficiencia cardiaca, 4 eran desnutridos, 2 presentaron síndrome nefrítico y 3 insuficiencia renal. Tres pacientes desarrollaron fenómenos embólicos en SNC, uno debutó con ACV, otro con aneurismas micóticos en SNC y el 3º con absceso cerebral. Estos 3 últimos pacientes tenían síndrome parameníngeo con LCR alterado y cultivo negativo. En 5 casos la vegetación se localizó en cavidades cardiacas derechas; 3 requirieron cirugía (verrugectomía y recambio valvular). Se aisló germen de hemocultivos en 6 pacientes, siendo el Staphylococcus aureus el más frecuente. Dos pacientes fallecieron. Conclusiones. Tres de los pacientes debutaron con síntomas de SNC como forma de presentación de EI. Consideramos que ante un niño con síntomas neurológicos, como hemiplejia, debemos pensar en endocarditis como probable etiología.

Immediate early genes and brain DNA remodeling in the Naples high- and low-excitability rat lines following exposure to a spatial novelty.

The aim of these studies was to map the neural consequences of exposure to a spatial novelty on the expression of immediate gene (IEG) and on unscheduled brain DNA synthesis (UBDS) in two genetic models of altered activity and hippocampal functions, i.e., the Naples High- (NHE) and Low-excitability (NLE) rats. Adult male rats of NLE and NHE lines, and of a random-bred stock (NRB) were tested in a Làt-maze, and corner crossings, rearings, and fecal boli were counted during two 10-min tests 24 h apart. For IEG expression, rats were exposed to a Làt-maze with nonexposed or repeatedly exposed rats used as controls, and were sacrificed at different time intervals thereafter. For UBDS, rats were sacrificed immediately after the first or the second exposure o a Làt-maze. IEG expression was measured by immunocytochemistry for the FOS and JUN proteins. NRB rats exposed for the first time to the maze showed extensive FOS and JUN positive cells in the reticular formation, the granular and pyramidal neurons of hippocampus, the amygdaloid nuclei, all layers of somatosensory cortex, and the granule cells of the cerebellar cortex. The positivity, stronger in rats exposed for the first time, was present between 2 and 6 h and was prevented by the NMDA receptor antagonist CPP (5 mg/kg). The positivity was very low in NHE rats, and it was stronger in NLE compared to NRB rats. UBDS was measured in ex vivo homogenates of brain areas by the incorporation into DNA of 3H-[methyl]-thymidine given intraventricularly 15 min before test trial 1 or 2 (pulse of 0.5 h).(ABSTRACT TRUNCATED AT 250 WORDS)

The dorsal noradrenergic bundle modulates DNA remodeling in the rat brain upon exposure to a spatial novelty.

A series of experiments were designed to study the role of the dorsal noradrenergic bundle (DNB) in the modulation of genomic remodeling in the mammalian brain. A series of experiments were designed to study the role of the dorsal noradrenergic system in relation to nonassociative tasks. Adult male Sprague-Dawley rats were either bilaterally lesioned in the DNB by intrabundle microinjection of 6-hydroxydopamine or were sham lesioned. All rats were given 50 microCi [3H-methyl]-thymidine and were sacrificed 0.5 h later. After the injection of the tracer, rats were either left undisturbed in the home cage or were exposed to a Làt-maze for 15 min after 15 min had passed from the time of injection. During the exposure to the maze, corner crossings and rearings were monitored. The rate of DNA synthesis was determined in several brain regions by measuring the amount of tracer incorporated into the DNA over a 0.5-h duration pulse. Under baseline conditions DNB-lesioned rats showed an increase in DNA synthesis in the hippocampus, hypothalamus, and rest of the brain. On the other hand, following exposure to the Làt-maze, sham-lesioned rats only showed an increase in DNA synthesis in the hippocampus, as compared to baseline conditions. Conversely, DNB-lesioned rats did not show an increase in hippocampal DNA synthesis as in the sham-lesioned rats. In contrast, DNA synthesis was increased in the neocortex and rest of the brain. In conclusion, the data support a role for noradrenergic systems in modulating brain DNA synthesis, probably of the unscheduled type, during information processing and storage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic receptor systems and unscheduled DNA synthesis in the rat brain.

Two experiments were carried out in the albino rat to investigate the role of brain adrenergic systems in DNA remodeling. Adult male Sprague-Dawley rats were given an intraventricular microinjection of an adrenergic drug or vehicle followed 2 h later by the intraventricular injection of 50 microCi of [3H-methyl]thymidine. The rats were sacrificed 0.5 h after the injection of the radioactive tracer. The rate of DNA synthesis was determined by measuring the amount of radioactive precursor incorporated into the DNA extracted from homogenates of several brain areas. In Experiment 1, at time 0 rats received the alpha-adrenergic antagonist phentolamine (5 micrograms), the beta antagonist propranolol (10 micrograms), the alpha agonist phenylephrine (1 microgram), the beta agonist isoproterenol (12.5 micrograms), or the vehicle. The latter decreased UBDS in neocortex, and increased it in the septum, neostriatum, hypothalamus, cerebellum, and rest of the brain. The alpha and beta agonists and antagonists induced several significant effects, depending on the brain region. In Experiment 2, rats were bilaterally lesioned in the dorsal noradrenergic bundle (DNB) by injection of 6-hydroxydopamine or were sham lesioned. One week later, at time 0 they were given the alpha agonist phenylephrine (1 microgram), the beta agonist isoproterenol (12.5 micrograms), or the vehicle. The DNB-lesioned rats showed a higher UBDS in the hippocampus, neocortex, and hypothalamus, which was reversed by the alpha or the beta agonist. The results suggest an influence of the DNB, probably as a tonic inhibitor of UBDS in the hippocampus and the hypothalamus which, in turn, are likely to be mediated by beta- and alpha-adrenergic receptors. In addition, a phasic inhibitory effect seems to be mediated by beta and alpha receptors in the neocortex, and by beta receptors in the cerebellum. A modulatory role of central adrenergic systems on unscheduled brain DNA synthesis may be inferred from these findings.