Recomendações científicas de boas práticas para o cuidado de enfermagem ao idoso em tratamento hemodialítico / Scientific recommendations for good practice in nursing care of the elderly on hemodialysis / Recomendaciones científicas para una buena práctica en los cuidados de enfermería a los ancianos en hemodiálisis

Objetivo: descrever recomendações científicas de boas práticas para o cuidado de enfermagem a pessoa idosa em tratamento hemodialítico. Método: scoping review, seguindo Manual do Instituto Joanna Briggs, conforme questão norteadora: "Quais são as recomendações científicas de boas práticas para o cuidado de enfermagem ao idoso em tratamento hemodialítico?". Critérios de inclusão: apresentar no título ou resumo as palavras "idoso", "hemodiálise" ou "tratamento hemodialítico". Exclusão: artigos duplicados, publicações que não abordem a hemodiálise, artigos incompletos ou indisponíveis. Resultados: Incluídos 13 artigos, dos quais emergiram as categorias: educação em saúde; assistência de enfermagem e cuidados paliativos. Como fortalezas do cuidado identificou-se: fortalecimento da autonomia, autocuidado, tomada de decisão, processo de enfermagem e identificação de condições de fragilidade e qualidade de vida. Conclusão: destaca-se a educação em saúde e utilização de escalas/instrumentos de avaliação como práticas importantes no cuidado a pessoa idosa em hemodiálise, sendo necessário fortalecer a temática dos cuidados paliativos.

Objective: to describe scientific recommendations of good practice for nursing care to the elderly on hemodialysis. Method: scoping review, following the Joa- nna Briggs Institute Manual, according to the guiding question: "What are the scientific recommendations of good practice for nursing care to the elderly on hemodialysis? Inclusion criteria: to include in the title or abstract the words "elderly", "hemodialysis" or "hemodialysis treatment". Exclusion: duplicate articles, publications that do not address hemodialysis, incomplete or unavailable articles. Results: Thirteen articles were included, from which emerged the categories: health education, nursing care and palliative care. Como fortalezas do cuidado identificou-se: fortalecimento da autonomia, autocuidado, tomada de decisão, processo de enfermagem e identificação de condições de fragilidade e qualidade de vida. Conclusão: destaca-se a educação em saúde e utilização de esca- las/instrumentos de avaliação como práticas importantes no cuidado a pessoa idosa em hemodiálise, sendo necessário fortalecer a temática dos cuidados paliativos.

Objetivo: describir recomendaciones científicas de buena práctica en cui- dados de enfermería a ancianos en hemodiálisis. Método: scoping review, siguiendo el Manual del Instituto Joanna Briggs, según la pregunta guía: "¿Cuáles son las recomen- daciones científicas de buena práctica para los cuidados de enfermería a los ancianos en hemodiálisis? Criterios de inclusión: presentar en el título o resumen las palabras "anci- ano", "hemodiálisis" o "tratamiento de hemodiálisis". Criterios de exclusión: artículos duplicados, publicaciones que no aborden la hemodiálisis, artículos incompletos o no dis- ponibles. Resultados: Incluídos 13 artigos, dos quais emergiram as categorias: educação em saúde; assistência de enfermagem e cuidados paliativos. Como fortalezas del cuidado se identificaron: fortalecimiento de la autonomía, autocuidado, toma de decisiones, pro- ceso de enfermería e identificación de las condiciones de fragilidad y calidad de vida. Conclusão: destaca-se a educação em saúde e a utilização de escalas/instrumentos de ava- liação como práticas importantes no cuidado a pessoa idosa em hemodiálise, sendo ne- cessário reforçar a temática dos cuidados paliativos.

Adult hemophagocytic syndrome with mutations in UNC13D and MYO5A genes: a case report and literature review / 中国综合临床

Objective:To explore the pathogenesis of primary hemophagocytic syndrome with UNC13D and MYO5A gene mutations.Methods:A case of adult hemophagocytic syndrome with gene mutation of UNC13D and MYO5A admitted to The 940th Hospital of the Joint Logistic Support Force of the PLA on January 28, 2022 was retrospectively analyzed in terms of laboratory examination, gene atlas of its close relatives and prognosis, and related literature was reviewed.Results:The patient was finally diagnosed with primary hemophagocytic syndrome, and chemotherapy was performed twice with hemophagocytic lymphohistiocytosis(HLH)-2004 regimen. The HLA matching of his cytoplasm was semi-compatible. Considering that his cytoplasm carried blood-macrophage related genes, it was not suitable to be selected as a donor, and there were no other suitable relatives. He was transferred to another hospital for allogeneic hematopoietic stem cell transplantation, but failed to receive allogeneic hematopoietic stem cell transplantation during telephone follow-up, and died.Conclusion:The gene mutation of primary hemophagocytic syndrome is the gold standard for the diagnosis of primary HLH. There may be dual gene inheritance pattern in primary HLH, and the combination of immune disorder caused by viral infection and genetic factors may lead to the pathogenesis of primary HLH.

Dois anos de pandemia da COVID-19: implicações para as salas de hemodinâmica e suas práticas atuais / Two years into the COVID-19 pandemic: implications for the cardiac catheterization laboratory and its current practices

A COVID-19 continua a sobrecarregar os sistemas de saúde. No auge da pandemia, os serviços de hemodinâmica do mundo todo tiveram redução significativa no volume de procedimentos devido a vários motivos, incluindo redistribuição de recursos médicos, alocação dos cardiologistas intervencionistas em alas da COVID-19 e preocupações dos médicos e pacientes com a transmissão viral. Em especial, as intervenções para doença cardíaca estrutural tiveram queda importante ­ de mais de 90% do volume. Para enfrentar esses desafios, os sistemas de saúde empregaram novas medidas de segurança e protocolos, incluindo pré-teste com reação em cadeia da polimerase para COVID-19, Equipamentos de Proteção Individuais e exigência de vacinação para garantir a segurança de pacientes e trabalhadores da saúde. Embora tais medidas tenham abordado parcialmente as questões de segurança, o diagnóstico e o tratamento da injúria miocárdica aguda permaneceram desafiadores durante a pandemia. Enquanto os mecanismos fisiopatológicos que causam injúria miocárdica não estão completamente elucidados, a maioria dos estudos sugere que a COVID-19 seja uma doença pró-inflamatória, associada a um estado de hipercoagulabilidade. Os estudos randomizados em andamento avaliam a eficácia de regimes antitrombóticos mais agressivos na COVID-19. Além disso, a apresentação de síndrome coronariana aguda junto da COVID-19 é variável, mais provavelmente atípica, tardia e está associada a altas taxas de eventos cardiovasculares adversos e óbito. É necessário implementar protocolos para agilizar diagnóstico, triagem e tratamento de pacientes com síndrome coronariana aguda, e também minimizar o risco de transmissão viral para os funcionários do hospital. A intervenção coronariana percutânea robótica oferece uma solução em potencial para as diversas questões de segurança enfrentadas pelos cardiologistas intervencionistas na era da COVID-19. Porém, ela também se apresenta com seu conjunto de limitações.

COVID-19 continues to overwhelm healthcare systems. During the peak of the pandemic, cardiac catheterization labs across the world observed a significant decrease in procedure volumes due to several reasons, including reallocation of medical resources, deployment of interventional cardiologists to the COVID-19 wards, and physician and patient concerns about viral transmission. In particular, structural heart disease interventions experienced a significant reduction in volume by more than 90%. To address these challenges, healthcare systems employed new safety measures and protocols, including COVID-19 rapid polymerase chain reaction pretesting, Personal Protective Equipment, and vaccination mandates to ensure safety of patients and healthcare workers. Although these measures partly addressed safety concerns, diagnosis and management of acute myocardial injury remained challenging throughout the pandemic. While the pathophysiological mechanisms leading to myocardial injury is not fully elucidated, most studies have suggested COVID-19 is a pro-inflammatory disease associated with a hypercoagulable state. Ongoing randomized studies are evaluating the efficacy of more aggressive antithrombic regimens in COVID-19. In addition, the presentation of acute coronary syndrome with concomitant COVID-19 infection is variable, more likely atypical, delayed, and is associated with higher rates of adverse cardiovascular events and death. It was necessary to implement protocols to expedite diagnosis, triage and management of patients with acute coronary syndrome, while minimizing the risk of viral transmission to hospital staff. Robotic percutaneous coronary intervention may offer in the future a potential solution to many of the safety concerns faced by interventional cardiologists during the COVID-19 era; however, it has its own set of limitations.

Alternativas diagnósticas y terapéuticas para las porfirias hepáticas agudas en adultos, desde una perspectiva actual

RESUMEN Introducción: Las porfirias hepáticas agudas son un trastorno genético causado por actividad irregular en la síntesis del grupo hemo. Aunque son de baja incidencia, su presencia puede aumentar el riesgo de muerte y afectar la calidad de vida de los pacientes. Se realizó una búsqueda bibliográfica con un intervalo desde el año 2015 al 2020, sobre porfirias hepáticas agudas. Objetivos: Actualizar sobre las alternativas diagnósticas y terapéuticas para las porfirias hepáticas agudas en adultos. Desarrollo: La exposición a ciertos factores precipitantes como fármacos, infecciones y estrés, conllevan a una crisis aguda de porfiria, que desencadenan síntomas neuroviscerales y requiere hospitalización. Existen teorías aisladas que explican el mecanismo de daño durante el ataque agudo, como la hiperactividad autónoma, inflamación, disfunción endotelial, mitocondrial, lesión renal y neurotoxicidad. Sin embargo, el reconocimiento clínico de estos mecanismos sin un diagnóstico conocido de porfiria es un reto para el personal médico, debido a la presencia de síntomas y signos inespecíficos, lo que retrasa el diagnóstico. Debido a la dependencia de la hemina de por vida, se han optado por nuevas alternativas terapéuticas como la supresión genética y el trasplante hepático. El pronóstico es favorable cuando se realiza el diagnóstico a tiempo. Conclusiones: Las alternativas diagnósticas y terapéuticas para las porfirias hepáticas agudas en adultos han evolucionado hacia el trasplante ortotópico hepático y la terapia génica, la cual se ha convertido en un enfoque terapéutico prometedor y validado para el tratamiento de los pacientes con porfirias hepáticas.

ABSTRACT Introduction: Acute hepatic porphyria is a genetic disorder caused by irregular activity in the synthesis of the heme group. Although they are of low incidence, their presence can increase the risk of death and affect the quality of life of patients. A bibliographic search was carried out with a time interval from 2015 to 2020 on acute hepatic porphyria. Objectives: To update on the diagnostic and therapeutic alternatives for acute hepatic porphyria in adults. Development: Exposure to certain precipitating factors such as drugs, infections, and stress leads to an acute porphyria crisis, which triggers neurovisceral symptoms and requires hospitalization. There are isolated theories that explain the mechanism of damage during the acute attack, such as autonomic hyperactivity, inflammation, endothelial and mitochondrial dysfunction, kidney damage, and neurotoxicity. However, clinical recognition of these mechanisms without a known diagnosis of porphyria is challenging for medical personnel, due to the presence of nonspecific symptoms and signs, delaying diagnosis. Due to the dependence on hemin for life, new therapeutic alternatives such as gene suppression and liver transplantation have been chosen. The prognosis is favorable when the diagnosis is made in time. Conclusion: Diagnostic and therapeutic alternatives for acute hepatic porphyria in adults have evolved towards orthopedic liver transplantation and gene therapy, which has become a promising and validated therapeutic approach for the treatment of patients with hepatic porphyria.

Porfiria hepato eritropoyética asociada a diabetes mellitus tipo 1: a propósito de un caso clínico / A clinical case of hepato-erythropoietic porphyria associated with type 1 diabetes mellitus / Relato de caso de porfiria hepato-eritropoiética associada a diabetes mellitus tipo 1

Las porfirias son un grupo complejo y heterogéneo de defectos en la vía de la síntesis del hemo. La porfiria hepato eritropoyética es un subtipo muy poco frecuente y de presentación en la infancia, con compromiso cutáneo predominante. Describimos el caso clínico de una paciente de 5 años, que se presenta con lesiones cutáneas e hipertricosis, se confirma el diagnóstico por elevación de uroporfirinas en orina y secuenciación del gen UROD.

Porphyria is a complex and heterogeneous group of heme synthesis disorder. Hepato-erythropoietic porphyria is a very rare subtype that onsets in childhood, and shows predominant skin involvement. We describe the clinical case of a 5-year-old patient who showed skin lesions and hypertrichosis and whose diagnosis was confirmed due to increased uroporphyrins in urine and UROD gene sequencing

A porfiria é um grupo complexo e heterogêneo de distúrbios da síntese do grupo heme. A porfiria hepato-eritropoiética é um subtipo muito raro que se inicia na infância e mostra envolvimento predominante da pele. Descrevemos o caso clínico de uma paciente de 5 anos que apresentou lesões cutâneas e hipertricose e cujo diagnóstico foi confirmado por aumento de uroporfirinas na urina e sequenciamento do gene UROD.

Porfiria eritropoyética. presentración de un caso / Erythropoietic porphyria. a case report

RESUMEN Las porfirias constituyen un grupo de trastornos, causados por defectos en la vía de síntesis del grupo hemo. En la porfiriaeritropoyética congénita, existe deficiencia de la uroporfirinógenosintetasa, lo que a su vez provoca acumulación de grandes cantidades de uroporfirina I en todos los tejidos, dando lugar a fotosensibilidad con lesiones mutilantes de la piel,eritrodoncia, anemia hemolítica, esplenomegalia y fragilidad ósea. El diagnóstico definitivo se fundamenta en la demostración de la actividad deficiente de la uroporfirinógenosintetasa o la determinación de mutaciones específicas en el gen respectivo;su tratamiento requiere colaboración multidisciplinaria. En el presente artículo se describe un caso de porfiriaeritropoyética, con la presentación clínica dermatológica muy característica.

SUMMARY Porphyrias are a group of disorders caused by defects in the synthesis pathway of heme. Congenital erythropoietic porphyria is characterized by uroporphyrinogen synthase deficiency, which causes accumulation of large amounts of uroporphyrin Iin all tissues; resulting in photosensitivity with mutilating skin lesions, erythrodontia, hemolytic anemia, splenomegaly, and bone fragility. Definitive diagnosis is based on demonstrating poor uroporphyrinogen synthase activity or determination of specific mutations in the respective gene; treatment requires multidisciplinary collaboration. A case of erythropoietic porphyria, with classical dermatological clinical presentation is reported.

Effect of pituitrin-water separation in laparoscopic removal of ovarian chocolate cyst and its effect on ovarian function / 中国基层医药

Objective To investigate the effect of pituitrin-water separation on hemoglobin and ovarian func-tion in laparoscopic ovarian chocolate cyst removal.Methods From February 2018 to February 2019,82 patients with ovarian chocolate cyst removed by laparoscopy were selected from the Second Affiliated Hospital of Wenzhou Medical University.They were randomly divided into observation group and control group according to the digital table,with 41 cases in each group.The control group underwent traditional laparoscopic tear-and-tear ovarian cyst removal,while the observation group underwent pituitrin-water separation.The changes of perioperative indicators ,the decrease of hemoglobin (Hb) before and after operation ,the positive rate of normal ovarian tissue on cyst wall and the number of normal follicles attached to cyst wall ,the changes of serum hormone levels before and after operation were compared between the two groups.Results The amount of bleeding during operation in the observation group [(58.97 ±8.74)mL] was less than that in the control group [(118.93 ±24.21)mL],and the operation time in the observation group[(57.46 ±8.27) min] was shorter than that in the control group [(87.38 ±10.19) min] ,the differences were ststistically significant between the two group ( t ＝14.916,14.598,all P ＜0.05 ).There was no statistically significant difference in the time of anal exhaust between the two groups (P＞0.05).The decrease of Hb in the observation group [(0.71 ±0.16)g／L] was lower than that in the control group [(1.27 ±0.35) g／L] ( t＝9.318,P＜0.05).The positive rate of normal ovarian tissue on cyst wall in the observation group (21.95%) was lower than that in the control group (56.10%),the number of normal follicles attached to the cyst wall in the obser-vation group (2.65 ±0.49) was less than that in the control group (4.86 ±1.24) ,the differences were ststistically significant between the two group ( χ2 ＝10.045, t ＝10.613, all P ＜0.05).The serum level of E2 [( 398.21 ± 17.84)pmol／L] in the observation group was higher than that in the control group [(367.83 ±15.21) pmol／L], while FSH [(6.72 ±0.28)mIU／mL] and LH [(5.23 ±0.38)mIU／mL] levels in the observation group were lower than those in the control group [(7.19 ±0.35)mIU／mL and (5.69 ±0.31)mIU／mL],the differences were ststisti-cally significant between the two group (t＝8.298,6.714,6.006,all P＜0.05).Conclusion The method of pitui-trin-water separation is effective in laparoscopic ovarian chocolate cyst removal ,which can reduce the injury during operation,has little effect on hemoglobin and improve the ovarian reserve function of patients .

Inhibición de la formación de ß-hematina de especies colombianas de Piper spp. y Calophyllum spp. como potenciales agentes antimaláricos / Inhibition of ß-hematin formation of Colombian species of Piper spp. and Calophyllum spp. as potential antimalarial agents

Resumen Nuevos agentes antimaláricos a partir de plantas son estudiados como alternativas en el tratamiento de la malaria. Los principales antimaláricos como la cloroquina tienen varios mecanismos de acción contra parásitos, uno de ellos es la inhibición de polimerización del grupo hemo, modelo que ha permitido el diseño de nuevos candidatos antimaláricos. En este sentido, el objetivo de este trabajo fue evaluar extractos de plantas de género Piper y Calophyllum sobre la capacidad de inhibición de la β-hematina. Se informa las concentraciones inhibitorias de la formación de β-hematina por parte de 40 extractos de diferente polaridad obtenidos a partir de las especies P. piedecuestanum, C. brasiliense, C. longinforium, y Calophyllum. sp. 19 extractos mostraron un mayor potencial para inhibir la formación de β−hematina con CI50 < 3mg / ml. Estas actividades respaldan principalmente, futuros estudios con el género Calophyllum, en el desarrollo y descubrimiento de nuevas sustancias antiplasmodiales con modos de acción conocido.(AU)

Abstract New antimalarial agents from plants are studied as alternatives in the treatment of malaria. The main antimalarials such as chloroquine have several mechanisms of action against parasites, one of which is the inhibition of polymerization of the heme group, a model that has allowed the design of new antimalarial candidates. In this sense the objective of this work was to evaluate extracts of genus Piper and Calophyllum plants on the inhibition capacity of β-hematin. Inhibitory concentrations of β-hematin are reported from 40 extracts of different polarity obtained from the species P. piedecuestanum, C. brasiliense, C. longinforium, and Calophyllum. sp. 19 extracts showed a greater potential to inhibit β-hematin with IC50 < 3 mg/ml. These activities mainly support future studies with the genus Calophyllum in the development and discovery of new antiplasmodial substances with known modes of action.(AU)

Prevalencia de Malassezia spp en pacientes con diabetes mellitus tipo 2 de acuerdo con el control glucémico / Prevalence of Malassezia spp in type 2 diabetes mellitus according to glycemic control

Resumen ANTECEDENTES: Malassezia spp es un saprófito de la piel, relacionada con diversas afecciones cutáneas, se ha reportado frecuencia elevada en pacientes con inmunosupresión. OBJETIVO: determinar la prevalencia de Malassezia spp en individuos con diabetes mellitus tipo 2 de acuerdo con el control glucémico. MATERIAL Y MÉTODO: estudio abierto, observacional, descriptivo y transversal, efectuado en pacientes voluntarios que participaron en la 24ª Carrera Nacional del Paciente con Diabetes el 15 de octubre de 2016 en la Ciudad de México, en quienes se realizó toma de glucemia capilar preprandial y hemoglobina glicosilada, así como pesquisa de Malassezia spp mediante frotis de la región malar, teñido con azul de metileno. RESULTADOS: se incluyeron 49 pacientes con diabetes mellitus tipo 2; hubo predominio de 31 pacientes sin buen control glucémico (67%) en comparación con 16 pacientes controlados (33%). Los frotis con levaduras escasas (+) estuvieron presentes en 21 (59%) pacientes sin control y en 7 (41%) pacientes con control; los frotis con cantidad de levaduras moderada (++) se observaron en 7 (74%) pacientes sin control y en 5 (26%) pacientes con control; los frotis con levaduras abundantes estuvieron presentes en 7 (63%) pacientes sin control y en 2 (37%) pacientes con control. CONCLUSIÓN: en nuestro estudio la prevalencia de Malassezia spp en pacientes con diabetes mellitus tipo 2 fue del 100%, con menor número de levaduras en los que tenían control glucémico adecuado, lo que puede indicar que la posibilidad de tener esta levadura aumenta con el descontrol glucémico y probablemente denota el grado de inmunosupresión en estos pacientes.

Abstract BACKGROUND: Malassezia spp is a saprophyte of the skin, related to diverse cutaneous affections, and has been reported a high frequency in patients with immunosuppression. OBJECTIVE: To determine the prevalence of Malassezia spp in individuals with type 2 diabetes mellitus according to glycemic control. MATERIAL AND METHOD: An open, observational, descriptive and cross-sectional study was performed in volunteer patients who participated in the 24th National March of the Patient with Diabetes in Mexico City on October 15, 2016; where preprandial capillary glycemia and glycosylated hemoglobin were taken. We took a scraping of the malar region skin to find Malassezia spp, smears stained with methylene blue. RESULTS: A total of 49 patients with type 2 diabetes mellitus were included; there were a predominance of 31 patients without glycemic control (67%) in comparison with 16 controlled patients (33%). Smears with low yeast (+) were present in 21 (59%) uncontrolled patients and in 7 (41%) controlled patients; smears with a moderate amount of yeast (++) were present in 7 (74%) uncontrolled patients and in 5 (26%) controlled patients; smears with abundant yeasts were present in 7 (63%) uncontrolled patients and in 2 (37%) controlled patients. CONCLUSION: In our study the prevalence of Malassezia spp in patients with type 2 diabetes mellitus was of 100%, with a lower number of yeasts in patients with adequate glycemic control; this can indicate that the possibility of presenting this yeast increases with bad glycemic control and probably denotes the degree of immunosuppression in these patients.

Analysis on modified Wenjingtongluo Decoction combined with acupunctureand moxibustion for improving ESR ,Fib and hemorheology indexes in patients with cervical spondylosis / 国际检验医学杂志

Objective To observe the effect of Wenjingtongluo Decoction combined with acupuncture and moxibustion on eryth-rocyte sedimentation rate (ESR) ,fibrinogen(Fib) and hemorheology indicators in the patients with cervical spondylosis .Methods 112 patients with cervical spondylosis from March 2010 to March 2015 were selected and divided into the Western medicine group and comprehensive treatment group ,56 cases in each group .The Western medicine group adopted the Western medicine treatment , while on this basis the comprehensive treatment group was assisted by the modified Wenjingtongluo Decoction plus acupuncture and moxibustion .The changes of ESR ,Fib ,C reactive protein (CRP) ,hematocrit(PCV) ,pain visual analogue scale(VAS) and hemorhe-ology indicators and curative effect were analyzed and compared between the two groups .Results The levels of CRP ,ESR ,Fib , PCV and VAS after 2-week treatment in the comprehensive treatment group were significantly lower than those in the Western medicine group(P<0 .05);the whole blood high shear reduced viscosity ,whole blood low shear reduced viscosity ,plasma viscosity , erythrocyte aggregation index ,erythrocyte electrophoresis time and platelet electrophoresis time after 2-week treatment in the com-prehensive treatment group were significantly lower than those before treatment (P<0 .05) ,while which in the Western medicine group had no statistical difference between before and after treatment (P>0 .05);the cure rate and total effective rate in the com-prehensive treatment group were 37 .50% and 94 .64% respectively ,which in the Western medicine group were 17 .86% and 80 .36% respectively ,the difference was statistically significant (P<0 .05) .Conclusion Modified Wenjingtongluo Decoction com-bined with acupuncture and moxibustion can significantly improve the clinical symptoms in the patients with cervical spondylosis and is worth clinical promotion and appliaction .

Application of magnetic resonance enterography and ectopic gastric mucosa imaging in children with lower gastrointestinal hemorrhage / 中华实用儿科临床杂志

Objective To evaluate the diagnostic value of magnetic resonance enterography(MRE)and ectopic gastric mucosa imaging(EGMI)in children with lower gastrointestinal hemorrhage.Methods The clinical data including gender,age,amount of bleeding and preoperative minimum hemoglobin(Hb)levels of 54 children with lower gastrointestinal hemorrhage were collected,who received surgical exploration in Department of Pediatric Surgery,Anhui Provincial Children's Hospital between February 2014 and April 2016.Children were divided into lesion group and non-lesion group according to the findings of surgical exploration.Lesion group were defined as children with Meckel's diverticulum(MD)or duplication of the small intestine by surgery and postoperative pathological findings.A total of 36 cases,25 cases of boys,11 cases of girls,aged(2.86±1.59)years old.Non-lesion group were defined as children,who underwent operation with negative result or with lesions but not MD or duplication of the small intestine.A total of 18 cases,14 cases of boys,4 cases of girls,aged(3.87±1.62)years old.MRE and EGMI were performed when the children stopped bleeding,before the inspection,should fasting for 4-6 h.SPSS 13.0 software was used for statistical processing.The evaluation of EGMI,MRE and the both in diagnosing MD or duplication of the small intestine were conducted by receiver operating characteristic curve(ROC).According to the principles of biggest gain best diagnostic value by Youden index,and the degree of sensitivity and specificity was calculated at this time,P0.05).There were statistically significant differences in age,amount of bleeding and preoperative minimum hemoglobin levels(t=2.179,2.027,2.222,all P<0.05).There were statistically significant differences in classification comparison by EGMI and MRE between 2 groups(x2=15.226,29.121,all P<0.01).The optimal cut-off value of EGMI and MRE in the diagnosis of enteric malformation was more than level 3,and the suspected positive and being positive value was assigned as positive results.According to the cut-off value above,EGMI,MRE and EGMI plus MRE in series and in parallel in the diagnosis of enteric malformation,the areas under curves(AUC)were 0.809,0.917,0.750 and 0.847,respectively.The sensitivity was 61.1％,75.0％,55.6％and 80.6％,respectively.The specificity was 90.4％,94.4％,94.4％and 88.9％,respectively.The Youden's indexes were 0.515,0.694,0.500 and 0.695,respectively.The optimal cut-off value of age and preoperative minimum hemoglobin levels in the diagnosis of enteric malformation were 2.92 years and 80 g/L,respectively.The AUC was 0.761 and 0.672.The Youden's indexes were 0.515 and 0.333.There was no significant differences statistically in AUC compared with age,MRE and EGMI(all P<0.05).Conclusions The high diagnostic value in children with lower gastrointestinal hemorrhage is found by using MRE and EGMI.Then,MRE as a separate diagnosis method is also worthy of clinical application.

Metabolismo del hemo: las dos caras de los efectos de la acumulación de precursores y porfirinas / Heme metabolism: the janus nature of precursorsand porphyrins / Metabolismo do hemo: as duas faces dos efeitos da acumulação de precursores e porfirinas

Las porfirias son enfermedades metabólicas consecuencia de fallas en la biosíntesis del hemo, caracterizadas por un patrón específico de acumulación y excreción de intermediarios, responsables de su patofisiología. En las porfirias agudas el exceso de ácido d-aminolevúlico (ALA) produce una sintomatología neuroabdominal asociada al daño oxidativo por formación de especies reactivas de oxígeno (ROS), originadas por autooxidaxión del ALA. En las cutáneas, la sintomatología es producto de la acumulación de porfirinas, que como el ALA, inducen la formación de ROS. Su desencadenamiento se precipita por factores endógenos (ayuno, estrés, hormonas) y/o exógenos (fármacos), en particular algunos anestésicos. Se presenta una revisión de los estudios bioquímicos y genéticos en pacientes con diferentes porfirias obtenidos en el Centro de Investigaciones de Porfirias y Porfirinas (CIPYP), durante los últimos 38 años, que permitieron ampliar el conocimiento sobre las bases moleculares sobre estas patologías. Se describen los logros resultantes del empleo de modelos experimentales de porfiria, inducida farmacológica o genéticamente, que contribuyeron a la clasificación de algunas drogas como prohibidas para pacientes con porfiria. Finalmente, las porfirinas generadoras de ROS, y por ende inductoras de muerte celular, tienen su aplicación para combatir infecciones por organismos hemo-deficientes como Trypanosoma cruzi y también para ser utilizadas como fotosensibilizadores en la terapia fotodinámica (TFD).

Porphyrias comprise a group of metabolic disorders of the heme biosynthesis pathway resulting in a specific accumulation and excretion of intermediates which are responsible for their pathophysiology. Acute porphyrias are characterized by acute neurovisceral symptoms due to the overproduction and accumulation of d-aminolevulinic acid (ALA) which leads to an oxidative damage resulting from the formation of reactive oxygen species (ROS). In cutaneous porphyrias, the symptomatology is a result of porphyrin accumulation which also induces ROS moulding. In both cases, their clinical signs are precipitated by endogenous factors (stress, hormones, low calories intake) and/or exogenous drugs, in particular some anaesthetics. A review of the biochemical and genetic results obtained from patients with different porphyrias, diagnosed at the CIPYP during the last 38 years is presented here, aimed at obtaining additional evidence about the molecular nature of these disorders. The achievements obtained from experimental porphyria models -pharmacologically or genetically induced- are also described, which contributed to the classification of some drugs as prohibited for their use in porphyric patients. Finally, as porphyrins produce ROS and therefore cellular death, they can be used to treat infections by heme-deficient organisms like Trypanosoma cruzi and also as photosensitizers in photodynamic therapy (TFD).

As Porfirias são doenças metabólicas decorrentes de falhas na biossíntese do Hemo, caracterizadas por um padrão específico de acumulação e excreção de intermediários responsáveis de sua patofisiologia. Nas Porfirias Agudas, o excesso de ácido δ-aminolevulínico (ALA) produz uma sintomatologia neuroabdominal associada ao dano oxidativo por formação de espécies reativas de oxigênio (ROS), decorrentes da auto-oxidação do ALA. Nas Cutâneas a sintomatologia é produto da acumulação de porfirinas, que como o ALA, induzem a formação de ROS. Seu desencadeamento precipita-se por fatores endógenos (jejum, estresse, hormônios) e/ou exógenos (fármacos), especialmente alguns anestésicos. Apresenta-se uma revisão dos estudos bioquímicos e genéticos em pacientes com diferentes Porfirias obtidos no Centro de Investigações de Porfirias e Porfirinas (CIPYP), durante os últimos 38 anos, que permitiram ampliar o conhecimento sobre as bases moleculares destas patologias. Descrevem-se as conquistas resultantes do uso de modelos experimentais de Porfiria, induzida farmacológica ou geneticamente, que contribuíram à classificação de algumas drogas como proibidas para pacientes com Porfiria. Afinal, as porfirinas geradoras de ROS e, por conseguinte, indutoras de morte celular têm sua aplicação para combater infecções por organismos hemo-deficientes como Trypanosoma cruzi e também ser utilizadas como fotossensibilizadores na terapia fotodinâmica (TFD).

Effect of Yiqi Yangyin Huoxue Decoction combined with Western medicines on serum CRP,TNF-α,blood lipid and hemorheologic levels in coronary heart disease angina pectoris / 国际检验医学杂志

Objective To investigate the effect of Yiqi Yangyin Huoxue Decoction combined with Western medicine therapy , while on this basis the observation group was combined with the on serum CRP ,TNF‐α,blood lipid and hemorheology levels in cor‐onary heart disease angina pectoris .Methods Totally 114 patients with coronary heart disease(CHD) angina pectoris were random‐ly divided into observation group (n=57) and control group (n=57) according to the random number table method .The control group was treated with Western medicine treatment ,while on this basis the observation group was combined with the therapy of Yiqi Yangyin Huoxue Decoction .The treatment cource was 4 weeks in the two groups .Serum CRP ,TNF‐α,blood lipids ,hemorheol‐ogy levels ,frequency and duration of angina pectoris attack ,efficacy of angina pectoris and ECG and adverse reactions were contras‐tively analyzed in the two groups .Results The levels of serum CRP and TNF‐αafter treatment in the two groups were decreased (P<0 .05);sthe serum levels of CRP and TNF‐α after treatment in the observation group were lower than those in the control group(P<0 .05);the TG ,TC and LDL‐C levels after treatment in the two groups were decreased (P<0 .05);the TC ,LDL‐C and TG levels after treatment in the observation group were lower than those in the control group (P<0 .05);fibrinogen ,plasma vis‐cosity and whole blood viscosityafter treatment in the two groups were decreased (P<0 .05);the fibrinogen ,plasma viscosity and whole blood viscosity after treatment in the observation group were lower than those in the control group (P<0 .05);the angina pectoris attack frequency after treatment in the two groups were reduced (P<0 .05) ,the duration was shortend (P<0 .05);but the angina pectoris attack frequency after treatment in the observation group was lower than that in the control group (P<0 .05) ,the duration was shorter than that in the control group (P<0 .05);the total effective rate of angina pectoris and ECG in the observa‐tion group was higher than that in the control group (P<0 .05) .The two groups had no serious adverse reactions during the treat‐ment process .Conclusion Yiqi Yangyin Huoxue Decoction combined with Western medicine can reduce serum CRP ,TNF‐α,blood lipid and hemorheologic levels in CHD angina pectoris ,and has remarkable curative effect with safety and reliability .

Efecto de los micronutrientes en polvo en el estado nutricional y en los valores hemáticos de preescolares sanos. Medellín, 2013 / The effect of powdered micronutrients on the hematologic values and nutritional status of healthy preschoolers. Medellín, 2013 / Efeito dos micronutrientes em pó no estado nutricional e nos valores hemáticos de crianças sadias em idade pré-escolar. Medellín, 2013

Las carencias de micronutrientes son un problema de salud pública común en muchos países, principalmente en aquellos en vía de desarrollo; las deficiencias más prevalentes son las de vitamina A, hierro y yodo, para reducirlas se pueden ejecutar estrategias como la fortificación de alimentos. OBJETIVO: evaluar el efecto de la fortificación de la dieta con micronutrientes en polvo en el estado nutricional y los valores hemáticos de preescolares sanos. METODOLOGIA: ensayo clínico triple ciego, con asignación aleatoria de grupos y controlado con placebo. Se analizaron 90 preescolares sanos a quienes se suministró 1g de mezcla de micronutrientes al día con 12,50 mg de hierro (fumarato ferroso). Antes y después de nueve semanas, se midieron los niveles de hemoglobina, ferritina sérica, transferrina, ácido fólico y los indicadores nutricionales. RESULTADOS :la concentración de hemoglobina disminuyó en el grupo de intervención, pasando de 12,80 g/dL a 12,10 g/dL (p=0,000), mientras que en el grupo placebo no hubo variación (p=0,639); así mismo la transferrina disminuyó significativamente solo en el grupo intervenido (p=0,004); el nivel de ferritina al final del estudio no difirió intra o entre grupos de intervención. Las reacciones adversas fueron similares en ambos grupos: dos niños presentaron náusea y dos tuvieron dolor abdominal, sin diferencias estadísticas. CONCLUSIONES:la fortificación de alimentos durante nueve semanas con los micronutrientes en polvo empleados en el estudio, no mejoró los niveles hematológicos, ni el estado nutricional de los niños sanos estudiados; los alimentos fortificados fueron bien tolerados por los preescolares.

Micronutrient deficiencies are a common public health problem, particularly in developing countries. Vitamin A, iron and iodine deficiencies are the most prevalent. To reduce these, many strategies such as food fortification can be implemented. OBJECTIVE:to assess the effect of a diet fortified with powdered micronutrients on the nutritional status and hematological values of healthy preschoolers. METHODOLOGY: a randomized, triple-blind, placebo-controlled trial conducted with 90 healthy preschoolers who were given 1g of powdered micronutrients per day with 12.5 mg of iron (ferrous fumarate).The levels of hemoglobin, serum ferritin, transferrin, folic acid and the nutritional indicators were measured before and after nine weeks. RESULTS:for the group receiving powdered micronutrients, hemoglobin concentration decreased from 12.80 g / dL to 12.10 g / dL (p = 0.000), whereas the placebo group showed no change (p = 0.639); likewise, transferrin decreased significantly only for the powdered micronutrients group (p = 0.004); the ferritin level showed no difference between groups or inside any of them. Adverse reactions were similar for both groups:two children had nausea and two abdominal pain. There were no statistically significant differences. CONCLUSIONS:fortifying the individuals' diet with the powdered micronutrients used in this study for nine weeks did not improve the hematological levels or the nutritional status of the healthy preschoolers. Additionally, the fortified foods were well tolerated by the children.

As carências de micronutrientes são um problema de saúde pública comum em muitos países, principalmente naqueles em via de desenvolvimento; as deficiências mais prevalentes são de vitamina A, ferro e iodo, para reduzi-las podem ser realizadas estratégias como a fortificação de alimentos. OBJETIVO: avaliar o efeito da fortificação da dieta com micronutrientes em pó no estado nutricional e os valores hemáticos de pré-escolares sadios. METODOLOGIA: ensaio clínico triplo-cego, com afetação aleatória de grupos e controlado com placebo.Foram analisados 90 pré-escolares sadios aos quais foi proporcionado 1g de mescla de micronutrientes por dia com 12,50 mg de ferro (fumarato ferroso).Antes e após nove semanas, foram medidos os níveis de hemoglobina, ferritina sérica, transferrina, ácido fólico e os indicadores nutricionais. RESULTADOS: a concentração de hemoglobina diminuiu no grupo de intervenção, passando de 12,80 g/dL a 12,10 g/dL (p=0,000), enquanto no grupo placebo não houve variação(p=0,639); do mesmo modo, a transferrina apenas diminuiu expressivamente no grupo intervindo (p=0,004); o nível de ferritina no final do estudo não divergiu intra ou entre os grupos de intervenção.As reações adversas foram semelhantes em ambos os grupos:duas crianças apresentaram náusea e duas tiveram dor abdominal, sem diferenças estatísticas. CONCLUSÕES: a fortificação de alimentos durante nove semanas com os micronutrientes em pó utilizados no estudo não melhorou os níveis hematológicos, nem o estado nutricional das crianças saudáveis analisadas; os alimentos fortificados foram bem tolerados pelas crianças.

A Case of Spontaneous Hemo-pneumothorax

Spontaneous hemo-pneumothorax, a hemothorax that occurs without trauma, is a very rare condition; however, as a result of excessive bleeding, it can be lethal. Also, if the bleeding is scanty, the physician might recognize hemothorax in case of performing invasive procedures, such as chest tube insertion, and may misunder stand as a complication of the procedure. For this reason, acknowledgement of the spontaneous hemo-pneumothorax in the emergency department is very important. We report on a case of a spontaneous hemo-pneumothorax in a healthy 18-year-old male presenting with chest pain who developed a spontaneous pneumothorax with a profuse amount of hemothorax.

Desarrollo de la Medicina Transfusional en el Instituto de Hematología e Inmunología en el período 1996-2010 / Development of the transfusion medicine in the Institute of Hematology and Immunology during 1996-2010

El desarrollo de la Medicina Transfusional en el Instituto de Hematología e Inmunología en los últimos 15 años, se ha caracterizado por el logro de resultados relevantes en aspectos metodológicos, técnico-investigativos y de desarrollo de los recursos humanos, como son: la actualización y distribución de procederes para bancos de sangre, servicios de transfusiones y de guías clínicas para el uso de los componentes de la sangre en todo el país; la implementación del sistema de gestión de la calidad y automatización en los bancos de sangre; la introducción de técnicas moleculares para el pesquisaje viral de donantes de sangre; la introducción de anticuerpos monoclonales hemoclasificadores de producción nacional; el desarrollo de investigaciones multicéntricas sobre aspectos socioculturales relacionados con la donación de sangre y el pesquisaje de agentes infecciosos en pacientes politransfundidos; la obtención y procesamiento de células madre hematopoyéticas de sangre periférica para trasplante y medicina regenerativa, así como el desarrollo de la hemovigilancia. Las proyecciones de trabajo deberán estar encaminadas a la creación de un banco de células progenitoras de cordón umbilical para uso clínico, la obtención y producción nacional de concentrados de factores de la coagulación para uso terapéutico y el desarrollo de un programa nacional de hemovigilancia

The development of the Transfusion Medicine in the Institute of Hematology and Immunology in past 15 years, has been characterized by the achievement of relevant results in the methodological, technical-research and of the development or human resources features including: the updating and distribution of procedures for the blood banks; transfusion services and of clinical guidances for the use of blood components in all the country; the implementation of the quality management system and the blood banks automation, the introduction of molecular techniques for the viral screening of blood donors; the introduction of hemoclassifying monoclonal antibodies of national production, the development of multicenter researches on the sociocultural features related to blood donation and the screening of infectious agents in poly-transfused patients; the obtaining and processing of hematopoietic stem cells of peripheral blood for transplantation and regenerative medicine, as well as the development of the hemo-surveillance. The work projections must to be aimed to creation of a bank of progenitor cells from the umbilical cord to clinical use, the achievement and national production of coagulation factor concentrates to therapeutic use, and the development of a national program of hemo-surveillance

Aspectos clínico-laboratoriais de crianças com doeça falciforme / Clinical and laboratorial aspects in children with sickle cell disease

As doenças falciformes compreendem a interação do geneS com diversas hemoglobinopatias, e talassemias. No Brasil, cerca de 0,1% a 0,3% da população negra é afetada pela doença e estima-se a existência de pelo menos dois milhões de portadores da hemoglobina S. Foram estudados 109 pacientes acompanhados clínica e laboratorialmente no Instituto de Puericultura e Pediatria Martagão Gesteira da Universidade Federal do Rio de Janeiro (IPPMG-UFRJ), com diagnóstico de doença falciforme. A observação dos resultados hematológicos e bioquímicos confirma de modo evidente as diferenças entre as diversas doenças que compõem o grupo das Doenças Falciformes. Dentre as principais complicações presentes na doença falciforme, a mais frequente no grupo foi a infecção bacteriana observada em 94,5% dos pacientes. As transfusões foram utilizadas em 72,5% dos pacientes. A deficiência de ferro prejudica a sìntese das hemoglobinas, diminuindo a concentração de hemoglobina S no interior dos eritrócitos, o que causa menos afoiçamento. 0 estado de ferropenia diminui a hemólise melhorando várias das complicações que acompanham estes pacientes.

Sickle cell disease (SCD) is due to the interaction of the S gene with another hemoglobinopathies and thalassemias. In Brazil, 0,1 to 0,3% of the black population is affected by this disease and there will be about 2 millions of sickle cell trait patients. We studied 109 SCD patients from lnstituto de Puericultura e Pediatria Martagao Gesteira da Universidade Federal do Rio de Janeiro(IPPMG-UFRJ). The biochemical and hematologic values showed the differences among this group of diseases. One of the most important complication of SCD is the bacterial infection which was observed in 94,5% of the patients. Blood transfusions were also very frequent and used in 72,5% of the patients. The iron deficiency results in an impaired hemoglobin synthesis, decreasing the HbS concentration leading to less sickling. The iron deficiency decreases the hemolysis improving the life quality of these patients.

The clinical effect of gastroscopy injection of norepinephrine combined with routine triple therapy on peptic ulcer patients with gastrointestinal bleeding / 中国基层医药

Objective To observe the effect of gastroscopy injection of norepinephrine combined with routine triple therapy on peptic ulcer with gastrointestinal bleeding. Methods 84 cases of gastroscopy upper gastrointestinal bleeding caused by peptic ulcer patients were randomly divided into two groups, the control group 42 cases;the observation group 42 cases, the observation group was guven endoscopic injection of norepinephrine combined conventional triple therapy,the control group was given conventional triple therapy with hemostatic therapy. Efficiency and adverse reactions were observed in patients. Results In the observation group,36 csses was significantly effective,5 cases was effective,1 case was not effective,the total effective rate was 97.6%. In the control group,21 cases was significantly effective, 16 cases was effective ,5 cases was not effective,the total effective rate was 88. 1% ,the difference of the total effective rate between the two groups was significant( x2 =5. 137, P ＜ 0. 05 ). There was no serious adverse reactions in the two groups. Conclusion Endoscopic injection of norepinephrine and routine triple therapy in treatment of gastrointestinal hemorrhage of peptic ulcer was significantly better than conventional medical treatment alone.

Neosporosis y toxoplasmosis en la liebre europea (Lepus europaeus) en la provincia de La Pampa (Argentina) / Infectious diseases and reproductive status in european hare (Lepus europaeus) in La Pampa province (Argentina)

El objetivo de este trabajo fue determinar la prevalencia a Neospora caninum (Nc) y Toxoplasma gondii (Tg) y conocer el periodo reproductivo de la liebre europea (Lepus europaeus) en la provincia de La Pampa (Argentina). Para ello se muestrearon 106 liebres procedentes de acopiadores de la provincia de La Pampa. Los sueros fueron analizados por un ensayo inmunoenzimático de competición para determinar anticuerpos a Nc y para Tg se realizó una prueba de hemaglutinación indirecta. Se encontraron 66 hembras, de las cuales 13 estaban preñadas, y 40 machos (p=0,01). Sobre un total de 44 sueros analizados para Nc, 5 (11,4%) dieron positivo. De los 106 sueros estudiados para Tg ninguno fue positivo.

The objective of this study was to determine the prevalence of these diseases and to know the reproductive season of the European hare (Lepus europaeus) in the Province of La Pampa (Argentina). To that aim, 106 hares coming from different places from La Pampa province were sampled. .Nc antibody diagnosis was performed by means of a competitive enzimoimmunoassay (ELISA-c), and an hemo-agglutination indirect assay (HAI) for Tg were carried out to know the disease status. From the total of hares sampled, 40 were male, 66 female (p=0.01) and 13 (19.7%) of them were detected as pregnant. Nc sero-prevalence was 11.4% over a total of 44. From 106 sera analyzed by HAI no one was positive for Tg.

Proteção funcional da enzima heme-oxigenase-1 na lesão renal aguda isquêmica e tóxica / Functional protection of heme-oxygenase-1 enzyme in ischemic and toxic acute kidney injury / Protección funcional de la enzima heme-oxigenasa-1 en la lesión renal aguda isquémica y tóxica

Objetivos: Verificar a proteção funcional da heme-oxigenase (HO-1), por meio do uso do seu indutor (Hemin) e seu inibidor químico (protoporfirina de zinco-ZnPP) na lesão renal aguda isquêmica e tóxica pela Polimixina B (PmxB) em ratos. Material: Foram utilizados ratos Wistar, adultos e machos divididos em 8 grupos: SHAM (controle), Isquemia (Isq), Isq+Hemin (indutor de HO-1), Isq+ZnPP (inibidor de HO-1), SALINA (controle), Polimixina B (PmxB), PmxB+Hemin, PmxB+ZnPP. Métodos: Jaffé (clearance de creatinina, Clcr) e FOX-2 (peróxidos urinários). Resultados: A isquemia (30´) dos pedículos reais e a administração de PmxB reduziu o Clcr com manutenção do fluxo urinário. Os peróxidos urinários se elevaram em ambas as lesões. A administração do Indutor de HO-1 determinou melhora da função renal e redução dos níveis de peróxidos urinários. Conclusão: Os resultados deste estudo demonstraram que a isquemia e a PmxB induzem LRA oxidativa. O indutor de HO-1 atenuou a lesão em ambos os modelos por atenuação do mecanismo redox.

Objectives: To investigate the functional protection of heme-oxygenase-1 enzyme (HO-1) when using its inducer (Hemin) and inhibitor (zinc protoporphyrin-ZnPP) in ischemic and toxic acute kidney injury by Polymixin B in mice. Materials: Adult male Wistar mice divided into 8 groups were used: SHAM (control), Ischemic (Isq), Isq+Hemin (Inducer of H0-1), Isq+ZnPP (inhibitor of H0-1), SALINA (control), Polimyxin B (PmxB), PmxB+Hemin, PmxB+ZnPP. Method: Analysis consists of Jaffé (creatinine clearance [crCl]) and FOX-2 (urinary peroxides [UP]). Results: Thirty minutes renal ischemia and its treatment with PmxB reduced the crCl and maintained urinary output. Urinary peroxide levels increased in both injuries. The administration of the inducer of H0-1 resulted in improvement in renal function and reduction in the levels of urinary peroxide. Conclusions: Findings indicated that ischemia and PmxB induce LAR (acute kidney injury [AKI]) by elevating the levels of urinary peroxide. The HO-1 inducer ameliorated the injury in both animal models through redox mechanism.

Objetivos: Verificar la protección funcional de la heme-oxigenasa (HO-1), por medio del uso de su inductor (Hemin) y su inhibidor químico (protoporfirina de zinc-ZnPP) en la lesión renal aguda isquémica y tóxica producida por la Polimixina B (PmxB) en ratas. Material: Fueron utilizadas ratas Wistar, adultas y machos divididos en 8 grupos: SHAM (control), Isquemia (Isq), Isq+Hemin (indutor de HO-1), Isq+ZnPP (inibidor de HO-1), SALINA (control), Polimixina B (PmxB), PmxB+Hemin, PmxB+ZnPP. Métodos: Jaffé (clearance de creatinina, Clcr) y FOX-2 (peróxidos urinarios). Resultados: La isquemia (30´) de los pedículos reales y la administración de PmxB redujo el Clcr con manutención del flujo urinario. Los peróxidos urinarios se elevaron en ambas lesiones. La administración del Inductor de HO-1 determinó mejora de la función renal y reducción de los niveles de peróxidos urinarios. Conclusión: Los resultados de este estudio demuestran que la isquemia y la PmxB inducen AKL por la elevación de los peróxidos urinarios. El inductor de HO-1 atenuó la lesión en ambos modelos por atenuación del mecanismo redox.