Clinical and Echocardiographic Factors Associated with Right Ventricular Systolic Dysfunction in Hemodialysis Patients.

BACKGROUND: Chronic kidney disease is a disorder of epidemic proportions that impairs cardiac function. Cardiovascular diseases are the leading cause of death in hemodialysis patients, and the understanding of new nontraditional predictors of mortality could improve their outcomes. Right ventricular systolic dysfunction (RVSD) has recently been recognized as a predictor of cardiovascular death in heart failure and hemodialysis patients. However, the factors contributing to RVSD in hemodialysis patients remain unknown. The aim of this study was to evaluate the clinical and echocardiographic factors associated with RVSD in hemodialysis patients. METHODS: A cross-sectional study was conducted in which 100 outpatients with end-stage renal disease on chronic hemodialysis were evaluated. A transthoracic echocardiographic examination was performed at optimal dry weight. Right ventricular systolic function was evaluated using tricuspid annular plane systolic excursion (TAPSE). Clinical and echocardiographic data were recorded for each patient. A multivariate linear logistic regression was created using RVSD (TAPSE <14 mm) as the dependent variable. RESULTS: Fifteen patients with RVSD and 85 patients without RVSD were analyzed. TAPSE had a positive correlation with left ventricular ejection fraction (LVEF) and myocardial relaxation velocity. Independent contributors to RVSD were LVEF (OR 1.14, 95% CI 1.05-1.26), left ventricular mass index (OR 1.02, 95% CI 1.00-1.04), and myocardial relaxation velocity (OR 1.81, 95% CI 1.18-3.19). CONCLUSIONS: Echocardiographic factors were significant contributors to RVSD. These measurements could be included as part of the routine workup in all end-stage renal disease patients on hemodialysis.

Association of KIR3DL1/S1 and HLA-Bw4 with CD4 T cell counts in HIV-infected Mexican mestizos.

Certain genotypic combinations of killer-cell immunoglobulin-like receptors (KIR) and human leukocyte antigens (HLA) have been associated with favourable outcomes after exposure to human immunodeficiency virus in Caucasoid and African populations. Human immunodeficiency virus (HIV) infection is characterized by a rapid exhaustion of CD4 cells, which results in impaired cellular immunity. During this early phase of infection, it is thought that the natural killer (NK) cells represent the main effector arm of the host immune response to HIV. This study investigates whether KIR and HLA factors are associated to CD4 T cell numbers after HIV infection in Mexican mestizos as assessed at the time of initial medical evaluation and subsequent clinical follow-up. KIR and HLA-B gene carrier frequency differences were compared between groups of patients stratified by CD4 T cell numbers as assessed during their first medical evaluation (a point in time at which all patients were anti-retroviral therapy naïve). In addition, the influence that these genetic factors have on averaged historical CD4 cell counts in patients subjected to follow-up (mostly therapy-experienced) was also evaluated. Our results suggest a protective role for the HLA-Bw4 and KIR3D + Bw4 combination in both therapy-naïve and therapy-experienced patients. This report furthers our understanding on the way that immune genes modulate HIV disease progression in less-studied human populations such as the Mexican mestizos with a special focus on CD4 T cell number and behaviour.

Efecto de la suplementación de omega 3 sobre IMC, ICC y composición corporal en mujeres obesas / Effect of Omega 3 fatty acids on body female obese composition

La evidencia sobre los posibles mecanismos de utilización de los ácidos grasos Omega 3 para mediar la obesidad requiere continuar con estudios clínicos con metodologías concretas. El objetivo fue evaluar mediante impedancia bioeléctrica el efecto de la suplementación de omega 3 sobre el Indicé de Masa Corporal (IMC), Índice Cintura Cadera (ICC) y composición corporal en mujeres obesas. Participaron 60 mujeres obesas adultas (IMC >30 Kg/m²) que fueron aleatorizadas en 3 grupos: Grupo 1) placebo, vitamina E (200 UI), Grupo 2) 1 g de omega 3) y Grupo 3) 2 g de omega 3. Todas recibieron dieta hipocalórica y ejercicio moderado. Se midieron; peso, IMC, índice cintura cadera y distribución grasa al inicio y cada mes por tres meses. Los resultados muestran que la suplementación con omega 3 tuvo una relación dosis respuesta disminuyendo significativamente el peso, IMC y la masa grasa total, en comparación con el grupo control. Estos efectos dependieron del tiempo y cantidad de Omega 3 suplementada, cuando se ajustó por el grado de cumplimiento de ejercicio, apego a la dieta y edad. Concluimos que la suplementación con Omega 3 es un coadyuvante eficaz en el manejo de la obesidad en mujeres premenopáusicas.

Evidence on the possible mechanisms for the use of Omega 3 fatty acids to mediate obesity requires clinical studies continue with specific methodologies. The aim was to assess the effect of omega-3 supplementation on Body Mass Index (BMI), Wais - Hip Index (WHI) and body composition of obese women using bioelectrical impedance. Subjects 60 premenopausal obese women (BMI > 30Kg/m²) were randomly assigned to 3 groups: Group 1) placebo, vitamin E (200 IU), group 2) 1 g of omega and group 3) 2 g of omega-3. All of them received a low calorie diet and moderate exercise. Weight, BMI, WHI, and fat distribution were measured at the beginning and every month for three months. The results show us Omega-3 supplementation significantly reduced weight, BMI, and total fat mass, compared to the control group, a dose-response effect. These effects depended on the time and amount of Omega 3 supplemented, when the degree of compliance of exercise, adherence to the diet and age were controlled. In conclusion the supplementation with omega- 3 is an efficient method in the management of obesity in premenopausal women.

[Effect of Omega 3 fatty acids on body female obese composition]. / Efecto de la suplementación de omega 3 sobre IMC, ICC y composición corporal en mujeres obesas.

Evidence on the possible mechanisms for the use of Omega 3 fatty acids to mediate obesity requires clinical studies continue with specific methodologies. The aim was to assess the effect of omega-3 supplementation on Body Mass Index (BMI), Wais - Hip Index (WHI) and body composition of obese women using bioelectrical impedance. Subjects 60 premenopausal obese women (BMI > 30Kg/m2) were randomly assigned to 3 groups: Group 1) placebo, vitamin E (200 IU), group 2) 1 g of omega and group 3) 2 g of omega-3. All of them received a low calorie diet and moderate exercise. Weight, BMI, WHI, and fat distribution were measured at the beginning and every month for three months. The results show us Omega-3 supplementation significantly reduced weight, BMI, and total fat mass, compared to the control group, a dose-response effect. These effects depended on the time and amount of Omega 3 supplemented, when the degree of compliance of exercise, adherence to the diet and age were controlled. In conclusion the supplementation with omega-3 is an efficient method in the management of obesity in premenopausal women.

Prognostic indications of the failure to treat amoebic liver abscesses.

OBJECTIVES: To identify the variables that predict the failure to treat amoebic liver abscesses. METHODS: We prospectively carried out a case-control study on a cohort of patients who had been diagnosed with amoebic liver abscesses using clinical, ultrasonic, and serologic methods. Patients with pyogenic abscesses, negative ELISA tests for amoebiasis, immunosuppression status, or previous abdominal surgery were excluded. All patients received metronidazole, and those who demonstrated 4 days of unfavorable clinical responses received percutaneous or surgical draining of the abscess. Demographic, laboratory, and ultrasonographic characteristics were assessed as prognostic indications of failure. RESULTS: Of 40 patients with amoebic liver abscess, 24 (mean age: 36·7±11·2 years) responded to medical treatment and 16 (41·8±11·6 years) required drainage, including 14 patients who underwent percutaneous drainage and two patients who required surgery. The albumin level, abscess volume, abscess diameter, and alkaline phosphatase level were all statistically significant (P<0·05) on the bivariate analysis. The highest (>99%) sensitivity and negative predictive value were observed for an abscess volume >500 ml and diameter >10 cm, while the best specificity and positive predictive value were achieved with the combination of low serum albumin level, high alkaline phosphatase level, and large abscess volume or diameter. CONCLUSIONS: The prognostic indications of the failure to treat amoebic liver abscesses include low albumin, high alkaline phosphatase, and large abscess volume or diameter. The combination of these variables is a useful and easy tool for determining appropriate therapy.

Experience with a new design of endoretractor for gasless laparoscopic cholecystectomy.

BACKGROUND: Cholecystectomy has replaced open surgery and is regarded as the standard procedure today. The pneumoperitoneum needed to create working space can induce cardiovascular changes. Gasless laparoscopic surgery is effective; we evaluate a new retractor design. METHODS: Patients older than 15 years with elective cholecystectomy and American Society of Anesthesiology I-II were consequently assigned to conventional or gasless surgery. We evaluated surgical time, hemodynamic stability, hours of hospital stay, and days of recuperation. RESULTS: We analyzed 22 cholecystectomies, 10 by the gasless technique and 12 by gas laparoscopy. We did not observe significant differences in surgical time, length of hospital stay, or days of recuperation. However, surgical exposition time was longer in the retractor group than was expected by chance (P<0.05). Hemodynamic stability was similar between the groups. CONCLUSIONS: Similar surgical and recuperation times and length of hospital stay were observed. Our design is comparable with conventional laparoscopic surgery despite longer surgical exposition time.

[Epidemiologic study on dental caries and treatment needs in schoolchildren aged six to twelve years from San Luis Potosi]. / Estudio epidemiológico sobre caries dental y necesidades de tratamiento en escolares de 6 a 12 años de edad de San Luis Potosí.

OBJECTIVE: To determine the experience, prevalence and severity of dental caries, as well as the Significant Caries Index (SiC) and the treatment needs (TN) in schoolchildren aged six to twelve years. Equally, to estimate the effect of caries in primary dentition on caries in permanent dentition. MATERIAL AND METHODS: A cross-sectional study was realized in 3865 schoolchildren from San Luis Potosí City, Mexico. Subjects were clinically evaluated by three standardized examiners (kappa > 0.85). For detection of caries was employed the WHO's criteria for primary (dmft) and permanent (DMFT) dentitions. In the statistical analyzes non-parametric test and logistic regression were used. RESULTS: Mean of age was 8.69 +/- 1.79 and 51.3% were women. In the primary dentition: dmft index was 1.88 +/- 2.34 and the caries prevalence (dmft >0) of 56.8%. In account to severity 22.0% and 5.6% have dmft >3 and dmft >6, respectively. In children of six years, the caries prevalence was 56.0% and the SiC of 5.45. In the permanent dentition: DMFT index was 1.11 +/- 2.03 and the caries prevalence (DMFT >0) of 36.8%. In account to severity 11.8% and 2.8% have DMFT >3 and DMFT >6, respectively. In children of twelve years, the DMFT index caries 4.14 +/- 4.15 and the SiC of 9.15. The TN index was of 88.5% for primary dentition and 93.6% for the permanent. In logistic regression we observed associated to caries prevalence in permanent dentition; presence of caries in primary dentition (OR = 6.37; p < 0.001), female sex (OR = 1.33; p < 0.001) and higher age (OR = 1.69; p < 0.001). CONCLUSIONS: Caries prevalence to six years old and DMFT index to twelve years old were highest to values established by WHO. Caries severity in the primary dentition was two times than observed in the permanent dentition. High TN in both dentitions was observed. Presence of caries in primary dentition was a strong risk indicator for to present caries in permanent dentition.

Role of extracellular Na+, Ca2+-activated Cl- channels and BK channels in the contraction of Ca2+ store-depleted tracheal smooth muscle.

1. In the present study, we investigated the series of events involved in the contraction of tracheal smooth muscle induced by the re-addition of Ca(2+) in an in vitro experimental model in which Ca(2+) stores had been depleted and their refilling had been blocked by thapsigargin. 2. Mean (+/-SEM) contraction was diminished by: (i) inhibitors of store-operated calcium channels (SOCC), namely 100 micromol/L SKF-96365 and 100 micromol/L 1-(2-trifluoromethylphenyl) imidazole (to 66.3 +/- 4.4 and 41.3 +/- 5.2% of control, respectively); (ii) inhibitors of voltage-gated Ca(2+) channels Ca(V)1.2 channels, namely 1 micromol/L nifedipine and 10 micromol/L verapamil (to 86.2 +/- 3.4 and 76.9 +/- 5.9% of control, respectively); and (iii) 20 micromol/L niflumic acid, a non-selective inhibitor of Ca(2+)-dependent Cl(-) channels (to 41.1 +/- 9.8% of control). In contrast, contraction was increased 2.3-fold by 100 nmol/L iberiotoxin, a blocker of the large-conductance Ca(2+)-activated K(+) (BK) channels. 3. Furthermore, contraction was significantly inhibited when Na(+) in the bathing solution was replaced by N-methyl-D-glucamine (NMDG(+)) to 39.9 +/- 7.2% of control, but not when it was replaced by Li(+) (114.5 +/- 24.4% of control). In addition, when Na(+) had been replaced by NMDG(+), contractions were further inhibited by both nifedipine and niflumic acid (to 3.0 +/- 1.8 and 24.4 +/- 8.1% of control, respectively). Nifedipine also reduced contractions when Na(+) had been replaced by Li(+) (to 10.7 +/- 3.4% to control), the niflumic acid had no effect (116.0 +/- 4.5% of control). 4. In conclusion, the data of the present study demonstrate the roles of SOCC, BK channels and Ca(V)1.2 channels in the contractions induced by the re-addition of Ca(2+) to the solution bathing guinea-pig tracheal rings under conditions of Ca(2+)-depleted sarcoplasmic reticulum and inhibition of sarcoplasmic/endoplasmic reticulum calcium ATPase. The contractions were highly dependent on extracellular Na(+), suggesting a role for SOCC in mediating the Na(+) influx.

[Prognostic value of pre-B immunophenotype in early treatment response among acute pediatric lymphoblast leukemia patients]. / Valor pronóstico del inmunofenotipo en la respuesta temprana de la leucemia aguda linfoblástica pre-B en niños.

OBJECTIVE: To determine the prognostic value of preB immunophenotype and its variants on early treatment response among of acute pediatric lymphoblast leukemia. PATIENTS AND METHODS: A case-control study nested in a cohort was carried out with male and female patients 15 years and younger with recently diagnosed pre-B lymphoblast leukemia. A panel of B, T, monoclonal antibodies of the myelo-monocytic and megakaryocytic cell type was used. Response was assessed by bone marrow aspiration 14 days post treatment. RESULTS: 54 patients were included. The median age was 7 years (2 months - 14 years) median leukocyte count was 13,450/mm3 (1200-986,000/mm3). We identified 29 cases with late pre-B immune phenotype, 19 cases with common pre B and 6 cases with early preB immunophenotype. Eleven, patients also displayed myeloid antigens. A significant association (p=0.034) was found between early treatment response and the presence of myeloid antigens. No association was found between the pre-B immunophenotype, age and leukocyte count with early treatment response (p=0.264). CONCLUSIONS: We need to pay special emphasis on early treatment response in children with lymphoblast leukemia as our study did not corroborate the common finding that clinical factors and immune phenotype can be predictive factors.

Valor pronóstico del inmunofenotipo en la respuesta temprana de la leucemia aguda linfoblástica pre-B en niños / Prognostic value of pre-B immunophenotype in early treatment response among acute pediatric lymphoblast leukemia patients

Objetivo: Determinar el valor pronóstico del inmunofenotipo pre B con sus variantes en la respuesta temprana al tratamiento de la leucemia aguda linfoblástica pediátrica, ajustando edad y cifra de leucocitos inicial. Pacientes y método: Se realizó un estudio de casos y controles anidado en una cohorte con pacientes menores de 15 años de edad, de los dos géneros, con leucemia aguda linfoblástica pre B de diagnóstico reciente. Se utilizó un panel de anticuerpos monoclonales específicos de la estirpe B, T, monocito mielocito y megacariocítica. Se evaluó la respuesta después de 14 días de tratamiento mediante aspirado de médula ósea. Resultados: Se incluyeron 54 pacientes. La mediana de edad fue de 7 años (2 m 14 años), la mediana de cifra de leucocitos fue 13,450/mm³ (1200-986,000/mm³). Se identificaron 29 casos con inmunofenotipo Pre B tardío, 19 casos pre B común y 6 casos de pre B precoz. Once pacientes presentaron antígenos mieloides asociados. Se encontró asociación significativa (p=0.034) entre respuesta temprana y la presencia de antígenos mieloides. No se demostró asociación entre las variantes del inmunofenotipo pre B, edad y cifra de leucocitos con la respuesta temprana (p=0.264). Conclusiones: Es necesario estudiar directamente la respuesta tem prana al tratamiento en los niños con leucemia linfoblástica ya que en nuestra muestra de pacientes los factores clínicos y el inmunofenotipo no fueron predictivos de ésta.

Objective: To determine the prognostic value of pre B immunophenotype and its variants on early treatment response among of acute pediatric lymphoblast leukemia. Patients and methods: A case control study nested in a cohort was carried out with male and female patients 15 years and younger with recently diagnosed pre B lymphoblast leukemia. A panel of B, T, monoclonal antibodies of the myelo monocytic and megakaryocytic cell type was used. Response was assessed by bone marrow aspiration 14 days post treatment. Results: 54 patients were included. The median age was 7 years (2 months - 14 years) median leukocyte count was 13,450/mm3 (1200-986,000/mm3). We identified 29 cases with late pre B immune phenotype, 19 cases with common pre B and 6 cases with early pre B immunophenotype. Eleven patients also displayed myeloid antigens. A significant association (p=0.034) was found between early treatment response and the presence of myeloid antigens. No association was found between the pre B immunophenotype, age and leukocyte count with early treatment response (p=0.264). Conclusions: We need to pay special emphasis on early treatment response in children with lymphoblast leukemia as our study did not corroborate the common finding that clinical factors and immune phenotype can be predictive factors.

Comparison of equivalence and determination of diagnostic utility of min-mod and clamp methods for insulin resistance in diabetes free subjects: a meta-analysis.

The gold standard for quantifying insulin sensitivity (IS) is the hyperinsulinemic-euglycemic clamp (Clamp) with a cut-off point of 5x10-2 (dL/min)/(microU/mL) or less to indicate insulin resistance. Bergman's minimal model (Min-Mod) is also being used to estimate IS, but there are doubts as to its equivalence with Clamp. The objective of the present study is to determine if Clamp and the tolbutamide and insulin techniques of Min-Mod are equivalent. Meta-analysis based on a bibliographic search from 1970 until the present was made for the MeSH terms: insulin resistance, hyperglycemic-clamp, euglycemic-clamp, Min-Mod, minimal model approach. Concordance was determined with both simple and intraclass correlation and Bland and Altman's concordance limits using R. Three of the 109 articles found were included. The concordance limits indicate that Clamp and Min-Mod are not equivalent, which could result in diagnostic errors if the accepted cut-off point is used for both methods. Given this lack of equivalence, a ROC analysis was performed and new diagnostic cut-off points of 2.4 and 4.6x0-2 (dL/min)/(microU/mL) for insulin and tolbutamide techniques of Min-Mod, respectively, are proposed, with adequate sensitivity, specificity, and predictive value. These values should be prospectively validated.