Evolución de los pacientes con enfermedad hepática crítica / Prognosis of patients with critical hepatic disease

INTRODUCTION: The acute liver failure on chronic (ACLF), is an entity, whose recognition is increasing. The ACLF and CLIF OF indexes have been recently presented with the objective of predicting mortality in this kind of patients. MATERIAL AND METHODS: All patients admitted to the Ramón y Cajal University Hospital diagnosed of acute liver failure on chronic during 2016 and 2017 were collected. We collect the scores: SOFA, CLIF, APACHE II, SAPS II and ACLF score in patients admitted to the ICU by comparing them with each other and define which stages have worse prognosis. RESULTS: A total of 46 patients were collected. The study presents an intra ICU mortality of 31% (15/46) and a six-month mortality of 59.6% (28/46). Patients classified as death, present ACLF values ​​at admission (49.5 vs 60 p = 0.001), and at three days (46.66 vs 59.4 p = 0.001) higher than survivors. In the analysis of the ROC curve, the area under the curve in relation to six-month mortality is higher in the ACLF index (0.8) compared to the MELD (0.69) SOFA (0.66) SAPS II (0.69) or APACHE II (0.65). Patients with ACLF indexes above 65 had an intra UCI mortality of 54%, however, mortality at 6 months is 90%. Patients with ACLF values ​​greater than 65 present mean values ​​of lactic acid, leukocytes, INR or bilirubin higher than those under 65 in a statistically significant manner. CONCLUSIONS: The data presented in this study suggest that the ACLF index works as an adequate predictor of intra-ICU mortality and at 6 months.

INTRODUCCIÓN: El fallo hepático agudo sobre crónico es una entidad cuyo reconocimiento va en aumento. Los índices ACLF y CLIF OF, han sido presentados recientemente con el objetivo de predecir la mortalidad en este tipo de enfermos. MATERIAL Y MÉTODOS: Se recogen todos los pacientes ingresados en una unidad de cuidados intensivos (UCI) de un hospital terciario universitario, diagnosticados de fallo hepático agudo sobre crónico durante 2016 y 2017. Recogemos los índices SOFA, CLIF, APACHE II, SAPS II Y ACLF en pacientes ingresados en UCI comparándolos entre sí. Definimos que estadios presentan peor pronóstico. RESULTADOS: Se analizan un total de 46 pacientes. El estudio presenta una mortalidad intra-UCI del 31% (15/46) y una mortalidad a los seis meses de 59,6% (28/46). Los pacientes clasificados como éxitus presentan valores ACLF al ingreso (49,5 vs 60 p = 0,001), a los tres días (46,66 vs 59,4 p = 0,001) superiores a los supervivientes. En el análisis de la curva COR, el área bajo la curva en relación a la mortalidad a los seis meses, es superior en el índice ACLF (0,8) en comparación con el MELD (0,69) SOFA (0,66) SAPS II (0,69) o APACHE II (0,65). Los pacientes con índices ACLF superiores a 65 presentaban una mortalidad intra-UCI del 54% sin embargo, la mortalidad a los 6 meses es del 90%. Los pacientes con valores ACLF superiores a 65 presentan a su vez valores medios de láctico, leucocitos, INR o bilirrubina mayores de forma estadísticamente significativa. CONCLUSIONES: Los datos presentados en este estudio sugieren que el índice ACLF funciona como un adecuado predictor de mortalidad intra-UCI y a los 6 meses.

Assessment of mining activity on arsenic contamination in surface water and sediments in southwestern area of Santurbán paramo, Colombia.

The current emphasis of developing countries on policies that favor the intensification of mining exploitation as the main source of incomes, has generated negative consequences for ecosystems and rural communities, mainly due to the release of highly toxic elements into the environment. This study was carried out to evaluate the effect of the Vetas-California gold mining district on As distribution in stream sediments and surface water samples from Suratá River, located in the southwestern area of Santurbán paramo, Colombia. With this aim, samples distributed along the high Suratá River basin in areas near and far from mining areas were selected. Samples were chemically characterized. The As mobility, enrichment and sources were evaluated using sequential and single extractions, enrichment factor (EF), geoaccumulation index (Igeo), and hierarchical cluster analysis (HCA). The results highlight high As content (reaching up to 484 mg/kg) in stream sediment sampled near the gold mining district. For both sediment and water, the relative As content along the Suratá River exceeded the background content by 220 and 64.9 times, respectively. From the single-stage extractions performed, the reducible fractions found in As(NaOH) and As(HCl) were higher in all cases, meaning a high level of mobility and lixiviation of the As content in water samples by changes in pH and redox potentials. The correlations estimated using Spearman coefficients show that most of the bioavailable fraction of As(Exch) is related to main sediment constituents such as S, Fe2O3, SiO2, and Al2O3 and the relative As content. Calculation of the enrichment factor (EF) confirms high enrichments around active sites of gold mining such as the municipalities of Vetas, California and Matanza with EF values of 285, 204, and 133, respectively. In addition, the Igeo values suggest moderate to strong As pollution due to the high Igeo found at the major mining effect points. The findings from this study are valuable for providing effective management options for risk prevention and control of the persistent As accumulation in Santurbán paramo.

Virus de la inmunodeficiencia humana en la era TARGA. Experiencia en un hospital de referencia / Human immunodeficiency virus in the intensive care unit in the targa era. Experience in a referral hospital

INTRODUCTION: The cause of ICU admission of HIV patients has changed during the HAART era. OBJECTIVE: To analyze HIV + patients admitted in the ICU of a tertiary university hospital, reference in HIV patients, during the HAART era. To describe the epidemiology of the disease in the ICU, cause of admission and comorbidities. Material and METHODS: Descriptive, retrospective study. HIV + patients admitted to the ICU from May 2013 to November 2017. Collected data: HIV diagnosis, HIV related previous illnesses, previous admissions, HBV coinfection, HCV, lymphocytes, CD4, adherence to treatment, cause of admission, microbiological isolation, severity scores (SOFA, SAPS II, APACHE II), mechanical ventilation, vasoactive drugs, albumin, intra ICU mortality). RESULTS: 1,511 patients were analyzed, 27 had previous diagnosis of HIV +, 5 (18.9%) were not adherent to treatment. Cause of admission: 13 patients altered level of consciousness. 7 patients acute respiratory failure. Seven patients shock. DISCUSSION: Patients who were not adherent to treatment or coinfected with HCV-HBV had lower average of CD4, lymphocyte, albumin and hemoglobin values which were associated with higher mortality and need for vasoactive drugs. (p < 0.005). Non treatment adherent HIV patients admitted to the ICU with infection have higher mortality percentages than those who comply with treatment (p < 0.005).

INTRODUCCIÓN: La causa en ingreso en UCI de los pacientes VIH ha cambiado durante la era TARGA. OBJETIVO: Analizar los pacientes VIH+ que ingresan en UCI de un hospital terciario universitario, referencia de pacientes VIH, durante la era TARGA. Describir la epidemiología de la enfermedad en UCI, motivos de ingreso, comorbilidades. MATERIAL Y MÉTODOS: Estudio descriptivo, retrospectivo. Pacientes VIH+ que ingresan en UCI desde mayo de 2013 hasta noviembre de 2017. Se recoge: diagnóstico VIH, enfermedades previas relacionada, ingresos previos, coinfección VHB, VHC, linfocitos, CD4, cumplimiento de tratamiento, causa de ingreso, aislamiento microbiológico, scores de gravedad (SOFA, SAPS II, APACHE II) ventilación mecánica, fármacos vasoactivos, albúmina, mortalidad intra UCI). RESULTADOS: Se analizan 1.511 pacientes, 27 presentan diagnóstico previo VIH+, 5 (18,9%) no eran cumplidores de tratamiento. Causa de ingreso: 13 pacientes con alteración del nivel de conciencia. Siete pacientes con insuficiencia respiratoria aguda. Siete pacientes shock. DISCUSIÓN: Los pacientes no cumplidores o coinfectados con VHC-VHB, presentan valores medios de CD4, linfocitos, albúmina y hemoglobina menores que se asocian a mayor mortalidad y necesidad de fármacos vasoactivos (p < 0,005). Los pacientes VIH no cumplidores que ingresan en UCI con infección, presentan porcentajes de mortalidad mayores que los cumplidores de tratamiento (p < 0,005).

Quistes de colédoco, una causa inusual de ictericia en pediatría: presentación de serie de casos / Bile duct cysts; an unusual cause of jaundice in paediatrics: presentation of a case series

Introducción Los quistes de la vía biliar o quistes de colédoco (QC) son una patología rara en nuestro medio. La etiología es desconocida, siendo la hipótesis más aceptada las anomalías en la unión biliopancreática. Objetivo Analizar los datos clínicos, diagnóstico y tratamiento de una serie de pacientes diagnosticados de QC y realizar una actualización sobre el tema. Metodo Se revisaron retrospectivamente los diagnósticos de QC en 20 años en un hospital terciario. Casos clínicos Se identificaron 4 casos, con predominio del sexo femenino. Rango de edad 16 meses a 4 años. Los signos y síntomas fueron ictericia y coluria (100%), vómitos (75%), dolor abdominal y acolia (50%). Ninguno tuvo masa palpable. La ecografía abdominal orientó el diagnóstico que se confirmó con colangio-resonancia magnética (colangio-RM). Se clasificaron como QC tipo I tres de los casos y uno como tipo IVa. El tratamiento fue quirúrgico, ningún paciente presentó complicaciones hasta la fecha. Conclusiones Los quistes de las vías biliares son de baja prevalencia. El tratamiento de elección es quirúrgico, requiriendo seguimiento estrecho, dado el riesgo de colangiocarcinoma.

Introduction Cysts of the bile duct or choledochal cysts are rare diseases in our area. The aetiology is unknown, with the most accepted hypothesis being a pancreatobiliary maljunction anomaly. Objective To analyse the clinical data, diagnosis and treatment of a number of patients with choledochal cyst, as well as presenting an update on this condition. Method A retrospective descriptive study was performed on paediatric patients diagnosed with choledochal cyst in the last 20 years in a tertiary hospital. Case reports A total of 4 choledochal cyst cases in childhood, predominantly female, are pre- sented. The most frequent reason for consultation was vomiting, and presenting with jaundice and choluria in all cases. Patients with choledochal cyst were classified as type I in 3 cases, and one case of type IVa. In all cases surgical treatment was performed; any patient had complications to date. Conclusions Cysts of the bile ducts have a low prevalence. The treatment of choice is surgical, requiring close monitoring due to the risk of cholangiocarcinoma.

[Bile duct cysts; an unusual cause of jaundice in paediatrics. Presentation of a case series]. / Quistes de colédoco, una causa inusual de ictericia en pediatría. Presentación de serie de casos.

INTRODUCTION: Cysts of the bile duct or choledochal cysts are rare diseases in our area. The aetiology is unknown, with the most accepted hypothesis being a pancreatobiliary maljunction anomaly. OBJECTIVE: To analyse the clinical data, diagnosis and treatment of a number of patients with choledochal cyst, as well as presenting an update on this condition. METHOD: A retrospective descriptive study was performed on paediatric patients diagnosed with choledochal cyst in the last 20 years in a tertiary hospital. CASE REPORTS: A total of 4 choledochal cyst cases in childhood, predominantly female, are pre- sented. The most frequent reason for consultation was vomiting, and presenting with jaundice and choluria in all cases. Patients with choledochal cyst were classified as type I in 3 cases, and one case of type IVa. In all cases surgical treatment was performed; any patient had complications to date. CONCLUSIONS: Cysts of the bile ducts have a low prevalence. The treatment of choice is surgical, requiring close monitoring due to the risk of cholangiocarcinoma.

When can species abundance data reveal non-neutrality?

Species abundance distributions (SAD) are probably ecology's most well-known empirical pattern, and over the last decades many models have been proposed to explain their shape. There is no consensus over which model is correct, because the degree to which different processes can be discerned from SAD patterns has not yet been rigorously quantified. We present a power calculation to quantify our ability to detect deviations from neutrality using species abundance data. We study non-neutral stochastic community models, and show that the presence of non-neutral processes is detectable if sample size is large enough and/or the amplitude of the effect is strong enough. Our framework can be used for any candidate community model that can be simulated on a computer, and determines both the sampling effort required to distinguish between alternative processes, and a range for the strength of non-neutral processes in communities whose patterns are statistically consistent with neutral theory. We find that even data sets of the scale of the 50 Ha forest plot on Barro Colorado Island, Panama, are unlikely to be large enough to detect deviations from neutrality caused by competitive interactions alone, though the presence of multiple non-neutral processes with contrasting effects on abundance distributions may be detectable.

Environmental occurrence of arsenic in Colombia: a review.

The international literature on the presence of arsenic (As) in Latin America does not disclose the true magnitude of the presence of As in Colombia. In this paper, we summarize the literature on As occurrence in Colombia. The data reveal that As is present in matrices such as soil, sediments and water and in the food chain. Some of the As concentrations exceed the limits specified by national and international regulations. Arsenic higher concentrations are associated with mining regions (e.g., soils, up to 148 mg/kg; sediments, up to 1400 mg/kg) and agricultural areas (e.g., vegetables, up to 5.40 mg/kg; irrigation water, up to 255 µg/L), and underscore the potential human and environmental risks associated with the presence of As in the country. This review highlights the importance of focusing research on understanding the occurrence, origin and distribution of As in Colombia to better understand its environmental and public health impact.