RESUMO
Several challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4-36.3).
RESUMO
Sleep disorders are a widespread condition in patients with Parkinson's disease (PD), which has been linked to a deregulation of the circadian cycle and therefore of the clock genes. The aim of this study was to evaluate the effect of melatonin (MEL) on the PER1 and BMAL1 clock genes in patients with PD. A double-blind, cross-over, placebo-controlled randomized clinical trial pilot study was conducted in 26 patients with stage 1-3 PD according to the Hoehn & Yahr scale, who received either 25 mg of MEL or a placebo at noon and 30 min before bedtime for three months. The relative expression of the PER1 and BMAL1 genes was measured, as well as the presence of daytime, nocturnal, and global sleepiness, and the progression of PD. The levels of the PER1 and BMAL1 genes at baseline were 0.9 (0.1-3) vs. 0.56 (0.1-2.5), respectively; while after the intervention with MEL or placebo the BMAL1 levels increased to 2.5 (0-3.70) vs. 2.2 (0.10-3.30), respectively (d = 0.387). Fifty percent (50 %) of patients had daytime sleepiness and sixty-five percent (65 %) had abnormal nighttime sleepiness, yet neither group showed changes after the intervention. Patients with PD exhibited an alteration in the levels of the clock genes: MEL increased the levels of BMAL1, but the PER1 levels remained unchanged.
Assuntos
Fatores de Transcrição ARNTL/genética , Melatonina/administração & dosagem , Doença de Parkinson/tratamento farmacológico , Proteínas Circadianas Period/genética , Transtornos do Sono-Vigília/tratamento farmacológico , Fatores de Transcrição ARNTL/sangue , Adulto , Idoso , Estudos Cross-Over , Método Duplo-Cego , Feminino , Regulação da Expressão Gênica , Humanos , Masculino , México , Pessoa de Meia-Idade , Doença de Parkinson/sangue , Doença de Parkinson/diagnóstico , Doença de Parkinson/genética , Proteínas Circadianas Period/sangue , Projetos Piloto , Transtornos do Sono-Vigília/sangue , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/genética , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Mexico has the largest number of clinical cases of actinomycetoma in North and South America. Species originally identified by less specific methods have been recently reclassified as other known species or as new species. OBJECTIVE: To assess, by 16S rRNA gene sequencing and phenotypic methods, the species distribution of 18 human clinical isolates originally identified as N. brasiliensis, some of them isolated between 1947 and 1959 in Mexico City. METHODS: Clinical isolates came from the Hospital General, "Dr. Manuel Gea Gonzalez", and Instituto Nacional de Diagnóstico y Referencia Epidemiológica (INDRE) in Mexico, D.F. The strains used in this study included 15 clinical strains isolated between 1947 and 1959 that were originally identified as N. brasiliensis and three more strains obtained in 2007 identified as Nocardia spp. The isolates were identified genotypically by sequencing the 16S rRNA gene, and their phenotypic profiles were obtained with the API Coryne(®) system. Antibiotic susceptibility patterns were tested according to the protocol of the Comité de l'antibiogramme de la Société française de microbiologie[4]. RESULTS: According to 16S rRNA gene, sequencing were identified among 18 human clinical isolates as Nocardia farcinica (n=11) and Nocardia brasiliensis (n=7). A high number of the strains were susceptible to the majority of the antibiotics tested. The phenotypic profiles of the strains were quite uniform for N. farcinica and some variability was observed for N. brasiliensis strains. CONCLUSION: N. farcinica was the most prevalent species identified. Modern methodologies should be applied in clinical laboratories to accurately identify etiological agents.
Assuntos
Nocardiose/microbiologia , Nocardia/isolamento & purificação , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Genótipo , Humanos , México/epidemiologia , Testes de Sensibilidade Microbiana , Nocardia/classificação , Nocardia/efeitos dos fármacos , Nocardia/genética , Nocardiose/epidemiologia , Fenótipo , Filogenia , RNA Ribossômico 16S/genéticaRESUMO
Parkinson's disease, a major neurodegenerative disorder in humans whose etiology is unknown, may be associated with some environmental factors. Nocardia otitidiscaviarum (GAM-5) isolated from a patient with an actinomycetoma produced signs similar to Parkinson's disease following iv injection into NMRI mice. NMRI mice were infected intravenously with a non-lethal dose of 5 x 10(6) colony forming units of N. otitidiscaviarum (GAM-5). Fourteen days after bacterial infection, most of the 60 mice injected exhibited parkinsonian features characterized by vertical head tremor, akinesia/bradykinesia, flexed posture and postural instability. There was a peak of nocardial growth in the brain during the first 24 h followed by a decrease, so that by 14 days nocardiae could no longer be cultured. At 24 h after infection, Gram staining showed nocardiae in neurons in the substantia nigra and occasionally in the brain parenchyma in the frontal and parietal cortex. At 21 days post-infection, tyrosine hydroxylase immunolabeling showed a 58% reduction of tyrosine hydroxylase in the substantia nigra, and a 35% reduction of tyrosine hydroxylase in the ventral tegmental region. Dopamine levels were reduced from 110 +/- 32.5 to 58 +/- 16.5 ng/mg protein (47.2% reduction) in brain from infected mice exhibiting impaired movements, whereas serotonin levels were unchanged (191 +/- 44 protein in control and 175 +/- 39 ng/mg protein in injected mice). At later times, intraneuronal inclusion bodies were observed in the substantia nigra. Our observations emphasize the need for further studies of the potential association between Parkinson's disease or parkinsonism-like disease and exposure to various nocardial species.
Assuntos
Encéfalo/microbiologia , Nocardiose/microbiologia , Nocardia , Transtornos Parkinsonianos/microbiologia , Animais , Encéfalo/metabolismo , Encéfalo/patologia , Feminino , Humanos , Imuno-Histoquímica , Camundongos , Nocardiose/metabolismo , Nocardiose/patologia , Transtornos Parkinsonianos/metabolismo , Transtornos Parkinsonianos/patologia , Organismos Livres de Patógenos Específicos , Substância Negra/microbiologia , Substância Negra/patologia , Tirosina 3-Mono-Oxigenase/metabolismoRESUMO
Parkinson's disease, a major neurodegenerative disorder in humans whose etiology is unknown, may be associated with some environmental factors. Nocardia otitidiscaviarum (GAM-5) isolated from a patient with an actinomycetoma produced signs similar to Parkinson's disease following iv injection into NMRI mice. NMRI mice were infected intravenously with a non-lethal dose of 5 x 10(6) colony forming units of N. otitidiscaviarum (GAM-5). Fourteen days after bacterial infection, most of the 60 mice injected exhibited parkinsonian features characterized by vertical head tremor, akinesia/bradykinesia, flexed posture and postural instability. There was a peak of nocardial growth in the brain during the first 24 h followed by a decrease, so that by 14 days nocardiae could no longer be cultured. At 24 h after infection, Gram staining showed nocardiae in neurons in the substantia nigra and occasionally in the brain parenchyma in the frontal and parietal cortex. At 21 days post-infection, tyrosine hydroxylase immunolabeling showed a 58 percent reduction of tyrosine hydroxylase in the substantia nigra, and a 35 percent reduction of tyrosine hydroxylase in the ventral tegmental region. Dopamine levels were reduced from 110 ± 32.5 to 58 ± 16.5 ng/mg protein (47.2 percent reduction) in brain from infected mice exhibiting impaired movements, whereas serotonin levels were unchanged (191 ± 44 protein in control and 175 ± 39 ng/mg protein in injected mice). At later times, intraneuronal inclusion bodies were observed in the substantia nigra. Our observations emphasize the need for further studies of the potential association between Parkinson's disease or parkinsonism-like disease and exposure to various nocardial species.
Assuntos
Humanos , Animais , Feminino , Camundongos , Encéfalo , Nocardia , Nocardiose , Doença de Parkinson , Encéfalo , Imuno-Histoquímica , Nocardiose , Doença de Parkinson , Organismos Livres de Patógenos Específicos , Substância Negra , Tirosina 3-Mono-OxigenaseAssuntos
Animais , Actinomycetales , Infecções por Actinomycetales , Nocardia asteroides , VenezuelaRESUMO
Amiodarone is a drug broadly used on cardiac arrhythmias despite its multiple side-effects. We present the case of an adult male with symptomatic ventricular tachycardia, receiving longterm amiodarone, who showed increased CK serum levels, sensorimotor neuropathy and secondary myopathy. Quadriceps biopsy showed atrophic changes and sural nerve intralysosomal deposits with intense axonal degeneration. The case illustrates the need to investigate and monitor peripheral neuropathy and muscular atrophy in chronic amiodarone use.
Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Doenças Neuromusculares/induzido quimicamente , Adulto , Amiodarona/farmacologia , Atrofia , Creatina Quinase/sangue , Inibidores Enzimáticos/efeitos adversos , Inibidores Enzimáticos/farmacologia , Humanos , Corpos de Inclusão/ultraestrutura , Isoenzimas , Lisossomos/enzimologia , Lisossomos/ultraestrutura , Masculino , Músculo Esquelético/patologia , Degeneração Neural , Condução Nervosa , Doenças Neuromusculares/sangue , Doenças Neuromusculares/patologia , Parestesia/induzido quimicamente , Fosfolipases/antagonistas & inibidores , Nervo Sural/patologia , Taquicardia Ventricular/tratamento farmacológicoAssuntos
Idoso , Atitude , Sexualidade , Idoso de 80 Anos ou mais , Fantasia , Feminino , Humanos , MasculinoRESUMO
Presentamos cinco casos de micetomas actinomicóticos, en el Hospital Independencia de Santiago del Estero entre Abril de 1988 y Abril de 1990. Todos los pacientes procedían de áreas rurales de nuestra provincia, cuatro de ellos de sexo femenino y el restante de sexo masculino, las edades oscilaron entre 38 y 47 años, presentaban localización podal y referían antecedentes de traumatismo con espinas vegetales o elementos punzantes. En cuatro de los casos el agente etiológico recuperado fue: actinomadura madurae, el restante fue diagnosticado por el estudio anátomo-patológico del material extraído por resección quirúrgica al observar "granos" típicos de Streptomycosis somaliensis. Los casos producidos por Actinomadura madurae presentaban alteraciones osteolíticas, que fueron aumentando con el tiempo de evolución de las lesiones; el caso debido a Streptomycoces somaliensis no presentó compromiso óseo
Assuntos
Actinomicose/complicações , Micetoma/etiologia , Osteólise/etiologia , Argentina , Doenças do Pé , Micetoma/diagnóstico , Micetoma/patologia , Streptomyces , Estreptomicina/uso terapêutico , Sulfametoxazol/uso terapêutico , Trimetoprima/uso terapêutico , Ferimentos e Lesões/complicaçõesRESUMO
Presentamos cinco casos de micetomas actinomicóticos, en el Hospital Independencia de Santiago del Estero entre Abril de 1988 y Abril de 1990. Todos los pacientes procedían de áreas rurales de nuestra provincia, cuatro de ellos de sexo femenino y el restante de sexo masculino, las edades oscilaron entre 38 y 47 años, presentaban localización podal y referían antecedentes de traumatismo con espinas vegetales o elementos punzantes. En cuatro de los casos el agente etiológico recuperado fue: actinomadura madurae, el restante fue diagnosticado por el estudio anátomo-patológico del material extraído por resección quirúrgica al observar "granos" típicos de Streptomycosis somaliensis. Los casos producidos por Actinomadura madurae presentaban alteraciones osteolíticas, que fueron aumentando con el tiempo de evolución de las lesiones; el caso debido a Streptomycoces somaliensis no presentó compromiso óseo