Lutzomyia (Pintomyia) fischeri (Diptera: Psychodidae: Phlebotominae), a probable vector of American cutaneous leishmaniasis: detection of natural infection by Leishmania (Viannia) DNA in specimens from the municipality of Porto Alegre (RS), Brazil, using multiplex PCR assay

In order to determine natural Leishmania (Viannia) infection in Lutzomyia (Pintomyia) fischeri, a multiplex PCR methodology coupled to non-isotopic hybridization was adopted for the analysis of sand fly samples collected by CDC light traps in an endemic area of American Cutaneous Leishmaniasis (ACL) in the periurban region of the municipality of Porto Alegre, Rio Grande do Sul State, Brazil. We analyzed by PCR methodology 560 specimens of Lutzomyia (Pintomyia) fischeri (520 females and 40 males). The wild sand flies were grouped into 56 pools (52 females and 4 males) of 10 each, and positive results were detected in 2 of the 52 female pools, representing a minimum infection rate of 0.38% based on the presence of at least 1 infected insect in the pool. This result associated with some local evidence such as anthopophily, spatial distribution in accordance with the transmission area and human case incidence, suggests that L. (P.)fischeri may be considered as a secondary vector of ACL in the studied locality.     

The impact of glycemic variability on length of stay and mortality in diabetic patients admitted with community-acquired pneumonia or chronic obstructive pulmonary disease

AimTo investigate the influence of glycemic variability (GV) on length of stay and in-hospital mortality in non-critical diabetic patients.MethodsA observation retrospective study was performed. Diabetic patients admitted between January and June 2016 with the diagnosis of community-acquire pneumonia (CAP) and/or acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled and glycemic control (persistent hyperglycemia, hypoglycemia, mean glucose level (MGL) and respective standard deviation (SD) and coefficient of variation (CV)) were evaluated. Primary outcomes were length of stay and in-hospital mortality.ResultsData from 242 patients were analyzed. Fifty-eight percent of the patients were male, with a median age of 77 years (min-max, 29–98). Patients had on average 2.1 glucose readings-day and the MGL was 193.3 mg/dl (min-max, 84.3–436.6). Hypoglycemia was documented in 13.4% of the patients and 55.4% had persistent hyperglycemia. The median length of hospital stay was 10 days (min-max, 1–66) and in-hospital mortality was 7.4%. We found a significant higher in-hospital mortality in older patients, with history of cancer and with nosocomial infections. We did not find any correlation between MGL, SD, CV, hypoglycemia or persist hyperglycemia and in-hospital mortality. A longer length of stay was observed in patients with heavy alcohol consumption and nosocomial infections. The length of stay was negatively correlated with the mean glucose level (r²-0.147; p < 0.05) and positively correlated with the coefficient of variation (p 0.162; p < 0.05).ConclusionThis study confirmed the negative impact of the glycemic variability in the outcomes of diabetic patients admitted with CAP or acute exacerbation of COPD.     

Self-efficacy profile in daily activities: Children at risk and with developmental coordination disorder

AimThe objectives of this study were: 1) to compare the perceptions of self-efficacy in the daily activities (self-care, schoolwork, and leisure) of boys and girls with DCD, or in children at risk for DCD (r-DCD) and in typical children (TD); 2) to investigate if a self-efficacy assessment could be a support tool in the establishment of children with the DCD profile.MethodsChildren between 6 to 8 years old (N=115: 35 with DCD, 40 with r-DCD, 40 with TD) were assessed using the Movement Assessment Battery for Children (MABC-2) and the Perceived Efficacy and Goal Setting System (PEGS). A two-way MANOVA showed significant effect for the perceived self-efficacy group.ResultsThe Bonferroni post hoc test indicated that in the self-care, schoolwork, leisure, and general self-efficacy dimensions the children with DCD presented significantly lower scores compared to children with r-DCD and TD (p < 0.001). A similar result was observed for r-DCD children in comparison with TD (p < 0.001). The discriminate analysis showed that perceived self-efficacy in leisure activities was the variable that most contributed to the discrimination of the groups.ConclusionThe judgment of children with DCD and r-DCD on the effectiveness of the execution of schoolwork and leisure activities may have been influenced by the motor skill difficulties showed by the children.     

Ureteral Stenosis After Renal Transplantation—A Single-Center 10-Year Experience

Background

Kidney transplantation (KT) is the definitive treatment for ESRD. Ureteral stenosis (US) is one of the most common urologic complications and has been reported in 2.6%–15% of KTs.

Parathyroidectomy in Persistent Post-transplantation Hyperparathyroidism — Single-center Experience

Background

Hyperparathyroidism is a common complication in chronic kidney disease and might persist in up to 25% of patients after transplantation. In this setting, vitamin D analogues further aggravate persistent hypercalcemia and cinacalcet has not been approved for these patients, some of whom will require parathyroidectomy to correct post-transplantation hyperparathyroidism.

Is porto sinusoidal vascular disease to be actively searched in patients with portal vein thrombosis?

Porto sinusoidal vascular liver disease(PSVD) and portal vein thrombosis(PVT)are distinct vascular liver diseases characterized, respectively, by an intrahepatic and a prehepatic obstacle to the flow in the liver portal system. PVT may also occur as a complication of the natural history of PSVD, especially if a prothrombotic condition coexists. In other cases, it is associated to local and systemic pro-thrombotic conditions, even if its cause remains unknown in up to25% despite an active search. In our opinion, the presence of PSVD should be suspected in patients with PVT especially in those with PVT "sine causa" and the active search of this condition should be included in their diagnostic work-out.However, sometimes the diagnosis of pre-existing PSVD is very hard. Biopsy cannot be fully discriminant as similar histological data have been described in both conditions. Liver stiffness may help as it has been shown to be higher in PSVD than in "pure" PVT, due to the presence of sclerosis in the portal venous radicles observable in PSVD patients. Nevertheless, comparing liver stiffness between PVT and PSVD has until now been restricted to very limited series of patients. In conclusion, even if it is still totally hypothetical, our point of view may have clinical consequences, especially when deciding to perform a liver biopsy in patients with a higher liver stiffness and suspending the anticoagulation in patients with PVT and no detectable prothrombotic factors.     

Serum brain-derived neurotrophic factor in patients with trauma psychopathology

Objective

Brain-derived neurotrophic factor (BDNF) has an important role in learning, motivation and regulation of mood. The aim of this study was to investigate levels of serum BDNF in patients with trauma psychopathology (acute and post-traumatic stress disorder) when compared to age and gender matched controls.

Method

A consecutive sample of 34 patients was evaluated regarding socio-demographic and clinical variables by means of a standard protocol, Davidson Trauma Scale, Beck Depression Inventory, Clinical Global Impression and the Global Assessment of Functioning. BDNF serum levels were measured right after the intake interview.

Results

Patients had higher BDNF levels than controls. Those levels, however, were higher right after the traumatic event, decreasing over time. When two groups of patients (recent and remote trauma) were investigated in separate, the recent trauma group (less than 1 year since the traumatic event) had higher BDNF than controls, but this effect was not detected in the remote trauma group. The recent and remote trauma groups had different BDNF levels. Those findings persisted, even controlling for symptom severity, use of psychotropic medication, and history of psychiatric disease.

Conclusions

As far as we know this is the first report of elevated serum BDNF levels in patients with recent trauma. Based in animal models that implicate BDNF in memory formation and consolidation, higher BDNF in recent PTSD could be related to memory and learning disruption central in PTSD psychopathology.