Cold modalities with different thermodynamic properties have similar effects on muscular performance and activation

Although tissue cooling is widely used in the treatment of musculoskeletal injuries there is still controversy about its effects on muscular performance. The combination of cooling and exercise justifies the study of this topic. The aim was to compare the effects of ice pack and cold-water immersion on the muscular performance parameters of plantar flexors and muscular activation of the triceps surae. 41 healthy men (mean age: 22.1 years, SD: 2.9) were randomly assigned to cooling with either ice pack (n=20) or cold-water immersion (n=21). Independent variables were cold modality (ice pack or cold-water immersion) and pre- and post-cooling measurement time. Dependent variables were muscular performance (measured during isometric and concentric contractions of plantar flexors) and electromyography parameters of the triceps surae (median frequency and root mean square amplitude). Dependent-samples t-tests were used to compare pre- and post-cooling data and independent-samples t-tests were used to compare the difference (pre- and post-cooling) between groups. Ice pack increased isometric peak torque (mean: 9.00 Nm, P=0.01) and both cold modalities reduced muscular activation in triceps surae (P<0.0001); Cold-water immersion and ice pack reduced peak torque and total work during dynamic isokinetic contraction at both velocities (mean: -11,00 Nm, P<0.05) and affected muscular activation in different ways. In conclusion, ice pack increases isometric torque, while both ice pack and cold-water immersion decrease concentric muscular performance. These results indicate that these cooling methods should be chosen with caution, considering the type of task required during training or rehabilitation. New studies investigating other muscle groups and joints are necessary.

Simultaneous detection and identification of the Xanthomonas species complex associated with tomato bacterial spot using species-specific primers and multiplex PCR

AIMS

To establish protocols for the simultaneous detection and identification of Xanthomonas species causing tomato bacterial spot.

METHODS AND RESULTS

We verified the specificity and sensitivity of the previously reported sets of primers designed for strains of the four species of Brazilian tomato bacterial spot xanthomonads, consisting of 30 of Xanthomonas euvesicatoria, 30 of X. vesicatoria, 50 of X. perforans and 50 of X. gardneri. Furthermore, we tested a multiplex PCR protocol for the purpose of concurrent species identification. The possibility of direct detection of the pathogens in diseased leaf samples was also verified. The primers were highly specific, amplifying only target DNA. The sensitivity of the primers in conventional PCR was 50 pg μl(-1) for purified DNA and ranged from 5 × 10(2) to 5 × 10(4) CFU ml(-1) when bacterial suspensions were analysed. The multiplex PCR was suitable for the detection of all four species and showed similar sensitivity to conventional PCR when tested on purified DNA. When using bacterial suspensions, its sensitivity was similar to conventional PCR only when a biological amplification step (Bio-PCR) was included. Both methods were able to detect the pathogens in symptomatic tomato leaves.

CONCLUSIONS

Brazilian Xanthomonas strains causing tomato bacterial spot can be differentiated and identified at species level by a PCR-based method and by a multiplex PCR.

SIGNIFICANCE AND IMPACT OF THE STUDY

This protocol may be a feasible alternative tool for the identification and detection of these pathogens in plant material and may be used for routine diagnostic purposes in plant pathology laboratories.

Radiological evaluation of facial types in mouth breathing children: a retrospective study

Mouth breathing is a condition often associated with a long face, half-open mouth and increased anterior facial height. We performed conventional lateral and frontal cephalograms of eighty-nine children with nasal and mouth breathing and independently measured Total Facial Height using the analysis technique of Ricketts, and the Morphologic Facial Index employing the technique of Avila. It was concluded that dolicofacial following mesofacial were the most frequent patterns found in mouth-breathing children and this suggests that both analyses can be used independently.

The influence of hepatitis C virus-human immunodeficiency virus co-infection on the appearance of liver enzyme elevation in people on high activity antiretroviral treatment

BACKGROUND

Liver enzyme elevation (LEE) as a consequence of HAART is a problem among patients with HIV-HCV co-infection.

METHODS

In this retrospective study, 145 patients with HIV who were on HAART and who developed LEE grades 3 and 4 of the World Health Organization (WHO) were followed up. Basal ALT, alcohol consumption, and HCV and HBV co-infection were recorded. Comparisons were made between patients with and without HCV co-infection.

RESULTS

Three patients without co-infection presented LEE grade 3 versus 38 with co-infection (104 episodes). An increase in basal ALT (RR: 1.01) and HCV co-infection (RR: 6.6) were the variables associated with LEE grade 3. The number of days that HAART had to be withdrawn due to LEE was 58.15 and 4.85 in subjects with and without co-infection, respectively (p=0.024).

CONCLUSION

Patients with HCV-HIV co-infection have more episodes of LEE and must go longer without HAART than people without co-infection.

Mycobacterium fortuitum complex endocarditis-case report and literature review

Endocarditis due to Mycobacterium fortuitum complex is a rare entity generally linked to the hospital environment. Only 18 cases have been published since 1966. Here we present a case of a female who developed an endocarditis due to Mycobacterium chelonae after valve replacement as well as a review of the literature. The course of this kind of endocarditis is generally subacute and the outcome is usually fatal. Blood cultures were positive in 75% of cases of metallic valve endocarditis, versus 20% in bioprostheses. The treatment must include antibiotics that have shown activity against these mycobacteria, such as amikacin, imipenem, cefoxitin, fluorinated quinolones and macrolides (especially clarithromycin). Surgical removal is recommended. Although the prognosis for the patient is poor, we should expect better outcomes with the use of new antibiotic regimens.

Paradoxical responses in a cohort of HIV-1-infected patients with mycobacterial disease

SETTING

Paradoxical worsening or relapse of opportunistic infections has been described after initiation of highly active anti-retroviral therapy (HAART) in human immunodeficiency virus (HIV) infected patients.

DESIGN

Retrospective study of a group of 33 HIV-infected patients with mycobacterial disease analysing the incidence and characteristics of patients with and without paradoxical response after starting HAART and/or mycobacterial treatment.

RESULTS

Nine patients in the group had paradoxical response. No significant difference of baseline characteristics was observed in these patients. The decrease in viral load was significantly greater among patients with paradoxical response than in patients without.

CONCLUSION

No clinical difference was found in the evolution of HIV-infected patients with mycobacterial disease after the resolution of the episode of paradoxical response.

Central retinal vein occlusion in a patient with thrombotic thrombocytopenic purpura

PURPOSE

To describe the occurrence of central retinal vein occlusion in a patient with thrombotic thrombocytopenic purpura.

METHODS

Case report.

RESULTS

A 52-year-old woman developed central retinal vein occlusion in the acute phase of thrombotic thrombocytopenic purpura, followed by iris neovascularization only 1 month after the onset of central retinal vein occlusion. Color Doppler imaging of the affected eye showed an increased resistive index of the central retinal artery and reduced blood flow velocity of the central retinal vein compared to the fellow eye.

CONCLUSION

We describe a rare association between central retinal vein occlusion and thrombotic thrombocytopenic purpura with rapid evolution of iris neovascularization. Our case demonstrates that close ophthalmologic attention is important in thrombotic thrombocytopenic purpura.

[Influence of a day care hospital on the incidence of hospital admission of AIDS patients]

BACKGROUND

Day care units have become an usual way of medical care for AIDS patients. However, their influence on the incidence of hospital admissions has not been evaluated.

METHODS

Observational and longitudinal study of a cohort of 308 patients with aids diagnosed between 1990 and 1994 and followed-up to June 1996. The incidence of hospital admissions according to the hospital of follow-up (with or without day care unit) was analyzed. A multivariate analysis of the number of hospital admissions was performed using regression model adjusted to a distribution of Poisson.

RESULTS

After AIDS diagnosis, the incidence of hospital admissions was 108 per 100 patient-years of follow up (21 days as inpatient per patient-year). Those patients controlled in the hospital with day care unit have less hospital admissions (relative risk after adjusting by CD4+ cells count and type of diagnostic disease: 0.64; CI95% 0.55-0.76), and less days as inpatient through their follow-up (11 to 31 days less). There was no difference in survival among patients followed in both hospitals.

CONCLUSIONS

A day care unit decrease the incidence of hospital admissions in aids patients. This positive impact is more evident in patients with lesser CD4+ cell counts.

Cutaneous lesions in patients with visceral leishmaniasis and HIV infection

Cutaneous lesions attributed to Leishmania are very seldom observed in classic Kala-Azar, but recently some reports have mentioned them in patients with HIV infection. We found cutaneous lesions whose biopsy disclosed the presence of Leishmania organisms in six patients of a group of 32 HIV patients with visceral Leishmaniasis. These lesions did not present a uniform or specific appearance, even though they tended to localize symmetrically on acral zones. They consisted of erythematous papules and hypopigmented macules on the dorsa of the hands, feet, and elbows; small subcutaneous nodules on the thighs; and erythematoviolaceous, scaly plaques on the face. These lesions accompanied in every case the other symptoms and/or signs of visceral leishmaniasis, responded to anti-leishmanial treatment, and were sometimes the first indicator of recurrence. The histopathological study was non-specific, but showed in every case the presence of abundant amastigotes within the dermal histiocytes and free in the dermis or subcutaneous tissue. Data from literature review are similar to ours.

Brainstem anaesthesia after peribulbar anaesthesia

PURPOSE

To present a case of brainstem anaesthesia as a complication of peribulbar anaesthesia.

CLINICAL FEATURES

A 75-yr-old woman received peribulbar anaesthesia for cataract surgery. A few seconds after the block performed, she had a respiratory arrest, became unconscious, and developed hypertension and tachycardia followed by hypotension and bradycardia. Ventilatory and haemodynamic support were performed before the patient regained adequate spontaneous breathing, and normal heart rate and blood pressure.

CONCLUSION

Peribulbar anaesthesia generally carries a low risk of serious complications. However, respiratory arrest and brainstem anaesthesia may occur as complications of peribulbar blocks.

Relapse of tuberculosis after treatment in human immunodeficiency virus-infected patients

OBJECTIVES

To evaluate the relapse rate of tuberculosis after a complete course of antituberculous therapy in human immunodeficiency virus-infected patients and to identify the risk factors for relapse.

PATIENTS AND METHODS

Historic cohort study of all adult patients who were diagnosed as having human immunodeficiency virus infection and a first episode of culture-proved tuberculosis at 2 university hospitals in Madrid, Spain, between 1986 and 1992, and who completed at least 6 months of treatment were included and followed up until September 1994.

RESULTS

Of 276 patients with human immunodeficiency virus infection and tuberculosis, 87 could not be evaluated (6 died before treatment, 39 died during treatment, 36 did not complete the planned therapy, and 6 were unavailable during treatment). The remaining 189 received a standard regimen (ie, 3 or 4 drugs, always including rifampin and isoniazid, for > or = 6 months). The median duration of follow-up for these 189 patients was 31.5 months, with a total of 4668 patient-months of follow-up after treatment; 105 patients (56%) were followed up until death. The relapse rate was 7.9% (2.7/100 patient-years). With multivariate analysis, a shorter duration of treatment and a low CD4+ cell count were associated with a greater probability of relapse. Relapses occurred in 5 (3.4%) of 148 patients who were treated for 9 or more months (1.7/100 patient-years) and in 10 (24%) of 41 patients who were treated for less than 9 months (10.9/100 patient-years) (P < .001; relative hazard, 9.2; 95% confidence interval, 3.1-26.9).

CONCLUSIONS

As standard antituberculous therapy for 9 months is associated with a low rate of relapse, maintenance therapy is not required. Duration of treatment for less than 9 months is associated with a high rate of relapse.

[An epidemiological and immunological study of human immunodeficiency virus infection in the southern area of Madrid]

The clinical characteristics and immunological parameters are characterized in different groups of infection by human immunodeficiency virus (HIV) in patients infected by HIV, and the prognostic markers of survival in patients diagnosed of acquired immunodeficiency syndrome (AIDS). This study was carried out in 312 patients from June 1984 to March 1989. The most common risk group was intravenous drug addicts (IVDA) 80.9%. We observed that during the last years there was an increase in the number of cases of heterosexual transmission. Through follow up, 17.6% of patients developed acquired immunodeficiency (AIDS). The incidence rate for AIDS was higher amongst homosexuals than IVDA (35.4/14.6). Esophageal candidiasis and extrapulmonary tuberculosis were the AIDS indicators most frequently encountered. Once the study period was over, with a follow up of 19.3 +/- 3.4 months, the probability of survival after 12 months was 70 +/- 0.07% and after 24 months was 42% +/- 0.09%. The risk group (homosexuals), the appearance of a neoplasia as the first diagnosis of AIDS, and the immunological parameters (CD3 less than 500, CD4 less than 400, CD4/CD8 ratio less than 0.5 and total lymphocyte count of less than 1700 were the markers with worst prognosis which correlated with survival rates (p less than 0.01). We confirmed that when comparing immunologic parameters amongst HIV infection groups, IgA levels were higher (p less than 0.05); the total number of lymphocytes, the number of helper lymphocytes and the CD4/CD8 ratio were lower (p less than 0.01) in IV and AIDS group with respect to group II and III, in patients with AIDS with respect to group IV-non-AIDS and in those who died with relation to AIDS.

Acute renal failure in cirrhosis associated with macroscopic hematuria of glomerular origin

Two patients with alcoholic cirrhosis developed an acute impairment of renal function during an episode of macroscopic hematuria, one of them requiring hemodialysis treatment. Later, when gross hematuria disappeared, renal function gradually improved. The histological findings in both patients showed a mild mesangial glomerulonephritis with IgA deposits on immunofluorescence, the presence of red blood cells casts obstructing the lumen in 40% to 50% of the renal tubules, and a marked tubular necrosis.

The salivary glands of Ameiva ameiva (Teiidae, Lacertilia). A morphological, morphometric and histochemical study

The authors studied morphological, morphometric, and histochemically the mucosubstances and proteins in the salivary glands of the lizard Ameiva. Based on the results, the authors concluded: 1. The labial salivary gland is formed by small mucous and mucoserous glands; the sublingual gland by mucoserous cells. 2. Mucous cells show neutral and sulphated mucosubstances and sialic acid. Mucoserous cells of the labial gland show neutral mucosubstance, sialic acid, hyaluronic acid and protein radicals. Mucoserous cells of the sublingual gland show neutral mucosubstance, sialic acid and protein radicals. 3. The average values for acinar area were: 1,198.11 microns 2 for mucoserous acini and 2,105.95 microns 2 for mucous acini of the labial salivary gland. The average values for nucleus volume were: 47.41 microns 3 for mucoserous cells and 38.97 microns 4 for mucous cells. 4. The average values for acinar area and nuclear volume of the mucoserous cells of the subingual gland were respectively: 1,474.62 microns 2 and 67.77 microns 3.

Fate of interferon-treated cells

Interferon-treated cultures of Ly cells survived initial infection with high multiplicities of vesicular stomatitis (VSV) or herpes simplex virus (HSV). In the case of HSV, infectious virus and intracellular viral antigen were rapidly eliminated from the interferon-treated cultures, and the cells grew out to form apparently normal monolayers that could be cultured indefinitely. In the VSV-infected Ly cultures, virus titers remained at low levels in interferon-treated cells but after about 14 days rapidly rose and the culture was destroyed. If interferon was added to the medium on days 4 and 6 after infection, virus titers rapidly declined but again recovered and the cells were destroyed. If, however, interferon treatment was resumed 9 days after initial infection, detectable infectious VSV was eliminated from the medium. Several methods, including cocultivation and molecular hybridization, failed to demonstrate persistence of a significant portion of the VSV genome in these cultures.