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El virus del dengue es responsable de un conjunto de enfermedades que comprenden desde la afección asintomática, hasta la enfermedad clásica febril y su forma más severa, la fiebre hemorrágica. El diagnóstico virológico es importante para el manejo clínico y la vigilancia epidemiológica. Algunos estudios evalúan la proteína viral NS1 como un posible marcador de infección temprana. En la siguiente investigación, realizada por científicos del Instituto de Medicina Tropical «Pedro Kourí» (IPK), se estudió la presencia de esta proteína en muestras de sangre de pacientes con infección confirmada por el dengue 4. El estudio de cinética mostró que los niveles de esta proteína aumentan o disminuyen durante la fase aguda de la enfermedad, resultado útil para conocer los mejores días para la recolectar la muestra destinada al diagnóstico de dengue.

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OBJECTIVES: The kinetics of three serological markers (IgM, IgA, and IgG) in serum, saliva, and urine samples from adult patients with primary or secondary dengue infection were studied. DESIGN: Serum, saliva, and urine samples were collected from 22 patients with clinical and confirmed dengue 3 virus infection during the outbreak in Havana City in 2001. They were tested by capture IgM (MAC-ELISA), IgA (AAC-ELISA), and IgE (EAC-ELISA) and IgG ELISA inhibition method (EIM) to detect specific dengue antibodies. RESULTS: Similar kinetics were observed in IgM, IgA, and IgG antibodies in saliva and IgA and IgG in urine samples from secondary cases compared with kinetics in serum samples, although the values were lower. No IgG antibody was detected in saliva and urine samples in primary cases and IgM antibody was not detected in urine samples from either primary or secondary infection. All secondary cases were positive for IgG in saliva and urine samples at day 7. The kinetics of specific IgE antibodies in primary and secondary cases were different. CONCLUSIONS: The kinetics of three serological markers (IgM, IgA, and IgG) in serum, saliva, and urine samples from adult patients with primary or secondary dengue 3 virus infection were studied for the first time, showing its behavior and usefulness in dengue virus diagnosis. The specific IgE could play a role as a serological marker in secondary infections.

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BACKGROUND: The detection of the IgM antibody for the dengue virus in serum by ELISA has become one of the most important and useful methods for diagnosis of dengue using a single acute-phase serum sample. Currently, this system is an invaluable tool for the surveillance of dengue fever (DF) and dengue hemorrhagic fever (DHF). The usefulness of other serological markers such as IgA and IgE have been less studied. OBJECTIVE: To study the IgM, IgA and IgE specific antibody response in dengue 3 infected patients with different clinical picture and type of infection. STUDY DESIGN: One hundred and twenty-seven serum samples collected on days 5-7 at the onset of fever from clinically and serologically confirmed dengue cases were studied. Forty-two were classified as primary dengue fever cases, 48 as secondary dengue fever cases and 37 as secondary dengue hemorrhagic fever cases. All samples were tested by capture ELISA in order to detect dengue IgM, IgA and IgE antibodies. RESULTS AND CONCLUSIONS: In this study, significant differences were observed in the IgM, IgA and IgE response between the study groups. High IgA and IgE OD ratios in secondary dengue cases were found. The usefulness of serotype specific IgM antibody detection is also analyzed and discussed. A priority for future dengue research in terms of protection, recovery of infection and immunopathogenesis is to elucidate the role of these immunoglobulins. The cross reactivity response to IgM between dengue virus serotypes in primary and secondary cases should also be more studied.

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This article summarise our experience with the Beta-Blocker in the management of congestive heart failure, which did not respond to the usual medical treatment

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The morbillivirus epizootic during 1990 to 1992 in Mediterranean striped dolphins (Stenella coeruleoalba) off the Mediterranean coast of Spain diminished these populations directly through mortalities, and indirectly through loss of normal fecundity. High levels of polychlorinated biphenyls (PCB's) also were detected in stranded animals. In addition to high numbers of abortions during the epidemic, unusual cystic structures were noted in the ovaries of several morbillivirus-infected dolphins with high PCB levels. These structures were identified as multiple luteinized cysts from their gross and histomorphologic characteristics. No morbillivirus antigens were detected in the lesions by immunohistochemistry. Because luteinized cysts occur when ovulation is impeded, either an effect of morbillivirus or PCB's on hypothalamic/pituitary function or an effect of PCB's on ovarian responsiveness are proposed as pathogenic mechanisms. These cysts may impede population recovery from the epidemic if similar cysts occurred on surviving dolphins.

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Isolated tricuspid valve incompetence resulting from blunt thoracic injury is rare. The diagnosis may be challenging. Subsequent clinical course may be variable. Early surgical intervention rather than medical therapy has been suggested in selected cases. We report a case of blunt chest trauma causing delayed chronic tricuspid regurgitation manifesting primarily as atrial fibrillation many years after the initial blunt chest trauma. Replacement of tricuspid valve restored normal sinus rhythm.

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Thoracotomy patch leads used for implantable cardioverter defibrillators (ICDs) are generally safe and effective. We describe two patients in whom a late complication of patch lead migration occurred years after the original implants, causing a bronchopleural fistula in one and lingular lobe collapse in the other patient. We conclude that patch migration is a late but possible complication of extrapericardial ICD leads, and should be suspected in patients who present with hemoptysis, atypical pneumonia, or lung collapse after the initial ICD surgery.

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This article summarise our experience with the Beta-Blocker in the management of congestive heart failure, which did not respond to the usual medical treatment.

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Tissues obtained from Stenella coeruleoalba stranded along the Spanish and Italian Mediterranean coasts from 1987 to 1994 were analysed for cadmium (Cd), copper (Cu), mercury (Hg), selenium (Se) and zinc (Zn). The age, length and weight of the dolphins were recorded. Hg levels were also assayed in skin biopsies from dolphins of the same species in the waters off northeastern Spain and in the Tyrrhenian and Ligurian Seas. Levels of all elements differed in muscle of stranded dolphins from the two areas. Hg was higher in tissues from animals stranded on the Italian coasts and in skin biopsies obtained in the Tyrrhenian and Ligurian Seas, than in the respective Spanish samples. This is probably related to Hg pollution from the natural weathering of cinnabar ores in central Italy. Se and Cd levels had similar accumulation patterns to those of Hg. Accumulation of Hg and Se is explained by the existence of a detoxification pathway involving both elements, however the reason for the similar Cd trend is unclear. Geographical differences in the accumulation pattern of these elements may reflect the existence of two different populations of Stenella coeruleoalba in the western Mediterranean.

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BACKGROUND: Studies of population biology are scarce in Mediterranean striped dolphins (Stenella coeruleoalba) mostly because of the lack of samples. Until now, studies of physical maturity, growth, and development of the flipper bones were not available for this species in the Mediterranean. METHODS: The osteological features and metric characters of the pectoral limbs of Mediterranean striped dolphins were analyzed with radiological techniques. Measurements were made directly on the radiographic films. RESULTS AND CONCLUSIONS: We found five carpal bones arranged in a proximal row of three and a distal row of two, although one or two additional osseous elements were occasionally observed. The phalangeal formula (excluding metacarpals) was established as 1-2:8-9-10:6-5-7:3-2:1-2. In metacarpals, epiphyseal ossification centers matured at the same time at both ends. As a general rule, the ossification of the epiphyses in the flipper bones showed a decreasing gradient in the proximodistal direction, confirming the pattern previously described in other species. Phalangeal epiphyses were not useful as indicators of skeletal maturity, and grading epiphyseal maturation of the distal radius and ulna is proposed as the more straight-forward and precise method for assessing bone maturation. In females, maturity of the flipper was achieved between 5 and 6 years of age and 160-175 cm of body length, whereas this maturation occurred between 8 and 9 years of age and 170-181 cm in length in males. Prediction of gender through examination of flipper structure was not feasible.

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During the summer and fall of 1990 hundreds of striped dolphins (Stenella coeruleoalba) died in the Spanish Mediterranean as a result of morbillivirus infection. A pathological investigation was carried out on dolphins from Valencia and Murcia which were among the first to die in the epizootic. The dolphins were in poor body condition and pneumonia was the main necropsy finding. Microscopic lung lesions characterized by necrosis of bronchial and bronchiolar epithelium and infiltration of alveoli with macrophages, lymphocytes, neutrophils and multinucleated syncytia were seen in most dolphins. Cytoplasmic and nuclear eosinophilic viral inclusions were present in bronchial and bronchiolar epithelium and in syncytia. Focal granulomatous inflammation associated with nematodes was also present. Brain lesions included diffuse degeneration and necrosis of neurons, microgliosis, perivascular cuffing, formation of syncytia and focal demyelination. Cytoplasmic and nuclear eosinophilic inclusions were present in neurons and glial cells. There was severe lymphoid necrosis and depletion of spleen and lymph nodes and syncytia also occurred in lymph nodes. Biliary and transitional epithelium contained nuclear and cytoplasmic eosinophilic inclusions. Immunoperoxidase staining using monoclonal antibodies to phocine distemper virus confirmed the presence of morbillivirus antigens in lung and brain. The distribution and severity of lesions in striped dolphins are similar to those of distemper in seals, harbor porpoises and terrestrial mammals. The formation of syncytia in the lung and brain may be a useful pathological indicator of morbillivirus infection and may be used in the investigation of pinniped and cetacean strandings in North America.

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