A simulated heat wave-but not herbicide exposure-alters resource investment strategy in an insect.

Animals are increasingly exposed to potential stressors related to environmental change, and multiple stressors may alter the dynamics by which animals acquire resources and invest those resources into important life-history traits. Stress may lead to the prioritization of current reproduction to maximize lifetime reproduction (i.e., terminal investment [TI]) or, in contrast, prioritize somatic investment over current reproduction to facilitate future reproductive opportunities (i.e., reproductive restraint [RR]). Tests of the TI and RR hypotheses typically use immune challenges as stressors, and have not been explicitly tested in the context of environmental change even though warming influences resource allocation patterns across taxa. Further, the multiple-stressor framework has been a useful construct to clarify the costs of complex environmental shifts to animals, but it has not been leveraged to understand such effects on investment strategy. Thus, we tested the TI and RR hypotheses by manipulating widespread features of environmental change-glyphosate-based herbicide (GBH; Roundup®) exposure and a simulated heat wave-in the variable field cricket (Gryllus lineaticeps). A simulated heat wave affected the life-history tradeoff between investment into reproduction and soma. Specifically, heat wave prioritized investment into ovary mass over non-reproductive tissue, even after accounting for food consumption, in support of the TI hypothesis. In contrast, GBH exposure did not affect any measured trait, and crickets did not discriminate between tap water and GBH solution during drinking. Therefore, some-but not all-aspects of environmental change may alter resource investment strategies in animals. We encourage continued integration of the multiple-stressor framework and life-history theory to better understand how animals respond to their rapidly changing environments.

Results of the performance verification of the CoaguChek XS system.

BACKGROUND: This is the first paper reporting a performance verification study of a point-of-care (POC) monitor for prothrombin time (PT) testing according to the requirements given in chapter 8 of the International Organization for Standardization (ISO) 17593:2007 standard "Clinical laboratory testing and in vitro medical devices - Requirements for in vitro monitoring systems for self-testing of oral anticoagulant therapy". The monitor under investigation was the new CoaguChek XS system which is designed for use in patient self testing. Its detection principle is based on the amperometric measurement of the thrombin activity generated by starting the coagulation cascade using a recombinant human thromboplastin. METHODS: The system performance verification study was performed at four study centers using venous and capillary blood samples on two test strip lots. Laboratory testing was performed from corresponding frozen plasma samples with six commercial thromboplastins. Samples from 73 normal donors and 297 patients on oral anticoagulation therapy were collected. Results were assessed using a refined data set of 260 subjects according to the ISO 17593:2007 standard. RESULTS: Each of the two test strip lots met the acceptance criteria of ISO 17593:2007 versus all thromboplastins (bias -0.19 to 0.18 INR; >97% of data within accuracy limits). The coefficient of variation for imprecision of the PT determinations in INR ranged from 2.0% to 3.2% in venous, and from 2.9% to 4.0% in capillary blood testing. Capillary versus venous INR data showed agreement of results with regression lines equal to the line of identity. CONCLUSION: The new system demonstrated a high level of trueness and accuracy, and low imprecision in INR testing. It can be concluded that the CoaguChek XS system complies with the requirements in chapter 8 of the ISO standard 17593:2007.

Chronic lymphocytic leukemia with a monoclonal immunoglobulin M lambda lymphocyte agglutinin.

A case of chronic lymphocytic leukemia is described in which peripheral blood films showed lymphocyte agglutination. A serum factor responsible for the agglutination was demonstrated. The factor was dependent upon the presence of anticoagulant solutions and was more active at room temperature than at 37 degrees C. It could be identified as a monoclonal immunoglobulin M. This mechanism has not been previously described in lymphocyte agglutination.

[Mirtazapine in the treatment of cocaine-dependence in patients with methadone]. / Mirtazapina en el tratamiento de la dependencia a la cocaína en pacientes con metadona.

OBJECTIVE: To evaluate efficacy, interactions and adherence to treatment in cocaine-dependent patients (according to DSM- IV criteria). Its impact on reducing/quitting both cocaine and especially benzodiazepines (BZP) is of a great concern. PATIENTS AND METHODS: Thirty-one patients with an average age of 35 years, mean methadone dose of 155 mg/day and an average staying time on MMP of 21 months started treatment with MTZ, 60 mg/day as a single dose. One patient had to take 90 mg/day. One patient was excluded because of poor performance in the methadone maintenance program (MMP). In the pre-treatment evaluation, 22% of the patients did not use BZP and 40% used only cocaine. Sixty three percent used cocaine in higher dose than 0.5 g/day. (Range: 0.5-2 g). Abusive alcohol drinkers or patients with severe organic or psychiatric impairment were discarded. RESULTS: MTZ is well tolerated and its adverse effects are welcome in this kind of patients. Adherence to treatment was quite good for these reasons and because MTZ has a short latency time. No dose adjustments or interactions with other prescriptions (e.g., HAART), were shown. Hamilton-17, GCI, stress and craving scales were employed. Drug use was monitored with enzyme immune assay. At the end of the study, seven patients (23%) managed to quit cocaine. No BZP use was reported in 20 patients (80%). CONCLUSION: MTZ has shown good results in ceasing street BZP abuse, as well as reducing cocaine abuse though in the minor abusers. Treatment adherence was quite good and no evidence of interactions with drug-related treatments was reported.

Desenvolvimento do UMELISA-TSH neonatal para dosagem de TSH em sangue coletado em papel filtro / Development of the ultramicroelisa for determination of neonatal TSH from blood spots on filter paper

O hipotireoidismo congênito, causado pela ausência anatômica ou funcional da glândula tireóide, apresenta freqüência mundial de aproximadamente 1:4000 recém-nascidos. A principal implicação da doença, o retardo mental, somente pode ser evitada se o tratamento se iniciar nas primeiras semanas de vida. Por isso, o diagnóstico precoce constitui a chave de êxito no tratamento da enfermidade. O Umelisa – TSH neonatal é um ensaio heterogêneo imunoenziomático tipo sanduíche, cuja fase sólida são micropoços de 10mL em tiras/placas pré-sensibilizadas com anticorpos policlonais anticadeia Beta do TSH. As amostras de sangue são eluídas com um conjugado anti_TSH policlonal/fosfatase alcalina e transferidas para placas de reação. A reação é revelada com substrato fluorigênico e a intensidade da fluorescência emitida é proporcional à concentração de TSH presente na amostra. A leitura é realizada automaticamente por um leitor fluorímetro-fotômetro computadorizado. A curva padrão validada contra ao padrão 80 558 da OMS varia dentro de uma faixa de 10-200 µUI/L, com limite de detecção de 2 µUI/L. Posteriormente, a curva foi ajustada para medir valores a partir de 0,1 µUI/L. A avaliação analítica mostrou uma precisão intra e inter-ensaio no ponto de corte (25 µUI/L) de 6,2 e 7,4 por cento, respectivamente. A correlação entre o Umelisa – TSH neonatal e o Delfia neonatal TSH foi boa (r = 0,99), além de não ser detectadas interferências significativas com outros hormônios hipofisários e proteínas séricas. A recuperação do teste foi de 101,1 +/- 3,7 por cento. Na prova de paralelismo, as concentrações calculadas de 3 amostras, após a correção com o fator de diluição, foi de +/- 6,4 por cento da concentração original da amostra pura. O Umelisa- TSH neonatal mostrou-se um método rápido e sensível, podendo ser utilizado como uma opção para programas de rastreamento em massa, já que permite operar com grandes quantidades de amostras garantindo eficiência e custo compatível com a tabela de exames complementares do Sistema Único de Saúde (SUS).

[Neuroleptic malignant syndrome, multiorgan failure and peripheral polyneuropathy]. / Síndrome neuroléptico maligno, fallo multiorgánico y polineuropatía periférica.

The Malignant Neuroleptic Syndrome (MNS) is characterised by the acute appearance of hyperthermia, muscular rigidity, loss of motor control, and alterations in the level of consciousness, which could prove fatal if not rapidly diagnosed and treated. It is held to be a serious idiosyncratic reaction which appears in patients being treated with neuroleptics, independently of the dosage and the length of time the drug has been prescribed. Relapses do not usually occur when the drug is re-prescribed, once the acute phase has been passed, which suggests the existence of predisposing factors. There are frequent complications (acute respiration difficulties, acute kidney failure, disseminated intravascular coagulation and multiorganic failure) which condition the prognosis. The treatment consists of the suppression of the neuroleptic, rehydration, and specific drugs (bromocryptine, sodium dantroline). We have analysed two new cases which reacted badly, one of them with a multiorganic failure and the other, who had a good initial therapeutical response but who went on to develop a peripheral neuropathy, an infrequent complication in international medical casebooks.

[Accidental pricking by a needle in a third-level hospital: associated factors]. / Pinchazos accidentales con aguja en un hospital de tercer nivel: factores asociados.

The needlestick injuries are the most frequent accidents among hospital staff. The aim of this study is to identify some factors associated with accidents caused by needlestick injuries at hospitals, so as to measure the risk that they present. A case-control study has been made, the subject of which is the nurses working at "Reina Sofía" Hospital in Córdoba and within the period June 30, 1990 and June 30, 1991. A more significant factor in relation to needlestick injuries was the recapping of the needle after being used. The risk of injury being 3.95, 7.68 an 17.85 times higher between those who recapped sometimes, frequently and always, respectively, versus those who had never recapped needles. Professional experiences resulted in being a protector factor against the needlestick injuries (OR = 0.93; 95% CI = 0.89; 0.97;) it's estimated that the risk injuring is less than half among personnel having ten years of experience. Knowing these risk factors is important for the development of specific prevention programs. Nevertheless, it is still important to identify other risk factors.

[Visceral leishmaniasis and multiple organ failure]. / Leishmaniasis visceral y fracaso multiorgánico.

BACKGROUND: Visceral leishmaniasis is a parasitic disease which has a good prognosis in previously healthy patients who have been successfully treated. At present, visceral leishmaniasis is increasingly reported in immunocompromised patients including those with AIDS, whose display a fulminating form and higher mortality. We report a case of visceral leishmaniasis in a healthy patient with a non classical clinical evolution of the disease. METHODS: A 17 years old patient without immunosuppressive factors was diagnosed by histologic evaluation of bone marrow which revealed intracellular leishmania amastigotes. Immediately the patient received treatment with antimony therapy. RESULTS: Patient developed a multi-organic failure (respiratory distress, disseminated intravascular coagulation, hepatic and renal insufficiency) and died at 13 days his after intensive care unit admission. CONCLUSIONS: The major new finding of this study is that in normal humans visceral leishmaniasis can have a dramatic short-term follow up in spite of correctly treatment. We suggest a possible immunological mechanism similar at non septic pathology.

[Laryngeal paralysis and olivopontocerebellar atrophy. Apropos of a case]. / Parálisis laríngea y atrofia olivopontocerebelosa. A propósito de un caso.

We display the study performed to a female patient affected of laryngeal paralysis to become, based in clinical and radiologic criteria, to diagnose her cerebellar atrophy. We justify our work because of how infrequently this illness heredodegenerative of the central nervous system begins with cranial pairs paralysis. We emphasize the importance that the new methods of explorations specially TAC and IRM, have to guess the possible etiologies of central originated paralysis.

[Pleomorphic adenoma of the nasal cavity. Presentation of a case]. / Adenoma pleomorfo de fosa nasal. Aportación de un caso.

We display a case of a female patient with a pleomorphic adenoma localized in the nasal fossa, with 10 years of evolution and that has been extirpated by an external way. We review the bibliography, we emphasize the rareness of the locality and make considerations about clinic, prognostication and treatment.