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INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice for symptomatic choledocholithiasis during pregnancy. In pregnant patients, aside from the risks inherent in the procedure and sedation, there is the added concern of the potentially damaging effects of ionizing radiation on the fetus. AIM: To describe the maternal and fetal results of ERCP performed to resolve symptomatic choledocholithiasis in pregnant patients. MATERIALS AND METHODS: A retrospective, descriptive, observational, and cross-sectional study was conducted. It included pregnant patients with choledocholithiasis that underwent ERCP within the time frame of June 2017 and June 2018. RESULTS: The study included 9 pregnant patients, with a mean gestational age of 24.1 weeks, that underwent ERCP. There were no maternal or fetal complications associated with sedation, mean fluoroscopy time was 26.7seconds, and one patient (11.1%) presented with mild post-ERCP pancreatitis that was resolved through medical management. Pregnancy progression was normal in 100% of the cases, resulting in the birth of neonates with a normal Apgar score, a mean weight of 3,120g, a mean length of 49.94cm, and a mean gestational age of 38.37 weeks. At follow-up at 6 months, the infants had a mean weight of 7.1kg and a mean length of 66.94cm. CONCLUSIONS: The results from our hospital center were similar to those described in the international literature, showing that ERCP in our medical environment is a feasible, safe, and efficacious method for both the mother and fetus. When performed by an experienced endoscopist, it should be considered the treatment of choice for choledocholithiasis in pregnant patients.
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BACKGROUND: Peroral endoscopic myotomy has recently been developed and performed on patients with good results. AIMS: To evaluate the technical feasibility of peroral endoscopic full-thickness and partial thickness myotomy in a porcine model. MATERIAL AND METHODS: Eighteen criollo pigs were randomly assigned to 2 groups: group A (partial-thickness myotomy) and group B (full-thickness myotomy). The mucosal defect proximal to the myotomy site was left open. On the seventh postoperative day the pig was euthanized and follow-up surgical exploration was performed. The duration of each procedure, postoperative progression of the animal, complications, and anatomopathologic findings were registered. RESULTS: The procedure was viable in all the pigs. The mean surgery duration was 81±35.3min (group A 51.11±11.12, group B 111±22.61; P<.05). The main complication during myotomy was subcutaneous emphysema (16%). The histopathologic study of the group A surgical specimens reported complete circular myotomy in all cases, and complete circular and longitudinal myotomy was reported in 100% of the group B sample. CONCLUSIONS: The endoscopic myotomy technique is feasible. Endoscopic partial-thickness myotomy was associated with shorter surgery duration and better results during the intraoperative period and the 7-day follow-up.
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Endoscopía Gastrointestinal/métodos , Esófago/cirugía , Boca/cirugía , Anestesia , Animales , Endoscopía Gastrointestinal/efectos adversos , Acalasia del Esófago/cirugía , Esfínter Esofágico Inferior/cirugía , Femenino , Músculos/cirugía , Cirugía Endoscópica por Orificios Naturales , Hemorragia Posoperatoria , PorcinosRESUMEN
INTRODUCTION: Some experimental, Phase II clinical trials and the preliminary reports of the Cuban Phase III clinical trial indicate that alpha-IFN (IFN) may be useful in relapsing remitting (RR) multiple sclerosis (MS). The reports in Cuba showed that 70% of the MS patients have cognitive dysfunction. OBJECTIVE: To assess the efficacy of IFN-alpha2b recombinant in the cognitive dysfunction of RR MS. PATIENTS AND METHODS: 57 RR-MS clinical definite patients from the randomised, double blind, placebo controlled study of 225 patients with RR-MS and brain MRI confirmed. Patients were randomly assigned to receive intramuscular IFN-alpha2b (Heberon R) 10 million IU (high dose), 3 million IU (low dose) or placebo twice week for 2 years. Outcome results were blinding evaluated considering changes in the following tests: Luria, WAIS, Benton and PASAT-3. Adverse events and side effects were not evaluated to maintain physician blinding. RESULTS: The initial comparison of the groups did not show any differences among the placebo (n=20), low dose (n=18) and high dose (n=19) considering age (p=0.234), gender, ethnic group (p=0.012), years ill (p=0.787), EDSS (p=0.203) and rate of relapses (p=0.432). The Luria's Test showed an improved in the low dose group from 2.50 +/- 1.34 to 1.39 +/- 1.85 (p=0.029) and in the high dose group from 3.22 +/- 1.89 to 2.17 +/- 1.50 (p=0.006) vs placebo 2.85 +/- 1.66 to 2.90 +/- 1.97 (p=0.723). The results of the Benton's test demonstrated that the low dose group had an improved from 5.50 +/- 1.10 to 6.22 +/- 1.31 (p=0.047), in the high dose group from 4.87 +/- 1.85 to 5.78 +/- 1.35 (p=0.005) where as in the placebo group worse from 5.15 +/- 1.76 to 5.05 +/- 2.11 (p=0.893). The WAIS test showed the same results, the low dose group increased from 5.17 +/- 1.34 to 6.06 +/- 1.21 (p=0.022), the high dose group from 4.56 +/- 1.38 to 5.39 +/- 1.29 (p=0.007) and the placebo group worse from 5.25 +/- 1.25 to 5.05 +/- 1.57 (p=0.354). Finally, the PASAT-3 test increased in the IFNs groups: from 45.72 +/- 10.61 to 49.94 +/- 11.68 (p=0.015) in the low dose group, from 42.67 +/- 11.04 to 48.72 +/- 8.84 (p=0.03) in the high dose group, but in the placebo group worse from 44.55 +/- 10.86 to 41.95 +/- 13.74 (p=0.655). CONCLUSION: IFN-alpha improved the cognitive dysfunction in RR-MS patients. The higher dose is more beneficial.
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Trastornos del Conocimiento/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Esclerosis Múltiple Recurrente-Remitente/tratamiento farmacológico , Esclerosis Múltiple Recurrente-Remitente/fisiopatología , Adulto , Ensayos Clínicos Fase II como Asunto , Ensayos Clínicos Fase III como Asunto , Trastornos del Conocimiento/diagnóstico , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Humanos , Interferón alfa-2 , Masculino , Esclerosis Múltiple Recurrente-Remitente/diagnóstico , Pruebas Neuropsicológicas , Placebos , Proteínas Recombinantes , Resultado del TratamientoRESUMEN
BACKGROUND, AIMS: Neutrophil cells constitute the first defense barrier against the oral bacterial challenge in the periodontium. Reduction of neutrophils could impair this response against periopathogenic bacteria such as Porphyromonas gingivalis. Our previous work implicates the apoptosis of neutrophils in the pathogenesis of periodontitis. We now demonstrate that granulocyte monocyte-colony stimulating factor (GM-CSF) present in the gingival crevicular fluid (GCF) and secreted during the immune response reduces the apoptosis of neutrophils. METHOD: In this study, the presence of GM-CSF and tumor necrosis factor-alpha (TNF-alpha) in GCF was determined in samples obtained from adult patients with periodontitis and from control subjects with clinically healthy gingiva. GCF was collected for 30 s using Periopaper(R) strips, and cytokines were quantified by ELISA. We used ex vivo culture of gingival tissue biopsies for 2 and 4 days in the presence of GM-CSF. Apoptosis was determined using the terminal TdT-mediated dUTP-biotin nick end labeling (TUNEL) technique, and expression of Bax by immunohistochemistry. RESULTS: The presence of GM-CSF and TNF-alpha was detected in the majority of sites from periodontal patients (83.3% and 63.3%, respectively), presenting a total amount of 27.65 and 42.38 pg, respectively. GM-CSF reduces the neutrophil apoptosis determined by double staining with TUNEL and myeloperoxidase and by a reduction of Bax expression. CONCLUSIONS: These findings suggest a novel mechanism by which neutrophils specifically accumulate in adult patients with periodontitis.
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Apoptosis , Factor Estimulante de Colonias de Granulocitos y Macrófagos/fisiología , Neutrófilos/fisiología , Periodontitis/inmunología , Proteínas Proto-Oncogénicas c-bcl-2 , Factor de Necrosis Tumoral alfa/fisiología , Adulto , Estudios de Casos y Controles , Enfermedad Crónica , Femenino , Expresión Génica , Líquido del Surco Gingival/química , Factor Estimulante de Colonias de Granulocitos y Macrófagos/análisis , Humanos , Técnicas para Inmunoenzimas , Etiquetado Corte-Fin in Situ , Masculino , Persona de Mediana Edad , Periodontitis/fisiopatología , Proteínas Proto-Oncogénicas/análisis , Proteínas Proto-Oncogénicas/biosíntesis , Factor de Necrosis Tumoral alfa/análisis , Proteína X Asociada a bcl-2Asunto(s)
Humanos , Niño , Adulto , Medicina Comunitaria , Servicios de Salud Comunitaria , Educación en Salud/normas , Educación en SaludRESUMEN
Plantea que la terapéutica de las plantas medicinales ha alcanzado en nuetros días tal importancia que un 80 por ciento de la población mundial la utliza para el alivio de sus enfermedades, adquiriendo mayor importancia cuando a partir de 1970 la OMS recomendó a los paises en desarrollo la integración de estas medicinas a los programas de salud (AU)
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Medicina Tradicional , Medicina de HierbasAsunto(s)
Humanos , Adulto , Niño , Servicios de Salud Comunitaria , Medicina Comunitaria , Educación en Salud/normas , Educación en SaludRESUMEN
Plantea que la fitoterapia cumple un papel muy importante en la atención primaria de la salud como recurso terapéutico muy efectivo, en que escasean muchos de los medicamentos de síntesis (AU)
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Atención Primaria de Salud , Medicina de HierbasRESUMEN
Describe los pricipios activos del Plantago major (Plantaginacene), Psidium guajava (Myrtaceae), Tumerindusindica (Caesalpinaceae), Zingiber officinale (Zingiberaceae); así como los formularios oficiales en Cuba (AU)
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Plantas MedicinalesRESUMEN
El Aloe Barbadensis Mill es una planta medicinal a la que se le atribuyen efectos beneficiosos en el tratamiento del asma bronquial. Se la emplea con estos fines por vias oral, intramuscular y subcutánea. En este trabajo se evalúa la toxicidad aguda del estraxto de Aloe barbadensis por via inhalatoria para incorporar esta via de administración a los mencionados. Después del tratamiento, no se observaron alteraciones macrocópicas ni histopatológicas significativas en los órganos analizados (AU)
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Aloe , Administración por Inhalación , ToxicologíaRESUMEN
Water samples from air conditioning cooling towers receiving different treatment protocols on five large municipal buildings in San Juan, P.R., were assayed for various Legionella spp. and serogroups by using direct immunofluorescence. Several water quality parameters were also measured for each sample. Guinea pigs were inoculated with water samples to confirm pathogenicity and recover viable organisms. Legionella pneumophila serogroups 1 to 6, L. bozemanii, L. micdadei, L. dumoffii, and L. gormanii were observed in at least one of the cooling towers. L. pneumophila was the most abundant species; its density reached 10(5) cells per ml, which is within the range that is considered potentially pathogenic to humans. A significantly higher density of L. pneumophila was observed in the cooling tower water that was not being treated with biocides. Percent respiration (INT) and total cell activity (acridine orange direct count) were inversely correlated with bacterial density. This study demonstrates that Legionella spp. are present in tropical air-conditioning cooling systems and that, without continuous biocide treatment, they may reach densities that present a health risk.
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Aire Acondicionado , Legionella/crecimiento & desarrollo , Microbiología del Agua , Animales , Recuento de Colonia Microbiana , Cobayas , Legionella/patogenicidad , Puerto Rico , Clima TropicalRESUMEN
Se plantea la hipótesis de que con la aplicación de una variante del sistema de reforzamiento por fichas, podía incrementarse la participación de los pacientes en las actividades desarrolladas en una comunidad terapéutica para psicóticos y alcohólicos, y de que su aplicación era factible dentro de la estructura organizativa mantenida en los tres últimos años de trabajo para lograr estos objetivos se llevó a cabo una investigación desarrollada en tres etapas de tres meses cada una, y se controló durante las mismas el comportamiento de los pacientes en cuanto a: asistencia diaria a la reunión matutina; cumplimiento del horario establecido para levantarse; y otros indicadores utilizados como control por no contemplarse en el sistema de gratificaciones(AU)
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Comunidad Terapéutica , Trastornos Psicóticos/terapia , Alcoholismo/terapiaAsunto(s)
Diabetes Mellitus/sangre , Lipoproteínas/sangre , Adolescente , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Electroforesis en Gel de Agar , Femenino , Humanos , Hiperlipidemias/diagnóstico , Lipoproteínas/biosíntesis , Lipoproteínas IDL , Lipoproteínas VLDL/biosíntesis , Lipoproteínas VLDL/sangre , MasculinoRESUMEN
Se valoró la utilización de aminoglucósidos durante el último semestre del año 1997 en los Servicios de Medicina Interna del Hospital Militar Comandante Manuel Fajardo de Santa Clara, Villa Clara. Se realizó un anális sobre las principales causas de uso de estos fármacos encontrándose que fueron las sepsis respiratorias las fundamentales. Se definieron los medicamentos más empleados dentro del grupo (Kanamicina, Amikacina y Gentamicina), su dosificación y duración del tratamiento, donde se pudieron hallar algunas dificultades. Se valoraron las interacciones producidas con otros fármacos (que fueron adecuadas) así como los efectos indeseables y las conductas del personal de la salud en este sentid. Pudo contarse que no se realizó un tratamiento impuesto con los aminoglucósidos como exitoso. Se formularon recomendaciones.