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Spinal muscular atrophy (SMA) is an autosomal recessive disorder with progressive muscle atrophy and weakness, caused by biallelic mutations in the survival motor neuron 1 (SNM1) gene. Onasemnogene abeparvovec (OA) is an approved gene replacement therapy for patients with SMA. We report on two patients with SMA type 1, weighing 20 kg, previously treated with Nusinersen, who received OA infusion at 7 years of age. To our knowledge, these two patients are the heaviest treated in the real-world and we describe their different courses after gene therapy, including liver impairment requiring long-term steroid treatment and additional immunosuppression, with only transitory improvement in functional outcomes. Our cases illustrate how careful risk-benefit consideration is required in treating older and heavier SMA patients with OA, especially in view of the multiple treatment choices available for older patients with SMA.
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Narcolepsy with cataplexy and myasthenia gravis are both chronic neurologic conditions causing symptoms of muscle weakness, often affecting facial muscles, and have both been attributed to an immune-mediated etiology. We report an adolescent girl diagnosed with both conditions and discuss possible shared mechanisms and the diagnostic challenges presented by her case to inform and aid clinicians managing children and young people with these rare conditions.
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Miastenia Gravis , Narcolepsia , Humanos , Miastenia Gravis/diagnóstico , Miastenia Gravis/complicações , Narcolepsia/diagnóstico , Narcolepsia/complicações , Feminino , AdolescenteRESUMO
Background: Real-world data on the efficacy and safety of onasemnogene abeparvovec (OA) in spinal muscular atrophy (SMA) are needed, especially to overcome uncertainties around its use in older and heavier children. This study evaluated the efficacy and safety of OA in patients with SMA type 1 in the UK, including patients ≥2 years old and weighing ≥13.5 kg. Methods: This observational cohort study used data from patients with genetically confirmed SMA type 1 treated with OA between May 2021 and January 2023, at 6 infusion centres in the United Kingdom. Functional outcomes were assessed using age-appropriate functional scales. Safety analyses included review of liver function, platelet count, cardiac assessments, and steroid requirements. Findings: Ninety-nine patients (45 SMA therapy-naïve) were treated with OA (median age at infusion: 10 [range, 0.6-89] months; median weight: 7.86 [range, 3.2-20.2] kg; duration of follow-up: 3-22 months). After OA infusion, mean ± SD change in CHOP-INTEND score was 11.0 ± 10.3 with increased score in 66/78 patients (84.6%); patients aged <6 months had a 13.9 points higher gain in CHOP-INTEND score than patients ≥2 years (95% CI, 6.8-21.0; P < 0.001). Asymptomatic thrombocytopenia (71/99 patients; 71.7%), asymptomatic troponin-I elevation (30/89 patients; 33.7%) and transaminitis (87/99 patients; 87.9%) were reported. No thrombotic microangiopathy was observed. Median steroid treatment duration was 97 (range, 28-548) days with dose doubled in 35/99 patients (35.4%). There were 22.5-fold increased odds of having a transaminase peak >100 U/L (95% CI, 2.3-223.7; P = 0.008) and 21.2-fold increased odds of steroid doubling, as per treatment protocol (95% CI, 2.2-209.2; P = 0.009) in patients weighing ≥13.5 kg versus <8.5 kg. Weight at infusion was positively correlated with steroid treatment duration (r = 0.43; P < 0.001). Worsening transaminitis, despite doubling of oral prednisolone, led to treatment with intravenous methylprednisolone in 5 children. Steroid-sparing immunosuppressants were used in 5 children to enable steroid weaning. Two deaths apparently unrelated to OA were reported. Interpretation: OA led to functional improvements and was well tolerated with no persistent clinical complications, including in older and heavier patients. Funding: Novartis Innovative Therapies AG provided a grant for independent medical writing services.
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Resumen La presente investigación tuvo como objetivo indagar sobre el conocimiento, las características y la utilidad de la técnica de perfilación criminológica dentro de una muestra de actores judiciales en Colombia, quienes, por sus funciones profesionales en la investigación criminal, se encontraban en posibilidad de aplicar la técnica. La metodología incluyó la realización de entrevistas semiestructuradas a 155 funcionarios pertenecientes a las principales instituciones de administración de justicia colombiana (Fiscalía, Policía Nacional, Defensoría del Pueblo, Instituto Nacional Penitenciario y Carcelario, y miembros de la rama judicial). Entre los resultados se encuentra que los actores judiciales consideran útil la técnica por la noción de cientificidad que tienen sobre ella. Asimismo, aunque se percibe útil, es poco usada debido al desconocimiento general derivado del poco entrenamiento recibido para su ejecución. Estos resultados se discuten frente a la historia reciente del estudio en materia criminológica en el país, la formación de sus profesionales y las brechas entre la investigación académica y su uso en la práctica de investigación criminal. Se concluye que la técnica en el contexto colombiano está aún en desarrollo, actualmente cuenta con algunas guías y protocolos al interior de cada institución y requiere de mayores ejercicios de evaluación de impacto y análisis exhaustivos de su relevancia y cientificidad.
Abstract This research study's objective was to explore the knowledge, characteristics and usefulness of the criminal profiling technique within a sample of judicial actors in Colombia who, due to their professional functions in criminal investigations, could possibly apply the technique. The methodology included performing semi-structured interviews on 155 officials belonging to Colombia's main institutions for the administration of justice (Prosecutor's Office, National Police, Ombudsman's Office, National Penitentiary and Prison Institute, and members of the judicial branch). Among the results, it was observed that judicial actors consider the technique useful due to the scientific notion they have regarding it. Furthermore, although it is perceived as being useful, it is seldom used because of a general lack of knowledge derived from scant training for its execution. These results are discussed in light of the recent criminological study carried out in the country, its professionals' education and the gaps in academic research and its use in criminal investigations. It was concluded that the technique is still being developed in the Colombian context. It currently have some guides and protocols within each institution, and requires more impact assessments and comprehensive analyses regarding its relevance and scientific nature.
Resumo O objetivo desta pesquisa foi indagar sobre o conhecimento, as características e a utilidade da técnica de perfil criminológico dentro de uma amostra de atores judiciais na Colômbia que, devido às suas funções profissionais na investigação criminal, são capazes de aplicar a técnica. A metodologia incluiu a realização de entrevistas semiestruturadas com 155 funcionários pertencentes às principais instituições de administração de justiça colombiana (Procuradoria, Polícia Nacional, Defensoria do povo, Instituto Nacional Penitenciário e Carcerário, e membros do poder judiciário). Entre os resultados, encontra-se que os atores judiciais consideram a técnica útil devido à noção de cientificidade que possuem sobre ela. Da mesma forma, embora seja percebida como útil, é pouco utilizada por causa do desconhecimento geral derivado do pouco treinamento recebido para sua execução. Esses resultados são discutidos à luz da história recente do estudo da criminologia no país, da formação de seus profissionais e as brechas entre a pesquisa acadêmica e sua utilização na prática da investigação criminal. Conclui-se que a técnica, no contexto colombiano, ainda está em desenvolvimento. Atualmente possui alguns guias e protocolos dentro de cada instituição e requer maiores exercícios de avaliação de impacto e análise exaustiva de sua relevância e cientificidade.
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Humanos , Psicologia Criminal , Pesquisa , Elementos QuímicosRESUMO
La humanización de los servicios de salud es la apuesta más importante que están desarrollando diferentes centros asistenciales en el país, lograr que el paciente y su familia se sientan más y mejor atendidos es todo un reto. Es así como el Hospital Infantil Universitario de San José cumpliendo con su promesa de valor "manos cálidas y confiables" renovó su unidad de oncología infantil convirtiéndola en un ambiente más agradable para los niños que atiende la institución. Este hospital era el antiguo Lorencita Villegas de Santos y fue rescatado en el año 2006 por la Fundación Universitaria de Ciencias de la Salud (FUCS) con 11 años de reapertura. Es conocido como el moderno Hospital Infantil Universitario de San José. La FUCS ha velado por su Institución y es así como gracias a su aporte económico y al de Asociados y Vélez, tras dos meses de remodelación, esta ala oncológica hoy es un hecho. Los niños tendrán un espacio más cómodo para ellos y sus acompañantes, en el que se sientan con un mejor estado de ánimo para afrontar sus procedimientos y recuperación. Es de resaltar que una quimioterapia puede tomar hasta seis u ocho horas diarias, lo cual genera un desgaste físico y mental que debe ser afrontado de la mejor manera.
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Humanos , Masculino , Feminino , Criança , Serviço Hospitalar de OncologiaRESUMO
Introduction: Listeria monocytogenes is a pathogen acquired through the consumption of contaminated foods.Thirteen serotypes have been reported, of which 1/2a, 1/2b, and 4b are responsible for 98% of human listeriosis cases. This study examines the association between serotypes and virulent clones, offering greater information and providingtools to prevent and control diseases caused by L. monocytogenes serotype 4b. Objective: To identify the serotypes from L. monocytogene strains isolated from different samples by performingthe molecular subtyping technique; to determine the 85M fragment that codifies for epidemic clone I.Methods : 108 strains of L. monocytogenes were used, isolated from samples of animals, body fluids, foods, and food processing plant equipment and spaces. The samples were identified by following the Bacteriological AnalyticalManual protocol described by the Food and Drug Administration (FDA). The strains were identified by PolymeraseChain Reaction (PCR) using primers and a standardized protocol from a previous research project. Serotypeidentification was performed by multiplex PCR. The determination of the 85M fragment of the SSCS cassette was done by following the protocol by Yildrim et al. Results : Of the 108 L. monocytogenes strains analyzed, 60.2% (65 strains) belonged to the 4b-4d-4e serotype, 17.6%(19 strains) were identified as 1/2a-3a serotype, 14.8% (16 strains) were 4a-4c serotype, 3.7% (4 strains) belonged to the 1/2c-3c serotype, and (3.7%) corresponded to the 1/2b-3b-7 serotype. It was determined that the L. monocytogenes strains serotype 4b-4d-4e and 1/2a-3b have the 85M fragment of the SSCS cassette.Conclusion : This study reports the predominant existence of L. monocytogenes strains serotype 4b-4d-4e in food, environmental, and clinical samples. The presence of an epidemic clone I region was also found in L. monocytogenes strains.
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Separação Celular , ListerioseRESUMO
Introducción. La microbiota del tubo digestivo humano contiene bacterias benéficas para la salud que regulan el funcionamiento del colon e inhiben algunos microorganismos patógenos intestinales. Las bifidobacterias aisladas de neonatos y de leche materna se usan como microorganismos probióticos para prevenir enfermedades infecciosas, incluidas las transmitidas por alimentos. Objetivo. Aislar e identificar Bifidobacterium sp. en humanos y determinar su capacidad bactericida frente a patógenos causantes de enfermedades transmitidas por alimentos, importantes en Colombia y en el mundo. Materiales y métodos. Se recolectaron 17 muestras de leche materna, y 19 muestras de meconio y heces de neonatos, en diferentes hospitales de Bogotá. Los 26 aislamientos sospechosos se identificaron a nivel de género mediante PCR 16-23S; para la identificación de especie, se secuenciaron algunos de los aislamientos. La capacidad antagonista de las 26 cepas de Bifidobacterium sp. fue evaluada contra Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Salmonella enteritidis ATCC 13076, Listeria monocytogenes ATCC 7644 y E. coli O157:H7 ATCC 35150. Para las cepas que presentaron mayor actividad antagonista, se analizó el extracto inhibidor con ensayos de difusión en placa. Resultados. Todas las cepas amplificaron la banda esperada para la confirmación de género; asimismo, las cepas Bif 013 y Bif 023 se identificaron por secuenciación como Bifidobacterium breve, con una homología del 97%. Del total de cepas, 17 mostraron capacidad de inhibir, al menos, uno de los patógenos evaluados. E. coli ATCC 25922 fue el patógeno más inhibido. Se determinó que la cepa Bif 023 es eficiente como antagonista, ya que inhibió todos los patógenos evaluados. Los halos de inhibición presentaron diámetros mayores a lo esperado, lo que indica una muy buena capacidad antagonista de las cepas nativas. Se aisló Bifidobacterium sp. de leche materna, meconio y heces de neonatos, por lo cual se confirmó que este microorganismo es microbiota humana (2). Conclusión. Se concluye que, debido a la gran capacidad antagonista de la mayoría de las bacterias aisladas, éstas pueden estar cumpliendo una importante función protectora en el recién nacido, en particular las cepas Bif 013 y Bif 023 aisladas de materia fecal. Estos microorganismos deben continuar siendo estudiados para definir su potencial probiótico. También, se pueden evaluar para bioconservación en la industria y contra patógenos transmitidos por alimentos.
Introduction. The microbiota in the human gastrointestinal tract contains beneficial microorganisms for human health, which contribute to the regulation of colonic function and inhibition of some intestinal pathogens growth. Bifidobacterium sp. isolated from newborns and breast milk are used as probiotic microorganisms, which are useful in the prevention of infectious diseases including foodborne illnesses. Objective: To isolate and identify human Bifidobacterium sp. and to determine its antibiotic activity against important pathogens which cause foodborne illnesses in Colombia and the world. Materials and methods. 17 breast milk samples and 19 meconium and newborn faeces samples were collected from different hospitals in Bogotá. 26 presumptive Bifidobacterium strains were identified at genus level by PCR 16-23S; some strains were identified at species level by nucleic acid sequencing. The antagonistic activity of 26 Bifidobacterium sp. strains was tested against Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Salmonella enteritidis ATCC 13076, Listeria monocytogenes ATCC 7644 and E. coli O157:H7 ATCC 35150. For the strains that showed a greater antibiotic activity, the inhibitory compound was analyzed using disk diffusion tests. Results. All strains amplified the expected band for genus confirmation. Strains Bif 023 and Bif 013 were identified by DNA-sequencing as Bifidobacterium breve, with 97% homology. 17 strains were able to inhibit at least one of the pathogens tested. Escherichia coli ATCC 25922 was the most inhibited. It was determined that the strain Bif 023 is highly efficient as an antagonist strain due its ability to inhibit all the evaluated pathogens. Inhibition areas showed higher diameters than expected, suggesting an enhanced antagonist capacity of native strains. Bifidobacterium sp. was isolated from breast milk, meconium and newborn faeces which confirmed that this microorganism is human microbiota. Conclusion. Due to the high antagonist activity of most isolated bacteria, they could be playing an important protective function in the newborn, in particular strains Bif 013 and Bif 023, isolated from faeces. Other studies must be performed with these organisms to determine their probiotic potential as well as their use in the biocontrol industry due their activity against foodborne pathogens.
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Humanos , Recém-Nascido , Lactente , Infecções por Bifidobacteriales , Doenças Transmitidas por Alimentos , Anti-Infecciosos , Leite Humano , Probióticos , Trato Gastrointestinal/microbiologia , Fezes , AntibacterianosRESUMO
Introducción. Enterobacter sakazakii es un patógeno oportunista emergente de alto riesgo, responsable de meningitis grave y enterocolitis necrosante. El principal vehículo de transmisión de esta bacteria son los productos infantiles deshidratados, debido a su contaminación después del tratamiento térmico. Objetivo. Identificar cepas de E. sakazakii en muestras de lactarios recolectadas en la ciudad de Bogotá, D.C. Materiales y métodos. Se analizaron 222 muestras de 9 lactarios, de superficies estériles y no estériles, utensilios empleados para la preparación de biberones y operarios. Se realizó recuento de coliformes totales y detección de E. sakazakii utilizando el protocolo propuesto por la Food and Drug Administration y por el Sistema Automático Bax® Dupont Qualicon. Resultados. De las 222 muestras recolectadas en las clínicas de Bogotá, se reportó que 27,4% (61) de las muestras analizadas presentaban coliformes totales; se detectó la presencia de E. sakazakii en 3,6% por el método automatizado de PCR BAX Dupont a partir de muestras de biberones y superficies. Conclusiones. Se demostró la presencia de E. sakazakii en lactarios en Colombia. Debido a que este microorganismo es un patógeno oportunista de alto riesgo para neonatos y que está asociado a las prácticas higiénicas en los lactarios, la información de este estudio puede ser útil para la toma de medidas profilácticas que reduzcan el riesgo de contaminación con este patógeno para la población infantil y, también, aporta información importante para la salud pública.
Introduction: Enterobacter sakazakii is an emergent opportunistic pathogen of high risk responsible of severe meningitis and necrotizing enterocolitis in neonates and infants with underlying medical conditions. One of the principal transmission vehicles for the transmission of these bacteria, is the infant dehydrated formula after exposing them to the heating treatment. Objective: To identify strains of E. sakazakii in milk feeders samples from Bogotá. Materials and methods: 222 samples from 9 milk feeders including sterile and non sterile surfaces, utensils used for the formula preparation and food handlers were analyzed. Total coliforms counts and identification of E. sakazakii was done using the FDA protocol and the automatic system Bax ® Dupont Qualicon. Results: From de 222 samples collected from hospitals in Bogotá, it was reported that 27.4% (61) had total coliforms, and the presence of E. sakazakii was detected in 3.6% (8) from one feeding bottle and surfaces. Conclusion: The presence of E. sakazakii strains was reported in Colombian milk feeders. Because this microorganism is a high risk opportunistic pathogen for newborn infants, usually associated with hygiene practices in milk feeders, the information of this research could be useful to develop preventive measurements to reduce the risk of contamination in the infant population and provides important public health information.
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Alimentos Infantis/microbiologia , Cronobacter sakazakii/isolamento & purificação , ColômbiaRESUMO
A 29 yrs-old patient was referred to our hospital due to generalized convulsions. She had hyperthyroidism treated with methimazole. Her MRI showed 4 metastatic lesions in the brain. She had a goiter with a "cold" nodule and a palpable ipsilateral lymph node. The FNAB disclosed a papillary thyroid carcinoma. Under 5 mg of MMI treatment, she had a subclinical hyperthyroidism and TRAb were 47.8 percent (n.v. < 10 percent). The CT scan also showed lung metastasis. She underwent a total thyroidectomy with a modified neck dissection and she received an accumulated radioiodine dose of 700 mCi during the following two years. She died from the consequences of multiple metastatic lesions. Studies were performed in DNA extracted from paraffin-embedded tissue from the tumor, the metastatic lymph node and the non-tumoral thyroid. The genetic analysis of tumoral DNA revealed point mutations in two different genes: the wild type CAA at codon 61 of N-RAS mutated to CAT, replacing glycine by histidine (G61H) and the normal GCC sequence at codon 623 of the TSHR gene was replaced by TCC, changing the alanine by serine (A623S). In the non-tumoral tissue no mutations were found. In vitro studies showed a constitutive activation of the TSHR. It is very probable that this activating mutation of the TSHR is unable to reach the end point of the PKA cascade in the tumoral tissue. One possibility that could explain this is the presence of a cross-signaling mechanism generating a deviation of the TSH receptor cascade to the more proliferative one involving the MAPKinase, giving perhaps a more aggressive behavior of this papillary thyroid cancer.
Paciente de 29 anos foi encaminhada ao Hospital de Clínicas por causa de convulsões generalizadas. Apresentava hipertiroidismo tratado com metimazol (MMI). A ressonância magnética mostrava quatro lesões metastáticas cerebrais. Possuía bócio com nódulo frio e linfonodo palpável ipsilateral. Usando 5 mg de MMI, a paciente apresentava hipertiroidismo subclínico e TRAb = 47,8 por cento (normal < 10 por cento). A tomografia computadorizada também mostrava metástases pulmonares. A paciente foi submetida a tiroidectomia total com dissecção cervical modificada e recebeu dose acumulada de radioiodo de 700 mCi durante o período de dois anos. Foi analisado o DNA extraído de tecido emblocado em parafina do tumor, do linfonodo metastático e de tecido tiroidiano não-tumoral. Foram encontradas mutações pontuais em dois genes: uma substituição do genótipo selvagem CAA no códon 61 de /N-RAS/ por CAT, substituindo a glicina pela histidina (G61H) e uma substituição da seqüência normal GCC no códon 623 do gene TSHR por TCC, trocando a alanina pela serina (A623S). Não foram encontradas mutações no tecido não-tumoral. Estudos in vitro mostraram ativação constitutiva de TSHR. Já que esta mutação ativadora de TSHR foi incapaz de atingir o final da cascata PKA no tecido tumoral, sugere-se que um mecanismo de cross-signaling possa explicar o desvio da cascata do receptor de TSH para outra mais proliferativa, envolvendo MAPKinase e levando ao comportamento mais agressivo deste câncer papilífero.
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Adulto , Feminino , Humanos , Carcinoma Papilar/genética , Doença de Graves/genética , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/genética , Neoplasias Encefálicas/secundário , Carcinoma Papilar/secundário , Carcinoma Papilar/cirurgia , Evolução Fatal , Rearranjo Gênico , Doença de Graves/patologia , Doença de Graves/cirurgia , Mutação Puntual/genética , Receptor Cross-Talk , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Receptores da Tireotropina/genética , Tireoidectomia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
Introducción. Listeria monocytogenes es un patógeno emergente adquirido por el consumo de alimentos contaminados. Causa una enfermedad llamada listeriosis, cuya tasa de mortalidad a nivel mundial varía entre 20 por ciento y 30 por ciento, alcanzando hasta un 80 por ciento en casos de infecciones neonatales. La técnica del ADN polimorfo amplificado aleatorio permite distinguir entre diferentes aislamientos y caracterizarlos molecularmente, lo cual aporta información útil acerca de la diversidad de este patógeno en Colombia. Objetivo. Caracterizar molecularmente diferentes aislamientos de L. monocytogenes aisladas de muestras clínicas y alimentos utilizando ésta técnica para determinar posibles relaciones entre estos dos orígenes. Materiales y métodos. Se analizaron 38 aislamientos de L. monocytogenes; 22 de muestras clínicas y 16 de alimentos y plantas procesadoras de alimentos utilizando dos oligonucléotidos de 10pb (HLWL-74 y Arbitrario). Los datos se analizaron utilizando los programas Quantity One y SYN-TAX. Resultados. Se detectó un alto porcentaje de polimorfismo mediante los oligonucleótidos HLWL-74 (81,81 por ciento) y Arbitrario (85,71 por ciento). Se pudieron describir dos linajes superiores luego del análisis, los cuales se dividieron a su vez en cuatro grupos mayores (A, B C y D) donde se observó una gran diversidad genética. La mayoría de aislamientos clínicos se agruparon bajo el mismo grupo y se encontraron alejados de los aislamientos de alimentos. Conclusión. Los resultados de este estudio demuestran que existe una gran diversidad de polimorfismos de ADN entre los aislamientos de L. monocytogenes que circulan en Colombia, lo que podría reflejar diferencias a nivel fenotípico y patogénico en estos aislamientos.
Introduction. Listeria monocytogenes is an emergent foodborne pathogen acquired by the ingestion of contaminated food. This bacterium causes a disease called listeriosis, whose mortality rate world wide is around 20% to 30%, reaching up to 80% in cases of neonatal infections. The random amplified polymorphic DNA technique allows different isolates to be distinguished and characterized at the molecular level, which can provide useful information about the diversity of this pathogen in Colombia. Objective. To molecularly characterize different L. monocytogenes isolates from food and clinical samples using this technique to determine possible relationships among these two origins. Materials and methods. Thirty eight L. monocytogenes isolates were analyzed; 22 from human clinical samples and 16 from food processing plants and food using two 10bp primers (HLW74, Arbitrary). The data were analyzed using Quantity One and SYN-TAX software. Results. A high percentage of polymorphism was detected with both primers (HLWL-74, 81,81%; Arbitrary, 85,71%). Two major lineages were found, which were divided into four major clusters (A, B C y D) and great genetic diversity was observed. Most of the clinical isolates were grouped within the same cluster, and were more distantly related to the food isolates. Conclusion. The results of this study demonstrate a high degree of genetic diversity of DNA polymorphisms among the L. monocytogenes isolates circulating in Colombia, which could reflect phenotypic and pathogenic differences in these isolates.
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Amostras de Alimentos , Listeria monocytogenes , Conformação MolecularRESUMO
Resumen Objetivo. Utilizar la técnica de amplificación aleatoria de ADN polimórfico ( random amplification of polymorphic DNA, RAPD para caracterizar molecularmente cepas de Staphylococci productoras de toxinas, aisladas de operarios de plantas de producción de alimentos. Materiales y métodos. Se utilizaron 31 aislamientos enterotoxigénicos de Staphylococci para la extracción y cuantificación de ADN. Posteriormente, se realizó un ciclo general de amplificación utilizando los oligonucleótidos HLWL-74 y arbitrario, seguido por la visualización de los productos de RAPD por electroforesis en gel de agarosa. Resultados. Para los dos oligonucleótidos utilizados, se observaron de 1 a 15 bandas, dos linajes, divididos en tres conglomerados (A, B y C). El oligonucleótido arbitrario generó 10 bandas polimórficas (66,66%) y el oligonucleótido HLWL-74 arrojó 13 bandas altamente polimórficas (86,66%). Cada oligonucleótido mostró un agrupamiento diferente de cada una de las cepas, lo cual muestra una alta diversidad de aislamientos de Staphylococci presentes en humanos. Conclusiones. Se presentó una alta diversidad molecular en cuanto a aislamientos de garganta, nariz y manos de un mismo individuo, así como en todos los aislamientos analizados, lo cual demuestra que las cepas enterotoxigénicas de Staphylococci encontradas en los operarios analizados tienen una alta diversidad molecular.
Objective. To use Randomly Amplified Polymorphic DNA (RAPD) to compare molecularly enterotoxigenic Staphylococci strains isolated from people working in food processing plants. Materials and methods. 31 Staphylococci enterotoxigenic isolates were used for extraction and quantification of DNA, followed by a general amplification cycle with the HLWL-74 and arbitrary oligonucleotides with visualization of the RAPD products by agarose gel electrophoresis. Results. The two oligonucleotides used generated 1 to 15 bands, two mayor lineages divided in three clusters (A, B, and C). The arbitrary oligonucleotide generated 10 polymorphic bands (66.66%), the HLWL-74 oligonucleotide generated 13 polymorphic bands (86.66%). Each oligonucleotide generated a different type of grouping with respect to each of the strains analyzed. This shows a high diversity between the human isolates of Staphylococci. Conclusion. A high molecular diversity was present amongst throat, nose and hands isolates from the same person, and among the analyzed isolates; this demonstrates a high molecular diversity in Staphylococci enterotoxigenic isolates.
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Humanos , Indústria Alimentícia , Staphylococcinum , Técnica de Amplificação ao Acaso de DNA Polimórfico , Oligonucleotídeos , Polimorfismo Genético , DNA , Escherichia coli EnterotoxigênicaRESUMO
Durante la reexploración mediastinal por hemorragia postoperatoria se encuentra que un porcentaje de los sangrados no tenían una causa quirúrgica y, por lo tanto, no tenían indicada la reintervención. El objetivo del estudio fue determinar factores predictores que permitieran reconocer el sangrado que no requiere cirugía. Metodología: estudio retrospectivo con 560 pacientes, de los que 50 fueron llevados a reexploración por sangrado. Los pacientes se dividieron en tres grupos: pacientes no reintervenidos, pacientes reintervenidos con lesión anatómica susceptible de reparación quirúrgica (sangrado quirúrgico) y pacientes reintervenidos en los que no se pudo identificar un sitio de sangrado (sangrado médico). Resultados: la mortalidad y el tiempo de permanencia en UCI fueron mayores en los pacientes con sangrado médico, en comparación con los otros dos grupos. El sangrado de tipo médico está significativamente asociado con un tiempo de circulación extracorpórea más prolongado (p=0,03) con la instauración de paro circulatorio de cualquier duración (p <0,001) y con procedimientos de categoría quirúrgica 3, según la clasificación de Hardy (p = 0,033).El uso de técnicas de ultrafiltración estuvo relacionado de manera estadísticamente significativa con una reducción en el sangrado de tipo médico. Conclusiones: la hemorragia que necesita reexploración después de cirugía cardiaca está relacionada con un marcado incremento de la mortalidad y de la estancia en la UCI. Pacientes en los que se predice un incremento en el riesgo de sangrado médico se pueden beneficiar del uso profiláctico de aprotinina o cualquier otro agente que reduzca la hemorragia, y es claro que se perjudican con una reoperación que no está indicada.
A percentage of post surgery bleedings that leads to mediastinal reintervention do not have a surgical cause, and therefore the reintervention was not indicated. The objective of the study was to determine predictive factors to recognize the bleeding that does not require surgery. Methodology: retrospective study with 560 patients, from whom 50 required reintervention for bleeding. The patients were divided in three groups: patients with not intervention, patients with reintervention and an anatomic lesion susceptible of surgical reparation (surgical bleeding), and patients with reintervention in whom a bleeding area could not be identify. (medical bleeding). Results: Mortality and time of permanence in ICU was higher in the patients with medical bleeding than in the other groups. Medical bleeding was associated with long time of extracorporeal circulation (p = 0,03), with circulatory arrest of any duration (p <0,001) and with surgery procedure category 3, according to Hardy's classification (p = 0,033). The use of ultrafiltartion techniques was statistically related with a reduction in the medical bleeding. Conclusion: bleedings that need reintervention after surgery are related with a high increase in mortality and time of permanence in ICU. Patients in whom a high risk of medical bleeding is predicted can be benefited from the prophylactic use of aprotinina or any other agent that help in the reduction of bleedings. It is clear that patients with medical bleeding are worse of if they go to surgery.
Assuntos
Humanos , Cirurgia Torácica , Transtornos da Coagulação Sanguínea , Ultrafiltração , Hemorragia Pós-Operatória , Circulação ExtracorpóreaRESUMO
La Cirugía Torácica Videoasistida (CAVDT) constituye en la actualidad una alternativa corrientemente utilizada para el tratamiento quirúrgico de una variedad de patologías que afectan los órganos intratorácicos. Se utiliza para el diagnóstico y tratamiento de enfermedades de la pleura y el espacio pleural, (biopsias pleurales, pleurodesis con talco, drenaje de hemotórax coagulado y pleurectomías); procedimientos sobre el pulmón (biopsias, resección de nódulos y tomores benignos) y otros procedemientos sobre el mediastino (timectomías y resección de tumores benignos). También se ha empleado para la realización de miotomías del esófago y cirugías antirreflujo. La principal ventaja radica en la menor morbilidad como resultado de la ausencia de una iniciación quirúrgica que comprometa los grandes músculos de la pared torácica y que requiera la separación de las costillas para acceder a la cantidad pleural. Esto se traduce en disminución significativa del dolor quirúrgico, menor compromiso de la función respiratoria en el postoperatorio inmediato, disminución de la estancia hospitalaria y menor incapacidad funcional. La evaluación preoperatoria es la misma empleada para la cirugía torácica convencional. Es importante tener en cuenta que en un porcentaje de estas pacientes puede ser necesaria la conversión a un procedimiento de toracotomía. Durante la cirugía es indispensable el empleo de intubación y ventilación selectiva y el anestesiólogo dispone de varias alternativas para mantener un intercambio gaseoso adecuado durante el trascurso del procedimiento