Cytokine Profile Response of Human Peripheral Blood Mononuclear Cells Stimulated by Bartonella bacilliformis.

Carrion's disease is a neglected endemic disease found in remote Andean areas. As an overlooked disease, knowledge of innate immune responses to Bartonella bacilliformis, the etiological agent, is scarce. This study aimed to evaluate the cytokine response to B. bacilliformis using in vitro human peripheral blood mononuclear cells (PBMCs) stimulations. PBMCs from naive adults were isolated by gradient centrifugation and cocultured with heat-inactivated (HI) B. bacilliformis at different incubation times (3, 6, 12, 24, and 36 h). Cytokines, chemokines, and growth factors were determined in culture supernatants by multiplex fluorescent bead-based quantitative suspension array technology. During the first 36 h, a proinflammatory response was observed, including tumor necrosis factor-α, interleukin (IL)-1α, IL-1ß, interferon-α2, and IL-6, followed by an anti-inflammatory response mainly related to IL-1RA. Moreover, high expression levels of chemokines IL-8, monocyte chemoattractant protein-1α, and macrophage inflammatory protein (MIP)-1ß were detected from 3 h poststimulation and MIP-1α was detected at 24 h. Some growth factors, mainly granulocyte macrophage colony-stimulating factor and granulocyte colony-stimulating factor, and in minor concentrations vascular endothelial growth factor, epidermal growth factor, and eotaxin, were also detected. Innate response to HI B. bacilliformis stimulation consists of a rapid and strong proinflammatory response characterized by a wide range of cytokines and chemokines followed by an anti-inflammatory response and increased specific growth factors.

Is ranitidine necessary as premedication for regimens containing paclitaxel? A non-inferiority study.

BACKGROUND: Histamine type-2-receptor antagonist drugs (H2-antagonists) have been used as standard treatment to prevent hypersensitivity reactions (HRs) in paclitaxel-containing regimens, however, their use has been strongly questioned. Ranitidine has been the most widely used H2-antagonist. Therefore, especially after its withdrawal from the market, the objective of this study is to determine the impact of its elimination from premedication on HR incidence. METHODS: A cohort, multicenter, observational, prospective, and non-inferiority study, including paclitaxel-naïve cancer patients, designed to determine the incidence of HRs of any grade associated with paclitaxel administration and analyze non-inferiority against the incidence estimated in the literature (20%), with 5% as the maximum difference (Δ). Patients with a solid neoplasm of any type/stage, who initiated treatment with paclitaxel without H2-antagonists in the premedication regimen were enrolled. RESULTS: A total of 441 patients were included, of whom 50 presented 54 HRs of any grade. The cumulative incidence was 11.3% (95%CI 8.5-14.7), thus fulfilling the hypothesis of non-inferiority. Of the overall HRs detected, 15 were grade ≥ 3 with a cumulative incidence of 3.4% (95%CI 1.9-5.5). CONCLUSIONS: This study demonstrates that the elimination of ranitidine from paclitaxel premedication schedules is non-inferior in the development of HRs of any grade compared to the administration of H2-antagonists.

First report of canine morbillivirus infection of adipose tissue-derived stem cells from dogs with distemper.

Background and Aim: Ribonucleic acid viruses remain latent in different cell types, including mesenchymal stem cells; however, the distemper virus remains undetected in these cells. This study aimed to determine whether adipose stem cells (ASCs) from dogs with distemper disease are infected with the canine morbillivirus (CM). Materials and Methods: Twelve dogs with the neurological phase of the disease and who were positive for CM by reverse transcription polymerase chain reaction (RT-PCR), were studied. ASCs from adipose tissue of the lesser omentum of these infected dogs were isolated and characterized. Direct fluorescence was used to detect the viral antigen in cell cultures. Flow cytometry and RT-PCR identified detectable quantities of the virus in two cultures, while electron microscopy confirmed the CM particles within ASCs. Results: This study revealed that ASCs of the omentum of dogs with distemper disease can be infected with CM, indicating their possible involvement in this virus latency and persistence. This suggests that its detection should be considered within the quality control process of stem cells intended for regenerative medicine. Conclusion: To the best of our knowledge, this is the first study that demonstrates that omentum ASCs from dogs with distemper disease can be infected with CM and may be involved in viral latency or persistence. Our study also suggests that the detection of CM should be considered within the quality control process of stem cells intended for regenerative medicine.

Validation of a semiological maneuver for the evaluation of spastic dynamic clubfoot: an approach based on the judgment of experts in physical medicine and rehabilitation.

BACKGROUND: The evaluation of spasticity of the plantar flexors in dynamic clubfoot is difficult due to the almost invariable concomitance of Achilles clonus, which is a semiological artifact. No description was found in the literature of a technique for inhibiting or reducing the discharge generated by Achilles clonus to allow a correct assessment of spasticity in this segment. AIM: Validation of a semiological maneuver that reduces or eliminates Achilles clonus for the adequate evaluation of spastic dynamic clubfoot. DESIGN: Multicenter cross-sectional study. SETTING: The study was conducted by 12 experts in physical medicine and rehabilitation from various clinics and hospitals in Colombia. POPULATION: Thirty-five adults with dynamic spastic clubfoot and Achilles clonus secondary to upper motor neuron syndrome who attended outpatient consultation at physical medicine and rehabilitation services in eight cities Colombia from August 2020 to February 2021. METHODS: The usual method for examining spastic plantar flexors was compared to the proposed semiological maneuver to evaluate the proposed maneuver contributed to the reduction or elimination of Achilles clonus to allow a more accurate measure of spasticity in this segment. Four dimensions were evaluated by the experts: time required for application, simplicity, effectiveness and clinical utility. A cutoff point was established to identify whether the maneuver was unacceptable, acceptable or excellent. RESULTS: The application of the maneuver was able to reduce or eliminate Achilles clonus as a masking sign of spasticity in the plantar flexors in 100% of the patients and was considered excellent in 77.1% of the cases for the four dimensions evaluated. A decrease in the degree of spasticity of the plantar flexors was observed when the maneuver was applied. CONCLUSIONS: The proposed maneuver reduces or eliminates Achilles clonus, which could allow a more precise evaluation of spasticity in this segment. All of the experts recommended including the maneuver in routine examinations of this population. CLINICAL REHABILITATION IMPACT: Applying the proposed maneuver could improve the selection of patients with spastic dynamic clubfoot who require specific treatment.

A Decreased Response to Resistin in Mononuclear Leukocytes Contributes to Oxidative Stress in Nonalcoholic Fatty Liver Disease.

BACKGROUND: Deregulation of immune response and oxidative stress contribute to nonalcoholic fatty liver disease (NAFLD) pathogenesis. Resistin is a physiological modulator of inflammation and redox homeostasis of different cell types. Increased resistin serum concentration and the direct association between resistin hepatic expression and NAFLD severity suggest that resistin participates in NAFLD pathogenesis. AIMS: To evaluate resistin-induced regulation of redox homeostasis in mononuclear leukocytes from NAFLD patients and controls. METHODS: We evaluated basal and resistin-mediated modulation of reactive oxygen species (ROS) and glutathione content by flow cytometry, and antioxidant enzyme activities by spectrophotometry. RESULTS: Peripheral blood mononuclear cells (PBMC) from NAFLD patients showed higher ROS content and glutathione peroxidase activity and lower glutathione content, superoxide dismutase and glutathione reductase activities than control PBMC. Resistin decreased ROS levels and superoxide dismutase activity and increased glutathione reductase and catalase activities in PBMC from controls but not from patients. Resistin decreased glutathione content in PBMC from control and NAFLD patients, with greater effect on patient cells. Basal and resistin-modulated ROS levels were directly associated with obesity-related risk factors for NAFLD. Hepatic myeloid cells and T-lymphocytes from NAFLD patients showed higher basal ROS content than cells from controls. Resistin decreased ROS levels in hepatic T-lymphocytes from controls but not from patients. CONCLUSIONS: Resistin regulates redox homeostasis in mononuclear leukocytes. A decreased response to resistin in leukocytes from NAFLD patients is associated with an impaired redox homeostasis.

Biological characteristics of a sub-population of cancer stem cells from two triple-negative breast tumour cell lines.

Triple-negative breast tumours (TNBTs) make up 15-20% of all breast tumours. There is no treatment for them, and the role that cancer stem cells (CSCs) have in carcinogenesis is still unclear, so finding markers and therapeutic targets in CSC exosomes requires these cells to exist as a homogeneous cell population. The objective of this work was to determine differences in ultrastructural morphology, proliferative capacity, and mouse-xenotransplantation characteristics of the MDA-MB-231 and MDA-MB-436 TNBT cell lines with the CD44 high /CD24 low phenotype in order to study their exosomes. The results show that the CD44 high /CD24 low MBA-MB-231 cells had a population doubling time of 41.56 h, compared to 44.79 h in the MDA-MB-436 cell line. After magnetic immunoseparation, 18.75% and 14.56% of the stem cell population of the MDA-MB-231 and MDA-MB-436 cell lines, respectively, were of the CD44 high /CD24 low phenotype, which were expanded to reach purities of 80.4% and 87.6%. The same expanded lineage in both cell lines was shown to possess the pluripotency markers Nanog and Oct4. Under a scanning electron microscope, the CD44 high /CD24 low lineage of the MBA-MD-231 cell line formed groups of more interconnected cells than this lineage of the MBA-MD-436 line. A total of 16% of the mice inoculated with the CD44 high /CD24 low lineage of either cell line presented tumours of the breast, lung, and submandibular ganglia, in whose tissues variable numbers of inoculated cells were found 30 days post-inoculation. By magnetic immunoselection, it was possible to isolate in similar quantities and characterize, expand, and xenotransplant the CD44 high /CD24 low lineage of the MDA-MB-231 and MDA-MB-436 cell lines. The former cell line has greater proliferative capacity, the two lines differ under scanning electron microscopy in how they intercommunicate, and both cell lines induce new tumours in mice and persist at least 30 days post-inoculation in the transplanted animal so their exosomes would also be different.

Limited expression of TLR9 on T cells and its functional consequences in patients with nonalcoholic fatty liver disease.

BACKGROUND/AIMS: Toll-like receptors (TLRs) modulate T cell responses in diverse diseases. Co-stimulation of T cell activation via TLR9 induces production of interferon gamma (IFN-γ), priming of which is critical for differentiation of pro-inflammatory macrophages. These macrophages have a crucial role in nonalcoholic fatty liver disease (NAFLD). We aimed to evaluate the expression of TLR9 protein on T cells and the consequences of TLR9-mediated triggering of these cells in patients with NAFLD. METHODS: Our study included 34 patients with simple steatosis, 34 patients with nonalcoholic steatohepatitis, eight patients with NAFLD who met general diagnostic criteria but lacked histological diagnosis, and 51 control subjects. We used a synthetic TLR9 ligand to co-stimulate T cells. We measured TLR9 expression in liver and peripheral T cells and CD69 and IFN-γ as phenotypic markers of T cell activation and differentiation by flow cytometry. RESULTS: TLR9 expression on liver and peripheral T cells was lowest in patients with simple steatosis and was positively associated with anthropometric, biochemical, and histopathological features of NAFLD. In vitro co-stimulation of T cells from patients with simple steatosis induced a limited number of IFN-γ-producing CD8+ T cells. At baseline, these patients showed a low frequency of circulating type 1 CD8+ cells. CONCLUSION: The positive associations between TLR9 and anthropometric, clinical, and histological features and the crucial role of IFN-γ-in NAFLD suggest that limited TLR9 expression and production of IFN-γ play a protective role in patients with simple steatosis.

Use of strong opioids for chronic pain in osteoarthritis: an insight into the Latin American reality.

INTRODUCTION: Osteoarthritis is the most common cause of arthritis and one of the main causes of chronic pain. Although opioids are frequently employed for chronic pain treatment, their usage for osteoarthritis pain remains controversial due to the associated adverse effects. Most guidelines reserve their use for refractory pain in patients with hip and knee osteoarthritis. The situation is even more complex in Latin America, where the prevalence of insufficient pain treatment is high because of the limited availability and use of strong opioids. Areas covered: In this article we review the epidemiology of osteoarthritis, its socioeconomic burden, its impact as a chronic pain cause and the pharmacological treatment options, giving emphasis to the role of strong opioids, their safety and efficacy, especially in Latin American countries, where restrictions regulate their usage. Expert commentary: Usage of strong opioids is safe and effective in the short-term management of osteoarthritis with moderate to severe pain, when other pharmacological treatments are inadequate and surgery is contraindicated, provided their use adheres to existing guidelines. Educational programs for patients and physicians and further research on treating chronic pain with opioids should be implemented to reduce adverse effects and improve care quality.

Hipoglicemia posprandial secundaria a síndrome dumping / Postprandial hypoglycemia secondary to dumping síndrome

La hipoglicemia en pacientes no diabéticos se define como un nivel sérico menor de 55 mg/dL que puede ser parte de la tríada de Whipple (síntomas de hipoglicemia, niveles bajos de glucosa sérica y resolución de la sintomatología tras la normalización de la glicemia). Puede ser mediada o no por insulina, dando manifestaciones en ayunas (posabsorptiva) o posprandiales (reactiva). Con el aumento de la cirugía bariátrica se ha observado una mayor incidencia de complicaciones como la hipoglicemia posprandial por el síndrome de dumping. Presentación del caso: paciente con antecedente de cirugía bariátrica y evidencia posoperatoria de hipoglicemia posprandial. Las pruebas de ayuno y de alimentos mixtos confirmó el síndrome de dumping. Discusión y conclusiones: la hipoglicemia es una urgencia médica frecuente, en la mayoría de los casos secundaria al uso de medicamentos en pacientes con diabetes mellitus. No obstante, en los no diabéticos puede presentarse de forma espontánea y estar relacionada con múltiples condiciones clínicas. En el posoperatorio de cirugía bariátrica, la aparición del síndrome de dumping puede ser incapacitante, con manifestaciones tempranas o tardías. El diagnóstico se basa en la clínica y en estudios funcionales e imagenológicos que confirmen la presencia de hipoglicemia posprandial y un rápido vaciamiento gástrico. El tratamiento inicial se basa en cambios en la alimentación, aunque pueden ser necesarios fármacos e incluso procedimientos quirúrgicos cuando hay refractariedad. Es por esto que la elección de los pacientes llevados a cirugía bariátrica debe ser realizado por un grupo multidisciplinario.

Hypoglycemia in non-diabetics has been defined as a post-prandial glucose level of less than 55 mg/dl which may be part of Whipple ́s triad (symptoms of hypoglycemia, low plasma glucose and relief of symptoms with the correction of low glucose). It may be mediated by insulin or may not be mediated by insulin, with fasting (postabsorbative) or postprandial (reactive) manifestations. The incidence of complications, such as, postprandial hypoglycemia related to dumping syndrome, has increased with the use of bariatric surgery. A case is presented in a patient who underwent bariatric surgery experiencing postoperative postprandial hypoglycemia. Dumping syndrome was confirmed by fasting and mixed-meal tests. Discussion and Conclusions: hypoglycemia is a common medical emergency and is usually secondary to medications used to treat diabetes. However, it may be spontaneous in non-diabetics and may be associated with multiple clinical disorders. Postoperative dumping syndrome following bariatric surgery may be disabling, with early or late manifestations. Diagnosis is based on symptoms and functional and imaging studies which confirm postprandial hypoglycemia and a rapid gastric emptying. Initial treatment is based on dietary modification, although medical therapy or surgical intervention may be required in refractory cases. Thus, the selection of candidates to undergo bariatric surgery must be conducted by a multidisciplinary group.

Caracterización del proceso de fermentación y del efecto de inhibición de Lactobacillus lactis en Staphylococcus aureus y Staphylococcus epidermidis / Characterization of the Fermentation Process and the Inhibition Effect of Lactobacillus lactis in Staphylococcus aureus and Staphylococcus epidermidis / Caracterização do processo de fermentação e do efeito de inibição de Lactobacillus lactis em Staphylococcus aureus e Staphylococcus epidermidis

Se evaluó el proceso fermentativo e inhibición in vitro de L. lactis en Staphylococcus aureus y Staphylococcus epidermidis; así mismo, el crecimiento de L. lactis a tres pH (2,5, 4,5 y 7), sales biliares (0,5, 1 y 2 %), bilis bovina (1 y 1,2 %) y dos temperaturas (38 y 45 °C). Se determinaron péptidos y ácidos orgánicos en sobrenadante de L. lactis por HPLC. Se hizo cinética de fermentación en la que se evaluó: pH, azúcar total, proteína y ácido láctico. Se realizó antibiograma de dicloxacilina, cefepime, penicilina y cefalotina. Se definió la inhibición de L. lactis y su sobrenadante en cepas patógenas. El mejor crecimiento fue a pH de 2,5 (3 x 10(12) UFC/ml); de 1 x 10(10) y 4 x 10(9) UFC/ml para 0,5 % de sales biliares y 1,2 % de bilis bovina, respectivamente; de 3,5 x 10(13) y 3,4 x 10(13) UFC/ml para 38 y 45 °C, respectivamente. El HPLC determinó los péptidos VAR-TIR-VAR y ácido láctico (83,11 %). La cinética de fermentación determinó la fase exponencial a 14:24 h con un valor 77 x 10(10) UFC/ml, valores de pH de 4,284, azúcar 2,33 mg/ml, proteína 1,44 mg/ml y acidez de 0,79 %. Se encontró que S. aureus y S. epidermidis fueron sensibles a todos los antibióticos. Las bacterias patógenas fueron resistentes a la cepa láctica, pero S. epidermidis fue sensible al sobrenadante de L. lactis. Se concluye que Lactobacillus lactis mostró adecuada capacidad de crecimiento, buenos parámetros de fermentación y efecto inhibitorio en cepas de S. aureus y S. epidermidis en condiciones in vitro.

The fermentative process and in vitro inhibition of L. lactis in Staphylococcus aureus and Staphylococcus epidermidis were assessed. The growth of L. lactis at three pH (2.5, 4.5 and 7), bile salts (0.5, 1 and 2 %), bovine bile (1 and 1.2 %) and two temperatures (38 and 45 °C) were evaluated. Peptides and organic acids in supernatant of L. lactis by HPLC were determined. Fermentation kinetics was carried out, evaluating: pH, total sugar, protein and lactic acid. An antibiogram of dicloxacilin, cefepime, penilicin and cefalotin was made. The inhibition of L. lactis and its supernatant were defined in pathogenic strains. The best growth was at a pH of 2.5 (3 x 10(12) UFC/ml); of 1 x 10(10) and 4 x 10(9) UFC/ml for 0.5 % of bile salts and 1.2 % of bovine bile, respectively; of 3.5 x 10(13) and 3.4 x 10(13) UFC/ml for 38 and 45 °C, respectively. The HPLC determined the peptides VAR-TIR-VAR and lactic acid (83.11 %). The fermentation kinetics determined the exponential phase at 14:24 h with a value of 77 x 10(10) UFC/ml, pH values of 4.284, 2.33 mg/ml sugar, 1.44 mg/ml protein and acidity of 0.79 %. It was found that S. aureus and S. epidermidis were sensitive to all antibiotics. The pathogenic bacteria were resistant to the lactic strain, but S. epidermidis was sensitive to the supernatant of L. lactis. The conclusion is that Lactobacillus lactis showed adequate growth capacity, good fermentation parameters and inhibitory effect in strains of S. aureus and S. epidermidis in in vitro conditions.

Avaliou-se o processo fermentativo e a inibição in vitro de L. lactis em Staphylococcus aureus e Staphylococcus epidermidis. Avaliou-se o crescimento de L. lactis a três pH (2,5, 4,5 e 7), sais biliares (0,5, 1 e 2 %), bílis bovina (1 e 1,2 %) e duas temperaturas (38 e 45 °C). Determinaram-se peptídeos e ácidos orgânicos em sobrenadante de L. lactis por HPLC. Fez-se cinética de fermentação, avaliando: pH, açúcar total, proteína e ácido láctico. Realizou-se antibiograma de dicloxacilina, cefepime, penicilina e cefalotina. Definiu-se a inibição de L. lactis e seu sobrenadante em cepas patógenas. o melhor crescimento foi a pH de 2,5 (3 x 10(12) UFC/ ml); de 1 x 10(10) e 4 x 10(9) UFC/ml para 0,5 % de sais biliares e 1,2 % de bílis bovina, respectivamente; de 3,5 x 10(13) e 3,4 x 10(13) UFC/ml para 38 e 45 °C, respectivamente. O HPLC determinou os peptídeos VAR-TIR-VAR e ácido láctico (83,11 %). A cinética de fermentação determinou a fase exponencial a 14h: 24m com um valor 77 x 10(10) UFC/ml, valores de pH de 4,284, açúcar 2,33 mg/ml, proteína 1,44 mg/ml e acidez de 0,79 %. Constatou-se que S. aureus e S. epidermidis foram sensíveis a todos os antibióticos. As bactérias patógenas foram resistentes à cepa láctica, mas S. epidermidis foi sensível ao sobrenadante de L. lactis. Conclui-se que Lactobacillus lactis mostrou uma adequada capacidade de crescimento, bons parâmetros de fermentação e efeito inibitório em cepas de S. aureus e S. epidermidis em condições in vitro.

Proton pump inhibitor therapy does not increase the incidence of spontaneous bacterial peritonitis in cirrhosis: a multicenter prospective study.

BACKGROUND & AIM: Retrospective studies show an association between proton pump inhibitor (PPI) therapy and spontaneous bacterial peritonitis (SBP). We investigate the relationship between PPI and SBP in decompensated cirrhotic patients in a large nationwide prospective study. METHODS: Seven hundred seventy patients with a diagnosis of decompensated cirrhosis were admitted consecutively in 23 hospitals in Argentina from March 2011 to April 2012; the patients were carefully investigated for PPI consumption in the previous 3 months. In total, 251 patients were excluded because of active gastrointestinal hemorrhage, antibiotic use during the preceding weeks, HIV-positive status and immunosuppressive therapy. RESULTS: Two hundred twenty-six out of 519 patients (43.5%) had received PPI therapy within the last 3 months. In 135 patients, PPIs were administered for longer than 2 weeks. A bacterial infection was shown in 255 patients (49.1%). SBP was diagnosed in 95 patients out of 394 patients with ascites (24.7%). There was no significant difference in the rate of PPI consumption between the infected and the non-infected patients (44.3% vs. 42.8%) or between the SBP patients and the patients with ascites without SBP (46% vs. 42%). In the SBP patients, the duration of PPI administration did not influence the rate of SBP occurrence. The type of bacteria and the origin of SBP infection were similar in the patients with and without PPI. CONCLUSION: In the current large, multicenter, prospective study, PPI therapy, specifically evaluated at admission of consecutive cirrhotic patients, was not associated with a higher risk of SBP.

Embarazo en adolescentes y resultado perinatal adverso: un análisis multivariado de factores predictivos de riesgo / Adolescent pregnancy and adverse perinatal outcome: multivariate analysis of the risk predictor factors

El embarazo en madres adolescentes constituye un serio problema de salud pública, debido a su alta prevalencia y a su asociación con una mayor morbilidad y mortalidad perinatal. Con el objetivo de identificar los factores asociados con un resultado perinatal adverso y evaluar su capacidad de predicción del pronóstico en madres adolescentes, se diseño un estudio tipo casos-controles. La población seleccionada incluyo 600 madres y sus hijos, distribuidos en dos grupos: casos (n=120, resultado perinatal adverso) y controles (n=480, resultados perinatal no adverso). La identificación de los factores de riesgo se hizo mediante la estimulación de la razón de probabilidades (RP) y por análisis multivariado discriminante. Las variables con la mayor asociación con un pronóstico perinatal desfavorable fueron edad ginecológica menor de 3 años (RP 3,69), falta de control prenatal (RP 3,11), presentación no cefálica (RP 2,74), complicaciones médicas en embarazo (RP 2,26), complicaciones en embarazos previos (RP 2,15), soltería (RP 1,81) y parto vaginal (RP 1,72). El modelo predictivo, obtenido a través del análisis multivariado, mostró una sensibilidad moderada (65%) y una alta especificidad (92%). El conocimiento y el control de estos factores puede mejorar la eficacia de los programas prenatales preventivos en embarazadas adolescentes. En la población analizada, parece importante la prevención de la actividad sexual precoz y de las uniones inestables, la promoción de un cuidado prenatal especializado para la adolescente, y un tratamiento enérgico de las complicaciones gestacionales y del parto(A)

Adolescent pregnancy is a serious health problem because of its high prevalence and association with increased perinatal mortality. In order to identify risk factors related to a poor perinatal outcome in teenage mothers and measure their predictive value, a case-control study was carried out. 600 adolescent mothers and their infants were analyzed and allocated into two groups: cases (n=120, adverse perinatal autcome) and controls (n=480, non-adverse perinatal autcome). Identification of risk factor was achieved through estimation of odds rations (OR) and multivariate analysis. Variables with the highest OR associated to poor perinatal outcome were gynecologic age less than 3 years (OR 3.69), no prenatal control (OR 3.11), non-cephalic presentation (OR 2.74), medical complications in pregnancy (OR 2.26), history of complications in previous pregnancies (OR 2.26), single status (OR 1.81), and vaginal delivery (OR 1.72). The predictive model, obtained from the multivariate discriminant analysis, showed a moderate sensitivity (65%) and a high specificity (92%). These finding may improve the efficacy of perinatal programs designed for adolescent mothers. Prevention of early sexual activity and unstable relationships, promotion of specialized prenatal care for this age, and vigorous treatment of antenatal and intrapartum complications appear to be important for the decrease of perinatal morbility and mortality in the analyzed population

[Functional nutriments in diet]. / Los alimentos funcionales en la dieta.

Functional nutriments contribute to improve one's health or to reduce the risk of suffering diseases, but they are not cures by themselves. They are not indispensable in the balanced diet of a healthy person, who already ingests all the nutrients which are needed. These may supplement the needs of some nutriments under special circumstances, but some of the substances considered beneficial can be prejudicial if taken in excess. The authors analyze the most common of these functional nutriments and they evaluate their advantages and inconveniences; furthermore, the authors analyze those cases in which the use of these nutriments is deemed adequate.

Ehrlichiosis canina / Canine ehrlichiosis

En este artículo se reporta un caso de Ehrlichiosis canina, diagnosticado mediante la detección de antígenos de Dirofilaria immitis, Borrelia burgdorferi y anticuerpos de Ehrlichia canis.1 en un caninomacho labrador dorado, con un peso de 36 kg y 6 años de edad. Se mencionan los procedimientos realizados para el diagnóstico, incluida la valoración clínica, exámenes de laboratorio y seguimiento terapéutico.

Uso de drogas en una unidad de cuidado intensivo neonatal / Use of drug in our neonatal intensive care unit

Con el propósito de documentar los patrones del uso de drogas en una unidad de cuidado intensivo neonatal, se analizaron datos recolectados prospectivamente en un período de tres años. Se estudiaron 711 niños consecutivamente admitidos a la unidad, en relación a las drogas recibidas durante los primeros 10 días de su ingreso. 98 por ciento de ellos recibieron al menos una droga, mientras que 84 por ciento estuvieron expuestos a dos o más drogas. El promedio general de drogas recibidas fue 4. El número de drogas fue inversamente proporcional al peso al nacer, 61 por ciento de los niños menores de 1500 gramos recibieron cuatro o más drogas, en comparación a 49 por ciento en niños mayores de este peso (p<0.05). El número de drogas fue directamente proporcional a la severidad del cuadro clínico. Un porcentaje significativamente mayor de los niños que eventualmente fallecieron recibió 4 o más drogas, en relación a los sobrevivientes (72 por ciento vs 44 por ciento) respectivamente, p<0.05). Las drogas más frecuentemente usadas, exceptuando los fluídos parenterales, fueron ampicilina (75 por ciento), amikacina (73 por ciento), y concentrado globular (51 por ciento). El uso de bicarbonato de sodio decreció sustancialmente durante el período analizado. Los datos de este estudio indican la naturaleza dinámica de la terapia con drogas dentro de una unidad neonatal, provee información para programas de educación sobre farmacodinamia y toxicidad, y permiten estimar la relación costo beneficio en estos pacientes criticamente enfermos

Introducción precoz de formula suplementaria a la alimentación al seno: análisis multivariado de los factores de riesgo / Precocius introduction of supplementary formula to the sinus feeding: multivaried analysis of the risk factors

Diseñamos este estudio por la alta frecuencia de introducción de fórmula como suplemento de la lactancia natural durante el primer mes de vida en nuestra población, y con el fin de identificar los factores de riesgo asociados. 14 variables sociodemográficas y asistenciales hospitalarias fueron analizadas en una muestra de 668 madres, 327 lactadoras exclusivas y 341 lactadoras mixtas. Por prueba chi cuadrado, estimación de riesgo relativo (RR), análisis multivariado y función discriminante, fueron identificados 8 factores particularmente predictivos de la posibilidad de introducción precoz de fórmula: primiparidad (RR:2.08), no control prenatal (RR:2.27), parto por cesárea (RR:2.00), decisión postnatal de amamantar (RR:2.58), primer contacto con el niño después de 12 horas (RR:1.72), primera toma del seno después de 12 horas (RR:2.75), alimentación por horario fijo (RR:2.30), y uso de fórmula en el hospital (RR:4.91). 67 por ciento de las madres que suplementaban el seno argumentaron insuficiencia de la lactancia materna para saciar al niño, como razón primaria para uso de fórmula. La capacidad predictiva de la función discriminante final para clasificar correctamente los dos grupos fué 64 por ciento en las lactadoras exclusivas (especificidad 0.64), y 70 por ciento en las lactadoras mixtas (sensibilidad 0.70). La identificación de estas variables predictivas de riesgo puede permitir una mejor efectividad de los programas de promoción de lactancia exclusiva para el lactante menor, a través de la modificación de los factores susceptibles de intervención. En nuestra población, parece importante enfatizar la promoción de la lactancia en el control prenatal, prestar especial atención a la primípara no experimentada, favorecer la autoestima hacia el amamantamiento en la etapa prenatal, estimular el contacto y la toma precoz al seno aún en las cesareadas, restringir el uso de fórmula dentro del hospital, y estimular la succión frecuente del seno mediante la alimentación según demanda. Los factores identificados son una advertencia para el personal de salud del importante rol que ejercen su actitud hacia la lactancia, los consejos nutricionales y las prácticas hospitalarias rutinarias sobre la promoción o inhibición de la lactancia natural.

Introducción precoz de fórmula suplementaria a la alimentación al seno: un análisis multivariado de los factores de riesgo / Precocious introduction of supplementary formula a the breast feeding: a multivaried analysis of the risk factors

Debido a la alta frecuencia de introducción de fórmulas como suplemento de la lactancia natural durante el primer mes de vida en nuestra población, se diseño este estudio, con el propósito de identificar los factores asociados con el riesgo de suplementación precoz. Catorce variables sociodemográficas y asistenciales hospitalarias fueron analizadas en una población de 668 madres, 327 lactantes exclusivas y 341 lactadoras mixtas. a través de prueba chi cuadrado, estimación de riesgo relativo, análisis multivariado y función discriminante, ocho factores fueron identificados como particularmente predictivos de la posibilidad de introducción precoz de fórmula: primiparidad (riesgo 2.08, no control prenatal (riesgo 2.27), parto por cesárea (riesgo 2.00), decisión postnatal amamantar (riesgo 2.58), primer contacto con el niño después de 12 horas (riesgo 1.72) primera toma del seno después de 12 horas (2.75), alimentación por horario fijo (riesgo 2.30), y uso de fórmula en el hospital (riesgo 4.91). 67 por ciento de las madres que suplementaban el seno argumentaron insuficiencia de la lactancia materna para saciar al niño, como razón primaria para uso de fórmula. La capacidad predictiva de la función discriminante final para clasificar correctamente los dos grupos fue 64 por ciento en las lactantes exclusivas (especificidad 0.64), y 70 por ciento en las lactantes mixtas (sensibilidad 0.70). La identificación de esas variables predictivas de riesgo puede permitir una mejor efectividad de los programas de promoción de lactancia exclusiva para el lactante menor, através de la modificación de los factores susceptibles de intervención. En nuestra población, parece importante enfatizar la promoción de la lactancia en el control prenatal, prestar especial atención a la primípara no experimentada, favorecer la autoestima hacia el amamantamiento en la etapa prenatal, estimular el contacto y la toma precoz al seno aún en las cesareadas, restringir el uso de fórmula dentro del hospital, y estimular la succión frecuente del seno mediante la alimentación según demanda. Los factores identificados son una advertencia para el personal de salud del importante rol que ejercen su actitud hacia la lactancia, los consejos nutricionales y las prácticas hospitalarias rutinarias sobre la promoción o inhibición de la lactancia natural

Predicción de mortalidad en una unidad de cuidado intensivo neonatal: un modelo de analisis discriminatorio / Prediction of mortality in a neonatal intensive care unity: a mode of disciminant analysis

Debido a la alta mortalidad observada en niños admitidos a la Unidad de Cuidado Intensivo Neonatal, se desarrollo un método para la predicción de riesgo de muerte. Durante un período de 18 meses 490 niños admitidos a la Unidad fueron prospectivamente evaluados, para determinar cuales variables clínicas y bioquímicas observables en las primeras 24 horas de vida, eran importantes para predecir mortalidad multivariado, se evaluaron 15 variables. 6 variables fueron identificadas como particularmente predictivas de mortalidad: peso al nacer, edad gestacional, hipotermia mayor de una hora, pH menor de 7.25 a la admisión PaCO2 mayor de 50 mmHg por másde una hora, ehiperglicemia. Se obtuvo una función discriminante final, cuya aplicación prospectiva a un grupo posterior de 40 admisiones consecutivas demostró una clasificación correcta en 75% de los niños de todo el grupo, 68% correctamente clasificados en el grupo de sobrevivientes, 88% en los no sobrevivientes. La identificación de tales factores predictivos puede permitir la disminución de la mortalidad, a través de la prevención y tratamiento enérgetico de los factores de alto riesgo. En nuestra población parece importante la prevención de la prematuridad, la estabilización térmica precoz y la prevención de la acidosis, hipercarbia e hiperglicemia