Prolonged-release pirfenidone in patients with pulmonary fibrosis as a phenotype of post-acute sequelae of COVID-19 pneumonia. Safety and efficacy.

INTRODUCTION: One of the major concerns with post-acute sequelae of COVID-19 (PASC) is the development of pulmonary fibrosis, for which no approved pharmacological treatment exists. Therefore, the primary aim of this open-label study was to evaluate the safety and the potential clinical efficacy of a prolonged-release pirfenidone formulation (PR-PFD) in patients having PASC-pulmonary fibrosis. METHODS: Patients with PASC-pulmonary fibrosis received PR-PFD 1800 mg/day (1200 mg in the morning after breakfast and 600 mg in the evening after dinner) for three months. Blood samples were taken to confirm the pharmacokinetics of PR-PFD, and adverse events (AEs) were evaluated monthly using a short questionnaire. Symptoms, dyspnea, and pulmonary function tests (spirometry, diffusing capacity for carbon monoxide, plethysmography, and 6-min walk test [6MWT]) were evaluated at baseline, and one and three months after having started the PR-PFD treatment. RESULTS: Seventy subjects with mild to moderate lung restriction were included. The most common AEs were diarrhea (23%), heartburn (23%), and headache (16%), for which no modifications in the drug study were needed. Two patients died within the first 30 days of enrolment, and three opted not to continue the study, events which were not associate with PR-PFD. Pulmonary function testing, 6MWT, dyspnea, symptoms, and CT scan significantly improved after three months of treatment with PR-PFD. CONCLUSION: In patients with PASC pulmonary fibrosis, three months' treatment with PR-PFD was safe and showed therapeutic efficacy. Still, it remains to be seen whether the pulmonary fibrotic process remains stable, becomes progressive or will improve.

Oportunidad en la salud digital: una respuesta al control de las demencias / Digital health services as a means to control dementia

The increase of the elderly population with a significant load of non-communicable diseases, accelerates pathological aging and increases the risk of dementia, generating a huge health, social and economic cost for any country. Dementia does not have an effective treatment yet, therefore, the focus must remain on prevention and early diagnosis. The early stages of dementia are known as mild cognitive impairment; at this stage is still possible to mitigate the progression of the disease, however, health systems worldwide face difficulties to provide universal access to health services, due to a lack of specialists and geographical distances, interfering with the access to healthcare centers. In this scenario, WHO urged countries to implement strategies to democratize and to expand the reach of health institutions. In this document, we briefly review the global and local situation of dementias and discuss some attempts to control their progression by using revolutionary digital tools. We believe the focus should be on the population that is just beginning to show cognitive impairment.

Crisis asmática grave asociada con infección viral / Severe asthmatic crisis related to viral infection

Resumen ANTECEDENTES: 50% de las crisis asmáticas son desencadenadas por infecciones virales, su relación con parámetros clínicos no se ha descrito en los adultos. OBJETIVO: determinar la prevalencia de crisis asmáticas de acuerdo con el espectro viral y su asociación con características clínicas y mecánica respiratoria. MATERIAL Y MÉTODO: estudio clínico, prospectivo y observacional en el que se incluyeron pacientes con crisis asmática grave del 1 de diciembre de 2010 al 31 de diciembre de 2011. Se excluyeron los pacientes con sospecha de infección bacteriana. Se aplicó cuestionario de síntomas, se determinó panel viral por hisopado nasal, espirometría y estudios de laboratorio. Se obtuvo el consentimiento informado de los participantes. RESULTADOS: se incluyeron en el estudio 100 pacientes. La edad promedio fue de 39±14 años, IMC 27±4 kg/m2, escala de Borg 6.2±1.2, escala mMRC 2.6±0.6, tiempo de los síntomas 7±7 días, FEV1 de 42±14%, oximetría de pulso 88±3% y estancia de 4.5±1.7 días. El 47% de los pacientes tenía rinitis alérgica. Se aisló virus en 36% (rinovirus 15% y coronavirus 6%). Al comparar la causa viral vs no viral, se observó que los pacientes eran menores en el primer grupo (36±13 vs 43±17 años, p=0.014); no hubo diferencia entre grado de obstrucción y síntomas. A mayor severidad del asma hubo más aislamientos de virus. CONCLUSIÓN: las crisis asmáticas asociadas con virus respiratorios tienen comportamiento clínico similar al de las no asociadas. En los pacientes con menor edad y con comportamiento más grave se aíslan virus con más frecuencia.

Abstract BACKGROUND: 50% of asthma attacks are triggered by viral in fections; its relationship with clinical parameters has not been described in adults. OBJECTIVE: To determine the prevalence of asthma attacks according to viral spectrum and its association with clinical features and respiratory mechanics. MATERIAL AND METHOD: A clinical, prospective and observational study with patients with severe asthma attended from December 1st 2010 to December 31st 2011. We excluded patients with suspected bacterial infection. Symptom questionnaire was applied, it was determined by nasal swab viral panel, spirometry and laboratory studies. Informed consent was obtained. RESULTS: One hundred patients were included. Mean age was 39±14 years, BMI 27±4 kg/m2, Borg 6.2±1.2, mMRC 2.6±0.6, length of symptoms 7±7 days and FEV1 of 42±14%, pulse oximetry 88±3% and stay 4.5±1.7 days; 47% of patients had allergic rhinitis. Virus was isolated in 36% (15% rhinovirus and 6% coronavirus). Comparing the non-viral vs viral etiology, patients were younger (36±13 vs 43±17 years, p=0.014) there was no difference between the degree of obstruction and symptoms. A greater severity of asthma was related to more isolation. CONCLUSION: Asthma attacks associated with respiratory viruses have similar clinical behavior to not associated ones. In younger patients with more severe behavior virus are isolated more frequently.

Identification of circulating miRNAs profiles that distinguish malignant pleural mesothelioma from lung adenocarcinoma.

Accurate diagnosis of malignant pleura mesothelioma (MPM) is challenging. Differential diagnosis of MPM versus lung adenocarcinoma (AD) is particularly difficult, yet clinically important since the two neoplasias call for different treatment approaches. Circulating miRNA-profiling to identify miRNAs that can be used to distinguish MPM from AD has not been reported. We conducted a wide screening study of miRNA profiles in serum pools of MPM patients (N = 11), AD patients (N = 36), and healthy subjects (N = 45) to identify non-invasive biomarkers for differential diagnosis of MPM and AD, using deep sequencing. Sequencing detected up to 300 known miRNAs and up to 25 novel miRNAs species in the serum samples. Among known miRNAs, 7 were upregulated in MPM and 12 were upregulated in AD compared to healthy controls. Of these, eight were distinctive for AD and three were unique for MPM. Direct comparison of the miRNA profiles for MPM and AD revealed differences in miRNA levels that could be useful for differential diagnosis. No differentially expressed novel miRNAs were found. Further bioinformatics analysis indicated that three upregulated miRNAs in MPM are associated with the p38 pathway. There are unique alterations in serum miRNAs in MPM and AD compared to healthy controls, as well as differences between MPM and AD profiles. Differing miRNA levels between MPM and AD may be useful for differential diagnosis. A potential association to p38 pathway of three upregulated miRNAs in MPM was revealed.

Signo de Leser-Trélat asociado a adenocarcinoma gástrico: Caso clínico / Leser-Trélat sign associated with gastric cancer: Report of one case

We report a 66-year-old male presenting with malaise, heartburn and pruritic seborrheic keratoses in both feet of sudden onset, suggesting a Leser-Trélat sign. An upper gastrointestinal endoscopy disclosed a gastric cancer. The patient was subjected to a total gastrectomy and duringfollow up, the skin lesions had disappeared.

Uso de segmentos intestinales en urología: seguimiento a 5 años / Use of intestinal segments im urology: a 5-year follow-up

Introducción: Desde hace más de 50 años se utilizan segmentos intestinales en urología para aumentar o reemplazar vejigas, reemplazar uréteres y derivar la orina a través de segmentos de intestino aislados. Objetivo: Describir la casuística de cirugías con uso de segmentos intestinales y a los menos 5 años de seguimiento completo, realizada en el Servicio de Urología del HCVB, sus principales indicaciones, técnicas y complicaciones. Materiales y métodos: Estudio observacional retrospectivo. Se revisaron 291 fichas de pacientes operados con uso de un segmento intestinal, con más de 5 años de seguimiento posterior, evaluando diagnóstico etiológico, técnica utilizada para enterocistoplastia, reservorio, neoimplante, ostomía y sus respectivas complicaciones a 3 meses, 5 años y final de seguimiento. Resultados: Se efectuaron 301 intervenciones (291 pacientes + 10 reinterveciones con uso de nuevos segmentos intestinales). Se seleccionan 111 casos (36,8 por ciento) en los que se dispone de seguimiento superior a 5 años. La principal indicación fue hiperactividad neurogénica del detrusor con 39 casos (35,14 por ciento); 30 casos (27,03 por ciento) de cistopatía intersticial; 16 casos (14,41 por ciento) de cáncer vesical; 11 casos (9,91 por ciento) de vejiga hiperactiva idiopática. Del total 70 fueron mujeres (63,06 por ciento), 41 fueron hombres (36,94 por ciento). La intervención más frecuente es la enterocistoplastia detubulizada de ampliación (79,28 por ciento), seguido por el reservorio ortotópico (10,9 por ciento). La elección del segmento intestinal se basó principalmente en la factibilidad anatómica, el íleon detubulizado en parche en U a la cara posterior para las enterocistoplastias de ampliación y el uso de segmentos de intestino grueso para fabricaciones deostomías continentes.La mayor cantidad de complicaciones se presenta en el periodo entre los 3 meses y 5 años de seguimiento (23 de 111 casos)

Introduction: Since over 50 years intestinal segments have been used in urology to augment or replace bladders, ureters and divert urine through isolated intestinal segments. Objective: The purpose of this article is to describe the use of intestinal segments in urological surgeries performed in the urological service of the HCVB, with a minimum of 5 years of follow-up. Indication, technique and complications are analyzed. Materials ad methods: It is an observational and retrospective study. 291 clinical charts of patients with use of intestinal segments in their surgery and more than 5 years of follow-up were analyzed. We evaluated diagnosis, technique used for bladder augmentation, reservoir, neoimplantation, stoma and their complications at a 3rd month, 5th year and end to follow-up moments. Results: A total of 301 surgeries were performed (291 patients + 10 revisions with use of new intestinal segments). 111 cases (36,8 percent) had a 5-year follow-up. Main indication for surgery was neurogenic detrusor hiperactivity in 39 cases (35,14 percent); there were 30 interstitial cystitis cases (27,03 percent); 16 cases ob bladder cancer (14,41 percent); 11 cases of idiopathic hyperactive bladder (9,91 percent). From the total group70 (63,06 percent) were female and 41 (36,94 percent) male. The most frequent surgery performed was the detubularized bladder augmentation (79,28 percent), followed by the orthotopic reservoir (19,9 percent).Election of the intestinal segment was based principally in technical feasibility, U-shaped detubularized ileum as a posterior patch for bladder augmentations and colon for continent stomas. Most complications occur between the 3rd month and the 5th year of follow-up (23 of 111 cases), needing non- surgical treatment in 12 cases, surgery in 6 cases and 3 patients stood in a life-risk situation. Continence is good in 88,7 percent of the cases. Conclusions: The use of intestinal segments for patch, reservoir and

Ostomías continentes para cateterismo intermitente: experiencia del Hospital Carlos van Buren / Continent stomas for intermittent catheterization: Hospital Carlos van Buren’s experience

Introducción: Existen situaciones en la práctica urológica, en que el daño al aparato esfinteriano, uretra o vejiga obliga a recurrir a algún mecanismo que permita derivar un reservorio o vejiga ampliada hacia la pared abdominal. Para estos fines es posible realizar ostomías continentes, con distintos segmentos intestinales, para autocateterismo intermitente limpio. Objetivo: Describir la experiencia con distintas técnicas de ostomía continente para cateterismo intermitente limpio, su evolución a través del tiempo y sus principales complicaciones según la casuística del Servicio de Urología del Hospital Carlos Van Buren. Materiales y Método: Estudio observacional retrospectivo. Revisión de 77 casos en los cuales se realizan ostomías continentes para cateterismo intermitente desde julio de 1988 a junio de 2009. Se evalúan: diagnóstico etiológico, técnica de ostomía, segmento intestinal, ubicación de extremo distal de ostomía y sus respectivas complicaciones precoces, tardías y estado al final del seguimiento. Resultado: En 83 ocasiones hemos necesitado hacer alguna derivación urinaria vesical continente a la pared abdominal con uso de segmentos intestinales. En 26 casos (31,3 por ciento) utilizamos íleon aplicado más alguna variedad que le permita cierta fijación. En nuestros últimos 33 (39,7 por ciento) pacientes hemos realizado la técnica de Yang-Monti, para ello se utilizó segmentos de intestino grueso en 27 casos (81,82 por ciento). La mayor cantidad de complicaciones de resolución quirúrgica (38,6 por ciento del total), se presentan en el periodo de 3 meses a 5 años; a su vez las complicaciones más graves lo hacen en el postoperatorio inmediato, en pacientes con baja reserva funcional (6 de 77) con 4 muertes en nuestra serie. La continencia es cercana al 100 por ciento, con 19,48 por ciento de reintervenciones de la ostomía para lograr este resultado. Conclusiones: El uso de ostomías continentes permite alcanzar un alto porcentaje de continencia

Introduction: There are situations in urologic practice, in which the damage to the sphincter, urethra or bladder forces to build some mechanism that allows diverting urine through a reservoir or augmented bladder towards the abdominal wall. For these purposes it is possible to build continent stomas, with different intestinal segments, for clean intermittent catheterization. Objective: To describe the Hospital Carlos van Buren’s experience with different continent stoma techniques for clean intermittent catheterization, its evolution through time and its main complications. Materials and Method: Retrospective observational study. From July 1988 to June 2009, 77 cases in which continent stomas for intermittent catheterization were built. Etiologic diagnosis, surgical technique, intestinal segment, location of distal end of the stoma and its respective early and delayed complications and status at the end of follow-up are evaluated. Results: In 83 occasions we have needed to make some continent urinary diversion to the abdominal wall with use of intestinal segments. In 26 cases (31.3 percent) we used folded ileum plus some variety of fixations. In our last 33 (39.7 percent) patients we have used the Yang-Monti technique, and for that we used thick bowel in 27 cases (81.82 percent).Most complications of surgical resolution (38.6 percent of the total), appeared in the 3 months to 5 years period; most serious complications appeared in the early post-operative period, in patients with low functional reserve (6 of 77) with four deaths in the series. Continence is almost 100 percent, with 19.48 percent of stomal re-interventions to obtain these results. Conclusions: The use of continent stomas allows a high percentage of continence. This allows self standing patients, with a positive impact on their quality of life when compared to incontinent stomas

Hiperactividad neurogénica del detrusor refractaria a tratamiento conservador: experiencia con el uso de segmentos intestinales / Neurogenic detrusor over activity refractory to conservative treatment: experience using intestinal segments

A pesar de la gran variedad de terapias descritas para el manejo de hiperactividad neurogénica del detrusor (HND), existe un número importante de pacientes que no logran mejoría con alternativas conservadoras. En ellos, bajar la presión y disminuir el porcentaje de daño renal mediante ampliación vesical con segmentos intestinales detubulizados, es una alternativa vigente. Objetivo: Describir la experiencia en el manejo de pacientes con HND refractaria a tratamiento conservador, que fueron tratados en forma quirúrgica con técnicas que utilizan segmentos intestinales, su evolución a través del tiempo y sus principales complicaciones. Materiales y métodos: Se revisaron fichas clínicas de 75 pacientes con diagnóstico de HND, operadas de enterocistoplastia entre 1988 y 2009. Se analizan: causa de daño neurológico, segmentos intestinales usados, técnica quirúrgica, necesidad de ostomía continente y complicaciones. Resultados: La serie estudiada está compuesta por 46 (61,33 por ciento) varones y 29 (38,67 por ciento) mujeres, con edad promedio 32,2 años (2,75 a 68 años). Las principales causas de daño neurológico fueron traumatismo raquimedular en 37 pacientes (49,43 por ciento) y mielomeningocele en 15 pacientes (20 por ciento). En total se realizaron 81 cirugías con uso de intestino: 6 corresponden a reintervenciones (3 ampliaciones con cierre de cuello y ostomía y 3 ostomías). De las 75 cirugías primarias se realizaron73 (97,33 por ciento) enterocistoplastias de aumento (en el 40 por ciento de los casos asociado a una ostomía continente), 1 cirugía de solamente ostomía continente y 1 reservorio. El segmento intestinal más utilizado para ampliación fue sigmoides; en los casos de ampliación y ostomía se prefirió ciego-íleon. La tendencia en los últimos 15 pacientes, es realizar la ostomía con técnica de Yang- Monti con colon o con doble segmento de íleon. El 30 por ciento de los pacientes requirió algún tipo de revisión quirúrgica en el...

Despite the wide variety of therapies described for the management of neurogenic detrusor over activity (NDH), a significant number of patients fail to improve with conservative treatment. In them, lowering pressure and decreasing the percentage of kidney damage by bladder augmentation with intestinal segments is a valid alternative. Objective: To describe the experience in the management of patients with NDH refractory to conservative treatment that were treated surgically with techniques using intestinal segments, their evolution over time and common complications. Materials and methods: We reviewed medical records of 75 patients with NDH with enterocystoplasty surgery between 1988 and 2009. We assessed: cause of neurological damage, intestinal segments used, surgical technique, need for continent ostomy and complications. Results: The studied group consists of 46 (61.33 percent) males and 29 (38.67 percent) females, mean age 32.2 years (2.75 to 68). The main causes of neurological damage were spinal cord injury in 37 patients (49.43 percent) and myelomeningocele in 15 patients (20 percent). A total of 81 surgeries using bowel were performed: 6 correspond to re-intervention (3 extensions with neck closure and ostomy; and 3 ostomies). Of the 75 primary surgeries, 73 (97.33 percent) were enlargement enterocystoplasty (in 40 percent of cases associated with a continent ostomy), 1 contienent ostomy surgery alone and 1 reservoir. The most widely used bowel segment for enlargement was sigmoid, in cases of expansion and ostomy a cecum-ileum segment was preferred. The trend in the last 15 patients was to perform an ostomy with Yang-Monti technique using colon or ileal double segment. On follow up over 5 years, 30 percent of the patients required some type of surgical revision and their main indications were incontinence, impaired opening of the bladder neck, urethral lithiasis and stenosis. Continence was good in 90.67 percent and 5.33 percent average...

Necesidad de nueva revascularización coronaria en pacientes diabéticos tratados con stents no recubiertos / New coronary revascularization in diabetics patients treated with bare metal stent

Antecedentes: Los pacientes diabéticos tratados con angioplastía coronaria (AC) poseen un mayor riesgo de reestenosis y por lo tanto de reintervención en comparación a los no diabéticos, lo que ha derivado en una mayor utilización de stents recubiertos con drogas en este grupo de pacientes. Objetivo: Analizar la incidencia de reintervención en pacientes diabéticos no seleccionados sometidos a una AC con stent no recubierto en el Hospital Regional de Concepción e identificar los predictores de la reintervención. Método: Entre Enero 2005 y Diciembre 2006, 571 pacientes fueron sometidos AC, de los cuales 108 (19 por ciento) eran diabéticos. En este grupo estudiamos sus características clínicas, factores de riesgo y los factores angiográficos tales como el vaso tratado, diámetro, longitud y número de stents. Mediante un seguimiento telefónico y de ficha clínica se determinó la existencia o no de una reintervención coronaria. Identificado elgrupo con reintervención coronaria, comparamos las variables clínicas y angiográficas y a través de un modelo de regresión logística se buscó identificar predictores de dicha intervención. Se utilizó t de student y test exacto de Fisher. Resultados: La edad promedio fue 61±10 años, 71(66 por ciento) hombres y 25 por ciento insulinorequirientes 47(44 por ciento) pacientes tenía dislipidemia, 93(86 por ciento) hipertensión y 26(25 por ciento) eran fumadores. La AC fue en contexto de un SCA s/SDST en 56(52 por ciento) pacientes, 38 (35 por ciento) por IAM en evolución y 12(11 por ciento) por angina estable. Se implantaron 138 stents (1,3 stent/pt) y fue exitosa en el 96 por ciento. En el seguimiento de 13,7 ±7 meses la mortalidad fue 4,6 por ciento y sólo 12(11 por ciento) pacientes fueron sometidos a una nueva revascularización, 75 por ciento de las cuales fue otra AC. De las reintervenciones, sólo 4(33 por ciento) pacientes tenía reestenosis, el resto fue por lesiones en otro vaso. La distribución de los factores de riesgo...

Diabetes mellitus is associated to a more severe and extensive coronary artery disease. Coronary angioplasty (PTCA) has been demonstrated to have similar immediate results compared with patients without diabetes; however, diabetic patients exhibit a higher rate of restenosis and target lesion revascularization. Aim: to study the real incidence of a new interventional procedures in diabetics patients who were treated with bare metal stents. Methods: From January 2005 to December 2006, 571 patients were submitted to PTCA at the Hospital Regional de Concepcion. 108 patients (195) were diabetics. Clinical characteristics, risk factors, and angiographic findings were tabulated. Telephone follow up was used to determine the performance of coronary re intervention. A logistics regression model was used to identify predictors of coronary re intervention. Results: The mean average age was 61±10 years, 66 percent were men and 25 percent required insulin treatment. Dyslypidemia was present in 86 percent, hypertension in 86 percent and 25 percent were smokers. Indication for PTCA was acute coronary syndrome in 52 percent, myocardial infarction in 35 percent and stable angina in 11 percent. They received 1,3 stents/pts and immediate success rate was 96 percent. During follow up (13,7±7 months) global mortality was 4,6% and only 12 (11 percent) patients had a second revascularization procedure, 67 percent of them performed in non stentedcoronary arteries. Four revascularizations (33 percent) were due to significant in-stent restenosis, seven (58 percent) to other significant lesions and 1 to subacute stent thrombosis. In the univariate and multivariate analysis we didnot find independent clinical or angiographic factors as predictors of new revascularization. However, it wasmore frequent in patients with proximal left anterior descending artery stents and long lesions (58 percent and 50 percent, respectively). Conclusion: In our experience, need for repeat...

Arg113His mutation of vanishing white matter is not present in multiple sclerosis.

Vanishing white matter (VWM) is a childhood leukoencephalopathy with central hypomyelination, white matter rarefaction, and cystic degeneration. Adult onset, variable phenotype, and high frequency characterize Arg113His mutation caused by G338A polymorphism associated with VWM. A patient with trauma-associated onset, and clinical features compatible with multiple sclerosis (MS), was homozygous for G338A mutation of eukaryotic translation initiation factor (eIF2B5). The authors checked a cohort of 101 MS patients, including 19 with head/neck trauma-associated onset, and failed to find the mutation, described above, in MS chromosomes. Our report does not exclude the presence in MS chromosomes of other mutations in the eIF2B gene family.

Angioplastía primaria en el infarto agudo al miocardio en el Hospital Regional de Concepción / Primary coronary angioplasty for acute myocardial infarction at the Hospital Regional de Concepcion

Antecedentes: En el infarto agudo al miocardio con supradesnivel del segmento ST (IAM c/SDST) la angioplastía primaria (AP) ha demostrado disminuir la mortalidad y el reinfarto en comparación con la trombolisis. Por esta razón, desde septiembre de 2005 instauramos la AP como el tratamiento de elección del IAM en nuestro hospital. Objetivo: Mostrar nuestra experiencia con AP en el tratamiento del IAM en el Hospital Regional de Concepción. Método: Revisamos las características clínicas, hallazgos angiográficos y los resultados de los pacientes con IAM c/SDST que fueron tratados con AP en nuestro hospital, en el periodo entre septiembre 2005 y abril de 2007. Analizamos el tiempo “puerta-balón”, los resultados angiográficos y los resultados clínicos precoces y alejados. El seguimiento ha sido a través de la visita médica y por medio de teléfono. Los valores muestran como promedio y DS. Resultados: En este periodo 147 pacientes con IAM c/SDST fueron tratados con AP, en un tiempo puerta-balón de 65 +/- 37 minutos. La edad promedio fue 61 +/- 12 años. 112 (76 por ciento) pacientes eran hombres, 36 (24 por ciento) diabéticos, 81 (55 por ciento) hipertensos, 21 (14 por ciento) tenían dislipidemia y 48 (33 por ciento) eran fumadores. El 76 por ciento se presentaron con IAM 6 horas de evolución y en el 46 por ciento el infarto fue de pared anterior. Hubo éxito angiográfico de 92 por ciento y la angioplastía fue con stent en el 93 por ciento. La mortalidad global fue 8,8 por ciento a 30 días con 2 por ciento de reinfarto. En el seguimiento alejado de 112 +/- 86 días la mortalidad fue 4,4 por ciento. El sexo femenino y la enfermedad multivaso fueron los únicos predictores independientes de mortalidad. Conclusión: Hemos logrado implementar la angioplastía primaria como método de elección en el IAM, cumpliendo con los tiempos internacionales establecidos y con una tasa de éxito superior al 90 por ciento.

Background: Compared to thrombolysis, primary coronary angioplasty (PTCA) has proven more effective to decrease mortality and re-infarction in patients with ST segment elevation myocardial infarction (STEMI). Therefore, from 2005 primary PTCA was used as the treatment of choice for patients with acute STEMI at our institution. Aim: to evaluate results obtained with primary PTCA in patients with STEMI at the Hospital Regional de Concepcion. Methods: The clinical characteristics, angiographic findings and results of primary PTCA were evaluated in consecutive patients treated from 2005 to 2007. Door to balloon time, angiographic results and early and late clinical results were evaluated. Follow up was obtained by clinical interviews and phone contact. Results are expressed as mean +/- SD. Results: 147 patients were treated. The door to balloon time was 65 +/- 37 min. Mean age was 61 +/- 12 years. 76 percent of patients were males, diabetes was present in 55 percent, hypertension in 14 percent, dyslipidemia in 33 percent and 33 percent of patients were smokers. 76 percent of patients presented 6hr after initiation of pain. An anterior wall MI was present in 46 percent. Angiographic success rate was 92 percent; stents were used in 93 percent of patients. Overall mortality rate was 8.8 percent at 30 days and reinfarction rate was 2 percent. After a mean follow up of 112 +/- 86 days, late mortality rate was 4.4 percent. Female gender and multi vessel disease were the sole predictors of mortality Conclusion: Primary PTCA at the Hospital Regional de Concepcion was performed with a success rate above 90 percent within an internationally accepted time interval following the initiation of MI.

Embarazo en pacientes con enterocistoplastía / Pregnancy in patients with enterocystoplasty

Un porcentaje considerable de pacientes que requieren cirugía vesical con intestino corresponden a mujeres en edad fértil. El embarazo y parto en este grupo de pacientes sólo ha sido reportado de forma ocasional. El objetivo del presente trabajo es describir una serie clínica de mujeres que consiguieron gestación y parto, posterior a cirugía de ampliación o derivación vesical con intestino. Revisión retrospectiva de fichas clínicas de 6 mujeres que cursaron con una gestación exitosa, posterior a cirugía de enterocistoplastía. Se consideró: diagnóstico pre operatorio, cirugía realizada, embarazo, tipo de parto y complicaciones. Desde el año 1988 a la fecha, se ha realizado cirugía vesical con intestino en 37 mujeres en edad fértil. Seis de ellas han conseguido embarazo, con siete gestaciones reportadas. Los diagnósticos pre operatorios fueron: tres cistopatías intersticiales, dos vejigas neurogénicas y una hiperactividad idiopática del Detrusor. El tipo de cirugía fue ampliación vesical con intestino detubulizado en cuatro casos y ampliación con cierre de cuello y ostomía continente en dos. Los embarazos fueron: feto único en cinco pacientes y gemelar en una. Las complicaciones más significativas fueron infección del tracto urinario y parto prematuro. El parto correspondió a cesárea en cinco mujeres y parto vaginal en una. Posterior al parto, una paciente requirió revisión de la ostomía por prolapso e incontinencia. Las mujeres en edad fértil que han requerido cirugía vesical con intestino, pueden conseguir un embarazo y parto exitoso con baja incidencia de complicaciones.

Concentraciones plasmáticas de digoxina en cuatro esquemas terapéuticos de uso común en la práctica clínica / Digoxin plasma levels in patients usign four common therapeutic schedules

Background: The different therapeutic schedules used for the prescription of digoxin have little theoretical support. Aim: To measure digoxin plasma levels in patients using four different prescription schedules. Patients and methods: Four groups of patients were studied. Group I corresponded to 56 patients taking digoxin 0.25 mg/day, from Monday to Friday. Group II corresponded to 30 patients taking digoxin 0.25 mg/day, from Monday to Saturday. Group III corresponded to 53 patients taking digoxin 0.25 mg/day continuosly. Group IV corresponded to 36 patients taking digoxin 0.125 mg/day continuosly. Plasma digoxin levels were measured in two consecutive Mondays before taking the daily dose of the drug. Serum creatinine was also measured and creatinine clearance was calculated. The therapeutic plasma concentration range was set between 0.5 and 2 ng/ml. Results: Mean plasma digoxin levels were 1.15±0.8 ng/ml in group I, 1.4±0.55 ng/ml in group II, 1.68±0.7 ng/ml in group III and 1.14±0.43 ng/ml in group IV. 93 percent of patients in group I, 80 percent of patients in group I, 80 percent of patients in group II, 75 percent of patients in group III and 94 percent of patients in group IV had therapeutic digoxin levels. A low creatinine clearance, an age over 65 and interactions with other drugs were risk factors associated with supratherapeutic levels, mostly seen in group II and group III with 20 percent and 24 percent respectively. Conclusions: Most patients using digoxin with different therapeutic schedules had plasma drug levels within the therapeutic range

Genetic evidence for a role for Src family kinases in TNF family receptor signaling and cell survival.

Mutant src(-/-) mice have osteopetrosis resulting from defective osteoclasts, the cells that resorb bone. However, signaling pathways involving Src family members in osteoclasts remain unclear. We demonstrate that expression of a truncated Src molecule, Src251, lacking the kinase domain, induces osteopetrosis in wild-type and src(+/-) mice and worsens osteopetrosis in src(-/-) mice by a novel mechanism, increased osteoclast apoptosis. Induction of apoptosis by Src251 requires a functional SH2, but not an SH3, domain and is associated with reduced AKT kinase activity. Expression of Src251 dramatically reduces osteoclast survival in response to RANKL/TRANCE/OPGL, providing evidence that Src family kinases are required in vivo for survival signaling pathways downstream from TNF family receptors.

[Smoking among Mexican physician. A comparative analysis with smokers who are not physicians]. / Tabaquismo en médicos mexicanos. Un análisis comparativo con fumadores que no son médicos.

OBJECTIVES: To determine prevalence, addiction knowledge and attitude on tobacco smoking in a group of smoking physicians (MF) and to compare these variables with smoking non-physicians (FNM) and non-smoking physicians (MNF) from the National Institutes of Health in Mexico (Insalud). MATERIAL AND METHODS: The results of a questionnaire among the three groups were compared. RESULTS: The prevalence of MF (22%) was significantly lower than in FNM (28%), (OR = 0.72, CI = 0.61-0.85). No significant differences regarding addiction and attitudes were found between them. The MNF had better knowledge and attitudes and agreed that their Institute should be a non-smoking area. CONCLUSION: Prevalence of smoking is lower among physicians than among FNM and the similarities between them suggest that addiction can provoke them and that a program for tobacco control is required.

Chromogenic plate assay distinguishing bacteriolytic from bacteriostatic activity of an antibiotic agent.

A solid agar plate assay was devised to discriminate bacteriolytic from bacteriostatic activity for a given antibacterial agent. The assay uses a bacterial culture harboring beta-galactosidase enzyme as reporter of cellular lysis. When a drop of bacteriolytic compound is placed on the agar, beta-galactosidase is released from the bacteria to the external solid medium where it hydrolyzes X-Gal substrate analogue, developing a blue halo at the edge of the inhibition growth zone. The assay was successfully evaluated against several antibiotics with well-known mechanism of action. It was found that bacteriostatic compounds consistently did not display blue halo at the inhibition zone.

Evaluación retrospectiva de pacientes llevados a reemplazo total de rodilla en el Hospital San José / Retrospective evaluation of patients after total knee arthoplasty at Hospital San José

Se evaluaron clinica y radiológicamente 79 reemplazos totales primarios cementados de rodilla (73 pacientes) realizados en el Hospital de San Jose de Bogota, con diagnostico de artrosis de rodilla con un seguimiento promedio de 25.43 meses (rango: 10.7 - 43.0 meses). Se utilizó en todos un mismo diseño protésico, abordaje quirurgico y valoración clínica y radiologica, aplicandoles para su evaluación postoperatoria, la escala de la Sociedad Americana de Rodilla, cosa hecha por un mismo observador. Se clasificaron 43 casos (54.4 por ciento) con la categoría de artrosis tipo uno, 14 (17.7 por ciento) con categoría dos y en la categoría tres, 22 casos (27.8 por ciento). Se obtuvo un puntaje promedio en la función del paciente de 62.81 puntos, el 29.1 por ciento: excelente, 35.4 por ciento; bueno, 22.8 por ciento, regular y malo en el 12.7 por ciento. El resultado clínico promedio fue de 87.16 puntos de lo cual el 74.6 por ciento; excelente, 20.2 por ciento: bueno, 2.53 por ciento: regular y el 2.53 por ciento: malo. Se encontró una relación estadisticamente significativa en la calificación funcional de la rodilla con cada una de las categorias (x2: 18.906; p<0.005)

Serological response to Helicobacter pylori recombinant antigens in Chilean infected patients with duodenal ulcer, non-ulcer dyspepsia and gastric cancer.

We have previously cloned 10 Helicobacter pylori antigen genes from a Chilean strain including: cytotoxin VacA, a truncated region of CagA (called A17), a species-specific protein (Ag26), urease subunits (UreA, UreB), a flagellin, (FlaB), heat shock proteins (HspA and HspB), an adhesin (HpaA) and a lipoprotein (Lpp20). Immunogenicity of these antigens was tested by immunoblot with sera of Chilean infected patients, revealing that HpaA, A17, HspB and VacA were more frequently recognized (86%, 82%, 68% and 68%, respectively). According to the clinical condition, it was determined that Lpp20 was preferentially recognized by sera from non-ulcer dyspepsia patients (80%), A17 and VacA by patients with duodenal ulcer (92% and 83% respectively), and HspB by patients with duodenal ulcer (83%) and gastric cancer (90%). An ELISA was developed with a purified mixture of A17 and VacA antigens to test the different groups of patients. It was found that sera from duodenal ulcer patients showed higher values than those from non-ulcer dyspepsia patients, but this difference was not significant (p<0.2). Moreover, sera from gastric cancer patients showed values lower than those from non-ulcer dyspepsia patients (p<0.019). These results indicate that, in the Chilean population, antibodies raised against VacA and A 7 are not markers either for duodenal ulcer or for gastric cancer.

Prevalence of cigarette smoking among employees of the Mexican National Institutes of Health.

OBJECTIVE: To determine the prevalence of cigarette smoking at the National Institutes of Health in Mexico (NIHM). MATERIAL AND METHODS: A survey was performed among workers who voluntarily answered a questionnaire. Smokers were identified with two specific questions, and type of employment was classified as physicians, administrative staff, investigators and support personnel. RESULTS: Total prevalence smoking was 28% (of 4,422 answered questionnaires). It was significantly higher among females, among administrative staff, and common-law and separated workers. It was significantly higher at the Mexican Institute of Psychiatry than at the remaining Institutes, even after adjusting for confounding. The prevalence was also higher among physicians from the same Institute. Of the smokers, 46% do so in their work areas and 78% of them would like to quit. CONCLUSIONS: The prevalence of smokers at the NIHM is as high as in the general population and a broad educational program for tobacco control and prevention is needed.