Miositis viral aguda asociada a síndrome de Guillain-Barré

Introducción: Las manifestaciones clínicas del síndrome de Guillain Barré y de la miositis viral aguda son diferentes. Ambos cuadros suelen ser autolimitados y pueden manifestarse tras un cuadro infeccioso. Objetivo: Informar acerca de una presentación inusual de dos afecciones en un mismo paciente. Presentación del caso: Niña de 4 años de edad, quien presenta síntomas de una miositis viral aguda, la que al mejorar, hizo más evidente la sintomatología característica del síndrome de Guillain Barré. El caso se confirmó a través de estudios hematológicos, citología de líquido cefalorraquídeo y estudios neurofisiológicos. La paciente recibió tratamiento con inmunoglobulina G humana intravenoso durante 5 días, tras lo cual presentó mejoría de los síntomas neurológicos. Conclusiones: La afectación del músculo y del sistema nervioso periférico pueden coexistir en la población pediátrica, pero no es condición usual, por lo que se necesita realizar más investigación para poder describir mejor esta entidad y su pronóstico.

Introduction: The clinical manifestations of Guillain Barré syndrome and acute viral myositis are different. Both conditions are usually self-limiting and can manifest after an infectious process. Objective: To report an unusual presentation of two conditions in the same patient. Case presentation: A 4-year-old girl presented with symptoms of acute viral myositis, which, with improvement, made more evident the characteristic symptoms of Guillain Barré syndrome. The case was confirmed through hematological studies, cerebrospinal fluid cytology and neurophysiological studies. The patient was treated with intravenous human immunoglobulin G for 5 days, after which she showed improvement of the neurological symptoms. Conclusions: The involvement of the muscle and the peripheral nervous system may coexist in the pediatric population, but it is not a usual condition, so more research is needed to better describe this entity and its prognosis.

A synthesized model of tuberculosis transmission featuring treatment abandonment.

In this paper, we propose and justify a synthesized version of the tuberculosis transmission model featuring treatment abandonment. In contrast to other models that account for the treatment abandonment, our model has only four state variables or classes (susceptible, latent, infectious, and treated), while people abandoning treatment are not gathered into an additional class. The proposed model retains the core properties that are highly desirable in epidemiological modeling. Namely, the disease transmission dynamics is characterized by the basic reproduction number $ \mathscr{R}_0 $, a threshold value that determines the number of possible steady states and their stability properties. It is shown that the disease-free equilibrium is globally asymptotically stable (GAS) only if $ \mathscr{R}_0 < 1 $, while a strictly positive endemic equilibrium exists and is GAS only if $ \mathscr{R}_0 > 1. $ Analysis of the dependence of $ \mathscr{R}_0 $ on the treatment abandonment rate shows that a reduction of the treatment abandonment rate has a positive effect on the disease incidence and results in avoiding disease-related fatalities.

A New Eulimnadia (Branchiopoda: Spinicaudata: Limnadiidae) from the US Virgin Islands.

We describe a new species of Eulimnadia from the Caribbean using fresh material from the island of St Thomas. Originally reported in 2003 as a Eulimnadia cf. texana (Packard, 1871) based on egg morphology, this species egg distinctly differs from E. texana by the number of lateral grooves and by the single domed end.

Fibromatosis gingival hereditaria: una rara enfermedad. Reporte de una familia / Hereditary Gingival Fibromatosis: A Rare Disease. A Family Report / Fibromatose gengival hereditária uma estranha doença: reporte de uma família

Resumen Introducción: la fibromatosis gingival hereditaria es un desorden genético raro que produce un sobre-crecimiento gingival y el desplazamiento dental asociado, la patogénesis y la base molecular de la enfermedad sigue siendo desconocida. Dado que es una enfermedad poco frecuente, es importante que el profesional en el área de la salud oral conozca las características clínicas, histológicas y genéticas de la enfermedad con el objetivo de realizar un correcto diagnóstico, plan de tratamiento y orientación sobre la condición de la patología. Presentación del caso: se reporta informe de una familia con tres generaciones afectadas con fibromatosis gingival hereditaria, en la que se describen las características clínicas, histopatológicas y tratamiento. Conclusión: la fibromatosis gingival hereditaria es un trastorno poco frecuente que genera diversos grados de aumento en el volumen gingival, los compromisos estéticos y funcionales a menudo requieren intervención quirúrgica, histológicamente es común la presencia de abundantes haces de colágeno y fibroblastos.

Abstract Introduction: Hereditary gingival fibromatosis is a rare genetic disorder that produces a gingival overgrowth and the associated dental displacement, the pathogenesis and the molecular basis of the disease remains unknown. Given that it is a rare disease, it is important that the professionals in the field of oral health know the clinical, histological and genetic characteristics of the disease in order to make a correct diagnosis, a treatment plan and the guidance on the condition of the pathology. Case presentation: Report of a family with three generations affected with hereditary gingival fibromatosis, in which the clinical, histopathological and treatment characteristics are described. Conclusions: Hereditary gingival fibromatosis is a rare disorder that generates varying degrees of increase in gingival volume, aesthetic and functional compromises often require surgical intervention, the presence of abundant bundles of collagen and fibroblasts is histologically common.

Resumo Introdução: a fibromatose gengival hereditária é uma desordem genética estranha que produz um so-brecrescimento gengival e o deslocamento dental associado, a patogênese e a base molecular da doença segue sendo desconhecida. Dado que é uma doença pouco frequente, é importante que o profissional na área da saúde oral conheça as características clínicas, histológicas e genéticas da doença com o objetivo de realizar um correto diagnóstico, plano de tratamento e orientação sobre a condição da patologia. Apresentação do caso: reporta-se o informe de uma família com três gerações afetados com fibromatose gengival hereditária, no que se descrevem as características clínicas, histopatológicas e tratamento. Conclusão: a fibromatose gengival hereditária é um transtorno pouco frequente que gera diversos graus de aumento no volume gengival, os compromissos estéticos e funcionais frequentemente requerem intervenção cirúrgica, histologicamente é comum a presença de abundantes feixes de colágeno e fibroblastos.

Correction: Proceraea exoryxae sp. nov. (Annelida, Syllidae, Autolytinae), the first known polychaete miner tunneling into the tunic of an ascidian.

[This corrects the article DOI: 10.7717/peerj.3374.].

Proceraea exoryxae sp. nov. (Annelida, Syllidae, Autolytinae), the first known polychaete miner tunneling into the tunic of an ascidian.

While studying organisms living in association with the solitary tunicate Phallusia nigra (Ascidiacea, Ascidiidae) from a shallow fringing reef at Zeytouna Beach (Egyptian Red Sea), one of the collected ascidians showed peculiar perforations on its tunic. Once dissected, the perforations revealed to be the openings of a network of galleries excavated in the inner tunic (atrium) by at least six individuals of a polychaetous annelid. The worms belonged to the Autolytinae (Syllidae), a subfamily that is well known to include specialized predators and/or symbionts, mostly associated with cnidarians. The Red Sea worms are here described as Proceraea exoryxae sp. nov., which are anatomically distinguished by the combination of simple chaetae only in anterior chaetigers, and a unique trepan with 33 teeth in one outer ring where one large tooth alternates with one medium-sized tricuspid tooth, and one inner ring with small teeth located just behind the large teeth. Male and female epitokes were found together with atokous individuals within galleries. Proceraea exoryxae sp. nov. constitutes the first known miner in the Autolytinae and the second species in this taxon known to live symbiotically with ascidians. The implications of finding this specialized parasite are discussed considering that Phallusia nigra has been introduced worldwide, in tropical and sub-tropical ecosystems, where it has the potential of becoming invasive.

Direct Self-Assembly of a 2D and 3D Star of David.

Two- and three-dimensional metallosupramolecules shaped like a Star of David were synthesized by the self-assembly of a tetratopic pyridyl ligand with a 180° diplatinum(II) motif and PdII ions, respectively. In contrast to other strategies, such as template-directed synthesis and stepwise self-assembly, this design enables the formation of 2D and 3D structures in one step and high yield. The structures were characterized by both one-dimensional (1 H, 13 C, 31 P) and two-dimensional (COSY, NOESY, DOSY) NMR spectroscopy, ESI-MS, ion-mobility mass spectrometry (IM-MS), AFM, and TEM. The stabilities of the 2D and 3D structures were measured and compared by gradient tandem mass spectrometry (gMS2 ). The high stability of the 3D Star of David was correlated to its high density of coordination sites (DOCS).

Ecosystem Alterations and Species Range Shifts: An Atlantic-Mediterranean Cephalaspidean Gastropod in an Inland Egyptian Lake.

The eastern Atlantic and Mediterranean marine Cephalaspidea gastropod Haminoea orbignyana was collected from Lake Qarun (Fayoum, Egypt), a landlocked lake that has undergone a shift from freshwater to estuarine conditions in the past 100 years. Species identity was confirmed by both morphological (anatomical dissection and scanning electron microscopy) and molecular methods (COI gene phylogeny). Observations suggested a robust population of H. orbignyana in the lake with a density of ca. 64 individuals/m2 and ca. 105 egg masses/m2 during surveys conducted in the summer of 2013. The vast majority of snails and egg masses were found under rocks. Observations of egg masses in the lab showed a gradual change from whitish to yellow-green as the eggs matured and the release of veliger larvae alone after about a week. Although adult cephalaspideans readily consumed filamentous red and green algae, and cyanobacteria, laboratory trials showed that they consumed significantly more of the red alga Ceramium sp., than of the green alga Cladophora glomerata, with consumption of Oscillatoria margaritifera being similar to those on the two algae. When grown on these resources for 16 days, H. orbignyana maintained their mass on the rhodophyte and cyanobacterium, but not in starvation controls. No cephalaspideans grew over the course of this experiment. Lake Qarun has been periodically restocked with Mediterranean fishes and prawns since the 1920s to maintain local fisheries, which represents a possible route of colonization for H. orbignyana. Yet, based on literature records, it seems more likely that invasion of the lake by this gastropod species has occurred only within the last 20 years. As human activities redistribute species through direct and indirect means, the structure of the community of this inland lake has become unpredictable and the long-term effects of these recent introductions are unknown.

ent-Labdane Diterpenoids from the Aerial Parts of Eupatorium obtusissmum.

Six new ent-labdane diterpenoids, uasdlabdanes A-F (1-6), were isolated from the aerial parts of Eupatorium obtusissmum. The new structures were elucidated through spectroscopic and spectrometric data analyses. The absolute configurations of compounds 1 and 2 were established by X-ray crystallography, and those of 3-6, by comparison of experimental and calculated electronic circular dichroism spectra. The antiproliferative activity of the compounds was studied in a panel of six representative human solid tumor cell lines and showed GI50 values ranging from 19 to >100 µM.

A localized PCR inhibitor in a porcelain crab suggests a protective role.

A number of polymerase chain reaction (PCR) inhibitors have been identified from biological and environmental samples. By and large, such substances are treated as random nuisances and contaminants with alternate functions; their inhibitory effects on DNA replication being a coincidental property of their molecular structure. Here, we demonstrate the presence of a localized PCR inhibitor in the foregut of the porcelain crab Petrolisthes rufescens (Anomura: Porcellanidae) from the Red Sea. The inhibitor precluded amplification of 28s, 16s and 18s gene sequences effectively but lost activity at 10(-2) dilutions from initial concentration. Heat treatment was ineffective in arresting inhibition and spectrophotometric techniques suggested that the inhibitor was not a melanin-type compound. The compound was not detected from midgut, hindgut, or gills of the crab. Activity of the inhibitor was precluded when samples were treated with suspensions from the midgut, suggesting that enzymatic degradation of the inhibitor likely happens at that part of the gut. As many microbial pathogens invade their hosts via ingestion, we suggest the presence of the localized inhibitor could carry a defensive or immunological role for P. rufescens. The identity of the inhibitory molecule remains unknown.

Ataxia-Telangiectasia: Reporte de caso / Ataxia-Telangiectasia: Case report

Presentamos el caso clínico de un niño de 9 años procedente de la región Cusco, con deterioro progresivo del estado neurológico caracterizado por síntomas cerebelosos, asociados a una historia de infecciones respiratorias repetidas y con hallazgos clínicos y de laboratorio que permitieron llegar al diagnóstico de Ataxia-Telangiectasia, enfermedad poco reportada en nuestro país. Se revisa la etiopatogenia, criterios diagnósticos y propuestas terapéuticas disponibles en la actualidad.

We report the case of a 9-year-old from the Cusco region, with progressive deterioration of neurological condition characterized by cerebellar symptoms associated with a history of repeated respiratory infections and clinical and laboratory features that allowed reaching the diagnosis of Ataxia-Telangiectasia, little reported disease in our country. The pathogenesis, diagnostic criteria and therapeutic approaches currently available are reviewed.

Adapting CBT for traumatized refugees and ethnic minority patients: examples from culturally adapted CBT (CA-CBT).

In this article, we illustrate how cognitive behavioral therapy (CBT) can be adapted for the treatment of PTSD among traumatized refugees and ethnic minority populations, providing examples from our treatment, culturally adapted CBT, or CA-CBT. CA-CBT has a unique approach to exposure (typical exposure is poorly tolerated in these groups), emphasizes the treatment of somatic sensations (a particularly salient part of the presentation of PTSD in these groups), and addresses comorbid anxiety disorders and anger. To accomplish these treatment goals, CA-CBT emphasizes emotion exposure and emotion regulation techniques such as meditation and aims to promote emotional and psychological flexibility. We describe 12 key aspects of adapting CA-CBT that make it a culturally sensitive treatment of traumatized refugee and ethnic minority populations. We discuss three models that guide our treatment and that can be used to design culturally sensitive treatments: (a) the panic attack-PTSD model to illustrate the many processes that generate PTSD in these populations, highlighting the role of arousal and somatic symptoms; (b) the arousal triad to demonstrate how somatic symptoms are produced and the importance of targeting comorbid anxiety conditions and psychopathological processes; and (c) the multisystem network (MSN) model of emotional state to reveal how some of our therapeutic techniques (e.g., body-focused techniques: bodily stretching paired with self-statements) bring about psychological flexibility and improvement.

Culturally adapted CBT (CA-CBT) for Latino women with treatment-resistant PTSD: a pilot study comparing CA-CBT to applied muscle relaxation.

We examined the therapeutic efficacy of a culturally adapted form of CBT (CA-CBT) for PTSD as compared to applied muscle relaxation (AMR) for female Latino patients with treatment-resistant PTSD. Participants were randomized to receive either CA-CBT (n = 12) or AMR (n = 12), and were assessed before treatment, after treatment, and at a 12-week follow-up. The treatments were manualized and delivered in the form of group therapy across 14 weekly sessions. Assessments included a measure of PTSD, anxiety, culturally relevant idioms of distress (nervios and ataque de nervios), and emotion regulation ability. Patients receiving CA-CBT improved significantly more than in the AMR condition. Effect size estimates showed very large reductions in PTSD symptoms from pretreatment to posttreatment in the CA-CBT group (Cohen's d = 2.6) but only modest improvements in the AMR group (0.8). These results suggest that CA-CBT can be beneficial for previously treatment-resistant PTSD in Latino women.

Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: long-term outcomes and predictors of response.

OBJECTIVE: The goal of this study was to assess the efficacy and safety of vagus nerve stimulation in a consecutive series of adults and children with treatment-resistant epilepsy (TRE). METHODS: In this retrospective review of a prospectively created database of 436 consecutive patients who underwent vagus nerve stimulator implantation for TRE between November 1997 and April 2008, there were 220 (50.5%) females and 216 (49.5%) males ranging in age from 1 to 76 years at the time of implantation (mean: 29.0 ± 16.5). Thirty-three patients (7.6%) in the primary implantation group had inadequate follow-up (<3 months from implantation) and three patients had early device removal because of infection and were excluded from seizure control outcome analyses. RESULTS: Duration of vagus nerve stimulation treatment varied from 10 days to 11 years (mean: 4.94 years). Mean seizure frequency significantly improved following implantation (mean reduction: 55.8%, P<0.0001). Seizure control ≥ 90% was achieved in 90 patients (22.5%), ≥ 75% seizure control in 162 patients (40.5%), ≥ 50% improvement in 255 patients (63.75%), and <50% improvement in 145 patients (36.25%). Permanent injury to the vagus nerve occurred in 2.8% of patients. CONCLUSION: Vagus nerve stimulation is a safe and effective palliative treatment option for focal and generalized TRE in adults and children. When used in conjunction with a multidisciplinary and multimodality treatment regimen including aggressive antiepileptic drug regimens and epilepsy surgery when appropriate, more than 60% of patients with TRE experienced at least a 50% reduction in seizure burden. Good results were seen in patients with non-U.S. Food and Drug Administration-approved indications. Prospective, randomized trials are needed for patients with generalized epilepsies and for younger children to potentially expand the number of patients who may benefit from this palliative treatment.

Feeding preferences of mesograzers on aquacultured Gracilaria and sympatric algae.

While large grazers can often be excluded effectively from algal aquaculture operations, smaller herbivores such as small crustaceans and gastropods may be more difficult to control. The susceptibility of three Gracilaria species to herbivores was evaluated in multiple-choice experiments with the amphipod Ampithoe ramondi and the crab Acanthonyx lunulatus. Both mesograzers are common along the Mediterranean coast of Israel. When given a choice, the amphipod preferred to consume Gracilaria lemaneiformis significantly more than either G. conferta or G. cornea. The crab, however, consumed equivalent amounts of G. lemaneiformis and G. conferta, but did not consume G. cornea. Organic content of these algae, an important feeding cue for some mesograzers, could not account for these differences. We further assessed the susceptibility of a candidate species for aquaculture, G. lemaneiformis, against local algae, including common epiphytes. When given a choice of four algae, amphipods preferred the green alga Ulva lactuca over Jania rubens. However, consumption of U. lactuca was equivalent to those of G. lemaneiformis and Padina pavonica. In contrast, the crab showed a marked and significant preference for G. lemaneiformis above any of the other three algae offered. Our results suggest that G. cornea is more resistant to herbivory from common mesograzers and that, contrary to expectations, mixed cultures or epiphyte growth on G. lemaneiformis cannot reduce damage to this commercially appealing alga if small herbivores are capable of recruiting into culture ponds. Mixed cultures may be beneficial when culturing other Gracilaria species.

Meningitis neonatal en el Hospital Nacional Cayetano Heredia / Neonatal meningitis at National Hospital Cayetano Heredia from Perú

Introducción: La meningitis neonatal es un problema prevalente en las unidades neonatales. Objetivo: Determinar la frecuencia, características clínicas y de laboratorio de los pacientes con meningitis neonatal en el periodo enero del 2003 a diciembre 2007. Material y Métodos: Se revisaron la base de datos de la unidad de cuidados intensivos neonatales, de la unidad de cuidados intermedios y de neurología neonatal. Se clasificaron los casos en formas precoces y tardías y se registraron los datos demográficos, clínicos y de laboratorio. Resultados: Se incluyeron 24 recién nacidos, que determinaron una prevalencia de 0.9 casos por milnacidos vivos. La forma precoz fue la más frecuente. Se aisló el germen en el 46 por ciento de los casos, más frecuente en la forma precoz. El 92 por ciento de los neonatos fue sintomático, siendo la fiebre e irritabilidad los síntomas más frecuentes. Los factores de riesgo más relacionados fueron ruptura prematura de membranas y fiebre materna intraparto. El líquido cefalorraquídeo mostró pleocitosis moderada con amplia variabilidad, destacando el predominio de polimorfonucleares en la forma temprana, además se observó hipoglucorraquia e hiperproteinorraquia de mayor grado en la forma temprana. La letalidad fue de 25 por ciento. Conclusiones: La meningitis neonatal tiene alta prevalencia, fue muy sintomática y presentó cambios moderados a severos en el líquido cefalorraquídeo.

Introduction: Neonatal meningitis is a prevalent problem in the neonatal units. Objective: To determine the frequency and clinical and laboratory characteristics of patients with neonatal meningitis from january 2003 to december 2007. Material and Methods: The database of the unitof intensive neonatal care, the one of the unit of intermediate cares and the database of neonatal neurology were revised. The cases were classified in precocious and late forms and it was registered the demographic, clinical and laboratory data. Results: 24 newborn were included, they determined a prevalence of 0.9 cases per thousand born alive. The precocious form was the most frequent. The germ was isolated in 46 per cent of the cases, more frequent in the early form. 92 per cent of the newborns were symptomatic, the fever and irritability were the most frequent symptoms. The most related risk factors were premature membranes rupture and maternal fever during labor. The cerebrospinal liquid showed moderate pleocitosis with wide variability, with polimorfonuclears preponderance prevalence in the early form, it was also observed a higher grade in hypoglicorrachia and hyperproteinorrachia in the same form. The letality was of 25 per cent. Conclusions: Neonatal meningitis has a high prevalence, it was very symptomatic and it presented moderate to severe changes in the cerebrospinal liquid.

Chemical deterrence of a cyanobacterial metabolite against generalized and specialized grazers.

Pitipeptolide A is the major secondary metabolite in a persistent population of the cyanobacterium Lyngbya majuscula from Guam. Because this cyanobacterium is of low preference to many sympatric consumers, we tested the hypothesis that this compound acted as a chemical defense. Pitipeptolide A was deterrent to urchins, two species of amphipods, and small herbivorous crabs, whereas it did not deter feeding by the sea hare Stylocheilus striatus, which readily consumes cyanobacteria. Although our comparison included various small invertebrates, which are often tolerant to algal chemical defenses, this cyanobacterial compound proved deterrent at natural concentrations to all but one of the consumer species tested. Thus, the production of defensive secondary metabolites is likely related to the common occurrence of L. majuscula on this coral reef despite the abundance of diverse grazers.

Supraphysiological concentrations of 5-aminolevulinic acid dimerize in solution to produce superoxide radical anions via a protonated dihydropyrazine intermediate.

5-aminolevulinic acid (ALA) is the committed biological precursor to porphyrins. At supraphysiological concentrations ALA can dimerize to form 3,6-dihydropyrazine-2,5-dipropanoic acid (DHPY), which transfers electrons to XTT in a reaction that does not require metal ions and is specifically inhibited by superoxide dismutase. The formation of DHPY from ALA follows dimerization kinetics with a pK of 7.8+/-0.1. At pH 11.2, DHPY is relatively stable, but when the pH is dropped to 6.0 rapid conversion to 2,5-(beta-carboxyethyl)pyrazine occurs via an intermediate with an absorption maximum of 370 nm. Formation of this intermediate is pH-dependent with a pK of 6.0+/-0.1. These data indicate that ALA dimerizes to produce superoxide from a protonated form of DHPY. The significance of these results with respect to the concentrations of ALA used in photodynamic therapy, and the increased incidence of liver cancer in acute intermittent porphyria, is discussed.