[Risk of falls and consumption of medicines in an elderly population]. / Riesgo de caídas asociado al consumo de medicamentos en la población anciana.

OBJECTIVES: To describe the risk factors and the effect of medication use on the risk of falls in a population of 65 years or older. MATERIAL AND METHODS: Descriptive study of falls in the elderly population. The risk factors and consequences of the fall were recorded. Hypnotic and sedative risk drugs, opioids, and the simultaneous consumption of six or more drugs were considered. Diuretics were also included. The cumulative incidence for each group and the corresponding relative risks of falls were analysed from the cases registered between June and November 2016. RESULTS: During the study period, 60 falls were reported, of which 66% were by women and 34% by men. The cumulative incidence of falls was 3 per thousand women (95% CI: 2.22-4.08), and 2 per thousand men (95% CI: 1.44-3.41). The majority (71%) had consumed risk medication. Six or more medications were taken by 40% of the men and 62.5% of the women, and 97.6% was risk medication. The relative risk of falls in people using hypnotics, sedatives and opioids compared to non-users was 8.7 in men and 7.1 in women. In people who took diuretics, the relative risk was 4.6 for both genders. In women on multiple medications the relative risk was 3.7 compared to 1.7 in men. CONCLUSIONS: Polypharmacy and the use of hypnotic and sedative drugs and opioids and diuretics are an important public health problem, due to being risk factors for falls in this population, with a greater impact for women.

Aislamiento y rendimiento del GMP mediante precipitación de lactosuero con ácido tricloroacético / GMP isolation and yield by whey precipitation with trichloroacetic acid

Durante la elaboración del queso, la k-caseína es hidrolizada por la renina (Quimosina E.C.3.4.23.4) en el enlace peptídico Fen105-Met106 generando dos fracciones: la para-k-caseína y el glicomacropéptido (GMP) que se libera al lactosuero. El GMP presenta una estructura química particular donde predominan los aminoácidos con cadena lateral ramificada, no presenta aminoácidos aromáticos y contiene carbohidratos unidos a residuos de treonina; por esta razón se le ha atribuido una variedad de actividades biológicas. Se ha estimado que en Venezuela se generan alrededor de 713 toneladas de lactosuero anualmente. Un volumen considerable de este subproducto se produce en el estado Zulia, constituyéndose esto en una fuente de péptidos y proteínas de alta calidad nutricional que está siendo subutilizada. Con el propósito de evaluar el aislamiento y rendimiento del GMP a partir de la precipitación de lactosuero de ricotta con ácido tricloroacético 50 por ciento, se realizaron 6 extracciones con este ácido a 50 mL de cada tipo de suero analizado: suero ricotta, suero comercial resuspendido y suero ácido (control negativo). Se verificó mediante pruebas químicas y PAGE-SDS 15 por ciento de manera indirecta, la presencia de GMP en las preparaciones obtenidas. Se observaron bandas de 6,5; 18,3 y 19,0 kDa en suero ricotta y suero comercial resuspendido. Las bandas de 18,3 y 19,0 posiblemente correspondan a la forma trimérica del péptido. El rendimiento del GMP en términos de proteínas fue en promedio 1,17 mg/50mL (1,17 por ciento) y 4,51 mg/50mL (0,81 por ciento), para suero ricotta y suero comercial, respectivamente. Los resultados indican que es factible obtener preparaciones del GMP, sin embargo, para plantear la producción a escala industrial de este péptido para su aprovechamiento, se requiere evaluar otros procedimientos donde se obtenga a bajo costo una preparación purificada del GMP.

During cheese manufacturing k-casein is hydrolyzed by rennin (Quimosine E.C.3.4.23.4) on peptidic bond Fen105- Met106 releasing two fractions: para-k-casein and glycomacropeptide (GMP). GMP shows a particular chemical structure in which ramified lateral chain aminoacids prevail, without aromatics aminoacids, but with carbohydrates short chains linked to some threonine residues; because of this, a variety of biological activities have been attributed to molecule. It has been considered that in Venezuela, 713 tons of whey are generated annually. An important volume of this byproduct is produced in the Zulia State, becoming itself a source of peptides and proteins of high nutritional quality that has been subused. With the purpose of evaluating GMP isolation and yield from ricotta whey precipitation with 50 percent trichloroacetic acid treatment, 6 extractions where performed with this acid to 50 mL of each analyzed whey: ricotta whey, resuspended commercial whey and acid whey (negative control). By means of chemical tests and PAGE-SDS 15 percent, indirect presence of GMP was verified in all preparations. Bands of 6.5, 18.3 and 19.0 kDa were observed in ricotta and commercial whey. Bands of 18.3 and 19.0 possibly correspond to the peptide trimeric structure. GMP yield in terms of protein content was 1.17 mg/50mL (1.17 percent) and 4.51 mg/50mL (0.81 percent), for ricotta and commercial whey, respectively. Results show that it feasible to obtain preparations of GMP, however, in order to produce this peptide industrially for its use, evaluation of low cost procedures for GMP purification is required.

Colgajo braquiorraquial en la cobertura de la inserción distal del tendón del bíceps / Brachioradial flap for coverage of the distal insertion of the biceps tendon

El músculo braquiorradial es un músculo flexor accesorio del codo que también se puede utilizar para dar la cobertura sin provocar un déficit funcional. Está indicado en la cobertura de los defectos complejos de la cara anterior y lateral del codo, especialmente cuando existe exposición articular, y también del tercio proximal del antebrazo. Se presenta el caso de un varón de 49 años de edad con un problema de cobertura en la región anterior de codo tras una reinserción de bíceps distal 4 semanas antes, mediante anclaje en tuberosidad bicipital. El colgajo de músculo braquiorradial es seguro, está bien vascularizado y es fácil de realizar, con una mínima morbilidad (AU)

The brachioradial muscle is an accesory flexor muscle of the elbow that may also be used for coverage without causing functional deficit. It is indicated for covering complex defects in the anterior and lateral aspects of the elbow, particularly when joint exposure exists, and also in the proximal third of the forearm. The case of a 49-year-old male with a coverage problem in the anterior elbow region 4 weeks after distal biceps reinsertion by anchoring in the bicipital tuberosity is reported. The brachioradial muscle flap is safe, well vascularized, and easy to perform with minimum morbidity (AU)

Desarrollo de un prototipo de bomba de flujo pulsátil para caracterizar las condiciones hidrodinámicas en un ambiente de circulación extracorpórea / Desarrollo de un prototipo de bomba de flujo pulsátil para caracterizar las condiciones hidrodinámicas en un ambiente de circulación extracorpórea

Es difícil generar con bombas convencionales las condiciones de flujo del sistema cardiovascular, con las cuales se emulen condiciones hemodinámicas para evaluar diferentes dispositivos interpuestos a la corriente sanguínea. Para resolver este inconveniente, se desarrolló un sistema automatizado de bombeo de flujo pulsátil, conformado por un controlador difuso que captura datos de los instrumentos de monitoreo de variables hidrodinámicas a través de una interfaz de adquisición, y aplica señales de control a una bomba de flujo pulsátil. Este sistema permite hacer pruebas hidromecánicas que brindan elementos para interpretar la influencia de las variables que intervienen en el flujo pulsante y simular condiciones hemodinámicas en un ambiente de circulación extracorpórea. Mediante técnicas de diseño asistido por computador, se construyó una bomba de diafragma accionada neumáticamente. El controlador se desarrolló mediante la técnica de Fuzzi Control (marca registrada), el cual regula el pulso y el flujo de acuerdo con parámetros y datos capturados con...

With conventional pumps, it is difficult to generate the cardiovascular system conditions that may emulate hemodynamic conditions for evaluating different devices interposed to the blood flow. In order to resolve this inconvenient, an automated pulsatile flow system formed by a diffuse controller that captures data from the monitoring instruments of hydrodynamic variables through an acquisition interface and applies control signals to a pulsatile flow pump, was developed. This system allows making hydromechanical tests that give elements for interpreting the influence of the variables that take part in the pulsatile flow and emulate hemodynamic conditions in an extracorporeal setting. Through computed assisted design techniques, a pneumatically operated diaphragmatic pump was constructed. The controller was developed by the Fuzzi Control® technique, which regulates pulse and flow according to the data captured by the acquisition interface. The prototype tests were realized in a fluids laboratory by varying frequency, hydraulic resistance, viscosity and pulse pressure, emulating hemodynamic adult conditions, and using as work fluid an aqueous solution with 5 cPo at 37°C for mimicking blood viscosity at corporal temperature. The reproduction of a pump that serves for analyzing the effect of variables in the pulsatile flow may be used in the study of different intravascular devices and help to refine technical and functional aspects in the preliminary study of extracorporeal circulation machines.

Esophageal GIST: therapeutic implications of an uncommon presentation of a rare tumor.

Gastrointestinal stromal tumors (GISTs) are rarely reported in the esophagus. The authors report a patient with an esophageal GIST, incidentally found after an echocardiogram. CT scan and endoscopic ultrasonography showed the tumor in the dependence of the muscularis propria of the esophageal wall. An Ivor-Lewis esophagectomy was performed. The tumor was well-circumscribed involving the submucosal and the muscular layers of the esophagus, measuring 13.5 x 8.5 x 7.6 cm, without involving the surgical margins. Histologically, the tumor consisted of spindle cells, with low mitotic index (2/50 HPF), that were immunoreactive for KIT (CD117) and CD34, consistent with GIST of high risk of aggressive behavior. No adjuvant therapy was given to the patient, who is alive and without evidence of disease 1 year after surgery. Since esophageal GISTs are rarely reported in the literature and usually have a poor prognosis, the diagnostic differentiation of these tumors from other more common mesenchymal neoplasms is essential, both for therapeutic and prognostic reasons.

Antineutrophil cytoplasmic antibodies (ANCA) in idiopathic pulmonary hemosiderosis.

Four children were diagnosed with idiopathic pulmonary hemosiderosis (IPH), over a period of 4 years. Retrospectively, antineurtrophil cytoplasmic antibodies (ANCA) were studied by indirect immunofluorescence (IIF) and ELISA in 18 sera from these patients, stored at -20 degrees C. ANCA-positive sera, from 1/20 to 1/1, 200 dilution, were found in 3/4 of the patients, by IIF. The patient with the highest titre of ANCA died 3 months later during an acute crisis, the other two patients need a minimal dose of steroids. In one case only, a patient who is still without treatment, had no ANCA. The antibodies anti-myeloperoxidase and anti-proteinase-3 were negative or at border line levels. Rheumatoid factor, antinuclear (Hep-2), anti-endomysial, anti-reticulin and antibasement membrane antibodies were negative in all sera. The surviving patients were followed-up for more than 10 years with no systemic or renal disease appearances. The presence of serum ANCA may help to classify children with pulmonary haemorrhage and may have a prognostic value.

[Walker-Warburg syndrome: cerebro-ocular dysgenesis and congenital muscular dystrophy]. / Síndrome de Walker-Warburg: disgenesia cerebro-ocular y distrofia muscular congénita.

We report the case of an infant with facial dysmorphism, congenital hydrocephalus, severe hypotonia and absence of psychomotor development, with ocular and cerebral malformations consistent with the diagnosis of Walker-Warburg syndrome (WWS). Investigations included a cerebral CT scan indicative of type II lissencephaly and a muscular biopsy which showed findings of muscular dystrophy. The association of hypotonia, developmental delay and seizures with a neuronal migration disturbance and retinal involvement raised the suspicion of a peroxisomal disorder. The pertinent biochemical investigations, however, were negative. The features of this syndrome are reviewed, emphasizing the similarities with other related disorders as cerebro-oculo-muscular syndrome. We suggest that muscle involvement should be investigated in every case of WWS.

[Cystic angiomatosis of bone with hematologic involvement. Report of a case]. / Angiomatosis quística de los huesos con repercusión hematológica. Presentación de un caso.

A case of cystic angiomatosis of bone without visceral involvement is presented. Lesions were noted in: skull, ribs, pelvis, long bones and phalanges. Besides clinical and radiological findings, the case, associates pancytopenia and coagulation disorders. The possibility of a bone marrow failure due to invasion of marrow by cystic angiomas and localized intravascular coagulation are discussed as cause of hematologic alterations.

[Leukemic infiltration in the anterior chamber of the eye]. / Infiltración leucémica en cámara anterior del ojo.

Leukaemic infiltration of the anterior chamber of the eye (hypopyon and corneal opacity) was the only sign of relapse in two girls with acute lymphoblastic leukaemia who had been off treatment for one and three years. The malignant cells had probably been present in the eye since the onset of the disease. The anterior segment of the eye may be a pharmacologycal "sanctuary" in patients with ALL. The response to radiotherapy was good but this treatment should be coupled with systemic chemotherapy and CNS prophylaxis.

[Evaluation of initial risk factors in acute lymphoblastic leukemias in children]. / Valoración de factores iniciales de riesgo en las leucemias agudas linfoblásticas del niño.

In an attempt to establish a possible correlation between clinical course and initial characteristics of the disease, 88 children with ALL (diagnosed between 1970-1978) were studied. Basis for comparison was whether relapses (medullary or extramedullary) occurred within 36 months. Twenty parameters, including history data, physical exploration, laboratory findings and early response to induction treatment, were evaluated. Statistical analysis showed a significant influence of the following factors: age less than 1 year, organomegalies (hepato or splenomegaly larger than 5 cm B.C.M.), adenomegalies (more than 3 cm in diameter), mediastinal mass, initial CNS infiltration, E-rosette forming blast-cells, acid phosphatase positivity and a good hematological response after 2nd week of treatment. Sex appeared as a prognostic factor after 36 months. Three group of patients could be distinguished according to risk factors: A) Patients without risk factors; 70.45% in continuous remission (CR) after 36 months. B) Patients with 1-2: 43.47% in CR at 36 months. C) Three or more: None attained 36 months in continuous CR. Differences are significant (p less than 0.05).

[Modification of complement factors and their inhibitors during meningococcal sepsis (author's transl)]. / Modificaciones de los factores del complemento y de sus inhibidores en el curso de sepsis meningocócicas.

Various complement components (C'1s, C'3, C'4, C'5, C'8, C'9, C'3 act., C'1 inh., C'3b inact.) and seric immunocomplexes (by polyethylene glycol, PEG) were evaluated in 43 children with meningococcal sepsis. 28 patients had disseminated intravascular coagulation (DIC), group I, and 15 did not show it, group II; 14 patients died in group I and none of group II. In 21 cases studies were repeated 24 hours later. In group I all complement components were decreased, specially C'3 (x: 67 mg./100 ml., p < 0.01) and C'5 (x: 8 mg./100 ml., p < 0.01) and they were lower 24 h. later. Results of group II were normal, except a decrease of C'5. Catabolic products of C'3 were founded in 11/14 cases of group I and two/nine of group II and products of C'3 act. in four/14 and one/10. PEG precipitation was positive in 10/14 cases of group I and 10/12 of group II and IgG, IgM, C'3 and C'4 were found in precipitations. This complement components were more frequently present in sepsis without DIC and after 24 h. of evolution. C'1 and C'3b inhibitors decreased after evolution in group I and by contrast increased in group II. This fall enhances complement activation.

[Hodgkin's disease and glomerulonefritis (author's transl)]. / Enfermedad de Hodgkin y glomerulonefritis.

A case of infradiaphragmatic Hodgkin's disease (mixed pattern) associated with glomerulonephritis in the childhood is reported. The pathogenic relationship between Hodking's disease and the renal lesion is discussed.