Endovascular treatment of a right pulmonary sequestration supplied by an aneurysmal aberrant artery originating from the abdominal aorta / Tratamento endovascular de sequestro pulmonar direito irrigado por artéria aneurismática aberrante originária da aorta abdominal

Abstract Endovascular embolization of arteries feeding pulmonary sequestrations is a growing therapeutic option. A 51-year-old woman with chest pain and hemoptysis was admitted. During hospitalization she presented 150 mL hemoptysis, hypotension, and hematocrit fell to 23.3%. Contrast-enhanced computed tomography confirmed a pulmonary sequestration irrigated by an aneurysmal artery from the abdominal aorta. The patient underwent endovascular coil embolization of the artery feeding the aneurysm and an Amplatzer device was deployed in the proximal third of the sequestration artery. Subsequent contrast-enhanced computed tomography confirmed complete thrombosis of the aberrant artery feeding the aneurysm and absence of irrigation of the pulmonary sequestration. At 56 months follow-up the patient remains asymptomatic, tomography showed involution of the sequestration and complete thrombosis of the aberrant artery. The challenges presented by the different treatment alternatives are discussed.

Resumo A embolização endovascular das artérias que alimentam os sequestros pulmonares é uma opção terapêutica em crescimento. Uma mulher de 51 anos com dor torácica e hemoptise foi internada. Durante a internação, ela apresentou hemoptise de 150 mL, hipotensão e queda do hematócrito para 23,3%. A tomografia computadorizada com contraste confirmou um sequestro pulmonar irrigado por uma artéria aneurismática originária da aorta abdominal. A paciente foi submetida a embolização endovascular da artéria que alimentava o aneurisma com uso de coils e dispositivo Amplatzer no terço proximal da artéria sequestrante. A tomografia subsequente confirmou a trombose completa da artéria aberrante que alimentava o aneurisma e a ausência de irrigação dentro do sequestro pulmonar. No seguimento de 56 meses, a paciente permanecia assintomática, e a tomografia mostrou involução do sequestro e trombose completa da artéria aberrante. Os desafios apresentados pelas diferentes alternativas de tratamento são discutidos neste artigo.

Infección por COVID-19 en pacientes en Hemodiálisis en Panamá 2020

Antecedentes y objetivo: Los pacientes con Enfermedad Renal Crónica (ERC) en Hemodiálisis son pacientes que tienen condiciones que los hacen pacientes de riesgo para la infección por COVID-19. Los pacientes en hemodiálisis han sido un grupo muy afectado, debido a que no pueden suspender sus tratamientos para mantener el aislamiento domiciliario, lo que aumenta su exposición y riesgo a infección por COVID-19. Para evaluar el comportamiento de la infección por SARS-CoV-2 en los pacientes en hemodiálisis crónica en Panamá, realizamos un estudio prospectivo de los pacientes infectados por COVID-19 en las Unidades de Hemodiálisis de la CSS de todo el país, para determinar las características de los pacientes afectados, los síntomas que presentaron, su evolución clínica y el desenlace de los pacientes infectados. Materiales y Médodos: Realizamos un estudio longitudinal descriptivo prospectivo multicéntrico de los casos positivos que se diagnosticaron desde el 15 de julio hasta el 31 de diciembre de 2020 en las 14 Unidades de Hemodiálisis de la CSS del país.  Resultados y conclusiones: Fueron incluidos un total de 333 pacientes en hemodiálisis con diagnóstico positivo para  infección  por SARS-CoV-2, de un total de 2194 pacientes que realizan hemodiálisis en las Unidades de la Caja de Seguro Social.  El 59.5% de los afectados fueron de sexo masculino.  La edad promedio fue de 56.75 años (DS 15.1 años).  La Tasa de Mortalidad encontrada en nuestro estudio fue de 26%. La incidencia acumulada de COVID-19 en pacientes en Hemodiálisis fue de 16% para el período de estudio del 2020. (provisto por Infomedic International)

Background and objective: Patients with Chronic Kidney Disease (CKD) on Hemodialysis are patients who have conditions that make them patients at risk for COVID-19 infection. Hemodialysis patients have been a highly affected group because they cannot stop their treatments to maintain home isolation, which increases their exposure and risk of COVID-19 infection. To evaluate the behavior of SARS-CoV-2 infection in patients on chronic hemodialysis in Panama, we conducted a prospective study of patients infected by COVID-19 in hemodialysis units throughout the country, to determine the characteristics of the affected patients, the symptoms they presented, their clinical evolution and the outcome of the infected patients. Materials and Methods: We conducted a multicenter prospective descriptive longitudinal study of the positive cases that were diagnosed from July 15, 2020 to December 31, 2020 in the 14 Hemodialysis Units of the Social Security Fund of the country. Results and conclusions: A total of 333 hemodialysis patients with a positive diagnosis for SARS-CoV-2 infection were included, out of a total of 2194 patients undergoing hemodialysis in the Units of the Social Security Fund. Fifty nine percet of those affected were male.  The mean age was 56.75 years (DS 15.1 years).  The Mortality Rate found in our study was 26%. The cumulative incidence of COVID-19 in hemodialysis patients was 16% for the 2020 study period. (provided by Infomedic International)

Aneurisma de aorta abdominal roto al duodeno: causa infrecuente de hemorragia digestiva masiva

Primary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.

Servicios de extensión de cuidados críticos: implicancias para enfermería / Critical care extension services: implications for nursing / Serviços de extensão de cuidados críticos: implicações para a enfermagem

Resumen 19. La Unidad de Cuidados Intensivos (UCI) se caracteriza por atender pacientes de extrema gravedad, donde el cuidado prima en su totalidad. La UCI, además, es una unidad cerrada y con cupos limitados, donde el personal que labora está altamente especializado, haciendo que sus funciones se limiten a ella. Esto provoca que los cuidados especializados se concentren en unidades intensivas, dejando a las unidades más básicas sin esta cobertura, de tal manera que el paciente críticamente enfermo o en vías de descompensación tenga un rápido deterioro en salas de menor complejidad por falta de atención específica. Se realizó una búsqueda sistemática de la literatura, que consiste en la utilización de buscadores y bases de datos especializadas. Se estructuró, finalmente, un narrativo de los resultados. Los Servicios de Extensión de Cuidados Críticos se aplican ya en distintas partes del mundo, sobre todo en Europa, Canadá, Australia y Argentina, pensando en la calidad de atención especialista al paciente crítico, bajo esta metodología. Se intentó identificar y describir funciones, determinar la estructura, beneficios y dificultades en la implementación de un Servicio de Extensión de Cuidados Críticos en el paciente adulto para que en un futuro se pueda aplicar a nuestra realidad tanto local como nacional.

Abstract 23. The Intensive Care Unit (ICU) is characterized by treating patients of extreme severity, where the care premium in its entirety. The UCI, in addition, is a closed unit with limited places, where the staff that works is highly specialized, making its functions limited to it. This causes specialized care to be concentrated in intensive units, leaving the most basic units without this coverage, in such a way that the patient critically ill or in the process of decompensation has a rapid deterioration in rooms of less complexity due to lack of specific attention. A systematic search of the literature was carried out, which consists of the use of search engines and specialized databases. Finally, a narrative of the results was structured. The Critical Care Extension Services are already applied in different parts of the world, especially in Europe, Canada, Australia and Argentina, thinking about the quality of specialist care for critical patients, under this methodology. We tried to identify and describe functions, determine the structure, benefits and difficulties in the implementation of a Critical Care Extension Service in the adult patient so that in the future it can be applied to our local and national reality.

Resumo 27. A Unidade de Terapia Intensiva (UTI) caracteriza-se por tratar pacientes de extrema gravidade, onde o prêmio é integralmente assistido. A UCI, além disso, é uma unidade fechada com vagas limitadas, onde a equipe que trabalha é altamente especializada, limitando suas funções a ela. Isso faz com que o foco de cuidados especializados em unidades de terapia intensiva, deixando as unidades mais básicas, sem essa cobertura, de modo que o paciente descompensação gravemente doente ou estar tem uma rápida deterioração em salas menos complexas devido à falta de atenção específica. Foi realizada uma busca sistemática da literatura, que consiste no uso de mecanismos de busca e bancos de dados especializados. Finalmente, uma narrativa dos resultados foi estruturada. Os Serviços de Extensão de Cuidados Críticos já são aplicados em diferentes partes do mundo, especialmente na Europa, Canadá, Austrália e Argentina, pensando na qualidade do atendimento especializado para pacientes críticos, sob esta metodologia. Nós tentamos identificar e descrever funções, determinar a estrutura, os benefícios e as dificuldades na implementação de um Critical Care Serviço de Extensão no paciente adulto no futuro pode ser aplicado a ambas as nossas realidades locais e nacional.

INCIDENCIA DEL RÍO BOGOTÁ EN LA CALIDAD MICROBIOLÓGICA DEL AGUA DEL RÍO MAGDALENA, MUNICIPIO DE FLANDES (TOLIMA) / IMPACT OF THE BOGOTÁ RIVER ON THE MICROBIOLOGICAL QUALITY OF THE WATER OF THE MAGDALENA RIVER, MUNICIPALITY OF FLANDES (TOLIMA)

La cuenca del río Bogotá está considerada como la más contaminada de Colombia, producto de la descarga de aguas residuales de una población superior a 7 millones de habitantes; aguas que al desembocar en la margen derecha del río Magdalena ­principal arteria fluvial nacional­ deterioran su calidad y ponen en potencial riesgo la salud de una vasta población de la región central del país que se abastece de esta fuente hídrica para consumo humano, riego y contacto primario. En esta investigación se evaluó la incidencia del río Bogotá en la contaminación microbiológica del río Magdalena que sirve de fuente de abastecimiento del acueducto urbano del municipio de Flandes, departamento del Tolima, durante la ocurrencia del fenómeno de El Niño entre 2015-2016. Se realizaron muestreos en 4 puntos estratégicos a partir de ensayos microbiológicos efectuados en el tramo del río Magdalena, comprendido desde antes de la desembocadura del río Bogotá hasta la captación del acueducto urbano de Flandes, durante dos temporadas diferentes: la seca en el mes de febrero de 2016 y de lluvia en abril de 2016. Se concluyó que es una fuente de abastecimiento muy deficiente para consumo humano a partir de la contaminación microbiológica que le incorpora el río Bogotá, en especial en temporada seca, incidiendo en la calidad del agua captada por el acueducto de Flandes que puede llegar a implicar riesgo a la salud, requiriéndose a corto plazo la incorporación de nuevos procesos en su sistema de tratamiento para garantizar la remoción de la carga microbiológica.

The basin of the Bogotá River is considered the most polluted basin in Colombia due to the discharge of wastewater from a population of over 7 million inhabitants. These waters that flow into the right bank of the Magdalena River -the main national fluvial artery- deteriorate their quality and potential putting at risk the health of a vast population of the central region of the country that is supplied with this water source for human consumption, irrigation and primary contact. This research evaluated the impact of the Bogotá River in the microbiological contamination of the Magdalena River that serves as a source of supply for the urban aqueduct in the municipality of Flandes, Department of Tolima, during the occurrence of El Niño phenomenon between 2015 and 2016. Samplings were completed at 4 strategic points from microbiological tests carried out in the Magdalena River section containing the area before the mouth of the Bogota River to the catchment of the urban aqueduct of Flandes during two different seasons, the dry season in the month of February 2016, and the rainy season in April 2016. It was concluded that it is a very poor source of supply for human consumption based on the microbiological contamination that the Bogota River adds especially in the dry season, affecting the quality of the water collected by the aqueduct of Flandes that may imply a health risk, requiring the incorporation of new processes in its treatment system in a short-term to guarantee the removal of the microbiological load.

Reemplazo de arco aórtico y aorta descendente proximal por aneurisma o disección aórtica con prótesis Thoraflex / Aortic arch and proximal descending aorta replacement with the Thoraflex* prosthesis

Resumen: El compromiso simultáneo del arco aórtico y aorta descendente proximal, ya sea por disección o aterosclerosis, constituye uno de los mayores desafíos que puede enfrentar un cirujano cardiovascular. La prótesis híbrida Thoraflex, introducida en los últimos años, ha resultado ser una importante ayuda para el tratamiento quirúrgico de esta compleja y grave patología. Esta consiste en un tubo protésico de Dacron con 4 ramas, para el reemplazo del arco aórtico y sus troncos braquiocefálicos y perfusión corporal distal, y una endoprótesis que queda como "trompa de elefante suspendida" en la aorta descendente proximal. Presentamos en esta oportunidad nuestra experiencia inicial en 4 pacientes, 3 con disección aórtica crónica y una con un aneurisma aterosclerótico, usando la prótesis híbrida Thoraflex.

Abstract: Atherosclerotic aneurysm or dissection of the aortic arch and proximal descending thoracic aorta is one of the major challenges for a cardiovascular surgeon. The new hybrid prosthesis Thoraflex has become an important devise to simplify the surgical treatment of this very complex and technically demanding aortic pathology. This hybrid prosthesis consists of a 4-branched arch graft with a stent-graft at the distal end. The proximal part is a gelatin-coated woven polyester prosthesis. The stented section is a self-expanding endoprosthesis constructed of thin-walled polyester and nitinol ring stents that is left in the proximal descending aorta as a "frozen elephant trunk". We present our initial experience with the Thoraflex prosthesis in four patients, three of them with chronic aortic dissection and one with an atherosclerotic aneurysm.

Preanalytical conditions can interfere with M. tuberculosis detection by PCR in respiratory samples

OBJECTIVES: Tuberculosis is one of the most prevalent infections in humans. Although culture is the reference for diagnosis, its sensitivity is compromised, especially in paucibacillary samples. Because polymerase chain reaction (PCR) amplifies mycobacterial DNA, it is more sensitive than culture for the diagnosis of Mycobacterium tuberculosis (Mtb). However, its performance can be affected by intrinsic sample inhibitors and by the extraction/detection techniques used. METHODS: We evaluated the influence of preanalytical conditions on Mtb detection in samples of sputum (SPU), bronchoalveolar lavage (BAL), and pleural fluid (PF) using combinations of extraction/detection methods. Respiratory samples were prepared to contain different concentrations of red blood cells and nucleated cells to which increasing amounts of Mtb colonies were inoculated and submitted to PCR. RESULTS: Up to 102 CFU/ml of Mtb were detected in the SPU in all methods, except for the Roche extraction/detection method, regardless of the preanalytical sample condition. In BAL samples, medium and high concentrations of cells and high concentrations of red blood cells contributed to a lower Mtb detection, regardless of the extraction method used. In PF, red blood cells were the variable that most interfered with Mtb detection, with better recovery (102 CFU/ml) observed with the Qiagen/Nanogen combination. CONCLUSION: The choice of Mtb extraction and detection method is of fundamental importance for PCR analytical sensitivity, especially when paucibacillary samples and/or samples containing potential PCR inhibitors are analyzed.

Synthesis of leading chalcones with high antiparasitic, against Hymenolepis nana, and antioxidant activities

The hymenolepiosis by Hymenolepis nana is a major public health problem in developing countries, and the commercial drugs against this parasitosis are not enough effective. The combination of antiparasitic and antioxidant agents has improved the treatment of some parasitoses. Thus, the development of new cestocidal and antioxidant agents to treat the hymenolepiosis cases is important. In the present study, four hydroxy- and four dihydroxy-chalcones were synthesized using the catalyst boron trifluoride diethyl etherate (BF3•OEt2). The antioxidant activity and antiparasitic against H. nana of chalcones were tested, as well as the toxicity by the brine shrimp lethality bioassay and the method of Lorke. The antioxidant activity was measured by three radical scavenging assays: 2,2'-azino-bis-3-ethylbenzothiazoline-6-sulphonic acid (ABTS), 2,2-diphenyl-1-picrylhydrazyl (DPPH), and ferric reducing antioxidant power (FRAP). The hydroxyl substitution pattern (number and position), mainly in ring B, was responsible for the chalcone antiparasitic activity. At least one meta or para hydroxyl group in ring B was essential for activity of the synthetic chalcones against H. nana; The time taken for the parasite to die by the 3b and 3e chalcones (20 mg/mL) treatment was up to six times lower than the control drug Praziquantel. On the other hand, chalcones with catechol structure in ring B (3g and 3h) showed the highest antioxidant values. The toxicity evaluations suggests that synthetic hydroxychalcones with cestocidal (3b and 3e) and antioxidant (3g and 3h) activities are safe compounds and potential in vivo agents to treat this parasitosis

Reporte inusual de un polipo sesil: colitis quistica profunda / Unusual report of a polipo sesil: deep cystic colitis

La colitis quística profunda (CQP) es una condición rara caracterizada por la presencia de quistes de moco, ubicados en la submucosa del colon y recto que puede ser localizada segmentaria o difusa. La colitis quística profunda debe considerarse como diagnóstico diferencial de lesiones polipoideas, su diagnóstico es histopatológico; el tratamiento es controversial y el pronóstico es excelente. Se describe el caso de una paciente con hallazgo por colonoscopia de un pólipo sésil el cual fue resecado, reportándose la biopsia como colitis quística profunda.

Deep cystic colitis is a rare condition characterized by the presence of mucous cysts located in the submucosa of the colon and rectum that can be localized, segmental or diffuse. Deep cystic colitis should be considered in the differential diagnosis of polypoid lesions, the diagnosis is histopathological; treatment is controversial and the prognosis is excellent. We describe a patient with a colonoscopy finding of sessile polyp which was resected, reporting biopsy as deep cystic colitis.

Obesidad, factor de riesgo de infección bacteriana ascendente durante el embarazo / Obesity, a risk factor for ascending bacterial infection during pregnancy

Background: Obesity in pregnancy is associated with significantly higher rates of infection. Aim: To compare the infectious morbidity in pregnant women with normal and altered body mass index (BMI). Material and Methods: Cross sectional retrospective study of 6,150 patients who had delivery or second trimester abortion during 2012. The patients were classified according to BMI as underweight, normal weight, overweight and obese. We compared the frequency of pregnancy and perinatal complications related to ascending bacterial infection (ABI). The data was obtained from the hospital’s databases. Results: Obese patients had higher rates of pregnancy and perinatal complications related to ABI compared to patients with normal weight. The odds ratios (OR) and 95% confidence intervals (CI) for second trimester abortion were 3.45 (1.63-7.31) p < 0.01, for preterm delivery 2.42 (1.51-3.87) p < 0.01, for labor and puerperium infections 3.42 (2.06-5.68) p < 0.01 and for early neonatal infectious and perinatal mortality 4.46 (1.75-11.37) p < 0.01. A logistic regression analysis revealed that obesity is an independent risk factor for second trimester abortion related to ABI with an OR of 3.18 (CI 95% 1.46-6.91), premature delivery related to ABI with an OR of 2.51 (CI 95% 1.54-4.09) and for delivery and postpartum infections with an OR of 4.44 (CI 95% 2.62 to 7.51). Conclusions: Obese pregnant women had a 2.5 to 4.5 times increased risk of infectious morbidity compared to normal weight patients. Obesity is an independent risk factor for second trimester abortion and preterm delivery related to ABI and delivery and postpartum infectious.

Doble piloro adquirido: una complicación poco usual de enfermedad úlceropeptica. A propósito de un caso / DOUBLE ACQUIRED PYLORUS: AN UNUSUAL COMPLICATION OF PEPTIC ULCER DISEASE. ABOUT A CASE

El Doble Píloro (DP) es un hallazgo endoscópico inusual en el que el antro gástrico se conecta al bulbo duodenal por dos orificios separados por un septo, tabique o puente. Su etiología puede ser congénita o adquirida siendo esta última la forma más común como complicación de una enfermedad ulcero péptica (EUP). La mayoría de las fistulas están localiza­das en la curvatura menor de antro gástrico. En los casos de DP adquirido se han descrito tres teorías en cuanto a su forma­ción. Puede presentarse con dolor en epigástrico, dispepsia o hemorragia digestiva aunque en ocasiones es un hallazgo ca­sual endoscópico o radiológico. En este caso presentamos a un paciente quien acude con clínica de Hemorragia Digestiva Superior a quien se le realiza gastroscopia donde se eviden­cia este hallazgo poco usual el cual fue confirmado mediante estudio radiológico. En general el pronóstico es favorable.

The Double Pylorus (DP) is an unusual finding in the gastros­copy where the gastric antrum and the duodenal bulb is con­nected to by two holes separated by a septum or bridge. Its etiology may be congenital or acquired the latter being the most common form as a complication of peptic ulcer disease (EUP). Most fistulas are located on the lesser curvature of the gastric antrum. There have been described three theories in the formation of acquired DP. It may present with epigastric pain, dyspepsia or gastrointestinal bleeding but sometimes it is an endoscopic or radiological incidental finding. We present a patient who presents with upper gastrointestinal bleedings­ymptoms in whom a gastroscopy where performed with this unusual finding which was confirmed by radiological study. In general the prognosis is favorable.

Actividad antibacteriana de extractos de frutos de nanchi (Byrsonima crassifolia (L.) Kunth), arrayán (Psidium sartorianum (O. Berg) Nied.) y ayale (Crescentia alata Kunth) / Antibacterial activity of extracts obtained from the nanchi (Byrsonima crassifolia (L.) Kunth), arrayan (Psidium sartorianum (O. Berg) Nied.) and ayale (Crescentia alata Kunth) fruits

Nanchi (Byrsonima crassifolia), arrayan (Psidium sartorianum) and ayale (Crescentia alata) are wild and under-utilized plants from Mexico; their fruits have been used as food and as Mexican traditional remedies against human bacterial infections (e.g. bacillary dysentery). However, scientific reports which support such uses or promote their consumption are scarce. In this work, the antibacterial activities of fruit extracts (i.e. hexanic, HE; chloroformic, CE; and methanolic, ME) were determined by the micro-dilution assay, establishing the Minimum Inhibitory Concentration (MIC) and Minimum Bactericide Concentration (MBC) against 21 human pathogenic bacteria. The HE of arrayan and ayale showed the highest activity against enterobacteria (E. coli, Salmonella spp. and Shigella spp.) (MIC 0.25-2 mg/mL; MBC 0.5-16 mg/mL). The arrayan ME was the most active against the Gram-positive bacteria, showing Staphylococcus aureus the highest sensitivity (MIC 2 mg/mL; MBC 2-4 mg/mL). The presented results support the traditional uses of these plant materials for treating bacterial infectious diseases.

Nanchi (Byrsonima crassifolia), arrayán (Psidium sartorianum) y ayale (Crescentia alata) son plantas silvestres subutilizadas de México; sus frutos son comestibles y usados como medicamentos tradicionales contra infecciones bacterianas humanas (e.g. disentería bacilar). Sin embargo, los reportes científicos que avalen los usos y promuevan su consumo son escasos. En este trabajo se determinó, ensayo de micro-dilución en caldo, la Concentración Mínima Inhibitoria (CMI) y Concentración Mínima Bactericida (CMB), de los extractos de frutos (hexánico, EH; clorofórmico, EC; y metanólico, EM) contra 21 bacterias patógenas humanas. Los EH de arrayán y ayale mostraron la mayor actividad (CMI 0.25-2 mg/mL; CMB 0.5-16 mg/mL) contra enterobacterias (Escherichia coli, Salmonella spp. y Shigella spp.). El EM de arrayán fue el más activo contra bacterias Gram positivas, presentando Staphylococcus aureus la mayor sensibilidad (CMI 2 mg/mL; CMB 2-4 mg/mL). Estos resultados apoyan el uso tradicional de estos materiales en padecimientos asociados al tratamiento de infecciones bacterianas.

Correlation between the response to Mycobacterium tuberculosis antigens and the tuberculin skin test in patients with rheumatoid arthritis in Colombia / Correlación de la respuesta a antígenos de Mycobacterium tuberculosis y la prueba cutánea de tuberculina en pacientes con artritis reumatoide

Introduction. Rheumatoid arthritis patients under treatment with anti-TNF-α are at a high risk of developing active tuberculosis, and therefore, screening for latent tuberculosis infection is recommended before anti-TNF-α therapy. Objective. To compare the tuberculin test and IFNγ production induced by culture filtrate proteins(CFPs) and Mycobacterium tuberculosis-specific CFP-10 antigens in rheumatoid arthritis patients. Materials and methods. An analytic transversal study was conducted in rheumatoid arthritis patients treated at Hospital Universitario San Vicente Fundación between January and December 2007. IFNγ production in response to CFPs and CFP-10 was measured in the supernatants of whole blood cultures and evaluated for correlations with tuberculin reactivity. The degree of concordance between both tests was also established. Results. Forty-five patients were included, of which 14 (31.1%) had a tuberculin reaction of ≥10 mm of induration, 9 (20%) produced IFNγ in response to CFP-10, and 7 were positive for both tests. The correlation between tests was r=0.53 (IC 95%:0.28-0.72), and the global concordance between tests was80%, with a Kappa coefficient of 0.48 (IC95%:0.20-0.76). Conclusions. Only two tuberculin (-)/CFP-10+ "anergic" patients were observed. By contrast, six tuberculin +/CFP-10(-) "tuberculin false-positive" patients were observed. These data suggest that the tuberculin test is not an appropriate tool for determining the need for tuberculosis prophylaxis.

Introducción. Los pacientes con artritis reumatoide bajo tratamiento con anti-TNFα están en alto riesgo de desarrollar tuberculosis activa, por lo cual se recomienda hacer la tamización para infección latente de tuberculosis, antes de iniciar el tratamiento. Objetivo. Comparar la prueba de tuberculina y la producción de IFNγ inducida por antígenos CFP (Culture Filtrate Protein) y antígenos específicos de Mycobacterium tuberculosis (CFP-10) para el diagnóstico de infección latente de tuberculosis en pacientes con artritis reumatoide. Materiales y métodos. Se llevó a cabo un estudio transversal analítico en pacientes con artritis reumatoide atendidos en el Hospital Universitario San Vicente Fundación, entre enero y diciembre de 2007, a los cuales se les determinó la producción de IFNγ en respuesta a CFP y CFP-10 en sobrenadantes de cultivos de sangre total, y se correlacionó con la reacción en la prueba de tuberculina. Además, se estableció el grado de concordancia entre ambas pruebas. Resultados. Se incluyeron 45 pacientes, de los cuales, 14 (31,1 %) tuvieron un diámetro de induración ≥10 mm (tuberculina positiva), nueve (20 %) produjeron IFNγ en respuesta a CFP-10, y siete fueron positivos para ambas pruebas. La correlación entre las pruebas fue de r=0,53 (IC95%: 0,28-0,72) y la concordancia global entre pruebas fue de 80 %, con un coeficiente kappa de 0,48 (IC95%: 0,20-0,76). Conclusiones. Solo se observaron dos pacientes con tuberculina positiva y CFP-10 positivo "anérgicos" y se encontraron seis pacientes con tuberculina positiva y CFP-10 negativa "falsos positivos para tuberculina", lo cual sugiere que la prueba de la tuberculina no es la más adecuada para indicar profilaxis para tuberculosis.

Effectiveness and safety of iodopovidone in an experimental pleurodesis model

OBJECTIVES: Chemical pleurodesis is an important therapeutic tool to control recurrent malignant pleural effusion. Among the various sclerosing agents, iodopovidone is considered effective and safe. However, in a recent study, ocular changes were described after iodopovidone was used in recurrent pneumothorax. The aim of the study was to evaluate the efficacy and morbidity of iodopovidone pleurodesis in an experimental model. METHODS: New Zealand rabbits were submitted to intrapleural injection of iodopovidone at concentrations of 2%, 4% and 10%. Biochemical (lactic dehydrogenase, proteins, triiodothyronine, free thyroxine, urea and creatinine) and immunological (Interleukin-8 [IL-8], VEGF and TGFβ) parameters were measured in the pleural fluid and blood. After 1, 3, 7, 14 and 28 days, groups of animals were euthanized, and macro- (pleura) and microscopic (pleura and retina) analyses were performed. RESULTS: An early pleural inflammatory response with low systemic repercussion was observed without corresponding changes in thyroid or renal function. The higher concentrations (4% and 10%) correlated with greater initial exudation, and maximum pleural thickening was observed after 28 days. No changes were observed in the retinal pigment epithelium of the rabbits. CONCLUSION: Iodopovidone is considered to be an effective and safe sclerosing agent in this animal model. However, its efficacy, tolerance and safety in humans should be further evaluated. .

Síndrome antifosfolípido: descripción de una cohorte de pacientes colombianos y evaluación delos factores de riesgo para trombosis / Antiphospholipid syndrome: description of a cohort from Colombia and evaluation of thrombosis risk factors

Introducción: El síndrome antifosfolípido es una enfermedad autoinmune, caracterizada portrombosis vascular y morbilidad gestacional en presencia de anticuerpos antifosfolípidos. Se handescrito varios factores de riesgo para el desarrollo de trombosis en estos pacientes, pero losestudios son heterogéneos y no discriminan entre eventos arteriales y venosos.Objetivo: Describir las manifestaciones clínicas e inmunológicas del síndrome antifosfolípidoen una cohorte de pacientes colombianos y establecer los factores de riesgo para el desarrollode trombosis venosa y arterial.Materiales y métodos: Se condujo un estudio analítico de corte transversal. Criterio de inclusión:Consenso de Sydney de 2006 y clasificación del síndrome antifosfolípido como secundario, segúncriterios del American College of Rheumatology.Resultados: Se incluyeron 100 pacientes; 84 de ellos mujeres; edad promedio 37.6 años. El 59%de los pacientes correspondía a síndrome antifosfolípido secundario. La manifestación clínicamás frecuente inicial y durante el seguimiento fue la trombosis venosa (56.52% y 47%, respectivamente),seguida por “manifestaciones no criterio” (23.91%), especialmente neurológicas. Latrombosis venosa profunda fue recurrente en el 46%; 30% de los individuos presentó trombocitopeniasevera. La ausencia de autoanticuerpos específicos discriminó entre formas primariasy secundarias. La diabetes mellitus fue un factor de riesgo significativo para trombosis venosa(6.4% vs. 0%; OR 2.205, IC 95%: 1.772–2.742) y el tabaquismo para enfermedad cerebrovascular(33.3% vs. 6%, OR 7.9, IC 95%: 1.5–41.324).Conclusiones: Esta cohorte de pacientes colombianos con síndrome antifosfolípido presentaalto porcentaje de manifestaciones no incluidas en los criterios clasificatorios, con compromisoorgánico grave, atípico y recurrente.

Pleural tuberculosis: is radiological evidence of pulmonary-associated disease related to the exacerbation of the inflammatory response?

OBJECTIVE: Pleural tuberculosis is the most frequently occurring form of extra pulmonary disease in adults. In up to 40% of cases, the lung parenchyma is concomitantly involved, which can have an epidemiological impact. This study aims to evaluate the pleural and systemic inflammatory response of patients with pleural or pleuropulmonary tuberculosis. METHODS: A prospective study of 39 patients with confirmed pleural tuberculosis. After thoracentesis, a high resolution chest tomography was performed to evaluate the pulmonary involvement. Of the 39 patients, 20 exhibited only pleural effusion, and high resolution chest tomography revealed active associated-pulmonary disease in 19 patients. The total protein, lactic dehydrogenase, adenosine deaminase, vascular endothelial growth factor, interleukin-8, tumor necrosis factor-α, and transforming growth factor-β1 levels were quantified in the patient serum and pleural fluid. RESULTS: All of the effusions were exudates with high levels of adenosine deaminase. The levels of vascular endothelial growth factor and transforming growth factor-β1 were increased in the blood and pleural fluid of all of the patients with pleural tuberculosis, with no differences between the two forms of tuberculosis. The tumor necrosis factor-α levels were significantly higher in the pleural fluid of the patients with the pleuropulmonary form of tuberculosis. The interleukin-8 levels were high in the pleural fluid of all of the patients, without any differences between the forms of tuberculosis. CONCLUSION: Tumor necrosis factor-α was the single cytokine that significantly increased in the pleural fluid of the patients with pulmonary involvement. However, an overlap in the results does not permit us to suggest that cytokine is a biological marker of concomitant parenchymal involvement. Although high resolution chest tomography can be useful in identifying these patients, the investigation of fast acid bacilli and cultures for M. tuberculosis in the sputum is recommended for all patients who are diagnosed with pleural tuberculosis.

Síndrome de dificultad respiratoria secundario a miasis sinusal y traqueopulmonar / Acute respiratory distress syndrome secondary to sinus and tracheopulmonary myiasis

La miasis es una enfermedad causada por la infestación de larvas en tejidos vivos o muertos; se clasifica entomológicamente o según el tropismo por los tejidos. Se reporta un caso de síndrome de dificultad respiratoria aguda secundario a miasis sinusal y traqueopulmonar en un hombre de 65 años, quien ingresó al servicio con epistaxis y sensación de obstrucción nasal. Se le hizo diagnóstico de crisis hipertensiva, se dio tratamiento sintomático y se hizo taponamiento nasal. El paciente reingresó a las 24 horas por edema hemifacial derecho, bradilalia y dificultad respiratoria; se retiró el tapón nasal y se evidenció salida de larvas. Se remitió a una institución de tercer nivel de atención, en donde fue valorado por otorrinolaringología y decidieron revisar las vías respiratorias bajo anestesia general, y desobstruirlas por infestación masiva de larvas. El paciente fue trasladado a la unidad de cuidados intensivos donde se diagnosticó síndrome de dificultad respiratoria aguda, y fue tratado con ivermectina y antibióticos. Posteriormente, se obtuvo una evolución satisfactoria a pesar de la gravedad del cuadro clínico. Se presenta un caso de síndrome de dificultad respiratoria aguda secundario a miasis sinusal y traqueopulmonar, y parece ser el primer caso reportado en Latinoamérica. Se destaca la adecuada evolución posterior al manejo médico sintomático y específico, a pesar de la alta mortalidad de este sindrome.

Myiasis is a disease caused by the infestation of larvae in dead or living tissue. It is classified entomologically or according to tropism of the tissues. We report a case of acute respiratory distress syndrome (ARDS) secondary to sinus and tracheopulmonary myiasis in a 65-year-old man who entered the service with epistaxis and nasal obstruction sensation. He was diagnosis with a hypertensive crisis, and symptomatic management and nasal plugging were performed. The patient was readmitted 24 hours later with right hemifacial edema, bradylalia and breathing difficulty. The nasal plug was removed and larvae came out. He was referred to a tertiary level care facility where he was assessed by otolaryngology and they decided to check the airways under general anesthesia to remove the blockage caused by a massive infestation of larvae. The patient was transferred to the ICU where he was diagnosed with ARDS, and managed with ivermectin and antibiotics. Subsequently, a satisfactory evolution, despite the severity of symptoms, was attained. We report a case of ARDS secondary to sinus and trachoepulmonary myiasis, the first case reported in Latin America. We highlight the satisfactory evolution after medical symptomatic and specific management, despite the high mortality of this disease.

Consumo de alcohol y sustancias adictivas en población escolar de 7 centros educativos municipio de Managua, Septiembre – Octubre del 2011 / Alcohol and substance abuse in schoolchildren from seven schools municipality of Managua, September-October 2011

Estudio descriptivo de corte transversal. Se concluye que los estudiantes entrevistados en su mayoría son adolescentes, del sexo masculino, religión católica. Habitan viviendas propias con una mediana de 3 dormitorios. Los convivientes de los estudiantes son principalmente familiares cercanos. La décima parte de los convivientes adultos fuman, un poco más ingiere licor y casi cuatro de cada cien de ellos usa o ha usado algún tipo de droga. Uno de cada tres estudiantes declara fumar o haber fumado, La mayoría son varones que han iniciado entre los 15 y 19 años. Prácticamente uno de cada tres estudiantes declara ingerir o haber ingerido licor, la mayoría son varones, entre 15 y 19 años. Cerca de cinco de cada cien estudiantes consumen o han consumido algún tipo de droga ilícita. La mayoría son varones que iniciaron el consumo entre 15 y 19 años. La clase de drogas con que se inician la mayoría de los estudiantes es la Marihuana, seguida por Crack o Cocaína, pero la tasa de abandono parece ser importante. La mayoría de los estudiantes tienen la percepción que dentro de los colegios se fuma, se ingiere licor y que se comercia y consumen drogas, también afirman la existencia de expendios de licor y drogas cercanos a los colegios.Los estudiantes, de forma mayoritaria piensan que los principales motivos para el consumo de sustancias ilícitas son: Curiosidad, Imitación, Presión de los amigos y stress emocional y proponen principalmente las siguientes medidas para prevención y control: Charlas educativas, aplicación de la prohibición de venta a menores, Mas vigilancia en los centros educativos y aumentar la Consejería escolar

É possível diferenciar derrames pleurais linfocíticos secundários a tuberculose ou linfoma através de variáveis clínicas e laboratoriais? / Differentiating between tuberculosis-related and lymphoma-related lymphocytic pleural effusions by measuring clinical and laboratory variables: Is it possible?

OBJETIVO: Descrever características clínicas e laboratoriais em pacientes com derrames pleurais linfocíticos secundários a tuberculose ou linfoma, a fim de identificar as variáveis que possam contribuir no diagnóstico diferencial dessas doenças. MÉTODOS: Estudo retrospectivo com 159 pacientes adultos HIV negativos com derrame pleural linfocítico secundário a tuberculose ou linfoma (130 e 29 pacientes, respectivamente) tratados no Ambulatório da Pleura, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP), entre outubro de 2008 e março de 2010. RESULTADOS: A média de idade e de duração dos sintomas foi menor no grupo tuberculose que no grupo linfoma. Os níveis pleurais de proteínas, albumina, colesterol, amilase e adenosina desaminase (ADA), assim como os níveis séricos de proteínas, albumina e amilase, foram maiores no grupo tuberculose, enquanto os níveis séricos de colesterol e triglicérides foram maiores no grupo linfoma. As contagens de leucócitos e linfócitos no líquido pleural foram maiores no grupo tuberculose. Células malignas estavam ausentes no grupo tuberculose, entretanto, linfócitos atípicos foram observados em 4 desses pacientes. No grupo linfoma, a citologia para células neoplásicas foi positiva, suspeita e negativa em 51,8%, 24,1% e 24,1% dos pacientes, respectivamente. A imunofenotipagem do líquido pleural foi conclusiva na maioria dos pacientes com linfoma. CONCLUSÕES: Nossos resultados demonstram semelhanças clínicas e laboratoriais entre os pacientes com tuberculose ou linfoma. Embora os níveis de proteínas e ADA no líquido pleural tendam a ser mais elevados no grupo tuberculose que no grupo linfoma, mesmo essas variáveis mostraram uma sobreposição. Entretanto, nenhum paciente com tuberculose apresentou níveis de ADA no líquido pleural inferiores ao ponto de corte (40 U/L).

OBJECTIVE: To describe clinical and laboratory characteristics in patients with tuberculosis-related or lymphoma-related lymphocytic pleural effusions, in order to identify the variables that might contribute to differentiating between these diseases. METHODS: This was a retrospective study involving 159 adult HIV-negative patients with tuberculosis-related or lymphoma-related lymphocytic effusions (130 and 29 patients, respectively), treated between October of 2008 and March of 2010 at the Pleural Diseases Outpatient Clinic of the University of São Paulo School of Medicine Hospital das Clínicas Heart Institute, in the city of São Paulo, Brazil. RESULTS: Mean age and the mean duration of symptoms were lower in the tuberculosis group than in the lymphoma group. The levels of proteins, albumin, cholesterol, amylase, and adenosine deaminase (ADA) in pleural fluid, as well as the serum levels of proteins, albumin, and amylase, were higher in the tuberculosis group, whereas serum cholesterol and triglycerides were higher in the lymphoma group. Pleural fluid leukocyte and lymphocyte counts were higher in the tuberculosis group. Of the tuberculosis group patients, none showed malignant cells; however, 4 showed atypical lymphocytes. Among the lymphoma group patients, cytology for neoplastic cells was positive, suspicious, and negative in 51.8%, 24.1%, and 24.1%, respectively. Immunophenotyping of pleural fluid was conclusive in most of the lymphoma patients. CONCLUSIONS: Our results demonstrate clinical and laboratory similarities among the patients with tuberculosis or lymphoma. Although protein and ADA levels in pleural fluid tended to be higher in the tuberculosis group than in the lymphoma group, even these variables showed an overlap. However, none of the tuberculosis group patients had pleural fluid ADA levels below the 40-U/L cut-off point.