Differences in molecular sensitization profiles between a Spanish and Latin American mite allergic patients.

BACKGROUND AND OBJECTIVE: To analyze the sensitization pattern to Dermatophagoides pteronyssinus and to associate the diagnostic findings and clinical severity in 218 allergic patients from two different continents. METHODS: Mite allergic patients were recruited by the Allergology departments from Latin America (n=88: Colombia, Costa Rica and Guatemala) and Spain (N=130). All patients had allergic rhinitis with or without asthma and positive skin prick test results to D. pteronyssinus. Specific IgE levels to D. pteronyssinus, D. farinae, Der p 1, Der p 2, and Der p 23 were quantified by ImmunoCAP system (ThermoFisher Scientific). Allergenic profile was also determined by western blot. Comparative Statistical analysis was performed by GraphPad software. RESULTS: Patients recognized most frequently Der p 2 (79%) followed by Der p 1 (73%), and Der p 23 (69%) allergens. The percentage of asthmatic patients increases with the number of sensitizations however none statistically significant differences were found. Interestingly, asthmatic patients presented the highest median levels of total IgE and specific IgE levels of D. pteronyssinus and molecular allergens, mainly Der p 2. Analysing the two different populations, Spanish patients were predominantly sensitized to Der p 2 (88.46%) and Der p 1 (83.84%), whereas Latin American population were more sensitized to Der p 23. CONCLUSION: Our data support the relevance of Der p 2 in mite allergy as the major allergen, with the high number of patients sensitized to it and its importance in the development of asthma. Sensitization to Der p 23 was more important in Latin America.

Comparative study of mechanical vs. manual circumcision in the pediatric population: An alternative to the conventional technique? / Estudio comparativo entre circuncisión mecánica y manual en población pediátrica: ¿una alternativa a la técnica convencional?

OBJECTIVE: Circumcision is one of the most common surgical procedures in pediatric surgery. Even though manual suture (MANS) is regarded as the gold standard technique, easy-to-use mechanical suture (MECS) devices have been recently developed, with better postoperative results in the adult population. The objective of our study was to compare the operating time and incidence of postoperative complications between both techniques in our environment. MATERIALS AND METHODS: A retrospective study of patients undergoing circumcision in our institution from October 2021 to December 2022 was carried out. Operating time and complications observed in the first 14 postoperative days (edema, hematoma, dehiscence) were analyzed according to the technique used (MANS vs. MECS) and patient age (< 12 and ≥ 12 years old). RESULTS: 173 patients (147 MANS, 26 MECS) were included. Mean operating time was significantly lower in MECS patients, both in patients < 12 years old (16 min vs. 10 min, p= 0.002) and in patients ≥ 12 years old (23 min vs. 12 min, p< 0.001). Regarding complications, MECS patients ≥ 12 years old had a lower rate of suture dehiscence (23.5% vs. 0%, p< 0.001), with no significant differences in the younger group. CONCLUSIONS: MECS circumcision is a simple and effective technique involving shorter operating times than MANS circumcision, regardless of age. It has a lower rate of complications in older children (≥ 12 years), which means it stands as a valid alternative to the conventional technique.

OBJETIVOS: La circuncisión es una de las intervenciones quirúrgicas más realizadas en cirugía pediátrica. Aunque la técnica con sutura manual (SMAN) se considera el gold standard, recientemente se han desarrollado dispositivos de sutura mecánica (SMEC) de fácil manejo y con mejores resultados postoperatorios en la población adulta. El objetivo de nuestro estudio es comparar el tiempo quirúrgico y la incidencia de complicaciones postoperatorias entre ambas técnicas en nuestro ámbito. MATERIAL Y METODOS: Estudio retrospectivo de pacientes circuncidados en nuestro centro entre octubre 2021 y diciembre 2022. Se analizó el tiempo quirúrgico y las complicaciones observadas en los primeros 14 días postoperatorios (edema, hematoma, dehiscencia), en función de la técnica empleada (SMAN vs SMEC) y la edad de los pacientes (< 12 y ≥ 12 años). RESULTADOS: Se incluyeron 173 pacientes (147 SMAN, 26 SMEC). El tiempo quirúrgico medio fue significativamente menor en los pacientes con SMEC, tanto en < 12 años (16 min vs. 10 min, p= 0,002) como en ≥ 12 años (23 min vs 12 min, p< 0,001). En cuanto a las complicaciones, los pacientes con SMEC del grupo ≥ 12 años presentaron menor tasa de dehiscencia de sutura (23,5% vs 0%, p< 0,001), sin observarse diferencias significativas en el grupo de menor edad. CONCLUSIONES: La circuncisión con SMEC es una técnica sencilla y eficaz, que precisa un tiempo quirúrgico más reducido que la sutura manual, independientemente de la edad. Presenta menor tasa de complicaciones en los niños de mayor edad (≥ 12 años), por lo que se plantea como una alternativa válida a la técnica clásica.

Estudio comparativo entre circuncisión mecánica y manual en población pediátrica: ¿una alternativa a la técnica convencional? / Comparative study of mechanical vs. manual circumcision in the pediatric population: An alternative to the conventional technique?

Objetivos: La circuncisión es una de las intervenciones quirúrgicas más realizadas en cirugía pediátrica. Aunque la técnica con suturamanual (SMAN) se considera el gold standard, recientemente se handesarrollado dispositivos de sutura mecánica (SMEC) de fácil manejo ycon mejores resultados postoperatorios en la población adulta. El objetivo de nuestro estudio es comparar el tiempo quirúrgico y la incidencia decomplicaciones postoperatorias entre ambas técnicas en nuestro ámbito.Material y métodos: Estudio retrospectivo de pacientes circuncidados en nuestro centro entre octubre 2021 y diciembre 2022. Se analizóel tiempo quirúrgico y las complicaciones observadas en los primeros14 días postoperatorios (edema, hematoma, dehiscencia), en funciónde la técnica empleada (SMAN vs SMEC) y la edad de los pacientes(< 12 y ≥ 12 años). Resultados: Se incluyeron 173 pacientes (147 SMAN, 26 SMEC).El tiempo quirúrgico medio fue significativamente menor en los pacientes con SMEC, tanto en < 12 años (16 min vs. 10 min, p= 0,002) comoen ≥ 12 años (23 min vs 12 min, p< 0,001). En cuanto a las complicaciones, los pacientes con SMEC del grupo ≥ 12 años presentaron menortasa de dehiscencia de sutura (23,5% vs 0%, p< 0,001), sin observarsediferencias significativas en el grupo de menor edad. Conclusiones: La circuncisión con SMEC es una técnica sencillay eficaz, que precisa un tiempo quirúrgico más reducido que la suturamanual, independientemente de la edad. Presenta menor tasa de complicaciones en los niños de mayor edad (≥ 12 años), por lo que se planteacomo una alternativa válida a la técnica clásica.(AU)

Objective: Circumcision is one of the most common surgical procedures in pediatric surgery. Even though manual suture (MANS) isregarded as the gold standard technique, easy-to-use mechanical suture(MECS) devices have been recently developed, with better postoperative results in the adult population. The objective of our study was tocompare the operating time and incidence of postoperative complicationsbetween both techniques in our environment.Materials and methods: A retrospective study of patients undergoing circumcision in our institution from October 2021 to December 2022was carried out. Operating time and complications observed in the first14 postoperative days (edema, hematoma, dehiscence) were analyzedaccording to the technique used (MANS vs. MECS) and patient age(< 12 and ≥12 years old).Results: 173 patients (147 MANS, 26 MECS) were included.Mean operating time was significantly lower in MECS patients, bothin patients < 12 years old (16 min vs. 10 min, p= 0.002) and in patients≥12 years old (23 min vs. 12 min, p< 0.001). Regarding complications,MECS patients ≥12 years old had a lower rate of suture dehiscence(23.5% vs. 0%, p< 0.001), with no significant differences in the youngergroup. Conclusions: MECS circumcision is a simple and effective technique involving shorter operating times than MANS circumcision, regardless of age. It has a lower rate of complications in older children (≥12years), which means it stands as a valid alternative to the conventionaltechnique.(AU)

Implementing a pediatric robotic surgery program: future perspectives. / Implementación de un programa de cirugía robótica pediátrica. Perspectivas futuras.

INTRODUCTION: The minimally invasive approach using robotic technology is fully incorporated in the treatment of adult pathologies. The first international pediatric studies with a robotic approach date from 2002, and in Spain, from 2009. We present the implementation of a Pediatric Robotic Surgery program in our setting. MATERIALS AND METHODS: A proposal for the application of robotic technology in pediatrics was developed, and after the acquisition of a Da Vinci Xi system at our center, a program was initiated under the guidance of a pediatric surgeon experienced in this approach. RESULTS: 732 patients with a median age of 12 years (7 months-17 years) have been operated on since January 2019. 56% of the procedures were abdominal. 3 thoracic approaches and 11 urologic procedures were carried out. 1 conversion to open surgery was performed during a fundoplication. The median combined duration of abdominal and thoracic approaches was 155 minutes (70-380 minutes). There were no anesthetic or hemodynamic complications. The postoperative period in the cases in which the procedure was completed was uneventful, and patients were discharged after a median of 2 days (1-16 days). CONCLUSION: The main advantage of robotic procedures is the symmetrical movement in line with the surgeon's hands, which makes the learning curve shorter. In our experience, the robotic approach has allowed for greater precision in the surgical technique, favoring the patient's recovery.

INTRODUCCION: El abordaje mínimamente invasivo empleando tecnología robótica está plenamente incorporado a la patología del adulto. Las primeras series pediátricas internacionales con abordaje robótico datan del año 2002 y en España del 2009. Presentamos la implementación de un programa de Cirugía Robótica Pediátrica en nuestro centro. MATERIAL Y METODOS: Se elaboró una propuesta de aplicación de la tecnología robótica en el área pediátrica y tras la adquisición de una plataforma Da Vinci Xi en nuestro centro, se procedió al inicio del programa bajo la tutorización de un cirujano pediátrico experimentado en este abordaje. RESULTADOS: Se han intervenido 32 pacientes con una mediana de edad de 12 años (7 meses-17 años) desde enero de 2019. El 56% de los procedimientos fueron abdominales. Se realizaron tres abordajes torácicos y 11 procedimientos urológicos. Se realizó una conversión a cirugía abierta durante una fundoplicatura. La mediana de la duración en conjunto de los abordajes abdominales y torácicos fue de 155 minutos (70-380 minutos). No hubo complicaciones anestésicas ni hemodinámicas. El postoperatorio en los casos en los que se concluyó el procedimiento no presentó incidencias y el alta se realizó con una mediana de 2 días (1-16 días). CONCLUSION: La principal ventaja de los procedimientos robóticos es el movimiento simétrico en línea con las manos del cirujano, lo que hace que la curva de aprendizaje sea más corta. En nuestra experiencia, el abordaje robótico nos ha permitido una mayor precisión en la técnica quirúrgica favoreciendo la recuperación del paciente.

Neonatal appendicitis: how many sides does this coin have? / Apendicitis neonatal, ¿cuántas caras tiene esta moneda?

Neonatal appendicitis is a very rare entity associated with immune, vascular, hypoxic, and obstructive factors. We present two cases of neonatal appendicitis with different characteristics. The first case is a 15-day-old newborn with congenital hypothyroidism who had abdominal distension and sepsis data. An appendicular plastron was found. Hirschsprung's disease was ruled out through biopsies. The second case is a 27-week-old preterm newborn with history of necrotizing enterocolitis who presented an incarcerated inguinal hernia consistent with Amyand's hernia. The prognosis of neonatal appendicitis varies according to how fast diagnosis is achieved, since it is associated with high mortality rates in the first hours. Although appendicitis is the condition best known to the pediatric surgeon, it represents a diagnostic challenge in newborns as a result of its extreme rarity and how likely it is to present comorbidities.

La apendicitis neonatal es una entidad infrecuente que asocia factores inmunes, vasculares, hipóxicos y obstructivos. Presentamos dos casos de apendicitis neonatal con diferentes características. El primer caso es un neonato de 15 días de vida con hipotiroidismo congénito. Presentaba distensión abdominal y datos de sepsis. Se halló un plastrón apendicular y se descartó enfermedad de Hirschsprung mediante biopsias. El segundo caso es un prematuro de 27 semanas, con antecedente de enterocolitis necrotizante, que a los 53 días de vida presentó una hernia inguinal incarcerada compatible con hernia de Amyand. El pronóstico de la apendicitis neonatal va unido a la celeridad del diagnóstico, ya que supone una importante mortalidad en las primeras horas. Aunque la apendicitis es el cuadro más conocido por el cirujano pediátrico, a edad neonatal es un reto diagnóstico por su extrema rareza y probable comorbilidad.

Apendicitis neonatal, ¿cuántas caras tiene esta moneda? / Neonatal appendicitis: how many sides does this coin have?

La apendicitis neonatal es una entidad infrecuente que asocia fac-tores inmunes, vasculares, hipóxicos y obstructivos. Presentamos doscasos de apendicitis neonatal con diferentes características.El primer caso es un neonato de 15 días de vida con hipotiroidismocongénito. Presentaba distensión abdominal y datos de sepsis. Se hallóun plastrón apendicular y se descartó enfermedad de Hirschsprung me-diante biopsias. El segundo caso es un prematuro de 27 semanas, conantecedente de enterocolitis necrotizante, que a los 53 días de vida pre-sentó una hernia inguinal incarcerada compatible con hernia de Amyand.El pronóstico de la apendicitis neonatal va unido a la celeridad deldiagnóstico, ya que supone una importante mortalidad en las primerashoras. Aunque la apendicitis es el cuadro más conocido por el cirujanopediátrico, a edad neonatal es un reto diagnóstico por su extrema rarezay probable comorbilidad.(AU)

Neonatal appendicitis is a very rare entity associated with immune,vascular, hypoxic, and obstructive factors. We present two cases of neo-natal appendicitis with different characteristics.The first case is a 15-day-old newborn with congenital hypothy-roidism who had abdominal distension and sepsis data. An appendicularplastron was found. Hirschsprung’s disease was ruled out through biop-sies. The second case is a 27-week-old preterm newborn with history ofnecrotizing enterocolitis who presented an incarcerated inguinal herniaconsistent with Amyand’s hernia.The prognosis of neonatal appendicitis varies according to how fastdiagnosis is achieved, since it is associated with high mortality rates inthe first hours. Although appendicitis is the condition best known to thepediatric surgeon, it represents a diagnostic challenge in newborns as aresult of its extreme rarity and how likely it is to present comorbidities.(AU)

Severe Cutaneous Adverse Reactions to Drugs in Latin America: The RACGRAD Study.

BACKGROUND AND OBJECTIVE: Severe cutaneous adverse reactions to drugs (SCARs) are associated with high morbidity and mortality and with sequelae. Objective: To characterize patients with SCARs in 8 health care institutions in Latin America. METHODS: We performed a cross-sectional, descriptive, multicenter study of patients diagnosed with SCARs in Latin America between January 2009 and December 2018. The analysis was carried out using a database in BD Clinic. RESULTS: We collected 70 patients, of whom 42 (60%) were women. Mean age was 38.7 years. Forty-two patients (60%) had DRESS-DIHS, 12 (17.1%) TEN, 5 (7.1%) SJS, 6 (8.5%) AGEP, 4 (5.7%) other reactions not classified as SCARs, and 1 (1.4%) overlapping SJS-TEN. The main causative drugs were aromatic anticonvulsants in 31 cases (44.3%), ß-lactam antibiotics in 11 cases (15.7%), and non-ß-lactam antibiotics in 6 cases (8.6%). In all of the cases, the suspected drug was withdrawn at the first sign of a SCAR. Sixty-six patients (94.2%) received anti-inflammatory treatment, mostly systemic corticosteroids. Complications occurred in 53 cases (75.7%), and 3 patients died (4.3%). Thirteen patients (18.6%) had sequelae. CONCLUSIONS: This is the first multicenter report on SCARs in Latin America. DRESS-DIHS was the most frequently reported clinical entity, and anticonvulsants were the main triggers. Most of the patients received systemic corticosteroids. Complications were frequent, and 3 patients died.

Severe Cutaneous Adverse Reactions to Drugs in Latin America: The RACGRAD Study

Background: Severe cutaneous adverse reactions to drugs (SCARs) are associated with high morbidity and mortality and with sequelae. Objective: To characterize patients with SCARs in 8 health care institutions in Latin America. Methods: We performed a cross-sectional, descriptive, multicenter study of patients diagnosed with SCARs in Latin America between January 2009 and December 2018. The analysis was carried out using a database in BD Clinic. Results: We collected 70 patients, of whom 42 (60%) were women. Mean age was 38.7 years. Forty-two patients (60%) had DRESS-DIHS, 12 (17.1%) TEN, 5 (7.1%) SJS, 6 (8.5%) AGEP, 4 (5.7%) other reactions not classified as SCARs, and 1 (1.4%) overlapping SJS-TEN. The main causative drugs were aromatic anticonvulsants in 31 cases (44.3%), ß-lactam antibiotics in 11 cases (15.7%), and non–ß-lactam antibiotics in 6 cases (8.6%). In all of the cases, the suspected drug was withdrawn at the first sign of a SCAR. Sixty-six patients (94.2%) received anti-inflammatory treatment, mostly systemic corticosteroids. Complications occurred in 53 cases (75.7%), and 3 patients died (4.3%). Thirteen patients (18.6%) had sequelae. Conclusions: This is the first multicenter report on SCARs in Latin America. DRESS-DIHS was the most frequently reported clinical entity, and anticonvulsants were the main triggers. Most of the patients received systemic corticosteroids. Complications were frequent, and 3 patients died (AU)

[Evaluation of testicular growth after varicocele treatment in early childhood and adolescence based on the technique used (Palomo, Ivanissevich and embolization)]. / Valoración del crecimiento testicular tras el tratamiento del varicocele en la infancia y adolescencia en función de la técnica empleada (Palomo, Ivanissevich y embolización).

OBJECTIVES: To analyze, depending on the technique employed, recurrence, symptomatic improvement and testicular growth following treatment of testicular varicocele. MATERIAL AND METHODS: Descriptive retrospective study of 69 pediatric and adolescent males diagnosed with varicocele treated in our center by open technique according Ivanissevich technique (IT), Palomo (PT) and percutaneous embolization (PE) between 2000-2014. Variables analyzed were age, symptoms, differential testicular volume (RV), employed technique, recurrence, symptomatic improvement and RV after treatment. Association between qualitative variables was evaluated (chi-square test or Fisher's exact test). RESULTS: 69 patients with a median age of 14 years (7-19) were studied. PE was performed in 37 patients (53,6%), PT in 23 (33,3%) and IT in 9 (13%). Recurrence occurred in 16 patients (23,2%), 80% of them had been treated with PE. Eleven patients had pain (15.9%), there was improvement in 100% of patients treated with PE, but none of those treated by PT or IT improved. At diagnosis, 37 patients (53.6%) had decreased testicular volume (left testicular hypotrophy), in 28 cases the RV was >20%. After treatment, the RV was normalized in 11 cases (39,2%). CONCLUSIONS: The choice of therapeutic technique in pediatric varicocele should be based on patient characteristics, symptoms, experience center for embolization and previous recurrence. Regardless of the chosen technique, 39,2% of testicular hypotrophy with VD >20% present at diagnosis normalized after treatment.

OBJETIVOS: Analizar en función de la técnica empleada para tratamiento de varicocele, la recurrencia, alivio sintomático y crecimiento testicular en pacientes pediátricos y adolescentes. MATERIAL Y METODOS: Estudio descriptivo retrospectivo de 69 pacientes pediátricos y adolescentes diagnosticados de varicocele tratados en nuestro centro mediante abordaje abierto según técnica de Ivanissevich (TI), Palomo (TP) y embolización percutánea (EP) entre 2000-2014. Las variables fueron edad, síntomas, volumen testicular diferencial (VD), técnica empleada, recurrencia, mejoría sintomática y VD tras el tratamiento. Se evaluó la asociación entre variables cualitativas (test de Chi cuadrado o prueba exacta de Fisher). RESULTADOS: Se estudiaron 69 pacientes con mediana de edad de 14 años (7-19). Se realizó EP a 37 pacientes (53,6%), TP a 23 (33,3%) y TI a 9 (13%). Presentaron recurrencia 16 (23,2%), de ellos el 80% habían sido tratados mediante EP. Once pacientes tenían dolor al diagnóstico (15,9%), tras el tratamiento 100% de los tratados mediante EP presentaron alivio, mientras que en ninguno de los tratados mediante TI o TP mejoró el dolor. Al diagnóstico 37 pacientes (53,6%) presentaron hipotrofia testicular izquierda, en 28 casos el VD fue >20%. Tras el tratamiento, el VD se normalizó en 11 casos (39,2%). CONCLUSIONES: La elección de la técnica terapéutica de varicocele en pacientes pediátricos y adolescentes debería depender de las características del paciente, presencia de síntomas, experiencia del centro y recurrencia previa. Independientemente de la técnica elegida el 39,2% de hipotrofias testiculares con DV >20% al diagnóstico alcanzaron la normalización del volumen testicular tras el tratamiento.

Histological analysis of the reproductive system and gonad maturity of octopus rubescens / Análisis histológico del aparato reproductor y la madurez gonadal del pulpo octopus rubescens

This study described the reproductive system and gonadal development of Octopus rubescens from Bahía de Todos Santos, Baja California, Mexico. A total of 65 organisms, 35 males weighing 7.2 to 543.4 g and 30 females from 9.4 to 87.7 g where analyzed. The gonad development was defined through histological methods using Hematoxylin-eosin and Arteta- trichrome stains. We describe macroscopically the reproductive system of males and females, and characterized each of the anatomic components. Eight stages of maturity were recognized in females: 1. Immature, 2. Initial folliculogenesis, 3. Final folliculogenesis, 4. Previtelogenesis, 5. Early vitelogenesis, 6. Final vitelogenesis, 7. Maturing and 8. Spawn. In males five stages were identified: 1. Immature, 2. Maturing A, 3. Maturing B, 4. Mature type 1 and 5. Mature type 2. This work is the first histological description of the reproductive system of this species and the beginning for future research on its basic biology.

En el presente estudio se describió el aparato reproductor y el desarrollo gonadal del pulpo Octopus rubescens de la Bahía de Todos Santos en Baja California, México. Se realizó la descripción macroscópica del aparato reproductor de hembras y machos y se caracterizó cada una de las partes que lo integran. Para la descripción del desarrollo gonadal se utilizaron las técnicas histológicas de Hematoxilina-Eosina y la tinción tricrómica de Arteta. Se analizaron histológicamente un total de 65 organismos de los cuales 35 machos tuvieron un intervalo de peso de 7,2 a 543,4 g y las 30 hembras de 9,4 a 87,7 g. La escala de madurez en las hembras se caracterizó con ocho estadios: 1. Inmaduro, 2. Foliculogénesis inicial, 3. Foliculogénesis final, 4. Previtelogénesis, 5. Vitelogénesis inicial, 6. Vitelogénesis final, 7. Maduros y 8. Desovados. En los machos se identificaron cinco estadios: 1. Inmaduro, 2. En maduración A, 3. En maduración B, 4. Maduro tipo 1 y 5. Maduro tipo 2. Este trabajo constituye la primera descripción histológica del aparato reproductor de esta especie y sienta las bases para futuras investigaciones sobre su biología básica.

Negative predictive value of skin tests to neuromuscular blocking agents.

Allergy to neuromuscular blocking agents (NMBAs) is the most important caue of perioperative anaphylaxis in France. The diagnosis relies on a careful clinical history, the search of serum IgE antibodies, and the realization of skin tests. Although the skin tests are the most important tool and their sensitivity is widely recognized, the lack of information about their negative predictive value represents an important issue in the management of patients who require a new procedure with NMBA injection. We present a series of 49 patients with confirmed allergy to NMBAs, six of whom required a subsequent surgery with neuromuscular blockade. Negative skin tests allowed the selection of an alternative NMBA, which was well tolerated in all 6 cases. We found an excellent negative predictive value of skin tests in our series but larger studies are required to properly address this question.

Efecto de la anemia ferropénica nutricional sobre el contenido en hueso de Ca, P y Fe / Iron deficiency anemia effect of nutrition on the content in bone, Ca, P and Fe

La anemia ferropénica nutricional provoca una alteración de gran importancia en el metabolismo fosfocálcico. Con este estudio pretendemos comprobar cómo la anemia ferropénica nutricional afect ael depósito de Ca y P en fémur y el contenido de Fe en esternón, para ello determinamos Fe y Ca por espectrofotometría de absorción atómica y de P por espectrofotometría ultravioleta visible en ratas macho raza Wistar albina ferrodeficientes. El depósito de Ca y P en el fémur es significativamente (P <0.001) más bajo para el grupo anémico. Esto puede deberse al incremento de los niveles séricos de PTH y cortisol, inducidos por la ferrodeficiencia severa (Campos y col., 2007). Además se produce una drástica disminución (P < 0.001) en el contenido de Fe en esternón, hecho que incide de manera muy negativa en el proceso hematopoyético(AU)

Nutritional iron-deficiency anemia provokes a noteworthy alteration in the phosphorus and calcium metabolism. With the current study we tried to check how the nutritional iron deficiency anemia affects Ca and P deposit in femur and the Fe content in sternum. We determined Fe and Ca by atomic absorption spectrophotometry and P by ultraviolet /visibly spectrophotometry in Fe-deficient male wistar albino rats. Ca and P deposit in femur is significantly lower in the anaemic group. This can be due to the increase of the serum levels of PTH and cortisol, induced by the severe Fe-deficiency. In addition, a drastic decrease in the Fe content in sternum was recorded, fact that affects in a very negative way in the haematopoietic process(AU)

Relación hepatosomática y depósito de hierro en hígado durante la instauración de anemia ferropénica nutricional / Hepatosomatic index and iron liver stores during the instauration of nutritional ferropenic anaemia

El hígado es el principal órgano de almacén de hierro en el organismo y juega un papel crucial en la homeostasis de dicho mineral. Los niveles de hierro en se consideran un fiel reflejo del estatus de hierro en el organismo, hecho que nos indujo a determinar la relación hepatosomática y el contenido de hierro en hígado durante la instauración de la anemia ferropénica nutricional inducida experimentalmente en ratas en crecimiento. Los depósitos de hierro estaban profundamente deplecionados, el peso corporal y el peso hepático fue menor en animales anémicos. Como consecuencia, la relación hepatosomática se incrementó en animales ferrodeficientes. Durante la ferrodeficiencia, varios factores reguladores de la hepcidina se alteran, aumenta la demanda eritropoyética por disminución de los parámetros hematológicos, hay un menor aporte de oxígeno a los tejidos y se deplecionan los depósitos corporales, alterándose el metabolismo de hierro, hechos que conducen a una disminución de dicha hormona, lo cual se traducirá en una menor interacción con la ferroportina 1, evitando su internalización y degradación, de manera que aumenta el flujo de salida de hierro ferroso desde los hepatocitos y consecuentemente se reduce su depósito. Por otra parte, la ferrodeficiencia afectó el peso corporal, hecho que se puede atribuir a los menores niveles de hormonas tiroideas encontrados en esta patología. Puesto que hay una clara reducción de la hemoglobina y recuento de hematíes, el suministro de oxígeno a las células se limita considerablemente e incide negativamente en la síntesis de ATP e incremento de peso(AU)

Liver is main storage organ of iron in the organism and plays a crucial role in the homeostasis of this mineral. The levels of iron are considered a routine index of the iron status in the body, fact that encouraged us to asses the hepatosomatic index and the iron content in liver, during iron-deficiency anaemia in growing rats. In rats with iron-deficiency anaemia, iron deposits were deeply depleted, body weight and hepatic weight were lower, moreover the hepatic iron deposits were lower in anaemicrats. During the iron-deficiency, several regulatory factors of the hepcidin are impaired (the erythropoietic demand increase due to the decrease of the haematological parameters, there is a minor supply of oxygen to the tissues and the body stores are depleted, being the iron metabolism altered), facts that leads to a decrease of the above mentioned hormone, which will be translated in a minor interaction with the ferroportin1, avoiding its internalization and degradation, therefore increases the outflow of ferrous iron from the hepatocytes and consistently its storage diminishes in the above mentioned organ. On the other hand, the iron-deficiency impaired the body weight, fact that can be related with the lower levels of thyroid hormones found in this pathology. Moreover, since in iron deficiency situation the haemoglobin and red blood cells count diminish drastically, the supply of oxygen to the cells limits itself considerably, which affects in a negative way to the ATP synthesis andincrease of weight(AU)

[Delirium rating scale-revised-98 (DRS-R-98): Colombian adaptation of the Spanish version]. / Escala revisada-98 para valoración del delirium (DRS-R-98): adaptación colombiana de la versión española.

INTRODUCTION: Delirium is associated with high morbidity and mortality. There are no available instruments validated for evaluation and follow-up of this syndrome in Columbia. METHODS: An expert's panel adapted the Spanish DRSR- 98. In 110, randomly selected, medical-surgical hospitalized patients, 17 (15.5 %) of them with delirium diagnosed with DSM-IV-TR criteria, the inter-rater reliability, validity and sensitivity to clinical change of the new adaptation of the scale were measured. RESULTS: Internal consistency (Cronbach's alpha: 0.956), inter- rater reliability (ICC: 0.95) and validity (94.8 % under the ROC curve area) were very good. For the Cut-off score of 14 for the total scale score, sensitivity was 82.4% and specificity 97.8 %. The scale was sensitive to clinical change, with a mean difference of 12.9 (t: 4.071; p=0.007). CONCLUSIONS: The Colombian adaptation of the Spanish DRS-R-98 is sensitive, specific and reliable for assessment of delirium in hospitalized adults in medical surgical settings.

Double renal transplantation--a strategy with donors under 3 years old.

OBJECTIVE: To evaluate the transplantation of both kidneys from donors under 3 years old to older pediatric recipients, in order to provide adequate renal mass and improve graft survival. PATIENTS AND METHODS: Seven patients received a double kidney transplant from a donor under 3 years old (mean age 2.7 years). The primary renal disease was obstructive uropathy in two patients, and hemolytic uraemic syndrome, tuberous sclerosis, nephronoptisis, reflux nephropathy and nephrotic syndrome (one patient each). Recipients were 14-18 years old and had a mean height of 165.2 cm. Five were in dialysis and it was the second transplantation for two. Both kidneys were sequentially placed in the same iliac fossa; the first was placed the most cranially with the second placed caudal to the first. The surgical technique was similar to that used to place a single graft. Immunosuppression induction employed monoclonal antibodies followed by a triple therapeutic regime (mofetyl micofenolate/steroids/tacrolimus). RESULTS: Diuresis was started immediately with all the grafts and there was no thrombosis in any patient. One patient lost both grafts due to recurrence of her primary disease. Another patient developed lymphocele 1 year post transplant and required laparoscopic drainage. The grafts in six patients are doing well after a follow up of 1 to 7 years. CONCLUSION: Double transplant of both kidneys from a donor under 3 years old can provide sufficient renal mass for adequate renal function and does not present a higher risk of complications.