Endocarditis infecciosa : significado de la disfunción renal

Objetivo: Determinar la significación clínica y pronóstica de la disfunción renal en pacientes con Endocarditis Infecciosa (EI) Material y método: Estudio protocolizado, descriptivo, observacional y transversal de pacientes con EI diagnosticados según criterios de Duke. Se realizó un análisis comparativo entre los pacientes con EI sin (Grupo Sin) y con Disfunción Renal (Grupo DR), que se definió en base a uremia > 0.60 g/l y/o creatininemia > 1.5 mg/dl y/o hematuria o proteinuria. Fueron analizados en EPI info 6.04. Resultados: De un total de 110 EI incluidas, 58 (52.7%) presentaron DR principalmente secundaria a glomerulonefritis (n 22), sepsis (n 14), insuficiencia renal crónica (n 5), insuficiencia cardíaca, nefropatía diabética y nefrotoxicidad (n 4 cada una) y embólica (n 1). No hubo diferencias en la permanencia media hospitalaria (32 DS±23.3 vs 26.32 DS±17.28 días), el sexo (masculino: 60.3 vs 71.25%) y la demora diagnóstica (5.5 (DS±7.23) vs. 5.4 (DS±7.64 días)(pNS). La edad media fue mayor en el grupo DR en el LS (49.62 DS±15.71 vs 43.53 DS±17.94 años). El Grupo DR tuvo mas frecuentemente EI Definida (87.9 vs 67.3%) (p=0.0089) y no hubo diferencias en la localización Mitral (48.3 vs 48.1%) y Aórtica (44.8 vs 34.6%). La valvulopatía degenerativa se presentó en el LS en DR (34.5 VS 19.6%)(p=0.07). No hubo diferencias en la presencia de comórbidas (62.1 vs 71.2%) (pNS) pero la enfermedad últimamente fatal ocurrió mas frecuentemente en DR (51.4 vs 21.6%)(p=0.05). Al ingreso sólo la presencia de rales pulmonares (53.4 vs 32.7%) y púrpura cutánea (27.6 vs 13.5%) fueron más frecuentes en DR (p=0.05). La sepsis no controlada (34.5 vs 15.7%), insuficiencia cardíaca (51.7 vs 32.7%), encefalopatía (50 vs 27.5%), shock séptico (24.1 vs 7.8%) y fallo multiorgánico (34.5 vs 3.9%) fueron complicaciones más frecuentes en DR (p<0.05). La fiebre persistente se encontró en el LS en el grupo de DR (48.3 vs 32.7%)(p=0.09). No hubo diferencias en el hallazgo de vegetaciones por ecocardiografía (83.3 vs 75.6%). La anemia (Hb<9 mg/dl) (31.86 DS±53.41 vs 35.21 DS±7.85)(p=0.009), hipergammaglobulinemia (58.5 vs 29.8)(p=0.006) e hiperglucemia (36.1 vs 18.5)(p=0.03) se asociaron a DR. En el grupo con DR fue mas común la EI con cultivos negativos (31.5 vs 0%)(p=0.001) y el predominio de las infecciones por S. aureus Meticilino Resistente (MRSA)(21.6 vs 2.7%) (p=0.02). No hubo diferencias en la indicación de cirugía (31 vs 36.5%). La mortalidad hospitalaria fue significativamente mayor en DR (51.7 vs 25%)(p=0.0041)(OR 3.2, IC95%1.42-7.24). Conclusión: En los pacientes con EI la disfunción renal resultó ser un indicador de desarrollo de complicaciones infecciosas y cardíacas, de infección por MRSA y de mortalidad cruda hospitalaria.-

Nd and Sr isotopic composition of Cretaceous MORB

Chemical and isotopic (Nd and Sr) compositions have been determined for 12 Cretaceous basaltic samples (108 Ma old) from Holes 417D and 418A of Legs 51,52 and 53. We have found that: (1) The chemical compositions are typical of MORB. They do not vary systematically with the stratigraphic positions of the analyzed samples; thus, the chemical evolution is independent of the eruption sequence that occurred at this Cretaceous ridge. (2) REE patterns for all rocks are characterized by a strong LREE depletion with (La/Sm)N = 0.38-0.50; no significant Eu anomalies are found; HREE are nearly flat or slightly depleted towards Yb-Lu and have 12-18 * chondritic abundances. Combining the results of previous studies, it suggests that no significant temporal and spatial variation in magma chemistry (especially for LIL elements) has occurred in the 'normal' ridge segments over the last 150 Ma. (3) lsotopically, 143Nd/144Nd ratios vary from 0.513026 to 0.513154, corresponding to epsilon-Nd(0) = +7.5 to +10, and they fall in the typical range of MORB. However, these rocks have unexpectedly high 87Sr/86Sr ratios (0.70355-0.70470) which are attributed to the result of seawater-rock interaction. (4) The Nd model ages (Tin), ranging from 1.53 to 2.47 (average 2.06) AE, suggest that the upper mantle source(s) underwent a large scale chemical differentiation leading to LREE and other LIL element depletion about 2 AE ago, assuming a simple two-stage model. More realistically, the variation in Tm(Nd) or epsilon-Nd could be derived from mixing of heterogeneous mantle sources that were a consequence of continuous mantle differentiation and continental formation. (5) Because of the low mg values (0.52-0.63), the analyzed basaltic rocks do not represent primary liquids of mantle melting. The variation in La/Sm ratios and TiO2 are not compatible with a model in which all rocks are genetically related by a simple fractional crystallization. Rather, it is proposed that the basaltic rocks might have been derived from some heterogeneous upper mantle source with or without later magmatic mixing, and followed by some shallow-level fraetionations.

(Table S2) Cell concentrations of individual and combined Alexandrium spp. and phylogenetic groups as obtained by qPCR assay and Utermöhl counts, as well as particulate PSP toxin concentrations from discrete water depths

Molecular methods provide promising tools for routine detection and quantification of toxic microalgae in plankton samples. To this end, novel TaqMan minor groove binding probes and primers targeting the small (SSU) or large (LSU) ribosomal subunit (rRNA) were developed for two species of the marine dinoflagellate genus Alexandrium (A. minutum, A. tamutum) and for three groups/ribotypes of the A. tamarense species complex: Group I/North American (NA), Group II/Mediterranean (ME) and Group III/Western European (WE). Primers and probes for real-time quantitative PCR (qPCR) were species-specific and highly efficient when tested in qPCR assays for cross-validation with pure DNA from cultured Alexandrium strains. Suitability of the qPCR assays as molecular tools for the detection and estimation of relative cell abundances of Alexandrium species and groups was evaluated from samples of natural plankton assemblages along the Scottish east coast. The results were compared with inverted microscope cell counts (Utermöhl technique) of Alexandrium spp. and associated paralytic shellfish poisoning (PSP) toxin concentrations. The qPCR assays indicated that A. tamarense (Group I) and A. tamutum were the most abundant Alexandrium taxa and both were highly positively correlated with PSP toxin content of plankton samples. Cells of A. tamarense (Group III) were present at nearly all stations but in low abundance. Alexandrium minutum and A. tamarense (Group II) cells were not detected in any of the samples, thereby arguing for their absence from the specific North Sea region, at least at the time of the survey. The sympatric occurrence of A. tamarense Group I and Group III gives further support to the hypothesis that the groups/ribotypes of the A. tamarense species complex are cryptic species rather than variants belonging to the same species.

Vertical distribution of phytoplankton pigments in the equatorial Pacific

Abundance distribution and cellular characteristics of picophytoplankton were studied in two distinct regions of the equatorial Pacific: the western warm pool (0°, 167°E), where oligotrophic conditions prevail, and the equatorial upwelling at 150°W characterized by high-nutrient low-chlorophyll (HNLC) conditions. The study was done in September-October 1994 during abnormally warm conditions. Populations of Prochlorococcus, orange fluorescing Synechococcus and picoeukaryotes were enumerated by flow cytometry. Pigment concentrations were studied by spectrofluorometry. In the warm pool, Prochlorococcus were clearly the dominant organisms in terms of cell abundance, estimated carbon biomass and measured pigment concentration. Integrated concentrations of Prochlorococcus, Synechococcus and picoeukaryotes were 1.5x10**13, 1.3x10**11 and 1.5x10**11 cells/m**2, respectively. Integrated estimated carbon biomass of picophytoplankton was 1 g/m**2, and the respective contributions of each group to the biomass were 69, 3 and 28%. In the HNLC waters, Prochlorococcus cells were slightly less numerous than in the warm pool, whereas the other groups were several times more abundant (from 3 to 5 times). Abundance of Prochlorococcus, Synechococcus and picoeukaryotes were 1.2x10**13, 6.2x10**11 and 5.1x10**11 cells/m**2, respectively. The integrated biomass was 1.9 g C/m**2. Prochlorococcus was again the dominant group in terms of abundance and biomass (chlorophyll, carbon); the respective contributions of each group to the carbon biomass were 58, 7 and 35%. In the warm pool the total chlorophyll biomass was 28 mg/m**2, 57% of which was divinyl chlorophyll a. In the HNLC waters, the total chlorophyll biomass was 38 mg/m**2, 44% of which was divinyl chlorophyll a. Estimates of Prochlorococcus, Synechococcus and picoeukaryotes cell size were made in both hydrological conditions.