Acute toxic leukoencephalopathy associated with a non-prescription weight loss supplement: a report of two cases.

Weight loss dietary supplements are used with some frequency by an increasingly overweight population. Some products are not adequately regulated and may pose potential health risks. We report two new cases of acute toxic leukoencephalopathy (ATL) due to the use of a supplement marketed as a thermogenic weight loss aid. ATL is a heterogeneous clinic-radiological entity that has been associated with various compounds, such as chemotherapeutic drugs and immunomodulators. It is characterized by an often reversible periventricular and infratentorial demyelination. The commercialization of non-regulated weight loss products continues to be a health risk in our population.

Time volunteered on community health activities by brigadistas in Nicaragua.

OBJECTIVE: To report on how brigadistas ("health brigadiers") in Nicaragua volunteer their time before the introduction of expanded responsibilities (beyond the scope of integrated community case management (iCCM)) for sick children 2-59 months old. METHODS: Three complete teams of brigadistas (n = 12 brigadistas total) were selected from remote communities in the department of Matagalpa. Each respondent brigadista was interviewed privately regarding the frequency and duration (i.e., preparation, round-trip travel, and implementation time) of 13 separate activities. The correlation between their overall estimates and summed times of individual activities were measured. RESULTS: Brigadista mean density was 1 per 156 total population (range: 120-217). Each team had one encargado/a ("manager") with an iCCM drug box plus two to four asistentes ("assistants"). All resided in the community they served. Eight reported competing time demands during one to nine months of the year. Brigadistas volunteered an average of 75 hours per month (range: 35-131). Encargados were busier than asistentes (98 versus 68 hours per month). Three activities accounted for 70% of their time: 1) iCCM (30%: treatment (11%), follow-up (19%)); 2) receiving training (21%); and 3) promoting birth planning (19%). Brigadistas' time was divided among preparation (12%), travel (27%), and implementation (61%). Overall estimates were highly correlated (+0.70) with summed implementation time. CONCLUSIONS: Brigadistas from these remote Nicaraguan communities were busy with different activities, levels of effort, and patterns of task-sharing. These findings, plus an ongoing job satisfaction survey and a follow-on time study after the introduction of the new interventions, will inform policy for this valuable volunteer cadre.

Myogenic Akt signaling attenuates muscular degeneration, promotes myofiber regeneration and improves muscle function in dystrophin-deficient mdx mice.

Duchenne muscular dystrophy, the most common form of childhood muscular dystrophy, is caused by X-linked inherited mutations in the dystrophin gene. Dystrophin deficiencies result in the loss of the dystrophin-glycoprotein complex at the plasma membrane, which leads to structural instability and muscle degeneration. Previously, we induced muscle-specific overexpression of Akt, a regulator of cellular metabolism and survival, in mdx mice at pre-necrotic (<3.5 weeks) ages and demonstrated upregulation of the utrophin-glycoprotein complex and protection against contractile-induced stress. Here, we found that delaying exogenous Akt treatment of mdx mice after the onset of peak pathology (>6 weeks) similarly increased the abundance of compensatory adhesion complexes at the extrasynaptic sarcolemma. Akt introduction after onset of pathology reverses the mdx histopathological measures, including decreases in blood serum albumin infiltration. Akt also improves muscle function in mdx mice as demonstrated through in vivo grip strength tests and in vitro contraction measurements of the extensor digitorum longus muscle. To further explore the significance of Akt in myofiber regeneration, we injured wild-type muscle with cardiotoxin and found that Akt induced a faster regenerative response relative to controls at equivalent time points. We demonstrate that Akt signaling pathways counteract mdx pathogenesis by enhancing endogenous compensatory mechanisms. These findings provide a rationale for investigating the therapeutic activation of the Akt pathway to counteract muscle wasting.

Copulatory mechanics of ghost spiders reveals a new self-bracing mechanism in entelegyne spiders.

Spiders evolved a distinctive sperm transfer system, with the male copulatory organs located on the tarsus of the pedipalps. In entelegyne spiders, these organs are usually very complex and consist of various sclerites that not only allow the transfer of the sperm themselves but also provide a mechanical interlock between the male and female genitalia. This interlocking can also involve elements that are not part of the copulatory organ such as the retrolateral tibial apophysis (RTA)-a characteristic of the most diverse group of spiders (RTA clade). The RTA is frequently used for primary locking i.e., the first mechanical engagement between male and female genitalia. Despite its functional importance, some diverse spider lineages have lost the RTA, but evolved an apophysis on the femur instead. It can be hypothesized that this femoral apophysis is a functional surrogate of the RTA during primary locking or possibly serves another function, such as self-bracing, which involves mechanical interaction between male genital structures themselves to stabilize the inserted pedipalp. We tested these hypotheses using ghost spiders of the genus Josa (Anyphaenidae). Our micro-computed tomography data of cryofixed mating pairs show that the primary locking occurs through elements of the copulatory organ itself and that the femoral apophysis does not contact the female genitalia, but hooks to a projection of the copulatory bulb, representing a newly documented self-bracing mechanism for entelegyne spiders. Additionally, we show that the femoral self-bracing apophysis is rather uniform within the genus Josa. This is in contrast to the male genital structures that interact with the female, indicating that the male genital structures of Josa are subject to different selective regimes.

Skeletal muscle Nur77 expression enhances oxidative metabolism and substrate utilization.

Mitochondrial dysfunction has been implicated in the pathogenesis of type 2 diabetes. Identifying novel regulators of mitochondrial bioenergetics will broaden our understanding of regulatory checkpoints that coordinate complex metabolic pathways. We previously showed that Nur77, an orphan nuclear receptor of the NR4A family, regulates the expression of genes linked to glucose utilization. Here we demonstrate that expression of Nur77 in skeletal muscle also enhances mitochondrial function. We generated MCK-Nur77 transgenic mice that express wild-type Nur77 specifically in skeletal muscle. Nur77-overexpressing muscle had increased abundance of oxidative muscle fibers and mitochondrial DNA content. Transgenic muscle also exhibited enhanced oxidative metabolism, suggestive of increased mitochondrial activity. Metabolomic analysis confirmed that Nur77 transgenic muscle favored fatty acid oxidation over glucose oxidation, mimicking the metabolic profile of fasting. Nur77 expression also improved the intrinsic respiratory capacity of isolated mitochondria, likely due to the increased abundance of complex I of the electron transport chain. These changes in mitochondrial metabolism translated to improved muscle contractile function ex vivo and improved cold tolerance in vivo. Our studies outline a novel role for Nur77 in the regulation of oxidative metabolism and mitochondrial activity in skeletal muscle.

Survival and clinical features in Hispanic amyotrophic lateral sclerosis patients.

The demography, survival, and motor phenotypes of amyotrophic lateral sclerosis (ALS) patients have been rarely described in Hispanic countries. The clinical characteristics and survival of a series of Mexican ALS patients are described. Mexican patients with definite ALS were included in a five-year retrospective longitudinal study. Their demographic and clinical features, cumulative survival rates, and independent predictive factors for survival were analysed. Sixty-one definite ALS patients were included. The median follow-up period was 35 months (range 12-108 months). Males were predominant (1.8: 1), the mean age at onset was 47.5 ± 10.5 years, and the median interval from onset to diagnosis was 12 months. Spinal onset occurred in 66% of patients. Upper motor neuron phenotype was predominant in 53% of patients. The overall mean survival from onset was 68.6 months, and from diagnosis was 57.8 months. Longer survival was determined in patients aged ≤ 40 years (54.7 months) compared with other age groups (p = 0.006). In conclusion, the clinical heterogeneity, male predominance, and survival rates in our sample are consistent with those of other studies. Patients in this series had a younger age at onset and a clear trend toward longer survival compared with those of other population studies.

A new species of the genus emFernandezina/em Birabén, 1951 (Araneae: Palpimanidae: Otiothopinae) from Colombia.

Specimens of the palpimanid spider subfamily Otiothopinae Platnick are commonly collected in soil and leaf litter in tropical and subtropical environments (Platnick 1975; Cala-Riquelme et al. 2018). However, otiothopines are generally poorly represented in biological collections and usually collected in low numbers during field campaigns, with many species represented by only a single sex (Cala-Riquelme et al. 2018). These difficulties, combined with our scarce knowledge of the biology and natural history of these spiders, mean that there are regional gaps in our systematic understanding of the group. Thus, taxonomic additions and notes about natural history are essential in order to increase our knowledge of the group and gradually close those gaps.

A fresh look at Cosmetus Perty, 1833 (Opiliones: Cosmetidae), with new synonymies and description of two new species from Colombia.

Cosmetus Perty, 1833 is the type genus of the most diverse subfamily of Laniatores, Cosmetinae. The genus currently includes 22 valid species with a disconnected distribution, including coastal forests of NE Brazil, dry forests of the Ecuadorian Pacific, Choc-Darien moist forests and the Venezuelan Andes. The morphology among species in the genus is quite variable, but they share almost exclusively the fused spine in area III. The type species Cosmetus varius is little known due to few, poor quality illustrations, a vague type locality, and lost type material, and was misidentified by Koch in 1840, making it difficult to define or even taxonomically revise the genus. Herein we: (1) provide distribution maps for nominal Cosmetus species; (2) recognize the poorly defined type species C. varius as a species occurring in central-eastern Bahia, agreeing with the itinerary of Spix and von Martius; (3) synonymize three other species from central-eastern Bahia with C. varius; (4) provide images of the external morphology of three Brazilian species of the genus; and (5) describe two new sympatric species from the Colombian Pacific region (Choc-Darien moist forest), thus representing the first report of the genus for the country. Both Colombian species, Cosmetus acanti sp. nov. and Cosmetus villarreali sp. nov., have similar external morphology but are remarkably different in genital morphology. Morphological evidence indicates that Cosmetus may be an artificial group. However, given the chaotic taxonomy of the family Cosmetidae, and the deep intertwining of nomenclature, we do not know at the moment where each of those species should be classified.

An update of morphological and distributional data of the genus Patrera Simon (Araneae: Anyphaenidae: Anyphaeninae) with the description of twenty-five new species from Colombia.

The knowledge on the diversity of the genus Patrera Simon in Colombia is widely expanded. P. auricoma (L. Koch, 1866) and P. armata (Chickering, 1940) are redescribed and their females are described for the first time and recorded from Cundinamarca and Meta departments, respectively. Aysha strandi (Caporiacco, 1947) is synonymized with P. armata. Three species groups in the genus Patrera are proposed to include the bulk of its species (fulvastra, florezi, and philipi). These groups are diagnosed based on sexual characters. Twenty-five new species are herein described, illustrated and mapped: P. anchicaya n. sp. (♂♀); P. barbacoas n. sp. (♂); P. borjai n. sp. (♂♀); P. danielae n. sp. (♂♀); P. dimar n. sp. (♂♀); P. perafani n. sp. (♂♀); P. platnicki n. sp. (♂); P. quillacinga n. sp. (♂♀), and P. ramirezi n. sp. (♂♀) into the fulvastra species group. P. bonaldoi n. sp. (♂♀); P. boteroi n. sp. (♂); P. carvalhoi n. sp. (♂♀); P. florezi n. sp. (♂♀); P. perijaensis n. sp. (♀); P. quimbaya n. sp. (♂♀); P. sampedroi n. sp. (♂); P. yukpa n. sp. (♂♀), and P. wiwa n. sp. (♂♀) in florezi species group. P. sutu n. sp. (♂); P. chucurui n. sp. (♂♀); P. dawkinsi n. sp. (♂); P. dentata n. sp. (♂); P. dracula n. sp. (♂); P. kuryi n. sp. (♂♀), and P. longitibialis n. sp. (♂) in philipi species group. We also briefly discuss some aspects of the species groups' genital morphology, based on a comparison with the type, P. fulvastra Simon. Additionally, distribution maps for all Colombian species including new records for P. armata (Chickering, 1940), P. auricoma (L. Koch, 1866) and P. suni Dupérré Tapia, 2016 from Cundinamarca, Meta and Nariño departments are also herein included.

Two new species of the armored spider genus Tetrablemma O. P.-Cambridge, 1873 from northern South America (Araneae: Synspermiata: Tetrablemmidae).

Two new species of the armored spider genus Tetrablemma O. P.-Cambridge, 1873 from Colombia and Venezuela are herein described and illustrated: Tetrablemma tatacoa sp. nov. from Huila department, Colombia and T. mochima sp. nov. from Sucre state, Venezuela. These species represent the second record of the genus in the New World. Specimens of these new species were collected in pristine ecosystems, which suggests a natural Gondwanan distribution of the genus. Additionally, a distribution map of the Tetrablemma species in America is herein included.

Two new species of the ghost spider genus Macrophyes O. Pickard-Cambridge, 1893 from Colombia and description of the first male of Mesilla Simon, 1903 (Araneae: Anyphaenidae: Anyphaeninae).

Two new species of the elongated-body ghost spider genus Macrophyes O. Pickard-Cambridge, 1893 from Colombia are herein described and illustrated: Macrophyes sanzi n. sp. known by both sexes from Chocó department and Macrophyes ceratii n. sp. by females from Santander department. Additionally, the male of Mesilla vittiventris Simon, 1903 is described for the first time based on specimens from Nariño and Cauca departments, Colombia. A distribution map for the species herein reported is included.

A new species of the armored spider genus Caraimatta Lehtinen, 1981 from Colombia (Araneae: Synspermiata: Tetrablemmidae).

A new species of the armored spider genus Caraimatta Lehtinen, 1981 from Colombian Tropical dry forest fragments is described and illustrated: Caraimatta brescoviti sp. nov. (based on male and female) from Bolivar and Sucre departments, representing the first record of the genus from Colombia. Additionally, photographs of Monoblemma muchmorei Shear, 1978 (other tetrablemmid species previously recorded from the country) are given. A map with the known distribution and an identification key for males and females of the Caraimatta species are also included.

Neurotrophic Factors and Their Receptors Are Altered by the Mere Partial IGF-1 Deficiency.

Neurotrophic factors (NTFs) are a relevant group of secreted proteins that modulate growth, differentiation, repair, and survival of neurons, playing a role in the maintenance of the synaptic unions, dendrites, and axons and also being crucial for peripheral nervous system development and regulating plasticity in the adult central nervous system. On the other hand, insulin-like growth factor 1 (IGF-1) has been ascertained multiple beneficial actions in the brain: neuro-development, -protection, -genesis and plasticity. To further investigate the possible mechanisms underlying IGF-1 deficiency in the establishment of neurological disease, microarray and reverse transcription polymerase chain reaction gene expression analyses coupled with in silico processing were performed in an experimental model of partial IGF-1 deficiency. Results show that the mere IGF-1 deficiency seems to be responsible for an altered expression of genes coding for neurotrophic factors (particularly ciliary neurotrophic factor and mesencephalic astrocyte-derived neurotrophic factor), their receptors and signaling pathways (specially RET). The presented findings support that IGF-1 deficiency might be involved in the establishment and progression of neurodegenerative disorders.

Five new species of the Ghost Spider genus Anyphaenoides Berland from Colombia (Araneae: Anyphaenidae: Anyphaeninae).

Five new species of the ghost spider genus Anyphaenoides Berland from Colombia are described and illustrated: A. sierraensis sp. nov. (based on male and female) from Magdalena department, A. caribensis sp. nov. (male and female) from Atlántico department, A. foreroi sp. nov. (male) from Vaupes department, A. hilli sp. nov. (male) from Putumayo department and A. enigmaticus sp. nov. (male and female) from Santander department.

Revealing the diversity of ant-eating spiders in Colombia II: morphology, distribution, and taxonomy of the trilobatus group of the genus Tenedos O. Pickard-Cambridge, 1897 (Araneae: Zodariidae)

Tenedos O. Pickard-Cambridge, 1897, is the most diverse arrangement of Neotropical zodariids. The genus is composed by several species group, which only the barronus group is formally recognized. However, several groups remain uncharacterized despite being easily distinguishable by the distinctive sexual morphology. We formally proposed a second species group in Tenedos, the trilobatus group, including the known species Tenedos trilobatus Jocqué & Baert, 2002 from Colombia and T. figaro Jocqué & Baert, 2002 from Ecuador, whose type specimens are redescribed herein. Seven new species of the trilobatus group from Colombia are proposed based on both sexes: T. anchicaya sp. n. (♂♀), T. chiribiquete sp. n. (♂♀), T. cumbre sp. n. (♂♀), T. gabi sp. n. (♂♀), T. quimbaya sp. n. (♂♀), T. huila sp. n. (♂♀), T. valle sp. n. (♂♀). New data on the distribution range of Tenedos trilobatus in Colombia are included. We further provide distribution maps and an identification key for all species of the group. Morphological remarks of the new group and a comparison of it with the barronus group are included.

Novel Oral Anticoagulants as Treatment for Vertebral Artery Dissection: Case Report.

BACKGROUND AND PURPOSE: Cervical artery dissections, which may be traumatic or spontaneous, account for a significant proportion of strokes in the young. Antithrombotic therapy is the mainstay of treatment, but new oral anticoagulants could be an alternative treatment to the optimal strategy of anticoagulation followed by antiplatelet drugs. SUMMARY OF CASE: We report the case of a 40-year-old patient with a spontaneous vertebral artery dissection who developed a cerebellar ischemic stroke, who had a favorable outcome and complete vessel recanalization after three months of treatment with the oral factor Xa inhibitor rivaroxaban. CONCLUSION: New oral anticoagulant could constitute an alternative and new therapeutic option in cervical artery dissections.

A new species of the genus Parachemmis Chickering, 1937 from Colombia (Araneae, Corinnidae, Corinninae).

The spider genus Parachemmis Chickering, 1937 (Araneae: Corinnidae: Corinninae) is reported from Colombia for the first time. Parachemmis julioblancoisp. n. Martinez-G & Villarreal is described and illustrated from the Sierra Nevada de Santa Marta, Magdalena department. The exclusive morphology of the short and apically truncated retrolateral tibial apophysis and club-like tegular laminar process of the male palp indicates that the specimens described herein belong to a new species of Parachemmis. A map of the distribution of species in the genus is included.

Revealing the diversity of ant-eating spiders in Colombia I: morphology, distribution and taxonomy of the barronus group of the genus Tenedos O. Pickard-Cambridge, 1897 (Araneae: Zodariidae)

The genus Tenedos O. Pickard-Cambridge, 1897 is the most diverse among Neotropical Zodariids. It is composed of 44 species, fourteen of which occur in Brazil, while in Colombia, the diversity of the genus is poorly known, with only seven species recorded for the country. Based on genital morphology, several species groups can be distinguished within the genus, but these have not been formally established. We propose the species group barronus to include 41 species, 34 of which are distributed in Colombia and the other seven exclusively occurring in: Brazil (one Amazonian species), Peru (three Andean species), and Venezuela (three Andean species). The previously proposed species Tenedos andes Jocqué & Baert, 2002; T. peckorum Jocqué & Baert, 2002; T. jocquei Quijano & Galvis, 2018 and T. capote Jocqué & Baert, 2002 are redescribed based on the type material and the females of the two former species are described for the first time. T. barronus (Chamberlin, 1925) and T. persulcatus Jocqué & Baert, 2002 are reported for Colombia for the first time, the female of the latter is described. Twenty-eight new species are herein described, illustrated and their distributions are represented (species listed according to morphological affinities): T. ayo sp. n. (♂♀), T. calebi sp. n. (♂), T. caqueta sp. n. (♂), T. choco sp. n. (♂♀), T. cofan sp. n. (♂♀), T. dankittipakuli sp. n. (♂♀), T. eberhardi sp. n. (♂♀), T. neitai sp. n. (♂♀), T. tama sp. n. (♂♀), T. griswoldi sp. n. (♂♀), T. guacharos sp. n. (♂), T. henrardi sp. n. (♂♀), T. humboldti sp. n. (♂♀), T. carlosprietoi sp. n. (♂♀), T. narinensis sp. n. (♂), T. mesa sp. n. (♂), T. macagual sp. n. (♂♀), T. marquetones sp. n. (♂), T. medina sp. n. (♂♀) , T. pensilvania sp. n. (♂), T. piedecuesta sp. n. (♂♀), T. quipile sp. n. (♂♀), T. santarosa sp. n. (♂♀), T. luzmarinae sp. n. (♂♀), T. tatama sp. n. (♂♀), T. ticuna sp. n. (♂♀), T. wayuu sp. n. (♂) and T. yurayaco sp. n. (♂). We further provide new morphological data for some species included in the barronus group, and briefly discuss some aspects on morphological affinities and distribution between the species, based on a comparison with Tenedos type species, T. lautus O. Pickard-Cambridge, 1897. Distribution maps for all Colombian species, including new records for T. barronus and T. persulcatus, are also herein included. Additionally, an identification key for all species of the barronus group is provided.

National Registry of Cardiac Rehabilitation Programs in Mexico II (RENAPREC II).

OBJECTIVE: The aim of this paper is to compare the state of Cardiac Rehabilitation Programs (CRP) in 2009 with 2015. Focus is directed on health care, training of health-providers, research, and the barriers to their implementation. METHODS: All authors of RENAPREC-2009, and other cardiac rehabilitation leaders in Mexico were requested to participate. These centres were distributed into two groups: RENAPREC-2009 centres that participated in 2015, and the new CRP units. RESULTS: In 2009 there were 14 centres, two of which disappeared and another two did not respond. CRP-units increased by 71% (n=24), and their geographic distribution shows a centripetal pattern. The coverage of CRP-units was 0.02 centres per 100,000 inhabitants. Only 4.4% of eligible patients were referred to CRP, with a rate of 10.4 patients/100,000 inhabitants in 2015. The ratio of Clinical Cardiologists to Cardiac Rehabilitation Specialists was 94:1, and the ratio of Intervention Specialists to cardiac rehabilitation experts was 16:1. Cardiac rehabilitation activities and costs varied widely. Patient dropout rate in phase II was 12%. Several barriers were identified: financial crisis (83%), lack of skilled personnel (67%), deficient equipment (46%), inadequate areas (42%), and a reduced number of operating centres (38%). CONCLUSIONS: CRPs in Mexico are still in the process of maturing. Mexican CRP-centres have several strengths, like the quality of the education of the professionals and the multidisciplinary programs. However, the lack of referral of patients and the heterogeneity of procedures are still their main weaknesses.

Epilepsy, parkinsonism, and neuroleptic malignant syndrome in a child.

A 9-year-old girl with akinetic-rigid parkinsonism with tremor is described. She was hospitalized with neuroleptic malignant syndrome that started 3 days after anticonvulsant drug treatment owing to epileptic seizures. Cranial magnetic resonance imaging (MRI) was normal, and during the follow-up, magnetic resonance spectroscopy revealed a decrement on N-acetylaspartate in the basal ganglia, suggesting neuronal dysfunction. The basal ganglia and dopamine are involved in the pathophysiology of parkinsonism and neuroleptic malignant syndrome and have been recognized in seizure propagation and seizure threshold. Parkinsonism in children is considered an acquired, secondary, and reversible disorder with a dramatic improvement to treatment. However, our patient still has parkinsonism 2 years after diagnosis. This case represents the unusual presentation of epilepsy, parkinsonism, and neuroleptic malignant syndrome, which might have a common pathophysiologic pathway (dopaminergic dysfunction) involving the basal ganglia and the hypothalamus.