Intercambio de gases respiratorios, respuestas cardiacas y metabólicas en altitud: estudio en pentatletas ecuatorianos / Breathing gas exchange and cardiac and metabolic responses by Ecuadorian pentathletes during altitude training

Introducción: El análisis de indicadores biomédicos como parte de la teoría y metodología del entrenamiento deportivo es sustancial en su proceso de dirección. Describe y analiza los efectos fisiológicos del entrenamiento específico en hipoxia en pentatletas es la base prospectiva para modelar entrenamientos efectivos que incidan significativamente en el rendimiento deportivo, permitiendo la dosificación correcta del estímulo físico. Objetivo: Determinar algunos indicadores relacionados con el intercambio de gases respiratorios, respuestas cardiacas y metabólicas en la altitud de pentatletas masculinos Sub 23 del Ecuador. Métodos: Se estudió la población del equipo masculino de Pentatlón Militar de las Fuerzas Armadas Ecuatorianas categoría Sub23 (6 sujetos) durante el macrociclo de entrenamiento del año 2014. Se investigaron indicadores de peso, frecuencia cardiaca, vo2 máximo, ritmo, velocidad, lactato, coeficiente de correlación y velocidad de recuperación de la frecuencia cardiaca y del lactato en sangre. Resultados: Se describieron los datos individuales y promedios de la población estudiada, entre los datos más relevantes se estimó una frecuencia cardiaca en reposo con un promedio de 46,33 por ciento, por debajo de las normativas internacionales. Otros indicadores también se comportaron muy por debajo de lo esperado, aunque el análisis individual de los sujetos mostró características útiles para futuros entrenamientos. Conclusiones: Potenciar aún más los parámetros funcionales investigados a través de un mejor estímulo físico, aprovechando las ventajas inherentes del entrenamiento en la altura y conformando posteriormente baremos nacionales de interés para el entrenador y la comisión técnica del deporte estudiado (AU)

Introduction: Analysis of biomedical indicators as a component of sport training theory and methodology is a crucial part of its management process. Describing and analyzing the physiological effects of specific hypoxic training on pentathletes is the prospective basis to model effective training programs significantly impacting on sport performance, allowing appropriate dosing of physical stimuli. Objective: Determine some indicators related to breathing gas exchange and cardiac and metabolic responses by male under-23 Ecuadorian pentathletes during altitude training. Methods: A study was conducted of the male under-23 military pentathlon team of the Ecuadorian Armed Forces (six subjects) during the 2014 training macrocycle. The indicators analyzed were weight, heart rate, VO2 max, rhythm, speed, lactate, correlation coefficient, and blood lactate and heart rate recovery speed. Results: Four tables show the data obtained, both individual and average for the study population. The most relevant data include an estimate of heart rate at rest with an average 46.33 ppm, below international standards. Other indicators were also considerably lower than the values expected, but individual analysis of subjects revealed characteristics useful for future training. Conclusions: It is recommended to further strengthen the functional parameters studied via a better use of physical stimuli, making use of the advantages inherent to altitude training to eventually develop national standard values of interest to both trainers and the technical committee for the sport being analyzed (AU)

Sangrado gastrointestinal en pacientes hospitalizados / Gastrointestinal bleeding in hospitalized patients

El sangrado gastrointestinal es una complicación potencial del paciente que se hospitaliza. Como las descripciones iniciales en cuidados intensivos relacionaban el sangrado por úlceras de estrés con alta mortalidad, la investigación fue creciente en los pacientes críticos. No sucedió lo mismo con los hospitalizados y los trabajos disponibles son escasos. Los principales factores de riesgo se han descrito en los críticos (ventilación mecánica más de 48 horas y coagulopatía). La eficacia de la terapia no se ha demostrado en aquellos en la sala general. La evidencia indirecta muestra utilidad marginal de estos medicamentos en la prevención del sangrado gastrointestinal. En los casos críticos hay abundante información pero la interpretación es confusa. Se ha documentado una tasa alta de formulación para prevenir el sangrado en los hospitalizados, la mayoría sin indicación clara, lo cual puede exponer al paciente a eventos adversos innecesarios y gastos adicionales al sistema de salud. Se recomiendan estrategias para implementación de guías para el uso racional de estos fármacos...

Gastrointestinal bleeding is a potential inpatient complication. Research has extensively focused in critically ill patients due to initial descriptions of high mortality related to bleeding due to stress ulceration. On the other hand, research evaluating GI bleeding in inpatients is scarce with few available reports. The main risk factors have been described in critically ill patients (requiring mechanical ventilation for more than 48 hours and coagulopathy). Treatment efficacy has not been demonstrated in patients hospitalized in the general ward. Indirect evidence show marginal usefulness of these medications in gastrointestinal bleeding prevention. There is plentiful data on critically ill patients but with confusing interpretation. It has been documented that preventive medicines are often prescribed to avoid bleeding in inpatients, with no clear indication in most cases, exposing the patient to unnecessary adverse events and additional costs for the healthcare system. Implementation guidelines are recommended for the rational use of these medicines...

Molecular characterisation of hepatitis B virus in the resident Chinese population in Panama City

Despite the effectiveness of current hepatitis B virus (HBV) vaccines, it is estimated that 350 million individuals suffer from chronic HBV infection and more than 50% of these affected individuals live on the Asian continent. Panama is a country with a great diversity of foreign groups; the Chinese community is a large example of this phenomenon. There is an urgent need to perform studies that evaluate the prevalence and the genetic diversity of HBV in this community. This study aimed to evaluate the prevalence of HBV and its genotypes and mutant variants in the Chinese population residing in Panama. In total, 320 subjects were enrolled in the study. Forty-two subjects (13.1%) were positive for HBsAg and HBV-DNA from 18 subjects revealed the presence of genotypes B2 and C1. Secondary mutations associated with drug resistance at positions rtV207L and rtN239T of the reverse transcriptase gene were identified. Additionally, the mutation pair A1762T/G1764A was found in three samples and the mutation G1896A was detected in an HBeAg-negative subject. In conclusion, to our knowledge, this is the first study to report high HBV prevalence rates in resident ethnic Chinese in Central America and the presence of genotypes B2 and C1 in this region.

Strong correlation by ultrasonography of hepatomegaly and the presence of co-infection in HIV/HCV cirrhotic patients

OBJECTIVES: Progression of hepatic fibrosis is accelerated in patients co-infected with human immunodeficiency virus and hepatitis C virus compared to hepatitis C virus mono-infected patients. This study aimed to compare ultrasound features and selected clinical and biochemical variables between patients with human immunodeficiency virus/hepatitis C virus co-infection (n = 16) versus hepatitis C virus mono-infection (n = 16). METHODS: Each patient underwent abdominal ultrasound, and a specific evaluation was performed in order to detect findings consistent with chronic liver disease. Characterization of spleen size, liver structural pattern, diameter of the portal, spleen, and mesenteric veins was based on classical ultrasound parameters. Propensity score was used for control of selection bias and performed using binary logistic regression to generate a score for each patient. The Fisher and Mann-Whitney tests were used to evaluate categorical variables and continuous variables, respectively. RESULTS: On univariate analysis right hepatic lobe size was larger in human immunodeficiency virus/hepatitis C virus patients (157.06 ± 17.56 mm) compared to hepatitis C virus mono-infected patients (134.94 ± 16.95 mm) (p = 0.0011). The left hepatic lobe was also significantly larger in human immunodeficiency virus/hepatitis C virus patients Cirrhosis (115.88 ±22.69 mm) versus hepatitis C virus mono-infected patients (95.06 ±24.18 mm) (p= 0.0177). Also, there was a strong correlation between hepatomegaly and co-infection (p=0.005). CONCLUSION: Human immunodeficiency virus infection was the primary variable influencing liver enlargement in this population. Hepatomegaly on ultrasound was more common among cirrhotic human immunodeficiency virus/hepatitis C virus co-infected patients than among cirrhotic hepatitis C virus mono-infected patients. This aspect is very important in the management of human immunodeficiency virus/hepatitis C virus co-infected patients, because screening for hepatocellular carcinoma is necessary in this population.

Two sequential PCR amplifications for detection of Schistosoma mansoni in stool samples with low parasite load / Duas amplificações sequenciais por PCR para detecção de Schistosoma mansoni em amostras de fezes com baixa carga parasitária

Schistosomiasis constitutes a major public health problem, with an estimated 200 million individuals infected worldwide and 700 million people living in risk areas. In Brazil there are areas of high, medium and low endemicity. Studies have shown that in endemic areas with a low prevalence of Schistosoma infection the sensitivity of parasitological methods is clearly reduced. Consequently diagnosis is often impeded due to the presence of false-negative results. The aim of this study is to present the PCR reamplification (Re-PCR) protocol for the detection of Schistosoma mansoni in samples with low parasite load (with less than 100 eggs per gram (epg) of feces). Three methods were used for the lysis of the envelopes of the S. mansoni eggs and two techniques of DNA extraction were carried out. Extracted DNA was quantified, and the results suggested that the extraction technique, which mixed glass beads with a guanidine isothiocyanate/phenol/chloroform (GT) solution, produced good results. PCR reamplification was conducted and detection sensitivity was found to be five eggs per 500 mg of artificially marked feces. The results achieved using these methods suggest that they are potentially viable for the detection of Schistosoma infection with low parasite load.

A esquistossomose constitui grande problema de saúde pública, sendo que estimativas apontam para 200 milhões de pessoas infectadas no mundo e 700 milhões de pessoas em áreas de risco. No Brasil, existem áreas de alta, média e baixa endemicidade. Estudos demonstram que nas áreas endêmicas de baixa prevalência da infecção, a reduzida sensibilidade dos métodos parasitológicos torna-se evidente. Isto dificulta o diagnóstico, pela presença de resultados falso-negativos. O objetivo deste estudo foi a padronização de um protocolo de reamplificação da PCR (Re-PCR) para a detecção de Schistosoma mansoni em amostras com menos de 100 ovos por grama (opg) de fezes. Foram utilizados três métodos para ruptura dos envoltórios dos ovos de S. mansoni e duas técnicas de extração de DNA foram aplicadas. O DNA extraído foi quantificado e os resultados sugerem que a técnica de extração de melhor produtividade foi a que associa esferas de vidro a uma solução de isotiocianato de guanidina/fenol/clorofórmio (GT). Aplicou-se a Re-PCR, que demonstrou sensibilidade para a detecção de cinco ovos/500 mg de fezes artificialmente marcadas. Assim, essas novas ferramentas são potencialmente aplicáveis nas infecções por S. mansoni com baixa carga parasitária.

Full-length genomic sequence of hepatitis B virus genotype C2 isolated from a native Brazilian patient

The hepatitis B virus (HBV) is among the leading causes of chronic hepatitis, cirrhosis and hepatocellular carcinoma. In Brazil, genotype A is the most frequent, followed by genotypes D and F. Genotypes B and C are found in Brazil exclusively among Asian patients and their descendants. The aim of this study was to sequence the entire HBV genome of a Caucasian patient infected with HBV/C2 and to infer the origin of the virus based on sequencing analysis. The sequence of this Brazilian isolate was grouped with four other sequences described in China. The sequence of this patient is the first complete genome of HBV/C2 reported in Brazil.

Estudos sobre infecções pelos vírus da hepatite B (HBV), hepatite C (HCV), hepatite delta (HDV) e vírus GB-C (GBV-C) em diferentes regiões da América do Sul / Studies on viral infections by hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis delta virus (HDV) and GB virus C (GBV-C) in different regions of South America

As hepatites virais estão entre as mais importantes pandemias mundiais da atualidade. Existem várias causas de hepatite, entre elas, o vírus da hepatite B (HBV), o vírus da hepatite C (HCV) e o vírus da Hepatite Delta (HDV). Da mesma forma, o vírus GB-C (GBV-C) é importante na coinfecção com outros vírus, como o HIV. Nesse estudo, várias regiões da América do Sul foram analisadas. Na Colômbia, os estados do Amazonas e Magdalena foram encontradas como regiões hiperendêmicas para HBV. O genótipo F3 (75%) foi o mais prevalente. Determinou-se que o subgenótipo F3 é o mais antigo dos subgenótipos F. No estado de Chocó, encontrou-se o subgenótipo A1 (52,1%) como o mais prevalente. Surpreendentemente, nesse mesmo estado foram encontrados nove casos autóctones de infecção pelo genótipo E (39,1%). Para o HCV, em Bogotá, encontrou-se o subtipo 1b (82,8%) como o mais prevalente. Da mesma forma, estimou-se que esse subtipo foi introduzido por volta de 1950 e se propagou exponencialmente entre 1970 a 1990. O HDV foi identificado em casos de hepatite fulminante do estado de Amazonas, todos classificados como genótipo 3. Se determinou que o HDV/3 se espalhou exponencialmente a partir de 1950 a 1970 na América do Sul e depois desta época, esta infecção deixou de aumentar, provavelmente devido a introdução de vacinação contra o HBV. GBV-C foi procurado em doadores de sangue colombianos infectados com HCV e/ou HBV de Bogotá e em povos indígenas com infecção pelo HBV no Amazonas. A análise filogenética revelou a presença do genótipo 2a como o mais prevalente entre os doadores de sangue e o 3 nos povos indígenas estudados. A presença do genótipo 3 na população indígena foi previamente relatada na região de Santa Marta, na Colômbia e nos povos indígenas da Venezuela e da Bolívia. No Chile, foi realizado um estudo com 21 pacientes cronicamente infectados pelo HBV sem tratamento antiviral prévio...

Viral hepatitis are among the major pandemics in the world nowadays. There are many causes of hepatitis, including hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis delta virus (HDV). Similarly, GB virus C (GBV-C) is a relevant agent in co-infection with HIV. In this study, several regions of South America were studied. In Colombia, the states of Amazonas and Magdalena were identified as highly endemic areas for HBV. Genotype F3 (75%) was the most prevalent. It was determined that subgenotype F3 is the oldest among all F subgenotypes. In the state of Chocó, subgenotype A1 (52.1%) was the most prevalent. Surprisingly, nine indigenous cases of infection by genotype E (39.1%) were found in this state. For HCV, in Bogotá, subtype 1b (82.8%) was the most frequent. Likewise, it was estimated that this subtype was introduced around 1950 and spread exponentially from 1970 to 1990. HDV has been identified in cases of fulminant hepatitis in the state of Amazonas, all of them classified as genotype 3. It was determined that the HDV/3 spread exponentially from 1950 to 1970 in South America and after this time, this infection stopped to increase, probably due to introduction of vaccination against HBV. GBV-C was sought in Colombian blood donors infected with HCV and/or HBV in Bogotá and indigenous peoples with HBV infection in the Amazon. The phylogenetic analysis revealed the presence of genotype 3 as the most prevalent among blood donors and in three studied indigenous people. The presence of genotype 3 in the indigenous population has been previously reported in the region of Santa Marta, Colombia, and in the indigenous peoples of Venezuela and Bolivia. In Chile, a study was carried out with 21 patients chronically infected with HBV without any prior antiviral treatment...

Validación de la escala diagnóstica de Alvarado en pacientes con dolor abdominal sugestivo de apendicitis en un centro de segundo nivel de complejidad / Validation of the Alvarado diagnostic scale in patients with abdominal pain suggesting appendicitis at a second level health care center

Introducción. La apendicitis es la condición quirúrgica más común a la que se enfrenta el cirujano. Aún se hace un uso indiscriminado de métodos diagnósticos, con aumento de costos y sin disminución de las apendicectomías no terapéuticas. El propósito fue validar la capacidad diagnóstica de la escala de Alvarado para el diagnóstico de apendicitis y determinar su utilidad para discriminar las conductas diagnósticas.Materiales y métodos. Se diseñó un estudio prospectivo de pruebas diagnósticas para valorar la escala de Alvarado en pacientes con duda diagnóstica de apendicitis. El método de referencia fue el reporte histopatológico. Con los valores se definieron niveles de riesgo (bajo, intermedio, alto) y se simuló el valor de uso de recursos. Resultados. Se incluyeron 71 pacientes (37% hombres). En 66,7% se presentó apendicitis. La tasa de apendicectomía no terapéutica fue de 22,6% y de laparotomía no terapéutica, 17,7%. El valor de uso de recursos sin la escala fue de $ 113’217.000, con una frecuencia de apendicectomías en blanco de 22,6%. El esquema propuesto mostró un gasto de $101’582.000, con una frecuencia potencial de apendicectomías en blanco de 8,0%.Discusión. La escala de Alvarado permite clasificar a los pacientes en grupos de riesgo bajo (0-4 puntos) con probabilidad de apendicitis de 7,7%; intermedio (5-7 puntos) con probabilidad de apendicitis de 57,6%, y alto (8-10 puntos) con probabilidad de apendicitis de 90,6%. La aplicación de la escala disminuye los costos en 10% y disminuye las apendicectomías no terapéuticas a 8%. Su uso es eproducible y ofrece como ventajas el uso más racional de los recursos y la disminución de cirugías innecesarias.

Introduction. Acute appendicitis is the most common entity encountered by surgeons. There is still an indiscriminate use diagnostic methods with undue costs and no diminution in the number of negative appendectomies. The aim of this study was to evaluate the diagnostic capacity of the Alvarado scale in patients with suspected appendicitis and to determine its usefulness in the discrimination and definition of diagnostic conducts. Material and methods. A prospective study of diagnostic tests and methods was designed in order to evaluate the Alvarado scale in patients with uncertain diagnosis of appendicitis. The method of reference was the pathology report. The levels of risk (low, intermediate, high) were defined according to the scale values and the cost of resources was simulated. Results. Seventy one patients (37% men) were included; 66.7% had appendicitis. The rate of negative appendectomies was 22.6% and the rate of negative laparotomies was 17.7%. The cost of the resources utilized without using the scale was Colombian Pesos $ 113,217 million (1USDollar = 2,900 Col Pesos $) with a negative appendectomy rate of 22.6%. The proposed scheme showed an expense of Col Pesos $ 101,582 million, with a negative appendectomy rate of 8.0%. Discussion. The Alvarado scale permits the classification of patients with suspected appendicitis in groups: a low-risk group (0-4 points) with a probability of appendicitis of 7.7%; an intermediate risk-risk group (5-7 points) with probability of appendicitis of 57.6%; and a high risk group (8-10 points) with a probability of appendicitis of 90.6%. Application of the scale diminished costs by 10% and reduced the rate on negative appendectomies by 8%. Its use is reproducible and offers the advantage a more rational use of resources and diminution in the number of unnecessary operations.