Ventilación mecánica y traqueotomía. Protocolo de destete de ventilación mecánica y decanulación de la Unidad de Cuidados Respiratorios Intermedios de la Fundación Jiménez Díaz / Mechanical ventilation weaning protocol and decannulation of the Intermediate Respiratory Care Unit of the Fundación Jiménez Díaz

En este artículo se pretende presentar un protocolo de decanulación de pacientes procedentes de los Servicios de Cuidados Intensivos en los que el destete de ventilación mecánica ha sido imposible, saliendo de esta unidad con ventilación mecánica sobre traqueotomía. La aparición de unidades de cuidados intermedios respiratorios ha hecho posible ubicar en ellas a estos pacientes al ser unidades donde se maneja la vía aérea superior, la ventilación mecánica y la endoscopia respiratoria. Nuestro Servicio de Neumología dispone de una Unidad de Cuidados Intermedios y tiene amplia experiencia en el destete de ventilación mecánica y posterior decanulación de estos enfermos. No existe en la literatura ningún artículo que presente de manera global el manejo de estos enfermos, por ello presentamos el protocolo que seguimos en nuestra unidad y con el que obtenemos unos resultados muy favorables en este tipo de enfermos (AU)

This article presents a decanulation protocol procedure for difficult to wean patients from the intensive care units in whom mechanical ventilation weaning has not been possible, and left this units needing invasive mechanical ventilation and tracheotomy. The appearance of the socalled Intermediate Respiratory Units allow pulmonologists, specialized in critical care medicine to treat these patients as those units deal with upper airway management, artificial invasive and non invasive mechanical ventilation and respiratory endoscopy. Our Pulmonology service include an intermediate respiratory unit and have wide experience in weaning patients from mechanical ventilation and subsequent decanulation. At present, no article in the literature globally explains the management of these patients. We present the protocol we follow in our unit with which we have obtained very favorable results in this type of patient (AU)

Duplication dup(1)(q41q44) defined by fluorescence in situ hybridization: delineation of the 'trisomy 1q42-->qter syndrome'.

We report on a novel case of pure partial tandem duplication 1q42q43 confirmed by fluorescence in situ hybridization (FISH). We compare the manifestations of our patient with similar cases previously reported. We conclude that the most common clinical manifestations of trisomy 1q42qter are prenatal and postnatal growth retardation, relative macrocephaly, triangular face, prominent forehead, broad nasal bridge, abnormal philtrum, micro/retrognathia, cardiac defects and mental retardation. We would like to emphasize the importance of the FISH technique in the identification of the duplicated segment.

Euchromatic variant 16p+. Implications in prenatal diagnosis.

BACKGROUND: Euchromatic imbalances at the cytogenetic level are usually associated with phenotypic consequences. Among the exceptions are euchromatic variants of chromosome 16 (16p+) with normal phenotype. There is a growing list of euchromatic duplications and deletions involving both G-positive and G-negative bands that seem to be phenotypically neutral, but these euchromatic variants are rare. OBJECTIVE: The aim of this report is to describe a new familial case of euchromatic variant 16p+ and to emphasise the misinterpretation of these rare euchromatic variants particularly when ascertained at prenatal diagnosis. METHODS AND RESULTS: Fluorescence in situ hybridisation with clone RP11-261A7 showed an amplified signal in the larger chromosome 16. This clone contains FLJ43855 gene, similar to sodium- and chloride-dependent creatine transporter. CONCLUSION: So, this 16p+ variant that involves amplification of pseudogenetic sequences is considered a polymorphism in normal individuals.

Multiple data sets, congruence, and hypothesis testing for the phylogeny of basal groups of the lizard genus Sceloporus (Squamata, Phrynosomatidae).

Several data partitions, including nuclear and mitochondrial gene sequences, chromosomes, isoenzymes, and morphological characters, were used to propose a new phylogeny and to test previously published hypotheses about the phylogenetic positions of basal clades of the lizard genus Sceloporus and the relationship of Sceloporus to the former genus "Sator". In accord with earlier studies, our results grouped "Sator" as internal to Sceloporus, and both support a hypothesis of transgulfian vicariance for the origin of the former genus "Sator" on islands in the Sea of Cortez. Robustness of support for internal nodes in our best tree was established though widely used indices (bootstrap proportions, decay values) but also through congruence among independent data partitions. Several deep nodes in the tree recovered by several methods, including equally weighted and differentially weighted parsimony and maximum likelihood models, are only weakly supported by the traditional indices. This methodological concordance is taken as evidence for insensitivity of the deep structure of the topology to alternative assumptions.

Mice infected with the larvae of Taenia crassiceps exhibit a Th2-like immune response with concomitant anergy and downregulation of Th1-associated phenomena.

Infection of intermediate hosts with eggs of taeniid parasites results in a larval infestation known as cysticercosis. A number of studies have indicated that cysticercosis is associated with immunosuppression, although little is known about the mechanisms involved. In the present study, mice infected with the larvae of Taenia crassiceps were found to exhibit a pronounced energy, which preferentially affected T-cells located anatomically close to the parasite. This anergy was linked to late events in the T cell activation pathway; that is, stimulation through the T cell receptor(TCR)/CD3 complex by Concanavalin-A, or plate-bound monoclonal antibodies (mAb) to TCR alpha beta or CD3 epsilon, or combinations of phorbol ester and ionomycin (all of which can bypass early membrane-related events), failed to fully activate T lymphocytes. The relative proximity of T cells to the parasite was directly related to upregulation of IL-4 and downregulation of IL-2 production. In addition, the profiles of parasite-specific Abs showed an exclusive increase of serum IgG1 during infection. Taken together, the data suggest that infection of mice with larvae of T. crassiceps alters the balance of CD4+ Th cells by upregulating Th2 and downregulating Th1 cells located in close proximity to the parasite.

Epidemiology of cattle anaplasmosis in Colombia: I. prevalence and distribution of agglutinating antibodies.

A survey to detect antibodies against Anaplasma marginale, using the Card Test, was conducted on serum samples collected from cattle of Cordoba Department and north-eastern region of the Department of Antioquia in the Republic of Colombia. The samples were from native cattle of Spanish descent (Bos taurus), Zebu (Bos indicus) and various Zebu-native crosses. The age range was between three and eight year olds. The results revealed that 90.3% of the samples were positive. All breeds showed a high prevalence of antibodies.