Insuflación rectal con ozono en infecciones intestinales / Rectal Insufflation with Ozone in Intestinal Infections

Introducción: Las infecciones intestinales se relacionan con trastornos del sistema inmune y de la microbiota intestinal. Pueden ser recurrentes y producir otras alteraciones intestinales y sistémicas, que empeoran con la terapia antimicrobiana. La ozonoterapia ha sido usada en el tratamiento de infecciones intestinales. Objetivos: Recopilar información sobre los efectos biológicos, terapéuticos y la seguridad de la administración del ozono por insuflación rectal en el tratamiento de las infecciones intestinales. Métodos: Para la búsqueda de información se empleó el motor de búsqueda Google Académico. Se consultaron artículos en las bases de datos PubMed y SciELO de la Biblioteca Virtual de Salud. Además, se realizó una búsqueda general en los idiomas español e inglés, a partir de los artículos más relevantes acerca del estudio. Se utilizaron como palabras clave: infecciones, insuflación, microbioma gastrointestinal, ozono como términos más concretos. En el estudio no se aplicó ninguna restricción acerca del ámbito geográfico ni de la edad. Conclusiones: La aplicación rectal de ozono es segura, tiene acciones biológicas y terapéuticas útiles para tratar las infecciones intestinales. Actúa como inmunomodulador y protector de la microbiota intestinal, lo que permite enfrentar esta problemática de salud desde el punto de vista preventivo, curativo y de rehabilitación de los daños causados, tanto por los gérmenes como por los efectos de los antibióticos(AU)

Introduction: Intestinal infections are related to disorders of the immune system and intestinal microbiota. They can be recurrent and produce other intestinal and systemic alterations, which worsen with antimicrobial therapy. Ozone therapy has been used in the treatment of intestinal infections. Objectives: To compile information on the biological, therapeutic effects and safety of the administration of ozone by rectal insufflation in the treatment of intestinal infections. Methods: Google Scholar search engine was used for searching information. Articles were consulted in PubMed and SciELO databases of the Virtual Health Library. In addition, a general search was carried out in Spanish and English, based on the most relevant articles about the study. The keywords used were infections, insufflation, gastrointestinal microbiome, ozone as more specific terms. No restrictions on geographic area or age were applied in the study. Conclusions: The rectal application of ozone is safe, it has useful biological and therapeutic actions to treat intestinal infections, acting as an immunomodulator and protector of the intestinal microbiota, which allows us to face this health problem from a preventive, curative and rehabilitation point of view of the damage caused, both by germs and by the effects of antibiotics(AU)

Caracterización de los derrames pleurales y ascíticos mediante la concentración de proteínas, comparación con los criterios actuales / Characterization of pleural and ascites effusions using concentration of their proteins and their comparison with current criteria

Introducción: Los líquidos serosos se clasifican tradicionalmente en exudados/trasudados según la concentración de proteínas y otros criterios que presentan un gran margen de error. Posteriormente se ensayan criterios por separado: en 1972 Light y otros para los líquidos pleurales y en 1992 el criterio de Runyon para los líquidos ascíticos, con sensibilidades respectivas del 98 % y 97 %. Hoy se sigue aplicando el criterio primario con un error hasta del 40 %. Objetivo: Identificar el margen de error en la clasificación de los líquidos pleurales y ascíticos cuando se emplea el criterio clásico (Starling), respecto a los criterios actuales de Light y Runyon utilizando reactivos de producción nacional. Métodos: Se estudiaron 185 muestras de líquidos (121 pleurales y 64 ascíticos) en el periodo de los años 2017-2022 en el Hospital Clínico Quirúrgico Docente Miguel Enríquez de La Habana. Resultados: Se encontraron discordancias en la clasificación de exudados/trasudados de los líquidos empleando los diferentes métodos de diferenciación, importantes en la clínica. Empleando el criterio clásico de las proteínas de Starling, el 9,1 % y el 17,2 % de los derrames pleurales y ascíticos, respectivamente, tuvo errores en su clasificación como exudado o trasudado. Conclusión: El margen de error en la clasificación de los líquidos pleurales y ascíticos osciló entre un 9-17 % cuando se emplea el criterio clásico de las proteínas (Starling), respecto a los criterios actuales de Light y Runyon.

Introduction: Serous fluids are classified as exudates/ transudates based on protein concentration and other criteria that have a large margin of error. Subsequently, criteria were tested separately for pleural fluids in 1972 by Light et al and for ascitic fluids in 1992 the Runyon criteria with respective sensitivities of 98 % for the first and 97 % for the second. Currently, the primary criterion continues to be applied with an error of up to 40 %. Objective: To identify the margin of error in the classification of pleural and ascitic fluids when using the classical criteria (Starling) with respect to the current criteria of Light and Runyon using nationally produced reagents. Methods: 185 fluid samples were studied - 121 pleural and 64 ascitic - in the period 2017/2022 at the Miguel Enriquez Clinical Surgical Teaching Hospital in Havana. Results: Discordances were found in the classification of exudates / transudates of liquids using the different differentiation methods, important in the clinical diagnosis, concluding that using the classic criterion of Starling proteins, 9,1 % and 17,2 % of the pleural and ascitic effusions had errors in their classification as exudate and/or transudate. Conclusion: The margin of error in the classification of pleural and ascitic fluids ranged from 9-17% when the classical criteria of proteins (Starling) is used with respect to the current criteria of Light and Runyon.

Lymphocyte Subsets in Defense Against New Pathogens in Patients with Cancer.

INTRODUCTION: Immunity in cancer patients is modified both by the cancer itself and by oncospecific treatments. Whether a patient's adaptive immunity is impaired depends on their levels of naive lymphocytes and other cell populations. During the COVID-19 pandemic, cancer patients are at greater risk of progressing to severe forms of the disease and have higher mortality rates than individuals without cancer, particularly while they are receiving cancer-specific therapies. An individual's protection against infection, their response to vaccines, and even the tests that determine the humoral immune response to SARS-CoV-2, depend on lymphocyte populations, meriting their study. OBJECTIVE: Estimate blood concentrations of lymphocytes involved in the immune response to new pathogens in cancer patients. METHODS: We carried out an analytical study of 218 cancer patients; 124 women and 94 men, 26-93 years of age, who were treated at the National Oncology and Radiobiology Institute in Havana, Cuba, March-June, 2020. Patients were divided into five groups: (1) those with controlled disease who were not undergoing cancer-specific treatment; (2) those undergoing debulking surgery; (3) patients undergoing chemotherapy; (4) patients undergoing radiation therapy and (5) patients currently battling infection. We evaluated the following peripheral blood lymphocyte subpopulations via flow cytometry: B lymphocytes (total, naive, transitional, memory, plasmablasts and plasma cells); T lymphocytes (total, helper, cytotoxic and their respective naive, activated, central memory and effector memory subsets); and total, secretory and cytotoxic natural killer cells and T natural killer cells. We also estimated neutrophil/lymphocyte ratios. Lymphocyte concentrations were associated with controlled disease and standard cancer therapy. For variables that did not fall within a normal distribution, ranges were set by medians and 2.5-97.5 percentiles. The two-tailed Mann-Whitney U test was used to measure the effect of sex and to compare lymphocyte populations. We calculated odds ratios to estimate lymphopenia risk. RESULTS: All cancer patients had lower values of naive helper and cytotoxic T lymphocyte populations, naive B lymphocytes, and natural killer cells than normal reference medians. Naive helper T cells were the most affected subpopulation. Memory B cells, plasmablasts, plasma cells, activated T helper cells, and cytotoxic central memory T cells were increased. Patients undergoing treatment had lower levels of naive lymphocytes than untreated patients, particularly during radiation therapy. The risk of B lymphopenia was higher in patients in treatment. The odds ratio for B lymphopenia was 8.0 in patients who underwent surgery, 12.9 in those undergoing chemotherapy, and 13.9 in patients in radiotherapy. CONCLUSIONS: Cancer and conventional cancer therapies significantly affect peripheral blood B lymphocyte levels, particularly transitional T helper lymphocytes, reducing the immune system's ability to trigger primary immune responses against new antigens.

Caso clínico: Paciente doble heterocigoto para Hemoglobina New York (HB Kaohsiung) y Alfa Talasemia (­α3.7/αα) / Double heterozygous patient for New York Hemoglobin (HB Kaohsiung) and Alpha Thalassemia (­α3.7/αα)

Resumen Se reporta el caso de una paciente adulta, asintomática, sin historial familiar de anemia o enfermedades crónicas, atendida en el Laboratorio Clínico del Área de Salud de Aserrí que acude a control salud por seguimiento a tratamiento de anemia. Se revisa el histórico del expediente médico del propositus, donde se evidencia que el VCM por debajo del límite de referencia normal, hace incurrir al médico tratante en el error de asociar microcitosis con anemia ferropriva. Sin embargo, el Laboratorio Clínico de Aserrí cuenta con un algoritmo de donde se deriva que los índices y la morfología obtenidos en este hemograma son sugestivos de Talasemia, por lo que se envía la muestra al Laboratorio de Estudios Especializados e Investigación del Hospital Nacional de Niños Dr. Carlos Sáenz Herrera para realizar una electroforesis de hemoglobina. En este análisis se detecta una variante de hemoglobina. A nuestro buen saber, no se ha descrito anteriomente un caso de doble heterocigota como el aquí mencionado, por lo que se reporta el primer caso en Costa Rica de un doble heterocigota hemoglobina New York/-3.7 Alfa Talasemia.

Abstract An asymptomatic adult female, with no previous family history of anemia or chronic diseases, goes to consultation at Aserrí ´s Clínic for anemia follow up. A history review of the medical record shows that MCV is below the lower reference range. This MCV value induces the physician to treat the patient for iron deficiency anemia. Using the algorithm of the Clinical Laboratory in Aserrí, such erythrocytic indices are suggestive of Thalassemia. For these reason a blood sample is sent for hemoglobin electrophoresis and molecular analysis at the specialized hematology laboratory at the National Children´s Hospital. A variant hemoglobin is detected. To our knowledge, this is the first case of compound heterozygous for Hemoglobin New York/-3.7 Alfa Thalassemia in Costa Rica.

Technical Note: An alternative approach to verify 6FFF beam dosimetry for Ethos and MR Linac without using a 3D water tank.

PURPOSE: The current approach to Linac beam dosimetry verification is typically performed utilizing a three-dimensional (3D) water tank system. The 3D beam scanning process is cumbersome, labor intensive, error-prone, and costly. This is especially challenging for the new Ethos system and MR Linacs with a ring gantry. This work proposes an alternative approach to verify 6FFF beam dosimetry for Ethos, ViewRay MRIdian® Linac, and other Linacs with 6FFF beam quality using two-dimensional (2D) ion chamber arrays. METHODS: Percentage depth dose (PDD) and profiles of an Ethos, an MRIdian® Linac, and several Linacs with 6FFF beams were measured at the nominal beam current. The beam energy was detuned by changing the bending magnet current on one TrueBeam. PDDs and profiles were measured for detuned beam energies. The peak shape of the 6FFF profile was defined by a "slope" parameter and unflatness. Correlations between peak slope and unflatness metrics vs PDDs were used to evaluate the sensitivity of beam energy to beam profile changes at different field sizes and depths. RESULTS: Strong correlations were found between peak slope and PDDs for all Linacs with 6FFF beam. The R-squared values in the linear regression fitting between PDD and peak slope and unflatness were 0.99 and 0.84, respectively. Both profile slope and unflatness were proportional to PDD at the 10 cm depth and the peak slope was 4.3 times more sensitive than PDD. We have identified that measurements with a shallow depth are preferred to quantify the beam energy consistency. CONCLUSIONS: Our work shows the feasibility of verifying 6FFF beam quality of Ethos, MR Linac, and other Linacs by defining a profile slope measured from 2D ionization chambers array devices. This new approach provides a simplified method for performing a routine beam quality check without using a 3D water tank system while maximizing cost effectiveness and efficiency.