[Classical nephroprotection: Renin angiotensin aldosterone system inhibitors]. / Nefroprotección clásica: inhibidores del sistema renina angiotensina aldosterona.

The role of the renin angiotensin aldosterone system (RAAS) in the pathophysiology of hypertension, cardiovascular disease and kidney disease has been known for years. RAAS inhibitors have been the mainstay of chronic kidney disease (CKD) treatment. Studies have shown that therapy with angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensinII receptor blockers (ARBs) reduce the excretion of albuminuria and slow the progression of kidney disease in patients with and without diabetes. In clinical practice, RAAS inhibitors are recommended as the antihypertensive of choice in patients with CKD and albuminuria with or without diabetes. In addition, they have demonstrated cardiovascular benefits beyond blood pressure control. The use of RAAS inhibitors in non-proteinuric nephropathy and advanced CKD is not without controversy. Double blockade of the RAAS is contraindicated. On the other hand, it is essential to know how to titrate doses and avoid side effects, mainly hyperkalaemia.

[Primary neurolymphomatosis in the cauda equina as the initial symptom of human immunodeficiency virus]. / Neurolinfomatosis primaria de cola de caballo como manifestacion inicial del virus de la inmunodeficiencia humana.

TITLE: Neurolinfomatosis primaria de cola de caballo como manifestacion inicial del virus de la inmunodeficiencia humana.

A little key to oxalate formation in oil paints: protective patina or chemical reactor?

By means of synchrotron based techniques, we propose an integrated mechanism for the degradation of 19th century chrome yellow oil paints based on pigment reconstructions from historical recipes. We show that for certain paint formulations the darkening of these colours is triggered by the binder photodegradation which leads to the formation of calcium oxalate at the expense of the filler CaCO3, and the reduction of the chrome yellow pigment (Cr6+/Cr3+). Considering that calcium oxalate is formed as a thin superficial layer, that may prevent light absorption by the paint bulk, we discuss its role as protective patina.

Microplastics in coastal sediments from Southern Portuguese shelf waters.

Microplastics are well-documented pollutants in the marine environment that result from fragmentation of larger plastic items. Due to their long chemical chains, they can remain in the environment for long periods of time. It is estimated that the vast majority (80%) of marine litter derives from land sources and that 70% will sink and remain at the bottom of the ocean. Microplastics that result from fragmentation of larger pieces of plastic are common to be found in beaches and in the water surface. The most common microplastics are pellets, fragments and fibres. This work provides original data of the presence of microplastics in coastal sediments from Southern Portuguese shelf waters, reporting on microplastic concentration and polymer types. Microplastic particles were found in nearly 56% of sediment samples, accounting a total of 31 particles in 27 samples. The vast majority were microfibers (25), identified as rayon fibres, and fragments (6) identified as polypropylene, through infrared spectroscopy (µ-FTIR). The concentration and polymer type data is consistent with other relevant studies and reports worldwide.

Evidence of microplastics in samples of zooplankton from Portuguese coastal waters.

Records of high concentrations of plastic and microplastic marine debris floating in the ocean have led to investigate the presence of microplastics in samples of zooplankton from Portuguese coastal waters. Zooplankton samples collected at four offshore sites, in surveys conducted between 2002 and 2008, with three different sampling methods, were used in this preliminary study. A total of 152 samples were processed and microplastics were identified in 93 of them, corresponding to 61% of the total. Costa Vicentina, followed by Lisboa, were the regions with higher microplastic concentrations (0.036 and 0.033 no. m⁻³) and abundances (0.07 and 0.06 cm³ m⁻³), respectively. Microplastic: zooplankton ratios were also higher in these two regions, which is probably related to the proximity of densely populated areas and inputs from the Tejo and Sado river estuaries. Microplastics polymers were identified using Micro Fourier Transformed Infrared Spectroscopy (µ-FTIR), as polyethylene (PE), polypropylene (PP) and polyacrylates (PA). The present work is the first report on the composition of microplastic particles collected with plankton nets in Portuguese coastal waters. Plankton surveys from regular monitoring campaigns conducted worldwide may be used to monitor plastic particles in the oceans and constitute an important and low cost tool to address marine litter within the scope of the Marine Strategy Framework Directive (2008/56/EC).

Reacción anafiláctica secundaria a quiste hidatídico hepático roto / Anaphylactic reaction secondary to a ruptured liver hydatid cyst: case report

We report a four years old girl consulting in the emergency room for severe abdominal pain and vomiting secondary to a blunt abdominal trauma during a bicycling accident. A chest and abdomen CAT scan showed ruptured hydatid cysts in the lung and liver and free intraperitoneal fluid. During evolution, the patient developed respiratory distress, bronchial obstruction, a papular exanthema and edema. Due to lack of response to steroids, she was operated excising the ruptured hepatic cyst and performing a peritoneal lavage. The patient had a good postoperative evolution. In a second surgical procedure, the lung cyst was excised. The patient is currently receiving albendazole and is asymptomatic after nine months of follow up.

La hidatidosis es una enfermedad parasitaria, zoonótica y endémica de gran importancia en nuestro país. El quiste hidatídico no complicado suele ser asintomático y es más frecuente encontrarlo en población adulta, siendo infrecuente su diagnóstico en la población pediátrica. Presentamos el caso de una paciente de 4 años de edad derivada al Servicio de Urgencia del Hospital de Chillán por cuadro de abdomen agudo posterior a trauma abdominal con manubrio de bicicleta, cuyo estudio tomográfico reveló la presencia de quiste hidatídico hepático y pulmonar rotos, que evoluciona con reacción anafiláctica secundaria.

Perfil microbiológico del saco herniario en hernias complicadas operadas en el Servicio de Urgencias / Infection of hernia sac of complicated abdominal hernias

Background: When a complicated hernia is operated, there may be a higher risk of infection when a mesh is placed in a place potentially colonized by intestinal bacteria translocated from the gut. Aim: To perform a microbiological study of the hernia sac of patients subjected to emergency surgery due to complicated hernias. Material and Methods: Prospective study of patients operated for complicated abdominal hernias. Prior to the repair, a culture was obtained from the exposed sac. A portion of this sac was excised and cultured also. Results: Forty one patients aged 46 to 88 years (30 females) were studied. Only one sac tissue sample culture was positive. In six patients, the sac surface cultures disclosed coagulase negative Staphiloccocus. These patients did not receive antimicrobial therapy and although a mesh was placed, no comphcation was recorded. It is possible that these positive cultures were due to contamination of samples. Conclusions: From a microbiological point of view it is safe to place a mesh during the repair of complicated hernias.

La incarceración de una hernia abdominal es una de las emergencias quirúrgicas más comunes. La reparación protésica de las hernias complicadas está aún en discusión, ya que muchos cirujanos temen la infección de la malla al implantarla en un sitio inflamado y potencialmente colonizado por bacterias translocadas desde el tubo digestivo. Nuestro estudio tiene como objetivo el determinar la presencia de estos microorganismos en el saco hemiario de los pacientes adultos operados de urgencia con diagnóstico de hernia abdominal complicada, a través de cultivos de la superficie y fragmento del mismo, junto con establecer una correlación con las variables clínicas y de laboratorio del paciente al ingreso. Se estudiaron 41 pacientes, observándose un cultivo positivo en la muestra de tejido del saco. Por otro lado, seis pacientes cuyas muestras de superficie resultaron con desarrollo de Staphiloccocus coagulosa negativo, a pesar de no utilizarse terapia antibiótica y haberse reparado con malla, presentaron una excelente evolución sin complicaciones ulteriores, por lo tanto, no descartamos que las muestras correspondan a falsos positivos debido a contaminación de las mismas. Nuestra casuística permite aportar con un antecedente más al algoritmo de decisiones acerca de la utilización de prótesis en hernioplastía de urgencia. Nos parece que desde el punto de vista microbiológico local, la reparación protésica parece ser segura.

Efficacy of fluoroquinolones against pathogenic oral bacteria.

This article reviews the characteristics of the main fluoroquinolones used in dentistry (ciprofloxacin, levofloxacin and moxifloxacin), including pharmacokinetic/ pharmacodynamic parameters, susceptibility profiles of oral bacteria and clinical trials on their efficacy in dental practice. It seems that some of these antibiotics might represent a safe alternative in patients with allergy, intolerance, or lack of response to beta-lactams.

Authentic cell-specific and developmentally regulated expression of pro-opiomelanocortin genomic fragments in hypothalamic and hindbrain neurons of transgenic mice.

The pro-opiomelanocortin (POMC) gene is expressed in a subset of hypothalamic and hindbrain neurons and in pituitary melanotrophs and corticotrophs. POMC neurons release the potent opioid beta-endorphin and several active melanocortins that control homeostasis and feeding behavior. POMC gene expression in the CNS is believed to be controlled by distinct cis-acting regulatory sequences. To analyze the transcriptional regulation of POMC in neuronal and endocrine cells, we produced transgenic mice carrying POMC27*, a transgene containing the entire 6 kb of the POMC transcriptional unit together with 13 kb of 5' flanking regions and 8 kb of 3' flanking regions. POMC27* was tagged with a heterologous 30 bp oligonucleotide in the third exon. In situ hybridization studies showed an accurate cell-specific pattern of expression of POMC27* in the arcuate nucleus and the pituitary. Hypothalamic mRNA-positive neurons colocalized entirely with beta-endorphin immunoreactivity. No ectopic transgenic expression was detected in the brain. Deletional analyses demonstrated that neuron-specific expression of POMC transgenes required distal 5' sequences localized upstream of the pituitary-responsive proximal cis-acting elements that were identified previously. POMC27* exhibited a spatial and temporal pattern of expression throughout development that exactly paralleled endogenous POMC. RNase protection assays revealed that POMC27* expression mimicked that of POMC in different areas of the CNS and most peripheral organs with no detectable ectopic expression. Hormonal regulation of POMC27* and POMC was identical in the hypothalamus and pituitary. These results show that distal 5' sequences of the POMC gene located between -13 and -2 kb target expression into the CNS of transgenic mice in a precise neuron-specific, developmentally and hormonally regulated manner.

Accurate spatial and temporal transgene expression driven by a 3.8-kilobase promoter of the bovine beta-casein gene in the lactating mouse mammary gland.

The spatial, temporal, and hormonal pattern of expression of the beta-casein gene is highly regulated and confined to the epithelial cells of the lactating mammary gland. Previous studies have shown that 1.7 kb of the bovine beta-casein promoter were able to drive cell-specific and hormone-dependent expression to a mouse mammary cell line but failed to induce accurate expression to the mammary gland of transgenic mice. We investigated here the ability of 3.8 kb of the bovine beta-casein gene promoter to drive the expression of the human growth hormone (hGH) gene in transgenic mice. A Northern blot analysis using total RNA obtained from different tissues of lactating and nonlactating females revealed the presence of hGH mRNA only in the mammary gland of lactating females. hGH mRNA was not detectable in the mammary gland of virgin females or males. A developmental analysis showed that hGH mRNA only peaked on parturition, resembling more closely the bovine beta-casein temporal expression pattern rather than the murine. In situ hibridization studies performed on mammary gland sections showed that the cellular pattern of hGH expression was homogeneous in all lobules from heterozygous and homozygous transgenic mice. Silver grain counts on the tissue sections highly correlated with the hGH contents in the milk determined by radioimmunoassay (r = 0.996). Thus 3.8 kb of the bovine beta-casein promoter direct a high-level expression of a reporter gene to the lactating mammary gland of transgenic mice in a tissue-specific and developmentally regulated manner.

Mujeres y desplazamiento: una realidad en la ciudad de Montería / Women and displacement: a reality in the city of Monteria

La realización de este estudio es producto de la urgencia de reconocer la realidad de las mujeres desplazadas por la violencia, enfrentadas a un exodo forzado. Pretende ubicar esas dimensiones que toma la cotidianidad en que se desenvuelven sus interacciones sociales y se manifiestan las relaciones de género. Las mujeres son mayoritarias entre los afectados por la violencia política en Colombia. En muchos trabajos y en diversas investigaciones realizadas acerca de esta temática no se examinan sus especificidades. Se encontraron vacios en los enfoques y los análisis realizados hasta ahora sobre la problemática de las mujeres migrantes porque estos no profundizan en la vulnerabilidad particular de las mujeres, quienes, al no tener preparación suficiente para desenvolverse en el mercado laboral, inexorablemente son discriminadas socialmente y quedan confinadas en oficios mal pagados con salarios que sólo les permiten sobrevivir, afectándose asi su dignidad y sus derechos. Esta investigación recoge un proceso inicial de promoción y educación de mujeres desplazadas en la ciudad de Monteria, dinamizado por la Corporación Maria Cano. Desde la visión de género, se analizaron las condiciones y los contextos en los cuales ellas intervienen; también se estudió la invisibilidad de la violencia que se ejerce sobre las mujeres desplazadas, para impulsar la real aplicación de los derechos humanos en las comunidades receptoras

Nefropatía IgA: experiencia en el Hospital Universitario del Valle / IgA nephropathy: experience in the Hospital del Valle

Se estudiaron 56 casos de nefropatía IgA, que se obtuvieron en 506 biopsias renales exitosas efectuadas entre 1980 y 1989 en el Hospital Universitario del Valle, Cali, Colombia. El objetivo fue establecer la prevalencia e incidencia de los hallazgos histoinmunopatológicos y para ello se revisaron 80,005 informes de biopsias elaboradas en ese período. El (59 por ciento) correspondió al sexo femenino. La hematuria aislada fue la presentación de clínica más comúnmente observada (67.8 por ciento) y fue seguida por el síndrome nefrótico (26.8 por ciento). Los depósitos mesangiales percibidos en mayor número fueron los de IgA en 16 casos (28.6 por ciento): 10 (17.8) de IgA más C3 y de IgA más IgG, respectivamente. Todos tenían proliferación mesangial celular y en 25 pacientes (44.6 por ciento) la proliferación mesangial fue mixta, celular y de matriz asociadas. En 7 (12.5 por ciento) se vieron esclerosis focal segmentaria y crecientes, con cambios intersticiales y atrofia tubular en 9 de ellos (16 por ciento), respectivamente. El (5.4 por ciento) 3,156 de los pacientes evolucionaron hacia la insuficiencia renal terminal y fueron transplantados. La nefropatía IgA no es una entidad tan benigna como se sugirió y es la primera causa de la glomerulonefritis primaria y de la hematuria glomerular. Se requieren pruebas urinarias y biopsias renales tempranas para su diagnóstico y manejo precoz (INV.)

Daño miocárdico secundario a asfixia neonatal grave / Myocardial damage following neonatal severe asphyxia

Se estudian prospectivamente dieciséis recién nacidos con asfixia grave, con el propósito de evaluar el compromiso miocárdico y su forma de presentación clínica. En tres RNT AEG (18,7%) se diagnóstico daño miocárdico a través de electrocardiogramas seriados realizados durante las primeras 72 horas de vida. Dos de ellos evidenciaron signos de isquemia subendocárdica difusa y el tercero un trazado compatible con necrosis de pared posteroinferior del ventrículo izquierdo. La medición de la creatinfosfoquinasa y su fracción MB no fue útil para determinar lesión miocárdica. Los tres neonatos evolucionaron con un síndrome de dificultad respiratoria sin insuficiencia cardíaca. Uno de ellos falleció, encontrándose en el estudio histopatológico hemorragias focales en los músculos papilares y septum. Este estudio demuestra la importancia de efectuar electrocardiogramas seriados en los neonatos con asfixia grave, puesto que la disfunción cardíaca puede cursar en forma inadvertida, manifestándose como un síndrome de dificultad respiratoria