Estado de ansiedad y comportamientos relacionados con la alimentación de los deportistas del departamento de Antioquia durante la medida de aislamiento obligatorio por covid-19 / State of anxiety and behaviors related to the diet of athletes in the department of Antioquia during the mandatory isolation measure due to covid-19 / Estado de ansiedade e comportamentos relacionadoscom a alimentação de atletas do departamento de Antioquia durante a medida de isolamento obrigatório devido à covid-19

Objetivo: identificar el impacto de la medida de confinamiento social, decretada por el gobierno colombiano ante el covid-19, sobre los niveles de ansiedad y los comporta­mientos alimentarios de los deportistas adscritos a selecciones Antioquia. Metodología: estudio observacional descriptivo de corte transversal en deportistas de altos logros deportivos de Indeportes Antioquia que fueron atendidos en el área de medicina, entre enero y agosto 2020. Se indagó sobre aspectos de ansiedad y compor­tamientos alimentarios, ocasionados durante la medida de aislamiento social derivada de la pandemia por covid-19. Resultados: la encuesta fue respondida por 150 deportistas. En hombres, la ansiedad aumenta a medida que se incrementa el grupo de edad. En las mujeres, el fenómeno es opuesto. Para la misma calificación de ansiedad alta, el porcentaje va disminuyendo con la edad. Con referencia a los comportamientos relacionados con la alimentación, analizados bajo una circunstancia tan compleja, como es la pandemia por covid-19, permitió a los profesionales del deporte y la salud direccionar recomendaciones efectivas para los deportistas que asesoran, frente al manejo de la ansiedad y el control de ciertos comportamientos negativos que pueden afectar la salud y el rendimiento deportivo. Conclusiones: los resultados con respecto a la ansiedad coinciden con estudios actua­les, en los que, en términos generales, las poblaciones evaluadas muestran niveles de ansiedad baja y esto se relaciona con una escasa tendencia a alteraciones en la conducta alimentaria en la población estudiada.

Objective: to identify the impact of the social confinement measure decreed by the Colombian government in the face of Covid-19 on anxiety levels and eating behaviors in athletes attached to different teams in the department of Antioquia. Methodology: cross-sectional descriptive observational study in athletes with high sports achievements from Indeportes Antioquia, who were treated in the medical area between January and August 2020. Aspects of anxiety and eating behaviors, caused during the social isolation measure derived of the Covid-19 pandemic were studied. Results: the survey was answered by 150 athletes. In men, anxiety increases as the age group increases. In women, the phenomenon is opposite. For the same high anxiety rating, the percentage decreases with age. With reference to behaviors related to eating, analyzed under such a complex circumstance, such as the Covid-19 pandemic, allowed sports and health professionals to direct effective recommendations for the athletes they advise, regarding anxiety management and the control of certain negative behaviors that can affect their health and their performance. Conclusions: the results regarding anxiety coincide with current studies, in which, in general terms, the assessed populations show low levels of anxiety; this is related to a low tendency to alterations in eating behavior in the studied population.

Objetivo: identificar o impacto da medida de confinamento social, decretada pelo governo colombiano diante da covid-19, nos níveis de ansiedade e comportamentos alimentares de atletas lotados nas equipes de Antioquia. Metodologia:estudo observacional descritivo transversal em atletas com altas conquistas esportivas do Indeportes Antioquia que foram atendidos na área médica, entre janeiro e agosto de 2020. Aspectos de ansiedade e comportamentos alimentares, causados durante a medida de isolamento social derivada do covid-19 pandemia. Resultados: a pesquisa foi respondida por 150 atletas. Nos homens, a ansiedade aumenta à medida que a faixa etária aumenta. Nas mulheres, o fenômeno é oposto. Para a mesma alta taxa de ansiedade, a porcentagem diminui com a idade. No que se refere aos comportamentos relacionados com a alimentação, analisados numa circunstância tão complexa, como é a pandemia de covid-19, permitiu aos profissionais do desporto e da saúde direcionar recomendações eficazes aos atletas que aconselham, no que diz respeito à gestão da ansiedade e ao controlo de determinados comportamentos negativos. que podem afetar a saúde e o desempenho esportivo.Conclusões:os resultados relativos à ansiedade coincidem com os estudos atuais, nos quais, em termos gerais, as populações avaliadas apresentam baixos níveis de ansiedade e isto está relacionado com uma baixa propensão a alterações do comportamento alimentar na população estudada.

Bradyrhizobium and Pseudomonas strains obtained from coal-mining areas nodulate and promote the growth of Calopogonium muconoides plants used in the reclamation of degraded areas.

AIMS: The objective of this work was to isolate and characterize indigenous rhizobia from coal-mining areas able to efficiently nodulate and fix nitrogen in association with Calopogonium mucunoides (calopo). METHODS AND RESULTS: Isolation, authentication and morphological, biochemical and molecular characterization of the autochthonous rhizobia were performed and their symbiotic efficiency (SE) evaluated. Efficient rhizobial isolates suitable for the inoculation of calopo in coal-mining regions were obtained. A total of 30 isolates were obtained after nodulation authentication, of which five presented high SE with plant-growth promoting traits such as indole-3-acetic acid production, phosphate solubilization and biofilm formation. These isolates were identified as belonging to Bradyrhizobium, Pseudomonas and Rhizobium. CONCLUSIONS: Bradyrhizobium sp. A2-10 and Pseudomonas sp. A6-05 were able to promote calopo plant growth using soil obtained from coal-mining degraded areas, thus indicating their potential as inoculants aiming at land reclamation. SIGNIFICANCE AND IMPACT OF THE STUDY: To our knowledge, this is the first report of Pseudomonas nodule formation in calopo. Furthermore, the results demonstrated that autochthonous rhizobia obtained from degraded soils presented high SE in calopo and possess a wide range of plant-growth promoting traits. Ultimately, they may all contribute to an increased leguminous plant growth under stress conditions. The selected rhizobia strains may be used as inoculants and present a valuable role in the development of strategies aiming to recover coal-mining degraded areas. Bacterial inoculants would greatly reduce the use of often harmful nitrogen fertilizers vastly employed in revegetation programmes of degraded areas.

Impact of intra-aortic balloon pump on short-term clinical outcomes in ST-elevation myocardial infarction complicated by cardiogenic shock: A ‘real life’ single center experience / Impacto del balón de contrapulsación intraaórtico en el pronóstico clínico a corto plazo de pacientes con infarto agudo de miocardio con elevación del segmento ST complicado con shock cardiogénico: experiencia de «vida real»

OBJECTIVE: To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS). DESIGN: A single-center retrospective case-control study was carried out. SETTING: Coronary Care Unit. PATIENTS: Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP). VARIABLES: Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit. RESULTS: Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38-3.11; p = 0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4-10.6; p = 0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2-9.1; p = 0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2-8.1; p = 0.018) were the only variables independently associated to increased 30-day mortality. CONCLUSION: In our 'real life' experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization

OBJETIVO: Analizar el uso e impacto del balón de contrapulsación intraaórtico (BCIA) en la mortalidad a 30 días y en los desenlaces clínicos a corto plazo de pacientes con infarto agudo de miocardio con elevación del segmento ST complicado con shock cardiogénico. DISEÑO: Estudio de casos y controles unicéntrico y retrospectivo. Ámbito: Unidad Coronaria. PACIENTES: Los datos fueron obtenidos de 825 pacientes consecutivos admitidos en una unidad coronaria con diagnóstico de infarto agudo de miocardio con elevación del segmento ST desde enero de 2009 hasta agosto de 2015. Un total de 73 pacientes en situación de shock cardiogénico al ingreso derivados a una revascularización coronaria percutánea urgente fueron incluidos para el análisis y estratificados en función de la utilización del BCIA (44 pacientes recibieron BCIA). VARIABLES: Antecedentes cardiológicos, situación hemodinámica al ingreso, características angiográficas y periprocedimiento, y variables derivadas de la estancia en la Unidad Coronaria. RESULTADOS: La mortalidad a 30 días fue similar entre los tratados con BCIA y aquellos con tratamiento convencional (29,5 y 27,6%, respectivamente; HR con BCIA 1,10, IC 95% 0,38-3,11; p = 0,85). Así mismo, no encontramos diferencias significativas con respecto a los desenlaces clínicos a corto plazo: días en ventilación mecánica, tiempo hasta la estabilidad hemodinámica, requerimiento de fármacos vasoactivos y días de estancia en la Unidad Coronaria. En el análisis multivariante, las únicas variables asociadas de forma independiente con una mayor mortalidad a 30 días fueron peor función renal al ingreso (HR 3,9, IC 95% 1,4-10,6; p = 0,008), antecedentes de enfermedad arterial periférica (HR 3,3, IC 95% 1,2-9,1; p = 0,019) y diabetes mellitus (HR 3,2, IC 95% 1,2-8,1; p = 0,018). CONCLUSIÓN: En nuestra experiencia de la «vida real», la utilización del BCIA no modifica la mortalidad a 30 días ni los desenlaces clínicos a corto plazo en pacientes con infarto agudo de miocardio con elevación del segmento ST complicado con shock cardiogénico que son derivados a una estrategia de revascularización coronaria percutánea urgente

Impact of intra-aortic balloon pump on short-term clinical outcomes in ST-elevation myocardial infarction complicated by cardiogenic shock: A "real life" single center experience.

OBJECTIVE: To analyze the use and impact of the intra-aortic balloon pump (IABP) upon the 30-day mortality rate and short-term clinical outcome of non-selected patients with ST-elevation acute myocardial infarction (acute STEMI) complicated by cardiogenic shock (CS). DESIGN: A single-center retrospective case-control study was carried out. SETTING: Coronary Care Unit. PATIENTS: Data were collected from 825 consecutive patients with acute STEMI admitted to a Coronary Care Unit from January 2009 to August 2015. Seventy-three patients with CS upon admission subjected to emergency percutaneous coronary intervention (PCI) were finally included in the analysis and were stratified according to IABP use (44 patients receiving IABP). VARIABLES: Cardiovascular history, hemodynamic situation upon admission, angiographic and procedural characteristics, and variables derived from admission to the Coronary Care Unit. RESULTS: Cumulative 30-day mortality was similar in the patients subjected to IABP and in those who received conventional medical therapy only (29.5% and 27.6%, respectively; HR with IABP 1.10, 95% CI 0.38-3.11; p=0.85). Similarly, no significant differences were found in terms of the short-term clinical outcome between the groups: time on mechanical ventilation, days to hemodynamic stabilization, vasoactive drug requirements and stay in the Coronary Care Unit. Poorer renal function (HR 3.9, 95% CI 1.4-10.6; p=0.008), known peripheral artery disease (HR 3.3, 95% CI 1.2-9.1; p=0.019) and a history of diabetes mellitus (HR 3.2, 95% CI 1.2-8.1; p=0.018) were the only variables independently associated to increased 30-day mortality. CONCLUSION: In our "real life" experience, IABP does not modify 30-day mortality or the short-term clinical outcome in patients presenting STEMI complicated with CS and subjected to emergency percutaneous coronary revascularization.

Geometric morphometrics for the taxonomy of 11 species of Anopheles (Nyssorhynchus) mosquitoes.

The subgenus Anopheles (Nyssorhynchus) (Diptera: Culicidae) includes the primary vectors of Plasmodium spp. in Colombia. Most adult females of this subgenus are difficult to identify in the field using the available keys. With the objective of further investigating the discriminatory power of modern morphometrics, both landmark-based and outline-based approaches were explored using the wing venation geometry of 11 Anopheles (Nyssorhynchus) species. Wing shape was able to separate the closest species of the subgenus. When the 11 species were analysed together, validated classification scores on average 5.3-8.6 times higher than those expected by chance were observed. These scores computed from the total sample of 11 species were not satisfactory for the recognition of Anopheles benarrochi B, Anopheles oswaldoi s.l. and Anopheles strodei. These sibling species were captured in sympatry. To improve the identification power of the morphometric tool, it was necessary to analyse these species separately from the remaining species. The best classification scores were obtained using a combination of 12 landmarks collected not only on the intersections of wing veins, but also on spots. An outline approach also gave excellent reclassification scores. Another pair of sibling species, collected in allopatry, Anopheles nuneztovari and Anopheles rangeli, also showed high classification scores.

Cómo tratamos en nuestra práctica clínica diaria el hipotiroidismo subclínico / How we treat subclinical hypothyroidism in our daily clinical practice

Objetivo. Estudiar el abordaje terapéutico del hipotiroidismo subclínico (HTS): frecuencia de instauración de tratamiento sustitutivo, motivos de inicio, dosis y duración, en la población mayor de 14 años del centro de salud. Material y métodos. Estudio observacional, longitudinal retrospectivo. Se incluyeron 1.156 pacientes con episodio T86 del CIAP en OMI. Excluidos: 10 duplicados, 180 sin criterios de inclusión o imposibilidad para recoger datos, 25 diagnosticados en otro laboratorio y 359 con hipotiroidismo clínico (HTC). Variables. Sexo, edad, cifra de hormona estimulante del tiroides (TSH) al diagnóstico y al iniciar tratamiento, última TSH recogida en la historia clínica (HC) si no tratado, TSH de confirmación diagnóstica, anticuerpos anti-TPO (ATA), presencia de astenia, bocio, síntomas neuropsiquiátricos, hipercolesterolemia; si hay HTS secundario; progresión a HTC; intervalo diagnóstico-inicio tratamiento, dosis de inicio y final, duración y motivos de la interrupción. Resultados. Se incluyeron 582 pacientes: 508 mujeres. Edad media: 43,03 (de 15,97). HTS tratado: 330 (56,7%); TSH al diagnóstico < 10: 81,6%; TSH media en tratados: 11,22 (de 10,49); ATA realizados: 315 (54%)+166 (52,7%); No consta recogido en HC. Astenia: 64%; bocio: 65%. El 67% no fueron tratados: normofunción espontánea. Dosis de inicio: 86% ≤ 50μg. Finales ≤ 50: 43%. Duración del tratamiento: 1-5 años, 41%; > 5 años, 40%. Inicio del tratamiento inmediato al diagnóstico, 38%. Permanecen tratados el 93%. Variables que aumentan la probabilidad de instauración de tratamiento (regresión logística): cifra TSH (OR 32,5; IC 12,8-82,6); ATA+(OR 4,7; IC 2,8-7,7); astenia (OR 2,5; IC 1,5-4); Bocio (OR 3; IC 1,3-6,6). Conclusiones. La decisión de tratar es generalmente adecuada, pero con frecuencia se cronifica un trastorno analítico instaurando tratamientos excesivamente prolongados sin intentos de retirada. Descuidamos la anamnesis y la exploración (AU)

Objective. To study the therapeutic approach to subclinical hypothyroidism (HTS), the frequency of introducing replacement therapy, reasons for starting, doses, and duration, in the population over 14 years-old in a Primary Care Centre. Material and methods. Longitudinal, retrospective observational study of 1156 patients with a hypothyroidism/myxedema episode (T86 in the International Classification of Primary Care (ICPC)) entered in the OMI program were studied. Excluded: 10 duplicates, 180 no inclusion criteria or inability to collect data, 25 diagnosed in another laboratory, 359 with clinical hypothyroidism (HTC). Measurements. Sex, age, TSH value to diagnosis and initiate treatment, or latest TSH recorded in the clinical history (HC) if not treated, TSH diagnostic confirmation, antiTPO antibodies (ATAs), presence of fatigue, goitre, neuropsychiatric symptoms, raised cholesterol, if HTS secondary, progression to HTC, diagnostic-start treatment interval, initial and final dose, duration, reasons for discontinuation. Results. 582 patients: 508 women. Mean age: 43.03 (sd 15.97). HTS treated: 330 (56.7%); TSH at diagnosis < 10: 81.6%; Mean TSH treated: 11.22 (sd 10.49); Made ATAs performed: 315 (54%),+166 (52.7%); Fatigue not recorded in HC: 64%; Goitre: 65%. 67% untreated: returned to normal spontaneously. Starting dose: 86% ≤ 50μg. Final ≤ 50: 43%. Treatment duration: 1-5 years 41%; > 5 years 40%. Immediate treatment after diagnosis 38%. Remain treated 93%. Variables that increase the likelihood of onset of treatment (Logistic Regression): TSH value (OR 32.5, CI 12.8- 82.6), ATAs+(OR 4.7, CI 2.8-7.7); Fatigue (OR 2.5, CI 1.5-4), Goitre (OR 3, CI 1.3-6.6). Conclusions. The decision to treat is generally adequate, but often becomes a chronic analytical disorder, because of unduly prolonged treatment without attempts to withdraw it. Clinical history and physical examination tend to be ignored (AU)

[How we treat subclinical hypothyroidism in our daily clinical practice]. / Cómo tratamos en nuestra práctica clínica diaria el hipotiroidismo subclínico.

OBJECTIVE: To study the therapeutic approach to subclinical hypothyroidism (HTS), the frequency of introducing replacement therapy, reasons for starting, doses, and duration, in the population over 14 years-old in a Primary Care Centre. MATERIAL AND METHODS: Longitudinal, retrospective observational study of 1156 patients with a hypothyroidism/myxedema episode (T86 in the International Classification of Primary Care (ICPC)) entered in the OMI program were studied. Excluded: 10 duplicates, 180 no inclusion criteria or inability to collect data, 25 diagnosed in another laboratory, 359 with clinical hypothyroidism (HTC). MEASUREMENTS: Sex, age, TSH value to diagnosis and initiate treatment, or latest TSH recorded in the clinical history (HC) if not treated, TSH diagnostic confirmation, antiTPO antibodies (ATAs), presence of fatigue, goitre, neuropsychiatric symptoms, raised cholesterol, if HTS secondary, progression to HTC, diagnostic-start treatment interval, initial and final dose, duration, reasons for discontinuation. RESULTS: 582 patients: 508 women. Mean age: 43.03 (sd 15.97). HTS treated: 330 (56.7%); TSH at diagnosis < 10: 81.6%; Mean TSH treated: 11.22 (sd 10.49); Made ATAs performed: 315 (54%),+166 (52.7%); Fatigue not recorded in HC: 64%; Goitre: 65%. 67% untreated: returned to normal spontaneously. Starting dose: 86% ≤ 50µg. Final ≤ 50: 43%. Treatment duration: 1-5 years 41%; > 5 years 40%. Immediate treatment after diagnosis 38%. Remain treated 93%. Variables that increase the likelihood of onset of treatment (Logistic Regression): TSH value (OR 32.5, CI 12.8- 82.6), ATAs+(OR 4.7, CI 2.8-7.7); Fatigue (OR 2.5, CI 1.5-4), Goitre (OR 3, CI 1.3-6.6). CONCLUSIONS: The decision to treat is generally adequate, but often becomes a chronic analytical disorder, because of unduly prolonged treatment without attempts to withdraw it. Clinical history and physical examination tend to be ignored.

Perfil microbiológico de la Infecciones en Unidades de Cuidados Intensivos de Colombia (EPISEPSIS Colombia) / Microbiological profile of infections in the Intensive Care Units of Colombia (EPISEPSIS Colombia)

Introducción y objetivoEn Colombia faltan datos fiables sobre el comportamiento de la sepsis. Se pretende determinar la prevalencia de los microorganismos en las principales infecciones tratadas en las unidades de cuidados intensivos (UCI) de nuestro país.MétodosEste es un subestudio de una cohorte prospectiva recolectada en 10 hospitales durante 6 meses. Los criterios de inclusión eran hospitalización en UCI y confirmación de una infección según las definiciones del CDC, considerando tres grupos (comunidad, hospital, UCI) según el sitio de adquisición de la infección.ResultadosSe incluyó en el análisis a 826 pacientes; el 51% contrajeron procesos infecciosos extrahospitalarios; el 5,33%, en el hospital y el 43,7%, en UCI. Los diagnósticos más frecuentes fueron neumonía (29,54%), infección intraabdominal (18,16%) e infección del tracto urinario (11,62%). El microorganismo más frecuente en las infecciones extrahospitalarias fue Escherichia coli —pulmón (16,4%), peritoneo (57,7%), orina (55,5%) y sangre (22,4%)—. En las adquiridas en UCI predomina también E. coli —peritoneo (29,3%) y orina (52,9%)—, excepto en pulmón y sangre, en los que fueron Staphylococcus aureus (32,4%) y Klebsiella pneumoniae (15,7%) los más prevalentes. Se tomaron cultivos a 655 pacientes, de los que el 40% recibió antibióticos antes de la toma, sin que esto afectara al porcentaje de positividad (p=0,583).ConclusionesLa neumonía fue la infección más frecuente independientemente del sitio de adquisición. E. coli fue el patógeno más prevalente, excepto en las infecciones pulmonares adquiridas en UCI, donde lo fue S. aureus (AU)

AbstractBackground and objective: Valid and reliable data regarding sepsis is lacking in Colombia. Ouraim was to determine the prevalence of the microorganisms in the main infections treated inIntensive Care Units (ICUs) in our country.Methods: This is a sub-study of a prospective cohort with 10 general hospitals in Colombiaduring a 6-month period. The inclusion criteria were hospitalization in ICU and confirmation ofinfection according to the CDC definitions. Patients were classified into three groups, that is,community, hospital and intensive care, according to the site where the infection was acquired.Results: A total of 826 patients were included in this analysis. Of these, 51% developed infectionsin the community, 5.33% in the hospital and 43.7% in intensive care unit. Overall, themost common diagnoses were pneumonia (29.54%), intra-abdominal infection (18.16%) and urinarytract infection (11.62%). The most frequent germ in community-acquired infections wasE. coli —–lung (16. 4%), peritoneum (57.7%), urine (55.5%), blood (22.4%)—–. E. coli —–peritoneum(29.3%), urine (52.9%)—– also predominated in the ICU-acquired infections, except for lung andblood in which Staphylococcus aureus (32.4%) and Klebsiella pneumoniae (15.7%) were the mostprevalent. Cultures were requested from 655 patients, 40% of them having received antibioticsbefore cultures were taken, although this did not affected the percentages of positive cultures(P = 0.583).Conclusions: Pneumonia was the main cause of infection regardless of the site of acquisition.E. coli was the most prevalent germ, except in the pulmonary infections acquired in UCI inwhich S. aureus was the most prevalent (AU)

[Microbiological profile of infections in the Intensive Care Units of Colombia (EPISEPSIS Colombia]. / Perfil microbiológico de la Infecciones en Unidades de Cuidados Intensivos de Colombia (EPISEPSIS Colombia).

BACKGROUND AND OBJECTIVE: Valid and reliable data regarding sepsis is lacking in Colombia. Our aim was to determine the prevalence of the microorganisms in the main infections treated in Intensive Care Units (ICUs) in our country. METHODS: This is a sub-study of a prospective cohort with 10 general hospitals in Colombia during a 6-month period. The inclusion criteria were hospitalization in ICU and confirmation of infection according to the CDC definitions. Patients were classified into three groups, that is, community, hospital and intensive care, according to the site where the infection was acquired. RESULTS: A total of 826 patients were included in this analysis. Of these, 51% developed infections in the community, 5.33% in the hospital and 43.7% in intensive care unit. Overall, the most common diagnoses were pneumonia (29.54%), intra-abdominal infection (18.16%) and urinary tract infection (11.62%). The most frequent germ in community-acquired infections was E. coli -lung (16. 4%), peritoneum (57.7%), urine (55.5%), blood (22.4%)-. E. coli -peritoneum (29.3%), urine (52.9%)- also predominated in the ICU-acquired infections, except for lung and blood in which Staphylococcus aureus (32.4%) and Klebsiella pneumoniae (15.7%) were the most prevalent. Cultures were requested from 655 patients, 40% of them having received antibiotics before cultures were taken, although this did not affected the percentages of positive cultures (P=0.583). CONCLUSIONS: Pneumonia was the main cause of infection regardless of the site of acquisition. E. coli was the most prevalent germ, except in the pulmonary infections acquired in UCI in which S. aureus was the most prevalent.

Understanding tropism and immunopathological mechanisms of relapsing fever spirochaetes.

Mice infected with relapsing fever (RF) spirochaetes survive recurrent waves of high-level bacteraemia with little, if any, clinical complications or tissue injury. In the absence of B-cells, peak bacteraemia does not resolve, resulting in multi-organ complications. During peak bacteraemia, large amounts of interleukin-10 (IL-10) are produced in blood and tissues. In mice unable to clear peak bacteraemia, exogenous IL-10 greatly reduced the clinical manifestations, serum levels of CXCL13, cerebral microgliosis, and the pathogen load. In contrast, IL-10 deficiency in mice unable to clear peak bacteraemia resulted in microvascular complications with distinct severities, depending on the serotype: serotype 2 (Bt2), which causes peak bacteraemia of c. 10(8)/mL, resulted in rapid death from subarachnoid and intraparenchymal haemorrhage; in contrast, serotype 1, which causes peak bacteraemia of c. 10(7)/mL, resulted in milder multi-organ haemorrhage and thrombosis. IL-10 deficiency also resulted in multi-organ haemorrhage and thrombosis with infarction in wild-type mice despite lower peak bacteraemia. Two mechanisms for pathogen control have been identified: antibody clearance of peak bacteraemia, and antibody-independent lowering of bacteraemia via phagocytosis in the spleen. IL-10 plays opposite roles in pathogen control, depending on the severity of bacteraemia: during persistent high bacteraemia, IL-10 helps to control it by protecting innate immune cells from apoptosis; in contrast, during transient peak bacteraemia, IL-10 slows down antibody-mediated clearance. A successful outcome from RF depends on a balanced immune response to clear bacteraemia while avoiding microvascular injury, in which production of IL-10, in response to the pathogen load, plays a critical role.

Heroin addiction in African Americans: a hypothesis-driven association study.

Heroin addiction is a chronic complex disease with a substantial genetic contribution. This study was designed to identify gene variants associated with heroin addiction in African Americans. The emphasis was on genes involved in reward modulation, behavioral control, cognitive function, signal transduction and stress response. We have performed a case-control association analysis by screening with 1350 variants of 130 genes. The sample consisted of 202 former severe heroin addicts in methadone treatment and 167 healthy controls with no history of drug abuse. Single nucleotide polymorphism (SNP), haplotype and multi-SNP genotype pattern analyses were performed. Seventeen SNPs showed point-wise significant association with heroin addiction (nominal P< 0.01). These SNPs are from genes encoding several receptors: adrenergic (ADRA1A), arginine vasopressin (AVPR1A), cholinergic (CHRM2), dopamine (DRD1), GABA-A (GABRB3), glutamate (GRIN2A) and serotonin (HTR3A) as well as alcohol dehydrogenase (ADH7), glutamic acid decarboxylase (GAD1 and GAD2), the nucleoside transporter (SLC29A1) and diazepam-binding inhibitor (DBI). The most significant result of the analyses was obtained for the GRIN2A haplotype G-A-T (rs4587976-rs1071502-rs1366076) with protective effect (P(uncorrected) = 9.6E- 05, P(corrected) = 0.058). This study corroborates several reported associations with alcohol and drug addiction as well as other related disorders and extends the list of variants that may affect the development of heroin addiction. Further studies will be necessary to replicate these associations and to elucidate the roles of these variants in drug addiction vulnerability.

Genetic susceptibility to heroin addiction: a candidate gene association study.

Heroin addiction is a chronic complex disease with a substantial genetic contribution. This study was designed to identify genetic variants that are associated with susceptibility to develop heroin addiction by analyzing 1350 variants in 130 candidate genes. All subjects had Caucasian ancestry. The sample consisted of 412 former severe heroin addicts in methadone treatment, and 184 healthy controls with no history of drug abuse. Nine variants, in six genes, showed the lowest nominal P values in the association tests (P < 0.01). These variants were in noncoding regions of the genes encoding the mu (OPRM1; rs510769 and rs3778151), kappa (OPRK1; rs6473797) and delta (OPRD1; rs2236861, rs2236857 and rs3766951) opioid receptors; the neuropeptide galanin (GAL; rs694066); the serotonin receptor subtype 3B (HTR3B; rs3758987) and the casein kinase 1 isoform epsilon (CSNK1E; rs1534891). Several haplotypes and multilocus genotype patterns showed nominally significant associations (e.g. OPRM1; P = 0.0006 and CSNK1E; P = 0.0007). Analysis of a combined effect of OPRM1 and OPRD1 showed that rs510769 and rs2236861 increase the risk of heroin addiction (P = 0.0005). None of these associations remained significant after adjustment for multiple testing. This study suggests the involvement of several genes and variants in heroin addiction, which is worthy of future study.

Modulation of cystic fibrosis lung disease by variants in interleukin-8.

Cystic fibrosis pulmonary disease is characterized by excessive and prolonged inflammation. CF Pulmonary disease severity exhibits considerable variation that, to some extent, appears to be due to the presence of modifier genes. Several components of the inflammatory response are known to have altered regulation in the CF lung. Genetic variants in 52 inflammatory genes were tested for associations with lung disease indices in a CF patient population (n=737) homozygous for the DeltaF508 cystic fibrosis transmembrane conductance regulator mutation. Variants in three inflammatory genes showed significant genotypic associations with CF lung disease severity, including IL8 and previously reported TGFbeta1 (P< or =0.05). When analyzed by gender, it was apparent that IL8 variant associations were predominantly due to males. The IL8 variants were tested in an additional CF population (n=385) and the association in males verified (P< or =0.01). The IL8 variants were in strong linkage disequilibrium with each other (R2> or =0.82), while variants in neighboring genes CXCL6, RASSF6 and PF4V1 did not associate (P> or =0.26) and were in weaker LD with each other and with the IL8 variants (0.01< or =R2< or =0.49). Studies revealed differential expression between the IL8 promoter variant alleles (P<0.001). These results suggest that IL8 variants modify CF lung disease severity and have functional consequences.

Identification of a locus for type I punctate palmoplantar keratoderma on chromosome 15q22-q24.

BACKGROUND: The identification of the molecular basis of disorders of keratinisation has significantly advanced our understanding of skin biology, revealing new information on key structures in the skin, such as the intermediate filaments, desmosomes, and gap junctions. Among these disorders, there is an extraordinarily heterogeneous group known as palmoplantar keratodermas (PPK), for which only a few molecular defects have been described. A particular form of PPK, known as punctate PPK, has been described in a few large autosomal dominant pedigrees, but its genetic basis has yet to be identified. AIM: Identification of the gene for punctate PPK. METHODS: Clinical examination and linkage analysis in three families with punctate PPK. RESULTS: A genomewide scan was performed on an extended autosomal dominant pedigree, and linkage to chromosome 15q22-q24 was identified. With the addition of two new families with the same phenotype, we confirmed the mapping of the locus for punctate PPK to a 9.98 cM interval, flanked by markers D15S534 and D15S818 (maximum two point lod score of 4.93 at theta = 0 for marker D15S988). CONCLUSIONS: We report the clinical and genetic findings in three pedigrees with the punctate form of PPK. We have mapped a genetic locus for this phenotype to chromosome 15q22-q24, which indicates the identification of a new gene involved in skin integrity.

Granuloma formation and parasite disintegration in porcine cysticercosis: comparison with human neurocysticercosis.

Taenia solium cysticerci infect human beings and pigs, causing cysticercosis. In this study the pig was used as a model to characterize the immune response against cysticerci, given the difficulties in analysing the developing immune response in infected human brains. Metacestodes in different stages of viability or degeneration were isolated from the brain, heart and skeletal muscle of naturally infected swine, and the adjacent tissue was examined histologically. The immune response elicited by the cysticerci was classified into four separate stages. In stage I the parasites were surrounded by a thin layer of collagen type I, and by stage II there was a sparse inflammatory infiltrate. In stage III, granuloma formation was evident, and by stage IV the parasite was surrounded by an eosinophil-rich infiltrate and its vesicular membrane had begun to degenerate. The final stage, IV, was detected mainly in the heart but not in the brain. The granulomatous reaction in swine resembled that described previously in human patients, but differed in the abundance of eosinophils, the relative paucity of plasma cells, and the discrete deposition of collagen. These differences were probably due to the fact that in pigs the immune response can be examined earlier than in human patients, in whom sampling is inevitably made at a more chronic stage.

¿Es costo efectiva la realizacion de los estudios radiologicos rutinarios en los pacientes con trauma cerrado en el servicio de urgencias? / ¿Is cost-effectiveness the rutinary use of radiographs in patients with close trauma in Emergency service?

El objetivo principal del presente estudio es el de determinar si es costo efectiva la realización de las radiografías de columna cervical, tórax y pelvis a todos los pacientes con trauma cerrado que acuden al servicio de urgencias. La percepción, tanto por los médicos del servicio de Urgencias, como por los cirujanos y los radiólogos, es que un alto número de estos estudios tienen resultados normales y que por lo tanto su realización no se justifica. Se revisaron las historias clínicas y los reportes radiológicos de 408 pacientes a los que se les realizó el protocolo de radiografías adoptado por el servicio de urgencias de nuestro hospital por recomendación del ATLS radiografías de columna cervical proyección lateral, tórax y de pelvis) con diagnóstico de politraumatismo secundario a trauma cerrado durante el período de junio de 1997 a mayo de 1998. Se incluyeron todos los pacientes mayores de 15 años con estas características. Se hizo la medición de costos, efectividad y la evaluación de asociación entre los hallazgos clínicos y los resultados de los estudios radiológicos. Encontramos que el examen físico es un mal predictor de la presencia de alteraciones en los pacientes con este tipo de trauma y sólo la presencia de déficit sensitivo en trauma cervical, dolor pélvico en trauma de pelvis y huellas externas en el trauma de tórax se asocian significativamente a hallazgos en la radiografía. La realización de los estudios radiológicos rutinarios, propuesto por la ATLS en los pacientes con trauma cerrado en el servicio de urgencias es costo-efectiva

[Factors associated with hospital mortality in patients admitted to the intensive care unit in Colombia]. / Factores asociados con la mortalidad hospitalaria en pacientes admitidos en cuidados intensivos en Colombia.

OBJECTIVES: To describe the demographic features, reasons for hospital admission and factors associated with hospital mortality in patients admitted to intensive care in Colombia. METHOD: A cohort study of patients admitted to intensive care units (ICUs). Of 89 ICUs identified in Colombia, 20 in ten cities were invited to gather information on 200 consecutive patients admitted to each ICU. RESULTS: Three thousand sixty-six patient cases were available for analysis. The mean age was 53 years and 43% were women (men vs. women, p < 0.001). The most frequent cause of admission was medical (63.9%), acute myocardial infarction patients (7.1%) comprising the largest group. Severity of disease measured as APACHE II and III was a mean 14.0 (SD 6.9) and 48.3 (SD 23.5), respectively. Multivariate analysis, independent of adjustment for severity (APACHE II or III), showed that the factors associated with hospital death were the need for mechanical ventilation, pupillary response, transfer from a medical ward, and management by the ICU team prior to admission (p < 0.01). CONCLUSION: The most common reason for admission to an ICU in Colombia was myocardial infarction. Besides severity of disease, other variables related to medical care in Colombia are associated with hospital mortality, such as invasive ventilation. Although these variables may be artifacts related to disease severity, they are more likely to be related to quality of care.

Factores asociados con la mortalidad hospitalaria en pacientes admitidos en cuidados intensivos en Colombia / Factors associated with hospital mortality in patients admitted to the intensive care unit in Colombia

OBJETIVOS: Describir las características demográficas, las causas de ingreso y los factores asociados con la mortalidad hospitalaria en pacientes admitidos en cuidados intensivos en Colombia. MATERIAL Y MÉTODO: Cohorte de pacientes en una muestra de unidades de cuidados intensivos (UCI). De 89 UCI identificadas, 20 unidades en 10 ciudades de Colombia fueron invitadas a recolectar información sobre 200 pacientes consecutivos ingresados en cada unidad. RESULTADOS: Estuvieron disponibles para ser analizados 3.066 pacientes. El promedio de edad fue de 53 años, el 43 por ciento eran mujeres (p < 0,001). La causa más frecuente de ingreso fue no quirúrgica (63,9 por ciento), principalmente infarto miocárdico (7,1 por ciento). La gravedad de la enfermedad, medida por APACHE II y III, fue como promedio de 14,0 (DE, 6,9) y 48,3 (DE, 23,5), respectivamente. En el análisis multivariado, independientemente de la escala utilizada para ajustar por confusión por la gravedad de la enfermedad (APACHE II y III), los factores asociados con muerte hospitalaria fueron la necesidad de ventilación mecánica, la respuesta pupilar a la luz, el proceder del área médica (no quirúrgico) y el manejo por el grupo de UCI antes de la admisión en cuidados intensivos (p < 0,01). CONCLUSIÓN: La causa más frecuente de ingreso en cuidados intensivos en Colombia fue el infarto miocárdico. Además de la gravedad de la enfermedad, existen en Colombia otras variables dependientes de la atención médica que se asocian con mortalidad, como la ventilación mecánica invasiva. Aunque podrían ser marcadores residuales de gravedad de la enfermedad, más probablemente están asociadas con la calidad de la atención brindada (AU)

In vitro activity of antituberculous agents against Mycobacterium tuberculosis isolates from Bogota, DC (Colombia) evaluated by the ETest.

Tuberculosis tests for antimicrobial susceptibility takes weeks. However, delayed therapy, can compromise the patient, as well as lead to an increase in disease incidence. Among infectious diseases, tuberculosis continues to be a leading cause of death in the world. The E-test is a new concept for Minimal Inhibitory Concentrations (MIC) determinations for antimicrobial agents that is based on a predefined antibiotic gradient on a plastic strip calibrated with a continuous logarithmic MIC scale covering 15 two-fold dilutions. MICs of rifampin, isoniazid, and ethambutol were determined by using the E-test (AB BIODISK, Solna, Sweden) for 30 clinical strains of Mycobacterium tuberculosis isolated from four hospitals, and were compared with the Bactec method. To make the inoculum with a turbidity equivalent to a McFarland 3.0 standard, we obtained a sample from an agar surface and the Bactec 460, as described by the manufacturer. Excellent agreement (100% for rifampin, 96.8% for ethambutol, and 90% for isoniazid) was demonstrated between the E-test MIC distributions and the Bactec interpretive criteria for all clinical isolates of M. tuberculosis tested. The E-test appears to be a good alternative method for testing the susceptibility of M. tuberculosis isolates to the three, most-commonly-used therapeutic agents.