The effects of hyperammonemia in learning and brain metabolic activity

Ammonia is thought to be central in the development of hepatic encephalopathy. However, the specific relation of ammonia with brain energy depletions and learning has not been studied. Our work attempts to reproduce an increase in rat cerebral ammonia level, study the hyperamonemic animals’ performance of two learning tasks, an allocentric (ALLO) and a cue guided (CG) task, and elucidate the contribution of hyperammonemia to the differential energy requirements of the brain limbic system regions involved in these tasks. To assess these goals, four groups of animals were used: a control (CHA) CG group (n?=?10), a CHA ALLO group (n?=?9), a hyperammonemia (HA) CG group (n?=?7), and HA ALLO group (n?=?8). Oxidative metabolism of the target brain regions were assessed by histochemical labelling of cytochrome oxidase (C.O.). The behavioural results revealed that the hyperammonemic rats were not able to reach the behavioural criterion in either of the two tasks, in contrast to the CHA groups. The metabolic brain consumption revealed increased C.O. activity in the anterodorsal thalamus when comparing the HA ALLO group with the CHA ALLO group. Significant differences between animals trained in the CG task were observed in the prelimbic, infralimbic, parietal, entorhinal and perirhinal cortices, the anterolateral and anteromedial striatum, and the basolateral and central amygdala. Our findings may provide fresh insights to reveal how the differential damage to the brain limbic structures involved in these tasks differs according to the degree of task difficulty.     

Efectividad y seguridad de la terapia de rescate en pacientes VIH

IntroductionThe treatment used after failure of at least two lines of antiretroviral treatment in HIV patients is called salvage therapy. The study aims to describe the characteristics of HIV patients subjected to such a regimen, and determine the safety and effectiveness of treatment with tipranavir (TPV), darunavir (DRV), enfuvirtide (ENF) and etravirine (ETR) combined with an optimised antiretroviral regimen.Patients and methodsHIV patients treated with ENF, TPV, DRV or ETR in a tertiary hospital infectious diseases department subjected to at least 12 weeks treatment. The patient characteristics are described and the effectiveness, durability and adherence to the treatment analysed.ResultsThere were 28 patients studied, with an average of 10 treatment regimens prior to starting salvage therapy (SD = 3.5; 95 % CI, 8.9-11.1). A total of 85.7 % patients had treatment adherence > 90 %. For ENF, 70.8 % of the treatment lines were suspended during follow-up. After salvage therapy, the percentage of patients with viral load (VL) < 400 copies/ml doubled, and cases with undetectable CV (< 50 copies/ml) almost tripled. The treatments used did not change the liver or kidney profiles; however, they changed the lipid profile and increased the percentage of patients with hyperglycaemia.ConclusionsThe salvage therapy studied was effective. Good adherence to the therapy is critical for its effectiveness.     

Three Outbreak-causing Neisseria meningitidis Serogroup C Clones,Brazil

During 2003–2012, 8 clusters of meningococcal disease were identified in Rio de Janeiro State, Brazil, all caused by serogroup C Neisseria meningitidis. The isolates were assigned to 3 clonal complexes (cc): cc11, cc32, and cc103. These hyperinvasive disease lineages were associated with endemic disease, outbreaks, and high case-fatality rates.     

Una causa excepcional de hepatitis aguda en el adulto: parvovirus B19

There are multiple causes of hepatitis. The most frequent etiologies are viral, usually hepatitis A, B and C viruses. However, other, non-hepatotropic viruses can cause this disease, including parvovirus B19. We present a case of acute hepatitis due to parvovirus B19, as well as a review of the epidemiological, clinical, diagnostic and therapeutic features of this entity.     

18F-FDG PET/CT in the diagnosis of prosthetic valve endocarditis

Prosthetic valve endocarditis is a major diagnostic challenge in clinical practice, due to the lower sensitivity of the modified Duke criteria and a higher percentage of cases with negative or inconclusive echocardiography results. The delay in establishing medical and surgical treatment increases the morbidity/mortality rate. New imaging techniques and 18F-FDG PET/CT in particular have meant a significant advance in cases of high clinical suspicion and negative or inconclusive echocardiography, increasing the overall sensitivity of the modified Duke criteria.We report the case of a male patient with prosthetic valve endocarditis, where 18F-FDG PET/CT provided the diagnostic key, determining the origin of the endocarditis and avoiding treatment delay.     

Internet como fuente de información sobre salud en pacientes de atención primaria y su influencia en la relación médico-paciente

ObjectiveTo describe the use of the Internet by primary care patients to seek health related information, understand how they are influenced by this information, and evaluate its impact on the doctor-patient relationship.DesignCross sectional study, through self-administered survey.SettingOne urban health center in Madrid.ParticipantsA total of 323 questionnaires were collected from patients between 14 and 75 years old who attended a physician's office for any reason, excluding illiterate patients and those with neurological or psychiatric problems preventing them from completing the survey.MeasurementsInternet usage, ability of the internet to clarify doubts regarding health issues, patient lifestyle changes, socio-demographic variables, and physician's receptivity to the use of internet by patients.Results61% (CI 95%: 56%-67%) of patients used the Internet as a source of health information: Internet queries were able to address health doubts in 92.4% of users, 53.5% reported that the Internet changed their thinking about their health in at least one instance, 30% made behavioral changes (of which 60.1% discussed these changes with their physician), 44.3% had more questions at the physician's office, and 80.8% believe that the doctor would be willing to talk about the information found on the internet.ConclusionsUsing the Internet to find information about health is very common, with positive influence on physician-patient relationship. This may be useful for achieving behavioral changes in patients and can be used as a tool in medical practice.