Nystagmus in a newborn: a manifestation of Joubert syndrome in the neonatal period.

Joubert syndrome is a rare disorder, usually autosomal recessive, with a prevalence of 1:80 000 to 1:100 000. This disease presents most commonly as breathing irregularities, although the two major clinical criteria are hypotonia and developmental delay, sometimes associated with ocular movement abnormalities. The severity of the presentation varies, ranging from mild cases with normal intelligence to severe developmental delays associated with early death. We report a case of a newborn who presented to the emergency department for absent ocular fixation and torsional nystagmus without other neurological abnormalities. Her cranial MR showed cerebellar vermis agenesis and a molar tooth sign. Her laboratory evaluation, and renal and abdominal ultrasound were normal. An electroretinogram showed mixed retinal dystrophy and an AHI1 homozygous missense c.1981T>C mutation was identified (parents are carriers). Throughout infancy, she has shown mild developmental delay and hypotonia, but no respiratory abnormalities. Owing to variable expressivity, a high level of suspicion is required

Necrotizing Fasciitis Post- Acute Appendicitis

A Fasceíte Necrotizante (FN) é um processo infeccioso da fascia profunda, de evolução rápida e progressiva com necrose secundária do tecido celular subcutâneo. Os autores apresentam um caso de FN da parede abdominal, como complicação extremamente rara de apendicite aguda. Trata-se de uma criança, apendicectomizada por apendicite aguda gangrenada, que evolui para quadro infeccioso grave, com dor e processo inflamatório da parede abdominal. Após diagnóstico, foi submetido a desbridamento cirúrgico da parede abdominal e drenagem de abcesso intraperitoneal. Realizada terapêutica antibiótica, desbridamentos cirúrgicos e pensos sucessivos da lesão e ao 22º dia efectuou-se enxerto dermo-epidérmico de área cruenta residual da parede abdominal. Porque o prognóstico está intimamente relacionado com o tempo decorrido até ao diagnóstico correcto e início de terapêutica adequada, é de extrema importância que este diagnóstico seja considerado

Peritonite por Rhizobium radiobacter

Rhizobium radiobacter (Agrobacterium radiobacter) is an aerobic Gram-negative rod belonging to Agrobacterium genus, a group of phytopathogenic bacteria present in the soil that has been implicated in human opportunistic infections. We report a clinical case of bacterial peritonitis in a 5-year-old child with chronic renal disease in peritoneal dialysis, who had a history of direct soil contact identified. The infection was treated with ceftazidime and piperaciline+tazobactam without relapses or the need to remove the peritoneal dialysis catheter

Severe Influenza B Pneumonia Virus in a Newborn

A infecção por vírus influenza B é rara no período neonatal com uma incidência desconhecida. Relata-se o caso de uma recém-nascida de termo, reinternada ao nono dia de vida por quadro de má perfusão periférica, gemido, dificuldade alimentar e dificuldade respiratória com necessidade de ventila ção mecânica, óxido nítrico inalado e surfactante. A radiografia de tórax no primeiro dia apresentava infiltrado intersticial ligeiro, difuso. Esteve sob ventilação invasiva durante 11 dias e oxigenoterapia 15 dias, tendo tido alta ao 20º dia, clinicamente bem. É fundamental pensar em infecção por vírus influenza B quando existe história de possível contágio, e em mães sem imunização anti-influenza. Não há terapêutica aprovada neste grupo etário, devendo ser tomadas medidas de suporte, de contenção e prevenção da disseminação da infecção

Nontyphoidal Salmonella Gastroenteritis in Children: a 10 Year Review

Introdução: A Salmonella não tifoide é o agente mais frequente das toxinfeções alimentares nos países desenvolvidos. Em Portugal, são notificados em média 450 casos por ano, 80% dos quais em crianças. Métodos: Revisão casuística dos casos confirmados por coprocultura, internados num hospital do grupo I, na região de Lisboa e Vale do Tejo, entre 1999 e 2008. Análise estatística no programa SPSS® v16.0, com aplicação do teste de Spearman e significância estatística para p< 0,05. Resultados: Identificaram-se 213 internamentos. A mediana anual foi de 21 internamentos, 39% ocorrendo no verão. A mediana das idades foi de 4,2 anos, com doze casos em lactentes até aos três meses. Houve um predomínio no sexo masculino (57%). A mediana do total de leucócitos foi de 9300/mL e da proteína C reativa de 8,8 mg/dL, não se relacionando com a ocorrência de bacteriemia. A duração média do internamento foi de 5,2 dias. As principais complicações foram desidratação (117/213), bacteriemia (8/213), convulsão febril (6/213), síndrome de Mallory-Weiss (5/213) e apendicite aguda (3/213). Os serotipos mais isolados foram: S. Enteritidis (76%), S. Typhimurium (19%), outros (S. O4,5:i-, S. Derby, S. Hayfa, S. Menden, S. Rissen) (5%). Encontraram-se 27% de resistências à ampicilina e 15% ao trimetoprim-sulfametoxazol, sem resistências ao ceftriaxone. Conclusões: Nos 10 anos estudados, o número de casos manteve-se elevado, com morbilidade relevante e resistências significativas aos antibióticos de primeira linha

Effects of 2 or 5 consecutive exercise days on adipocyte area and lipid parameters in Wistar rats

<p>Abstract</p> <p>Background</p> <p>Exercise has been prescribed in the treatment and control of dyslipidemias and cholesterolemia, however, lipid responses to different training frequencies in hypercholesterolemic men have been inconsistent. We sought to verify if different frequencies of continuous moderate exercise (2 or 5 days/week, swimming) can, after 8 weeks, promote adaptations in adipocyte area and lipid parameters, as well as body weight and relative weight of tissues in normo and hypercholesterolemic adult male rats.</p> <p>Methods</p> <p>Normal cholesterol chow diet or cholesterol-rich diet (1% cholesterol plus 0.25% cholic acid) were freely given during 8 weeks to the rats divided in 6 experimentals groups: sedentary normal cholesterol chow diet (C); sedentary cholesterol-rich diet (H); 5× per week continuous training normal cholesterol chow diet (TC5) and cholesterol-rich diet (TH5); 2× per week continuos traning normal cholesterol chow diet (TC2) and cholesterol-rich diet (TH2).</p> <p>Results</p> <p>No changes were observed in lipid profile in normal cholesterol chow diet, but both 2 a 5 days/week exercise improved this profile in cholesterol-rich diet. Body weight gain was lower in exercised rats. Decrease in retroperitoneal and epididymal relative weights as well as reductions in adipocyte areas under all diets types were observed only in 5 days/week, while 2 days/week showed improvements mainly in cholesterol-rich diet rats.</p> <p>Conclusion</p> <p>Our results confirm the importance of exercise protocols to control dyslipidemias and obesity in rats. The effects of 5 days/week exercise were more pronounced compared with those of 2 consecutive days/week training.</p

Endotoxin levels correlate positively with a sedentary lifestyle and negatively with highly trained subjects

Introduction: A sedentary lifestyle increases the risk of developing cardiovascular disease, obesity, and diabetes. This phenomenon is supported by recent studies suggesting a chronic, low-grade inflammation status. Endotoxin derived from gut flora may be key to the development of inflammation by stimulating the secretion of inflammatory factors. This study aimed to examine plasma inflammatory markers and endotoxin levels in individuals with a sedentary lifestyle and/or in highly trained subjects at rest. Methods: Fourteen male subjects (sedentary lifestyle n = 7; highly trained subjects n = 7) were recruited. Blood samples were collected after an overnight fast (similar to 12 h). the plasmatic endotoxin, plasminogen activator inhibitor type-1 (PAI-1), monocyte chemotactic protein-1 (MCP1), ICAM/CD54, VCAM/CD106 and lipid profile levels were determined.Results: Endotoxinemia was lower in the highly trained subject group relative to the sedentary subjects (p < 0.002). in addition, we observed a positive correlation between endotoxin and PAI-1 (r = 0.85, p < 0.0001), endotoxin and total cholesterol (r = 0.65; p < 0.01), endotoxin and LDL-c (r = 0.55; p < 0.049) and endotoxin and TG levels (r = 0.90; p < 0.0001). the plasma levels of MCP-1, ICAM/CD54 and VCAM/CD106 did not differ.Conclusion: These results indicate that a lifestyle associated with high-intensity and high-volume exercise induces favorable changes in chronic low-grade inflammation markers and may reduce the risk for diseases such as obesity, diabetes and cardiovascular diseases.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Physiol, Div Nutr, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biosci, São Paulo, BrazilUniv São Paulo, Canc Metab Grp, Inst Biomed Sci, Dept Cell & Dev Biol, BR-05508 São Paulo, BrazilUniv Prebiteriana Mackenzie, Dept Phys Educ, Biol & Hlth Sci Ctr, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Physiol, Div Nutr, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biosci, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, São Paulo, BrazilFAPESP: 2008/03533-1Web of Scienc