Thermosensitive/thermochromic silicone and infrared thermography mapping in 60 consecutive cases of epilepsy surgery

Background

Epilepsy surgery represents a therapeutic opportunity for those patients who do not respond to drug therapy. However, an important challenge is the precise identification of the epileptogenic area during surgery. Since it can be hard to delineate, it makes it necessary to use auxiliary tools as a guide during the surgical procedure. Electrocorticography (ECoG), despite having shown favorable results in terms of reducing post-surgical seizures, have certain limitations. Brain mapping using infrared thermography mapping and a new thermosensitive/thermochromic silicone (TTS) in epilepsy surgery has introduced a new resource of noninvasive and real-time devices that allow the localization of irritative zones.

Methods

Sixty consecutive patients with drug-resistant epilepsy with surgical indications who decided to participate voluntarily in the study were included in the study. We measured brain temperature using two quantitative methods and a qualitative method: the TTS sheet. In all cases, we used ECoG as the gold standard to identify irritative areas, and all brain tissue samples obtained were sent to pathology for diagnosis.

Results

In the subgroup in which the ECoG detected irritative areas (n = 51), adding the results in which there was a correlation with the different methods, the efficiency obtained to detect irritative areas is 94.11% (n = 48/51, P ≤ 0.0001) while the infrared thermography mapping method independently has an efficiency of 91.66% (P ≤ 0.0001). The TTS has a sensitivity of 95.71% and a specificity of 97.9% (P ≤ 0.0001) to detect hypothermic areas that correlate with the irritative zones detected by ECoG. No postoperative infections or wound dehiscence were documented, so the different methodologies used do not represent an additional risk for the surgical proceedings.

Conclusion

We consider that the infrared thermography mapping using high-resolution infrared thermography cameras and the TTS are both accurate and safe methods to identify irritative areas in epilepsy surgeries.

Determinación de intersecciones probabilísticas relacionadas con daño cerebral adquirido a partir de la determinación de probabilidades a priori y a posteriori

BACKGROUND

The acquired brain damage is a common neurological disorder.

OBJECTIVE

Determine the probabilistic intersections of variables related to acquired brain damage from the determination of a priori and a posteriori probabilities.

METHOD

Analytical retrospective study. A descriptive analysis was carried out, confidence intervals were calculated to obtain the mean and the proportion with α = 0.05 considering the age of the patient and the diagnosis. An analysis of probabilistic intersection, a priori and a posteriori probability was performed considering diagnosis, sex and age decade; finally, chi squared was calculated.

RESULTS

736 patients were analyzed. The most frequent diagnosis was language disorder. The patients diagnosed with memory disorder were the youngest and those diagnosed with degenerative cognitive disorder the oldest. The probability that a patient with sequelae due to acquired brain damage arrives at the hospital, at the language pathology service, to be diagnosed with a language disorder and that this patient is also a man is 29.06%.

CONCLUSIONS

The high prevalence of short and long-term disability generated by acquired brain damage highlights the importance of an early and timely detection and diagnosis so that it favors prompt and efficient specialized care.

Face mask and protective eyewear-associated headache among healthcare workers during the COVID-19 pandemic

OBJECTIVE

The objective of this study was to investigate the prevalence, clinical features, and factors related to personal protective-associated headaches.

METHODS

We conducted a cross-sectional study among healthcare workers using an online questionnaire.

RESULTS

We surveyed 305 participants. The N95 face-mask was the most used device by 93%. Of 305 respondents, 206 experienced headaches while wearing protective equipment; 36.06% suffered from a headache disorder before the pandemic. The prevalence of de novo headache was 39.01%. Gender, age, or exposure to coronavirus disease were not determining factors to develop headache. Headache intensity was higher in front-line healthcare workers and was correlated (r = 0.728) with the time wearing protective equipment. The more days per month the participants wore personal protective equipment the shorter the time to headache onset after donning equipment.

CONCLUSION

Our study confirms the relationship between frequent and prolonged use of protection devices with headaches and reaffirms the implication of external pressure as a primary mechanism.

Clinical and sociodemographic findings in a cohort of 4632 pediatric patients with language, speech and learning disorders

OBJETIVO

Describir y analizar aspectos clínicos y sociodemográficos de una cohorte de pacientes con trastornos del lenguaje, del habla y del aprendizaje.

MÉTODO

Estudio retrospectivo descriptivo. Se seleccionaron expedientes de 4632 pacientes (años 2011 a 2015). Se calcularon medias, desviaciones estándar, porcentajes y frecuencias, Con la finalidad de evaluar si existía diferencia significativa entre variables se utilizó la prueba de ji al cuadrado y se realizó un análisis de probabilidad condicional entre las variables para obtener la probabilidad a priori y a posteriori.

RESULTADOS

Los trastornos del lenguaje, del habla y del aprendizaje se presentaron con mayor frecuencia en el sexo masculino, con 3358 pacientes (72.5%). El diagnóstico más frecuente fue el trastorno del lenguaje, diagnosticado en 2924 pacientes (63.1%). Se encontraron mayores incidencia y prevalencia de retraso del lenguaje en el sexo masculino (p < 0.05).

CONCLUSIONES

De todas las variables estudiadas, solo la incidencia de retraso en el desarrollo del lenguaje con respecto al sexo masculino fue significativa; de cada cuatro pacientes, tres eran de sexo masculino y uno de sexo femenino.

OBJECTIVE

To describe and analyze clinical and sociodemographic aspects of a cohort of patients with language, speech and learning disorder.

METHOD

Descriptive retrospective study. Patient records (2011 to 2015) were selected, making up a total of 4632. Averages, standard deviations, percentages and frequencies were calculated; in order to assess whether there was a significant difference between variables, chi squared test and a conditional probability analysis was performed between the variables to obtain a priori and a posteriori probability.

RESULTS

Disorders of language, speech and learning occurred more frequently in males, 3358 patients (72.5%). The most frequent diagnosis was language development disorder, diagnosed in 2924 patients (63.1%). A higher incidence and prevalence of language delay were found for the male sex (p < 0.05).

CONCLUSIONS

Of all the variables studied, only the incidence of delay in language development with respect to the male sex was significant; three out of four patients were male and 1 female.

[Uncertainty, dynamic systems, principles of quantum mechanics and their relationship to the health-disease process (analysis proposal).]

The purpose of this work is to discuss the importance and possible application of some foundations of quantum mechanics in the health-disease process, considering for this, that the laws and foundations of atomic theory are the same that govern displacement in space and time in human beings. Based on the impossibility of determining the displacement of subatomic particles in a given space and time, as a consequence of not having measuring instruments for said microscales, we propose feasible that the same happens with the uncertainty generated by the times and movements of human beings in really large spaces, reason why the analysis of the temporo-spatial location of a moving subject, in a certain time and space is impossible, fact that we consider, could represent the behavior in Pandemics. The foundations of quantum mechanics that have been considered for this purpose are dynamic systems, the Schrödinger cat paradox, the Heisenberg uncertainty principle, the law of gases, times and movements, and the Maxwell-Boltzmann entropy. On the other hand, it is proposed to consider the adaptation of measurement ecis ecisión statistical procedures (decisión tree and set theory) and finally the implementation of a unitary probabilistic cube is proposed, which allows locating a subject immersed in the health process disease through three axes developed considering the definition of health stipulated by the WHO.

Ten years of experience of the Mexican Academy of Surgery in the promotion of the next generations of researchers

Objective

To describe the productivity of the research works presented in the Interuniversity and resident doctors Competition of the Mexican Academy of Surgery since its origin in 2010.

Method

Observational cross-sectional descriptive study in which the variables are considered: category of participation (university/resident) type of work (research, clinical case, etc.), university and institution of origin, type of presentation [poster/oral]) Descriptive statistics was used.

Results

Since 2010, 9 interuniversity competitions and 8 resident doctors have been developed. A total of 974 papers were presented, predominantly residents (65.29%), oral presentations (54.51%) and original works (58.11%). 8.9% of the published works.

Conclusions

The Contest is a good forum to disseminate research in the new generations of doctors.

Comparison of ocular vestibular myogenic response by acoustic stimulation at 500 and 1000 Hz in healthy subjects

Objective

To compare the amplitude of potentials by acoustic stimulation at 500 Hz versus 1000 Hz in healthy subjects.

Methods

25 subjects; potentials were performed with acoustic stimuli burst-type at 500 and 1000 Hz with a stimulation rate of 5.1 at 100 dB in both ears. Descriptive statistics tests were performed, confidence intervals were calculated for the mean with 95% reliability, standard error graphs and t-test for related samples.

Results

The values obtained in amplitude when performing an acoustic stimulus at 1000 Hz show a faster response compared to that obtained in the frequency of 500 Hz. The t-test showed a significant difference in the amplitude in the 1000 Hz frequency between ears with a significance value of p < 0.025.

Conclusions

It is strengthened the hypothesis that in the amplitude of potentials by aerial acoustic stimulation in the frequency of 1000 Hz a greater amplitude is generated in relation to the one generated in the frequency of 500 Hz.

Daño auditivo inducido por ruido recreativo

[No disponible]

Point-of-care gastrointestinal and urinary tract sonography in daily evaluation of gastrointestinal dysfunction in critically ill patients (GUTS Protocol)

There is currently a lack of universally accepted criteria for gastrointestinal (GI) failure or dysfunction in critical care. Moreover, the clinical assessment of intestinal function is notoriously difficult and thus often goes unrecognized, contributing to poor outcomes. A recent grading system has been proposed to define acute gastrointestinal injury (AGI) in conjunction with other organ function scores (e.g., SOFA). Ultrasonography has become widely accepted as a diagnostic tool for GI problems and pathology. We propose a sonographic examination of the abdomen, using the GUTS protocol (gastrointestinal and urinary tract sonography) in critically ill patients as part of the point-of-care ultrasound evaluation in patients with AGI. This article reviews possible applications of ultrasonography that may be relevant to monitor the GI function in critically ill patients. The GI ultrasound protocol (GUTS) focuses on four gastrointestinal endpoints: gastrointestinal diameter, mucosal thickness, peristalsis, and blood flow. Moreover, it is possible to examine the urinary tract and kidney function. Real-time ultrasound with the GUTS protocol is a simple, inexpensive, bedside imaging technique that can provide anatomical and functional information of the GI tract. Further studies are needed to investigate the utility of GUTS with other parameters, such as GI biomarkers, AGI class, and clinical outcomes.

Metabolic changes during brief periods of ewe–lamb separation at different ages

The present study evaluated metabolic changes in lambs during three brief periods of ewe–lamb separation, namely 1 min (T1), 10 min (T10) and 60 min (T60). The lambs were divided by age into the following three groups: 15 days (G1 = 40 lambs), 30 days (G2 = 40 lambs) and 60 days (G3 = 40 lambs). The hypothesis to be tested was that breaking the ewe–lamb bond at different ages and for these brief time periods will cause significant metabolic changes in the lambs. To this end, blood samples were taken from the three test groups 24 h before separation to establish reference values (RVs), and again at the end of the three separation times. The following blood variables were analysed for all three study groups: glucose (mg/dL), lactate (mg/dL), calcium (Ca2+, mmol/L), sodium (Na+, mmol/L), potassium (K+, mmol/L), haematocrit (HTC, %), pCO2 (mmHg), pO2 (mmHg), HCO3– (mmol/L) and pH. Results showed that the G1 lambs suffered the greatest metabolic changes for the variables pO2, pCO2, glucose, lactate, pH, HCO3–, Ca2+, Na+, K+ and HCT. With respect to time, the first 10 min of separation from the mother induced marked metabolic changes in the 15-, 30- and 60-day-old lambs, but, at 60 min, the G2 and G3 lambs tended to recover their physiological RVs, while the G1 lambs did not. These findings showed that breaking the ewe–lamb bond immediately generated metabolic changes in the lambs even though they remained in a familiar, habitual environment. They also indicated that the age of the lambs at separation was a significant factor, as the older animals tended to re-establish their RVs after the metabolic changes, likely because their physiological compensating mechanisms are more efficient, or perhaps because the intensity of attachment to the mother decreases with greater age.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

[Quantitative evaluation proposal of a ultrasonographic protocol for weaning from mechanichal ventilation]

INTRODUCTION

Mechanical ventilation is a therapy for vital support used in a significant proportion of critically ill patients. The right time to successfully discontinue this therapy is a challenge for the intensive care specialist. For this reason it is still a subject for research. The echocardiographic evaluation of the diastolic dysfunction, the diaphragm, and the lung have become an invaluable tool for weaning from mechanical ventilation protocols, especially in patients with difficult or prolonged weaning from mechanical ventilation. There is still a need to validate, in controlled trials, the efficacy of an ultrasound protocol for weaning from mechanical ventilation that integrates the three modalities in a single protocol.

METHODS

Based on current literature, we developed a score justified by a mathematical model based on inequations. When χ ⇒ 5 the risk of failure in the weaning process rises, the weaning process should be suspended; when χ ⇒ 1 the risk of failure is low, the weaning process should be continued.

CONCLUSIONS

The use of math models for decision-making is of great importance, as it sets an objective parameter within the existing evaluations. We proposed the use of inequations to set intervals of solution with the three points of care for ultrasound-guided weaning from mechanical ventilation. With this, the inequations proposed generate an area of certainty within the proposed values and the solution intervals.

Standardization of Sonographic Diaphragm Thickness Evaluations in Healthy Volunteers

BACKGROUND

B-mode ultrasound can be used to measure diaphragm thickness at the zone of apposition. We believe it is necessary to develop normal values for diaphragm thickness at rest in a large group of healthy subjects and compare them with international results.

METHODS

Ultrasound measurements of diaphragm thickness at expiratory rest were taken in 109 healthy individuals, with results stratified by sex, body mass index, and thorax circumference. The following methods were used for analysis and interpretation. Multivariable databases with descriptive statistical analyses were made. The Pearson chi-square test was used to evaluate the distribution between variables. Additionally, mean and SD values were calculated. For standardization, the data were separated by sex within a 95% CI, and we calculated a Z test. A 95% CI was also constructed for proportion analyses.

RESULTS

One hundred nine healthy volunteers were included in the study, and the correlation between the body mass index and thorax circumference values with a Pearson chi-square test resulted in an r = 0.69. Additionally, the average value of diaphragmatic thickness was 0.19 ± 0.04 cm (95% CI 0.17-0.20 cm) for men and 0.14 ± 0.03 cm (95% CI 0.13-0.15 cm) for women (P = .001). There was no relation between body mass index thorax circumference, and diaphragmatic thickness.

CONCLUSION

Real-time ultrasound of the diaphragm is a simple, inexpensive, and portable imaging technique that can provide qualitative anatomical information. The findings in this study show that sonographic diaphragm evaluations can be applied to the general population.

[Analysis of the joint and a posteriori probability between primary empty sella, its comorbidities and audiovestibular pathology]

BACKGROUND

Primary empty sella is a herniation of the sellar diaphragm into the pituitary space. It is an incidental finding and patients may manifest neurological, ophthalmological and/or endocrine disorders. Episodes of vertigo, dizziness, and hearing loss, have been reported.

OBJECTIVE

To determine the conditional probability, as well as the statistical dependency, through the Bayesian analysis in patients with primary empty sella and audiovestibular disorders.

PATIENTS

Individuals who attended the National Rehabilitation Institute from January 2010 to December 2011, diagnosed with primary empty sella and audiovestibular disorders.

MATERIAL AND METHODS

An analysis was performed on a sample of 18 patients with a diagnosis of primary empty sella confirmed with magnetic resonance studies and who had signs of vertigo, hearing loss and dizziness.

RESULTS

Of the 18 patients studied, 3 (16.66%) had primary empty sella as the only clinical evidence. In 9 patients (50%) empty sella was associated with vertigo, and 16 patients (88.88%) were diagnosed with hearing loss, with sensorineural hearing loss being the most frequent (77.77%). The intersection between the proportions of primary empty sella with the presence and type of hearing loss was calculated. Thus for sensorineural hearing loss, the calculated ratio was P(AB)=0.6912, and for conductive and mixed hearing loss the value of P(AB)=0.0493 in both cases.

CONCLUSIONS

Bayesian analysis and conditional probability enables the dependence between two or more variables to be calculated. In this study both mathematical models were used to analyse comorbidities and audiovestibular disorders in patients diagnosed with primary empty sella.

[Acoustic trauma generated by exposure to gun powder]

BACKGROUND

Noise-induced hearing loss has increased due to factors such as industrialization. It is estimated that one third of the world's population suffers from some degree of hearing loss caused by exposure to high-intensity noise. Exposure to noise can cause disease of various ear structures, especially destruction of outer hair cells, causing varying degrees of hearing lossObjective: To describe the audiological findings in a group of subjects who were exposed to a source of fireworks explosion in the state of Tlaxcala Mexico.

METHODOLOGY

We carried out an audiometric study in eight patients admitted to CENIAQ-INR who were exposed to a firecracker explosion. In each subject, airway with conventional pure tone audiometry from 125 to 8000 Hz was assessed using a clinical audiometer (model 622, Minimate, Madsen) Clinical case: Hearing loss at all frequencies was found in all eight patients, from mild to severe in both ears. Audiogram showed decreases from 4000 Hz, diagnosing third-degree acoustic trauma in all patients.

CONCLUSIONS

The main symptom was reported by patients with tinnitus. Other scenarios in which patients report the presence of tinnitus are acoustic trauma due to use of audio players in symphony orchestra musicians and detonating military firearms. Audiometric assessment is recommended after an explosive accident as an accurate method to determine if there is any hearing impairment.

[Hearing gain with binaural-bimodal adaptation in patients with a cochlear implants]

Binaural hearing allows the optimal performance of the auditory system with a better perception of the sounds that make up language and better discrimination in noisy environments. The use of binaural-bimodal stimulation includes a combination of 2 different pacing modes: a cochlear implant in one ear , and acoustic stimulation through a conventional hearing aid in the other. The aim of this study is to determine the hearing gain in patients with cochlear implant alone and hearing aid. Twenty prelingually hearing impaired patients, 11 female and 9 male subjects were recruited with mean age at implantation and 3.91 ± 1.56 years and 6.07 ± 2.18 years at the time of audiological assessment at six months post-implantation. Implanted patients were assessed per month after the surgery for the first telemetry subsequently were reassessed every month to make changes to schedules stimulation map according to the auditory responses and progress shown in speech therapy. When calculating the mean and standard deviation of the auditory response in implanted subjects, you can appreciate that in the group of patients with cochlear implant plus hearing aid using the values obtained were lower at all frequencies, indicating a higher gain using auditory hearing aid over a cochlear implant, in comparison to patients who only used the cochlear implant. Comparing auditory responses in patients implanted with and without hearing aid, statistically significant differences were observed at all frequencies except at 2 kHz, showing that there is a better discrimination in noisy environments. The patients use more AA gain greater hearing gain compared with patients who only used the IC.

[Importance of stimulation of the areas involved in the mathematical processing: effects on neurodevelopment]

This paper aims to discuss and analyze the role of mathematics in neurodevelopment, for which discusses the historical, ontogenetic and physiological bases involved. The methodology of this paper is a deductive analysis, describing the use of mathematics in ancient cultures to the specialization of brain regions. Sensory perceptions are useful for the acquisition and development of cortical functions thus sensory stimulations is essential for the maturation of specialized neurologic functions.

[Measurement of acetylcholine and sleep patterns]

INTRODUCTION

Acetylcholine is an essential neurotransmitter in the central nervous system as it has an effect on sleep, memory and learning. Intracerebral microdialysis is an in vivo surgical technique that is used to measure the concentration of substances in the extracellular space.

METHODS

The rats were stereotaxically implanted with microdialysis cannulae guided to the hypothalamic medial preoptic area and bipolar stainless steel electrodes to obtain sleep records simultaneously with microdialysis samplings during 24 hours exposed to clean air followed by 24 hours of exposure to ozone. Microdialysis fractions were injected into chromatograph system.

RESULTS

Results showed that paradoxical sleep and wakefulness decreased by 54.2% and 27.9%, respectively, while slow wave sleep increased by 35.1% during the ozone exposure phase and a concomitant decrease of extracellular acetylcholine of 56.2% was observed during the light-dark phase.

CONCLUSION

That surgical method employed using electroencephalography and intracerebral microdialysis allows the quantification of extracellular acetylcholine and simultaneously with patterns related to sleep. We propose that the decrease in paradoxical sleep is the behavioral expression of disruptions of cholinergic modulation and, that post-exposure effects observed in the hypothalamic medial preoptic area can be explained on the basis of the hypothalamic role in the sleep-wake cycle.

[Viability of the parietal bone autografts preserved in adipose tissue. Preliminary report of an experimental study in rats]

INTRODUCTION

Decompressive craniectomy is an alternative in cases where there is increased intracranial pressure. Bone autografts are accepted as a method of reconstruction of the skull. The aim of this paper is to describe the macroscopic and radiological findings of autologous parietal bone in rats after storage in adipose tissue as a reservoir.

METHODS

We used 20 Wistar rats which underwent a craniectomy. 4 groups were formed: group I, the bone flap fat remained for 14 days, group II, the flap remained for 21 days, in group III, for 28 days and in group IV for 35 days. They were euthanized 70 days after reattached.

RESULTS

When removing the flap of subcutaneous fat, a high bright whitish microvasculature and presence in 11 of the flaps. Following 70 days of re-injertarse was found that 56.25% of the animals presented terraced edges, reflecting some consolidation in the radiological analysis 31.25% of cases showed areas of consolidation. Animals in group II and III findings showed more consolidation.

CONCLUSIONS

The bone flap remained viable during their stay in adipose tissue. Fibrous tissue and neovasculature were important findings that reflect the proper process of bone healing. You need the histological studies complemented biomechanics, neurological and bioacoustics.

Analysis of oropharyngeal dysphagia through fibroendoscopy evaluation of swallowing in patients with Parkinson's disease

BACKGROUND

Parkinson's disease (PD) has a high incidence in Mexico and is estimated at approximately 500,000 patients. One of the main clinical manifestations of PD is dysphagia, which is the difficult passage of food from the mouth to the stomach. The aim of this study was to assess oropharyngeal dysphagia through fibroendoscopy evaluation of swallowing in patients with PD.

METHODS

We conducted a census sample of patients with PD: 17 males and 10 females, aged >49 years. Clinical history, physical examination and neurological evaluation of swallowing fibroendoscopy were carried out.

RESULTS

Of the symptomatic patients, 16 patients (59.25%) reported dysphagia. Fibroendoscopic evaluation demonstrated swallowing disorders in 25 patients (92.59%). The main findings were poor bolus control in 19 patients (70.37%), deficits in bolus propulsion in 25 patients (92.59%), impaired swallowing in 14 patients (51.85%), fractional swallowing in 11 patients (40.74%), reduced epiglottic tilting in 11 patients (48.14%), food residue in vallecula in 24 patients (88.88%) and piriform sinus in 19 patients (70.37%). There was no correlation between duration of PD and degree of involvement of oropharyngeal dysphagia.

CONCLUSIONS

Oropharyngeal dysphagia in patients with PD is a common symptom and can range from the oral cavity to the upper esophageal sphincter. Early onset of severe dysphagia is exceptional in this disease and should alert the clinician to the diagnostic possibility of parkinsonism.

Spectrographic cry analysis in newborns with profound hearing loss and perinatal high-risk newborns

BACKGROUND

Crying is the first neurophysiological demonstration of the newborn. The acoustic analysis of crying episodes can provide useful information in the early diagnosis of several pathologies.

METHODS

We carried out a spectrographic cry analysis of 40 infants with several diseases such as neonatal asphyxia, breathing disorders, deafness and neurological disorders. Statistical t-test was used in order to compare means of fundamental frequencies (F0) of cries among pathologies, as well as contingency tables for qualitative variables and melodic form.

RESULTS

No significant differences of F0 were found by applying the t-test among pathologies. Time of inspiration in breathing disorders is higher compared with other groups. Infants with deafness and neurological disorders present poor melodic forms. Qualitative analysis revealed more often glottal roll and vibrato.

CONCLUSIONS

Cry analysis is clinically useful for early detection of diseases in newborns as a result of alterations in the central nervous system that are reflected in phonoarticulatory and respiratory functions for sound emission.

Effects of oxcarbazepine on monoamines content in hippocampus and head and body shakes and sleep patterns in kainic acid-treated rats

The aim of this work was to analyze the effect of oxcarbazepine (OXC) on sleep patterns, "head and body shakes" and monoamine neurotransmitters level in a model of kainic-induced seizures. Adult Wistar rats were administered kainic acid (KA), OXC or OXC + KA. A polysomnographic study showed that KA induced animals to stay awake for the whole initial 10 h. OXC administration 30 min prior to KA diminished the effect of KA on the sleep parameters. As a measure of the effects of the drug treatments on behavior, head and body shakes were visually recorded for 4 h after administration of KA, OXC + KA or saline. The presence of OXC diminished the shakes frequency. 4 h after drug application, the hippocampus was dissected out, and the content of monoamines was analyzed. The presence of OXC still more increased serotonin, 5-hidroxyindole acetic acid, dopamine, and homovanilic acid, induced by KA.

Experience in the management of the severe form of human influenza A H1N1 pneumonia in an intensive care unit

BACKGROUND

At the beginning of the second trimester of 2009 there was an influenza A (H1N1) outbreak. The aim of this study is to describe the clinical presentation and mortality of the severe form of pneumonia in patients with human influenza A H1N1.

METHODS

We conducted a retrospective review of all files of confirmed and suspected patients with severe human influenza A (H1N1) pneumonia.

RESULTS

We studied 26 patients admitted to the ICU from April 1 to December 31, 2009, among which 16 were males (61.54%) and 10 females (38.46%) with an average age of 52.26 ± 15.48 years. The time of onset of symptoms to admission to the ICU was 6.3 ± 3.19 days. The most frequent symptoms and signs were salmonated sputum (47%), chills (45%), dry cough (44%) and myalgia (42%). The mortality rate was 19.23%. The treatment was based on antiviral therapy, modulating inflammation and ventilatory techniques to optimize oxygenation. There was an association between combined therapy based on methylprednisolone, activated protein C and statins with a better survival (p = 0.05).

CONCLUSIONS

Pneumonia virus of human influenza A (H1N1) is associated with high morbidity and mortality. According to our results, it is recommended to make an early diagnosis and to initiate a treatment regimen based on treatment bundles designed to optimize oxygenation, reduce viral load and modulate inflammation.

Chronic exposure to toluene changes the sleep-wake pattern and brain monoamine content in rats

Toluene, found in glues and cleaners, is among the inhalants most commonly abused by workers and young drug addicts. In this study, we examined the changes in sleep patterns and monoamine content induced by chronic toluene exposure. Rats were chronically exposed to toluene vapors beginning at 30 days of age for a duration of 30 days. Experiment I was performed in a control group (n=10) and a chronic toluene exposure group (n=10). Rats were implanted with bipolar stainless steel electrodes for electroencephalographic recording (EEG). In experiment II, conducted in two other groups (control and exposed to toluene, n=10 each), animals were sacrificed by decapitation prior to chromatographic analysis. We found that chronic toluene administration affected the organization of sleep patterns and monoamine content. Dopamine (DA) and noradrenaline (NA) increased in the midbrain and striatum. 3,4-dihydroxyphenylacetic acid (DOPAC) increased only in the striatum. Midbrain levels of serotonin (5-HT) increased in the pons and decreased in the hypothalamus and striatum. 5-hydroxyindoleacetic acid (5-HIAA) increased in the pons, midbrain and striatum and decreased in the hypothalamus. Chronic toluene exposure induced changes in the serotonergic and dopaminergic systems and increased SWS and PS deficits. We conclude that toluene exposure disrupts the sleep-wake cycle by affecting the monoaminergic response in cerebral areas related to sleep.

Sciences of complexity and chaos to analyze vectors and zoonosis

The present paper discusses the fundamentals of the sciences of complexity and chaos as tools in the proliferation of vectors and zoonosis. The first part of the article discusses the rationale and history of the sciences of complexity, a different view as to understand and analyze dynamic systems. These concepts explain the dynamics of the origin of life itself and break the paradigms of linearity and reductionism. This is exemplified by using fractal geometry, the law of the small world and time series analysis among other tools to understand the behavior of chaotic systems, which are presented in the form of the spread of zoonotic diseases. We conclude that most infections and the spread of diseases transmitted by animals tend towards being chaotic, and it is mentioned that 75% of emerging diseases are zoonotic in origin. Therefore, the tools are not linear. They are indispensable for understanding the dynamic behavior of the spread of these diseases.

[Neurological effects by occlusion of the carotid artery and induced hypoxia in newborn rats]

BACKGROUND

Hypoxic-ischemic encephalopathy is a cause of disability in the infant population. One of the most used animal models in the hypoxic-ischemic encephalopathy in immature brain is the preparation of Levine applied by Rice in newborn rats and consists of the bond of the left common carotid artery followed by induced hypoxia. The objective of this investigation was to study the neurological effects of the bond of the left common carotid and induced hypoxia in newborn rats.

METHODS

Five control rats, five sham rats and five rats with hypoxic-ischemic lesion by means of the application of Levine's preparation at 7 days of age were used. On day 42, all rats were evaluated by time of grasping, posterior reflex test and analysis of the spontaneous locomotor activity (number of bipedal movements, number of stepped stalls, grooming time).

RESULTS

The lesioned group presented less grasping time, lower number of positive responses to the posterior reflex and lower number of stepped stalls (p = 0.024, 0.002 and 0.0001, respectively). There were no statistically significant differences in grooming time or number of bipedal movements.

CONCLUSIONS

Newborn rats in whom Levine preparation was applied presented clinical alterations that may resemble some of the signs that accompany infantile cerebral palsy (grasp problems, wrong response to postural reflexes and alteration in locomotion).

Analysis of normal and denerved laryngeal vocalization in guinea pigs (Cavia porcellus)

Paralysis of the left vocal chord is frequent in human clinical practice; because of its anatomic similarity with human, the guinea pig might be a suitable biological model to analyze the phoniatric behavior in denerved animals. Forty newborn guinea pigs were used (20 control and 20 experimental); an incision was made in the ventricular region with the animals under general anesthesia over the middle line of the neck, until the lower left laryngeal nerve was found, the same was secured with alligator clips so that afterward a two-part dissection could be performed and the middle section could be removed (1cm) from the nerve endings (distal and proximal) before they were separated from the laryngeal structure. After recovery from surgery, vocal emissions were recorded in solitary for 6 minutes. The animals that had nerves removed showed an increase in fundamental vocalization frequency compared with the controls. F test was carried out (P=0.05) and no significant difference was found. When analyzing functional recovery, we found that the guinea pigs compensated vocal emissions at 20 days. With regard to the unilateral paralysis, the motility was frequently compensated by the healthy vocal chord, improving voice emission, and loss of air inhalation.

[Type I spinal atrophy (Werdnig-Hoffman disease). Case report]

BACKGROUND

We report a case of type I spinal muscular atrophy (SMA), also known as Werdnig-Hoffmann disease.

METHODS

This was a descriptive case report. The patient was in the pediatric intensive care unit of a medical center.

CASE REPORT

The patient was a 5 1/2 month-old male admitted to the emergency room from another hospital with a diagnosis of pneumonia with right apical atelectasis and with poor clinical evolution. The patient showed symptoms of acute respiratory failure and also generalized muscular weakness. Auscultation showed disseminated crackles, ronchi and hypotonic limbs. In view of his respiratory condition he was admitted to the Pediatric Intensive Care Unit and intubated. Chest X-ray showed a narrow chest with an apical infiltration and a left parahilar atelectasis. During the first days in the ICU, successful extubation was not possible because the patient showed hypoxemia and bradycardia. SMA was suspected because of the general muscular weakness; therefore, biopsy and neurophysiology studies were performed, demonstrating an axonal motor polyneuropathy with tongue fasciculations and signs of chronic denervation. The Pathology Service reported neurogenic fascicular atrophy and genetic analysis supported the diagnosis by blood test sampling, revealing a homozygous state for a deletion on exon 7 of the gene SMN1. Fifteen days after his admission to the hospital, the patient showed severe respiratory and heart failure to the CPR maneuvers.

CONCLUSIONS

Type 1 SMA is a rare entity with few cases reported in the literature, but it is important for the pediatrician to be familiar with this disease because of its severe implications.

Serotonin and 5-hydroxy-indole-acetic acid contents in dorsal raphe and suprachiasmatic nuclei in normal, malnourished and rehabilitated rats under 24 h of sleep deprivation

It has been discussed that serotonin (5-HT) could be involved in the effects of sleep deprivation (SD) and/or malnutrition (M) on the sleep-wake cycle. The aim of this work was to study the effects of the M, SD and its interaction on 5-HT and 5-hydroxy-indole-acetic acid (5-HIAA) contents in the dorsal raphe (DR) and the suprachiasmatic nuclei (SCN), two sleep-wake cycle regulators. Forty-eight puppets rats were obtained from mothers fed with low or normal casein diet. They were allocated in 3 groups (n=16 each): prenatal/postnatal casein malnutrition (6/6%), prenatal casein malnutrition/nutritional casein rehabilitation (6/25%) and prenatal/postnatal casein well-nourished state (25/25%). When rats were 60 days old, 24 animals were exposed to sleep deprivation by means of forced locomotion during 24 h. The remaining 24 were kept under normal conditions of sleep-wake cycle. Then, all animals were sacrificed by decapitation. DR and SCN were dissected and processed to determine the 5-HT and 5-HIAA contents by means of HPLC. It was observed that 6/6% rats showed a 5-HT increase (DR p<0.011; SCN p<0.019) as well as in SD (DR p<0.0008; SCN p<0.0009) with respect to 25/25% rats. No differences were found in 6/25% rats. Therefore, 5-HIAA decreased significantly in both nuclei in all the groups, notably in M+SD animals (DR p<0.001; SCN p<0.001). We conclude that the sleep-wake cycle disruptions produced by chronic M and SD are mediated in part by a synergistic effect on 5-HT in the DR-SCN pathway, perhaps due to a delay in the development of such brain structures.

[Utility of the guinea pig like model of audiology studies and proposal of surgical accesses to the ear and neck]

We discuss the utility of the guinea pig model in audiology research and describe the different surgical accesses to the middle and inner ear in order to use these techniques for the production of experimental deafness. In addition, we describe a surgical technique for laryngeal denervation. Finally, we discuss the auditory-evoked potentials obtained in newborn and mature animals, in whom experimental deafness was produced. Our purpose was to confirm the use of the guinea pig as an ideal model for audiologic studies and for neck surgery.

[Sleep alterations in childhood victims of sexual and physical abuse]

INTRODUCTION

The abused child syndrome is related to a variety of emotional disorders, among which are the "post-traumatic stress syndrome" and the phenomena "re-experience," which is related to disturbances of the normal sleep-wake cycle.

OBJECTIVE

To determine the polysomnographic characteristics of the abused child syndrome and compare them with paired healthy children.

MATERIAL AND METHODS

After two-night habituation, all-night video-digital polygraphic recordings following recommendations of the International Federation of Clinical Neurophysiology were performed in 15 abused child syndrome and 15 healthy controls.

RESULTS

In the abused child syndrome patients, the main sleep changes were decreased sleep efficiency, decreased sleep onset sleep latency, increased wakefulness, decreased REM sleep and total sleep time.

CONCLUSIONS

The abused child syndrome have abnormal sleep patterns, independent of the type of abuse, age or sex. Sleep alterations are a new characteristic of the abused child syndrome, not previously described.

[Use and production of biomedical models in the field of audiology]

Presently paper mentions the importance that has the use and the production of animal models in scientific research, the relevance that has its use to be able to make a good pursuit in the research, highlighting as well as to facilitate the reproductive of the study in question. Lastly it is mentioned the models more used in the field of the audiology.

[Cry analysis of hypoacoustic children and normal hearing children]

OBJECTIVE

We analyzed the spectrograms of the cry of deaf children and compared the results with those of normal children.

MATERIAL AND METHODS

Twenty deaf children (0-2 years of age, both sexes) and 20 normal hearing children of both sexes within the same age range were studied. The deaf cases were selected from patients with high-risk pregnancies who are followed up at the National Institute of Perinatology (INPer), Department of Human Communication. Brainstem evoked potential responses were carried out in order to corroborate hearing loss in the affected group and to verify normal hearing in the other group. During physical examination in the Human Communication Clinic of the Inper, the cry was recorded with a Fisher tape recorder and MK2 unidirectional microphone. Sonograms were analyzed in the "Laboratorio de Bioacústica" of the Institute of the Human Communication (CNR) using the Software Cool Edit 96. We registered the fundamental frequency and 6 harmonic F1 at F6 (Hz). The cry frequencies of the deaf children were compared and of the normal hearing children using one-way analysis of variance. A typology of frequencies was organized by means of cluster analysis by the method of Ward and was compared with the study groups by means of contingency analysis (chi square).

RESULTS

No significant difference was demonstrated in the fundamental frequency or in the harmonic by means of the one-way analysis. With cluster analysis, 8 types were obtained that were not different when compared with the study groups. The hypothesis was rejected with the obtained data.

CONCLUSIONS

Upon confirmation of the obtained results, analysis of the spectrogram of deaf children at early ages does not have the ability to identify the problem and thus cannot be used as a method for early detection of deafness.

[Communication and auditory behavior obtained by auditory evoked potentials in mammals, birds, amphibians, and reptiles]

METHODS

ANIMALS

amphibians, Frog catesbiana (frog bull, 30 animals); reptiles, Sceloporus torcuatus (common small lizard, 22 animals); birds: Columba livia (common dove, 20 animals), and mammals, Cavia porcellus, (guinea pig, 20 animals). With regard to lodging, all animals were maintained at the Institute of Human Communication Disorders, were fed with special food for each species, and had water available ad libitum. Regarding procedure, for carrying out analysis of auditory evoked potentials of brain stem SPL amphibians, birds, and mammals were anesthetized with ketamine 20, 25, and 50 mg/kg, by injection. Reptiles were anesthetized by freezing (6 degrees C). Study subjects had needle electrodes placed in an imaginary line on the half sagittal line between both ears and eyes, behind right ear, and behind left ear. Stimulation was carried out inside a no noise site by means of a horn in free field. The sign was filtered at between 100 and 3,000 Hz and analyzed in a computer for provoked potentials (Racia APE 78).

RESULTS

In data shown by amphibians, wave-evoked responses showed greater latency than those of the other species. In reptiles, latency was observed as reduced in comparison with amphibians. In the case of birds, lesser latency values were observed, while in the case of guinea pigs latencies were greater than those of doves but they were stimulated by 10 dB, which demonstrated best auditory threshold in the four studied species. Last, it was corroborated that as the auditory threshold of each species it descends conforms to it advances in the phylogenetic scale.

CONCLUSIONS

Beginning with these registrations, we care able to say that response for evoked brain stem potential showed to be more complex and lesser values of absolute latency as we advance along the phylogenetic scale; thus, the opposing auditory threshold is better agreement with regard to the phylogenetic scale among studied species. These data indicated to us that seeking of auditory information is more complex in more evolved species.

Development of isolation-induced vocal behavior in normal-hearing and deafened guinea pig infants

Infants in many different animal species require auditory information from conspecifics to learn appropriate responses to important environmental and social cues. Isolation calls are emitted by infant guinea pigs in contexts of social separation from their mothers. The aim of the present study was to examine the ontogeny of the isolation calls in normal-hearing and deafened infant guinea pigs, from 2 to 40 days postpartum and to determine the role of hearing maternal vocalization in infant guinea pig vocal responses in contexts of social proximity and isolation. Female newborn pigmented guinea pigs (Cavia porcellus) were housed with their birth mother and siblings. Water and dry food were available ad libitum. One day postpartum, the cochlea of infants in the experimental group was destroyed. The control group consisted of normal-hearing female siblings. Vocalizations from infants in the experimental and control groups were recorded for 6 minutes when with the mother before isolation, 6 minutes when alone, and then 6 minutes when with the mother after reunion. Recordings were made 5 days per week from 2 to 40 days after birth. The duration of calling was calculated for each 6-minute period of recording. Results demonstrated that deaf infants vocalize more than normal-hearing infants during social isolation from their mothers. Vocal activity of isolated deaf and normal-hearing infants decreased substantially over development, almost disappearing by the end of the study period. These results indicate that maternal vocal behavior modulates the vocal responses of guinea pigs early in infant development and supports other evidence that the guinea pig offers a viable model for investigating audition in deaf and normal-hearing human infants.