Chromium (VI) bioremediation potential of filamentous fungi isolated from Peruvian tannery industry effluents.

The tannery is an important trade in various Peruvian regions; however, tannery effluents are a serious local environmental threat due to its highly toxics components and lack of efficient treatment. The untreated effluents produced by tannery factories in Arequipa Rio Seco Industrial Park (PIRS) have formed a lake in the region nearby. In this work, we study the capability of filamentous fungi species found in this effluents lake with potential for chromium (VI) bioremediation. Fourteen species of filamentous fungi were isolated; only two species were identified Penicillium citrinum and Trichoderma viride, and third strain identified as Penicillium sp. The filamentous fungi showed that are fully tolerant to chromium (VI) concentrations up to 100 mg/L. These fungal strains showed significant growth in chromium (VI) concentrations up to 250 mg/L. Tolerant index (TI) analysis revealed that P. citrinum and T. viride began adaptation to chromium (IV) concentrations of 250 and 500 mg/L, after 6 and 12 days, respectively. When exposed to higher Cr (VI) concentrations (1000 mg/L), only T. viride was able to show growth (enhance phase). Interestingly, one of the significant responses from these fungal strains to increasing chromium (VI) concentrations was an increment in secreted laccase enzymes. Our results show tolerance and adaptation to elevated concentrations of chromium (VI) of these fungal strains suggesting their potential as effective agents for bioremediation of tannery effluents.

[Early statin therapy in acute myocardial infarction]. / Tratamiento precoz con estatinas en el infarto agudo de miocardio.

OBJECTIVES: To evaluate the effects of the early administration of statins during acute myocardial infarction (MI). DESIGN: A retrospective cohort study was carried out. SETTING: National (Spain). PATIENTS OR PARTICIPANTS: Patients included in the ARIAM registry from January 1999 to December 2008 with a diagnosis of MI. INTERVENTIONS: None. MAIN VARIABLES: We used logistic regression analysis and propensity scoring to determine whether the administration of statins during the first 24h of MI acts as a protective factor against: 1) mortality, 2) the incidence of lethal arrhythmias, or 3) cardiogenic shock. RESULTS: A total of 36 842 patients were included in the study. Statins were administered early in 50.2% of the patients. Statin administration was associated with younger patients with known previous dyslipidemia, obesity, a history of ischemic heart disease, heart failure, presence of sinus tachycardia, use of beta-blockers, angiotensin-converting enzyme inhibitors, thrombolysis and percutaneous coronary intervention. Mortality was 8.2% (13.2% without statin versus 3% with statin, P<.001). Multivariate analysis demonstrated that statin administration acted as a protective factor against mortality (adjusted OR 0.518, 95%CI 0.447 to 0.601). Continued use of statins was associated with a reduction in mortality (adjusted OR 0.597, 95%CI 0.449 to 0.798), and the start of treatment was a protective factor against mortality (adjusted OR 0.642, 95%CI 0.544 -0.757). Statin therapy also exerted a protective effect against the incidence of lethal arrhythmias and cardiogenic shock. CONCLUSIONS: These results suggest that early treatment with statins in patients with MI is associated with reduced mortality.

Endometriosis intestinal como causa de abdomen agudo / Intestinal endometriosis as a cause of acute abdomen

El dolor abdominal es motivo de consulta médica muy frecuente y además es un síntoma inespecífico que aparece en un gran número de patologías tanto digestivas como extra digestivas. La endometriosis intestinal es una enfermedad poco frecuente y común gran espectro clínico, lo cual hace difícil su diagnóstico. Se presenta el caso clínico de paciente que curso son síndrome abdominal agudo secundario a endometriosis intestinal. Se hace una revisión del tema en la literatura mundial (AU)

Abdominal pain is a frequent cause of medical consultation and is also a nonspecific symptom that occurs in a large number of both digestive and extraintestinal disorders. Intestinal endometriosis is a rare disease with a broad clinical spectrum, hampering diagnosis. We report the case of a patient with acute abdomen secondary to intestinal endometriosis. A review of the topic in the world literature is provided (AU)

Clinical predictors for the aetiology of peripheral lymphadenopathy in HIV-infected adults.

OBJECTIVES: The aim of the study was to determine the aetiology and clinical predictors of peripheral lymphadenopathy in HIV-infected individuals during the antiretroviral (ARV) era in a nontuberculosis endemic setting. METHODS: A multicentred, retrospective cohort study of peripheral lymph node biopsies in HIV-positive adults was carried out. A total of 107 charts were identified and reviewed for clinical features, lymphadenopathy size, and ARV use and duration. Biopsy results were categorized, and multivariate logistic regression determined independent predictors of lymphadenopathy aetiology. RESULTS: Evaluation of 107 peripheral lymph node biopsies revealed that 42.9% of peripheral lymphadenopathy was attributable to malignancy, 49.5% to reactive changes, and 7.5% to infections, with only 2.8% of all cases secondary to tuberculosis. Fevers, weight loss, ARV use, and lower viral loads are significantly associated with nonreactive lymphadenopathy. CONCLUSIONS: Lymphadenopathy is likely to be reactive or malignant in nontuberculosis endemic regions. Readily available clinical features can aid clinicians in predicting the underlying aetiology, those at risk for malignancy, and who to biopsy.

Histerectomía obstétrica por sepsis en el puerperio / Obstetric hysterectomy due to sepsis in the puerperium

Los sangrados de origen obstétrico y las infecciones pélvicas severas constituyen las primeras causas para la realización de una histerectomía en el estado grávido puerperal. La decisión de realizar una histerectomía con un diagnóstico oportuno va a influir en la evolución y pronóstico de estas pacientes. El objetivo principal del presente estudio es analizar la histerectomía obstétrica por procesos infecciosos pélvicos severos, mediante un análisis retrospectivo de 5 años en pacientes del Hospital General de México y del Centro de Esterilidad y Ginecología Integral. Se incluyeron 17 casos de histerectomía obstétrica, el grupo de edad promedio fue entre los 20 y 30 años, la principal indicación fue la deciduomiometritis en el 35,2%, el tiempo promedio de la cirugía fue de 124,4min, las complicaciones principales fueron lesiones al tracto urinario y aquellas secundarias al proceso séptico (CID), la mortalidad fue del 35% (AU)

Bleeding of obstetric origin and severe pelvic infections are the main causes of hysterectomy in the puerperium. Timely diagnosis and hysterectomy influence the outcome of these patients. The main objective of the present study was to analyze obstetric hysterectomy for severe pelvic infectious processes. We retrospectively analyzed obstetric hysterectomies for severe pelvic infectious processes and sepsis in the puerperium performed over a 5-year period in the General Hospital of Mexico. Seventeen cases of obstetric hysterectomy were analyzed. Most patients were aged between 20 and 30 years. The main indication was endometritis in 35.2%, and the mean operating time was 124.4min. The main complications were urinary tract lesions and those secondary to the septic process (disseminated intravascular coagulation). Mortality was 35% (AU)

Minimally invasive pancreatic surgery of the entire gland: initial experience.

Many pancreatic cancer surgeons have been slow to adopt minimally invasive pancreatic surgery (MIPS) due a lack of formalized minimally invasive training and the perceived difficulty in dissecting pancreatic tumors and tissue away from the superior mesenteric vessels and consequent concerns for adequacy of oncologic margins and lymph node retrieval. A review of the first 29 MIPS procedures for malignant and premalignant tumors of the pancreas with the aid of a sterilizeable robotically-controlled camera holder was undertaken. As opposed to other robots currently available, this device allows for hand-assistance by the operating surgeon. Fourteen minimally invasive distal pancreatectomies (MIDP) (10 laparoscopic, 3 hand-assisted, 1 converted to open), 13 MIPDs (6 laparoscopic, 5 hand-assisted, 2 converted to open), and 2 laparoscopic central pancreatectomies have been performed. Seventeen (59%) of these patients were treated for cancer. Of these, 11 underwent a MIPD and 6 a MIDP. There were postoperative complications in seven patients (24%) at 30 days. Thirty and 90 day mortality was 3%. A sterilizeable robotically-controlled laparoscope holder that enables the operating surgeon to remain in contact with the patient and have the option of a hand-assisted approach may be particularly helpful for minimally invasive approaches to malignant and premalignant pancreatic tumors.

Should a complex uropathy be a contraindication for renal transplantation in children?

BACKGROUND: Anatomic and functional disorders of the lower urinary tract represent up to 40% of the causes of renal failure in children. Several centers avoid renal transplantation in these patients because of the high risk of complications and lower graft survival. The aim of this work was to determine the frequency of urinary tract abnormalities (UTAs) among our pediatric series, and to compare the frequency of complications, function, and long-term graft survival among patients without versus with UTA. METHODS: This single-center, retrospective study compared outcomes between pediatric recipients with versus without UTA. We analyzed demographic features, etiology, pretransplant protocol, urinary tract rehabilitation, incidence of complications, rejection events, as well as graft function and survival. RESULTS: Among 328 pediatric cases performed between 1998 and 2008, we excluded nine patients due to incomplete medical records, analyzing 319 procedures in 312 patients. Sixty-seven patients (21%) had UTA. The average age, weight, and height at the time of grafting were significantly lower in the urologic group: 11.1 versus 12.6 years, 28.8 versus 34.4 kg; 125.4 versus 138.4 cm, respectively. There were significantly higher frequencies of a transperitoneal approach and vena cavae and aortic anastomoses among patients with UTA (P < .001), posing a greater technical challenge in this population. No differences in creatinine levels were observed at 0.5, 1, 2, 5, and 10 years: 1.3 versus 1.6 at 5 years, and 1.4 versus 1.5 at 8 years. Urologic complications, including urinary tract infections (UTIs), occurred among 80.6% of patients with UTA versus 42.1% in the non-UTA group (P < .001). UTIs appeared predominantly in patients with UTA (62.7% vs 35.3%, P < .001), representing a 2.7-fold risk compared with those children transplanted for other reasons. Rejection incidence was similar in both groups (49.8%). There was no significant difference in 5-y (89.8% vs 85%) or 10-year (83% vs 67%) graft survivals between the groups (P = .162). CONCLUSION: Our results demonstrated that with proper interdisciplinary care, graft and patient survivals of pediatric recipients with UTAs were not affected; therefore, these patients should not be rejected for transplantation.

Matching the peripheral intravenous catheter to the individual patient.

Up to eighty percent of all patients admitted to hospital worldwide will receive a peripheral IV and this procedure is now considered indispensable to human health. However, despite its global use, the choice of catheter is not always governed by clear and universal guidelines. After reviewing the few best-practice recommendations which exist, we propose a patient--and therapy--driven matrix for deciding on the gauge and length of peripheral catheter for the individual patient. This matrix takes patient age, clinical stability, current state of veins, therapy duration and the nature of the medication to be delivered into consideration. Use of such a matrix will not deliver a formulaic answer but will orient choices along logical, evidence-based lines. This approach will be an advance on the all-too-common reliance on habit and tradition in the choice of peripheral IV catheter.

[Atrioventricular block in unstable angina. Results of the ARIAM registry]. / Bloqueo auriculoventricular en la angina inestable. Resultados del registro ARIAM.

OBJECTIVE: Describe the frequency of high degree atrioventricular block (HDAVB) in patients with unstable angina (UA), analyze the variables associated with their appearance and evaluate whether HDAVB is independently associated with increased mortality or increased length of ICU stay. DESIGN: Retrospective descriptive study of patients with UA included in the ARIAM registry. SETTING: ICUs from 129 hospitals in Spain. PATIENTS: From June 1996 to December 2003 a total of 14,096 patients were included in the ARIAM registry with a diagnosis of UA. MAIN VARIABLES OF INTEREST: Variables associated with the development of HDAVB, variables associated with the mortality of patients with UA, variables associated with the length of ICU stay of patients with UA. RESULTS: HDAVB frequency was 1%. Development of HDAVB was independently associated with the Killip classification and the presence of sustained ventricular tachycardia or ventricular fibrillation. Crude mortality of patients was significantly increased when HDAVB was present (9% versus 1%, p < 0,001). When adjusted for other variables, HDAVB was not associated with increased mortality. Development of HDAVB in patients with UA was independently associated with an increase in the length of ICU stay (adjusted odds ratio 1.89: 95% confidence interval: 1.33-5.69). CONCLUSIONS: Patients with UA complicated with HDAVB represent a high-risk population with an increased ICU stay.

Common occurrence of enterotoxin genes and enterotoxicity in Bacillus thuringiensis.

Seventy-four strains of Bacillus thuringiensis thuringiensis representing 24 serovars were examined for the presence of three enterotoxin genes/operons; the non-haemolytic enterotoxin Nhe, the haemolytic enterotoxin hbl and the Bacillus cereus toxin bceT using polymerase chain reaction. The nheBC genes were found in all strains examined, the hblCD genes in 65 of the 74 strains and bceT in 63 strains. There was little consistency of the distribution of enterotoxin loci among strains of the same serovar in serovars that were well represented in our collection. Culture supernatants from all but one strain inhibited protein synthesis in Vero cells, generally with a toxicity equivalent to that seen in strains of B. cereus isolated from incidents of food poisoning. Microbiological Societies.

[Epidemiological study of pediculosis capitis and scabies in schoolchildren from Antofagasta, Chile, 1995]. / Estudio epidemiológico de la pediculosis capitis y sarna en escolares básicos de Antofagasta, Chile, 1995.

In order to contribute to a better knowledge of the pediculosis capitis and scabies during March-December 1995, 1122 primary schoolchildren under 14 years of age in the city-port of Antofagasta in northern Chile (20 degrees South lat.), were examined. A total of 285 (25.4%) were found to be infested with Pediculus humanus capitis and only 20 (1.8%) with Sarcoptes scabiei. In general the rates of infestation to both ectoparasitic diseases were higher in groups of younger schoolchildren, also higher in women than in men and in those groups with high indexes of crowding and ignorance of the transmission mechanism of pediculosis capitis and scabies.

Hemodynamic effects of calcitonin in the normal rat.

Calcitonin (CT) was administered acutely (IV 4-8 U/kg) and chronically (SC 2 U/kg/day x 150 day) to normal male rats. Measurements included heart rate (HR), mean blood pressure (MBP), cardiac index (CI), peripheral vascular resistance (PVR), and stroke volume index (SVI). The MBP was higher in CT rats examined under pentobarbital anesthesia. Upon awakening from anesthesia, rats chronically on CT exhibited impaired recovery of CI and SVI. Hemodynamic effects were not seen in rats acutely treated with CT. Heart weight was unchanged in chronic treatment with CT. Therefore, CT had minimal hemodynamic effects in the normal male rat.

Physiological factors associated with the lower maximal oxygen consumption of master runners.

We examined the hemodynamic factors associated with the lower maximal O2 consumption (VO2max) in older formerly elite distance runners. Heart rate and VO2 were measured during submaximal and maximal treadmill exercise in 11 master [66 +/- 8 (SD) yr] and 11 young (32 +/- 5 yr) male runners. Cardiac output was determined using acetylene rebreathing at 30, 50, 70, and 85% VO2max. Maximal cardiac output was estimated using submaximal stroke volume and maximal heart rate. VO2max was 36% lower in master runners (45.0 +/- 6.9 vs. 70.4 +/- 8.0 ml.kg-1.min-1, P less than or equal to 0.05), because of both a lower maximal cardiac output (18.2 +/- 3.5 vs. 25.4 +/- 1.7 l.min-1) and arteriovenous O2 difference (16.6 +/- 1.6 vs. 18.7 +/- 1.4 ml O2.100 ml blood-1, P less than or equal to 0.05). Reduced maximal heart rate (154.4 +/- 17.4 vs. 185 +/- 5.8 beats.min-1) and stroke volume (117.1 +/- 16.1 vs. 137.2 +/- 8.7 ml.beat-1) contributed to the lower cardiac output in the older athletes (P less than or equal 0.05). These data indicate that VO2max is lower in master runners because of a diminished capacity to deliver and extract O2 during exercise.