An initial experience with intraoperative O-Arm for deep brain stimulation surgery: can it replace post-operative MRI?

Deep brain stimulation (DBS) is used to treat movement disorders, severe psychiatric disorders, and neuropathic pain, among other diseases. Advanced neuroimaging techniques allow direct or indirect localization of the target site, which is verified in many centers by the intraoperative recording of unitary neuronal activity. Intraoperative image acquisition technology (e.g., O-Arm) is increasingly used for accurate electrode positioning throughout the surgery. The aim of our study is to analyze the initial experience of our team in the utilization of O-Arm for planning DBS and monitoring its precision and accuracy throughout the procedure. The study included 13 patients with movement disorders. All underwent DBS with the intraoperative O-arm image acquisition system (iCT) and Medtronic StealthStation S7 cranial planning system, placing a total of 25 electrodes. For each patient, we calculated the difference between real and theoretic x, y, z coordinates, using the paired Student's t test to evaluate absolute and directional differences and the one-sample Student's t test to analyze differences in Euclidean distances. No statistically significant differences were found in absolute, directional, or Euclidean distances between intended and actual x, y, and z coordinates, based on iCT scan. Our experience confirms that utilization of the O-Arm system in DBS provides accurate and precise verification of electrode placements throughout the procedure. Recent studies found no significant differences between iCT and postoperative MRI, the current gold standard. Further prospective studies are warranted to test the elimination of postoperative MRI when this system is used.

Depuración de lactato a gran altitud / Lactate clearance at high altitude

OBJETIVO: el estudio pretende caracterizar la depuración de lactato (DL) en pacientes críticamente enfermos, a gran altitud. DISEÑO: estudio prospectivo de cohorte. ÁMBITO: unidad de Cuidados Intensivos de Adultos del Hospital del Norte de la ciudad de El Alto, La Paz (Bolivia), a 4 150 metros sobre el nivel del mar, periodo 25 de abril 2016-01 de junio 2018. PACIENTES: todos los pacientes ingresados a la Unidad de Cuidados Intensivos de Adultos, nativos de gran altitud, así como residentes de la misma por lo menos los últimos 6 meses. RESULTADOS: se incluyeron 250 pacientes, con sobrevida de 68%, promedio de edad 50 años; en el grupo de 170 supervivientes, poco más de la cuarta parte del lactato de ingreso fue depurado (26%), a comparación del grupo de 80 fallecidos, en el cual incluso el valor de lactato se vio incrementado alrededor de la quinta parte del lactato de ingreso (21%), ambos con p ≤ 0.05 mediante el test de ANOVA. En pacientes críticamente enfermos a gran altitud, el riesgo relativo entre depuración de lactato ≥ 26% y sobrevida es de 2.7 con sensibilidad 0.72 y especificidad de 1. DISCUSIÓN Y CONCLUSIONES: la depuración de lactato en individuos críticamente enfermos nativos de gran altitud, se asocia a mayor sobrevida y debería ser considerado como un objetivo durante la reanimación en pacientes críticos, de forma similar a estudios realizados en otras latitudes

OBJECTIVE: to characterize the lactate clearance on critically ill patients, at high altitude. DESIGN: prospective cohort study. FIELD: critical Care Unit of "Hospital del Norte" in El Alto, La Paz (Bolivia), during the period April 25, 2016 ­ June 01, 2018. PARTICIPANTS: critically ill patients residents of high altitude at least the last 6 months, admitted to the Adult Critical Care Unit. RESULTS: 250 patients were included, with survival of 68%, age average of 50 years; in the 170 survivors, lactate clearance average was 26%, in contrast with 80 deceased patients who presented an increased lactate level of 25%, p ≤ 0.05, both of them through ANOVA test. In high landers critically ill patients, relative risk of lactate clearance ≥ 26% and survival was 2.7 with sensitivity 0.72 and specificity 1. DISCUSSION AND CONCLUSIONS: lactate clearance in critically ill high landers dwellers, is associated with survival and it should be considered also as a reanimation objective, comparable to other studies developed in different latitudes

Fast specific field detection of RHDVb.

This work describes a simple and rapid test for field detection of the emerging rabbit pathogen RHDVb. The assay is specific for RHDVb, showing no cross-reactivity with other RHDV types giving a specific result in under 10 min using rabbit liquid exudates or liver homogenate samples taken at necropsy.

Impact of intra-aortic balloon pump on short-term clinical outcomes in ST-elevation myocardial infarction complicated by cardiogenic shock: A ‘real life’ single center experience / Impacto del balón de contrapulsación intraaórtico en el pronóstico clínico a corto plazo de pacientes con infarto agudo de miocardio con elevación del segmento ST complicado con shock cardiogénico: experiencia de «vida real»

OBJECTIVE: To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS). DESIGN: A single-center retrospective case-control study was carried out. SETTING: Coronary Care Unit. PATIENTS: Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP). VARIABLES: Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit. RESULTS: Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38-3.11; p = 0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4-10.6; p = 0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2-9.1; p = 0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2-8.1; p = 0.018) were the only variables independently associated to increased 30-day mortality. CONCLUSION: In our 'real life' experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization

OBJETIVO: Analizar el uso e impacto del balón de contrapulsación intraaórtico (BCIA) en la mortalidad a 30 días y en los desenlaces clínicos a corto plazo de pacientes con infarto agudo de miocardio con elevación del segmento ST complicado con shock cardiogénico. DISEÑO: Estudio de casos y controles unicéntrico y retrospectivo. Ámbito: Unidad Coronaria. PACIENTES: Los datos fueron obtenidos de 825 pacientes consecutivos admitidos en una unidad coronaria con diagnóstico de infarto agudo de miocardio con elevación del segmento ST desde enero de 2009 hasta agosto de 2015. Un total de 73 pacientes en situación de shock cardiogénico al ingreso derivados a una revascularización coronaria percutánea urgente fueron incluidos para el análisis y estratificados en función de la utilización del BCIA (44 pacientes recibieron BCIA). VARIABLES: Antecedentes cardiológicos, situación hemodinámica al ingreso, características angiográficas y periprocedimiento, y variables derivadas de la estancia en la Unidad Coronaria. RESULTADOS: La mortalidad a 30 días fue similar entre los tratados con BCIA y aquellos con tratamiento convencional (29,5 y 27,6%, respectivamente; HR con BCIA 1,10, IC 95% 0,38-3,11; p = 0,85). Así mismo, no encontramos diferencias significativas con respecto a los desenlaces clínicos a corto plazo: días en ventilación mecánica, tiempo hasta la estabilidad hemodinámica, requerimiento de fármacos vasoactivos y días de estancia en la Unidad Coronaria. En el análisis multivariante, las únicas variables asociadas de forma independiente con una mayor mortalidad a 30 días fueron peor función renal al ingreso (HR 3,9, IC 95% 1,4-10,6; p = 0,008), antecedentes de enfermedad arterial periférica (HR 3,3, IC 95% 1,2-9,1; p = 0,019) y diabetes mellitus (HR 3,2, IC 95% 1,2-8,1; p = 0,018). CONCLUSIÓN: En nuestra experiencia de la «vida real», la utilización del BCIA no modifica la mortalidad a 30 días ni los desenlaces clínicos a corto plazo en pacientes con infarto agudo de miocardio con elevación del segmento ST complicado con shock cardiogénico que son derivados a una estrategia de revascularización coronaria percutánea urgente

Impact of intra-aortic balloon pump on short-term clinical outcomes in ST-elevation myocardial infarction complicated by cardiogenic shock: A "real life" single center experience.

OBJECTIVE: To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS). DESIGN: A single-center retrospective case-control study was carried out. SETTING: Coronary Care Unit. PATIENTS: Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP). VARIABLES: Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit. RESULTS: Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38-3.11; p=0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4-10.6; p=0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2-9.1; p=0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2-8.1; p=0.018) were the only variables independently associated to increased 30-day mortality. CONCLUSION: In our "real life" experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization.

Valor pronóstico del análisis del vector de bioimpedancia en pacientes ingresados por descompensación aguda de insuficiencia cardiaca: cohorte de validación / Prognostic value of analysing the bioimpedance vector for patients hospitalised for acute decompensated heart failure: a validation cohort

Objetivos. Evaluar el impacto pronóstico del análisis del vector de bioimpedancia (bioelectrical impedance vector analysis [BIVA]) en pacientes ingresados por insuficiencia cardiaca (IC). Material y métodos. Cohorte prospectiva de 105 pacientes ingresados por IC. El BIVA se realizó previo al alta, y la muestra final se dividió en 3 grupos según el valor obtenido: hiperhidratación [hiperH] (>74,3%), normohidratación [normoH] (72,7-74,3%) y deshidratación [desH] (<72,7%). En el seguimiento, se consideraron eventos adversos la mortalidad total y los reingresos por IC. Resultados. Se observó una mayor incidencia de eventos en los pacientes hiperH y desH respecto a los normoH (Kaplan-Meier: log rank 2,1; p=0,04), con un incremento de riesgo independiente en el análisis multivariado (HR 2,6 [1,05-6,44]; p=0,039). Conclusiones. El análisis BIVA en pacientes ingresados por IC permite estratificar el riesgo de reingreso por IC y mortalidad total en el seguimiento a largo plazo (AU)

Objectives. To assess the prognostic impact of the bioimpedance vector (bioelectrical impedance vector analysis [BIVA]) for patients hospitalized for heart failure (HF). Material and methods. A prospective cohort of 105 patients hospitalized for HF. BIVA was performed prior to discharge, and the final sample was divided into 3 groups according to the value obtained: hyperhydration [hyperH] (>74.3%), normal hydration [normoH] (72.7-74.3%) and dehydration [desH] (<72.7%). In the follow-up, total mortality and readmissions for HF were considered adverse events. Results. A higher incidence of events was observed among the patients with hyperH and desH compared with those with normoH (Kaplan-Meier: log-rank, 2.1; p=.04), with an increase in independent risk in the multivariate analysis (HR, 2.6 [1.05-6.44]; p=.039). Conclusions. BIVA helps stratify the risk of readmission for HF and total mortality in the long-term follow-up of patients hospitalized for HF (AU)

Prognostic value of analysing the bioimpedance vector for patients hospitalised for acute decompensated heart failure: A validation cohort.

OBJECTIVES: To assess the prognostic impact of the bioimpedance vector (bioelectrical impedance vector analysis [BIVA]) for patients hospitalized for heart failure (HF). MATERIAL AND METHODS: A prospective cohort of 105 patients hospitalized for HF. BIVA was performed prior to discharge, and the final sample was divided into 3 groups according to the value obtained: hyperhydration [hyperH] (>74.3%), normal hydration [normoH] (72.7-74.3%) and dehydration [desH] (<72.7%). In the follow-up, total mortality and readmissions for HF were considered adverse events. RESULTS: A higher incidence of events was observed among the patients with hyperH and desH compared with those with normoH (Kaplan-Meier: log-rank, 2.1; p=.04), with an increase in independent risk in the multivariate analysis (HR, 2.6 [1.05-6.44]; p=.039). CONCLUSIONS: BIVA helps stratify the risk of readmission for HF and total mortality in the long-term follow-up of patients hospitalized for HF.

Incidencia de la morosidad de las cuentas por cobrar en la rentabilidad y la liquidez: estudio de caso de una Empresa Social del Estado prestadora de servicios de salud / The incidence of delinquent accounts receivable in profitability and liquidity: a case study on the state social enterprise

OBJETIVOS: determinar la incidencia de la morosidad de las cuentas por cobrar en la rentabilidad y liquidez de la Empresa Social del Estado Hospital Universitario Erasmo Meoz, período 2005-2009, realizada en la ciudad de Cúcuta, Departamento Norte de Santander, Colombia. METODOLOGIA: se aplicó una investigación de tipo documental, para determinar y analizar los indicadores financieros referentes a la morosidad de las cuentas por cobrar, rentabilidad y liquidez; por lo tanto, se requirió de la revisión y consulta detallada de fuentes primarias (estados financieros e informes) de la Empresa Social del Estado Hospital Universitario Erasmo Meoz período 2005 - 2009 RESULTADOS: en particular, se evidenció el crecimiento acelerado de los costos y los gastos sin ningún control con respecto al aumento en las ventas, igualmente el crecimiento de las cuentas por cobrar, lo cual incidió directamente en la sostenibilidad financiera del Hospital. DISCUSION: ante la problemática que refleja el Hospital por la alta morosidad de cartera y la insostenibilidad financiera, la Institución requiere con urgencia promover lineamientos y estrategias financieras que conduzcan al mejoramiento de la competitividad y oportunidad en la prestación de servicios de salud de tercer y cuarto nivel de complejidad, beneficiándose los usuarios más pobres de la región y su área de influencia.

OBJECTIVE: to determine the incidence of delinquent accounts receivable on the profitability and liquidity of the Erasmo Meoz University Hospital State Social Enterprise, 2005-2009 period, carried out in the city of Cúcuta, Norte de Santander Department, Colombia. METHODOLOGY a documentary research was carried out in order to determine and analyze the financial indicators referring to delinquent accounts receivable, profitability and liquidity; however a detailed review and inquiry into the primary sources (financial statements and reports) for the Erasmo Meoz University Hospital State Social Enterprise in the 2005-2009 period was required. RESULTS: pin particular there was accelerated growth of costs and expenses with no control with respect to a rise in sales. Likewise the accounts receivable grew, directly impacting the Hospital's financial sustainability. DISCUSSION: faced with the problem reflected by the Hospital in its high portfolio delay in payment of liabilities and financial unsustainability, the Institution urgently needs to introduce guidelines and financial strategies which promote greater competition and opportunity in the provision third and fourth level of complexity healthcare services, thus benefiting the region's poorer residents and its area of influence.

IRS1, TCF7L2, ADRB1, PPARG, and HHEX polymorphisms associated with atherogenic risk in Mexican population.

Objective. We aimed to explore the association between polymorphisms of IRS1 (rs1801278), TCF7L2 (rs7903146 and rs12255372), ADRB1 (rs1801253), PPARG (rs1801282), and HHEX (rs5015480) genes with atherogenic risk (AI = Total cholesterol/HDL) in MetS, T2D, and healthy populations from the Mexican Social Security Institute. Methodology and Results. Four hundred thirty-five MetS, 517 T2D, and 547 healthy individuals were selected. The association between the SNPs and the atherogenic index was evaluated by multiple linear regression and multinomial logistic regression models. The ADRB1 gene showed a statistically significant association with high-risk atherogenic index, OR = 2.94 (IC 95% 1.64-5.24; P < 0.0001) for the Arg/Gly variant, under the dominant model an OR = 2.96 (IC 95% 1.67-5.25; P < 0.0001), and under the Log additive model an OR = 2.52 (IC 95% 1.54-4.15; P < 0.0001). Conclusions. The Arg389Gly polymorphism of the ADRB1 gene may be a worthy biological marker to predict the risk of developing cardiovascular diseases given a high-risk atherogenic index.

Metabolic and reproductive status are not improved from 11 to 25 day post-partum in non-weaned primiparous rabbit does.

The aim of present work was to analyze the body reserves and ovarian features of lactating primiparous rabbit does under extensive reproductive management (artificial insemination (AI) at 25 days post-partum (dpp)) compared with the common insemination rhythm at 11 dpp. A total of 48 primiparous Californian×New Zealand White rabbit does suckling 8 kits were used to assess liveweight, estimated body composition, serum metabolic and endocrine parameters (oestradiol and progesterone concentrations) and ovarian features like follicle population and atresia rate, and oocyte maturation. Rabbit does were randomly allocated in two experimental groups: (a) lactating does euthanized at early post-partum period (11 dpp) according to a semi-intensive rhythm (n=24), and (b) lactating does euthanized at later post-partum period (25 dpp) according to a more extensive rhythm (n=24). Liveweight, body energy content, lipid depots and serum non-esterified fatty acids (NEFA) concentrations decreased from parturition to post-partum period (P<0.05). In addition, serum protein and glucose concentrations increased in the post-partum period (P<0.05). Similar oestradiol and progesterone levels were found in rhythms as well as similar follicle population and nuclear and cytoplasmic maturation rates measured as metaphase II and cortical granule migration, respectively in both post-partum times. However, the number of preovulatory follicles on the ovarian surface was lower (P<0.05) and the atresia rate tended to be higher with a lower percentage of healthy follicles (P<0.1) in ovaries from females of extensive group. In conclusion, the body reserves, serum metabolic parameters and oocyte quality of primiparous non-weaned rabbits does at the late post-partum time (25 days) were not improved. Thus this reproductive management did not present any advantages compared to earlier post-partum (11 days) reproductive rhythm.

[Ectopic relapse of an operated craniopharyngioma. Case report and review of the literature]. / Recidiva a distancia de craneofaringioma intervenido. Caso clínico y revisión de laliteratura.

INTRODUCTION. Craniopharyngioma is an embrionary tumor of the sellar and/suprasellar region derived from fusiform cells of Rathke´s cleft. Although locoregional relapse is the way classically proposed for relapse after treatment, it has been described, in a few cases, the possibility of ectopic relapse out of the sellar-suprasellar region, by direct seeding of cells during surgery on the surgical field, or by cell dissemination in the cerebrospinal fluid (CSF). It is proposed to report the case of a patient with relapse of a craniopharyngioma in the frontal lobe, who was previously operated ten years after, as well as to review the similar cases reported in the literature to the date. RESULTS. A systematic review of the literature has allowed to find 21 cases previously reported. Direct cellular seeding was the most frequent implantation mechanism. In all cases, the preferred treatment was radical surgical removal when this was possible. The time of latency between first surgery and relapse differed from 1 to 21 years. CONCLUSIONS. It is interesting, in the differential diagnosis, to bear in mind the possibility of ectopic relapse of craniopharyngioma in patients who have been operated because of this type of tumor and who present a new mass in nervous central system (CNS). In view of the long time of latency that can pass between the resection of a craniopharyngioma and his relapse, there becomes necessary a long follow-up of these patients by periodic imaging tests.

Recidiva a distancia de craneofaringioma intervenido. Caso clínico y revisión de la literatura / Ectopic relapse of an operated craniopharyngioma. Case report and review of the literature

Introducción. El craneofaringioma es un tumor embrionario de la región selar y/o supraselar derivado de células fusiformes de la bolsa de Rathke. Aunque la forma clásicamente propuesta para la recidiva tras el tratamiento es a nivel locorregional, se ha descrito, en raras ocasiones, la posibilidad de recidiva ectópica fuera de esta localización, bien por siembra directa de células durante la cirugía en el campo quirúrgico, bien por diseminación celular a través de líquido cefalorraquídeo (LCR). Se presenta el caso de una paciente con metástasis en el lóbulo frontal de un craneofaringioma previamente intervenido diez años antes y se revisan los casos similares publicados en la literatura hasta la fecha.Resultados. Una revisión sistemática de la literatura ha permitido encontrar 21 casos publicados previamente. La siembra celular directa fue el mecanismo de implantación más frecuente. En todos, el tratamiento de elección fue la resección quirúrgica completa, cuando esta fue posible. El tiempo de latencia entre la primera cirugía y la recidiva ectópica varió entre 1 y 21 años.Conclusiones. Es interesante tener presente en el diagnóstico diferencial la posibilidad de recidiva ectópica de craneofaringioma en pacientes que hayan sido intervenidos de este tipo de tumor y que presenten una nueva masa en sistema nervioso central (SNC). Dado el largo tiempo de latencia que puede transcurrir entre la resección de un craneofaringioma y su recidiva, se hace necesario un seguimiento largo de estos pacientes mediante pruebas periódicas de imagen (AU)

Introduction. Craniopharyngioma is an embrionary tumor of the sellar and/suprasellar region derived from fusiform cells of Rathke´s cleft. Although locoregional relapse is the way classically proposed for relapse after treatment, it has been described, in a few cases, the possibility of ectopic relapse out of the sellar-suprasellar region, by direct seeding of cells during surgery on the surgical field, or by cell dissemination in the cerebrospinal fluid (CSF). It is proposed to report the case of a patient with relapse of a craniopharyngioma in the frontal lobe, who was previously operated ten years after, as well as to review the similar cases reported in the literature to the date.Results. A systematic review of the literature has allowed to find 21 cases previously reported. Direct cellular seeding was the most frequent implantation mechanism. In all cases, the preferred treatment was radical surgical removal when this was possible. The time of latency between first surgery and relapse differed from 1 to 21 years.Conclusions. It is interesting, in the differential diagnosis, to bear in mind the possibility of ectopic relapse of craniopharyngioma in patients who have been operated because of this type of tumor and who present a new mass in nervous central system (CNS). In view of the long time of latency that can pass between the resection of a craniopharyngioma and his relapse, there becomes necessary a long follow-up of these patients by periodic imaging tests (AU)

Asociación entre alergia e intolerancia a proteínas de leche devaca y enterocolitis hemorrágica en el primer mes de vida / Association between allergy and cow's milk protein intolerance and hemorrhagic enterocolitis in the first month of life

Introducción y objetivos. La alergia/intolerancia a proteínas de leche de vaca incluye entre sus manifestaciones la diarrea, en ocasiones sanguinolenta (enterocolitis hemorrágica). El objetivo del estudio es establecer si existe relación entre los pacientes con enterocolitis hemorrágica y el incremento de IgE específica para leche de vaca. Sujetos y métodos Revisión de los menores de un mes ingresados en la unidad de lactantes del Hospital Infantil Niño Jesús entre 2000 y 2006, con diagnóstico de sospecha de intolerancia a proteínas de leche de vaca. Las variables estudiadas fueron: edad al ingreso, sexo, tiempo de gestación, tipo de parto, peso de recién nacido, tipo de lactancia, antecedentes familiares de alergia, sintomatología al ingreso, alteraciones en la exploración física al ingreso e IgE específica para proteína de leche de vaca. Resultados Se incluyeron 33 pacientes, 25 fueron varones(69%). En un 44% de los pacientes se encontró sangre en las heces. La IgE específica sólo fue positiva en el 15,1%. En la mitad de los pacientes que presentaban diarrea se encontró sangre en heces (8/16). En 5 se detectó una elevación de la IgE específica, pero en ninguno se evidenció sangre en heces. Conclusiones En nuestro estudio no parece encontrarse relación entre la enterocolitis hemorrágica y la positivización de las IgE específicas. Sin embargo, no se puede descartar que los pacientes con deposiciones sanguinolentas presenten alergia a proteínas de leche de vaca no mediada por IgE (intolerancia a proteínas de leche de vaca) (AU)

Introduction. Cow’s milk protein allergy / intolerance, includes among its manifestations diarrhea, occasionally with blood (hemorrhagic proctocolitis). The aim of our study is to determine if there is relationship between patients with hemorrhagic proctocolitis and cow´s milk specific immunoglobulin E (IgE) elevation .Subjects and methods. We studied patients younger than one month hospitalized at Hospital Infantil Niño Jesus’ breast-fed babies service since 2000 to 2006, diagnosed of cow’s milk protein intolerance. Age, sex, gestation time, type of childbirth, newborn weight, type of feeding, allergy familiar precedents, clinical manifestations, physical exploration features and specific IgE were the variables we studied. Results. 33 patients were included, 25 were males (69%).Bloody stools were found in 44% of the patients. Specific IgE was positive only in 15,1%. We found blood in stools in half of the patients who had presented diarrhea (8/16). Five patients presented specific IgE elevation but none of them had bloody stools. Conclusions. Our study does not find relationship between hemorrhagic proctocolitis and the specific IgE positivization. However no mediated IgE cow’s milk protein allergy (intolerance) is not be able to rule out at patients with bloody stools (AU)

Production of 2-phenylethanol in the biotransformation of cinnamyl alcohol by the plant pathogenic fungus Colletotrichum acutatum / Producción de 2-feniletanol en la biotransformación de alcohol cinamílico mediante el hongo fitopatogénico Colletotrichum acutatum

Biocatalytic processes may offer a cheaper alternative to natural production of flavours. The biotransformation of cinnamyl alcohol is investigated using the plant pathogenic fungus Colletotrichum acutatum as a biocatalyst. Results show that substrate is converted to 3-phenyl-1-propanol, 1-phenyl-1,3- propanediol, 2-phenylethanol, 1-phenyl-1,2-ethanediol, 3-phenyl propyl acetate, and hydrocinnamic acid. The structures of the metabolic products are elucidated on the basis of their spectral data. 2-phenylethanol has a sweet, floral odor and a wide variety of applications, especially, for the perfume and food industries. A time-course experiment demonstrates that 2-phenylethanol appeared after 120 hours, reaching almost 8% of relative abundance. Additionally, the influence that the culture broth has on the conversion capacity is investigated. It has been discovered that cinnamyl alcohol is converted faster when the substrate is incorporated in a Sabouraud medium; under this condition, 2-phenylethanol is the most common product after 288 hours reaching about 90% of the relative abundance. Biotransformation of cinnamyl alcohol using C. acutatum in a Sabouraud medium can offer a simple and efficient way to obtain 2-phenylethanol with high yield.

Los procesos biocatalíticos pueden ofrecer una alternativa económica para la producción natural de sabores. La biotransformación de alcohol cinamílico es investigada usando el hongo fitopatógeno Colletotrichum acutatum como biocatalizador. Los resultados muestran que el sustrato es convertido en 3-fenil-1-propanol, 1-fenil-1,3-propanodiol, 2-feniletanol, 1-fenil-1,2-etanodiol, 3-fenil propil acetato, y ácido hidrocinámico. Las estructuras de los productos metabólicos son elucidados con base en la información espectroscópica. El 2-feniletanol tiene un olor floral suave y una variedad de aplicaciones, especialmente, en perfumería y alimentos. Un estudio en el curso del tiempo demuestra que el 2-feniletanol aparece después de 120 horas y alcanza casi 8% de la abundancia relativa. Adicionalmente, se investiga la influencia del medio de cultivo en la capacidad de conversión. Se encuentra que el alcohol cinamílico es convertido más rápido cuando el sustrato es incorporado en medio Sabouraud; bajo esta condición, el 2-feniletanol es el producto mayoritario después de 288 horas alcanzando cerca del 90% de la abundancia relativa. La biotransformación de alcohol cinamílico mediante C. acutatum en medio Sabouraud puede ofrecer una alternativa simple y eficiente de obtener 2-feniletanol con alto rendimiento.

Biotransformación de trans-cinamaldehído conel hongo filamentoso Aspergillus sp / Biotransformation of trans-cinnamaldehyde by the filamentous fungus Aspergillus sp

El desarrollo de métodos biocatalíticos ha permitido la preparación de una amplia variedad de productos con alto valor agregado a través de procesos simples, selectivos, económicos y respetuosos con el medio ambiente. En este trabajo se evaluó la transformación microbiana causada por el hongo Aspergillus sp. sobre el sustrato arilpropanoide trans-cinamaldehído. El proceso se llevó a cabo empleando los medios de cultivo líquido Sabouraud y Czapeck-Dox, a temperatura promedio de 24°C, humedad relativa entre 45 y 60% y agitación orbital a 120 rpm. El sustrato se transformó principalmente a los productos metabólicos: 3-fenil-1-propanol, alcohol cinamílico, 3-fenilpropanal, acetato 3-fenilpropílico, acetato de cinamilo, alcohol bencílico, 1-fenilpropanol y 2-fenilpropanol. A partir de los resultados se concluyó que el hongo Aspergillus sp. convirtió inicialmente el trans-cinamaldehído mediante reacciones de reducción, y posteriormente modificó los productos resultantes por esterificación y descarboxilación, generando varios compuestos que se emplean como materias primas en diferentes industrias. Se discute una posible ruta metabólica y el efecto del medio de cultivo en la transformación del sustrato.

The development of biocatalytic methods has allowed the preparation of a wide variety of products with high added value through simple, selective, economical and environmentally friendly processes. In this work, the microbial transformation of arylpropanoide substrate trans-cinnamaldehyde using the fungus Aspergillus sp. was investigated. The process is carried out in liquid media culture Sabouraud y Czapeck-Dox to an average temperature 24oC, relative humidity between 45 and 60%, and with agitation at 120 rpm on a orbital shaker. The biotransformation of the substrate generated mainly the metabolic products 3-phenyl-1-propanol, cinnamyl alcohol, 3-phenylpropanal, 3-phenylpropyl acetate, cinnamyl acetate, benzylic alcohol, 1-phenylethanol, and 2-phenylethanol. From the results it is concluded that the fungus Aspergillus sp. initially converted the trans-cinnamaldehyde by reduction reactions, and later modified the products resulting through esterification and decarboxylation. In the process, several compounds used as raw materials in different industries were generated. The metabolic pathway and culture medium effect on substrate transformation are discussed.

Estructura de la consulta pediátrica en el Servicio de Urgencia: Hospital Infantil Roberto del Río / Structure of the paediatric population attending the Emergency Service: Roberto del Rio Children´s Hospital

La planificación y definición de políticas en un Servicio de Urgencia (SU), requiere información sobre la estructura y otros aspectos de la población que acude a éste. Objetivo: Conocer la morbilidad y estructura demográfica de la población atendida en el SU del Hospital Infantil Roberto del Río. Método: Se calculó una muestra representativa de 4.500 boletines correspondientes a pacientes atendidos durante los 12 meses del 2002, a ser extraída al azar para detectar motivos de consulta con frecuencia no inferior a 0,005, con una precisión de ± 0,002 y con un grado de confianza de 95 por ciento. Resultados: No fueron incluidos 144 boletines que estaban extraviados, por lo que el análisis descriptivo incluyó a 4.356. El 10,74 por ciento de los pacientes fueron enviados desde la atención primaria con interconsulta, y el 89,26 por ciento restante consultó espontáneamente. El 52,64 por ciento fueron hombres y el promedio de edad fue de 52 meses. Los principales motivos de consulta fueron agrupados por síndromes: febril (45,45 por ciento); respiratorio (18,42 por ciento); digestivo (16,27 por ciento); doloroso (10,79 por ciento). Los diagnósticos de ingreso más frecuentes fueron: Infección respiratoria alta, (19,70 por ciento); Síndrome bronquial obstructivo (11,74 por ciento); Diarrea aguda (10,63 por ciento); Bronquitis aguda (8,04 por ciento) y Síndrome febril sin causa aparente (5,48 por ciento). El 6,5 por ciento de los pacientes fueron hospitalizados. Comentario: Este trabajo nos permite conocer la demanda del SU, aportando antecedentes desconocidos en nuestro medio. La ausencia de enfermedades graves, como meningitis bacteriana, shock séptico o paro cardiorrespiratorio, se debe a que son poco frecuentes y por eso escaparon a la potencia del estudio. Hubo omisión de información en los boletines de atención.

Air reduction of intussusception.

AIM: To show that intussusception in children is reducible in most cases, using air. METHODS: Initially we used a barium enema to treat paediatric intussusception. Now we use an air enema. We consider the latter reduction technique to be the method of choice in the treatment of intussusception in childhood. RESULTS: Over a period of 21 years, we have treated 151 patients presenting with intussusception. In a group of 130 children treated with barium enema we managed to reduce the intussusception in 110 cases (84.6 %). We used air pressure to treat a second group of 21 children; the success rate in this group was 100 %. CONCLUSIONS: In order to avoid a surgical operation this technique must become more generally known. We are of the opinion that if the method is applied correctly, it is almost always possible to correct intussusception using air.

Synergistic cooperation between hypoxia and transforming growth factor-beta pathways on human vascular endothelial growth factor gene expression.

Signaling by transforming growth factor (TGF)-beta family members is mediated by Smad proteins that regulate gene transcription through functional cooperativity and association with other DNA-binding proteins. The hypoxia-inducible factor (HIF)-1 is a transcriptional complex that plays a key role in oxygen-regulated gene expression. We demonstrate that hypoxia and TGF-beta cooperate in the induction of the promoter activity of vascular endothelial growth factor (VEGF), which is a major stimulus in the promotion of angiogenesis. This cooperation has been mapped on the human VEGF promoter within a region at -1006 to -954 that contains functional DNA-binding sequences for HIF-1 and Smads. Optimal HIF-1alpha-dependent induction of the VEGF promoter was obtained in the presence of Smad3, suggesting an interaction between these proteins. Consistent with this, co-immunoprecipitation experiments revealed that HIF-1alpha physically associates with Smad3. These results demonstrate that both TGF-beta and hypoxia signaling pathways can synergize in the regulation of VEGF gene expression at the transcriptional level.

Vascular gene transfer driven by endoglin and ICAM-2 endothelial-specific promoters.

The involvement of the vascular endothelium in a large number of diseases supports the importance of vascular-specific gene delivery for their treatment. The hereditary hemorrhagic telangiectasia type 1 is an example of a vascular inherited disease (OMIM 187300). This is an autosomal dominant vascular disorder originated by mutations in the endoglin gene and associated with frequent epistaxis, telangiectases, gastrointestinal bleedings, and arteriovenous malformations in brain, lung and liver. Here, we address for the first time the possibility of using in vivo gene transfer to target endoglin expression to the vasculature. The promoter of the endothelial gene, ICAM-2, was used to generate transgenic animals which demonstrated endothelial expression of endoglin. Next, the promoters of the human endothelial genes, endoglin and ICAM-2, were inserted upstream of the human endoglin cDNA, and the resulting constructs were systemically or locally delivered, demonstrating endoglin expression in the vessel walls of liver, lung and skin. These gene transfer experiments represent an initial step in the treatment of the hereditary hemorrhagic telangiectasia type 1 by gene therapy, and suggest that endoglin and ICAM-2 promoters can be used to deliver other genes to the endothelium specifically.

Sensitivity to exogenous GH and reversibility of the reduced IGF-I gene expression in aging rats.

BACKGROUND: IGF-I gene expression and IGF-I plasma concentration decline with age. A decreased sensitivity to GH has been suggested to be a contributory mechanism to this, in addition to attenuated GH secretion. OBJECTIVE: This study focuses on the sensitivity to exogenous GH and the reversibility of the reduced IGF-I gene expression in aging male rats. DESIGN: Three groups of male Wistar rats aged 3 months (young adult), 11 months (middle-aged) and 27 months (old), received recombinant human GH (rhGH) (150 microg/12 h s.c.) for seven consecutive days. RESULTS: This rhGH treatment completely reversed plasma immunoreactive IGF-I (IR-IGF-I) and hepatic IGF-I mRNA levels in 11-month-old and 27-month-old animals to the levels of the young group of animals. The sensitivity in the old group (percentage of increment after the same or lower dose of rhGH per body weight) was increased for both parameters; serum IGF-I increment: 15% in 3-month-old, 42.6% in 11-month-old and 119.1% in 27-month-old rats; and hepatic IGF-Ib mRNA increase: 45% in 3-month-old, 27.8% in 11-month-old and 64.3% in 27-month-old rats. IGF binding protein-3 (IGFBP-3) mRNA level in the liver was significantly decreased in the old group and only a partial reversion occurred in this group after rhGH treatment; the percentage of increment was also higher in the old group of rats. In extrahepatic tissues IGF-I mRNA was not significantly different in the kidney and the testis of the three groups, and the rhGH treatment produced a significant and similar increase of IGF-I mRNA level in the kidney of the three groups of rats and in the testis of the 27-month-old animals. The GHr/GHBP mRNA remained unchanged in the liver and in the kidney or the testis of the three groups, and was not influenced by the rhGH treatment. Exogenous rhGH decreased pituitary GH mRNA accumulation in a more intense manner in the old group versus control of each group: young adult, 25%; middle-aged, 41.2%; and old rats, 55%. The action of rhGH on pituitary immunoreactive GH (IR-GH) content was only significantly evident in the young group. CONCLUSIONS: These results establish that exogenous rhGH recovers the attenuated liver IGF-I gene expression and the diminished plasma IR-IGF-I in old rats to the levels of young adult animals. They also indicate that the hepatic and extrahepatic (kidney and testis) sensitivity to one established dose per weight of exogenous rhGH is not altered in old animals, or could be potentially increased in some tissues.