Genetic deletion of c-Jun amino-terminal kinase 3 (JNK3) modestly increases disease severity in a mouse model of multiple sclerosis

The c-Jun amino terminal kinases (JNKs) regulate transcription, and studies suggest they contribute to neuropathology in the EAE model of MS. To examine the role of the JNK3 isoform, we compared EAE in JNK3 null mice to wild type (WT) littermates. Although disease severity was similar in female mice, in male JNK3 null mice the day of onset and time to reach 100% incidence occurred sooner, and disease severity was increased. While glial activation in spinal cord was similar, white matter lesions were increased in JNK3 null mice. These results suggest JNK3 normally limits EAE disease in a sex-dependent manner.

Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community‐acquired pneumonia

BACKGROUND AND OBJECTIVE

Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP.

METHODS

We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when ≥3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection.

RESULTS

Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP.

CONCLUSION

This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP.

Alloantigen-specific response is preserved and autoimmunity is maintained in an HIV-positive patient with immunoglobulin A nephropathy undergoing renal transplantation: a warning about long-term reduction in immunosuppression--a case report

We report the case of a 43-year-old patient with HIV infection treated with antiretroviral therapy, which was complicated by immunoglobulin A (IgA) nephropathy and renal failure, who subsequently was transplanted using a deceased donor kidney transplant. During the late posttransplant period we detected specific anti-donor HLA antibodies showing a preserved alloantigen response. A renal biopsy showed no acute cellular or humoral rejection, an absence of pericapillary C4d deposits or SV40 infected cells, but demonstrated IgA mesangial deposits and mild interstitial fibrosis probably related to calcineurin inhibitor toxicity. This case shows that allo- and autoimmune responses are preserved despite immunosuppressive treatment and original HIV disease. It warns of the importance of maintaining optimal monitoring and immunosuppressive strategies among HIV-positive recipients who become solid organ transplant recipients.

The 10/66 Dementia Research Group's fully operationalised DSM-IV dementia computerized diagnostic algorithm, compared with the 10/66 dementia algorithm and a clinician diagnosis: a population validation study

Background

The criterion for dementia implicit in DSM-IV is widely used in research but not fully operationalised. The 10/66 Dementia Research Group sought to do this using assessments from their one phase dementia diagnostic research interview, and to validate the resulting algorithm in a population-based study in Cuba.

Methods

The criterion was operationalised as a computerised algorithm, applying clinical principles, based upon the 10/66 cognitive tests, clinical interview and informant reports; the Community Screening Instrument for Dementia, the CERAD 10 word list learning and animal naming tests, the Geriatric Mental State, and the History and Aetiology Schedule – Dementia Diagnosis and Subtype. This was validated in Cuba against a local clinician DSM-IV diagnosis and the 10/66 dementia diagnosis (originally calibrated probabilistically against clinician DSM-IV diagnoses in the 10/66 pilot study).

Results

The DSM-IV sub-criteria were plausibly distributed among clinically diagnosed dementia cases and controls. The clinician diagnoses agreed better with 10/66 dementia diagnosis than with the more conservative computerized DSM-IV algorithm. The DSM-IV algorithm was particularly likely to miss less severe dementia cases. Those with a 10/66 dementia diagnosis who did not meet the DSM-IV criterion were less cognitively and functionally impaired compared with the DSMIV confirmed cases, but still grossly impaired compared with those free of dementia.

Conclusion

The DSM-IV criterion, strictly applied, defines a narrow category of unambiguous dementia characterized by marked impairment. It may be specific but incompletely sensitive to clinically relevant cases. The 10/66 dementia diagnosis defines a broader category that may be more sensitive, identifying genuine cases beyond those defined by our DSM-IV algorithm, with relevance to the estimation of the population burden of this disorder.

[Late onset epilepsy as the first symptom of pseudohypoparathyroidism]

INTRODUCTION

The late onset epilepsy is defined like that start in the adult life after the 25 years old. The diagnostic assessment of the late onset epilepsy forces to discard, in the absence of the principal causes like stroke, tumors and trauma to the metabolic cause like plausible. The persistent hypocalcemia, apart of its acute repercussions, produces severe neurologic consequences.

CASE REPORT

Feminine patient of 61 years old, that assists with a tonic clonic generalized seizure and tetany facts in the physical exam (Chvostek and Trousseau), round facies, obesity and metacarpals abnormalities. The hypocalcemia, hyperphosphatemia and resistance to parathyroid hormone (with normal levels of cAM in urine after stimulation with PTH) triad outline the pseudohypoparathyroidism.

CONCLUSIONS

Consider by the clinical history, biochemical results and clinical findings consistent with Albright hereditary osteodystrophy a pseudohypoparathyroidism type Ia in this patient; is the more common form of this disorders and have a dominant pattern of inheritance, is produced by a detectable mutation in the stimulatory Gs alpha, one protein of the adenylil cyclase complex (GNAS1) that is traduced in a inefficacy of the PTH renal receptor. The main goals of treatment are reduce and maintain the serum calcium and PTH levels, respectively.

[Multiple cerebral tuberculomas]

INTRODUCTION

The tuberculosis is a disease that continues being important cause of morbidity and mortality at worldwide level. Its presentation as tuberculomas cerebral manifold at level of the central nervous system is little frequent in immunocompetent patients and can be confused with other etiology.

CASE REPORT

An indigenous young man, immunocompetent consulted for history of headache, nausea, vomits, convulsions, double vision and hemiparesia left side, which in the cerebral tomography of revenue was showing injuries compatible with cerebral abscesses; for which he received treatment with antibiotics without improvement for what there takes biopsy of the injuries that reported tuberculomas, specific treatment being initiated later and the primary area being investigated without the same one be detecting. After the first procedural step with evident clinical and radiographic improvement.

CONCLUSIONS

The tuberculosis in anyone of their forms of presentation must be included within the diagnosis differential of the patients in our endemic countries for this disease. The clinical and radiological diagnosis of cerebral injuries is difficult and single usually it obtains to the diagnosis during a pathology study that shows tuberculomas with caseosa necrosis, epiteliodes cell and the acid alcohol bacilli resistant.

Ethnicity: post-traumatic stress disorder (PTSD) differences among black, white, and Hispanic veterans who differ in degrees of exposure to combat in Vietnam

Clinical observations and empirical evidence suggest that, among Vietnam combat veterans, Blacks are more maladjusted than Whites (e.g., Parsons, 1985; Penk et al., 1985). The prediction that minority group status is associated with poorer post-war adjustment and higher rates of PTSD was examined among Vietnam combat veterans who were seeking treatment for addiction disorders. Adjustment scores among groups comparable in combat exposure were found to be similar for both Whites and Hispanics; Blacks, however, score significantly higher on both PTSD symptoms on MMPI scales. These findings indicate that ethnicity contributes importantly to PTSD in selected instances, but that minority group status alone does not account for observed differences. Additional research is indicated in which careful attention is given to the complicating and interacting role of addiction disorders in sampling.

Perioperative nursing research. Part VII: Postoperative care

The implications for further research will be determined by the changes in surgery and perioperative nursing itself. Things are changing. The development of biliary lithotripsy and more flexible laser angioplasty, to name but two, will reduce the potential for traditional complications of surgery. Bleeding and infection will diminish with less invasive procedures. Similarly, the postoperative course of surgical patients will be assisted by earlier signs detected by pulse oximeters, more accurate assessments of neurological status, and even intraoperative management of acute myocardial infarction. The role of the perioperative nurse will be by no means diminished. In fact, it will expand.

Treatment of acute leukemia during pregnancy: presentation of nine cases

The hematologic and obstetric problems of nine pregnant patients with acute leukemia are analyzed. Seven patients received chemotherapy during various trimesters of pregnancy, four during the first 10 weeks, and there was no evidence of congenital malformations in any of their offspring. Six of nine babies are alive and healthy with a normal growth 2 months to 15 years after birth, one child was stillborn, and two children died 21 and 90 days after birth. These results were compared with others in the literature and the conclusions are that pregnancy is not a contraindication for treatment of acute leukemia, that cytotoxic drugs may not cause congenital malformations, and that the management of pregnant patients with acute leukemia should be carefully planned.

Amino acid pools in the feto-maternal system

The determinations of the amino acid pools, including tryptophan (by fluorescence spectrometry), in the arterial and venous blood of the mother, the arterial and venous blood of the fetus (cord blood), the amniotic fluid and the placenta was done in eight women at the moment of delivery. Only nine amino acids (asp, try, met, phe, ser, cys, lys, gly, thr) were significantly retained and four (arg, glu, pro and glu-NH2) were significantly released by the fetal tissues. In contrast with this behavior most amino acids were retained by the maternal tissue, try, phe and hist showing the highest retention. When the amino acids are grouped as essential and nonessentials, the maternal tissues retained both categories without apparent discrimination, while the fetal tissues retained essential amino acids preferentially. Our results emphasize the importance of the placenta as the regulating system of the fetal milieu under normal conditions. Thus human fetal blood levels of amino acids are patterned after the placental ones and not after the maternal values obtained at the same time. It is apparent that the placenta seems to function as a nonspecific retention filter for outgoing amino acids, but that its function is selective in respect to the release of amino acids into the fetal circulation.