The tumor microenvironment of benign and malignant salivary gland tumors.

BACKGROUND: Treatment of salivary gland tumors (SGTs) remains challenging. Little is known about the immune landscape of SGTs. We aimed to characterize the tumor microenvironment in benign and malignant SGTs. METHODS: Eleven benign and nine malignant tumors were collected from patients undergoing curative intent surgery. Specimens were analyzed using mass cytometry by time-of-flight. Immune cell populations were manually gated, and T cells were clustered using the FlowSOM algorithm. Population frequencies were compared between high-grade and low-grade malignancies, corrected for multiple hypothesis testing. RESULTS: There were trends towards increased CD4+ and CD8+ T cells among malignant tumors. High-grade malignancies exhibited trends towards higher frequencies of CD8+ PD-1+ CD39+ CD103+ exhausted T cells, CD4+ FoxP3+ TCF-1+ CD127- Tregs, and CD69+ CD25- CD4+ T cells compared to low-grade malignancies. CONCLUSION: SGTs exhibit significant immunologic diversity. High-grade malignancies tended to have greater infiltration of exhausted CD8+ T cells and Tregs, which may guide future studies for immunotherapy strategies.

A mass cytometry approach to track the evolution of T cell responses during infection and immunotherapy by paired T cell receptor repertoire and T cell differentiation state analysis.

T cell receptor (TCR) recognition followed by clonal expansion is a fundamental feature of adaptive immune responses. Here, we developed a mass cytometric (CyTOF) approach combining antibodies specific for different TCR Vα- and Vß-chains with antibodies against T cell activation and differentiation proteins to identify antigen-specific expansions of T cell subsets and assess aspects of cellular function. This strategy allowed for the identification of expansions of specific Vß and Vα chain expressing CD8+ and CD4+ T cells with varying differentiation states in response to Listeria monocytogenes, tumors, and respiratory influenza infection. Expanded Vß chain expressing T cells could be directly linked to the recognition of specific antigens from Listeria, tumor cells, or influenza. In the setting of influenza infection, we showed that the common therapeutic approaches of intramuscular vaccination or convalescent serum transfer altered the clonal diversity and differentiation state of responding T cells. Thus, we present a new method to monitor broad changes in TCR specificity paired with T cell differentiation during adaptive immune responses.

Surfactant therapy using vibrating-mesh nebulizers in adults with COVID-19-induced ARDS: A case series.

Coronavirus adult respiratory distress syndrome, characterized by decreased surfactant due to lysis of type II pneumocytes and hyaline membrane formation, contributes to severe hypoxemia. The administration of surfactant via high-flow nasal cannula (HFNC) may positively affect lung structure and function in this context. In this study, we report on five clinical cases, encompassing patients aged 40-60 years of both sexes, who tested positive for coronavirus disease 2019 via real-time polymerase chain reaction and exhibited significant pulmonary compromise with elevated inflammatory biomarkers. These patients were treated with aerosol therapy using surfactant delivered through vibrating-mesh nebulizers alongside HFNC. Of these patients, four demonstrated positive responses to the treatment, suggesting that aerosol therapy with surfactant through vibrating-mesh nebulizers could be a viable rescue therapy in adults receiving HFNC oxygen therapy for hypoxemic respiratory failure caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unfortunately, one patient had a negative outcome and succumbed. The findings from these cases indicate that the use of aerosol therapy with vibrating-mesh nebulizers as rescue therapy might offer an alternative approach for managing adults with hypoxemic respiratory failure due to SARS-CoV-2, as evidenced by the positive outcomes in four out of the five cases presented.

Síndrome de Asia: revisión sistemática de literatura

Ha habido muchos casos de aparición de autoanticuerpos y síntomas de enfermedad después de la exposición a adyuvantes, no solo después del aumento de senos con implantes de silicona, sino también como un efecto secundario muy raro de la vacunación, como el síndrome de la guerra del Golfo o el síndrome de miofascitis macrofágica. Las enfermedades cuyos síntomas se desarrollaron después de dicha exposición adyuvante se denominan síndrome autoinmune/inflamatorio inducido por adyuvantes (ASIA). El grupo de adyuvantes incluye no solo implantes de silicona, sílice, escualeno y aluminio, sino también componentes de tinta utilizados para hacer tatuajes. Analizando los informes disponibles sobre la influencia de los adyuvantes en el desarrollo de enfermedades autoinmunes, se concluye que, además de la exposición prolongada a la silicona, también es necesaria la coexistencia de otros factores, como genéticos o ambientales. Los análisis claramente no confirman un mayor riesgo de desarrollar una enfermedad autoinmune después del aumento de senos con implantes de silicona o tatuajes, pero parece que entre estas pacientes hay un grupo que está más predestinado a desarrollar síntomas de la enfermedad. En la población general, los beneficios de la vacunación son obvios, y el riesgo de eventos adversos graves después de la inmunización es incomparablemente menor que el riesgo de desarrollar una enfermedad específica y sus complicaciones, también para pacientes con enfermedades autoinmunes diagnosticadas. Debido a la heterogeneidad de los datos en estudios previos y las dificultades para diagnosticar ASIA, parece necesario realizar más análisis de la influencia de los adyuvantes en el desarrollo de enfermedades autoinmunes y refinar los criterios de diagnóstico de ASIA, que ahora permiten un diagnóstico demasiado fácil de esta enfermedad. (provisto por Infomedic International)

There have been many cases of occurrence of autoantibodies and disease symptoms after adjuvant exposure, not only after breast augmentation with silicone implants, but also as a very rare side effect of vaccination, such as Gulf War syndrome or macrophagic myofasciitis syndrome. Diseases whose symptoms developed after such adjuvant exposure are called adjuvant-induced autoimmune/inflammatory syndrome (ASIA). The adjuvant group includes not only silicone, silica, squalene and aluminum implants, but also ink components used to make tattoos. Analyzing the available reports on the influence of adjuvants on the development of autoimmune diseases, it is concluded that, in addition to prolonged exposure to silicone, the coexistence of other factors, such as genetic or environmental, is also necessary. The analyses clearly do not confirm an increased risk of developing an autoimmune disease after breast augmentation with silicone implants or tattoos, but it seems that among these patients there is a group that is more predestined to develop symptoms of the disease. In the general population, the benefits of vaccination are obvious, and the risk of serious adverse events after immunization is incomparably lower than the risk of developing a specific disease and its complications, also for patients with diagnosed autoimmune diseases. Due to the heterogeneity of data in previous studies and the difficulties in diagnosing ASIA, further analysis of the influence of adjuvants on the development of autoimmune diseases and refinement of the diagnostic criteria for ASIA, which now allow too easy diagnosis of this disease, seems necessary. (provided by Infomedic International)

Impacto del lugar de residencia en la supervivencia de los pacientes con trasplante renal. ¿Puede la telemedicina mejorar este desenlace? / How residence affects the survival of kidney transplant recipients, can it be improved by telemedicine?

Antecedente: el trasplante renal es el tratamiento de elección en la enfermedad crónica terminal. Un adecuado seguimiento en el postrasplante mejora la supervivencia del injerto y del paciente a largo plazo. Objetivo: comparar los desenlaces clínicos de la población trasplantada renal que vive en el área metropolitana de Medellín con los que residen por fuera de este lugar, con el fin de plantear un modelo de atención para el seguimiento por medio de la telemedicina. Métodos: estudio descriptivo, retrospectivo y de un único centro. Se determinó la tasa de supervivencia mediante las curvas de Kaplan-Meier. Resultados: durante el período 2005-2015 se realizaron 754 trasplantes, el 42 % vivía por fuera del área metropolitana. Al agrupar esta cohorte según el lugar de residencia, se observó que la supervivencia de los pacientes residentes en el área metropolitana a 1, 3 y 5 años fue del 96,8 %, 93,7 % y 91,8 %, respectivamente, en contraste con el 94,4 %, 90,3 % y 85,2 % de los del área rural. Esta diferencia fue estadísticamente significativa a favor de los que viven en Medellín (log-rank test p = 0,048; Hazard ratio = 1,68; IC 95 % 0,99-2,84, p = 0,052). Conclusión: la supervivencia fue inferior en los pacientes trasplantados renales que viven por fuera del área Metropolitana. Lo anterior motiva el desarrollo de un modelo de atención para estos pacientes mediado por la telemedicina para facilitar el acceso al seguimiento postrasplante.

Background: Kidney transplantation is the treatment of choice for end-stage renal disease. An adequate post-transplant follow-up improves the graft and patient's long-term survival. Objective: The aim of this study was to compare the outcomes of kidney transplant patients who live in the Medellin metropolitan area with those who live outside this area, to propose a model for follow-up care through telemedicine. Methods: Descriptive, retrospective and one-center study. Kaplan-Meier method was used to determine the survival rate. Results: Between 2005 and 2015, 742 patients were transplanted, 42% of whom lived outside the metropolitan area. The survival rates after 1, 3 and 5 years of treatment in patients in the metropolitan area of Medellín compared to those outside were 96.8%, 93.7% y 91.8% and 94.4%, 90.3% y 85.2% respectively, with statistically significant differences (Log-rank test p=0.048, Hazard ratio 1.68, IC 95% 0.99-2.84, p=0.052). Conclusion: The survival rate was lower in kidney transplant patients living outside the urban area. These findings motivate the development of a telemedicine project to facilitate the follow-up of these patients after a kidney transplantation.

Folleto complementario de Parasitología Médica para estudiantes de la carrera de Medicina / Supplementary booklet of Medical Parasitology for medicine major students

RESUMEN Fundamento: la asignatura Microbiología y Parasitología Médica aporta las herramientas necesarias para el abordaje de los problemas de salud de la población, en los que intervienen agentes biológicos. Objetivo: diseñar un folleto complementario sobre el tema Parasitología Médica de la asignatura Microbiología y Parasitología Médica para estudiantes de segundo año de la carrera de Medicina de la Facultad de Ciencias Médicas Ernesto Che Guevara de la Serna de Pinar del Río. Métodos: se realizó una investigación educativa, con un universo de 455 estudiantes de segundo año de Medicina durante el curso 2019-2020, en la Facultad de Ciencias Médicas "Ernesto Ché Guevara de la Serna" de Pinar del Río, y 118 profesores que conforman el claustro de este año de la carrera. La muestra quedó conformada por 171 estudiantes y 16 profesores seleccionados de manera intencional. Resultados: se evidenció cierto grado de desactualización sobre los contenidos de Parasitología Médica en la asigantura Microbiología y Parasitología Médica. Se constató la necesidad de estudiantes y profesores de contar con un folleto complementario de Parasitología Médica. Se elaboró un Folleto Complementario de Parasitología Médica para estudiantes de la carrera de Medicina. Conclusiones: el folleto confeccionado fue valorado por los especialistas como útil y pertinente, por la actualización de sus contenidos y tratamiento metodológico.

ABSTRACT Rationale: the subject Medical Microbiology and Parasitology provides the necessary tools for the approach of health problems of the population, in which biological agents are involved. Objective: to design a complementary booklet on the topic Medical Parasitology of the subject Medical Microbiology and Parasitology for second academic-year students of medicine major at Ernesto Che Guevara de la Serna School of Medical Sciences of Pinar del Río. Methods: an educational research was carried out with a target group of 455 students from second academic-year students of medicine major during the course 2019-2020 at Ernesto Che Guevara de la Serna School of Medical Sciences of Pinar del Río and 118 professors comprising the teaching staff of this academic year in medicine major. The sample included 171 students and 16 professors who were intentionally selected. Theoretical, empirical and statistical methods were applied. Results: there was evidence of a certain degree of lack of updating on the contents of Medical Parasitology in the Microbiology and Medical Parasitology course. The need of students and professors to have a complementary booklet on Medical Parasitology was noted. A Complementary Booklet on Medical Parasitology was devised for students of medicine major. Conclusions: the booklet was considered useful and pertinent by the specialists, due to its updated contents and methodological treatment.

Nephrotic syndrome associated with primary atypical hemolytic uremic syndrome / Síndrome nefrótica associada à síndrome hemolítico-urêmica atípica primária

Abstract Primary atypical hemolytic-uremic syndrome is a rare disease characterized by non-immune microangiopathic hemolytic anemia, thrombocytopenia, and renal dysfunction; it is related to alterations in the regulation of the alternative pathway of complement due to genetic mutations. The association with nephrotic syndrome is unusual. We present here a pediatric patient diagnosed with primary atypical hemolytic-uremic syndrome associated with nephrotic syndrome who responded to eculizumab treatment.

Resumo A síndrome hemolítico-urêmica atípica primária é uma doença rara, caracterizada por anemia hemolítica microangiopática não-imune, trombocitopenia e disfunção renal; está relacionado a alterações na regulação da via alternativa do complemento devido a mutações genéticas. A associação com a síndrome nefrótica é incomum. Apresentamos aqui um paciente pediátrico com diagnóstico de síndrome hemolítico-urêmica atípica primária associada à síndrome nefrótica que respondeu ao tratamento com eculizumab.

It is time to adapt the definition of chronic kidney disease according to age

Abstract Chronic kidney disease is a condition with high morbidity, mortality and healthcare costs which affects all population groups, having a significant impact on their quality of life. Its classification has been modified over time and there is still no universal consensus to differentiate a physiological change in kidney clearance from a pathological change. Below, we will discuss the importance of reconsidering the definition and classification in the general population according to age, including children and adults. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2080).

Hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli in a renal transplant recipient case report / Síndrome hemolítico-urêmica causada por Escherichia coli produtora de toxina Shiga em um relato de caso de receptor de transplante renal

Abstract Thrombotic microangiopathies are disorders characterized by nonimmune microangiopathic hemolytic anemia, thrombocytopenia, and multi-systemic failure. They are classified as thrombotic thrombocytopenic purpura, atypical hemolytic-uremic syndrome, and typical hemolytic uremic syndrome. The latter is associated with intestinal infections by Shiga toxin-producing bacteria. Typical hemolytic uremic syndrome in adults is an extremely rare condition, characterized by high morbidity and mortality. It has been seldom described in solid organ transplant recipients. Here is presented the case of a kidney transplant recipient who had typical hemolytic uremic syndrome with multisystem commitment, refractory to management and with a fatal outcome.

Resumo Microangiopatias trombóticas são distúrbios caracterizados por anemia hemolítica microangiopática não imune, trombocitopenia e insuficiência multissistêmica. Elas são classificadas como púrpura trombocitopênica trombótica, síndrome hemolítico-urêmica atípica e síndrome urêmica hemolítica típica. Essa última está associada a infecções intestinais por bactérias produtoras da toxina Shiga. A síndrome hemolítica urêmica típica em adultos é uma condição extremamente rara, caracterizada por alta morbimortalidade. Esta é raramente descrita em receptores de transplantes de órgãos sólidos. Apresentamos aqui o caso de um receptor de transplante renal que apresentava síndrome hemolítico-urêmica típica com comprometimento multissistêmico, refratário ao tratamento, e com desfecho fatal.

Fundamentos teóricos del proceso de formación pedagógica de los estudiantes de licenciatura en Enfermería / Theoretical foundations of the process of pedagogical training of the students of Bachelor degree in Nursing

RESUMEN Introducción: el proceso de formación pedagógica en todas las áreas del conocimiento ha estado matizado por la necesidad de una preparación de los profesionales que trabajan en el desarrollo del proceso de enseñanza-aprendizaje y en los procesos educativos en general, tanto en el ámbito escolar como comunitario. Sin embargo, el proceso de formación pedagógica de los estudiantes de la carrera Licenciatura en Enfermería en la actualidad no permite que los egresados desarrollen capacidades pedagógicas que tributen al desarrollo del modo de actuación Educar. Objetivo: argumentar la importancia del modo de actuación Educar en el Proceso de Formación Pedagógica en la carrera Licenciatura en Enfermería desde un análisis histórico tendencial. Métodos: se utilizó el método general dialéctico materialista, para posibilitar el empleo de métodos teóricos y empíricos. De igual forma, se dedica un espacio al análisis conceptual y a sus características. Resultados: se sistematizan los análisis acerca del objeto y el carácter central del modo de actuación Educar del profesional de Enfermería, con base en la determinación de sus tendencias principales y la definición de la variable. Conclusiones: se reconoce la importancia de la formación pedagógica del Licenciado en Enfermería para su desempeño profesional, que demanda en la actualidad novedosas transformaciones desde el modo de actuación Educar.

ABSTRACT Introduction: the process of pedagogical training in all areas of knowledge has been nuanced by the need for a training of professionals working in the development of teaching-learning process and in the educational processes in general, both at university and community level. However, at present the process of pedagogical training for the students of Bachelor degree in Nursing does not allow the graduates to develop instructive skills with the aim at contributing with the development pedagogical purposes. Objective: to analyze the importance of the modes of action regarding the teaching of pedagogical skills along with the process of training the students of Bachelor degree in Nursing from a historical trend. Methods: the wide-ranging dialectical materialistic method was applied, making possible the use of theoretical and empirical methods. Likewise, a space is devoted to the conceptual analysis and its characteristics. Results: the analysis of the object and the central character of the nursing professional ways of educating are systematized, based on the determination of its main trends and the definition of the variable. Conclusions: the importance of a pedagogical training of the students of Bachelor degree in Nursing for the professional performance is recognized, which at this time demands an innovative transformation from the mode of educational actions.

Tuberculosis urogenital en un paciente con falla renal, estado del arte / Urogenital tuberculosis in a patient with kidney failure, state of the art

RESUMEN La tuberculosis es una enfermedad infecciosa y frecuente en países en vía de desarrollo. Esta puede causar una amplia variedad de complicaciones y presentaciones atípicas con alta morbimortalidad. De la forma genitourinaria se sospechada muy poco, razón por la cual su diagnóstico se hace, usualmente, de forma tardía o no se realiza. Esto conlleva a consecuencias muy graves en los pacientes, por ejemplo, la enfermedad renal crónica terminal. A continuación, se presenta un reporte de caso de una paciente con la anterior enfermedad, secundaria a una tuberculosis renal bilateral diagnosticada tardíamente y se realiza una revisión de la literatura sobre este tema.

SUMMARY Tuberculosis is a common infectious disease in developing countries, which can cause a variety of complications and atypical manifestations with high morbidity and mortality. The urogenital form is rarely suspected, resulting in delayed diagnosis or even no diagnosis, which can have serious consequences for the patients, such as chronic end-stage renal disease. We report on a patient with chronic end-stage renal failure caused by a delayed diagnosis of bilateral renal tuberculosis and a literature review on this topic.

Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review / Diálise peritoneal com múltiplas trocas bem-sucedida em paciente com grave toxicidade hematológica por metotrexato: relato de caso e revisão de literatura

Abstract Methotrexate is an effective medication to control several diseases; however, it can be very toxic, being myelosuppression one of its main adverse effects, which increases in severity and frequency in patients with renal failure. We present the case of a 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis, under treatment with peritoneal dialysis, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopenia with mucositis that improved with support measures and multiple-exchange peritoneal dialysis. We reviewed 20 cases published to date of pancytopenia associated with methotrexate in patients on dialysis and found high morbidity and mortality, which is why its use in this type of patient is not recommended. However, when this complication occurs, a therapeutic option could be the use of multiple-exchange peritoneal dialysis in addition to supportive therapy for drug-related toxicity, although it is recognized that studies are required to show the role of multiple-exchange peritoneal dialysis in the removal of this medication.

Resumo Apesar de sua toxicidade, o metotrexato é um medicamento eficaz no controle de várias doenças. A mielossupressão, um de seus principais efeitos adversos, aumenta em gravidade e frequência nos pacientes com insuficiência renal. Apresentamos o caso de um homem de 68 anos de idade com doença renal terminal relacionada à vasculite associada ao ANCA em diálise peritoneal, que recebeu a medicação em dose baixa em função da atividade da doença e que teve como complicação pancitopenia grave com mucosite, tratada com medidas de suporte e diálise peritoneal com múltiplas trocas. Revisamos 20 casos publicados até o presente momento sobre pancitopenia associada a metotrexato em pacientes em diálise. Foi identificada alta morbidade e mortalidade, razão pela qual seu uso nesse tipo de paciente não é recomendado. No entanto, quando esta complicação ocorre, uma opção terapêutica pode ser o uso de diálise peritoneal com múltiplas trocas, além da terapia de suporte para toxicidade medicamentosa. Maiores estudos são necessários para demonstrar o papel da diálise peritoneal com múltiplas trocas na remoção desse medicamento.

Linfohistiocitosis hemofagocítica en trasplante renal / Haemophagocytic lymphohistiocytosis in kidney transplant recipients

RESUMEN La linfohistiocitosis hemofagocítica (LHH) posterior al trasplante renal hace referencia a un estado hiperinflamatorio grave, asociado a la activación no controlada de los linfocitos T citotóxicos y macrófagos por causa infecciosas y/o secundaria al tratamiento inmunosupresor. Las causas más prevalentes dentro de las infecciones son la histoplasmosis, la tuberculosis y las infecciones por virus herpes. Se caracteriza por fiebre, organomegalias, citopenias, hiperferritinemia, hipertrigliceridemia y/o hipofibrinogenemia; puede acompañarse con hemofagocitosis documentada en la médula ósea, el hígado u otros órganos. Su curso puede ser fulminante con progresión a falla multisistémica y la muerte. El tratamiento va enfocado a controlar tempranamente la causa desencadenante, reducir la inmunosupresión y controlar la inflamación. En pocos casos es necesario el uso de otros inmunosupresores, quimioterapia o, en situaciones muy seleccionadas, se puede requerir el trasplante de médula ósea.

SUMMARY Hemophagocytic lymphohistiocytosis (HLH) in renal transplant recipients is a life-threatening hyper-inflammatory syndrome; associated with uncontrolled activation of cytotoxic T-lymphocytes and macrophages due to infections or immunosuppressive therapy. Histoplasmosis, tuberculosis and herpes virus infection are among the leading infectious causes. It is characterized by fever, organomegaly, cytopenia, hyperferritinemia, hypertrigiceridemia and/or hypofibrinogenemia; which may be accompanied by hemophagocytosis in bone marrow, liver or other organs. HLH can follow a rapidly fatal course, with progression to multisystemic failure and death. The treatment is based on early control of the triggering cause, reducing immunosuppression and stop the inflammatory process. In some cases, is necessary to use other immunosuppressant, chemotherapy and in a very few cases, a bone marrow transplant may be required.

Tratamiento exitoso de poliangeítis microscópica con compromiso grave del sistema nervioso central y renal en una paciente anciana / Successful treatment of microscopic polyangiitis with severe compromise of central nervous system and renal in a very elderly patient

RESUMEN El compromiso neurológico del sistema nervioso central (SNC) en las vasculitis asociadas a anticuerpos anticitoplasma de neutrófilos (ANCAS, del inglés anti-neutrophil cytoplasmic autoantibodies) es raro y potencialmente catastrófico. El estándar de tratamiento ha sido la ciclofosfamida con pulsos de esteroides, sin embargo, este esquema no tiene evidencia fuerte para el compromiso del sistema nervioso central y no está exento de efectos adversos graves sobre todo en la población anciana. En los últimos años, ha aparecido el rituximab como terapia alternativa a la ciclofosfamida para inducir la remisión en este tipo de vasculitis, no obstante, su uso con compromiso neurológico grave también ha sido anecdótico. Se presenta el caso de una paciente de 84 años de edad con poliangeítis microscópica y compromiso neurológico y renal grave, tratada con rituximab evolucionando favorablemente alcanzando la remisión de la enfermedad.

SUMMARY The neurological involvement of the central nervous system (CNS) in vasculitis associated with ANCAS is rare and potentially catastrophic. The standard treatment is cyclophosphamide with pulses of steroids; however, this scheme has no strong evidence for central nervous system involvement and is not free of serious adverse effects especially in the elderly population. In recent year's rituximab has appeared as an alternative therapy to cyclophosphamide to induce remission in this type of vasculitis, however its use with severe neurological involvement has also been anecdotal. We present the case of 84-year-old patient who presented a microscopic polyangiitis with severe neurological and renal involvement, treated with rituximab with a favorable evolution in reaching remission of the disease.

Primary hiperoxaluria diagnosed after kidney transplantation: report of 2 cases and literature review / Hiperoxalúria primária diagnosticada após transplante renal: relato de dois casos e revisão da literatura

Abstract Primary hyperoxaluria (PH) is a very rare genetic disorder; it is characterized by total or partial deficiency of the enzymes related to the metabolism of glyoxylate, with an overproduction of calcium oxalate that is deposited in different organs, mainly the kidney, leading to recurrent lithiasis, nephrocalcinosis and end stage renal disease (ESRD). In patients with ESRD that receive kidney transplantation alone, the disease has a relapse of 100%, with graft loss in a high percentage of patients in the first 5 years of transplantation. Three molecular disorders have been described in PH: mutation of the gene alanin glioxalate aminotransferase (AGXT); glyoxalate reductase/hydroxy pyruvate reductase (GRHPR) and 4-OH-2-oxoglutarate aldolase (HOGA1). We present two cases of patients with a history of renal lithiasis who were diagnosed with primary hyperoxaluria in the post-transplant period, manifested by early graft failure, with evidence of calcium oxalate crystals in renal biopsy, hyperoxaluria, hyperoxalemia, and genetic test compatible; they were managed with proper diet, abundant oral liquids, pyridoxine, hydrochlorothiazide and potassium citrate; however, they had slow but progressive deterioration of their grafts function until they reached end-stage chronic renal disease.

Resumo A hiperoxalúria primária (HP) é um distúrbio genético muito raro, caracterizado por deficiência total ou parcial das enzimas relacionadas ao metabolismo do glioxilato, superprodução de oxalato de cálcio que se deposita em vários órgãos (principalmente os rins) resultando em litíase recorrente, nefrocalcinose e doença renal terminal (DRT). Nos pacientes com DRT que recebem transplante renal, a doença apresenta recidiva em 100% dos casos, com perda do enxerto nos primeiros cinco anos após o transplante num elevado percentual de pacientes. Três distúrbios moleculares foram descritos na HP: mutação dos genes da alanina-glioxilato aminotransferase (AGXT), glioxilato redutase/hidroxipiruvato redutase (GRHPR) e 4-OH-2-oxoglutarato aldolase (HOGA1). Apresentamos dois casos de pacientes com histórico de litíase renal diagnosticados com hiperoxalúria primária no período pós-transplante, manifestada na forma de perda precoce do enxerto com evidências de cristais de oxalato de cálcio na biópsia renal, hiperoxalúria, hiperoxalemia e testes genéticos compatíveis. Os pacientes foram tratados com abordagem nutricional, líquidos orais em abundância, piridoxina, hidroclorotiazida e citrato de potássio. Contudo, os pacientes apresentaram deterioração lenta e gradual da função do enxerto e evoluíram para doença renal terminal.

Sodium bicarbonate versus isotonic saline solution to prevent contrast-induced nephropathy: a systematic review and meta-analysis / El bicarbonato de sodio en comparación con solución salina isotónica para prevenir la nefropatía inducida por contraste: una revisión sistemáticay meta-análisis

Introduction: Contrast-induced nephropathy is one of the main causes of acute kidney injury and increased hospital-acquired morbidity and mortality. The use of sodium bicarbonate for nephroprotection has emerged as a preventative strategy; however, its efficacy is controversial compared to other strategies, such as hydration using 0.9% saline solution. Objective: To compare the effectiveness of sodium bicarbonate vs. hydration using 0.9% saline solution to prevent contrast-induced acute kidney injury. Methods: A systematic review of studies registered in the COCHRANE, PUBMED, MEDLINE, LILACS, SCIELO and EMBASE databases was conducted. Randomized controlled studies that evaluated the use of 0.9% saline solution vs. sodium bicarbonate to prevent contrast-induced nephropathy were included. Results: A total of 22 studies (5,686 patients) were included. Sodium bicarbonate did not decrease the risk of contrast-induced nephropathy (RD= 0.00; 95% CI= -0.02 to 0.03; p= 0.83; I²= 0%). No significant differences were found in the demand for renal replacement therapy (RD= 0.00; 95% CI= -0.01 to 0-01; I²= 0%; p= 0.99) or in mortality (RD= -0.00; 95% CI= -0.001 to 0.001; I²= 0%; p= 0.51). Conclusions: Sodium bicarbonate administration is not superior to the use of 0.9% saline solution for preventing contrast-induced nephropathy in patients with risk factors, nor is it better at reducing mortality or the need for renal replacement therapy.

Introducción: La nefropatía inducida por medio de contraste es una de las causas principales de lesión renal aguda, lo cual incrementa la morbilidad y mortalidad intrahospitalaria. La nefroprotección con bicarbonato de sodio ha surgido como una estrategia preventiva, sin embargo su eficacia es controversial cuando se compara con estrategias como la hidratación con solución salina al 0.9%. Objetivo: Comparar la efectividad del bicarbonato de sodio versus la hidratación con solución salina al 0.9% en la prevención de la lesión renal aguda inducida por contraste. Métodos: Se realizó una revisión sistemática de los estudios registrados en COCHRANE, PUBMED, MEDLINE, LILACS, SCIELO y EMBASE. Se incluyeron estudios aleatorizados, controlados donde se evaluó el uso de solución salina al 0.9% versus bicarbonato de sodio para prevenir la nefropatía por medio de contraste. Resultados: Se incluyeron 22 estudios (5,686 pacientes). El bicarbonato de sodio no disminuyó el riesgo de nefropatía inducida por contraste (DR= 0.00 IC 95%= -0.02-0.03; p= 0.83, I2=0%). Tampoco se encontró diferencia significativa en la necesidad de terapia de reemplazo renal (DR= 0.00 IC 95%= -0.01-0-01, I2= 0%, p= 0.99); ni en la mortalidad (DR= -0.00, IC 95%= -0.001-0.001, I2= 0%, p= 0.51). Conclusiones: La administración de bicarbonato de sodio no es superior al suministro de solución salina al 0.9% en la prevención de nefropatía inducida por medio de contraste en pacientes con factores de riesgo. Su uso tampoco es superior en la reducción de mortalidad y el requerimiento de terapia de reemplazo renal.

Approaches and perspectives to toxicogenetics and toxicogenomics / Aproximaciones y perspectivas en toxicogenética y toxicogenómica

Toxicology is one of the scientific disciplines that has most evolved in recent years due to scientific and technological advances that have created a deeper understanding of the genetic and molecular basis for appreciative variability in toxic response from one person to another. The application of this knowledge in toxicology is known as toxicogenetics and toxicogenomics. The latter is the discipline that studies the genomic response of organisms exposed to chemical agents, including drugs, environmental pollutants, food additives, and other commonly used chemical products. The use of emerging omic technologies, such as genomics, transcriptomics, proteomics, metabolomics and bioinformatics techniques, permits the analysis of many variants of genes simultaneously in an organism exposed to toxic agents in order to search for genes susceptible to damage, to detect patterns and mechanisms of toxicity, and determine specific profiles of gene expression that give origin to biomarkers of exposure and risk. This constitutes predictive toxicology.

La toxicología es una de las disciplinas científicas que más ha evolucionado en los últimos años; esto se ha dado gracias a los avances científicos y tecnológicos que han generado un conocimiento cada vez más profundo de las bases genéticas y moleculares de la variabilidad en la respuesta tóxica de unas personas a otras. La aplicación de estos conocimientos a la toxicología se conoce como toxicogenética y toxicogenómica; esta última es la disciplina que estudia la respuesta genómica de los organismos expuestos a agentes químicos, dentro de los que se incluyen fármacos, contaminantes ambientales, aditivos alimentarios y otros productos químicos de uso común. Dichos estudios se adelantan mediante el empleo de las tecnologías ómicas emergentes, como genómica, trascriptómica, proteómica, metabolómica y las técnicas bioinformáticas, las cuales permiten analizar múltiples variantes de genes simultáneamente de un organismo expuesto a agentes tóxicos, con el propósito de buscar los relacionados con susceptibilidad al daño, detectar de patrones y mecanismos de toxicidad, determinar moléculas endógenas susceptibles al ataque de agentes tóxicos y determinar perfiles específicos de expresión de genes que pueden originar biomarcadores de exposición y riesgo, constituyendo la toxicología predictiva.

Características de pacientes con complicaciones crónicas de la diabetes hospitalizados en una institución de salud del municipio de Pereira (Colombia) / Characteristics of patients with chronic complications of diabetes hospitalized in a health facility in Pereira (Colombia)

Objetivo Identificar algunas características demográficas y clínicas presentes en pacientes diabéticos con complicaciones crónicas, hospitalizados en una Institución de salud del municipio de Pereira (Colombia). Metodología Estudio descriptivo realizado en 30 pacientes diabéticos hospitalizados, mayores de 18 años, con diagnóstico de más de dos años de complicación crónica, orientados en tiempo, lugar y persona, que aceptaron participar voluntariamente firmando el consentimiento informado. Se realizó anamnesis, valoración clínica con examen físico y revisión de historia clínica a cada paciente. Los datos se registraron en una ficha clínica y se analizaron en el programa Epi-Info 2003. Resultados La distribución de los pacientes fue igual por género, 67,0% mayores de 60 años, 97,0% de estratos socioeconómicos 1 y 2 y 93,0% sólo con escolaridad primaria. Todas las personas valoradas tenían hipertensión arterial y el 27,0% eran tratadas por enfermedad cardíaca. El 87,0% de los pacientes presentaba retinopatía, 49,0% nefropatía 87,0% neuropatía y 23,0% pie diabético. El 67,0% de estas complicaciones estuvieron presentes en población mayor de 60 años. ConclusionesCon la valoración clínica sistemática, los análisis de laboratorio y los estudios tempranos y específicos de diagnóstico, el profesional de enfermería puede identificar de forma precoz algunas manifestaciones de complicaciones, que pueden ser oportunamente intervenidas para mejorar la calidad de vida de los pacientes con diabetes.

ObjectiveTo identify some demographic and clinical characteristics present in diabetic patients with chronic complications, hospitalized in a health institution in Pereira (Colombia). Methodology Descriptive study carried out with 30 diabetic inpatients, aged 18 years, diagnosed with more than two years of chronic complication, oriented in time, place and person, who voluntarily agreed to participate by signing the informed consent. An anamnesis was performed, which included a clinical assessment by means of a physical examination and a review of each patient's clinical history. Data were recorded in a medical record and analyzed using Epi-Info 2003 program. Results The distribution of patients was the same by gender, 67,0% over 60 years, 97,0% of socioeconomic strata 1 and 2 and 93,0% only had primary schooling. All the persons examined had hypertension and 27,0% were treated for heart disease. The 87.0% of patients had retinopathy, 49,0% nephropathy, 87,0% neuropathy, and 23,0% diabetic foot. The 67,0% of these complications were present in the population over 60 years. Conclusions With the systematic clinical evaluation, laboratory tests, and the early and specific diagnosis studies, the professional nurse can identify early on some manifestations of complications, which may conveniently be intervened to improve the quality of life of patients with diabetes.

Caracterización sero-epidemiológicade convivientes de pacientes conlepra en Colombia entre 2003 y 2007 / Sero-epidemiological characterization of household contactsof leprosy patients from Colombia 2003-2007

Introducción: los convivientes de los pacientes con lepra son una población con alto riesgo dedesarrollar la enfermedad. En este estudio se hizo una caracterización de los convivientes depacientes con lepra en la región Caribe y el departamento de Antioquia.Materiales y métodos: se realizó un estudio descriptivo transversal con 383 convivientes de 95pacientes multibacilares y paucibalares registrados dentro del programa de lepra de los estudiosrealizados por el Instituto Colombiano de Medicina Tropical (ICMT) en el periodo 2003-2007en Bolívar, Córdoba, Sucre y Antioquia. Se aplicó un formulario de preguntas en busca de obtener las variables de interés en cuanto al conviviente yal paciente y se definió el valor de inmunoglobulina M (IgM) anti PGL-1 para cada conviviente por medio delmétodo ELISA (Enzyme-Linked Immuno Sorbent Assay, por su nombre en inglés). Para el procesamiento dela información se utilizó el programa estadístico SPSS versión 8.0®.Resultados: el porcentaje de convivientes de 0 a 19 años de sexo masculino fue superior a los de sexo femenino, siendo contraria esta frecuencia en mayores de 20años. La mayoría de los convivientes son amas de casa (27 %) y agricultores (4,4 %). El 53% residía en Córdoba,29,4 % en Bolívar, 11,5 % en Sucre y la menor proporción correspondió al departamento de Antioquia. Losconvivientes cursaron primaria y secundaria incompletas en una proporción de 32 % y 20 %, respectivamente. Fue poco el grado de educación superior encontrado enlos convivientes (2,3 %). El riesgo de presentar anticuerposIgM antiPGL-1 positivos es mayor para las mujeres que para los hombres con un OR de 2,01. Conclusión: esta caracterización permite identificar lapoblación de convivientes en tres regiones de Colombia, para orientar posibles acciones que impacten en la transmisión de la enfermedad.

Introduction: Leprosy is a disease with catastrophicconsequences for health. In this articlethe household contacts of leprosy patients in the Caribbean region and the department of Antioquiawere characterized.Materials and methods: A retrospective study was conducted with 383 contacts of 95 patients with multibacillary or paucibacillary leprosy recordedin the Leprosy program studies carriedout by the Colombian Institute of Tropical Medicine (ICMT) at the period 2003 - 2007 in the departments of Bolivar, Cordoba and Sucre. Asurvey was taken seeking to obtain the variables of interest in terms of the household contactand the patient, and it was defined the presence or absence of anti PGL-1 antibodies using theEnzyme-Linked ImmunoSorbent Assay (ELISA) technique. The software SPSS version 8.0 wasused to process the information; and the data analysis included absolute and relative frequenciesof qualitative variables, summary measures for quantitative variables, and proportion differences by sex were determined by using a levelof significance of 5 %. Results: The percentage of women was higherthan men after age 20, while men predominated in the five-year periods from 0 to 19 years. Mostof were households contacts were housewives (27 %) and 4.4 % farmers. 53 % lived in Cordoba,29.4 % in Bolivar, 11.5 % in Sucre and the lowest corresponded to the department of Antioquia.The households contacts studied elementary school and incomplete high school at a rate of 32 % and 20 % respectively, and had a low degreeof higher education (2.1 % -2.3 %). Women have a higher risk of presenting anti PGL-1 antibodiesthan men (OR 2.01). Conclusion: the household contacts of leprosypatients are mainly female, with a mean cohabitation time of 12 years. This characterization allowsthe recognition of the population in three Colombian regions, in order to direct possible actions which could impact the illnesses transmission.