Hemorragia del tracto digestivo superior, enfoque para el médico general / Upper digestive tract bleeding, approach for the general Practitioner / Hemorragia do trato digestivo superior, enfoque para o médico geral

La hemorragia del tracto digestivo superior (HTDS) es el sangrado originado por encima del ángulo de Treitz. A pesar del aumento en las estrategias de prevención, del incremento en los tratamientos con Inhibidor de bomba de protones (IBP) y de la intervención endoscópica temprana, esta patología sigue siendo una causa frecuente de consulta a urgencias, con una morbimortalidad no despreciable y alta carga para el sistema de salud. Esta revisión se enfoca en la HTDS de causa diferente a las varices. La principal causante de esta entidad es la enfermedad ácido-péptica, que es consecuencia del gran consumo de antiinflamatorios no esteroideos (AINES) y de la infección por Helicobacter Pylori. Otras causas son el síndrome de Mallory Weiss, la esofagitis erosiva, las malformaciones arteriovenosas y la malignidad.

Upper gastrointestinal bleeding (UGIB) refers to any bleeding originating above the angle of Treitz. Despite an increase in prevention strategies, proton pump inhibitor (PPI) therapy and early endoscopic intervention, this pathology continues to be an important cause of admission to the emergency department for gastrointestinal causes, having a pretty high morbidity and mortality in addition to a high burden on the health system. This review focuses on non-variceal UGIB. The main cause of this entity being peptic acid disease, due to great consumption of NSAIDs and Helicobacter Pylori infection. Other causes are Mallory Weiss syndrome, erosive esophagitis, arteriovenous malformations, and malignancy.

A hemorragia do trato digestivo superior (HTDS) é o sangrado originado acima do ângulo de Treitz. Apesar do aumento nas estratégias de prevenção, do incremento nos tratamentos com Inibidor da bomba de prótons (IBP) e da intervenção endoscópica precoce, esta patologia segue sendo uma causa frequente de consulta a urgências, com uma morbimortalidade não depreciável e alta carga para o sistema de saúde. Esta revisão se enfoca na HTDS de causa diferente às varizes. A principal causante desta entidade é a doença ácido-péptica, que é consequência do grande consumo de anti-inflamatórios não esteróideos (AINES) e da infecção por HelicobacterPylori. Outras causas são a síndrome de Mallory Weiss, a esofagites erosiva, as malformações arteriovenosas e a malignidade. Palavras-chave: hemorragia gastrointestinal; úlcera péptica; endoscopia gastrointestinal; inibidores da bomba de prótons; medicina geral.

Prevalence of pulmonary hypertension in COPD patients living at high altitude.

BACKGROUND: Pulmonary hypertension (PH) is associated with poor prognosis for patients with chronic obstructive pulmonary disease (COPD). Most of the knowledge about PH in COPD has been generated at sea level, with limited information associated with high altitude (HA). OBJECTIVES: To assess the prevalence and severity of PH in COPD patients living in a HA city (2,640 m). METHODS: Cross-sectional study in COPD patients with forced expiratory volume in the first second / forced vital capacity ratio (FEV1/FVC) post-bronchodilator <0,7. Transthoracic echocardiography (TTE), spirometry, carbon monoxide diffusing capacity, and arterial blood gasses tests were performed. Patients were classified according to the severity of airflow limitation. PH was defined by TTE as an estimated systolic pulmonary artery pressure (sPAP) > 36 mmHg or indirect PH signs; severe PH as sPAP > 60 mmHg; and disproportionate PH as an sPAP > 60 mmHg with non-severe airflow limitation (FEV1 > 50% predicted). RESULTS: We included 176 COPD patients. The overall estimated prevalence of PH was 56.3% and the likelihood of having PH increased according to airflow-limitation severity: mild (31.6%), moderate (54.9%), severe (59.6%) and very severe (77.8%) (p = 0.038). The PH was severe in 7.3% and disproportionate in 3.4% of patients. CONCLUSIONS: The estimated prevalence of PH in patients with COPD at HA is high, particularly in patients with mild to moderate airflow limitation, and greater than that described for COPD patients at low altitude. These results suggest a higher risk of developing PH for COPD patients living at HA compared to COPD patients with similar airflow limitation living at low altitude.

Development of the materials analysis and particle probe for Proto-MPEX.

The Prototype Material Plasma Exposure eXperiment (Proto-MPEX) is a linear plasma device being used in plasma source research and development (R&D) for the proposed MPEX. Once the R&D is completed, this device can also be used to perform plasma-material interaction studies. To perform these studies, a new materials analysis and particle probe (MAPP) has been constructed. The MAPP's components are a sample holder and manipulator and a custom vacuum chamber with ports to facilitate surface chemistry diagnostics. The MAPP's overall design enables rapid sample turnaround and in vacuo surface characterization. The surface analysis vacuum chamber has ports for x-ray photoelectron spectroscopy, thermal desorption spectroscopy, back-scatter ion scattering spectroscopy, forward-scatter ion scattering spectroscopy, and direct recoil spectroscopy. The sample manipulator and holder is a Lesker/UHV Multi-Centre Analytical Stage, which is used to place the samples in the exposure region of the Proto-MPEX or the analysis position in the MAPP vacuum chamber. The sample holder has a heating capability of up to 1200 °C for heated exposure and for desorption studies. In this work, we present the MAPP's design and the first tungsten sample exposure with ex situ analysis that shows a surface deposition layer on the exposed target, highlighting the need for additional in situ measurements on the Proto-MPEX.

A genome-wide association study identifies novel gene associations with facial skin wrinkling and mole count in Latin Americans.

BACKGROUND: Genome-wide association studies (GWASs) have identified genes influencing skin ageing and mole count in Europeans, but little is known about the relevance of these (or other genes) in non-Europeans. OBJECTIVES: To conduct a GWAS for facial skin ageing and mole count in adults < 40 years old, of mixed European, Native American and African ancestry, recruited in Latin America. METHODS: Skin ageing and mole count scores were obtained from facial photographs of over 6000 individuals. After quality control checks, three wrinkling traits and mole count were retained for genetic analyses. DNA samples were genotyped with Illumina's HumanOmniExpress chip. Association testing was performed on around 8 703 729 single-nucleotide polymorphisms (SNPs) across the autosomal genome. RESULTS: Genome-wide significant association was observed at four genome regions: two were associated with wrinkling (in 1p13·3 and 21q21·2), one with mole count (in 1q32·3) and one with both wrinkling and mole count (in 5p13·2). Associated SNPs in 5p13·2 and in 1p13·3 are intronic within SLC45A2 and VAV3, respectively, while SNPs in 1q32·3 are near the SLC30A1 gene, and those in 21q21·2 occur in a gene desert. Analyses of SNPs in IRF4 and MC1R are consistent with a role of these genes in skin ageing. CONCLUSIONS: We replicate the association of wrinkling with variants in SLC45A2, IRF4 and MC1R reported in Europeans. We identify VAV3 and SLC30A1 as two novel candidate genes impacting on wrinkling and mole count, respectively. We provide the first evidence that SLC45A2 influences mole count, in addition to variants in this gene affecting melanoma risk in Europeans.

Quantitative bone SPECT analysis of mandibular condyles in an asymptomatic population: an approach to normal reference values.

Bone scintigraphy is an extremely valuable technique in diagnosis and treatment planning for patients with condylar hyperplasia (CH). The main objective of this study was to develop an approach to determine normal activity values in the mandibular condyles, adjusted to age and sex, through quantitative analysis of bone single-photon emission computed tomography (SPECT) on a condyle-by-condyle basis and to compare these values with those of a control group comprising patients with confirmed CH. Technetium 99 m-methylene diphosphonate (99mTc-MDP) SPECT studies of the mandibular condyles were performed in patients with no mandibular pathology for quantitative analysis. Regions of interest were drawn on slices representing the upper, middle, and inferior thirds of each condyle and on the summation of transaxial slices representing the whole condyle (three-dimensional approach). The clivus was used for internal validation and the condyle to clivus ratios were calculated. These ratios were compared between 'normal' and 'diseased' condyles. A total 144 condyles in normal patients and 25 in confirmed CH patients were analysed. Differences between the ratios were evaluated through the coefficient of variation. In normal patients, the ratios to the clivus on the summed condyle image showed the lowest variability: range 0.3-1.28 (median 0.74). The quantile regression model showed significant differences with respect to sex, but not to age. The Mann-Whitney test showed significant differences in the ratios to clivus between normal and diseased condyles (P<0.0001).

Neogene precipitation, vegetation, and elevation history of the Central Andean Plateau.

Andean uplift played a fundamental role in shaping South American climate and species distribution, but the relationship between the rise of the Andes, plant composition, and local climatic evolution is poorly known. We investigated the fossil record (pollen, leaves, and wood) from the Neogene of the Central Andean Plateau and documented the earliest evidence of a puna-like ecosystem in the Pliocene and a montane ecosystem without modern analogs in the Miocene. In contrast to regional climate model simulations, our climate inferences based on fossil data suggest wetter than modern precipitation conditions during the Pliocene, when the area was near modern elevations, and even wetter conditions during the Miocene, when the cordillera was around ~1700 meters above sea level. Our empirical data highlight the importance of the plant fossil record in studying past, present, and future climates and underscore the dynamic nature of high elevation ecosystems.

Equilibrio, cinética y termodinámica de la adsorción del colorante DB-86 sobre carbón activado de la cáscara de yuca / Equilibrium, kinetic and thermodynamic of direct blue 86 dye adsorption on activated carbon obtained from manioc husk

RESUMEN Objetivo. Establecer mediante experimentos por lote la capacidad de remoción, la cinética y termodinámica de adsorción del carbón activado preparado a partir de la cáscara de yuca (Manihot esculenta) en la remoción del colorante azul directo 86. Materiales y métodos. La metodología experimental consistió inicialmente en la preparación del carbón activado por activación química de la cáscara de yuca con H3PO4 y su posterior calcinación a 530°C. En la caracterización se determinaron las propiedades de textura mediante el índice de yodo e índice de azul de metileno, se cuantificaron los grupos funcionales orgánicos ácidos y básicos con el método Boehm, y se realizó el análisis próximo siguiendo las normas ASTM D-2867-70, ASTM D2866 y ASTM D2866-94. En el estudio por lote, el efecto de varios parámetros sobre la capacidad de adsorción fueron evaluados: el pH (2, 4, 8 y 10), la temperatura (25, 30 y 40°C) y la concentración inicial de colorante (20, 40, 60, 80 y 100 mg/L). Tanto las características fisicoquímicas como los ensayos de adsorción del carbón activado preparado a partir de la cáscara de yuca (CAY) fueron comparadas con otro de marca comercial (CAM). Resultados. Los resultados de la caracterización indican que ambos carbones tienen una química de superfície heterogénea, de naturaleza ácida para el CAY y básica para el CAM. La máxima capacidad obtenida fue 6.1 mg/g para el CAY y de 3.7 mg/g para el CAM. Los cálculos termodinámicos indican que la remoción es espontánea y para ambos carbones la cinética se ajusta al modelo de pseudo segundo orden. Conclusiones. El carbón activado obtenido a partir de la cáscara de yuca puede considerarse un adsorbente eficiente en la remoción de colorantes.

ABSTRACT Objective. To establish by means of experimenting by batch the capacity of removal, the kinetics and adsorption thermodynamics of activated carbon prepared from manioc husk (Manihot esculenta) in the removal of direct blue 86 dye. Materials and methods. Firstly, the experimental methodology worked on the preparation of activated carbon by chemical activation of manioc husk with H3PO4 calcined at 530°C. In the characterization the texture properties were determined by means of the blue methylene and iodine indices, the basic and acidic functional groups were quantified by the Boehm method, and the proximate analyses were done following the norms ASTM D2867-70, ASTM D2866 and ASTM D2866-94. During the batch studies, the effect of several parameters over the adsorption capacity was evaluated: pH (2, 4, 8 and 10), temperature (25, 30 and 40°C) and initial concentration of the dye (20, 40, 60, 80 and 100 mg/L). Both physicochemical and adsorption characteristics of the activated carbon from manioc husk (CAY) were compared against those of a commercial brand (CAM). Results. The results of characterization showed that both carbons have a chemistry heterogeneous surface, acidic for CAY and basic for CAM. The maximum capacity obtained was 6.1 mg/g for CAY and 3.7 mg/g for CAM. The thermodynamic calculations showed that the removal was spontaneous. The kinetics for both carbon samples fits a pseudo second-order model. Conclusions. The activated carbon obtained from the manioc husk can be considered an efficient adsorbent for the removal of dyes.

Exceptional preservation of mid-Cretaceous marine arthropods and the evolution of novel forms via heterochrony.

Evolutionary origins of novel forms are often obscure because early and transitional fossils tend to be rare, poorly preserved, or lack proper phylogenetic contexts. We describe a new, exceptionally preserved enigmatic crab from the mid-Cretaceous of Colombia and the United States, whose completeness illuminates the early disparity of the group and the origins of novel forms. Its large and unprotected compound eyes, small fusiform body, and leg-like mouthparts suggest larval trait retention into adulthood via heterochronic development (pedomorphosis), while its large oar-like legs represent the earliest known adaptations in crabs for active swimming. Our phylogenetic analyses, including representatives of all major lineages of fossil and extant crabs, challenge conventional views of their evolution by revealing multiple convergent losses of a typical "crab-like" body plan since the Early Cretaceous. These parallel morphological transformations may be associated with repeated invasions of novel environments, including the pelagic/necto-benthic zone in this pedomorphic chimera crab.

Assessing and addressing cognitive impairment in bipolar disorder: the International Society for Bipolar Disorders Targeting Cognition Task Force recommendations for clinicians.

OBJECTIVES: Cognition is a new treatment target to aid functional recovery and enhance quality of life for patients with bipolar disorder. The International Society for Bipolar Disorders (ISBD) Targeting Cognition Task Force aimed to develop consensus-based clinical recommendations on whether, when and how to assess and address cognitive impairment. METHODS: The task force, consisting of 19 international experts from nine countries, discussed the challenges and recommendations in a face-to-face meeting, telephone conference call and email exchanges. Consensus-based recommendations were achieved through these exchanges with no need for formal consensus methods. RESULTS: The identified questions were: (I) Should cognitive screening assessments be routinely conducted in clinical settings? (II) What are the most feasible screening tools? (III) What are the implications if cognitive impairment is detected? (IV) What are the treatment perspectives? Key recommendations are that clinicians: (I) formally screen cognition in partially or fully remitted patients whenever possible, (II) use brief, easy-to-administer tools such as the Screen for Cognitive Impairment in Psychiatry and Cognitive Complaints in Bipolar Disorder Rating Assessment, and (III) evaluate the impact of medication and comorbidity, refer patients for comprehensive neuropsychological evaluation when clinically indicated, and encourage patients to build cognitive reserve. Regarding question (IV), there is limited evidence for current evidence-based treatments but intense research efforts are underway to identify new pharmacological and/or psychological cognition treatments. CONCLUSIONS: This task force paper provides the first consensus-based recommendations for clinicians on whether, when, and how to assess and address cognition, which may aid patients' functional recovery and improve their quality of life.

Prevalence of upper respiratory diseases and associated factors in Colombian Creole horses / Prevalência de doenças do trato respiratório superior e fatores associados em Cavalos Crioulos colombianos

To determine the prevalence of diseases of the upper respiratory tract and associated factors in the Colombian Creole Horse Valley Aburrá in 2015, a random sampling of 15 farms in southern Aburrá Valley under different management conditions was performed. A total of 105 CCC underwent general clinical examination, respiratory endoscopic evaluation and a detailed inspection of housing conditions and management. A low prevalence of upper respiratory tract diseases was observed, including Pharyngeal Lymphoid Hyperplasia 38.1%, Recurrent Laryngeal Neurophaty 12.38%, Dorsal Displacement of the Soft Palate 7.62%, and presence of tracheal secretions not associated with a specific pathology. A bivariate analysis showed association between tracheal secretions and frequency of training per week (OR = 9.86), duration of the training sessions (OR = 5.55) and inadequate ventilation of the stable (OR = 10.52). Association between HLR and inadequately ventilated barns was also observed (OR = 14.9). Logistic regression showed association between tracheal secretions and inadequate ventilation (OR = 7.18). We conclude that inadequate ventilation was the most important factor for the incidence of upper respiratory tract diseases in horses at the southern area of the Aburrá Valley.(AU)

O presente trabalho objetivou determinar a prevalência das doenças do trato respiratório superior e fatores associados no cavalo Crioulo colombiano do Vale de Aburrá, em 2015. Uma amostra aleatória de 15 fazendas no sul do Vale de Aburrá, sob diferentes condições de manutenção, foi realizada. Cento e cinco CCC foram submetidos a exame clínico geral, à avaliação endoscópica respiratória e a uma inspeção detalhada das condições habitacionais. Observou-se uma baixa prevalência de doenças do trato respiratório superior, incluindo hiperplasia faríngea linfoide 38.1%, neuropatia laríngea recorrente 12.38%, deslocamento dorsal do palato mole 7.62% e presença de secreção traqueal não associada a uma patologia específica. A análise bivariada mostrou associação entre secreção traqueal e frequência de treinamento por semana (OR = 9.86), duração das sessões de treinamento (OR = 5.55) e ventilação inadequada do estábulo (OR = 10.52). Associação entre HLR e boxes inadequadamente ventilados também foi observada (OR = 14.9). A regressão logística mostrou associação entre secreção traqueal e ventilação inadequada (OR = 7.18). Conclui-se que a ventilação inadequada foi o fator mais importante para a incidência de doenças do trato respiratório superior em cavalos na zona sul do Vale do Aburrá.(AU)

Equine metabolic syndrome in Colombian creole horse: case report / Síndrome metabólica equina em cavalo crioulo Colombiano: relato de caso

The equine metabolic syndrome is a condition that can be recognized because of obesity, insulin resistance and laminitis. Genetic factors could play a role in the occurrence of this syndrome. Certain breeds such as ponies (including the South American creole horses) have a lower sensibility to insulin and a higher prevalence of hyperinsulinemia. The environment and management conditions, such as overfeeding and lack of exercise are factors that bring a propensity for obesity. The adipose tissue works as an endocrine organ producing hormones (adipokines or adipocytokines) that affect the horse´s metabolism. The objective of this report is to describe the first case report of a Colombian creole mare with a metabolic syndrome, diagnosed by means of the combined test of glucose-insulin and clinical signs. Early diagnosis of this entity and an adequate treatment are useful for improving the life and the zootechnical conditions of the patient.(AU)

A síndrome metabólica equina é uma alteração reconhecida por apresentar obesidade, resistência à insulina e laminite. Fatores genéticos poderiam ser relevantes na ocorrência dessa síndrome, em que certas raças consideradas pôneis (incluídas as raças crioulas de cavalos sul-americanos) têm mais baixa sensibilidade à insulina e mais alta prevalência de apresentar hiperinsulinemia. As condições ambientais e de manejo, como superalimentação e falta de exercício, são fatores predisponentes para o desenvolvimento da obesidade. O tecido adiposo cumpre atividades como um órgão endócrino produtor de hormônios (adipocinas ou adipocitocinas) que afetam o metabolismo do cavalo. O objetivo deste relatório é descrever o primeiro registro de caso de uma égua de raça Cavalo Crioulo Colombiano (CCC) com síndrome metabólica, diagnosticada pela prova combinada de glicose-insulina e por quadro clínico. O diagnóstico precoce desta entidade e seu tratamento adequado permitem melhorar as condições de vida e zootécnicas do paciente que dela padece.(AU)

Methodological recommendations for cognition trials in bipolar disorder by the International Society for Bipolar Disorders Targeting Cognition Task Force.

OBJECTIVES: To aid the development of treatment for cognitive impairment in bipolar disorder, the International Society for Bipolar Disorders (ISBD) convened a task force to create a consensus-based guidance paper for the methodology and design of cognition trials in bipolar disorder. METHODS: The task force was launched in September 2016, consisting of 18 international experts from nine countries. A series of methodological issues were identified based on literature review and expert opinion. The issues were discussed and expanded upon in an initial face-to-face meeting, telephone conference call and email exchanges. Based upon these exchanges, recommendations were achieved. RESULTS: Key methodological challenges are: lack of consensus on how to screen for entry into cognitive treatment trials, define cognitive impairment, track efficacy, assess functional implications, and manage mood symptoms and concomitant medication. Task force recommendations are to: (i) enrich trials with objectively measured cognitively impaired patients; (ii) generally select a broad cognitive composite score as the primary outcome and a functional measure as a key secondary outcome; and (iii) include remitted or partly remitted patients. It is strongly encouraged that trials exclude patients with current substance or alcohol use disorders, neurological disease or unstable medical illness, and keep non-study medications stable. Additional methodological considerations include neuroimaging assessments, targeting of treatments to illness stage and using a multimodal approach. CONCLUSIONS: This ISBD task force guidance paper provides the first consensus-based recommendations for cognition trials in bipolar disorder. Adherence to these recommendations will likely improve the sensitivity in detecting treatment efficacy in future trials and increase comparability between studies.

Prevalence of hearing loss and tinnitus in Iraq and Afghanistan Veterans: A Chronic Effects of Neurotrauma Consortium study.

The purpose of this study was to describe the prevalence of hearing loss and tinnitus in a cohort of Iraq and Afghanistan Veterans (IAV) with common post-deployment conditions, including traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and other typical post-concussive conditions such as headaches and vertigo/dizziness. This retrospective observational study used data from the national Veterans Health Administration (VA) data repository from fiscal years 2001-2014. Veteran data was included if there were at least three years of VA care, with one or more years of care in 2007 or after. We identified comorbidities that may be associated with post-deployment hearing loss or tinnitus including TBI, PTSD, depression, and common post-concussive symptoms using International Classification of Diseases, 9th Revision, Clinical Modification codes. A multinomial logistic regression analysis was used to examine conditions associated with hearing loss or tinnitus. Among IAV, 570,332 were included in the final analysis. Of these, 7.78% of these were diagnosed with hearing loss alone, 6.54% with tinnitus alone, and 6.24% with both hearing loss and tinnitus. Comorbid TBI, PTSD, and depression were significantly associated with increased rates of hearing loss, tinnitus, or both conditions together. Older individuals, males, and those with TBI, PTSD, or vertigo/dizziness were significantly more likely to have hearing loss, tinnitus, or both. In order to provide more holistic post-deployment support, this myriad of conditions should be carefully considered in the planning of clinical care and beyond.

Recombinant human thyrotropin stimulation prior to 131I therapy in toxic multinodular goitre with low radioactive iodine uptake. / La estimulación previa con rhTSH mejora la respuesta al tratamiento con radioyodo en pacientes con bocio multinodular tóxico de baja captación.

AIM: Stimulation with recombinant human thyrotropin (rhTSH) increases thyroid radioiodine uptake, and is an aid to 131I therapy in non-toxic multinodular goitre (MNG). However, there are not many studies using rhTSH prior to 131I in toxic multinodular goitre to improve hyperthyroidism and compressive symptoms. MATERIAL AND METHOD: A prospective study was conducted on patients with MNG and hyperthyroidism. Patients were recruited consecutively and divided into group I, stimulated with 0.3mg of rhTSH before radioiodine therapy, and a control group or group II, without stimulation. Thyroid function, radioiodine thyroid uptake, thyroid weight, and compressive symptoms were measured, and patients were followed-up for 9 months. RESULTS: Group I consisted of 16 patients (14 women), with a mean age 69.7 years, and group II with 16 patients (12 women), with a mean age 70.7 years. After stimulation with 0.3mg rhTSH in group I, 131I uptake (RAIU) at 24h increased by 78.4%, and the estimated absorbed dose by 89.3%. In group II, the estimated absorbed dose was lower than group I after stimulation with rhTSH (29.8Gy vs. 56.4Gy; P=0.001). At 9 months of follow-up, hyperthyroidism was controlled in 87.5% of patients in group I, and 56.2% in group II (P=0.049). The mean reduction in thyroid weight was higher in group I than in group II (39.3% vs. 26.9%; P=0.017), with a tendency towards subjective improvement of compressive symptoms in group I, although non-significant. Only 2 patients described tachycardias after rhTSH administration, which were resolved with beta-blockers. CONCLUSION: Stimulation with 0.3mg of recombinant human thyrotropin prior to radioiodine therapy achieves a reduction in thyroid weight and functional improvement in patients with hyperthyroidism and multinodular goitre with low uptake, and with no need for hospital admission.

GASES SANGUÍNEOS, ELECTROLITOS Y VARIABLES METABÓLICAS DETERMINANTES DEL ESTADO ÁCIDO-BASE EN CABALLOS CRIOLLOS COLOMBIANOS / COMPARISON OF BLOOD GASES, ELECTROLYTES, AND METABOLIC DETERMINANTS OF ACID-BASE STATUS IN COLOMBIAN CRIOLLO HORSES

Se determinaron y compararon los valores de los gases sanguíneos, electrolitos, lactato, hematocrito y estado ácido-base en sangre venosa y arterial de 17 equinos criollos del Centro de Veterinaria y Zootecnia de la Universidad CES, para lo cual se utilizó el sistema Epoc Blood Analysis®, analizador portátil de sangre que permite obtener resultados de gases, iones y metabolitos. Los resultados arrojados muestran que hay diferencia estadística significativa (p < 0,05) en la glucosa arterial con respecto a la edad y en el lactato venoso con respecto al sexo; además, al comparar la sangre venosa contra la sangre arterial, se hallaron diferencias estadísticas significativas en la presión parcial de oxígeno (pO2), la presión parcial de CO2 (PCO2), la saturación de oxígeno (cSO2) sodio, calcio ionizado, glucosa, bicarbonato, base exceso sanguínea (BEb), base exceso extracelular (BE(ecf)), PCO2 y PO2 corregidas por temperatura. Se concluye que se deben tomar muestras arteriales para realizar valoraciones precisas de los pacientes y que variables, como la pO2, la pCO2 y la cTCO2, dependen en gran medida de la temperatura ambiental, la temperatura del paciente y la altitud, condiciones que modifican las presiones parciales de los gases.

We determined and compared the values of blood gases, electrolytes, lactate, hematocrit and acid-base status for both arterial and venous blood in seventeen horses from the Veterinary and Zootechnical Center at CES University. We used the Epoc Blood Analysis® portable system, which allows analyzing and obtaining information about gases, ions and metabolites. Our results show that there is a statistically significant difference (p < 0,05) in the values of arterial glucose according to the age and in the concentration of venous lactate according to the sex. Likewise, when we compared the values obtained from arterial blood with the values obtained from venous blood, we found statistically significant differences in the oxygen partial pressure (pO2), carbon dioxide partial pressure (pCO2), oxygen saturation level (cSO2), sodium, ionized calcium, glucose, bicarbonate, blood base excess (BEb), extracellular base excess (BE(ecf)), temperature-corrected PO2 and pCO2. Based on these results, we can conclude that we should take arterial blood samples in order to assess accurately the status of the patients and that variables such as oxygen partial pressure, carbon dioxide partial pressure and the oxygen saturation level are largely dependent on the environmental temperature, patient's temperature and altitude; as these conditions modify the gas partial pressures.

Pathophysiological Basis of Acute Respiratory Failure on Non-Invasive Mechanical Ventilation.

Noninvasive mechanical ventilation (NIMV) was created for patients who needed noninvasive ventilator support, this procedure decreases the complications associated with the use of endotracheal intubation (ETT). The application of NIMV has acquired major relevance in the last few years in the management of acute respiratory failure (ARF), in patients with hypoxemic and hypercapnic failure. The main advantage of NIMV as compared to invasive mechanical ventilation (IMV) is that it can be used earlier outside intensive care units (ICUs). The evidence strongly supports its use in patients with COPD exacerbation, support in weaning process in chronic obstructive pulmonary disease (COPD) patients, patients with acute cardiogenic pulmonary edema (ACPE), and Immunosuppressed patients. On the other hand, there is poor evidence that supports the use of NIMV in other pathologies such as pneumonia, acute respiratory distress syndrome (ARDS), and during procedures as bronchoscopy, where its use is still controversial because the results of these studies are inconclusive against the decrease in the rate of intubation or mortality.

Humidification on Ventilated Patients: Heated Humidifications or Heat and Moisture Exchangers?

The normal physiology of conditioning of inspired gases is altered when the patient requires an artificial airway access and an invasive mechanical ventilation (IMV). The endotracheal tube (ETT) removes the natural mechanisms of filtration, humidification and warming of inspired air. Despite the noninvasive ventilation (NIMV) in the upper airways, humidification of inspired gas may not be optimal mainly due to the high flow that is being created by the leakage compensation, among other aspects. Any moisture and heating deficit is compensated by the large airways of the tracheobronchial tree, these are poorly suited for this task, which alters mucociliary function, quality of secretions, and homeostasis gas exchange system. To avoid the occurrence of these events, external devices that provide humidification, heating and filtration have been developed, with different degrees of evidence that support their use.

Noninvasive Mechanical Ventilation in Acute Respiratory Failure Patients: A Respiratory Therapist Perspective.

Physiotherapist in Chile and Respiratory Therapist worldwide are the professionals who are experts in respiratory care, in mechanical ventilation (MV), pathophysiology and connection and disconnection criteria. They should be experts in every aspect of the acute respiratory failure and its management, they and are the ones who in medical units are able to resolve doubts about ventilation and the setting of the ventilator. Noninvasive mechanical ventilation should be the first-line of treatment in acute respiratory failure, and the standard of care in severe exacerbations of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema, and in immunosuppressed patients with high levels of evidence that support the work of physiotherapist. Exist other considerations where most of the time, physicians and other professionals in the critical units do not take into account when checking the patient ventilator synchrony, such as the appropriate patient selection, ventilator selection, mask selection, mode selection, and the selection of a trained team in NIMV. The physiotherapist needs to evaluate bedside; if patients are properly connected to the ventilator and in a synchronously manner. In Chile, since 2004, the physioterapist are included in the guidelines as a professional resource in the ICU organization, with the same skills and obligations as those described in the literature for respiratory therapists.

"Melioidosis in Antioquia, Colombia: an emerging or endemic disease? A cases series".

BACKGROUND: Melioidosis is endemic in Malaysia, the southwest of Thailand, and northern Australia. The incidence in Thailand is 4.4/1000000 inhabitants, where it causes 19% of community-acquired pneumonia (CAP) and 20% of bacteremic pneumonia, and the mortality is 50%. Sporadic cases have been described in Central and South America. The objective of this study was to describe the clinical and epidemiological features and ecological characteristics of melioidosis in Antioquia, Colombia. METHODS: This is a case series description. RESULTS: Seven cases were identified. Burkholderia pseudomallei was isolated from peripheral blood, pleural fluid, and urine and was identified by the automated system VITEK 2 (bioMérieux) and API 20NE biochemical kit. Five of the cases had a bacteremic form with shock and pulmonary compromise and two of these patients died. The non-bacteremic melioidosis cases had genitourinary, abdominal, and osteoarticular compromise. All patients had comorbidities and lived in rural hot and humid areas in the west central region of Colombia (Antioquia). Diabetes mellitus, renal insufficiency, and other chronic diseases are important risk factors for the development of severe forms. CONCLUSIONS: The cases presented here are similar to those occurring in endemic areas regarding comorbidity, risk factors, clinical presentation, and environmental conditions. It is necessary to establish whether melioidosis is an endemic and under-diagnosed disease or an emerging disease in Colombia.

Aislamiento de bacterias degradadoras de pesticidas organofosforados encontrados en suelos y en leche bovina / Isolation of organophosphorus pesticides degrading bacteria found in soil and bovine milk

The increasing use of organophosphorus pesticides in agricultural practices over the past few years has generated a number of environmental problems; these compounds tend to bioaccumulate through food chains showing high levels of toxicity triggering potential health risk for species that are exposed to these substances. In this research were used the Soxhlet and solid phase micro extraction in headspace (HS-SPME) methods for the extraction of organophosphorus pesticides in agricultural cattle soils and bovine milk, respectively. The presence of demeton-S-methylsulfon was determined at concentrations between 272.9 and 1793.3 ppm in cropland and 12.9 ppm in cow milk. Native soil bacteria were isolated showing degrading capacity of these pesticides, Bacillus sp and Pantoea agglomerans which gave results of degradation of 73.5% and 68.6 %, respectively, in the concentration of chlorpyrifos, showing that these microorganisms are a possible solution for improving soils contaminated by this class of pesticides.

El incremento en el uso de pesticidas organofosforados en las prácticas agrícolas a través de los últimos años, ha generado una serie de problemas ambientales. Estos compuestos tienden a bioacumularse a través de las cadenas tróficas presentando altos niveles de toxicidad desencadenando potenciales riesgos para la salud de las especies que son expuestas a este tipo de sustancias. En esta investigación se usaron los métodos de extracción soxhlet y micro extracción en fase sólida en espacio de cabeza (HS-SPME) para la extracción de pesticidas organofosforados en suelos de cultivo y leche de ganado bovino, respectivamente. Se determinó la presencia de demetón-S-metilsulfón en concentraciones entre 272.9 y 1793.3 ppm en los suelos de cultivo y 12.9 ppm en leche de vaca. Se aislaron bacterias nativas de suelo con capacidad degradadora de estos pesticidas, Bacillus sp y Pantoea agglomerans, obteniéndose resultados de degradación del compuesto organofosforado, clorpirifos de 73.5% y 68.67%, respectivamente, evidenciando que estos microorganismos son una posible solución para el mejoramiento de suelos contaminados por esta clase de pesticidas.