Condición nutricional de escolares indígenas otomíes en situación de alta marginación / Nutritional status of indigenous Otomi schoolchildren in high marginal situation / Estado nutricional de população escolar de cultura indígena otomí em situação de alta marginalização

Resumen Introducción: El panorama de la salud y nutrición de la población mexicana se enmarca en la conjunción de desnutrición crónica infantil, sobre todo en el medio rural e indígena, y el incremento significativo del sobrepeso y obesidad. Esta información proveniente de encuestas arroja resultados generalizados, sin considerar las particularidades del contexto biosociocultural en que viven comunidades indígenas, codeterminante de la condición nutricional de éstas. Objetivo: Estudiar el estatus nutricional de un grupo de escolares de cultura otomí residentes en una comunidad de México en situación de marginación, considerando el contexto biosociocultural en el que viven. Métodos: Estudio prospectivo transversal realizado en una localidad del Estado de México. Muestra por conveniencia constituida por 214 menores, entre 6 y 12 años de edad. Se emplearon técnicas antropométricas internacionalmente aceptadas para recabar la estatura y el peso, y se calculó el IMC. El estatus de nutrición se estimó con base en el peso, la estatura y el IMC para la edad y se compararon con los referentes de la OMS. Resultados: La prevalencia de estatura baja para la edad y la desnutrición es menor, no así el sobrepeso/obesidad que afecta a un tercio de los menores. Solo para el IMC por edad y sexo hubo diferencias en ciertos grupos de edad. Las puntuaciones z de los tres indicadores son semejantes entre niños y niñas. Discusión y Conclusiones: En comparación con los parámetros nacional y estatal, los menores estudiados muestran prevalencia menor de sobrepeso y obesidad asociado a su contexto sociocultural.

Abstract Introduction: The health and nutrition outlook of the Mexican population may be framed in terms of chronic infant malnutrition, largely in the rural and indigenous sectors, and a significant increase in overweight and obesity. This general information is obtained from surveys without taking into account the biosociocultural context that is a codeterminant of the nutritional condition of many small indigenous communities. Objective: To study the nutritional status of Otomí school children living in a marginalized Mexican community from the perspective of the biosociocultural context in which they live. Methods: This is a prospective and transversal study carried out in a location of the state of México, México. The convenience sample was constituted by 214 children between 6 and 12 years old. Internationally accepted anthropometric techniques were used to collect data on the height and weight of these children. BMIs were calculated. The status of nutrition was estimated based on the expected weight, height, and BMI for each age. These data were compared with the corresponding WHO references. Results: The prevalence of low height and malnutrition related to the ages of these children was found to be low, but one in three of these children was found to be overweight or obese. There were some age groups differences regarding the BMI. The z scores of the three indicators are similar between boys and girls. Discussion and Conclusions: In comparison to the national and state parameters, the children studied showed a low prevalence of overweight and obesity associated with their sociocultural context.

Resumo Introdução: O panorama da saúde e nutrição da população mexicana se enquadra na conjunção de desnutrição infantil crónica, sobretudo no médio rural e indígena, e o incremento significativo do sobrepeso e obesidade. Esta informação vinda de enquetes gera resultados generalizados, sem considerar as particularidades do contexto biosociocultural em que vivem comunidades indígenas, co-determinante da condição nutricional destas. Objetivo: Estudar o estado nutricional de um grupo de escolares de cultura Otomí residentes em uma comunidade do México em situação de marginação, considerando o contexto biosociocultural em que vivem. Métodos: Estudo prospectivo transversal realizado em uma localidade do Estado do México. Amostra de conveniência constituída por 214 menores entre 6 e 12 anos de idade. Empregaram-se técnicas antropométricas internacionalmente aceitas para coletar a altura e o peso, e foi calculado o IMC. O estado de nutrição foi estimado com base no peso, a altura e o IMC para a idade e foram comparados com os referentes da OMS. Resultados: A prevalência da baixa altura para a idade e a desnutrição é menor, no entanto o sobrepeso/obesidade afeta a um terço dos meninos. Apenas para o IMC por grupos de idade e sexo houve diferenças em determinadas faixas etárias. As pontuações z dos três indicadores são semelhantes entre meninos e meninas. Discussão e Conclusões: Em comparação com os parâmetros nacionais e estaduais, os meninos estudados mostram menor prevalência de sobrepeso e obesidade associado ao seu contexto sociocultural.

Incidencia de enfermedad pulmonar obstructiva crónica en pacientes con el virus de la inmunodeficiencia humana. Análisis post-hoc del estudio viva / Incidence of chronic obstructive pulmonary disease in patients with human immunodeficiency virus. Post-hoc analysis of the viva study

Introducción: desde la aparición de la terapia antiretroviral la supervivencia de los pacientes infectados por el virus de la inmunodeficiencia humana (VIH) ha aumentado considerablemente tomando importancia la aparición de otras patologías crónicas en estos pacientes como puede ser la enfermedad pulmonar obstructiva crónica (EPOC). Nuestro objetivo fue conocer la incidencia de EPOC en una cohorte de pacientes VIH derivados en un programa de detección de hipertensión pulmonar (HTP). Material y Métodos: análisis post-hoc, de un prospectivo, pseudo-experimental de pacientes con infección del VIH a los que se les preguntaba por disnea y en caso afirmativo eran derivados a consultas de neumología para despistaje de HTP. Resultado: desde 2014 hasta 2016, reclutamos un total de 32 pacientes, con un predominio de varones (75%). La disnea según la mMRC (Medical Reserach Council) fue grado 1, 2 y 3 en el 37,5%, 43,8% y 18,8%, respectivamente. La prevalencia de tabaquismo fue del 87,1% (intervalo de confianza [IC] 95%: 71- 96,4%), y 18 pacientes fueron catalogados de EPOC (62%; IC95%: 42,2 - 79,3%). Conclusión: la incidencia de EPOC en nuestra serie fue muy superior a la de la población general. Es necesario plantear estrategias de búsqueda activa de EPOC en estos pacientes para un diagnóstico y tratamiento precoz

Introduction: Since the advent of antiretroviral therapy, the survival of patients infected with the human immunodeficiency virus (HIV) has considerably increased, with the occurrence of other chronic diseases such as chronic obstructive pulmonary disease (COPD) gaining importance in these patients. Our objective was to find out the incidence of COPD in a cohort of HIV patients that were referred to a program to detect pulmonary hypertension (PH). Materials and Methods: Post hoc analysis of a prospective, quasi-experimental study on HIV-infected patients who were asked whether they had dyspnea. If this was the case, they were referred to a pulmonologist for PH screening. Results: From 2014 to 2016, we recruited a total of 32 patients, with a predominance of male recruits (75%). According to the mMRC (Modified Medical Research Council) Dyspnea Scale, 37.5%, 43.8% and 18.8% were classified as Grade 1, 2 and 3, respectively. The prevalence of smoking was 87.1% (95% confidence interval [CI]: 71 - 96.4%), and 18 patients were classified with COPD (62%; 95% CI: 42.2 - 79.3%). Conclusion: The incidence of COPD in our sample was much higher than that of the general population. It is necessary to plan active search strategies for COPD in these patients for early diagnosis and treatment

Características clínicas y sociodemográficas de pacientes con diabetes tipo 1 en un Hospital Universitario de Colombia / Clinical and sociodemographic characteristics of patients with diabetes mellitus type 1 in a University Hospital of Colombia

Resumen ANTECEDENTES: La diabetes mellitus tipo 1 es una enfermedad autoinmunitaria causada por la interacción de múltiples factores ambientales y genéticos que conducen a la destrucción autoinmunitaria de células B pancreáticas productoras de insulina. La incidencia y prevalencia de la diabetes mellitus tipo 1 varían considerablemente en todo el mundo. OBJETIVO: Establecer las características clínicas y sociodemográficas de los pacientes con diabetes mellitus tipo 1. MATERIAL Y MÉTODO: Estudio descriptivo de corte transversal y retrospectivo en el que se incluyeron pacientes con diabetes tipo 1 que ingresaron a un hospital universitario de Colombia en el periodo comprendido entre 2012 y 2016. Posteriormente se realizó análisis estadístico según las variables. RESULTADOS: La prevalencia intrahospitalaria de la diabetes mellitus tipo 1 fue de 19 casos por cada 100,000 pacientes mayores de 13 años. Fue más frecuente en mujeres con 61.3%, la edad promedio al diagnóstico fue de 14.89 años. El diagnóstico se estableció de forma clínica sin estudios de autoinmunidad, se trataba de pacientes con enfermedad no controlada con HbA1c promedio de 11.5%, las complicaciones más frecuentes fueron la cetoacidosis diabética con 46.6%, al igual que la hipoglucemia. La insulina más frecuentemente prescrita en este grupo de pacientes fue glargina, glulisina y e insulina regular. CONCLUSIÓN: Los hallazgos sugieren que algunas características de la diabetes mellitus tipo 1 podrían ser similares y algunas diferentes a lo reportado en otros estudios; sin embargo, pueden plantearse algunas posibles investigaciones tomando estos resultados como base.

Abstract BACKGROUND: Diabetes mellitus type 1 is an autoimmune disease caused by the interaction of multiple environmental and genetic factors leading to the autoimmune destruction of pancreatic B cells producers of insulin. The incidence and prevalence of diabetes mellitus type 1 vary considerably all around the world. OBJECTIVE: To establish the clinical and socio-demographic characteristics of diabetes mellitus type 1. MATERIAL AND METHOD: A descriptive, cross-sectional and retrospective study that included patients with diabetes type 1 who entered to a university hospital of Colombia from 2012 to 2016. Then, a statistical analysis was done according to variables. RESULTS: Intrahospitalary prevalence of diabetes mellitus type 1 was of 19 cases for each 100,000 patients older tan 13 years. It was more frequent in women with 61.3%; the mean age at diagnosis was of 14.89 years. Diagnosis was established in a clinical manner without autoimmunity studies, they were patients with not-controlled disease with a mean HbA1c of 11.5%; the frequent complications were: diabetic cetoacidosis with 46.6%, as well as hypoglycemia. The most frequently prescribed insulin in these patients was glargine, glulisine and regular insulin. CONCLUSIONS: The findings suggest that some characteristics of diabetes mellitus 1 could be similar and some different to that reported in other studies; however, some possible investigations may be considered taking these results as basement.

Anticuerpos anti-Fya con reacción anamnésica asociada con anti-D en transfusión intrauterina: reporte de un caso / Anti-Fya antibodies with anamnestic reaction associated to anti-D in intrauterine transfusion: A case report

Resumen ANTECEDENTES La enfermedad hemolítica perinatal ocurre después de una transfusión sanguínea, que sensibiliza con antígenos eritrocitarios, hemorragia materno-fetal durante el embarazo o al momento del parto. La incidencia de anticuerpos anti-D ha disminuido de 14 a 0.1% en las madres D-negativas. No existe una inmunoglobulina que evite o disminuya la aloinmunización por otros antígenos eritrocitarios durante el embarazo. La incompatibilidad del grupo sanguíneo Duffy es una causa común de enfermedad hemolítica perinatal. OBJETIVO Exponer el caso de una paciente con hijo con enfermedad hemolítica perinatal por anticuerpos anti-Fya y anti-D tratado con transfusión intrauterina. CASO CLÍNICO Paciente de 22 años, con antecedente de múltiples transfusiones sanguíneas y datos clínicos de síndrome anémico. En la semana 28 del embarazo fue valorada para aplicarle inmunoglobulina anti-D. Luego de aplicarle dos unidades de concentrado eritrocitario Rh negativo se observó incompatibilidad (++) en fase de antiglobulina humana (Coombs), por esto se realizó el escrutinio de anticuerpos irregulares en gel, que resultó positivo en células I y II (+++). Enseguida se inició el protocolo de identificación de anticuerpos irregulares con un panel de 11 células, que reportó aglutinación en las células 1, 2, 3, 5, 6, 7, 8 y 11, sin mostrar especificidad. El estudio de adsorción del anticuerpo anti-D mostró células de antígeno D+ con las que se estableció el diagnóstico de anticuerpos anti-Fya y anti-D. El embarazo finalizó mediante cesárea con el nacimiento de un varón con grupo y Rh O positivo, de 30.1 semanas de gestación (talla de 40 cm y peso de 2000 g) con hidrops fetal. Se le realizaron ciclos de reanimación e ingresó a la unidad de cuidados intensivos neonatales, sin tratamiento farmacológico, y después de una hora de vida extrauterina falleció. La madre se dio de alta del hospital 36 horas después del puerperio, sin complicaciones adicionales. CONCLUSIÓN Los anticuerpos antieritrocitarios anti-Fya, solos o en combinación con otros anticuerpos, provocan enfermedad hemolítica perinatal severa. El laboratorio de inmunohematología tiene participación importante en el diagnóstico, seguimiento y tratamiento de la enfermedad hemolítica perinatal.

Abstract BACKGROUND Hemolytic disease of the fetus and newborn occurs after alloimmunization with red blood cells antigens by blood transfusion, maternal-fetal hemorrhage during pregnancy or at delivery. Currently, the incidence of alloimmunization by anti-D antibody has been reduced from 14% to 0.1% of D-negative mothers, however, there is no immunoglobulin that prevents or decreases alloimmunization by other red blood cells antigens during pregnancy. The incompatibilities of the Duffy blood group are a common cause of hemolytic disease of the fetus and newborn. OBJECTIVE To present the case of a neonate with perinatal hemolytic disease secondary to anti-Fya and anti-D antibodies managed with intrauterine transfusion. CLINICAL CASE A 22-year-old patient with a history of multiple blood transfusions and clinical data of anemic syndrome. In the 28th week of pregnancy it was evaluated for the application of anti-D immunoglobulin. The blood bank was asked for two units of Rh negative erythrocyte concentrate. Incompatibility (++) in the human antiglobulin phase (Coombs) was observed, so the irregular antibody gel was screened, which was positive in cells I and II (+++). An identification protocol for irregular antibodies was initiated with a panel of 11 cells, which reported agglutination in cells 1, 2, 3, 5, 6, 7, 8 and 11, without specificity. The adsorption study of the anti-D antibody showed D + antigen cells. The diagnosis of anti-Fya and anti-D antibodies was established. The pregnant woman was terminated by caesarean section, from which a male with a group was born and Rh O positive, of 30.1 weeks of gestation (size of 40 cm and weight of 2000 g) with fetal hydrops. He underwent resuscitation cycles, entered the neonatal intensive care unit, without pharmacotherapy and died after one hour of extrauterine life. The mother withdrew 36 hours after the puerperium, without additional complications. CONCLUSION The antibodies anti-Fya alone or next to other alloantibodies produce severe hemolytic disease of the fetus and newborn. The laboratory of immunohematology in the blood bank is an essential tool in the diagnosis, monitoring and treatment of hemolytic disease of the fetus and newborn.

Outcome and toxicity of intensity modulated radiotherapy with simultaneous integrated boost in locally advanced non-small cell lung cancer patients

Purpose. The aim of this study was to assess the feasibility and treatment outcome of intensity modulated radiation therapy with simultaneous integrated boost (SIB-IMRT) in locally advanced non-small cell lung cancer (NSCLC) patients. Materials and methods. A total of 64 NSCLC patients with stage IIB (3%), IIIA (36%), and IIIB (61%) were treated with concomitant (N = 47; 73%) or sequential (N = 9; 14%) chemotherapy between February 2009 and January 2014. Eight patients (13%) received RT alone. All patients received the same irradiation scheme using IMRT: prophylactic dose for mediastinum was 56 Gy at 1.65 Gy/fraction and SIB to macroscopic disease up to 68 Gy at 2 Gy/fraction. Results. The median follow-up was 16 months (range, 1-70 months). The overall survival rate for all patients was 79% after 1 year and 46% after 2 years. Disease-free survival (DFS) was 81 and 45% after 1 and 2 years, respectively, resulting in a median DFS of 16 months. Multivariate analysis showed a statistically significant association between stage IIIB patients and a higher risk of mortality (HR 2.11; P = 0.019). In addition, T4 stage associated with higher risk of recurrence (HR 2.23; P = 0.024) while concomitant chemoradiation was associated with lower risk of any recurrence (HR 0.34; P = 0.004) No patient experienced grade ≥3 esophagitis and only 6 cases (9%) had grade 3 pneumonitis. Only having a higher lung volume was associated with higher risk of pneumonitis in the multivariate analysis (HR 16.21; P = 0.022). Conclusion. This study in advanced NSCLC patients shows that SIB-IMRT is an effective technique with acceptable toxicity, also when combined with chemotherapy (AU)

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Origen celular de micropartículas circulantes en pacientes con enfermedad tromboembólica venosa y cáncer / Celular origin of circulating microparticles in patients with venous thromboembolism and cancer

Las micropartículas (MPs) son unas vesículas extracelulares consideradas potentes efectores celulares. Están presentes en individuos sanos y se encuentran elevadas en estados patológicos como enfermedades inflamatorias, neoplásicas y trombosis. La relación entre enfermedad tromboembólica venosa (ETV) y cáncer está bien establecida. Se piensa que las MPs serían una conexión patogénica entre ambas entidades. De confirmarse, podrían utilizarse como biomarcadores. Nuestro objetivo fue caracterizar las MPs en ambas patologías atendiendo a su origen celular (celular, endotelial, plaquetar, leucocitario y las que exhibían en su superficie mucina 1). También se estudiaron parámetros funcionales como el dímero D (DD) y la P-selectina soluble (sPS). Se consideraron 96 pacientes con ETV idiopática y 85 con neoplasias avanzadas de pulmón, gástrico o páncreas. A todos ellos se les realizó un seguimiento clínico de dos años en el que se excluyeron del estudio aquellos que fueron diagnosticados de cáncer en el grupo de ETV o que desarrollaron trombosis en el grupo de pacientes neoplásicos. Finalmente, se analizaron 82 pacientes con ETV y 68 con cáncer. En nuestros resultados encontramos que las MPs totales y las MPs de origen plaquetar diferenciaban ambos grupos de pacientes. Además, se determinaron cifras significativamente mayores de DD y sPS (p <0,001) en el grupo de ETV. Las diferencias encontradas entre ambos grupos, teniendo en cuenta el origen de las MPs, podrían estar causadas por las características protrombóticas del grupo neoplásico y por el secuestro de las mismas dentro de los coágulos activos en el grupo de ETV

Microparticles (MPs) are extracellular vesicles considered to be powerful cellular effectors. They are present in healthy individuals and are elevated in pathological conditions such as inflammatory and neoplastic diseases, and thrombosis. The relationship between venous thromboembolism (VTE) and cancer has been well established. MPs are thought to be a pathogenic connection between the two entities. If confirmed, they could be used as biomarkers. Our aim was to characterize the MPs in both diseases according to their cellular origin (cellular, endothelial, platelet, leukocyte and those that exhibited mucin 1 on their surface). Functional parameters such as D-dimer (DD) and soluble P-selectin (sPsel) were also studied. 96 patients with idiopathic VTE and 85 with advanced lung, stomach or pancreatic neoplasia were considered. All of them were followed clinically for two years and those who were diagnosed with cancer in the VTE group or those who developed thrombosis in the group of neoplastic patients were excluded from the study. Finally, 82 VTE patients and 68 cancer patients were analyzed. In our results, we found that total MPs and platelet-derived MPs differentiated both patient groups. Additionally, significantly greater numbers of DD and sPsel (p <0.001) were determined in the VTE group. The differences found between both groups, taking into account the origin of the MPs, could be caused by the prothrombotic characteristics of the neoplastic group and their sequestration within active clots in the VTE group

Cancer incidence in Spain, 2015

Purpose. Periodic cancer incidence estimates of Spain from all existing population-based cancer registries at any given time are required. The objective of this study was to present the current situation of cancer incidence in Spain. Methods. The Spanish Network of Cancer Registries (REDECAN) estimated the numbers of new cancer cases occurred in Spain in 2015 by applying the incidence-mortality ratios method. In the calculus, incidence data from population-based cancer registries and mortality data of all Spain were used. Results. In 2015, nearly a quarter of a million new invasive cancer cases were diagnosed in Spain, almost 149,000 in men (60.0%) and 99,000 in women. Globally, the five most common cancers were those of colon-rectum, prostate, lung, breast and urinary bladder. By gender, the four most common cancers in men were those of prostate (22.4%), colon-rectum (16.6%), lung (15.1%) and urinary bladder (11.7%). In women, the most common ones were those of breast (28.0%), colon-rectum (16.9%), corpus uteri (6.2%) and lung (6.0%). In recent years, cancer incidence in men seems to have stabilized due to the fact that the decrease in tobacco-related cancers compensates for the increase in other types of cancer like those of colon and prostate. In women, despite the stabilization of breast cancer incidence, increased incidence is due, above all, to the rise of colorectal and tobacco-related cancers. Conclusion. To reduce these incident cancer cases, improvement of smoking control policies and extension of colorectal cancer screening should be the two priorities in cancer prevention for the next years (AU)

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Pentoxifylline during steroid window phase at induction to remission increases apoptosis in childhood with acute lymphoblastic leukemia

Purpose: Pentoxifylline (PTX) has been shown to increase chemotherapy-induced apoptosis. A clinical trial was developed to evaluate the effect of the addition of PTX to the induction steroid window phase in children with acute lymphoblastic leukemia (ALL). Methods: Thirty-two children were enrolled on this study. Children with a new diagnosis of ALL were randomly assigned to receive prednisone (PRD) 40 mg/m2/day only during the 7-day treatment pre-phase (PRD group, 11 patients) or to receive PRD with PTX (10 mg/kg/day) (PTX group, 11 patients); the control group included children with normal bone marrow (10 patients). Bone marrow aspiration (BMA) was performed at diagnosis (day -7) in all groups, and at day 0 (end of PRD window) for patients with ALL (PRD and PTX groups). Apoptosis was evaluated by flow cytometry (FC) using Annexin V-fluorescein isothiocyanate (FITC)/propidium iodide (PI) stains. Statistical analysis was performed using the Mann–Whitney U test. Results: Apoptotic index at day -7 was similar in all groups. However, at day 0 post-treatment, apoptosis was significantly higher in the PTX group than in the PRD group (p < 0.001). There were no serious adverse effects associated with PTX. Conclusions: PTX potentiates blast apoptosis induced by PRD in children with ALL during steroid window phase (AU)

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Indicators for childhood asthma in Spain, using the Rand method

OBJECTIVE: To develop quality indicators to measure asthma care in primary health care. METHOD: A modified RAND was used, which included the systematic review of the literature in Embase, Cochrane and Pubmed Quality Agencies and Database. The work group identified the indicators, translated them into Spanish and resolved any duplicates. Each indicator is composed of several dimensions (access to care, clinical effectiveness, patient-centred quality and patient safety). A multidisciplinary panel of 98 professionals from all over Spain were invited to score each indicator using a Likert scale. After calculating the average and median of each indicator, this information was sent to those who responded (n = 38) for a second round and further scoring. The agreement percentage for the group was obtained for each indicator. RESULTS: Of the 105 asthma indicators reviewed, we selected 46 that were presented to the panel of experts. In both Delphi phases, 37.1% of the members of the initial panel of experts responded. Of these, 26 were primary care paediatricians, six were pulmonologists, three were nurses, two were pharmacists and one was an allergist. For 32 indicators, agreement exceeded 70% and seven of those scored highest for the various care aspects for asthmatic children. CONCLUSION: Quality indicators are presented for the follow-up of asthma and their implementation in primary care, which have undergone a strict selection and agreement process by a multidisciplinary work group

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Diabetes mellitus postrasplante según técnica de diálisis previa al trasplante / No disponible

La diabetes mellitus postrasplante (DMPT) es una de las complicaciones más importantes del paciente trasplantado renal, pues tiene importantes repercusiones sobre la supervivencia del injerto y del paciente. El diagnóstico de DMPT debe realizarse según los criterios de la American Diabetic Association. Estudios recientes demuestran la utilidad de realizar un test de tolerancia oral a la glucosa a todos los pacientes. Son muchos los factores de riesgo que favorecen la DMPT. Controlando los factores modificables (inmunosupresión, obesidad, infecciones…) se puede reducirla incidencia de DMPT. Según los datos del RMRC los pacientes en diálisis peritoneal son más jóvenes, pero presentan un mayor porcentaje de dislipemia y obesidad. Datos recientes sugieren que la inflamación subclínica, la adiponectina y la ghrelina pueden ser un importante factor patogénico en el desarrollo de la resistencia a la insulina y la diabetes mellitus. No existen evidencias claras de que la técnica de diálisis influya en el estado inflamatorio subclínico y las adipocitoquinas. Según datos del grupo español de estudio de la DMPT existe relación entre las concentraciones de ghrelina y el sexo en los pacientes de diálisis peritoneal. La complicación metabólica más frecuente de los pacientes en diálisis peritoneal es la hiperglicemia. La hiperglicemia pretrasplante favorece la aparición de DMPT. No existen evidencias claras en la literatura que demuestren que la técnica de diálisis sea un factor de riesgo para la aparición de DMPT. Son necesarios más estudios multicéntricos que analicen las características clínicas y biológicas del paciente renal y su relación con la DMPT (AU)

Post-transplant diabetes mellitus (PTDM) is one of the most important complications in kidney transplant patients because it has a significant impact on graft and patient survival. Diagnosis of PTDM should be based on the American Diabetic Association criteria. Recent studies show the value of performing an oral glucose tolerance test in all patients. Multiple risk factors promote PTDM. PTDM incidence may be reduced by controlling modifiable factors (immune suppression, obesity, infections…). According to RMRC data, patients on peritoneal dialysis are younger, but have a greater incidence rate of dyslipidemia and obesity. Recent data suggest that subclinical information, adiponectin, and ghrelin may be a significant pathogenetic factor in development of insulin resistance and diabetes mellitus. There is no clear evidence that the dialysis procedure influences the subclinical inflammatory state and adipocytokines. According to data from the Spanish group for the study of PTDM, a relationship exists between ghrelin levels and sex in patients on peritoneal dialysis. The most common metabolic complication in patients on peritoneal dialysis is hyperglycemia. Pre-transplant hyperglycemia promotes the occurrence of PTDM. There is no clear evidence in the literature showing that the dialysis procedure is a risk factor for the occurrence of PTDM. Additional multicenter studies are required to analyze the clinical and biological characteristics of renal patients and their relationship to PTDM (AU)

Tratamiento profiláctico y anticipado de la infección por citomegalovirus en pacientes trasplantados renales mediante vanglanciclovir oral / Prophylactic and pre-emptive therapy for cytomegalovirus infection in kidney transplant patients using oral valganciclovir

Antecedentes: La enfermedad por citomegalovirus (CMV) es un problema sanitario muy importante en receptores de trasplante de órgano sólido (TOS). Una dosis diaria de valganciclovirha demostrado ser tan clínicamente efectiva y bien tolerada como ganciclovir oral dos veces al día en la prevención de la infección por CMV en los receptores de TOS de alto riesgo. Métodos: El objetivo del presente estudio fue evaluar la incidencia y severidad de la enfermedad por CMV en 150 receptores de trasplante renal que recibieron tratamiento profiláctico(grupo de alto riesgo, N = 66) o anticipado (grupo de bajo riesgo, N = 84) con valganciclovir oral (900 mg/día)durante tres meses según el riesgo basal de sufrir la misma. Se hizo un seguimiento de los síntomas clínicos de la enfermedad por CMV en los pacientes y la carga viral de CMV en plasma fue monitorizada semanalmente. Resultados: Un total de 31 pacientes (47%) del grupo de alto riesgo y 26 pacientes (31%) del grupo de riesgo estándar presentaron un resultado de PCR-CMV positivo. Doce pacientes (14,3%) del grupo de riesgo estándard que presentaron una elevada carga viral (PCR-CMV > 1.000 copias/mL) pero que permanecieron asintomáticos recibieron tratamiento anticipado. Cuatro pacientes (4,7%) del grupo de alto riesgo, en un tiempo medio de 35 días después del trasplante y dos pacientes (4,5%) del grupo de alto riesgo, tras completar el tratamiento profiláctico, desarrollaron la enfermedad por CMV, que fue de intensidad media a moderada en la mayoría de los casos. Aquellos pacientes que desarrollaron la enfermedad respondieron al tratamiento con ganciclovir ev durante 14 días seguido de valganciclovir oral hasta tres meses. Conclusión: El tratamiento profiláctico con valgancicloviroral para la prevención de CMV sólo es requerida en receptores de TOS de alto riesgo (AU)

Prophylactic and pre-emptive therapy with oral valganciclovir for cytomegalovirus infection in renal transplant recipients. Background: Cytomegalovirus infection is a very important health problem in solid organ transplant recipients (SOT). Once daily valganciclovir has been shown to be as clinically effective and well tolerated as oral ganciclovir tid in the prevention of CMV infection in high risk SOT recipients. Methods: The aim of the present study was to evaluate the incidence and severity of CMV disease in 150 renal transplant recipients that received either prophylactic [high risk group (HR), N =66] or pre-emptive [low risk group (LR), N = 84] therapy with oral valganciclovir (900 mg/day vo) for three months according to their basal risk. Patients were monitored for signs and symptoms of CMV disease and CMV plasma viral load was assessed weekly. Results: A total of 31 patients (47%) of the HR and 26 patients(31%) of the LR presented a positive CMV PCR result. Twelve patients(14.3%) in the LR that had a high viral load (CMV PCR >1,000 copies/mL) but remained asymptomatic received pre-emptive therapy. Four patients (4.7%) in the LR, after an average time of 35 days after transplant and two patients (4.5%) in the HR, after prophylactic treatment was completed, developed CMV disease. The disease was mild-moderate in most of the cases. Those patients that developed CMV disease responded to treatment with iv ganciclovir for 14 days followed by treatment with oral valganciclovir for up to three months. Conclusion: Prophylactic treatment with oral valganciclovir for CMV prevention is only required in high risk solid organ transplant recipients (AU)

Embarazo en receptoras de trasplante renal: efectos en la madre y en el niño / Pregnancy in recipients of kidney transplantation: effects on the mother and the child

El embarazo se contraindicaba en los inicios del trasplanterenal, pero actualmente la gestación es una parte más de los beneficios que aporta el mismo. El objetivo del estudio es analizar la viabilidad del embarazo post-trasplanterenal y sus consecuencias a nivel de la paciente, el injertorenal y el neonato. Se revisaron diez pacientes trasplantadas renales embarazadas con una edad media de 29 años y un tiempo medio post-trasplante de 44 meses. El filtrado glomerular estimado medio fue de 64 ml/min y la inmunosupresión fue con corticoides y tacrolimus. Se analizó la evolución de diferentes variables durante los meses de gestación y después del parto, inherentes a la madre, al injerto renal y al recién nacido. El embarazo llegó a término en nueve de las diez pacientes, seis por vía vaginal y tres con cesárea, con solo un aborto espontáneo en el primer trimestre. La presión arterial aumentó al final del embarazo y la creatinina se mantuvo estable durante los nueve meses con un incremento de la proteinuria a partir del tercer trimestre del embarazo. La dosis de tacrolimus se tuvo que aumentar en el tercer trimestre del embarazo para conseguir los niveles deseados y no se detectó ningún rechazo agudo durante el seguimiento, apareciendo como única complicación una pre-eclampsia que se resolvió con una cesárea. El parto tuvo lugar a las 37,2 semanas demedia y los recién nacidos presentaron un peso medio de2.809 g, destacando dos recién nacidos afectos de prematuridad/bajo peso al nacer sin surgir ninguna complicación de interés en los neonatos. El embarazo post- trasplante renal es seguro con una pauta inmunosupresora basada en esteroides y tacrolimus, con buenos resultados cuando antes del embarazo la función renal es correcta, no hay proteinuria y la presión arterial está controlada (AU)

When the field of transplantation was first developing, physicians worried about the teratogenicity of immunosuppressive medications and considered pregnancy ill-advised. The purpose of this study is to analyze pregnancy after kidney transplantation and their consequences on mother, graft and child. We rewiewten pregnant women with kidney transplantation, average of 29years old and 44 months post-kidney transplantation. The meanglomerular filtration rate was 64 ml/min and the immune suppression was with prednisone and tacrolimus. We analyze outcomes of differents variables before and during pregnancy, and after labour. Pregnancy finished in nine of ten patients. Three patients needed cesarean section and only one patient had a miscarriage on the first term. Blood arterial pressure increased at the end of pregnancy and the creatinine level was stable with a few increase of proteinuria at the third term. We increased the tacrolimus dose to obtain the correct blood levels and any rejection was detected. We had only one patient with preeclampsia that we solved with a cesarean section. Labours were a mean of37.2 weeks and the mean birth weight of infant was 2,809 g. Two newborns had prematurity without structural malformations. Pregnancy after kidney transplantation is safe with prednisone and tacrolimus when the renal function is good, proteinuria doesn’t exist and blood pressure is controlled (AU)

Primoinfección por citomegalovirus en forma de meningoencefalitis aguda en un paciente joven inmunocompetente / Cytomegalovirus primoinfection in form of acute meningoencephalitis in a young immunocompetent male patient

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IL-1beta induces VEGF, independently of PGE2 induction, mainly through the PI3-K/mTOR pathway in renal mesangial cells.

Vascular endothelial growth factor (VEGF) could play a relevant role in angiogenesis associated with chronic allograft nephropathy. Interleukin-1beta (IL-1beta) has a key role in inflammatory response. It induces prostaglandin (PG) E2, which is involved in VEGF release by some normal and tumor cells. In the present work, we studied the effect of IL-1beta on VEGF release by rat mesangial cells, the transduction signal, and whether or not PGE2 is involved in this effect. IL-1beta induced a time-dependent formation of VEGF (analyzed by enzyme-linked immunosorbent assay) and PGE2 (analyzed by enzyme immunoassay). The latter correlated with microsomal-PGE-synthase (mPGES)-1 expression rather than with cyclooxygenase (COX)-2 in terms of protein, determined by Western blotting. No effect of IL-1beta on COX-1, cytosolic PGES, or mPGES-2 expression was observed. Indomethacin exerted a nonsignificant effect on IL-1beta-induced VEGF, and exogenously added PGE2 exhibited a nonsignificant stimulatory effect on VEGF formation. SB 203580, a p38 mitogen-activated protein kinase inhibitor, weakly inhibited the induction of VEGF by IL-1beta in a concentration-dependent manner, whereas LY 294002, a phosphoinoside 3-kinase (PI3-K) inhibitor, and rapamycin, a mammalian target of rapamycin (mTOR) inhibitor, strongly inhibited both IL-1beta- and tumor necrosis factor-alpha-induced VEGF formation in a concentration-dependent manner. Rapamycin also decreased glomerular VEGF levels in the anti-Thy1.1 model of experimental glomerulonephritis. In conclusion, the PI3-K-mTOR pathway seems to be essential in cytokine-induced release of VEGF in mesangial cells.

Neuropatía de nervio ciático común secundaria a síndrome compartimental como complicación de cirugía bariátrica / Neuropathy of common sciatic nerve secondary to compartment syndrome as a complication after bariatric surgery

Introducción. Al tratarse la cirugía bariátrica de pacientes muy obesos e intervenciones prolongadas se ha descrito de forma aislada la presentación de un síndrome compartimental por compresión y rabdomiólisis secundaria. Presentamos un caso que presentó un síndrome compartimental, rabdomiólisis y neuropatía del nervio ciático común. Caso clínico. Varón de 39 años con obesidad mórbida e hipertensión arterial que tras ser sometido a intervención de cirugía bariátrica de 5 h de duración presentó dolor intenso, empastamiento en muslo y paresia en musculatura dependiente del nervio ciático común izquierdo. Se objetivó creatincinasa (CK) de 78.000 UI y en la tomografía computarizada inicial aumento del volumen del compartimento glúteo izquierdo que evolucionó, en control a los 10 meses, hacia atrofia glútea y en isquiotibiales. La evolución fue negativa, sin recuperación funcional y mal control del dolor. El paciente presentó un síndrome compartimental y rabdomiólisis desencadenados por la presión sobre la zona glútea de la mesa operatoria. La duración prolongada de la cirugía, la obesidad y la afectación microvascular por la hipertensión podrían ser factores implicados en el desarrollo del cuadro. La afectación del nervio ciático, no descrita como complicación de este tipo de cirugía, se explica por la presión ejercida por el cuadro compartimental sobre el nervio, con isquemia secundaria. Conclusiones. La determinación precoz de CK, realización de cambios posturales durante la intervención y una exploración neuromuscular postoperatoria precoz buscando signos de síndrome compartimental se deberían realizar de forma sistemática tras la cirugía bariátrica. La realización de una fasciotomía descompresiva precoz ante un síndrome compartimental podría reducir o evitar complicaciones neurológicas

Introduction. With regards to the use of bariatric surgery on very obese patients and prolonged interventions, isolated cases of a compartment syndrome by compression and secondary rhabdomyolysis have been described. We describe a case which presented with a compartment syndrome, rhabdomyolysis and neuropathy of the common sciatic nerve. Clinical case. A 39 year old male with morbid obesity and high blood pressure, who after being subjected to 5 hours long bariatric surgical intervention, presented with intense pain, muscle binding and paresis in the musculature dependent on left common sciatic nerve. A creatinkinase (CK) level of 78,000 IU and volume increase of the left gluteal compartment were noted. On serial computarized tomography scans this increased leading to gluteal atrophy and ischiotibials. Evolution was negative without functional recovery and poor pain control. The patient presented with a compartment syndrome and secondary rhabdomyolysis triggered by the pressure on the gluteal zone on the operating table. The prolonged duration of the surgery, obesity and microvascular affectation due to hypertension, could be factors implicated in the development of the syndrome. The affectation of the sciatic nerve, not described as a complication of this type of surgery, is explained by pressure exercised on the compartment block on the sciatic nerve, with secondary ischaemia. Conclusions. Early determination of CK, carrying out postural changes during surgery and early post-operative neuromuscular examination, looking for signs of compartment syndrome, should be systematically carried out after bariatric surgery. The early carrying out of a decompressive fasciotomy considering a compartment syndrome could reduce or avoid the neurological complications

Pseudomasa renal izquierda infrecuente: ectopia esplénica / Rare left kidney pseudomass: splenic ectopy

La presencia de tejido esplénico ectópico es una realidad clínica infrecuente, de carácter habitualmente asintomático y generalmente hallazgo incidental. El interés desde el punto de vista urológico subyace en la posibilidad de simular tumoraciones suprarrenales, renales y retroperitoneales izquierdas, así como masas intrapélvicas, inguinales y gonadales. Presentamos una paciente de 42 años con el diagnóstico de sospecha de seudotumor en polo superior de riñón izquierdo finalmente filiado como bazo ectópico. Revisamos aspectos etiopatogénicos, diagnósticos y terapéuticos en la literatura. Destacamos la oportunidad de incluir el tejido esplénico ectópico en el diagnóstico diferencial de las masas renales, suprarrenales y retroperitoneales izquierdas. Resaltamos la utilidad de los estudios de imagen como la T.A.C. y la R.N.M.; otorgando un papel complementario de elección a la gammagrafía hepatoesplénica. De igual modo, abogamos por una actitud abstencionista en casos seleccionados de bazo ectópico extrapélvico, asintomático y bajo confirmación diagnóstica, difiriendo la oportunidad de esplenectomía de presentarse clínica asociada o experimentar hipertensión portal (AU)

Efectos electrocardiograficos del Cavinton. / Electrocardiographic effects of Cavinton

En una muestra de diez pacientes se investigo los efectos de una nueva droga vasodilatadora sobre la presion arterial, frecuencia cardiaca, asi como su efecto sobre los intervalos PR, QTc y el complejo QRS.Esta droga redujo la presion arterial, la frecuencia cardiaca y prolongo los intervalos RR y QTc del electrocardiograma