Left ventricular hypertrophy, fibrosis heart, and diastolic dysfunction in chronic kidney disease / Hipertrofia del ventrículo izquierdo, fibrosis cardiaca y disfunción diastólica en la enfermedad renal crónica

Cardiovascular diseases occur 75 to 80% as causes of morbidity and mortality in patients with chronic kidney disease. In epidemiological studies the causes of cardiovascular deaths are sudden death, arrhythmias, heart failure, coronary arteries disease and myocardial infarction. Heart failure and cardiac arrhythmias are caused mainly by left ventricular hypertrophy and cardiac fibrosis. Pathophysiological factors involved in left ventricular hypertrophy ventricular hypertrophy have been divided into 3 categories: related to afterload, related to preload and not related to afterload or preload. Myocardial hypertrophy induces the activation of cellular apoptosis signals and activates metabolic pathways able to increase extracellular matrix production up to fibrosis. Fibrosis leads to progressive impairment in contractility with stiffening of myocardial wall, diastolic and systolic dysfunction and finally dilated cardiomyopathy with congestive heart failure. The main of this review is to understand the pathophysiology of left ventricular hypertrophy, cardiac fibrosis and diastolic dysfunction.

Las enfermedades cardiovasculares se presentan del 75al 80% como causas de morbimortalidad en pacientes con enfermedad renal crónica. En estudios epidemiológicos, las causas más frecuentes de muerte cardiovascular son: muerte súbita, arritmias, falla cardiaca, enfermedad arterial coronaria e infarto del miocardio. La insuficiencia cardiaca y las arritmias cardiacas son causadas por la hipertrofia del ventrículo izquierdo y la fibrosis cardiaca. Los factores fisiopatológicos involucrados en la hipertrofia del ventrículo izquierdo se dividen en 3 categorías: relacionado a la poscarga, relacionado a la precarga y los no relacionados ni a la poscarga, ni a la precarga. La hipertrofia miocárdica induce la activación de señales de apoptosis celular y activa las vías metabólicas capaces de aumentar la producción de matriz extracelular hasta fibrosis. La fibrosis conduce al deterioro progresivo de la contractilidad y al engrosamiento de la pared del miocardio, causando disfunción diastólica, sistólica y miocardiopatía dilatada con insuficiencia cardiaca congestiva. El objetivo de esta revisión es conocer la fisiopatología de la hipertrofia del ventrículo izquierdo, de la fibrosis cardiaca y de la disfunción diastólica en la enfermedad renal crónica.

[Clinical and biochemical characteristics of patients with morbid obesity at the time of hospital admission and one year after undergoing bariatric surgery]. / Características clínicas y bioquímicas de pacientes con obesidad extrema al ingreso y un año después de someterse a cirugía bariátrica.

BACKGROUND: Three percent of Mexicans suffer from morbid obesity. Comorbidities associated to this condition diminish quality of life, increase mortality and health care costs. Despite bariatric surgery has specific indications and risks, it is the only treatment with effective long-term results. The aim of the study was to evaluate biochemical and clinical patient characteristics, both preoperatively and a year after they underwent bariatric surgery. METHODS: We carried out a quasi-experimental study that evaluates a sample of patients in the Clínica de Obesidad at Hospital de Especialidades (a third level hospital) between March 2011 and October 2015. RESULTS: A total of 150 patients were analyzed (60 % were women). Mean age was 41 ± 9 years and mean body mass index (BMI) was 48 kg/m2 (42-53 kg/m2). Before surgery, type 2 diabetes mellitus (T2DM) was present in 31 %, hypertension in 60 % and 30 % of the patients were "metabolically healthy obese". A year after surgery, the percentage of excess body weight loss was 66 %, T2DM and hypertension remission was 70 % and 50 %, respectively. CONCLUSION: Bariatric surgery is an effective treatment to reduce excess weight. It improves biochemical, and clinical parameters in extreme obese patients.

Introducción: el 3 % de la población mexicana padece obesidad extrema. Sus comorbilidades disminuyen la calidad de vida, aumentan la mortalidad y los costos de atención médica. El único tratamiento con resultados a largo plazo es la cirugía bariátrica, aunque tiene indicaciones y riesgos específicos. Buscamos evaluar las características de los pacientes de cirugía bariátrica al inicio y un año después del tratamiento quirúrgico. Métodos: estudio cuasi experimental con los datos antropométricos, clínicos y bioquímicos de una muestra de pacientes operados en la Clínica de Obesidad del Hospital de Especialidades del Centro Médico Nacional de marzo del 2011 a octubre del 2015. Resultados: fueron analizados 150 pacientes (60 % mujeres), la media de edad fue de 41 ± 9 años y el índice de masa corporal (IMC) de 48 kg/m2 (42-53 kg/m2). Previo a la cirugía, 31 % tenía diabetes mellitus tipo 2 (DM2) y 62 % hipertensión arterial (HAS). El 30 % eran obesos "metabólicamente sanos". Un año después de la cirugía el porcentaje del exceso de peso perdido fue de 66 %. La remisión de DM2 y HAS fue de 70 y 50 %, respectivamente. Conclusión: la cirugía bariátrica es efectiva en la pérdida de peso y en la mejoría de parámetros bioquímicos y clínicos en pacientes con obesidad extrema.

Differential Immune Profiles in Two Pandemic Influenza A(H1N1)pdm09 Virus Waves at Pandemic Epicenter.

BACKGROUND AND AIMS: Severe influenza A(H1N1)pdm2009 virus infection cases are characterized by sustained immune activation during influenza pandemics. Seasonal flu data suggest that immune mediators could be modified by wave-related changes. Our aim was to determine the behavior of soluble and cell-related mediators in two waves at the epicenter of the 2009 influenza pandemic. METHODS: Leukocyte surface activation markers were studied in serum from peripheral blood samples, collected from the 1(st) (April-May, 2009) and 2(nd) (October 2009-February 2010) pandemic waves. Patients with confirmed influenza A(H1N1)pdm2009 virus infection (H1N1), influenza-like illness (ILI) or healthy donors (H) were analyzed. RESULTS: Serum IL-6, IL-4 and IL-10 levels were elevated in H1N1 patients from the 2(nd) pandemic wave. Additionally, the frequency of helper and cytotoxic T cells was reduced during the 1(st) wave, whereas CD69 expression in helper T cells was increased in the 2(nd) wave for both H1N1 and ILI patients. In contrast, CD62L expression in granulocytes from the ILI group was increased in both waves but in monocytes only in the 2(nd) wave. Triggering Receptor Expressed on Myeloid cells (TREM)-1 expression was elevated only in H1N1 patients at the 1(st) wave. CONCLUSIONS: Our results show that during the 2009 influenza pandemic a T cell activation phenotype is observed in a wave-dependent fashion, with an expanded activation in the 2(nd) wave, compared to the 1(st) wave. Conversely, granulocyte and monocyte activation is infection-dependent. This evidence collected at the pandemic epicenter in 2009 could help us understand the differences in the underlying cellular mechanisms that drive the wave-related immune profile behaviors that occur against influenza viruses during pandemics.

Intestinal pseudo-obstruction in patients with systemic lupus erythematosus: a real diagnostic challenge.

Intestinal pseudo-obstruction secondary to systemic lupus erythematosus (SLE) is a rare syndrome described in recent decades. There are slightly over 30 published cases in the English language literature, primarily associated with renal and hematological disease activity. Its presentation and evolution are a diagnostic challenge for the clinician. We present four cases of intestinal pseudo-obstruction due to lupus in young Mexican females. One patient had a previous diagnosis of SLE and all presented with a urinary tract infection of varying degrees of severity during their evolution. We consider that recognition of the disease is of vital importance because it allows for establishing appropriate management, leading to a better prognosis and avoiding unnecessary surgery and complications.

Circadian variation of human acute phase response

Circadian variation of temperature, both normal and febrile, is a well known fact. Mediators of fever are also regulators of acute phase response and are associated with stimulation of pituitary hormone production related with defervescence and with a circadian pattern of secretion. Acute phase response may consequently have circadian variations in its components. Measurements of temperature, erythrocyte sedimentation rate, complete blood cell count, serum cortisol and fibrinogen were made at 7:00, 15:00, and 23 h during two consecutive days in 35 patients with fever and acute infection, 15 patients with clinically active ankylosing spondylitis without fever and 10 healthy volunteers. Temperature curves showed statistically significant circadian rhytms, with higher values at night and lower ones during early morning. Erythrocyte sedimentation rate, leukocyte count and fibrinogen also showed statistically significant circadian rhytms, but with higher values at 15:00 h. Serum cortisol also showed statistically significant circadian rhythmicity but with a higher rhytms adjusted mean (MESOR), and a 100º (6 h) phase shift in patients with fever, as compared to patients with ankylosing spondylitis and healthy controls. In conclusion, components of acute phase response, including fever, have circadian rhythmicity, but asunchronically. Differences between fever and ankylosing spondylitis can be due to the intensity of acute phase response stimulation

Granulomatosis linfomatoidea del colon: a propósito de um caso / Colon lymphoid granulomatosis: report of a case

Se informa un caso de granulomatosis linfomatoide del colon en un joven mexicano de 18 años de edad que se manifestó con diarrea de más de un mes de evolución, acompañada de fiebre y pérdida de peso; posteriormente presentó hemorragia gastrointestinal y datos clínicos de abdomen agudo por lo que fue intervenido quirúrgicamente. Se encontró un tumor en el ciego, perforado y completamente sellado por tejido inflamatorio, que histológicamente correspondió a una lesión inmunoproliferativa angiocéntrica. La localización y el comportamiento de la enfermedad en este caso fueron excepcionales

Hepatitis granulomatosa por fiebre Q / Fever Q induced granulomatous hepatitis

Se informa un caso de fiebre y granulomas hepáticos característicos, cuyo diagnóstico final fue fiebre Q. El interés de tal caso radica, por un lado, en que no cuenta con antecedentes epidemiológicos y, por otro, tampoco con la presentación clínica típica

El manitol no modifica la glucemia en los pacientes diabéticos / he effects of acute manitol infusion in diabetics

Con el propósito de investigar los efectos de la infusión aguda de manitol sobre la glucemia de pacientes diabéticos, se estudiaron 14 pacientes con diabetes tipo 2 que requerían la administración preoperatoria de manitol para reducir la presión intraocular. Las variaciones que sufrió la glucemia una hora, tres horas y 24 horas después de la administración del manitol no fueron estadísticamente diferentes de las que ocurrieron espontáneamente en seis pacintes con dibetes tipo 2 descontrolada que no recibieron manitol, y las que tuvieron ocho pacientes no diabéticos que recibieron manitol por enfermedad ocular. Las diferencias en los valores entre cada una de las muestras de cada grupo en los diferentes momentos tampoco fueron estadísticamente significativas.