Immunological follow-up of patients with renal transplants: A proposal for clinical practice in Colombia / Seguimiento inmunológico después de trasplante renal: una propuesta para la práctica clínica en Colombia.

Graft damage is a process that starts at the moment of transplantation, due to comorbidities of receptor, donor status, ischemia time, ischemia-reperfusion phenomenon, among others, those induce metabolic and immune factors that ultimately trigger clinical manifestations of graft dysfunction. However, the preclinical progression between the time of transplantation and the appearance of signs and symptoms of graft damage can take weeks to years. Therefore, the implementation of rational monitoring approaches during the post-transplantation period is critical and should include not only the clinical follow-up but also anticipate immunological graft damage. In the present essay, we propose an immunological monitoring algorithm for the post-renal transplantation period.

El daño del injerto es un proceso multifactorial que se inicia tempranamente después de la mayoría de los trasplantes de donantes sin HLA idéntico. Puede deberse a las comorbilidades del receptor, al estado del donante, al tiempo de isquemia, y al fenómeno de isquemia y reperfusión, entre otros, condiciones que inducen factores metabólicos e inmunológicos que finalmente desembocan en la disfunción del injerto. Sin embargo, entre el momento del trasplante y la aparición de los signos y síntomas existe un periodo que puede tardar semanas o años. Por ello, después del trasplante renal, es importante hacer un seguimiento racional que incluya la evaluación clínica y permita anticiparse al daño inmunológico del injerto. En este ensayo se propone un algoritmo de seguimiento del injerto renal después del trasplante.

Seguimiento inmunológico después de trasplante renal: una propuesta para la práctica clínica en Colombia / Immunological follow-up of patients with renal transplants: A proposal for clinical practice in Colombia

El daño del injerto es un proceso multifactorial que se inicia tempranamente después de la mayoría de los trasplantes de donantes sin HLA idéntico. Puede deberse a las comorbilidades del receptor, al estado del donante, al tiempo de isquemia, y al fenómeno de isquemia y reperfusión, entre otros, condiciones que inducen factores metabólicos e inmunológicos que finalmente desembocan en la disfunción del injerto. Sin embargo, entre el momento del trasplante y la aparición de los signos y síntomas existe un periodo que puede tardar semanas o años. Por ello, después del trasplante renal, es importante hacer un seguimiento racional que incluya la evaluación clínica y permita anticiparse al daño inmunológico del injerto. En este ensayo se propone un algoritmo de seguimiento del injerto renal después del trasplante.

Graft damage is a process that starts at the moment of transplantation, due to comorbidities of receptor, donor status, ischemia time, ischemia-reperfusion phenomenon, among others, those induce metabolic and immune factors that ultimately trigger clinical manifestations of graft dysfunction. However, the preclinical progression between the time of transplantation and the appearance of signs and symptoms of graft damage can take weeks to years. Therefore, the implementation of rational monitoring approaches during the posttransplantation period is critical and should include not only the clinical follow-up but also anticipate immunological graft damage. In the present essay, we propose an immunological monitoring algorithm for the post-renal transplantation period.

Bovine Viral Diarrhea Virus in Zoos: A Perspective from the Veterinary Team.

The many different species in close proximity make zoological collections a unique environment for disease transmission. Bovine Viral Diarrhea Virus (BVDV) is of special concern with zoos due to the numerous exotic ruminant species that this virus can infect. BVDV occurs as both a non-cytopathic and a cytopathic strain both of which are capable of infecting exotic ruminants. The cytopathic strain causes mucosal disease (MD) and death. Infection with the non-cytopathic strain may produce persistently infected (PI) animals. PI individuals may show vague clinical signs, including abortion. Management of BVDV in zoos should focus on identification of PI individuals and prevention of infection of other animals of the collection. Variability makes serological testing as the sole method of screening for BVDV infection undesirable in exotic ruminants. Combination testing provides a definitive answer, especially in sensitive wildlife. Use of a combination of antigen-capture ELISA (ACE) with haired skin, Real Time-PCR (RT-PCR) on whole blood, and antibody detection via serum neutralization has the greatest potential to identify PI animals. An animal that is positive on both ACE and RT-PCR, but is negative on serology should be considered highly suspicious of being a PI, and should be isolated and undergo repeat testing 4-6 weeks later to confirm positive status. This testing methodology also allows screening of pregnant and newborn animals. Isolation or culling may need to be considered in animals determined to be positive via combination testing. These decisions should only be made after careful consideration and evaluation, especially with endangered species.

Factores que generan estrés durante las prácticas clínicas en estudiantes de enfermería en una universidad de Lima / Factors that generate stress during the clinical practices in nursing students at a university at Lima

El presente estudio tuvo como Objetivo general: Identificar los factores que generan estrés durante las prácticas clínicas en estudiantes de enfermería de la escuela académico profesional de enfermería (EAP) de la Universidad Nacional Mayor de San Marcos (UNMSM) 2014, Material y Método el estudio de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal la muestra de 104 estudiantes de 2do, 3er y 4to, de la EAP de enfermería. Técnica empleada: la encuesta y el instrumento utilizado fue el cuestionario bilingüe de estresores de enfermería KESKAK modificada. Las pruebas estadística utilizada fue correlación de Pearson el cual relaciona validez entre ítems del intrumento y el coeficiente alfa de Cronbach: 0.954 el cual relaciona confiabilidad del instrumento. Resultados: los ítems con mayor puntuación pertenecen al factor extra personal entre los que tenemos: “incremento en hora de clases y prácticas” con puntaje promedio de 3.28 “el acumulo de trabajos y proximidad de exámenes” con puntaje promedio 3.25, “Cambio en el horario de clases teóricas ya establecidas” con puntaje promedio 3.22. Conclusiones: El factor que contribuye más en la generación de estrés, en los estudiantes de enfermería de la UNMSM, fue el factor extra personal “sobrecarga académica” con mayor puntuación promedio en comparación a los demás factores.

The present research had as objective: Identify stressors in c1inical practice in nursing students from the academic and professional nursing school (EAP) at the National University of San Marcos (San Marcos) 2014, the Materials and Methods research application, quantitative, descriptive method and transversal research of 104 students (2nd, 3rd and 4th) of the EAP nursing. Technique used: the survey and the instrument used was the modified KESKAK bilingual questionnaire of stressors of nursing. The statistical test used was Pearson correlation which relates the instrument validity between items and Cronbach's alpha coefficient: 0.954 which relates reliability of the instrument, Results: The highest scoring items belong to the extra personal factor among those which have “increased class time and practice” with score of 3.28 "the accumulation of papers and exams proximity” with score of 3.25, “Changes in the schedule established” with score of 3.22. Conclusions: The most contributing factor in the generation of stress in nursing students of San Marcos University, was the extra personal factor “academic overload” with the highest average score compared to other factors.

Role of Helicobacter pylori infection in Hispanic patients with anemia.

Pernicious anemia represents the final phase of a process that begins with Helicobacter pylori-associated gastritis and evolves through progressive levels of atrophy until loss of parietal cell mass. Numerous studies have suggested an association between H. pylori infection, unexplained iron deficiency anemia and cobalamin deficiency. Our research question was to determine whether there is an association between with H. pylori infection and development of anemia in Hispanic patients. This cross sectional pilot study involved data analysis of individual from years 2010-2012 examining the association between H. pylori infection and hemoglobin levels in patients with Hispanic ethnicity. A total of 189 records were evaluated, of which 33 fulfilled the inclusion criteria. The study sample was divided in two groups. Group-A: 5 subjects with H. pylori infection and anemia; Group-B: 28 patients with H. pylori without anemia. Fisher exact test applied between categorical variables to determine the statistical significance of symptoms comparing anemic vs. non-anemic H. pylori infected patients yielded a p = 0.0027. In addition, restoration of anemia in two subjects following eradication therapy without previous iron or cobalamin replacement therapy suggested a potential role of this bacterium in the development of anemia in Hispanics. In conclusion, from the results of this study a potential association between Helicobacter pylori infection and anemia in Hispanic patients is suggested. Restoration of hemoglobin after eradication of bacteria further supports this concept.

Hipertiroidismo congénito, Reporte de dos casos

Introducción: El hipertiroidismo es una patología tiroidea poco frecuente en neonatos, relacionada con el antecedente materno de enfermedad de Graves, y por lo tanto con el paso transplacentario de inmunoglobulinas estimulantes del receptor de TSH. Presentación de casos: Reportamos dos casos de sexo femenino, que se presentaron en el Hospital Universitario de Santander. El primero de los casos se manifestó en la primera semana; el segundo caso se presentó tardíamente después del primer mes de vida. Los síntomas que presentaron en común fueron taquicardia persistente e hiperactividad. En uno de los casos la presentación clínica fue confundida con una infección bacteriana, debido a la presencia de fiebre. Se confirma el diagnóstico con los niveles de TSH muy suprimidos y T4 libre elevada, al menos al doble del límite superior. Los dos casos observaron medicamentos antitiroideos y propanolol con buena evolución clínica y de laboratorios; no se observamos complicaciones a corto o largo plazo como arritmias o craneosinostosis. Discusión: El hipertiroidismo congénito es una patología poco frecuente y siempre debe ser sospechado en recién nacidos de madres con antecedente de enfermedad de Graves, sus manifestaciones pueden presentarse prenatalmente o postnatalmente, y su diagnóstico y tratamiento deben ser oportunos para evitar secuelas a largo plazo o incluso la muerte.

Introduction: Hyperthyroidism is a thyroidal pathology infrequent in neonates related with maternal history of Graves' disease, and therefore with the transplacental passage of stimulating TSH receptor immunoglobulins. Case report: We report two female gender cases at Hospital Universitario Santander, one of the two cases became manifest during the first week of life, and the other took longer time after the first month of life, as it can happen. Symptoms in common were persistent tachycardia and hyperactivity; one of the cases was mistaken for bacterial infection arising from fever. Diagnose was confirmed of highly suppressed TSH levels and high Free T4, at least twice the limit level. Both cases were treated for some time with antithyroid drugs and ß-blockers, showing good clinical and lab evolution; no complications like arrhythmias or craneosynostosis were observed. Discussion: Congenital hyperthyroidism is a rare condition and should always be suspected in infants of mothers with Graves' disease, its manifestations may occur prenatally or postnatally, and their diagnosis and treatment should be timely to avoid long-term sequelae or death.

Synovial sarcoma of the hypopharynx in pregnancy.

Synovial sarcomas of the hypopharynx are a rare form of soft tissue sarcomas. In the head and neck, they are most commonly found on the pharyngeal wall in areas that do not have synovial cells. We review a case of a 23 year-old pregnant female who presented to our hospital with acute airway obstruction due to a large hypopharynx lesion. She underwent emergency tracheotomy and tumor debulking. Pathology revealed synovial sarcoma. After the procedure the patient went into labor delivering a 29 weeks premature child. Six weeks after being discharged from the hospital the patient had a partial pharyngectomy performed to excise the remnant base of the tumor. She has had no recurrence at the 30-month post-operative period.

Promotoras in mental health: a review of English, Spanish, and Portuguese literature.

Promotoras have worked in various areas of public health; however, there is a lack of understanding about their work in mental health. This article reviews the literature in 3 different cultures/languages (English, Spanish, and Portuguese) and aims to describe promotoras' roles, training, and interventions and their outcomes related to mental health activities. Results demonstrate that in different cultures/languages, promotoras empower community members to promote mental health and prevent exacerbation of individuals' mental illness. Promotoras, when trained carefully, have the ability to increase awareness and to promote mental health in populations that would otherwise have limited or no access to care.

Mononeuropatía postraumática en la Unidad de Trauma del Hospital Universitario del Valle, Cali / Postraumatic mononeuropathies in the Valle University Hospital, Cali

Introducción: La mononeuropatía es la más común de las neuropatías dolorosas; los síndromes de atrapamiento y el trauma son las causas más frecuentes. Materiales y métodos: Se realizó un estudio retrospectivo con 164 casos de mononeuropatía postraumática distribuidos en 134 pacientes que ingresaron a la Unidad de Trauma del Hospital Universitario del Valle, Cali, entre agosto, 1999 y julio, 2000. Resultados: Se encontró a la mononeuropatía postraumática como una entidad de predominancia masculina (88.1/100) con una mayor incidencia en los grupos de adolescentes y adultos jóvenes (15-29 años). El tiempo promedio de diagnóstico fue 3.6 días, con 57.9/100 de las lesiones diagnosticadas el mismo día de ingreso a la unidad de trauma.Conclusiones: En el HUV existe buena habilidad y conocimiento del personal médico de urgencias para diagnosticar las mononeuropatías después de un trauma. Sin embargo, sirve poco diagnosticarlas oportunamente si el tratamiento adecuado no se brinda en forma rápida y adecuada