Citicoline May Prevent Cognitive Decline in Patients with Cerebrovascular Disease.

Introduction: Neuroprotective drugs such as citicoline could improve cognitive performance and quality of life. We studied the effect of citicoline treatment and its association with Vascular Risk Factors (VRF) and APOE on cognition in patients with Subjective Cognitive Complaints (SCC) and Mild Cognitive Impairment (MCI). Methods: This is an observational and prospective study with citicoline during 12 months follow-up. Eighty-one subjects who met criteria for SCC/MCI, aged 50-75 years with VRF were included and prescribed citicoline 1g/day. Subjects with previous cognitive impairment and any other central nervous system affection were excluded. Wilcoxon Signed Ranks test and paired samples t-test were used to analyze the change in neuropsychological performance. Results: Mean age of the sample was 68.2 (SD 6.8) years and 26 (32.09%) were females. Fifteen subjects (24.6%) were APOE-ε4 carriers, fifty-six (76.7%) had hypertension, fifty-eight (79.5%) had dyslipidemia, twenty-one (28.8%) had diabetes mellitus and twenty-six (35.6%) had cardiopathy. Thirty-two (43.8%) subjects were diagnosed as SCC and forty-one (56.16%) as MCI. During the follow-up, Tweny-six patients (81.25%) in the group of SCC remained stable, six subjects (18.8%) converted to MCI. Twelve patients (29.9%) with MCI reverted to SCC and twenty-nine patients (70.7%) remained stable. At follow-up, SCC subjects had an improvement in the global language domain (p=0.03), naming (p<0.001), attention (p=0.01) and visuospatial abilities (p<0.01). MCI group showed an improvement in the screening test (p=0.03), delayed memory (p<0.01), global cognition (p=0.04) and in cognitive flexibility (p=0.03). Presence of APOE-ε4 had no impact on the above findings. Discussion: SCC subjects showed an improvement in language and attention domains, while those with MCI performed better after 12 months in total scores of MoCA and RBANS domains, some converting back to SCC. This supports the idea that citicoline may prevent cognitive decline in patients with cognitive deficits.

Linfoma de Hodgkin pulmonar primario

Se presenta el caso de una mujer de 25 años con tos, fiebre, disnea y dolor pleurítico de tres meses de evolución, con una lesión cavitante en la tomografía de tórax. Ella recibió tratamiento antituberculoso en otra institución de salud sin respuesta favorable. Se le realizó biopsia por toracoscopía que reveló presencia de células de Reed Sternberg consistentes con el subtipo de esclerosis nodular del Linfoma de Hodgkin. La paciente cumplió los criterios de linfoma de Hodgkin pulmonar primario, entidad extremadamente infrecuente y muy poco reportada.

We present the case of a 25-year-old woman with a three-month history of cough, fever, dyspnea, pleuritic pain, and a cavitating lesion on chest tomography. She received antituberculous treatment in another health institution without a favorable response. A thoracoscopic biopsy revealed the presence of Reed Sternberg cells consistent with the nodular sclerosis subtype of Hodgkin's lymphoma. The patient met the criteria for primary pulmonary Hodgkin's lymphoma, an extremely infrequent and rarely reported entity. A brief review of the literature is carried out.

Clima organizacional en el personal de enfermería en una unidad de cuidados intensivos / Organizational environment in nursing staff in an intensive care unit

Introducción: el sistema organizacional genera un determinado clima de trabajo que repercute en las motivaciones de los miembros de la organización y en su comportamiento, por lo que al evaluar el clima organizacional se mide la forma como es percibida la organización. Objetivo: identificar el clima organizacional en el personal de enfermería de la unidad de cuidados intensivos (UCI) del Hospital de Especialidades (HE) No. 14 del Instituto Mexicano del Seguro Social (IMSS), en Veracruz, México. Metodología: estudio observacional, descriptivo y transversal, en el que participaron 49 enfermeras de los turnos matutino, vespertino y nocturno de la UCI del HE No. 14. Durante junio y julio de 2019, se aplicó el instrumento Clima Organizacional de Litwin y Stringer, que contiene 53 ítems en sus 9 dimensiones. Resultados: el nivel promedio global del clima organizacional en la UCI fue de 26.4, lo que lleva a categorizarlo como bueno. Las dimensiones: recompensa, estándares y conflicto obtuvieron una puntuación de 23.5 a 24.8, que se traduce como un promedio regular del clima organizacional. Conclusiones: hay un clima organizacional bueno en el personal de enfermería. El componente que influye de manera positiva es la dimensión cooperación, ya que el trabajador empatiza con sus compañeros de servicio. La dimensión conflicto influye de manera negativa, pues abarca la falta de motivación del personal para realizar su trabajo.

Introduction: Organizational systems generate certain workplace environment that affects the staff members' motivation and their behavior, which is why assessing the organizational environment allows to measure the staff perception on the organization. Objective: To identify the organizational environment of the nursing staff at the Specialty Hospital (SH) No. 14 intensive care unit (ICU) of the National Institute for Social Security (Instituto Mexicano del Seguro Social), in Veracruz, Mexico. Methods: Observational, descriptive, and cross-sectional study, which included 49 nurses from the morning, afternoon and night shifts of the aforementioned ICU. During June and July 2019, it was administered the instrument Organizational Climate by Litwin and Stringer, which contains 53 items in its 9 dimensions. Results: The global average level of the organizational environment in the ICU was 26.4, which leads to categorize it as good. The dimensions reward, standards and conflict obtained a range from 23.5 to 24.8, i.e., a regular average of the organizational environment. Conclusions: There is an organizational environment classified as good in the nursing staff. The component that has a positive influence is the cooperation dimension, since the worker empathizes with his fellow employees. The conflict dimension has a negative influence, given that it includes the lack of motivation of the staff to carry out their work.

Estimating Neonatal Necrotizing Enterocolitis Based on Feeding Practices.

(1) Background: The relationship between enteral nutrition and neonatal necrotizing enterocolitis (NEC) among premature neonates is still unclear. The present work was designed to assess the relationship between NEC and feeding strategies compared to control infants. (2) Methods: A retrospective case-control study of premature infants (<35 weeks' gestation) with or without NEC that examined feeding practices and clinical characteristics at birth and 3, 7, and 14-day hospitalization, with a longitudinal and cross-sectional analysis. (3) Results: A total of 100 newborns with NEC diagnosis and 92 neonates without the disease with similar demographic and clinical characteristics were included. The median day of NEC diagnosis was 15 days (Interquartile Range (IQR) 5-25 days). A significantly higher number of neonates that were fasting on days 7 and 14 developed NEC (p < 0.05). In the longitudinal analysis, generalized linear and mixed models were fit to evaluate NEC association with feeding strategies and showed that exclusive mother's own milk (MM) and fortified human milk (FHM) across time were significantly less likely associated with NEC (p < 0.001) and that enteral fasting was positively related with NEC. In the cross-sectional analysis, a binary logistic regression model was fit and predicted 80.7% of NEC cases. MM was also found to correlate with a reduced risk for NEC (OR 0.148, 95% CI 0.044-0.05, p = 0.02), and in particular, on day 14, several factors were related to a decreased odd for NEC, including birth weight, antenatal steroids, and the use of FHM (p < 0.001). (4) Conclusions: MM and FHM were associated with less NEC compared to fasting on days 7 and 14. Feeding practices in Neonatal Intensive Care Units (NICUs) should promote exclusive MM across the two-week critical period as a potential guideline to improve NEC outcome.

Síndrome de superposición de hepatitis autoinmune y colangitis biliar primaria asociada a trombosis de vena porta post COVID-19

Presentamos el caso de una mujer de 53 años con antecedentes de artritis reumatoide que, tras recuperarse de un cuadro de COVID-19grave, desarrolló hemorragia digestiva como manifestación de hipertensión portal e insuficiencia hepática progresiva. Basados en la serología y ecografía, se diagnosticó un síndrome overlap de hepatitis autoinmune y colangitis biliar primaria asociado a trombosis de vena porta. La respuesta a la corticoterapia y anticoagulación fue favorable. El compromiso hepático, inducido por el virus, está descrito en la COVID-19. Sin embargo, pueden desarrollarse enfermedades autoinmunes y fenómenos tromboembólicos, teniendo el hígado como órgano diana.

Linking the scientific knowledge on marine frontal systems with ecosystem services.

Primary production hotspots in the marine environment occur where the combination of light, turbulence, temperature and nutrients makes the proliferation of phytoplankton possible. Satellite-derived surface chlorophyll-a distributions indicate that these conditions are frequently associated with sharp water mass transitions named "marine fronts". Given the link between primary production, consumers and ecosystem functions, marine fronts could play a key role in the production of ecosystem services (ES). Using the shelf break front in the Argentine Sea as a study case, we show that the high primary production found in the front is the main ecological feature that supports the production of tangible (fisheries) and intangible (recreation, regulation of atmospheric gases) marine ES and the reason why the provision of ES in the Argentine Sea concentrates there. This information provides support to satellite chlorophyll as a good indicator of multiple marine ES. We suggest that marine fronts could be considered as marine ES hot spots.

Clinic-Based Validation of Cerebrospinal Fluid Biomarkers with Florbetapir PET for Diagnosis of Dementia.

BACKGROUND: Cerebrospinal fluid (CSF) biomarker studies have shown variable accuracy for diagnosis of Alzheimer's disease (AD); therefore, internal validation is recommended. OBJECTIVE: To investigate the correlation between CSF biomarkers and cerebral 18-Florbetapir positron emission tomography (Amyloid-PET) and calculate their sensitivity and specificity to obtain the optimal clinical cut-off points to diagnose the etiology of cognitive impairment. METHODS: We performed Amyloid-PET scans and CSF biomarker levels analyses in 68 subjects (50 with mild cognitive impairment, 11 with AD dementia, and 7 with non-AD dementia). Visual examination of Amyloid-PET scans was performed. CSF analyses were performed using standard sandwich ELISA. RESULTS: Amyloid-PET was positive in 36 subjects, negative in 26, and inconclusive in 6. Optimal clinical cut-off points for CSF markers were the following: amyloid-ß 1-42 (Aß42) = 629 pg/ml, total tau (t-tau) = 532 pg/ml, phosphorylated tau (p-tau) = 88 pg/ml, and t-tau/Aß42 ratio = 0.58. T-tau/Aß42 ratio showed the best sensitivity and specificity (92 and 84%, respectively). T-tau and p-tau CSF levels (r2 = 0.867) followed by the t-tau and t-tau/Aß42 CSF ratio (r2 = 0.666) showed the strongest inter-marker correlation. Interestingly, subjects with inconclusive Amyloid-PET showed intermediate values for all CSF markers between negative and positive Amyloid-PET groups. CONCLUSIONS: CSF t-tau/Aß42 ratio appears to be the most accurate AD CSF marker. The presence of intermediate values for CSF markers among the subjects with inconclusive Amyloid-PET suggests the presence of other dementias associated with AD pathology or intermediate phenotypes.

[Maternal mental health: a risk factor affecting the social and emotional well-being of Mexican children]. / Salud mental materna: factor de riesgo del bienestar socioemocional en niños mexicanos.

OBJECTIVES: To estimate the prevalence of symptoms of depression and anxiety in mothers from three population areas in the state of San Luis Potosí, Mexico, and to analyze the association between these symptoms and the emotional health of their children. METHODS: Assessment was conducted on 173 mother-child pairs from three different population areas: urban, rural, and indigenous rural. Women's symptoms of depression and anxiety were evaluated, together with their children's behavioral problems. RESULTS: A high prevalence of symptoms of depression and anxiety was found in the three areas included. The proportion of depressive symptoms was highest in the urban and rural areas (38.7% and 38.6%, respectively). The highest prevalence of anxiety symptoms was observed in the rural area (31.8%). The strongest association between maternal anxiety and maternal depression was found in the rural area (odds ratio [OR] = 11.0; 95% CI: 1.3-95.5). The indigenous rural area showed the highest prevalence of behavioral problems among children (61%). An association between such problems and maternal anxiety (OR = 2.2; 95% CI: 1.1-4.3) and maternal depression (OR = 2.5; 95% CI: 1.3-4.6) was noted. CONCLUSIONS: The mental health of mothers can put the social and emotional well-being of their children at risk. This conclusion is supported by the findings, namely high prevalences and an association between symptoms of anxiety and depression and behavioral problems. In Mexico, reliable information on the mental health status of women and children in the three population areas studied is needed in order to implement measures towards expanding coverage for evaluation and prevention.

Papila de Morning Glory y atención a edad temprana: presentación de un paciente / Papilla of Morning Glory and attention at an early age: presentation of a patient

La papila de Morning Glory es una alteración congénita del nervio óptico de predominio unilateral e incidencia muy escasa que se caracteriza por un disco óptico de tamaño incrementado, excavación profunda, presencia de restos de tejido glial y disposición radial de la vascularización retiniana, es más común en mujeres que en varones y la agudeza visual está muy disminuida de forma unilateral. Está muchas veces asociada a defectos de la línea media facial y anomalías graves del sistema nervioso central. No existe tratamiento para esta enfermedad, deben detectarse todas para tratarlas cuando sea posible. Es habitual la presencia de anomalías de la refracción: miopía, astigmatismo e hipermetropía. Se presenta un niño de tres meses de edad que fue llevado a la Consulta de Pediatría y Retina por estrabismo y nistagmo al que se le diagnosticó esta anomalía del disco óptico, por lo que fue enviado a la Consulta de Baja Visión para ser atendido en la de edad temprana para su rehabilitación(AU)

Nistagmo y baja visión / Nystagmus and low vision

El nistagmo es un movimiento incontrolado, rítmico e involuntario de ambos ojos, que se manifiesta al fijar la mirada en una dirección; puede ser congénito o adquirido, y se asocia a enfermedades oculares en la infancia. Mediante un diagnóstico precoz se logra la rehabilitación visual. Las medidas irán encaminadas a conseguir el máximo de visión: gafas para corregir las ametropías, ejercicios y estimulación visual. Una investigación realizada en la Consulta de baja visión del Hospital Universitario Arnaldo Milián Castro de Santa Clara mostró que, de 894 pacientes atendidos, el 1,3 por ciento presentaron nistagmo congénito idiopático, asociado a otras enfermedades, y 11 pacientes mejoraron la visión con el uso de cristales. Predominó la raza blanca, el sexo masculino y las edades comprendidas entre cero y 14 años. Tiene una baja prevalencia y un porcentaje exitoso de rehabilitados visualmente. Los pacientes deben enviarse a edades tempranas a la Consulta de baja visión(AU)

Salud mental materna: factor de riesgo del bienestar socioemocional en niños mexicanos / Maternal mental health: a risk factor affecting the social and emotional well-being of Mexican children

Objetivos. Estimar la prevalencia de síntomas depresivos y de ansiedad (SDyA) en madres de tres zonas poblacionales (ZP) del estado de San Luis Potosí, México, y analizar la asociación entre los SDyA y sus efectos en la salud emocional de sus hijos. Métodos. Se evaluaron 173 parejas (madre-hijo) de tres ZP: Zona urbana (ZU), rural (ZR) y rural indígena (ZRI). Se estudiaron los SDyA de las mujeres, y las dificultades conductuales (DC) de los niños. Resultados. Se encontró una alta prevalencia de SDyA en las tres ZP. La mayor proporción de síntomas depresivos la presentaron la ZU y la ZR (38,7 y 38,6%). La prevalencia más alta de síntomas de ansiedad se observó en la ZR (31,8%). La asociación entre los SDyA y la depresión materna más fuerte se estimó en la ZR (razón de momios o RM = 11,0; IC95%: 1,3-95,5). En la ZRI se estimó la mayor prevalencia de DC en los niños (61%). Se encontró una asociación entre las DC y la ansiedad materna (RM = 2,2; IC95%: 1,1-4,3) y la depresión materna (RM = 2,5; IC95%: 1,3-4,6). Conclusiones. La salud mental de las madres puede poner en riesgo el bienestar socioemocional de sus hijos, lo que viene respaldado por la alta prevalencia y la asociación entre SDyA y DC encontrada. En México se necesita disponer de información fiable sobre el estado de salud mental de las mujeres y los niños de las tres ZP, para implantar medidas que amplíen su cobertura evaluativa y preventiva.

Objectives. To estimate the prevalence of symptoms of depression and anxiety in mothers from three population areas in the state of San Luis Potosí, Mexico, and to analyze the association between these symptoms and the emotional health of their children. Methods. Assessment was conducted on 173 mother–child pairs from three different population areas: urban, rural, and indigenous rural. Women's symptoms of depression and anxiety were evaluated, together with their children's behavioral problems. Results. A high prevalence of symptoms of depression and anxiety was found in the three areas included. The proportion of depressive symptoms was highest in the urban and rural areas (38.7% and 38.6%, respectively). The highest prevalence of anxiety symptoms was observed in the rural area (31.8%). The strongest association between maternal anxiety and maternal depression was found in the rural area (odds ratio [OR] = 11.0; 95% CI: 1.3-95.5). The indigenous rural area showed the highest prevalence of behavioral problems among children (61%). An association between such problems and maternal anxiety (OR = 2.2; 95% CI: 1.1-4.3) and maternal depression (OR = 2.5; 95% CI: 1.3-4.6) was noted. Conclusions. The mental health of mothers can put the social and emotional wellbeing of their children at risk. This conclusion is supported by the findings, namely high prevalences and an association between symptoms of anxiety and depression and behavioral problems. In Mexico, reliable information on the mental health status of women and children in the three population areas studied is needed in order to implement measures towards expanding coverage for evaluation and prevention.

Salud mental materna: factor de riesgo del bienestar socioemocional en niños mexicanos / Maternal mental health: a risk factor affecting the social and emotional well-being of Mexican children

RESUMEN Objetivos Estimar la prevalencia de síntomas depresivos y de ansiedad (SDyA) en madres de tres zonas poblacionales (ZP) del estado de San Luis Potosí, México, y analizar la asociación entre los SDyA y sus efectos en la salud emocional de sus hijos. Métodos Se evaluaron 173 parejas (madre-hijo) de tres ZP: Zona urbana (ZU), rural (ZR) y rural indígena (ZRI). Se estudiaron los SDyA de las mujeres, y las dificultades conductuales (DC) de los niños. Resultados Se encontró una alta prevalencia de SDyA en las tres ZP. La mayor proporción de síntomas depresivos la presentaron la ZU y la ZR (38,7 y 38,6%). La prevalencia más alta de síntomas de ansiedad se observó en la ZR (31,8%). La asociación entre los SDyA y la depresión materna más fuerte se estimó en la ZR (razón de momios o RM = 11,0; IC95%: 1,3-95,5). En la ZRI se estimó la mayor prevalencia de DC en los niños (61%). Se encontró una asociación entre las DC y la ansiedad materna (RM = 2,2; IC95%: 1,1-4,3) y la depresión materna (RM = 2,5; IC95%: 1,3-4,6). Conclusiones La salud mental de las madres puede poner en riesgo el bienestar socioemocional de sus hijos, lo que viene respaldado por la alta prevalencia y la asociación entre SDyA y DC encontrada. En México se necesita disponer de información fiable sobre el estado de salud mental de las mujeres y los niños de las tres ZP, para implantar medidas que amplíen su cobertura evaluativa y preventiva.

ABSTRACT Objectives To estimate the prevalence of symptoms of depression and anxiety in mothers from three population areas in the state of San Luis Potosí, Mexico, and to analyze the association between these symptoms and the emotional health of their children. Methods Assessment was conducted on 173 mother–child pairs from three different population areas: urban, rural, and indigenous rural. Women's symptoms of depression and anxiety were evaluated, together with their children's behavioral problems. Results A high prevalence of symptoms of depression and anxiety was found in the three areas included. The proportion of depressive symptoms was highest in the urban and rural areas (38.7% and 38.6%, respectively). The highest prevalence of anxiety symptoms was observed in the rural area (31.8%). The strongest association between maternal anxiety and maternal depression was found in the rural area (odds ratio [OR] = 11.0; 95% CI: 1.3-95.5). The indigenous rural area showed the highest prevalence of behavioral problems among children (61%). An association between such problems and maternal anxiety (OR = 2.2; 95% CI: 1.1-4.3) and maternal depression (OR = 2.5; 95% CI: 1.3-4.6) was noted. Conclusions The mental health of mothers can put the social and emotional well-being of their children at risk. This conclusion is supported by the findings, namely high prevalences and an association between symptoms of anxiety and depression and behavioral problems. In Mexico, reliable information on the mental health status of women and children in the three population areas studied is needed in order to implement measures towards expanding coverage for evaluation and prevention.

Morbimortalidadppor meningoencefalitis bacteriaa en una unidad de cuidados inttensivos pediatricos / Morbimortality for bacterial meningitis of the Intensive Cares Unit

Se realizó un estudio transversal y descriptivo de 87 pacientes egresados con el diagnóstico de meningoencefalitis bacteriana de la Unidad de Cuidados Intensivos del Hospital Docente Pediátrico del Cerro durante el período comprendido entre el 1º de enero de 1992 y el 31 de diciembre de 2004. Se describen los pacientes estudiados, según variables de caracterización individual y de la afección; asimismo, se identifica la relación entre algunas de dichas variables y la mortalidad. Se determinó que la enfermedad fue más frecuente en el grupo etáreo de 1-4 años y en el sexo masculino. El germen más común fue el Haemophilus influenzae . La edad inferior a 3 meses, la meningoencefalitis neumocócica y el diagnóstico tardío se relacionaron con una menor supervivencia. Un gran número de niños (71,3%) presentó complicaciones, resultado de la enfermedad. La mortalidad general fue de 9,2 %.

It was carried out a traverse and descriptive study of 87 patients discharged with the diagnosis of bacterial meningitis of the Intensive Cares Unit of the Hospital Docente Pediátrico del Cerro during the period between January 1º 1992 and December 31 the 2004. The patients are described according to variables of individual characterization and of the affection and also it is identified the relationship between some of this variables and the mortality. It was determined that the illness was more frequent in the group 1-4 year-old and in the masculine sex. The most common germ was Haemophilus influenzae. The inferior age to 3 months, the neumoccocal meningitis and the late diagnosis was related with a smaller survival. A great number of children (71,3%) presented complications product of the illness. The general mortality was 9,2%.

Phase II trial of thalidomide and daily oral dexamethasone for treatment of hormone refractory prostate cancer progressing after chemotherapy.

BACKGROUND: Responses to monotherapy corticosteroid or thalidomide have been described in prostate cancer, in chemotherapy naïve subjects. METHODS: A total of 39 men with hormone refractory, metastatic prostate cancer who had progression during or after at least 1 conventional cytotoxic drug were treated on a single-arm Phase II trial with dexamethasone, 0.75 mg twice a day plus thalidomide, 100-400 mg/day. RESULTS: Best-observed responses included >50% prostate-specific antigen (PSA) reduction with no radiologic progression: 10 of 39 (26%; 95% confidence interval 13% to 42%). An additional 14 of 39 had decreased PSA but then with radiologic or other progression by 12 weeks. Median progression-free survival was 84 days. Toxicity appeared treatable; there were 5 nonfatal thromboses. There was 1 subject who had complete PSA and radiologic response; 4 responders tolerated treatment without progression for more than 1 year. CONCLUSIONS: PSA responses were frequent. Mostly, these were not durable, but some lasted more than a year. Further investigation on determinants of response durability for these or related compounds should be considered. The response rate of the present data does not support Phase III testing of this regimen for this population.

Evolución y manejo terapeútico del episodio asmatico severo en una unidad de cuidados intensivos pediatricos / Evaluation and treatment of severe asthmatic episode admitted in the Intensive Cares Unit

A pesar de los notables adelantos que se han originado en el conocimiento de la naturaleza inflamatoria de la afección y en su terapéutica, el asma bronquial continúa siendo una causa significativa de morbilidad y mortalidad en el mundo. Con el objetivo de identificar las características evolutivas y referentes a la terapéutica de los pacientes con episodio asmático severo se realizó un estudio transversal, descriptivo y con carácter prospectivo de 57 niños con este diagnóstico, ingresados en la Unidad de Cuidados Intensivos Pediátricos ( UCIP) de nuestro Centro, durante un período de 7 años (1999-2005). La severidad del episodio asmático se evaluó según la escala de Downes.El 29,8 por ciento de los pacientes había ingresado anteriormente en la UCIP por episodio asmático grave. El 66,6 por ciento recibió atención médica de urgencia en las primeras 12 horas de iniciada la exacerbación. La hipoxemia fue la alteración gasométrica más común, detectándose en 71,9 por ciento de los enfermos. En 18 pacientes (31,6 por ciento), se presentaron complicaciones, lo cual alargó significativamente su estadía. La mayoría de los pacientes respondió bien a las estrategias habituales de tratamiento. Sólo 2 niños necesitaron ventilación mecánica. No hubo fallecidos en la muestra estudiada. Se recomienda la evaluación sistemática de la severidad de cada episodio asmático y la identificación de los pacientes con riesgo de empeorar y morir para instaurar el tratamiento más adecuado de forma oportuna(AU)

Evolucion y manjjo terapeutico del episodio asmtico severo en una unidad de cuuidados intensivos pediatricos / Evaluation and treatment of severe asthmatic episode admitted in the Intensive Cares Unit

A pesar de los notables adelantos que se han originado en el conocimiento de la naturaleza inflamatoria de la afección y en su terapéutica, el asma bronquial continúa siendo una causa significativa de morbilidad y mortalidad en el mundo. Con el objetivo de identificar las características evolutivas y referentes a la terapéutica de los pacientes con episodio asmático severo se realizó un estudio transversal, descriptivo y con carácter prospectivo de 57 niños con este diagnóstico, ingresados en la Unidad de Cuidados Intensivos Pediátricos ( UCIP) de nuestro Centro, durante un período de 7 años (1999-2005). La severidad del episodio asmático se evaluó según la escala de Downes. El 29,8 % de los pacientes había ingresado anteriormente en la UCIP por episodio asmático grave. El 66,6 % recibió atención médica de urgencia en las primeras 12 horas de iniciada la exacerbación. La hipoxemia fue la alteración gasométrica más común, detectándose en 71,9 % de los enfermos. En 18 pacientes (31,6 %), se presentaron complicaciones, lo cual alargó significativamente su estadía. La mayoría de los pacientes respondió bien a las estrategias habituales de tratamiento. Sólo 2 niños necesitaron ventilación mecánica. No hubo fallecidos en la muestra estudiada. Se recomienda la evaluación sistemática de la severidad de cada episodio asmático y la identificación de los pacientes con riesgo de empeorar y morir para instaurar el tratamiento más adecuado de forma oportuna.

In spite of the remarkable advances that have occurred in the knowledge of the inflammatory nature of the affection and in their therapy, the bronchial asthma is a significant cause of morbidity and mortality in the world. It was carried out a traverse and prospective study of 57 children with severe asthmatic episode admitted in the Intensive Cares Unit of the Hospital Docente Pediátrico del Cerro during a 7 years period (1999-2005). The severity of the asthmatic episode was evaluated according to the Downes' scale. 29.8% of the patients had entered previously in the UCIP for serious asthmatic episode and 66.6% received medical attention in the first 12 hours of initiate the crisis. The hipoxemia was detected in the 71.9% of the patients. In 18 children (31.6%) complications were presented, that lengthened their demurrage significantly. Most of the patients responded well to the habitual strategies of treatment. Two children needed mechanic ventilation only. No patient died in the studied sample. It is recommended the systematic evaluation of asthmatic episode severity and the identification of the patients with risk of dying to establish the most appropriate treatment in an opportune way.

Morbimortalidad por meningoencefalitis bacteriana en una unidad de cuidados intensivos pediátricos / Morbimortality for bacterial meningitis of the Intensive Cares Unit

Se realizó un estudio transversal y descriptivo de 87 pacientes egresados con el diagnóstico de meningoencefalitis bacteriana de la Unidad de Cuidados Intensivos del Hospital Docente Pediátrico del Cerro durante el período comprendido entre el 1º de enero de 1992 y el 31 de diciembre de 2004. Se describen los pacientes estudiados, según variables de caracterización individual y de la afección; asimismo, se identifica la relación entre algunas de dichas variables y la mortalidad. Se determinó que la enfermedad fue más frecuente en el grupo etáreo de 1-4 años y en el sexo masculino. El germen más común fue el Haemophilus influenzae . La edad inferior a 3 meses, la meningoencefalitis neumocócica y el diagnóstico tardío se relacionaron con una menor supervivencia. Un gran número de niños (71,3 por ciento) presentó complicaciones, resultado de la enfermedad. La mortalidad general fue de 9,2 por ciento(AU)

It was carried out a traverse and descriptive study of 87 patients discharged with the diagnosis of bacterial meningitis of the Intensive Cares Unit of the Hospital Docente Pediátrico del Cerro during the period between January 1º 1992 and December 31 the 2004. The patients are described according to variables of individual characterization and of the affection and also it is identified the relationship between some of this variables and the mortality. It was determined that the illness was more frequent in the group 1-4 year-old and in the masculine sex. The most common germ was Haemophilus influenzae. The inferior age to 3 months, the neumoccocal meningitis and the late diagnosis was related with a smaller survival. A great number of children (71,3 percent) presented complications product of the illness. The general mortality was 9,2 percent(AU)

Costos de infecciones intrahospitalarias por Staphylococcus aureus; meticilino resistente vs. meticilino sensible / Cost of Staphylococcus aureus hospital acquired infections, methicilin-resistant vs. methicilin susceptible isolates

La Infección Hospitalaria (IH) es un problema de Salud a nivel mundial por su alta morbimortalidad y costos asistenciales elevados. En Uruguay como otros países de Latino América hay pocos datos sobre los costos de estas infecciones. S. aureus es uno de los patógenos hospitalarios más importantes a nivel mundial, en Uruguay en 1997 constituían el 36% de las IH. Se realizó en el Hospital de Clínicas de Montevideo (hospital universitario de alta complejidad) la vigilancia durante 9 meses de las IH por S. aureus comparando los costos de infecciones por S. aureus meticilino sensible (SAMS) y S. aureus meticilino resistente (SAMR). Se utilizaron las recomendaciones de “Infection Control and Hospital Epidemiology” y las guías de Wenzel y cols. para la definición de las diferentes infecciones. Se analizaron 67 infecciones 33 SAMS y 34 SAMR. Treinta y cuatro correspondieron a infecciones del torrente sanguíneo (ITS) y 16 infecciones del sitio quirúrgico (ISQ). Los indicadores de costos utilizados fueron la estadía hospitalaria por la infección por nivel de servicio, estudios realizados para diagnóstico y evaluación de la infección y tratamiento antibiótico. Se compararon los costos de las infecciones por SAMR y SAMS. Se encontraron diferencias estadísticamente significativas en las infecciones del torrente sanguíneo, mediana de 5916 dólares en pacientes con SAMR y 1963 dólares en SAMS. Es importante continuar con estudios de vigilancia y de costos de las IH para tener mayor conocimiento de estas así los administradores y trabajadores de la Salud podrán tener mejores argumentos para realizar medidas de prevención y control

An efficient expression system for the production of functionally active human LKB1.

Human LKB1, also known as STK11, is a tumour-suppression protein that mediates important functions in cellular proliferation and polarization. It might constitute an important target in cancer therapy. In order to produce large amounts of recombinant protein for biochemical and functional studies, a full-length cDNA clone was subcloned and expressed in Escherichia coli and insect cells. Although fusion proteins corresponding to LKB1 with 6xHis, GST and MBP tags could be overexpressed in E. coli, only MBP-LKB1 was recovered in a soluble, but heavily degraded form. Further studies demonstrated that this protein was not functional. Subsequent expression in insect cells of LKB1 with 6xHis and GST tags yielded insoluble products also. However, when chaperones Hsp70 and its cofactors Hsp40 and Hsdj were co-expressed with GST-LKB1, a clear increase in the solubility of the final protein was obtained. Moreover, this soluble, purified recombinant GST-LKB1 demonstrated to be a phosphoprotein, with at least residue Ser325 phosphorylated. The purified protein was functionally active as being able to demonstrate autophosphorylation in the absence of any associated kinase.