Unusual increase of cases of myelitis in a pediatric hospital in Argentina

Fil: Perez, Guadalupe. Servicio de Control Epidemiológico e Infectología. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"; Argentina.Fil: Rosanova, María T. Servicio de Control Epidemiológico e Infectología. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"; ArgentinaFil: Freire, María C. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Servicio de Nerovirosis; Argentina.Fil: Paz, María I. Servicio de Neurología. Hospital de Pediatría "Prof. Dr. Juan P.Garrahan"; Argentina.Fil: Ruvinsky, Silvina. Servicio de Control Epidemiológico e Infectología. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"; Argentina.Fil: Rugilo, Carlos. Carlos. Servicio de Diagnóstico por Imágenes. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"; Argentina.Fil: Ruggieri, Victor. Servicio de Neurología. Hospital de Pediatría "Prof. Dr. Juan P.Garrahan"; Argentina.Fil: Cisterna, Daniel. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Servicio de Nerovirosis; Argentina.Fil: Martiren, Soledad. Servicio de Control Epidemiológico e Infectología. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"; Argentina.Fil: Lema, Cristina. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Servicio de Nerovirosis; Argentina.Fil: Savransky, Andrea. Servicio de Neurología. Hospital de Pediatría "Prof. Dr. Juan P.Garrahan"; Argentina.Fil: González, Soledad. Servicio de Control Epidemiológico e Infectología. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"; Argentina.Fil: Martinez, Leila. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Servicio de Nerovirosis; Argentina.Fil: Viale, Diana. Servicio de Microbiología. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"; Argentina.Fil: Bologna, Rosa. Servicio de Control Epidemiológico e Infectología. Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"; Argentina.The association between enterovirus D68 and acute flaccid myelitis was first described in the United States in 2014. Since then, sporadic cases have been reported in Canada and Europe. This study describes a series of cases of acute flaccid myelitis at Hospital de Pediatría "Prof. Dr. Juan P. Garrahan," in Buenos Aires, Argentina, during 2016

Anestesia espinal e hipotensión en paciente obstétrica obesa mórbida a propósito de un caso

ResumenEl embarazo, combinado con la obesidad, determina alteraciones en la farmacocinética y farmacodinamia de las drogas anestésicas. Ambas, embarazo y obesidad mórbida aumentan en forma significativa el volumen de distribución de la mayoría de las drogas utilizadas. La obesidad se asocia a alteraciones anatómicas, fisiológicas y bioquímicas que afectan virtualmente a todos los sistemas; una de las mayores alteraciones es la hipotensión materna durante la cesárea que sigue siendo una complicación frecuente de la anestesia espinal y se asocia con eventos adversos maternos y fetales. En la actualidad la anestesia espinal en la paciente obesa mórbida es adecuada administrando fluidoterapia controlada con apoyo de un vasopresor, los vasopresores disponibles en general no se asocian a deterioro significativo de la madre y el feto de tal manera no deben abandonarse en la práctica obstétrica. El anestesiólogo se enfrenta con objetivos claros y definidos tomando en cuenta los cambios anatómicos, fisiológicos y el uso de vasopresores que no causen daño al binomio materno fetal en este tipo de paciente. El objetivo del reporte de caso es destacar: Frecuencia, importancia clínica, tratamiento profiláctico y terapéutico de hipotensión inducida durante la anestesia espinal en paciente gestante con obesidad mórbida sometida a cesárea segmentaria

Atelectasia total izquierda en Inducción Anestésica en paciente eclámptica resuelta en quirófano a propósito de un caso

Las alteraciones en el intercambio gaseoso son una complicación frecuente durante la anestesia general y la ventilación mecánica. Los cambios observados son reversibles aplicando las diferentes técnicas de rescate alveolar, hoy en día las atelectasias se consideran la principal causa de hipoxemia intraoperatoria apareciendo en los primeros minutos de iniciada la Anestesia General. Las pacientes eclámpticas desaturan rápidamente cuando están en apnea, ya que el útero grávido ejerce presión hacia arriba logrando que los lóbulos inferiores del pulmón disminuyan su capacidad pulmonar, esto causa atelectasia y colapso de los lóbulos inferiores. El deterioro de la ventilación en estas pacientes es evidente.  Se comenta el caso de una paciente de 15 años de edad con diagnóstico de eclampsia que presenta Resistencia a la ventilación posterior a la intubación, con frecuencia la anestesia general produce microatelectasia, sin embargo, es novedoso el hallazgo de atelectasia total pulmonar izquierda durante la inducción anestésica. La utilización de una fracción inspiratoria de oxigeno elevada durante la inducción anestésica y aumento de la presión intraabdominal en el embarazo son factores favorecedores del desarrollo de atelectasia

Diversity of picornaviruses in rural Bolivia

Fil: Nix, W Allan. Centers for Disease Control and Prevention; Estados Unidos.Fil: Khetsuriani, Nino. Centers for Disease Control and Prevention; Estados Unidos.Fil: Peñaranda, Silvia. Centers for Disease Control and Prevention; Estados Unidos.Fil: Maher, Kaija. Centers for Disease Control and Prevention; Estados Unidos.Fil: Venczel, Linda. Centers for Disease Control and Prevention; Estados Unidos.Fil: Cselkó, Zsuzsa. Centers for Disease Control and Prevention; Estados Unidos.Fil: Freire, Maria Cecilia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Cisterna, Daniel. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Lema, Cristina L. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Rosales, Patricia. Ministry of Health and Sports; Bolivia.Fil: Rodríguez, Jacqueline R. Pediatric Hospital San Antonio de Los Sauces; Bolivia.Fil: Rodríguez, Wilma. Ministry of Health and Sports; Bolivia.Fil: Halkyer, Percy. Pan-American Health Organization; Bolivia.Fil: Ronveaux, Olivier. Pan-American Health Organization; Bolivia.Fil: Pallansch, Mark A. Centers for Disease Control and Prevention; Estados Unidos.Fil: Oberste, M Steven. Centers for Disease Control and Prevention; Estados Unidos.The family Picornaviridae is a large and diverse group of viruses that infect humans and animals. Picornaviruses are among the most common infections of humans and cause a wide spectrum of acute human disease. This study began as an investigation of acute flaccid paralysis (AFP) in a small area of eastern Bolivia, where surveillance had identified a persistently high AFP rate in children. Stools were collected and diagnostic studies ruled out poliovirus. We tested stool specimens from 51 AFP cases and 34 healthy household or community contacts collected during 2002-2003 using real-time and semi-nested reverse transcription polymerase chain reaction assays for enterovirus, parechovirus, cardiovirus, kobuvirus, salivirus and cosavirus. Anecdotal reports suggested a temporal association with neurological disease in domestic pigs, so six porcine stools were also collected and tested with the same set of assays, with the addition of an assay for porcine teschovirus. A total of 126 picornaviruses were detected in 73 of 85 human individuals, consisting of 53 different picornavirus types encompassing five genera (all except Kobuvirus). All six porcine stools contained porcine and/or human picornaviruses. No single virus, or combination of viruses, specifically correlated with AFP; however, the study revealed a surprising complexity of enteric picornaviruses in a single community

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Neurologic disease due to Adenovirus infection

El objetivo de este trabajo fue determinar la prevalencia de adenovirus (ADV) en las infecciones del sistema nervioso central (SNC). Se analizaron 108 muestras de líquido cefalorraquídeo (LCR) provenientes de 79 casos de encefalitis, 7 meningitis y 22 de otras patologías neurológicas, recibidas en el período 2000-2002. Cuarenta y nueve (47.35%) se obtuvieron de pacientes inmunocomprometidos. La presencia de ADV se investigó mediante reacción en cadena de la polimerasa en formato anidado (Nested-PCR). La identificación del genogrupo se realizó mediante análisis filogenético de la secuencia nucleotídica parcial de la región que codifica para la proteína del hexón. Se detectó la presencia de ADV en 6 de 108 (5.5%) muestras de LCR analizadas. Todos los casos positivos pertenecieron a pacientes con encefalitis que fueron 79, (6/79, 7.6%). No se observó diferencia estadísticamente significativa entre los casos de infección por ADV en pacientes inmunocomprometidos e inmunocompetentes (p>0.05). Las cepas de ADV detectadas se agruparon en los genogrupos B1 y C. En conclusión, nuestros resultados describen el rol de los ADV en las infecciones neurológicas en Argentina. La información presentada contribuye al conocimiento de su epidemiología, en particular en casos de encefalitis.The aim of this study was to assess the prevalence of adenovirusm (ADV) infections in neurological disorders. A total of 108 cerebrospinal fluid (CSF) samples from 79 encephalitis cases, 7 meningitis and 22 other neurological diseases analysed in our laboratory between 2000 and 2002 were studied. Forty nine (47.4%) belonged to immunocompromised patients. Viral genome was detected using nested polymerase chain reaction (Nested-PCR) and ADV genotypes were identified using partial gene sequence analysis of hexon gene. Adenovirus were detected in 6 of 108 (5.5%) CSF samples tested. All of these were from encephalitis cases, 6/79, representing 7.6% of them. No statistically significant differences were observed (p>0.05) between the immunocompromised and non immucocompromised patients with ADV infection of the central nervous system. Two ADV genotypes (B1 and C) were identified. In conclusion, our results describe the role of ADV in neurologic infections in Argentina. The results contribute to the knowledge of ADV epidemiology, specially in encephalitis.Fil: Lema, Cristina L. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Servicio de Neurovirosis; Argentina.Fil: Cisterna, Daniel. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Servicio de Neurovirosis; Argentina.Fil: Freire, María Cecilia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Servicio de Neurovirosis; Argentina

Neurologic disease due to Adenovirus infection

El objetivo de este trabajo fue determinar la prevalencia de adenovirus (ADV) en las infecciones del sistema nervioso central (SNC). Se analizaron 108 muestras de líquido cefalorraquídeo (LCR) provenientes de 79 casos de encefalitis, 7 meningitis y 22 de otras patologías neurológicas, recibidas en el período 2000-2002. Cuarenta y nueve (47.35%) se obtuvieron de pacientes inmunocomprometidos. La presencia de ADV se investigó mediante reacción en cadena de la polimerasa en formato anidado (Nested-PCR). La identificación del genogrupo se realizó mediante análisis filogenético de la secuencia nucleotídica parcial de la región que codifica para la proteína del hexón. Se detectó la presencia de ADV en 6 de 108 (5.5%) muestras de LCR analizadas. Todos los casos positivos pertenecieron a pacientes con encefalitis que fueron 79, (6/79, 7.6%). No se observó diferencia estadísticamente significativa entre los casos de infección por ADV en pacientes inmunocomprometidos e inmunocompetentes (p>0.05). Las cepas de ADV detectadas se agruparon en los genogrupos B1 y C. En conclusión, nuestros resultados describen el rol de los ADV en las infecciones neurológicas en Argentina. La información presentada contribuye al conocimiento de su epidemiología, en particular en casos de encefalitis.The aim of this study was to assess the prevalence of adenovirusm (ADV) infections in neurological disorders. A total of 108 cerebrospinal fluid (CSF) samples from 79 encephalitis cases, 7 meningitis and 22 other neurological diseases analysed in our laboratory between 2000 and 2002 were studied. Forty nine (47.4%) belonged to immunocompromised patients. Viral genome was detected using nested polymerase chain reaction (Nested-PCR) and ADV genotypes were identified using partial gene sequence analysis of hexon gene. Adenovirus were detected in 6 of 108 (5.5%) CSF samples tested. All of these were from encephalitis cases, 6/79, representing 7.6% of them. No statistically significant differences were observed (p>0.05) between the immunocompromised and non immucocompromised patients with ADV infection of the central nervous system. Two ADV genotypes (B1 and C) were identified. In conclusion, our results describe the role of ADV in neurologic infections in Argentina. The results contribute to the knowledge of ADV epidemiology, specially in encephalitis.Fil: Lema, Cristina L. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Servicio de Neurovirosis; Argentina.Fil: Cisterna, Daniel. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Servicio de Neurovirosis; Argentina.Fil: Freire, María Cecilia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Servicio de Neurovirosis; Argentina