Polineuropatía por amiloidosis por transtiretina de inicio tardío. Caso clínico / Late-onset hereditary transthyretin amyloidosis with polyneuropathy. Report of one case

Hereditary transthyretin amyloidosis is a multisystemic autosomal dominant genetic disorder characterized by progressive distal sensory-motor polyneuropathy or restrictive cardiomyopathy, secondary to amyloid deposits. Its pathogenesis lies in the TTR gene mutation, and the Val50Met mutation is the most frequent. Patients have significant differences in the onset and severity of clinical presentation according to their country of origin. The diagnosis of this pathology is complex, even more in countries where it is not considered endemic. However, early suspicion and management are essential to improve survival and avoid unnecessary diagnostic and therapeutic strategies. We report a 69-year-old woman who presented a sensory-motor polyneuropathy, predominantly sensory, associated with distal neuropathic pain and bilateral vitritis. The history of her Italian father with polyneuropathy of unspecified etiology stood out. A vitreous biopsy identified amyloid substance deposits (congo red positive). These were also confirmed on a superficial peroneal nerve biopsy. During the etiological study of her polyneuropathy, an increased Kappa/Lambda index of 2.55 mg/L stood out. Therefore, light chain amyloidosis was suspected, and chemotherapy treatment was indicated without favorable response. After 10 years of progressive neurological and ophthalmological involvement, a genetic study confirmed the first case of late-onset hereditary transthyretin amyloidosis Val50Met with polyneuropathy in Chile.

[Late-onset hereditary transthyretin amyloidosis with polyneuropathy. Report of one case]. / Polineuropatía por amiloidosis por transtiretina de inicio tardío. Caso clínico.

Hereditary transthyretin amyloidosis is a multisystemic autosomal dominant genetic disorder characterized by progressive distal sensory-motor polyneuropathy or restrictive cardiomyopathy, secondary to amyloid deposits. Its pathogenesis lies in the TTR gene mutation, and the Val50Met mutation is the most frequent. Patients have significant differences in the onset and severity of clinical presentation according to their country of origin. The diagnosis of this pathology is complex, even more in countries where it is not considered endemic. However, early suspicion and management are essential to improve survival and avoid unnecessary diagnostic and therapeutic strategies. We report a 69-year-old woman who presented a sensory-motor polyneuropathy, predominantly sensory, associated with distal neuropathic pain and bilateral vitritis. The history of her Italian father with polyneuropathy of unspecified etiology stood out. A vitreous biopsy identified amyloid substance deposits (congo red positive). These were also confirmed on a superficial peroneal nerve biopsy. During the etiological study of her polyneuropathy, an increased Kappa/Lambda index of 2.55 mg/L stood out. Therefore, light chain amyloidosis was suspected, and chemotherapy treatment was indicated without favorable response. After 10 years of progressive neurological and ophthalmological involvement, a genetic study confirmed the first case of late-onset hereditary transthyretin amyloidosis Val50Met with polyneuropathy in Chile.

Mandibular distraction of free iliac crest bone graft as treatment in a patient with a history of gunshot wound. case report

ABSTRACT Introduction: The combination of non-vascularized iliac crest bone graft and distraction osteogenesis in a second surgical intervention has only been described to achieve alveolar ridge augmentation. This technique is not recommended to treat bone defects of the jaws caused by firearm projectile. Case presentation: 40-year-old woman with a segmental mandibular defect in the mandible body caused by the impact of a firearm projectile at the age of 1 year. The patient developed a severe Class II dentofacial anomaly that required a two-stage treatment; she underwent mandibular reconstruction with free iliac crest bone graft followed by a bilateral mandibular distraction at the level of the iliac crest bone graft. With these interventions, a remarkable improvement of the patient's malformation was achieved. Conclusion: Horizontal distraction of the free iliac crest bone graft is a safe and predictable procedure to treat dentolabial anomalies requiring mandibular reconstruction. This procedure was performed in the patient without complications. Further studies on the effectiveness of this technique are required.

RESUMEN Introducción. La combinación del injerto de la cresta ilíaca no vascularizado y la distracción osteogénica del injerto en una segunda intervención quirúrgica solo ha sido descrita para lograr un aumento del reborde alveolar. Esta técnica no se recomienda para tratar defectos óseos en la mandíbula causados por proyectil de arma de fuego. Presentación del caso. Mujer de 40 años con un defecto mandibular segmentario en el cuerpo mandibular causado por el impacto de un proyectil de arma de fuego a la edad de 1 año. La paciente desarrolló una anomalía dentofacial grave Clase II que requirió dos tratamientos en diferentes momentos: en primer lugar, se le practicó una reconstrucción mandibular con injerto de cresta ilíaca libre y posteriormente, una distracción mandibular bilateral que incluyó un injerto libre de cresta ilíaca. Con estas intervenciones se logró una mejoría notable de la malformación de la paciente. Conclusión. La distracción horizontal del injerto de cresta ilíaca libre es un procedimiento seguro y predecible para tratar anomalías dentolabiales que requieran reconstrucción de la mandíbula; no obstante, es necesario realizar más estudios sobre la efectividad de la técnica frente este tipo de malformaciones.

Uso de eritromicina como procinético para cesárea con cuatro horas de ayuno / Use of erythromycin as a prokinetic for cesarean section with four hours of fasting

Resumen: El ayuno preoperatorio es fundamental como requisito previo a la mayoría de cirugías tanto para las electivas como para las urgencias relativas. Sin embargo, no siempre se cumplen las condiciones idóneas al momento de abordar a un paciente y la falta de ayuno es una condición que puede poner en riesgo la vida del mismo, siendo un factor de riesgo mayúsculo para la broncoaspiración del contenido gástrico. Hasta el momento se cuenta con un reducido arsenal farmacológico de medicamentos que con distinta función e intensidad aceleran el vaciamiento gástrico; la eritromicina no se encuentra en esta lista de manera oficial. A pesar de que ya ha sido utilizada ampliamente con este fin en el ámbito de los procedimientos endoscópicos, no existen aún suficientes reportes en los que se haya puesto a prueba su eficacia procinética en cirugía de urgencia, específicamente una cesárea. Este artículo, además de ofrecer un breve sumario de dicho macrólido, presenta el caso de una paciente embarazada con ingesta alimenticia reciente, en la cual se obtuvieron las condiciones idóneas para cirugía tan sólo cuatro horas después de la administración de la eritromicina.

Abstract: Preoperative fasting is essential as a prerequisite for most surgeries, either elective procedures or relative emergencies. However, the ideal conditions for surgery are not always fulfilled at the time of approaching a patient, and the lack of fasting is a factor that could endanger patient's life, being a major risk factor for bronchoaspiration of gastric content. Until now there is a small pharmacological list of medications that with different function and intensity accelerate gastric emptying, erythromycin is not officially on this list. Despite the fact that it has already been widely used for this purpose in the field of endoscopic procedures, there are not enough reports about its efficacy in emergency surgery, specifically C-section. This article, in addition to offering a brief summary of this macrolide, presents a case in which after erythromycin administration to a pregnant patient with a recent food intake, the ideal conditions for surgery were obtained only four hours later.

Cardiomiopatía amiloídea por transtiretina: diagnóstico y manejo en la actualidad / Transthyretin amyloid cardiomyopathy: a review

RESUMEN: La cardiomiopatía amiloide por transtiretina (CATTR) es una enfermedad caracterizada por depósito extracelular de fibrillas amiloides en el miocardio, a partir de transtiretina mal plegada, generando una miocardiopatía restrictiva. Esta proteína mal plegada puede tener origen hereditario o adquirido, siendo más frecuente en adultos mayores. La CA-TTR ha surgido como una causa subdiagnosticada de insuficiencia cardíaca con fracción de eyección preservada (IC FEp). El pilar fundamental para su diagnóstico es la alta sospecha clínica, basada en diversas banderas de alerta ya que la sintomatología que provoca suele ser inespecífica. Como veremos en esta revisión, el diagnóstico puede sustentarse con la cintigrafía ósea, reservando para situaciones particulares la toma de biopsia. Con el advenimiento de nuevas terapias que impactan en la sobrevida de esta enfermedad, el tiempo para realizar el diagnóstico certero y la diferenciación de otras causas de amiloidosis cardíaca como la de cadenas livianas, se ha tornado crucial.

ABSTRACT: Transthyretin amyloid cardiomyopathy (AT-TR-CM) is a disease characterized by extracellular deposition of amyloid fibrils in the myocardium, from misfolded transthyretin, generating a restrictive cardiomyopathy. This misfolded protein may be inherited or acquired, and is more prevalent in elderly patients. ATTR-CM has emerged as an underdiagnosed cause of heart failure with preserved ejection fraction (HF-PEF). The fundamental pillarfor its diagnosis is high clinical suspicion since the symptoms are usually nonspecific. The diagnosis can be made from bone scintigraphy, reserving myocardial biopsy for particular situations. With the advent of new therapies that affect the survival of these patients, a timely diagnosis has become crucial.

Polymeric Ionic Liquids Derived from L-Valine for the Preparation of Highly Selective Silica-Supported Stationary Phases in Gas Chromatography.

A series of silica-supported polymeric ionic liquid (PIL)-based stationary phases derived from a vinylic L-valine ionic liquid monomer and divinylbenzene (DVB) as the crosslinking agent have been prepared and studied as gas chromatographic stationary phases. These coated gas chromatographic columns exhibited good thermal stabilities (230-300 °C) and high efficiencies (1700-2700 plates/m), and were characterized using a linear solvation parameter model in order to understand the effects of the amount of DVB on the features of the resulting composite systems. Their retention behavior and separation efficiencies were demonstrated using the Grob test. By tuning the crosslinking degree for the IL-derived stationary phase, the separation selectivity and resolution of different compounds were improved. The different retention behaviors observed for many analytes indicate that these stationary phases may be applicable as new types of GC stationary phases.

Fronto-Orbital Advance in a Patient With Roberts Syndrome.

Roberts Syndrome is an extremely rare syndrome reporting about 150 cases in the literature, with a very low survival rate. The authors present a case of a female patient with Roberts Syndrome who also had a coronal craniosynostosis. The aim of this case report is to present a case of a patient with Roberts Syndrome with a brachycephaly that required management of fronto-orbital advancement. In conclusion Roberts Syndrome is a rare disease, which can have different skeletal variations. This syndrome can manifest itself with craniosynostosis, with the requirement of a comprehensive management to correct it and avoid compression of the brain with endocranial hypertension.

Structural bases that underline Trypanosoma cruzi calreticulin proinfective, antiangiogenic and antitumor properties.

Microbes have developed mechanisms to resist the host immune defenses and some elicit antitumor immune responses. About 6 million people are infected with Trypanosoma cruzi, the protozoan agent of Chagas' disease, the sixth neglected tropical disease worldwide. Eighty years ago, G. Roskin and N. Klyuyeva proposed that T. cruzi infection mediates an anti-cancer activity. This observation has been reproduced by several other laboratories, but no molecular basis has been proposed. We have shown that the highly pleiotropic chaperone calreticulin (TcCalr, formerly known as TcCRT), translocates from the parasite ER to the exterior, where it mediates infection. Similar to its human counterpart HuCALR (formerly known as HuCRT), TcCalr inhibits C1 in its capacity to initiate the classical pathway of complement activation. We have also proposed that TcCalr inhibits angiogenesis and it is a likely mediator of antitumor effects. We have generated several in silico structural TcCalr models to delimit a peptide (VC-TcCalr) at the TcCalr N-domain. Chemically synthesized VC-TcCalr did bind to C1q and was anti-angiogenic in Gallus gallus chorioallantoic membrane assays. These properties were associated with structural features, as determined in silico. VC-TcCalr, a strong dipole, interacts with charged proteins such as collagen-like tails and scavenger receptors. Comparatively, HuCALR has less polarity and spatial stability, probably due to at least substitutions of Gln for Gly, Arg for Lys, Arg for Asp and Ser for Arg that hinder protein-protein interactions. These differences can explain, at least in part, how TcCalr inhibits the complement activation pathway and has higher efficiency as an antiangiogenic and antitumor agent than HuCALR.

AL amyloidosis in the Chilean public health system: a pending debt: multicenter study of the Chilean Monoclonal Gammopathies Cooperative Group / Amiloidosis AL en el sistema público de Chile: una deuda pendiente: estudio multicéntrico

ABSTRACT Background: Immunoglobulin light chain (AL) amyloidosis is a rare and underdiagnosed entity. Aim: To characterize patients with AL amyloidosis in Chilean public health centers. Material and Methods: We conducted a retrospective, multicenter study. Public centers of the Chilean Monoclonal Gammopathies Cooperative Group were asked to search for patients with AL amyloidosis in their databases. Epidemiological, clinical and laboratory characteristics were evaluated. Results: Forty-two patients aged 22 to 84 years were found. Twenty four percent had localized AL amyloidosis; 64% had a lambda light chain clone; 47% were associated with multiple myeloma and 9% with non-Hodgkin lymphoma. The most commonly involved organ was the kidney (76%). Serum free light chains were measured in 31% and an echocardiogram was performed in 74% of patients. Seventeen percent of patients received only palliative care, 17% were treated with bortezomib, 21% with thalidomide, and 40% with melphalan. No patient was transplanted. The mean overall survival (OS) of the group was 19 months. The 5-year OS was 28%. Conclusions: It is important to obtain these realistic, national data to initiate strategies to improve early diagnosis and proper management of this disease.

La amiloidosis AL es una entidad poco frecuente y subdiagnosticada. Mientras todo el mundo discute sobre las nuevas herramientas diagnósticas y terapéuticas, en Chile y en América Latina en general, estamos lejos de esa realidad. El objetivo del presente estudio fue caracterizar a los pacientes con amiloidosis AL en centros del sistema público de nuestro país. Se realizó un estudio retrospectivo, multicéntrico, descriptivo. Los centros públicos del grupo cooperativo hematológico chileno buscaron en sus bases de datos pacientes diagnosticados con amiloidosis AL. Se evaluaron las características epidemiológicas, clínicas y de laboratorio. La edad media fue de 65 años. A 24% de los pacientes se les diagnosticó amiloidosis AL localizada; 64% tuvo paraproteína con cadena ligera lambda; 47% se asoció con mieloma múltiple y 9% con linfoma no Hodgkin. El órgano afectado con mayor frecuencia fue el riñón (76%). Las cadenas ligeras libres de suero se realizaron en 31% y ecocardiograma en 74%. El 17% recibió solo cuidados paliativos, 17% recibió tratamiento con bortezomib, 21% con talidomida y 40% con melfalán. Ningún paciente fue trasplantado. La media de sobrevida global (SG) del grupo fue de 19 meses. La SG a 5 años fue de 28%. Es importante reportar estos resultados nacionales para iniciar estrategias que mejoren tanto el diagnóstico temprano como el tratamiento de esta patología. Por lo tanto, mejorar la sospecha diagnóstica es crucial.

AL amyloidosis in the Chilean public health system: a pending debt. Multicenter study of the Chilean Monoclonal Gammopathies Cooperative Group.

BACKGROUND: Immunoglobulin light chain (AL) amyloidosis is a rare and underdiagnosed entity. AIM: To characterize patients with AL amyloidosis in Chilean public health centers. MATERIAL AND METHODS: We conducted a retrospective, multicenter study. Public centers of the Chilean Monoclonal Gammopathies Cooperative Group were asked to search for patients with AL amyloidosis in their databases. Epidemiological, clinical and laboratory characteristics were evaluated. RESULTS: Forty-two patients aged 22 to 84 years were found. Twenty four percent had localized AL amyloidosis; 64% had a lambda light chain clone; 47% were associated with multiple myeloma and 9% with non-Hodgkin lymphoma. The most commonly involved organ was the kidney (76%). Serum free light chains were measured in 31% and an echocardiogram was performed in 74% of patients. Seventeen percent of patients received only palliative care, 17% were treated with bortezomib, 21% with thalidomide, and 40% with melphalan. No patient was transplanted. The mean overall survival (OS) of the group was 19 months. The 5-year OS was 28%. CONCLUSIONS: It is important to obtain these realistic, national data to initiate strategies to improve early diagnosis and proper management of this disease.

Coxiella burnetii infection in sheep and goats: a public risk health, Colombia / Infección por Coxiella burnetii en ovinos y caprinos: un riesgo en salud publica en Colombia

Objective. The aim of this study was to provide molecular evidence of C. burnetii in sheep and goats from some herds of Valledupar, Cesar, Colombia. Materials and methods. Fifteen herds of sheep and goats were chosen by convenience to investigate the infection by C. burnetii, during March and April of 2013. 328 female goats and 66 sheep from 15 herds were included in this study. Milk from ewes and vaginal mucus samples from goats were analyzed by Polymerase Chain Reaction for DNA detection of transposase gene (IS1111) of C. burnetii. Results. DNA of C. burnetii in 6% (4/66) of sheep's milk and 0.6% (2/328) vaginal mucus from goats was found. 13% (2/15) of the herds had at least one infected animal. Discussion. Our findings suggest the circulation of C. burnetii in sheep and goats from some herds of Valledupar, Colombia, and it highlights the possibility of occurrence of infections in humans and animals. Conclusions. The detection of C. burnetii in sheep milk could represent a public health risk factor for people who consuming raw milk, cheeses or people associated to agriculture and livestock handling. Further studies are necessary to evaluate other routes such as tick's bite, feces, milk from goats and vaginal mucus from sheep of this region of Colombia.

Objetivo. El objetivo de este estudio fue proporcionar evidencia molecular de infección por C. burnetii en ovinos y caprinos de algunos rebaños de Valledupar, Cesar, Colombia. Materiales y métodos. Quince rebaños de ovinos y caprinos fueron seleccionados a conveniencia para investigar la infección por C. burnetii, durante marzo y abril de 2013. En este estudio se incluyeron 328 caprinos y 66 ovinos de 15 rebaños. La leche procedente de ovinos y muestras de moco vaginal de caprinos fueron analizados mediante PCR (Reacción en Cadena de Polimerasa) para la detección de ADN del gen transposasa (IS1111) de C. burnetii. Resultados. Se encontró ADN de C. burnetii en 6% (4/66) de leche de oveja y 0,6% (2/328) de moco vaginal de cabras. El 13% (2/15) de los rebaños tenían al menos un animal infectado. Discusión. Nuestros hallazgos sugieren la circulación de C. burnetii en ovinos y caprinos de algunos rebaños de Valledupar, Colombia, y destaca la posibilidad de ocurrencia de infecciones en humanos y animales. Conclusiones. La detección de C. burnetii en la leche de oveja podría representar un factor de riesgo para la salud pública de las personas que consumen con frecuencia leche cruda, quesos o personas que trabajan en la agricultura y manipulación de ganado. Otros estudios son necesarios para evaluar otras rutas como la mordedura de la garrapata, las heces, la leche de las cabras y el moco vaginal de las ovejas de esta región de Colombia.

Determination of volatile compounds in cider apple juices using a covalently bonded ionic liquid coating as the stationary phase in gas chromatography.

A chromatographic method for the separation of volatile compounds in Asturian cider apple juices has been developed. For this separation purpose, a monocationic imidazolium-based ionic liquid bearing a reactive terminal iodine atom was synthesized by a quaternization-anion exchange chemical sequence. Next, the gas chromatography (GC) stationary phase was prepared by covalently linking the imidazolium monolith to the reactive silanol groups of the inner capillary wall at 70 °C. This coated GC column exhibited good thermal stability (290 °C), as well as good efficiency (2000 plates/m) in the separation of volatile compounds from Asturian apple cider juices, and was characterized using the Abraham solvation parameter model. The intra-day and inter-day precision of the chromatographic method was evaluated, obtaining relative standard deviations from 3.7 to 12.9% and from 7.4 to 18.0%, respectively. Furthermore, recoveries from 82.5 to 122% were achieved. Graphical Abstract Covalent bonding of an ionic liquid to inner column wall led to a great improvement of the separation efficiencies of stationary phases in gas chromatography.

Gas chromatographic analysis of fatty acid methyl esters of milk fat by an ionic liquid derived from L-phenylalanine as the stationary phase.

A Gas Chromatography (GC) method has been developed for the separation and characterization of the different fatty acids in anhydrous milk fat (AMF) by means of an ionic liquid stationary phase, characterized by a monocationic imidazolium salt derived from L-phenylalanine. The inner surface of a fused silica capillary column was modified using this ionic liquid functionality and 3-aminopropyldiethoxymethyl silane. This coated GC column, which exhibited good thermal stability (270°C) and good efficiency (2700 plates/m), has been characterized using the Abraham solvation parameter model. The intra-day and inter-day precision of the method have been evaluated, obtaining relative standard deviations (RSD) from 0.99% to 4.0% and from 2.8% to 9.2%, respectively. Furthermore, recoveries from 90% and 99% have been achieved.

Coxiella burnetii in bulk tank milk and antibodies in farm workers at Montería, Colombia / Coxiella burnetii en leche de tanque y anticuerpos en trabajadores rurales en Montería, Colombia / Coxiella burnetii em leite de tanque bovina e anticorpos em trabalhadores rurais de Montería, Colômbia

Background: Q fever is a zoonotic disease caused by Coxiella burnetii. In Colombia it is not a notifiable disease in humans and is most likely under diagnosed. There are no studies about its prevalence in important reservoir species, such as cattle. Objective: the aim of this study was to investigate the frequency of C. burnetii infection in cattle farms and determine the frequency of antibodies in farm workers at risk in rural areas of Montería, Córdoba (Colombia). Methods: eleven cattle farms were randomly chosen to investigate the infection by C. burnetii. Bulk tank milk samples of each farm were analyzed by conventional PCR for DNA detection of transposase gene IS1111 of C. burnetii. Serum samples from 61 apparently healthy people living in eight farms were analyzed by indirect inmunofluorescence against phase II IgG antibodies to C. burnetii. Results: we report the presence of C. burnetii DNA in 45% of bulk tank milk samples from cattle farms and a 61% frequency of antibodies (IgG phase II ≥1/64) in farm workers at risk. Conclusion: our results demonstrate the circulation of this bacterium in the studied farms in Montería, Colombia, showing that at-risk farm workers have a high antibody frequency.

Antecedentes: la fiebre Q es una zoonosis causada por Coxiella burnetii. En Colombia no es una enfermedad notificable en humanos y probablemente es subdiagnosticada. De otro lado, no se han realizado estudios acerca de su prevalencia en importantes reservorios como los bovinos. Objetivos: el objetivo de este estudio fue determinar la frecuencia de infección por C. burnetii en fincas de ganado bovino y determinar la frecuencia de la presencia de anticuerpos en trabajadores de fincas en riesgo en áreas rurales del municipio de Montería, Córdoba (Colombia). Métodos: once fincas de ganado bovino fueron aleatoriamente seleccionadas para investigar la frecuencia de infección por C. burnetii. Muestras de leche de tanque de cada finca fueron analizadas mediante PCR convencional para detección del gen transposasa IS1111 de C. burnetii. Asimismo, se colectaron muestras de suero sanguíneo de 61 personas aparentemente saludables que vivían en ocho de las fincas estudiadas, las cuales fueron analizadas mediante el ensayo de inmunofluorescencia indirecta para detección de anticuerpos IgG contra fase II de C. burnetii. Resultados: en este estudio se reporta la presencia de ADN de C. burnetii en 45% de las muestras de leche de tanque de las fincas ganaderas estudiadas y una frecuencia de anticuerpos contra C. burnetii (IgG Fase II ≥1/64) del 61% en trabajadores de fincas en riesgo. Conclusiones: los resultados de este estudio demuestran la circulación de C. burnetii en las fincas estudiadas de un área de Montería, Colombia. También, los trabajadores de fincas en situación de riesgo presentan una alta frecuencia de anticuerpos contra este patógeno.

Antecedentes: a febre Q é uma zoonose causada por Coxiella burnetii. Na Colômbia não é uma doença de notificação obrigatória em seres humanos e é provavelmente subdiagnosticada. Além disto, não há estudos sobre sua prevalência nas principais espécies de reservatórios, como os bovinos. Objetivos: determinar a frequência de infecção por C. burnetii em fazendas de gado de leite e determinar a frequência de anticorpos em trabalhadores rurais em risco do município de Montería, Córdoba (Colômbia). Métodos: 11 fazendas de gado leiteiro foram selecionadas aleatoriamente para investigar a frequência de infecção por C. burnetii. Amostras de leite do tanque de cada fazenda foram analisadas por PCR convencional para a detecção do gene IS1111 transposase de C. burnetii. Além disso, amostras de soro de 61 pessoas aparentemente saudáveis que vivem em oito das propriedades estudadas foram analisadas por imunofluorescência indireta para a detecção de anticorpos IgG contra C. burnetii fase II. Resultados: neste estudo, o DNA de C. burnetii foi encontrado em 45% das amostras de leite do tanque, e uma frequência de anticorpos contra C. burnetii (fase II IgG ≥ 1/64) de 61% em trabalhadores rurais em risco. Conclusões: os resultados deste estudo demonstram a circulação de C. burnetii em algumas fazendas de gado em uma área de Montería, Colômbia. Além disso, os trabalhadores rurais em situação de risco têm uma alta frequência de anticorpos contra este patógeno.

A chemometric approach to characterization of ionic liquids for gas chromatography.

A chemometric study was carried out to characterize three ionic liquid types (ILs) with hexacationic imidazolium, polymeric imidazolium, and phosphonium cationic cores, using a range of contra-anions such as halogens, thiocyanate, boron anions, triflate, and bistriflimide. The solvation parameter model developed by Abraham et al., unsupervised techniques as cluster analysis (CA), and supervised techniques as linear discriminant analysis (LDA), step-LDA, quadratic discriminant analysis (QDA), and multivariate regression techniques as discriminant partial least squares (D-PLS), or multiple linear regression (MLR) were used to characterize the functionalized ILs above. CA established two main groups of phases, those with an acidic H-bond and those with basic ones. Once detected, the two natural groups, a linear and quadratic delimiters with good classification (>96 %) and prediction (>92 %) capacities were computed. The use of step-LDA technique allowed us to establish that a, b, and s solvation parameters were the most discriminant variables. These variables were used for modeling purposes, and a D-PLS and MLR models were constructed using a binary response. The explained variance of categorical variable by the model validated by cross-validation was 65 %, and 94.5 % of ILs were correctly predicted. IL characterization carried out would allow the appropriate selection of phases for gas chromatography (GC).

[Spontaneous exposition of a midline palatal torus]. / Exposición espontánea de un torus palatino de la línea media.

INTRODUCTION: Palatal torus, or torus palatinus, is a benign bone alteration that may cause some discomfort during phonation or swallowing. When its growth or persistent exposition produces unpleasant symptoms, it must be surgically removed. CASE PRESENTATION: We treated an 82-year-old female patient who consulted for a painful ulcerous lesion she had had for a year and which produced halitosis and discomfort when swallowing. During the oral cavity physical exam we observed a hard protuberance on the midline. It showed a perforation and ulceration of the lateral posterior palatal mucosa on the left side. We considered the following diagnosis: palatal torus, osteoma, pyogenic granuloma, or a soft-tissue neoplasia. We decided to surgically remove it and to perform a histopathological examination. Clinical evolution was satisfactory with complete resolution one month after surgery. The histopathological examination showed hyperostosis along with chronic inflammation of the soft tissues and a simple hyperplasia of the mucosa, which in turn indicated a palatal torus. DISCUSSION: We report an unusual case of spontaneous exposition of a palatal torus which took up almost all of the hard palate area. Its resection is described and we inform the histopathological findings. In the literature review, we did not find a previous report of a spontaneous exposition of a palatal torus.

Exposición espontánea de un torus palatino de la línea media / Spontaneous exposition of a midline palatal torus

Introducción. El torus , o rodete, palatino es una alteración ósea benigna que puede generar molestias en la fonación y en la deglución. Cuando su crecimiento o exposición persistente producen síntomas molestos, debe ser resecado quirúrgicamente. Presentación del caso. Se trata de una paciente de 82 años de edad, que consultó por una lesión ulcerativa de un año de evolución, que producía dolor, halitosis y molestia a la deglución. En el examen físico de la cavidad oral, se observó una prominencia de consistencia dura en la línea media, con perforación y ulceración de la mucosa palatina en su porción lateral posterior izquierda. Se consideraron los diagnósticos de torus palatino, osteoma, granuloma piógeno y neoplasia de tejidos blandos. Se decidió resecarla quirúrgicamente y hacer el estudio histopatológico. La evolución clínica fue satisfactoria, con resolución completa un mes después de la cirugía. En el estudio de histopatología se observó hiperostosis ósea con inflamación crónica de los tejidos blandos e hiperplasia simple de la mucosa, que corresponden a un torus palatino. Discusión. Se reporta un inusual caso de exposición espontánea de un torus palatino que ocupaba casi toda la bóveda palatina, se describe su resección quirúrgica y se informan los hallazgos de histopatología. En la revisión bibliográfica realizada, no se encontró un reporte previo de exposición espontánea de torus palatino.

Introduction: Palatal torus, or torus palatinus, is a benign bone alteration that may cause some discomfort during phonation or swallowing. When its growth or persistent exposition produces unpleasant symptoms, it must be surgically removed. Case presentation: We treated an 82-year-old female patient who consulted for a painful ulcerous lesion she had had for a year and which produced halitosis and discomfort when swallowing. During the oral cavity physical exam we observed a hard protuberance on the midline. It showed a perforation and ulceration of the lateral posterior palatal mucosa on the left side. We considered the following diagnosis: palatal torus, osteoma, pyogenic granuloma, or a soft-tissue neoplasia. We decided to surgically remove it and to perform a histopathological examination. Clinical evolution was satisfactory with complete resolution one month after surgery. The histopathological examination showed hyperostosis along with chronic inflammation of the soft tissues and a simple hyperplasia of the mucosa, which in turn indicated a palatal torus. Discussion: We report an unusual case of spontaneous exposition of a palatal torus which took up almost all of the hard palate area. Its resection is described and we inform the histopathological findings. In the literature review, we did not find a previous report of a spontaneous exposition of a palatal torus.

Seguridad y utilidad de la maniobra de retrovisión en ciego y colon ascendente / Safety and usefulness of the retrograde-viewing maneuver in the cecum and ascending colon

Objetivo: Analizar la utilidad y seguridad de la maniobra de retrovisión en ciego y colon realizada en una serie de 20 pacientes. Sede: Centro Hospitalario del Estado Mayor Presidencial y Hospital Ángeles Lomas. Tipo de estudio: Prospectivo, comparativo, transversal y observacional. Análisis estadístico: Por porcentajes. Pacientes y método: Veinte pacientes con indicación de colonoscopia. Las variables evaluadas fueron: factibilidad de realizar la maniobra, complicaciones presentadas y comparación de lesiones localizadas con la endoscopia convencional y por medio de la retrovisión. Resultados: Edad promedio de 53 años (33 a 72 años); 12 mujeres y 8 varones. La maniobra de retrovisión fue factible en l6 de las colonoscopias (80%). La complicación más frecuentemente observada fue erosión leve de la mucosa por fricción de la punta del endoscopio en el ciego, en cuatro enfermos (20%), lo que no ameritó ningún tratamiento. No hubo perforación ni sangrado en caso alguno. La maniobra de retrovisión aportó un diagnóstico endoscópico adicional en tres enfermos (15%), siendo dos pólipos pequeños y un divertículo del ciego. Conclusiones: La maniobra de retrovisión en ciego fue útil y segura, ya que permitió diagnosticar un 15% más de lesiones que no fueron observadas antes de realizar la maniobra; esto sin presentar complicaciones.

Objective: To analyze the usefulness and safety of the retrograde-viewing maneuver in the cecum and colon performed in a series of 20 patients. Setting: Third level health care center. Type of study: Prospective, comparative, cross-sectional, and observational. Statistical analysis: Percentages. Patients and method: Twenty patients with indication for colonoscopy. Assessed variables were: feasibility of the maneuver. Complications and comparison of injuries localized with conventional endoscopy and by means of the retrograde-viewing device. Results: Average age was 53 years (33 to 72 years), 12 women and 8 men. The retrograde viewing maneuver was feasible in 16 of the colonoscopies (80%). The most frequent complication observed was slight erosion of the mucosa due to the friction caused by the tip of the endoscope in the cecum in four patients (20%), which did not need any treatment. There was no perforation or bleeding in any case. The retrograde-viewing maneuver provided an additional endoscopic diagnosis in three patients (15%), being these small polyps and a diverticulum in the cecum. Conclusions: Retrograde-viewing in the cecum was useful and safe, as it allowed to diagnose 15% more lesions than those observed before performing the maneuver; without presenting complications.

Polymeric imidazolium ionic liquids as valuable stationary phases in gas chromatography: chemical synthesis and full characterization.

Seven new functionalized polymerizable ionic liquids were chemically prepared, and later applied for the preparation of polymeric stationary phases in gas chromatography. These coated GC columns, which exhibited good thermal stabilities (240-300°C) and very high efficiencies (3120-4200 plates/m), have been characterized using the Abraham solvation parameter model. The chromatographic behavior of these polymeric IL columns has been deeply studied observing excellent selectivities in the separation of many organic substances such as alkanes, ketones, alcohols, amines or esters in mixtures of polar and non polar solvents or fragrances. Remarkably, the challenging separation of xylene isomers has been possible using a bis(trifluoromethylsulfonyl)amide based imidazolium IL coated column as a gas chromatography stationary phase.