How many patients with post-chikungunya chronic inflammatory rheumatism can we expect in the new endemic areas of Latin America?

Post-chikungunya chronic inflammatory rheumatism (pCHIK-CIR) is one of the consequences that are impacting new endemic countries, such as those in the Americas. The relative frequency of pCHIK-CIR is highly variable, ranging from 14.4 % to 87.2 % (including variable number of patients and follow-up times). Based on those non-weighted values, it is difficult to estimate which would be the expected number of patients with CHIK who will develop CIR. For these reasons, we modeled weighted estimations based on pooled data extracted from those eight representative studies in order to provide cumulative proportion of pCHIK-CIR over time and median time of it, but also estimations of the number of patients with CHIK reported in Latin American countries (within a 95 % CI). This model estimated a prevalence of 47.57 % for pCHIK-CIR (95 % CI 45.08-50.13), with a median time to 50 % of pCHIK-CIR in 20.12 months. Given the reported number of patients with acute CHIK during 2014 in the Americas, our estimates suggest that from those patients, 385,835-429,058 patients will develop pCHIK-CIR. Despite the limitations of these estimates, the provided figures of pCHIK-CIR presented here are preliminary approximations of what the future burden of related rheumatic disease in the region as a consequence of CHIK infection for 2015-2016 could be, given the timeframe of median time of occurrence.

Selected contribution: cerebrovascular nos and cyclooxygenase are unaffected by estrogen in mice lacking estrogen receptor-alpha.

Estrogen alters reactivity of cerebral arteries by modifying production of endothelium-dependent vasodilators. Estrogen receptors (ER) are thought to be involved, but the responsible ER subtype is unknown. ER-alpha knockout (alphaERKO) mice were used to test whether estrogen acts via ER-alpha. Mice were ovariectomized, with or without estrogen replacement, and cerebral blood vessels were isolated 1 mo later. Estrogen increased levels of endothelial nitric oxide synthase and cyclooxygenase-1 in vessels from wild-type mice but was ineffective in alphaERKO mice. Endothelium-denuded middle cerebral artery segments from all animals constricted when pressurized. In denuded arteries from alphaERKO but not wild-type mice, estrogen treatment enhanced constriction. In endothelium-intact, pressurized arteries from wild-type estrogen-treated mice, diameters were larger compared with arteries from untreated wild-type mice. In addition, contractile responses to indomethacin were greater in arteries from wild-type estrogen-treated mice compared with arteries from untreated wild-type mice. In contrast, estrogen treatment of alphaERKO mice had no effect on diameter or indomethacin responses of endothelium-intact arteries. Thus ER-alpha regulation of endothelial nitric oxide synthase and cyclooxygenase-1 pathways appears to contribute to effects of estrogen on cerebral artery reactivity.

Prognostic factors and management of civilian penetrating duodenal trauma.

OBJECTIVE: This study was designed to investigate risk factors in the final outcome of patients with civilian penetrating abdominal trauma and duodenal injuries, the value of the different surgical approaches used, and to define when more complex procedures are indicated, instead of the simple primary repair. METHODS: The study design was a retrospective review of prospectively collected data of a 4-year period (July 1992 to June 1996). RESULTS: A total of 167 patients were admitted with penetrating abdominal trauma and duodenal injuries at San Juan de Dios Hospital in Santafé de Bogotá, Colombia. CONCLUSION: The independent and significant risk factors that determine the severity of duodenal injury and need for complex procedures, as identified in this series, are preoperative or intraoperative shock; Abdominal Trauma Index higher than 25; and associated injuries to the pancreas, superior mesentric vessels, and colon. These factors are associated with an increased incidence of septic complications, duodenal fistula, and late mortality.

Utilidad diagnóstica de la toracoscopia en heridas toracoabdominales izquierdas por arma cortopunzante: estudio prospectivo / Usefulness of thoracoscopy in the management of stab wounds

De manera relativamente frecuente y originado por un traumatismo toracoabdominal ya sea penetrante y/o cerrado, se presentan lesiones del diafragma que favorecen la aparicion de hernias diafragmaticas, que de no ser detectadas y manejadas de manera oportuna conllevan una importante morbimortalidad. Con el fin de establecer la sensibilidad y especificidad de la toracoscopia en el diagnostico de heridas diafragmaticas por arma cortopunzante especificamente del lado izquierdo, se realizó el presente trabajo. Es un estudio prospectivo de cohorte dinámica desarrollado entre mayo de 1995 y abril de 1997 en el hospital San Juan de Dios de Santa Fe de Bogota. Se incluyeron pacientes entre 15 y 50 años ingresados por urgencias que presentaran herida por arma cortopunzante toracoabdominal izquierda, normales hemodinámicamente y sin indicacion de cirugía inmediata. Previa firma de autorizacion se llevaron a toracoscopia y posterior laparotomia para verificacion de los hallazgos. El universo del estudio lo conformaron 28 pacientes, 26 hombres y 2 mujeres con un promedio de edad de 26 años y con una frecuencia modal de TRTS: 12, ISS: 9, ATI: 2, PT-TI: 5. La mitad de los pacientes presento herida diafragmática y en el 25 por ciento lesiones intraabdominales asociadas; el tiempo promedio de toracoscopia fue de 33 minutos y de laparotomia de 37 minutos. En el análisis estadistico se encontro una sensibilidad de la prueba del 100 por ciento con una tasa de falsos negativos de 0 por ciento y un valor predictivo negativo del 100 por ciento. En conclusion estamos frente a una prueba de alto rendimiento que nos garantiza el diagnostico de una lesion que de ser omitida tiene una alta morbimortalidad.

Calcium regulation of agonist binding to alpha7-type nicotinic acetylcholine receptors in adult and fetal rat hippocampus.

Quantitative autoradiography was used to compare the binding properties of alpha7-type nicotinic acetylcholine receptors in fetal and adult rat hippocampus. Whereas there were high levels of 125I-alpha-bungarotoxin (125I-alpha-BTX) binding throughout fetal hippocampal field CA1, there was a significant decrease in binding site density in the adult. The affinity of 125I-alpha-BTX binding, as well as alpha-cobratoxin and nicotine potency to displace 125I-alpha-BTX, did not change with age. Addition of Ca2+ to the assay buffer did not alter 125I-alpha-BTX binding, or alpha-cobratoxin inhibition of 125I-alpha-BTX binding, although it significantly increased nicotine affinity at both ages. The effect of Ca2+ on agonist affinity was dose-dependent, with an EC50 value of 0.25-0.5 mM. Ca2+ also significantly increased the cooperativity of nicotine displacement curves in stratum oriens of the adult, but not in the fetus. These findings indicate that the properties of hippocampal 125I-alpha-BTX binding sites are largely similar across age. Ca2+ selectively enhances the affinity of agonist binding, with no change in antagonist binding. This ionic effect may result from potentiation of agonist binding to a desensitized state of the alpha7 nicotinic acetylcholine receptor and may represent an important neuroprotective mechanism.

Uso práctico de los índices de trauma / Trauma indexes: a practical use

Presentamos una propuesta para la aplicación práctica de metodos de cuantificacion del trauma, en el Hospital San Juan de Dios de Santa Fe de Bogota. Al ingreso del paciente al servicio de Urgencias se calcula un indice fisiologico, el Revised Trauma Score (RTS). En el postoperatorio se realiza el Injury Severity Score (ISS), con base en el Abbreviated Injury Scale (AIS), que indica la severidad anatómica de la lesion. Con los anteriores datos y la edad, se calcula el Trauma Score-Injury Severity Score (TRISS), con lo que se obtiene la Probabilidad de supervivencia (Ps). Para el paciente con trauma abdominal, se calcula el Abdominal Trauma Index (ATI), como indice pronostico de complicaciones , utilizando el Organ Injury Scaling (OIS). Al paciente con trauma torácico se le cuantifica el Penetrating Thoracic Trauma Index (PTTI), con el cual se obtiene como resultado, al sumarlo con el ATI, el Penetrating Trauma Index (PTI). Con estos indices se pretende cuantificar la severidad del trauma y lograr una buena prediccion de los resultados, lo que permite evaluar la calidad de la atencion, comparar grupos e inclusive guiar politicas administrativas.

Health care informatics research implementation of the VA-DHCP Spanish version for Latin America.

The VA DHCP, hospital computer program represents an integral solution to the complex clinical and administrative functions of any hospital world wide. Developed by the Department of Veterans Administration, it has until lately run exclusively in mainframe platforms. The recent implementation in PCs opens the opportunity for use in Latinamerica. Detailed description of the strategy for Spanish, local implementation in Colombia is made.