Seropositivity for Bovine Viral Diarrhea and Enzootic Bovine Leukemia viruses in Blanco Orejinegro cattle in Colombia and infection associated-factors / Soropositividade para o vírus da diarréia viral bovina e leucemia bovina enzoótica em bovinos Blanco Orejinegro na Colômbia e fatores associados à infecção

ABSTRACT Serological controls for diseases of viral origin in animal production systems and the identification of factors associated with infections are decisive elements to establish prevention and control measures. The aim of this study was to establish the serological status for Bovine Viral Diarrhea (BVD) and Enzootic Bovine Leukemia (EBL) viruses in Blanco Orejinegro (BON) cattle from Colombia, and to identify the factors associated with seropositivity. A cross-sectional study was conducted with a total of 498 animals of all age groups and physiological states of the BON breed were selected, belonging to 14 herds located in 6 states of Colombia, in which a survey with 27 questions was conducted. By means of the chi-square test, possible factors associated with seropositivity against the 2 viruses were identified. A sample of 4 ml of blood was taken from each animal to extract plasma and make indirect Elisa tests to detect antibodies against both pathogens. General seropositivity of 27,1% was obtained for EBL, finding as factors associated with seropositivity the inadequate disposition of placental tissues after delivery of the cows and the non-performance of serological tests on new animals entering the herd. For BVD, seropositivity obtained was 50,6%, and the factors associated with seropositivity identified were having had a history of the disease in the herd, and using semen from bulls that are not known to be free for the infection. We suggest establishing control measures considering the factors associated with each viral infection to limit their expansion in the BON cattle production systems of Colombia.

RESUMO Os controles sorológicos para doenças de origem viral nos sistemas de produção animal e a identificação de fatores associados à infecção são elementos decisivos para estabelecer medidas de prevenção e controle. O objetivo deste estudo foi estabelecer o status sorológico dos vírus da Diarréia Viral Bovina (BVD) e da Leucemia Bovina Enzoótica (EBL) em bovinos Blanco Orejinegro (BON) da Colômbia e identificar os fatores associados à soropositividade. Foram selecionados 498 animais de todas as faixas etárias e estados fisiológicos da raça BON, de 14 rebanhos localizados em seis regiões da Colômbia, nos quais foi realizada uma pesquisa para identificar possíveis fatores associados à soropositividade contra os dois vírus. Foi retirada uma amostra de 4 ml de sangue de cada animal para extrair plasma e fazer testes ELISA indiretos para detectar anticorpos contra os dois patógenos. Obteve-se soropositividade geral de 27,1% para EBL, encontrando como fatores associados à soropositividade a disposição inadequada dos tecidos placentários após o parto das vacas e a não realização de testes sorológicos em novos animais que entraram no rebanho. Para a BVD, a soropositividade obtida foi de 50,6%, e os fatores associados à soropositividade identificados foram: histórico de doença no rebanho e uso de sêmen de touros que não são reconhecidos como livres da infecção. Sugerimos o estabelecimento de medidas de controle considerando os fatores associados a cada infecção viral para limitar sua expansão nos sistemas de produção de gado BON da Colômbia.

Prevalence and risk factors for colonization of Campylobacter spp. in household dogs in Metro Manila, Philippines

@#Campylobacter is one of the four leading causes of diarrheal diseases worldwide, with the number of cases surpassing those of salmonellosis and shigellosis. Contact with companion animals such as cats and dogs has been implicated in human infections. This study aimed to determine the prevalence and risk factors for Campylobacter spp. colonization among household dogs in Metro Manila, Philippines. Faecal samples were collected from 195 dogs and processed using selective enrichment. Campylobacter spp. were detected and identified through PCR amplification of genus- and species-specific genes. The overall prevalence of Campylobacter spp. was 9.74% (19/195), with C. upsaliensis as the predominant species with a prevalence of 7.2% (14/195), followed by C. jejuni at 2.05% (4/195). Both C. upsaliensis and C. jejuni were observed in 15.8% (3/19) of samples positive for Campylobacter spp. Furthermore, Campylobacter colonization in dogs was associated with the gender of the dog owner and presence of other pets in the household. These results reinforce the need for good hygiene practices when handling dogs in order to reduce the possibility of acquiring campylobacteriosis resulting from pet interactions.

Retención de cápsula endoscópica en enfermedad de Crohn ¿cómo manejarla? / Retained capsule endoscopy in Crohn´s disease: how to manage it?

Capsule endoscopy is a technique that allows the study of the small intestine, through a device that is swallowed by the patient, capturing images as it travels through the digestive tract. Capsule retention is the most serious complication. We report the case of a 69 year-old male presenting with iron deficiency anemia, with normal upper endoscopy and colonoscopy; but obscure gastrointestinal bleeding was diagnosed and therefore a study with capsule endoscopy was requested. The patient evolves with retained capsule in the small intestine with ulcerated stenosis as shown by imaging. This finding was confirmed by enteroscopy with biopsy, without being able to extract the capsule. Medical management with corticosteroids was indicated for intestinal obstruction secondary to inflammatory stenosis in the context of Crohn's disease: The capsule was expelled after 21 days of ingestion, with a positive outcome

La cápsula endoscópica es una técnica que permite el estudio del intestino delgado, mediante un dispositivo que es deglutido por el paciente y captura imágenes en su recorrido por el tubo digestivo. La complicación más grave es la retención de la cápsula. Se reporta el caso de un paciente de sexo masculino, de 69 años con anemia ferropénica, con endoscopia alta y colonoscopia normal; planteándose sangrado gastrointestinal de origen oscuro por lo que se solicita estudio con cápsula endoscópica. El paciente evoluciona con retención de la cápsula en intestino delgado, visualizándose en las imágenes la presencia de estenosis ulcerada, hallazgo que se confirma mediante enteroscopia con toma de biopsias, sin lograr extraer la cápsula. Se indica manejo médico con corticoides por obstrucción intestinal secundario a estenosis inflamatoria en contexto de enfermedad de Crohn, expulsando espontáneamente la cápsula al día 21 de su ingestión, sin complicaciones.

Candidemias en pediatría: distribución de especies y sensibilidad a los antifúngicos / Candidemia in Pediatrics: Species distribution and antifungal susceptibility

Las infecciones graves causadas por levaduras del género Candida son frecuentes en la población hospitalaria. Debido a las diferencias en la distribución de especies y la sensibilidad a los antifúngicos según el área geográfica y el tipo de paciente, resulta importante estudiar la epidemiología de cada institución. Con este propósito, hemos realizado un estudio retrospectivo y descriptivo sobre las candidemias ocurridas en el Hospital de Ninos «Superiora Sor María Ludovica¼ de la ciudad de La Plata. En un período de 6 años (2010-2015) se registraron 177 episodios de candidemia. Las especies predominantes fueron Candida albicans (45%) y Candida parapsilosis (28%). Las salas de internación con mayor cantidad de episodios fueron las unidades de terapia intensiva de pediatría, la neonatal y la cardiovascular (58%). En los casos donde se realizaron pruebas de sensibilidad a los antifúngicos, no se observó resistencia a la anfotericina B en todo el período y la resistencia a azoles se limitó a 4 aislamientos de especies menos frecuentes.

Serious infections caused by Candida yeasts are frequent in the hospital population. Due to differences in species distribution and antifungal susceptibility testing depending on the geographic area and the type of patient, it is important to study the epidemiology of each institution. For this purpose, we conducted a retrospective, descriptive study on the occurrence of candidemia in the Children's Hospital "Superiora Sor María Ludovica" of the city of La Plata. In a 6-year period (2010-2015), 177 candidemia episodes were recorded. The predominant species were Candida albicans (45%) and Candida parapsilosis (28%). The hospital wards with the highest number of candidemia episodes were the pediatric, neonatal and cardiovascular intensive care units (58%). No resistance to amphotericin B was observed throughout the period whereas resistance to azoles was limited to 4 strains of less frequent species.

Analysis of the Skin to Calyceal Distance (SCD) to the upper pole calyx among Filipino patients: A guide to upper pole access Percutaneous Nephrolithotomy (PCNL)

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> Precise entry to the upper posterior calyx is key to a successful and safe upper pole access PCNL. The surgeon's knowledge of the average skin to calyceal distance can serve as a guide to avoid inadvertent injury to both the kidney and collateral organs during the percutaneous puncture.<br /><strong>METHODS:</strong> The authors analyzed the radiologic images of 84 patients who underwent unenhanced 64-slice helical CT scan (Toshiba®). Skin-to-calyceal distance (SCD) to the upper posterior calyx were measured using the Vitrea® software inherent to the CT scan.<br /><strong>RESULTS:</strong> The mean SCDs is non-hydronephrotic kidneys were 54.9 ± 13.7 mm and 61.4 ± 12.5 mm on the right and left, respectively while in hydronephrotic kidneys, the mean SCDs were 60.3 ± 11.8 mm and 58.6 ± 13.1 mm on the right and left, respectively. There was no statistically significant difference between the right and left upper pole SCD in both groups (p = 0.84).<br /><strong>CONCLUSION:</strong> The mean SCD to the upper posterior calyx among Filipino adults is about 6.0 cm. By limiting the depth of the initial puncture to within the distance, the endourologist may avoid overshooting the targeted calyx, thus avoiding undue injury to the kidney or intraabdominal structures.</p>

Proboscis lateralis with rhinosinusitis

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This report aims to describe unique manifestations of proboscis lateralis and highlight the importance of a multidisciplinary approach to address the problems that arise from this rare congenital anomaly.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 13-year-old girl diagnosed with proboscis lateralis presented with a trunk-like appendage projecting from the surface of the right supramedial canthal area. She also had clear nasal discharge, nasal congestion, mouth-breathing and snoring since birth. Paranasal Sinus (PNS) CT scan with 3D reconstruction showed agenesis of the right paranasal sinuses and expansile aeration of the left paranasal sinuses. Due to her condition, the drainage system of the paranasal sinuses was obstructed causing chronic rhinosinusitis (CRS). This hindered plans for reconstructive surgery despite medical management, hence, the patient underwent Endoscopic Sinus Surgery (ESS).<br /><strong>CONCLUSIONS:</strong> Proboscis lateralis is a rare congenital anomaly that results in aesthetic problems as well as airway concerns such as rhinosinusitis and obstructive sleep apnea syndrome (OSAS). Management entails a multidisciplinary approach to address functional and aesthetic problems of the patient.</p>

Detección del VPH en mujeres con y sin alteraciones citológicas del cérvix en Castilla y León: estudio poblacional / Detection of HPV in women with no cellular alterations detected in uterine cytology in Castilla y León, population study

RESUMEN OBJETIVO: estimar la prevalencia de cambios y alteraciones cervicales en mujeres pertenecientes al Programa de Prevención y Detección Precoz de Cáncer de Cuello del Útero de Castilla y León, e identificar la coexistencia y genotipo más frecuente del VPH. MATERIALES Y MÉTODOS: estudio cuantitativo, observacional, descriptivo, transversal, retrospectivo, efectuado en mujeres de 25 a 64 años de edad que participaron en las pruebas de cribado de 2012 a 2014. Los resultados de la citología cervical convencional se interpretaron de acuerdo con la clasificación Bethesda 2001. La detección y genotipificación del VPH se realizó con PCR. Las variables cualitativas se describen mediante frecuencias absolutas y relativas (porcentajes) de sus categorías, con IC95% . Para estudiar la asociación entre variables cualitativas se utilizó la prueba de χ2. Se consideró estadísticamente significativo el valor de p≤0.05. RESULTADOS: se analizaron 190,203 muestras de frotis de cuello uterino. El 66.4% de las muestras citológicas no mostró lesiones ni alteraciones morfológicas. De las muestras citológicas con alteraciones se identificaron 7,083 con metaplasia, 2,844 con células escamosas atípicas (1.5%), 855 con lesiones de bajo grado (0.4%), 255 con lesiones de alto grado (0.13%) y 198 con lesiones cancerosas (0.1%). Las lesiones intraepiteliales de bajo y alto grado, además de los carcinomas, fueron más frecuentes en las muestras positivas a VPH (p<0.001). En relación con la atrofia vaginal de mujeres perimenopáusicas, los genotipos más frecuentes fueron el VPH-53 (0.7%), VPH-31 (0.6%) y VPH-58 (0.5%). En pacientes con lesiones intraepiteliales el genotipo más frecuente fue el VPH-16. CONCLUSIONES: la prevalencia del VPH suele ser más alta conforme aumenta la severidad de la lesión citológica detectada. El genotipo aislado con mayor frecuencia en lesiones intraepiteliales de alto o bajo grado es el VPH-16.

ABSTRACT OBJECTIVE: To estimate the prevalence of cervical changes and alterations in women belonging to the Program for the Prevention and Early Detection of Cervical Cancer of Castilla y León, and to identify the most frequent presence and genotype of Human Papilloma Virus (HVP). MATERIAL AND METHODS: A quantitative, observational, descriptive, cross-sectional, retrospective study of women aged 25-64 years who participated in screening tests during 2012 and 2014. The results of conventional cervical cytology were interpreted according with the Bethesda 2001 classification. The detection and genotyping of HPV was performed across PCR. Qualitative variables are described by absolute and relative frequencies (percentages) of their categories, with a 95% confidence interval (CI 95%). To study the association between qualitative variables, the χ2 test was used. The value of p≤0.05 was considered statistically significant. RESULTS: 190,203 samples of cervical smears were analyzed during the period. 66.4% of the cytological samples showed no lesions or morphological alterations. Of the cytological samples with alterations we identified 7,083 with metaplasia, 2,844 with atypical squamous cells (1.5%), 855 with low grade lesions (0.4%), 255 with high grade lesions (0.13%) and 198 with cancerous lesions%). Low- and high-grade intraepithelial lesions, in addition to carcinomas, were more frequent in HPV positive samples (p <0.001). To the vaginal atrophy of perimenopausal women we detected HPV-53 (0.7%), HPV-31 (0.6%) and HPV-58 (0.5%) genotypes. In patients with intraepithelial lesions the most frequent genotype was HPV-16. CONCLUSIONS: the prevalence of HPV is usually higher according to the severity of the cytological lesion detected. The most frequently isolated genotype in high-grade low-grade intraepithelial lesions is HPV-16.

Actividad física en residentes de medicina familiar de Bogotá y su recomendación a los pacientes / Physical Activity in Bogotá Family Practice Residents and their recommendation to Patients

Objetivo: Identificar los hábitos de actividad física (AF) en residentes de medicina familiar de Bogotá y las recomendaciones que dan sobre esta a los pacientes. Metodología: Estudio de corte transversal con aplicación de parte de la encuesta de Healthy Doctor = Healthy Patient y preguntas sobre las "Características del médico y de la práctica clínica" de la iniciativa Exercise is Medicine® en los profesionales en formación en medicina familiar de 5 universidades de Bogotá. Resultados: El total de participantes fue de 9? residentes, quienes reportaron AF vigorosa, moderada y leve. Conclusiones: Los resultados evidenciados y comparados con la literatura internacional disponible (Reino Unido, Estados Unidos, Nueva Zelanda y Canadá) muestran que hay convergencia en la necesidad de capacitar médicos de atención primaria en la forma correcta de interrogar y recomendar la AF, de forma escrita, teniendo el formato incluido en la historia clínica esto respaldado por iniciativas internacionales.

Objective: To identiíy habits and physical activity recommendations in family medicine residente of Bogotá. Methodologyt Cross

Proboscis lateralis with rhinosinusitis

OBJECTIVE: This report aims to describe unique manifestations of proboscis lateralis and highlight the importance of a multidisciplinary approach to address the problems that arise from this rare congenital anomaly.METHODS:Design: Case ReportSetting: Tertiary Government HospitalPatient: OneRESULTS: A 13-year-old girl diagnosed with proboscis lateralis presented with a trunk-like appendage projecting from the surface of the right supramedial canthal area. She also had clear nasal discharge, nasal congestion, mouth-breathing and snoring since birth. Paranasal Sinus (PNS) CT scan with 3D reconstruction showed agenesis of the right paranasal sinuses and expansile aeration of the left paranasal sinuses. Due to her condition, the drainage system of the paranasal sinuses was obstructed causing chronic rhinosinusitis (CRS). This hindered plans for reconstructive surgery despite medical management, hence, the patient underwent Endoscopic Sinus Surgery (ESS).CONCLUSIONS: Proboscis lateralis is a rare congenital anomaly that results in aesthetic problems as well as airway concerns such as rhinosinusitis and obstructive sleep apnea syndrome (OSAS). Management entails a multidisciplinary approach to address functional and aesthetic problems of the patient.

Analysis of the Skin to Calyceal Distance (SCD) to the upper pole calyx among Filipino patients: A guide to upper pole access Percutaneous Nephrolithotomy (PCNL)

OBJECTIVE: Precise entry to the upper posterior calyx is key to a successful and safe upper pole access PCNL. The surgeon's knowledge of the average skin to calyceal distance can serve as a guide to avoid inadvertent injury to both the kidney and collateral organs during the percutaneous puncture.METHODS: The authors analyzed the radiologic images of 84 patients who underwent unenhanced 64-slice helical CT scan (Toshiba®). Skin-to-calyceal distance (SCD) to the upper posterior calyx were measured using the Vitrea® software inherent to the CT scan.RESULTS: The mean SCDs is non-hydronephrotic kidneys were 54.9 ± 13.7 mm and 61.4 ± 12.5 mm on the right and left, respectively while in hydronephrotic kidneys, the mean SCDs were 60.3 ± 11.8 mm and 58.6 ± 13.1 mm on the right and left, respectively. There was no statistically significant difference between the right and left upper pole SCD in both groups (p = 0.84).CONCLUSION: The mean SCD to the upper posterior calyx among Filipino adults is about 6.0 cm. By limiting the depth of the initial puncture to within the distance, the endourologist may avoid overshooting the targeted calyx, thus avoiding undue injury to the kidney or intraabdominal structures.

Genetic polymorphisms in NAT1, NAT2, GSTM1, GSTP1 and GSTT1 and susceptibility to colorectal cancer among Filipinos

@#Objectives. Polymorphisms in metabolic genes which alter rates of bioactivation and detoxification have been shown to modulate susceptibility to colorectal cancer. This study sought to evaluate the colorectal cancer risk from environmental factors and to do polymorphism studies on genes that code for Phase I and II xenobiotic metabolic enzymes among Filipino colorectal cancer patients and matched controls. Methods. A total of 224 colorectal cancer cases and 276 controls from the Filipino population were genotyped for selected polymorphisms in GSTM1, GSTP1, GSTT1, NAT1 and NAT2. Medical and diet histories, occupational exposure and demographic data were also collected for all subject participants.Results. Univariate logistic regression of non-genetic factors identified exposure to UV (sunlight) (OR 1.99, 95% CI: 1.16-3.39) and wood dust (OR 2.66, 95% CI: 1.21-5.83) and moldy food exposure (OR 1.61, 95% CI:1.11-2.35) as risk factors; while the NAT2*6B allele (recessive model OR 1.51, 95% CI :1.06-2.16; dominant model OR 1.87, 95% CI: 1.05-3.33) and homozygous genotype (OR 2.19, 95% CI: 1.19-4.03) were found to be significant among the genetic factors. After multivariate logistic regression of both environmental and genetic factors, only UV radiation exposure (OR 2.08, 95% CI: 1.21-3.58) and wood dust exposure (OR 2.08, 95% CI: 0.95-5.30) remained to be significantly associated with increasing colorectal cancer risk in the study population.Conclusion. This study demonstrated that UV sunlight and wood dust exposure play a greater role in influencing colorectal cancer susceptibility than genotype status from genetic polymorphisms of the GST and the NAT` genes.

True congenital macroglossia surgically managed using a modified Kole technique

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe a 2-year-old boy with true congenital macroglossia surgically managed using a modified Kole technique.<br /><strong>METHODS:</strong> <br /><strong>Design:</strong> Surgical Innovation<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 2-year-old boy presented with congenital macroglossia, associated with difficulty feeding and phonating. On physical examination, the massive tongue had both increased length and width. At rest, it protruded between the upper and lower teeth with drying and fissuring of the tip. Dribbling of saliva and mandible prognathism were also noted. The child was surgically treated with a modified Kole technique, wherein the apex of the anterior wedge resection was extended to the posterior third midline. Final histopathology was consistent with cavernous hemangioma.<br /><strong>CONCLUSION:</strong> The modified Kole technique proved viable as the preoperative results were considered satisfactory. Tongue volume was uniformly reduced in length and width enabling mouth and jaw closure while tongue sensation and mobility were preserved. Feeding, speech intelligibility and cosmesis were markedly improved. Future application of this modification may prove its usefulness.</p>

Tumores virilizantes del ovario: presentación de dos casos manejados mediante cirugía por monopuerto / Virilizing tumors of the ovary: presentation of two cases managed by single-port surgery

Los tumores virilizantes, corresponden al 1% de todos los tumores funcionales del ovario. Estos tipos de tumores virilizantes se originan de las células pluri-potenciales del estroma ovárico, tienen la capacidad de secretar 17-hidroxiprogesterona, testosterona y androstenediona, desencadenando hiperandrogenismo clínico. Son catalogados como de bajo potencial maligno, con un patrón de crecimiento lento, bien diferenciados, diagnosticados en su mayoría en estadío I y II, de buen pronóstico y típicos de mujeres en edad reproductiva. El objetivo de esta comunicación es presentar dos casos clínicos con diagnóstico de tumor virilizante de ovario, tratadas con cirugía laparoscópica por mono puerto.

Virilizing tumors, corresponding to 1% of all functional ovarian tumors. Those type of virilizing tumors originate from pluripotential ovarian stromal cells and have the capacity to secrete 17-hydroxyprogesterone, testosterone and androstenedione, triggering clinical hyperandrogenism. They are classified as low malignant potential, well differentiated, with a pattern of slow growth, mostly diagnosed in stage I and II, with good prognosis and typical of women of reproductive age. The aim of this paper is to present two cases of virilizing ovarian tumor treated by mono port laparoscopic surgery.

Surco diagonal del lóbulo de la oreja: prevalencia y asociación con enfermedad cardiovascular en población hospitalizada / Diagonal earlobe crease: prevalence and association between semiology and cardio- vascular disease in hospitalized population

El Surco Diagonal del Lóbulo de la Oreja (DELC) corresponde al primer signo extra cardíaco de Enfermedad Coronaria (EC) y se asocia con ateroesclerosis generalizada, existiendo controversia en torno a su validez. Objetivos: Determinarla prevalencia del signo en la población de muy alto riesgo cardiovascular hospitalizada en un centro del área sur de Santiago y conocer su comportamiento en relación a EC y Accidente Cerebrovascular (ACV). Método: Estudio de casos y controles. Se incluyeron 304 pacientes masculinos >60 años, con antecedente de EC y hospitalizados entre mayo y diciembre de 2012 en el Hospital El Pino. Se dividieron en dos grupos evaluándose retrospectivamente la presencia/ausencia de DELC mediante fotografía. Grupo 1: sometidos a Coronariografía, con obstrucción significativa (>50 por ciento estenosis) ≥1 arteria coronaria. Grupo 2: sometidos a Tomografía Computarizada de cerebro con hipodensidad parénquima cerebral, borramiento surcos, edema cerebral, y/o hemorragia intraparenquimatosa. Se definieron como controles pacientes con resultado de intervenciones sin las lesiones definidas. Relación casos y controles 1:1. Se determinó la prevalencia del signo. Los resultados se ajustaron según factores de riesgo cardiovascular, mediante regresión logística condicional. Resultados: Prevalencia DELC casos (56,96 por ciento), fue mayor que controles (43,04 por ciento) (p<0,01). Odds ratio de DELC: EC= 2,79 [1,14–6,83] (p<0,03), y ACV = 2,55 [1,19–5,48] (p<0,02). Conclusión: Este estudio identificó una diferencia significativa entre la prevalencia de DELC en ambos grupos, coincidiendo los resultados de nuestra población con la literatura disponible. Se detectó asociación positiva, significativa e independiente de los factores de riesgo cardiovascular, entre DELC con EC y ACV...

The Diagonal Earlobe Crease is the first extracardiac sign of Coronary Heart Disease (CHD), associated with generalized atherosclerosis. There is controversy about its validity. Objective: Determine sign’s prevalence in hospitalized population with very-high cardiovascular risk, of a medical center in the southern area of Santiago-Chile, and recognize its association with CHD and Cerebrovascular Disease (CVD). Method: Case and control study. 304 male patients, >60 years-old, with personal CHD medical history and hospitalized between May and December of 2012 at El Pino Hospital were included. They were divided in 2 groups, evaluating the presence/absence of DELCby photography. Group 1: submitted to coronarography with significant obstruction (>50 percent stenosis) in >1 coronary artery. Group 2: submitted to simple brain computed tomography with hypodensity of cerebral parenchyma, effacement of sulci, brain edema and/or intraparenchymatous hemorrhage. Controls we redefined as patients wich result of interventions lack the described injuries. Case-Control ratio of 1:1. The sign’s prevalence was determined. The results where adjusted according to cardiovascular risk factors, by conditional logistic regression. Results: Prevalence of DELC in cases (56.96 percent), was higher than controls(43.04 percent) (p<0.01). DELC Odds Ratio: CHD = 2.79 [1.14-6.83](p<0.03), and CVD = 2,55 [1.19–5.48] (p<0.02). Conclusion: This study identified a significative difference between prevalence in both groups, similar with the tendency described in literature. This study, also detected a significant positive association, independent of cardiovascular risk factors, between DELC with CHD and CVD...

Genetic polymorphisms in CYP1A1, GSTM1, GSTP1, GSTT1, NAT1 and NAT2 and oral cavity cancer risk among Filipinos

Polymorphisms in metabolic genes have been shown to modulate susceptibility to oral cavity cancer. Cases (n=176) and controls (n=317) from the Filipino population were genotyped for selected polymorphisms in CYP1A1, GSTM1, GSTP1, GSTT1, NAT1 and NAT2. Medical and diet histories, occupational exposure and demographic data were also collected for all subjects. The CYP1A1m1/m1 genotype is protective against oral cancer, while being homozygous for the GSTP1 c.313G genotype and heterozygous for the NAT1*10 homozygotes and non-homozygotes for the CYP1A1 m1 allele. The risk from heterozygosity for the NAT1*10 allele was limited to subjects who were not homozygous for the GSTP1 c.313G genotype remained a significant oral cancer risk modifier, together with environmental variables, the homozygous GSTP1 c.313G genotype remained a significant oral cancer risk modifier, together with environmental risk factors, such as smoking, passive smoking, inverted smoking and tobacco chewing, and environmental protective factors, i.e. moderate consumption of fish sauce (patis) and shrimp paste (bagoong). The GSTP1 c.313G polymorphism increases susceptibility for oral cavity cancer in the Filipino population.

An anatomical study of the cochlea among Filipinos using high-resolution computed tomography scans

Objective@#To describe the cochlear anatomy among Filipinos through high resolution computed tomography (HRCT) imaging. @*Methods@#Design: Retrospective Study Setting: Tertiary Private University Hospital Patients: Cochlear images retrospectively obtained from computed tomography (CT) scans of subjects who underwent cranial, facial, paranasal sinus and temporal bone computed tomography from October 2009 to July 2010 were reconstructed and analyzed. @*Results@#388 cochlear images were obtained from the scans of 194 subjects (101 males and 93 females, aged 1 to 90 years old, mean = 52 years) and reconstructed for analysis. The mean coiled cochlear height measured 4.36 mm on the right (A.D.) and 4.34 mm on the left (A.S.). Measurement from the oval window to the distal end of the basal turn (equivalent to the horizontal dimension of the cochlea or the mean length of the basal turn) was 7.55 mm A.D. and 7.60 mm A.S. The vertical and horizontal dimensions of right and left cochleas were identical in all subjects (S.D. = 0.35). The right and left cochlear turns were identical in each subject, exhibiting 2 1/2 turns in 92.3% of subjects and 2 3/4 turns in 7.7% of subjects.The cochlear dimensions were similar in all subjects, regardless of age. No cochlear ossification or malformation was noted on any CT image.@*Conclusion@#The 7.55 mm mean length of the cochlear basal turn among Filipinos in this study was 1.24 mm shorter than the average length of the basal turn of 8.81 mm reported elsewhere. Further studies of the cochlear dimensions in specific age groups and its correlation to audiometric status are recommended to determine other significant physiologic correlations.

Diferencias en el metabolismo lipídico, niveles de homocisteína, folato y vitamina B12 entre gestaciones gemelares y únicas / Differences in lipid metabolism, homocysteine levels, serum folic acid and vitamin B12 between single and twin pregnancies

Antecedentes: Se están usando diferentes tipos de suplementación nutricional durante la gestación, sin embargo, existen escasez de estudios que se centren en los resultados metabólicos de los mismos. Objetivos: Comprobar si mediante la suplementación se logra el control del impacto de los múltiples cambios metabólicos que conlleva una gestación múltiple, usando análisis comunes. Método: Comparamos tres diferentes grupos de pacientes entre la semana gestacional 25 y 27. Un grupo de 46 gestaciones únicas, un grupo de 38 gestaciones gemelares espontáneas y otro grupo de 32 gestaciones gemelares tras técnicas de reproducción asistida. Comparamos niveles de colesterol LDL, HDL, triglicéridos, folato sérico, vitamina B12, homocisteína, hemoglobina, creatinina y plaquetas. Resultados: Los niveles de triglicéridos fueron más altos en ambos grupos de gemelares (p<0,001) y los niveles de colesterol fueron similares en los tres grupos. Las concentraciones de folato sérico fueron mayores en las gestaciones gemelares (p<0,001). El resto de parámetros estudiados fueron similares en los tres grupos. Conclusión: La suplementación siguiendo las recomendaciones de la ACOG y la SEGO es efectiva en el control de colesterol LDL, HDL, folato sérico, vitamina B12, homocisteína, hemoglobina, creatinina y plaquetas. Sólo los niveles de triglicéridos no se relacionan con la suplementación y pueden estar relacionados con mayor incidencia de colestasis y preeclampsia en gestaciones múltiples.

Background: Different ways of nutritional supplementation are being advised by physicians during pregnancy, but there is a lack of literature focused on its metabolical results. Aims: Check if the control of the impact that the multiple metabolic changes related to multiple pregnancies have on the mother's homeostasis is achieved with the supplementation, through common used blood tests. Method: We compare three different groups of patients between the 25 and 27th week of gestation. One group of 46 single pregnancies, a second group of 38 spontaneous twin pregnancies and another group of 32 twin pregnancies after assisted reproduction techniques. We compare the levels of LDL, HDL-cholesterol, triglycerides, serum folic acid, Vit B12, homocysteine, haemoglobine, creatinine and platelets. Results: The levels of triglycerides were higher in both groups of twin pregnancies (p<0.001), but the levels of cholesterol remain similar. Folic acid concentrations were higher in the groups of twin pregnancies (p<0.001). The rest of levels studied were similar in the 3 groups. Conclusion: The supplementation following the ACOG and SEGO recommendations seems to be effective in controlling the values of LDL, HDL-cholesterol, serum folic acid, Vit B12, homocysteine, haemoglobine, creatinine and platelets. Only the levels of triglycerides appear unaffected by the supplementation and can be related with the higher incidence of preeclampsia and cholestasis seemed among twin pregnancies.

Síndrome Poliglandular Autoinmune Tipo II: Posible Asociación con HLA DRB1*-DQB1* / Possible association of Type II Autoimmune Polyendrocrine Syndrome with HLA DRB1*-DQB1*

Los síndromes poliendocrinos autoinmunes (APS) asocian enfermedades endocrinas autoinmunes con otros desórdenes autoinmunes no endocrinos. El APS tipo II se caracteriza por compromiso primario suprarrenal, tiroideo y/o DM tipo I. Presentamos un paciente masculino de 46 años que fue internado por astenia, adinamia, hiporexia, severa disminución de peso, mareos y vómitos. Antecedente de obesidad y diabetes diagnosticada 3 años antes. Presentaba hipotensión arterial, hiperpigmentación de mucosas y pliegues, anemia, hiponatremia e hipoglucemias frecuentes a pesar de la disminución de la dosis de insulina. Se diagnosticó insuficiencia suprarrenal, concomitantemente con hipotiroidismo y diabetes tipo 1, todas de origen autoinmune, iniciándose reemplazo hormonal. Se encontró una posible asociación del HLA DRB1*-DQB1* en los estudios genéticos. Conclusiones: Nuestro paciente presenta el HLA DQB1*0302 descripto en el APSII, pero el HLA DRB1 *08 encontrado no está descripto en este síndrome ni en ningún otro desorden autoinmune. En pacientes con Diabetes tipo 1 que disminuyan el requerimiento insulínico, habría que descartar insuficiencia suprarrenal, un componente del APS II, como factor etiológico, a pesar de su baja prevalencia.

Autoimmune polyendocrine syndromes (APS) are the association of autoimmune endocrine diseases with other non-endocrine autoimmune disorders. Type II APS is defined by occurrence of Addison´s disease with thyroid autoimmune disease and/or type 1 diabetes mellitus. We present a 46-year-old male patient who was hospitalized because of asthenia, adynamia, hyporexia, severe loss of weight, dizziness and vomiting. Diabetes mellitus had been diagnosed 3 years earlier when he was obese. He presented arterial hypotension, anemia, darkening of the skin and oral mucosa, hyponatremia and frequent hypoglycemia although his insulin dose was decreased. Adrenal insufficiency was diagnosed together with hypothyroidism and type 1 diabetes, all of them of autoimmune origin. Hormonal replacement treatment was initiated. Genetic studies were performed and a new polymorphism was found. Conclusions: HLA DRB1 *08 found in our patient has not been described in APS II or in any other autoimmune disorders. He also has HLA DQB1*0302 described in previous reports related to APS II. In type 1 diabetic patients whose insulin requirement decreases, it would be advisable to rule out adrenal insufficiency, a component of APS II, as an etiologic factor in spite of its low prevalence. In diabetic obese patients (mainly young) who lose weight without a defined cause, type 1 diabetes mellitus should be excluded.

Acromegalia: comparación de los niveles séricos de IGF-I por dos inmunoensayos y su correlación con la prueba de tolerancia oral a la glucosa / Acromegaly: Comparison of serum IGF-1 levels measured by two immunoassays and their correlation with the Oral Glucose Tolerance Test

Introducción: La determinación de IGF-I en suero o plasma es una herramienta esencial en el diagnóstico y seguimiento de la acromegalia. Sin embargo, se deben tener presentes algunos inconvenientes en su medición por diferentes inmunoensayos. Objetivos: Evaluar dos inmunoensayos para la determinación de IGF-I y su correlación con el nadir de GH en el TTOG en pacientes acromegalicos. Materiales y métodos: Se analizaron 37 pacientes acromegálicos, 20 mujeres y 17 hombres. IGF-I fue determinada por Immulite 1000, (IMM) y por IRMA (DSL). Se realizó el TTOG y se determinó glucosa y GH en todos los tiempos (basal, 30, 60, 90 y 120min). Se consideró respuesta normal un nadir de GH <1ng/ml. Nueve pacientes se encontraban bajo tratamiento y 28 sin tratamiento. Análisis estadístico: se utilizaron el test de Wilcoxon, de Bland y Altman y curvas ROC. Se consideró significativa una p<0,05. Resultados: Las concentraciones basales de glucosa fueron 97,86±10,91 mg/dl, de GH 2,8 (1,59-14,4) ng/ml, de IGF-I por IMM 602±318 ng/ml y por DSL 1006±596 ng/ml. IGF-I por IMM y DSL mostró una diferencia significativa con p <0,01 y un bias de - 403,2 ng/ml con valores menores por IMM. IGF-I elevada por IMM y DSL, se encontró en el 84% y en el 97% respectivamente. IGF-I elevada con nadir de GH >1ng/ml se encontró en el 70%, con nadir de GH normal en el 13,5%. IGF-I normal con nadir >1ng/ml en el 2,7% y con nadir de GH normal en el 13,5%. El área bajo las curvas ROC no mostró diferencias significativas. Conclusiones: Los niveles de IGF-I determinados por IMM y DSL fueron significativamente diferentes mostrando un bias negativo para IMM. La mayoría de los valores del nadir de GH fueron consistentes con los niveles de IGF-I observándose una discrepancia en el 30% de los pacientes, estuvieran o no bajo tratamiento.

Introduction: IGF-I determination in serum or plasma is an essential tool in the diagnosis and follow-up of acromegaly. Hepatic production of IGF-I is regulated by GH and circulates bound to several IGF-I binding proteins which extends its half life. IGF-I is not released in a pulsatile pattern and has no significant variability in 24 h. Objective: To evaluate two different methodologies in IGF-I levels determination and their correlation with GH nadir in OGTT in acromegalic patients. Material and methods: We analyzed 37 acromegalic patients, 20 women and 17 men, mean age was 45±12 years. IGF-I levels were assayed by Immulite 1000, DPC (IMM) and DSL-5600 ACTIVE® IGF-I Coated-Tube IRMA (DSL) and OGTTs (at baseline and at 30, 60, 90 and 120 minutes) were performed by measuring plasma glucose and GH assay by immunochemiluminometric assay (Access); we considered a nadir <1ng/ml as normal response. Nine patients were under medical treatment (cabergoline: 4, octeotride: 4, and cabergoline plus octeotrite: 1) and 28 without treatment. Statistical analysis: Wilcoxon and, Bland and Altman tests and ROC curves. Differences were considered significant at p< 0.05. Results: Basal glucose levels were 97.86±10.91 mg/dl and mean GH was 2.8 (1.59-14.4) ng/ml. Mean IGF-I levels performed by IMM were 602±318 ng/ml and 1006±596 ng/ml by DSL. There was a statistically significant difference between both methodologies (p<0.01). Bland and Altman test showed a bias of - 403.2 ng/ml with lower values by IMM. We observed elevated IGF-I levels in 84% by IMM and in 97% by DSL, and only one patient had normal levels with both methodologies. Elevated IGF-I levels and GH nadir >1ng/ml were observed in 70% of the patients, increased IGF-I with normal GH nadir in 13.5%, normal IGF-I with GH nadir >1ng/ml in 2.7% and normal IGF-I with normal GH nadir in 13.5%. Patients under treatment: 3 showed normal GH nadir with elevated IGF-I levels, in 2 of them by both methodologies, and in the other one it was normal by IMM and elevated by DSL; the other 6 showed GH nadir > 1ng/ml, 5 of them presented elevated IGF-I by both methodologies and the other one showed discrepancy in IGF-I levels. The under ROC curve area and confidence interval (CI) of 95% for IGF-I IMM and DSL were 0.96 (0.90-1.00) and 0.91 (0.82-1.00) respectively. Differences between the ROC curves areas were not significant Conclusions: IGF-I levels determined by IMM and DSL were statistically significantly different. IGF-I levels showed a negative bias by IMM. Most of the results of GH nadir were consistent with IGF-I levels but we observed discrepancy in 30% of the patients, regardless of whether they were under treatment or not.

Estudio retrospectivo sobre las posibles complicaciones maternofetales de la exposición a cabergolina / Retrospective Study of any potencial Adverse Effects of Cabergoline on Pregnancy and Embryofetal Development

Objetivos: Estimar la frecuencia de complicaciones maternofetales en mujeres que se embarazaron durante el tratamiento con cabergolina (CAB). Estimar la frecuencia de patología detectada posnacimiento en los niños producto de dichos embarazos. Material y métodos: Estudio retrospectivo y multicéntrico de 86 embarazos en 78 mujeres con hiperprolactinemia idiopática (7) o tumoral (44 micro y 27 macro), en tratamiento con CAB en el momento de la concepción. Edad: 20 a 45 años; PRL inicial: 30 a 1429 ng/ml; duración del tratamiento previo al embarazo 1 a 120 meses; dosis: 0.125 a 4 mg/semana. El rango de exposición embriofetal a la CAB fue de 3 a 27 semanas, el 96.39% de las pacientes la recibió durante el primer trimestre y el 3.61% hasta el segundo. Resultados: No hubo complicaciones mayores durante el embarazo. Se registraron 7 abortos espontáneos (8.1%) y 75 partos, de los cuales 49 fueron vaginales y 26 cesáreas. Se registraron 69 recién nacidos, 63 fueron a término y 6 pretérmino (8.8%), ninguno bajo peso para la edad gestacional. En 3 (5.2%) recién nacidos se observó: 1 malformación mayor (Síndrome de Down) y 2 menores (hernia umbilical e inguinal). Se obtuvo seguimiento de 42 recién nacidos; se diagnosticó epilepsia refractaria en uno y un trastorno generalizado del desarrollo en otro. No se halló una mayor frecuencia de complicaciones en los embarazos ni en los recién nacidos expuestos a CAB que en la población normal. Sería necesario mayor número de pacientes para concluir sobre la seguridad de CAB durante el embarazo.

Objectives: To assess the rate of any potential adverse effects on pregnancy and embryo-fetal development in women who became pregnant under treatment with cabergoline (CAB). To follow up medical data of children who were born from mothers exposed to Cab in early weeks of gestation. Material and methods: Observational, retrospective and multicenter study on 86 pregnancies in 78 women with idiopathic or tumoral hyperprolactinemia. All patients were under Cab at conception. The average age was 29 (range: 20-45). Pituitary images at diagnosis showed 44 microadenomas, 27 macroadenomas and 7 were normal. Serum PRL at baseline was between 30 and 1429 ng/ml. Duration of therapy before pregnancy ranged from 1 to 120 months. Maternal and fetal exposure to cabergoline and doses ranged from 0.125 to 4 mg/week. The mean serum PRL level under which patients achieved pregnancy was 17 ng/ml. Fetal exposure ranged from 3 to 27 weeks; 96.39% of patients received CAB during the first trimester of pregnancy and 3.61% until the second one. Results: No significant complications during pregnancy were found. Seven women (8.1%) had spontaneous abortions. Term deliveries were recorded in 63/69, preterm in six (8.8%), none of them with low weight for gestational age. Neonatal abnormalities were observed in 3 (5.2%): 1 major (Down syndrome) and 2 minor malformations (umbilical and inguinal hernia). Two out of 42, developed abnormalities during the follow- up, one of them was a refractory epilepsy during the second month of life, the other presented a Pervasive Developmental Disorder diagnosed in the third year of life. Conclusion: No significantly higher frequency of complications was found in pregnancies and/or offspring exposed to CAB than in normal population. Larger series of patients are needed to asses the safety.