HPLC-DAD analysis, antifungal and antioxidant activity of Solanum dolichosepalum bitter extracts and fractions

Abstract Solanum dolichosepalum is a plant with anti-infective effects. It is a healing agent and has ethnopharmacological uses. In this study, the antifungal activity of extracts and fractions of this species on C. albicans and F. oxysporum was evaluated. The antioxidant activity was measured using the ABTS and DPPH methods, and by determining the total content of phenolic compounds. An HPLC-DAD qualitative analysis was carried out to identify phenolic compounds and alkaloids. Pearson's correlation coefficients were calculated. Inhibitory effects were found in all the extracts and fractions on the analyzed microorganisms. F. oxysporum was the microorganism most sensitive to the action of S. dolichosepalum extracts. All extracts and fractions showed antioxidant activity, with the acetone extract and the acetone fraction being those that generated the best results. The content of total phenolic compounds showed that acetone has a greater affinity with the phenolic compounds present in S. dolichosepalum. In this plant, p-Hydroxybenzoic, vanillic, ferulic, trans-cinnamic, caffeic, p-coumaric, and rosmarinic acids were found, as well as theobromine, quercetin, and luteolin. The content of total phenolic compounds was determined to be directly proportional to the inhibition of the ABTS and DPPH radicals, and the inhibition of the analyzed microorganisms. It was determined that the extracts and fractions obtained from S. dolichosepalum show antioxidant and antifungal activity.

Complicaciones alejadas postrasplante cardíaco / Late complications after heart transplantation

Resumen El trasplante cardíaco es en la actualidad un procedimiento de elección para los pacientes con insuficiencia cardíaca avanzada. A pesar de los avances logrados hasta la fecha, las complicacio nes con requerimiento de internación siguen siendo elevadas. El objetivo principal de este trabajo fue describir las complicaciones post trasplante cardíaco que requirieron internación durante el seguimiento, y el objetivo secundario evaluar su incidencia según el grupo etario en una cohorte de receptores de trasplante cardíaco en la Argentina. Se realizó un estudio de cohorte retrospectivo. Se incluyeron de forma consecutiva 198 pacientes receptores de trasplante cardíaco realizados en el período enero 2010 a mayo 2019. Durante el seguimiento se reinternaron al menos una vez 105 pacientes (53%) y la causa de reinternación cardiovascular más frecuente fue el rechazo del injerto (31%), mientras que las infecciones lo fueron dentro de las de causas no cardiovasculares (21%). La densidad de incidencia de mortalidad fue de 8 (IC95% 5.4-11.7) cada 100-pacientes/año para el grupo que tuvo reinternación y de 1 cada 100-pacientes/año (IC 95% 0.4-2.8) para el grupo que no la tuvo. Concluimos que las complicaciones con requerimiento de internación son frecuentes en los trasplantados en nuestro medio y condicionan la supervivencia a largo plazo. Las principales causas de reinternación son el rechazo del injerto y las infecciones, con una incidencia similar en los grupos etarios analizados.

Abstract Heart transplantation is currently a procedure of choice for patients with advanced heart failure. Despite a continuous improvement in morbidity and mortality made to date, complications requiring hospitalization continue to be high. The main objective of this study was to describe complications that required hospitalization after a heart transplant, and the secondary objective is to evaluate its incidence according to age group in a cohort of heart transplant recipients in Argen tina. A retrospective cohort study was carried out. One hundred and ninety-eight heart transplant recipients were consecutively included in the period between January 2010 and May 2019. During follow-up, 105 patients (53%) had at least one readmission, and the most frequent cause of cardiovascular readmission was graft rejection (31%), while infections were the most frequent non-cardiovascular causes (21%). Mortality density incidence was 8 (95% CI 5.4-11.7) per 100-patients/year for the group that had readmission and 1 per 100-patients/year (95% CI 0.4-2.8) for the group that did not have. We conclude that complications requiring hospitalization are frequent in transplanted patients and affect long-term survival. The main causes of readmission are graft rejection and infections, and they had similar incidence in the age groups we analyzed.

Índice PROFUND y mortalidad intrahospitalaria en pacientes pluripatológicos. Análisis post-hoc / PROFUND index and intrahospital mortality in plurypathological patients. A post-hoc analysis

Resumen El índice PROFUND se desarrolló y validó para predecir mortalidad a 12 meses en pacientes pluripatológicos. Sin embargo, su valor potencial para predecir mortalidad intrahospitalaria no ha sido suficientemente estudiado. Se evaluó la capacidad del índice PROFUND en comparación con la proteína C re activa (PCR), la albúmina, y el ancho de distribución eritrocitaria (ADE) para predecir mortalidad intrahospitalaria, mediante el análisis posterior de una cohorte prospectiva de 111 pacientes pluripatológicos internados en clínica médica. La edad promedio fue 75.8 ± 9.3 años. La mortalidad intrahospitalaria fue de 17% (19 pacientes). La mediana (RIQ) del índice PROFUND, albúmina, PCR y ADE en los fallecidos y sobrevivientes fue 12 (4) y 6 (7) p< 0.0001, 2.5 (0.4) y 2.6 (0.8) p 0.295, 58 (64) y 40 (60) p 0.176, 14.5 (2) y 14.6 (3) p 0.523, respectivamente. El análisis logístico multivariado mostró que el índice PROFUND se asocia con mortalidad intrahospitalaria (p 0.0003). El riesgo de fallecer durante la internación es 20% mayor por cada punto que se incrementa el índice PROFUND (OR 1.2, IC95% 1.1-1.4). El área bajo la curva de las características operativas del receptor (AUC-ROC) del índice PROFUND para predecir mortalidad durante la internación (0.760, IC95% 0.628-0.891) fue mayor a la del ADE, PCR y albúmina (0.494 IC95% 0.364-0.624 p 0.012; 0.583 IC95% 0.437-0.728 p 0.028; 0.621 0.494-0.748 p 0.109, respectivamente). El índice PROFUND se asocia a mortalidad intrahospitalaria, con una mayor capacidad predictiva que los biomarcadores estudiados, lo cual se sumaría a su valor pronóstico a largo plazo en pacientes pluripatológicos.

Abstract The PROFUND index was developed and valid to predict mortality at 12 months in polypathological patients (PP). However, its potential value for predicting in-hospital mortality has not been sufficiently studied. The ability of the PROFUND index in comparison with C-reactive protein (CRP), albumin, and red blood cell distribu tion width (RDW) to predict in-hospital mortality was evaluated through the subsequent analysis of a prospective cohort of 111 multiple pathological patients admitted to the clinic medical. The mean age was 75.8 ± 9.3 years. In-hospital mortality was 17% (19 patients). The median (IQR) of the PROFUND index, albumin, CRP and ADE in the deceased and survivors was 12 (4) and 6 (7) p < 0.0001, 2.5 (0.4) and 2.6 (0.8) p 0.295, 58 (64) and 40 (60) p 0.176, 14.5 (2) and 14.6 (3) p 0.523, respectively. The multivariate logistic analysis showed that the PROFUND index is associated with in-hospital mortality (p 0.0003). The risk of dying during hospitalization is 20% higher for each point that the PROFUND index increases (OR 1.2, 95% CI 1.1-1.4). The area under the curve the receiver operating characteristic (AUC-ROC) of the PROFUND index to predict mortality during hospitalization (0.760, 95% CI 0.628-0.891) was higher than that of the RDW, CRP and albumin (0.494 95% CI 0.364-0.624 p 0.012; 0.583 95% CI 0.437-0.728 p 0.028; 0.621 0.494-0.748 p 0.109, respectively). The PROFUND index is associated with in-hospital mortality, with a greater predictive capacity than the biomarkers studied, which would add to its long-term prognostic value in multiple pathological patients.

Valor del indice urea/creatinina en orina aislada para estimar el hipercatabolismo proteico grave en pacientes ventilados / Value of the urea/creatinine index in isolated urine to estimate severe protein hypercatabolism in ventilated patients

RESUMEN Objetivo: Estudiar la capacidad discriminativa de hipercatabolismo proteico grave del índice urea/creatinina en orina aislada en pacientes críticos ventilados. Metodos: Estudio prospectivo, observacional. Incluyó 52 pacientes sin insuficiencia renal. Variables: nitrógeno urinario total estimado a partir de la urea en orina de 24 horas al segundo (T1) y cuarto día (T2) e índice urea/creatinina en orina aislada previo a la recolección de orina de 24 horas. Resultados: Presentaron hipercatabolismo proteico grave (nitrógeno urinario total estimado > 15g) 14 pacientes (26,9%) en T1 y 29 (55,7%) en T2. El 84% de los pacientes presentaron bajo riesgo nutricional por la escala Nutrition Risk in the Critically Ill. En el segundo día, la correlación de Pearson del nitrógeno urinario total estimado con el índice urea/creatinina fue: 0,272 (p = 0,051) y en el cuarto día: 0,276 (p = 0,048). El índice urea/creatinina al cuarto día, tuvo una tendencia a mayor discriminación del hipercatabolismo proteico grave que el Acute Physiology and Chronic Health Evaluation II y Nutrition Risk in the Critically Ill (AUC 0,741 versus 0,669 y 0,656, IC95%: 0,602 - 0,880; 0,519 - 0,818 y 0,506 - 0,806 respectivamente). El valor de corte optimo del índice urea/creatinina para diagnóstico de hipercatabolismo proteico grave fue de 16,15 con una sensibilidad de 79,31% (IC95%: 59,74 - 91,29), especificidad de 60,87% (IC95%: 38,78 - 79,53), valor predictivo positivo 71,88% (IC95%: 53,02 - 85,60), valor predictivo negativo 70,0% (IC95%: 45,67 - 87,18), LR (+) 2,03 (IC95%: 1,18 - 3,49) y LR (-) 0,34 (IC95%: 0,16 - 0,74). Conclusión: El índice urea/creatinina realizado al cuarto día tiene un discreto valor para estimar el hipercatabolismo proteico grave por nitrógeno urinario total y no reemplaza al mismo en pacientes críticos ventilados sin falla renal. Por su razonable sensibilidad podría ser utilizado como cribado para identificar a quien tomar la muestra de orina de 24 horas.

ABSTRACT Objective: To study the ability of the urea/creatinine index to identify severe protein catabolism from the isolated urine of critically ventilated patients. Methods: This was a prospective, observational study. It included 52 patients without kidney failure. Variables: total urinary nitrogen estimated from the urea in 24-hour urine on the second (T1) and fourth days (T2) and urea/creatinine index in isolated urine before 24-hour urine collection. Results: Severe protein hypercatabolism (estimated total urinary nitrogen > 15g) was present in 14 patients (26.9%) at T1 and in 29 (55.7%) at T2. Eighty-four percent of patients had low nutritional risk by the Nutrition Risk in the Critically Ill score. At T1, the Pearson correlation between the estimated total urinary nitrogen and the urea/creatinine index was 0.272 (p = 0.051), and at T2 it was 0.276 (p = 0.048). The urea/creatinine index at T2 had a tendency to better discriminate severe protein hypercatabolism than Acute Physiology and Chronic Health Evaluation II and Nutrition Risk in the Critically Ill (AUC 0.741 versus 0.669 and 0.656, 95%CI: 0.602 - 0.880; 0.519 - 0.818 and 0.506 - 0.806, respectively). The optimal cutoff value of the urea/creatinine index for the diagnosis of severe protein hypercatabolism was 16.15, with a sensitivity of 79.31% (95%CI: 59.74 - 91.29), specificity of 60.87% (95%CI: 38.78 - 79.53), positive predictive value 71.88% (95%CI: 53.02 - 85.60), negative predictive value 70.0% (95%CI: 45.67 - 87.18), LR (+) 2.03 (95%CI: 1.18 - 3.49), and LR (-) 0.34 (95%CI: 0.16 - 0.74). Conclusion: The urea/creatinine index measured on the fourth day has a certain ability to estimate severe protein hypercatabolism (as defined by estimated total urinary nitrogen) but does not replace total urinary nitrogen in critically ventilated patients without kidney failure. Due to its reasonable sensitivity, it could be used as a screen to identify which patients to take a 24-hour urine sample from.

Índice PROFUND y valoración global subjetiva. Valor pronóstico en pacientes pluripatológicos internados / PROFUND index and global subjective assessment. Prognostic value in hospitalized pluripathological patients

Resumen El índice PROFUND es una de las puntuaciones pronósticas sugeridas en pacientes pluripatológicos (PP). A pesar del valor pronóstico de la desnutrición y su prevalencia en esta población, el mismo no incluye una variable que estime el estado nutricional. La valoración global subjetiva (VGS) es una herramienta ampliamente validada para tal fin. Se evaluó mediante un estudio prospectivo y observacional, la capacidad pronóstica de mortalidad a 12 meses del índice PROFUND y VGS en PP internados en clínica médica. Ingresaron al estudio 111 pacientes. Edad 75.8 (± 9.3) años. Índice PROFUND 7.6 (± 4.7) puntos. El 60.1% presentaba desnutrición moderada-severa por VGS. Fallecieron 66 dentro del año. En el modelo de Cox, la VGS y el índice PROFUND se asocian con mortalidad a los 12 meses (p < 0.0001 y p 0.0026 respectivamente). En los desnutridos severos, el riesgo es aproximadamente 6 veces mayor en comparación a los normonutridos (HR: 6.514, IC95% 2.826-15.016) y para un mismo nivel de VGS, el riesgo es un 10% mayor por cada punto que aumenta el índice PROFUND (HR: 1.106, IC95% 1.036-1.181). El AUC para predecir mortalidad a 12 meses del índice PROFUND y VGS fue: 0.747 (IC95%: 0.656-0.838); 0.733 (IC95%: 0.651-0.816) y al combinar las dos variables: 0.788 (IC95%: 0.703-0.872, p 0.048). Como conclusión el índice PROFUND y la VGS se asocian con mortalidad y tienen un valor pronóstico similar. La combinación de ambas herramientas permitiría establecer mejor el pronóstico y el manejo en esta compleja población

Abstract The PROFUND index is one of the suggested prognostic scores in pluripathological patients (PP). Despite the prognostic value of malnutrition and its prevalence in this population, it does not include a variable that estimates nutritional status. Subjective global assessment (SGA) is a widely validated tool for this purpose. The prognostic capacity of 12-month mortality of PROFUND index and SGA in PP admitted to a medical clinic was evaluated by a prospective and observational study. 111 patients entered the study. Age 75.8 (± 9.3) years. PROFUND index 7.6 (± 4.7) points. 60.1% had moderate-severe malnutrition due to VGS. 66 died within the year. In the Cox model, SGA and PROFUND index are associated with mortality at 12 months (p <0.0001 and p 0.0026 respectively). In severe malnutrition, the risk is approximately 6 times higher compared to normonutrition (HR: 6.514, 95% CI 2.826-15.016) and for the same level of SGA, the risk is 10% higher for each point that the PROFUND index increases (HR: 1.106, 95% CI 1.036-1.181). The AUC for predicting 12-month mortality from PROFUND index and SGA was: 0.747 (95% CI: 0.656-0.838); 0.733 (95% CI: 0.651-0.816) and when combining the two variables: 0.788 (95% CI: 0.703-0.872, p 0.048). In conclusion, PROFUND index and SGA are associated with mortality and have a similar prognostic value. The combination of both tools would allow better prognosis and management in this complex population.

Seguimiento y características clínicas de los pacientes con nódulos tiroideos en nuestra práctica clínica antes de 2015 / Follow-up and clinical characteristics of patients with thyroid nodules in our clinical practice before 2015

INTRODUCCIÓN: Los nódulos tiroideos son una consulta muy prevalente en Endocrinología. Las guías de la Asociación Americana de Tiroides (2015) animaban a realizar estudios a largo plazo. El objetivo de este estudio fue revisar las características, el seguimiento y la evolución de los nódulos de tiroides seguidos en nuestras consultas hasta 2015. MATERIAL Y MÉTODOS: Estudio retrospectivo de pacientes con al menos dos ecografías o cirugía. Los datos clínicos, ecográficos y de punción, así como la evolución y los resultados histológicos de aquellos operados, se analizaron con métodos descriptivos, bivariados y de regresión. RESULTADOS: 1.420 pacientes seguidos en Endocrinología a largo plazo fueron incluidos. 20 se excluyeron por tener una sola ecografía. El 71,2% presentaban normofunción, 9,6% hipertiroidismo subclínico, 9,5% hipotiroidismo subclínico, 5,7% hipotiroidismo clínico y 4% hipertiroidismo clínico. Del total de nódulos seguidos (n= 1400), 64,1%, 15,6% y 20,3% permanecieron estables, aumentaron y disminuyeron respectivamente. Los que crecieron no tuvieron más características sospechosas en las ecografías. De los intervenidos (457 casos (32,6% del total), 207 fueron malignos (45,2%). 57% de ellos fueron diagnosticados e intervenidos durante el primer año, en la primera evaluación. La aparición de nódulos malignos en el resto de pacientes fue de 89 casos (6,3% de todos los nódulos seguidos, 38,3% de ellos, incidentalomas). La ecografía y la citología empleadas antes de la homogenización de los criterios diagnósticos tuvieron una baja sensibilidad y especificidad en nuestro medio. CONCLUSIONES: Más de la mitad de los cánceres de tiroides fueron diagnosticados en la evaluación inicial del nódulo tiroideo. Más de la mitad de los nódulos no operados en el primer año mantienen el mismo tamaño a largo plazo. No encontramos predictores clínicos del aumento de tamaño. El valor diagnóstico de la ecografía y PAAF sin unos criterios estandarizados homogéneos es bajo.

INTRODUCTION: Thyroid nodules are a very prevalent consultation in endocrinology. Guidelines from the American Thyroid Association (2015) encouraged to conduct follow-up studies in the long term. This study object was to review the clinical characteristics, follow-up and evolution of thyroid nodules visited in our consultations till 2015. MATERIAL AND METHODS: Retrospective study of patients that had at least two thyroid ultrasounds or had been operated. Clinical, ultrasound and FNA (fine needle aspiration) data as well as the evolution and histology results of those operated, were analyzed with descriptive, bivariated and regression analyses. RESULTS: 1.420 patients followed in Endocrinology in the long term were included. 20 were excluded for having only one ecography. 71,2% had normal function, 9,6% subclinical hyperthyroidism, 9,5% subclinical hypothyroidism, 5,7% clinical hypothyroidism and 4% clinical hyperthyroidism. Of all the nodules followed (n=1400), 64,1%, 15,6% and 20,3% remained the same size, grew and decreased respectively. Nodules that grew didn´t have more suspicious sonographic characteristics. Of the operated nodules (457 cases (32,6% of all), 207 were cáncer (45,2%). 57% of them were diagnosed and intervened during the first year, in the first evaluation. Malignant nodules were detected in the rest of patients in 89 cases (6,3% of all the followed nodules, 38,3% of them were incidental cases). The ultrasound and citology diagnoses used before the homogenization of diagnoses criteria had a low senitivity and specificity in our clinical environment. CONCLUSIONS: More than half of the thyroid cancers were diagnosed in the initial evaluation of the thyroid nodule. More than half of nodules non operated in the first year remained the same size long term. We could not find clinical predictors of growth. The diagnostic value of the ultrasound and FNA is low without standardized and homogenous criteria.

Aspectos relevantes de los cursos de especialización en ortopedia avalada por la Universidad Nacional Autónoma de México / Relevant aspects of the orthopedic residency program endorsed by the National Autonomous University of Mexico

Resumen: Se presenta el proceso de formación de recursos humanos para la salud en Ortopedia de la Facultad de Medicina. Así como también se muestra la evolución que ha ocurrido en la enseñanza de la Ortopedia, que originó la formación del Programa Único de Especialidades Médicas (PUEM), mostramos aspectos relevantes de su desarrollo, y en la actualidad, se ha agregado supervisión periódica de las sedes promoviendo el cumplimiento de este plan y permitiendo su evolución y mejora continua de la enseñanza de la Ortopedia.

Abstract: The process of training human resources for health in Orthopedics of the School of Medicine is presented. As well as the evolution that has occurred in the teaching of Orthopedics, that led to the formation of the Single Program of Medical Specialties (PUEM in spanish), we show relevant aspects of its development and current periodic supervision of the hospitals promoting the fulfillment of this plan allowing its evolution and continuous improvement of the teaching of Orthopedics.

Automated Office Blood Pressure Measurement

Manual blood pressure (BP) recorded in routine clinical practice is relatively inaccurate and associated with higher readings compared to BP measured in research studies in accordance with standardized measurement guidelines. The increase in routine office BP is the result of several factors, especially the presence of office staff, which tends to make patients nervous and also allows for conversation to occur. With the disappearance of the mercury sphygmomanometer because of environmental concerns, there is greater use of oscillometric BP recorders, both in the office setting and elsewhere. Although oscillometric devices may reduce some aspects of observer BP measurement error in the clinical setting, they are still associated with higher BP readings, known as white coat hypertension (for diagnosis) or white coat effect (with treated hypertension). Now that fully automated sphygmomanometers are available which are capable of recording several readings with the patient resting quietly, there is no longer any need to have office staff present when BP is being recorded. Such readings are called automated office blood pressure (AOBP) and they are both more accurate than conventional manual office BP and not associated with the white coat phenomena. AOBP readings are also similar to the awake ambulatory BP and home BP, both of which are relatively good predictors of cardiovascular risk. The available evidence suggests that AOBP should now replace manual or electronic office BP readings when screening patients for hypertension and also after antihypertensive drug therapy is initiated.

Automated Office Blood Pressure Measurement

Manual blood pressure (BP) recorded in routine clinical practice is relatively inaccurate and associated with higher readings compared to BP measured in research studies in accordance with standardized measurement guidelines. The increase in routine office BP is the result of several factors, especially the presence of office staff, which tends to make patients nervous and also allows for conversation to occur. With the disappearance of the mercury sphygmomanometer because of environmental concerns, there is greater use of oscillometric BP recorders, both in the office setting and elsewhere. Although oscillometric devices may reduce some aspects of observer BP measurement error in the clinical setting, they are still associated with higher BP readings, known as white coat hypertension (for diagnosis) or white coat effect (with treated hypertension). Now that fully automated sphygmomanometers are available which are capable of recording several readings with the patient resting quietly, there is no longer any need to have office staff present when BP is being recorded. Such readings are called automated office blood pressure (AOBP) and they are both more accurate than conventional manual office BP and not associated with the white coat phenomena. AOBP readings are also similar to the awake ambulatory BP and home BP, both of which are relatively good predictors of cardiovascular risk. The available evidence suggests that AOBP should now replace manual or electronic office BP readings when screening patients for hypertension and also after antihypertensive drug therapy is initiated.

Stent-graft relining in a patient with acute aortic aneurysm and a completely migrated endograft

Abstract Stent-graft migration and type I endoleaks are associated with a higher rate of reintervention and increased mortality and morbidity. This article describes a patient presented with an infrarenal aortic stent-graft which had migrated into the aortic sac with loss of all aortic neck attachment. The acutely expanding abdominal aortic aneurysm was treated by placing a second modular endograft within and above the migrated stentgraft. The patient returned 36 months later, with features of an acute myocardial infarction, severe bilateral lower limb ischemia, and renal failure. He was too ill for intervention and demised within 48 hours.

Prevalencia de hipotiroidismo subclínico en pacientes con síndrome coronario agudo / Prevalence of subclinical hypothyroidism in patients with acute coronary syndrome

INTRODUCTION: Subclinical hypothyroidism (SH) is characterized by elevation of thyroid stimulating hormone (TSH) with normal free thyroxine (FT4). SH has been associated with cardiovascular risk factors (CVRF) such as increased blood pressure, lipid level and atherosclerosis; however, its association with coronary heart disease is controversial. OBJECTIVES: The primary objective was to know the prevalence of SH in patients with acute coronary syndrome (ACS) in 3 hospitals of the Viña del Mar-Quillota Health Service. The secondary objective was to know the prevalence of CVRF in patients with SH and euthyroidism. MATERIAL AND METHOD: A cross-sectional study that included patients admitted for ACS. CVRF and thyroid hormone levels were recorded. RESULTS: Of the 81 patients recruited, 11 (13.6 percent) had SH. AHT was present in 68.3 percent of euthyroid and 90.9 percent of SH (p = 0.16). 55 percent of euthyroid and 63.6 percent of SH had dyslipidemia (p = 0.74). Overweight or obesity was found in 76.6 percent of euthyroid and 54.5 percent of SH (p = 0.15). The median CVRF was 3 (IQR 2-4) in euthyroid and 3 (IQR 3-4) in SH (p = 0.78). CONCLUSIONS: The prevalence of SH in patients with ACS was not higher than that reported in the general population and there were no differences in CVRF between SH and euthyroid. We require prospective cohort studies with a larger sample size to establish incidence and risk of adverse cardiovascular outcomes in SH.

Púrpura de Schönlein-Henoch en adulto HIV positivo adicto a cocaína y ANCA-p positivo / Henoch-Schönlein purpura in a cocaine consumer man with HIV infection and ANCA-p positivity

La púrpura de Schönlein-Henoch (PSH) es una vasculitis de pequeños vasos con depósito de inmunocomplejos de IgA. La presentación en adultos es rara y grave. Los casos comunicados de PSH en pacientes infectados por HIV son escasos. Los anticuerpos anticitoplasma de neutrófilos (ANCA), detectados por inmunofluorescencia indirecta (IFI), se encuentran comúnmente en otras vasculitis sistémicas primarias pero rara vez en PSH y es aún más inusual el patrón perinuclear (ANCA-p). Por otra parte, la positividad de los ANCA puede ser detectada en una serie de condiciones patológicas distintas de las vasculitis de pequeños vasos en asociación a procesos infecciosos, incluyendo el HIV, o a consumo de cocaína, y en especial el patrón de ANCA-p vinculado a medicamentos o enfermedades autoinmunes e inflamatorias intestinales. Se presenta el caso de un varón de 35 años con hábitos tóxicos (cocaína, marihuana) que consultó por dolor abdominal, hematoquecia y lesiones purpúricas en extremidades inferiores, que agregó fiebre, artralgias y progresión de lesiones purpúricas asociadas a síndrome nefrítico y ANCA-p (+). Durante la internación se detectó infección por HIV. La biopsia renal evidenció una nefropatía a IgA que tuvo una respuesta favorable al tratamiento corticoideo y antiproteinúrico. La comunicación del caso obedece a la rareza de la presentación y a la complejidad para establecer el diagnóstico y la terapéutica. Aún resta dilucidar el rol de los ANCA en la etiopatogenia y el manejo de la PSH del adulto.

The Henoch-Schönlein purpura (HSP) is a small vessel vasculitis with IgA immune complex deposition. The presentation in adults is rare and severe. Reported cases of HSP in patients infected with HIV are scarce. Neutrophil cytoplasmic antibodies (ANCA) are commonly found in other systemic vasculitis, but rarely in HSP and even more unusual the perinuclear pattern. Beside small vessel vasculitis, positivity of ANCA can be detected in a number of different pathological conditions in association with infectious processes, including HIV, or cocaine use, and especially the pattern of ANCA-p, associated with drugs, inflammatory bowel or autoimmune diseases. We report the case of a 35 years old man with toxic habits (cocaine, marijuana) who consulted for abdominal pain, hematochezia and purpura on lower extremities, and later fever, joint pain and progression of purpura associated with nephritic syndrome and ANCA-p (+). During hospitalization HIV infection was detected. Renal biopsy showed IgA nephropathy with favorable response to corticosteroid and antiproteinuric treatment. The communication of the case is due to the rarity of the presentation and therapeutic diagnostic challenge. It remains to elucidate the role of ANCA in the pathogenesis and management of adult PSH.

Test purchase of new synthetic tryptamines via the Internet: Identity check by GC-MS and separation by HPLC.

Over the past few years, a continuous alteration of the recreational drug market took place. Among other novel psychoactive drugs, new synthetic tryptamine derivatives appeared on the market. These compounds are mainly traded via the Internet, which has become an important marketplace for the sale of recreational drugs. The goal of our research was to check, if 13 new synthetic tryptamines obtained by test purchase via different online vendors meet the promised identity. Analysis was performed by GC-MS, using a common 30 m HP-5MS capillary column as stationary phase. Subsequently, a simple HPLC method for the separation of these tryptamines was developed. Therefore, the aim was to establish a method to separate a broad spectrum of trypamines simultaneously within short time. Measurements were performed by a LiChrospher® RP-18e column and a mobile phase consisting of 0.1% triethylammonium acetate buffer, methanol and acetonitrile. Both presented methods were found to be suitable for the identification as well as separation of tryptamines as the analysis times were short and the selectivity sufficient. Moreover, enantioseparation of 3 chiral tryptamine derivatives purchased via the Internet by HPLC-UV and an Astec® Cyclobond I™ 2000 as CSP was performed. All of them were sold as racemic mixtures.

Tiroiditis subaguda con ausencia de captación cintigráfica unilateral inicial / Subacute thyroiditis with initial unilateralabsence of scintigraphic uptake

Subacute thyroiditis is a transient inflammatory process of the thyroid gland and the most common cause of painful thyroiditis. It usually involves the whole thyroid. We present a clinical case of a 45 years old woman developing tachycardia, fever and painful sensation in the left anterior cervical region after an upper respiratory tract infection. In addition the patient presented an enlarged and painful left thyroid lobe. Laboratory analysis demonstrated elevated acute phase reactants, high T4 levels and suppressed thyrotropin with absence of antithyroid antibodies. Thyroid scintigram showed an absent left radioactive iodine uptake. One month later the patient started with malaise, fatigue with an enlarged painful right thyroid lobe. A new scintigram showed complete absence of radioactive iodine uptake. A course of prednisone was initiated with excellent clinical response. Four months later the patient was asymptomatic with normal thyroid function.

Manejo del dolor en colecistectomías laparoscópicas / Pain management in laparoscopic cholecistectomy

Introducción: El dolor puede definirse como una experiencia sensorial y psicológica displacentera, que se puede asociar a una lesión real, o potencial. En la colecistectomía laparoscópica, los principales eventos adversos que se presentan son las náuseas, vómitos y el dolor postoperatorio; siendo los mismos la causa más frecuente de reingreso y convalecencia hospitalaria. Objetivos: Analizar el cumplimiento de la adecuada analgesia en pacientes colecistectomizados según el protocolo analgésico de la OMS.Material y Método: Se seleccionaron y analizaron 211 casos de colecistetomías desde el 01/06/2013 al 31/05/2015, se identificaron las variantes de la misma y se estudió la analgesia utilizada y la respuesta del paciente a la misma. Retrospectivo, descriptivo, observacional. Resultados: De 211 colecistectomías, 180 (85.31%) fueron colecistectomía laparoscópica y drenaje. Cursaron su postoperatorio inmediato en unidades cerradas 3 (1,67%). En los 177 pacientes que cursaron el postoperatorio en sala general, el dolor fue manejado en las primeras 24hs con un paralelo de 150mg diclofenac a 21ml/h y asociación opioide débil + aine cada 8hs. En 40 de los 177 pacientes (22,60%) hubo que subir la escala analgésica. Se utilizó como corte, un dolor referido de más de 6 puntos en la escala visual analógica. Conclusiones: El manejo del dolor postoperatorio se encuentra aún lejos de un protocolo infalible. En nuestro medio la asociación analgésica presentada, resulta adecuada para un aceptable número de pacientes; pero al no ser los pacientes números, debemos centrarnos en la necesidad particular de cada uno de ellos para hacer su convalecencia lo menos displacentera posible

Introduction: Pain can be defined as a displeasing sensitive and psychological experience that may be associated to a real or potential injury. In laparoscopic cholecystectomy, main adverse effects are nausea, vomiting and postoperatory pain; these being most frequent causes for rehospitalization.Objectives: Analyze adequate pain management in cholecystectomized patients according WHO pain protocol. Material and method: Retrospective, descriptive, observational. There were selected and analyzed 211 cholecystectomies since 06/01/2013 until 05/31/2015, identified variables and studied used analgesia and patient ́s response to it. Results: Of 211 cholecystectomies, 180 were laparoscopic. In 3 cases the immediate postoperatory were cursed in ICUs. Of the 177 patients that were in general care unit, the pain was managed within the first 24 hours with 150mg of Diclofenac at a 21ml/h rate plus weak opioid + NSAID every 8 hours. In 40 patients of these, analgesic scale had to be rised. A value of 6 in visual analog scale was used. Conclusions: Pain management is far from flawless. In our medium, the presented analgesic association, results adequate for an acceptable number of patients. However, as patients are not numbers, we must focus in individual needs so we can make convalescence bearable

How Leptin Controls the Drive to Eat

A complex set of brain based systems modulate feeding to maintain constant body weight. The adipose derived-hormone, leptin, plays a crucial role in this control by acting on diverse leptin receptor (LepRb)-expressing neurons in the hypothalamus and brainstem to modify behavior and metabolism. In addition to controlling energy expenditure and satiety, leptin controls motivation and the reward value of food by regulating two interconnected systems: hypocretin (HCRT) neurons and the mesolimbic dopamine (MLDA) system. Modest/acute decreases in leptin levels, as associated with mild caloric restriction, increase MLDA activity and overall food-seeking behavior; in contrast, severe starvation or complete leptin deficiency blunt MLDA activity, along with motivation and associated behaviors. Lateral hypothalamic (LHA) LepRb neurons project to dopamine (DA) neurons in the ventral tegmental area, where neurotensin (NT) release augments MLDA function; these LepRb(NT) cells also innervate HCRT neurons to control Hcrt expression and inhibit HCRT neurons. Ablation of LepRb in these cells abrogates the control of HCRT cells by leptin and decreases activity and MLDA function. We propose that this neural pathway regulates the MLDA, activity, and motivation in response to leptin and nutritional status.

Experiencia subjetiva de estudiantes y docentes que vivencian un cambio curricular / Subjective experience of students and teachers who experience a curriculum change

Objetivo: Conocer la experiencia subjetiva de estudiantes y docentes respecto del cambio curricular. Metodología: Estudio transversal, muestra de 169 estudiantes de cuarto año curricular y 32 docentes. Información recogida en cuestionario “Inquietudes y procedimientos para adoptar Innovaciones Educativas” (IPIE) validado y adaptado al estudio. Análisis descriptivo. Estudio respetó normas éticas y consentimiento informado. Resultados: 26,0 por ciento de alumnos correspondió a Tecnología Médica; 22,5 por ciento Enfermería y Nutrición, respectivamente, y 29,0 por ciento Obstetricia. Edad media de 21,3+/-1,43 años. Mujeres 68,1 por ciento. En “Información”, los estudiantes mostraron el promedio más alto en el ítem “Quisiera saber lo que otros están haciendo en esta área” (4,1+/-0,9), y los docentes en “Me gustaría saber si se contará con los recursos para mantener esta innovación en un futuro inmediato” (4,7+/-0,4). En “Funcionalidad”, promedio más alto correspondió a “Me gustaría saber qué es lo que esta innovación va a requerir para mantenerla en el futuro” (4,3+/-0,8) y el más bajo en “Estoy totalmente ocupado/a en otras cosas, para mí la innovación no es prioridad” (2,4+/-1,4). En “Resultados”, los docentes presentaron el promedio más alto en “Me interesa evaluar mi impacto sobre los estudiantes” y “Quisiera que otros equipos de docentes se motiven con los logros que tenemos en este proceso de innovación curricular” (4,6+/-0,4; 4,6+/-0,4). Conclusiones: Estudiantes y docentes se mostraron conformes con la experiencia del cambio curricular. Aún existen dudas respecto de cómo este cambio afectará las competencias del estudiantado y la sustentabilidad en el tiempo. Es necesario continuar esta línea investigativa durante el ejercicio profesional de egresados.

Objective: To determine the subjective experience of students and teachers on curriculum change. Methodology: Cross-sectional study in a sample of 169 Regular fourth-year students and 32 teachers. Information collected in the survey “Concerns and procedures to adopt educational innovations” (IPIE) validated and adapted to the study. Descriptive analysis with means, medians, ranges, percentages and averages compared with t-test and ANOVA. Study respected ethical and informed consent. Results: 26.0 percent of students accounted for Medical Technology, Nursing and Nutrition 22.5 percent, 29.0 percent respectively and Obstetrics. Mean age 21.3 +/- 1.43 years. 68.1 percent women. In “Information”, students showed the highest average item “I want to know what others are doing in this area” (4.1 +/- 0.9), and teachers in “I wonder if they have the resources to keep this innovation in the immediate future “(4.7 +/- 0.4). In “Functionality” highest average corresponded to “I wonder what this innovation will be required to keep it in the future” (4.3 +/- 0.8) and lowest in the scale “I am fully occupied / to other things, for innovation is not my priority “(2.4 +/- 1.4). In teaching, in “Results” highest average “I am interested in evaluating my impact on students” and “I want other teachers to motivate teams with the achievements we have in this curricular innovation process” (4.6 +/- 0, 4, 4.6 +/- 0.4). Conclusions: students and teachers were satisfed with the experience of curriculum change. Still, there are doubts about how this will affect the student skills and sustainability over time. It is necessary to continue this line of research for the professional practice of graduates, to objectively assess the skills of the new student-centered curriculum.

Aneurisma verdadero en arteria ciática persistente: caso clínico / Persistent sciatic artery aneurysm: a case report

We report the case of a 71 years old female patient, who had a partially thrombosed true aneurysm in a persistent sciatic artery (PSA), treated in the Surgery Department of Hospital Dr. Eduardo Pereira of Valparaiso. The sciatic artery arises from the umbilical artery and during early embryological state is the main blood supply of the lower limbs. Later, the superficial femoral artery appears with the subsequent progressive involution of the sciatic artery. PSA is a rare congenital vascular anomaly that occurs when sciatic artery fails to regress during fetal development. This is associated with superficial femoral artery hipoplasia and the PSA becomes the dominant arterial inflow to the lower limb. This anatomic abnormality may be bilateral and can remain asymptomatic for many years, however, it has been described aneurysmal degeneration, like in this case, symptoms of sciatic nerve compression, aneurysm thrombosis and distal embolization.

Se reporta el caso de una paciente de 71 años, que presenta un aneurisma verdadero, parcialmente trombosado, en una Arteria Ciática Persistente (ACP), tratada en el Servicio de Cirugía del Hospital Dr. Eduardo Pereira de Valparaíso. La arteria ciática se origina en la arteria umbilical y durante las primeras fases embriológicas es el principal aporte sanguíneo de la extremidad inferior. Posteriormente aparece la arteria femoral superficial y se produce la progresiva involución de la arteria ciática. La ACP constituye una rara anomalía y ocurre por la falta de desarrollo de la arteria femoral superficial. La ACP se origina en el adulto en la arteria hipogástrica, transcurre hacia la región glútea a través de la escotadura ciática y sigue hacia distal por la parte posterior del muslo continuándose después con la arteria poplítea. Se acompaña de un variable menor desarrollo del eje arterial anterior de la arteria ilíaca externa y femoral superficial. Esta anomalía anatómica puede ser bilateral y puede permanecer asintomática durante muchos años, sin embargo, se ha descrito la degeneración aneurismática, como en este caso, y síntomas por compresión del nervio ciático, trombosis del aneurisma y embolización distal.

Endoprótesis recubierta en el manejo de la fístula cervical tras esofaguectomía / Covered stent in the management of cervical anastomotic leaks after esophaguectomy

Small cervical esophageal anastomotic leaks are usually treated conservatively, with considerable delays to oral feeding and a prolonged hospital stay. Self-expanding covered stents endoscopically placed are suggested as an alternative treatment. We report our hospital experience with covered stents, with good functional results but also potential morbidity.

La fístula anastomótica esofágica cervical suele manejarse de forma conservadora, lo que retrasa el inicio de la alimentación oral y prolonga la estancia hospitalaria. El uso de endoprótesis recubiertas colocadas vía endoscópica se utiliza como una alternativa para evitar esta situación. Presentamos dos casos manejados con endoprótesis recubierta, con adecuado funcionamiento pero no exenta de morbilidad.