Crisis miasténica súbita en un canino con miastenia gravis controlada

Se describe un caso de una crisis miasténica súbita en un canino, hembra, de 7 años de edad que presentaba miastenia gravis controlada. El diagnóstico previo de la enfermedad se confirmó mediante la realización de una prueba serológica específica. Luego de un período de estabilidad bajo tratamiento, el paciente presentó una crisis con un recrudecimiento de la sintomatología inicial. Se relatan los medios diagnósticos utilizados y el manejo terapéutico, tanto de la enfermedad y sus complicaciones, como de la crisis súbita

Alstom oxyfuel CFB boilers: A promising option for CO2 capture

AbstractFossil fuels will likely remain a major energy source for the foreseeable future, leading to the need for power plants including cost-effective CO2 mitigation systems. Oxygen fired CFB boiler technology is an advanced and competitive route to offer in a relative short term commercial units addressing the CO2 capture need.CFB boilers in operation have shown the ability of this technology to fire a wide range of low-cost fuels. A CO2 capture solution based on CFB technology would, hence, provide the plant with the option to utilize these lower cost fuels and as such is a promising option.Additionally the route of plant efficiency improvement is of great interest because it leads to CO2 mitigation together with energy sources savings and thus to operational cost reduction. Alstom has a long experience of large supercritical PC boilers and has developed a design of large supercritical CFB boilers.Oxygen firing can be easily applicable to CFB boilers. The oxygen-fired CFB concept has already been validated in Alstom’s bench- and pilot-scale test facilities.Next step will involve a demonstration of such technology at a medium scale from 100 MWe

Evaluation nutritionnelle du sujet âgé et complications survenant durant le séjour hospitalier

La dénutrition, résultant d'un déséquilibre entre les apports et les besoins de l'organisme, est très fréquente chez la personne âgée puisqu'elle concerne 4% des sujets âgés vivant à domicile et jusqu'à 50% des personnes âgées hospitalisées. Elle peut résulter d'une carence d'apport ou d'une situation d'hypercatabolisme. Ses conséquences en terme de morbi-mortalité sont nombreuses, faisant de la dénutrition un problème de santé publique majeur. Le diagnostic passe par des mesures anthropométriques simples, ainsi que des dosages biologiques. Ce travail, réalisé en milieu hospitalier, retrouve une prévalence de la dénutrition entre 43,2 et 62,4%, selon les outils utilisés pour le diagnostic. Les patients dénutris font plus de complications durant leur séjour, notamment en ce qui concerne les infections pulmonaires et la survenue de décès. On observe par ailleurs que la majorité des patients hospitalisés a un apport calorique et protéique nettement inférieur aux apports recommandés pour les sujets sains. Le médecin généraliste a un rôle central dans le dépistage et la prise en charge de la dénutrition chez les patients vivant à domicile, afin d'en diminuer les complications.Undernutrition, resulting from an imbalance between intakes and needs of the body, is very common in the elderly, since it concerns 4% of elderly living at home and up to 50% of hospitalized elderly. It can result from an intake deficiency or an hypercatabolism condition. Its consequences in terms of morbidity and mortality are numerous, making malnutrition a major public health problem. Diagnosis is made by simple anthropometric measurements and biological assays. This study, carried in a hospital, finds a prevalence of undernutrition between 43,2 and 62,4%, depending on the tools used for diagnosis. Malnourished patients have more complications during their stay, especially regarding lung infections and the occurrence of death. We also notes that most of hospitalized patients has caloric and protein intake far below recommended intake for healthy subjects. The general practitioner has a central role in the detection and treatment of malnutrition in patients living at home, in order to reduce complications.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Polineuropatia associada a hipotireoidismo em cães: Relato de seis casos

Six Doberman Pinscher, between six and eight years of age, were presented to the Veterinary Hospital from Faculty of Veterinary Science of The University of Buenos Aires. Neurological examination revealed tetraparesis with inability to walk, decreased muscle tonus and myotatic reflexes in all dogs. Serum cholesterol levels, creatine kinase and alkaline phosphatase activities were mildly to markedly elevated, and tibial motor nerve conduction velocities were slow in all dogs. Basal measurements of free T4 and TSH were determined by radioimmunoassay. Although fT4 values were within normal range, in all dogs TSH values were elevated. Based on this results, hypothyroidism was diagnosed and a supplementation therapy was established with oral levothyroxine (T4). Two weeks after treatment has been started, all patients had an improvement in clinical signs, and within a month gait became normal, as well as muscular tonus and spinal reflexes.Seis Dobermans Pinscher, entre seis e oito anos de idade, foram encaminhados ao Hospital Veterinário da Faculdade de Ciências Veterinárias da Universidade de Buenos Aires. O exame neurológico revelou tetraparesia com incapacidade para andar, diminuição do tono muscular e de reflexos miotáticos em todos os cães. Os níveis de colesterol, creatina quinase e fosfatase alcalina encontravam-se de moderada a acentuadamente elevados. As velocidades de condução nervosa do nervo tibial estavam diminuídas em todos os cães. Os níveis séricos basais de T4 livre e TSH foram determinados por radioimunoensaio e, embora os valores de T4 livre estivessem dentro dos limites de normalidade, em todos os cães o TSH estava elevado. Baseado nestes resultados, diagnosticou-se hipotireoidismo e iniciou-se uma suplementação oral com levotiroxina (T4). Duas semanas após o início do tratamento todos os pacientes tiveram melhora clínica e, dentro de um mês a locomoção, o tono muscular e os reflexos medulares tornaram-se normais

Tratamento com brometo de piridostigmina em canino com dificuldade de esvaziar a bexiga em canino positivo para miastenia gravis adquirida

Introduction: Acquired myasthenia gravis (AGM) is an immune-mediated disease that presents a decrease in the number or functionality of acetylcholine receptors at the nicotinic level. This leads to less effective muscle contraction. The most common clinical manifestation is episodic weakness that increases with exercise and improves with rest. Other clinical signs are: regurgitation and voice changes. The purpose of this report is to describe a canine, female with dysuria without stranguria who was taken to the Hospital School of Veterinary Medicine of the University of Buenos Aires. Methods: blood and urine tests, urine cultures, spinal radiographs, abdominal ultrasound, electromyography (EMG) of the anal sphincter and repetitive stimulation were performed. Antibodies against acetylcholine receptors (ACRA) were measured. Results: blood tests, urinalysis, spinal radiographs and abdominal ultrasound were normal. Urine cultures were negative. Anal sphincter EMG was preserved. Repetitive stimulation EMG was compatible with MGA. The patient was ACRA positive and his response to treatment with pyridostigmine bromide (BRP) was favorable. Conclusions: include MGA in canine patients with dysuria in the deferential diagnosis.Introducción: La miastenia gravis adquirida (MGA) es una enfermedad inmunomediada, que presenta disminución en el número o funcionalidad de receptores de la acetilcolina a nivel nicotínico. Esto conlleva que la contracción muscular sea menos efectiva. La manifestación clínica más común es la debilidad episódica que aumenta con el ejercicio y mejora con el reposo. Otros signos clínicos son regurgitaciones y cambios de voz. El propósito de este reporte es describir un canino hembra con disuria sin estranguria que fue llevado a consulta al Hospital Escuela de Medicina Veterinaria de la Universidad de Buenos Aires. Metodología: se realizaron análisis de sangre y orina, urocultivos, radiografías de columna, ecografía abdominal, electromiografía (EMG) de esfínter anal y de estimulación repetitiva, se midieron anticuerpos contra receptores de la acetilcolina (ACRA). Resultados: fueron normales los análisis de sangre, urianálisis, radiografías de columna y ecografía de abdomen. Los urocultivos fueron negativos. La EMG del esfínter anal fue conservada. La EMG estimulación repetitiva fue compatible con MGA. El paciente resultó ACRA positivo y su respuesta al tratamiento con bromuro de piridostigmina (BRP) fue favorable. Conclusiones: incluir dentro del diagnóstico deferencial a la MGA en pacientes caninos con disuria.Introdução: a miastenia grave adquirida (MGA) é uma doença imunomediada, que apresenta diminuição no número ou funcionalidade dos receptores da acetilcolina a nível nicotínico. Isto, produz uma contração muscular menos efetiva. A manifestação clínica mais comum é a debilidade motora que aumenta o exercício e melhora com o repouso. Outros estados clínicos são: regurgitação e mudança na voz. O propósito deste artigo é descrever um canino fêmea com disúria sem estrangúria que foi levado a consulta no Hospital da Escola de Medicina Veterinária da Universidade de Buenos Aires. Metodologia: realizaram análises de sangue e urina, urocultura, radiografia da coluna, ecografia abdominal, eletromiografia (EMG) e esfíncter anal e de estimulação repetitiva, mediram anticorpos contra receptores de acetilcolina (ACRA). Resultados: análises de sangue, urinálise, radiografias de coluna e ecografia de abdômen foram normais. As uroculturas foram negativas, A EMG de esfíncter anal foi conservada. A EMG estimulação repetitiva foram compatíveis com MGA. O paciente resultou ACRA positivo e sua resposta ao tratamento com bromuro de piridostigma (BRP) foi favorável. Conclusão: incluir dentro do diagnóstico diferencial a MGA em pacientes com disúria

Impaired implicit learning of syntactic structure in children with developmental language disorder:Evidence from syntactic priming

Background and aims Implicit learning mechanisms associated with detecting structural regularities have been proposed to underlie both the long-term acquisition of linguistic structure and a short-term tendency to repeat linguistic structure across sentences (structural priming) in typically developing children. Recent research has suggested that a deficit in such mechanisms may explain the inconsistent trajectory of language learning displayed by children with Developmental Learning Disorder. We used a structural priming paradigm to investigate whether a group of children with Developmental Learning Disorder showed impaired implicit learning of syntax (syntactic priming) following individual syntactic experiences, and the time course of any such effects. Methods Five- to six-year-old Italian-speaking children with Developmental Learning Disorder and typically developing age-matched and language-matched controls played a picture-description-matching game with an experimenter. The experimenter’s descriptions were systematically manipulated so that children were exposed to both active and passive structures, in a randomized order. We investigated whether children’s descriptions used the same abstract syntax (active or passive) as the experimenter had used on an immediately preceding turn (no-delay) or three turns earlier (delay). We further examined whether children’s syntactic production changed with increasing experience of passives within the experiment. Results Children with Developmental Learning Disorder’s syntactic production was influenced by the syntax of the experimenter’s descriptions in the same way as typically developing language-matched children, but showed a different pattern from typically developing age-matched children. Children with Developmental Learning Disorder were more likely to produce passive syntax immediately after hearing a passive sentence than an active sentence, but this tendency was smaller than in typically developing age-matched children. After two intervening sentences, children with Developmental Learning Disorder no longer showed a significant syntactic priming effect, whereas typically developing age-matched children did. None of the groups showed a significant effect of cumulative syntactic experience. Conclusions Children with Developmental Learning Disorder show a pattern of syntactic priming effects that is consistent with an impairment in implicit learning mechanisms that are associated with the detection and extraction of abstract structural regularities in linguistic input. Results suggest that this impairment involves reduced initial learning from each syntactic experience, rather than atypically rapid decay following intact initial learning. Implications Children with Developmental Learning Disorder may learn less from each linguistic experience than typically developing children, and so require more input to achieve the same learning outcome with respect to syntax. Structural priming is an effective technique for manipulating both input quality and quantity to determine precisely how Developmental Learning Disorder is related to language input, and to investigate how input tailored to take into account the cognitive profile of this population can be optimised in designing interventions

Miastenia gravis adquirida generalizada en caninos y su presentación con miositis de músculos masticatorios

Cinco caninos de 4 a 9 años de edad fueron diagnosticados con miastenia gravis adquirida en asociación con miositis de músculos masticatorios, en el Hospital Escuela de la Facultad de Ciencias Veterinarias de Buenos Aires, durante el periodo 2013-2016. El diagnóstico se confirmó mediante la realización de pruebas serológicas específicas, electromiografías y biopsias musculares de los músculos masticatorios. Se realizó el tratamiento con bromuro de piridostigmina y prednisolona, por el origen inmunomediado de ambas enfermedade

Uphill production of dihydrogen by enzymatic oxidation of glucose without an external energy source

Chemical systems do not allow the coupling of energy from several simple reactions to drive a subsequent reaction, which takes place in the same medium and leads to a product with a higher energy than the one released during the first reaction. Gibbs energy considerations thus are not favorable to drive e.g., water splitting by the direct oxidation of glucose as a model reaction. Here, we show that it is nevertheless possible to carry out such an energetically uphill reaction, if the electrons released in the oxidation reaction are temporarily stored in an electromagnetic system, which is then used to raise the electrons’ potential energy so that they can power the electrolysis of water in a second step. We thereby demonstrate the general concept that lower energy delivering chemical reactions can be used to enable the formation of higher energy consuming reaction products in a closed system

Combinations of QT-prolonging drugs: towards disentangling pharmacokinetic and pharmaco-dynamic effects in their potentially additive nature.

Background: Whether arrhythmia risks will increase if drugs with electrocardiographic (ECG) QT-prolonging properties are combined is generally supposed but not well studied. Based on available evidence, the Arizona Center for Education and Research on Therapeutics (AZCERT) classification defines the risk of QT prolongation for exposure to single drugs. We aimed to investigate how combining AZCERT drug categories impacts QT duration and how relative drug exposure affects the extent of pharmacodynamic drug–drug interactions. Methods: In a cohort of 2558 psychiatric inpatients and outpatients, we modeled whether AZCERT class and number of coprescribed QT-prolonging drugs correlates with observed rate-corrected QT duration (QTc) while also considering age, sex, inpatient status, and other QTc-prolonging risk factors. We concurrently considered administered drug doses and pharmacokinetic interactions modulating drug clearance to calculate individual weights of relative exposure with AZCERT drugs. Because QTc duration is concentration-dependent, we estimated individual drug exposure with these drugs and included this information as weights in weighted regression analyses. Results: Drugs attributing a ‘known’ risk for clinical consequences were associated with the largest QTc prolongations. However, the presence of at least two versus one QTc-prolonging drug yielded nonsignificant prolongations [exposure-weighted parameter estimates with 95% confidence intervals for ‘known’ risk drugs + 0.93 ms (–8.88;10.75)]. Estimates for the ‘conditional’ risk class increased upon refinement with relative drug exposure and coadministration of a ‘known’ risk drug as a further risk factor. Conclusions: These observations indicate that indiscriminate combinations of QTc-prolonging drugs do not necessarily result in additive QTc prolongation and suggest that QT prolongation caused by drug combinations strongly depends on the nature of the combination partners and individual drug exposure. Concurrently, it stresses the value of the AZCERT classification also for the risk prediction of combination therapies with QT-prolonging drugs

Off–label long acting injectable antipsychotics in real–world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study

Introduction: Information on the off–label use of Long–Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on– vs off–label LAIs and predictors of off–label First– or Second–Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method: In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off– or on–label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off–label group. Results: SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on– and off–label use. Approximately 1 in 4 patients received an off–label prescription. In the off–label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion: Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off–label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co–morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns