Persistent diarrhea in northeast Brazil: etiologies and interactions with malnutrition

With the improved control of acute diarrheal illness mortality with oral rehydration therapy, persistent diarrhea is now emerging as a major cause of childhood mortality in tropical developing areas like the impoverished populations in Brazil's Northeast. "Graveyard surveillance" in the rural community of Guaiuba in northeastern Brazil revealed fully half of the 70% diarrhea mortality was due to persistent diarrheal illnesses. Furthermore, 11% of 14 or more diarrheal illnesses per child per year in an urban slum in Fortaleza persisted beyond 14 days, a definition that clearly identified the high risk children for heavy diarrhea burdens. Not only did heavy diarrhea burdens ablate the key "catch-up" growth seen in severely malnourished children and in children following previous diarrheal illnesses, but malnutrition significantly predisposed children to a greater incidence and duration of diarrhea as well as a greater incidence of persistent diarrhea. Etiologic studies of 37 children presenting with persistent diarrhea to Hospital das Clinicas in Fortaleza revealed that Cryptosporidium (in 13%) and enteroadherent E. coli (36% with aggregative, 29% with diffuse and 13% with localized adherence to HEp-2 cells) were the predominant potential pathogens found in the stool or upper small bowel. These findings suggest that persistent diarrhea is emerging as an important health problem in Brazil's Northeast, that it identifies a high risk child for heavy diarrhea burdens, that important interactions occur with malnutrition and that Cryptosporidium and enteroadherent E. coli warrant further study as potential etiologies of this major cause of morbidity and mortality.

Expiratory flow limitation during exercise in competition cyclists

In some trained athletes, maximal exercise ventilation is believed to be constrained by expiratory flow limitation (FL). Using the negative expiratory pressure method, we assessed whether FL was reached during a progressive maximal exercise test in 10 male competition cyclists. The cyclists reached an average maximal O2 consumption of 72 ml. kg-1. min-1 (range: 67-82 ml. kg-1. min-1) and ventilation of 147 l/min (range: 122-180 l/min) (88% of preexercise maximal voluntary ventilation in 15 s). In nine subjects, FL was absent at all levels of exercise (i.e., expiratory flow increased with negative expiratory pressure over the entire tidal volume range). One subject, the oldest in the group, exhibited FL during peak exercise. The group end-expiratory lung volume (EELV) decreased during light-to-moderate exercise by 13% (range: 5-33%) of forced vital capacity but increased as maximal exercise was approached. EELV at peak exercise and at rest were not significantly different. The end-inspiratory lung volume increased progressively throughout the exercise test. The conclusions reached are as follows: 1) most well-trained young cyclists do not reach FL even during maximal exercise, and, hence, mechanical ventilatory constraint does not limit their aerobic exercise capacity, and 2) in absence of FL, EELV decreases initially but increases during heavy exercise.

Anthraquinone-2,6-disulfonate (AQDS) as a catalyst to enhance the reductive decolourisation of the azo dyes Reactive Red 2 and Congo Red under anaerobic conditions

In this study, we assessed the catalytic effect of anthraquinone-2,6-disulfonate (AQDS) to enhance the reductive decolourisation of the azo dyes Reactive Red 2 and Congo Red in batch and continuous-flow experiments. While testing the anaerobic sludge 1 in assays free of AQDS, the highest values for the first-order kinetic constant (k1) were found with co-substrates formate and glucose. In the assays that contained 50 microM of AQDS, the k1 values increased with all co-substrates tested, increasing by 3.5-fold when ethanol was the electron donor. The upflow anaerobic sludge blanket (UASB) reactors R1 (AQDS-free) and R2 (AQDS-supplemented) reached excellent decolourisation efficiencies (higher than 90%) even for the high Congo Red concentration tested (1.2 mM). However, electron donor depletion in the influent drastically decreased the colour removal capacity in both bioreactors. Reactor R2 presented higher stability and decolourisation efficiency compared to R1, indicating that the addition of a redox mediator can be valuable for treating dye-coloured wastewaters.

Overview of Beneficial Effects of (Poly)phenol Metabolites in the Context of Neurodegenerative Diseases on Model Organisms

The rise of neurodegenerative diseases in an aging population is an increasing problem of health, social and economic consequences. Epidemiological and intervention studies have demonstrated that diets rich in (poly)phenols can have potent health benefits on cognitive decline and neurodegenerative diseases. Meanwhile, the role of gut microbiota is ever more evident in modulating the catabolism of (poly)phenols to dozens of low molecular weight (poly)phenol metabolites that have been identified in plasma and urine. These metabolites can reach circulation in higher concentrations than parent (poly)phenols and persist for longer periods of time. However, studies addressing their potential brain effects are still lacking. In this review, we will discuss different model organisms that have been used to study how low molecular weight (poly)phenol metabolites affect neuronal related mechanisms gathering critical insight on their potential to tackle the major hallmarks of neurodegeneration.

Spontaneous rupture of the spleen associated with pneumonia

Spontaneous rupture of the spleen is a rare and life-threatening complication of bacterial pneumonia, only six properly documented cases having been reported to date. A case of spontaneous splenic rupture associated with pneumonia caused by Legionella pneumophila is presented, together with a review of the literature. Most of the patients were aged over 50, but none had predisposing conditions. Left lung involvement predominated. Legionellosis and Q fever were the most frequent etiologic diagnoses. Empiric antibiotic therapy was adequate in all but two patients. One patient died; he had not undergone laparotomy. Spontaneous rupture of the spleen is an extremely rare complication of bacterial pneumonia that endangers the patient's life if surgery is not performed immediately. This complication should be borne in mind in patients with atypical pneumonia who have left quadrant pain and a falling hematocrit, even in the absence of prior splenomegaly.

The effect of denudation and injection timing in the reproductive outcomes of ICSI cycles: new insights into the risk of in vitro oocyte ageing

STUDY QUESTION

Does the time elapsed between oocyte pick-up (OPU) and denudation or injection affect the probability of achieving a live birth (LB) in ICSI cycles?

SUMMARY ANSWER

Prolonged oocyte culture before denudation (>4 h) was associated with an increase in clinical pregnancy (CP), LB and cumulative LB (CLB) rates when compared with earlier denudation timings.

WHAT IS KNOWN ALREADY

Oocyte maturation is a complex and dynamic process involving structural and biochemical modifications in the cell necessary to support fertilization and early embryo development. While meiotic competence is easily identifiable by the presence of an extruded first polar body, cytoplasmic maturation cannot be assessed microscopically. Culturing oocytes with their surrounding cumulus cells (CCs) prior to ICSI can enhance the completion of in vitro cytoplasmic maturation; conversely, prolonged culture may induce cell degeneration. The optimal culture intervals prior to oocyte denudation and/or injection have not yet been established and may prove relevant for the improvement of ICSI reproductive outcomes.

STUDY DESIGN, SIZE, DURATION

This is a single-centre retrospective cohort analysis of 1378 ICSI cycles performed between January 2005 and October 2018. Data were categorized according to: (i) the time interval between OPU and denudation (<3 h, 3-4 h and ≥4 h), (ii) the time interval between denudation and ICSI (<1.5 h, 1.5-2 h, ≥2 h) and (iii) the time interval between OPU and ICSI (<5 h, 5-6 h and ≥6 h). The effect of these timings on fertilization, CP, LB and CLB rates were compared. The culture intervals between different procedures were dependent exclusively on laboratory workload.

PARTICIPANTS/MATERIALS, SETTING, METHODS

ICSI cycles performed in women younger than 40 years old using autologous gametes with at least one metaphase II injected oocyte were included. The effect of oocyte culture duration prior to denudation and injection of the oocytes was compared using multivariable regression accounting for potential confounding variables.

MAIN RESULTS AND THE ROLE OF CHANCE

Fertilization and oocyte damage rate after ICSI was found to be independent of the time interval to denudation (<3 h, 3-4 h and ≥4 h) and/or injection (<5 h, 5-6 h and ≥6 h). Extending oocyte culture before denudation significantly improved CP (29.5%, 42.7% and 50.6%, respectively), LB (25.1%, 34.4% and 40.7%, respectively) and CLB rates (26.0%, 36.1% and 42.2%, respectively), particularly if the time interval was at least 4 h. Additionally, LB (31.7%, 35.8% and 27.4%, respectively) and CLB rates (34.2%, 36.6% and 27.7%, respectively) were also dependent on the time from OPU to injection.

LIMITATIONS, REASONS FOR CAUTION

This study is limited by its retrospective nature and potential unmeasured confounding cannot be excluded. Furthermore, the effect of even shorter or longer periods of culture before denudation and/or injection were not evaluated and should not be extrapolated from these results.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings propose new evidence of a previously unrecognized protective effect of the CCs-oocyte interactions in human ART, raising the question of a possible downstream effect in embryogenesis which significantly affects LB rates. Additionally, this is the first study to suggest a negative effect of further extending culture before ICSI on LB and CLB rates, thus potentially allowing for the narrowing of an optimal ICSI time interval. Simple strategies such as the establishment of more effective time frames to perform these procedures and adjusting laboratory practice may prove beneficial, ultimately improving ICSI reproductive outcomes.

STUDY FUNDING/COMPETING INTEREST(S)

None.

TRIAL REGISTRATION NUMBER

N/A.

ECG Characterization of paroxysmal atrial fibrillation: parameter extraction and automatic diagnosis algorithm

Paroxysmal atrial fibrillation (PAF) is one of the most common heart arrhythmias. It is very difficult to detect unless an explicit Atrial Fibrillation episode occurs during the exploration. The present paper describes a number of low level parameters extracted from ECG traces where no Atrial Fibrillation process is present. The ability of this parameter set to characterize PAF patients is studied and discussed. Based on these parameters a modular automatic classification algorithm for PAF diagnosis is developed and evaluated.

[The effect of nocturnal oxygen therapy in patients with sleep apnea syndrome and chronic airflow limitation]

Oxygen therapy for patients with sleep apnea-hypopnea syndrome (SAHS) usually causes significant side effects. The aim of this study was to assess the effect of short-term nocturnal oxygen therapy in patients with SAHS and chronic obstructive pulmonary disease. Ten patients with diagnoses of SAHS were enrolled. The patients' mean age was 63 (10) years, mean apnea-hypopnea index (AHI) was 58 +/- 17, mean FVC was 59 +/- 8% of reference and mean FEV1 was 40 +/- 14% of reference. Using a random, single blind design, two polysomnographic studies were performed on two consecutive nights. Oxygen was administered on one night at a mean flow rate of 1.3 +/- 04 l/min and on the other night air was administered at the same rate. Arterial blood gases were analyzed at the end of each study. Oxygen administration improved nocturnal hypoxia and reduced the AHI, which was 40 +/- 20 with oxygen and 58 +/- 17 with air (p < 0.005). Improvement was achieved at the expense of a reduction in the number of hypopneic episodes. No significant differences were observed in apneic episodes and only a slight increase in the duration of hypopneic episodes was observed (21 +/- 7 s with air and 27 +/- 8 s with oxygen [p < 0.01]). Neither quality of sleep nor heart rate changed. Slight respiratory acidosis was observed in 50% of the patients. In conclusion, nocturnal oxygen administration in patients with SAHS and COPD improved nocturnal hypoxia and reduced the total number of respiratory events. However, in these patients oxygen should be administered with care, even when the rate of flow is low, given the tendency for pCO2 and respiratory acidosis to increase.

Effect of nitrate on the reduction of Reactive Red 2 by mesophilic anaerobic sludge

This research aimed to evaluate the effect of nitrate on anaerobic azo dye reduction by using mesophilic bioreactors, in the absence (reactor R2) and in the presence (reactor R1) of redox mediators. The azo dye Reactive Red 2 (RR2) and the redox mediator anthraquinone-2,6-disulphonate (AQDS) were selected as model compounds. The results showed that the bioreactors were efficient on RR2 reduction, in which ethanol showed to be a good electron donor to sustain dye reduction under anaerobic conditions. The redox mediator AQDS increased the rates of reductive decolourisation, but its effect was not so remarkable compared to the previous experiments conducted. Contrary to the raised hypothesis that the nitrate addition could decrease decolourisation rates and catalytic properties of the redox mediators, no effect of nitrate was observed in the bioreactors, suggesting that the presence of nitrate in textile wastewaters will not decrease the capacity of anaerobic reactors supplemented or not with redox mediators to decolourize azo dyes.

Automatic Paroxysmal Atrial Fibrillation Based on not Fibrillating ECGs

OBJECTIVES

The objective of the paper is to describe an automatic algorithm for Paroxysmal Atrial Fibrillation (PAF) Detection, based on parameters extracted from ECG traces with no atrial fibrillation episode. The modular automatic classification algorithm for PAF diagnosis is developed and evaluated with different parameter configurations.

METHODS

The database used in this study was provided by Physiobank for The Computers in Cardiology Challenge 2001. Each ECG file in this database was translated into a 48 parameter vector. The modular classification algorithm used for PAF diagnosis was based on the nearest K-neighbours. Several configuration options were evaluated to optimize the classification performance.

RESULTS

Different configurations of the proposed modular classification algorithm were tested. The uni-parametric approach achieved a top classification rate value of 76%. A multi-parametric approach was configured using the 5 parameters with highest discrimination power, and a top classification rate of 80% was achieved; different functions to typify the parameters were tested. Finally, two automatic parametric scanning strategies, Forward and Backward methods, were adopted. The results obtained with these approaches achieved a top classification rate of 92%.

CONCLUSIONS

A modular classification algorithm based on the nearest K-neighbours was designed. The classification performance of the algorithm was evaluated using different parameter configurations, typification functions and number of K-neighbors. The automatic parametric scanning techniques achieved much better results than previously tested configurations.

Assessing the Efficacy of Botulinum Toxin in Treating Neuropathic Pain: A Report of Two Cases

This study examines the efficacy of botulinum neurotoxin type A (BoNT-A) in neuropathic pain management. Neuropathic pain (NP) is a chronic condition that remains challenging to treat. While botulinum neurotoxin type A (BoNT-A) has been proposed as a therapeutic option, its efficacy in trauma-induced NP remains unclear. This report presents two patients with NP in their fingers - one following a traumatic amputation and the other a sharp laceration - who underwent two sessions of BoNT-A injections. Neither patient experienced improvement in pain severity or functionality, and severe allodynia persisted. These findings suggest that BoNT-A may have limited efficacy in certain neuropathic pain conditions, emphasizing the need for careful patient selection and further research into alternative therapeutic strategies. Additionally, this study introduces the "neuropathic finger" as a model for investigating local drugs with potential antineuropathic properties.

Anaesthetic Management in a Duchennne Muscle Dystrophy Patient for Treatment of Recurrent Pneumothorax

INTRODUCTION

Duchenne muscular dystrophy (DMD) is an x linked recessive disorder. Long term prognosis is ominous, with development of respiratory distress and cardiomyopathy in advanced stage of the disease and expected death in the teens-to-mid 20s due to respiratory or cardiac failure. Peri-operative management of this patients is challenging due to difficult airway anatomy (macroglossia, limited neck and mandibular mobility). Additionally, they are at risk of developing malignant hyperthermia, rhabdomyolysis and hyperkalemic cardiac arrest when exposed to halogenated inhalational anaesthetics and depolarizing muscle relaxants.

METHODS

We describe a case of DMD proposed to a thoracotomy for treatment of recurrent pneumothorax and its anaesthetic approach.

RESULTS

A 22-year-old male patient with DMD presented at emergency department due dyspnoea starting at 3 days associated with right scapular pain, enhanced by breathing. The patient already presents with mild cardiomyopathy (ejection fraction of 55%, mild mitral and tricuspid regurgitation), severe restrictive respiratory defect, requiring continuous BiPAP. The patient was markedly denourished (BMI of 12 kg/m2) and presented with nearly absent breathing sounds on the right side. Chest radiography showed large pneumothorax on the right side with no signs of tension. Drainage was performed. Despite initial success, recurrence of pneumothorax occurred on the several attempts of clamping. A bronchopleural fistula was suspected and operative treatment was considered. Considering the comorbidities, he was graded ASA IV with a difficult airway due to macroglossia, limited neck and mandibular mobility. Oro-tracheal intubation was performed with slight sedation (propofol, without neuromuscular blocks). Difficult airway anatomy (direct laryngoscopy - Cormack 4) successfully approached with a bougie and Mccoy blade. Fibreoptic intubation approach was immediately available in the operating room, if required. Total intravenous anaesthesia was decided (remifentanil and propofol, administered by continuous infusion, without neuromuscular blockers). Volume controlled protective ventilation as used (tidal volume 6-8ml/kg, respiratory frequency of 14-16/ min; FiO2: 0,5). No bronchopleural fistula was detected and pleurodesis was performed with biologic glue. Patient remained intubated and was transferred to the ICU for monitoring, having been discharged on the 2nd day to the ward. Despite this, pneumothorax recurrence occurred, and surgery was performed again, using the same anaesthetic approach, this time with successful closure of the bronchopleural fistula.

CONCLUSION

Total intravenous anaesthesia, without neuromuscular blockers, is a safe and effective option for DMD patients. Anaesthesiologists must consider the possibility of cardio-pulmonary disabilities, difficult airway management, as well as the high risk of malignant hyperthermia in these patients.

Daily dynamics of grandiose narcissism: distribution, stability, and trait relations of admiration and rivalry states and state contingencies

On the basis of the Narcissistic Admiration and Rivalry Concept and recent theories on narcissistic pursuit of status, we provide a differentiated analysis of individual differences in the within-person dynamics of grandiose narcissism. In two daily diary studies (Sample 1: 56 days; Sample 2: 82 days; total participants: N = 198; total observations: N = 12,404), we investigated the degree, stability, and trait correlates of individual differences in average narcissism-relevant states (perceived status success, perceived admiration and rejection, positive and negative affect, and assertive and hostile behavior) as well as individual differences in within-person contingencies between these states. The results indicated substantial and stable between-person differences in averaged states that were related to their corresponding narcissism trait self-reports. State contingencies showed substantial strength, significant interindividual differences, and stability across the 56 and 82 days, respectively. We only found weak support for associations between state contingencies and trait narcissism self-reports. These findings support a differentiated approach to the conceptualization and assessment of grandiose state narcissism and call for even more comprehensive and fine-grained investigations.