RESUMO
Resumen Globalmente, los fármacos son el tipo de agente más frecuentemente implicado en las intoxicaciones pediátricas y las Ben-zodiacepinas el grupo farmacológico más frecuente. La reacción paradojal, secundaria a la exposición a Benzodiacepinas se caracteriza por la presencia de signosintomatología contraria a los efectos sedativos hipnóticos esperados, pudiendo presentarse con inquietud, ansiedad, hostilidad y alteraciones de la conducta, entre otros. La mayoría de los trabajos hallados acerca de este síndrome en pediatría lo describen secundario a Midazolam endovenoso, en contexto de sedación consciente para la realización de diferentes procedimientos. Las causas por los cuales se puede generar este fenómeno de desinhibición no han sido clarificadas, postulándose tres hipótesis: la desregulación colinérgica central, el aumento del tono gabaérgico en el sistema límbico, tálamo e hipotálamo y el desbalance de serotonina. Se expone una serie de 15 pacientes de entre 1 año y 5 años, expuestos accidentalmente a Benzodiacepinas, principalmente Clonazepam y Lorazepam, a fin de describir las características de esta reacción. En esta serie se observó con latencia breve y duración variable, de hasta 11 horas, la presencia en orden de frecuencia, de: ansiedad, irritabilidad, gritos, hostilidad y conductas agresivas, llanto inconsolable, incapacidad de contención por familiares, conductas irracionales, excitación psicomotriz, desinhibición emocional, alucinaciones y aumento de locuacidad, asociado frecuentemente a ataxia.
Abstract Globally, medicines are the most frequently toxins involved in pediatric poisonings, and Benzodiazepines are the most fre-quent pharmacological group in those poisonings. The paradoxical reaction, secondary to Benzodiazepines exposure, is characterized by the presence of contrary expected sedative-hypnotic effects, and may present with restlessness, increased anxiety, hostility, and behav-ioral alterations, among others. The studies we found about this syndrome in pediatric patients describe it most frequently secondary to endovenous Midazolam, in the context of the conscious sedation to perform different procedures. The reasons why this reaction is generated have not been clarified, three hypotheses are postulated: the central cholinergic dysregulation, the increased Gabaergic tone in the limbic system, thalamus and hypothalamus and the serotonin imbalance. A series of 15 patients, between 1 year and 5 years old, accidentally exposed to Benzodiazepines, mainly Clonazepam and Lorazepam, to describe the characteristics of the paradoxical reaction secondary to Benzodiazepines exposure. In this case series, we observed with short latency and variable duration, up to 11 hours, the presence in order of frequency of: anxiety, irritability, screams, hostility and aggressive behaviors, inconsolable crying, inability to con-tain by their family members, irrational behaviors and psychomotor excitement, emotional disinhibition, hallucinations and increased talkativeness, frequently associated with ataxia.
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Resumen La marihuana o cannabis es la sustancia psicoactiva ilícita de mayor consumo. Una consecuencia no deseada de la regulación de su cultivo y la difusión popular de su uso medicinal y recreativo, es su asociación con el aumento de la disponibilidad de cultivos en la población general y de productos, como alimentos y fármacos elaborados con infusiones de esta planta, con concentraciones desconocidas de delta-9-tetrahidrocannabinol (A9THC), su principal componente psicoactivo. Se presenta una serie de 3 pacientes expuestos a esta sustancia de forma no intencional, por vía digestiva, asistidos de forma presencial por los servicios de Toxicología y Emergencias del Hospital Interzonal de Agudos Especializado en Pediatría "Sor María Ludovica" de La Plata. A diferencia de la absorción por vía inhalatoria, por vía digestiva se producen concentraciones mucho más variables y ciclos temporales mayores de A9THC y sus metabolitos, que ejercen sus efectos sobre los receptores CB1, dispuestos en el sistema nervioso central, incluido tronco encefálico, región con mayor presencia de éstos en niños, lo que justifica las manifestaciones neurológicas frecuentes y de mayor gravedad en este grupo etario, en relación a los adultos. La sospecha clínica, la anamnesis y la detección temprana de cannabinoides en orina son los pilares fundamentales para establecer el diagnóstico temprano. El tratamiento consiste en medidas de sostén y sintomáticas, que se implementan según la gravedad del cuadro. Debe considerarse la posibilidad de exposición a esta sustancia frente a cuadros de letargo o somnolencia de aparición brusca, con ataxia, modificaciones del humor, alteraciones sensoperceptivas, convulsiones o coma, con o sin insuficiencia respiratoria, con taquicardia o bradicardia. Es de fundamental importancia la educación y concientización de los adultos a cargo de niños sobre estos riesgos.
Abstract Marijuana or cannabis is the illicit psychoactive substance most widely used. An unwanted consequence of the regula-tion of its cultivation and the popular diffusion of its medicinal and recreational use, is the association with an increase in the avail-ability of crops in the general population, products, foods and medicines made with cannabis infusions, with unknown concentra-tions of delta-9-tetrahydrocannabinol (A9THC), the most important psychoactive component. We present a series with 3 patients with unintentional exposure to this substance through the digestive tract, assisted by the Toxicology and Emergency services of the Interzonal Hospital for Acute Specialized in Pediatrics "Sor María Ludovica". Unlike absorption through the inhalation route, more variable concentrations and greater temporal cycles of A9THC and its metabolites are produced through the digestive route, which exert their effects on CB1 receptors, arranged in the central nervous system, including brainstem, the region with greatest presence of this receptors in children, that justifies the frequent and more serious neurological manifestations in children, compared to adults. Clinical suspicion, anamnesis and early detection of cannabinoids in urine are the fundamental pillars to establish an early diagnosis. Treatment consists in supportive and symptomatic measures, that are implemented according to the severity of the condition. The possibility of exposure to this substance must be estimated in the face of sudden onset of lethargy or drowsi-ness, with ataxia, mood modifications, sensory-perceptual disturbances, seizures or coma, with or without respiratory failure, with tachycardia or bradycardia. The education and awareness of caretakers adults, about these risks is of fundamental importance.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Cannabis/intoxicação , Cannabis/toxicidade , Absorção Gastrointestinal , Uso da Maconha/efeitos adversosRESUMO
Malassezia furfur is part of the human skin microbiota. Its volatile organic compounds (VOCs) possibly contribute to the characteristic odour in humans, as well as to microbiota interaction. The aim of this study was to investigate how the lipid composition of the liquid medium influences the production of VOCs. Growth was performed in four media: (1) mDixon, (2) oleic acid (OA), (3) oleic acid + palmitic acid (OA+PA), and (4) palmitic acid (PA). The profiles of the VOCs were characterized by HS-SPME/GC-MS in the exponential and stationary phases. A total number of 61 VOCs was found in M. furfur, among which alkanes, alcohols, ketones, and furanic compounds were the most abundant. Some compounds previously reported for Malassezia (γ-dodecalactone, 3-methylbutan-1-ol, and hexan-1-ol) were also found. Through our experiments, using univariate and multivariate unsupervised (Hierarchical Cluster Analysis (HCA) and Principal Component Analysis (PCA)) and supervised (Projection to Latent Structures Discriminant Analysis (PLS-DA)) statistical techniques, we have proven that each tested growth medium stimulates the production of a different volatiles profile in M. furfur. Carbon dioxide, hexan-1-ol, pentyl acetate, isomer5 of methyldecane, dimethyl sulphide, undec-5-ene, isomer2 of methylundecane, isomer1 of methyldecane, and 2-methyltetrahydrofuran were established as differentiating compounds among treatments by all the techniques. The significance of our findings deserves future research to investigate if certain volatile profiles could be related to the beneficial or pathogenic role of this yeast.
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Malassezia/química , Compostos Orgânicos Voláteis/análise , Compostos Orgânicos Voláteis/isolamento & purificação , Meios de Cultura/química , Cromatografia Gasosa-Espectrometria de Massas , Metabolismo dos Lipídeos , Lipídeos/química , Malassezia/metabolismo , Metaboloma , Metabolômica/métodos , Microextração em Fase Sólida , Compostos Orgânicos Voláteis/químicaRESUMO
Chromoblastomycosis is a chronic cutaneous and subcutaneous mycosis, is caused by dematiaceous fungi, the most frequently implicated are Fonsecaea, Phialophora, Cladophialophora, Rhinocladiella and Exophiala. We report a woman who was treated before with mycological cure, but she experience a relapse requiring treatment again. Direct microscopic examination and skin biopsy with culture were necessary to identify a Exophiala psychrophila, and for our knowledge this is the first case reported.
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Growing antimicrobial resistance is considered a potential threat for human health security by health organizations, such as the WHO, CDC and FDA, pointing to MRSA as an example. New antibacterial drugs and complex derivatives are needed to combat the development of bacterial resistance. Six new copper and cobalt complexes of azole derivatives were synthesized and isolated as air-stable solids and characterized by melting point analyses, elemental analyses, thermogravimetric analyses (TGA), and infrared and ultraviolet/visible spectroscopy. The analyses and spectral data showed that the complexes had 1:1 (M:L) stoichiometries and tetrahedral geometries, the latter being supported by DFT calculations. The antibacterial activities of the metal complexes by themselves and combined with silver nanoparticles (AgNPs; 2 µg mL-1) were assessed in vitro by broth microdilution assays against eight bacterial strains of clinical relevance. The results showed that the complexes alone exhibited moderate antibacterial activities. However, when the metal complexes were combined with AgNPs, their antibacterial activities increased (up to 10-fold in the case of complex 5), while human cell viabilities were maintained. The minimum inhibitory concentration (MIC50) values were in the range of 25-500 µg mL-1. This study thus presents novel approaches for the design of materials for fighting bacterial resistance. The use of azole complexes combined with AgNPs provides a new alternative against bacterial infections, especially when current treatments are associated with the rapid development of antibiotic resistance.
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Antibacterianos/química , Antibacterianos/farmacologia , Azóis/química , Azóis/farmacologia , Nanopartículas Metálicas/química , Prata/química , Bactérias/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Cobalto/química , Coloides , Cobre/química , Humanos , Ligantes , Testes de Sensibilidade Microbiana , Microscopia de Força Atômica , Modelos Moleculares , Estrutura Molecular , Análise Espectral , TermogravimetriaRESUMO
Malassezia species are lipophilic and lipid-dependent yeasts belonging to the human and animal microbiota. Typically, they are isolated from regions rich in sebaceous glands. They have been associated with dermatological diseases such as seborrheic dermatitis, pityriasis versicolor, atopic dermatitis, and folliculitis. The genomes of Malassezia globosa, Malassezia sympodialis, and Malassezia pachydermatis lack the genes related to fatty acid synthesis. Here, the lipid-synthesis pathways of these species, as well as of Malassezia furfur, and of an atypical M. furfur variant were reconstructed using genome data and Constraints Based Reconstruction and Analysis. To this end, the genomes of M. furfur CBS 1878 and the atypical M. furfur 4DS were sequenced and annotated. The resulting Enzyme Commission numbers and predicted reactions were similar to the other Malassezia strains despite the differences in their genome size. Proteomic profiling was utilized to validate flux distributions. Flux differences were observed in the production of steroids in M. furfur and in the metabolism of butanoate in M. pachydermatis. The predictions obtained via these metabolic reconstructions also suggested defects in the assimilation of palmitic acid in M. globosa, M. sympodialis, M. pachydermatis, and the atypical variant of M. furfur, but not in M. furfur. These predictions were validated via physiological characterization, showing the predictive power of metabolic network reconstructions to provide new clues about the metabolic versatility of Malassezia.
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Fusariosis have been increasing in Colombia in recent years, but its epidemiology is poorly known. We have morphologically and molecularly characterized 89 isolates of Fusarium obtained between 2010 and 2012 in the cities of Bogotá and Medellín. Using a multi-locus sequence analysis of rDNA internal transcribed spacer, a fragment of the translation elongation factor 1-alpha (Tef-1α) and of the RNA-dependent polymerase subunit II (Rpb2) genes, we identified the phylogenetic species and circulating haplotypes. Since most of the isolates studied were from onychomycoses (nearly 90 %), we carried out an epidemiological study to determine the risk factors associated with such infections. Five phylogenetic species of the Fusarium solani species complex (FSSC), i.e., F. falciforme, F. keratoplasticum, F. lichenicola, F. petroliphilum, and FSSC 6 as well as two of the Fusarium oxysporum species complex (FOSC), i.e., FOSC 3 and FOSC 4, were identified. The most prevalent species were FOSC 3 (38.2%) followed by F. keratoplasticum (33.7%). In addition, our isolates were distributed into 23 haplotypes (14 into FOSC and nine into FSSC). Two of the FSSC phylogenetic species and two haplotypes of FSSC were not described before. Our results demonstrate that recipients of pedicure treatments have a lower probability of acquiring onychomycosis than those not receiving such treatments. The antifungal susceptibility of all the isolates to five clinically available agents showed that amphotericin B was the most active drug, while the azoles exhibited lower in vitro activity.
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DNA Espaçador Ribossômico/genética , Dermatoses do Pé/epidemiologia , Fusariose/epidemiologia , Fusarium/classificação , Fusarium/genética , Onicomicose/epidemiologia , Fator 1 de Elongação de Peptídeos/genética , RNA Polimerase II/genética , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Colômbia/epidemiologia , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/microbiologia , Fusariose/tratamento farmacológico , Fusariose/microbiologia , Fusarium/efeitos dos fármacos , Fusarium/isolamento & purificação , Haplótipos/genética , Humanos , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Onicomicose/tratamento farmacológico , Onicomicose/microbiologia , Filogenia , Análise de Sequência de DNARESUMO
Malassezia pachydermatis is a basidiomycetous yeast that causes infections in humans and animals. Here, we report the genome sequence of Malassezia pachydermatis strain CBS 1879, which will facilitate the study of mechanisms underlying pathogenicity of the only non-lipid-dependent Malasezzia species.
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Seborrheic dermatitis (SD) is a chronic, widespread skin condition, which is considered a multifactorial disease influenced, in part, by Malassezia spp. opportunistic activities, as well as various endogenous and exogenous factors. Malassezia species are lipophilic, lipid-dependent yeasts that are members of the normal mycobiota of the human skin. Their isolation from SD lesions varies around the world and the study of the relationship among factors such as gender, age, immunosuppressive condition of the patient and SD development, can lead to a better understanding of this disease. To elucidate the association of age and gender with the development of SD and to precisely determine the Malassezia species involved in the disease, samples were obtained from 134 individuals, including individuals without lesions, human immunodeficiency virus positive patients, individuals with seborrheic dermatitis, and HIV patients with seborrheic dermatitis. Malassezia spp. were identified by phenotypic and genotypic methods and a phylogenetic analysis was performed using Bayesian inference. This study revealed that age and gender are not predisposing factors for SD development, and that the most frequent species of Malassezia related to SD development among the Colombian population is M. restricta. We also report the isolation of M. yamatoensis for the first time in Colombia, and propose an ITS2 secondary structure from Malassezia taxa that can be used for precise identification and to establish more robust phylogenetic relationships.
Assuntos
Causalidade , DNA Espaçador Ribossômico/genética , Dermatite Seborreica/epidemiologia , Dermatite Seborreica/microbiologia , Malassezia/classificação , Malassezia/genética , Filogenia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Análise por Conglomerados , Colômbia/epidemiologia , DNA Espaçador Ribossômico/química , Feminino , Variação Genética , Genótipo , Infecções por HIV/complicações , Humanos , Malassezia/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Modelos Moleculares , Dados de Sequência Molecular , Conformação de Ácido Nucleico , Análise de Sequência de DNA , Adulto JovemRESUMO
Presentamos el caso de un quiste óseo aneurismático en la columna cervical que se manejó con embolización intravascular con partículas. Se obtuvo una muy buena respuesta y una marcada disminución de su tamaño, por lo que no se llevó a resección quirúrgica.
A case of aneurysmal bone cyst of the cervical spine treated with particulate embolization with a very good answer and marked involution of the mass, for which it doesnt lead to surgical resection.