Increased activation of protein C, but lower plasma levels of free, activated protein C in uraemic patients: relationship with systemic inflammation and haemostatic activation.

Chronic renal failure (CRF) courses with both systemic inflammatory reaction and haemostatic activation. We explored the relationship of these processes with plasma levels of free, activated protein C (APC) and complexes of APC with its inhibitors in patients with CRF under conservative treatment. Plasma concentrations of inflammatory cytokines [tumour necrosis factor alpha (TNFalpha) and interleukin 8], acute-phase proteins (C-reactive protein, fibrinogen, alpha1-anti-trypsin and von Willebrand factor), and markers of haemostatic activation (thrombin-anti-thrombin complexes, plasmin-anti-plasmin complexes, and fibrin and fibrinogen degradation products) were higher in patients than in controls. Inflammatory and haemostatic markers were significantly and positively correlated. Total plasma APC and APC:alpha1-anti-trypsin (alpha1AT) complexes were 44% and 75% higher in patients than in controls (P = 0.0001), whereas free APC was 20% lower (P < 0.015). No significant difference was observed in APC:protein C inhibitor (PCI) complexes between both groups. The free/total APC ratio was significantly lower in patients than in controls (P < 0.0001). Total plasma APC and APC:alpha1AT were positively correlated with activation markers of haemostasis and acute-phase proteins, whereas free APC was inversely correlated with plasma levels of creatinine, acute-phase proteins and fibrin degradation products (FnDP). Systemic inflammation and activation of haemostasis are interrelated processes in CRF. APC generation was increased in response to elevated thrombin production, but the inflammatory reaction, associated with increased synthesis of alpha1AT, reduced its anticoagulant effect. Lower free plasma APC in CRF may be pathogenically associated with atherothrombosis, a major cause of death in this disease.

Sialolitiasis de glándula submaxilar / Submaxilar gland sialolitiasis

Se presenta un caso de sialolitiasis submaxilar con cálculo intraglandular, sin manifestaciones clinicas anteriores, con un tamaño de 22 X 19 mm y un peso de 4.5 g

Lesiones laringotraqueales post-intubación prolongada / Prolonged postintubation laryngotracheal injuries

De los 503 pacientes que ingresaron a la Unidad de Cuidados Intensivos (U. C.I.) del Hospital Universitario de Cartagena durante el segundo semestre de 1992 y el año de 1993, se evaluaron 50, presentando 26 de ellos lesiones laringotraqueales secuelas de su intubación. La intubación endotraqueal entre cinco y doce dias deja secuelas superficiales y la solución de las mismas o su pronostico es mucho mejor que cuando la intubación ha sido por 20 dias o mas, pues las lesiones cicatriciales son de peor pronostico. La intubación durante cinco dias o menos no deja secuelas laringotraqueales y pacientes en quienes se sospecha tratamiento prolongado de su via aerea obstruida, deben someterse sin dilaciones a traqueostomia

[Social marketing applied to condom promotion: a proposal for intervention in groups at risk for sexually transmitted diseases]. / El marketing social aplicado a la promoción del condón: una propuesta de intervención sobre grupos en riesgo de enfermedades de transmisión sexual.

Sexually transmitted diseases (STDs) are an important worldwide health problem. Their association with AIDS an other insidious viral processes have brought them to the foreground of sanitary authorities and general population concern. Often, health services have to struggle with reinfections, which concentrate in pockets of risk that consume large amount of care and constitute an important link in the transmission of these diseases. General publicity have little impact among high risk groups. Thus, it becomes necessary to be more precise and divide into segments the target population we want to reach. Prevention of reinfection in these communities requires the implementation of healthy behaviours through the promotion of a tangible product (condom). Regarding these considerations, social marketing emerges as the right instrument to be used. Through individual focused interviews with prostitutes, homosexual and young promiscuous heterosexual patients from a STDs Prevention, Diagnosis and Treatment Centre, determining factors of the use condoms and related behaviour guidelines have been identified. Also, a social marketing strategy is suggested to prevent these diseases among groups at risk by means of condom promotion.