Utilidad del apósito liofilizado de piel de cerdo en el manejo de cicatrización de úlcera de pie diabético / Usefulness of lyophilized pig skin dressings in wound healing as treatment for diabetic foot ulcer

Resumen Objetivo: Mostrar la utilidad del apósito liofilizado de piel de cerdo comparado con el manejo conservador con sulfadiazina de plata en el proceso de cicatrización de la úlcera de pie diabético. Materiales y Método: Estudio cuasiexperimental en pacientes con diagnóstico de pie diabético, se establecieron 2 grupos de estudio utilizando una relación 2:1, el grupo de exposición (10 pacientes) tratado con apósito liofilizado de piel de cerdo y el grupo de control (5 pacientes) manejado con sulfadiazina de plata. La utilidad se midió con la cicatrización en semanas de tratamiento. El análisis estadístico incluyó prueba de t, prueba de z, regresión logística simple y cálculo de la probabilidad del evento. Resultados: El tiempo de cicatrización fue más corto en el grupo manejado con apósito liofilizado de piel de cerdo (10,20 semanas) que en el grupo con manejo a base de sulfadiazina de plata (13,8 semanas). A las 9 semanas de iniciado el tratamiento, la mitad de las pacientes con apósito de piel de cerdo ya habían cicatrizado comparado con la cicatrización en el grupo manejado con sulfadiazina de plata (20%). La probabilidad de cicatrización a las 11 semanas en paciente manejados con sulfadiazina de plata es 20% y con apósito liofilizado de piel de cerdo 80%. Conclusión: El apósito liofilizado de piel de cerdo tuvo mejores resultados en el estudio, comparado con el manejo estándar con sulfadiazina de plata. Es necesario realizar un estudio aleatorizado para determinar la efectividad de este material como herramienta terapéutica.

Aim: To demonstrate the usefulness of lyophilized pig skin dressings versus usual management with silver sulfadiazine in wound healing treatment for diabetic foot ulcers. Materials and Method: In this quasi-experimental study, we included patients diagnosed with diabetic foot. We established two groups with a distribution (2:1), the exposure group treated with lyophilized pig skin dressings (10 patients) and the control group (5 patients), the standard of care with silver sulfadiazine. Usefulness was measured with wound healing in treatment weeks. Statistical analysis included t-test, z-test, simple logistic regression, and calculation of probability of an event. Results: Wound healing time was shorter in the group treated with lyophilized pig skin dressing (10.20 weeks) than in the group treated with silver sulfadiazine (13.8 weeks). At 9 weeks after treatment started, 50% of patients treated with lyophilized pig skin dressings had complete wound healing compared with the patients in the group managed with silver sulfadiazine. (20%). The probability of wound healing been completed at 11 weeks in a patient managed with silver sulfadiazine is 20%, compared to lyophilized pig skin dressings is 80%. Conclusion: Lyophilized pig skin dressings had better outcomes than silver sulfadiazine in wound healing treatment for diabetic foot ulcers inside the study. Is mandatory develop another study with a randomized design to determinate the effectiveness as a therapeutic alternative.

Anti-nucleosome antibodies increase the risk of renal relapse in a prospective cohort of patients with clinically inactive systemic lupus erythematosus.

An important goal in the management of systemic lupus erythematosus (SLE) is the prediction of relapses. This study assesses whether anti-nucleosome antibodies (anti-NCS) increase the risk of renal relapse in inactive SLE. A prospective cohort of 115 patients with inactive SLE (M-SLEDAI ≤ 2) were followed for 12 months to assess the development of relapse (increase of M-SLEDAI ≥ 4) and specific renal flare (renal SLEDAI ≥ 4). At baseline, we identified potential risk factors for relapse, including anti-NCS. At baseline, 18 (16%) of the 115 patients with inactive SLE were anti-NCS positive. At the 12-month follow-up, anti-NCS-positive patients had a higher incidence of renal relapse compared to anti-NCS-negative patients (38.9% vs 13.4%, respectively). In Cox regression analysis, after adjusting for age, disease duration, anti-dsDNA, and immunosuppressive drugs, the presence of anti-NCS positivity at baseline increased the risk of renal relapse (HR: 5.31, 95% CI 2.03-13.92). Nevertheless, there were no differences in the incidence of other relapses in anti-NCS-positive versus anti-NCS-negative. Our results indicate that in inactive SLE, anti-NCS determination can be useful for identifying patients with a higher risk of developing renal relapse. Interestingly, this study identified that continued use of oral immunosuppressive therapy in patients with inactive SLE can reduce the risk of renal relapse.

Etnomedicina en Los Altos de Chiapas, México / Ethnomedicine in The Highlands of Chiapas, Mexico

The objective of the this research was to register the current popular therapeutic use of medicinal plants in the Tzotzil indigenous population, in The Highlands of Chiapas, Mexico. The data were collected from 59 informants (39% men, 61% women) between 20 and 86 years old, through a semi-structured questionnaire in the Tzotzil language. From the information collected, a total of 59 species of medicinal plants were registered, belonging to 55 genera and 37 botanical families. The families Asteraceae (with 6 species and UR=51), Lamiaceae (4, UR=37) and Lauraceae (4, UR=21), are were the most representative in the study area. The highest use value index (UVI) was reported for Matricaria chamomilla (UVI=0.42), Mentha sativa (UVI=0.36) and Ruta graveolens (UVI=0.31). According to the informant consensus factor (ICF), the main pathological categories treated are were of the reproductive system (ICF=0.80), respiratory infections (ICF=0.75) and diseases of the digestive system (ICF=0.70). The species reported and their diversity of uses satisfy the needs of families with socioeconomic deficiencies.

El objetivo de la esta investigación fue registrar el uso terapéutico popular actual de plantas medicinales en la población indígena Tzotzil, en Los Altos de Chiapas, México. Los datos fueron recolectados de 59 informantes (39% hombres, 61% mujeres) entre 20 y 86 años, a través de un cuestionario semiestructurado en el idioma Tzotzil. De la información recabada, se registraron un total de 59 especies de plantas medicinales, pertenecientes a 55 géneros y 37 familias botánicas. Las familias Asteraceae (con 6 especies y RU=51), Lamiaceae (4, RU=37) y Lauraceae (4, RU=21), son fueron las más representativas en el área de estudio. El índice de valor de uso más alto (IVU) se informó para Matricaria chamomilla (IVU=0.42), Mentha sativa (IVU=0.36) y Ruta graveolens (IVU=0.31). Según el factor de consenso del informante (FCI), las principales categorías patológicas tratadas son fueron del sistema reproductivo (ICF=0.80), las infecciones respiratorias (ICF=0.75) y las enfermedades del sistema digestivo (ICF=0.70). Las especies reportadas y su diversidad de usos satisfacen las necesidades de las familias con deficiencias socioeconómicas.

Serum levels of P-glycoprotein and persistence of disease activity despite treatment in patients with systemic lupus erythematosus.

Around 25% of patients with systemic lupus erythematosus (SLE) could be refractory to conventional therapies. P-glycoprotein expression on cell surface has been implied on drug resistance, however, to date, it is unknown if P-gp serum levels are associated with SLE disease activity. Evaluate the association of serum P-gp levels and SLE with disease activity despite treatment. A cross-sectional study was conducted on 93 female SLE patients, all receiving glucocorticoids at stable doses for the previous 6 months before to baseline. SLE patients were classified into two groups: (a) patients with active disease [SLE disease activity index (SLEDAI) ≥ 3] despite treatment, and (b) patients with inactive disease (SLEDAI < 3) after treatment. Forty-three healthy females comprised the control group. Serum P-gp, anti-DNA, and both anti-nucleosome antibody levels were measured using ELISA. Active-SLE patients despite treatment had higher P-gp levels compared with inactive-SLE after treatment (78.02 ng/mL ± 114.11 vs. 33.75 ng/mL ± 41.11; p = 0.018) or versus reference group subjects (30.56 ng/mL ± 28.92; p = 0.011). P-gp levels correlated with the scores of SLEDAI (r = 0.26; p = 0.01), Mexican-SLEDAI (MEX-SLEDAI) (r = 0.32; p = 0.002), SLICC/ACR damage index (r = 0.47; p < 0.001), and with prednisone doses (r = 0.33; p = 0.001). In the multivariate model, the high P-gp levels were associated with SLICC/ACR score (p = 0.001), and SLEDAI score (p = 0.014). Our findings support a relationship between serum P-gp levels and SLE with disease activity despite treatment, but it requires further validation in longitudinal studies.

Serum levels of adiponectin and leptin as biomarkers of proteinuria in lupus nephritis.

INTRODUCTION: There are controversial results about the role of serum leptin and adiponectin levels as biomarkers of the severity of proteinuria in lupus nephritis. OBJECTIVE: The aim of this study was to evaluate the relationship between serum leptin and adiponectin levels with severity of proteinuria secondary to lupus nephritis (LN). METHODS: In a cross-sectional study, 103 women with systemic lupus erythematosus (SLE) were evaluated for kidney involvement. We compared 30 SLE patients with LN, all of them with proteinuria, versus 73 SLE patients without renal involvement (no LN). A comprehensive set of clinical and laboratory variables was assessed, including serum levels of leptin and adiponectin by ELISA. Multivariate analyses were used to adjust for potential confounders associated with proteinuria in LN. RESULTS: We found higher adiponectin levels in the LN group compared with the no LN group (20.4 ± 10.3 vs 15.6 ± 7.8 µg/mL; p = 0.02), whereas no differences were observed in leptin levels (33.3 ± 31.4 vs 22.5 ± 25.5 ng/mL; p = 0.07). Severity of proteinuria correlated with an increase in adiponectin levels (r = 0.31; p = 0.001), but no correlation was observed with leptin. Adiponectin levels were not related to anti-dsDNA or anti-nucleosome antibodies. In the logistic regression, adiponectin levels were associated with a high risk of proteinuria in SLE (OR = 1.06; 95% CI 1.01-1.12; p = 0.02). Instead, leptin was not associated with LN. CONCLUSION: These findings indicate that adiponectin levels are useful markers associated with proteinuria in LN. Further longitudinal studies are required to identify if these levels are predictive of renal relapse.

The ability of selected cladoceran species to utilize domestic wastewaters in Mexico City.

The population growth patterns of four cladocerans, viz. Alona rectangula, Ceriodaphnia dubia, Moina macrocopa and Daphnia pulex on wastewaters from a treatment plant at Iztacalco, Mexico City were analyzed in this study. Crude wastewater (tank A) did not support A. rectangula and all animals in the replicates died after 5 days. A. rectangula with partially treated wastewater (tank B) showed growth curves similar to controls where algal density was 1 x 10(6) cells ml(-1). With wastewater from tank C (last stage before treatment with purifying agents such as chlorine), the populations maintained a low density (7 ind. ml(-1)). In wastewaters from tanks A and B, C. dubia showed no positive population growth, but in water from tank C, they maintained a low density (2 ind. ml(-1)). D. pulex showed no positive growth in all replicates involving wastewater. Only in controls (diet of algae Chlorella), the population density increased with time. M. macrocopa showed higher population growth in crude wastewaters than controls. Partially treated wastewater from tank B also resulted in a greater population growth than in the controls. However, when wastewater from the tank C was used, the population declined after day 12. Under comparable conditions, A. rectangula reached much higher peak abundances (55 ind. ml(-1)) than the rest of the cladoceran species. The rates of population growth (r) of the tested cladoceran species followed trends similar to the peak population densities. A. rectangula had the highest growth rates (0.25 per day) in controls and from the wastewater from tank B. The r-values were negative for A. rectangula and C. dubia in crude wastewater. For M. macrocopa the r-values were higher (0.19) in crude wastewater than in algae (0.15). However, r-values of M. macrocopa became negative when cultured in treated wastewater from tank C.

[Prognostic factors associated with mortality in newborns with congenital diaphragmatic hernia]. / Factores pronósticos asociados a mortalidad en recién nacidos con hernia diafragmática congénita.

UNLABELLED: The objective was to identify prognostic factors associated with mortality in newborns with congenital diaphragmatic hernia. METHODS: Study design was cases and controls nested in a cohort. We studied 65 newborns. Variables analyzed included gestational age, birth weight, Apgar and Silverman scores, surgery timing, presence of pneumothorax, degree of pulmonary hypoplasia, persistent pulmonary hypertension, mean airway pressure, blood gas analysis, ventilatory indexes, and risk of death score at admission. RESULTS: Median gestational age was 38 weeks and median birth weight was 2,975 g. Lung hypoplasia ranged from 20-95%. Mortality was 40%; its main cause was persistent pulmonary hypertension. In multivariate analysis significant prognostic factors were risk of death > 50% (ORa = 59, 95% Confidence interval [CI] = 9.6-361) and mean airway pressure > 13 (ORa = 6, 95% CI = 1.2-29). CONCLUSIONS: Factors that influence prognosis of newborns with congenital diaphragmatic hernia are related with ventilation process as well as mortality risk score at admission to neonatal intensive care unit.

Tripanosomiasis americana cerebral en un paciente con síndrome de inmunodeficiencia adquirida, diagnóstico por exámen directo y confirmado por reacción de polimerasa en cadena (PCR) en líquido cefalorraquídeo / A case report of a cerebral american trypanosomiasis in a patient with aids, diagnosed by direct examination of cerebrospinal fluid and confimred by pcr

Se describe la aparición de un cuadro meningoencefálico en un paciente con enfermedad de chagas 7 años después de que las pruebas para el virus de inmunodeficiencia adquirida (VIH) dieran positivas. Formas compatibles con tripomastigotes de Trypanosoma cruzi fueron visualizadas al microscopio de luz en LCR y posteriormente comprobadas como tales por reacción de polimerasa en cadena (PCR). El paciente fue tratado con benznidazol y ha sobrevivido 2 años al cuadro meningoencefálico con buena recuperación de las funciones cerebrales. Se trata del primer caso reportado en Venezuela donde la inmunosupresión, inducida por VIH, determinó una reactivación de la enfermedad de Chagas que involucró al SNC. La enfermedad de Chagas es endémica en Venezuela y en buena parte de Latinoamérica y es creciente el número de pacientes con VIH/SIDA, por lo que la probabilidad de coinfección debe ser tomada en cuenta a fin de iniciar un tratamiento antiparasitario oportuno. Se discute la importancia del examen del LCR para la detección de T. cruzi como patógeno oportunista en los cuadros meningoencefálicos de pacientes con VIH/SIDA, el uso del PCR como indicador temprano de la presencia de parásitos en sangre o tejidos y la posibilidad de iniciar tratamientos parasiticidas en todos los pacientes seropositivos para ambas enfermedades