Fibromuscular dysplasia: unusual cause of abdominal pain.

Spontaneous dissection of the renal artery is a rare phenomenon, and is more common amongst men. It is not a frequent cause of abdominal pain², which is why diagnosis is often late. The case under study is a 45 year old patient that presented sudden pain in the left renal fossa of 12 hours evolution, with no findings from the basic laboratory tests (lab testing, urinary sediment and ultrasound), an abdominal CAT was therefore carried out, which showed areas of renal infarction, as well as an emergency arteriogram, which gave findings of a possible Fibromuscular Dysplasia of the left intrarenal artery as the first diagnostic probability with a partially thrombosed focal dissection.

Influenza in hospitalized children in Ireland in the pandemic period and the 2010/2011 season: risk factors for paediatric intensive-care-unit admission.

Influenza causes significant morbidity and mortality in children. This study's objectives were to describe influenza A(H1N1)pdm09 during the pandemic, to compare it with circulating influenza in 2010/2011, and to identify risk factors for severe influenza defined as requiring admission to a paediatric intensive care unit (PICU). Children hospitalized with influenza during the pandemic were older, and more likely to have received antiviral therapy than children hospitalized during the 2010/2011 season. In 2010/2011, only one child admitted to a PICU with underlying medical conditions had been vaccinated. The risk of severe illness in the pandemic was higher in females and those with underlying conditions. In 2010/2011, infection with influenza A(H1N1)pdm09 compared to other influenza viruses was a significant risk factor for severe disease. An incremental relationship was found between the number of underlying conditions and PICU admission. These findings highlight the importance of improving low vaccination uptake and increasing the use of antivirals in vulnerable children.

International outbreak investigation of Salmonella Heidelberg associated with in-flight catering.

Rapid and wide dispersal of passengers after flights makes investigation of flight-related outbreaks challenging. An outbreak of Salmonella Heidelberg was identified in a group of Irish travellers returning from Tanzania. Additional international cases sharing the same flight were identified. Our aim was to determine the source and potential vehicles of infection. Case-finding utilized information exchange using experts' communication networks and national surveillance systems. Demographic, clinical and food history information was collected. Twenty-five additional cases were identified from Ireland, The Netherlands, Norway, USA and Canada. We conducted a case-control study which indicated a significant association between illness and consumption of milk tart (OR 10.2) and an egg dish (OR 6) served on-board the flight. No food consumed before the flight was associated with illness. Cases from countries other than Ireland provided supplementary information that facilitated the identification of likely vehicles of infection. Timely, committed international collaboration is vital in such investigations.

Low and decreasing vaccine effectiveness against influenza A(H3) in 2011/12 among vaccination target groups in Europe: results from the I-MOVE multicentre case-control study.

Within the Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE) project we conducted a multicentre case­control study in eight European Union (EU) Member States to estimate the 2011/12 influenza vaccine effectiveness against medically attended influenza-like illness (ILI) laboratory-confirmed as influenza A(H3) among the vaccination target groups. Practitioners systematically selected ILI / acute respiratory infection patients to swab within seven days of symptom onset. We restricted the study population to those meeting the EU ILI case definition and compared influenza A(H3) positive to influenza laboratory-negative patients. We used logistic regression with study site as fixed effect and calculated adjusted influenza vaccine effectiveness (IVE), controlling for potential confounders (age group, sex, month of symptom onset, chronic diseases and related hospitalisations, number of practitioner visits in the previous year). Adjusted IVE was 25% (95% confidence intervals (CI): -6 to 47) among all ages (n=1,014), 63% (95% CI: 26 to 82) in adults aged between 15 and 59 years and 15% (95% CI: -33 to 46) among those aged 60 years and above. Adjusted IVE was 38% (95%CI: -8 to 65) in the early influenza season (up to week 6 of 2012) and -1% (95% CI: -60 to 37) in the late phase. The results suggested a low adjusted IVE in 2011/12. The lower IVE in the late season could be due to virus changes through the season or waning immunity. Virological surveillance should be enhanced to quantify change over time and understand its relation with duration of immunological protection. Seasonal influenza vaccines should be improved to achieve acceptable levels of protection.

Effect of increasing trypsin concentrations on seminal coagulum dissolution and sperm parameters in spider monkeys (Ateles geoffroyi).

Seminal coagulum formation in spider monkeys (Ateles geoffroyi) interferes with the efficient recovery and evaluation of spermatozoa. The main objective was to assess the effect of increasing concentrations of trypsin on dissolution of seminal coagulum and spermatic parameters. Seminal coagulum was incubated at 37 °C without trypsin or in the presence of increasing trypsin concentrations (0.1%, 1.0%, and 5.0%). For each sample, coagulum dissolution time was measured, and sperm concentration, viability, motility, and morphology were evaluated using light microscopy and/or transmission electronic microscopy (TEM). Trypsin concentrations of 1.0% and 5.0% more rapidly liquefied seminal coagulum, averaging 32 and 21 min, respectively, compared with nontrypsinized controls, with maintenance of greater sperm viability (70.8% and 72.5%, respectively). Coagulum treated with 1.0% trypsin and the liquid ejaculate fraction averaged higher sperm motility (40.1% and 55.6%, respectively) than control samples, and both 1.0% and 5.0% trypsin treatment allowed recovery of increased numbers of motile spermatozoa. There was greater sperm fragmentation at the head and midpiece level after treatment with 1.0% and 5.0% trypsin (55.8% and 55.9%); however, the percentage of normal morphology in structurally intact spermatozoa did not differ relative to controls. With transmission electronic microscopy imaging, there were similar percentages of spermatozoa with plasma membrane swelling in the midpiece and acrosomal regions in trypsin-treated samples and controls. In conclusion, trypsin treatment of spider monkey seminal coagulum exerted a concentration-dependent effect on dissolution time and various spermatic parameters. Higher trypsin concentrations caused more rapid liquefaction of coagulum and recovery of greater numbers of motile spermatozoa, but may adversely affect fragmentation of spermatozoa and could compromise sperm function and cryopreservation potential.

[Acute methyl parathion poisoning with extrapyramidal manifestations not previously reported]. / Intoxicación aguda por paratión-metílico con manifestaciones extrapiramidales antes no informadas.

A 14-year-old female attempted suicide by ingesting the organophosphate methyl parathion. A severe acute poisoning developed with the characteristic symptomatology: muscarinic, nicotinic and neurologic, as well serum cholinesterase activity decreased 88%. An extrapyramidal syndrome appeared suddenly nine days after the onset with ocular and buccal crisis, neck and trunk dystonic movements, and hypertonia and tremors. The patient improved with the administration of i.v. diphenhydramine. Other causes of toxic extrapyramidalism and organophosphate intermediate syndrome were discarded. Although an absolute causal relationship of the transient extrapyramidal symptomatology to the organophosphate exposure cannot be clearly established in this case, we speculate a possible delayed inhibition of the dopaminergic receptors in the substantia nigra and the basal ganglia.

[Experience in the use of central venous catheterization via subclavian puncture in a pediatric hospital]. / Experiencia en el uso de la cateterización venosa central por punción subclavia en un hospital pediátrico.

OBJECTIVE: To assess the frequency and type of complications during central venous catheter installation by subclavian puncture, and during its use in children admitted to an ICU. PATIENTS AND METHODS: Patients from one month to 15 years of age, admitted to the Intensive Care Unit of the Hospital de Pediatría Centro Médico Nacional, Siglo XXI, who underwent a percutaneous infraclavicular subclavian puncture for central venous catheter complications were included. Clinical features, diagnosis, complications and indications for the procedure were registered. RESULTS: 92 patients and 102 subclavian punctures were included for analysis. Effectively index was 88.3%. Main diagnosis was infectious diseases in 29.4% and neoplasia in 22.5%. Hemodynamic monitoring was the more frequent indication for the procedure (44%). Of the catheter 45% were successfully installed at first intent. The complication in the installation appear in 11.7%. Was arterial subclavian puncture (6.8%), hematoma (2.9%), without hemodynamic deterioration no any case. The mean time of permanence was 8.8 days. The late complications was present in average 7.3 days, in 18.6% of the cases. Predominance infection in entrance place of catheter. CONCLUSIONS: Installation of venous central catheter by subclavian puncture prove a great utility in our patients, with a few complications and a high effectively. For experimental personal the central venous catheterization by subclavian puncture in pediatric patients to be importance in the first place in critical ill children.

[The treatment of status epilepticus in children]. / Tratamiento del estado epiléptico en niños.

In children the status epilepticus (SE) constitutes a neurological emergency related to a high rate morbi-mortality. The prompt recognition and management are essentially to prevent irreversible neurologic damage. The frequency of SE in emergency rooms and pediatric intensive care units (PICU) is high because of several causes in the group of children less than five years old and particularly in the first year of life. In this paper are analyzed the actual state of drug therapy, general management and prevention of complication to decrease the incidence of severe sequelae in this patients. We suggest a general guide for the pediatrician and intensivist that include monitoring in a PICU for permanent valuation of the patient which result in a better treatment to improve the outcome and survival.

Citomegalovirus como agente causal de lesiones ulcerativas en tubo digestivo. / Cytomegalovirus as etiological agent of ulcerative lesions in digestive tract

Las numerosas comunicaciones sobre cuadros diarreicos, sangrados y perforaciones en tubo digestivo ocasionados probablemente por citomegalovirus en pacientes adultos homosexuales, plantean la posibilidad de la infeccion directa de la mucosa intestinal por el virus citomegalico contenido en el liquido seminal. En la edad pediatrica se encontraron trece casos con cuadros de diarrea prolongada, en ocasiones con sangre en las evacuaciones provocados por ulceraciones muy similares a las descritas en el adulto; el proceso de vasculitis que acompano a las lesiones mostro las celulas caracteristicas de la infeccion por citomegalovirus. Se establecio asi la posibilidad de infeccion directa de las celulas del tracto gastrointestinal por las particulas virales contenidas en la leche materna con posible diseminacion posteriormente a otros organos