Caracterización clínica de insuficiencia cardiaca en pacientes internados en el Instituto Nacional de Cardiología, Paraguay

Introducción: la insuficiencia cardiaca es una de las enfermedades cardiovasculares más prevalentes en la población general y el estadio obligatorio de todas las patologías cardiovasculares, la cual irá en aumento a medida que crezca la expectativa de vida de la población. Objetivo: determinar las características de pacientes con insuficiencia cardiaca internados en el Instituto Nacional de Cardiología de Paraguay, durante un periodo de tres meses del año 2020. Metodología: estudio descriptivo de una muestra de 140 pacientes con diagnóstico de insuficiencia cardiaca. Los criterios para establecer este diagnóstico fueron clínicos y/o ecocardiográficos. Resultados: la media de edad fue 66 años, 57% del sexo masculino. El 88% de los pacientes presentaron hipertensión arterial. La etiología más frecuente fue la isquémica (26%), la mayoría consultó en clase funcional III y presentó fracción de eyección reducida, calculándose una prevalencia institucional 7,2%. Conclusión: el perfil del paciente con diagnóstico de insuficiencia cardiaca que consulta en este servicio es de un hombre de aproximadamente 66 años en clase funcional III, con fracción de eyección reducida y de etiología isquémica, cuyas patologías de base son hipertensión arterial y diabetes mellitus.

Introduction: Heart failure is one of the most prevalent cardiovascular diseases in the general population and the mandatory stage of all cardiovascular pathologies, which will increase as the life expectancy of the population grows. Objective: To determine the characteristics of patients with heart failure hospitalized at the National Institute of Cardiology of Paraguay, during a period of three months of the year 2020. Methodology: Descriptive study of a sample of 140 patients diagnosed with heart failure. The criteria to establish this diagnosis were clinical and/or echocardiographic. Results: The average age was 66 years, 57% male, and 88% of the patients had arterial hypertension. The most frequent etiology was ischemic (26%), the majority consulted in functional class III and presented reduced ejection fraction, calculating an institutional prevalence of 7.2%. Conclusion: The profile of the patient with a diagnosis of heart failure who consults in this service is that of a man of approximately 66 years old, in functional class III, with reduced ejection fraction and ischemic etiology, whose underlying pathologies are arterial hypertension and diabetes mellitus.

Protective effect of aspirin treatment on mouse behavior in the acute phase of experimental infection with Trypanosoma cruzi.

Chagas disease is a potentially fatal disease caused by the parasite Trypanosoma cruzi, which can in some cases affect the central nervous system. The objective was to evaluate the effect of aspirin (ASA) in the behavior of mice infected with T. cruzi during the acute phase. This was an experimental study with random assignation. Twenty four BALB/c mice were divided into four groups of six animals each as follows: only ASA (OA), ASA before infection (BI), ASA after infection (AI) and only infection (OI). The strain used for infection was M/HOM/Bra/53/Y. An ASA dose of 100 mg/kg per day was administered 72 h before infection to BI group and the same dose 48 h after infection to AI group. Mice behavior in the open field test, mortality, and brain histopathology was evaluated. Data were analyzed using ANOVA, chi square test, and Kaplan-Meier with long-rank for survival analysis. In the open field test, the OA group has similar results with the BI group, in the variables of immobility and escape. Also, the OA group displayed significantly higher rates of micturition (p < 0.001) and defecation (p < 0.001) compared to infected groups. Mortality was higher in BI group (p = 0.02). The presence of T. cruzi amastigotes were higher in brain tissues of the AI and OI groups (p = 0.008). In conclusion, the administration of ASA before infection seemed to prevent behavioral changes induced by the acute infection, but it led to accelerated mortality. The study highlighted the potential importance of the pathways inhibited by ASA in the early hours of acute infection with T. cruzi.

[Acute toxicity of Xanthium spinosum leaves in BALB/C mice]. / Toxicidad aguda de las hojas de Xanthium spinosum en ratones BALB/C.

The leaves of the Xanthium spinosum plant have been used culturally in Paraguay for their medicinal properties. Acute toxicity of mature leaf extract was evaluated. For the study, 35 Balb/c mice were selected and allocated into 7 groups, 6 test groups and 1 control group. The extract was prepared in concentrations of 6% and 9% (g/dL). The 6% concentration was administrated to 3 test groups and 9% concentration to the remaining 3 groups, with doses between 200 and 1000 mg/kg per mouse. After 14 days of observation, blood samples were taken for laboratory studies of urea and transaminases and organs were examined for pathological studies. There were increased levels of GOT and urea in the test groups compared to the control group. In conclusion, the consumption of mature leaf extract of Xanthium spinosum can cause hepatic damage.

Toxicidad aguda de las hojas de Xanthium spinosum en ratones BALB/C / Acute toxicity of Xanthium spinosum leaves in BALB/C mice

Las hojas de la planta Xanthium spinosum se utilizan culturalmente en Paraguay por sus propiedades medicinales. Se evaluó la toxicidad aguda del extracto de hojas maduras; para el estudio se seleccionaron 35 ratones BALB/C machos que fueron distribuidos en 7 grupos, 6 de ensayo y 1 de control. El extracto fue preparado en concentraciones de 6 y 9% (g/dL); se administró la solución 6% a tres grupos y la solución 9% a los otros tres grupos, con dosis entre 200 y 1000 mg/kg. Al final de 14 días de observación, se extrajeron muestras de sangre para estudios laboratoriales de urea y transaminasas, además de órganos para estudios anatomopatológicos. Se determinaron aumentos en los niveles de GOT y urea en comparación al grupo control. Se concluye que el consumo del extracto de hojas maduras de Xanthium spinosum puede causar daño hepático...

The leaves of the Xanthium spinosum plant have been used culturally in Paraguay for their medicinal properties. Acute toxicity of mature leaf extract was evaluated. For the study, 35 Balb/c mice were selected and allocated into 7 groups, 6 test groups and 1 control group. The extract was prepared in concentrations of 6% and 9% (g/dL). The 6% concentration was administrated to 3 test groups and 9% concentration to the remaining 3 groups, with doses between 200 and 1000 mg/kg per mouse. After 14 days of observation, blood samples were taken for laboratory studies of urea and transaminases and organs were examined for pathological studies. There were increased levels of GOT and urea in the test groups compared to the control group. In conclusion, the consumption of mature leaf extract of Xanthium spinosum can cause hepatic damage...

Identification of a new amide-containing thiazole as a drug candidate for treatment of Chagas' disease.

Although the parasitic infection Chagas' disease was described over 100 years ago, even now there are not suitable drugs. The available drugs nifurtimox and benznidazole have limited efficacies and tolerances, with proven mutagenic effects. Attempting to find appropriate drugs to deal with this problem, here we report on the development and pharmacological characterization of new amide-containing thiazoles. In the present study, we evaluated the in vitro and in vivo effects of new candidates against Trypanosoma cruzi, the etiological agent of Chagas' disease. The lead amide-containing thiazole derivative had potent in vitro activity, an absence of both in vitro mutagenic and in vivo clastogenic effects, and excellent in vitro selectivity and in vivo tolerance. The compound suppressed parasitemia in mice, modifying the anti-T. cruzi antibodies like the reference drug, benznidazole, and displayed the lowest mortality among the tested drugs. The present evidence suggests that this compound is a promising anti-T. cruzi agent surpassing the lead optimization stage in drug development and leading to a candidate for preclinical study.

Leucemia mieloide aguda con t(8; 21)(q22; q22): reporte de casos / Acute myeloid leukaemia with t(8; 21)(q22; q22): case report

La leucemia mieloide aguda es una neoplasia hematopoyética caracterizada por la proliferación clonal de blastos inmaduros en médulas ósea interfiriendo con sus funciones normales. Tiene una supervivencia aproximada de 35% afectando principalmente a adultos mayores de 60 años y niños menores de un año y preferentemente al sexo masculino. Un hallazgo frecuente es la presencia de la translocación cromosómica t (8; 21) (q22; q22) que involucra a los genes RUNX1 y RUNX1T1. La detección de esta alteración tiene implicancia diagnóstica y pronóstica de la enfermedad. El objetivo de este trabajo es describir y reportar dos casos de leucemia mieloide aguda en pacientes masculinos de 14 y 24 años que presentaron clínica, laboratorio y morfología típicos de la enfermedad pero con edad de aparición no habitual, enfatizando además, el pronóstico bueno desde el punto de vista citogenético de esta translocación en ambos casos.

Acute myeloid leukemia is a haematopoietic neoplasia characterized by clonal proliferation of immature blasts in bone marrow, interfering with its normal functions. Overall survival is about 35% affecting mainly male adults over 60 years old and infants under one year old. Genetic translocation t(8;21)(q22;q22) is a recurrent finding and involves RUNX1 and RUNX1T1 genes. The detection of this genetic translocation is relevant to the diagnosis and prognosis of the disease. The objective of this work is to report two cases of acute myeloid leukaemia in 14 and 24 years old male patients with typical clinical, laboratorial and morphological findings but with unusual appearing ages, emphasizing the good prognosis from the genetic point of view of this translocation in both cases.

Expresión de la proteína p53 en esófago de Barrett y adenocarcinomaesofágico: experiencia del Departamento de Patología, IICS / Expression of p53 protein in Barret’s esophagus and esophageal cancer: experience of the Department of Pathology, IICS

El esófago de Barrett constituye el cambio del epitelio escamoso a columnar (metaplasia) secundaria al reflujo gastro-esofágico. El significado clínico es la predisposición a úlceras, sangrado y desarrollo de adenocarcinoma. Se desconoce el periodo necesario para el desarrollo de displasia y la transición a carcinoma, lo que hace necesario contar con indicadores de la progresión neoplásica o de transformación maligna. La proteína p53 participa del control del ciclo celular, síntesis y reparación del ADN y muerte celular programada. Numerosos trabajos describen la acumulación de la proteína p53 en lesiones displásicas de esófago sugiriendo que esta alteración participaría en la tumorgénesis esofágica. Este trabajo tiene como objetivo determinar, la expresión de p53, por inmunohistoquímica en 58 biopsias de esófago de las cuales, 42 correspondieron a esófago de Barrett y 16 a adenocarcinoma esofágico describiendo la frecuencia de expresión de p53, asi como las características clínicas, endoscópicas e histológicas de las lesiones. La expresión de p53 fue positivo en 15/42 (36%) casos de esófago de Barrett, la frecuencia fue mayor en los que presentaban esofagitis y en los casos con displasia que en los que no presentaban estas características. Por otro lado, p53 fue positivo en 9/16 (56%) de los adenocarcinomas. El estudio por inmunohistoquímica de p53 en estas dos entidades podría utilizarse como un indicador que contribuya al mejor manejo de la enfermedad en estos pacientes.

Barrett's esophagus is the change of the squamous epithelium to columnar (metaplasia) secondary to gastro-oesophageal reflux.The clinical significance is a predisposition to ulcers, bleeding and development of adenocarcinoma.It is not known the time needed for the development of dysplasia and the transition to carcinoma, which makes necessary to have indicators of neoplastic progression or malignant transformation. p53 protein participates in cell cycle control, DNA synthesis and repair and programmed cell death. Numerous papers describe the accumulation of p53 protein in esophageal dysplastic lesions, suggesting that this alteration would participate in esophageal tumorigenesis. The objective of this work was to determine the expression of p53 by immunohistochemistry in 58 esophageal biopsies of which 42 corresponded to Barret’s esophagus and esophageal and 16 to esophageal adenocarcinoma, describing the frequency of expression of p53, as well as the clinical, endoscopic and histological characteristics of the lesions. p53 expression was positive in 15/42 (36%) cases of Barrett's esophagus; the frequency was higher in those with esophagitis and in patients with dysplasia than in those without these characteristics. On the other hand, p53 was positive in 9/16 (56%) of adenocarcinomas. The study of p53 in these two entities could be used as an indicator that contributes to a better management of the disease in these patients.

Prevalencia del síndrome de Burnout en médicos anestesiólogos del Paraguay durante el año 2010 / Prevalence of Burnout syndrome in anesthesiologists of Paraguay during 2010

El síndrome de Burnout constituye un tipo de estrés laboral que se observa en profesionales de la salud que mantienen contacto directo y constante con otras personas. Para determinar su prevalencia en los médicos anestesiólogos del Paraguay, durante el 2010, se realizó un estudio observacional, descriptivo y de corte transverso en 146 médicos anestesiólogos del Paraguay mediante el cuestionario Maslash Burnout Inventory que evalúa las dimensiones del síndrome. Se identificó una prevalencia global de síndrome de Burnout de 72,6%. En el grupo de médicos residentes la prevalencia fue 88,6% (x2= 8,14 P<0,005). El cansancio emocional fue la dimensión más frecuente 60,9%. Los menores de 35 años padecieron el síndrome en mayor número 83,1% (x2= 8,14 P<0,005). Tener una pareja estable se identificó como un factor de protección (x2= 3,77 P<0,05). No se identificó relación significativa con el sexo y lugares de trabajo (medicina pública y privada). La prevalencia hallada fue alta en comparación a otros estudios. Ser médico residente, menor de 35 años, no tener una pareja estable y con sobrecarga de trabajo son los factores más frecuentes encontrados en el Síndrome de Burnout en los anestesiólogos del Paraguay.

Burnout Syndrome is a type of occupational stress observed health professionals who keep direct and constant contact with other persons. To determine its prevalence in anesthesiologist in 2010, this cross-sectional descriptive study was carried out in 146 Paraguayan anesthesiologist using the Maslash Burnout Inventory. This instrument evaluates the dimensions of the syndrome. A global prevalence of BS 72.6% was found. In the group of resident physician we found a prevalence of 88.6% (x2= 8.14 P<0.005). The most frequent dimension was the emotional exhaustion (60.9%). The syndrome was more frequent in the anesthesiologsts under 35 years of age (83.1%; x2= 8.14 P<0.005). Having a stable partner was identified as a protective factor (x2= 3.77 P<0.05). No significant relation was found with sex and working places (public and private medicine). The prevalence of BS found was high in comparison to other studies. Being a resident physician, under 35 year old, not having a stable partner and overload of work are the factors most frequently found in the Burnout Syndrome in Paraguayan anesthesiologysts.