Análisis de sobrevida en pacientes de edad avanzada que inician hemodiálisis crónica en Servicio de Salud Chileno / Survival of older patients starting hemodialysis in Chile

The proportion of older people with end stage renal disease is increasing. Their prognosis is characterized by a high mortality and poor quality of life. Aim: To analyze the survival of patients starting chronic hemodialysis (CHD) according to their age. Material and Methods: Patients admitted to CHD in the East Metropolitan Health Service of Santiago in a 2-year period were analyzed. Four age groups were created, separating patients older than 70 years in a special group. Results: During the study period, 459 patients were admitted to CHD and were followed for an average of 27 months. The frequency of cardiovascular comorbidity, cancer, and chronic renal disease of unknown cause (attributed to nephrosclerosis) increased along with age. Mortality was higher at older ages. There was a significant association between starting CHD with a catheter, Charlson comorbidity index and increasing age with mortality. For those aged over 80 years, mortality at three months and one year was 25 and 43% respectively. Conclusions: Age, Charlson index and vascular access are predictors of mortality in older adults entering hemodialysis. This study suggests the importance of considering comorbidities, assessment by specialists and creating an arteriovenous fistula in this age group.

Resultados a largo plazo en trasplante renal de donantes con criterios expandidos / Long-term outcomes with expanded criteria donors in kidney transplantation

Background: Kidney transplantation of expanded criteria deceased donors (DCE) has become a common clinical practice. However, DCE outcomes are inferior compared to kidney transplants from standard criteria donors (DCS). Aim: To evaluate intermediate and long-term outcomes of DCE transplanted patients. Material and Methods: Cadaveric kidney transplants were evaluated using a retrospective cohort of eight consecutive years. Complications and long-term function of the transplant were assessed in DCE and DCS kidney recipients. Results: Of 213 patients analyzed, 34 (16%) underwent DCE transplantation. DCS recipients spent more time on the waiting list for transplantation (p = 0.04). DCE recipients showed higher frequency of surgical complications (p = 0.04), vascular complications (p = 0.02), acute transplant rejection (p = 0.05), and hospitalizations (p = 0.01). Creatinine (mg/dL) in DCE and DCS recipients was 2.3 and 1.5 respectively at year one (p < 0.01) and 2.6 and 1.6 respectively at year five (p < 0.01). Graft survival in the DCE group was significantly lower at 5 years (61 and 89% respectively, p < 0.01). Conclusions: DCE grafts are associated with lower survival, higher hospitalization rate and commonly develop surgical complications and rejections.

Diagnóstico, clasificación y tratamiento de las infecciones en el pie diabético / Diagnosis, classification, and treatment of infections in the diabetic foot

Objetivo: Revisar la literatura para establecer lineamientos y recomendaciones para disminuir la amputación y muerte relacionadas con las infecciones del pie diabético. Sede: Centro de Prevención y Salvamento de Pie Diabético San Elian, Veracruz, Veracruz. Diseño: Revisión de la literatura. Material y Métodos: Se realizó una búsqueda en la literatura para la respuesta adecuada de los siguientes ejes de investigación: clasificación de la infección (cómo se determina la gravedad de la infección); importancia de clasificar (cómo se define una infección grave, qué puntaje tiene la osteomielitis en la gravedad de la infección), y tratamiento (momento óptimo, tratamiento no quirúrgico, uso de antibióticos, cultivos, manejo de osteomielitis y tiempo de tratamiento). Resultados: Las clasificaciones de PEDIS (Perfusión, extensión, profundidad, infección y sensibilidad), IDSA (Infectious Disease Society of America) y San Elian clasifican la gravedad de la infección en leve, moderada y grave. La desbridación quirúrgica de tejido infectado debe realizarse sin diferimiento en forma inicial y subsecuente tantas veces como sea necesario con ''destechamiento'' de trayectos fistulosos. En las infecciones de moderadas a graves se recomienda tratamiento empírico de amplia cobertura (Gram positivos, Gram negativos y anaerobios). El cultivo de la herida antes de iniciar o continuar el tratamiento empírico se hace en infecciones moderadas o graves y se ajusta con el resultado del cultivo si no mejora o empeora la infección. El Staphylococcus aureus se aísla en un 40 y 50 %, con resistencia a la meticilina en un 30 a 40 %. Los antibióticos de elección son la vancomicina, la tigeciclina o el linezolid. La osteomielitis es una infección moderada profunda, caracterizada por descarga purulenta, exposición del hueso, ''dedo en salchicha'', o prueba del estilete positivo. El diagnóstico definitivo se hace con biopsia o resonancia magnética nuclear. La hospitalización está indicada en casos graves en pacientes hemodinámicamente y metabólicamente inestables. Conclusiones: Las infecciones de pie diabético pueden ser de leves a graves y pueden culminar en amputación parcial del pie, de la extremidad o hasta causar la defunción del paciente. Se requiere de una atención sistemática e integral con base en la clasificación y puntaje de San Elian.

Objective: To review the literature to establish guidelines and recommendations to diminish amputation and deaths related to diabetic foot infections. Setting: Centro de Prevención y Salvamento de Pie Diabético San Elian, Veracruz, Veracruz, Mexico. Design: Review of the literature. Material and Methods: We performed a search in the literature to find an adequate answer to the following research questions: classification of the infection (how to determine the severity of the infection), relevance of classifying (how is a severe infection defined, what score can be given to osteomyelitis in the severity of the infection) and treatment (optimal time, non-surgical treatment, antibiotics use, handling of osteomyelitis, and time of treatment). Results: PEDIS (perfusion, extension, depth, infection, and sensitivity), IDSA (Infectious Disease Society of America) and San Elian classify the infection as mild, moderate and severe. Surgical debridement of the infected tissue must be performed without delay initially and subsequently as many times as required with ''unroofing'' of fistulous tracts. In moderate to severe infections an ample coverage (Gram positive and Gram negative and anaerobic bacteria) treatment is recommended. Culturing of the injury before or during empirical treatment is performed for moderate to severe infections and should be adjusted to the result of the culture if the infections does not improve or gets worse. Staphylococcus aureus is isolated 40 to 50%, with resistance to methicillin in 30 to 40%. Choice antibiotics are vancomycin, tigecycline and linezolid. Osteomyelitys is a deep moderate infection, characterized by purulent discharge, bone exposure, ''sausage toe'' or positive probe-to bone test. Definite diagnosis is reached with biopsy or magnetic nuclear resonance. Hospitalization is indicated in severe cases of hemodynamically and metabolically unstable patients. Conclusions: Diabetic foot infections can go from mild to severe and end in partial amputation of the feet, the extremity, or even cause death of the patient. Systematic and integral care based on the San Elian classification and score is required.

Caracterización de polen apícola fresco recolectado en Cacute, en los Andes Venezolanos / Characterization of fresh bee pollen collected in Cacute, in Venezuelan Andes

El polen apícola es el segundo producto de la colmena más consumido, después de la miel de abejas; sin embargo, en Venezuela aún no se han elaborado las normas para su control de calidad. En el presente trabajo, se recolectó polen fresco en Cacute, Municipio Rangel, Estado Mérida de Venezuela, se separó manualmente en cuatro colores. Estos granos de polen fueron observados con el microscopio para su identificación botánica por comparación con la palinoteca de referencia. Cada tipo de po len se identificó utilizando una palinoteca de referencia: 1. Brassica napus (amarillo), 2. Fraxinus americana (anaranjado), 3. Zea mays (pardo), 4. Datura arborea (cremoso). La descripción sensorial permitió percibir diferencias de olor (resina, paja, miel), sabor (ácido, amargo, astringente, dulce) y textura (crujiente, pegajosa, polvorosa), además del color utilizado para separar las especies vegetales. La com posición físico- química varió así: 8,74 - 9,90 g agua/100 g polen, 2,15 - 33,9 g cenizas/100 g polen, 2,00 - 3,36 g extracto etéreo/ 100 g polen y 16,54 - 26,30 g proteína/100 g polen.

Bee pollen is the second product of the comb most consumed, after honey; however, there are no regulations for its quality control in Venezuela. In this work, fresh bee pollen collected in Cacute, Rangel County, Mérida state from Venezuela, was separated manually into fours colors. These pollen grains were observed with the microscope for its botanical identification by comparison with the pollen reference collection. Each pollen type was identified with a pollen reference collection: 1. Brassica napus (yellow). 2. Fraxinus americana (orange). 3. Zea mays (brown). 4. Da tura ar borea (creamy). Sensory evaluation allowed perception of differences in odour (resin, straw, honey), flavour (sour, bitter, astringent, sweet) and texture (crispy, sticky, powdery). The physicochemical composition varied as fo llows: 8,74 - 9,90 g water/100 g pollen, 2,15 - 33,9 g ash/100 g pollen, 2,00- 3,36 g fat/100 g pollen y 16,54 - 26,30 g protein/ 100 g pollen.

Caracterización física, culinaria y nutricional de frijol del altiplano subhúmedo de México / Physical, culinary and nutritional characterization in dry bean from the highlands of Mexico

In the improvement of a given crop species, knowledge on the grain quality and related traits in the progenitors used in the breeding process is needed to establish their usefulness as a source of a given character, and as well as to plan the proper combinations between progenitors. The aim of the present research was to characterize a group of 49 genotypes of Phaseolus vulgaris and one of Phaseolus coccineus, in relation to physical, cooking and nutritional grain traits. Cultivar Blanco Tlaxcala (P. coccineus) showed a larger grain size and lower protein content than any of the P. vulgaris cultivars. The 86 of the studied genotypes showed cooking times lower to 115 min, and a significant correlation between this trait and water sorption capacity (r = 0.78 **) was found. Cultivars Redlands Pioneer and ICA Zerinza could be used as source of low cooking time; and Perry Marrow, Kaboon and ICA Zerinza in the production of low shell content cultivars. Genotypes G 2333, Negro Lolotla, REN 27 and J 117 showed the highest grain protein content. On the other hand, BY 94022, Pinto Villa and Negro 150 had the lowest trypsin inhibitor activity. Results support the possible use of the above genotypes as sources of those grain traits. In general, large variability was found for most of the quality traits determined; therefore, there is scope for improvement through recombination and selection.