Validación externa y reproducibilidad del cuestionario PUMA para el diagnóstico de EPOC en una población latinoamericana: validación externa del cuestionario PUMA / External validation and reproducibility of the PUMA questionnaire for the diagnosis of COPD in a Latin American population: external validation of the PUMA questionnaire

Resumen El uso de escalas de predicción clínica puede incrementar la detección temprana de enfermedad pulmonar obstructiva crónica (EPOC). Su rendimiento en población latinoamericana ha sido pobremente estudiado. Nuestro objetivo fue determinar la validez y reproducibilidad del cuestionario PUMA, como herramienta de tamización en atención primaria en población colombiana, mediante un estudio tipo corte transversal; donde se establecieron las características operativas del cuestionario, área bajo la curva de características operativas del receptor (ACOR) y el mejor punto de corte para esta población. 1.980 sujetos fueron incluidos en el análisis. La prevalencia de EPOC correspondió a 18,9%. La capacidad discriminatoria del cuestionario fue de 0,69 (IC95%: 0,66-0,72), para un punto de corte óptimo mayor de 5, con una sensibilidad del 60%, especificidad 66% y un valor predictivo negativo de 88%. La escala PUMA para tamizaje de pacientes en riesgo de EPOC tiene una capacidad discriminatoria moderada y una excelente reproducibilidad en la población estudiada.

The use of clinical prediction scales may increase the early detection of chronic obstructive pulmonary disease (COPD). The performance characteristics of these scales in the Latin American population is poorly studied. We aimed to evaluate validity and reproducibility of PUMA questionnaire as a screening tool in primary care in a Colombian population. A cross-sectional study was performed. Operational characteristics of the questionnaire, the area under the received operator curve (AUROC), and the best cut-off point of the score were calculated. 1,980 individuals were included in this analysis. Prevalence of COPD was 18.9%. AUROC of the questionary was 0.69 (CI95%: 0.66-0.72), with an optimal cut-off point greater than 5 (sensitivity 60%, specificity 66%); predictive negative value was 88%. PUMA's scale for the screening of patients at risk of COPD has a moderate accuracy and an excellent reproducibility in the studied population.

Evaluación in vitro de la capacidad biorremediadora de hongos filamentosos sobre petróleo crudo / Bioremediative Capacity Evaluation in vitro of the filamentous fungi on crude oil

Resumen Objetivo. Evaluar la capacidad biorremediadora de algunas especies de hongos filamentosos en suelos contaminados con petróleo crudo. Métodos. Se aislaron 138 cepas a partir de 90 cultivos primarios en muestras de suelos obtenidas en los municipios de Yondó (Antioquia), Acacías (Meta) y Tumaco (Nariño), se identificaron las especies por medio de claves taxonómicas y la amplificación por PCR de la región ITS ubicándose en siete géneros de hongos filamentosos. Del total de las especies se escogieron tres para el experimento que fueron: Neosartorya sp. Cepa A/N -1, Aspergillus sp. Cepa Y/As-3 y Rhizomucor sp. Cepa 1A/R-1; se realizó la micorremediación con la técnica de Landfarming modificado al diseñarse un microcosmos con 50g de suelo contaminado con petróleo crudo °API de 21.6 a concentraciones de 20.000 ppm y 30.000ppm para cada una de las especies en un inóculo de 300 conidios/ml en agua destilada, ajustado en cámara de Neubauer y las tres especies en consorcio en suelo contaminado con petróleo crudo °API de 21.6 a concentraciones de 40.000ppm, 60.000ppm, 80.000ppm y 100.000ppm con un inóculo de 300 conidios/ml. Se valoró el proceso por espectofotometría. Además se estableció las enzimas empleadas en la micorremediación y la citotoxicidad de las cepas empleadas. Resultado. La micorremediación realizada por las especies individuales fue en promedio entre 2 y 6 días y cuando se aplicaron las tres especies en consorcio se realizó en un promedio entre 6 y 10 días, la enzima empleada es peroxidasa y la citotoxicidad es negativa.

Abstract Objective. Evaluate the bioremediation capacity of some species of filamentous fungi in soils contaminated with crude oil. Methods. 138 strains were isolated from 90 primary culture in soil samples obtained in the municipalities of Yondó (Antioquia), Acacías (Meta) and Tumaco (Nariño), species were identified by means of taxonomic keys and PCR amplification of the ITS region located in seven genera of filamentous fungi. Of the total of the species, three were chosen for the experiment, which were: Neosartorya sp. Cepa A/N- 1, Aspergillus sp. Cepa Y/As -3 and Rhizomucor sp. Cepa 1A/R-1; Micoremediation was performed with the modified Landfarming technique when designing a microcosm with 50g of soil contaminated with crude oil API 21.6 at concentrations of 20,000 ppm and 30,000ppm for each of the species in an inoculum of 300 conidia / ml in water distilled, adjusted in Neubauer chamber and the three species in consortium in soil contaminated with crude oil API 21.6 at concentrations of 40,000ppm, 60,000ppm, 80,000ppm and 100,000ppm with an inoculum of 300 conidia / ml. The process was evaluated by spectrophotometry. In addition, the enzymes used in the micoremediation and cytotoxicity of the strains used were established. Result. The micoremediation performed by the individual species was on average between 2 and 6 days and when the three species were applied in a consortium it was carried out on average between 6 and 10 days, the enzyme used is peroxidase and the cytotoxicity is negative.

Microscopic mild focal cortical dysplasia in temporal lobe dual pathology: an electrocorticography study.

BACKGROUND: Associations between electrophysiological and histological findings might provide an insight into the epileptogenicity of mild focal cortical dysplasia (FCD) in patients with temporal lobe epilepsy (TLE) and a dual pathology. SUBJECTS AND METHODS: A total of 22 patients with pharmacoresistant TLE were included in the study, 16 of them with histologically confirmed hippocampal sclerosis (HS) associated with neocortical temporal mild Palmini Type-I FCD subtypes and 6 with HS. Intraoperative electrocorticography (ECoG) recordings were analysed for epileptiform discharge frequency and morphology. Associations between histological, and electrocorticography pattern findings in these patients were analysed. Electroclinical outcomes in these patients were also evaluated. RESULTS: Neocortical areas with mild Palmini Type-I FCD showed a significantly higher spike frequency (SF) recorded in the inferior temporal gyrus than those neocortical areas in patients with HS. There was a tendency to higher spike frequency and lower amplitude in neocortical areas with histopathologic subtype IB FCD in relation with IA during intraoperative ECoG. Post-SF excision and amplitude were significantly lower during neocortical post-excision intraoperative ECoG than during neocortical pre-excision recording. There was no difference found in the clinical outcome between patients with and without FCD. CONCLUSIONS: Intraoperative electrocorticographic interictal spike frequency recorded in the neocortical inferior temporal gyrus may help to characterize the histopathologic subtypes of mild Palmini Type-I FCD in patients with temporal lobe epilepsy (TLE) and a dual pathology. Our data support the epileptogenicity of neocortical mild FCD in TLE and assessments of ECoG patterns are relevant to determine the extent of the resection in these patients which can influence the electroclinical outcome.

[Stereotaxic biopsy and 192Ir implant in intracranial tumors. A review of 7 years of experience]. / Biopsia estereotáxica e implante de Ir-192 en tumores intracraneales. Revisión de 7 años de experiencia.

INTRODUCTION: The combination of stereotaxic techniques, advances in neuroimaging and the creation of continually improving software has permitted stereotaxic biopsy of cerebral lesions at the most varied sites. Improvement in the method of permanent interstitial radiation (brachytherapy) improves the precision with which the radioactive sources may be inserted, releasing a maximum dose of radiation to the tumour with minimum radiation to the surrounding tissue. PATIENTS AND METHODS: We treated 237 patients (aged 1 to 78 years) with intracranial lesions, all included in the protocol of our centre. Stereotaxic systems of Leksell, Riechert-Mundinger, Micromar and Estereoflex were used. The procedure was in three stages: acquisition of the image, surgical planning and surgical operation. The imaging guide was the computerized axial tomography (CAT). RESULTS: Stereotaxic biopsy guided by CAT images was done in 153 patients. These were divided into three groups, taking the biopsy findings as the reference: group A (primary tumors, 128), group B (metastatic tumors, 15) and group C (non-malignant lesions, 10). Ninety six permanent implants of 192Ir were inserted, with a low dose of 4-7 cGy/h and a total dose of 80-120 Gy. CONCLUSIONS: Stereotaxic biopsy is a very effective procedure with a significantly low range of complications. The permanent implant with a low dose rate, well situated and using a source of 192Ir is a safe, simple, effective method for the treatment of primary and recurrent glial tumours, and non-glial tumours which fulfil criteria for this type of brachytherapy.

[Neurofibroma with mucus-producing glands. Report of a case and literature review]. / Neurofibroma con glándulas mucoproductoras. Presentación de un caso y revisión de la literatura.

INTRODUCTION: Most tumors of peripheral nerve sheaths containing glands are malignant tumors associated with Von Recklinghausen's disease. CLINICAL CASE: A 39 year old man consulted with a tumour on a finger of the right hand, which was not painful, and was slow growing. There was no past history of neurofibromatosis. Histological study showed a tumour of the peripheral nerve sheath, a benign type of neurofibroma containing glands. Immunohistochemical techniques confirmed that it had the stroma of a Schwannoma with well-defined glandular epithelial elements. CONCLUSIONS: A neurofibroma with glands is considered to be a rare type of divergent differentiation, and of considerable interest to pathologists, since it must be differentiated from other tumoral lesions. Immunohistochemical study is very useful for this.

[A multidisciplinary approach to the management of cerebral vascular malformations]. / Enfoque multidisciplinario en el manejo de las malformaciones vasculares cerebrales.

INTRODUCTION: Cerebral vascular malformations (CVM) are a heterogeneous group of lesions. One way of classifying them is according to histological criteria, clinical features, imaging findings, electroencephalography and distinctive pathology. OBJECTIVES: To report the results obtained in 16 patients clinically diagnosed as having CVM and operated on in the Centro Internacional de Restauración Neurológica (La Habana, Cuba) between March 1995 and October 1998. We also consider the usefulness of diagnostic tools for neurosurgical management and anatomo-pathological diagnosis. PATIENTS AND METHODS: We review the clinical findings, images, electroencephalograms and diagnostic histology of 16 patients. The gender distribution was 10 men and 6 women who were aged between 9 and 48 years. Stereotaxic resection guided by CAT and angiography was done in all cases. RESULTS: The predominant symptoms were headache and generalized tonic-clonic convulsions. CAT and angiography were helpful in determining the clinical diagnosis and location. The most frequent electroencephalographic finding was focal slowing associated with inactive epileptiform disorders. Histological study showed that there were 3 cases of arteriovenous malformations (AVM), one angioma cavernosa and one mixed vascular malformation (AVM plus angioma cavernosa). The malformation was not resected (it was treated with a clip) in the remaining case. CONCLUSION: Our results show the importance of structural imaging studies and their relationship to functional studies in the presumptive diagnosis of CVM corroborated by post-operative histological diagnosis.

[Electroencephalogram findings in lesionectomies: preliminary results]. / Hallazgos del electrocorticograma en lesionectomías: resultados preliminares.

INTRODUCTION: Use of the electrocorticogram (EcoG) in planning lesionectomies is a controversial subject at present. MATERIAL AND METHODS: We describe a series of 5 patients with epileptic crises, 3 with arteriovenous malformations in whom the lesion was completely resected, followed by postoperative angiography, and two with gliomas with low grade malignancy in whom iridium 192 was implanted. RESULTS: 1. The most frequent reason for consultation was convulsions. 2. In our series of patients the commonest site was the frontal zone of the right hemisphere. 3. Potentials with epileptiform characteristics were registered at the edges of the lesions and occasionally over the lesion itself. In two cases electro-clinical crises were seen. 4. The lesions were resected from normal tissue independently of the EcoG results. CONCLUSION: Although they are preliminary findings, the results of the study support the usefulness of this technique to guide the surgical procedures used for the treatment of intractable epilepsy.

[Central neurocytoma]. / Neurocitoma central.

INTRODUCTION: A central neurocytoma (CN) is a rare tumor, of neuronal origin, well-differentiated and found intraventricularly. It mainly affects young adults. Firm diagnosis is made on immunohistochemical (IHQ) and ultrastructural studies, since on optic microscopy it is similar in appearance to an oligodendroglioma or to an ependymoma. PATIENTS AND METHODS: We studied 4 cases, three after surgical resection and one on autopsy. The average age was 29, ranging from 3 to 63. Both sexes were equally affected. In all cases IHQ techniques were used (GFAP, neurofilament, synaptophysin and specific neuronal enolase) and they were studied by electron microscopy. RESULTS: IHQ was negative for GFAP and neurofilament, but intensely positive for synaptophysin and specific neuronal enolase. On ultrastructural study there were few neurofilaments, microtubules and dense central granules typical of neural differentiation. CONCLUSIONS: The findings in our cases lead to diagnosis of NC and confirm that this tumor is a distinct clinicopathological entity.

Neurocitoma central / Central neurocitoma

Introducción. El neurocitoma central (NC) es un tumor raro, de origen neuronal, bien diferenciado y de localización intraventricular; afecta preferentemente a adultos jóvenes. El diagnóstico definitivo se establece por el estudio inmunohistoquímico (IHQ) y ultraestructural debido a su semejanza con el oligodendroglioma y el ependimoma al microscopio óptico. Pacientes y métodos. Se procesaron 4 casos, 3 procedentes de resección quirúrgica y 1 de autopsia. La edad media fue de 29 años, con un rango entre 3 y 63 años; ambos sexos se afectaron por igual. A todos los casos se les realizó técnicas de IHQ (GFAP, neurofilamento, sinaptofisina y enolasa neuronal específica) y se estudiaron por microscopía electrónica. Resultados. La IHQ resultó negativa para la GFAP y para el neurofilamento, y fue intensamente positiva para la sinaptofisina y la enolasa neuronal específica. El aspecto ultraestructural evidenció escasos neurofilamentos, microtúbulos y gránulos de centro denso propios de la diferenciación neural. Conclusiones. Los hallazgos encontrados en nuestros casos permitieron realizar el diagnóstico de NC y confirmaron a este tumor como una entidad clinicopatológica distintiva

[Clinico-pathological correlation in the main types of dementia]. / Correlación clinicopatológica en los principales tipos de demencias.

INTRODUCTION: Dementia has became a serious health problem in developed countries. The objective of this study was to establish the possible correlation between the initial clinical diagnosis and the anatomopathological criteria. Pathological confirmation of the cases clinically diagnosed as Alzheimer disease/senile dementia Alzheimer type (AD/SDAT) and multi-infarct dementia (MID) was carried out. MATERIAL AND METHODS: Twelve brains from demented patients were studied. Brains were removed at post-mortem intervals of 1-3 hours to guarantee an adequate conservation of the tissue. The brains were weighed, fixed for 4 weeks in 10% buffered neutral formalin and coronally sectioned at intervals of approximately 1 cm. Bilateral sections of neocortex from frontal, temporal, parietal lobes, cingulate gyrus, amygdala, hippocampus, thalamus, cerebellum and unilateral sections of locus ceruleus and substantia nigra were taken. Five micrometer sections of the paraffin embedded material were stained by the following methods: hematoxylin-floxine, Congo red and Bielschowsky silver impregnation. RESULTS: Our neuropathological results showed a high correlation with the initial clinical classification and confirmed the diagnosis of AD/ SDAT in 6 cases, MID in 3 cases and mixed dementia in 1 case. Two cases did not exhibited morphological evidence of dementia. CONCLUSIONS: We concluded that the methodology applied for the morphologic diagnosis of dementia was feasible, useful and reproducible. Further studies will be necessary using a larger number of sample.

Correlación clinicopatológica en los principales tipos de demencias / Clinic pathological correlation in the main types of dementias

Inrtoducción. La demencia se ha convertido en un serio problema de salud en los países industrializados. Con este trabajo nos proponemos establecer la posible correlación entre el diagnóstico clínico preliminar y el criterio anatomopatológico en los casos ilustrados, y realizar un estudio neuropatológico post mortem para el diagnóstico y clasificación de los pacientes. Material y métodos. Se estudiaron los encéfalos de 12 pacientes dementes con diagnóstico clínico de enfermedad de Alzheimer/demencia senil tipo Alzheimer (EA/DSTA) seis casos y demencia multinfarto (DMI) seis casos. Se practicó la evisceración del encéfalo dentro de las tres primeras horas de fallecido. Los encéfalos se pesaron y fijaron en formol neutro al 10 por ciento posteriormente se realizaron cortes coronales con un intervalo de 1 cm tomando fragmentos bilaterales de corteza frontal, temporal y parietal, girus cingulado, amigdala, hipocampo, tálamo, cerebelo y fragmentos unilaterales de sustancia negra y locus ceréleo, para ser incluidos en parafina, teñidos con hematoxilina/floxina, rojo congo y tinción de Bielchowsky. Resultados. El estudio neuropatológico exhibió una alta correlación en relación a la clasificación clínica inicial, confirmando el diagnóstico de EA/DSTA en 6 casos, DMI en 3 y DMx en 1 caso. En 2 casos no se encontraron evidencias morfológicas que sustentaran los criterios clínicos de demencia. Conclusiones. Podemos concluir que la metodología aplicada para el diagnóstico morfológico resultó factible, útil y reproducible para el diagnóstico, siendo necesario incrementar el número de casos

Contenido de catecolaminas en tejido suprarrenal humano: diferencias entre el tejido adulto y fetal / Contents of catecholamines in suprarrenal human tissue: differences between adult and fetal tissue

Con el objetivo de realizar una caracterización comparativa entre los niveles de catecolaminas noradrenalina (CA), dopamina (DA) y adrenalina (A) en la glándula adrenal fetal humana (GAF) (n=7) entre 10-12 semanas de edad gestacional y la glándula adrenal adulta (GAA) post-mortem (n=7) de sujetos con edad promedio de 65,4 a 9,4 años, se midieron sus concentraciones utilizando un sistema de cromatografía líquida de alta resolución con detección electroquímica. Las concentraciones (ng/mg peso h£medo) encontradas fueron: NA 24,43 a 7,1; A 3,6 a 2,9 y DA 0,45 a 0,27 para la GAF y NA 58,2 a 37,5, Aa 352,3 a 214,9 y DA 0,19 a 0,07 en la GAA. El valor de la DA fetal fue 2,4 veces superior al detectado en la GAA. Se comprobó por primera vez que la GAF correspondiente a edades gestacionales comprendidas entre las 10 y 12 semanas, es significativamente (p < 0,01) más rica en DA que el tejido adulto