Sintomatología depresiva y trastornos neurocognitivos en pacientes con VIH adherentes y no adherentes a TARAA: estudio transversal analítico / Depressive symptomatology and neurocognitive disorders in haart-adherent and non-adherent hiv patients: a cross-sectional analytical study

Introducción: Las personas portadoras del virus de inmunodeficiencia humana (VIH) presentan mayor comorbilidad de trastornos neurocognitivos y del ánimo que la población general. La introducción de los antirretrovirales ha disminuido significativamente la demencia asociada a VIH, relacionado a la adherencia a la terapia antirretroviral altamente activa (TARAA). Diversos estudios han demostrado la coexistencia de otros factores para explicar dicho trastorno cognitivo, tales como enfermedad neurológica previa, enfermedad psiquiátrica, consumo de drogas, nivel educativo, reserva cognitiva, entre otras. Objetivo: Determinar el grado de sintomatología depresiva, deterioro cognitivo y su relación con la adherencia a TARAA y otros factores de curso clínico en pacientes portadores de VIH en control ambulatorio. Métodos: Estudio transversal. Se incluyeron pacientes que viven con VIH adscritos al programa de infectología del Hospital Dr. Gustavo Fricke, Viña del mar, Chile. Se utilizaron datos sociodemográficos, clínicos y se aplicaron las escalas Depression in the Medicaly III Questionary, Montreal Cognitive Assesment y Morysky Green Levin Test. Resultados: Se incluyeron 29 participantes, en su mayoría hombres (86,2%) y con escolaridad técnica o profesional (86.2%). No hubo diferencias entre variables biodemográficas, depresivas ni subdimensiones cognitivos. Entre pacientes adherentes y no adherentes se encontró diferencias significativas respecto a la presencia de algún deterioro cognitivo. Conclusiones: Los resultados deben ser interpretados con cautela, dado su alcance limitado. Futuros estudios traslacionales debieran incorporar mediciones más certeras del nivel de adherencia al TARAA.

Introduction: Human immunodeficiency virus (HIV) carriers present more neurocognitive and mood disorders than the general population. The introduction of antiretrovirals has significantly lowered the incidence of HIV associated dementia, and this is related to adherence to highly active antiretroviral therapy (HAART). Several studies have shown the coexistence of other factors that could explain the cognitive disorder, such as a pre-existing neurological disease, psychiatric disease, drug consumption, level of education, cognitive reserve, and others. Objective: To determine the degree of depressive symptomatology and cognitive impairment and their relation to adherence to HAART and other factors of the clinical course of HIV carriers in outpatient supervision. Methods: Cross-sectional study. We included HIV patients in the infectious diseases program, Dr Gustavo Fricke Hospital, Viña del Mar, Chile. We used sociodemographic and clinical data and we applied the Depression in the Medically Ill questionnaire, Montreal Cognitive Assessment, and the Morysky Green Levin Test. Results: 29 patients participated, mainly men (86.2%) with technical or professional education (86.2%). There were no significant differences in sociodemographic, depressive, or cognitive subdomain variables. There were significant differences in cognitive impairment between adherents and non-adherents. Conclusions: Care should be taken with interpreting the results, given their limited scope. Future cross-sectional studies should incorporate more accurate measurements of HAART adherence.

Portación de Staphylococcus aureus enterotoxigénico tipo A, en frotis nasofaríngeos en manipuladores de alimentos / Carriage of Staphylococcus aureus among food service workers

Background Staphylococcus aureus produces 11 serotypes of endotoxins that may cause food poisoning. Aim To determine the prevalence of type A enterotoxigenic Staphylococcus aureus carriage among food service workers in Chillan, Chile. Material and Methods Pharyngeal swabs were obtained from 100 food service workers and were cultured in Agar plates. After identifying the presence of Staphylococcus aureus, DNA was extracted to identify type A toxin by conventional PCR. Results Thirty eight percent of samples were colonized with Staphylococcus aureus. Among these, 26% were toxin A producers. Conclusions Half of the sampled workers carried Staphylococcus aureus and a quarter of these produced type A enterotoxin.

Melatonina inhibe la respuesta de cortisol a ACTH: posible mediación a través del gen reloj Per1 / Melatonin inhibition of the cortisol response to ACTH may be exerted through period circadian protein homolog 1 (Per1)

Background: Circadian cortisol production results from the interaction of the circadian production of ACTH, the autonomic nervous system and intrinsic factors within the gland. An additional regulator is the neuro-hormone melatonin. In human adrenal gland cultures, melatonin inhibited ACTH stimulated cortisol production and Per1 mRNA expression. ACTH actions on the adrenal involve early and late responses. Aim: To investigate the effects of melatonin on the time course of ACTH stimulated cortisol production and of Per1 expression in the lamb adrenal gland. Material and Methods: Adrenal glands and plasma of five newborn lambs were obtained. Adrenal glands were cut in 15 mg explants. Three of these explants were stored for RNA extraction. The rest of explants were using in different culture protocols with ACTH and melatonin. Results: Lambs had an in vivo a circadian variation in plasma cortisol and in adrenal Per1 expression. In vitro, ACTH stimulated an early and late increase in cortisol production and an early increase in Per1 expression reaching a maximum at 3 hours of treatment. Melatonin inhibited the early Per1 response to ACTH without affecting the early ACTH stimulated cortisol production. However, melatonin inhibited the late response of cortisol production to ACTH. Conclusions: The inhibitory actions of melatonin on Per1 response to ACTH may contribute to the inhibitory effects of melatonin on adrenal steroidogenic response to ACTH.

Menores niveles tisulares de la enzima convertidora de angiotensina I homologa (ECA-2) y angiotensina-(1-9) están asociados a mayor remodelamiento de la pared aórtica de ratas hipertensas / Lower tissue levels of homologous angiotensin I converting enzyme (ACE-2) and angiotensin 1-9 are associated to increased remodeling of the aortic wall of hypertensive rats

Antecedentes: Recientemente hemos propuesto en un modelo experimental de infarto al miocardio una significativa interregulación entre los niveles de la enzima convertidora de angiotensina I (ECA) y su homóloga (ECA-2), junto con que angiotensina (Ang)-(1-9) más que Ang-(1-7) actuaría como uncontrarregulador de Ang II. Sin embargo tal relación no se ha investigado en el remodelado aórtico hipertensivo. Objetivo: Determinar la expresión de ECA y ECA-2, los niveles de Angs I, II, (1-7) y (1-9) y los parámetros de remodelado de la pared aórtica de ratas hipertensas. Métodos: Ratas normotensas Lewis (n=18) fueron randomizadas a hipertensión (HTA) por sobrecarga de presión (modelo Goldblatt, GB, 2 riñones-1 pinzado, n=9). Ratas pseudo-operadas se usaron como controles (S, n=9). A las 6 semanas post cirugía, se determinó la masa cardíaca relativa (MCR) y la presión arterial sistólica (PAS). En la aorta torácica se determinó el grosor de la túnica media (GTM), área de la TM (ATM), niveles de mRNA de ECA y ECA-2, factor de crecimiento transformante tipo beta (TGF-beta), inhibidor del activador de plasminógeno (PAI-1) y de la proteína quimioatractante de monocitos (MCP-1) por RT-PCR. La actividad y niveles proteicos de ECA y ECA-2 por fluorimetría y Western blot y los niveles de Angs I, II, (1-7) y (1-9) por HPLC y radioinmunoensayo. Resultados: La MCR y la PAS aumentaron significativamente (p<0,05) en el grupo GB respecto a su control S. Las ratas hipertensas mostraron un aumento significativo (p<0.05) del GTM (18 por ciento), ATM (31 por ciento), niveles de mRNA de ECA (164 por ciento), TGF-beta (105 por ciento), PAI-1(51 por ciento), MCP-1 (53 por ciento) junto con mayor actividad (89 por ciento), niveles proteicos de ECA (130 por ciento) y Ang II (48 por ciento). Esos efectos se asociaron a una significativa disminución del mRNA, los niveles proteicos y actividad...

Background: In experimental models of myocardial infarction we have recently proposed a significantinter-regulation between levels of Angiotensin I converting enzyme (ACE) and its homologous, ACE-2; in addition, we have proposed that Angiotensin 1-9 (Ang-(1-9)) rather than Ang-(1-7) counter regulates Ang II. These relations have not been investigated in hypertensive aortic wall remodeling. Aim: To measure de expression of ACE and ACE-2, the aortic wall levels of Ang I, Ang II, Ang-(1-7) and Ang-(1-9), along with parameters of aortic wall remodeling in hypertensive rats. Methods: 18 Lewis rats were randomized to Goldblatt (2 kidneys, 1 clamped) induced hypertension (n=9) or sham operation (controls, n=9). Six weeks after surgery, relative cardiac mass (RCM), systolic blood pressure (SBP), medial layer aortic wall thickness (MLT) and ML area (MLA) were measured. The aortic wall levels of ACE and ACE-2, tissue growth factor beta (TGF- beta), plasminogen activator inhibitor (PAI-1) and monocyte chemoattractant protein (MCP-1) were determined by RT-PCR. Activity and protein levels of ACE and ACE-2 were measured by fluorometry and Western Blot and ANG I, Ang II, Ang-(1-7) and Ang-(1-9) levels were determined using HPLC and radioimmunoassay. Results: RCM and SBP increased significantly in hypertensive as opossed to sham operated rats...

Menor expresión de la enzima convertidora de angiotensinaI omóloga (ECA2) se asocia a mayor remodelamiento de la pared aórtica de ratas con niveles geneticamente elevados de angiotensina II / Decreased expression of homologous angiotensin I converting enzyme (ACE2) is associated to increased remodeling of the aortic arterial wall in rats with genetically elevated levels of angiotensin II

Introducción: El polimorfismo de la enzima convertidora de angiotensina I (ECA) determina mayor actividadde ECA y niveles de angiotensina (Ang) II en ratas Brown Norway (BN) y menor actividad de ECA y niveles de Ang II en ratas Lewis (L). La interregulación entre ECA, ECA2 y su relación con remodelamiento aórtico hipertensivo no ha sido explorada Objetivo: Determinar la expresión de ECA y ECA2 y los parámetros de remodelamiento vascular hipertensivo en la aorta de ratas con niveles genéticamente determinados de ECA. Métodos: A ratas macho homocigotas de 150 grs BN y LL, se les indujo HTA por 6 semanas por el procedimiento Goldblatt (GB, 2 K-1clip). Ratas pseudo-operadas se usaron como controles (sham). Se determinó la presión arterial sistólica (PAS), el grosor de la túnica media (GTM), área de la TM (ATM), expresión génica deECA, ECA2 ,TGF-beta, PAI-1 y MCP-1 por RT-PCR y también proteica de ECA y ECA2 por Western Blot. Resultados: La masa cardiaca relativa y la PAS aumentaron significativamente en los grupos GB respecto a sus controles Sham, sin diferencias por efecto del polimorfismo de la ECA. En condiciones de normotensión las ratas BN mostraron que la pared aórtica expresa mayores niveles génicos y proteicos de la ECA(60% y 134%, respectivamente) y menores de ECA2 (74% y 73%, respectivamente) respecto de las ratas L(p<0.05). Estos resultados se asociaron con mayores GTM y ATM como en los niveles de mRNA de TGF-beta y, PAI-1 en las aortas de ratas BN respecto de las ratas L (p<0,05). En respuesta a un estrés hipertensivo las ratas con mayores niveles de ECA y menores niveles de ECA2 mostraron mayor GTM (p<0,05, respecto de GB-L), sin diferencias en los otros parámetros evaluados...

Background: Angiotensin I converting enzyme (ACE) polymorphism determines increased ACE and Ang IIlevels in Brown Norway rats (BN) and decreased ACE and Ang II levels in Lewis (L) rats. The interactionbetween ACE and ACE2 in relation to aortic remodeling associated to hypertension has not been explored. Aim: to determine the expression of ACE and ACE2 along with parameters of remodeling in hypertensive rats with genetically determined levels of ACE. Methods: BN and L rats weighing 150 g were made hypertensive by the Goldblatt procedure (GB, 2K-1 clip). Sham operated rats were used as controls. Systolic blood pressure (SBP), media thickness (MT), and MT area were measured. RT-PCR was used to determine the genetic expression of ACE, ACE2, TGF-beta, PAI-1 and MCP-1. Western Blot was used to measure the protein fraction of ACE and ACE2 Results: Relative cardiac mass and SBP increases significantly in GB rats compared to controls; ACE polymorphism did not influence this effect. The aortic wall of normotensive BN rats expressed increased genic and protein levels of ACE (60% and 134%, respectively) and decreased levels of ACE2 (74% and 73%, respectively) compared to L rats (p<0.05). These findings were associated to increased MT and MT area as well as increased mRNA for TGF-beta and PAI 1 in BN rats compared to L rats (p<0.05). In response to hypertensive stress, rats with increased ACE and decreased ACE2 levels developed increased MT compared to GB-L rats; other parameters of remodeling were not affected...

La melatonina reduce la respuesta de cortisol al ACTH en humanos / Melatonin reduces cortisol response to ACTH in humans

Background: Melatonin receptors are widely distributed in human tissues but they have not been reported in human adrenal gland. Aim: To assess if the human adrenal gland expresses melatonin receptors and if melatonin affeets cortisol response to ACTH in dexamethasone suppressed volunteers. Material and methods: Adrenal glands were obtained from 4 patients undergoing unilateral nephrectomy-adrenalectomy for renal cáncer. Expression of mRNA MT1 and MT2 melatonin receptors was measured by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). The effect of melatonin on the response to intravenous (i.v.) ACTH was tested (randomized cross-over, double-blind, placebo-controlled tríal) in eight young healthy males pretreated with dexamethasone (1 mg) at 23:00 h. On the next day at 08:00 h, an i.v. Une was inserted, at 08:30 h, and after a blood sample, subjeets ingested 6 mg melatonin or placebo. At 09:00 h, 1-24 ACTH (Cortrosyn, 1µg/1.73 m² body surface área) was injected, drawing samples at 0, 15, 30, 45 and 60 minutes after. Melatonin, cortisol, cortisone, progesterone, aldosterone, DHEA-S, testosterone and prolactin were measured by immunoassay. Results: The four adrenal glands expressed only MT1 receptor mRNA. Melatonin ingestión reduced the cortisol response to ACTH from 14.6+1.45µg/dl at 60 min in the placebo group to 10.8+1.2µg/dl in the melatonin group (p <0.01 mixed model test). It did not affect other steroid hormone levels and abolished the morningphysiological decline of prolactin. Conclusions: The expression ofMTl melatonin receptor in the human adrenal, and the melatonin reduction of ACTH-stimulated cortisol production suggest a direct melatonin action on the adrenal gland .

Miocardiopatía espongiforme en una mujer anciana. Descripción ecocardiográfica / Spongy cardiomyopathy in an elderly woman, echocardiographic description

La miocardiopatía espongiforme, también conocida como ausencia aislada de compactación del ventrículo izquierdo, es una anomalía congénita recientemente descrita y que resulta de la interrupción en la morfogénesis embrionaria del miocardio ventricular izquierdo el cual permanece engrosado por grandes trabéculas y sinusoides y que suele expresarse clínicamente con manifestaciones de insuficiencia cardíaca, arritmias y eventos embólicos. Esta enfermedad suele detectarse en la infancia o en la adolescencia, menos frecuentemente en la vida adulta y muy excepcionalmente en la senectud. Presentamos aquí el caso de una mujer de 75 años de edad que corresponde a uno de los casos de miocardiopatía espongiforme de mayor edad entre los que se han publicado; sus manifestaciones clínicas y ecocardiográficas son típicas de esta variedad de miocaridopatía. El caso se comenta a la luz de los hechos más relevantes que existen en la escasa literatura publicada sobre esta interesante enfermedad.

Isolated left ventricular noncompaction, also known as spongy myocardium or spongy cardiomyopathy, is a recently described congenital disease caused by an arrest in the left ventricular myocardial embriogenesis that makes the ventricular wall to persist thickened with multiple trabecular formations and deep sinusoidal recesses. It is clinically characterized by heart failure, cardiac arrhythmia and systemic embolic events. Most of the affected subjects are detected during childhood or adolescence, others in the adult life but very few elderly patients have been reported in the worldwide medical literature. We here report the case of a 75-year-old woman that is one of the oldest patients ever reported, whose clinical picture and echocardiographic findings are typical of this modality of cardiomyopathy. We do comments on this case in regard to the most relevant facts that appear in the limited medical literature about this interesting disease. (Arch Cardiol Mex 2005; 75: 184-187.

Prevalencia de glaucoma simple hipertension ocular y factores asociados en mayores de 40 años en la ciudad del cusco / Prevalence of simple glaucoma ocular hipertension and associated factors in elder people then 40 years in the Cusco city

El glaucoma constituye un problema de salud pública muy importante, ya que es la segunda causa de ceguera en el mundo después de la catarata. El presente estudio tiene como objetivo determinar las características clinico-epidemiológicas de glaucoma en mayores de 40 años de la ciudad del Cusco. La muestra estuvo constituida por 450 personas de ambos sexos mayores de 40 años de edad seleccionados al azar. El promedio de edad fue 55.68(DE igual 11.94). El promedio de presión intraocular (PIO) de toda la población estudiada fue 16.22 mmHg(DE igual 3.07), con un rango de 10-41 mmHg y una moda de 17mmHg. No hallamos diferencia estadística significativa (p mayor 0.05) entre los promedios de ambos ojos ni con respecto al sexo en la población total. El promedio de PIO incrementa con la edad para ambos sexos y lado de ojo. No encontramos diferencia estadística entre los promedios de PIO respecto al sexo y lado de ojo en las personas normales. La PIO promedio en los hipertensos oculares fue 22.75 (DE igual 2.33), no hubo diferencia estadística significativa entre los promedios de ambos ojos. La PIO promedio en glaucomatosos fue 25.97 (DE igual 8.26) y un 25 por ciento presentaba PIO en valores normales, con una diferencia significativa mayor para el ojo derecho. La relación copa/disco promedio del total fue 0.28 (DE igual 0.1), no hubo diferencia entre los promedios para ambos ojos, pero sí entre los grupos de normales, hipertensos oculares y glaucomatosos. La prevalencia de glaucoma crónico simple fue 1.78 por ciento y para hipertensión ocular 2.22 por ciento. Hallamos una asociación del glaucoma con PIO elevada, edad avanzada, nivel socioeconómico bajo y antecedente familiar de glaucoma en primer grado (p menor 0.05), pero no con el tabaquismo, sexo, antecedentes de hipertensión ocular, diabetes y miopía.

Capacidad de predecir una recaída de lupus eritematoso generalizado, mediante anticuerpos anti-DNA de hebra doble, por la técnica de Farr / Predictive capacity of double stranded anti DNA antibodies for relapses in patients with inactive systemic lupus erythematosus using Farr technique

Background: Patients with inactive systemic lupus erythematosus (SLE) and elevated high affinity double-stranded anti-DNA antibodies (anti-dsDNA), measured using Farr technique, would have a risk of relapse that fluctuates between 40 to 80 percent according to different series. Aim: To study the association between anti-dsDNA levels measured using Farr technique and disease activity and their predictive capacity for relapses. Material and methods: Anti-dsDNA antibodies were measured according to Farr method in 60 healthy subjects, 69 patients with other connective tissue diseases and in 120 patients with SLE. Farr positive were considered those individuals with anti-dsDNA levels over 10.4 IU/ml. Disease activity, assessed using MEX-SLEDAI score was related with anti-dsDNA levels in 101 patients. Forty seven patients with inactive disease were followed for 17ñ14 months. Results: Anti-dsDNA levels were 3ñ2.5 IU/ml (range 1-26) in subjects without LED, and 127ñ500 IU/ml (range 1-5280) in patients with LED. Sixty subjects had an active SLE and 43 (72 percent) were Farr positive; in 41 the disease was inactive and 13 (32 percent) were Farr positive (p <0.001), OR 5.45. Twelve of the 47 followed patients had a relapse and 10 (83 percent) were Farr positive. Of those that did not have a relapse, 13 (37 percent) were Farr positive (p< 0.02, RR 5.22). Six of 15 patients that were followed for more than on year (40 percent), were Farr positive. Conclusions: Elevated anti-dsDNA antibodies measured using Farr technique in patients with inactive generalised lupus erythematosus, predicted the risk of relapse. However less than half of patients with inactive disease and elevated Farr relapsed in a period of one year. The need to treat patients with inactive SLE and positive Farr should therefore be considered debatable