5-Year management and outcomes of penetrating neck injury in a trauma center. Penetrating neck injury / Manejo y resultados de trauma penetrante de cuello en 5 años dentro de un centro de urgencias. Trauma penetrante de cuello

Background Penetrating neck injuries represent 5–10% of all traumatic injuries, these bring with them a high rate of morbidity and mortality due to vital structures that could be injured in this area. The aim of this study was to determine the epidemiological and clinical characteristics of penetrating neck injuries. Methods This was a retrospective, unicentric and descriptive study that included all patients who underwent neck exploration surgery. Results A total of 70 neck exploration cases were reviewed, 34 (49%) didn’t had any injury. Thirty (43%) had at least one hard sign, 42 (60%) patients showed at least one soft sign. Statistical analysis showed only surgical time (252±199.5 vs. 155±76.4; p=0.020) and transfusions (1.87±3 vs. 0.4±0.856; p=0.013) were statistically significant. We report a mortality of 2 (3%) patients. Conclusions Our prevalence of neck surgical exploration without vascular injury was slightly higher (49% vs. 40%) than literature. We highlight the importance of not performing neck explorations in all patients who present a penetrating injury. We did not obtain differences between groups for hard signs and soft signs. We were not able to identify whether or not there would be an injury based on clinical characteristics. Imaging studies should be performed to avoid unnecessary neck explorations; however, depending on the clinical scenario some surgery cannot be avoided (AU)

Antecedentes Las lesiones penetrantes de cuello representan entre el 5-10% de todas las lesiones traumáticas, estas traen consigo una alta tasa de morbimortalidad por estructuras vitales que podrían lesionarse en esta área. El propósito de este estudio fue determinar las características epidemiológicas y clínicas del trauma penetrante de cuello. Métodos Estudio retrospectivo, unicéntrico y descriptivo que incluyó a todos los pacientes sometidos a cirugía de exploración de cuello. Resultados Se revisaron un total de 70 casos de exploración de cuello, 34 pacientes (49%) no presentaron ninguna lesión. Treinta pacientes (43%) tenían al menos un signo duro, 42 pacientes (60%) mostraron al menos un signo blando. El análisis estadístico mostró que solo el tiempo quirúrgico (252±199,5 vs. 155±76,4; p=0,020) y las transfusiones (1,87±3 vs, 0,4±0,856; p=0,013) fueron estadísticamente significativas. Reportamos la mortalidad de 2 pacientes (3%). Conclusiones Nuestra prevalencia de exploración quirúrgica de cuello sin lesión vascular fue ligeramente superior (49 vs. 40%) que la literatura. Destacamos la importancia de no realizar exploraciones de cuello en todos los pacientes que presentan una lesión penetrante. No obtuvimos diferencias entre grupos para signos duros y signos blandos. No pudimos identificar si hubiera o no una lesión en función de las características clínicas. Se deben realizar estudios de imagen para evitar exploraciones innecesarias del cuello; sin embargo, dependiendo del escenario clínico, no se pueden evitar algunas cirugías (AU)

Modeling dose rate increase from the addition of Uranium-232 for use as a tracer in uranium fuels.

The isotope 232U is being considered for additive to uranium fuel for use as a tracer. The 232U decay chain has high energy gammas that can be used for tracer purposes. However, the presence and intensity of such gammas may increase effective dose rates to workers around such materials This study examines the dose rate from different uranium materials that varying amounts of 232U has been added to. Several materials and their respective storage geometries are modeled for particle transport calculations. For each material and 232U concentration, gamma source terms were generated using SCALE 6.2 ORIGEN. These source terms were then used in MCNP for each material and geometry. Upon analysis, it was determined that the baseline dose from enriched uranium dominates until the 232U concentration reaches about 10-100 parts per trillion (ppt), after which the dose rate increases linearly.

Exploration of producing Uranium-232 for use as a tracer in uranium fuels.

This study examines the production of 232U via neutron irradiation. Uranium-232 is considered for use as a tracer in nuclear fuel. However, a source of 232U is needed. This study examines the production of 232U via neutron irradiation of targets constructed out of either 231Pa or 230Th in the High Flux Isotope Reactor. HFIR targets were modeled in MCNP to determine 232U yield in protactinium and thorium targets. Flux tallies were used inside the targets to determine the neutron flux inside each target. This flux was then used in SCALE 6.2 ORIGEN to determine the 232U yield, as well as the buildup of the byproduct 233U. Several 230Th enrichments were examined to determine how 232U yield is affected by 230Th enrichment, as well as the effects of the presence of 232Th. The buildup of 228Th and 229Th in thorium targets was also examined, as these isotopes may impact the feasibility of recycling of thorium target materials.

Pericardite epistenocárdica: ainda existe? / Epistinocardial pericarditis: does it still exist?

INTRODUÇÃO: A pericardite epistenocáridica é caracterizada como processo inflamatório benigno que ocorre de um a três dias após o infarto (IAM). Com o advento do tratamento de reperfusão, houve uma redução significativa da incidência. Relatamos caso de IAM que evoluiu com derrame pericárdico volumoso com repercussões hemodinâmicas. RELATO DE CASO: Homem, 58 anos, admitido com IAM com supradesnivelamento ST (IAMCSST) anterior, de duas horas de evolução e submetido à trombólise com sucesso. Dois dias após, apresentou recorrência de angina e novo IAMCSST anterior. Foi tratado clinicamente e solicitada transferência para hospital terciário para realização de cateterismo dois dias após. Esse revelou lesão grave em artéria descendente anterior e disfunção importante do ventrículo esquerdo (VE). Foi submetido à angioplastia com stent farmacológico com sucesso. Evoluiu estável, em uso de dupla antiagregação plaquetária, entretanto o ecocardiograma revelou derrame pericárdico volumoso (22 mm), com discreto colabamento de átrio direito na diástole, FEVE 30%, aneurisma apical e trombos em VE. Durante internação, apresentou flutter controlado com amiodarona. Foi tratado com altas doses de aspirina (500mg 8/8h) e colchicina (0.5 mg 12/12h) sem redução do derrame. Optou-se pela realização de janela pleuropericárdica, com drenagem de 350 ml de líquido citrino. Paciente recebeu alta após 14 dias, em uso de rivaroxabana e clopidogrel. Em consulta ambulatorial após cinco meses, paciente estava oligossintomático com ecocardiograma revelando ainda disfunção VE (FE=27%), com acinesia apical, sem trombos e ausência de derrame pericárdico. DISCUSSÃO: A pericardite epistenocárdica está geralmente, relacionada a infartos extensos sem tratamento de reperfusão. Há raros relatos de derrames pericárdicos volumosos, com repercussão hemodinâmica e necessidade de drenagem. É preconizado o uso de AAS em doses anti-inflamatórias, associado a colchicina. Nesse caso, essas medidas não foram suficientes. A anticoagulação era necessária devido trombos e flutter, porém com risco de transformação hemorrágica. A literatura mostra que na vigência de derrame pericárdico, a anticoagulação pode ser segura com controle ecocardiográfico frequente. CONCLUSÃO: Apesar de infrequente, pericardite epistenocárdica pode apresentar derrames volumosos, a despeito da terapia de reperfusão. Este caso evoluiu com achados ecocardiográficos raros e de alto risco com sinais incipientes de tamponamento cardíaco. Inicialmente tratado de forma conservadora, sem regressão do derrame, evoluiu com necessidade de abordagem cirúrgica.

Electro-steric opening of the CLC-2 chloride channel gate.

The widely expressed two-pore homodimeric inward rectifier CLC-2 chloride channel regulates transepithelial chloride transport, extracellular chloride homeostasis, and neuronal excitability. Each pore is independently gated at hyperpolarized voltages by a conserved pore glutamate. Presumably, exiting chloride ions push glutamate outwardly while external protonation stabilizes it. To understand the mechanism of mouse CLC-2 opening we used homology modelling-guided structure-function analysis. Structural modelling suggests that glutamate E213 interacts with tyrosine Y561 to close a pore. Accordingly, Y561A and E213D mutants are activated at less hyperpolarized voltages, re-opened at depolarized voltages, and fast and common gating components are reduced. The double mutant cycle analysis showed that E213 and Y561 are energetically coupled to alter CLC-2 gating. In agreement, the anomalous mole fraction behaviour of the voltage dependence, measured by the voltage to induce half-open probability, was strongly altered in these mutants. Finally, cytosolic acidification or high extracellular chloride concentration, conditions that have little or no effect on WT CLC-2, induced reopening of Y561 mutants at positive voltages presumably by the inward opening of E213. We concluded that the CLC-2 gate is formed by Y561-E213 and that outward permeant anions open the gate by electrostatic and steric interactions.

Impact of COVID-19 pandemic on asthma symptoms and management: A prospective analysis of asthmatic children in Ecuador.

BACKGROUND: Asthma affects up to 33% of children in Latin American settings. The ongoing COVID-19 pandemic has had a significant impact on access to and use of health services. We aimed to evaluate the impact of the COVID-19 lockdown on asthma exacerbations, medical facility visits, and use of asthma medications in children. METHODS: We used data from a prospective cohort of 213 children aged 5-17 years in 3 Ecuadorian cities and analysed the impact of the COVID-19 lockdown on asthma. Outcomes (asthma exacerbations, emergency room [ER] visits, planned and unplanned outpatient visits, and use of inhaled corticosteroids and Beta-2 agonists) were analysed using repeated Poisson counts (ie, number of events per participant before and during the COVID-19 lockdown). RESULTS: During compared to before lockdown: a) the number of asthma exacerbations remained constant (IRR, 0.87; 95% CI: 0.72-1.05; p = 0.152); b) outpatient visits (IRR 0.26, 95% CI 0.14-0.47, p < 0.001) declined 74% while ER visits declined 89% (IRR 0.11, 95% CI 0.04-0.32, p < 0.001); and c) there was no change in inhaled corticosteroids use (IRR 1.03, 95% CI 0.90-1.16, P = 0.699) while Beta-2 agonist use increased (IRR 1.32, 95% CI 1.10-1.58, P = 0.003). CONCLUSIONS: In a cohort of Ecuadorian children with asthma, health services attendance decreased dramatically after COVID-19 lockdown, but asthma exacerbations and use of inhaled corticosteroids were unchanged. Future analyses will address the question of the effect of SARS-CoV-2 infection on asthma exacerbations and control in this paediatric population.

Efectos de la suplementación con vitamina D en el control del asma en pacientes adultos: una revisión sistemática / Effects of vitamin D supplementation on asthma control in adult patients: a systematic review

INTRODUCCIÓN: El asma es una enfermedad crónica inflamatoria de la vía aérea e inmunomediada en su patogénesis. La vitamina D es un inmunomodulador que regula el perfil secretor de citoquinas, entre otras funciones celulares. Una asociación entre la suficiencia de vitamina D y mejoría en la función pulmonar, control de asma y número de exacerbaciones se ha propuesto en adultos, importante dada la elevada prevalencia de insuficiencia de vitamina D globalmente. OBJETIVO: Conocer los efectos de la suplementación con vitamina D en el control del asma en adultos. MÉTODOS: Se realizó una revisión sistemática de la literatura a través de una búsqueda en la base de datos PubMed y EMBASE. Los desenlaces primarios fueron cambios en VEF1, control sintomático, frecuencia de exacerbaciones, además de eventos adversos y FEM como desenlaces secundarios. La calidad de evidencia de los desenlaces fue evaluada a través del modelo GRADE. RESULTADOS: Siete estudios fueron seleccionados después de remover duplicados y aplicar los criterios de inclusión y exclusión, con calidad de evidencia muy baja aplicando sistema GRADE. DISCUSIÓN: No se encontraron diferencias estadísticamente significativas tras la suplementación con vitamina D en los desenlaces evaluados en general, pero dada la calidad de evidencia muy baja y que no se reportaron efectos adversos serios, es necesario tomar cautelosamente estos resultados. Asímismo no se puede descartar la utilidad de esta terapia como tratamiento auxiliar a los pacientes asmáticos con este déficit vitamínico.

BACKGROUND: Asthma is an airway chronic disease, with an important inflammatory component within its pathogenesis, driven by a dysregulated immune response. Vitamin D is an immunomodulator that regulates cell proliferation, differentiation and cytokine secretion profile. An association between vitamin D sufficiency and improvement in pulmonary function, asthma control and a decrease in exacerbations have been proposed in the adult population, which falls into importance given the high prevalence of vitamin D insufficiency globally. OBJECTIVE: To know vitamin D supplementation effects in asthma control in adults. METHODS: Through a PubMed and EMBASE database search, a systematic review of the literature was conducted. Primary outcomes were: changes in FEV1, symptomatic control, exacerbation frequency and PEF and adverse events as secondary outcomes. Outcome evidence quality assessment was made using the GRADE model. Results: Seven studies were selected after taking out duplicates, applying inclusion and exclusion criteria. In all cases, evidence quality assessed by the GRADE system yielded very low quality. CONCLUSIONS: No statistically significant differences were found after vitamin D supplementation in the overall evaluated outcomes. Nonetheless, a cautious interpretation of studies is mandatory, because evidence quality was very low and no serious adverse events were reported. Hence this treatment usefulness as an ancillary therapy for vitamin D deficient asthmatic patients cannot be dismissed.

Bone Mass Loss and Sarcopenia in Ecuadorian Patients.

OBJECTIVE: To study the association between osteoporosis and sarcopenia and determine the prevalence of osteosarcopenia in patients who attended a rheumatology center in Ecuador. METHODS: A cross-sectional study was conducted in a population of patients who had a densitometric study. The diagnosis of sarcopenia was determined by the DXA standard gold test, screening, and conventional methods (bioimpedance, anthropometric measurements, SARC-F, muscle function, and gait test). RESULTS: A total of 92 patients were studied. The median age was 66 ± 10, 90% females. Using the criteria of SMI, 65% had sarcopenia of which 9% had only sarcopenia and 56% had osteosarcopenia; 22% had only osteopenia/osteoporosis; and 13% none of these conditions. The prevalence of sarcopenia according to handgrip strength was 60%, gait speed 45%, and SARC-F score 40%. The prevalence of osteosarcopenia according to handgrip strength was 51%, gait speed 34%, and SARC-F score 32%. Osteoporosis was associated with a higher prevalence of sarcopenia using the criteria of SMI since 40% had sarcopenia in the normal DXA group, 64% in the osteopenia group, and 76% in the osteoporosis group (p=0.017). Of the women, 69% had sarcopenia compared to 33% of the men (p=0.034). The BMI was lower in the group with sarcopenia (25.1 ± 4.1 kg/m2) compared to the group without sarcopenia (29.4 ± 4.1 kg/m2, p < 0.001). Patients with osteosarcopenia and sarcopenia had lower BMI, handgrip strength, ASM, SMI, and total-body skeletal muscle mass than those with osteopenia/osteoporosis or normal patients. CONCLUSION: 65% of the studied population had sarcopenia. It is clear that the prevalence of sarcopenia is higher in patients with greater loss of bone mass. Identifying pathways that affect both bone and muscle could facilitate the development of treatments that simultaneously improve osteoporosis and sarcopenia.

Clinical Characteristics in Patients with Rheumatoid Arthritis: Differences between Genders.

OBJECTIVE: To compare the clinical characteristics of a group of men and women with rheumatoid arthritis (RA) and determine the differences between genders. MATERIALS AND METHODS: A descriptive and comparative cross-sectional study was developed with a group of 50 men and a control group of 50 women with RA, from a rheumatology center in the city of Guayaquil, Ecuador. Data collected included clinical manifestations, comorbidities, treatment, and disease activity. Clinical and activity differences between sexes were analyzed. RESULTS: Women were more devoted to housework (66%), while men consumed more tobacco (34%) and alcohol (38%). Fatigue (60%), loss of appetite (54%), and weight loss (44%) were more common in women. No differences were found in comorbidities or treatment. Women had higher values of DAS-28 (3.4 vs 2.5), HAQ-DI (1.1 vs 0.4), ESR (33.0 vs 23.2), painful joints (8 vs 3), swollen joints (6 vs 2), and overall physician assessment (3 vs 2). CONCLUSION: The results are similar to other publications that establish that women have a more aggressive disease with greater activity of the disease and disability.

Evidencia clínica y microscópica de la degradación de hilos de dermosustentación de polidioxanona en presencia de ácido hialurónico: reporte de caso / Microscopic and clinical evidence of the degradation of polydioxanone lifting threads in the presence of hyaluronic acid: a case report

Se expone el caso de una paciente remitida por complicaciones posteriores a la implantación superficial en el tercio medio facial de hilos de polidioxanona espiculados. Presentaba edema, equimosis, palpación superficial del hilo y plicación dérmica. Para el tratamiento planteamos un novedoso protocolo de degradación clínica de hilos de polidioxanona, empleando ácido hialurónico inyectándolo en el área de su implantación. Se infiltró ácido hialurónico no reticulado en el trayecto a lo largo del recorrido del hilo. El seguimiento a los siete, 21 y 45 días evidenció disminución del edema, de los pliegues e irregularidades dérmicas por la tracción del hilo y atenuación de rítides secundarias. Una muestra del hilo en ácido hialurónico fue observado en campana de flujo laminar evidenciándose degradación a las 72 horas. Administrar ácido hialurónico fue efectivo para inducir la biodegradación clínica del hilo. La hipótesis derivada sugiere que el ácido hialurónico no reticulado es un poderoso catalizador de la degradación hidrolítica de la polidioxanona.

We present the case of a female patient with complications from superficial implantation of polydioxanone spiculated threads in the facial middle third. The manifestations were edema, ecchymosis, superficial palpation of the thread and skin plication. For the treatment we propose a novel protocol of clinical degradation of polydioxanone threads, using hyaluronic acid injecting it into the implantation area of the polydioxanone threads. Non-cross linked hyaluronic acid was infiltrated along the path of the thread. The follow-up at seven, 21 and 45 days showed decreased edema, folds and skin irregularities due to wire traction and attenuation of secondary rhytides. A sample of the thread in hyaluronic acid was observed in a laminar flow campaign evidencing degradation at 72 hours. Administering hyaluronic acid was effective in inducing clinical biodegradation of the thread suggesting that non-crosslinked hyaluronic acid is a powerful catalyst for the hydrolytic degradation of polydioxanone.

Two glutathione transferase isoforms isolated from juvenile cysts of Taenia crassiceps: identification, purification and characterization.

We identified and characterized the first two glutathione transferases (GSTs) isolated from juvenile cysts of Taenia crassiceps (EC 2.5.1.18). The two glutathione transferases (TcGST1 and TcGST2) were purified in a single-step protocol using glutathione (GSH)-sepharose chromatography in combination with a GSH gradient. The specific activities of TcGST1 and TcGST2 were 26 U mg-1 and 19 U mg-1, respectively, both at 25°C and pH 6.5 with 1-chloro-2,4-dinitrobenzene (CDNB) and GSH as substrates. The Km(CDNB) and Kcat(CDNB) values for TcGST1 and TcGST2 (0.86 µm and 62 s-1; 1.03 µm and 1.97 s-1, respectively) and Km(GSH) and Kcat(GSH) values for TcGST1 and TcGST2 (0.55 µm and 11.61 s-1; 0.3 µm and 32.3 s-1, respectively) were similar to those reported for mammalian and helminth GSTs. Mass spectrometry analysis showed that eight peptides from each of the two parasite transferases were a match for gi|29825896 glutathione transferase (Taenia solium), confirming that both enzymes are GSTs. The relative molecular masses were 54,000 ± 0.9 for the native enzymes and 27,500 ± 0.5 for the enzyme subunits. Thus, TcGST1 and TcGST2 are dimeric proteins. Optimal TcGST1 and TcGST2 activities were observed at pH 8.5 in the range of 20-55°C and pH 7.5 at 35-40°C, respectively. TcGST1 and TcGST2 were inhibited by cibacron blue (CB), bromosulphophthalein (BST), rose bengal (RB), indomethacin and haematin (Hm) with 50% inhibitory concentrations (IC50) in the µm range. TcGST1 was inhibited in a non-competitive manner by all tested inhibitors with the exception of indomethacin, which was uncompetitive. The discovery of these new GSTs facilitates the potential use of T. crassiceps as a model to investigate multifunctional GSTs.

Perforación espontánea de aorta infrarrenal por úlcera ateroesclerótica. Reporte de un caso / Spontaneous rupture of infrarenal aorta due to an atheroesclerotic ulcer. Case report

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Determination of Vitamin D Status in a Population of Ecuadorian Subjects.

INTRODUCTION: Vitamin D is a preprohormone known to play a key role in phosphocalcic metabolism; its main source comes from the synthesis at the skin level by ultraviolet (UV) radiation. OBJECTIVE: The purpose of this study was to determine the levels of vitamin D in an Ecuadorian population. MATERIALS AND METHODS: Retrospective study of Ecuadorian subjects from the city of Guayaquil, who had an initial study of 25 (OH)-D serum, as the indicator of Vitamin D status, in the period of 2015-2016. RESULTS: A total of 269 Ecuadorian subjects were analyzed, with a mean age of 54.73 ± 16.58; 85% (229) were females and 15% (41) males; mean vitamin D was 27.29 ± 10.12 ng/dl [6.41-88.74]; 70% of the population showed levels below 30 ng/dL of vitamin D, whereas only 30% (81) had normal values. 69% (185) had levels between 29 and 10 ng/dl and 1% (3) levels below 10 ng/dl. High levels of vitamin D were evidenced in the summer months in relation to the winter months. CONCLUSION: It is evident that, despite the location of Ecuador and the intensity of UV rays it receives throughout the year, Ecuadorian subjects have insufficient levels of vitamin D.

Outcomes and Surgical Complications in Kidney Transplantation.

BACKGROUND: Kidney transplantation is the most cost-effective therapy for end-stage renal disease. Post-operative complications account for 15%-17% of all cases and are associated with significant morbidity. Currently 4.8% of post-transplantation patients have returned to dialysis. Our center's main transplant origin is cadaveric donation. OBJECTIVE: To review surgical complications of kidney transplantation over the past 5 years. METHODS: This was an observational descriptive study that included all patients from 2011 to 2015. RESULTS: A total of 55 cases were reviewed. Diabetic nephropathy was the etiology in 30.9% of cases. Post-surgical complications occurred in 12.7% of patients with a post-operative mortality of 4%. Graft survival at 1 year was 82.4% with a 91% 1-year patient survival. CONCLUSION: Early identification and treatment of surgical complications are critical for patient and graft survival. Complications are low but significant.

Epidemiología y evolución perioperatoria de lesión vascular periférica en civiles por trauma penetrante durante una década / Epidemiology and outcomes for civilian peripheral vascular injury in penetrating trauma during a decade

Introducción: Las lesiones causadas por trauma penetrante son una de las principales causas de morbimortalidad en todo el mundo. Para una gestión eficiente y un tratamiento adecuado, es esencial lograr una rápida detección, localización y caracterización de la lesión. Objetivo: Determinar la epidemiología y revisar el manejo perioperatorio de lesiones vasculares periféricas en extremidades durante una década. Material y métodos: Se utilizaron datos de 2006-2015 de un hospital universitario con pacientes con diagnóstico de lesión vascular en extremidades. Resultados: Se reportó un total de 110 casos. En 26 de los pacientes (23,6%) la lesión fue causada por una herida por arma punzo cortante y en 84 pacientes (76,4%) por proyectil de arma de fuego. El sitio lesionado más común fue la extremidad inferior. Veintiséis pacientes (23,6%) no mostraron lesión durante la angiografía. Se identificaron un total de 150 lesiones vasculares. Conclusiones: La arteria más comúnmente lesionada fue la femoral. Los factores predictivos de las lesiones estadísticamente significativos fueron la puntuación de la gravedad de la lesión, el grado de choque y los pacientes con lesiones múltiples. Seis amputaciones reportadas coinciden con un trauma severo. La ausencia de signos duros no descarta la posibilidad de lesión arterial. Se recomienda la reparación con injerto de safena invertido para las lesiones no reparables de manera primaria (AU)

Background: Penetrating trauma injuries are a leading cause of morbidity and mortality worldwide. For efficient management and appropriate treatment, the injuries need to be rapidly detected, located, and characterised. Objective: To describe the epidemiology and review the management of vascular injuries over a 10-year period. Material and methods: Data were used from patients with a diagnosis of vascular injury in extremities between 2006 and 2015 from a university hospital. Results: A total of 110 cases were reported. In 26 (23.6%) patients the injury was caused by a stab wound, and by a gunshot wound in 84 (76.4%) patients. The most common injury site was the lower limb. Twenty-six (23.6%) patients showed no injury in the angiography. A total of 150 vascular injuries were identified. Conclusion: The most commonly injured artery was the femoral. Statistically significant injury predictive factors were the injury severity score, the degree of shock, and patients with multiple injuries. Six amputations reported were associated with severe trauma. The absence of severe signs does not rule out the possibility of arterial injury. Inverted saphenous vein graft repair is recommended for non-repairable injuries (AU)

Reporte de caso: herida por proyectil de arma de fuego en aorta abdominal / Case report: Gunshot wound to abdominal aorta

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Olcegepant blocks neurogenic and non-neurogenic CGRPergic vasodepressor responses and facilitates noradrenergic vasopressor responses in pithed rats.

BACKGROUND AND PURPOSE: Olcegepant (BIBN4096BS) is a selective non-peptide CGRP receptor antagonist with acute antimigraine properties. Since systemic vascular tone is modulated by perivascular (primary sensory CGRPergic and sympathetic) nerves, this randomized study investigated in pithed rats the effect of acute i.v. treatment with olcegepant on the neurogenic and non-neurogenic: (i) CGRPergic vasodepressor responses; and (ii) noradrenergic vasopressor responses. The pithed rat is an experimental model predictive of systemic (cardio) vascular side effects. EXPERIMENTAL APPROACH: Seventy-five male Wistar rats (divided into 15 groups, n = 5 each) were pithed, artificially ventilated and prepared for: (i) spinal stimulation (T9 -T12 ; 0.56-5.6 Hz) of the sensory CGRPergic vasodepressor outflow or i.v. bolus injections (0.1-1 µg·kg-1 ) of α-CGRP, substance P or acetylcholine, which induced frequency-dependent or dose-dependent vasodepressor responses; or (ii) spinal stimulation (T7 -T9 ; 0.03-3 Hz) of the sympathetic vasopressor outflow or i.v. bolus injections (0.03-3 µg·kg-1 ) of noradrenaline, which produced frequency-dependent or dose-dependent vasopressor responses. KEY RESULTS: Olcegepant (1000 and 3000 µg·kg-1 , i.v.) dose-dependently blocked the vasodepressor responses to sensory nerve stimulation or i.v. α-CGRP, without affecting those to substance P or acetylcholine. Whereas it potentiated the vasopressor responses to sympathetic nerve stimulation or i.v. noradrenaline. CONCLUSIONS AND IMPLICATIONS: Olcegepant (i.v.) selectively blocked the neurogenic and non-neurogenic CGRPergic vasodepressor responses. This blockade by olcegepant potentiated the neurogenic and non-neurogenic noradrenergic vasopressor responses in pithed rats, an effect that might result in an increased vascular resistance and, consequently, in a prohypertensive action.

Nailfold capillaroscopy in diabetes mellitus.

INTRODUCTION: Diabetes mellitus (DM) is characterized by chronic hyperglycemia states and the development of specific microvascular disorders such as retinopathy and nephropathy. Conventional methods are used to study the vascular compromise of this entity, however, the use of capillaroscopy for the evaluation of capillary microarchitecture is not frequently used. METHODS AND MATERIALS: Observational and descriptive study of 65 patients with an established diagnosis of DM and a control group that underwent an initial capillaroscopy examination. The parameters considered were: Capillary diameter (ectasia and giant capillaries), cross-linked, tortuous, arborified capillaries, avascular zones, haemorrhages, dominant morphology, visibility of the subpapillary venous plexus (SPVP), cuticulitis and SD pattern. RESULTS: Capillaroscopy was performed in 65 patients, the findings were: tortous capillaries (63%), crosslinked capillaries (59%), avascular areas (48%), ectasias (39%), giant capillaries (11%). The capillaroscopic findings were evident in the majority of the studied population, 83%, compared to 17% who did not have capillaroscopic alterations. CONCLUSION: Significant capillaroscopic changes were demonstrated in patients with DM, in turn, we described a specific pattern consisting of: capillary dilatation, avascular zones and tortuous capillaries. Patients with more comorbidities and evolution of the disease showed greater microvascular damage.

Osteoporosis en enfermedades reumáticas e inducidas por glucocorticoides / Osteoporosis in rheumatic diseases and glucocorticoid induced

La osteoporosis es una enfermedad esquelética sistémica caracterizada por disminución de la densidad mineral ósea con alteraciones de la microarquitectura del hueso y aumento del riesgo de fractura. Se ha demostrado que depende de procesos fisiológicos y secundarios a otras patologías como son las enfermedades reumáticas, e incluso asociado al uso de glucocorticoides siendo esta la causa más frecuente de osteoporosis asociada a fármacos, y que a su vez representa una problemática de gran magnitud en la actualidad. Debido a esto, se presenta esta revisión con el fin de recalcar la importancia clínica de la osteoporosis en las enfermedades reumáticas e inducidas por glucocorticoides (AU)

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density, changes in bone microarchitecture and increased risk of fracture. It has been shown that depends on physiological processes and secondary to other pathologies and associated with the use of glucocorticoids, the latest being the most common cause of osteoporosis associated to drugs, this may be represent a great magnitude public health issue. This review is presented in order to emphasize the clinical importance of osteoporosis in rheumatic diseases and glucocorticoid-induced osteoporosis (AU)