Laryngeal sensitivity in patients with amyotrophic lateral sclerosis

Recent studies have shown the involvement of the sensory nervous system in patients with amyotrophic lateral sclerosis (ALS). The aim of our study was to investigate the correlation between the laryngeal sensitivity deficit and the type of ALS onset (bulbar or spinal) in a large series of 114 consecutive ALS patients. Participants were subdivided into two groups, bulbar and spinal ALS, according to the clinical onset of disease and submitted to a clinical and instrumental evaluation of swallowing, including a fiber-optic endoscopic evaluation of swallowing with sensory testing. Dysphagia severity was scored using the Penetration–Aspiration Scale (PAS) and the Pooling score (P-score). In addition, three patients with laryngeal sensitivity deficit were submitted to a laryngeal biopsy to assess the status of the sensory innervation. All patients showed a normal glottal closure during phonation and volitional cough. Fifty-six subjects (49%), 14 spinal- and 42 bulbar-onset ALS, showed dysphagia at the first clinical observation (PAS score >1; P-score >5). Dysphagia resulted more frequently in bulbar-onset ALS (P < 0.01). Thirty-eight (33%) patients had a sensory deficit of the larynx. The sensory deficit of the larynx was significantly more frequent in bulbar-onset ALS (P < 0.01). The sensory deficit of the larynx among dysphagic patients was also significantly more frequent in bulbar-onset ALS (P = 0.02). Several abnormalities were found in all three subjects who underwent a laryngeal biopsy: in one patient, no intraepidermal fiber was found; in the other two, the fibers showed morphological changes. Our observations are important to consider for assessment and management of dysphagia in patients with AL

Herpetofauna of Estação Ambiental de Peti, an Atlantic Rainforest fragment of Minas Gerais State, southeastern Brazil

Fornecemos aqui uma lista de espécies de anfíbios e répteis da Estação de Pesquisa e Desenvolvimento Ambiental de Peti, uma reserva de Mata Atlântica localizada nas montanhas da Cadeia do Espinhaço, estado de Minas Gerais, sudeste do Brasil. Essa lista originou-se de um inventário conduzido durante 78 dias de trabalhos de campo, 13 anos após a realização de um primeiro levantamento. Entre abril de 2002 e outubro de 2004, aplicamos o método de procura visual durante caminhadas nas trilhas da floresta, em diversos corpos d'água e nos sítios reprodutivos dos anuros. Foram registradas 48 espécies, incluídas nas ordens Anura (29), Gymnophiona (1), Chelonia (1), Crocodylia (1) e Squamata (16 espécies: uma anfisbena, cinco lagartos e 11 serpentes). Treze espécies não haviam sido registradas no inventário anterior, e 14 espécies registradas anteriormente não foram detectadas em nosso inventário. São discutidas possíveis explicações para as diferenças observadas. Embora nenhuma espécie esteja incluída nas listas de espécies ameaçadas do Estado de Minas Gerais e do Brasil, a reserva deve ser considerada importante para a manutenção das populações da herpetofauna local.Here we provide a list of amphibians and reptiles of Estação de Pesquisa e Desenvolvimento Ambiental de Peti, an Atlantic rainforest reserve located in the mountains of the Espinhaço Range, State of Minas Gerais, southeastern Brazil. This list originated from a 78-days inventory conducted in the area 13 years after a first inventory. We actively searched for amphibians and reptiles in forest trails and anuran breeding sites. Between April 2002 and October 2004 we recorded 48 species belonging to Anura (29 species), Gymnophiona (1), Chelonia (1), Crocodylia (1), and Squamata (16 species: one amphisbaenian, five lizards and 10 snakes). Thirteen species were not recorded in the first inventory, and 14 species previously recorded were not found in the present work. Possible explanations for these differences are discussed. Although none of the recorded species is included in the available lists of threatened species for the State of Minas Gerais and Brazil, the reserve must be considered an important source of natural habitats to the local herpetofauna.CEMI

Late recognition and illness severity are determinants of early death in severe septic patients

OBJECTIVE: To identify the independent variables associated with death within 4 days after the first sepsis-induced organ dysfunction. METHODS: In this prospective observational study, severe sepsis and septic shock patients were classified into 3 groups: Group 1, survivors; Group 2, late non-survivors; and Group 3, early non-survivors. Early death was defined as death occurring within 4 days after the first sepsis-induced organ dysfunction. Demographic, clinical and laboratory data were collected and submitted to univariate and multinomial analyses. RESULTS: The study included 414 patients: 218 (52.7%) in Group 1, 165 (39.8%) in Group 2, and 31 (7.5%) in Group 3. A multinomial logistic regression analysis showed that age, Acute Physiology and Chronic Health Evaluation II score, Sepsis-related Organ Failure Assessment score after the first 24 hours, nosocomial infection, hepatic dysfunction, and the time elapsed between the onset of organ dysfunction and the sepsis diagnosis were associated with early mortality. In contrast, Black race and a source of infection other than the urinary tract were associated with late death. Among the non-survivors, early death was associated with Acute Physiology and Chronic Health Evaluation II score, chronic renal failure, hepatic dysfunction Sepsis-related Organ Failure Assessment score after 24 hours, and the duration of organ dysfunction. CONCLUSION: Factors related to patients' intrinsic characteristics and disease severity as well as the promptness of sepsis recognition are associated with early death among severe septic patients.Fundacao de Amparo a Pesquisa do Estado de Sao PauloFederal University of São Paulo Department of Anesthesiology Pain and Critical CareLatin American Sepsis InstituteFederal University of São Paulo Department of Infectious DiseasesSírio Libanês Hospital Intensive Care UnitHospital Israelita Albert Einstein Intensive Care UnitUNIFESP, Department of Anesthesiology Pain and Critical CareUNIFESP, Department of Infectious DiseasesSciEL

Late recognition and illness severity are determinants of early death in severe septic patients

OBJECTIVE: To identify the independent variables associated with death within 4 days after the first sepsis-induced organ dysfunction. METHODS: In this prospective observational study, severe sepsis and septic shock patients were classified into 3 groups: Group 1, survivors; Group 2, late non-survivors; and Group 3, early non-survivors. Early death was defined as death occurring within 4 days after the first sepsis-induced organ dysfunction. Demographic, clinical and laboratory data were collected and submitted to univariate and multinomial analyses. RESULTS: The study included 414 patients: 218 (52.7%) in Group 1, 165 (39.8%) in Group 2, and 31 (7.5%) in Group 3. A multinomial logistic regression analysis showed that age, Acute Physiology and Chronic Health Evaluation II score, Sepsis-related Organ Failure Assessment score after the first 24 hours, nosocomial infection, hepatic dysfunction, and the time elapsed between the onset of organ dysfunction and the sepsis diagnosis were associated with early mortality. In contrast, Black race and a source of infection other than the urinary tract were associated with late death. Among the non-survivors, early death was associated with Acute Physiology and Chronic Health Evaluation II score, chronic renal failure, hepatic dysfunction Sepsis-related Organ Failure Assessment score after 24 hours, and the duration of organ dysfunction. CONCLUSION: Factors related to patients' intrinsic characteristics and disease severity as well as the promptness of sepsis recognition are associated with early death among severe septic patients

Diffuse glioblastoma resembling acute hemorrhagic leukoencephalitis

We report the case of a young man with sudden onset of diplopia after an upper respiratory tract infection. Based on the first radiological findings acute hemorrhagic leukoencephalitis, a variant of acute disseminated encephalomyelitis, was suspected and treatment with high dose intravenous dexamethasone was started but it was stopped for intolerance. The patient clinically worsened, developing gait instability, ataxia and ophthalmoplegia; brain MRI performed 20 days later showed severe progression of the disease with subependymal dissemination. After brain biopsy of the right temporal lesion the histological diagnosis was glioblastoma. These findings suggest that MRI features of acute hemorrhagic leukoencephalitis may dissimulate the diagnosis of diffuse glioma/glioblastoma. This case underscores the importance of considering diffuse glioma in the differential diagnosis of atypical signs and symptoms of acute hemorrhagic leukoencephalitis and underlines the relevant role of integrating neuroradiologic findings with neuropathology

DNA DSB Repair Dynamics following Irradiation with Laser-Driven Protons at Ultra-High Dose Rates

Protontherapy has emerged as more effective in the treatment of certain tumors than photon based therapies. However, significant capital and operational costs make protontherapy less accessible. This has stimulated interest in alternative proton delivery approaches, and in this context the use of laser-based technologies for the generation of ultra-high dose rate ion beams has been proposed as a prospective route. A better understanding of the radiobiological effects at ultra-high dose-rates is important for any future clinical adoption of this technology. In this study, we irradiated human skin fibroblasts-AG01522B cells with laser-accelerated protons at a dose rate of 10 9 Gy/s, generated using the Gemini laser system at the Rutherford Appleton Laboratory, UK. We studied DNA double strand break (DSB) repair kinetics using the p53 binding protein-1(53BP1) foci formation assay and observed a close similarity in the 53BP1 foci repair kinetics in the cells irradiated with 225 kVp X-rays and ultra- high dose rate protons for the initial time points. At the microdosimetric scale, foci per cell per track values showed a good correlation between the laser and cyclotron-accelerated protons indicating similarity in the DNA DSB induction and repair, independent of the time duration over which the dose was delivered

Neonatal hyperbilirubinemia: a critical appraisal of current guidelines and evidence

The neurological damage of neonatal hyperbilirubinemia is often seen in developed countries as a remnant of a long gone past before the introduction of effective phototherapy and exchange transfusion. However, several reports in the past two decades from the United States have led to the institution of a Kernicterus National Registry. Similar reports from all over Western Europe have forced the pediatric national societies to issue specific guidelines on the clinical management of neonatal hyperbilirubinemia. The present paper reviews the highlights and pitfalls of the documents from Australia, Canada, New Zealand, India, Israel, Spain, Norway and South Africa

Description of the tadpole of Scinax luizotavioi from the Atlantic rainforest of southeastern Brazil

We describe and figure for the first time the tadpoles of the hylid frog Scinax luizotavioi from stream backwaters and associated puddles of the Atlantic rainforest of southeastern Brazil. External morphology, colour in life and detailed morphometric data are presented. Diagnostic characteristics that help to distinguish S. luizotavioi tadpoles from other species within the S. catharinae group include labial tooth row formula, disposition of oral papillae and colour in life