Conyza bonariensis as an alternative host for Colletotrichum species in Argentina.

AIMS: This study investigated the diversity of Colletotrichum isolates recovered from Conyza bonariensis leaves through the use of morphological characteristics, growth rate, carbon sources utilization and phylogenetic analysis. METHODS AND RESULTS: In all, 30 Colletotrichum isolates recovered from C. bonariensis leaves showing symptoms of disease were included in the present study. Based on the analysis of morphology and sequences, the isolates were distributed into six Colletotrichum species complexes. The concatenated alignment of GAPDH and ITS sequences showed that 20 out of 30 isolates were included in four species complexes which comprise the most important pathogens causing anthracnose in soybean or anthracnose and stalk rot in maize: C. truncatum, C. orchidearum, C. gloeosporioides and C. graminicola. The remaining 10 isolates were included in the C. boninense and C. destructivum species complexes or could not be assigned to any complex with the available information. CONCLUSION: Weeds belonging to genus Conyza are host to soybean and maize potential pathogenic species of Colletotrichum and could have a role as inoculum reservoir for cross contamination in the agroecosystem. SIGNIFICANCE AND IMPACT OF THE STUDY: The combined use of morphological, kinetics and physiological parameters of growth and phylogenetic analysis in Colletotrichum isolates from Conyza leaves allowed the detection of species complexes previously not identified in Argentina.

[Unsuspected pulmonary thromboembolism in the Emergency Department]. / Tromboembolismo pulmonar no sospechado en el Servicio de Urgencias.

BACKGROUND AND OBJECTIVES: Pulmonary embolism (PE) is a disease that sometimes has a significant delay in diagnosis. This situation may lead to an increase in morbidity and mortality in patients who have it. The aim of our study has been to define the clinical profile of patients with unsuspected PE in the emergency department and the factors that influence the delayed diagnosis. PATIENTS AND METHODS: A total of 148 patients admitted with diagnosis of PE confirmed by CT (n=133) or by high-probability ventilation-perfusion scintigraphy scan (n=15) were retrospectively analyzed. They were divided into two groups: those with unsuspected disease in the emergency department (USPE) and those who it was suspected (SPE). Baseline characteristics of the patients, risk factors, signs and symptoms in the emergency department, complementary test, days of hospitalization and mortality were studied. RESULTS: The USPE was found in 63/148 patients (42.6%) in the emergency department. Dyspnea and chest pain were the most frequent clinical manifestations of this disease, this being more commonly identified in the SPE group than in the USPE group, with significant differences (OR=0.4 [0.2-0.9] for dyspnea and OR=0.3 [0.2-0.7] for chest pain). However, However, the presence of thrombocytopenia (OR=3.4 [1.1-10.2], P<.05), normal electrocardiogram (EC) (OR=3.4 [1.1-10.2], P<.05), and localization of PE in right lung (OR=4.7 [2-11.3], P<.001) were risk factors for not suspect it. Days of hospitalization, days of symptoms and mortality were not statistically different between groups. CONCLUSIONS: According to the results, the proportion of unsuspected PE in the emergency department was high (close to 40%). The presence of dyspnea and chest pain was associated to suspicion of SPE. On the contrary, the presence of thrombocytopenia, normal EC and right localization of PE were associated to the non-suspicion of SPE in the emergency department.

Normalization of the sleep-wake pattern and melatonin and 6-sulphatoxy-melatonin levels after a therapeutic trial with melatonin in children with severe epilepsy.

This study evaluated the sleep-wake pattern, plasma melatonin levels and the urinary excretion of its metabolite, 6-sulphatoxy-melatonin among children with severe epileptic disorders, before and after a therapeutic trial with melatonin. Ten paediatric patients, suffering from severe epileptic disorders, were selected and given a nightly dose of 3 mg of a placebo, for 1 wk; for the next 3 months, the placebo was replaced with a nightly dose of 3 mg of melatonin. At the end of each treatment period, the urinary excretion of 6-sulphatoxy-melatonin (for the intervals 09.00 - 21:00 hr or 21:00-09:00 hr) and plasma levels of melatonin (recorded at 01:00, 05:00, 09:00, 13:00, 17:00 and 21:00 hr) were recorded, over a period of 24 hr; an actigraph record was also kept. Sleep efficiency among patients who received melatonin was significantly higher than among those given the placebo, with fewer night-time awakenings. Periodic plasma melatonin levels were regained and a better control gained of convulsive episodes, in that the number of seizures decreased. We conclude that melatonin is a good regulator of the sleep-wake cycle for paediatric patients suffering from severe epilepsy, moreover, it to a better control of convulsive episodes.

[Quantitative salivary gland scintigraphy in head and neck cancer patients following radiotherapy]. / Gammagrafía salival cuantitativa en pacientes con cáncer de cabeza y cuello tratados con radioterapia.

OBJECTIVE: To assess the role of quantitative salivary gland scintigraphy (SGS) in the detection of functional impairment of salivary glands in patients with head and neck cancer treated with radiotherapy (RT). MATERIAL AND METHODS: We studied 19 patients (17 men), mean age 62.4 years (44-75). Three studies were performed to each patient: baseline, 3 and 18 months after RT. SGS was acquired for 25 minutes following injection of 3.7 MBq/kg of (99m)Tc-pertechnetate with lemon juice at the end of minute 15. Excretion fraction (EF), counts per minute/pixel/MBq (CMPM) and uptake percentage were obtained from time-activity curves from ROIs placed over parotid (PG) and submandibular glands (SMG) and related to the doses received by the PG. RESULTS: EF showed a significant reduction from the baseline to the 3 months study (p<0.001) for the PG and SMG and from the baseline to the 18 months study for the SMG (p<0.001). A significant improvement of EF was seen from the 3 months to the 18 months study for the PG (p<0.05). CMPM did not change significantly from the baseline to the 3 months and 18 months studies for the PG and showed a significant reduction (p<0.01) for the SMG from the baseline to 18 months study. The uptake percentage did not change significantly between studies. A moderate association was observed between the doses to PG and the 3m study parameters. CONCLUSIONS: EF was more sensitive than uptake in assessing post-RT impairment of salivary function. In addition, it reflected functional recovery of parotid glands over time.

Evolution and associated factors of hand hygiene compliance in a pediatric tertiary hospital.

BACKGROUND: The objective is to know the evolution of the Degree of Compliance with Recommendations (DCR) on hand hygiene (HH) and its associated factors in the pediatric care areas (PCAs) of a tertiary hospital. METHODS: Observational, cross-sectional study, repeated over time, with direct observation of the DCR on HH during the daily activity of health care workers. Over 13 years, 9226 HH opportunities were observed. Associations between DCR, PCA and other variables (eg, age, sex, and professional position) were examined using χ² and adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: DCR on HH in 9 PCAs was 64.3% (95% CI, 63.3-65.3), and in the group of non-pediatric areas it was 49.6% (95% CI, 49.1-50.1). The areas with the highest degree of compliance were Oncology 72.8% (95% CI, 69.2-76.4), Neonatology 73.2% (95% CI, 71.3-75.1), and Neonatal intensive care unit 70.0% (95% CI, 67.5-72.6). These were the areas with the strongest association with HH compliance, with aOR:2.8 (95% CI, 2.2-3.6); aOR, 3.0 (95% CI, 2.6-3.6) aOR:2.6 (95% CI, 2.1-3.1), respectively. Other associated factors were the indications "after an activity," aOR, 1.6 (95% CI, 1.5-1.8) and the availability of pocket-size alcohol-based solution, aOR, 2.1(95% CI, 1.9-2.3). CONCLUSIONS: The DCR on HH in PCAs is higher than in other areas, although there is still margin for improvement. We have identified modifiable factors that have an independent association with HH compliance in PCAs. Focusing on modifiable factors will increase compliance with HH with the ultimate goal of reducing healthcare associated infections.

[Cerebellar ataxia of Norman-Jaeken. Presentation of seven Spanish patients]. / Ataxia cerebelosa de Norman-Jaeken. Presentación de siete pacientes españoles.

AIM: To show that the cerebellar ataxias described by Norman and by Jaeken (CDG1a) are the same disease. PATIENTS AND METHODS: Seven patients, five females and two males (there were two siblings pairs), who presented a severe cerebellar disease slowly progressive associated with generalized cerebellar atrophy. The sister of one of the patients of the series had been studied because of psychomotor retardation but she died at two years of age due to respiratory problems. An autopsy was carried out that showed severe cerebellar atrophy, and the histological study revealed loss of granular cells and diverse abnormalities of Purkinje's cells, especially focal swellings of 'asteroid bodies' or 'cactus like' type. This suggested to us that Norman's ataxia and CDG1a could be the same pathological entity. RESULTS: All seven patients had severe cerebellar hypoplasia-atrophy and a small brainstem. Most patients showed peripheral neuropathy with decreased motor nerve conduction velocity, but very little decreased sensory nerve conduction velocity. All seven patients had highly raised serum concentrations of asialotransferrin, and heterozygous molecular PMM2 deficit (CDG1a). One of these seven cases was the patient whose sister had histological cerebellar changes corresponding to Norman's ataxia. CONCLUSION: The findings observed in our series suggest that the diseases described by Norman and Jaeken are the same pathological entity and CDG1a can be the biological basis of the histological changes of the cerebellum in Norman's ataxia. We suggest the name of Norman-Jaeken ataxia or disease for this entity.

Amelia: analysis of its epidemiological and clinical characteristics.

Eighteen cases of amelia in the Spanish Collaborative Study of Congenital Malformations (ECEMC) were analyzed epidemiologically. Prevalence at birth was 0.15 per 10,000 newborn infants, which is not different from that reported by other authors. Affected females outnumbered males. When compared with the control group, a lower birth weight, shorter gestation, lower placental weight, greater frequency of single umbilical artery, noncephalic presentation at birth, and more frequent maternal vaginal bleeding were observed in amelia cases. There were no significant variations of parental age. None of these patients was exposed to known teratogens, apart from 1 born to a diabetic mother; 3 patients had a genetic condition. Comparison of these variables with other studies is difficult because there is only one study that specifically analyzed amelia. Our data together with previous observations suggest that the genetic basis of amelia might be more important than has been considered previously.

Exercise-related atrioventricular block. Influence of myocardial ischemia.

A 62-year-old woman was noted to have complete heart block immediately following an exercise stress test. Coronary arteriography subsequently revealed a significant lesion in the right coronary artery, which was successfully dilated. Thallium-exercise testing following angioplasty showed no evidence of inducible ischemia and no arrhythmia was seen, supporting the idea that exercise-related heart block may occur secondary to myocardial ischemia.

Self-reported snoring in pregnancy. Association with fetal outcome.

OBJECTIVES: To determine the incidence of self-reported snoring in pregnant compared with nonpregnant women. To compare indicators of fetal outcome in pregnant women with self-reported frequent snoring vs those without snoring. STUDY DESIGN: Prospective, nonrandomized screening and comparison between groups. PATIENTS: Three hundred fifty pregnant women and 110 age-matched nonpregnant women. METHODS: Survey evaluating self-reported snoring. For the pregnant women, infant birthweight, APGAR scores, and other indicators of fetal outcome were obtained by record review. RESULTS: Frequent snoring was reported in 14% of the pregnant women vs 4% of the nonpregnant women (Chi2=6.2; df=1; p<0.05). The pregnant women who reported frequent snoring did not have deliveries resulting in infants with evidence of an increase in compromised outcomes. CONCLUSIONS: Frequent snoring is reported more often in pregnant than in nonpregnant women. Snoring mothers do not appear to be at increased risk for delivering infants with fetal compromise as might be expected with the concomitant occurrence of obstructive sleep apnea.

Animal model of acute pulmonary thromboembolism treated by local recirculation of streptokinase through the lung.

Massive acute pulmonary thromboembolism has a high mortality within the first few hours. Surgical intervention can remove only larger thrombi. Systemic fibrinolytic administration requires many hours for adequate treatment. We describe an anesthetized dog model of acute, massive, disseminated pulmonary thromboembolism achieved by injection of 1.7 ml/kg of 1-hour-old thrombi directly into the pulmonary artery. The emboli were lysed with 50,000 IU streptokinase recirculated for 20 minutes through the isolated pulmonary vascular bed by use of a roller pump while the systemic bed was supported by conventional cardiopulmonary bypass. On reestablishing natural circulation all hemodynamic parameters returned to preembolism values. Success of lysis was histologically confirmed. Perfusion of the pulmonary vascular bed without inclusion of streptokinase in the perfusate worsened the hemodynamic state of the animals compared with an untreated nonperfused control group.

Institutional childcare and the affective deficiency syndrome: consequences on growth, nutrition and development.

It is generally accepted that, in the face of certain family and social circumstances, a minor may need to be taken into care within an institution, a course of action that provides, at least, an alternative to the risks of abandonment and life "on the street". Nevertheless, the reality of life in childcare centres can lead to children undergoing an additional trauma after escaping the miserable situation of the family home. After the advances made in recent years (economic, healthcare, social, legal, etc.), it has been suggested that the institutionalization of a minor, as a rule, does not in itself represent a negative factor for the child's wellbeing. In order to test this hypothesis, we studied two groups of children in care. The first group comprised 101 children being cared for in a large traditional institution during 1986. The second group was composed of 66 children studied in 1996, resident in a smaller, charitable institution, providing a more family-like atmosphere. Growth evaluation methods were applied, including anthropometry (weight, height, weight/height ratio, body mass index, Rorer index and weight index), nutrition (skin folds, body density, percentage of body fat and weight of the fat) and development (psychometry: Boehm test, CMMS, Raven and EIT). The data were analyzed by means of the Student's t-test. The most important result obtained was the demonstration that the second group of children presented results that were clearly higher in nearly all the studied variables, thus showing that institutionalization in itself does not have a negative influence on child development.

Temporary mechanical circulatory support for severe cardiac failure: experimental study.

We describe a technique for mechanical cardiac assistance in an acute model of severe cardiac failure. Cardiac dysfunction was induced by a high dose of halothane in 13 dogs. Seven served as controls. Following median sternotomy, a pneumatically driven device was implanted in the other six dogs in a para-aortic position, using a simple surgical technique without cardiopulmonary bypass. The aorta was cross-clamped during cardiac assistance. During hemodynamic studies, the seven control animals with induced cardiac failure showed high end-diastolic left ventricular and right atrial pressures with low cardiac index and systolic left ventricular and aortic pressures. All dogs in this group died within 30 minutes. Use of a monovalvular cardiac assist device in the experimental group of six dogs to pump blood from the aortic root to the descending aorta in a counterpulsation manner, confirmed good preservation of systemic hemodynamic parameters after induction of heart failure. All animals in this treated group survived more than 45 minutes. Hemodynamically, the device acts as a new ventricle and the impaired left ventricle functionally becomes a left atrium. This condition is clinically appropriate for recovery of left ventricular function in severe acute myocardial failure.

Neural tube defects: an experimental model in the foetal rat.

We report on our experience in the experimental induction of Neural Tube Defects (NTD) in the foetal rat by maternal administration of retinoic acid. The teratogen diluted in olive oil was administered in a single intragastric dose (125 mg/kg body weight) to pregnant rats (n = 31) on the 10th day of gestation. Pure olive oil was given to control rats (n = 9). The foetuses were recovered by caesarian section on the 20th day and prepared for morphological investigation. We have studied 201 experimental and 82 control animals. There were NTD in 36.3% of experimental foetuses and none in the control ones. Sacral dysraphism was the most frequent defect but we also observed Arnold Chiari malformations and crowding of the bony limits by an enlarged neural axis. Other associated malformations found were: craneofacial (78.1%), caudal (80%), anorectal (31.4%), and limb defects (89.5%). This simple and inexpensive model may allow us to gain a better knowledge of the biology in the foetus with NTD.

[Venezuelan equine encephalitis. 1995 outbreak: clinical profile of the case with neurologic involvement]. / Encefalitis equina venezolana. Epidemia de 1995: perfil clínico de los casos con compromiso neurológico.

INTRODUCTION: Venezuelan equine encephalitis virus has caused periodic epidemics and epizootics in the American continent since the 1920s. Such events have been profusely documented from the epidemiologic point of view, however, reports concerning the clinical features of this disease are rather scarce. OBJECTIVE: To analyze the clinical characteristics evidenced by Venezuelan equine encephalitis patients from Zulia state (western Venezuela) studied during the outbreak that occurred in Colombia and Venezuela in 1995. These cases, classified as complicated, were hospitalized at the Hospital Universitario de Maracaibo, state of Zulia, Venezuela. PATIENTS AND METHODS: The clinical charts of 313 Venezuelan equine encephalitis patients hospitalized during the period January 1st 1995-March 31st 1996 were reviewed. These cases accounted for 2.82% of 11,072 patients that were medically assisted during the outbreak. The following variables were analyzed: age, gender, signs and symptoms, contact history, complications and evolution. RESULTS: Intracranial hypertension signs became eloquent in 55.9% of these patients. Neurologic complications were represented by two cases of cerebellitis, two cases of meningoencephalitis and one case of encephalomyelitis. The mortality rate was 1.7%. CONCLUSION: Our results corroborate the benign evolutionary profile that is typical of this entity.

[Contribution of radioguided detection and selective biopsy of the sentinel lymph node to staging in 100 patients with cutaneous melanoma]. / Contribución de la detección radioguiada y biopsia selectiva del Ganglio centinela al estadiaje de 100 pacientes con melanoma cutáneo.

OBJECTIVE: A selective sentinel node (SN) biopsy appears to be an alternative to conventional lymph node dissection for staging patients with cutaneous melanoma. This study has aimed to analyze our experience in the localization of the sentinel node with a probe detector and lymphoscintigraphy and its utility in the staging of this disease. MATERIAL AND METHODS: 100 patients, 56 female and 44 male, 51.5 31.5 mean age, diagnosed of cutaneous melanoma were studied. The lymphoscintigraphy was performed in all cases to detect the area of lymphatic drainage after peritumoral intradermal administration of 600 uCi of 99mTc-colloidal sulfur, and planar images were acquired every 10 minutes until activity was detected in these areas. Afterwards, the intraoperative localization of the sentinel node with a probe detector was performed and the selective biopsy of the node was sent to the Pathology Department for its histologic study. RESULTS: The lymphoscintigraphy study was positive in 99 of the 100 cases and it was identified intraoperatively in 98 cases. The histologic analysis was negative in 78.9% and positive in 21.1% of the nodes. CONCLUSIONS: Radioisotopic lymphography and intraoperative probe detection are two very useful techniques for locating the sentinel node and staging patients with cutaneous melanoma. Many patients are benefiting from the selective biopsy of the sentinel node because of the decreased post-surgical morbidity and better staging of the cutaneous melanoma.

[Family physician attitudes towards insulinization in type II diabetics]. / Actitudes de los médicos de familia ante la insulinización de diabéticos tipo 2.

AIM: To determine the attitudes of Toledo Health Area family physicians about starting insulinization in type 2 diabetic patients. MATERIALS AND METHODS: Descriptive, cross-sectional study. A self-completed questionnaire was given to 353 family physicians of the Toledo Health Area, asking about socio-demographic and occupational data, and including the Spanish version of the Diabetes Attitude Scale (DAS-3sp) questionnaire to evaluate attitudes and motivations related to diabetes. RESULTS: A total of 66 responses were received, of which 50.8% were from females. Mean age (±standard deviation) was 49.97±7.40. Results of the different DAS-3sp subscales (values from 1 to 5) were: S1 (need for special training): 4.52±0.38; S2 (seriousness of type2 diabetes): 4.18±0.42; S3 (value of tight control): 4.15±0.39; S4 (psychosocial impact of diabetes): 3.79±0.48; and S5 (need for patient autonomy): 3.72±0.55. No statistically significant differences were obtained with the four first subscales with sex, specialized training, being a resident tutor, type of contract or clinical setting. There were statistically significant differences in S5 compared with sex (3.90±0,60 in men vs 3.54±0.45 in women; t=2.701; P=.009) and with being a resident tutor (3.99±0.58 vs 3.64±0.52 in non-tutors; t=2.188; P=.033). CONCLUSIONS: The attitudes regarding starting insulin treatment in type2 diabetic patients are positives among Toledo Health Area family physicians, specially in the clinical aspects, but they are lower in the psychosocial impact and patient autonomy.

[Clinical outcomes of cataract surgery combined with 23-gauge vitrectomy]. / Resultados clínicos de la cirugía combinada de catarata con vitrectomía 23-gauge.

PURPOSE: To report the clinical outcomes of cataract surgery (phacoemulsification and intraocular lens implantation) combined with 23-gauge vitrectomy, and to evaluate the effectiveness and safety of this technique. METHODS: A retrospective, consecutive, non-comparative study which included 105 eyes. Phacoemulsification and intraocular lens implantation (in the capsular sac) combined with 23-gauge vitrectomy were performed. Indications for undergoing surgery were varied. Best corrected logMAR visual acuity (VA) and intraocular pressure (IOP) were measured pre- and postoperatively, and postoperative complications were recorded. RESULTS: Patients were followed-up for a mean of 16.6±9.9 months. The mean preoperative VA was 0.83±0.40 logMAR, and mean postoperative VA one month after surgery was 0.44±0.38 logMAR. The postoperative visual acuity improved in 83.8% of cases. The mean preoperative IOP was 16.6±3.7mmHg, while the mean postoperative IOP was 22.5±12.8mmHg (1 day after surgery), 17.5±6.8mmHg (after 1 week), and 15.3±3.8mmHg (after 1 month). Postoperative complications included posterior capsular opacification (n=5), macular edema (n=4), corneal de-epithelization (n=3), retinal detachment (n=2), proliferative vitreoretinopathy (n=2), choroidal detachment (n=1), macular hole (n=1), vitreous hemorrhage (n=1), epiretinal membrane (n=1), and transient elevated intraocular pressure (n=36). CONCLUSIONS: The surgery reported in this study involving phacoemulsification combined with 23-gauge vitrectomy was found to be safe and effective, and was associated with improved clinical features, including rapid rehabilitation, a low incidence of complications, and avoids repeat surgery.