Evaluación de la escala de BISAP en el pronóstico de la pancreatitis aguda / Assessment of a predictive score for complications and mortality among patients with acute pancreatitis

Background: It is important to stratify patients with acute pancreatitis according to their risk. Many staging systems for acute pancreatitis have been proposed, each with advantages and disadvantages. Aim: To evaluate the sensitivity, specificity, positive and negative predictive value of the BISAP system. Material and Methods: Retrospective crosses sectional study, which included all patients that presented with acute pancreatitis to a private hospital in Mexico City from 2003 to 2009. The variables needed to calculate BISAP and complications were obtained from the medical records. Results: The records of 345 patients with a mean aged of 52 years (57 percent males) were analyzed. Twelve percent had complications and 2.3 percent died. Patients with a BISAP score over three had a significantly higher mortality. The sensitivity, specificity and positive predictive value of a BISAP score over three for mortality were 12.5, 92.9 and 4 percent, respectively. Conclusions: Because of its high negative predictive value and specificity the BISAP system can be used to stratify patients who are at low risk for complications related to pancreatitis. If the patient has a score of 3 or higher it is necesary to use other scoring systems which are more sensitive and have a higher positive predictive value.

La pancreatitis aguda afecta aproximadamente a 200.000 personas por año en los Estados Unidos. Puede cursar de manera leve o de manera agresiva con una morbi-mortalidad alta. Es importante estratificar a los pacientes de manera temprana de acuerdo a su riesgo. Nosotros analizamos el sistema BISAP y determinamos su sensibilidad, especificidad, valor predictivo positivo y negativo en relación a morbi-mortalidad. Métodos: Realizamos un estudio transversal retrospectivo e incluimos a todos los pacientes con diagnóstico de pancreatitis aguda en un hospital privado de tercer nivel en la ciudad de México desde el 2003 a 2009. Se obtuvo la morbi-mortalidad y las variables necesarias para calcular el BISAP. Se estratificaron los pacientes. Se utilizó la prueba de Fisher para comparación de variables. Resultados: 345 pacientes fueron incluidos. Edad promedio de 51,8 años. La morbilidad fue de 11,6 por ciento y la mortalidad 2,3 por ciento. Conforme aumentaba el puntaje BISAP había una tendencia hacia más morbilidad. Dividimos la población en un grupo de BISAP bajo (< 3) y un grupo con BISAP alto (> = 3) y observamos una diferencia estadísticamente significativa en cuanto a la morbilidad de ambos grupos. El BISAP tiene una alta especificidad y valor predictivo negativo. Su sensibilidad y valor predictivo positivo son pobres. Conclusiones: Dado su alto valor predictivo negativo y especificidad el BISAP se puede utilizar para estratificar los pacientes que tienen un bajo riesgo de presentar pancreatitis aguda severa relacionada con morbilidad. Si el paciente examinado presenta un BISAP > = 3, creemos necesario utilizar otro sistema con más sensibilidad y valor predictivo positivo para el manejo.

Pulmonary tuberculosis: evaluation of interferon-gamma levels as an immunological healing marker based on the response to the Bacillus Calmette-Guerin

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis whose interaction with the host may lead to a cell-mediated protective immune response. The presence of interferon-gamma is related to this response. With the purpose of understanding the immunological mechanisms involved in this protection, the lymphoproliferative response, IFN-gamma and other cytokines like interleukin (IL-5, IL-10), and tumor necrosis factor alpha (TNF-alfa) were evaluated before and after the use of anti-TB drugs on 30 patients with active TB disease, 24 healthy household contacts of active TB patients, with positive purified protein derivative (PPD) skin tests (induration > 10 mm), and 34 asymptomatic individuals with negative PPD skin test results (induration < 5 mm). The positive lymphoproliferative response among peripheral blood mononuclear cells of patients showed high levels of IFN-gamma, TNF-alfa, and IL-10. No significant levels of IL-5 were detected. After treatment with rifampicina, isoniazida, and pirazinamida, only the levels of IFN-gamma increased significantly (p < 0.01). These results highlight the need for further evaluation of IFN-gamma production as a healing prognostic of patients treated.

Immunochemotherapy in American cutaneous leishmaniasis: immunological aspects before and after treatment

In this study, we evaluated the immune response of patients suffering from cutaneous leishmaniasis treated with two distinct protocols. One group was treated with conventional chemotherapy using pentavalent antimonium salts and the other with immunochemotherapy where a vaccine against cutaneous leishmaniasis was combined with the antimonium salt. Our results show that, although no differences were observed in the necessary time for complete healing of the lesions between the two treatments, peripheral blood mononuclear cells from patients treated by chemotherapy showed smaller lymphoproliferative responses at the end of the treatment than those from patients in the immunochemotherapy group. Furthermore, IFN-gamma production was also different between the two groups. While cells from patients in the chemotherapy group produced more IFN-gamma at the end of treatment, a significant decrease in this cytokine production was associated with healing in the immunochemotherapy group. In addition, IL-10 production was also less intense in this latter group. Finally, an increase in CD8+ -IFN-gamma producing cells was detected in the chemotherapy group. Together these results point to an alternative treatment protocol where healing can be induced with a decreased production of a potentially toxic cytokine

Impacto del programa de educación sexual: adolescencia, tiempo de decisiones / Impact of the sexual education program: adolescence, time for decision

Se desarrolla un programa de educación sexual llamado Adolescencia Tiempo de Decisiones en dos establecimientos escolares en la Región Metropolitana, durante 24 meses y se compara sus resultados con otros tres establecimientos escolares sin educación sexual. Es un estudio de intervención en una cohorte grupal controlada de escolares adolescentes. El seguimiento se hace con escuesta anónimas que abarcan 4.448,4.123 y 4.057 escolares evaluados antes de iniciar el programa y a los 21 meses y 33 meses de programa respectivamente. Las escuelas con programa además contaron con consultoras locales y atención clínica confidencial en un Centro Universitario Especializado en adolescente (CEMERA). En los establecimientos escolares intervenidos aumentaron significativamente los conocimientos en sexualidad, reproducción, anticoncepción y Enfermedades de Transmisión Sexual, siendo más evidente entre los adolescentes sin relaciones sexuales al final del estudio. Se retrasa el inicio de las relaciones sexuales en los colegios intervenidos y los alumnos y alumnas que deciden continuar con relaciones sexuales previenen más el embarazo. Se produjo un descenso significativo de los embarazos en los colegios intervenidos especialmente de los abortos obligados por sus padres, apoderados o personas que influencian sus vidas. Hubo importantes diferencias de género en los hallazgos del estudio y se considera que es un aporte científicamente validado, para las políticas públicas en educación sexual y prevención del embarazo en adolescentes escolares

Schistosoma mansoni: identification of a 46KDa antigen of the schistosomular surface by monoclonal antibody

Um anticorpo monoclonal da subclasse IgG2a, designado C6G9, foi obtido pela imunizacao de camundongos BALB/c com antigenos de ovo de Schistosoma mansoni. Esse anticorpo monoclonal possibilitou a identificacao de um antigeno de peso molecular aproximado de 46 quilodaltons (KDa), cuja expressao foi avaliada atraves da reacao de imunofluorescencia indireta. O referido antigeno persistiu no tegumento do esquistossomulo em desenvolvimento pelo menos ate 96 horas pos-transformacao. O anticorpo monoclonal reagiu tambem com a superficie de cercarias, mas nao com a de vermes adultos. O C6G9, em presenca de complemento, foi tambem capaz de mediar niveis significativos de citoxicidade para esquistossomulos recem-transformados.

Tratamiento antibiótico del pie diabético: ventajas de la vía regional intravenosa como alternativa a la vía sistémica / Antibiotic treatment for diabetic foot. Advantages of intravenous regional route as alternative for systemic route

Diabetic angiopathy prevents adequate access of antibiotic agents to septic areas of the diabetic foot. We treated 22 such patients with antibiotics infused through a superficial vein associated to tourniquette occlusion of the limb (Group A). a control group of 47 patients, similar in age, sex and severity of diabetes received conventional systemic therapy (Group B). 45% of the patients exhibited occlusive arterial disease. Surgery was performed by the same team in both groups. Group A received regional anesthesia at the same time of the first antibiotic infusion. Group B received general or spinal anesthesia. Amputation was required in 5% of patients in Group A compared to 30% of patients in Group B (p < 0,02). Hospital stay was also significantly shorter in patients from Group A. No complications of this form of therapy were obseved. Thus, regional antibiotic therapy may improve prognosis and facilitate management in patients with septic diabetic foot