Complicações neurológicas determinadas pela anestesia subaracnóidea

JUSTIFICATIVA E OBJETIVOS: Complicações neurológicas da anestesia subaracnóidea, apesar de raras, podem determinar seqüelas importantes. O objetivo deste estudo é apresentar estas complicações com a finalidade de esclarecer os fatores desencadeantes, o que facilita o diagnóstico das lesões. CONTEÚDO: São apresentadas as seguintes complicações: lesão de nervo desencadeada pela agulha e cateter, cefaléia pós-punção, síndrome da artéria espinhal anterior, hematoma espinhal, meningite bacteriana, meningite asséptica, aracnoidite adesiva, síndrome da cauda eqüina e sintomas neurológicos transitórios. CONCLUSÕES: O conhecimento dos fatores desencadeantes de complicações neurológicas determinadas pela anestesia subaracnóidea pode prevenir as lesões, diagnosticar e tratar mais precocemente e, desse modo, mudar o prognóstico das mesmas.

High concentrations of the melatonin metabolite, N-1-acetyl-N (2)-formyl-5-methoxykynuramine, in cerebrospinal fluid of patients with meningitis: a possible immunomodulatory mechanism

We evaluated the presence of the melatonin metabolite N-1-acetyl-N-2-formyl-5-methoxykynuramine (AFMK), in cerebrospinal fluid (CSF) of patients with viral meningitis (n = 20) and control samples (n = 8) and correlate AFMK levels with inflammatory markers such as cellularity, protein, tumor necrosis factor (TNF)-alpha, interleukin (IL)-8 and IL-1 beta levels. A portion of the CSF was extracted with dichloromethane (1:5) and analyzed by high-performance liquid chromatography (HPLC) under standardized conditions for AFMK. AFMK was detected in 16 of 20 CSF samples of patients with viral meningitis; the concentration of AFMK was found to be above the quantification limit (50 nmol/L) in six of these samples. AFMK was not detected in any of the eight control samples. The samples were classified into groups according to AFMK levels: undetectable (< 10 nmol/L, group I), detectable but below the quantification limit (< 50 nmol/L, group II), and quantified (> 50 nmol/L, group III). Group II presented the highest levels of proteins and IL-8, whereas group III showed the lowest levels of the inflammatory parameters. This study supports our hypothesis that inflammation favors the formation of AFMK and that this compound has immunomodulatory activity in vivo.

Neonatal meningitis according to the microbiological diagnosis: a decade of experience in a tertiary center

The aim of this study was to evaluate the incidence of and mortality due to meningitis and compare data according to microbiological diagnosis. This was a ten-year retrospective study conducted at a neonatal intensive care unit (NICU). Newborns with meningitis confirmed by positive CSF culture were included; those with congenital infection or malformations that made lumbar puncture impossible were excluded. The variables investigated were birth weight, gestational and postnatal age, procedures, hematological and CSF parameters, and complications. Parametric and non-parametric tests were used (statistical value p<0.05). The incidence of meningitis was 0.6% and mortality was 27%. of the 22 cases, 59% involved Gram-negative bacteria; 36% Gram-positive and 5% fungi. The groups did not differ in relation to birth weight, gestational and postnatal age, procedures or hematological and CSF parameters. Sepsis, convulsions and deaths were frequent in both groups, without statistical difference. Gram-negative cases showed abscesses and higher frequency of ventriculitis and hydrocephaly. Meningitis was infrequent, but presented high mortality and frequent complications.

Use of lytic bacteriophage for control of experimental Escherichia coli septicemia and meningitis in chickens and calves

A lytic bacteriophage, which was previously isolated from sewage and which attaches to the K1 capsular antigen, has been used to prevent septicemia and a meningitis-like infection in chickens caused by a K1+ bacteremic strain of Escherichia coli. Protection was obtained even when administration of the phage was delayed until signs of disease appeared. The phage was able to multiply in the blood. In newly borne colostrum-deprived calves given the E. coli orally, intramuscular inoculation of phage delayed appearance of the bacterium in the blood and lengthened life span. With some provisos there is considerable potential for this approach to bacterial-disease therapy.

Meningitis and pneumococcal pyomyositis in a child with intramuscular hemangiomas: an autopsy case report

Pyomyositis is the bacterial infection of skeletal muscle, usually accompanied by abscesses. The main etiologic agent is Staphylococcus aureus. There are rare cases attributed to Streptococcus pneumoniae. This paper presents an autopsy of a four year old child with multiple congenital intramuscular hemangiomas that developed pneumococcal pyomyositis associated with meningitis. The authors propose the hypothesis that patients with hemangiomas, mainly the intramuscular type, may also represent a risk group for pyomyositis. The possibility of respiratory/meningeal co-infection, might also be considered even if the clinical picture is restricted to the muscular system.

First record of molluscs naturally infected with Angiostrongylus cantonensis (Chen, 1935) (Nematoda: Metastrongylidae) in Brazil

Seeking the identification of Angiostrongylus cantonensis as a potential etiological agent of three clinical cases of eosinophilic meningitis, mollusc specimens were collected in the state of Espírito Santo, Brazil. The snails were identified as Sarasinula marginata (45 specimens), Subulina octona (157), Achatina fulica (45) and Bradybaena similaris (23). Larvae obtained were submitted to polymerase chain reaction and restriction fragment length polymorphism diagnosis. Their genetic profile were corresponded to A. cantonensis. Rattus norvegicus experimentally infected with third-stage larvae, developed menigoencephalitis, and parasites became sexually mature in the lungs. Additionally, larvae obtained from A. fulica snails, from São Vicente, state of São Paulo, also showed genetic profiles of this nematode. This is the first record of Brazilian molluscs infected with this nematode species.

Detection of bovine herpesvirus 5 (BoHV-5) in formalin-fixed, paraffin-embedded bovine brain by nested PCR in Colombian cattle

Fifteen cases of viral meningoencephalitis in Colombian cattle were tested by nested PCR analysis for the detection of bovine herpesvirus 5 (BoHV-5). All fatal cases had shown severe neurological signs and had occurred following natural outbreaks of the disease. The neurological infection was histologically characterized by mild to moderate inflammatory changes in the brain and cerebellum, including meningitis, mononuclear perivascular cuffing, gliosis, haemorrhage, and the presence of Gitter cells (macrophages) accompanying large areas of malacia. No intranuclear inclusion bodies were seen in any of the cases. Results from BoHV-5 molecular extraction analyses showed there were five positive cases thus confirming the presence of the virus in Colombia.

Development of globular embryos from the hybridization between 'Pêra Rio' sweet orange and 'Poncã' mandarin

Objetivou-se estudar a influência de diversas concentrações do meio MT, sacarose, vitaminas, carvão ativado e ácido giberélico no cultivo de embriões imaturos oriundos do cruzamento entre laranjeira 'Pêra Rio' x tangerineira 'PONCÃ' . Os embriões foram excisados sob condições assépticas e inoculados em 15 mL do meio de cultura MT, de acordo com cada experimento a seguir: 1) concentrações do meio de cultura MT (0%, 50%, 100%, 150% e 200%) combinados com 0, 30, 60 e 90 g.L-1 de sacarose; 2) concentrações de vitaminas do meio MT (0%, 50%, 100%, 150% e 200%) combinados com 0, 30, 60 e 90 g.L-1 de sacarose e; 3) concentrações de carvão ativado (0; 0.5; 1; 1.5 e 2 g.L-1) combinados com GA3 (0; 0.01; 0.1; 1 e 10 mg.L-1). Após a inoculação, os embriões foram mantidos por 90 dias em sala de crescimento à temperatura de 27±1ºC, fotoperíodo de 16 horas e irradiância de 32 µmol.m-2.s-1. A utilização de 50% e 100% do meio MT associado a 60 e 90 g.L-1 de sacarose, respectivamente, acrescido de 0.01 mg.L-1 de GA3, proporcionou melhor desenvolvimento de embriões globulares. Não houve necessidade da adição de carvão ativado e vitaminas no meio MT para o cultivo de embriões globulares.

Mangas minimamente processadas amadurecidas naturalmente ou com etileno e armazenadas em diferentes embalagens

Avaliaram-se produtos minimamente processados de mangas 'Tommy Atkins' amadurecidas naturalmente ou com etileno. Os frutos amadurecidos com aplicação de etileno foram colhidos no estádio meio-maturo (de vez) e tratados com etileno (1g.L-1) e mantidos em câmaras, por 12 horas, a 23-25ºC e 85-90% UR. Os frutos foram selecionados, lavados com detergente, sanitizados (200mg.L-1 de cloro) e armazenados por 12 horas, a 10ºC. Após este período, foram processados sob condições assépticas, a 12ºC, acondicionados em embalagem PET ou bandeja de poliestireno expandido recoberta por filme de PVC e armazenados a 3ºC. Foram avaliados, a cada 3 dias, a resistência e a coloração da polpa, os teores de ácido ascórbico, sólidos solúveis (SS), acidez titulável (AT), carboidratos solúveis, redutores e amido, relação SS/AT, pH e atividade da peroxidase. Durante o período de armazenamento, os pedaços de manga tornaram-se mais firmes e mantiveram-se amarelos, porém mais escurecidos, o que foi indicado por redução na luminosidade. Os teores de ácido ascórbico nos pedaços das mangas amadurecidas com etileno apresentaram-se menores que os das amadurecidas naturalmente. A acidez apresentou tendência de redução durante o armazenamento, com as amadurecidas com etileno apresentando os maiores valores e os menores pH. Os produtos de mangas amadurecidas com etileno apresentaram os maiores valores de SS, mas menor relação SS/AT, indicando gosto mais azedo. Os teores de carboidratos solúveis e de amido não apresentaram variação com tendência definida, mas os de carboidratos redutores apresentaram tendência de acréscimo, e a atividade da peroxidase, de decréscimo durante o armazenamento. Os produtos de mangas amadurecidas naturalmente foram superiores aos amadurecidos com etileno, mantendo boa qualidade e aparência adequada para a comercialização até o 13º dia, enquanto os das amadurecidas com etileno, por 11 dias.

Molecular typing and antifungal susceptibility of clinical sequential isolates of Cryptococcus neoformans from São Paulo State, Brazil

The antifungal susceptibility profiles and the genetic variability of 83 sequential clinical isolates of Cryptococcus neoformans, including four Cryptococcus gattii isolates, obtained from 38 São Paulo AIDS patients with cryptococcal meningitis were assessed by electrophoretic karyotyping and random amplified polymorphic DNA (RAPD) analysis. The majority of the Cryptococcus neoformans isolates were highly susceptible to amphotericin B and fluconazole. Twenty percent of the minimum inhibitory concentration values for amphotericin B varied from 0.5 to 1 mu g mL(-1). For fluconazole, 22% occurred in the range 8-16 mu g mL(-1). Sequential isolates from nine patients showed a trend towards lower susceptibility to fluconazole, flucytosine, itraconazole and amphotericin B. The results of molecular typing by electrophoretic karyotyping and RAPD analysis showed the presence of 22 electrophoretic karyotypes (EK) and 15 RAPD profiles that were highly correlated. Our results provided evidence for the occurrence of genetic changes in some strains associated with microevolution during the course of infection. We also observed both microevolution and simultaneous coinfection with two distinct Cryptococcus neoformans strains in one patient. In some patients, we found changed EK- and RAPD patterns in association with increased MIC values.

Uso de antibióticos para o controle de bactérias endógenas visando à micropropagação da figueira

A descontaminação dos explantes é um dos princípios básicos para o sucesso da cultura de tecidos. Um dos problemas diagnosticados na propagação in vitro da figueira, através de gemas apicais, é a contaminação endógena dos explantes por bactérias. Este trabalho teve como objetivo avaliar a eficiência de alguns antibióticos em meio de cultura para o controle de bactérias endógenas em gemas apicais de figueira. Foram avaliados os seguintes tratamentos: T1(sem adição de antibiótico); T2 (30 mg L-1 de cloranfenicol); T3 (250 mg L-1 de ampicilina sódica); T4 (500 mg L-1 de ácido nalidícico); T5 (150 mg L-1 de cefalotina sódica); T6 (500 mg L-1 de tetraciclina), e T7 (400 mg L-1 de norfloxacina). Após coletados em campo, os segmentos de ramos contendo as gemas foram colocados em recipiente com água corrente. Posteriormente, as gemas apicais foram imersas em álcool etílico a 70% e hipoclorito de sódio a 2,5%. Todo procedimento de desinfestação externa dos explantes foi realizado em câmara de fluxo laminar. Os explantes foram inoculados em tubos de ensaio contendo 15 mL de meio básico MS suplementado, após a autoclavagem, com as doses de antibióticos de acordo com os tratamentos estabelecidos. Após a inoculação, os explantes foram mantidos em sala de crescimento por quatro dias no escuro e, em seguida, sob fotoperíodo de 16 horas de luz branca fria e irradiância de 25 µmol m s-1, na temperatura de 22 ± 3ºC. A assepsia realizada externamente nos explantes foi suficiente para o controle de contaminação fúngica, e a adição de antibióticos ao meio, após autoclavagem, foi eficiente para o controle de bactérias endógenas, cujo antibiótico ampicilina sódica proporcionou mais de 90% de explantes sobreviventes.

Antimicrobial resistance of isolated Streptococcus pneumoniae in a hospital of the Brazilian public system

Streptococcus pneumoniae is the predominant bacterial agent that affects the human population with pneumonia. This disease is an important cause of death in the elderly and the children under five years old. In this study, 29 strains of invasive S. pneumoniae were isolated from 29 patients of pneumonia, bacteremia and meningitis in the laboratory of the Municipal Hospital in Paulinia, Brazil, from May 2006 to October 2007. Patients' age ranged from 8 months old to 60 years old. These strains of S. pneumoniae were isolated from blood, pleural fluid and cerebrospinal fluid (CSF) of patients. After typing of encapsulated strains of S. pneumoniae through quellung reaction, their resistance to antimicrobial agents was gauged through Disc Diffusion Technique followed by determination of minimum inhibitory concentration (MIC). Among the 29 strains analyzed, 23 were methicillin-sensitive and six were methicillin-resistant and penicillin intermediate resistant. No strain presented full resistance to penicillin. Serotyping was performed only in two samples, which belonged to serotype 18. Our data may alert ambulatory regarding the incidence of pneumococcal strains resistant to the most common drugs due to inappropriate use of antimicrobials and also collaborate to the elaboration of pneumococcal conjugate vaccines specific to each region.

Lymphocyte transformation assay for C neoformans antigen is not reliable for detecting cellular impairment in patients with Neurocryptococcosis

Background: Cryptococcus neoformans causes meningitis and disseminated infection in healthy individuals, but more commonly in hosts with defective immune responses. Cell-mediated immunity is an important component of the immune response to a great variety of infections, including yeast infections. We aimed to evaluate a specific lymphocyte transformation assay to Cryptococcus neoformans in order to identify immunodeficiency associated to neurocryptococcosis (NCC) as primary cause of the mycosis.Methods: Healthy volunteers, poultry growers, and HIV-seronegative patients with neurocryptococcosis were tested for cellular immune response. Cryptococcal meningitis was diagnosed by India ink staining of cerebrospinal fluid and cryptococcal antigen test (Immunomycol-Inc, SP, Brazil). Isolated peripheral blood mononuclear cells were stimulated with C. neoformans antigen, C. albicans antigen, and pokeweed mitogen. The amount of H-3-thymidine incorporated was assessed, and the results were expressed as stimulation index (SI) and log SI, sensitivity, specificity, and cut-off value (receiver operating characteristics curve). We applied unpaired Student t tests to compare data and considered significant differences for p<0.05.Results: The lymphotoxin alpha showed a low capacity with all the stimuli for classifying patients as responders and non-responders. Lymphotoxin alpha stimulated by heated-killed antigen from patients with neurocryptococcosis was not affected by TCD4+ cell count, and the intensity of response did not correlate with the clinical evolution of neurocryptococcosis.Conclusion: Response to lymphocyte transformation assay should be analyzed based on a normal range and using more than one stimulator. The use of a cut-off value to classify patients with neurocryptococcosis is inadequate. Statistical analysis should be based on the log transformation of SI. A more purified antigen for evaluating specific response to C. neoformans is needed.

Cultivo de embriões imaturos de citros em diferentes concentrações de carvão ativado e ácido giberélico

Adição de carvão ativado e giberelina no meio de cultura podem proporcionar melhores condições no desenvolvimento de embriões imaturos de citros. Objetivou-se avaliar o efeito de carvão ativado e GA3 (ácido giberélico) no cultivo de embriões imaturos provenientes do cruzamento entre laranjeira 'Pêra Rio' x tangerineira 'Poncã'. Após 118 dias da polinização, frutos imaturos, com 3 a 4 cm de diâmetro, foram coletados, suas sementes removidas e tratadas com álcool (70%) por cinco minutos, hipoclorito de sódio (2%) por 20 minutos e, posteriormente, lavadas três vezes em água destilada e autoclavada. em condições assépticas, os tegumentos das sementes foram separados, os embriões globulares excisados e inoculados em tubos de ensaio contendo 15 mL do meio MT, acrescido de carvão ativado (0; 0,5; 1; 1,5 e 2 g L-1) e GA3 (0; 0,01; 0,1; 1 e 10 mg L-1). Após a inoculação, os embriões permaneceram por 90 dias em sala de crescimento a 27+1ºC, fotoperíodo de 16 horas e irradiância de 32 mmol m-2 s-1. Maior comprimento da parte aérea foi obtido em meio MT, acrescido de 0,1 e 1 mg L-1 de GA3, combinado com 2 g L-1 de carvão ativado. Maior comprimento do sistema radicular, massa da matéria fresca e número de folhas de plântulas foram obtidos em meio MT, acrescido de 0,01 mg L-1 de GA3, na ausência de carvão ativado. A adição de carvão ativado influenciou na concentração de ácido giberélico acrescido no meio de cultura.

Influência do banho de aspersão ante-mortem na contaminação microbiana da carne bovina

To determine the effects of the pre-slaughter showering on some meat quality parameters, the bacterial changes in the Longus colli muscle and the contamination of the meat surface at three different points of the slaughter line were studied. Sixteen Nelore steers were slaughtered in a commercial slaughterhouse. Eight animals were submitted to pre-slaughter showering; a control group of eight animals were slaughtered without showering. Aseptic samples were collected for evaluations in the muscle depth, in the anterior portion of Longus colli muscle, just before chilling. The swab method was used for sampling carcass surface right after dressing, before carcasse washing, and at the beginning of chilling. Longus colli muscle samples were used to determine bacteria total count, psychrotrophic count and Enterobacteriaceae count, after 5, 24 and 48 hours from slaughtering, and in carcass surface, bacteria total count and psychrotrophic count. Multivariate methods were used to evaluate bacterial data the use of pre-slaughter showering did not affect the bacteria total counts, in the deep tissue. A significant growth of psychrotrophic bacteria was detected in both treatments. No significant differences (P>.05) were found in bacteria total count and psychrotrophic count between treatments. Also, no differences (P>.05) were detected between counts taken at different momments at the kill floor: skinning, before carcasse washing, and at the cooler, before chilling.