The disordering effect of SARMs on a biomembrane model.

From medicine to sport, selective androgen receptor modulators (SARMs) have represented promising applications. The ability of SARMs to selectively interact with the androgen receptor (AR) indicates that this kind of molecule can interfere with numerous physiological and pathological processes controlled by the AR regulatory mechanism. However, critical concerns in relation to safety and potential side effects of SARMs remain under discussion and investigation. SARMs, being hydrophobic/organic compounds, can be subjected to hydrophobic interactions. In this perspective, we hypothesize that SARMs interact with lipid membranes, producing significant physical and chemical changes that could be associated with several effects that SARMs represent in biological systems. In this context, the effect of SARMs on lipid membranes mediated by non-specific interactions is little explored. Here, we report significant information related to the changes that ostarine, ligandrol, andarine, and cardarine produce in the thermodynamic properties of a lipid biomembrane model. Physical changes and chemical interactions of the systems were investigated by differential scanning calorimetry (DSC), dynamic light scattering (DLS), attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR), and theoretical calculations implementing density functional theory (DFT). We demonstrate that ostarine, ligandrol, andarine, and cardarine can strongly interact with a lipid biomembrane model composed of 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC), and accordingly, these molecules can be incorporated into the polar/hydrophobic regions of the lipid bilayer. By employing theoretical calculations, we gained insights into the possible electrostatic interactions between SARMs and phospholipid molecules, enhancing our understanding of the driving forces behind the interactions of SARMs with lipid membranes. Overall, this investigation provides relevant knowledge related to the biophysical-chemical effects that SARMs produce in biomembrane models and could be of practical reference for promising applications of SARMs in medicine and sport.

Defining the characteristics of intermediate care models including transitional care: an international Delphi study.

BACKGROUND: Although there is growing utilisation of intermediate care to improve the health and well-being of older adults with complex care needs, there is no international agreement on how it is defined, limiting comparability between studies and reducing the ability to scale effective interventions. AIM: To identify and define the characteristics of intermediate care models. METHODS: A scoping review, a modified two-round electronic Delphi study involving 27 multi-professional experts from 13 countries, and a virtual consensus meeting were conducted. RESULTS: Sixty-six records were included in the scoping review, which identified four main themes: transitions, components, benefits and interchangeability. These formed the basis of the first round of the Delphi survey. After Round 2, 16 statements were agreed, refined and collapsed further. Consensus was established for 10 statements addressing the definitions, purpose, target populations, approach to care and organisation of intermediate care models. DISCUSSION: There was agreement that intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care. Models are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination. CONCLUSIONS: This study identified key defining features of intermediate care to improve understanding and to support comparisons between models and studies evaluating them. More research is required to develop operational definitions for use in different healthcare systems.

Calcium and protons affect the interaction of neurotransmitters and anesthetics with anionic lipid membranes.

We study how zwitterionic and anionic biomembrane models interact with neurotransmitters (NTs) and anesthetics (ATs) in the presence of Ca(2+) and different pH conditions. As NTs we used acetylcholine (ACh), γ-aminobutyric acid (GABA), and l-glutamic acid (LGlu). As ATs, tetracaine (TC), and pentobarbital (PB) were employed. By using differential scanning calorimetry (DSC), we analyzed the changes such molecules produce in the thermal properties of the membranes. We found that calcium and pH play important roles in the interactions of NTs and ATs with the anionic lipid membranes. Changes in pH promote deprotonation of the phosphate groups in anionic phospholipids inducing electrostatic interactions between them and NTs; but if Ca(2+) ions are in the system, these act as bridges. Such interactions impact the physical properties of the membranes in a similar manner that anesthetics do. Beyond the usual biochemical approach, we claim that these effects should be taken into account to understand the excitatory-inhibitory orchestrated balance in the nervous system.

Biophysical investigation of liposome systems decorated with bioconjugated copolymers in the presence of amantadine.

Liposome-based technologies derived from lipids and polymers (e.g., PEGylated liposomes) have been recognized because of their applications in nanomedicine. However, since such systems represent myriad challenges and may promote immune responses, investigation of new biomaterials is mandatory. Here, we report on a biophysical investigation of liposomes decorated with bioconjugated copolymers in the presence (or absence) of amantadine (an antiviral medication). First, copolymers of poly(N,N-dimethylacrylamide-co-fluoresceinacrylate-co-acrylic acid-N-succinimide ester)-block-poly(N-isopropylacrylamide) (PDMA-b-PNIPAM) containing a fluorescence label were biofunctionalized with short peptides that resemble the sequence of the loops 220 and 130 of the binding receptor of the hemagglutinin (HA) protein of the influenza A virus. Then, the bioconjugated copolymers were self-assembled along with liposomes composed of 1,2 dimyristoyl-sn-glycero-3-phosphocholine, sphingomyelin, and cholesterol (MSC). These biohybrid systems, with and without amantadine, were systematically characterized using differential scanning calorimetry (DSC), dynamic light scattering (DLS), and cryogenic transmission electron microscopy (cryoTEM). Finally, the systems were tested in an in vitro study to evaluate cytotoxicity and direct immunofluorescence in Madin Darbin Canine Kidney (MDCK) cells. The biohybrid systems displayed long-term stability, thermo-responsiveness, hydrophilic-hydrophobic features, and fluorescence properties and were presumable endowed with cell targeting properties intrinsically integrated into the amino acid sequences of the utilized peptides, which indeed turn them into promising nanodevices for biomedical applications.

Fluidized or not fluidized? Biophysical characterization of biohybrid lipid/protein/polymer liposomes and their interaction with tetracaine.

BACKGROUND: Nanomedicine and the pharmaceutical industry demand the investigation of new biomaterials to improve drug therapies. Combinations of lipids, proteins, and polymers represent innovative platforms for drug delivery. However, little is known about the interactions between such compounds and this knowledge is key to prepare successful drug delivery systems. METHODS: Biophysical properties of biohybrid vesicles (BhVs) composed of phospholipids, proteins, and amphiphilic block copolymers, assembled without using organic solvents, were investigated by differential scanning calorimetry and dynamic light scattering. We studied four biohybrid systems; two of them included the effect of incorporating tetracaine. Thermal changes of phospholipids and proteins when interacting with the amphiphilic block copolymers and tetracaine were analyzed. RESULTS: Lysozyme and the copolymers adsorb onto the lipid bilayer modifying the phase transition temperature, enthalpy change, and cooperativity. Dynamic light scattering investigations revealed relevant changes in the size and zeta potential of the BhVs. Interestingly, tetracaine, a membrane-active drug, can fluidize or rigidize BhVs. CONCLUSIONS: We conclude that positively charged regions of lysozyme are necessary to incorporate the block copolymer chains into the lipid membrane, turning the bilayer into a more rigid system. Electrostatic properties and the hydrophilic-lipophilic balance are determinant for the stability of biohybrid membranes. GENERAL SIGNIFICANCE: This investigation provides fundamental information associated with the performance of biohybrid drug delivery systems and can be of practical significance for designing more efficient drug nanocarriers.

The effect of neuroleptic drugs on DPPC/sphingomyelin/cholesterol membranes.

The hydrophobic nature of neuroleptic drugs renders that these molecules interact not only with protein receptors, but also with the lipids constituting the membrane bilayer. We present a systematic study of the effect of seven neuroleptic drugs on a biomembrane model composed of DPPC, sphingomyelin, and cholesterol. Differential scanning calorimetry (DSC) measurements were used to monitor the gel-fluid phase transition of the lipid bilayer at three pH values and also as a function of drug concentration. The implementation of a new methodology to mix lipids homogeneously allowed us to assemble bilayers completely free of organic solvents. The seven neuroleptics were: trifluoperazine, haloperidol decanoate, clozapine, quetiapine, olanzapine, aripiprazole, and amisulpride. The DSC results show that the insertion of the drug into the bilayer produces a fluidization and a disordering of the bilayer. The bilayer perturbation is qualitatively the same for all the studied drugs, but quantitatively different. The driving force for the neuroleptic drug to place itself in the lipid bilayer is entropic in nature, signaling to the importance of the size and geometry of the drugs. The drug protonated species produce stronger effects than their non-protonated forms. At high concentrations two of the neuroleptics revert the fluidization effect and another completely abolishes the gel-fluid transition. The DSC data and the associated discussion contribute to the understanding of the interactions between neuroleptic drugs and lipid membranes.

Thermal behavior of a lipid-protein membrane model and the effects produced by anesthetics and neurotransmitters.

Despite decades of intense research to understand the phenomenon of anesthesia and its membrane-related changes in neural transmission, where lipids and proteins have been proposed as primary targets of anesthetics, the involved action mechanisms remain unclear. Based on the overall agreement that anesthetics and neurotransmitters induce particular modifications in the plasma membrane of neurons, triggering specific responses and changes in their energetic states, we present here a thermal study to investigate membrane effects in a lipid-protein model made of 1,2-dimyristoyl-sn-glycero-3-phosphocholine and albumin from chicken egg white under the influence of neurotransmitters and anesthetics. First, we observe how ovalbumin, ovotransferrin, and lysozyme (main albumin constituents from chicken egg white) interact with the lipid membrane enhancing their lipophilic character while exposing their hydrophobic domains. This produces a lipid separation and a more ordered hybrid lipid-protein assembly. Second, we measured the thermotropic changes of this assembly induced by acetylcholine, γ-aminobutiric acid, tetracaine, and pentobarbital. Although the protein in our study is not a receptor, our results are striking, for they give evidence of the great importance of non-specific interactions in the anesthesia mechanism.

La Cruz Roja española en la profesionalización enfermera entre 1912 y 1939 / Spanish Red Cross In Nursing Professionalization Between 1912 And 1939. Bibliographic Review

Introducción: La fundación de la Cruz Roja Española se puede remontar a la tercera Guerra Carlista, los fines, principios y el servicio de esta institución repercutieron en el desarrollo de la profesión de enfermería en la época. Objetivo: determinar la implicación de la Cruz Roja Española en la profesionalización enfermera entre 1912 y 1939. Material y método: se realizó una búsqueda bibliográfica en los principales portales de búsqueda, así como en bibliotecas de especialización en historia de la enfermería. Resultados: la Cruz Roja Española participó en el desarrollo asistencial y formativo de la enfermería, fundando y regentando hospitales propios y hospitales de campaña para atender a los heridos surgidos de diferentes conflictos bélicos, como las propias Guerras Carlistas, la Guerra del Rif o la Guerra Civil Española. En la formación fundaron diversos Hospitales-Escuelas que impartían una formación teórico-práctica, supervisada por monjas religiosas. Conclusión: la participación de la Cruz Roja en la profesionalización enfermera radica en la colaboración, atención y asistencia de los heridos en numerosos conflictos bélicos a nivel nacional, como fueron las Guerras Carlistas, la Guerra del Rif y la Guerra Civil Española. La Cruz Roja también participó en el avance y mejora de la formación reglada hasta la época, contando con figuras como la de Dama Enfermera, Enfermeras profesionales y enfermeras especialistas. (AU)

Background: The foundation of the Spanish Red Cross can be traced back to the third Carlist War, the purposes, principles, and service of this institution had an impact on the development of the nursing profession at the time. Objective: to determine the involvement of the Spanish Red Cross in nursing professionalization between 1912 and 1939. Methods: A bibliographic search was carried out in the main search portals, as well as in specialized libraries in nursing history. Results: The Spanish Red Cross participated in the development of nursing care and training, founding and running its own hospitals and field hospitals to care for the wounded from various wars, such as the Carlist Wars themselves, the Rif War or the Spanish Civil War. In the training they founded various Hospital-Schools that provided theoretical practical training, supervised by religious nuns. Conclusion: The participation of the Red Cross in the professionalization of nursing lies in the collaboration, care, and assistance of the wounded in numerous armed conflicts at the national level, such as the Carlist Wars, the Rif War and the Spanish Civil War. The Red Cross also participated in the advancement and improvement of regulated training up to that time, with figures such as the Lady Nurse, professional nurses, and specialist nurses. (AU)

Oral Immunogenicity in Mice and Sows of Enterotoxigenic Escherichia Coli Outer-Membrane Vesicles Incorporated into Zein-Based Nanoparticles.

Enterotoxigenic Escherichia coli (ETEC) strains are a major cause of illness and death in neonatal and recently weaned pigs. The immune protection of the piglets derives from maternal colostrum, since this species does not receive maternal antibodies through the placenta. In the present study, outer membrane vesicles (OMVs) obtained from main ETEC strains involved in piglet infection (F4 and F18 serotypes), encapsulated into zein nanoparticles coated with Gantrez®® AN-mannosamine conjugate, were used to orally immunize mice and pregnant sows. Loaded nanoparticles were homogeneous and spherical in a shape, with a size of 220-280 nm. The diffusion of nanoparticles through porcine intestinal mucus barrier was assessed by a Multiple Particle Tracking technique, showing that these particles were able to diffuse efficiently (1.3% diffusion coefficient), validating their oral use. BALB/c mice were either orally immunized with free OMVs or encapsulated into nanoparticles (100 µg OMVs/mouse). Results indicated that a single dose of loaded nanoparticles was able to elicit higher levels of serum specific IgG1, IgG2a and IgA, as well as intestinal IgA, with respect to the free antigens. In addition, nanoparticles induced an increase in levels of IL-2, IL-4 and IFN-γ with respect to the administration of free OMVs. Orally immunized pregnant sows with the same formulation elicited colostrum-, serum- (IgG, IgA or IgM) and fecal- (IgA) specific antibodies and, what is most relevant, offspring suckling piglets presented specific IgG in serum. Further studies are needed to determine the infection protective capacity of this new oral subunit vaccine.

Curso y final de la vida profesional de Elvira López Mourín / Course and professional end of the nurse elvira lópez mourín

Introducción: Elvira López Mourín fue una enfermera profesional y militar que formó parte de la primera promoción de enfermeras profesionales de la Cruz Roja española. Se trasladó al Hospital de Melilla para atender las demandas sani tarias de la Guerra del Rif. Su participa ción en el acto del primer vuelo sanitario español la convirtió en noticia en los me dios de la época y ha permitido recupe rar su figura. Su recorrido profesional se pierde después del año 1933 cuando se incorpora como enfermera del Cuerpo Auxiliar Subalterno del Ejército en el Hospital Militar de Urgencia de Madrid. Objetivo: determinar el curso y final profesional de la enfermera Elvira López Mourín. Método: se realizó una revisión bibliográfica en los medios electrónicos y de biblioteca disponibles. Se solicitó a los principales archivos históricos docu mentación de sus años de servicio. Se realizaron entrevistas a tres informantes y vecinos del pueblo natal de Elvira que la habían conocido. Resultados: Elvira López Mourín presta sus servicios como enfermera profesional y militar en el Cuerpo Auxiliar Subalterno del Ejército hasta el año 1939, cuando es sometida a un Consejo de Guerra, bajo el gobierno de la dicta dura franquista, del que queda absuelta de todos los cargos. A partir del 12 de mayo de 1940 se reincorpora al Cuerpo Auxiliar Subalterno del Ejército prestando sus servicios en el Hospital Militar de Ur gencia de Madrid hasta el 4 de septiem bre de 1958 cuando se retiró. Conclusión: el acto que rememo ra a Elvira López Mourín es su exitosa participación en la primera misión de vuelo sanitario en España. Durante su carrera profesional ejerció como enfer mera en Melilla y como parte del Cuerpo Auxiliar Subalterno del Ejército en el Hospital Militar de Urgencia de Madrid (AU)

Background: Elvira López Mourín was a professional and military nurse who was part of the first promotion of professional nurses of the Spanish Red Cross. She moved to the Melilla Hospital to meet the health demands of the Rif War. Her participation in the act of the first Spanish sanitary flight made her news in the media of the time and has allowed her figure to be recovered. Her professional career was lost after 1933 when she joined the Army's Junior Auxi liary Corps as a nurse at the Madrid Emergency Military Hospital. Purpose: to determine the course and professional end of the nurse Elvira López Mourín. Methods: A bibliographic review was carried out in the available electronic and library media. Documentation of his years of service was requested from the main historical archives. Interviews were conducted with three informants and re sidents of Elvira's hometown who had known her. Results: Elvira López Mourín pro vided her services as a professional and military nurse in the Subordinate Auxiliary Corps of the Army until 1939, when she was subjected to a War Council, under the government of the Franco dictators hip, from which she was acquitted of all charges. As of May 12, 1940, she rejoi ned the Subordinate Auxiliary Corps of the Army, providing her services at the Emergency Military Hospital in Madrid until September 4, 1958, when she reti red. Conclusion: the act that comme morates Elvira López Mourín is her suc cessful participation in the first medic flight mission in Spain. During her pro fessional career, she worked as a nurse in Melilla and as part of the Subordinate Auxiliary Corps of the Army at the Madrid Emergency Military Hospital. She retired at the age of 65 in 1958 and worked as a nurse during the reign of Alfonso XIII and Victoria Eugenia and the Rif War, the dic tatorship of Primo de Rivera, the go vernment of the Second Republic, the Civil War, and the government of the Franco dictatorship (AU)

A technique based on droplet evaporation to recognize alcoholic drinks.

Chromatography is, at present, the most used technique to determine the purity of alcoholic drinks. This involves a careful separation of the components of the liquid elements. However, since this technique requires sophisticated instrumentation, there are alternative techniques such as conductivity measurements and UV-Vis and infrared spectrometries. We report here a method based on salt-induced crystallization patterns formed during the evaporation of alcoholic drops. We found that droplets of different samples form different structures upon drying, which we characterize by their radial density profiles. We prove that using the dried deposit of a spirit as a control sample, our method allows us to differentiate between pure and adulterated drinks. As a proof of concept, we study tequila.

Ionic interactions determine the morphology of dried alkali/liposome suspension droplets.

We sought to understand why saline drops produce intriguing patterns when drying in the presence of zwitterionic liposomes. Specifically, we would like to comprehend why the nature of such patterns is hierarchically driven by the Hofmeister series. The liposome suspension is made of 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) with alkali metal chlorides. A complexity analysis of the patterns gives a fractal dimension around 1.71, which means that the drying process resembles a DLA mechanism. A physicochemical study, including the determination of zeta potential, molecular dynamics simulations, microrheology, and calorimetry, supports the fact that electrostatic interactions among head groups of phospholipids with alkali cations are the driven forces behind the assembling of the observed structures. Moreover, we found that the morphology of the dried droplets is sensitive to the substrate. Our findings could be used in a biological context, for example, to characterize cells in ionic media.

The calorimetric properties of liposomes determine the morphology of dried droplets.

The evaporation of liquid droplets deposited on a substrate is a very complex phenomenon. Driven by capillary and Marangoni flows, particle-particle and particle-substrate interactions, the deposits they leave are vestiges of such complexity. We study the formation of patterns during the evaporation of liposome suspension droplets deposited on a hydrophobic substrate at different temperatures. We observed that as we change the temperature of the substrate, a morphological phase transition occurs at a given temperature Tm. This temperature corresponds to the gel-fluid lipid melting transition of the liposome suspension. Optical microscopy and atomic force microscopy are used to study the morphology of the patterns. Based on the radial density profiles we found that all structures can be classified into two groups: patterns composed by nearly uniform deposition (below Tm) and prominent structures containing randomly distributed voids (above Tm).

Anesthetic diffusion through lipid membranes depends on the protonation rate.

Hundreds of substances possess anesthetic action. However, despite decades of research and tests, a golden rule is required to reconcile the diverse hypothesis behind anesthesia. What makes an anesthetic to be local or general in the first place? The specific targets on proteins, the solubility in lipids, the diffusivity, potency, action time? Here we show that there could be a new player equally or even more important to disentangle the riddle: the protonation rate. Indeed, such rate modulates the diffusion speed of anesthetics into lipid membranes; low protonation rates enhance the diffusion for local anesthetics while high ones reduce it. We show also that there is a pH and membrane phase dependence on the local anesthetic diffusion across multiple lipid bilayers. Based on our findings we incorporate a new clue that may advance our understanding of the anesthetic phenomenon.

La profesión enfermera en el ejército y en la aeronáutica española (1855-1931) / The Nursing Profession In The Spanish Army And Aeronautics. Between 1855 And 1931. A Bibliographic Review

Introducción: La asistencia a los heridos en el campo de combate crea la necesidad de integrar de una manera razonada la medicina, la táctica militar y la enfermería, consistiendo esta última en la administración de cuidados prehospitalarios, procedimientos quirúrgicos y estabilización de los heridos. Objetivo: determinar las principales funciones de la profesión enfermera en el Ejército y la Aeronáutica Españolas entre 1855 y 1931. Material y método: se ha realizado una revisión bibliográfica de las principales bases de datos y motores de búsqueda científicos, así como de bibliotecas especializadas en historia de la enfermería. Los criterios de inclusión han sido: documentos que analizasen las funciones de los practicantes, enfermeros y enfermeras militares; así como su rango y escalafón. Resultados: a partir del año 1855 con la organización de la Escala Facultativa, la figura de practicante militar deja de ser una figura destinada a ser un futuro médico para incorporar funciones y responsabilidades propias. La Guerra de Marruecos implicó que la logística militar se especializase, creando aeronaves para tácticas militares con la apertura del aeródromo de Cuatro Vientos (Madrid) en 1911 y realizando la primera misión de aeroevacuación española en la misma Guerra del Rif en el año 1922. No sería hasta el año 1988 cuando la mujer se pudo incorporar al Ejército como militar profesional. Conclusión: Los aportes del ejército y aeronáutica españolas a la profesión de enfermería radican principalmente en tres grandes campos, el ámbito extrahospitalario, el ámbito de la cirugía general y vascular y el campo de la traumatología. (AU)

Background: Assistance to the wounded in the combat field creates the need to integrate medicine, military tactics and nursing in a reasoned manner, the latter consisting of the administration of prehospital care, surgical procedures and stabilization of the wounded. Objective: to determine the main functions of the nursing profession in the Spanish Army and Aeronautics between 1855 and 1931. Methods: A bibliographic review of the main scientific databases and search engines, as well as specialized libraries in the history of nursing, has been carried out. The inclusion criteria were: documents that analyzed the functions of military practitioners, nurses; as well as their rank and rank. Results: Starting in 1855 with the organization of the Facultative Scale, the figure of military practitioner ceased to be a figure destined to be a future doctor to incorporate their own functions and responsibilities. The Moroccan War implied that military logistics specialized, creating aircraft for military tactics with the opening of the Cuatro Vientos aerodrome (Madrid) in 1911 and carrying out the first Spanish air evacuation mission in the same Rif War in 1922. It would not be until 1988 when the woman was able to join the Army as a professional soldier. Conclusion: The contributions of the Spanish army and aeronautics to the nursing profession lie mainly in three large fields: the extra-hospital field, the field of general and vascular surgery, and the field of traumatology. (AU)

Función cardiovascular evaluada mediante ecocardiografía en ancianos hospitalizados / Cardiovascular function assessed by echocardiogram in hospitalized elderly

Teniendo en cuenta que los ancianos tienden a padecer enfermedades cardiovasculares, se decidió realizar un estudio descriptivo y transversal de los 205 ingresados en el Servicio de Geriatría del Hospital Clinicoquirúrgico Docente Dr Ambrosio Grillo Portuondo de Santiago de Cuba durante 2008, a todos los cuales se les indicó una ecocardiografía -con independencia del motivo de ingreso y el antecedente de cardiopatía o no- para evaluar no solo la función del sistema cardiovascular, sino la presencia de hipertrofia o dilatación ventriculares. Tanto esto último como el diagnóstico de cardiopatía isquémica predominaron en la casuística, si bien conviene especificar que en los pacientes seniles primó la dilatación ventricular, seguida de las insuficiencias sistólica ligera y diastólica de grado I, respectivamente. El uso de esa técnica fue válido para obtener la información necesaria al respecto, teniendo en cuenta que las imágenes ecocardiográficas resultaron muy reveladoras de cardiopatías existentes, pues de los 74 pacientes que no las refirieron en la anamnesis, 20 presentaban miocardiopatía hipertrófica y 12 daño valvular(AU)

Regarding elderly tend to have cardiovascular diseases, it was decided to carry out a descriptive and cross-sectional study with the 205 hospitalized patients at the Geriatrics Service from Dr Ambrosio Grillo Portuondo Clinical-Surgical Teaching Hospital located in Santiago de Cuba during the year 2008. All elderly were suggested to have an echocardiogram done -independently of the hospitalization motive and of having cardiopathy history or not- in order to assess not only the function of the cardiovascular system, but also the presence of ventricular hypertrophy or dilation. All this along with the diagnosis of ischemic cardiopathy prevailed in the case material, although it is important to specify that ventricular dilation was predominant in senile elderly, followed by I grade mild systolic and diastolic failures, respectively. The use of that technique was valid in order to obtain the necessary information, taking into account that echocardiographic images showed existing cardiopathies, since out of the 74 patients who did not report them in their history, 20 had hypertrophic cardiomyopathy and 12 had valvar damage(AU)

Función cardiovascular evaluada mediante ecocardiografía en ancianos hospitalizados / Cardiovascular function assessed by echocardiogram in hospitalized elderly

Teniendo en cuenta que los ancianos tienden a padecer enfermedades cardiovasculares, se decidió realizar un estudio descriptivo y transversal de los 205 ingresados en el Servicio de Geriatría del Hospital Clinicoquirúrgico Docente Dr Ambrosio Grillo Portuondo de Santiago de Cuba durante 2008, a todos los cuales se les indicó una ecocardiografía -con independencia del motivo de ingreso y el antecedente de cardiopatía o no- para evaluar no solo la función del sistema cardiovascular, sino la presencia de hipertrofia o dilatación ventriculares. Tanto esto último como el diagnóstico de cardiopatía isquémica predominaron en la casuística, si bien conviene especificar que en los pacientes seniles primó la dilatación ventricular, seguida de las insuficiencias sistólica ligera y diastólica de grado I, respectivamente. El uso de esa técnica fue válido para obtener la información necesaria al respecto, teniendo en cuenta que las imágenes ecocardiográficas resultaron muy reveladoras de cardiopatías existentes, pues de los 74 pacientes que no las refirieron en la anamnesis, 20 presentaban miocardiopatía hipertrófica y 12 daño valvular.

Regarding elderly tend to have cardiovascular diseases, it was decided to carry out a descriptive and cross-sectional study with the 205 hospitalized patients at the Geriatrics Service from Dr Ambrosio Grillo Portuondo Clinical-Surgical Teaching Hospital located in Santiago de Cuba during the year 2008. All elderly were suggested to have an echocardiogram done -independently of the hospitalization motive and of having cardiopathy history or not- in order to assess not only the function of the cardiovascular system, but also the presence of ventricular hypertrophy or dilation. All this along with the diagnosis of ischemic cardiopathy prevailed in the case material, although it is important to specify that ventricular dilation was predominant in senile elderly, followed by I grade mild systolic and diastolic failures, respectively. The use of that technique was valid in order to obtain the necessary information, taking into account that echocardiographic images showed existing cardiopathies, since out of the 74 patients who did not report them in their history, 20 had hypertrophic cardiomyopathy and 12 had valvar damage.

Síndrome de Dubin-Johnson y embarazo: presentación de un caso / Dubin-Johnson Syndrome and pregnancy: a case presentation

El Síndrome de Dubin-Johnson es un trastorno hereditario muy raro, se describe como una ictericia crónica no hemolítica, caracterizada por acumulación de bilirrubina conjugada en el suero y el hallazgo macroscópico de una pigmentación hepática generalizada en forma de granos oscuros, pero sin ninguna otra alteración. Esta hiperbilirrubinemia crónica a predominio de la directa de origen familiar, no hemolítico, es debida a un trastorno del transporte de la bilirrubina del hepatocito hasta el canalículo biliar y depósito en el hepatocito de un pigmento oscuro, similar a la melanina. En el embarazo, la ictericia, usualmente ausente en el primer trimestre, aumenta en el segundo y sobre todo en el tercer trimestre; a medida que tienen otros embarazos los valores se hacen más acentuados. En este caso, la paciente era portadora de dos gestaciones, en el último embarazo se observó el patrón clínico y bioquímico, con exacerbación a medida que avanzaba el tercer trimestre. No fue necesario realizar una biopsia hepática para corroborar el diagnóstico pues la embarazada portaba un estudio del Instituto de Gastroenterología realizado a su hermano menor a la edad de 16 años el 1993. La gestación cursó normalmente y se obtuvo un recién nacido normal sin posteriores complicaciones(AU)

Dubin-Johnson Syndrome is a rare inherited disorder, It is described as a chronic jaundice not hemolytic, characterized by accumulation of bilirubin conjugate in serum and macroscopic finding a liver pigmentation widespread form of dark grains, but without any other alteration. This chronic hyperbilirubinemia to predominance of the direct familiar source, not hemolytic, is due to a disorder of the hepatocyte bilirubin transport until the biliary channel. In pregnancy, jaundice, usually absent in the first quarter, increases in the second and particularly in the third quarter; in proportion to other pregnancies, values become more accentuated. In this case, the patient had carried two pregnancies, with clinical and biochemical exacerbation pattern that was observed in last pregnancy as they progressed q3. It was not needed a liver biopsy to confirm the diagnosis because of the pregnant had a study done to her brother by the Institute of Gastroenterology at the age of 16 years on 1993. Gestation was typically studied and it was obtained a newborn normal without any complication(AU)

Incidentaloma o carcinoma de la glándula suprarrenal / Incidentaloma or adrenal gland carcinoma

Se expone el caso clínico de un paciente de 60 años de edad, de piel blanca y procedencia urbana, que acudió a consulta por presentar, desde hacía 6 meses, dolor lumbar de moderada intensidad, de carácter terebrante que se irradiaba al flanco derecho, además de anorexia y pérdida de peso, lo cual empeoró progresivamente. En el examen físico se palpó una masa tumoral confusa, no dolorosa y con bordes mal definidos. Los resultados de los exámenes complementarios, incluida biopsia del riñón derecho y de la glándula suprarrenal, se correspondieron con las alteraciones características de un incidentaloma o carcinoma de dicha glándula(AU)

The clinical case of a 60 year-old white skin patient of urban origin who went to the out-patient department for 6 months, as he suffered from a gloomy lumbar pain of moderate intensity, which was irradiated to the right flank and, in occasions, to the leg of the same side is exposed. Besides, he suffered from anorexy and weight loss which worsened progressively. In the physical examination a confused unpainful tumoral mass, with undefined borders was palpated. The results of other examinations, including biopsy of the right kidney and of the adrenal gland, were in correspondance with the characteristic changes of an incidentaloma or carcinoma of this gland(AU)

Incidentaloma o carcinoma de la glándula suprarrenal / Incidentaloma or adrenal gland carcinoma

Se expone el caso clínico de un paciente de 60 años de edad, de piel blanca y procedencia urbana, que acudió a consulta por presentar, desde hacía 6 meses, dolor lumbar de moderada intensidad, de carácter terebrante que se irradiaba al flanco derecho, además de anorexia y pérdida de peso, lo cual empeoró progresivamente. En el examen físico se palpó una masa tumoral confusa, no dolorosa y con bordes mal definidos. Los resultados de los exámenes complementarios, incluida biopsia del riñón derecho y de la glándula suprarrenal, se correspondieron con las alteraciones características de un incidentaloma o carcinoma de dicha glándula.

The clinical case of a 60 year-old white skin patient of urban origin who went to the out-patient department for 6 months, as he suffered from a gloomy lumbar pain of moderate intensity, which was irradiated to the right flank and, in occasions, to the leg of the same side is exposed. Besides, he suffered from anorexy and weight loss which worsened progressively. In the physical examination a confused unpainful tumoral mass, with undefined borders was palpated. The results of other examinations, including biopsy of the right kidney and of the adrenal gland, were in correspondance with the characteristic changes of an incidentaloma or carcinoma of this gland.