Oral manifestations in patients with coronavirus disease 2019 (COVID-19) identified using text mining: an observational study.

Text mining enables search, extraction, categorisation and information visualisation. This study aimed to identify oral manifestations in patients with COVID-19 using text mining to facilitate extracting relevant clinical information from a large set of publications. A list of publications from the open-access COVID-19 Open Research Dataset was downloaded using keywords related to oral health and dentistry. A total of 694,366 documents were retrieved. Filtering the articles using text mining yielded 1,554 oral health/dentistry papers. The list of articles was classified into five topics after applying a Latent Dirichlet Allocation (LDA) model. This classification was compared to the author's classification which yielded 17 categories. After a full-text review of articles in the category "Oral manifestations in patients with COVID-19", eight papers were selected to extract data. The most frequent oral manifestations were xerostomia (n = 405, 17.8%) and mouth pain or swelling (n = 289, 12.7%). These oral manifestations in patients with COVID-19 must be considered with other symptoms to diminish the risk of dentist-patient infection.

Presence of periodontal pathogenic bacteria in blood of patients with coronary artery disease.

It has been hypothesised that oral bacteria can migrate, through the blood, from the mouth to the arterial plaques, thus exacerbating atherosclerosis. This study compared bacteria present in the peripheral blood of individuals with and without coronary artery disease (CAD). RNA sequences obtained from blood were downloaded from GEO (GSE58150). Eight patients with coronary artery calcification (CAC) scoring > 500 and eight healthy individuals were analysed. After conducting quality control, the sequences were aligned to the hg38 reference genome using Hisat2. Bacterial taxa were analysed by inputting the unmapped sequences into Kraken. Ecological indices were calculated using Vegan. The package DESeq2 was used to compare the counts of bacteria per standard rank between groups. A total of 51 species were found only in patients with CAD and 41 were exclusively present in healthy individuals. The counts of one phylum, one class, three orders, two families and one genus were significantly different between the analysed groups (p < 0.00032, FDR < 10%), including the orders Cardiobacteriales, Corynebacteriales and Fusobacteriales. Twenty-three bacterial species belonging to the subgingival plaque bacterial complexes were also identified in the blood of individuals from both the groups; Fusobacterium nucleatum was significantly less frequent in patients with CAD (p = 0.0012, FDR = 4.8%). Furthermore, the frequency of another 11 bacteria differed significantly among patients with CAD than that among healthy individuals (p < 0.0030, FDR < 10%). These bacteria have not been previously reported in patients with atherosclerosis and periodontitis. The presence of members of the subgingival plaque bacterial complexes in the blood of patients with CAC supports the hypothesis that the periodontopathogens can be disseminated through the blood flow to other body parts where they may enhance inflammatory processes that can lead to the development or exacerbation of atherosclerosis.

BRCA1 and BRCA2 mutations in a sample of breast and ovarian cancer families from the Colombian pacific / Mutaciones en los genes BRCA1 y BRCA2 en una muestra de familias con cáncer de mama y/u ovario del pacífico colombiano

Abstract Introduction: Breast cancer is the most common neoplasia of women from all over the world especially women from Colombia. 5%­10% of all cases are caused by hereditary factors, 25% of those cases have mutations in the BRCA1/BRCA2 genes. Objective: The purpose of this study was to identify the mutations associated with the risk of familial breast and/or ovarian cancer in a population of Colombian pacific. Methods: 58 high-risk breast and/or ovarian cancer families and 20 controls were screened for germline mutations in BRCA1 and BRCA2, by Single Strand Conformation Polymorphism (SSCP) and sequencing. Results: Four families (6.9%) were found to carry BRCA1 mutations and eight families (13.8%) had mutations in BRCA2. In BRCA1, we found three Variants of Uncertain Significance (VUS), of which we concluded, using in silico tools, that c.81­12C>G and c.3119G>A (p.Ser1040Asn) are probably deleterious, and c.3083G>A (p.Arg1028His) is probably neutral. In BRCA2, we found three variants of uncertain significance: two were previously described and one novel mutation. Using in silico analysis, we concluded that c.865A>G (p.Asn289Asp) and c.6427T>C (p.Ser2143Pro) are probably deleterious and c.125A>G (p.Tyr42Cys) is probably neutral. Only one of them has previously been reported in Colombia. We also identified 13 polymorphisms (4 in BRCA1 and 9 in BRCA2), two of them are associated with a moderate increase in breast cancer risk (BRCA2 c.1114A>C and c.8755­66T>C). Conclusion: According to our results, the Colombian pacific population presents diverse mutational spectrum for BRCA genes that differs from the findings in other regions in the country.

Resumen Introducción: El cáncer de mama es la neoplasia más común en mujeres de todo el mundo, y, también de Colombia. 5% a 10% de todos los casos son causados por factores hereditarios; 25% de estos casos tienen mutaciones en los genes BRCA1/BRCA2. Objetivo: El propósito de este estudio fue el de identificar mutaciones asociadas con riesgo de cáncer de mama y/u ovario familiar en pacientes del pacífico colombiano. Métodos: Fueron revisados para mutaciones en BRCA1 y BRCA2 de línea germinal mediante SSCP y secuenciación 58 familias de alto riesgo para cáncer de mama y/u ovario y 20 controles Resultados: cuatro familias (6.9%) presentaron mutaciones en BRCA1 y ocho familias (13.8%) en BRCA2. En BRCA1, encontramos tres variantes de significado clínico desconocido (VUS), de las cuales concluimos, usando herramientas bioinformáticas, que c.81­12C>G y c.3119G>A (p.Ser1040Asn) son probablemente deletéreas, y c.3083G>A (p.Arg1028His) es probablemente neutral. En BRCA2, encontramos tres VUS: una mutación nueva y dos previamente descritas, usando análisis bioinformáticos, concluimos que c.865A>G (p.Asn289Asp) y c.6427T>C (p.Ser2143Pro) son probablemente deletéreas y c.125A>G (p.Tyr42Cys) es probablemente neutral. Solo una de ellas ha sido reportada previamente en Colombia. También identificamos 13 polimorfismos (4 en BRCA1 y 9 en BRCA2), dos de ellos asociados con un moderado incremento del riesgo para cáncer de mama (BRCA2 c.1114A>C and c.8755­66T>C). Conclusión: de acuerdo con nuestros resultados, la población del suroccidente colombiano presenta un espectro mutacional diverso para los genes BRCA que difiere de lo encontrado en otras regiones del país.

BRCA1 and BRCA2 mutations in a sample of breast and ovarian cancer families from the Colombian pacific.

INTRODUCTION: Breast cancer is the most common neoplasia of women from all over the world especially women from Colombia. 5%-10% of all cases are caused by hereditary factors, 25% of those cases have mutations in the BRCA1/BRCA2 genes. OBJECTIVE: The purpose of this study was to identify the mutations associated with the risk of familial breast and/or ovarian cancer in a population of Colombian pacific. METHODS: 58 high-risk breast and/or ovarian cancer families and 20 controls were screened for germline mutations in BRCA1 and BRCA2, by Single Strand Conformation Polymorphism (SSCP) and sequencing. RESULTS: Four families (6.9%) were found to carry BRCA1 mutations and eight families (13.8%) had mutations in BRCA2. In BRCA1, we found three Variants of Uncertain Significance (VUS), of which we concluded, using in silico tools, that c.81-12C>G and c.3119G>A (p.Ser1040Asn) are probably deleterious, and c.3083G>A (p.Arg1028His) is probably neutral. In BRCA2, we found three variants of uncertain significance: two were previously described and one novel mutation. Using in silico analysis, we concluded that c.865A>G (p.Asn289Asp) and c.6427T>C (p.Ser2143Pro) are probably deleterious and c.125A>G (p.Tyr42Cys) is probably neutral. Only one of them has previously been reported in Colombia. We also identified 13 polymorphisms (4 in BRCA1 and 9 in BRCA2), two of them are associated with a moderate increase in breast cancer risk (BRCA2 c.1114A>C and c.8755-66T>C). CONCLUSION: According to our results, the Colombian pacific population presents diverse mutational spectrum for BRCA genes that differs from the findings in other regions in the country.

INTRODUCCIÓN: El cáncer de mama es la neoplasia más común en mujeres de todo el mundo, y, también de Colombia. 5% a 10% de todos los casos son causados por factores hereditarios; 25% de estos casos tienen mutaciones en los genes BRCA1/BRCA2. OBJETIVO: El propósito de este estudio fue el de identificar mutaciones asociadas con riesgo de cáncer de mama y/u ovario familiar en pacientes del pacífico colombiano. MÉTODOS: Fueron revisados para mutaciones en BRCA1 y BRCA2 de línea germinal mediante SSCP y secuenciación 58 familias de alto riesgo para cáncer de mama y/u ovario y 20 controles. RESULTADOS: cuatro familias (6.9%) presentaron mutaciones en BRCA1 y ocho familias (13.8%) en BRCA2. En BRCA1, encontramos tres variantes de significado clínico desconocido (VUS), de las cuales concluimos, usando herramientas bioinformáticas, que c.81­12C>G y c.3119G>A (p.Ser1040Asn) son probablemente deletéreas, y c.3083G>A (p.Arg1028His) es probablemente neutral. En BRCA2, encontramos tres VUS: una mutación nueva y dos previamente descritas, usando análisis bioinformáticos, concluimos que c.865A>G (p.Asn289Asp) y c.6427T>C (p.Ser2143Pro) son probablemente deletéreas y c.125A>G (p.Tyr42Cys) es probablemente neutral. Solo una de ellas ha sido reportada previamente en Colombia. También identificamos 13 polimorfismos (4 en BRCA1 y 9 en BRCA2), dos de ellos asociados con un moderado incremento del riesgo para cáncer de mama (BRCA2 c.1114A>C and c.8755­66T>C). CONCLUSIÓN: de acuerdo con nuestros resultados, la población del suroccidente colombiano presenta un espectro mutacional diverso para los genes BRCA que difiere de lo encontrado en otras regiones del país.

Hepatitis anictérica como manifestación de sífilis congénita / Anicteric Hepatitis as Congenital Syphilis Manifestation

La sífilis congénita es un problema de salud pública mundial, la mayoría de los neonatos infectados no presenta manifestaciones clínicas de la enfermedad y la determinación de Ig M específica utilizada para el diagnóstico es de bajo rendimiento, por lo que el diagnóstico en el recién nacido depende del diagnóstico de sífilis en la gestante. Presentamos la historia clínica de una recién nacida, hija de una madre con sífilis gestacional inadecuadamente tratada. Durante su hospitalización se evidenció compromiso hepático con aumento de la aspartato amino transferasa e hiperbilirrubinemia con aumento de la fracción conjugada. Se descartó compromiso de SNC. Los cultivos para gérmenes comunes de sangre y orina fueron negativos. Las determinaciones de Ig M para CMV, rubeola, toxoplasma , Herpes I y II fueron negativas. Las ecografías transfontanelar, cardiaca, renal y de vías urinarias y hepatobiliar fueron normales. Durante la hospitalización, a los 9 días de vida presentó un episodio de infección bacteriana asociada. Recibió tratamiento con penicilina cristalina durante 14 días con normalización de los niveles de bilirrubina y de aspartato aminotransferasa. El seguimiento clínico y serológico a los 3 meses de edad mostró patrón de crecimiento y desarrollo normal y VDRL no reactiva.

Congenital syphilis is a global public health problem. The majority of infected children have no clinical manifestations of the disease and the specific IgM determination in newborns has low diagnostic performance. The diagnosis depends mostly of the diagnosis in mothers before birth. We report a newborn that was inadequately treated prenatally. At birth, the liver involvement was detected, with increase in aspartate amino transferase and of conjugated fractions of bilirubin. CNS involvement was ruled out and cultures of blood and urine were negative for bacteria. Determinations for IgM of CMV, rubella, toxoplasmosis and herpes I and II, were negative. Transfontanellar, heart, kidney, urinary tract and hepatobiliary ultrasound examinations were normal. Crystalline penicillin treatment for 14 days was undertaken, obtaining normal levels of bilirubin and aspartate aminotransferase at the end of treatment. The clinical and serological follow-up after 3 months showed a normal growth and development pattern with non-reactive VDRL tests.

Evaluación de la reproducción inducida de nicuro Pimelodus blochii (Telostei: Pimelodidae) utilizando diferentes inductores hormonales / Evaluation of induced breeding of Pimelodus blochii nicuro (telostei, pimelodidae) using different inducing hormone

Objetivo. Evaluar el efecto de dos inductores hormonales en la reproducción inducida de nicuro Pimelodus blochii. Materiales y métodos. Para los procesos experimentales fueron utilizados adultos sexualmente maduros, sometidos a tres tratamientos aplicados vía intramuscular, en dosis única de 0.25 mL/kg Ovaprim® (OVAP) (T1), 0.5 mL/kg de OVAP (T2) y 6.25 mg/kg de Extracto de Hipófisis de Carpa (EHC) (T3), para este último tratamiento la inyección fue dividida en 20 y 80%, con un intervalo de 12 h entre aplicaciones. Previo a la extracción de los gametos, los animales fueron tranquilizados por inmersión en una solución de Metanosulfonato de Tricaina (90 mg/L). El desempeño reproductivo fue evaluado mediante el índice de ovulación (hembras ovuladas/hembras tratadas), fecundidad absoluta (Fa) (ovocitos/hembra), fecundidad relativa (Fr) en función del número de ovocitos desovados por gramo de peso. La fecundación se realizó en seco y seis horas post-fecundación (HPF) se determinó la tasa de fertilidad. Resultados. La ovulación (ºh) para el T1 fue a las 297.1±30.0, T2 294.6±32.9 y T3 247.3±13.1 ºh. En todos los tratamientos se obtuvieron hembras ovuladas, donde los mayores índices de ovulación fueron obtenidos con Ovaprim® (T1 y T2) con 36.4 y 50%, respectivamente. Las tasas de fecundación obtenidas fueron mayores a un 50%, para el tratamiento 1 y 2, con valores de 74.5 y 32.7%, respectivamente. Conclusiones. El uso de inductores hormonales puede ser efectivo para garantizar la reproducción inducida del nicuro, en dosis única de 0.25 y 0.5 mL/kg de Ovaprim®.

Objective. Evaluate the effect of two hormonal inducers in induced breeding of nicuro Pimelodus blochii. Materials and methods. The experimental process used sexually mature adults exposed to three intramuscular treatments, a single dose of 0.25 mL/g Ovaprim® (OVAP) (T1), 0.5 mL/kg of OVAP (T2) and 6.25 mg/kg of pituitary carp extract (EPC) (T3), for the latter treatment the injection was divided into 20 and 80%, with an interval of 12 hours between applications. Prior to the removal of gametes, the animals were tranquilized by immersion in a Tricaine Methanesulfonate (90 mg/L) solution. Reproductive performance was evaluated using ovulation rates (females ovulated/treated females), fertility (Fa) (eggs/female), relative fertility (Fr) depending on the number of eggs spawned per gram of weight. The dry method of fertilization was used and the fertility rate was determined six hours post-fertilization (HPF). Results. The Ovulation (ºh) was: for T1 297.1±30.0, T2 294.6±32.9 and T3 247.3±13.1ºh. Ovulated females were obtained in all treatments, where the highest rates of ovulation were obtained with Ovaprim ® (T1 and T2) with 36.4 and 50% respectively. Fertilization rates were higher than 50% for treatments 1 and 2, with values of 74.5 and 32.7% respectively. Conclusions. The use of hormonal inducers may be effective to ensure nicuro induced reproduction with a single dose of 0.25 and 0.5 mL/kg Ovaprim®.

Prevalencia y severidad de las lesiones precursoras de malignidad en una área de alto riesgo de cáncer gástrico. Pasto 2012 / Prevalence and severity of gastric cancer precursor lesions in a high risk area

Las lesiones precursoras de malignidad (gastritis crónica atrófica, metaplasia intestinal y displasia leve), según lo demuestran múltiples estudios, están claramente relacionadas con el riesgo que presentan como predictoras del cáncer gástrico y más aún en nuestra región considerada como de alto riesgo de esta patología. Se realizó un estudio prospectivo descriptivo con 212 pacientes entre 11 y 89 años de edad procedentes de la zona amarilla del departamento de Nariño, atendidos en el Centro de Investigaciones de Enfermedades Digestivas (CIED) del Centro Hospital La Rosa dependiente de la ESE Pasto Salud a quienes se tomaron 7 biopsias de mucosa gástrica sometidas a un procesamiento y coloración especial de Giemsa modificado para detectar lesiones precursoras de malignidad y presencia de Helicobacter Pylori. La prevalencia para gastritis crónica atrófica antrocorporal fue de 38,6%, metaplasia intestinal 24,4% y displasia leve 1,5%; presencia de infección para Helicobacter pylori en gastritis crónica atrófica 73,5%, para metaplasia intestinal 52% y displasia leve 100%; en relación a la severidad de las lesiones precursoras de malignidad de acuerdo a la escala de OLGA, 11,5% se clasificó como estadios III y IV; a excepción de un solo caso clínico todos fueron Helicobacter Pylori positivos. Se pone en consideración de la comunidad médica el protocolo del CIED para seguimiento y vigilancia de las lesiones precursoras de malignidad tratando de demostrar que la mayor estrategia sigue siendo la prevención para el control del cáncer gástrico en las regiones de alto riesgo.

Atrophic chronic gastritis (ACG), intestinal metaplasia (IM) and mild dysplasia (MD)) are all precursor lesions which have been clearly demonstrated by many studies to be related to risks for development of gastric cancer (GC). This is especially true in our region which is considered to be a high risk area for this disease. We conducted a prospective study of 212 patients between the ages of 11 and 89 years who were from the yellow zone of Nariño. Patients were cared for in the Centro de Investigaciones de Enfermedades Digestivas (CIED - Center for the Investigation of Digestive Diseases) at the Centro Hospital la Rosa which is part of the public health care system of Pasto. Seven gastric mucosa biopsies were taken from each subject and stained with specially modified Giemsa stain to detect precursor lesions and the presence of Helicobacter pylori. The prevalence of ACG was 38.6%, the prevalence of IM was 24.4%, and the prevalence of MD was 1.5%. Prevalence of H. pylori infections among patients with ACG was 73.5% while among patients with IM it was 52%, but prevalence rose to 100% among patients with MD. When severity of precursor lesions on the OLGA-staging (Operative Link for Gastritis Assessment) scale was 11.5%, lesions were classified as stage III and IV. With one exception, all of these patients were H. pylori positive. We would like to ask the medical community to consider CIED's Follow-up and Monitoring Protocol for precursor lesions in order to demonstrate that the best strategy continues to be GC prevention in high risk regions.

Hiperamonemia neonatal causada por defectos del ciclo de la urea / Neonatal hyperammonemia in urea cycle disorders patients

Los defectos del ciclo de la úrea se deben a deficiencias de diferentes enzimas; las manifestaciones clínicas son similares y están relacionadas con la hiperamonemia. Se presentan las historias clínicas de tres neonatos a término, sin evidencia de alteración al nacimiento. Se les detectó hiperamonemia y se sospechó enfermedad metabólica. La cromatografía de aminoácidos sugirió defectos del ciclo de la úrea. El manejo incluyó dieta con restricción de proteínas, administración de benzoato de sodio, exsanguinotransfusión y diálisis peritoneal pese a lo cual fallecieron. Se revisan las causas de hiperamonemia en el neonato y se propone una secuencia para su diagnóstico.

Determinación del gen aac(6´)-aph(2´´) asociado con resistencia a aminoglucósidos en cepas de Staphylococcus coagulasa negativa en una unidad neonatal en Bogotá / Detection of gene aac(6´)-aph(2´´) in associated with aminoglucosides resistance in Staphylococcus coagulase-negative strains isolates from one neonatal unit in Bogota

Antecedentes. La causa más común de resistencia a antibióticos aminoglucósidos en bacterias Gram positivas, especialmente en S. epidermidis, es la enzima modificante AAC(6’)-APH(2"), capaz de acetilar y fosforilar un amplio rango de antibióticos. Objetivo. Determinar la presencia del gen aac(6’)-aph(2") en cepas de Staphylococcus coagulasa negativa aisladas en infecciones neonatales, e investigar la concordancia con las pruebas de sensibilidad in-vitro.Material y métodos. Se determinó la presencia del gen aac(6’)-aph(2") en 63 cepas de estafilococos coagulasa negativa provenientes de hemocultivos y puntas de catéter, de la Unidad de Neonatología del Instituto Materno Infantil, en Bogotá. Resultados. Staphylococcus epidermidis fue el germen más frecuente y el gen aac(6’)-aph(2") estaba presente en 55 (87,3%) cepas; de éstas, 42 (73,4%) cepas provenían de hemocultivos y 13 (23,6%) cepas de punta de catéter. La susceptibilidad a gentamicina se determinó mediante concentración inhibitoria mínima y para amikacina por difusión en disco. No se encontró asociación estadísticamente significativa entre la presencia del gen aac(6’)-aph(2") y la resistencia a gentamicina y amikacina. Conclusión. La presencia del gen aac(6’)-aph(2") de resistencia a aminoglucósidos es muy alta en cepas de Staphylococcus epidermidis. Diferencias en la expresión del gen pueden explicar parcialmente la falta de consistencia con las pruebas de susceptibilidad utilizadas en la clínica.

Background. The most common cause of resistance to aminoglucosides is the acetilation and phosphorilation of the antibiotic by the enzyme AAC(6’)APH(2"). Objetive. To determine the presence of the gene aac(6’)-aph(2") in strains of coagulase-negative Staphylococci isolated from infected neonates and to investigate the concordance with the susceptibility tests in-vitro. Materials and methods. the aac(6’)-aph(2") gene was determined in 63 coagulase-negative Staphylococci strains isolated from blood cultures and catheter tips obtained from the neonatal care unit at the Instituto Materno Infantil in Bogotá, Colombia. Results. Staphylococcus epidermidis was the most frequently identified microorganism. The aac(6’)-aph(2") gene was detected in 55 out of 63 strains (73,43%), 42 strains (87,5%) isolated from blood cultures, and 13 strains (23,6%) isolated from catheter tips. Susceptibility to gentamycin was determined by minimum inhibitory concentration, and susceptibility to amikacin by the disk diffusion antibiotic sensitivity test. There was no a significant statistical association between the presence of the gene and the microbial susceptibility to either gentamycin or amikacin. Conclusion. The presence of the aac(6’)-aph(2") gene in strains of Staphylococcus epidermidis is very high. Differences in the expression of the gene might explain some cases of inconsistency with the susceptibility tests.

Encefalopatía neonatal. Algo mas que asfixia al nacer / Neonathal encefhalopathy something more that perinatal asphysia

La hiperglicinemia no cetósica (HGNC) es un error innato del metabolismo, de carácter recesivo, debido a un defecto en el sistema de clivaje, que ocasiona acumulación de glicina en la sangre y en el sistema nervioso central, donde activa dos receptores diferentes. El receptor localizado en la médula espinal, inhibitorio, provoca la apnea y el hipo de estos pacientes. El receptor cortical, excitatorio, produce la lesión cerebral y las convulsiones. Se presenta la historia de un recién nacido masculino, a término, que se torna encefalopático en los primeros días de vida. No presentó hipoglicemia, acidosis metabólica, cetosis ni hiperamonemia. La ecografía transfontanelar fue normal. A los seis días ameritó ventilación mecánica. La cromatografía en capa fina mostró banda de glicina en plasma y orina. El paciente recibió manejo con benzoato de sodio, diazepam y restricción proteica. A los 20 días de vida presentó mejoría neurológica y salió del hospital a los 42 días de vida con igual manejo. El estudio de acilcarnitinas en sangre por tandem-masas hecho en Santiago de Compostela fue normal. La cuantificación de aminoácidos hecha en el CEDEM mostró aumento de los niveles de glicina en plasma y LCR y la relación glicina LCR / plasma confirmó el diagnóstico de hiperglicinemia no cetósica típica. Se revisan las causas de encefalopatía neonatal y se plantea una secuencia para el diagnóstico.

Neuropharmacological profile of ethnomedicinal plants of Guatemala.

We carried out the Irwin's test with some different extracts of the aerial parts of Thidax procumbens L., the leaves of Neurolaena lobata (L.) R. Br., bark and leaves of Byrsonima crassifolia (L.) Kunth. and Gliricidia sepium Jacq. Walp., and root and leaves of Petiveria alliacea L. At dosage of 1.25 g dried plant/kg weight aqueous extracts of bark and leaves of Byrsonima crassifolia (L.) Kunth. and Gliricidia sepium Jacq. Walp. demonstrated the most activity: decrease in motor activity, back tonus, reversible parpebral ptosis, catalepsy and strong hypothermia. These extracts of both plants were assayed for effects on CNS and they caused very significant reductions in spontaneous locomotor activity, exploratory behavior and rectal temperature and they increased the sodium pentobarbital-induced sleeping time.

[Anticoagulation in hemodialysis with a single dose of low molecular weight heparin]. / Anticoagulación en hemodiálisis con dosis única de heparina de bajo peso molecular.

The aim of this work was to compare the benefits and problems of low molecular weight heparin use in chronic hemodialysis, compared to conventional heparin. We studied 35 patients that received low molecular weight heparin (Enoxaparine, molecular weight 4000) during 115 consecutive hemodialysis procedures and conventional heparin during the subsequent 35 procedures. We assess the heparin dose, partial thromboplastin time before dialysis and at 3 and 120 min during the procedure, arterio-venous fistula compression time, clot formation in the circuit and residual volume of filters. Median total dose of conventional heparin was 6289 U (range 3000-10000) compared to 5555 U (range 2000-8000) of low molecular weight heparin. When the dose was calculated per kg of body weight, it was lower for low molecular weight heparin than for conventional heparin (87.8 U (range 33-100) vs 100 U (range 50-176)). Partial thromboplastin time achieved was lower with low molecular weight heparin, compared with conventional heparin, at 3 (64.26 vs 125.2 sec) and 120 min (39.1 vs 84.45 sec). Clot formation, arteriovenous fistula compression time and residual volume of filters were similar for both types of heparin. It is concluded that a single dose of low molecular weight heparin simplifies anticoagulation during hemodialysis, modifies less the partial thromboplastin time and does not alter filter re-utilization.

[Sclerotherapy with 75% ethanol in the control of hemorrhage caused by peptic ulcer disease]. / Escleroterapia con etanol al 75% en el control de la hemorragia por enfermedad ulcero-péptica.

We present our experience using ethanol as sclerosant of non-variceal bleeding lesions of the upper digestive tract and the result of its hemostatic effect when compared with patients who received conventional medical treatment. Since January 1989, 48 patients admitted with active bleeding or signs of high risk for rebleeding (clot or visible vessel) were submitted to sclerosis. The historic control group included patients admitted before 1989, being both groups comparable in clinical and endoscopic characteristics. Surgery was performed in 5 cases of the sclerosis group (10.4%) versus 14 of the control group (37.8%). Five of the patients in the sclerotherapy group died, one of them due to upper G.I. bleeding as the primary cause. We dit not observe a statistically significant difference in hospital stay, transfusion requirements or mortality. There were no complications as a result of the method. Sclerotherapy was not immediately effective in 2 patients; three patients who rebled were subject to new sclerosis, which was effective in controlling bleeding in two of them. In conclusion, sclerosis is a safe and effective method to achieve hemostasis, diminishing the re-bleeding and the need for surgery in cases of digestive bleeding due to peptic ulcer disease. Future studies using larger samples could show decrease in mortality.

[Clinical and prognostic factors of mortality in upper digestive hemorrhage]. / Factores clínicos pronósticos de mortalidad en hemorragia digestiva superior.

In order to investigate prognostic factors we prospectively followed 741 patients with upper gastrointestinal bleeding (UGIB). Eleven variables were identified with mortality predictive value. Hematemesis, age of 50 y/o, more than 120 heart beat/minute, 3 or more units of pack red blood cells, esophageal varices, cirrhotic liver and renal failure had independent predictive value. Our findings could help to identify high risk patients.

[Upper gastrointestinal hemorrhage. Prospective analysis of 741 cases]. / Hemorragia digestiva superior. Analisis prospectivo de 741 casos.

A prospective study was performed to evaluate the epidemiological characteristics and clinical outcome of patients with upper digestive bleeding. Between April 1987 and May 1993, 741 patients, 517 men and 224 women, with a mean age of 50.48 years (range, 12 to 94) were admitted to the emergency department with this diagnosis. The chief complaint was tarry stool (88.4%). A total of 717 patients underwent endoscopic examination within a mean time of 17.2 hours of arrival at the emergency department. Duodenal ulcers were found in 216 (35.9%) patients, gastric ulcer in 240 (32.4%), gastritis in 74 (10%), esophageal varices in 38 (5.1%), and other causes in 121 patients (16.5%). 478 required blood transfusion (range of 1 to 15 blood units transfused). 80.4% of patients who died necessitated transfusion versus 62.5% of the patients who had a satisfactory outcome. A total of 672 cases (92%) were managed with medical therapy. In 90 cases (12.2%) endoscopic injection treatment with 75% alcohol was performed. 60 patients (8.18%) had surgical therapy, 81.7% of whom underwent emergency operation to arrest bleeding. The global mortality was 10.6% (78 of 741 patients), compared to 18.3% in patients who were operated. The highest mortality occurred in patients with esophageal varices. We conclude that peptic ulcer is still the mayor cause of upper digestive bleeding. The high mortality found in patients who required surgical therapy creates the need to select those patients who may get benefits of alternate therapies which may improve the outcome.

Evaluación de indicadores indirectos de salud mental en los barrios El Paraíso, Sucre y San Martín de Bogotá / evaluation of indirect indicators of mental health in the districts El Paraíso, Sucre y San Martín from Bogotá

Con el objetivo principal de identificar factores de riesgo capaces de generar enfermedad mental se llevó a cabo un estudio de corte transversal. Se realizaron 300 encuestas en una muestra de familias de tres barrios del nororiente de Bogotá, en las que se interrogaba sobre variables socio económicas y psicosociales identificadas previamente