Life-threatening gastrointestinal bleeding related to the treatment of strongyloidiasis hyperinfection in an immunocompromised patient

The clinical course and sequel of the life-threatening gastrointestinal (GI) bleeding during the treatment of strongyloides helmintic hyperinfection induced by immunosuppression in a patient with multiple myeloma is presented. A 55-year old male patient was diagnosed with strongyloides infection with stool analysis and intestinal biopsy shortly after his combined chemotherapy for myeloma. He was commenced on albendazole anthelmintic therapy. However, after initiation of the treatment he suffered life-threatening GI bleeding. Repeated endoscopies, including intraoperative enteroscopy, concluded to diffuse multifocal intestinal bleeding. The patient required huge amounts of red blood cells and plasma transfusions and correction of haemostasis with recombinant activated factor VII. Abdominal aorto-angiography showed numerous microaneurysms ("berry aneurysms") in the superior and inferior mesenteric arteries' territories. While the biopsy taken prior to the treatment with albendazole did not show evidence of vasculitis, the biopsy taken after initiation of therapy revealed leukoclastic aggregations around the vessels which was also consistent with vasculitis. These findings suggest that--in addition to direct destruction of the mucosa-vasculitis could be an important additive factor to the massive GI bleeding during the anthelmintic treatment. This might result from substances released by the worms that have been killed with anthelmintic drugs. Current guidelines advise steroids to be tapered and stopped in case of systematic parasitic infections as they reduce immunity and precipitate parasitic hyperinfection. In our pinion, steroid therapy might be of value in the management of strongyloides hyperinfection related vasculitis--in addition to the specific anthelmintic treatment. Indeed, steroid therapy of vasculitis with other means of supportive care yielded in sequel of the bleeding and in recovery of the patient.     

Efficacy of amoxicillin/clavulanic acid in preventing infectious and inflammatory complications following impacted mandibular third molar extraction.

OBJECTIVE: To find out whether the frequency of postoperative infectious and inflammatory complications (IC) in subjects treated with placebo (Pl) is greater than those treated with antibiotic (Ab) after extraction of an impacted mandibular third molar (M3). Our hypothesis is there are more IC in Pl than in Ab, with a maximum ratio difference of 0.067. STUDY DESIGN: A double-blind placebo-controlled randomized clinical trial. The sample was derived from the population of subjects attending Cruces Hospital for evaluation and extraction of 1 M3 under local anesthesia. Patients were treated with postoperative placebo or amoxicillin/clavulanic acid 500/125 mg 3 times a day during 4 days. The outcome variable was infectious and inflammatory complications. Sex, age, smoking, molar depth, angulation, need for sectioning, ostectomy, and operation time were recorded. Analysis was by intention to treat, risk measures, and logistic regression. RESULTS: In 490 subjects (259 Ab and 231 Pl), the frequency of IC was 1.9% in the Ab and 12.9% in the Pl group (OR 7.6, 95%CI 2.9-19.9; P < .001). The number needed to treat was 10 (7-16). Unadjusted relative risk was 0.15 (0.06-0.38) (P < .001). Absolute reduction risk was 0.11(0.066-0.155)]. Therefore, the hypothesis cannot be rejected. Multivariate analysis shows treatment with antibiotic (OR = 8.66 (3.17-23.67); P < .001) and age (OR = 1.08 (1.00-1.16); P = .029) are the only variables to be included in the logistic regression model. CONCLUSION: Amoxicillin/clavulanic acid is efficacious in reducing the incidence of IC following third molar extraction but should not be prescribed in all cases.     

Neural correlates of inhibitory control are associated with stimulant-like effects of alcohol

Poor inhibitory control and heightened feelings of stimulation after alcohol are two well-established risk factors for alcohol use disorder (AUD). Although these risk factors have traditionally been viewed as orthogonal, recent evidence suggests that the two are related and may share common neurobiological mechanisms. Here we examined the degree to which neural activity during inhibition was associated with subjective reports of stimulation following alcohol. To assess neural changes during inhibition, moderate alcohol drinkers performed a stop signal task during fMRI without drug. To assess subjective responses to alcohol they ingested alcohol (0.8 g/kg) or placebo beverages under double-blind conditions and provided subjective reports of stimulation and sedation. Feelings of stimulation following alcohol were inversely associated with activity in the supplementary motor area, insula, and middle frontal gyrus during inhibition (successful stop trials compared to go trials). Feelings of sedation did not correlate with brain activation. These results extend previous findings suggesting that poor inhibitory control is associated with more positive subjective responses to alcohol. These interrelated risk factors may contribute to susceptibility to future excessive alcohol use, and ultimately lead to neurobiological targets to prevent or treat AUD.Subject terms: Risk factors, Reward     

Down‐regulation of glutamatergic terminals (VGLUT1) driven by Aβ in Alzheimer's disease

Alzheimer's disease (AD) is characterized phenotypically by memory impairment, histologically by accumulation of pTau and β‐amyloid peptide and morphologically by a loss of nerve terminals in cortical and hippocampal regions. As glutamate is the principle excitatory neurotransmitter of the central nervous system (CNS), the glutamatergic system may play an important role in AD. To date, not many studies have addressed the deleterious effects of Aβ on glutamatergic terminals; therefore the aim of this study was to investigate how Aβ affects glutamatergic terminals and to assess the extent to which alterations in the glutamatergic neurotransmission could impact susceptibility to the illness. The present study shows that Aβ caused a loss of glutamatergic terminals, measured by VGLUT1 protein levels, in Tg2576 primary cell cultures, Tg2576 mice and AD patient brains, and also when Aβ was added exogenously to hippocampal cell cultures. Interestingly, no correlation was found between cognition and decreased VGLUT1 levels. Moreover, when Aβ_1–42 was intracerebroventricularlly administered into VGLUT1+/‐ mice, altered synaptic plasticity and increased neuroinflammation was observed in the hippocampus of those animals. In conclusion, the present study not only revealed susceptibility of glutamatergic nerve terminals to Aβ induced toxicity but also underlined the importance of VGLUT1 in the progression of AD, as the decrease of this protein levels could increase the susceptibility to subsequent deleterious inputs by exacerbating Aβ induced neuroinflammation and synaptic plasticity disruption. © 2016 Wiley Periodicals, Inc.     

Spanish versus English as a language of publication and impact factor of Neurologia

Although the English language is considered nowadays as the international language of medical publications, some important Spanish journals with impact factor in the Journal Citation Reports as Neurologia, they bet for the publication in Spanish. Neurologia is the official publication of the Sociedad Espa?ola de Neurología and there is the conviction that you can have a Spanish language journal with a high quality and a strong impact. Its presence in the most important international data bases and the possibility of free access to its contents through Internet guarantees its proper diffusion around the world. From the point of view of citation, the repercussion of the language for Neurologia, is reflected in the fact that the 46,8 % of the citations that receive are from journals that are published in Spanish. The main factor to improve the impact of the journal is the quality of their papers, as well as the fulfillment of the international rules about periodical publications, the punctuality in its edition and distribution, the presence in national and international bibliographical data bases, its free diffusion in Internet, the training of its researchers and their sensitivity to consult and cite articles that have been published in quality Spanish journals, when necessary.