Hipovitaminosis D en pacientes hemodiálizados (HD): factores relacionados e influencia sobre la fuerza muscular / Hypovitaminosis D in patients on hemodialysis (HD): related factors and influence on muscle strength

Introducción: La deficiencia de 25 (OH) vitamina D es una alteración prevalente en los pacientes con enfermedad renal crónica (ERC) , sin embargo en nuestro medio no es medida de manera rutinaria y por ende no suele hacerse reposición vitamínica. Nuestro objetivo fue determinar la prevalencia y los factores relacionados a deficiencia de 25 (OH) D en pacientes con ERC en hemodiálisis (HD), particularmente la relación con la función y masa muscular. Métodos: Efectuamos un estudio prospectivo, multicéntrico, en pacientes adultos en HD crónica que no estuvieran recibiendo ningún derivado de la vitamina D. Se midieron en sangre los niveles de 25(OH) D, Hemoglobina, PCR, Albúmina, Ca, P, FAL, PTHi. Se realizó la medición de la fuerza del puño con dinamómetro, y la prueba de sentado-parado. Se aplicó el índice de Karnofsky para clasificar el estado funcional., Se realizó una bioimpedanciometría (BCM; Frese nius Medical Care) en aquellos pacientes sin, contraindicación. Resultados: Se incluyeron 138 pacientes. La 25(OH) vitamina fue de 20.43 ± 10.5 ng/ml, la prevalencia de insuficiencia /defi ciencia 87% (37% con menos de 15 ng/ml). Las concentraciones de vitamina D/deficiencia mostraron correlación/relación significativa con la edad, la presencia de diabetes, los niveles de hemoglobina y albúmina, la fuerza y la masa muscular y la clase funcional (p<0.05) . Conclusión: Alta prevalencia de hipovitaminosis D en pacientes hemodializados particularmente gerontes y diabéticos. Esto estaría relacionado con la desnutrición, anemia, clase funcional y la fuerza/masa muscular de los pacientes, estos últimos dos factores no reportados hasta ahora. Todos estos factores deben ser considerados al momento de la sustitución vitamínica y en la evaluación de la efectividad de la misma.(AU)

Background: 25 (OH) vitamin D deficiency is a prevailing alteration in patients with chronic kidney disease (CKD); however, in our environment, it is not routinely measured and, therefore, vitamin replacement is unusual. Our purpose was assessing the prevalence of and the factors related to 25 (OH) vitamin D deficiency in patientswith CKD in hemodialysis (HD), especially the relation to function and muscle mass. Methods: We conducted a prospective, multicenter study in adult patients on chronic HD who were not receiving any vitamin D derivative. Blood levels of 25 (OH) D, Hemoglobin, CRP, Albumin, Ca,P, ALP and PTHi were measured. The handgrip strength was measured with a dynamometer and the sitting-rising test was carried out. A bioimpedance analysis (BCM; Fresenius Medical Care) was conducted in the patients who had no contraindications. Results: 138 patients were included. The levels of 25 (OH) vitamin D were 20.43±10.5 ng/ml; the insufficiency/deficiency had 87% prevalence (and 37% prevalence with less than 15 ng/ml). Vitamin D concentrations/ deficiency showed a significant correlation with/ relation to age, diabetes, hemoglobin and albumin levels, muscle strength and mass, and functional class (p<0.05). Conclusion: High prevalence of hypovitaminosis D in patients on hemodialysis, particularly in the elderly and in patients with diabetes. This should be related to undernutrition, anemia, the functional class and the muscle strength/mass of patients, the latter two being unreported factors until now. All these factors should be considered when vitamin replacement is conducted and when its effectiveness is assessed.(AU)

Hipovitaminosis D en pacientes hemodiálizados (HD): factores relacionados e influencia sobre la fuerza muscular / Hypovitaminosis D in patients on hemodialysis (HD): related factors and influence on muscle strength

Introducción: La deficiencia de 25 (OH) vitamina D es una alteración prevalente en los pacientes con enfermedad renal crónica (ERC) , sin embargo en nuestro medio no es medida de manera rutinaria y por ende no suele hacerse reposición vitamínica. Nuestro objetivo fue determinar la prevalencia y los factores relacionados a deficiencia de 25 (OH) D en pacientes con ERC en hemodiálisis (HD), particularmente la relación con la función y masa muscular. Métodos: Efectuamos un estudio prospectivo, multicéntrico, en pacientes adultos en HD crónica que no estuvieran recibiendo ningún derivado de la vitamina D. Se midieron en sangre los niveles de 25(OH) D, Hemoglobina, PCR, Albúmina, Ca, P, FAL, PTHi. Se realizó la medición de la fuerza del puño con dinamómetro, y la prueba de sentado-parado. Se aplicó el índice de Karnofsky para clasificar el estado funcional., Se realizó una bioimpedanciometría (BCM; Frese nius Medical Care) en aquellos pacientes sin, contraindicación. Resultados: Se incluyeron 138 pacientes. La 25(OH) vitamina fue de 20.43 ± 10.5 ng/ml, la prevalencia de insuficiencia /defi ciencia 87% (37% con menos de 15 ng/ml). Las concentraciones de vitamina D/deficiencia mostraron correlación/relación significativa con la edad, la presencia de diabetes, los niveles de hemoglobina y albúmina, la fuerza y la masa muscular y la clase funcional (p<0.05) . Conclusión: Alta prevalencia de hipovitaminosis D en pacientes hemodializados particularmente gerontes y diabéticos. Esto estaría relacionado con la desnutrición, anemia, clase funcional y la fuerza/masa muscular de los pacientes, estos últimos dos factores no reportados hasta ahora. Todos estos factores deben ser considerados al momento de la sustitución vitamínica y en la evaluación de la efectividad de la misma.

Background: 25 (OH) vitamin D deficiency is a prevailing alteration in patients with chronic kidney disease (CKD); however, in our environment, it is not routinely measured and, therefore, vitamin replacement is unusual. Our purpose was assessing the prevalence of and the factors related to 25 (OH) vitamin D deficiency in patientswith CKD in hemodialysis (HD), especially the relation to function and muscle mass. Methods: We conducted a prospective, multicenter study in adult patients on chronic HD who were not receiving any vitamin D derivative. Blood levels of 25 (OH) D, Hemoglobin, CRP, Albumin, Ca,P, ALP and PTHi were measured. The handgrip strength was measured with a dynamometer and the sitting-rising test was carried out. A bioimpedance analysis (BCM; Fresenius Medical Care) was conducted in the patients who had no contraindications. Results: 138 patients were included. The levels of 25 (OH) vitamin D were 20.43±10.5 ng/ml; the insufficiency/deficiency had 87% prevalence (and 37% prevalence with less than 15 ng/ml). Vitamin D concentrations/ deficiency showed a significant correlation with/ relation to age, diabetes, hemoglobin and albumin levels, muscle strength and mass, and functional class (p<0.05). Conclusion: High prevalence of hypovitaminosis D in patients on hemodialysis, particularly in the elderly and in patients with diabetes. This should be related to undernutrition, anemia, the functional class and the muscle strength/mass of patients, the latter two being unreported factors until now. All these factors should be considered when vitamin replacement is conducted and when its effectiveness is assessed.

Upper leg lengthening on an intramedullary nail: a preliminary report.

Current methods of treatment for anisomelia are based on distraction osteogenesis. This involves creating callus during gradual distraction using an external fixator. The lengthening of long bones by Ilizarov's method requires keeping the external fixator in place for a long period of time, which increases the risk of complications, such as pin - track infection, stiffness of the joint, misalignment, and fracture of the regenerate. In order to shorten the period during which the external fixator must remain in place, we have introduced a method which enables the external fixator to be removed when the distraction phase is completed. During the period 1999-2001 we carried out femoral lengthening in 9 patients, using a combination of external fixation and intramedullary nail. After osteotomy of the femur and fixation by intramedullary nail, an external fixator was also applied, allowing for gradual distraction. After the requisite lengthening had been obtained by distraction at the rate of 1 mm per day, the nail was locked and the external fixator was removed. The operated patients ranged in age from 13 to 23; the average age at the moment of surgery was 16,2 years. The mean femoral anisomelia was 4,5 cm (range: 2,5-8,3). In seven cases the etiology of the anisomelia was congenital, in one case avascular necrosis of the femur, and in one case a history of femur fracture. The average duration of external fixation was 11 days for 1 cm of bone lengthening. All the lengthening femurs healed without bone union complications. In 8 cases we obtained complete isomelia, wile in 1 case there remained an inequality of 6 mm due to premature callus maturation and bone union. This is turn was caused by the patient's voluntary termination of distraction in conjunction with a two-week delay in the scheduled clinical follow-up. The removal of the external apparatus upon completion of distraction made it possible to institute early rehabilitation and enabled a quick restoration of physiological mobility in the knee joint. The chief advantages of limb lengthening using an intramedullary nail are the significant reduction in the duration of external fixation, protection of the bone regenerate against fracture, and a shorter period of time for rehabilitation. The disadvantages of this method include the extended surgical procedure and the risk of nail wedging in the intramedullary canal, which prevents lengthening.

Experiencia en diálisis peritoneal crónica / Experiences in chronic peritoneal dialysis

Conclusiones: Nuestra experiencia inicial con DPI resultó satisfactoria. Los resultados dependen fuertemente de la selección del paciente. Los resultados con DPCA son alentadores. Es preciso trabajar con materiales confiables. Se estima que una atinada selección de los candidatos es necesaria. (AU)

Experiencia en diálisis peritoneal crónica / Experiences in chronic peritoneal dialysis

Conclusiones: Nuestra experiencia inicial con DPI resultó satisfactoria. Los resultados dependen fuertemente de la selección del paciente. Los resultados con DPCA son alentadores. Es preciso trabajar con materiales confiables. Se estima que una atinada selección de los candidatos es necesaria.

Some features of the ecology of fleas inhabiting the nests of the suslik (Citellus citellus (L.)). I: Population dynamics, sex ratio, feeding, reproduction.

While studying the suslik fleas in artificial nests planted in free nature, significant changes in the population dynamics of N. setosa, C. simplex and C. orientalis (from the spring build up to the autumnal peak and the decrease of flea number until the next spring) were noted. The predominance of females in the spring period was recorded in N. setosa. Significant seasonal changes in the number of engorged females of N. setosa and C. simplex and of C. orientalis males (the increase of engorged specimens in the spring and summer) were demonstrated. A significant predominance of females with mature eggs in the spring and summer and their negligible number in the autumn were found in N. setosa and C. simplex.

Mosquito studies on the Isla de la Juventud, Cuba, at the beginning of rain period.

A total of 8418 mosquitoes belonging to 16 species were collected in 11 localities of the Isla de la Juventud. The most abundant species was Aedes taeniorhynchus (92% of specimens collected). The species Wyeomyia vanduzeei and Mansonia nigricans were encountered on the island for the first time.

Metodos de trabajo entomologico para investigaciones de campo en arbovirus en Cuba. / Entomologic working methods for field researches in arbovirus in Cuba

Se oferece un metodo para captura, clasificacion y conservacion de culicidos con vistas a estudios arbrovirologicos, de acuerdo con las condiciones que existen en Cuba. Se posibilita por este metodo obtener una mayor eficiencia en las muestras al no usarse anestesicos ni otros medios que produzcan mortalidad en los insectos colectados. Se puede usar en otros dipteros hematofagos y en estudios entomologicos relacinados con otras enfermedades transmisibles

Experimental transmission of Tahyna virus (California group) to wild rabbits (Oryctolagus cuniculus) by mosquitoes.

Two wild rabbits (Oryctolagus cuniculus) were subcutaneously infected with a dose of 2.6 dex. i.c. LD50/0.02 ml of extraneurally passaged Tahyna virus strain "236". During the 24-72 hours interval p.i. viremia was demonstrated in both animals ranging from 1.0 to 3.42 dex. i.e. LD50/0.02. Mosquitoes Aedes vexans, which had fed on them, transmitted the virus to one of three other rabbits. During 24-96 hours interval after terminated feeding of infectious mosquitoes viremia was detected in this animal ranging from 0.49 to 4.08 dex i.c. LD50/0.02 ml. Seroconversion was revealed by means of plaque reduction neutralization test 11 days after infection.

Virological examination of mosquito larvae from southern Moravia.

254 pools of 4,115 mosquito larvae belonging to nine species were examined by isolation experiments. The larvae were collected in breeding places in an inundated forest--a natural focus of Tahyna virus, in April, June and July 1974 and 1975. Tahyna virus was isolated from one pool of 10 Culiseta annulata larvae collected in July 1974. Ecological questions concerning this finding are discussed.

Dynamics of the natural focus of Tahyna virus in southern Moravia and species succession of its vectors, the mosquitoes of the genus Aedes.

The paper deals with the occurrence of Aedes mosquitoes in southern Moravia and with Tahyna virus infection rates for them in 1972; a comparison of the data from previous years reveals the dynamics of the natural focus under long-term study. A total of 13,204 mosquitoes of the genus Aedes was processed in 122 tests, resulting in 17 Tahyna virus strains isolates. As concerns the valence of the natural focus, the most important was the inundated forest in the Drnholec locality. Infection rates for the mosquitoes were also determined in various microbiotopes of the said locality. A. cinereus, from which Tahyna virus was first isolated in the summer of 1972, was much more numerous than in the preceding seasons studied, indicating its important role as vector of Tahyna virus. The cell line of Aedes albopictus was demonstrated to be susceptible enough for virus detection from mosquitoes collected in the field.