Severe flea-borne typhus complicated by hemophagocytic lymphohistiocytosis: A case report and review of literature.

Flea-borne typhus (FBT), also known as murine typhus, is a zoonotic infection caused by R. typhi with world-wide distribution. In the United States, the infection is uncommon but remains endemic in some areas, including Los Angeles County. It typically manifests as a benign acute febrile illness but can be complicated in a minority of cases. Associated hemophagocytic lymphohistiocytosis (HLH) has been described in a limited number of cases. Here, we present a case of a patient with FBT complicated by HLH treated empirically with doxycycline with subsequent resolution of HLH. Also included is a review of the literature of other published cases.

The molecular profile of the inflammatory process differs among various neurodevelopmental disorders with or without cognitive component: A hypothesis of persistent systemic dysfunction and hyper-resolution.

Introduction: Challenges of diverse origin in childhood can alter the growth and development of the central nervous system, affecting structures and functions. As a consequence of the damage suffered during the perinatal period, long periods of dysfunctionality may occur, such as regulatory disorders, which may result in remaining in a process of low-grade inflammation. We previously found that perinatal risks and neurological signs are associated with long-term changes in circulating concentrations of molecules of the inflammatory process, findings that are consistent with the postulate that long periods of dysfunction may condition long-lasting low-grade inflammation or parainflammation. The aim of this study was to assess whether different expressions of neurological disorders show variations in their inflammatory molecule profiles or whether there is a common pattern. Methods: We included screening for (a) caregiver-perceived risk detection of regulatory disturbances, using the DeGangi instrument; (b) dysautonomia or asymmetries, through neurodevelopmental assessments; (c) cognitive developmental disturbances (using the Bailey instrument). We assessed protein molecules on a multiplex system, and lipid molecules by ELISA. Results: We found a similar, although not identical, pattern of cytokine profiles with the presence of risk of regulatory disturbances, dysautonomia and asymmetries; but an opposite inflammatory profile was associated with cognitive impairment. Discussion: Our results suggest that there are diverse, probably limited, molecular footprints associated with impaired function, and that these footprints may depend on the response requirements necessary to adjust to the altered internal environment. Here we propose a theoretical model that suggests possible scenarios for inflammatory outcomes associated with chronic challenges.

Adjunctive efficacy of systemic metronidazole in the surgical treatment of periodontitis: a double-blind parallel randomized clinical trial.

OBJECTIVES: The purpose of this study was to evaluate the clinical and microbiological impact of adjunctive metronidazole to periodontal surgery. MATERIALS AND METHODS: Systemically healthy patients, with stages III-IV, grades B-C periodontitis, were randomly assigned to receive metronidazole or placebo adjunctive to periodontal surgery, after subgingival instrumentation. Clinical variables were recorded at the initial visit, 6 weeks after subgingival instrumentation, and 3, 6, and 12 months after surgery. Microbiological samples were taken at initial and final visits and analyzed by quantitative polymerase chain reaction. RESULTS: Our results showed no statistically significant differences in the reduction of probing depth between the initial and final (1 year) visits in the two treatment groups. Additionally, no statistically significant differences were observed between study groups when comparing the post-subgingival instrumentation and final visits. However, 3 months after surgery, probing depth (mean difference, MD = 0.31 mm, 95% confidence interval, CI [0.13; 0.49]; p = 0.001) and clinical attachment level (MD = 0.64 mm, 95% CI [0.02; 1.27]; p = 0.044) were significantly lower in the test group. CONCLUSIONS: The adjunctive use of systemic metronidazole to periodontal surgery has a limited clinical and microbiological impact in the present study, and therefore, its use is not recommended. CLINICAL RELEVANCE: There are no studies that have evaluated the clinical and microbiological impact of the adjunctive use of systemic metronidazole to periodontal surgery (step 3 of periodontal therapy). The results of the present study do not support the adjunctive use of systemic metronidazole to periodontal surgery.

Pharmaceutical compound removal efficiency by a small constructed wetland located in south Brazil.

The fate of pharmaceuticals during the treatment of effluents is of major concern since they are not completely degraded and because of their persistence and mobility in environment. Indeed, even at low concentrations, they represent a risk to aquatic life and human health. In this work, fourteen pharmaceuticals were monitored in a constructed wetland wastewater treatment plants (WWTP) assessed in both influent and effluent samples. The basic water quality parameters were evaluated, and the removal efficiency of pharmaceutical, potential for bioaccumulation, and the impact of WWTP were assessed using Polar Organic Chemical Integrative Sampler (POCIS) and biofilms. The pharmaceutical compounds were quantified by High Performance Liquid chromatography coupled to mass spectrometry. The sampling campaign was carried out during winter (July/2018) and summer (January/2019). The WWTP performed well regarding the removal of TSS, COD, and BOD5 and succeeded to eliminate a significant part of the organic and inorganic pollution present in domestic wastewater but has low efficiency regarding the removal of pharmaceutical compounds. Biofilms were shown to interact with pharmaceuticals and were reported to play a role in their capture from water. The antibiotics were reported to display a high risk for aquatic organisms.

Endogenous Endophthalmitis Heralding Central Nervous System Involvement by Nocardia Farcinica.

Nocardiosis is an uncommon opportunistic infection caused by aerobic, gram-positive, weakly acid-fast, filamentous bacteria of the genus Nocardia that presents as a suppurative disease in immunocompromised hosts. Herein the authors describe the case of an elderly male with granulomatosis with polyangiitis (GPA) on chronic immunosuppressive therapy that presented initially with visual symptoms and developed focal neurological deficits. Nocardia should be considered as a potential pathogen in any immunosuppressed patient presenting with endogenous endophthalmitis and new-onset focal neurological deficits. Early recognition and treatment may prevent irrevocable neurological compromise stemming from misdiagnosis.

The Severity of Neurological Dysfunction in Preschool Children, Secondary to Damage Generated During the Perinatal Period, is Associated With a Pro-Inflammatory Pattern of Serum Molecules.

Disorders in the child's neurological development caused by perinatal risks can lead to long-term altered neurological signs that begin at an early age and involve persistent functional disorders. Recent data suggest that tissue dysfunction, not just acute damage, may initiate or perpetuate an inflammatory response. The aim of this study was to find out if any neurological dysfunction in preschool children secondary to damage generated during the perinatal period is associated with the magnitude of perinatal risks and long-term modifications in the serum concentrations of inflammatory molecules. The participants, aged 1-4 years, were on neurodevelopmental follow-up and rehabilitation therapy from the first three months of life and had no acute disease data. We classified the children into three groups according to the importance of their perinatal risks: low, medium, and high. The results show that 1) the magnitude of perinatal risks correlated with the severity of neurological dysfunction; 2) the greatest changes in the concentrations of the molecules of the inflammatory process were associated with the most altered neurological signs. This suggests that persistent nervous system dysfunction keeps inflammatory responses active even in the absence of an acute process of infection or damage.

Lemierre's Syndrome Due to Methicillin-Resistant Staphylococcus aureus.

Lemierre's syndrome is an uncommon and potentially fatal complication of oropharyngeal and facial infections. It involves an associated septic thrombophlebitis, bacteremia, and septic emboli. Traditionally, compromise of the internal jugular vein has been described in conjunction with an infection caused by anaerobes, especially, Fusobacterium necrophorum. In recent years, however, variant forms have been appearing, including other vessel compromise and other etiologic agents. We present the case of Lemierre's syndrome in a 31-year-old male with facial vein thrombosis, septic emboli to the lungs, and bacteremia caused by methicillin-resistant Staphylococcus aureus. We hope that this case will raise awareness about variant presentations and promote a timely diagnosis and appropriate treatment of this potentially fatal infection.

Prioritization of Chicken Meat Processing Interventions on the Basis of Reducing the Salmonella Residual Relative Risk.

Protecting public health by controlling Salmonella in chicken meat products continues to be a challenge to both industry and policymakers. Studies evaluating the combined use of commercially available antimicrobial interventions are scarce. The aim of this work was to develop a risk-based prioritization framework to rank chicken meat processing interventions that achieve the greatest Salmonella relative risk reduction. A baseline model characterizing the current U.S. broiler industry food safety intervention practices was created from direct observation of processes and expert elicitation. Results showed the combination of chlorine at the bird wash station and peroxyacetic acid at the on-line reprocessing and chill stages as the most common U.S. processing scenario. Irradiation at packaging and acidified sodium chlorite at evisceration were the most effective single processing interventions (98.8 and 91.6% risk reduction, respectively); however, no single intervention was able to comply with the current Food Safety and Inspection Service Salmonella postchill performance standards. The combination of peroxyacetic acid in at least one of the chicken processing stages with the current set of U.S. baseline interventions achieved >99% Salmonella relative risk reduction and ensured Food Safety and Inspection Service compliance. Adding more than one intervention to the U.S. current practice did not enhance (<2%) the overall Salmonella risk reduction. This study can help poultry processors to prioritize food safety interventions to maximize Salmonella reduction and public health protection.

Construction of a highly saturated linkage map in Japanese plum (Prunus salicina L.) using GBS for SNP marker calling.

This study reports the construction of high density linkage maps of Japanese plum (Prunus salicina Lindl.) using single nucleotide polymorphism markers (SNPs), obtained with a GBS strategy. The mapping population (An x Au) was obtained by crossing cv. "Angeleno" (An) as maternal line and cv. "Aurora" (Au) as the pollen donor. A total of 49,826 SNPs were identified using the peach genome V2.1 as a reference. Then a stringent filtering was carried out, which revealed 1,441 high quality SNPs in 137 An x Au offspring, which were mapped in eight linkage groups. Finally, the consensus map was built using 732 SNPs which spanned 617 cM with an average of 0.96 cM between adjacent markers. The majority of the SNPs were distributed in the intragenic region in all the linkage groups. Considering all linkage groups together, 85.6% of the SNPs were located in intragenic regions and only 14.4% were located in intergenic regions. The genetic linkage analysis was able to co-localize two to three SNPs over 37 putative orthologous genes in eight linkage groups in the Japanese plum map. These results indicate a high level of synteny and collinearity between Japanese plum and peach genomes.

La importancia de la Tomografía Axial Computarizada (TAC) en los traumatismos torácicos. Presentación de caso / Importance of Computed Axial Tomography (CAT) on thoracic traumas. Case presentation

Se estudió un paciente masculino de 30 años de edad, con antecedentes de salud; que sufrió una caída desde una altura. Fue atendido en el Cuerpo de Guardia del Hospital Clínico-Quirúrgico de Holguín, donde se presentó con un trauma torácico cerrado. En estudios radiológicos de urgencia, no se evidenciaron lesiones óseas, pleuroparenquimatosas ni mediastinales; sin embargo, por la evolución clínica posterior, se le realiza un interrogatorio y examen físico exhaustivo, y se indica una tomografía axial computarizada de tórax, en la que aparecen lesiones contusionales bibasales postraumáticas. Se impone tratamiento medicamentoso y, a su término, se reevalúa clínica y radiológicamente, con una evolución satisfactoria del cuadro.

A 30-year-old male patient with medical records, with a closed thoracic trauma, who was treated at the Emergency Room, after falling from a height, at Holguin´s Clinical Surgical Hospital. Radiological studies not showed pleuroparenchymal and mediastinal lesions. Due to clinical evolution, a thorough physical examination was computerized. Thorax tomography was indicated. Bibasal contusional posttraumatic lesions were detected. Medication, clinical and radiological re-evaluation led to the satisfactory evolution of patient´s clinical picture.

Steroid-Induced Psychosis in the Pediatric Population: A New Case and Review of the Literature.

OBJECTIVES: Iatrogenic steroid-induced psychosis is a rare but serious adverse side effect seen largely in the adult population that less commonly affects children and adolescents. Given the significant distress steroid-induced psychosis may cause, recommendations are needed for effective management. Here we conducted a systematic review of the literature and report a new case of steroid-induced psychosis in a 12-year-old patient. METHODS: We performed a systematic search using Embase, PubMed, Scopus, and PsychInfo. Key terms included ("steroid induced" or "corticosteroid induced" or "glucocorticoid induced") and ("psychosis" or "hallucinations" or "delusions") and ("child" or "adolescent" or "pediatric"). A total of 15 articles of steroid-induced psychosis in children and adolescents were found in the scientific literature. This report includes those articles and a novel case of steroid-induced psychosis. RESULTS: Children with asthma, autoimmune diseases, and cancer have been reported to experience steroid-induced psychosis. The mean age of children with steroid-induced psychosis was 12 ± 3.6 years. Our team presents a report of steroid-induced psychosis in a 12-year-old patient with discoid-type lupus erythematosus. Within days of treatment with 40 mg prednisone daily, this patient began to drool, became mute, and was responding to internal stimuli. Treatment was difficult secondary to the acute exacerbation of lupus, requiring ongoing therapy. It was initially unclear whether the acute psychosis was a manifestation of lupus, a side effect of medication, or a combination of the two risk factors. Neurology consultation ruled out lupus cerebritis. Psychosis was treated with haloperidol 5 mg. Psychosis did not resolve until the steroid taper was complete and the patient was no longer taking any prednisone. CONCLUSIONS: Given the common use of glucocorticoid therapy in children, it is important that physicians and parents recognize the signs of steroid-induced psychosis and are aware of the data on treating this complication.

La importancia de la Tomografía Axial Computarizada (TAC) en los traumatismos torácicos. Presentación de caso

Se estudió un paciente masculino de 30 años de edad, con antecedentes de salud; que sufrió una caída desde una altura. Fue atendido en el Cuerpo de Guardia del Hospital Clínico-Quirúrgico de Holguín, donde se presentó con un trauma torácico cerrado. En estudios radiológicos de urgencia, no se evidenciaron lesiones óseas, pleuroparenquimatosas ni mediastinales; sin embargo, por la evolución clínica posterior, se le realiza un interrogatorio y examen físico exhaustivo, y se indica una tomografía axial computarizada de tórax, en la que aparecen lesiones contusionales bibasales postraumáticas. Se impone tratamiento medicamentoso y, a su término, se reevalúa clínica y radiológicamente, con una evolución satisfactoria del cuadro.(AU)

A 30-year-old male patient with medical records, with a closed thoracic trauma, who was treated at the Emergency Room, after falling from a height, at Holguin´s Clinical Surgical Hospital. Radiological studies not showed pleuroparenchymal and mediastinal lesions. Due to clinical evolution, a thorough physical examination was computerized. Thorax tomography was indicated. Bibasal contusional posttraumatic lesions were detected. Medication, clinical and radiological re-evaluation led to the satisfactory evolution of patient´s clinical picture.(AU)

Introducing the Body-QoL®: A New Patient-Reported Outcome Instrument for Measuring Body Satisfaction-Related Quality of Life in Aesthetic and Post-bariatric Body Contouring Patients.

OBJECTIVE: To develop a new patient-reported outcome instrument (PRO) to measure body-related satisfaction quality of life (QoL). METHODS: Standard 3-phase PRO design was followed; in the first phase, a qualitative design was used in 45 patients to develop a conceptual framework and to create preliminary scale domains and items. In phase 2, large-scale population testing on 1340 subjects was performed to reduce items and domains. In phase 3, final testing of the developed instrument on 34 patients was performed. Statistics used include Factor, RASCH, and multivariate regression analysis. Psychometric properties measured were internal reliability, item-rest, item-test, and test-retest correlations. RESULTS: The PRO-developed instrument is composed of four domains (satisfaction with the abdomen, sex life, self-esteem and social life, and physical symptoms) and 20 items in total. The score can range from 20 (worst) to 100 (best). Responsiveness was 100 %, internal reliability 93.3 %, and test-retest concordance 97.7 %. Body image-related QoL was superior in men than women (p < 0.001) and decreased with increasing age (p = 0.004) and BMI (p < 0.001). Post-bariatric body contouring patients score lower than cosmetic patients in all domains of the Body-QoL instrument (p < 0.001). After surgery, the score improves by on average 21.9 ± 16.9 (effect size 1.8, p < 0.001). CONCLUSIONS: Body satisfaction-related QoL can be measured reliably with the Body-QoL instrument. It can be used to quantify the improvement in cosmetic and post-bariatric patients including non- or minimally invasive procedures, suction assisted lipectomy, abdominoplasty, lipoabdominoplasty, and lower body lift and to give an evidence-based approach to standard practice. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Physicochemical properties and structural characteristics of whole grain Oryza sativa L. with different treatments.

Physicochemical properties and structural characteristics of whole rice flours with different treatments (soaking, germination and extrusion cooking) were studied. Water solubility, water absorption, crystallinity, adsorption isotherms (BET and GAB models), and glass transition temperature of the samples were determined. Water solubility and water absorption were enhanced by extrusion cooking process (3.17-4.98 vs. 24.1-53.76 g/100 g and 2.77-3.05 vs. 4.46-7.04 ml/g, respectively), but crystallinity was decreased (30-33 vs. 4-16%). Adsorption isotherms showed that extruded samples exhibited higher equilibrium moisture content as compared with their corresponding non-extruded samples (5.0-19.2 vs. 4.0-16.1 g water/g solids). There were no changes in glass transition temperature values in the studied moisture range (3.8-16 g/100 g). These results allow the correct use of whole rice flours with different treatments in foods and also contributed to the knowledge of stabilization of the products.

Soaking and extrusion effects on physicochemical parameters, phytic acid, nutrient content and mineral bio-accessibility of whole rice grain.

A combination of soaking and extrusion processes of whole rice grain was studied. The effects of temperature (35-55 °C) and time (24-48 h) of soaking treatment on phytic acid (PA), protein and ashes losses using a factorial design were evaluated. Taking into account ash, protein and PA losses, whole rice was soaked 24 h at 45 °C and extruded using a Brabender single screw extruder. Effects of extrusion temperature (160-190 °C) and moisture content (14-19 g/100 g) on product characteristics were evaluated using surface response methodology. Values corresponding to the different responses were: Expansion (1.64-3.28), Specific Volume (5.68-11.06 cm(3)/g), Water absorption (3.41-4.43 mL/g) and Solubility (45.44-66.20 g/100 g). The content of PA was reduced from 740.09 to 163.47 mg/100 g (77%) after both processes, resulting in a higher mineral bio-accessibility, and a 7.3% decrease of protein digestibility. Total soluble phenolics and trolox equivalent antioxidant capacity (TEAC) were affected according to the treatment. Both treatments were important to obtain a nutritionally improved whole grain product.

Interacción madre-hijo durante la alimentación en niños con hipotiroidismo congénito / Mother-infant interaction during feeding time in children with congenital hypothyroidism

La interacción madre-hijo es un elemento esencial para el desarrollo integral del niño, especialmente durante los primeros años de vida y en presencia de enfermedades como el hipotiroidismo congénito o condiciones socioemocionales del cuidador y la familia. Objetivo: Evaluar la interacción madre-hijo durante la alimentación en díadas con niños con hipotiroidismo congénito e intervención temprana, y compararla respecto a díadas con niños sanos. Material y métodos: Estudio observacional, comparativo, transversal y prospectivo. Se formaron tres grupos: 1) díadas con niños con hipotiroidismo congénito e intervención temprana bajo tratamiento hormonal sustitutivo; 2) díadas con niños sanos sin intervención temprana; 3) díadas con niños sanos (sin hipotiroidismo) con intervención temprana. La edad de los niños fue de 0 a 12 meses. Se visitaron los hogares para videograbar la interacción durante la alimentación del niño. Se comparó la interacción entre los tres grupos con las puntuaciones totales y por subescalas de la Nursing Caregiver Assessment Feeding Scales. Resultados: El Grupo 1 obtuvo califi caciones más altas en la interacción, seguido por el Grupo 3 y con menores puntajes el Grupo 2. Conclusiones: La intervención temprana favorece la interacción madre-hijo. Las diferencias esperadas en la interacción por la condición socioeconómica o la escolaridad materna fueron menores ante la exposición a la intervención temprana

Mother-infant interaction is essential for the overall infant development, especially during the fi rst years of life, and in the presence of diseases such as congenital hypothyroidism or socio-emotional adverse conditions of the caregiver or the family. Objective: To evaluate the mother-infant interaction during feeding sessions in dyads with children with congenital hypothyroidism included in an early intervention program and compare dyads with healthy children. Materials and methods: Observational, comparative, cross-sectional and prospective study. Three groups were formed: 1) 159 dyads, children with congenital hypothyroidism who received early hormone replacement therapy and early intervention program; 2) 254 dyads with healthy children without early intervention program, and 3) 59 dyads with healthy children (no hypothyroidism) with early intervention program. The age of the children was 0-12 months. Dyads home were visited to videotape the interaction during feeding moment of the child. Interaction between three groups with total scores and subscales of Nursing Caregiver Assessment Feeding Scales was compared. Results: Group 1 scored higher on interaction, followed by Group 3 and Group 2, with lower scores. Birth order and maternal age had greater association with scores on the total test (p < 0.01). Conclusions: Major differences in the children’s scores were observed. Early intervention program strategies promote mother-infant interaction. The expected differences in interaction related with socioeconomic status or maternal education were lower with the effect of the exposure to an early intervention program