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OBJECTIVES Few data regarding follow-up of patients after COVID-19 discharge are available. We aim to describe the long-term outcomes of survivors of hospitalization for COVID-19 followed up first at an outpatient facility and subsequently by telephone. METHODS Observational prospective study conducted at a tertiary general hospital. Clinical and radiological progression was assessed and data recorded on a standardized reporting form. Patients were divided into three groups according to PaO2/FiO2 at hospitalization: PaO2/FiO2 > 300, PaO2/FiO2 300-200 and PaO2/FiO2 < 200. A logistic multivariate regression model was performed to identify factors associated with persistence of symptoms. RESULTS Facility follow-up: 302 patients were enrolled. Median follow-up was 45 days after discharge; 78% (228/294) of patients had COVID-19-related symptoms (53% asthenia, 56% respiratory symptoms) and 40% (122/302) had residual pulmonary radiographic lesions. PaO2/FiO2 300 was associated with resolution of chest radiographic lesions; OR = 0.56 (0.42 to 0.74), (p, Graphical abstract Image 1

Basal cell carcinoma (BCC) is locally aggressive and its prognosis depends on the risk of recurrence. The initial location of the tumor is a key criterion for calculating the risk of recurrence. The aim of this study was to evaluate the sites that appear to be most at risk of recurrence of BCC. All cases of BCC analyzed at the anatomopathology laboratory of the University Hospital of Montpellier for 1 year were retrospectively included. In case of recurrence on the same site, only carcinomas that had previously been completely removed were analyzed. Among 803 BCC, 37 (4.6%) were confirmed as recurrent, including 34 (92%) on the head. The locations statistically at higher risk of recurrence were the temporal and frontal/temporal areas (32.4%), the medial canthus and lower eyelid area (18.9%), the ala and tip of the nose (16.2%), and the ears (8.1%). The frontal/temporal regions appear to be an area of major interest in this series. A high risk of recurrence was confirmed in the periorificial locations for the ear, the nose, and periorbital area, but not for the perioral area. In addition, the entire nose did not appear to be at risk, only the tip and the ala.

Objetivo: Avaliar as percepções de profissionais da saúde sobre situações de erros de medicação associado a rotulagem. Métodos: Estudo transversal com 1.056 técnicos de enfermagem, enfermeiros e farmacêuticos entrevistados em 10 capitais brasileiras. Avaliamos a percepção dos participantes sobre a dificuldade em diferenciar ou ver as informações nos rótulos, a probabilidade de ocorrer um erro de medicação e a frequência de erros de medicação, incluindo: 1) frascos ou rótulos semelhantes; 2) duas embalagens do mesmo medicamento, mas com doses diferentes; 3) rótulos de ampolas; 4) rótulos das embalagens blister; e 5) etiquetas impressas nas embalagens secundárias. Resultados: A maioria dos participantes relatou ser difícil ou muito difícil diferenciar entre frascos idênticos (82,4%) e entre diferentes doses do mesmo medicamento (82,5%). A identificação de informações importantes sobre ampolas, blisters e embalagens secundárias foi considerada difícil ou muito difícil por 89,9%, 64,4% e 48,9% dos participantes, respectivamente. Aproximadamente metade dos participantes relatou que um erro era mais provável de ocorrer em situações envolvendo dificuldade em ver as informações em uma ampola, rótulos semelhantes e embalagens do mesmo medicamento, mas com doses diferentes. Conclusão: A dificuldade em pelo menos uma das situações que envolvem a identificação ou diferenciação dos rótulos dos medicamentos é comum entre os profissionais de saúde, levando a uma maior probabilidade de erros de medicação.

The third volume of The Cambridge History of Communism spans the period from the 1960s to the present, documenting the last two decades of the global Cold War and the collapse of Soviet socialism. An international team of scholars analyze the rise of China as a global power continuing to proclaim its Maoist allegiance, and the transformation of the geopolitics and political economy of Cold War conflict in an era of increasing economic interpenetration. Beneath the surface, profound political, social, economic and cultural changes were occurring in the socialist and former socialist countries, resulting in the collapse and transformations of the existing socialist order and the changing parameters of world Marxism. This volume draws on innovative research to bring together history from above and below, including social, cultural, gender, and transnational history to transcend the old separation between Communist studies and the broader field of contemporary history.

Radiological and orthopaedic outcome in severe and moderate haemophilia A and B patients undergoing long-term prophylactic treatment were prospectively investigated focusing on the age of onset of prophylaxis and the number of joint bleedings prior to treatment. We report on 21 patients with severe and moderate haemophilia A and B receiving prophylactic treatment of between 3.1 and 16.1 years duration. Three patient groups were evaluated according to the age at onset of prophylaxis. In group I (n = 8) prophylactic treatment was initiated in the first 2 years of life. Patients of group II (n = 6) received prophylaxis at the age of 3-6 years. Late-onset or secondary prophylactic treatment was started at the age of 6 years and above in 7 patients (group III). All patients received virus-inactivated F VIII or F IX concentrates at dosages of 30-40 IU, in some cases up to 50 IU/kg body weight i. v. three times per week for those with haemophilia A and twice per week for those with haemophilia B. Elbow, knee and ankle joints were investigated at 3-4 yearly intervals according to the radiological and orthopaedic scores recommended by the World Federation of Haemophilia (WFH). The total number of joint bleedings before and after start of prophylaxis were recorded in all patients. In group I 7 out of 8 patients had unaffected joints with constant radiological and orthopaedic scores of zero or 1, after a median of 11.25 years of prophylactic treatment. One patient in this group demonstrated mild radiological alterations (score 4). Patients of group II showed neither radiological nor orthopaedic alterations at study entry. Worsening joint scores could be detected despite ongoing prophylaxis after the 3-year interval (median orthopaedic score 4, median radiological score 8). Treatment group III already showed considerable joint damage at study entry with a median radiological score of 11 (0-33) and a median orthopaedic score of 4 (0-11). Despite prophylactic treatment both, orthopaedic (median 8, range 2-12) and radiological scores (median 19.5, range 2-47) deteriorated after 3 years. Prior to onset of prophylaxis no or only one joint bleeding occurred in treatment group I. In group II, a median of 6 joint bleeds (range 1-8) were reported before prophylaxis was started. Patients of group III usually experienced a median of more than 10 joint haemorrhages (range 6-10 or more). Under prophylactic treatment the number of joint bleedings decreased significantly in groups II and III. However, radiological and orthopaedic scores increased as a sign of progressing osteoarthropathic alterations in patients reporting more than 6 joint haemorrhages before onset of prophylaxis whereas no joint alterations could be assessed in patients with no or only one joint bleeding episode prior to prophylaxis. Even a small number of joint bleedings seems to cause irreversible osteoarthropathic alterations leading to haemophilic arthropathy. Once apparent, further progression of joint damage could not be arrested despite of prophylactic treatment (group II and III). In order to prevent haemophilic arthropathy, effective prophylaxis should be started before or at least after the first joint bleeding in severe haemophilia A and B.

Resumen: El tumor inflamatorio de Pott es una complicación infrecuente de la sinusitis frontal caracterizada por tumefacción y edema en la frente por absceso subperióstico secundario a osteomielitis del hueso frontal. Complicaciones añadidas son: celulitis por extensión a la órbita e infección intracraneal por extensión posterior asociando alto riesgo de meningitis, absceso intracraneal y trombosis del seno venoso. Un diagnóstico temprano y un tratamiento intensivo médico y quirúrgico son esenciales para una óptima recuperación de los pacientes afectados. En la era antibiótica es extremadamente infrecuente, habiéndose descritos muy pocos casos en la bibliografía reciente.Presentamos un caso de tumor inflamatorio de Pott en un varón de 7 años que, como complicación de una pansinusitis aguda, presenta tumefacción frontal con celulitis preseptal y afectación intracraneal con trombosis de venas oftálmica y orbitaria superior y absceso epidural frontal con extensión hasta espacio subaracnoideo. Abstract: Pott's puffy tumor is a rare complication of frontal sinusitis characterized by swelling and edema in the brow due to a subperiosteal abscess associated with frontal osteomyelitis. Added complications are cellulitis by extension to the orbit and intracranial infection by posterior extension, with high risk of meningitis, intracranial abscess, and venous sinus thrombosis. Early diagnosis and aggressive medical or surgical treatment are essential for optimal recovery of affected patients. In the antibiotic age it is extremely rare, with very few cases described in the recent literature.A case is presented of a Pott inflammatory tumor in a 7 year-old boy, as a complication of acute pansinusitis who presented with front preseptal swelling and intracranial involvement with thrombosis of ophthalmic and superior orbital veins and frontal epidural abscess extending to the subarachnoid space.

Resume Introduction La fievre Q aigue est une affection proteiforme, parfois responsable de manifestations neurologiques centrales ou meningees et exceptionnellement de neuropathies avec moins de 15 cas rapportes dans la litterature. Observation Nous presentons une observation de polyradiculonevrite aigue severe satellite d’une fievre Q aigue, d’evolution favorable apres traitement antibiotique et immunoglobulines intraveineuses (IgIV). Conclusion En cas de polyradiculonevrite aigue atypique par l’existence d’un syndrome infectieux, de cephalees et de troubles neuro-ophtalmologiques, la serologie de Coxiella burnetii doit etre realisee meme en l’absence d’exposition animale, car la fievre Q requiert un traitement antibiotique et une surveillance serologique specifiques.

Duchenne muscular dystrophy (DMD) is an X-linked muscle disorder characterized by progressive and irreversible loss of muscular function. As muscular disease progresses, the repair mechanisms cannot compensate for cellular damage, leading inevitably to necrosis and progressive replacement by fibrous and fatty tissue. Cardiomyopathy and respiratory failure are the main causes of death in DMD. In addition to the well-described muscle and heart disease, cognitive dysfunction affects around 30% of DMD boys. Myocardial fibrosis, assessed by late gadolinium enhancement (LGE), using cardiovascular magnetic resonance imaging (CMR), is an early marker of heart involvement in both DMD patients and female carriers. In parallel, brain MRI identifies smaller total brain volume, smaller grey matter volume, lower white matter fractional anisotropy and higher white matter radial diffusivity in DMD patients. The in vivo brain evaluation of mdx mice, a surrogate animal model of DMD, showed an increased inorganic phosphate (P(i))/phosphocreatine (PCr) and pH. In this paper, we propose a holistic approach using techniques of magnetic resonance imaging, spectroscopy and diffusion tensor imaging as a tool to create a “heart and brain imaging map” in DMD patients that could potentially facilitate the patients’ risk stratification and also future research studies in the field. © 2017 Stichting European Society for Clinical Investigation Journal Foundation

Melanoma is the deadliest skin cancer. RACK1 (Receptor for activated protein kinase C) protein was proposed as a biological marker of melanoma in human and domestic animal species harboring spontaneous melanomas. As a scaffold protein, RACK1 is able to coordinate the interaction of key signaling molecules implicated in both physiological cellular functions and tumorigenesis. A role for RACK1 in rewiring ERK and JNK signaling pathways in melanoma cell lines had been proposed. Here, we used a genetic approach to test this hypothesis in vivo in the mouse. We show that Rack1 knock-down in the mouse melanoma cell line B16 reduces invasiveness and induces cell differentiation. We have developed the first mouse model for RACK1 gain of function, Tyr::Rack1-HA transgenic mice, targeting RACK1 to melanocytes in vivo. RACK1 overexpression was not sufficient to initiate melanomas despite activated ERK and AKT. However, in a context of melanoma predisposition, RACK1 overexpression reduced latency and increased incidence and metastatic rate. In primary melanoma cells from Tyr::Rack1-HA, Tyr::NRas

Human mutations of the GRID1 gene encoding the orphan delta1 glutamate receptor-channel (GluD1) are associated with schizophrenia but the explicit role of GluD1 in brain circuits is unknown. Based on the known function of its paralog GluD2 in cerebellum, we searched for a role of GluD1 in slow glutamatergic transmission mediated by metabotropic receptor mGlu1 in midbrain dopamine neurons, whose dysfunction is a hallmark of schizophrenia. We found that an mGlu1 agonist elicits a slow depolarizing current in HEK cells co-expressing mGlu1 and GluD1, but not in cells expressing mGlu1 or GluD1 alone. This current is abolished by additional co-expression of a dominant-negative GluD1 dead pore mutant. We then characterized mGlu1-dependent currents in dopamine neurons from midbrain slices. Both the agonist-evoked and the slow postsynaptic currents are abolished by expression of the dominant-negative GluD1 mutant, pointing to the involvement of native GluD1 channels in these currents. Likewise, both mGlu1-dependent currents are suppressed in GRID1 knockout mice, which reportedly display endophenotypes relevant for schizophrenia. It is known that mGlu1 activation triggers the transition from tonic to burst firing of dopamine neurons, which signals salient stimuli and encodes reward prediction. In vivo recordings of dopamine neurons showed that their spontaneous burst firing is abolished in GRID1 knockout mice or upon targeted expression of the dominant-negative GluD1 mutant in wild-type mice. Our results de-orphanize GluD1, unravel its key role in slow glutamatergic transmission and provide insights into how GRID1 gene alterations can lead to dopaminergic dysfunctions in schizophrenia.

Summary Mucormycosis infections are rare in France, and are caused by fungi of the class Zygomycetes, order Mucorales. The prognosis of these emergent pathologies remains severe. We report a case of a 44-year-old man, who has been admitted to the Emergency Care Unit, for a fly-away acute sinusitis resistant to antibiotic treatment. Biological parameters revealed a diabetic ketoacidosis. On day 2 after admission, ocular dysfunctions happened. An ethmoido-oculo-cerebral lesion was revealed by a cerebral MRI, suggesting a mucormycosis infection. Isolation of Rhizopus orizae was performed by a surgical histologic biopsy. Mucormycosis agents of are ubiquitary. Rhino-cerebral lesions are the most common clinical manifestations. Diabetic ketoacidosis and hematologic malignancies are respectively the two higher risk factors of mucormycosis development. This angioinvasive fungal infection induces more than a 50 % rate mortality despite the first surgical-line therapy. To conclude, a global therapeutic care and a complete knowledge of this varied clinical fungi infection must be controlled. The actual incidence of diabetes is increased, thus a mucormycosis infection must be evoked in non-responsive head and neck infections.

Myelodysplastic syndrome with erythroid hypoplasia or erythroblastopenia has not yet been clearly defined, and in most patients it is mistaken for acquired pure red cell aplasia. Including one additional patient reported in this article, a literature review revealed only 50 cases over the last 20 years. These patients were predominantly elderly males, all required regular packed red cell transfusions, and they had a poor prognosis, mainly because of acute transformation. The mechanisms of erythroid aplasia remain unclear. However, recent data suggest the association of an intrinsic stem cell defect with immunological implication.

Resumen Objetivo: Evaluar la relevancia clinica de modificar el criterio diagnostico de enfermedad pulmonar obstructiva cronica (EPOC) utilizando el limite inferior de la normalidad (LIN) en una cohorte de pacientes diagnosticados de EPOC. Material y metodos: La poblacion de estudio se recluto entre pacientes previamente diagnosticados de EPOC por criterio GOLD y con un seguimiento previo por el medico responsable superior a un ano. Resultados: Cuando la EPOC se definio por criterio LIN se identificaron pacientes con mayor repercusion clinica y funcional que cuando se utilizo el criterio GOLD. Los pacientes con EPOC por criterio LIN presentaban valores significativamente mas bajos de volumen espiratorio forzado en el primer segundo (FEV1) sobre la capacidad vital forzada (FVC) FEV1/FVC: 0,52 (0,9) frente a 0,67 (0,2), p = 0,000; de FEV1: 49,5% (16,5) frente a 62% (14,2), p = 0,0000; de FVC 69,4 (18,7) frente a 73,3, p = 0,04; mayor grado de disnea valorada mediante la escala del Medical Research Council (MRC) 2,98 (1,1) frente a 2,67 (1,12), p = 0,003; un mayor numero de exacerbaciones anuales 2,32 (1,5) frente a 1,84 (0,9), p = 0,001; mas visitas a Urgencias 2,17 (1,6) frente a 1,45 (0,74), p = 0,001; y mas ingresos hospitalarios 1,75 (1,2) frente a 1,1 (80,4), p = 0,005. Sin embargo, los pacientes no incluidos como EPOC por el criterio LIN presentaron grados clinicamente relevantes de disnea y un elevado consumo de recursos sanitarios. Utilizando el criterio del LIN para establecer el diagnostico, la EPOC no se asocio con un incremento del riesgo cardiovascular, cerebrovascular ni del riesgo de enfermedad vascular periferica. Conclusiones: El uso del LIN como criterio para establecer el diagnostico de EPOC, frente al criterio GOLD, excluye un elevado numero de pacientes con repercusion clinica y con un elevado consumo de recursos sanitarios. El uso de este criterio no proporciona informacion adicional a la hora de establecer una posible relacion entre EPOC y enfermedad vascular.

The Zarit Caregiver Burden Scale, translated and validated into Spanish, is sensitive to the application of a Psychoeducational Intervention Program (PIP) for the prevention and reduction of burden in caregivers of Alzheimer's disease (AD) patients (EDUCA study). The data obtained in EDUCA was used to reanalyse its psychometric properties and the cut-off points of the Zarit scale.The scale was administered to 115 caregivers of patients with AD who were randomised to receive a PIP or standard care for four months. Internal reliability and a factorial analysis of principal components were assessed, and the impact of PIP on each of the subscales was evaluated. A cut-off point was defined for the Zarit scale to identify the caregivers most sensitive to receiving a PIP.A good internal reliability (Cronbach alpha coefficient of 0.92) was obtained, with three principal components (burden, competency and dependence) explaining 54.75% of the variance. The application of PIP showed statistically significant differences versus standard care for the dependence subscale (p = 0.0082) (p = 0.062 for the burden scale). The Zarit scale cut-off points which combine better sensitivity and specificity were 56/57 and 59/60, for the 5/6 and 6/7 cut-off points of the General Health Questionnaire (GHQ-28) scale, respectively.This study confirms the good psychometric properties of the Zarit scale found in previous studies. The dependence component appeared to be most influenced by the application of a PIP in the clinical trial. Caregivers with a Zarit scale score of 60 or more benefit most from the PIP.

Resume L’enjeu de cette etude est d’integrer une demarche de gestion des risques a une structure d’achat de dispositifs medicaux. La raison d’etre et les criteres de succes pour la mise en œuvre d’une telle demarche y sont explicites. L’objectif etant de proposer une methode generale et adaptable a toute organisation biomedicale. Les outils utilises y sont detailles (analyse, evaluation, et maitrise du risque au cours de notre processus achat).

The spontaneous evolution of the structures obtained by submonolayer deposition of Ni on Cu(1 1 1) at room temperature has been studied by scanning tunnelling microscopy. The growth of an additional Cu plane on top of Ni-rich monolayer (ML) islands, and the simultaneous development of a characteristic electron standing wave pattern, have been observed in real time. From these observations we could derive the composition of the surface plane of the two kinds of bilayer islands that coexist in the deposit. A simple nucleation model is presented to explain the different evolution of pure and partially covered ML islands.

We report a 49-year-old man suffering from chronic hypereosinophilia whose biological tests revealed a gene rearrangement between FIP1L1 and PDGFRA as well as a T-cell clonality. After 1 year of therapy with imatinib mesylate (100 mg daily), the patient was clinically asymptomatic, the fusion transcript was undetectable using RTQ-PCR and no lymphoproliferative disorders occurred. This unique combination raises the question of the physiopathology of such a grey zone hypereosinophilia and their management.

Resume Le syndrome d’activation macrophagique (SAM) est un syndrome immunologique rare, d’evolution rapidement fatale en l’absence de traitement. Si les lymphomes sont des causes classiques de SAM, l’association a un lymphome de Hodgkin est exceptionnelle. Nous rapportons l’observation d’un homme de 79 ans chez qui le diagnostic de SAM revelait un lymphome de Hodgkin d’issue fatale. Nous discutons l’interet des dosages du sCD25 et de l’interleukine 18 lorsque le diagnostic est difficile, ainsi que les donnees recentes sur le SAM associe a un lymphome de Hodgkin.

ObjetivoComparar la nitroglicerina transdérmica (NTG) con las infiltraciones en las tendinitis del manguito de los rotadores (TMR).DiseñoEstudio experimental con asignación aleatoria y controlada de individuos.EmplazamientoÁrea básica semirrural, en la comarca del Garraf (Barcelona), con una población asignada de 12.000 habitantes.Pacientes y métodosPacientes diagnosticados de TMR de menos de 6 semanas de evolución que no hubiesen respondido a tratamiento con AINE por vía oral. Los pacientes se distribuyeron aleatoriamente en 2 grupos: a) grupo A: infiltración local por vía posterior con corticoide depot y anestésico local, y b) grupo B: parche de 5 mg de NTG durante 3 días.Mediciones principalesSe valoraron edad, sexo, dolor (medido con la escala analógica visual) y efectos adversos. Si la respuesta era parcial, se repitió el mismo tratamiento hasta un máximo de 3 veces, con intervalos de 15 días y se realizó un control a los 7–10 días del tratamiento, considerando mejoría total la disminución del dolor más de 5 puntos en la EVA, mejoría parcial la disminución en 3–5 puntos y fracaso si no existía mejoría del dolor o bien disminuía en menos de 3 puntos.ResultadosSe incluyeron 48 pacientes, 33 mujeres (69%) y 15 varones (31%) con una edad media de 61 años. En el grupo A obtuvieron mejoría total (MT) 19 pacientes, 3 lograron mejoría parcial (MP) y sólo hubo 2 fracasos. En el grupo B presentaron MT 5 pacientes, otros 5 mostraron MP y en 14 fracasó el tratamiento, con diferencias estadísticamente significativas al comparar los 2 grupos. En cuanto a efectos adversos, 4 pacientes del grupo A presentaron dolor leve en la zona de punción y 15 personas del grupo B tuvieron cefalea (8 de los casos abandonaron el tratamiento debido a ello).ConclusiónEl tratamiento con la NTG no es una clara alternativa a las infiltraciones en las TMR, dado que no es un tratamiento más efectivo y, por el contrario, hay un mayor número de pacientes con efectos adversos que deben abandonar el tratamiento.AimsTo compare transdermal nitroglycerin (NTG) and corticosteroid infiltration in patients with rotator cuff tendinitis (RCT).DesignExperimental, randomized controlled study.SettingSemirural basic health area in the Garraf region of Barcelona province, Spain, with a population of public heath service users of 12000.Patients and methodsPatients diagnosed as having RCT of less than 6 weeks’ evolution who had not responded to treatment with oral nonsteroid antiinflammatory drugs. The patients were distributed randomly into two groups: a) group A, local infiltration via a posterior approach with a depot corticosteroid and local anesthesia, and b) group B, treated for 3 days with a 5-mg NTC patch.Main measuresAge, sex, pain (measured with an analog visual scale) and adverse events. In patients who showed a partial response, treatment was repeated up to 3 times at 15-day intervals. Pain was tested after 7–10 days of treatment. Complete improvement was considered a reduction in pain of more than 5 points on the analog visual scale; partial improvement was considered a reduction of 3–5 points, and treatment failure was recorded when there was no improvement in pain or when there was a decrease of less than 3 points.ResultsA total of 48 patients were included; 33 (69%) were women and 15 (31%) were men. Mean age was 61 years. In group A, complete improvement was seen in 19 patients and partial improvement in 3; treatment failed in 2 patients. In group B complete improvement was seen in 5 patients, partial improvement in 5, and failure of treatment in 14. The difference between groups was statistically significant. Adverse events were mild pain at the injection site in 4 patients from group A, and headache in 15 patients from group B, 8 of whom abandoned treatment for this reason.ConclusionTreatment with NTG is not a clear alternative to infiltration of corticosteroids in patients with RCT, because of its lack of effectiveness and because of the greater number of patients who had adverse events that lead them to abandon treatment.

Objetivos: Analizar la respuesta al tratamiento con calcitonina en la hipercalcemia por inmovilización en niños críticamente enfermos. Pacientes y métodos: Se incluyeron en el estudio 4 niños de edades comprendidas entre 3 y 14 años con hipercalcemia por inmovilización, con calcemia previa entre 12,2 y 13,4 mg/dl, y calcio iónico entre 1,44 y 2,2 mmol/l, que no respondieron a tratamiento con hiperhidratación y furosemida. Se realizó tratamiento con calcitonina subcutánea y/o intranasal, en dosis de 6 a 20 U/kg/día. Resultados: Tras el tratamiento con calcitonina se consiguió un descenso progresivo del calcio, normalizándose los valores de calcemia (8,6 a 10,5 mg/dl) entre los 4 y 20 días de tratamiento. No se observaron efectos secundarios al tratamiento. No se produjeron alteraciones en los valores de fósforo ni fosfatasa alcalina durante el tratamiento. Conclusión: La calcitonina puede ser un tratamiento efectivo en los niños críticamente enfermos con hipercalcemia por inmovilización. : Objectives: To evaluate the response to calcitonin treatment in critically ill children with hypercalcemia due to immobilization. Patients and methods: Four children aged 3–14 years were diagnosed with hypercalcemia due to immobilization. Detected levels of calcemia and ionic calcium ranged from 12.2–13.4 mg/dl and 1.44–2.2 mmol/l respectively. None of the children responded to rehydration or frusemide. Treatment was with subcutaneous and/or intranasal calcitonin at a dose of 6–20 IU/kg/day. Results: After calcitonin administration, serum calcium decreased progressively until normal calcemia levels were reached between days 4 and 20 of treatment (8.6–10.5 mg/dl). No treatment-related adverse effects or alterations in phosphorus levels or alkaline phosphatases were observed. Conclusions: Calcitonin might be an effective treatment for hypercalcemia due to immobilization in critically ill children.

The aim of the present study was to evaluate in HIV-positive patients with bacterial pneumonia, the diagnostic value of a new endoscopic technique that uses a single catheter to perform a telescopic plugged catheter (TPC) followed by a modified protected bronchoalveolar lavage (mpBAL). Fifty-eight HIV-positive patients with respiratory infection were included in the study. Samples from TPC and mpBAL were cultured quantitatively. Standard bronchoalveolar lavage was performed to rule out opportunistic infections. According to the clinical and microbiological results, patients were classified in the study group (27 with bacterial pneumonia) or the control group (31 without bacterial pneumonia). Sensitivity of TPC was 56% [95% confidence intervals (CI) 37–75%] and its specificity was 100%; these figures were 56% (CI, 37–75%) and 94% (CI, 86–100%) for mpBAL. When both techniques were assessed together, sensitivity increased to 70% (CI, 53–87%). The use of a single catheter reduced the cost of the originally described pBAL procedure by approximately 50%. The use of a single catheter to perform a TPC followed by a mpBAL can improve the diagnostic yield in HIV-positive patients with bacterial pneumonia, and reduces its cost.

Pott's puffy tumor is a rare complication of frontal sinusitis characterized by swelling and edema in the brow due to a subperiosteal abscess associated with frontal osteomyelitis. Added complications are cellulitis by extension to the orbit and intracranial infection by posterior extension, with high risk of meningitis, intracranial abscess, and venous sinus thrombosis. Early diagnosis and aggressive medical or surgical treatment are essential for optimal recovery of affected patients. In the antibiotic age it is extremely rare, with very few cases described in the recent literature. A case is presented of a Pott inflammatory tumor in a 7 year-old boy, as a complication of acute pansinusitis who presented with front preseptal swelling and intracranial involvement with thrombosis of ophthalmic and superior orbital veins and frontal epidural abscess extending to the subarachnoid space.

This investigation evaluates, in a prospective, randomized and controlled manner, whether noninvasive ventilatory support (NIVS) with bilevel positive airway pressure (BiPAP) facilitates recovery from acute respiratory failure (ARF) in patients with chronic obstructive pulmonary disease (COPD). Twenty four patients (mean age (+/-SEM) 68 +/- 2 yrs) with COPD (forced expiratory volume in one second (FEV1) at discharge 33 +/- 2% predicted), who attended the emergency room because of ARF (pH 7.33 +/- 0.01; arterial oxygen tension (Pa,O2) 6.0 +/- 0.2 kPa; arterial carbon dioxide tension (Pa,CO2) 7.9 +/- 0.3 kPa), were initially randomized. Four out of the 14 patients (29%) allocated to received NIVS did not tolerate it. Of the remaining 20 patients, 10 received NIVS with BiPAP in a conventional hospital ward during the first 3 days of hospitalization (two daytime sessions of 3 h duration each). All 20 subjects were treated with oxygen, bronchodilators and steroids. On the first and third hospitalization days, before and 30 min after withdrawing oxygen therapy and/or BiPAP ventilatory support, we measured peak expiratory flow, arterial blood gas values, ventilatory pattern, occlusion pressure (P0.1), and maximal inspiratory (MIP) and maximal expiratory (MEP) pressures. All patients were discharged without requiring tracheal intubation and mechanical ventilation. Hospitalization time was similar in both groups (11.3 +/- 1.3 vs 10.6 +/- 0.9 days, control vs BiPAP, respectively). Arterial oxygenation, respiratory acidosis and airflow obstruction improved significantly throughout hospitalization in both groups. By contrast, the ventilatory pattern, P0.1, MIP and MEP did not change. NIVS with BiPAP did not cause any significant difference between groups. We conclude that noninvasive ventilatory support with bilevel positive airway pressure does not facilitate recovery from acute respiratory failure in patients with chronic obstructive pulmonary disease. Furthermore, a substantial proportion of patients (29%) do not tolerate noninvasive ventilatory support under these circumstances. From these results, we cannot recommend the use of noninvasive ventilatory support with bilevel positive airway pressure in the routine management of chronic obstructive pulmonary disease patients recovering from acute respiratory failure.

La production d'exces d'enthalpie dans le systeme Pd/LiOD, ainsi que pour les alliages du palladium dependrait du protocole experimental et celle-ci serait due a un feed-back positif. Nous decrivons ce protocole et nous donnons une interpretation du feed-back positif. Le developpement de l'etude conduisant a l'obtention de taux specifiques de production d'exces d'enthalpie de ? 4 kW cm -3 , est illustre jusqu'aux temperatures de ? 100 °C (c. a d. de chaleur de basse temperature)

Answer: Cyclospora cayetanensis. Cyclospora cayetanensis is an intestinal coccidian protozoon that has emerged as a significant human infectious agent worldwide, causing self-limiting gastroenteritis in immunocompetent hosts. Human-to-human spread of the parasite occurs indirectly via the environment through oocysts in contaminated water, food, or soil. The parasite has a cosmopolitan distribution and is endemic in tropical and subtropical areas (3). The parasite is commonly limited to travelers to Latin America, the Indian subcontinent, and Southeast Asia, including China (4); therefore, infection with Cyclospora cayetanensis is known as traveler's diarrhea (5). Cyclospora cayetanensis is an important cause of waterborne and food-borne outbreaks due to imported fruits and vegetables from developing countries. The underreporting of infection with this parasite likely occurs because standard examinations for ova and parasites may not include the identification of Cyclospora oocysts. This oversight is at least partly due to the lack of awareness of this disease among the public and medical workers (1). The following criteria have been established for the diagnosis of cyclosporiasis (by the CDC in 1997): detection of oocysts in stool, intestinal fluid, or small bowel biopsy specimens by microscopic examination; demonstration of oocyst sporulation; and detection by molecular methods (not a routine parasitology screening tool) (2). Cyclospora cayetanensis oocysts are spherical and between 8.0 and 10 μm in diameter, with a 50-nm-thick wall and an outer threadlike coat, which is referred to as a wrinkle by some researchers (see Fig. 1a and b in the photo quiz). Diagnostic tests also include phase-contrast microscopy, modified acid-fast staining with variable staining (from pale to red) (see Fig. 1c and d in the photo quiz), and autofluorescence with UV illumination. Ova and parasite exams typically include only direct and concentrated microscopic exams and trichrome stains without modified acid-fast staining or autofluorescence testing. Multiple stool specimens collected on subsequent days are required because parasites are shed intermittently. Of note, two of our patient's specimens were positive, and one was negative. The treatment for Cyclospora infection is a 7-day course of oral trimethoprim-sulfamethoxazole, which proved to be effective for our patient. Health care providers should evaluate Cyclospora infection in patients presenting long-lasting diarrheal illness and order the appropriate tests for this parasite. (See page 3821 in this issue [doi:10.1128/JCM.00256-12] for photo quiz case presentation)

A 43-year-old man presented to our hospital with a 15-day history of watery diarrhea. He did not report any unusual medical history except for multiple stays in Southeast Asia, including China, where he ate local and fresh food products. He had symptoms of gastroenteritis with watery diarrhea, loss

Q fever is a polymorphic disease, which can induce neurological disturbances. The central nervous system is mainly involved while peripheral neuropathies are rare with less than 15 cases reported in the literature.We report here a case of acute polyradiculoneuritis associated with acute Q fever, with favorable outcome after antibiotic and intravenous immunoglobulin therapies.Serologic tests for Coxiella burnetii should be performed in case of unusual polyradiculoneuritis with fever, headache and neuro-ophthalmologic disorders, even when environmental exposure is lacking, because Q fever requires specific antibiotic treatment and serological follow-up.

Background: Mycophenolate (MF) is effective as induction therapy for lupus nephritis (LN) in patients with normal renal function; however, little is known about its role in patients with impaired renal failure. The purpose of this study was to evaluate the response to MF in LN and its association with baseline renal function. Methods: Data were obtained for 90 patients from 12 Spanish renal units who were receiving MF as induction therapy for LN. Patients were classified into 2 groups: group 1 (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m2) and group 2 (eGFR 2). The primary outcome measure was the percentage of patients who achieved any response and its relationship with initial eGFR. The secondary outcome measures were the percentage of patients who achieved a complete response (CR) or partial response (PR) and the appearance of relapses during treatment and side effects. Results: At initiation of MF treatment, there were no differences in the main parameters between group 1 (n = 63; eGFR 87 ± 23 ml/min/ 1.73 m2) and group 2 (n = 27; eGFR 44 ± 12 ml/min/1.73 m2). Exposure to prednisone and MF was similar. The percentages of patients who achieved a response in groups 1 and 2 were, respectively, 69.2 and 43.8% at 6 months and 81.3 and 73.7% at 12 months. CR was more frequent in group 1, whereas PR was similar in both groups. Four patients relapsed and side effects were unremarkable. Conclusions: MF is effective and safe as induction therapy for LN, and response is even achieved in patients with baseline renal impairment.

In patients with short bowel syndrome (SBS), the carbohydrate overload to the colon may disturb the normal pattern of colonic fermentation with production of D-lactic acid and subsequent development of a metabolic D-lactic acidosis. We measured D-lactic acid in blood, urine, and feces, as well as the composition of fecal water and fecal reducing substances from 11 patients with SBS, comparing the results with those from normal subjects. The fecal water from patients with SBS was characterized by low pH, potassium, and volatile fatty acids, high osmotic gap, and high concentration of L- and D-lactic acid. Five of 11 had abnormal amounts of fecal reducing substances. Fecal D-lactic acid was increased in nine of 11 patients. However, none of these patients showed D-lactic acid in urine, and only one had a very low concentration in plasma. These results show that D-lactic acid was overproduced in the colon of most of the patients with SBS. However, other factors such as absorption or impaired D-lactic acid metabolism may be necessary for a plasmatic increase of D-lactic acid.

Questionnaires are frequently used for measuring physical activity. The aim of this study was to validate the Spanish version of the Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ) in Spanish men. Healthy men (n = 187) aged 20-60 years were recruited. The MLTPAQ was administered to assess the quantity (total activity metabolic index) and quality (heavy, moderate, and light) of physical activity performed in the last year, quarter, month, and week. Fitness was assessed with an exercise test. Spearman's correlation coefficients between the total activity metabolic index and exercise test duration, time to maximal theoretical heart rate, and caloric intake were 0.57, 0.46, and 0.40, respectively. The intraclass correlation coefficients between the total activity metabolic indexes in the last year and in the last quarter, month, and week were 0.62, 0.46, and 0.35, respectively. In multiple linear regression, the heavy, moderate, and light activity metabolic index, age, body mass index, and basal heart rate explained 40% of the variability of time to the maximum theoretical heart rate. The Spanish version of the MLTPAQ is a valid instrument to measure the quantity and quality of physical activity performed in the last year (also in periods shorter than 1 year) by Spanish men aged 20-60 years. Only heavy physical activity is related to cardiorespiratory fitness.

We reply to the critique by Morrison [Phys. Lett. A 185 (1994) 498] of our paper [Phys. Lett. A 176 (1993) 118]. Apart from this general classification of our experiments into stages 1–5, we find that his comments are either irrelevant or inaccurate or both.

We review some of the key facts in the phenomenology of Pd-hydrides usually referred to as «cold fusion». We conclude that all theoretical attempts that concentrate only on few-body interactions, both electromagnetic and nuclear, are probably insufficient to explain such phenomena. On the other hand we find good indications that theories describing collective, coherent interactions among elementary constituents leading tomacroscopic quantum-mechanical effects belong to the class of possible theories of those phenomena.

Trophic effects of 17β-estradiol (βE2) on in vitro developing hypothalamic cells have been reported. Insulin-like growth factor I (IGF-I) is also a potent trophic factor for cultured hypothalamic cells. An interaction between sexual steroids and insulin-like growth factors (IGFs) in modulating growth of hypothalamic cells has been suggested. Thus, we tested whether βE2 modulates the levels of IGF-I, its membrane receptor and its binding proteins in rat hypothalamic culturs. Using both neuron- and glial-enriched cultures obtained from fetal rat hypothalami we found that addition of βE2 elicited a significant increase in IGF-I receptor levels in neurons, without affecting its affinity. On the other hand, the three different IGF-binding proteins (IGFBPs) found in the conditioned medium of the cultures were differentially modulated by βE2 in the two types of cells studied. Overall, neuronal cultures produced greater amounts of IGFBPs after treatment with βE2, with IGFBP2 reaching significantly higher levels. On the contrary, treatment with βE2 did not significantly alter the amounts of IGFBPs produced by glial cells. Finally, the levels of immunoreactive IGF-I found either in the medium or in cellular extracts in both neuronal and glial cultures were not modified by treatment with βE2. These results strongly support previous observations of a trophic synergistic interaction between IGFs and βE2 on hypothalamic cells. Thus, an increase in IGF-I receptors and/or IGFBPs after exposure to βE2 may result in an enhanced response of hypothalamic neurons to IGF-I. Further, the present findings strengthen our recent observation that the effects of βE2 on hypothalamic glial cells are neuronally mediated, since IGF-I receptors and IGFBPs are modulated by this sex hormone in neurons, but not in glial cells.