Influence of blood metabolites and body condition score at parturition on fertility and milk yield in Holstein cows / Influencia de metabolitos sanguíneos y condición corporal al parto sobre la fertilidad y producción de leche de vacas Holstein / Influência dos metabólitos sanguíneos e da condição corporal ao nascimento na fertilidade e produção de leite de vacas Holstein

Abstract Background: Variables associated with body tissue mobilization place dairy cows at greater risk of reproductive failure. Objective: To investigate the association between blood metabolites and body condition score (BCS) at the beginning of lactation and the reproductive efficiency and milk yield of Holstein cows in a hot environment. Methods: In total, 165 Holstein cows were selected for the study from which blood samples were taken to determine the concentration of various blood metabolites and their association with the reproductive efficiency and milk yield. Results: Cows with serum β-hydroxybutyrate (BHBA) ≤0.8 mmol/L one week postpartum were 3.3 times more likely to become pregnant at first service, and 2.2 times more likely to become pregnant before 80 d postpartum than cows with higher serum BHBA levels. The odds (OR 2.7; 95% CI 1.3-5.4; p<0.01) of a cow getting pregnant at first service were higher in cows with serum creatinine levels higher than 2.0 mg/dL one week postpartum than cows with lower blood levels of this metabolite. The BCS at 30 and 60 d postpartum that predicted pregnancy at first service and pregnancy to all services was 3.0. Blood urea nitrogen >15 mg/dL, creatinine <1.8 mg/dL, total protein ≤5.0 mg/dL one week postpartum, and >0.40 units of BCS loss during the first 30 d postpartum were critical threshold that predicted the likelihood of 305-d milk yield higher than 10,500 kg. Conclusions: Serum BHBA and creatinine one wk after calving as well as BCS 30 and 60 d post-calving provided reasonably accurate cut-off screening values to discriminate cows with better reproductive performance and higher 305-d milk yield.

Resumen Antecedentes: Las variables asociadas a mayor movilización de tejido corporal en vacas lecheras conducen a un mayor riesgo de falla reproductiva. Objetivo: Investigar la asociación entre los metabolitos sanguíneos y condición corporal (BCS) al comienzo de la lactancia y la eficiencia reproductiva y producción de leche de vacas Holstein en un ambiente caluroso. Métodos: En total, se seleccionaron 165 vacas Holstein de las cual se tomaron muestras de sangre para determinar la concentración de varios matabolitos sanguíneos, los cuales se asociaron con el desempeño reproductivo y producción de leche. Resultados: Las vacas con β-hidroxibutirato (BHBA) en suero ≤0,8 mmol/L una semana postparto tuvieron 3,3 veces más probabilidades de quedar preñadas en los primeros servicios, y 2,2 veces más probabilidades de quedar gestantes antes de los 80 días postparto que las vacas con mayores niveles séricos de BHBA. Las probabilidades (OR 2,7; IC 95% 1,3-5,4; p<0,01) de que una vaca se preñara en el primer servicio fueron mayores en vacas con niveles de creatinina en suero sanguíneo superiores a 2,0 mg/dL una semana postparto que las vacas con niveles más bajos de este metabolito en sangre. Una BCS de 3 a los 30 y 60 días postparto fue un buen predictor de la preñez al primer servicio y la gestación considerando todos los servicios. El nitrógeno ureico en sangre >15 mg/dL, la creatinina <1,8 mg/dL, la proteína total ≤5,0 mg/dL una semana después del parto y >0,40 unidades de pérdida de BCS durante los primeros 30 días postparto fueron los valores críticos para predecir una producción de leche a 305 días superior a 10.500 kg. Conclusiones: El BHBA y la creatinina en suero sanguíneo una semana postparto, así como la BCS 30 y 60 d después del parto, proporcionan valores razonablemente precisos para identificar las vacas que tendrán mejor desempeño reproductivo y mayor producción de leche a 305 días.

Resumo Antecedentes: A maior mobilização do tecido corporal das vacas leiteiras leva a um aumento do risco de falhas reprodutivas. Objetivo: Para investigar a relação entre os metabolitos sanguíneos e condição do corpo (BCS) para o início da lactação e eficiência reprodutiva e produção de leite de vacas Holstein num ambiente quente. Métodos: No total, foram selecionadas 165 vacas da raça Holandesa, das quais foram coletadas amostras de sangue para determinar a concentração de vários metabólitos sanguíneos, associados ao desempenho reprodutivo e à produção de leite das vacas. Resultados: As vacas com β-hidroxibutirato (BHBA) soro ≤0,8 mmol/L de uma semana após o nascimento foram 3,3 vezes mais probabilidade de engravidar nos primeiros serviços, e 2,2 vezes mais provável que seja grávida antes de 80 dias após o parto do que vacas com níveis séricos de BHBA mais elevados. As probabilidades (OR 2,7, IC de 95% 1,3-5,4, p<0,01) que uma vaca preñara primeiros serviços vacas foram maiores com níveis mais elevados de creatinina no soro do sangue >2,0 mg/dL, uma semana pós-parto do que vacas com níveis sanguíneos mais baixos deste metabolito. Um CC de 3 aos 30 e 60 dias pós-parto foi um bom predictor de gravidez no primeiro serviço e gestação, considerando todos os serviços. O azoto de ureia no sangue >15 mg/dL, creatinina <1,8 mg/dL e proteína total, ≤5,0 mg/dL uma semana após o parto e >0,40 unidades perda CC durante os primeiros 30 dias após o nascimento estavam valores críticos que previram produção de leite em 305 dias >10.500 kg. Conclusões: BHBA e creatinina sérica, uma semana após o parto, bem como CC 30 e 60 d após o parto, forneceram valores razoavelmente precisos para discriminar vacas com melhor desempenho reprodutivo e maior produção de leite em 305 dias.

Recomendaciones para el manejo inicial del síndrome inflamatorio multisistémico relacionado temporalmente con COVID-19, en niños y adolescentes / Recommendations for the initial management of multisystem inflammatory syndrome temporally related to COVID-19, in children and adolescents

El síndrome inflamatorio multisistémico en niños y adolescentes temporalmente relacionado con COVID-19 es una presentación clínica de la infección por SARS-CoV-2. Comparte algunas características con la enfermedad de Kawasaki, el shock tóxico, la sepsis, el síndrome de activación macrofágica y la miocarditis. Son escasas las publicaciones que abordan su manejo inicial, que tiene semejanzas con el propuesto para el shock séptico. Esta revisión analiza dicho abordaje basado en las características propias del síndrome inflamatorio multisistémico relacionado con COVID-19, de acuerdo con el paradigma de construcción de una "guía de práctica institucional", y sugiere estrategias de aproximación terapéutica, que incluyen detección temprana, estabilización, referencia, tratamiento específico y análisis de proceso

Multisystem inflammatory syndrome temporally related to COVID-19 in children and adolescents is a clinical presentation of SARS-CoV-2 infection. It shares some features with Kawasaki disease, toxic shock, sepsis, macrophage activation syndrome, and myocarditis. Few publications have addressed its initial management, which is similar to that proposed for septic shock. This review analyzes such approach based on the characteristics typical of multisystem inflammatory syndrome related to COVID-19 in accordance with the paradigm of an "institutional practice guideline" and suggests therapeutic approach strategies, including early detection, stabilization, referral, specific treatment, and process analysis.

SIRS o no SIRS: ¿es esa la infección? Una revisión crítica de los criterios de definición de sepsis / SIRS or not SIRS: Is that the infection? A critical review of the sepsis definition criteria

Resumen El enfoque moderno de la sepsis se ha centrado en la creación de consensos globales que utilizan distintos criterios para pesquisarla en forma precoz, con el fin de disminuir la morbimortalidad asociada a ella. Hasta la aparición del tercer y último consenso de adultos (Sepsis-3), el síndrome de respuesta inflamatoria sistémica (SIRS) fue el pilar diagnóstico utilizado por defecto en todas las edades. En Sepsis-3 se decidió retirar el SIRS, lo que generó un debate internacional sobre la oportunidad de dicho cambio. Esta revisión narrativa desarrolla la historia de las distintas definiciones de sepsis centradas en SIRS, las fortalezas, las debilidades y la pertinencia de los distintos elementos que ocasionaron el debate. Dada la ausencia de actualizaciones pediátricas en Sepsis-3, se hace especial énfasis en las implicaciones para las futuras definiciones de sepsis en esta etapa de la vida.

Abstract The modern approach to sepsis has focused on creating a global consensus with different criteria to early investigate it in order to reduce the morbidity and mortality associated with this complex entity. Until the third and last consensus of adults (Sepsis-3), the systemic inflammatory response syndrome (SIRS) was the diagnostic pillar used by default for all ages. In Sepsis-3, it was decided to withdraw the SIRS, which generated an international debate about the timing of such change. This narrative review develops the history of the different definitions of sepsis focused on SIRS, their strengths and weaknesses, and the relevance of the different elements that caused the debate. Given the absence of pediatric updates in Sepsis-3, a particular emphasis is placed on the implications for future definitions of sepsis at this stage of life

Variabilidad terapéutica en lactantes con bronquiolitis hospitalizados en unidades de cuidados intensivos latinoamericanas / Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis

Resumen: Objetivo: describir las terapias utilizadas en lactantes con bronquiolitis aguda admitidos en 20 Uni dades de Cuidados Intensivos (UCI) pediátricos miembros de LARed en 5 países latinoamerica nos. Pacientes y Método: Estudio observacional retrospectivo, multicéntrico, de datos del Registro Latinoamericano de Falla Respiratoria Aguda Pediátrica. Se incluyeron niños menores de 2 años ingresados a UCI pediátrica por bronquiolitis aguda comunitaria entre mayo-septiembre 2017. Se recolectaron datos demográficos, clínicos, soporte respiratorio, terapias utilizadas y resultados clí nicos. Se realizó análisis de subgrupos según ubicación geográfica, tipo financiación y presencia de academia. Resultados: Ingresaron al registro 1155 pacientes con falla respiratoria aguda. Seis casos fueron excluidos por no tener formulario completo. De los 1147 pacientes, 908 eran menores de 2 años. De ellos, 467 tuvieron diagnóstico de bronquiolitis aguda, correspondiendo a la principal causa de ingreso a UCI pediátrica por falla respiratoria aguda (51,4%). Las características demográficas y de gravedad entre los centros fueron similares. El soporte máximo respiratorio más frecuente fue cánula nasal de alto flujo (47%), seguido por ventilación mecánica no invasiva (26%) y ventilación mecánica invasiva (17%), con un coeficiente de variación (CV) amplio entre los centros. Hubo una gran dispersión en uso de terapias, siendo frecuente el uso de broncodilatadores, antibióticos y corticoides, con CV hasta 400%. El análisis de subgrupos mostró diferencias significativas en soporte respiratorio y tratamientos utilizados. Un paciente falleció en esta cohorte. Conclusión: Detectamos gran variabilidad en el soporte respiratorio y tratamientos entre UCI pediátricas latinoamericanas. Esta variabilidad no es explicada por disparidades demográficas ni clínicas. Esta heterogeneidad de tratamientos debería promover iniciativas colaborativas para disminuir la brecha entre la evidencia científica y la práctica asistencial.

Abstract: The objective of this study was to describe the management of infants with acute bronchiolitis admit ted to 20 pediatric intensive care units (PICU) members of LARed in 5 Latin American countries. Pa tients and Method: Retrospective, multicenter, observational study of data from the Latin American Registry of Acute Pediatric Respiratory Failure. We included children under 2 years of age admitted to the PICU due to community-based acute bronchiolitis between May and September 2017. Demo graphic and clinical data, respiratory support, therapies used, and clinical results were collected. A subgroup analysis was carried out according to geographical location (Atlantic v/s Pacific), type of insurance (Public v/s Private), and Academic v/s non-Academic centers. Results: 1,155 patients were included in the registry which present acute respiratory failure and 6 were excluded due to the lack of information in their record form. Out of the 1,147 patients, 908 were under 2 years of age, and out of those, 467 (51.4%) were diagnosed with acute bronchiolitis, which was the main cause of admission to the PICU due to acute respiratory failure. The demographic and severity characteristics among the centers were similar. The most frequent maximum ventilatory support was the high-flow nasal can nula (47%), followed by non-invasive ventilation (26%) and invasive mechanical ventilation (17%), with a wide coefficient of variation (CV) between centers. There was a great dispersion in the use of treatments, where the use of bronchodilators, antibiotics, and corticosteroids, representing a CV up to 400%. There were significant differences in subgroup analysis regarding respiratory support and treatments used. One patient of this cohort passed away. Conclusion: we detected wide variability in respiratory support and treatments among Latin American PICUs. This variability was not explained by demographic or clinical differences. The heterogeneity of treatments should encourage collabora tive initiatives to reduce the gap between scientific evidence and practice.

Estudio exploratorio: relación entre nivel de pobreza y exposiciones agudas a sustancias potencialmente tóxicas en Chile / Exploratory study: Association between the poverty level and acute exposures to potentially toxic substances in Chile

Objetivo: explorar la siguiente pregunta de investigación: ¿De qué manera el nivel socioeconómico de una persona, específicamente el nivel de pobreza se asocia a las características de las exposiciones agudas a sustancias con potencial tóxico en Chile? Métodos: estudio epidemiológico, de diseño transversal y semi-ecológico. Se recopiló información proveniente de una muestra de casos atendidos por el Centro de información toxicológica y de medicamentos de la Pontificia Universidad Católica de Chile (CITUC). La variable independiente corresponde al índice de pobreza comunal de la Encuesta de Caracterización Socioeconómica Nacional (CASEN). Las variables dependientes fueron las características de las exposiciones registradas por el centro toxicológico de acuerdo con el nivel de pobreza de los casos observados. Se analizó el fenómeno a través de tablas cruzadas, cálculo de Odds Ratio con análisis estratificado. Resultados: se observan diferencias significativas en las circunstancias de las exposiciones: las personas que viven en comunas con mayor porcentaje de pobreza muestran más exposiciones intencionales versus aquellas con menor porcentaje de pobreza. Otro hallazgo significativo es el uso del sistema de salud en casos de exposiciones dependiente de la situación socioeconómica. Para las otras variables no se encuentran diferencias significativas entre los grupos comparados. Conclusio-nes: se observa una relación entre el nivel de pobreza y las exposiciones a sustancias potencialmente tóxicas. Los resultados abren una línea investigativa y nuevas interrogantes que podrían generar medidas de control de las intoxicaciones en Chile.Palabras clave:toxicología; exposición a compuestos químicos; envenenamiento; determinantes sociales de la saludAbstractObjective: explore the following research question: How is a person's socio-economic level, the poverty, associated with the characteristics of acute exposures to substances with toxic potential in Chile?. Methods: epidemiological, cross-sectional and semi-ecological study. Information collected from a sample of cases attended by the Centre for Toxicological and Drug Information of the Pontifical Catholic University of Chile (CITUC). The independent variable corresponds to the communal poverty index of the National Socioeconomic Characterization Survey. Dependent variables were the characteristics of the exposures recorded by the toxicological center according to the poverty level of the cases observed. The phenomenon is analyzed through cross-tables, calculating Odds Ratios with stratified analysis. Results: significant differences observed in the circumstances of exposures: people living in communes with higher poverty rates show more intentional exposures versus those with lower poverty rates. Another significant finding is the use of the health system in cases of exposures, depending on the socio-economic situation. For the other variables, there are no significant differences between the compared groups. Conclusions: there is a link between the poverty level and acute exposures to potentially toxic substances. The results open a research line and new questions that could generate measures to control poisonings in Chile.Keywords:poisoning; social determinants of health; poverty(1) Centro de Información Toxicológica y de Medicamentos, Pontificia Universidad Católica de Chile.(2) Unidad docente de Farmacología y Toxicología, Facultad de Medicina, Pontificia Universidad Católica de Chile.(3) Departamento de Salud del Adulto y Senescente, Escuela de Enfermería, Pontificia Universidad Católica de Chile.(4) Departamento de Laboratorios Clínicos, Facultad de Medicina, Pontificia Universidad Católica de Chile.(5) Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile.Autor de correspondencia: Juan Carlos Ríos jriosb@uc.clFecha de envío: 19 de agosto de 2019 - Fecha de aceptación: 26 de diciembre de 2019

Obstrucción intestinal por semillas de Vasconcellea: reporte de tres casos y revisión de la literatura / Intestinal obstruction due to Vasconcellea seeds: Report of three cases and literature review / Obstrução intestinal por sementes de Vasconcellea: reporte de três casos e revisão da literatura

Vasconcellea spp., es una especie de papaya andina que crece en las áreas rurales cerca a Medellín, Colombia. Debido al agradable y dulce sabor de sus frutos, con frecuencia los niños ingieren accidentalmente sus semillas. Luego de la ingestión, las semillas se engranan en la luz del colon y obstruyen la salida de la materia fecal, lo que causa dolor y distensión abdominal, y favorece la translocación bacteriana. El diagnóstico se basa en la historia clínica y el tacto rectal. El tratamiento depende del grado de afectación local y sistémica e incluye la desimpactación del contenido rectal bajo anestesia general y lavados del colon con solución salina al 0,9%. En los casos más graves se ha requerido colostomía derivativa. En la literatura médica no existen reportes de obstrucción intestinal por semillas de Vasconcellea, posiblemente porque se han confundido con las del género Carica. En este artículo se describen tres casos tratados en servicios pediátricos de Medellín en los años 2012 y 2013; observamos que es una entidad poco sospechada, lo que lleva a un diagnóstico tardío con posibles consecuencias catastróficas. Es importante educar a la población para prevenir la ingestión de las semillas.

Vasconcellea spp., is a species of Andean papaya commonly cultivated in rural communities close to Medellín, Colombia. Due to the pleasant and sweet flavor of its fruits, children frequently ingest its seeds accidentally. After ingestion, the seeds are engaged in the colonic lumen and block the exit of stools, causing pain and bloating, and promoting bacterial translocation. Diagnosis is based on clinical history and rectal examination. Treatment depends on the degree of local and systemic involvement and includes disimpaction of rectal contents under general anesthesia and colonic washes with 0.9% saline solution. In severe cases derivative colostomy has been required. In the literature there are no reports of intestinal obstruction due to Vasconcellea seeds, possibly because it has been mistaken for seeds of the genus Carica. In this article, three cases treated at pediatric services in Medellín, Colombia, in 2012 and 2013 are described. We note that this is a rarely suspected disease, leading to late diagnosis and potential catastrophic consequences. It is important to educate people to prevent the ingestion of the seeds.

Vasconcellea spp., é uma espécie de mamão papaia andino que cresce nas áreas rurais perto a Medellín, Colômbia. Devido ao agradável e doce sabor de seus frutos, com frequência as crianças ingerem acidentalmente suas sementes. Depois da ingestão, as sementes se engrenam na luz do cólon e obstruem a saída da matéria fecal, o que causa dor e distensão abdominal, e favorece a translocação bacteriana. O diagnóstico se baseia na história clínica e o tato retal. O tratamento depende do grau de afetação local e sistémica e inclui a desimpactação do conteúdo retal sob anestesia geral e lavagens do cólon com solução salina a 0,9%. Nos casos mais graves foi necessário colostomia derivativa. Na literatura médica não existem reportes de obstrução intestinal por sementes de Vasconcellea, possivelmente porque se confundiram com as do gênero Carica. Neste artigo se descrevem três casos tratados em serviços pediátricos de Medellín nos anos 2012 e 2013; observamos que é uma entidade pouco suspeitada, o que leva a um diagnóstico tardio com possíveis consequências catastróficas. É importante educar à população para prevenir a ingestão das sementes.

Reaching for the Holy Grail: insights from infection/cure models on the prospects for vaccines for Trypanosoma cruzi infection

Prevention of Trypanosoma cruzi infection in mammals likely depends on either prevention of the invading trypomastigotes from infecting host cells or the rapid recognition and killing of the newly infected cells by T. cruzi-specific T cells. We show here that multiple rounds of infection and cure (by drug therapy) fails to protect mice from reinfection, despite the generation of potent T cell responses. This disappointing result is similar to that obtained with many other vaccine protocols used in attempts to protect animals from T. cruzi infection. We have previously shown that immune recognition of T. cruzi infection is significantly delayed both at the systemic level and at the level of the infected host cell. The systemic delay appears to be the result of a stealth infection process that fails to trigger substantial innate recognition mechanisms while the delay at the cellular level is related to the immunodominance of highly variable gene family proteins, in particular those of the trans-sialidase family. Here we discuss how these previous studies and the new findings herein impact our thoughts on the potential of prophylactic vaccination to serve a productive role in the prevention of T. cruzi infection and Chagas disease.

Biomarkers of therapeutic responses in chronic Chagas disease: state of the art and future perspectives

The definition of a biomarker provided by the World Health Organization is any substance, structure, or process that can be measured in the body, or its products and influence, or predict the incidence or outcome of disease. Currently, the lack of prognosis and progression markers for chronic Chagas disease has posed limitations for testing new drugs to treat this neglected disease. Several molecules and techniques to detect biomarkers in Trypanosoma cruzi-infected patients have been proposed to assess whether specific treatment with benznidazole or nifurtimox is effective. Isolated proteins or protein groups from different T. cruzi stages and parasite-derived glycoproteins and synthetic neoglycoconjugates have been demonstrated to be useful for this purpose, as have nucleic acid amplification techniques. The amplification of T. cruzi DNA using the real-time polymerase chain reaction method is the leading test for assessing responses to treatment in a short period of time. Biochemical biomarkers have been tested early after specific treatment. Cytokines and surface markers represent promising molecules for the characterisation of host cellular responses, but need to be further assessed.

Cocaína y estado convulsivo / Cocaine and convulsive status

El consumo de cocaína continúa siendo un problema social importante por las consecuencias agudas y crónicas asociadas a su consumo. La cardiotoxicidad asociada al consumo de cocaína es una de las consecuencias más estudiadas; sin embargo, este alcaloide también se asocia con complicaciones neurológicas. En el presente reporte describimos el caso de una mujer de 32 años quien desarrolla una crisis convulsiva secundaria a la ingesta oral de cocaína. Se hace una revisión de los aspectos toxicocinéticos y toxicodinámicos de la cocaína, así como la fisiopatología de esta complicación.

Cocaine remains a major social problem for the consequences associated with its acute and chronic consumption. Cardiotoxical consequences associated with cocaine use is mostly studied, however, this alkaloid is also associated with neurological complications. In this report we describe the case of a 32 year old woman who developed a convulsive status secondary to cocaine ingestion. Also we review the toxicokinetic and toxicodynamic aspects of cocaine, as well as the pathophysiology of this complication.

Ventajas del inicio precoz de dieta enteral en anastomosis gastrointestinales: experiencia preliminar / Advantages of early enteral feeding in gastrointestinal anastomosis: initial experience

Demostrar el beneficio del inicio enteral posterior a anastomosis gastrointestinales, comparado con el manejo tradicional. Estudio realizado en el Hospital General del Sur “Dr. Pedro Iturbe”, Maracaibo. Se realizó un estudio prospectivo, descriptivo y transversal, basado en el análisis de los pacientes sometidos a anastomosis gastrointestinales durante el período comprendido entre septiembre 2008 y marzo 2009, con diagnóstico de trauma abdominal penetrante, neoplasias, restitución del tránsito intestinal y obstrucción intestinal. Se evaluaron las variables edad, sexo antecedentes, diagnóstico de ingreso, tipo de intervención quirúrgica, anastomosis realizada, tiempo de estancia hospitalaria, aparición de íleo postoperatorio, tolerancia a la dieta (náuseas y/o vómitos), dehiscencia de anastomosis, complicaciones infecciosas y mortalidad. Se evaluó un total de 51 pacientes; 27 casos y 24 controles, edad promedio de 42,7±21 años y 33,3±10,5 años respectivamente. La mayoría presentó antecedentes de importancia: quirúrgicos 29,4% respiratorios 13,7%, cardiovasculares 9,8%. El diagnóstico de ingreso más frecuente fue herida por arma de fuego en 41,2% pacientes, herida por arma de blanca, restitución de transito neoplasias 15,7% cada uno. Complicaciones postoperatorias 16,7% de los controles presentó íleo postoperatorio mientras ninguno de los casos presentó esta complicación. Sólo 7,4% de los casos presentó dehiscencia total o parcial de la anastomosis realizada, comparado con 16,7% de dehiscencias en el grupo control. Complicaciones infecciosas abscesos intraabdominales en los casos 3,7%, en contraste con los controles 50%, infecciones de herida 25% casos, mientras el segundo 18,5%, entre otras. El tiempo de estancia hospitalaria fue de 4,7±1,8 días (3-10) para el grupo de los casos, en oposición a 10,2±6,3 días (5-24) en el grupo control. No hubo muertes en los pacientes estudiados. El inicio de dieta enteral precoz, es beneficioso para todo paciente...

To demostrate the benefit of early enteral feeding in patients with gastrointestinal anastomosis, comparing with traditional management. Study done in Hospital General de Sur “Dr. Pedro Iturbe”, Maracaibo. This is a prospective, descriptive and transversal in patients submitted to gastrointestinal anastomosis in the period between September 2008 and March 2009 with diagnosis of penetrating abdominal trauma, cancer, restoration of intestinal continuity and intestinal obstruction. There were evaluated age, gender, initial diagnosis, surgical procedure, hospital stay, postoperative ileus, complications and mortality. There were evaluated 51 patients, 27 cases and 24 control. Mean age 42,7±21 years and 33,3±10,5, years respectively. Diagnosis were gunshort wounds 41,2%, stab wounds, restoration of intestinal continuity and cancer 15,7% each. In control group there was a 16,7% of postoperative ileus and none in case group. There was a 7,4% of anastomotic leak-age in case group vs 16,7% in control group. Intraabdominal abscess was 3,7% in case group vs 50% in control group. Hospital stay 4,7±1,8 days in case group and 10,2±6,3 days in control group. No mortality in this study. Early enteral feeding has benefit in all patients submitted to gastrointestinal anastomosis, reduces complications, hospital stay and mortality. The gastrointestinal phisiology is not altered and improves cicatrization.

In vitro and in vivo experimental models for drug screening and development for Chagas disease

Chagas disease, a neglected illness, affects nearly 12-14 million people in endemic areas of Latin America. Although the occurrence of acute cases sharply has declined due to Southern Cone Initiative efforts to control vector transmission, there still remain serious challenges, including the maintenance of sustainable public policies for Chagas disease control and the urgent need for better drugs to treat chagasic patients. Since the introduction of benznidazole and nifurtimox approximately 40 years ago, many natural and synthetic compounds have been assayed against Trypanosoma cruzi, yet only a few compounds have advanced to clinical trials. This reflects, at least in part, the lack of consensus regarding appropriate in vitro and in vivo screening protocols as well as the lack of biomarkers for treating parasitaemia. The development of more effective drugs requires (i) the identification and validation of parasite targets, (ii) compounds to be screened against the targets or the whole parasite and (iii) a panel of minimum standardised procedures to advance leading compounds to clinical trials. This third aim was the topic of the workshop entitled Experimental Models in Drug Screening and Development for Chagas Disease, held in Rio de Janeiro, Brazil, on the 25th and 26th of November 2008 by the Fiocruz Program for Research and Technological Development on Chagas Disease and Drugs for Neglected Diseases Initiative. During the meeting, the minimum steps, requirements and decision gates for the determination of the efficacy of novel drugs for T. cruzi control were evaluated by interdisciplinary experts and an in vitro and in vivo flowchart was designed to serve as a general and standardised protocol for screening potential drugs for the treatment of Chagas disease.

Epidemiología de la sepsis en pediatría: primer estudio colombiano multicéntrico / Epidemiology of sepsis in pediatrics: first colombiam multicenter survey

En el año 2002 la campaña Sobreviviendo a la Sepsis estableció algunos lineamientos para disminuir la elevada mortalidad en el mundo por la sepsis. Entre estos lineamientos se encuentra la recomendación para reconocer que la sepsis es una enfermedad que causa probablemente muchas muertes y un alto costo de atención en las unidades de cuidado intensivo pediátrico. Conocer sobre el comportamiento de este padecimiento probablemente sea el primer paso para poder impactarla. En el mundo hay pocos estudios de la epidemiología de la sepsis en niños y, en Colombia, menos aun. Quizá el estudio realizado en Estados Unidos en los años noventa sea de los más representativos. En Latinoamérica, especialmente en Brasil. Se han desarrollado también algunos estudios sobre la epidemiología de la enfermedad. Los autores se proponen iniciar un estudio multicéntrico sobre la epidemiología de la sepsis pediátrica en Colombia, por lo que se ha diseñado una página en Internet www.sepsisencolombia.com. para la recolección de los datos y la actualización permanentemente a la comunidad científica local en este tema.

In 2002, the Surviving sepsis campaign defined a strategy that aimed to reduce the high mortality due to sepsis. One point of this strategy was a recommendation to recognize that the sepsis is an important cause of deaths and high economic costs in the pediatric intensive care units. Knowledge of the disease is the first step to impact it. There are few studies of the sepsis epidemiology in the world children, and even less in Colombia. Maybe, the most important study in this field was developed in the United States in the nineties. In Latin-America there are others studies, especially in Brazil, but none in Colombia. The authors pretend to do a multicenter study about the epidemiology of the pediatric sepsis in Colombia. A web site has been designed to collect data and to give up-to-date information to the local scientific community about this topic: www.sepsisencolombia.com.

Revascularización miocárdica en la población femenina / Myocardial revascularization in the female population

OBJECTIVES: To analyze the factors that influence outcomes of surgical myocardial revascularization in the female population. PATIENTS AND METHOD: This is a retrospective study in which 128 woman, subjected to GABC[IBM1] from January to September 2004, were enrolled in an univariate and multivariate analysis of risk factors associated with morbidity and mortality. Results: The mean age was 69.19 +/- 9.05 [IBM2] years, the most frequent pathologies, comorbilities, were dyslipemia, hypertension, and myocardial infarction. Unestable angina was found in 63.28% patients and stenosis in the left main coronary artery 42.96%; NYHA III-IV in 23.43%. The EuroSCORE mean preoperative risk was [IBM3] 5.57. Twelve surgeries were emergencies. Mean of grafts was 2.57. Mortality corresponded to 5.4% in programmed surgeries, 7% global. Univariate analysis identified this risk factors releated to mortality (p < 0.05): age older than 67 years, NYHA III-IV and emergency surgery, complicated in 25.2%. Follow-up was kept in 90.8% of patients, mean follow-up time was 17.11 (+/- 14.94) months; 115 patients did not present angina. The risk factor for angina during follow-up, in the univariate analysis (p < 0.05) was not having used the left internal thoracic artery as graft for the anastomosis of the anterior descending artery. CONCLUSIONS: Emergency surgery, age older than 67 years, and NYHA III-IV, were independent risk factors associated with mortality in this group. The use of artery grafts associated to reduced angina during follow-up.

Disección espontánea de la arteria coronaria descendente anterior tratada mediante cirugía sin circulación extracorpórea / Surgical treatment of a spontaneous dissection of the left anterior descending coronary artery without the use of cardiopulmonary bypass

Se presenta un caso de disección espontánea de la arteria coronaria descendente anterior en una mujer de 51 años, sin relación con factores desencadenantes conocidos. El inicio clínico fue un IAM no Q anterior, controlado con tratamiento médico y buena evolución clínica. El cateterismo cardíaco evidenció la disección de la arteria descendente anterior, que producía deterioro de la función sistólica. Se realizó revascularización arterial urgente mediante injerto de mamaria interna izquierda a descendente anterior sin CEC. El posoperatorio cursó sin complicaciones y a 25 meses del procedimiento la paciente se encuentra asintomática. Se realiza, además, una exposición de las consideraciones clínicas relacionadas con esta patología.

Troca de valva com a prótese valvar modelo Omnicarbon: seguimento clínico de 10 anos / Valve replacement with the Omnicarbon valve prosthesis: a 10-year follow-up

OBJETIVO: Estudar retrospectivamente os resultados de 264 pacientes submetidos à implementação cirúrgica de válvula modelo Omnicarbon entre abril 1985 e maio 1995. MÉTODOS: No momento da cirurgia, a média de idade dos pacientes que receberam essa prótese mecânica era de 57±11 anos. As válvulas modelo Omnicarbon foram colocadas em posição aórtica em 36 por cento dos casos, na posição mitral em 44 por cento dos casos, e nas duas posições em 20 por cento dos casos. O seguimento clínico foi feito cuidadosamente, com a maioria dos pacientes submetidos ao exame físico em nossa clínica. Levando em conta o histórico do caso, os cardiologistas faziam perguntas aos pacientes sobre as complicações relacionadas à válvula. RESULTADOS: O seguimento acumulado dos pacientes foi de 1291 anos, com média de seguimento de 5,4 anos. A sobrevida após 10 anos foi de 79,4±3,9 por cento, incluindo todas as causas de morte e os casos de mortalidade precoce. As complicações relatadas durante os 11 anos de estudo incluem: tromboembolismo (0,1 por cento), hemorragia (0,4 por cento), endocardite (0,2 por cento), e insuficiência não-estrutural (1,2 por cento). Não foram detectadas anemia hemolítica, trombose valvar, ou insuficiência estrutural durante esse longo período de estudo. A capacidade funcional desses pacientes foi avaliada subjetivamente pelo sistema de classificação da NYHA. Com o tempo de seguimento maior do que 5 anos em média, nossos pacientes que receberam a válvula modelo Omnicarbon se encontram na classe I ou II da NYHA. CONCLUSAO: As próteses mecânicas modelo Omnicarbon apresentam um bom desempenho clínico por até 10 anos, tanto em posição aórtica quanto mitral. Os resultados indicam uma baixa incidência de tromboembolismo e complicações hemorrágicas.

Programa de mejoramiento de la calidad de las escuelas unidocentes: mi mejor escuela unidocente: guía informativa de recursos pedagógicos para el aula / Quality improvement program in the schools: my best school: informative guide of pedagogic reources

Los contenidos de esta guía contribuyen al mejoramiento de la comprensión lectora, al uso de guías de autoaprendizaje y a la elaboración de proyectos, los mismos que buscan promover en las niñas y niños el desarrollo del aprendizaje autónomo, el trabajo cooperativo y la formación democrática...