Enfermedad de Buerger o el endotelio como laberinto: a propósito de un caso clínico / Buerger's disease or the endothelium as a labyrinth: case report

La enfermedad de Buerger, también llamada tromboangeítis obliterante, es una enfermedad vascular inflamatoria transmural no aterosclerótica, segmentaria, que afecta pequeños y medianos vasos de las extremidades, de especial asociación etiopatogénica con el tabaquismo. Ocurre comúnmente en hombres menores de 50 años, siendo un diagnóstico diferencial en el escenario de pacientes con isquemia crónica. Se presenta el caso de un hombre de 43 años, con antecedente de tabaquismo pesado, quien cursaba con claudicación intermitente llegando hasta el dolor en reposo, asociado a úlceras de aspecto vasculopático en miembros inferiores, en ausencia de pulsos distales (pedio, tibial posterior); la pletismografía reportó mayor compromiso infrapoplíteo, con circulación colateral segmentaria por arteriografía, sin posibilidad de revascularización endovascular. Se consideró un caso compatible con enfermedad de Buerger, planteándose un manejo híbrido: médico (con agentes antiagregantes) y quirúrgico (con puente femoropoplíteo directo). Se realiza una breve revisión de tema de esta enfermedad de rara aparición

Abstract. Buerger's disease, also called thromboangiitis obliterans, is a non-atherosclerotic, segmental, transmural inflammatory vascular disease affecting small and medium-sized vessels of the extremities with a special etiopathogenic association with smoking; it commonly occurs in men under 50 years of age, and is a differential diagnosis in the setting of patients with chronic ischemia. We describe the case of a 43-year-old man, with a history of heavy smoking, who presented with intermittent claudication reaching pain at rest, associated with ulcers of vasculopathic appearance in the lower limbs, in the absence of distal pulses (pedius, posterior tibial); plethysmography reported greater infrapopliteal involvement, with segmental collateral circulation by arteriography, without the possibility of endovascular revascularization. The case was considered compatible with Buerger's disease, and hybrid management was weighed: medical (with antiplatelet agents) and surgical (with direct femoropopliteal bridging). A brief review of this rare disease is presented

Draft Genome Sequence of Streptomyces sp. Strain RKCA744, Isolated from the Arauca River, Colombia.

Streptomyces sp. strain RKCA744 was isolated from sediment collected from the Arauca River, Colombia.

¿Son los criterios de la ASGE suficientes para la estratificación del riesgo de coledocolitiasis? / ¿Are the ASGE criteria sufficient to stratify the risk of choledocholithiasis?

Resumen Introducción: la patología biliar litiásica es una de las entidades más frecuentes en el área de cirugía general y en gastroenterología. El tratamiento varía según el lugar donde se alojen los cálculos. Para esto, se han definido diversas escalas de estratificación del riesgo de presentar coledocolitiasis, pero son los criterios planteados por la Sociedad Americana de Endoscopia Gastrointestinal (American Society for Gastrointestinal Endoscopy, ASGE) los más usados a nivel mundial, ya que tienen una precisión diagnóstica definida del 70 %. Los procedimientos o ayudas diagnósticas establecidas por estos criterios, en ocasiones, prolongan el tiempo de hospitalización, aumentan los costos y pueden tener complicaciones. Metodología: se realizó un estudio observacional analítico, de tipo transversal retrospectivo, con datos obtenidos a partir de las historias clínicas de pacientes sometidos a colecistectomía laparoscópica, en la Clínica CES de Medellín, entre julio y diciembre de 2017. Resultados y conclusiones: se analizaron 424 historias clínicas de pacientes sometidos a colecistectomia laparoscópica. De ellos, 254 (56,76 %) se categorizaron como de riesgo bajo, mientras que 94 (22,11 %) fueron de riesgo intermedio y 76 (17,88 %) de riesgo alto. Se encontró una frecuencia de coledocolitiasis del 90,8 % en aquellos categorizados como de riesgo alto y del 26,6 % en los pacientes de riesgo intermedio. En la categoría de riesgo intermedio se hallaron diferencias estadísticamente significativas entre ambos grupos para los valores de bilirrubina total, bilirrubina directa y aspartato aminotransferasa (AST) (p = 0,001; p = 0,014; p = 0,007, respectivamente). La baja frecuencia de coledocolitiasis en la categoría de riesgo intermedio puede ser explicada por cálculos menores a 5 mm no visibles en la colangiorresonancia. A partir de este estudio, se propone ajustar los rangos de valores de los criterios de la ASGE para la categoría de riesgo intermedio, permitiendo tener una mayor precisión a la hora de clasificar los pacientes con patología litiásica y disminuir costos y estancia hospitalaria.

Abstract Introduction: Biliary lithiasis is one of the most frequent diseases in the area of general surgery and gastroenterology. Treatment varies depending on the location of the gallstones. Several stratification scales of the risk of choledocholithiasis have been defined, being the criteria proposed by the American Society of Gastrointestinal Endoscopy (ASGE) the most used worldwide, with a diagnostic accuracy of 70%. However, the procedures or diagnostic aids defined by these criteria, sometimes, increase hospital stay, costs, and may lead to the development of complications. Methodology: An observational, analytical, retrospective, cross-sectional study was conducted with data obtained from the clinical records of patients undergoing laparoscopic cholecystectomy at the CES Clinic in Medellín, Colombia, between July and December of 2017. Results and conclusions: 424 medical records were analyzed, of which 254 (56.76%) were classified as low-risk, 94 (22.11%) as intermediate-risk and 76 (17.88%) as high-risk. The frequency of choledocholithiasis was 90.8% in high-risk patients and 26.6% in intermediate-risk patients. For the intermediate-risk category, statistically significant differences were found between the two groups for the total bilirubin, direct bilirubin, and AST values (p: 0.001, p: 0.014, p:0.007, respectively). The low frequency of choledocholithiasis in the intermediate-risk category can be explained by less than 5mm gallstones not identified by the cholangioresonance. Based on this study, we propose to adjust the ranges of the ASGE criteria variables for the intermediate-risk category for better accuracy when classifying patients with biliary lithiasis and, thus, reduce costs and hospital stay.

Assessment of adherence to preventive treatment of plaque-induced oral diseases using sugar-free gums: a controlled clinical trial / Evaluación de la adhesión al tratamiento preventivo de enfermedades bucales inducidas por placa bacteriana mediante el uso de gomas de mascar sin azúcar: ensayo clínico controlado

Abstract Introduction: the aim of this study was to assess the adherence to a preventive treatment of plaque-induced oral diseases using two sugar-free gums, establishing their effect on cariogenic bacteria counts as a biological marker of treatment response. Methods: a double-blind, randomized, parallel-group, controlled intervention study was conducted in 96 young adult university students in an experimental period of 30 days. Participants were distributed into two groups and given a chewing gum with either pentitol or hexitol + CPP-ACP complex to be taken three times a day for 20 minutes after conventional oral hygiene. Saliva samples were collected at baseline to evaluate counts of Streptococcus mutans (SM) and Lactobacillus spp. A survey was conducted at the end of the experimental period to assess the levels of adherence to treatment, remeasuring bacterial counts. Results: SM counts showed statistically significant differences between the study groups at the end of the experimental period, with a decreasing tendency in both groups. Intragroup difference was observed in patients who took pentitol gum with a marked reduction in SM counts. Conclusion: the final estimate of adherence to treatment showed that the type of chewing gum patients were given had no influence and therefore such gums can be used, considering the therapeutic agents that most contribute to patient's particular case and preferences.

Resumen Introducción: el objetivo consistió en evaluar la adherencia a un tratamiento preventivo de enfermedades bucales inducidas por placa bacteriana, utilizando dos gomas de mascar sin azúcar y establecer su efecto sobre recuentos de bacterias cariogénicas como indicador biológico de los efectos del tratamiento. Métodos: se realizó un estudio de intervención, doble ciego, de grupos paralelos, aleatorizado controlado, en 96 adultos jóvenes universitarios, en un período experimental de 30 días. Los participantes fueron distribuidos en dos grupos con asignación de una goma de mascar con pentitol o con hexitol + complejo CPP-ACP que debían ser consumidas 20 minutos/tres veces al día después de la higiene oral convencional. Al inicio del studio fueron recolectadas muestras de saliva para evaluar recuentos de Estreptococos del grupo mutans (SM) y Lactobacillus spp. Al finalizar el período experimental, se realizó una encuesta para evaluar los niveles deadherencia al tratamiento y los recuentos bacterianos fueron medidos nuevamente. Resultados: Los recuentos de SM mostraron diferencias estadísticamente significativas entre los grupos de estudio al final del período experimental, con tendencia hacia la disminución en ambos grupos. Se observó diferencia intragrupo en los pacientes que consumieron la goma de mascar con pentitol, con marcada reducción de los recuentos de SM. Conclusión: la estimación final de la adherencia al tratamiento mostró que el tipo de goma de mascar asignada al paciente no tuvo influencia y, por lo tanto, estas pueden ser utilizadas teniendo en cuenta los agentes terapéuticos que más aporten al caso particular del paciente y las preferencias del mismo.

Characterization of Actinobacterial Communities from Arauca River Sediments (Colombia) Reveals Antimicrobial Potential Presented in Low Abundant Isolates.

INTRODUCTION: New strategies have been arisen to set a rapid and effective screening for selection of microorganism with bioactive potential. This study suggests that combination of physicochemical pretreatments and taxonomic dereplication of microbial collections through MALDI-TOF MS, facilitates the detection of low abundance actinobacteria with potential as a source of antimicrobial agents. MATERIAL AND METHODS: An unstudied microbial community from a tropical river sediment in Colombian Orinoquía is described, applying an extended cultivation strategy using physicochemical pretreatments, biological screenings and taxonomic dereplication through MALDI-TOF MS approach. RESULTS: Actinobacteria-like isolates (790) were growth and their antimicrobial activity was assessed against methicillin-resistant Staphylococcus aureus, Vancomycin-resistant Enterococcus faecium, extended-spectrum ß-lactamase Klebsiella pnumoniae, and clinical isolates of Cladosporium cladosporioides and Epicoccum nigrum. Seventy-eight isolates, belonging to the Streptomycetaceae family according to 16S rDNA analysis were found to have antimicrobial activity and were categorized as low abundance actinobacteria by MALDI-TOF MS. CONCLUSION: The results suggest that combination of physicochemical pretreatments and taxonomic dereplication of microbial collections through MALDI-TOF MS, facilitates the detection of low abundance actinobacteria with potential as a source of antimicrobial agents.

Dietary Intake Patterns Are Consistent Across Seasons in a Cohort of Healthy Adults in a Metropolitan Population.

BACKGROUND: Current literature provides conflicting data regarding seasonal variability in dietary intake. OBJECTIVE: Our aim was to examine seasonal variation in dietary intake in healthy adults from the metropolitan Washington, DC, area. DESIGN: This study utilized an observational cohort design. PARTICIPANTS/SETTING: Male and female healthy volunteers (n=103) between the ages of 18 and 75 years were recruited from the metropolitan Washington, DC, area to participate in a clinical study at the National Institutes of Health Clinical Center from February 2011 to June 2014. MAIN OUTCOME MEASURES: Three- to seven-day food records were collected from subjects (n=76) at three time points (12 to 15 weeks apart). Subjects were excluded from analysis (n=27) if they completed less than three time points. Food records were reviewed by nutrition staff, assigned to a season, and coded in Nutrient Data System for Research for energy, macronutrient, micronutrient, and food-group serving analysis. STATISTICAL ANALYSES: Multivariate general linear models were run on energy, macronutrient, micronutrient, and food-group intakes, while being adjusted for age, sex, race, and body mass index (calculated as kg/m(2)). RESULTS: Subjects had a mean±standard deviation body mass index of 25±3.9 and age of 34±12.4 years. Subject demographics were 71.1% white, 9.2% black/African American, 13.2% Asian, and 6.6% unknown race, with 44.7% males and 55.3% females. Mean intake of energy across seasons was 2,214.6±623.4 kcal with 17.3%±4.1%, 33.6%±5.5%, 46.6%±8.0%, and 2.7%±3.2% of calories from protein, fat, carbohydrate, and alcohol, respectively. Intakes of energy, macronutrients, micronutrients, and food groups did not differ between seasons. CONCLUSIONS: People living in the metropolitan Washington, DC, area did not exhibit seasonal variation in dietary intake. Therefore, when designing studies of nutrient intake in a metropolitan population, these findings suggest that investigators do not need to consider the season during which diet is examined.

Cultivo biotecnológico de macrohongos comestibles: una alternativa en la obtención de nutracéuticos / Biotechnological cultivation of edible macrofungi: an alternative for obtaining nutraceutics

Los macromicetos han sido parte de la cultura humana desde hace miles de años y aparecen descritos como alimento humano en las más importantes civilizaciones de la historia. Se han descrito muchísimas propiedades nutricéuticas de los macromicetos, como sus propiedades anticancerígenas y antitumorales, hipocolesterolémicas, antivirales, antibacterianas, o inmunomoduladoras, entre otras. Dado que la producción de hongos por cultivo tradicional y la extracción de los metabolitos bioactivos en algunos casos son muy dispendiosas, la biotecnología es fundamental para el desarrollo de técnicas rentables y productivas para la obtención de estos metabolitos. Es el desarrollo de esta tecnología y la facilidad que proporciona en cuanto al manejo de sus variables, lo que ha permitido realizar el cultivo en medio líquido del micelio de macrohongos con significativa reducción de tiempo y aumento en la producción de sus metabolitos, lo que ha impulsado aún más su obtención y el estudio de compuestos con potencial como medicamentos, nutricéuticos y cuasifarmacéuticos tanto del medio agotado como del micelio. El objetivo de esta revisión es el de ofrecer una visión general de la utilización de la fermentación en estado líquido como herramienta tecnológica para la obtención de hongos comestibles, su estudio y el de sus bioactivos, mediante la descripción de las diferentes condiciones de cultivo que en los últimos años se han empleado, así como los resultados obtenidos. Se discutirá lo correspondiente a los géneros Agaricus, Flammulina, Grifola, Pleurotus y Lentinula, con énfasis en este último, dado que el Shiitake ha sido considerado desde siempre como el hongo medicinal por excelencia(AU)

Macromycetes have been part of the human culture for thousand years, and have been reported as food in the most important civilizations in history. Many nutraceutical properties of macromycetes have been described, such as anti-cancer, anti-tumour, cholesterol lowering, antiviral, antibacterial, or immunomodulatory, among others. Given that production of mushrooms by traditional cultivation and extraction of bioactive metabolites is very difficult in some cases, biotechnology is essential for the development of profitable and productive techniques for obtaining these metabolites. It is the development of this technology, and the ease in which it enables the use of its variables that has allowed mycelium to be cultivated in liquid medium of macrofungi, with a significant reduction in time and an increased production of metabolites. This increased production has led to the study of compounds that have medicinal, nutriceutical and quasi-farmaceutical potential, in the exhausted media and the mycelium. The aim of this review is to provide an overview of the use of liquid-state fermentation as a technological tool for obtaining edible fungi, and the study of these and their metabolites, by describing the different cultivation conditions used in recent years, as well as the results obtained. The relevance of Agaricus, Flammulina, Grifola, Pleurotus and Lentinula genera, will also be discussed, with emphasis on the last one, since Shiitake has been always considered as the ultimate medicinal mushroom(AU)

[Biotechnological cultivation of edible macrofungi: an alternative for obtaining nutraceutics]. / Cultivo biotecnológico de macrohongos comestibles: una alternativa en la obtención de nutracéuticos.

Macromycetes have been part of the human culture for thousand years, and have been reported as food in the most important civilizations in history. Many nutraceutical properties of macromycetes have been described, such as anti-cancer, anti-tumour, cholesterol lowering, antiviral, antibacterial, or immunomodulatory, among others. Given that production of mushrooms by traditional cultivation and extraction of bioactive metabolites is very difficult in some cases, biotechnology is essential for the development of profitable and productive techniques for obtaining these metabolites. It is the development of this technology, and the ease in which it enables the use of its variables that has allowed mycelium to be cultivated in liquid medium of macrofungi, with a significant reduction in time and an increased production of metabolites. This increased production has led to the study of compounds that have medicinal, nutriceutical and quasi-farmaceutical potential, in the exhausted media and the mycelium. The aim of this review is to provide an overview of the use of liquid-state fermentation as a technological tool for obtaining edible fungi, and the study of these and their metabolites, by describing the different cultivation conditions used in recent years, as well as the results obtained. The relevance of Agaricus, Flammulina, Grifola, Pleurotus and Lentinula genera, will also be discussed, with emphasis on the last one, since Shiitake has been always considered as the ultimate medicinal mushroom.

PATRONES DE REPLICACIÓN Y BANDEO NO DIFERENCIAL EN ARDILLAS COLOMBIANAS DEL GÉNERO Sciurus (RODENTIA, SCIURIDAE) / Replication Patterns and no Differential Banding in Colombian Squirrels, Sciurus (Rodentia, Sciuridae)

Las ardillas colombianas muestran una gran variabilidad citogenética lo que ha despertado el interés en ahondar aspectos evolutivos en el grupo. Para esto, varias herramientas de bandeo cromosómico convencional como bandas diferenciales Q y R y bandas no diferenciales C y NOR fueron analizadas permitiendo, por primera vez en las ardillas colombianas, detectar señales de cromosómicas inusuales de replicación e inactivación de heterocromatina y cromosomas marcadores específicos. Se explica la utilidad de cada uno de estos complementos en el análisis citogenético de especies y las observaciones para los citotipos de las ardillas colombianas.

Colombian Squirrels cytogenetics showed a great variability which has renewed the interest in evolutionary aspects within the group. Many chromosome banding tools must be analyzed carefully in addition to the classical G-banding G technique. These techniques include other differential bands like Q and R banding and nondifferential banding (C and NOR). In this article the use of each of these supplements in the cytogenetic analysis of species and cytotypes observations for the Colombian squirrels is explained.

Neutropenia febril en pacientes pediátricos: un enfoque diagnóstico y terapéutico / Febrile neutropenia in pediatric patients: a diagnostic and therapeutic approach

Durante las últimas décadas ha habido un progreso muy notorio en el tratamiento de los pacientes con cáncer: se ha reducido significativamente la tasa de mortalidad gracias a los nuevos agentes quimioterapéuticos y a la puesta en práctica de modalidades modernas de tratamiento; sin embargo, la mayoría de los agentes usados producen una profunda depresión del sistema inmune aumentando la susceptibilidad a las infecciones. La neutropenia febril es la complicación más común en pacientesque reciben terapia contra el cáncer; hace cuarenta años se estableció por primera vez la asociación entre el recuento bajo de neutrófilos circulantes, la fiebre y el riesgo de infección y desde entonces la terapia antibiótica empírica se ha convertido en la piedra angular en el tratamiento de esta complicación; infortunadamente, las hospitalizaciones prolongadas que son necesarias para estos tratamientos, además de ser muy costosas, tienen un gran impacto psicológico en los niños y sus familias. El desarrollo de modelos de estratificación del riesgo ha permitido identificar a qué pacientes se les pueden ofrecer otras opciones, como la terapia oral o la ambulatoria. En esta revisión sepresentan conceptos actualizados sobre la neutropenia febril en pediatría.

Treatment of patients with neoplastic diseases has improved over the past several decades: a significant reduction in the mortality rate due to cancer has been achieved with the newchemotherapeutic agents and with modern treatment modalities. However, most of these agents produce a profound depression of the immune system thus increasing the susceptibility to infections. Febrile neutropenia is the most common complication in patients being treated for malignant diseases. Forty yearsago the association was first established between low neutrophil count, fever and infection; since then, empiric antibiotic therapy has become the cornerstone in the management of this complication. Unfortunately, the long periods of hospital stay necessary for these treatments,besides being expensive, produce important psychological effects on patients and their families. Thedevelopment of risk-stratification models has allowed the identification of low-risk patients to whom other options may be offered, such as the oral or ambulatory therapy. This review presents up to date concepts on febrile neutropenia in pediatric patients.

Pruebas dinßmicas en endocrinología pediátrica: pubertad precoz central: [revisión] / Dynamic testing in pediatric endocrinology, central precocious puberty: [review]

La pubertad precoz se define como el inicio de la pubertad antes de los 8 años en las niñas y de los 9 años en los niños; sin embargo, hay factores que pueden afectar el inicio de la pubertad, como son la raza, el bajo peso al nacer y la obesidad. Los cambios físicos tempranos característicos del comienzo de la pubertad aparecen como resultado de la producción de hormonas sexuales como consecuencia de la activación del eje hipotálamo hipófisis-gonadal. El inicio de la pubertad comienza con el desarrollo de las mamas en las niñas y con el aumento del tamaño testicular en los niños...

VARIACIÓN CARIOLÓGICA EN DIFERENTES FENOTIPOS DE Sciurus granatensis (RODENTIA, SCIURIDAE) / Karyologic Variation in Different Phenotypes of Sciurus granatensis (Rodentia, Sciuridae)

Siete ejemplares de Sciurus granatensis (ardilla colombiana) de diferentes fenotipos según color, rescatadas del tráfico ilegal de fauna silvestre de Colombia fueron estudiadas. Mediante técnicas convencionales de bandeo cromosómico G, C, Q, R y NOR se estableció su cariotipo 2n=42. Se encontraron tres cariomorfos de acuerdo al Número Fundamental (NF) y características propias de cada uno de los complementos ocasionadas por distintos rearreglos cromosómicos, lo cual sugiere que S. granatensis es un complejo de especies. No se observó relación entre cariotipo y fenotipo. La variación en el color del pelaje se debe probablemente a las condiciones ambientales.

Seven specimens of Sciurus granatensis (redtailed squirrel) rescued from illegal fauna traffic in Colombia were studied; they had different phenotypes according to colour. G, C, Q, R and NOR chromosome banding was used, being found a 2n=42 diploid number for the Sciurus granatensis Colombian squirrels. There were 3 karyomorphs according to fundamental number (FN) and different chromosomal characteristics caused by rearregement, suggesting that S. granatensis represents a complex of species. Relationships between karyotype and phenotype were not observed. The variation in the colour of sqirrels’ fur was probably due to environmental conditions.