TLR4 polymorphism and haplotype are associated with obesity and lipid profile in young population: a pilot study.

BACKGROUND: The single nucleotide polymorphisms in the TLR4 gene can decrease or increase the response to lipopolysaccharide, increasing the susceptibility to inflammatory diseases, affecting the expression or receptor function by inducing a low-grade chronic inflammatory response. PURPOSE: The objective of this study was to evaluate the association of SNPs - 2570 A > G (rs2737190), - 2081 G > A (rs10983755), 896 A > G (rs 4986790), and 1196 C > T (rs4986791) of the TLR4 gene with obesity and metabolic alterations in the young population. RESULTS: In this study, it was found that the carriers of the heterozygous genotype of the SNPs - 2081 G > A, 896 A > G, and 1196 C > T confer a higher risk of developing obesity (OR = 3.73, p = 0.018; OR = 5.66, p = 0.014, and OR = 8.95, p = 0.014, respectively). Also, with the lipid profile, the SNP - 2081 G > A was associated with total cholesterol (TC) ≥ 200 mg/dL (OR = 3.91, p = 0.020) and Kannel index > 3% (OR = 4.00, p = 0.008). The SNP 896 A > G was associated with LDL-c ≥ 100 mg/dL (OR = 3.64, p = 0.040) and Kannel index > 3% (OR = 4.33, p = 0.016), and the SNP 1196 C > T was associated with TC ≥ 200 mg/dL (OR = 4.37, p = 0.048), Castelli index > 4.5/> 5% (OR = 5.33, p = 0.016), and Kannel index > 3% (OR = 16.00, p = 0.001). Finally, the AGGT haplotype was associated with Castelli index > 4.5/> 5% (OR = 5.40, p = 0.015) and Kannel index > 3% (OR = 10.46, p < 0.001), and the AAAC haplotype was associated with obesity (OR = 3.56, p = 0.020), TC ≥ 200 mg/dL (OR = 4.04, p = 0.007), LDL-c ≥ 100 mg/dL (OR = 2.98, p = 0.030) and Kannel index > 3% (OR = 4.20, p = 0.002). CONCLUSION: The heterozygous genotype of the SNPs - 2081 G > A, 896 A > G and 1196 C > T of the TLR4 gene was associated with altered lipid profile and development of obesity in young university students of Guerrero State, Mexico.

Resultados y evolución funcional de pacientes críticos con ictus isquémico sometidos a trombectomía mecánica / Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit

OBJETIVO: Estudiar los resultados y las complicaciones del tratamiento endovascular (TEV) en pacientes con ictus isquémico agudo ingresados en una unidad de cuidados intensivos (UCI). Analizar los factores que podrían influir en la mortalidad y en el grado de discapacidad al alta y un año después del ictus. DISEÑO: Estudio prospectivo observacional. Ámbito: UCI polivalente. Hospital de tercer nivel. PACIENTES: Sesenta pacientes adultos. Muestra consecutiva. INTERVENCIONES: Ninguna. Variables de interés: Datos epidemiológicos, tiempo desde la clínica inicial hasta el TEV, resultado angiográfico, tiempo de estancia en UCI, días de ventilación mecánica, complicaciones neurológicas, National Institutes of Health Stroke Scale (NIHSS) al ingreso y al alta de UCI, escala de Rankin modificada (mRS) al año de evolución. RESULTADOS: Edad media 68,90±8,84años. Mediana de tiempo hasta el TEV: 180min. Mediana NIHSS al ingreso: 17,5; al alta: 3. Flujo distal en el 90% de los casos. Mediana estancia en UCI: 3días. Ventilación mecánica: 81,7%. Independencia funcional (mRS≤2) 50% al año del ictus. Fallecimientos: 22 (36,6%); 8 (13,3%) en la UCI y el resto durante el primer año. CONCLUSIONES: Las variables asociadas a un peor estado funcional fueron la transformación hemorrágica sintomática, la ausencia de recanalización y las complicaciones durante el procedimiento. La transformación hemorrágica y la hidrocefalia se asociaron a mayor mortalidad. Se consiguió flujo distal en la mayoría de los casos, con una baja tasa de complicaciones. La mitad de los pacientes alcanza independencia funcional al año del ictus

PURPOSE: To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. DESIGN: Observational prospective study. SETTING: Mixed ICU. Third level hospital. PATIENTS: Sixty adult patients. Consecutive sample. INTERVENTIONS: None. Variables of interest: Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. RESULTS: Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. CONCLUSIONS: The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke

Tratamiento con carfilzomib. ¿Deberían estos pacientes ingresar en la unidad de cuidados intensivos? / Treatment with carfilzomib. Should these patients be admitted in the Intensive Care Unit?

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Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit. / Resultados y evolución funcional de pacientes críticos con ictus isquémico sometidos a trombectomía mecánica.

PURPOSE: To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. DESIGN: Observational prospective study. SETTING: Mixed ICU. Third level hospital. PATIENTS: Sixty adult patients. Consecutive sample. INTERVENTIONS: None. VARIABLES OF INTEREST: Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. RESULTS: Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. CONCLUSIONS: The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke.

Infectious complications related to external ventricular shunt. Incidence and risk factors. / Complicaciones infecciosas relacionadas con el drenaje ventricular externo. Incidencia y factores de riesgo.

OBJECTIVE: Infectious complications related to external ventricular shunt (ICREVS) are a main problem in neurocritical intensive care units (ICU). The aim of the review is to assess the incidence of ICREVS and to analyse factors involved. METHODS: Retrospective analysis, adult polyvalent ICU in a third level reference hospital. Patients carrying external ventricular shunt (DVE) were included. Those patients with central nervous system infection diagnosed prior DVE placement were excluded. RESULTS: 87 patients were included with 106 DVE. Most common admittance diagnosis was subarachnoid haemorrhage (49.4%). 31 patients with 32 DVE developed an ICREVS. Infection rate is 19.5 per 1000 days of shunt for ICREVS and 14 per 1000 days for ventriculitis. 31.6% of the patients developed ICREVS and 25.3% ventriculitis. Patients who developed ICREVS presented higher shunt manipulations (2.0 ± 0.6 vs. 3.26 ± 1.02, p=0.02), shunt repositioning (0.1 ± 0.1 vs. 0.2 ± 0.1) and ICU and hospital stay (29.8 ± 4.9 vs 49.8 ± 5.2, p<0.01 y 67.4 ± 18.8 vs. 108.9 ± 30.2, p=0.02. Those DVE with ICREVS were placed for longer not only at infection diagnosis but also at removal (12.6 ± 2.1 vs. 18.3 ± 3.6 and 12.6 ± 2.1 vs. 30.4 ± 7.3 days, p<0.01). No difference in mortality was found. CONCLUSIONS: One out of three patients with a DVE develops an infection. The risk factors are the number of manipulations, repositioning and the permanency days. Patients with ICREVS had a longer ICU and hospital average stay without an increase in mortality.

[Epidemiological surveillance for multidrug-resistant microorganisms in a general ICU]. / Vigilancia epidemiológica para microorganismos multirresistentes en una UCI polivalente.

OBJECTIVE: Multidrug resistant (MDR) microorganisms represent a threat for patients admitted in Intensive Care Units (ICUs). The objective of the present study is to analyse the results of epidemiological surveillance cultures for these microorganisms in one of these units. METHODS: General ICU. Retrospective analysis, descriptive statistics. Analysis of epidemiological surveillance cultures for MDR microorganisms in 2015. Studied microorganisms: Methicillin-resistant Staphylococcus aureus (MRSA), ESBL-and/or carbapenemase-producing Klebsiella pneumoniae (CESBL-KP) and MDR Acinetobacter baumannii (MDRAB). RESULTS: One thousand, two hundred and fifty nine patients admitted. A total of 2,234 specimens from 384 patients were analysed (690, 634, 62 and 286 were rectal, throat, nasal and skin swabs respectively). Global APACHE II was 18.3 ± 8 versus 21.7 ± 7.8 in patients colonized/infected on admission. Global mortality was 19.7% versus 22.3% in patients colonized/infected on admission. The higher sensitivities achieved with the different samples for the different microorganism detection were as follows. MRSA: 79% and 90% for nasal and nasal + throat swabs, respectively. MDRAB: 80% and 95% for throat and throat + rectal swabs, respectively. CESBL-KP: 95% and 98% for rectal and rectal + throat swabs, respectively. 94 out of the 384 patients (24.4%) were colonized/infected with MDR at admission. 134 patients (10.6% of the total patients admitted) were colonized/infected with a total of 169 MMR during the hospital stay. MRSA has the earliest colonization/infection (9.2 ± 6.4days) and ESBL-producing Enterobacteriaceae, the latest (18.7± 16.4 days). CONCLUSIONS: 24.4% of patients were colonized/infected by MDR at admission. Nasal, throat and rectal swabs were the most effective specimens for recovering MRSA, MDRAB and CESBL-KP, respectively. The combination of two specimens improves MDR detection except for CESBL-KP. Skin swabs are worthless. The most prevalent MDR at admission were ESBL-producing Enterobacteriaceae while the most frequent hospital acquired MDR was MDRAB..

Es tiempo de cambiar la política de visitas en la UCI / It is time to change the visiting policy in intensive care units

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Dissipative curvature fluctuations in bilayer vesicles: Coexistence of pure-bending and hybrid curvature-compression modes.

We have studied the relaxation dynamics of shape fluctuations in unilamellar lipid vesicles by neutron spin echo (NSE). The presence of a hybrid curvature-compression mode coexisting with the usual bending one has been revealed in the experimental relaxation functions at high q . Differently to the conventional relaxation approximately q (3) typical for bending modes, the hybrid mode was found to relax as approximately q (2) , which is compatible with a dissipation mechanism arising from intermonolayer friction. Complementary data obtained from flickering spectroscopy (FS) in giant unilamellar vesicles confirm the existence of both modes coexisting together. By combining NSE and FS data we have depicted the experimental bimodal dispersion diagram, which is found compatible with theoretical predictions for reliable values of the material parameters. From the present data two conventional dynamical methods (NSE and FS) have been shown to be suitable for measuring intermonolayer friction coefficients in bilayer vesicles.

Bimodal spectrum for the curvature fluctuations of bilayer vesicles: pure bending plus hybrid curvature-dilation modes.

We study thermal undulations of giant bilayer vesicles by flickering spectroscopy. The experimental fluctuation spectra are scrutinized in view of the classical Helfrich theory. Pure bending modes are revealed to be unable to predict the large fluctuations systematically found at a high wave vector. Hybrid curvature-dilational modes are then invoked as a more efficient mode of motion in producing high curvatures. A bimodal spectrum of the thermal undulations has been theoretically developed for the shell-like topology. Reconciliation between experiments and theory is achieved when this bimodal spectrum is considered.

[Familial hypobetalipoproteinemia]. / Hipobetalipoproteinemia familiar.

We present the case of a 5-month-old girl, with consanguineous parents, who was born at 28 weeks of gestation and who showed intermittent signs of abdominal distension accompanied by increased regurgitation and vomiting after food intake. Significant biochemical alterations (reduced levels of triglicerides, cholesterol, and vitamin A and absence of apolipoprotein B and vitamin E) led to the diagnosis of homozygous hypobetalipoproteinemia, which was subsequently confirmed by genetic studies.

Hipobetalipoproteinemia familiar / Familial hypobetalipoproteinemia

Se presenta el caso de una paciente de 5 meses, de padres consanguíneos y prematura de 28 semanas de gestación, con signos de distensión abdominal intermitentes que se acompañaban de incremento de las regurgitaciones y de vómitos tras las tomas y cuyas importantes alteraciones bioquímicas (niveles descendidos de triglicéridos, colesterol, vitamina A y ausencia de apolipoproteína B y vitamina E) permitieron establecer el diagnóstico de hipobetalipoproteinemia homozigoto, por estudios genéticos posteriores (AU)

The health-development link: travel as a public health issue.

The process of globalization has rendered societies interdependent on one another and has fostered the movement of people, goods and ideas at unprecedented speed and volume. Global travel has grown from 25 million in 1950 to 500 million in 1993, and estimations by 2010 reach 1 billion. The increased intensity and quantity of travel has resulted in greater vulnerability to the domino-type spread of old, new and re-emerging infectious diseases. Travelers and local populations are also vulnerable to death and disability due to accidents, violence and injuries, chronic diseases such as those due to substance abuse (tobacco, alcohol and others), and to undesirable behaviors such as those related to sex-tourism. This article argues that tourism, understood as any type of travel, is one of the most important sectors of the economy in many countries and, therefore, can contribute to community and national development. It also asserts that travel, as a factor in the spread of disease, lies in the realm of public health inquiry. It calls for greater collaboration between the tourism-travel industry and community, national and global leaders to promote and enforce "responsible tourism."

[Prenatal diagnosis of fetal ovarian cyst, postnatal spontaneous remission]. / Diagnóstico prenatal de quiste de ovario fetal, resolución espontánea posnatal.

UNLABELLED: Prenatal diagnosis of fetal ovarian cyst, spontaneously resolved in the postnatal period. INTRODUCTION: Fetal ovarian cysts are an unusual entity, which is generally discovered during an ultrasonographic fetal examination. The objective of this report is to present a clinical case of a female fetus with an ovarian cysts which was diagnose by an ultrasound (US) at 36.5 week gestation which was spontaneously resolved in the postnatal period. CLINICAL CASE: A 22 year old woman to whom an US was performed to evaluate the gestational age due to the fact that she was to be programmed for a cesarean due to vulvovaginal condyloma. The US reported a 36.5 week gestation, the fetus was female and a cyst of 50 x 44 mm diameter was found in the fetal pelvis, lateral to the bladder. The child was born two weeks later by cesarean section and without complications. The control pelvic US at one month of age showed that the cysts was 54 x 45 mm in diameter. It was decided and wait to see what would happen. At five months of age the pelvic US showed the absence of the cyst. CONCLUSION: The diagnosis of the fetal ovarian cysts was based on three ultrasonographic criteria: 1. presence of a cystic structure of regular size which is located in the lower and lateral side of the abdomen, 2. integrity of urinary and gastrointestinal tracts, and 3. female sex of the fetus. The treatment depends on the size of the cyst and the ultrasonographic images of torsion and hemorrhage.

Aspergilloma de uraco manifestado como masa abdominal

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[Effectiveness and safety of mebendazole compared to nitazoxanide in the treatment of Giardia lamblia in children]. / Eficacia y seguridad de mebendazol contra nitazoxanida en el tratamiento de Giardia lamblia en niños.

OBJECTIVE: Compare the effectiveness and safety of mebendazole versus nitazoxanide in the treatment of Giardia lamblia in children. Giardiasis is an intestinal protozoan of worldwide distribution which most frequently affects the infantile population. In Mexico we have, found a frequency of three to sixty percent. We have, used different medications in it's treatment, but the experience with mebendazole and nitazoxanide is scarce. METHOD: An experimental study as a clinical assay. We included children from the ages of 4 to 12 years old, which had a positive Giardia lamblia cysts in their feces. The children were divided into to two groups: A, were a administered 100 mg of mebendazole every 12 hours, for three days; B, were administered 100 mg of nitazoxanide every 12 hours, for three days; A feces control study was performed at three, five and seven days post treatment. At the end of the treatment we asked the parents if the children had presented any adverse events during the administration of the medication. For the statistical analysis we used Student's t and Chi squared. RESULTS: We studied 82 children, 41 (50%) for each group. In group A, the control feces studies were negative 33 resulting in a 80.4% effectiveness; in group B, 32 were negative resulting in a 78.0% effectiveness, without being statistically significant with a p = 0.8. We found adverse, events in 9 (22%) of the children in group A and 16 (39%) in group B, there was, statistically significant difference with p = 0.09. However, we discovered that the children who received nitazoxanide suffered from abdominal pain more frequently. CONCLUSIONS: We can conclude that both mebendazole and nitazoxanide are efficient for use against infection due to Giardia lamblia, however, the secondary reactions with nitazoxanide were more frequent than with mebendazol.