Causes of hypercalcemia in renal transplant recipients: persistent hyperparathyroidism and others

Hypercalcemia is common in patients after kidney transplantation (KTx) and is associated with persistent hyperparathyroidism in the majority of cases. This retrospective, single-center study evaluated the prevalence of hypercalcemia after KTx. KTx recipients were evaluated for 7 years after receiving kidneys from living or deceased donors. A total of 301 patients were evaluated; 67 patients had hypercalcemia at some point during the follow-up period. The median follow-up time for all 67 patients was 62 months (44; 80). Overall, 45 cases of hypercalcemia were classified as related to persistent post-transplant hyperparathyroidism (group A), 16 were classified as "transient post-transplant hypercalcemia" (group B), and 3 had causes secondary to other diseases (1 related to tuberculosis, 1 related to histoplasmosis, and 1 related to lymphoma). The other 3 patients had hypercalcemia of unknown etiology, which is still under investigation. In group A, the onset of hypercalcemia after KTx was not significantly different from that of the other groups, but the median duration of hypercalcemia in group A was 25 months (12.5; 53), longer than in group B, where the median duration of hypercalcemia was only 12 months (10; 15) (P<0.002). The median parathyroid hormone blood levels around 12 months after KTx were 210 pg/mL (141; 352) in group A and 72.5 pg/mL (54; 95) in group B (P<0.0001). Hypercalcemia post-KTx is not infrequent and its prevalence in this center was 22.2%. Persistent hyperparathyroidism was the most frequent cause, but other important etiologies must not be forgotten, especially granulomatous diseases and malignancies.

Indicadores de calidad del Programa de Detección Precoz de Hipoacusia Permanente del Hospital Padre Hurtado / Quality indicators of the newborn hearing screening program in Hospital Padre Hurtado

Introducción: La detección precoz de hipoacusia permanente en lactantes beneficia el desarrollo integral del paciente. Los programas cuyo objetivo es la identificación universal de hipoacusia debieran tener como meta determinados criterios de calidad en su ejecución. Objetivo: El objetivo del presente trabajo es comunicar los resultados del Programa de Detección Precoz de Hipoacusia en el Hospital Padre Hurtado. Material y método: Se incluyen los recién nacidos entre el 1 de enero de 2014 y el 31 de agosto de 2016. Los pacientes sin factores de riesgo para hipoacusia congénita se evalúan con examen de emisiones otoacústicas, y los pacientes con factores de riesgo con potenciales auditivos automatizados de tronco encefálico. Refieren aquellos pacientes con exámenes alterados en forma uní o bilateral. La etapa diagnóstica incluye potenciales auditivos evocados con tono, impedanciometría de alta frecuencia y audiometría de refuerzo visual. Los pacientes con diagnóstico de hipoacusia permanente son amplificados e inician proceso de habilitación. Resultados: En el período de estudio el universo a evaluar fue de 12.313 recién nacidos. Se completó la etapa de pesquisa en 98.4% con una tasa de referencia de 0.6%. 79 pacientes pasaron a etapa diagnóstica, completaron su evaluación antes de 3 meses en 95% de los casos. Se confirmó hipoacusia sensorioneural en 7 casos, con una tasa de 0.56 por 1.000 recién nacidos vivos. En 57% de los pacientes se amplificaron antes de los seis meses de vida. Conclusiones: El Programa de Hipoacusia Congénita del Hospital Padre Hurtado cumple con los indicadores de calidad recomendados en los ítemes de pesquisa y diagnóstico. En la etapa de habilitación con audffonos esto se realiza antes de los seis meses de vida sólo en 57% de los casos.

Introduction: Quality indicators of the newborn hearing screening program in Hospital Padre Hurtado. Aim: Asses the accomplishment of quality indicators of the newborn hearing screening program in Hospital Padre Hurtado, Chile, as proposed by the Joint Committee on Infant Hearing Loss (JCIH). Material and method: Two stage screening protocol: otoacoustic emissions for babies in the well-infant nursery and automated auditory brainstem responses for those in the intensive care unit orwith risk factors. If they fail one or both ears they proceed to a comprehensive audiological assessment. Results: 12.313 live births between 01/01/2014 and 108/31/16, 12.103 were screened before discharge (98.4%). 79 cases proceeded to diagnostic assessment, referral rate 0.6%. 95% infants completed audiological evaluation before three months, seven cases were diagnose with permanent sensorineural hearing loss for a prevalence of 0.56 per 1000 live births. Amplification was provided before 6 months of age in 57% of deaf children. Conclusions: Quality indicators of the JCIH are met by our newborn hearing screening program with the exception of adequate timing for the provision of hearing aids: 57% before six months of age.

Morfoanatomia do eixo vegetativo aéreo de Ayapana triplinervis (Vahl) R.M. King & H. Rob. (Asteraceae) / Morphoanatomy of the vegetative aerial axis of Ayapana triplinervis (Vahl) RM King & H. Rob. (Asteraceae)

Ayapana triplinervis (Asteraceae) é uma erva medicinal da Amazônia conhecida como "Japana branca" e "Japana roxa" utilizada como tônico, digestivo, antidiarréico dentre outros. Objetivou-se caracterizar neste estudo a morfoanatomia caulinar e foliar de A. triplinervis, para corroborar se esta espécie apresenta morfotipos, além de fornecer dados para sua identificação. Amostras foram coletadas no Horto de Plantas Medicinais da Universidade Federal Rural da Amazônia e Embrapa Amazônia Oriental, analisadas morfologicamente e segundo técnicas usuais em anatomia vegetal. O caule é cilíndrico branco ou roxo, com epiderme unisseriada persistente e endoderme com bainha amilífera e estrias de Caspary. As folhas são simples, opostas, triplinervadas, com base atenuada ou decorrente. Possuem estômatos anomocíticos, cera em placas ou granular, glândulas peroladas, mesofilo dorsiventral com feixes colaterais e ductos secretores. A. triplinervis apresentou caracteres morfoanatômicos diferentes entre os tipos branca e roxa, o que possibilita a distinção dos dois morfotipos.

Ayapanatriplinervis (Asteraceae), also known as "Japana branca" and "Japana roxa" in Brazil, is a medicinal herb from the Amazon used as tonic, digestive, antidiarrheal, among others. This study aimed to characterize the morphoanatomy of the aerial vegetative axis of A. triplinervis to corroborate that this species has morphotypes, in order to provide data for their identification. Samples were collected in the Garden of Medicinal Plants of the Federal Rural University of Amazônia and Embrapa Amazônia Oriental, and they were analyzed morphologically and by the standardtechniques of plant anatomy. The stem is cylindrical, white or purple, with uniseriate epidermis, trichomes and endoderm with starch sheath and Casparian strips. The leaves are simple, opposite, with attenuate or arising basis; they have anomocytic stomata, epicuticular wax plates or granules, pearl glands, dorsiventral mesophyll with collateral vascular bundles and secretory ducts. Ayapana triplinervis showed different morphoanatomical features betweenthe white and purple types, which enablesthe distinction between the two morphotypes.

Epidemiología de la Leptospirosis en Tolima, Colombia, 2009 - 2011 / Epidemiology of leptospirosis in Tolima - Colombia, 2009 - 2011

OBJETIVOS: describir el comportamiento epidemiológico de pacientes con diagnóstico presuntivo de leptospirosis en el departamento del Tolima (Colombia), entre 2009 y 2011. METODOLOGIA: estudio descriptivo transversal. Se analizaron variables epidemiológicas, clínicas y de laboratorio de 243 pacientes con diagnóstico presuntivo de leptospiroris, utilizando los criterios de FAINE modificado. RESULTADOS : se encontraron 48 casos con diagnóstico presuntivo positivo (19,8%), 87 casos negativos (35,8%) y 108 casos no concluyentes (44%). El icterohemorrágico fue el serovar más frecuente entre los presuntamente positivos, con una edad promedio de aparición de la enfermedad de 37 años, se presentó principalmente en hombres (87%), residentes de zona urbana, con deficiencia de servicios públicos (80,9%). El tratamiento hospitalario fue necesario para el 87,6% de los pacientes, se encontraron casos en forma aguda (91%),conalteración hepática (65,9%); la mortalidad fue del 19%. CONCLUSIONES la leptospirosis es una patología con diferentes características demográficas y clínicas, con un diagnóstico difícil y en ocasiones tardío; si se tuviera un registro adecuado de algunas características en las fichas podría hacerse un diagnóstico presuntivo a priori.Se presentó asociación entre el diagnóstico presuntivo de leptospiroris y laborar en ambiente abierto, residir en condiciones sanitarias deficientes, presentar dolor en las pantorrillas y presentar fiebre.

OBJECTIVE:: To describe the epidemiological behavior of patients with presumptive diagnosis of leptospirosis in department of Tolima (Colombia), between 2009 and 2011. METHODOLOGY A cross sectional study was carried out. Epidemiological, clinical and laboratory findings of 243 patients with presumptive leptospiroris, utilizing modified FAINE criteria were analyzed. RESULTS : There were 48 cases with presumptive diagnosisof leptospirosis (19.8%), 87 negative cases (35.8%) and 108 inconclusive cases (44%). The icterohaemorrhagiaewas the serovarmost common among presumptive positive, most patients were male (87%), with the mean age of 37years, residents of urban areas, with deficient public services (80.9%). Hospital treatment was required in 87.6% of patients;there were acute cases of the disease (91%), hepatic impairment (65.9%), 19% of the patients died. CONCLUSIONS : Leptospirosis is a disease with different demographic and clinical characteristics, with difficult and sometimes late diagnosis. Presumptive diagnosis of leptospiroris was associated with working in open environment, living in unsanitary conditions, having calf pain and fever.

Vivencias subjeiivas de adolescentes con obesidad respecto a su tratmmiento / Subjctive experiiences of adolescents with obesity regarding to their trattment

Este estudio pretendió comprender las vivencias subjetivas de adolescentes chilenos con obesidad, respecto a su tratamiento para adelgazar. Se empleó una metodología cualitativa y se realizó un diseno descriptivo. La muestra quedó constituida por nueve participantes entre 13 y 18 anos. Los datos se recogieron con entrevistas focalizadas y se analizaron según los principios de la Grounded Theory. Los resultados indican que para los participantes es importante contar con un tratamiento multidisciplinario en donde también reciban el apoyo del entorno para su realización. La motivación intrínseca para generar el cambio se sindica como relevante y toma gran importancia, sentir que es posible llevar a cabo el tratamiento y ver los efectos positivos de éste. En cuanto a los conflictos que presentan en su realización, se senala la falta de constancia, las dificultades para cambiar hábitos y el ambiente externo, cuando éste no ayuda a mantener el tratamiento.

The objective of this study was to understand the subjective experiences of Chilean adolescents with obesity, regarding their treatment to lose weight. A qualitative methodology and descriptive design was performed. The sample was formed by nine participants between 13 and 18 years old. The data was collected through focused interviews and was analyzed according to the principles of Grounded Theory. Results indicate thatfor participants is important to have a multidisciplinary treatment with environment support to fulfill its realization. Intrinsic motivation to create change is as relevant and feeling that it is possible to carry out the treatment and see the positive effects of it, takes great relevance. As for the conflicts that occur in their implementation, important points are the lack of consistency, difficulty of changing habits and the external environment, when it does not help to maintain treatment.

Pharmacological effects of two cytolysins isolated from the sea anemone Stichodactyla helianthus.

Sticholysins I and II (St I/II) are cytolysins purifi ed from the sea anemone Stichodactyla helianthus. In this study, we show their pharmacological action on guinea-pig and snail models in native and pH-denatured conditions in order to correlate the pharmacological fi ndings with the pore-forming activity of both isoforms. In guinea-pig erythrocytes (N = 3), St II possessed higher haemolytic activity in comparison with St I and this activity was lost at an alkaline pH. In molluscan central neurons (N = 30), they irreversibly decreased the amplitude of the cholinergic response; St I (EC 50 0.6 μmolL–1) was more potent than St II (EC 50 >6.6 μmolL–1) and they both increased the duration of the action potential; these effects were absent at an alkaline pH. In guinea-pig isolated atrium (N = 25), both increased the amplitude of the contraction force, but St II was more potent than St I (EC 50 0.03 μmolL–1 and 0.3 μmolL–1, respectively) and this effect persisted at an alkaline pH. In summary, both cytolysins have neuroactive and cardioactive properties. The main mechanism in molluscan neurons seems to be associated with the cytolytic activity of these molecules, whereas in guinea-pig atrium, the existence of an additional pharmacological mechanism might be contributing to the observed effect.

Estudio del índice de masa corporal en los niños y adolescentes de los colegios liceos navales de Lima y Callao agosto 2007 / Study of body mass index in children and adolescents in schools secondary schools in Lima and Callao naval August 2007

Objetivos Determinar la incidencia de sobrepeso y obesidad mediante el IMC de los niños y adolescentes escolares, de los colegios Liceos Navales de Lima y Callao, desde primaria a secundaria y luego comparar las características propias entre cada colegio. Material y Métodos Los datos se obtuvieron de una ficha de recolección de datos donde se incluyeron a todos los niños y adolescentes escolares de los Liceos Navales que dependen de la Marina de Guerra del Perú (8985 alumnos) durante Agosto del 2007. Se calculó el Índice de Masa Corporal por la fórmula de Quetelet. Resultados Se observó una importante diferencia entre el IMC entre los alumnos de primaria y secundaria en todos los colegios, mostrando promedios de sobrepeso en 23,9 por ciento en las primarias vs 17.2 por ciento en las secundarias (razón de 1.4) y de obesidad promedio de 21,3 por ciento en las primarias vs 6,2 por ciento en las secundarias (razón de 3.4). Conclusiones El estudio muestra mayor obesidad y sobrepeso en primaria frente a secundaria, sobretodo obesidad. La incidencia de bajo peso y déficit de peso no mostró diferencia significativa demostrando ser una variable independiente del nivel socioeconómico del Colegio. La tendencia aparente de la obesidad y sobrepeso en los colegios en estudio, es decrecer a medida que transcurre la adolescencia en la etapa escolar. Los índices de sobrepeso y obesidad primaria en este estudio son mayores que las cifras referenciales de hace 5 a 10 años en el país. Recomendaciones En el presente estudio, con población de magnitudes sin precedentes en el Perú, describe que la incidencia de sobrepeso y obesidad encontrada en los Liceos Navales, en especial en niños de primaria, es elevada en comparación con estudios realizados por otros autores. Este hallazgo nos hace reflexionar y tomar medidas de prevención para evitar las consecuencias mórbidas de la obesidad y sobrepeso en el futuro.

Quiste de retención prostético: una causa rara de retención aguda de orina / Prostatic cyst causing urinary obstruction: report of one case

Las lesiones quísticas localizadas en la línea media de la glándula prostética presentan una incidencia difícil de estimar, debido a que la mayoría son asintomáticas y suelen ser un hallazgo casual durante el estudio de otra patología urológica. Presentamos el caso de un varón de 85 años que en el transcurso de un episodio de retención aguda de orina es diagnosticado de un quiste de retención prostético, y realizamos una revisión de la literatura.

The incidence of medial prostatic cysts is unknown, since most of them are asymptomatic, and usually appear as an incidental finding during the study of other urological disease. We report an 85 years oíd man with a urinary obstruction. Rectal palpation disclosed a mass that was adjacent to the prostate. Magnetic resonance showed a cystic lesión of the right seminal vesicle. The cyst was drained, obtaining 250 mi of fluid and urinary obstruction subsided. After three months of follow up, the patient remains asymptomatic.

Comparação da eficiência dos caldos de enriquecimento seletivo no isolamento de Salmonella Dublin / Comparison of the efficiency of selective enrichment broths for Salmonella Dublin isolation

The aim of this study was to compare three different selective enrichment broths: Rappaport-Vassiliadis (RV), selenite cystine (SC) and Muller-Kauffmann tetrathionate (MKT) for Salmonella Dublin isolation from faecal samples of calf experimentally infected. The bacteriological procedure involved pre-enrichment stages in Hajna-GN broth (only for the samples inoculated in RV broth), selective enrichment, culture in modified brilliant green agar (BGA), presumptive biochemistry tests (using triple-sugar-iron agar and lysine-agar) and slide agglutination test with poli-O and poli-H Salmonella antiserum. The effects of enrichment temperatures using RV broth were also evaluated (37ºC and 42ºC). SC broth was significantly more efficient in the isolation of Salmonella Dublin (P<0,05), whereas RV broth incubated at 42ºC had a lower efficiency in the microbiological isolation.

Concentrações séricas de retinol de éguas gestantes em haras do Vale do Rio Doce e Sul de Minas Gerais / Retinol serum concentration in pregnant mares in farms of Vale do Rio Doce and Sul de Minas Gerais, Brazil

Foram analisadas as concentrações séricas de retinol de 16 éguas gestantes em haras de duas diferentes regiões de Minas Gerais (Vale do Rio Doce e Sul de Minas). Os animais foram mantidos em pastagens com sal mineral à vontade, sem qualquer suplementação concentrada. Amostras de sangue foram coletadas a cada 30 dias, nos meses de maio a novembro de 2002, objetivando verificar a necessidade de suplementação das éguas com vitamina A nos meses de seca. A concentração de betacaroteno das pastagens também foi correlacionada com as concentrações sorológicas de vitamina A, a fim de verificar a utilização da reserva hepática dessa vitamina pelos eqüinos. As análises do retinol sorológico e do betacaroteno das pastagens foram realizadas por cromatografia líquida de alta eficiência (HPLC). O experimento foi em parcelas subdivididas, no delineamento inteiramente ao acaso, e os resultados foram comparados pelo teste Duncan. A correlação entre as concentrações séricas de retinol e betacaroteno das pastagens foi estimada pelo método de Pearson. Os resultados demonstraram que, no ano de 2002, não houve necessidade de suplementação das éguas dos haras das regiões estudadas nos meses de seca e que não houve correlação entre os teores de retinol plasmático das éguas com os de betacaroteno das pastagens.

Retinol serum concentrations were analyzed from 16 pregnant mares raised in farms of two different regions of Minas Gerais state, Brazil (Vale do Rio Doce and Sul de Minas). The animals were maintained on pasture with free access to mineral supplement without grain concentrate supplementation. Blood samples were collected monthly from May to November 2002, aiming to verify the need of vitamin A supplementation during the dry season. The concentration of beta-carotene from pasture samples was also correlated with blood plasma concentration to verify the utilization of hepatic stock of vitamin A. High performance liquid chromatography (HPLC) was used to determine vitamin A and beta-carotene concentrations. The used statistics was the split plot design and the results were compared by Duncan test. The Pearson correlation between the serum concentration of retinol and beta-carotene from pasture was estimated. The results demonstrated that the supplementation of pregnant mares in farms of the studied regions was not necessary during the dry season and that no significant correlation between the serum concentration of retinol and beta-carotene from pasture was observed.

Candidíase em pacientes transplantados renais / Candidiasis in kidney transplant patients

O objetivo do trabalho foi verificar a prevalência de candidíase em transplantados renais. Foram avaliados os prontuários dos pacientes transplantados no Hospital das Clínicas de Ribeirão Preto de fevereiro de 1968 a fevereiro de 1995. Nesse período foram transplantados 620 pacientes. Destes, 87 apresentaram 107 episódios de candidíase. Locais mais acometidos: trato urinário com 55 episódios, trato respiratório com 28, e trato gastrointestinal com 16. O agente etiológico mais freqüente foi C. albicans com 65 casos seguido de C. tropicalis com 12 e C. glabrata com 11 casos. As infecções do trato urinário mostraram incidência maior (61,7%) nos primeiros 6 meses. A maioria se apresentou clínicamente como infecção bacteriana. No trato respiratório, as infecções foram caracterizadas por recuperação do agente no escarro. No trato gastrointestinal, 9/16 episódios foram esofágicos, com epigastralgia, dor retroesternal, às vezes acompanhados de candidíase oral ou odinofagia. Nos outros episódios o agente foi recuperado nas fezes com quadro clínico de gastroenterite. Nas infecções dos tratos urinário e respiratório, houve associação da candidíase com antibioticoterapia prévia (76% e 67% respectivamente), além de infecções bacterianas concomitantes (34% e 64% respectivamente). As infecções por Candida sp tiveram prevalência geral em torno de 14,5%. A localização predominante foi no trato urinário e, em seguida, nos tratos respiratório e gastrointestinal, apresentando alto índice de associação com antibioticoterapia prévia e infecções bacterianas.

The medical records of 620 patients submitted to renal transplant from February 1968 to February 1995 were surveyed for Candida infection. Of these, 87 presented 107 episodes of candidiasis. In 42.9% the infection appeared up to 6 months after the transplant. The most frequent involved sites were: urinary tract, respiratory tract, and gastrointestinal tract. The most frequent etiological agents were: C. albicans, C. tropicalis and C. glabrata. Most urinary tract infections occurred in the first 6 months (61.7%) and manifested clinically as a bacterial infection. In the respiratory tract infections were characterized by isolation of the agent in sputum. In the gastrointestinal infections, 9/16 episodes were esophageal. There were 3 deaths directly related to Candidiasis (one pulmonary and 2 disseminated cases). In the urinary tract, and respiratory tract infections there was association of candidiasis with previous antibiotic treatment (76% and 67%, respectively), and with concomitant bacterial infections (34% and 64%, respectively). The overall prevalence of Candida infections was 14.5%. The predominant location was in the urinary tract (51.0%), followed by the respiratory (26.0%) and gastrointestinal tract (15.0%), with a high rate of association with previous antibiotic treatment and bacterial infections.

The serological differentiation of acute and chronic schistosomiasis japonica using IgA antibody to egg antigen

Two groups of Schistosoma japonicum infected patients (acute and chronic) and non-infected individuals were studied using IgA antibody to egg antigen (SEA) and IgG and IgM antibodies to keyhole limpet haemocyanin (KLH). The means and standard deviation of the optical density in ELISA of acute, chronic and negative groups for IgA anti-SEA were 583ñ124.7, 98.2ñ78.8 and 82.2ñ39.3, respctively. There was a statistically significance between acute patients and chronic patients (P<0.01). The means and standard deviation of IgG and IgM antibodies to KLH were 501.5ñ150.6, 113.0ñ79.1, 28.8ñ56.3 and 413.6ñ148.5, 70.2ñ14.8, 65.3ñ45.3, repectively. The detection results of IgA to SEA compared with the IgG and IgM to KLH did not demonstrate a significant difference (P>0.01). The sensitivities of IgA to SEA and IgG and IgM antibodies to KLH for the detection of acute infection were 95.24 per cent, 90.48 per cent and 85.71 per cent respectively. Therefore, this study showed that the detection of IgA to SEA is also a useful new method for the serological differentiation of acute and chronic schistosomiasis japonica in humans.

Testes sorológicos para pesquisa de anticorpos em soros de camundongos tratados pelo Trypanosominum TC D30 / Serum test methods for research of antibodies in serum of mice treated by Trypanosominum TC D30

Propomos para o presente trabalho a realizaçäo das reaçöes sorológicas: de fixaçäo do complemento, imunofluorescência indireta e hemaglutinaçäo, onde foram testados soros de camundongos tratados com Trypanosominum TC D30, na pesquisa de imunoglobulinas circulantes, eventualmente existentes no sangue desses animais. Como controle, foram utilizados soros de animais normais associados a soluçäo fisiológica, em substituiçäo ao antígeno, seguindo-se o mesmo esquema usado no tratamento

Tru-cut needle biopsy of subcutaneous fat in the diagnosis of secondary amyloidosis in rheumatoid arthritis

In order to investigate the presence of secondary amyloidosis in patients with rheumatoid artritis (RA), we performed and abdominal subcutaneous fat biopsy with a truc-cut needle in 50 patients. The tissue was stained with Congo red and was observed with polarized light microscopy. We found amyloid deposits in 78 percent of our patientas. We randomly selected ten patients with a positive biopsy and a second procedure was performed. Tissues were studied with electron microscopy. We found unbranced fibrils characteristic of amyloid in all of them. We found a direct correlation with rheumatoid factor titers: the more intense the amyloid deposit, the higher the rheumatoid factor titers (p< 0.001). We did not find any correlation betwen amyloid deposits and clinical manifestations of disease. Amyloid deposits in RA are more frequent than previously thought, and their clinical importance remains to be determined