Anti-Spike antibodies 3 months after SARS-CoV-2 mRNA vaccine booster dose in patients on hemodialysis: the prospective SENCOVAC study.

Background: Patients on hemodialysis are at high-risk for complications derived from coronavirus disease 2019 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity 3 months after the booster dose. Methods: This is a multicentric and prospective study assessing immunoglobulin G anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Results: A total of 711 patients [67% male, median age (range) 67 (20-89) years] were included. Of these, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, P = .001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, P = .693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated with mRNA-1273 booster (P = .001), lower time from booster (P = .043) and past breakthrough SARS-CoV-2 infection (P < .001). Conclusions: In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated with mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infection.

[Immunotyping of lymphocytes in the gastric mucosa of patients infected by H. pylori in two regions with contrast in the risk of developing gastric cancer]. / Inmunotipificación de linfocitos en mucosa gástrica de pacientes infectados por H. pylori en dos regiones geográficas con contraste en el riesgo de desarrollar cáncer gástrico.

Helicobacter pylori (H. pylori) infection involves multiple factors internal and external to the host. Among the internal factors, the immune response plays a fundamental role in the process of antigen presentation, lymphocytic response and cytokine-mediated regulatory response that are directly as sociated with disease progression and prognosis. OBJECTIVE: To compare the immune response in gas tric mucosa of H. pylori infected patients in two regions comparing the risk of developing gastric can cer. PATIENTS AND METHOD: 71 participants with symptoms of dyspepsia were included. The samples for biopsies were collected from different regions of the gastric mucosa; the identification of H. pylori was carried out by culture and polymerase chain reaction (PCR) of the ureA gene. For the characteri zation of the histopathological alterations and the immunophenotyping of lymphocytes, anti-human mouse monoclonal antibodies specific for each antigen were used: T lymphocytes: CD3 and CD8; B lymphocytes: CD20; Natural Killer Cells: CD56; Macrophages: CD68. RESULTS: The prevalence of H. pylori was 83.1%, the predominant types of gastritis were chronic gastritis and multifocal atrophic gastritis with intestinal metaplasia (63.4% and 22.5%, respectively). The cellular response was charac terized mainly by polymorphonuclear lymphocytes and positive anti-CD8 reactivity both in stroma and epithelium. CONCLUSIONS: Multifocal atrophic gastritis was more prevalent in the high-risk region for gastric cancer (GC) while non-atrophic gastritis and the expression of CD3 and CD8 antigens in the foveolar epithelium was higher in the low-risk region.

Aggressive angiomyxoma of the vagina: Case report and review of the literature / Angiomixoma agresivo de vagina: reporte de caso y revisión de la literatura

RESUMEN Objetivos: Presentar el caso de una paciente con diagnóstico de angiomixoma agresivo de vagina, y hacer una revisión de la literatura del diagnóstico, tratamiento y pronóstico. Materiales y métodos: Mujer de 46 años de edad, quien consulta por disuria y sensación de masa en vagina. Tras la exploración física y los estudios imagenológicos se observa tumoración en vagina con extensión hacia cavidad pélvica, la cual es extraída por cirugía vaginal. La patología quirúrgica mostró angiomixoma agresivo de vagina. La lesión presentó recurrencia al tercer mes posoperatorio requiriendo una nueva cirugía por vía retrorrectal. Se realizó una búsqueda en las bases de datos Medline vía PubMed, LILACS, SciELO y Google Scholar, con los términos: "Angiomixoma", "Agresivo" y "Vagina",incluyendo artículos de revisión, reportes y series de caso en inglés y español publicados desde 1995. Se extrajo información sobre el diagnóstico referente a síntomas, signos, pruebas de inmunohistoquímica e imágenes utilizadas, el tipo de tratamiento -quirúrgico o de otro tipo- y el pronóstico. Se hace descripción narrativa de los hallazgos Resultados: Se identificaron 23 títulos, de los cua- les 14 reportes de caso, 2 series de casos clínicos y un artículo de revisión cumplieron los criterios de inclusión. El 65 % de las pacientes tenía entre 30 y 50 años. El diagnóstico se hizo con estudios de inmunohistoquímica en 8 de los casos y se utilizaron imágenes diagnósticas en 12 casos; la tomografía mostró mejor delimitación de las lesiones. El trata- miento quirúrgico se aplicó en todos los reportes y se complementó con terapia hormonal en 4 casos. Se hizo seguimiento a 14 de los 17 casos reportados. Conclusión: El angiomixoma agresivo de vagina es una entidad poco frecuente. Es necesario evaluar la utilidad de las diferentes pruebas de inmunohistoquímica en los casos identificados como angiomixoma agresivo por histopatología. Se requiere evaluación del tratamiento hormonal como coadyuvante de la cirugía. El pronóstico es bueno.

ABSTRACT Objectives: To present the case of a patient diagnosed with aggressive angiomyxoma of the vagina and to conduct a review of the diagnosis, treatment and prognosis of this disease condition. Materials and Methods: A 46-year old female patient complaining of dysuria and vaginal mass sensation. Physical exploration and imaging studies revealed a tumor extending into the pelvic cavity. The mass was resected through a vaginal approach and pathology of the surgical specimen showed an aggressive angiomyxoma of the vagina. New retrorectar surgery was performed three months after the initial resection because of recurrence. A search was conducted in the Medline via PubMed, Lilacs, Scielo and Google Scholar databases using the terms "Angiomyxoma," "Aggressive" and "Vagina." The search included review articles, case reports and case series published in English and Spanish since 1995. The information extracted included diagnosis, symptoms, signs, immunohistochemistry and imaging studies used, type of treatment surgical or other - and prognosis. Findings are described in narrative form. Results: Overall, 23 titles were identified, of which 14 case reports, 2 clinical case series and 1 review article met the inclusion criteria. Sixty-five per cent of the patients were between 30 and 50 years of age. Diagnosis was made by immunohistochemistry in 8 cases, and diagnostic imaging was used in 12 cases. Computed tomography showed sharper contours of the lesions. Surgical treatment was applied in all reports, supplemented by hormonal therapy in 4 cases. There was follow-up in 14 of the 17 cases reported. Conclusion: Aggressive angiomyxoma of the vagina is rare. Assessment of the role of various immunohistochemical tests is needed in cases identified as aggressive angiomyxoma on histopathology. Evaluation of hormonal treatment as an adjunct to surgery is required. Prognosis is good.

Aggressive angiomyxoma of the vagina: Case report and review of the literature.

OBJECTIVE: To present the case of a patient diagnosed with aggressive angiomyxoma of the vagina and to conduct a review of the diagnosis, treatment and prognosis of this disease condition. METHODS: A 46-year old female patient complaining of dysuria and vaginal mass sensation. Physical exploration and imaging studies revealed a tumor extending into the pelvic cavity. The mass was resected through a vaginal approach and pathology of the surgical specimen showed an aggressive angiomyxoma of the vagina. New retrorectar surgery was performed three months after the initial resection because of recurrence. A search was conducted in the Medline via PubMed, Lilacs, Scielo and Google Scholar databases using the terms "Angiomyxoma," "Aggressive" and "Vagina." The search included review articles, case reports and case series published in English and Spanish since 1995. The information extracted included diagnosis, symptoms, signs, immunohistochemistry and imaging studies used, type of treatment surgical or other - and prognosis. Findings are described in narrative form. RESULTS: Overall, 23 titles were identified, of which 14 case reports, 2 clinical case series and 1 review article met the inclusion criteria. Sixty-five per cent of the patients were between 30 and 50 years of age. Diagnosis was made by immunohistochemistry in 8 cases, and diagnostic imaging was used in 12 cases. Computed tomography showed sharper contours of the lesions. Surgical treatment was applied in all reports, supplemented by hormonal therapy in 4 cases. There was follow-up in 14 of the 17 cases reported. CONCLUSIONS: Aggressive angiomyxoma of the vagina is rare. Assessment of the role of various immunohistochemical tests is needed in cases identified as aggressive angiomyxoma on histopathology. Evaluation of hormonal treatment as an adjunct to surgery is required. Prognosis is good.

TITULO: ANGIOMIXOMA AGRESIVO DE VAGINA: REPORTE DE CASO Y REVISIÓN DE LA LITERATURA. OBJETIVO: Presentar el caso de una paciente con diagnóstico de angiomixoma agresivo de vagina, y hacer una revisión de la literatura del diagnóstico, tratamiento y pronóstico. METODOS: Mujer de 46 años de edad, quien consulta por disuria y sensación de masa en vagina. Tras la exploración física y los estudios imagenológicos se observa tumoración en vagina con extensión hacia cavidad pélvica, la cual es extraída por cirugía vaginal. La patología quirúrgica mostró angiomixoma agresivo de vagina. La lesión presentó recurrencia al tercer mes posoperatorio requiriendo una nueva cirugía por vía retrorrectal. Se realizó una búsqueda en las bases de datos Medline vía PubMed, LILACS, SciELO y Google Scholar, con los términos: "Angiomixoma", "Agresivo" y "Vagina",incluyendo artículos de revisión, reportes y series de caso en inglés y español publicados desde 1995. Se extrajo información sobre el diagnóstico referente a síntomas, signos, pruebas de inmunohistoquímica e imágenes utilizadas, el tipo de tratamiento -quirúrgico o de otro tipo- y el pronóstico. Se hace descripción narrativa de los hallazgos. RESULTADOS: Se identificaron 23 títulos, de los cua- les 14 reportes de caso, 2 series de casos clínicos y un artículo de revisión cumplieron los criterios de inclusión. El 65 % de las pacientes tenía entre 30 y 50 años. El diagnóstico se hizo con estudios de inmunohistoquímica en 8 de los casos y se utilizaron imágenes diagnósticas en 12 casos; la tomografía mostró mejor delimitación de las lesiones. El trata- miento quirúrgico se aplicó en todos los reportes y se complementó con terapia hormonal en 4 casos. Se hizo seguimiento a 14 de los 17 casos reportados. CONCLUSIONES: El angiomixoma agresivo de vagina es una entidad poco frecuente. Es necesario evaluar la utilidad de las diferentes pruebas de inmunohistoquímica en los casos identificados como angiomixoma agresivo por histopatología. Se requiere evaluación del tratamiento hormonal como coadyuvante de la cirugía. El pronóstico es bueno.

Análisis de la gestión del saneamiento en el asentamiento informal Bajo Los Anonos, San José, Costa Rica, desde una visión social, técnica e institucional / Analysis of the sanitation management in the informal settlement Bajo Los Anonos, San José, Costa Rica, from a social, technical and institutional perspective

RESUMEN: Objetivo: Analizar desde los ámbitos social, técnico e institucional las condiciones de saneamiento que hay actualmente en el asentamiento informal Bajo Los Anonos ubicado en San José, Costa Rica. Métodos: Mediante la aplicación de encuestas a los habitantes del lugar, se realizó una caracterización técnica y social de la autogestión del saneamiento en la comunidad; además, se realizó un muestreo simple de aguas residuales en tres puntos distintos de la comunidad; finalmente, se realizó una encuesta con preguntas abiertas al gestor ambiental de la Municipalidad de Escazú para conocer su perspectiva. Resultados: Aunque un 82% coincidió en que el mal manejo de las aguas residuales es una de las principales problemáticas, más de la mitad de las personas encuestadas no encuentran relación entre el nivel de saneamiento y su injerencia en la salud. El tránsito de aguas residuales en las calles expone a la población a un nivel de riesgo. Aunque la Municipalidad de Escazú es consciente de la problemática, no se tienen planes claros para la comunidad.Conclusiones: La comunidad presenta problemas en cuanto a la correcta gestión de las aguas residuales, debido a una combinación de factores, tales como la falta de acceso a sistemas de saneamiento de calidad, malas prácticas de las vecinas y los vecinos y la falta de apoyo institucional.

ABSTRACT Objective: To analyze from a social, technical and institutional perspective the sanitation conditions that currently exist in the informal settlement Bajo Los Anonos located in San José, Costa Rica. Methods: By applying surveys to the inhabitants of the place, it was made a technical and social characterization of the self-management of sanitation in the community; in addition, it was realized a simple sampling of wastewater in three different points of the community; finally, we made a survey with open questions to the environmental manager of the Municipality of Escazú to know their perspective. Results: Although 82% agreed that poor wastewater management is one of the main problems, more than half of the people did not find a relationship between the level of sanitation and its interference in health. Transit of wastewater in the streets exposes the population to a level of risk. Even though the Municipality of Escazú is aware of the problem, there are no clear plans for the community. Conclusions: The community presents problems regarding the correct management of wastewater, due to a combination of factors, such as lack of access to quality sanitation systems, bad practices of neighbors and lack of institutional support.

Punctual mutations in 23S rRNA gene of clarithromycin-resistant Helicobacter pylori in Colombian populations.

AIM: To characterize punctual mutations in 23S rRNA gene of clarithromycin-resistant Helicobacter pylori (H. pylori) and determine their association with therapeutic failure. METHODS: PCR products of 23S rRNA gene V domain of 74 H. pylori isolates; 34 resistant to clarithromycin (29 from a low-risk gastric cancer (GC) population: Tumaco-Colombia, and 5 from a high-risk population: Tuquerres-Colombia) and 40 from a susceptible population (28 from Tumaco and 12 from Túquerres) were sequenced using capillary electrophoresis. The concordance between mutations of V domain 23S rRNA gene of H. pylori and therapeutic failure was determined using the Kappa coefficient and McNemar's test was performed to determine the relationship between H. pylori mutations and clarithromycin resistance. RESULTS: 23S rRNA gene from H. pylori was amplified in 56/74 isolates, of which 25 were resistant to clarithromycin (20 from Tumaco and 5 from Túquerres, respectively). In 17 resistant isolates (13 from Tumaco and 4 from Túquerres) the following mutations were found: A1593T1, A1653G2, C1770T, C1954T1, and G1827C in isolates from Tumaco, and A2144G from Túquerres. The mutations T2183C, A2144G and C2196T in H. pylori isolates resistant to clarithromycin from Colombia are reported for the first time. No association between the H. pylori mutations and in vitro clarithromycin resistance was found. However, therapeutic failure of eradication treatment was associated with mutations of 23S rRNA gene in clarithromycin-resistant H. pylori (κ = 0.71). CONCLUSION: The therapeutic failure of eradication treatment in the two populations from Colombia was associated with mutations of the 23S rRNA gene in clarithromycin-resistant H. pylori.

Post-chikungunya chronic inflammatory rheumatism: Follow-up of cases after 1 year of infection in Tolima, Colombia.

INTRODUCTION: Chronic Inflammatory Rheumatism (CIR) is one of the recognized and increasingly reported consequence post-chikungunya infection (pCHIK) in Colombia and Latin America. METHODS: Retrospective cohort study of 128 patients with CHIK that persisted with pCHIK-CIR after 59-68 weeks (1.13-1.31 years). This information was evaluated by means of a telephone survey and according to validated criteria (WHO 2015) previously (patients with >12 weeks post-CHIK with ≥1 manifestations [continuous/recurrent]: chronic polyarthralgia [pCHIK-CPA], stiffness and/or joint edema). RESULTS: Of the total CHIK-infected subjects finally included (n = 65), 28 (43.1%) reported pCHIK-CPA; and 38 patients (58.5%) at least one persistent rheumatological symptoms over the last year (pCHIK-CIR); 38.5% of them, morning stiffness, 18.5% joint edema, and 3.1% joint redness. No significant sex differences were found; 60% of patients with pCHIK-CPA aged> 40 years (RR = 3.75; 95%CI 1.47-9.53). The 29.2% of patients required medical attention because of symptoms. CONCLUSIONS: Nearly half of patients with CHIK had at least one rheumatologic symptom persistent over a year, and the third of them, pCHIK-CPA. These results are comparable with previous estimates obtained in other cohorts in the country (Risaralda and Sucre) and are consistent with results from other studies in France and India.

La expresión de CD64 en neutrófilos, procalcitonina y presepsina sérica son útiles para diferenciar infección de actividad en pacientes con lupus eritematoso sistémico y respuesta inflamatoria patients with systemic lupus erythematosus and inflammatory response / CD64 expression in neutrophils, Procalcitonin and serum presepsina are useful for differentiating infection activity in patients with systemic lupus erythematosus and inflammatory response

Introducción: La diferenciación entre actividad lúpica de infecciones en pacientes con lupus eritematoso sistémico (LES) es difícil debido a una presentación clínica similar. El objetivo es evaluar la utilidad de una serie de biomarcadores para diferenciar infecciones de actividad en pacientes con LES admitidos con respuesta inflamatoria sistémica (SIRS). Métodos: Pacientes con LES y SIRS que consultaron al servicio de urgencias fueron seleccionados. Se realizaron mediciones de diferentes marcadores como procalcitonina, expresión de CD64 de neutrófilos y presepsina al ingreso y fueron comparados con la presencia o no de infección, la cual se consideró presente con cultivos positivos y/o evidencia microbiológica por PCR. Se calculó la sensibilidad y especificidad de cada biomarcador y puntos de corte usando curvas ROC.

Rapidly progressive glomerulonephritis associated to afebrile endocarditis and anti-proteinasa 3 anca / Glomerulonefritis rápidamente progresiva asociada a endocarditis afebril y anca anti-proteinasa 3

Absctrat Endocarditis associated with antiPR3 ANCA and acute kidney injure generates a challenge in its diagnosis and treatment. In order to make a review about that combination, we presented a patient with necrotizing glomerulonephritis produced by a Enterococcus faecalis's subacute endocarditis and antiPR3 ANCA positive. Differential diagnosis is made between an acute kidney failure produced by ANCA's vasculitis vs necrotizing glomerulonephritis by endocarditis. Frequently it is necessary to make a biopsy to get a diagnosis. Negative immunofluorescence will guide to vasculitis associated ANCA, while positive immune complexes will guide to poststreptococcal glomerulonephritis. Other challenge that generates the association of acute kidney disease, endocarditis and antiPR3 ANCA is the treatment. ANCA positive can prompt to start immunosuppressant treatments. However, in the context of endocarditis, it could be inadvisable and even dangerous to use it. For this reason, it is controversial the use of immunosuppressant in combination with antibiotics in the acute process, in contrast with the use of only antibiotics. In the current paper we collect the 19 reports in the literature about endocarditis associated with antiPR3 ANCA, the treatment and the renal evolution of each patient. We concluded, generally, a better improvement of kidney function in patients treated with only antibiotics than those patients treated with the combination of antibiotics and corticoids. However, there are so few reports that we can't consider significant the different between both treatment groups.

Resumen La endocarditis asociada a ANCA anti-PR3 e insuficiencia renal plantea un dilema tanto en su diagnóstico como tratamiento. Para abordar una revisión de dicho tema, se presenta el caso de un paciente con glomerulonefritis rápidamente progresiva secundaria a endocarditis subaguda por Enterococcus faecalis y positividad para ANCA anti-PR3. El diagnóstico diferencial principal se establecería entre una afectación renal de una vasculitis asociada a ANCA no diagnosticada previamente vs una glomerulonefritis postinfecciosa secundaria a la endocarditis. En muchos casos es necesario disponer de una biopsia renal que esclarezca el diagnóstico, ya que una inmunofluorescencia negativa orientará hacia una vasculitis, mientras que una positividad para inmunocomplejos iría a favor de una glomerulonefritis postestreptocócica. El tratamiento a seguir es otro reto que se plantea en la coexistencia de insuficiencia renal aguda, endocarditis y ANCA anti-PR3 positivo. La positividad de ANCAs induce a valorar iniciar tratamiento con inmunosupresores, no obstante, en el lecho de una endocarditis puede resultar desaconsejado e incluso poner en riesgo la vida del paciente someterlo a un estado de inmunosupresión. Es, por tanto, controvertido el uso de inmunosupresión en combinación con antibioterapia en el proceso agudo en contraposición al uso de antibioterapia exclusivamente. En el actual artículo se recogen los 19 casos publicados en la literatura de endocarditis asociados a ANCA anti-PR3, así como el tratamiento que se realizó en cada uno de los casos y la evolución en la función renal de cada paciente, concluyendo, en general, una mejor recuperación de la función renal en los pacientes tratados con antibioterapia en exclusiva que en aquellos tratados con la combinación antibiótico-corticoides. Sin embargo, dado el pequeño tamaño muestral, no se puede considerar significativa la diferencia entre ambos tratamientos.

Distinguishing infections vs flares in patients with systemic lupus erythematosus.

SLE is a chronic autoimmune disease involving multiple systems. Patients with SLE are highly susceptible to infections due to the combined effects of their immunosuppressive therapy and the abnormalities of the immune system that the disease itself causes, which can increase mortality in these patients. The differentiation of SLE activity and infection in a febrile patient with SLE is extremely difficult. Activity indexes are useful to identify patients with lupus flares but some clinical and biological abnormalities may, however, make it difficult to differentiate flares from infection. Several biological markers are now recognized as potential tools to establish the difference between SLE activity and infection, including CRP and procalcitonin. It is possible, however, that the use of only one biomarker is not sufficient to confirm or discard infection. This means that new scores, which include different biomarkers, might represent a better solution for differentiating these two clinical pictures. This review article describes several markers that are currently used, or have the potential, to differentiate infection from SLE flares.

La tuberculosis como problemática presente en el ámbito laboral

Introducción. La tuberculosis (TB) es una enfermedad infecciosa causada por el bacilo Mycobacterium tuberculosis que puede considerarse un peligro para los trabajadores de la salud, puesto que el riesgo de contagio podría ser mayor para este grupo con respecto a la población general. Métodos. Alcance descriptivo, diseño retrospectivo. Resultados. Se identificaron 100 casos de TB en trabajadores de la salud, siendo los más afectados los médicos, profesionales del género femenino y los trabajadores con edades comprendidas entre los 25 y 29 años. El 56% correspondieron a TB extrapulmonar y se evidenciaron 15 casos de co-infección TB/VIH. La mayoría de los casos terminaron el tratamiento, sin embargo, hubo 4 casos de fallecimiento. Conclusión. Es necesario crear sistemas de vigilancia ocupacional de la TB en instituciones de salud y continuar con investigaciones sobre esta temática de importancia para el sector público y laboral de la cual existe escasa información en el país.

Introduction. Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacillus, that can be considered a danger for health workers, since as the risk of infection could be major for these workers with regard to the population in general. Objective. This descriptive and retrospective study pretend to characterize to the health workers with diagnosis of tuberculosis in the Bogota city D.C. in the period between 2011- 2014. Methods. It has been identified one hundred cases with TB in the health workers, being most affected doctors, female workers and ages between 25 and 29 years. The 56% corresponded to extrapulmonary TB and it show 15 cases of co-infection TB/HIV. Results. The maj ority of cases had completed the treatment, there were four cases of death. It is necessary creating the TB occupational surveillance systems in health institutions and continue with investigations on this subject of importance to the public and labor sectors of which there is little information in the country.

Introdução. A tuberculose é uma doença infecciosa causada pelo bacilo Mycobacterium tuberculosis que pode considerar-se um perigo para os trabalhadores da saúde, uma vez que o risco de contagio poderia ser maior para estes trabalhadores com respeito à população em geral. Métodos. Trata-se de um estudo descritivo, de desenho retrospectivo. Resultados. Identificaram-se 100 casos de TB em trabalhadores de saúde sendo os mais afetados, os médicos, professionais do género feminino e os trabalhadores com idades compreendidas entre os 25-29 anos. O 56% dos casos corresponderam a TB extrapulmonar e se evidenciaram 15 casos de co-infecção VIH/SIDA e tuberculose. A maioria dos doentes terminou o tratamento, mas houve quatro casos de morte. Conclusão. É necessário criar sistemas de vigilância ocupacional da TB em instituições de saúde e continuar com pesquisas sobre esta temática de importância para o setor público e laboral, da qual há pouca informação no país.

Use of sevelamer in chronic kidney disease: beyond phosphorus control.

Sevelamer is a non-calcium phosphate binder used in advanced chronic kidney disease (CKD) and in dialysis for hyperphosphataemia control. Several experimental, observational studies and clinical trials have shown that sevelamer has pleiotropic effects, beyond hyperphosphataemia control, including actions on inflammation, oxidative stress, lipid profile and atherogenesis, vascular calcification, endothelial dysfunction and the reduction of several uremic toxins. This is the biological basis for its global effect on cardiovascular morbidity and mortality in patients with chronic kidney disease. This review focuses on these pleiotropic actions of sevelamer and their impact on cardiovascular health, with the experience published after more than ten years of clinical expertise.

Análisis prospectivo de los bioinsumos agrícolas en Colombia: una consulta a expertos / Prospective analysis of agricultural bioinoculants in Colombia: an expert consultation

La productividad y sostenibilidad de la agricultura en Colombia pueden ser influidas positivamente a través del aprovechamiento de la biodiversidad para la producción de bioinsumos. Fueron analizados a mediano y largo plazo, los posibles escenarios futuros generados por las regulaciones que intervienen en el avance tecnológico de los bioinsumos, a través de la aplicación de una encuesta Delphi, con la participación de 23 expertos, teniendo en cuenta las tres dimensiones del desarrollo sostenible. Sobre la base de este estudio, se encontró que el 65% de los expertos consideran que el impacto de la innovación o el desarrollo tecnológico del uso de bioinsumos en la producción agrícola, tiene un alto impacto económico con un nivel de concordancia significativo (≥0.05). Adicionalmente, el 65% seleccionó como el mejor escenario, en el cual se den condiciones que promuevan mayor desarrollo, acceso y aplicación de los bioinsumos, de tal forma que se incremente el ritmo de incorporación de la tecnología por parte de los productores. En conclusión, más allá del nivel de desarrollo tecnológico, es necesario revisar los procesos legislativos para la comercialización de los bioinsumos, fue evidente que el éxito futuro de la industria de la producción de productos biológicos dependerá de la gestión de empresas innovadoras, la eficiente comercialización de los mismos, la educación y transferencia a los productores y el progreso de la investigación.

Productivity and sustainability of agriculture in Colombia can be influenced positively through the use of biodiversity for the production of bioinoculants. They were analyzed in the medium and long term, the future scenarios generated by the regulations involved in the technological advancement of bio-products through the application of a Delphi survey, with the participation of 23 experts in bio-products, taking into account the three dimensions sustainable development. Based on this study, it was found that 65% of the experts believe that the impact of innovation and technological development of the use of bio- products in agricultural production, has a high economic impact with a significant level of agreement (≥0.05). Additionally, 65% selected as the best scenario, in which conditions that promote greater development, access and application of bio-products, so that the rate of adoption of technology is increased by the producers to make. In conclusion, beyond the level of technological development is necessary to revise the legislative process for the marketing of bio-products, it was clear that the future success of the industry in the production of biological products depend on the management of innovative enterprises, efficient marketing thereof, education and transfer to producers and the progress of the investigation.

Osteoma coroideo. A propósito de un caso / Choroidal Osteoma: with regard to a case

Introducción: el osteoma coroideo (OC) es un tumor benigno de la coroides, muy poco frecuente, capaz de producir auténtico tejido óseo. Afecta típicamente a mujeres jóvenes y sanas y se localiza en el polo posterior, preferentemente en la región yuxtapapilar. Generalmente es una lesión unilateral con etiología aún desconocida. Mediante la ultrasonografía y la tomografía computarizada se puede llegar al diagnóstico al demostrar la placa calcificada correspondiente a la lesión. Caso clínico: presentamos el caso de osteoma coroideo en una paciente femenina de 36 años de edad con pérdida de la agudeza visual de ojo izquierdo y antecedente de trauma ocular. En la TAC de orbita hubo una calcificación alargada de aproximadamente 7mm localizada en la región posterior superior del ojo izquierdo, aparenta yuxtapapilar, que no se modifica con el contraste en relación con osteoma coroideo. Se realizó tomografía de coherencia óptica de OI donde se evidenció elevación del EPR, posible lesión sugerente de una membrana neovascular coroidea y líquido subretinal, por lo cual se colocó 3 dosis de antiangiogénicos, mejorando la visión a cuenta dedos a 2 MT. Conclusiones: el osteoma coroideo es un tumor intraocular benigno poco frecuente, más común en pacientes jóvenes sanas cuyo diagnóstico se confirma con la calcificación visible por TAC; entre las complicaciones que producen baja visón está el desprendimiento exudativo y hemorragia, en donde está indicado terapia fotodinámica, fotocoagulación y antiangiogénicos.

Introduction: choroidal osteoma (OC) is a rare benign tumor of the choroid, capable of producing real bone tissue. It typically affects young healthy women, and it is located in the posterior pole, preferably in the juxtapapillary region. It is usually a unilateral lesion with still unknown etiology. Diagnosis can be made by ultrasonography and computed tomography by showing the corresponding calcifed plaque of the injury. Case study: we report a case of choroidal osteoma in a female patient of 36 years of age with loss of visual acuity of the left eye and a history of ocular trauma. In the TAC there was an elongated orbit calcifcation of about 7mm, located in the upper posterior region of the left eye, appears juxtapapillary, which is not modifed by the contrast in relation to choroidal osteoma. Optical coherence tomography was performed in the LE, where EPR evidenced elevation, a possible lesion suggestive of choroidal neovascular membrane and subretinal fuid, applying 3 doses of antiangiogenic, improving vision. Conclusions: choroidal osteoma is a rare benign intraocular tumor, more common in young healthy patients whose diagnosis was confrmed by CT visible calcifcation; among its complications that cause low vision is the exudative detachment and bleeding; being photodynamic therapy, photocoagulation and antiangiogenic treatment of choice.

Uso del sevelamer en la enfermedad renal crónica. Más allá del control del fósforo / Using sevelamer in chronic kidney disease. Beyond phosphorus control

El sevelamer es un captor no cálcico de fósforo que se utiliza en la ERC avanzada y en diálisis para el control de la hiperfosforemia. Varios estudios experimentales, observacionales y ensayos clínicos han mostrado que el sevelamer tiene efectos pleiotrópicos, más allá del control de la hiperfosforemia, incluyendo acciones sobre la inflamación, el estrés oxidativo, el perfil lipídico y la aterogénesis, la calcificación vascular, la disfunción endotelial y la disminución de diversas toxinas urémicas, todo lo cual sería la base biológica de su efecto global sobre la morbilidad y la mortalidad cardiovascular en pacientes con enfermedad renal crónica. En esta revisión, se hace énfasis en estas acciones pleiotrópicas del sevelamer y su impacto en la salud cardiovascular, con la experiencia publicada después de más de 10 años de experiencia clínica (AU)

Sevelamer is a calcium-free phosphate binder used in advanced chronic kidney disease (CKD) and in dialysis to control hyperphosphatemia. Several experimental and observational studies and clinical trials have shown that sevelamer has pleiotropic effects that go beyond controlling hyperphosphatemia; these pleiotropic effects include acting on inflammation, oxidative stress, lipid profile and atherogenesis, vascular calcification, endothelial dysfunction and decreasing various uremic toxins. All of these represent the biological basis for the global effect of sevelamer on cardiovascular morbidity and mortality in patients with CKD. In this review, we emphasis these pleiotropic actions of sevelamer and their impact on cardiovascular health, with the experience published after more than 10 years of clinical experience (AU)

Electroforesis en Gel de Campo Pulsado (PFGE) para la diferenciación molecular de Listeria monocytogenes / Pulsed-field gel electrophoresis (PFGE) for the molecular differentiation of Listeria monocytogenes

En Colombia no es obligatoria la notificación deL. monocytogenes en alimentos, pero se vigilan los alimentos dealto riesgo. Clínicamente se reportan como microorganismoGram-positivo sólo cuando causan meningitis. L. monocytogeneses un patógeno intracelular, transmitido por alimentos, letalpara humanos y animales, que causa Listeriosis; enfermedadque genera varios brotes en el mundo, con pérdidashumanas y económicas. Pocos trabajos en Colombia hanlogrado identificar y serotipificar molecularmente losaislamientos, lo que sólo permite distribuir teóricamentelos serotipos en linajes. Esta revisión se limita a mostrarcaracterísticas del patógeno, su importancia en salud públicay en la industria de alimentos, generalidades de la PFGECHEF;identificando el protocolo estandarizado de trabajoy las enzimas de restricción adecuadas para cortar el ADN.Se encontró que la combinación de enzimas XbaI-AscI,seguida de ApaI es la que ofrece mejores resultados en ladiferenciación de los aislamientos; agrupándolos por linajes;mostrando variaciones intra-serotipo y que en varios paíseslatinoamericanos se analizan los resultados a través dePulseNet, lo que garantiza la comparación de los patronesde PFGE en igualdad de condiciones...

The reporting of L. monocytogenes in food in Colombia is not a mandatory; however, foods consideredhigh-risk are monitored, and the organism is only reported clinically as Gram-positive when it causesmeningitis. L. monocytogenes is a foodborne, intracellular, pathogen which causes listeriosis, a disease lethalto humans and animals. Outbreaks of this disease worldwide can bring about human and economiclosses. Only a few studies in Colombia have been able to identify and molecularly serotype isolatesallowing only the theoretical distribution of serotypes by lineage. This review explains the characteristicsof the pathogen, its importance in public health and in the food industry, and provides an overview ofPFGE-CHEF; identifying the standard work protocol and the appropriate restriction enzymes to cutDNA. We found that the enzyme combination, XbaI-AscI, followed by ApaI offers the best results todifferentiate isolates, by grouping them by lineages, and displaying intra-serotype variations. Additionally,we found that in several Latin American countries the results are analyzed using PulseNet; this ensuresthe comparison of PFGE patterns in equivalent conditions...

Na Colômbia não há uma notificação compulsóriade L. monocytogenes em alimentos, mas alimentos de altorisco são monitorados. Clinicamente, são relatados comoorganismos Gram-positivos apenas quando eles causammeningite. L. monocytogenes é um patógeno intracelularde origem alimentar, letal para seres humanos e animais,que causa a listeriose, que gera surtos em todo o mundo,com perdas humanas e econômicas. Poucos trabalhos naColômbia identificaram e sorotipificaram molecularmenteos isolados, que só permite a distribuição de sorotiposteoricamente em linhagens. Esta avaliação é limitada amostrar características do patógeno, sua importância nasaúde pública e na indústria de alimentos, e uma visãogeral do PFGE-CHEF; identificar o protocolo-padrão detrabalho e enzimas de restrição apropriadas para cortar oADN. Verificou-se que a combinação de enzimas XbaIAscI,seguido por ApaI representa a combinação de enzimasque ofereceu melhores resultados na diferenciação dosisolados, agrupando-a por linhagens, mostrando a variaçãointra-serotipo e que, em muitos países da América Latina,os resultados são analisados através PulseNet, que asseguraa comparação de padrões de PFGE em igualdade decondições...

Déficit de Tiamina: Beriberi y síndrome de Wernicke-Korsakoff / Thiamine deficiency: Beriberi and Wernicke-Korsakoff syndrome

La historia de la medicina reporta que algunos años atrás, antes de que se describiera la vitamina B 1 llamada también tiamina, ya se había descrito una enfermedad en un grupo de navegantes japoneses que causaba lesiones en el sistema nervioso y cardiovascular, entidad que se la conocía con el nombre de beriberi. El objetivo de la revisión es recordar la función de la vitamina B 1 en nuestro metabolismo, su importancia y requerimientos, además de conocer las consecuencias de su déficit, signos, síntomas y cuadros clínicos que se presentarían en ausencia de ésta. El beriberi y el Síndrome de Wernicke-Korsakoff son cuadros clínicos que aparecen por la deficiencia de tiamina; sus manifestaciones son variadas, incluyen trastarnos neurológicos, cardiovasculares, psiquiátricos y pueden llevar incluso a la muerte.

Medicine history tells us that some years ago, before vitamine B1, also called thiamine, were described, it was already known a disease in a group of Japanese sailors. That disease caused damage in the nervous and cardiovascular systems and was known with the name of beriberi. The objective of this study is to remember the vitamine B1function in our metabolism, its importance and requirements as well as to know the consequences derived from its deficiency, signs, symptoms and medical profiles appearing because of thiamine deficiency; its features are varied, and include neurological, cardiovascular, and psychiatric disorders. They can even lead patients to death.

Projeto de intervenção para melhorar a qualidade da atenção ao pré-natal na ESF Jardim América no município de Campo Belo-MG

O presente trabalho teve como objetivo, elaborar um plano de intervenção para melhorar a qualidade da atenção ao pré-natal na ESF Jardim América no Município Campo Belo-MG. Durante a gravidez, muitas mudanças acontecem no corpo da mulher, fazendo com que esse período exija cuidados especiais. O Ministério da Saúde lançou a Política de Humanização do Pré-Natal e Nascimento, em que se busca garantir o acesso e a qualidade do acompanhamento pré-natal, com humanização. Todas as Unidades Básicas de Saúde do SUS devem oferecer atendimento adequado com uma assistência médica frequente. As complicações da gestação, parto e puerpério (período que sucede o parto) constituem a décima causa de mortes em mulheres. Com um acompanhamento pré-natal e atenção ao parto adequado, consegue-se evitar a maior parte dessas mortes