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A 68-years-old Hispanic man, complained of night sweats, low grade fewer, unexplained weight loss, and memory problems over 3 months. Abdominal tomography showed multiple intra-abdominal adenopathy and biopsy confirmed classic Hodgkin's lymphoma. He commenced treatment with chemotherapy. Three months later, he had acute onset of inattention, auditory hallucinations and alterations of anterograde memory. The patient developed psychomotor agitation, unresponsive to a combination of neuroleptics and benzodiazepines. Brain MRI showed a small established cerebellar infarction. Electroencephalogram was normal. Tests for toxic metabolic encephalopathy were negative. One oligoclonal IgG bands was found in the Cerebrospinal fluid (CSF), which was not observed in corresponding serum, but cell count and protein were normal. Extensive testing for infectious encephalitis was unremarkable. CSF testing for commercially available neural and non-neural autoantibodies was negative. The patient fulfilled the Gultekin diagnostic criteria for paraneoplastic limbic encephalitis and methylprednisolone IV 1g/d for 5 days was given. He recovered rapidly, with progressive improvement in memory and psychomotor agitation. After treatment commenced, results for antibodies to mGluR5 in CSF taken prior to treatment were returned as positive. mGluR5 is found on post-synaptic terminals of neurons and microglia and is expressed primarily in the hippocampus and amygdala. This case highlights the difficulties in diagnosing this type of encephalitis: the CSF did not show pleocytosis, the MRI showed only chronic change and the electroencephalogram was normal. The dramatic recovery after methylprednisolone help to better characterized the clinical spectrum of auto-immune encephalitis. Diagnosing anti mGlutR5 encephalitis may lead to potentially highly effective treatment option and may anticipate the diagnostic of a cancer. A high index of suspicion is needed to avoid missed diagnosis. In patients with unexplained encephalitis, testing for antibodies to mGluR5 in CSF and serum should be considered. When there is a reasonable index of suspicion of auto-immune encephalitis, treatment should not be delayed for the antibody results.

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The hypothesis tested is that Fe administration leads to a response in rat brain modulating the effects of later oxidative challenges such as chlorpromazine (CPZ) administration. Either a single dose (acute Fe overload) or 6 doses every second day (sub-chronic Fe overload) of 500 or 50 mg Fe-dextran/kg, respectively, were injected intraperitoneally (ip) to rats. A single dose of 10 mg CPZ/kg was injected ip 8 h after Fe treatment. DNA integrity was evaluated by quantitative PCR, lipid radical (LR·) generation rate by electron paramagnetic resonance (EPR), and catalase (CAT) activity by UV spectrophotometry in isolated brains. The maximum increase in total Fe brain was detected after 6 or 2 h in the acute and sub-chronic Fe overload model, respectively. Mitochondrial and nuclear DNA integrity decreased after acute Fe overload at the time of maximal Fe content; the decrease in DNA integrity was lower after sub-chronic than after acute Fe overload. CPZ administration increased LR· generation rate in control rat brain after 1 and 2 h; however, CPZ administration after acute or sub-chronic Fe overload did not affect LR· generation rate. CPZ treatment did not affect CAT activity after 1-4 h neither in control rats nor in acute Fe-overloaded rats. However, CPZ administration to rats treated sub-chronically with Fe showed increased brain CAT activity after 2 or 4 h, as compared to control values. Fe supplementation prevented brain damage in both acute and sub-chronic models of Fe overload by selectively activating antioxidant pathways.

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Introducción: Las enfermedades de la vía biliar y la litiasis vesicular son una causa poco frecuente de dolor abdominal agudo en niños, a diferencia de lo que ocurre en adultos. Con la masificación del ultrasonido es posible detectar litiasis biliar en pacientes asintomáticos, lo que podría explicar el aumento de su incidencia. Objetivos: Describir los hallazgos ecográficos y las características epidemiológicas de los pacientes pediátricos con diagnóstico de colelitiasis. Metodología: Análisis retrospectivo de las características clínicas y ecográficas de pacientes pediátricos con colelitiasis en el Hospital Padre Hurtado (Santiago de Chile), entre 2002 y 2012. Resultados: 33 casos (13 hombres y 20 mujeres), de 21 días de vida hasta 15 años, todos evaluados con ecografía abdominal. El diagnóstico se realizó como hallazgo incidental en 3 pacientes; en 13 pacientes se indicó el estudio por cólico biliar recurrente; a 4 pacientes, por sospecha de apendicitis aguda; en 9 casos, como dolor abdominal asociado a vómitos; en 2 casos, como hallazgo en estudio renal, y en 2 pacientes, dentro del estudio de una pancreatitis. En la ecografía, la litiasis múltiple se presentó en el 93% de los casos. En 2 casos se observó coledocolitiasis asociada. Un 93% presentó vía biliar normal. El tratamiento de elección fue la colecistectomía laparoscópica. Conclusión: La litiasis biliar en nuestra población pediátrica es más frecuente de lo informado en la literatura. Como principales factores de riesgo se identificaron el sobrepeso y la obesidad. El principal motivo de realización del examen es el dolor abdominal.

Introduction: Biliary tract and gallstone diseases are a rare cause of acute abdominal pain in children, which is not the case in adults. With the widespread use of ultrasound examination, now we can detect gallstones in asymptomatic patients, which could explain the increased incidence. Objective: To describe the sonographic findings and epidemiological characteristics of pediatric patients diagnosed with cholelithiasis. Methodology: We performed a retrospective analysis of the clinical and sonographic characteristics of the pediatric patients with cholelithiasis in the Hospital Padre Hurtado (Santiago de Chile) during the period 2002-2012. Results: There were a total of 33 cases, 13 males and 20 females with an age range from 21 days old up to 15 years old, all of them were evaluated with abdominal ultrasound. In 3 patients the diagnosis was an incidental finding, 13 patients were studied for recurrent biliary colic, 4 patients as suspected acute appendicitis, 9 cases as abdominal pain associated with vomiting, 2 cases as a finding in renal study and 2 patients in the context of pancreatitis study. Ultrasound showed multiple lithiasis in 93%. In 2 cases there was also a choledocholithiasis. Normal biliary duct was seen in 93% of the cases. The treatment of choice was laparoscopic cholecystectomy. Conclusion: Cholecystolithiasis is more in children than is suggested in literature, and ultrasound is an appropriate imaging study for its detection. The main risk factors identified were excess weight and obesity. The main objective of this test is abdominal pain.

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Introducción: La pancreatitis aguda (PA) es un proceso inflamatorio pancreático que cursa con dolor abdominal y vómito. Es una entidad infrecuente en pediatría, por lo que existen pocos estudios en la literatura. Las principales causas son trauma, infecciones, fármacos y litiasis. En diversos estudios aparece como primera causa la idiopática; la causa litiásica es infrecuente. El estudio imaginológico se inicia con Ultrasonido (US) y se puede complementar con Tomografía computalizada (TC). Objetivo: Describir los hallazgos imaginológicos y las características epidemiológicas de los pacientes pediátricos con PA. Metodología: Análisis retrospectivo de las características clínicas y radiológicas de niños con PA, durante los años 2004-2012. Se obtuvo un total de 11 casos, 5 varones (45%) y 6 mujeres (55%), todos evaluados con algún método imaginológico. Resultados: Las formas de presentación fueron: aguda, 73%; recurrente, 9%; insuficiencia pancreática, 18%. Los principales síntomas fueron: dolor abdominal, 100%; vómito, 72,7%; fiebre, 9%; diarrea, 18%; ictericia, 9%. Las etiologías fueron: litiásica, 36,4%; idiopática, 27,3%; farmacológica, 18,2%; autoinmune, 9%; hipertrigliceridemia, 9%. Los hallazgos imagenológicos fueron: páncreas aumentado de tamaño, 63,6%; líquido libre, 45,5%; colelitiasis, 36,4%; derrame pleural, 18,2%; colecciones, 18,2%; vía biliar dilatada, 9%. Conclusión: A diferencia de otros estudios, la causa más frecuente de PA en esta serie es la litiásica, lo que concuerda con el alto índice de colelitiasis en la población adulta del país. En este contexto se hace relevante el estudio etiológico de las PA con métodos de imágenes para precisar el tratamiento adecuado.

Introduction: Acute pancreatitis (AP) is an inflammatory pancreatic disease that presents with abdominal pain and vomiting. It is a rare entity in the pediatric population, thus, there are few studies reported in literature. The main etiologies are trauma, infection, drugs, and lithiasis among others. In several studies, the main reported cause is idiopathic, and biliary causes are infrequent. Imaging study usually begins with an abdominal ultrasound, which can be complemented with CT. Objective: The objective is to describe the imaging findings and epidemiological characteristics of children with AP. Method: We performed a retrospective analysis of clinical and radiological features of pediatric patients with AP, between the years 2004-2012. We obtained a total of 11 cases, 5 males (45%) and 6 females (55%), all evaluated with an imaging study. Results: The three forms of presentation were acute 73%, recurrent 9% and pancreatic insufficiency 18%. The main symptoms were abdominal pain 100%, vomiting 72.7%, fever 9%, diarrhea 18%, and jaundice 9%. The most frequent etiology was lithiasic (36.4%), idiopathic (27.3%), drugs (18.2%), autoimmune (9%), and hypertriglyceridemia 9%. The imaging findings were enlarged pancreas 63.6%, free fluid 45.5%, cholelithiasis 36.4%, pleural effusion 18.2%, collections 18.2% and dilated bile duct 9%. Conclusion: Unlike other studies, the most common cause of AP in this series is lithiasic, consistent with the high rate of cholelithiasis in the adult population of our country. In this context it is relevant to study the etiology of AP by imaging studies to determine the adequate treatment.

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In open ecological systems, community structure can be determined by physically modulated processes such as the arrival of individuals from a regional pool and by local biological interactions. There is debate centering on whether niche differentiation and local interactions among species are necessary to explain macroscopic community patterns or whether the patterns can be generated by the neutral interplay of dispersal and stochastic demography among ecologically identical species. Here we evaluate how much of the observed spatial variation within a rocky intertidal metacommunity along 800 km of coastline can be explained by drift in the structure of recruits across 15 local sites. Our results show that large spatial changes in recruitment do not explain the observed spatial variation in adult local structure and that, in comparison with the large drift in structure of recruits, local adult communities converged to a common, although not unique, structure across the region. Although there is no unique adult community structure in the entire region, the observed variation represents only a small subset of the possible structures that would be expected from passive recruitment drift. Thus, in this diverse system our results do not support the idea that rocky intertidal metacommunities are structured by neutral mechanisms.

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OBJECTIVE: Craniofacial malformations comprise diverse diagnoses, implying a wide range of morbidity and disability among populations. Our aim was to study them as a group and describe their epidemiological factors inside a population as well as finding common risk factors for their presentation in Colombia. METHODS: We conducted a case-control study in several Colombian hospitals participating in the ECLAMC (Spanish acronym for Latin-American Collaborative Study of Congenital Malformations) program. For the analysis we included 374 cases of isolated malformations and 728 controls, out of 44,701 births. RESULTS: A rate of 83.67 cases per 10,000 births was found for craniofacial malformations as a group, with an overall sex ratio of 1. We found predominance for their presentation on the right side. As main associations we obtained a positive family history of another craniofacial malformation (OR: 3.10 CI 95% [2.24-4.30]), particularly preauricular tags (OR 52.36 CI 95% [12.62-217.16]), preauricular pits (OR: 36.35 CI 95% [4.82-274.27]) and cleft lip with or without palate (OR: 2.50 CI 95% [1.07-5.84]). Medication use during pregnancy was also linked to malformations (OR: 2.00 CI 95% [1.38-2.89]). Specific agents such as ferrous sulfate (OR: 1.46 CI 95% [1.13-1.89]), folic acid (OR: 1.35 CI 95% [1.02-1.79]) and nifedipine (OR: 2.88 CI 95% [1.22-6.79]) also showed a significant correlation. Maternal alcohol use was also identified as a possible risk factor (OR: 2.45 CI 95% [1.39-4.29]). CONCLUSIONS: Craniofacial malformations are frequently encountered among the group of congenital defects. When they present in an isolated fashion, familial history is an important risk factor, although some prenatal factors such as alcohol and some medications may have influence over their prevalence.

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Invasion by marine nonindigenous species (NIS) is a spread phenomenon. The tunicate Pyura praeputialis shows pronounced disjoint geographical distribution: along thousands of kilometers in wave-swept headlands on the southeastern coast of Australia, from where it appears to have originated, and exclusively along 60-70 km inside the Bay of Antofagasta, Chile. mtDNA sequences suggested that the species invaded this rocky shore recently. We used field manipulations and juvenile P. praeputialis transplant techniques to test hypotheses regarding the capacity of the tunicate to survive and grow at different sites and tidal heights inside and outside Antofagasta, and its competitive performance for primary space (inside the Bay) against the native mussel Perumytilus purpuratus. We conclude that survival and growth of P. praeputialis showed no significant differences among sites inside and outside the Bay, and suggest that the restrictive distribution of the species in Chile is caused by a specific oceanographic retention mechanism and/or its brief larval dispersal. We demonstrated that, inside the Bay, P. praeputialis outcompetes Perumytilus from the Mid-Low intertidal, constraining Perumytilus to the Upper Mid-Intertidal, modifying the local pattern of intertidal zonation. We show that predation on P. praeputialis juveniles by starfish and snails constitutes a regulatory mechanism for the setting of its low intertidal limit. Major ecological impacts caused by NIS invasions to rocky shores by aggressive primary space users may result in negative aspects, but also may contribute to biodiversity enhancement. We call attention to the need for increment manipulations and testing of ecological hypotheses regarding marine NIS.

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The aim of the present study was to characterize the effect of oxidative stress on iron reduction rates in biological systems. The tested oxidative stress conditions included acute iron overload in rats, UV-B irradiation in algae cultures and leaves, and paraquat treatment and aging in soybean embryonic axes upon imbibition. Treatment of rats with iron-dextran resembles hemochromatosis secondary to iron loading anemias and high oral iron intake. A significant increase was detected in both iron deposits in liver cells and microsomal iron content after 4 h of a single dose of iron-dextran, however, the iron reduction rate was not affected in the presence of either NADPH or NADH as cofactor. In vivo iron reduction rate in Chlorella vulgaris cells was not significantly different in log and stationary phases. Exposure of the cultures to UV-B doses of O.8 and 4.4 kJ/m2 increased iron reduction rate by intact cells from 6 (control) to 32 and 64 nmol/lO(9) cell.min, respectively. UV-B exposure of soybean leaves lead to a significant increase in leakage of electrolytes probably due to membrane damage, however, iron reduction rates were not significantly different in control and irradiated leaves. Soybean embryonic axes incubated in the presence of paraquat or axes from aged seeds showed a significant decrease in fresh weight of the axes after 30 h of development. Moreover, the consistent increase in iron reduction rates measured in control axes during the imbibition period was inhibited either in the presence of paraquat or with aged embryonic axes. The data presented here suggest that iron reduction does not seem a universal early index of oxidative damage in biological systems, in spite of its crucial role in oxidative metabolism.

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Se realizó un estudio descriptivo sobre el comportamiento de la Infección Respiratoria Aguda en menores de cinco años del área de influencia del centro de salud de barrio Horizontes de Bogotá. Entre el 1 de enero y el 31 de diciembre de 1989. En el cual se compara dicho comportamiento entre el grupo de niños pertenecientes al programa de salud familiar de la Escuela Colombiana de Medicina y un grupo muestra de los niños que no reciben en forma directa la influencia del programa pero pertenecen a la misma comunidad y por lo tanto sometidos a los mismos factores de riesgo. Para el estudio se obtuvieron los datos revisando el total de historias clinicas de niños menores de cinco años pertenecientes al programa y una muestra significativa de niños no pertenecientes al programa. Se analizaron variables como sexo, edad, motivos de consulta, días de evolución, sintomatología y grado de severidad. Cruzándolas estadísticamente con el hecho de pertenecer o no al programa de salud familiar. El análisis estadístico de los datos obtenidos muestran que los niños del programa de salud familiar consultan en una forma mas precoz y en mayor numero en comparación con los niños no pertenecientes al programa, presentado sin embargo la misma severidad clínica los dos grupos

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