Evolución del estado nutricional y de la función pulmonar en una cohorte de pacientes con fibrosis quística seguidos en un centro de atención integral / Change over time of nutritional status and lung function in a cohort of patients with cystic fibrosis followed in a multidisciplinary care center

Cystic Fibrosis is a multisystemic inherited disease that requires ongoing care by multidisciplinary teams. The objective of this study is to describe changes on nutrition and lung function in a cohort of patients in a Cystic Fibrosis (CF) Care Center at the Hospital Infantil Universitario San José in Bogotá (HIUSJ), between 2010 and 2013.Is a descriptive study in a cohort of CF patients during four years of follow-up. The quantitative variables were described using medians and interquartile ranges, and the qualitative variables with absolute frequencies and percentages. Descriptive statistics was used to summarize the findings. Of the 63 patients in the initial group, 47 (74.6%) completed the follow-up time. The age range was between 3 to 30 years. The median BMI increased as follows: 17.9 (RIQ: 12.5-25.6) in 2010, 18.6 (RIQ: 12.9-24.8) in 2011, 18.9 RIQ (13.6-26.5) in 2012 and 19.0 (RIQ: 13.5-25.8) in 2013, with lower values in men. The forced expiratory volume in the first second (FEV1) at admission was classified as severe (FEV1 <40%) in 7.1%, moderate (FEV1 40-69%) in 35.7%, mild (FEV1 70-79%) in 7.1% and as normal (FEV1> 80%) in 50%. It is concluded that during the 4 years of follow-up at the HIUSJ CF Center there is an improvement in BMI and a deterioration in lung function in the whole group. The importance of establishing more reference centers to improve clinical outcomes and of implement a National registry to follow up over time are highlighted.

La fibrosis quística es una enfermedad hereditaria, multisistémica, cuyo manejo continuo requiere de equipos multidisciplinarios de salud. El objetivo de este trabajo es describir la evolución nutricional y de la función pulmonar en una cohorte de pacientes en el centro de atención integral de la fibrosis quística (FQ), del Hospital Infantil Universitario San José de Bogotá (HIUSJB), entre 2010 y 2013. Estudio descriptivo, en una cohorte de pacientes, en seguimiento durante cuatro años. Las variables cuantitativas fueron descritas mediante medianas y rangos intercuartílicos y las cualitativas con frecuencias absolutas y porcentajes. De los 63 pacientes del grupo inicial, 47 (74.6%), completaron el tiempo de seguimiento. El rango de edad fue de 3 a 30 años. La mediana del IMC (índice de masa corporal) se incrementó así: 17.9 (RIQ:12.5-25.6) en el 2010, 18.6 (RIQ:12.9-24.8) en el 2011, 18.9 ( RIQ(13.6-26.5) en el 2012 y 19.0 (RIQ:13.5-25.8) en el 2013, con menores valores en los hombres. El volumen espiratorio forzado en el primer segundo (VEF1) al ingreso fue clasificado como severo (VEF1<40%) en el 7.1%, moderado (VEF1 40-69%) en el 35.7%, leve (VEF1 70-79%) en el 7.1% y como normal (VEF1>80%) en el 50%. Se concluye que durante los 4 años de seguimiento en el programa de FQ del HIUSJ, ocurre una mejoría del IMC en todo el grupo y un deterioro de la función pulmonar. Se resalta la importancia de constituir más centros de referencia para mejorar los desenlaces clínicos e implementar un registro Nacional para hacer seguimiento a través del tiempo.

Validación concurrente e implementación de una guía de informe radiológico: determinación de la calidad / Concurrent validation and implementation of a radiology report guideline: determination of quality

Objetivo: Implementar una guía de informe radiológico (GIR). Método: Los parámetros usados para su evaluación fueron: datos demográficos, información clínica, cuerpo del informe y conclusión. Se realizó una validación concurrente determinando los valores de kappa entre dos observadores (30 informes) y a la vez sirvió como prueba piloto. Se hizo una calificación retrospectiva de informes radiológicos del sistema Picture Archiving and Communication System (PACS) del Hospital de la Fundación Santa Fe de Bogotá, con un puntaje de 0 a 100, lo cual indicó la calidad de los informes. Resultados: Se evaluaron 150 informes radiológicos en tres fases: preentrenamiento (fase 1), entrenamiento (fase 2) y postentrenamiento (fase 3). Al comparar las fases 1 y 2, se observó que en la 2 los estudios calificados como buenos y excelentes tenían una diferencia estadísticamente significativa en comparación con la fase 1 (p < 0,01); los estudios excelentes aumentaron y los buenos disminuyeron, mientras que los estudios calificados como aceptables no mostraron una diferencia estadísticamente significativa entre estas dos fases (p < 0,11). Al comparar las fases 2 y 3, no se encontraron diferencias estadísticamente significativas en los estudios calificados como aceptables, buenos o excelentes. Al comparar las fases 1 y 3 se observaron diferencias estadísticamente significativas entre los estudios aceptables, buenos y excelentes (p < 0,01, respectivamente). Conclusión: Este trabajo mostró un efecto positivo luego de la implementación de una GIR basada en estándares internacionales. Los factores evaluados respecto a su calidad mostraron sostenibilidad en el tiempo luego del entrenamiento de la GIR.

Astrocitoma pilocítico juvenil: una presentación poco usual / Juvenile pilocytic astrocytoma: an unusual presentation

El astrocitoma pilocítico es el tumor cerebral de origen glial más común en la edad pediátrica y su localización más frecuente es en la fosa posterior. Es considerado un glioma circunscrito (grado I de la Organización Mundial de la Salud) que, posterior a su resección quirúrgica completa, puede tener tasas de sobrevida hasta del 94 a diez años. La apariencia imaginológica clásica es descrita como una masa quística con un nódulo mural que realza con el medio de contraste en estudios de resonancia magnética y tomografía computarizada. El caso descrito es infrecuente, pues se presenta como una masa predominantemente sólida de localización frontal con un componente principalmente intraventricular.

[Perineal endometriosis with anal external sphincter involvement: a case-report]. / Endometrioma perianal involucrando esfínter anal externo: reporte de un caso.

The presence of perianal endometriosis involving the anal sphincter is a rare presentation of this disease, most cases are diagnosed late and few are reported in the literature despite the number of episiotomies performed today. We present a case in a female with perianal symptoms after an episiotomy 15 years ago and visualized by endoanal ultrasound. We also review the literature of this condition. The treatment of choice is wide excision of the lesion involving the anal sphincter so the sphincter defect should be repaired by sphincteroplasty. According to the literature, early diagnosis by clinical suspicion and confirmation by endoanal ultrasound, with wide excision of endometrioma gives satisfactory results regarding anal continence.

[Experience in surgical management of rectal prolapse in two hospitals in Mexico City]. / Experiencia del tratamiento quirúrgico del prolapso rectal en dos hospitales de tercer nivel en la ciudad de México.

BACKGROUND: Rectal prolapse is defined as a falling out of place of the rectum through anus. Surgery is the treatment of choice to reverse abnormal anatomy and to improve anorectal function. OBJECTIVE: To review the experience in recent years of surgical management of rectal prolapse in the Hospital Central Militar and Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran. METHODS: All patients with rectal prolapse who underwent surgical treatment between January 1993 through December 2008 at two institutions in Mexico City were included. Clinical information was obtained of the clinical files in both hospitals. Main study variables were age, sex, degree of prolapse, morbility and type of surgery performed. RESULTS: Fifty seven patients were included, predominantly female (59.6%) with a mean age of 45 years. The most frequent diagnosis was complete rectal prolapse. Fifteen patients (26%) were treated by perineal procedure and 42 (74%) through abdomen: 17 (40%) open and 25 (60%) laparoscopic. Morbidity rate was lower in the laparoscopic group with less length of hospital stay and a lower blood loss, but with higher recurrence rate. CONCLUSIONS: Although the laparoscopic surgery showed advantage related with a less morbility, blood loss and hospital stay, it showed higher recurrence rates."

Tres factores que influyen en la actitud de las personas ante la donación de órganos: [revisión] / Three influencing factors in people's attitude towards organ donation: [revision]

Se analiza la donación de órganos de cadáver para trasplantes a partir de tres postulados: 1) la influencia de la religión en la donación, particularmente del catolicismo; 2) la organización del sistema de información y acercamiento al donante y su familia, y 3) la formación personal de los miembros del equipo de salud. En la religión se encuentra una disociación entre la norma moral propuesta y la visión de los fieles. España, con su modelo de la Organización Nacional de Trasplantes, es el referente con una alta tasa de donación de órganos y gran credibilidad social en el sistema. El último postulado hace referencia a la importancia de contar con profesionales especialmente capacitados en la materia y en habilidades de comunicación. Se plantea la necesidad de tomar medidas administrativas y educativas que abarquen los puntos discutidos, con el fin de promover eficazmente la donación y aumentar el éxito de los programas de trasplante.

Cadaver organ donation for transplants is analyzed based on three factors: 1) Religious influence. The Catholic Church, as well as other Christian churches, accept transplants and organ donation as a sign of generosity; 2) An efficient information system for donors and families is necessary for obtaining potential donors; 3) The training of all members of the health team, and their personal views are of great importance to donors and family's decisions. There is a dissociation between religious moral principies and believer's perceptions. Spain, with its National Transplant Organization, has become the main point of reference, having a high rate of organs donation and great credibility. The third factor emphasizes the importance of having well trained professionals with the highest communication skills. Educational and management measures are needed for more successful organ donation and transplant programs.

Immunosuppression with generic tacrolimus and mycophenolate mofetil in renal transplant recipients: preliminary report in Chile.

The association of tacrolimus (TAC) and mycophenolate mofetil (MMF) in renal transplant patients has diminished the incidence of acute rejection. We evaluated the use of generic TAC and MMF as primary immunosuppression in 6 living related (LR) and 11 cadaveric (C) donor renal transplant recipients (9 men, 8 women) of mean age 37 +/- 12 years (range, 17-56 years) between May 2006 and June 2007. From day 0 all patients received TAC, MMF, and prednisone without antibody induction. They were followed for the development of acute rejection, graft loss, side effects, and mortality. Mean follow-up was 7.6 months (range, 2-15 months). No biopsy-proven acute rejection episodes, graft loss, or recipient deaths were observed. Creatinine levels at the end of the study were 1.90 +/- 1.0 mg/dL (range, 0.62-4.25 mg/dL for C recipients and 1.19 +/- 0.15 mg/dL (range, 0.91-1.35 mg/dL) for LR recipients. Mean systolic and diastolic blood pressures were 130/73 mm Hg with 12 patients (70.5%) on antihypertensive therapy with calcium antagonists and beta-blockers. Mean (range) of total cholesterol, triglycerides, and glucose were 172 (110-244) mg/dL, 139 (69-277) mg/dL, and 89 (63-129) mg/dL, respectively. MMF was suspended in 1 patient due to diarrhea and 1 other because of leukopenia. We observed that generic TAC and MMF yielded effective and safe immunosuppression in terms of mortality, biopsy-proven acute rejection, and graft loss with a low incidence of adverse effects during the study period.

Therapeutic drug monitoring of mycophenolic acid in kidney transplant patients: a abbreviated sampling strategy.

Mycophenolic acid (MPA) levels have demonstrated a good correlation with clinical outcomes, but with great pharmacokinetic variability between patients. Therapeutic drug monitoring (TDM) is recommended to include a 12-hour area under the concentration-time curve (AUC). Since full AUC estimates are not practical for routine monitoring, limited sampling strategies have been suggested. We evaluated MPA pharmacokinetics in 18 stable renal transplant patients receiving mycophenolate mofetil (MMF) as part of their immunosuppressive therapy. The correlation between measured and estimated AUC was assessed using 4 different sparse sampling algorithms. The mean values for C(0) and AUC(0-6h) were 1.8 +/- 1.2 mg/L and 31.1 +/- 14.8 mg*h/L, respectively. The dose-corrected AUC(0-6h) was 35.4 +/- 17.9 mg*h/L. Regarding the single time points, C(0) showed a low correlation with AUC(0-6h) (r(2) = .34); C(1.5), the best correlation (r(2) = .72); and C(3), the worst (r(2) = .07). Sparse sample algorithms used to estimate 12-hour AUC including C(0), C(1), C(2), C(3), C(4), and/or C(6) showed a good correlation with the calculated AUC(0-6) (r(2) = .81-.96). The algorithm that used C(0), C(1), C(2), and C(4) showed the best correlation, but we also found a good correlation (r(2) = .91) with C(0), C(1), and C(2). Based on these results, we have suggested using the 3-point algorithm (C(0), C(1), and C(2)) for MPA TDM in stable renal transplant patients due to the good correlation with drug exposure and better functionality than an algorithm using a 4-hour postdose measurement.

Glyphosate inhibits melanization of Cryptococcus neoformans and prolongs survival of mice after systemic infection.

Cryptococcus neoformans is a major fungal pathogen and is a relatively common cause of life-threatening meningoencephalitis. Glyphosate is a widely used herbicide that inhibits the synthesis of aromatic amino acids via the shikimate acid pathway. This study investigated the effects of glyphosate on C. neoformans growth, melanization, and murine infection. C. neoformans was relatively resistant to glyphosate, requiring concentrations >250 microg/mL for inhibition. Melanization of C. neoformans in the presence of L-dopa was inhibited by subinhibitory concentrations of glyphosate. Glyphosate inhibited autopolymerization of L-dopa and oxidation of L-epinephrine by cryptococcal cells, which is mediated by a laccase. Administration of glyphosate to mice infected with C. neoformans delayed melanization of yeast cells in vivo and prolonged average mouse survival. The results suggest that inhibition of melanization in vivo may facilitate control of C. neoformans infection.

Systematic analysis of oxidative degradation of polysaccharides using PAGE and HPLC--MS.

Oxidation of polysaccharides yields hydroxyaldehydes and hydroxycarboxylic acids. Aldehydes and carboxylic acids were separately conjugated to 8-aminonaphthalene-1,3,6-trisulfonic acid (ANTS) or tyrosine t-butyl ester (TBT). The ANTS-labeled derivatives were separated by molecular size on PAGE gels and detected by fluorescence. TBT-labeled derivatives were separated by reverse phase chromatography on a C18-HPLC column and analyzed by positive ion electrospray mass spectroscopy (HPLC--MS). This combination of procedures allowed a systematic analysis of carbohydrate oxidation products.

The spheroplast lysis assay for yeast in microtiter plate format.

A yeast lysis assay in the microtiter plate format improved precision and throughput and led to an improved algorithm for estimating lag time. The assay reproducibly revealed differences of 10% or greater in the maximal lysis rate and 50% or greater in the lag time. Clonal differences were determined to be the major source of variation. Microtiter-based assays should be useful for screening for drug susceptibility and for analyzing mutant phenotypes.

A spheroplast rate assay for determination of cell wall integrity in yeast.

The rate of formation of spheroplasts of yeast can be used as an assay to study the structural integrity of cell walls. Lysis can be measured spectrophotometrically in hypotonic solution in the presence of Zymolyase, a mixture of cell wall-digesting enzymes. The optical density of the cell suspension decreases as the cells lyse. We optimized this assay with respect to enzyme concentration, temperature, pH, and growth conditions for several strains of Saccharomyces cerevisiae. The level of variability (standard deviation) was 1-5% between trials where the replications were performed on the same culture using enzyme prepared from the same lot, and 5-15% for different cultures of the same strain. This assay can quantitate differences in cell wall structure (1) between exponentially growing and stationary phase cells, (2) among different S. cerevisiae strains, (3) between S. cerevisiae and Candida albicans, (4) between parental and mutated lines, and (5) between drug- or chemically-treated cells and controls.

Nonideal size-exclusion chromatography with zwitterions causes a pI-dependent elution of proteins from glycerol propylsilane-modified silica.

A potato homogenate containing proteins of similar molecular weights but varying pI values was separated by nonideal size-exclusion chromatography after attempts to resolve the proteins with common size-exclusion chromatography methods failed. The method used a zwitterion buffer to amplify electrostatic interactions between the proteins and the silica matrix. The proteins were sorted on the basis of pI in preference to molecular weight. Subsequent tests with marker proteins of known weight and pI verified the validity of the original findings. The method can be used for separation of isozymes and similarly sized proteins as an alternative to chromatofocusing or isoelectrofocusing.