Levosimendan as a treatment for acute renal failure associated with cardiogenic shock after hip fracture / Levosimendana como tratamento para insuficiência renal aguda associada a choque cardiogênico após fratura de quadril

Abstract Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse effects and increased mortality. Recently levosimendan, an inotropic positive agent, has been proved to be effective in acute heart failure, reducing the mortality and improving cardiac and renal performance. We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery.

Resumo Fármacos inotrópicos fazem parte do tratamento de insuficiência cardíaca; no entanto, o tratamento com inotrópicos tem sido amplamente debatido devido ao aumento da incidência de efeitos adversos e da mortalidade. Recentemente, levosimendana, um agente inotrópico positivo, provou ser eficaz na insuficiência cardíaca aguda, reduz a mortalidade e melhora o desempenho cardíaco e renal. Relatamos o caso de uma paciente de 75 anos, com história de insuficiência cardíaca e renal e fratura de quadril. Levosimendana foi usada na preparação do pré-operatório como terapia adjuvante para melhorar a função cardíaca e renal e permitir a cirurgia.

[Levosimendan as a treatment for acute renal failure associated with cardiogenic shock after hip fracture]. / Levosimendana como tratamento para insuficiência renal aguda associada a choque cardiogênico após fratura de quadril.

Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse effects and increased mortality. Recently levosimendan, an inotropic positive agent, has been proved to be effective in acute heart failure, reducing the mortality and improving cardiac and renal performance. We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery.

Levosimendan as a treatment for acute renal failure associated with cardiogenic shock after hip fracture.

Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse effects and increased mortality. Recently levosimendan, an inotropic positive agent, has been proved to be effective in acute heart failure, reducing the mortality and improving cardiac and renal performance. We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery.

Acceso y calidad del agua para el consumo humano en Santa Marta como indicador de inequidad en salud / Access and quality of water for human consumption in Santa Marta as an indicator of inequity in health

Objetivo: Determinar el acceso y la calidad del agua para el consumo humano en el área urbana de Santa Marta, por ser este un determinante del proceso salud­enfermedad que se debe transformar desde el marco de los Objetivos de Desarrollo del Milenio para el año 2015. Método: Estudio de corte transversal con 1557 viviendas seleccionadas por muestreo probabilístico por conglomerados, en las cuales se aplicó una encuesta de acceso al agua segura domiciliaria. Por cada comuna se tomó una muestra de agua para evaluar su calidad a través de la técnica de filtración de membrana y sustrato definido. Se utilizó Epi Info 7 para analizar los datos a través de asociación con Odds Ratio y para georeferenciarlos. Resultados: 94,7% de las viviendas tienen servicio de agua domiciliaria pero el 49,7% presentó cortes frecuentes del servicio. Las relaciones entre: acceso al agua domiciliaria y estrato (OR=4,27), y cortes del servicio y estrato (OR=2,61) fueron significativas (p<0,0001). Cuatro de las nueve muestras resultaron contaminadas con coliformes. Conclusión: Los tomadores de decisiones deben garantizar la calidad y acceso permanente al agua segura para el consumo humano a todas las personas para avanzar en la reducción de las brechas de inequidad en salud.

Objective: To determine the access and quality of water for human consumption in the urban area of Santa Marta as one of Social Determinants of Health that must be transformed in the framework of the Millennium Development Goals by 2015. Methods: A cross-sectional study was carried out with 1557 selected houses by cluster samplings, which were surveyed of household access to safe water. A water sample was taken from each district of Santa Marta in order to evaluate its quality of it through the membrane filtration technique and defined substrate. Epi Info 7 was used to analyze the data through association with Odds Ratio and to georeference them. Results: 94.7% of houses have home water service but 49.7% showed frequent service cuts. The relationship between household water access and socioeconomic stratum (OR = 4.27), and between service cuts and socioeconomic stratum (OR = 2.61) were significant (p < 0.0001). Four of the nine samples were contaminated with coliform. Conclusion: Decision makers must ensure quality and permanent access to safe water for human consumption to all people, so that there is an advance in reducing the health inequality gaps.

Inhibition of nuclear factor kappa B activation in early-stage chronic lymphocytic leukemia by omega-3 fatty acids.

Targeting the nuclear factor kappa B (NFκB) pathway is proposed as therapy for chronic lymphocytic leukemia (CLL). We hypothesized that an omega-3 fatty acids (n-3) supplement would suppress NFκB activation in lymphocytes of Rai Stage 0-1 CLL patients. The initial dose of 2.4 g n-3/day was gradually increased to 7.2 g n-3/day. After n-3 consumption: 1) plasma n-3 increased; 2) NFκB activation was suppressed in lymphocytes; 3) in vitro sensitivity of lymphocytes to doxorubicin was increased; and 4) expression of 32 genes in lymphocytes was significantly decreased.

Acetaminophen differentially enhances social behavior and cortical cannabinoid levels in inbred mice.

Supratherapeutic doses of the analgesic acetaminophen (paracetomol) are reported to promote social behavior in Swiss mice. However, we hypothesized that it might not promote sociability in other strains due to cannabinoid CB(1) receptor-mediated inhibition of serotonin (5-HT) transmission in the frontal cortex. We examined the effects of acetaminophen on social and repetitive behaviors in comparison to a cannabinoid agonist, WIN 55,212-2, in two strains of socially-deficient mice, BTBR and 129S1/SvImJ (129S). Acetaminophen (100mg/kg) enhanced social interactions in BTBR, and social novelty preference and marble burying in 129S at serum levels of ≥70 ng/ml. Following acetaminophen injection or sociability testing, anandamide (AEA) increased in BTBR frontal cortex, while behavior testing increased 2-arachidonyl glycerol (2-AG) levels in 129S frontal cortex. In contrast, WIN 55,212-2 (0.1mg/kg) did not enhance sociability. Further, we expected CB(1)-deficient (+/-) mice to be less social than wild-type, but instead found similar sociability. Given strain differences in endocannabinoid response to acetaminophen, we compared cortical CB(1) and 5-HT(1A) receptor density and function relative to sociable C57BL/6 mice. CB(1) receptor saturation binding (Bmax=958±117 fmol/mg protein), and affinity for [(3)H] CP55,940 (K(D)=3±0.8 nM) was similar in frontal cortex among strains. CP55,940-stimulated [(35)S] GTPγS binding in cingulate cortex was 136±12, 156±22, and 75±9% above basal in BTBR, 129S and C57BL/6 mice. The acetaminophen metabolite para-aminophenol (1 µM) failed to stimulate [(35)S] GTPγS binding. Hence, it appears that other indirect actions of acetaminophen, including 5-HT receptor agonism, may underlie its sociability promoting properties outweighing any CB(1) mediated suppression by locally-elevated endocannabinoids in these mice.

Indoleamine 2,3-dioxygenase mediates anhedonia and anxiety-like behaviors caused by peripheral lipopolysaccharide immune challenge.

Upregulation of indoleamine 2,3-dioxygenase (IDO) by proinflammatory cytokines has been implicated as a biological mediator of inflammation-related mood disorders. Clinical reports on this neuro-immune interaction remain correlative, while mechanism-centered preclinical experiments have focused on a relatively narrow, and somewhat controversial, survey of depression-like behaviors that include the forced swim and tail suspension tests. Here, we sought to determine whether peripheral immune challenge with Escherichia coli, lipopolysaccharides (LPS) precipitates the development of translationally relevant depression-like behaviors and to investigate the role of IDO in mediating these LPS-induced behaviors. Intraperitoneal injection of C57BL/6J mice with LPS resulted in a robust, but transient, reduction in exploratory locomotor activity (eLMA) that returned to near baseline levels by 24h. Sucrose preference, a preclinical correlate of anhedonia, was diminished by more than 20% in LPS-treated compared to saline-treated control mice, and LPS induced a significant increase in anxiety-like behavior at 24h that was independent eLMA. Pretreatment of mice with an IDO inhibitor, 1-methyltryptophan (1MT), ablated the anxiogenic effects of LPS, while having no impact on sickness associated changes in body weight or eLMA. Additionally, 1MT pretreatment attenuated the LPS-induced reduction in sucrose preference, which was also confirmed in IDO-1 null mice. Interestingly, acute systemic administration of l-kynurenine, the enzymatic product of IDO, precipitated an anhedonic and anxiogenic effect in naïve mice without effect on eLMA. In a preclinical model, these data implicate IDO as a pivotal mediator of LPS-induced depression- and anxiety-like behavior.

Inguinal syndrome secondary to Prevotella bivia after accidental bite in orogenital sex.

The authors report a case of an inguinal bubo in a young man caused by an anaerobe, Prevotella bivia, which was acquired during oral sexual intercourse. As far as the authors know, this is the first reported case of a sexually transmitted infection by Prevotella. Prevotella spp. inhabit the oral cavity and are highly prevalent in bacterial vaginosis, a polymicrobial syndrome resulting from replacement of the normal vaginal Lactobacillus spp. flora by high concentrations of anaerobic microorganisms such as Prevotella spp., Mobiluncus spp., Gardnerella vaginalis and other uncultivated anaerobes.

RBC and WBC fatty acid composition following consumption of an omega 3 supplement: lessons for future clinical trials.

BACKGROUND: Results from increasing numbers of in vitro and in vivo studies have demonstrated that omega 3 fatty acids incorporated in cell culture media or in the diet of the animals can suppress the growth of cancers. When human clinical trials are initiated to determine the ability of omega 3 fatty acids to alter growth or response to chemotherapeutic interventions of cancers, it will be essential to determine the omega 3 intake of individuals in the trial to determine compliance with consumption of the supplement and to correlate with endpoints of efficacy. We wondered if the fatty acid composition of RBCs might accurately indicate incorporation of omega 3 fatty acids in the WBCs. In this report we determine and compare the changes in fatty acid compositions of red blood cells and white blood cells in response to consumption of three doses of an omega 3 fatty acid supplement. RESULTS: We found that the fraction of omega 3 fatty acids in both red blood cells and white blood cells increased following consumption of the supplement. There was a linear, dose responsive increase in the fraction of omega 3 fatty acids in red blood cells but the increase in omega 3 in white blood cells was not linear. The magnitude of increase in omega 3 fatty acids was different between the two cell types. CONCLUSIONS: Fatty acid analysis of red blood cells is a good measure of compliance with supplement consumption. However, fatty acid analysis of white blood cells is needed to correlate changes in fatty acid composition of white blood cells with other biochemical changes in the white blood cells. TRIAL REGISTRATION: ClinicalTrials.gov NCT00899353.

Radiofrequency-radiation exposure does not induce detectable leakage of albumin across the blood-brain barrier.

The blood-brain barrier (BBB) consists of tight junctions between the endothelial cells that line the capillaries in the central nervous system. This structure protects the brain, and neurological damage could occur if it is compromised. Several publications by researchers at Lund University have reported alterations in the BBB after exposure to low-power 915 MHz energy. These publications increased the level of concern regarding the safety of wireless communication devices such as mobile phones. We performed a confirmation study designed to determine whether the BBB is altered in rats exposed in a transverse electromagnetic (TEM) transmission line cell to 915 MHz energy at parameters similar to those in the Lund University studies. Unanesthetized rats were exposed for 30 min to either continuous-wave or modulated (16 or 217 Hz) 915 MHz energy at power levels resulting in whole-body specific absorption rates (SARs) of 0.0018-20 W/kg. Albumin immunohistochemistry was performed on perfused brain tissue sections to determine the integrity of the BBB. Chi-square analysis revealed no significant increase in albumin extravasation in any of the exposed animals compared to the sham-exposed or home cage control animals.

Geographical clustering of Trypanosoma cruzi I groups from Colombia revealed by low-stringency single specific primer-PCR of the intergenic regions of spliced-leader genes.

A low-stringency single-primer polymerase chain reaction (LSSP-PCR) typing procedure targeted to the intergenic regions of spliced-leader genes (SL) was designed to profile Trypanosoma cruzi I stocks from endemic regions of Colombia. Comparison between SL-LSSP-PCR profiles of parasite DNA from vector faeces and cultures isolated from those faeces showed more conservative signatures than profiles using LSSP-PCR targeted to the minicircle variable regions (kDNA). This was also observed by analysing 15 parasite clones from one stock as well as serial samples of a same stock after in vitro culturing or inoculation into mice. Thus, SL-LSSP-PCR appears more appropriate than kDNA-LSSP-PCR for reliable typing of major T. cruzi I groups from in vitro cultured stocks and triatomine faeces. SL-LSSP-PCR grouped 46 of 47 T. cruzi I Colombian stocks according to their geographical procedences in four clusters: Cluster Cas from Casanare Department, Cluster Mg from Northern Magdalena department, Cluster Mom from Momposina Depression in Southern Magdalena and finally Cluster NW from northwestern Colombia, including Sucre, Chocó, Córdoba and Antioquia departments. Sequence analysis identified punctual mutations among amplicons from each cluster. Within Cluster Mg, sequence polymorphism allowed association with different sylvatic vector species. Novel SL sequences and LSSP-PCR profiles are reported from T. cruzi I infecting Eratyrus cuspidatus, Panstrongylus geniculatus and Rhodnius pallescens vectors.

High variability of Colombian Trypanosoma cruzi lineage I stocks as revealed by low-stringency single primer-PCR minicircle signatures.

In Colombia, high genetic variability has been found among Trypanosoma cruzi stocks isolated from different vector and host species, using isoenzyme analysis and RFLP of total kinetoplastid DNA (kDNA), suggesting that several genetically related T. cruzi populations might be present within a single geographical area or adjacent ones. The objective of this study was to use the low-stringency single primer (LSSP)-PCR technique on variable regions of kDNA minicircles of T. cruzi to determine possible genetic relationships among stocks from distinct geographical regions of Colombia and different vector species and hosts. Although LSSP-PCR analysis showed a high genetic variability among 30 Colombian T. cruzi stocks, 29 of them belonged to T. cruzi lineage I, confirming that this lineage is predominant in different vector and host species from Colombia. Interestingly, one stock isolated from a Pastrongylus geniculatus bug was identified as T. cruzi lineage IIb, using PCR strategies targeted to the intergenic region of miniexon genes, a sequence encoding the D7 domain of the 24salpha ribosomal genes and the A10 fragment, being this finding, the first description of this lineage in Colombia. The LSSP-PCR signatures allowed correlation of most isolates with their respective geographical origins, and in one case from host and vector specimens at a same region, suggesting a transmission event. Moreover, variations in LSSP-PCR profiles among T. cruzi I stocks from a same region suggest that they may have a multiclonal character. Our results show that LSSP-PCR is a fast, valuable technique for characterization of intra-lineage polymorphism among T. cruzi stocks.

[Detecting poliovirus in wastewater from Armenia, Colombia]. / Detección de poliovirus en Aguas residuales de Armenia, Colombia.

OBJECTIVES: Implementing environmental surveillance for poliovirus circulating from wastewater. METHODS: Six wastewater samples were collected from each final site within a wastewater collection system in Armenia, Quindío. Virus was extracted and concentrated by a method using polyethylenglycol and sodium chloride as concentrating agent. Polioviruses were identified by polymerase chain reaction assay with group-specific, serotype-specific and Sabin vaccine-specific primers. RESULTS: It was confirmed that the viral detection method is highly efficient. Poliovirus was detected in 5 of 6 (83%) samples collected. Serotype-specific identification revealed the presence of type 1 and type 3 polioviruses in the samples. All of them were of the vaccine type, which provided evidence regarding the non-circulation of wild poliovirus in the country. CONCLUSION: Wastewater surveillance can be a sensitive tool for detecting poliovirus circulation.

Detección de Poliovirus en Aguas Residuales de Armenia, Colombia / Detecting poliovirus in wastewater from Armenia, Colombia

OBJETIVOS: Implementar un método para la vigilancia ambiental de poliovirus circulante a partir de aguas residuales. MÉTODOS: Se colectaron 6 muestras de aguas residuales en los sitios finales de descarga del acueducto de Armenia, Quindío. Los virus fueron concentrados y extraídos por un método que usa el polietilenglicol y cloruro de sodio como agentes concentradores. La identificación de poliovirus se realizó mediante la técnica de reacción en cadena de la polimerasa empleando cebadores específicos de grupo, de serotipo y de cepa vacunal sabin. RESULTADOS: Se demostró la eficiencia de los métodos de detección viral empleados. Se encontró la presencia de poliovirus en 5 de las 6 (83 %) muestras colectadas. La identificación serotipo-específica reveló la presencia de poliovirus tipo 1 y 3 en las muestras estudiadas. Todos los poliovirus detectados resultaron ser del tipo vacunal lo cual aporta una evidencia más a favor de la no circulación de poliovirus salvaje en la región. CONCLUSIÓN El sistema de vigilancia a partir de aguas residuales puede ser una herramienta sensible para la detección de la circulación de poliovirus.

Prosa antropológica y otros estudios previos sobre sexualidad, erotismo y amor / Anthropologic prose and others previous studies on sexuality, erotism and love

Estudios previos antes de iniciar un trabajo de campo en el proyecto denominado "Razon y Sexualidad" que ha congregado a un grupo de sociólogos bajo la dirección de un antropólogo con el propósito de iniciar la exploración del campo empírico de la sexualidad, el erotismo y el amor en la ciudad de Cali. El Grupo desea lograr una mirada comprehensiva de la lógica práctica que rige esos juegos interactivos y relacionarla teoricamente con los intentos preventivos de ciertos daños que se pueden derivar del ejercicio. Porque el ejercicio del amor-erotismo implica riesgos para los propios actores y para otros miembros de la comunidad. El peligro de la fuerza de la sexualidad ha sido reconocido desde la antiguedad