COVID-19associated exfoliative shock syndrome / Síndrome de shock exfoliativo por covid-19

RESUMEN El síndrome de shock exfoliativo(SSE) asociado a COVID- 19 es una enfermedad recientemente descrita con características superpuestas de síndrome de shock tóxico (SST) y síndrome de la piel escaldada estafilocócica (SSSS, por sus siglas en inglés). Clínicamente se presenta con fiebre, hipotensión y erupción cutánea exfoliativa.Se expone un caso en donde las lesiones cutáneas por COVID-19 precedieron a las manifestaciones respiratorias.

ABSTRACT The exfoliative shock syndrome (ESS) associated with COVID-19 is a recently described disease with overlapping features of toxic shock syndrome (TSS) and staphylococcal scalded skin syndrome(SSSS). Clinically it presents with fever, hypotension, and exfoliative skin rash. A case is presented in which the skin lesions by COVID-19 preceded the respiratory manifestations.

Manejo anestésico de resección de quiste de vallécula en neonato. A propósito de un caso / Anesthetic management of vallecular cyst resection in neonate. A case report

Difficult airway management is one of the most important challenges an anesthesiologist faces. It is due to the high morbidity and mortality that it entails. The challenge is even greater if the patient is a newborn. For this reason, we should have different strategies that allow us to anticipate and treat possible complications derived from the procedure. In this case, we present a newborn with vallecular cyst and respiratory distress who is admitted for cyst resection. The gold-standard in anticipated difficult airway management is the fibrobronchoscope. We decided to perform an alternative management by means of orotracheal intubation with videolaryngoscope (Glydescope®) in spontaneous ventilation

El manejo de una vía aérea difícil es uno de los retos más importantes a los que puede enfrentarse un anestesiólogo debido a la elevada morbimortalidad que conlleva. El reto aún es mayor si el paciente es un neonato. Por este motivo, debemos contar con diferentes estrategias que permitan anticipar y poder tratar las posibles complicaciones derivadas del procedimiento. En este caso, presentamos un neonato con quiste de vallécula con clínica de trabajo respiratorio que es admitido para cirugía de exéresis del quiste. El gold standard en el manejo de una vía aérea difícil conocida es el fibrobroncoscopio. Nosotros decidimos realizar un manejo anestésico alternativo mediante intubación orotraqueal con videolaringoscopio (Glydescope®) en ventilación espontánea.

Indicaciones, hallazgos broncoscópicos y mortalidad en pacientes pediátricos con traqueostomía en un hospital de México / Indications, bronchoscopic findings and mortality in pediatric patients with tracheostomy in a Mexican hospital

INTRODUCTION. Tracheostomy is an old surgical procedure, wich is currwently performed, in pediatric patients. Bronchoscopy is an effective procedure to follow these patients as it reveals data that can not be obtained with other methods. The aim of this study was to determine indications, bronchoscopic findings and mortality in patients with tracheostomy at the Hospital del Niño Morelense (HNM). in addiction, we sought to detail the role of bronchoscopy in patients follow-up. METHODS. Observational, descriptive and transversal study. We reviewed the records of the patients with tracheostomy during 5 years looking for bronchoscopic findings. RESULTS: The main indication for tracheostomy was prolonged ventilation (74.4 percent). The main bronchoscopic diagnoses were subglottic stenosis (20 percent), granulomas in the trachea (70 percent), and in bronchi abnormal secretions (70 percent) mortality was 32.5 percent. CONCLUSIONS: The main indication for tracheostomy is prolonged ventuilation. Mortality in children with tracheostomy depends mainly on the underlying pathology. Bronchospy is useful for monitoring the child with a tracheostomy

INTRODUCCIÓN. La traqueostomía es un procedimiento quirúrgico antiguo, que se realiza en pediatría cada vez con mayor frecuencia. La broncoscopía es un procedimiento efectivo para el seguimiento del paciente con traqueostomía ya que nos revela datos que no se pueden obtener con otros métodos. Se tuvo como objetios determinar indicaciones, hallazgos broncoscópicos y mortalidad en pacientes con traqueostomía, en el Hospital del Niño Morelense (HNM). MÉTODOS. Estudio observacional, descriptivo y transversal. Se revisaron los expedientes de los pacientes a quienes se les realizó traqueostomía durante 5 años buscando hallazgos broncoscópicos. RESULTADOS. La principal indicación de traqueostomía fue la ventilación prolongada (74 por ciento). Los principales diagnósticos broncoscópicos fueron: estenosis subglótica (20 por ciento), granulomas en tráquea (70 por ciento) y en bronquios secreciones anormales (70 por ciento). La mortalidad fue de 32.5 por ciento. CONCLUSIONES. la principal indicación para traqueostomía fue la ventilación prolongada. la mortalidad en niños con traqueostomía depende principalmente de la patología subyacente. La broncoscopía es útil para el seguimiento del niño con traqueostomía

Genetic Differentiation of Colombian Populations of Anopheles darlingi Root (Diptera: Culicidae).

Anopheles darlingi Root is a primary vector of malaria in the neotropic region, a species not just highly anthropophilic but very efficient in transmitting Plasmodium species and considered the most important vector in the Amazon region. The main goal of this study was to determine the genetic structure of the A. darlingi populations using microsatellites (STR) in western and eastern regions of Colombia. DNA extraction was done with the cited protocol of band using the Genomic Prep™ cell and tissue isolation commercial kits. We used the STR reported by Conn et al (Mol Ecol Notes 1: 223-225, 2001). The analysis with STR proved there was a high genetic diversity and significant alterations of the Hardy-Weinberg equilibrium. The greatest genetic diversity was recorded in Mitu (Vaupes) (Na = 14, Ho = 0.520). The lowest was in Pueblo Nuevo (Cordoba) (Na = 12, Ho = 0.457). The eastern region and the Mitu (Vaupes) populations presented the highest number of primer alleles (Ap = 30; Ap = 13; Ap = 9), with variations between 0.010 and 0.097. The AMOVA revealed that the whole population underwent moderate genetic differentiation (F ST = 0.063, p < 0.05). The same differentiation was noticed (0.06 < F ST > 0.06, p < 0.05) with five of the six populations included in this job, and there was a low differentiation in the Las Margaritas (Santander) area (F ST = 0.02s3, p < 0.05). Our results suggest a slight positive correlation, which does not show a statistical significance between the geographic and genetic distances, probably suggesting that the moderate genetic differentiation found between pairs of populations does not need to be explained for the hypothesis of separation by distance.

Propuesta para la recertificación de las especialidades médicas en Colombia / Proposal for Recertification of Medical Specialties in Colombia

Este artículo hace una breve revisión de los aspectos que justifican implementar un proceso de recertificación de los médicos. Luego hace una descripción de este proceso en los países donde se cuenta con mayor experiencia y de las ventajas de tener un proceso de recertificación, así como de las críticas hacia el sistema. Finalmente, se presenta la creación del Consejo Colombiano de Acreditación y Recertificación Médica, de Especialistas y Profesionales Afines (CAMEC), como producto del trabajo de la Asociación Colombiana de Sociedades Científicas, y también el borrador del decreto del gobierno nacional en el que se propone la creación del Sistema Integrado para la Educación Continuada y el Desarrollo Profesional Continuo en Salud (SFCTHS).

This article gives a brief overview of the aspects that justify implementing a recertification of doctors. After a description of this process in the countries where it has the most experience, the advantages of having a recertification process and the criticism of the system is also discussed. Finally, the creation of the Council on Accreditation and Recertification Colombian Medical Specialist professionals (CAMEC, in Spanish), as a product of the work of the Colombian Association of Scientific Societies, and also the draft decree of the national government is proposed in the creation of the Integrated System for Continuing Education and Continuing Professional Development in Health (SFCTHS, in Spanish).

Evaluación integral de residentes de psiquiatría: un complemento del proceso de admisión al programa / Comprehensive Assessment of Psychiatric Residents: An Addition to the Program Admission Process

La formación de especialistas médicos es un proceso largo y complejo, cuyo objetivo primordial es garantizarle a la sociedad que sean profesionales idóneos para atender las necesidades de salud de la población. El primer paso para garantizar este objetivo es el proceso de admisión. En psiquiatría, como en otras especialidades, este proceso, el seguimiento a los residentes y los criterios utilizados para cada uno, son diferentes en cada país. En Colombia la admisión es un proceso heterogéneo, no estandarizado, que varía de manera significativa de una universidad a otra, incluso entre las mismas instituciones pertenecientes al sector público y entre aquellas de carácter privado. En la Universidad Nacional de Colombia el proceso de admisión está centralizado en la Oficina de Admisiones e incluye un examen escrito, en el que se debe obtener la puntuación estipulada como punto de corte o más, la calificación de la hoja de vida y una entrevista. El Comité Docente del Departamento de Psiquiatría consideraba que el procedimiento de admisión en general era bueno, pero, al igual que todo proceso de selección, imperfecto. Con base en esta consideración, la experiencia de algunos docentes y apoyados en la normatividad vigente que exigía una "evaluación integral" para los estudiantes de maestría y doctorado, se decidió, a partir de 1996, establecer esta modalidad de evaluación para los admitidos a la especialización en Psiquiatría, con el objeto de servir como complemento al proceso de admisión. El artículo describe la experiencia del proceso y sus resultados, fortalezas y debilidades.

The training of medical specialists is a long and complex process. Its purpose is to guarantee the society that they are the right professionals to meet the health needs of the population. The first step to ensure this objective is the admission process. In psychiatry this process, monitoring resident students and the criteria for each one are different in each country. Admission in Colombia is a heterogeneous process, not standardized, which varies greatly from one university to another, even between private and public universities. At the National University of Colombia, the admissions process is hand-led by the Admissions Office and includes: a written test for which you must obtain a minimum score, a resume rating and an interview. The Teaching Committee and the Department of Psychiatry considered the admission procedure in general to be good, but in need of refinement. Due to the experience of some teachers and given the current rules, a "comprehensive assessment" for master and doctoral students was required and in 1996 it was decided that this method of assessment for admission to a specialization in Psychiatry would serve to complement the admission process. The article describes the experience of the process and its outcomes, strengths and weaknesses.

[Comprehensive Assessment of Psychiatric Residents: An Addition to the Program Admission Process]. / Evaluación integral de residentes de psiquiatría: un complemento del proceso de admisión al programa.

The training of medical specialists is a long and complex process. Its purpose is to guarantee the society that they are the right professionals to meet the health needs of the population. The first step to ensure this objective is the admission process. In psychiatry this process, monitoring resident students and the criteria for each one are different in each country. Admission in Colombia is a heterogeneous process, not standardized, which varies greatly from one university to another, even between private and public universities. At the National University of Colombia, the admissions process is handled by the Admissions Office and includes: a written test for which you must obtain a minimum score, a resume rating and an interview. The Teaching Committee and the Department of Psychiatry considered the admission procedure in general to be good, but in need of refinement. Due to the experience of some teachers and given the current rules, a "comprehensive assessment" for master and doctoral students was required and in 1996 it was decided that this method of assessment for admission to a specialization in Psychiatry would serve to complement the admission process. The article describes the experience of the process and its outcomes, strengths and weaknesses.

[Proposal for Recertification of Medical Specialties in Colombia]. / Propuesta para la recertificación de las especialidades médicas en Colombia.

This article gives a brief overview of the aspects that justify implementing a recertification of doctors. After a description of this process in the countries where it has the most experience, the advantages of having a recertification process and the criticism of the system is also discussed. Finally, the creation of the Council on Accreditation and Recertification Colombian Medical Specialist professionals (CAMEC, in Spanish), as a product of the work of the Colombian Association of Scientific Societies, and also the draft decree of the national government is proposed in the creation of the Integrated System for Continuing Education and Continuing Professional Development in Health (SFCTHS, in Spanish).

Comparación de dos estrategias para la enseñanza de un módulo de entrevista clínica en estudiantes de pregrado de medicina / Comparison of two strategies for the teaching of a clinical interview module in undergraduate medical students

Introducción: Los cambios en la práctica médica limitan la disponibilidad de pacientes y han generado escenarios de enseñanza de la medicina cada vez más escasos. Por ello se ha hecho necesario desarrollar métodos multimedia en la educación médica. Materiales y métodos: Se diseñó un ensayo controlado, abierto, no aleatorizado para comparar dos métodos de enseñanza: clase magistral y una herramienta multimedia, dentro del proceso de enseñanza de un módulo de entrevista clínica en estudiantes de pregrado de medicina de una universidad pública y una privada. Resultados: 268 estudiantes, 156 que recibieron clase magistral y 112 que recibieron el material multimedia, participaron en el estudio. El promedio de las calificaciones obtenidas en la evaluación por los estudiantes que usaron el material multimedia fue significativamente más alto que quienes tomaron la clase magistral. Además, aprobar u obtener una calificación igual o mayor a 3,5 fue aproximadamente dos veces mayor en los que usaron la herramienta multimedia que en los que asistieron a clase. Conclusiones: La multimedia es una herramienta útil y eficiente para la enseñanza de la entrevista a estudiantes de medicina...

Introduction: Changes in medical practice have limited the availability of patients and scenarios for medical education, resulting in the need to develop multimedia tools for this purpose. Methods: This is a controlled, open, nonrandomized study comparing two teaching methods: Lecture vs. a multimedia tool, in the process of teaching a clinical interview module to undergraduate medical students from a public and a private universities. Results: 268 students participated in the study, 156 received a standard lecture and 112 multimedia material. The average scores on the examinations of students using the multimedia material were significantly higher than those who took the standard lecture. Approximately twice as many of the students using the multimedia tool obtained a passing score of 3.5 or higher when compared to those who attended the lecture. Conclusions: Multimedia is a useful and efficient tool for teaching the clinical interview to medical students...

Effects of genotype, level of supplementation, and organic chromium on growth performance, carcass, and meat traits grazing lambs.

The aim of the present study was to evaluate the effects of Suffolk×Dorper (SD) and Rambouillet (R) lamb genotypes, dietary supplementation, and organic chromium on growth performance, carcass, and meat traits in male lambs grazing ryegrass pasture. SD lambs had heavier cold carcass (HCW) and better carcass yield (CY) and rib eye area at 12th rib (RA) than R lambs; R had larger legs. Feed supplement increased average daily weight gain (ADG), slaughter live weight (SLW), hot carcass weight (HCW) and cold carcass weight (CCW), carcass yield, carcass length (CL), leg perimeter (LP), major thorax width (MTW), minor thorax width (MiTW), rib eye area and dorsal fat at 12th rib (DF12), and also decreased meat moisture. Organic chromium reduced dorsal fat at 12th rib and meat fat content.

Estudio experimental y teórico de la síntesis de n-alquil-nitroimidazoles / Experimental and theoretical study of shyntesis of n-alkyl-nitroimidazoles

En este trabajo se realizó un estudio experimental y teórico sobre la N-alquilación de nitroimidazoles. Los N-alquil-2-metil-nitroimidazoles corresponden a moléculas con actividad biológica, que se obtienen por la reacción del 2-metil-5-nitroimidazol y diferentes halogenuros de alquilo. En esta reacción se observó la formación de una mezcla de productos isoméricos en diferente proporción, denominados como N-alquil-2-metil-4-nitroimidazol y N-alquil-2-metil-5-nitroimidazol, respectivamente. La reacción sugiere la formación de un equilibrio tautomérico, que genera dos sitios nucleofílicos susceptibles a un ataque electrofílico por parte del halogenuro de alquilo. La reactividad local nucleofílica del anillo nitroimidazólico se determinó utilizando índices de reactividad local, como la función de Fukui y el potencial electrostático, además de la función de localización electrónica (ELF). La función de Fukui se integra en los átomos utilizando los esquemas de partición basados en el análisis de cargas de Mulliken y orbitales naturales de enlace (NBO). Por último, se evaluaron los perfiles de reacción. Los resultados mostraron una leve diferencia en la reactividad local, sin embargo, se observan diferencias significativas en las barreras energéticas, que explican la formación de un producto isomérico sobre el otro, encontrándo así, concordancia entre los resultados experimentales y los teóricos.

In this work we realized and experimental and theoretical study of the N-alkylation of nitroimidazoles. The N-alkyl-2-methyl-nitroimidazoles correspond to biologically active molecules, obtained by reaction of 2-methyl-5-nitroimidazole and different alkyl halides. This reaction showed the formation of a mixture of isomeric products in different proportions, denominated like N-alkyl-2-methyl-4-nitroimidazole and N-alkyl-2-methyl-5-nitroimidazole, respectively. The reaction suggestes the formation of a tautomeric equilibrium, which generates two nucleophilic sites susceptible to electrophilic attack by the alkyl halide. The local nucleophilic reactivity of the nitroimidazole ring is determined using local reactivity indices such as the Fukui function and the electrostatic potential, besides the electronic localization function (ELF). The Fukui function was integrated for each atom using partition schemes based on analysis of Mulliken charges and natural bond orbital (NBO). Finally the reaction profiles were assessed. The results show a minor difference in the local reactivity. Nevertheless a significant difference in energy barriers is observed explaining the formation of an isomeric product over another. These results agree quite well with the experimental data.

A gene-based SNP linkage map for pacific white shrimp, Litopenaeus vannamei.

Pacific white shrimp (Litopenaeus vannamei) are of particular economic importance to the global shrimp aquaculture industry. However, limited genomics information is available for the penaeid species. We utilized the limited public information available, mainly single nucleotide polymorphisms (SNPs) and expressed sequence tags, to discover markers for the construction of the first SNP genetic map for Pacific white shrimp. In total, 1344 putative SNPs were discovered, and out of 825 SNPs genotyped, 418 SNP markers from 347 contigs were mapped onto 45 sex-averaged linkage groups, with approximate coverage of 2071 and 2130 cm for the female and male maps, respectively. The average-squared correlation coefficient (r(2)), a measure of linkage disequilibrium, for markers located more than 50 cm apart on the same linkage group, was 0.15. Levels of r(2) increased with decreasing inter-marker distance from approximately 80 cm, and increased more rapidly from approximately 30 cm. A QTL for shrimp gender was mapped on linkage group 13. Comparative mapping to model organisms, Daphnia pulex and Drosophila melanogaster, revealed extensive rearrangement of genome architecture for L. vannamei, and that L. vannamei was more related to Daphnia pulex. This SNP genetic map lays the foundation for future shrimp genomics studies, especially the identification of genetic markers or regions for economically important traits.

Estrategia educativa novedosa en la prevención de factores de riesgo cardiovascular gracias a la alianza de programas estatales y la iniciativa universitaria / Innovative education strategy in prevention of cardiovascular risk factors thanks to an alliance between state programs and university initiative

El fracaso de las estrategias tradicionales que se basan en el manejo de guías y educación mediante charlas en las unidades de salud, es evidente en diferentes estudios, en especial en los EUROASPIRE. Por ello, surge la necesidad de crear nuevas tácticas que sean efectivas para cambiar los estilos de vida no saludables de las personas y las comunidades, y disminuir la prevalencia de los factores de riesgo modificables para aterosclerosis y bajar la incidencia de eventos cardiovasculares. Aquí se presenta una experiencia que si bien no mide aún el impacto sobre estos aspectos, fue bien recibida por la comunidad e involucró aspectos novedosos. Se demostró la posibilidad de unir esfuerzos entre las políticas y recursos estatales y los medios académicos universitarios. De este modo, se probó la utilidad del trabajo interdisciplinario entre académicos de diferentes formaciones y creativos de medios audiovisuales y de la comunicación así como una estrategia lúdico-educativa masiva que parece ofrecer grandes posibilidades como didáctica moderna eficiente en la búsqueda de cambios hacia estilos de vida saludable.

Failure in traditional strategies based on guidelines and educational management through lectures in health units is evident in different studies in particular in those of EUROASPIRE. Therefore, there is a need for creating new effective tactics for the change of non-healthy life-styles in subjects and communities and lower the prevalence of modifiable risk factors for atherosclerosis and for lowering the incidence of cardiovascular events. We present an experience that even though does not measure the impact on these aspects, was well received by the community and involved innovative aspects. The possibility to unite efforts between politics and state resources with university academic media was shown. Usefulness of interdisciplinary task between different academic disciplines and audiovisual media as well as a massive amusement- education strategy was proven and it appears to offer great possibilities as a modern and efficient didactis in the search of changes towards healthy lifestyles.

Growth kinetics of progenitor cell-enriched hematopoietic cell populations in long-term liquid cultures under continuous removal of mature cells.

BACKGROUND: During long-term culture of primitive hematopoietic cells large numbers of mature cells are generated that, on the one hand, consume nutrients and cytokines present in the medium and, on the other hand, may produce or elicit the production of soluble factors that limit the growth of primitive cells. Thus it is possible that under standard culture conditions hematopoietic stem and progenitor cells are unable to display their true proliferation and expansion potentials. METHODS: Hematopoietic cell populations, enriched for CD34+ cells, were obtained from both umbilical cord blood (UCB) and mobilized peripheral blood (MPB), and cultured in cytokine-supplemented liquid culture, under continuous removal of mature cells by means of weekly re-selection of primitive, lineage-negative (Lin-) cells. Proliferation and expansion capacities of such cells were determined weekly for a 42-day culture period. RESULTS: As expected, based on our previous studies in standard liquid cultures, throughout the culture period there was a continuous decrease in the proportion of progenitor cells; however, after every re-selection on days 7, 14 and 21, there was a significant enrichment for both CD34+ cells and colony-forming cells (CFC). As a result of such an enrichment, the cumulative increase in the numbers of total cells and CFC in cultures with two, three or four selections was significantly higher than the increments observed in standard cultures, in which only a single selection was performed on day 0. Cultures of UCB cells showed consistently higher levels of both total cells and CFC than cultures of MPB cells. DISCUSSION: Taken together, these results indicate that continuous removal of mature cells from liquid cultures of primitive progenitors results in higher increments in the levels of both total cells and CFC.

Biopsias percutáneas guiadas por escanografía: experiencia en el Hospital Universitario San Ignacio: período 2001- 2004 / Scanner-guided percutaneous biopsies: an experience at Hospital Universitario San Ignacio, 2001-2004

El término biopsia (gr. bios: vida, vital – opsis: ver) se refiere al acto de obtener una muestra de tejido vivo con el fin de establecer un diagnóstico preciso mediante su análisis histopatológico[1]. Las biopsias se pueden realizar a través de una cirugía (biopsia abierta) o por medio de la vía percutánea (biopsia cerrada). La primera biopsia percutánea trastorácica reportada data de 1883, se obtuvo para el diagnóstico de un proceso infeccioso y en 1886 para el diagnóstico de una enfermedad maligna, en ambos casos, el procedimiento se realizó sin ninguna guía o ayuda imagenológica[2]. En la actualidad es un procedimiento común en la determinación de la etiología de una anormalidad o alteración focal. Las biopsias percutáneas pueden ser realizadas bajo guía imagenológica, usando una variedad de métodos como la fluoroscopia, el ultrasonido, escanografía y menos frecuentemente la resonancia magnética.

In vitro characterization of two lineage-negative CD34+ cell-enriched hematopoietic cell populations from human UC blood.

BACKGROUND: During the last few years there has been increasing interest, from both biologic and clinical points of view, in the ex vivo expansion of umbilical cord blood (UCB)-derived hematopoietic cells. This has brought about the need to characterize different cell populations present in UCB, and to explore different ex vivo approaches for the culture, expansion and biologic manipulation of these cells. METHODS: By using a negative-selection method, two UCB cell populations were obtained that were enriched for primitive lineage-negative (Lin-) cells, including those expressing the CD34 Ag (35-93% of the total cells in each fraction). Population I was enriched for CD34+ Lin- cells, whereas population II was enriched for CD34+ CD38- Lin- cells. Both populations were cultured in serum-free liquid cultures supplemented with different combinations of early and late-acting recombinant cytokines (all of them added at 10 ng/mL). Every 5-7 days proliferation, expansion and differentiation capacities of each population were determined, for a total period of 25-42 days. RESULTS: Both cell populations showed extensive proliferation and expansion capacities; however, population II [2300- and 232-fold increase in nucleated and colony-forming cell (CFC) numbers, respectively] was clearly superior in both parameters compared with population I (1120- and 20-fold increase in nucleated and CFC numbers, respectively). Depending on the cytokine combination used, granulocytes, macrophages and erythroblasts were preferentially produced. We also observed that both populations were highly sensitive to the inhibitory effects of tumor necrosis factor-alpha, even in the presence of stimulatory cytokines. DISCUSSION: This study demonstrates that the two progenitor cell-enriched populations obtained by negative selection possess extensive proliferation and expansion potentials in vitro, generating significant numbers of both primitive and mature cells. These cells may be a good alternative to purified CD34+ cells, obtained by positive selection, for pre-clinical and clinical protocols aimed at the ex vivo expansion of UCB cells.

La dispensación de medicamentos desde la perspectiva de los expendedores - una experiencia con grupos focales – / The drugstore clerks view for the dispensation of drugs

Los dispensadores de medicamentos en Colombia son un grupo de personas que tienen una gran responsabilidad en el manejo adecuado de los fármacos. La mayoría de ellos no tienen la formación técnica y científica necesaria que les permita brindar la información que requieren los pacientes Con la aplicación de la investigación cualitativa se busca identificar las cualidades y calidades de los dispensadores de medicamentos relacionadas con práctica que realizan. En este trabajo se encontró que el personal que está dedicado al despacho de los medicamentos no tiene formación técnica ni profesional en el tema, el área física de la mayoría de las farmacias estudiadas es insuficiente generando caos en la atención, el volumen tan alto de fórmulas despachadas por día no les permite atender adecuadamente al usuario ni brindarle la información que requieren; los despachadores en muchas oportunidades no identifican el nombre de los antimicrobianos y los entregan sin fórmula médica...

Severe hematopoietic alterations in vitro, in bone marrow transplant recipients who develop graft-versus-host disease.

Graft-versus-host disease (GVHD) is currently one of the major obstacles for successful allogeneic bone marrow transplantation (BMT). GVHD results from a complex set of interactions between donor T cells and a variety of target tissues from the host. To gain a better understanding of the biology of the human hematopoietic system in GVHD patients, in the present study we have determined the progenitor cell content in bone marrow (BM) samples from BMT recipients, with and without GVHD, and followed their growth kinetics in Dexter-type long-term marrow cultures (LTMC). We have also assessed some aspects regarding the composition of the hematopoietic microenvironment developed in vitro. As compared to normal subjects, BMT recipients showed decreased numbers of myeloid, erythroid, and multipotent progenitor cells. Interestingly, progenitor levels were significantly lower in GVHD patients (7% of the levels in normal marrow) than in those without GVHD (44% of the levels in normal marrow). When marrow cells from BMT recipients were cultured in LTMC, hematopoiesis was sustained at lower levels and for shorter periods of time, as compared to cultures from normal subjects. The hematopoietic deficiencies observed in this in vitro system were also more pronounced in GVHD patients. In terms of the microenvironment elements, reduced numbers of fibroblastic progenitors and adherent stromal cells were observed in BMT recipients, as compared to normal subjects, who showed 7 colony-forming unit fibroblast (CFU-F)/10(5) marrow cells and 320,000 adherent cells in LTMC. Again, GVHD patients showed more severe deficiencies (0.16 CFU-F/10(5) marrow cells and 34,000 adherent cells in LTMC) than patients without GVHD (2 CFU-F/10(5) marrow cells and 122,000 adherent cells in LTMC). Our results demonstrate that the hematopoietic system of BMT recipients is impaired, both in terms of its in vitro composition and function, and that these deficiencies are clearly more pronounced in patients with GVHD than in those without GVHD. Finally, although the evidence is still preliminary, our results also indicate that the severity of the hematopoietic alterations may be greater in acute GVHD than in chronic GVHD.

In vitro characterization of the hematopoietic system in pediatric patients with acute lymphoblastic leukemia.

Acute lymphoblastic leukemia (ALL) has been recognized as a hematologic neoplasia that originates at the level of a primitive lymphoid stem/progenitor cell. To date, however, the biology of the hematopoietic system in this disorder is still not fully understood. In the present study, we have determined the progenitor cell content (including myeloid, erythroid and multipotent progenitors) in 14 children with ALL and followed the proliferation kinetics of these cells in Dexter-type long-term marrow cultures. We have also characterized some aspects related to the composition and function of the hematopoietic microenvironment developed in vitro. All patients included in this study showed extremely reduced levels of progenitor cells (median of 6.2% of the levels found in normal marrow). Proliferation of these cells in long-term cultures was markedly deficient, since they showed very low numbers - compared to normal cultures - and reached undetectable levels after only a few weeks. Regarding the microenvironment developed in vitro, whereas normal marrow samples contained a median of 8 fibroblastic progenitors/10(5) marrow cells and the stromal cell layers developed in culture contained a median of 341000 adherent cells per well, ALL marrow samples showed no fibroblastic progenitors and the numbers of adherent cells were 21% of those in normal cultures. Interestingly, the levels of TNFalpha and IL-6 in ALL culture supernatants were significantly increased, compared to normal cultures. Bone marrow samples from all 14 children were also analyzed once they reached a complete clinical and hematological remission. Myeloid, erythroid and multipotent progenitor cell levels were significantly increased, compared to patients at diagnosis, and proliferation of myeloid progenitors in long-term cultures was also improved. In contrast, proliferation of erythroid progenitors showed no difference to that in cultures from patients at diagnosis. The numbers of fibroblastic progenitors and adherent cells were significantly increased, compared to patients at diagnosis, and TNFalpha and IL-6 levels returned to normal. In summary, in the present study, we have demonstrated significant in vitro alterations of the hematopoietic system, both in terms of its composition and function, in pediatric patients with ALL. Importantly, most of these alterations are corrected, at least partially, after chemotherapy.