Evaluation of the serum procalcitonin level as an indicator of severity and mortality in abdominal sepsis due to secondary peritonitis.

BACKGROUND: Procalcitonin is a biomarker of sepsis, whose concentrations increase when some endotoxin enters the bloodstream. It is used, among other things, to discriminate the etiology of infections, increase or decrease the antibiotic spectrum, and predict mortality. OBJECTIVE: To determine the utility of the serum level of procalcitonin as a predictor of severity and mortality. METHOD: Retrospective, descriptive, cross-sectional study of patients diagnosed with abdominal sepsis during the period from April 2016 to February 2017. In all cases the severity was determined by APACHE II, SOFA, Mannheim and CONUT, and mortality. The sample was divided into those with procalcitonin > 10.1 and < 10. RESULTS: We included 99 cases (41 female and 58 male). The main organ causing abdominal sepsis was the appendix 56%. The mean of procalcitonin for the sample was 7.94 (standard deviation: ± 13.76). The findings, subjected to statistical verification by means of the Mann-Whitney U test, showed statistical significance among the cases with procalcitonin 10.1, with the Mannheim scores > 26 points (p = 0.003), CONUT > 6 points (p = 0.027) and presence of organic faults (p = 0.001), but not with APACHE, SOFA and mortality. CONCLUSIONS: Procalcitonin is related to the severity determined by the Mannheim index, CONUT and the development of organic faults.

INTRODUCCIÓN: La procalcitonina es un biomarcador de sepsis, cuyas concentraciones aumentan cuando alguna endotoxina entra en el torrente sanguíneo. Se emplea, entre otras cosas, para discriminar la etiología de las infecciones, escalar/desescalar antibióticos, aumentar o disminuir el espectro antibiotico, y predecir la mortalidad. OBJETIVO: Determinar si los valores de procalcitonina se relacionan con la gravedad y la mortalidad de los pacientes con sepsis abdominal. MÉTODO: Estudio retrospectivo, descriptivo y transversal de pacientes con diagnóstico de sepsis abdominal, de abril de 2016 a febrero de 2017. En todos los casos se determinó la gravedad mediante las escalas APACHE II, SOFA, Mannheim y CONUT, así como la mortalidad. Se dividió la muestra en pacientes con procalcitonina > 10.1 y < 10. RESULTADOS: Se incluyeron 99 casos (41 mujeres y 58 hombres). El principal órgano causante de sepsis abdominal fue el apéndice (56%). La media de procalcitonina para la muestra se situó en 7.94 (desviación estándar: ± 13.76). Los hallazgos, sometidos a verificación estadística mediante la prueba U de Mann-Whitney, mostraron una relación estadísticamente significativa en los casos con procalcitonina 10.1, puntajes de Mannheim > 26 puntos (p = 0.003), CONUT > 6 puntos (p = 0.027) y presencia de fallas orgánicas (p = 0.001); no hubo relación significativa entre los valores de procalcitonina y los puntajes de las escalas APACHE II y SOFA, ni con la mortalidad. CONCLUSIÓN: La gravedad medida por la procalcitonina se relaciona con la gravedad determinada mediante los índices de Mannheim y CONUT, y con el desarrollo de fallas orgánicas.

Synthesis and biological evaluation of novel ferrocene-naphthoquinones as antiplasmodial agents.

This work deals with the synthesis and evaluation of new compounds designed by combination of 1,4-naphthoquinone and ferrocene fragments in a 3-ferrocenylmethyl-2-hydroxy-1,4-naphthoquinone arrangement. A practical coupling reaction between 2-hydroxy-1,4-naphthoquinone and ferrocenemethanol derivatives has been developed. This procedure can be carried out "on-water", at moderate temperatures and without auxiliaries or catalysts, with moderate to high yields. The synthesized derivatives have shown significant in vitro antiplasmodial activity against chloroquine-sensitive and resistant Plasmodium falciparum strains and it has been shown that this activity is not related to the inhibition of biomineralization of ferriprotoporphyrin IX. Binding energy calculations and docking of these compounds to cytochrome b in comparison with atovaquone have been performed.

Antimalarial activity of imidazo[2,1-a]isoindol-5-ol derivatives and related compounds.

The synthesis of several series of imidazo[2,1-a]isoindol-5-ol derivatives and the results of their evaluation against Plasmodium falciparum are presented and discussed. The effects of electron-withdrawing or-donating substituents on different parts of the molecule, as well as those produced by the incorporation of an additional fused ring, were analyzed. Several compounds showed significant antimalarial activity in vitro with IC(50) values as low as 60 nM and a certain efficacy in vivo by reducing parasitemia in Plasmodium berghei mouse models.

Synthesis and nematocide activity of S-glycopyranosyl-6,7-diarylthiolumazines.

6,7-Diaryl derivatives of mono and di-S-glycopyranosylthiolumazine derivatives 5-8 were prepared to test their nematocide activity. In vitro tests against Caenorhabditis elegans were performed and it was found that monosubstituted derivatives 5-7 showed higher activity than the corresponding unsubstituted 2-thiolumazines 1-3, whilst 2-S,4-S-di-glycopyranosylpteridine derivative 8 was inactive in contrast to unsubstituted derivative 4. In order to check whether the lack of activity of 8 was due to the two bulky substituents of the pteridine nucleus, 2-S,4-S-dimethyl derivative 9 was synthesized and assayed showing also lack of activity. A theoretical study on the stability of the different possible tautomers of compound 4 was carried out in an attempt to explain some, in appearance, anomalous (13)C NMR data of this compound.

Tratamiento no quirúrgico del embarazo ectópico / Non surgery treatment of the ectopic pregnancy

En las últimas décadas se ha registrado un incremento muy importante en la incidencia del embarazo ectópico. Esta tendencia también se ha visto reflejada en los resultados de las nuevas técnicas de reproducción asistida. La introducción de la ecografía transvaginal, combinada con la medición de los niveles circulantes de ß-hCG, ha facilitado el diagnóstico del embarazo ectópico en un estadio en el que aún puede ser asintomático, ofreciendo así la oportunidad de considerar la utilización de métodos terapéuticos mas conservadores. Dichos métodos pueden variar desde la microcirugía tubaria, hasta la actitud expectante de una resolución espontánea, apoyada sólo en el monitoreo de los niveles de ß-hCG. El presente trabajo presenta el caso de un embarazo ectópico ocurrido luego de transferencia intrauterina de gametos en una paciente con patología tubaria. El tratamiento se realizó por aspiración transvaginal del saco gestacional combinado con la instilación local y subsiguiente apoyo sistémico con metotrexate. Se presenta además una revisión de la experiencia internacional sobre el tema