Ultrasound monitoring to detect embolic phenomena in the inferior vena cava during hip arthroplasty.

INTRODUCTION AND OBJECTIVES: Embolic phenomena frequently occur during hip joint replacement surgery, and may lead to haemodynamic instability in frail patients. Transoesophageal ultrasound monitoring is rarely available in non-cardiac operating theatres, and cannot be performed in awake patients under spinal anaesthesia. The main objectives of this prospective exploratory study were to determine the feasibility of using an alternative ultrasound approach to monitor the inferior vena cava during hip replacement surgery, and to determine the intra and interobserver reliability of the ultrasound findings. METHOD: We conducted a prospective exploratory study in 20 patients undergoing cemented hip arthroplasty in the supine position under spinal anaesthesia and sedation. The inferior vena cava was assessed through a subcostal window at 10 intraoperative time points, and the findings were rated on a qualitative embolism severity scale. The ultrasound images were evaluated by 2 independent observers. RESULTS: An adequate subcostal window was obtained in 90% of cases. Intra- and inter-observer reliability was high (kappa index >0.80, p < 0.001). Nearly all (95%) patients presented some degree of embolism, which was severe in 50% of cases. CONCLUSIONS: Our study suggests that ultrasound assessment of embolic phenomena in the inferior vena cava through a subcostal window is feasible in 90% of cases. The qualitative embolic severity rating scale is highly reproducible and has high intra- and inter-observer reliability.

Breastfeeding: a key modulator of gut microbiota characteristics in late infancy.

The objective of this study was to investigate the impact of the most commonly cited factors that may have influenced infants' gut microbiota profiles at one year of age: mode of delivery, breastfeeding duration and antibiotic exposure. Barcoded V3/V4 amplicons of bacterial 16S-rRNA gene were prepared from the stool samples of 52 healthy 1-year-old Australian children and sequenced using the Illumina MiSeq platform. Following the quality checks, the data were processed using the Quantitative Insights Into Microbial Ecology pipeline and analysed using the Calypso package for microbiome data analysis. The stool microbiota profiles of children still breastfed were significantly different from that of children weaned earlier (P<0.05), independent of the age of solid food introduction. Among children still breastfed, Veillonella spp. abundance was higher. Children no longer breastfed possessed a more 'mature' microbiota, with notable increases of Firmicutes. The microbiota profiles of the children could not be differentiated by delivery mode or antibiotic exposure. Further analysis based on children's feeding patterns found children who were breastfed alongside solid food had significantly different microbiota profiles compared to that of children who were receiving both breastmilk and formula milk alongside solid food. This study provided evidence that breastfeeding continues to influence gut microbial community even at late infancy when these children are also consuming table foods. At this age, any impacts from mode of delivery or antibiotic exposure did not appear to be discernible imprints on the microbial community profiles of these healthy children.

Detección de anticuerpos anti-Mycobacterium avium subsp. paratuberculosis en bovinos de hatos lecheros de trópico bajo en los departamentos de Sucre y Córdoba, Colombia / Detection of anti-Mycobacterium aviumsubsp. paratuberculosis antibodies in cows of low-tropic dairy herds in the Provinces of Sucre and Córdoba, Colombia

RESUMEN Objetivo. Reportar la frecuencia de la seropositividad a Mycobacterium avium subsp. paratuberculosis (MAP) y explorar los factores asociados al resultado positivo, tanto a nivel de hato como de animal. Materiales y métodos. Se llevó a cabo un estudio transversal en 204 vacas lecheras resultado del cruce de diferentes razas, en cinco hatos de zonas de trópico bajo ubicadas en tres municipios de los departamentos de Sucre y Córdoba (Colombia) en 2018. Los animales fueron seleccionados aleatoriamente y se colectaron muestras de sangre de cada uno. Se utilizó un kit comercial de ELISA para analizar los sueros. La información con respecto a los factores relacionados con los hatos y los animales se recopiló mediante cuestionarios. Se calcularon las estadísticas descriptivas para todas las variables (i.e. tamaño del hato, presencia de otros rumiantes en co-pastoreo con el ganado bovino en los últimos 2 años, edad de los animales, paridad y días desde el último parto), y se exploró la asociación entre dichas variables y el resultado a ELISA (p<0.05). Resultados. El 17.2% (35/204; IC 95%: 12.0-22.3%) de las vacas resultaron positivas a MAP mediante la prueba de ELISA, y los cinco hatos tenían animales seropositivos. La variable a nivel de hato presencia de otros rumiantes en co-pastoreo con el ganado bovino en los últimos 2 años y las variables a nivel de animal edad y paridad se encontraron asociados con los resultados positivos de ELISA. Conclusiones. El presente estudio encontró que el 17.2% de las vacas y el 100% de los hatos fueron positivos a MAP mediante la prueba de ELISA. Adicionalmente se identificaron variables asociadas que pueden ser de interés tanto para los productores como para los veterinarios de animales de producción, y orientar su enfoque para el manejo de la enfermedad.

ABSTRACT Objective. To report the frequency of seropositivity against Mycobacterium avium subsp. paratuberculosis (MAP) and to explore the factors associated with the positive outcome, both at herd and animal level. Materials and methods. A cross-sectional study was carried out on 204 dairy cows, result of the crossing of different breeds, from five low-tropic dairy herds, located in three municipalities of the Provinces of Sucre and Córdoba (Colombia) in 2018. The animals were randomly selected, and blood samples were collected from each one. A commercial ELISA kit was used to analyze the sera. Information regarding factors related to herds and animals was collected through questionnaires. Descriptive statistics were calculated for all variables (i.e. herd size, presence of other ruminants co-grazing with cattle in the last 2 years, age of the animals, parity, and days since the last birth), and the association between these variables and the result to ELISA (p<0.05) was explored. Results. The 17.2% (35/204; 95% CI: 12.0-22.3%) of the cows were positive for MAP by the ELISA test, and the five herds had seropositive animals. The herd-level variable presence of other ruminants in co-grazing with cattle in the last 2 years and the animal-level variables age and parity were associated with the positive ELISA results. Conclusions. The present study found that 17.2% of the cows and 100% of the herds were MAP positive by the ELISA test. Additionally, associated variables were identified and may be of interest to both producers and veterinarians of production animals, guiding their approach to disease management.

Mutations affecting pigmentation in man: I. Neuroectodermal melanolysosomal disease.

We describe a syndrome identified in three consanguineous families who had two and probably four common ancestors five generations ago. The syndrome is characterized by profound dysfunction of the central nervous system, silver-leaden colored hair, abnormal melanosomes and melanocytes, and abnormal inclusion bodies in fibroblasts, bone marrow histiocytes and lymphocytes which appear to represent abnormal lysosomal bodies. Because of the biochemical relationships between melanin-melanosomes and neuromelanin, we think that all the manifestations of the condition are related to and represent pleiotropic effects of a newly identified gene in man in its homozygous state. Biochemical reactions of the cells of these patients indicate presence of tyrosinase in the melanosomes.and show that the substance accumulated in cultured fibroblasts and in the bone marrow histiocytes is a PAS and Oil-red-O positive material but is Oil-red-O negative after extraction; it has the typical reactions of melanin withe the Masson and Fontana stain, but cannot be considered typical melanin, since without stain it is colorless. The ultrastructural studies showed round granules with variable matrix, similar in fibroblast and bone marrow, and with variable intensity of reaction to osmium. This mutation principally affects the neuroectoderm, but also the mesoderm.

The value and safety of percutaneous lung aspiration for children with serious pulmonary infections.

It is often difficult to establish the etiology of pulmonary infections in children. The diagnostic value and safety of percutaneous needle aspiration of the lung were investigated in 98 children who were suspected of having a bacterial pulmonary infection and who were seriously ill or had failed to respond to apparently adequate empiric antimicrobial therapy. The etiology of the pulmonary infection was established in 60 patients (61%); in the remaining 38 cases (39%) no bacterial microorganisms were recovered from the lung aspirate. Twenty-four (40%) patients in whom the pathogen(s) were identified were already receiving empiric antimicrobial therapy, and in 18 (66%) the original therapeutic regimen had to be changed to optimally treat the isolated microorganism(s). A total of 11 complications occurred in 10 children (10%): 9 pneumothoraces and two instances of mild, self-limited hemoptysis. Six of the pneumothoraces (66%) required treatment by either a thoracostomy and chest-tube or simple percutaneous aspiration. There were no deaths related to the procedures. It was concluded that percutaneous needle aspiration of the lung in children is a potentially useful and reasonably safe technique for the diagnosis of pulmonary infection in carefully selected cases when an exact etiologic diagnosis is needed.

Comparison between digestive endoscopy and 24-hour esophageal pH monitoring for the diagnosis of gastroesophageal reflux esophagitis: "presentation of 100 cases".

BACKGROUND/AIMS: We present the results obtained from 100 new cases of clinical esophagitis caused by gastroesophageal reflux at the Hospital of Caldas and at the Service of Gastroenterology of VIME (Endoscopical Video Medicine) in Manizales, Caldas, Colombia; between the months of June and November of 1996, evaluated by digestive endoscopy and classified based on the New Savary-Miller 5-Grade Classification. METHODOLOGY: The patients were selected based on the presence of symptomatology suggestive of esophagitis caused by gastroesophageal reflux; an endoscopy was performed followed by 24-hour esophageal pH monitoring. The patients were grouped according to their grade of esophagitis in the New Savary-Miller Classification. The central analysis was focused on determining the existing relationship between the observed esophagitis and the results obtained by the 24-hour esophageal pH monitoring. RESULTS: Findings show that 51% and 48% of patients with esophagitis grades 1 and 2 had a normal DeMeester's score (< 14.7) in channel 1. In channel 2 we found normal scores in 86% and 82% of esophagitis grades 1 and 2, respectively. CONCLUSIONS: We ask whether the average level of pathological reflux of 14.7 can be extrapolated to our population; also whether endoscopical overdiagnosis of esophagitis caused by gastroesophageal reflux exists, or if non-recognized causes of esophagitis exist. Another question is if it is justified to order 24-hour esophageal pH monitoring in patients with grades 1 and 2 esophagitis.

[The prediction of size from the knee-external malleolus distance]. / Predicción de la talla a partir de la distancia rodilla-maléolo externo.

UNLABELLED: The object of the present study was to establish the relationship between the size an body segments in Colombian adult subjects, to get an equation that allows to estimate the size from those segments and confront it with those described in the literature. SUBJECTS AND METHODS: Group 1: Subjects over 18 years were chosen without deformities, amputations neither edemas. Age, sex, weight, size, forearm length (Fl), lower segment length (LSL), navel-heel length (NHL), navel-malleolus length (NML), lower member length (LML), knee height (KH), knee-external malleolus length (KML). Group 2: The same variables were quantified and to these subjects were established the accuracy and precision of the obtained equations and were confronted with those described in the literature. Statistical analysis. The gotten results were analyzed by means of the Student "t" test, correlation analysis, and simple linear regression and multiple step by step. An alpha error of 5% was accepted. RESULTS: 189 subjects were evaluated in group 1 and 180 in group 2. 23 male and 156 female 37.5 +/- 17.5 years old and a size of 161.2 cm +/- 9.6 cm. There was a significant correlation (p < 0.0001) between size and all the measured segments. Predictive size regression equations were established choosing the following segments: FL, NML, KML, because of their easy determination, precise reference points and high "t". The estimated size was not significantly different from the real one just in those that use KML, age an sex: Male: Size = (KML x 1.21) - (0.117 x age) + 119.6. Female: Size = (KML x 1.263) - (0.159 x age) + 107.7. The equations described by Chumlea et al. using the KH just predict the size adequately in male, but overestimate it in female. CONCLUSIONS: 1. The equations using the KML predict the size in the colombian studied sample. 2. The Chumlea equations only adequately predict the size of the male colombian subjects.

Efectos de dos protocolos de entrenamiento sobre el lactato sanguíneo en caballos de paso fino / Effects of two training protocols on blood lactate in paso fino horses

RESUMEN Objetivo: comparar los efectos de un protocolo de entrenamiento de resistencia (ER) con un protocolo tradicional (ET) sobre la concentración sanguínea de lactato (L) y la creatin kinasa (CK). Materiales y Métodos: se aplicaron dos protocolos de entrenamiento durante 6 meses divididos en tres etapas. Se realizaron pruebas de esfuerzo antes de comenzar los protocolos de entrenamiento y al finalizar cada una de las etapas. En cada prueba se tomaron muestras de sangre venosa en reposo, durante el ejercicio y en recuperación para medir el lactato (L) y al inicio y al final para medir la creatin kinasa (CK) e inferir las adaptaciones metabólicas y musculares. Se calculó la diferencia de medianas del lactato basal por medio de la U Mann Whitney y se comparó la diferencia de medias del porcentaje de aclaramiento entre los grupos a través de la T de Students. Resultados: se encontró una diferencia significativa en el porcentaje de depuración de lactato entre ER y ET. También hubo un aumento significativo de los valores de CK intra-grupos, antes y después de las pruebas, pero manteniéndose dentro de los rangos de referencia. Discusión: el ER aumentó la capacidad de metabolizar el lactato pos-ejercicio en potros con entrenamiento de resistencia, aunque no hubo diferencias entre la máxima producción de L entre el grupo ER y ET. El comportamiento de la CK dentro de los rangos de referencia indica que no hubo daño muscular en los potros de ambos grupos.

ABSTRACT Objective: To compare the effects of a resistance training protocol (ER) with a traditional protocol (ET) on blood lactate concentration and CK. Materials and methods: Two training protocols were applied for 6 months divided into three stages. Effort tests were performed before beginning the training protocols and at the end of each stage. In each test, samples of venous blood were taken at rest, during exercise and in recovery to measure lactate (L), and at the beginning and at the end to measure creatine kinase (CK) and infer metabolic and muscular adaptations. The difference in baseline lactate medians was calculated using Mann Whitney U and the mean difference in the percentage of clearance between the groups was compared through the Students' T test. Results: A significant difference in the percentage of lactate clearance between ER and ET was found. There was also a significant increase in intra-group CK values, before and after the tests, but remaining within the reference ranges. Discussion: ER increased the ability to metabolize post-exercise lactate in foals with resistance training, although there was no difference between the maximum production of L between the ER group and ET. The behavior of CK within the reference ranges indicates that there was no muscle damage in the foals of both groups of foals.

Historia natural de la tuberculosis, fisiopatogenia de la infección y la enfermedad en el niño / Natural history of tuberculosis, infection and disease pathogenesis in children

The multiple manifestations of tuberculosis (TB) are a result of the relationships between Mycobacterium tuberculosis, the host and the environmental, social and cultural conditions. In TB pathogenesis, three factors must be considered: the virulence of the bacillus, the potential of cellular destruction and caseous necrosis, and the immune response and hypersensitivity to the infection.

La expresión múltiple de la tuberculosis se debe a la relación entre el Mycobacterium tuberculosis, el huésped y las condiciones medioambientales, sociales y culturales. En la patogenia de la tuberculosis se deben tener en cuenta tres factores: la virulencia del bacilo, la capacidad de producir destrucción celular y necrosis caseosa y la respuesta inmunitaria e hipersensibilidad a la infección.

Calidad de vida en pacientes con enfermedad cardiovascular: análisis de trayectorias por sexo y síntomas depresivos / Quality of life in patients with coronary heart disease: trajectory analysis by sex and depression symptoms

OBJETIVOS:evaluar la trayectoria de la Calidad de Vida (CV) en pacientes con enfermedad cardiovascular (ECV), analizando la influencia que tienen el sexo y la depresión. METODOLOGIA:i se tomó una muestra de 100 pacientes con la enfermedad y se les aplicó el sf36 durante su hospitalización y cada seis meses durante dos años. Mediante análisis multinivel, se evaluó la trayectoria de la CV de estos pacientes y se analizó la influencia de la depresión, medida con el Cuestionario de salud del Paciente (PHQ-9) y el sexo, en el componente físico de la calidad de vida. RESULTADOS el componente físico de la CV tiende a mejorar en los pacientes con ECV a lo largo del tiempo, en el cual los hombres presentan mayores niveles que las mujeres. Los síntomas depresivos se asocian con menores puntuaciones en el momento del evento cardíaco, pero también afectan la trayectoria, produciendo un declive significativo en este componente, en comparación con los pacientes sin depresión. CONCLUSION la CV de los pacientes con ECV tiende a mejorar en los meses posteriores al evento cardíaco para luego estabilizarse. Esta trayectoria tiende al declive en pacientes depresivos y presenta diferencias por sexos, en la cual las mujeres presentan menores niveles de CV.

OBJECTIVE: to evaluate Quality of Life (QOL) trajectory in Coronary Heart Disease (CHD) patients by analyzing the influence of variables such as gender and depression. METHODOLOGY the sf-36 was administered to a sample of 100 CHD inpatients. Additionally, the same instrument was administered to them every 6 months for two years following hospital discharge. Multilevel analyses were used to analyze the QOL trajectory of these patients. Similarly, the influence of depression was measured using the Patient Health Questionnaire (PHQ-9), and patient sex was included in the physical component of the QOL. RESULTS : the physical component of the QOL of CHD patients tended to improve overtime, with men showing higher scores than women. Moreover, depression symptoms were associated with lower scores at the moment of the cardiac event, but they also affected trajectory by producing a significant decline in this component in comparison to patients without depression. CONCLUSION: the QOL of patients with CHD had a tendency improve and stabilize itself some months after the cardiac event. This trajectory tends to decline for depressed patients and is different for each sex, since women had lower levels of QOL.

Etiologic diagnosis of bacterial nosocomial pneumonia in seriously ill patients.

We identified retrospectively 19 critically ill, intubated patients in whom tracheobronchial secretions had been cultured before antimicrobials were administered. Each of these patients had bacterial nosocomial pneumonia, as diagnosed by a positive bacterial culture from blood, pleural fluid, percutaneously aspirated lung material, special endobronchial brushings, and/or postmortem lung specimens. In 11 (58%) patients, the predominant organism in the tracheobronchial secretions was the same one identified in the diagnostic culture. However, in eight (42%) patients, the infecting bacteria were either not predominant or did not grow in the culture of respiratory secretions. We conclude that standard microbiologic studies of central tracheobronchial secretions are not always reliable for establishing the etiology of a bacterial nosocomial pneumonia in this type of patient.

Gastrostomía por endoscopia: presentación de 22 pacientes / Endoscopic gastrostomy: report on 22 patients

Desde enero de 1997 hasta enero de 1999, hemos realizado 22 gastrostomias endoscopicas, como parte de nuestra práctica en el Hospital de Caldas, Clinica de la Presentacion, Clinica Aman, Clinica de la Policia y Clinica Manizales. Para dicho procedimiento utilizamos el sistema de videoendoscopia, y en 77 casos un kit de gastrostomia de Abbott, realizandola en los otros 5 pacientes con un equipo fabricado en el mismo hospital con aditamentos tornados de sondas y pipetas de laboratorio. La principal indicacion para realizar el procedimiento fue la enfermedad neurologica con afeccion secundaria de la deglucion (14 pacientes), carcinoma del esofago en tratamiento con radioterapia (3 pacientes); trauma maxilofacial severo (3 pacientes); y cancer laringeo con criterios de irresecabilidad (2 pacientes). Tuvimos 13 pacientes de sexo femenino y 9 de sexo masculino. Las edades oscilaron entre 23 y 75 años. La duracion del procedimiento fue entre 20 y 30 minutos, y siempre fue realizado fuera del quirofano, sin requerir de instrumental especial. No tuvimos complicaciones en el acto quirurgico, el cual fue realizado solo con anestesia local. En ningun paciente se utilizó sedacion. La complicacion temprana posprocedimiento más frecuente, fue la infeccion de la herida alrededor de la gastrostomia, que se presento en 2 pacientes (9,09 por ciento), no teniendo, al parecer relacion con el tipo de equipo utilizado. En los 7 primeros casos iniciamos la nutricion 24 horas despues del procedimiento, pero en los 15 ultimas se hizo casi inmediatamente despues de terminado el mismo, sin complicaciones derivadas de esta conducta. Concluimos que el procedimiento es fácil de ejecutar, con muy pocas complicaciones, y que en hospitales de bajos recursos pueden fabricarse y usarse sondas que, cumpliendo con las especificaciones tecnicas, reemplazan las de marca, obteniendo los mismos resultados.

Semiología endoscópica del tracto digestivo superior: importancia para el cirujano / Endoscopic semiology of the upper digestive tract: its importance for the surgeon

En este articulo de revision se plasma nuestra experiencia de grupo en las caracteristicas semiologicas mas importantes de las lesiones del tracto digestivo superior. Con esto se pretende introducir al cirujano en la terminologia endoscopica y en la implicacion e importancia de la misma. La lectura de una endoscopia es tan importante para quien realiza el procedimiento como para quien la recibe y debe ejecutar un manejo de acuerdo con esa interpretacion.