The luminescent Chalcones. Its potential use as a luminescent and antitumoral agents / Chalconas luminiscentes. Su uso potencial como agentes luminiscentes y antitumorales

Background: Hepatocellular carcinoma (HCC) is one of the most diagnosed cancers worldwide. Chemoprevention of HCC can be achieved using natural or synthetic compounds that reverse, suppress, detect, or prevent cancer progression. Objectives: In this study, both the antiproliferative effects and luminescent properties of 2'-hydroxychalcones were evaluated. Methods: Cell viability was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay, spectroscopy assays, and density functional theory (DFT) calculations were used to determine the luminescent properties of 2 ́-hydroxychalcones. Results: Cytotoxic effects of 2 ́-hydroxychalcones were observed over the HepG2 and EA.hy926 cells. Since the chalcone moiety could be used as a fluorescent probe, these compounds may be helpful in cancer diagnosis and tumor localization. They may enable tumor observation and regression through the fluorescence during treatment; therefore, the compounds are a potential candidate as novel anticancer agents acting on human hepatomas. Conclusions: This report describes the chalcones' use as a specific luminescent biomarker in tumor cells. We also report the cellular uptake of 2'-hydroxychalcones, their cellular distribution, and the mechanisms that may be responsible for their cytotoxic effects

ANTECEDENTES: El carcinoma hepatocelular (CHC) es uno de los cánceres más diagnosticados en todo el mundo. La quimio prevención del CHC se puede lograr utilizando compuestos naturales o sintéticos que reviertan, supriman, detecten o prevengan la progresión del cáncer. OBJETIVOS: En este estudio, se investigó tanto los efectos antiproliferativos como las propiedades luminiscentes de las 2'-hidroxicalconas. MÉTODOS: La viabilidad celular se evaluó usando el ensayo colorimétrico (MTT), los ensayos de espectroscopia y los cálculos DFT se usaron para determinar las propiedades luminiscentes de las 2 ́-hidroxichalconas. RESULTADOS: Se observaron efectos citotóxicos sobre las líneas celulares del tipo HepG2 y EA.hy926. Dado que la estructura de la 2 ́-hidroxichalcona puede ser usada como sonda fluorescente, estos compuestos pueden ser útiles en el diagnóstico del cáncer y la localización del tumor, ya que pueden permitir la observación a través de la fluorescencia y la regresión del tumor durante el tratamiento, por lo que son candidatas potenciales como nuevos agentes anticancerígenos que podrían actuar sobre hepatomas humanos. CONCLUSIONES: Este trabajo describe el uso de las 2 ́-hidroxichalconas como un biomarcador luminiscente específico para células tumorales. También informamos la captación celular de 2>-hidroxicalconas, su distribución celular y los mecanismos que pueden ser responsables de sus efectos citotóxicos

Nefropatía aguda por fosfatos secundaria al uso de laxantes con fosfato de sodio: caso clínico-patológico / Acute phosphate nephropathy secondary to the use of oral sodium phosphate laxatives: report of one case

Acute phosphate nephropathy (APN) is an acute renal failure secondary to the use of oral sodium phosphate (OSP) laxatives, with a high risk of progression to chronicity. We report a 60-year-old woman with mixed connective tissue disease whose serum creatinine increased up to 2.0 mg/dL in her regular control tests, without an evident causative factor. Kidney biopsy showed numerous intratubular calcium phosphate deposits, consistent with APN. She had a history of OSP laxative intake, and a sodium phosphate enema was used before a colonoscopy performed six months earlier. The temporal association between the use of OSP laxatives and acute kidney injury, should lead to the suspicion of APN. The urine sediment is generally normal or with mild to moderate proteinuria. The diagnosis is confirmed with a kidney biopsy. Until now, there is no specific treatment for APN, thus prevention is essential. In high-risk patients for developing APN, the administration of these laxatives should be avoided.

Nueva ecuación para la estimación de la natriuresis diaria a partir de parámetros en plasma y orina aislada en población chilena / A new equation to estimate daily natriuresis from parameters in plasma and spot urine sample in the Chilean population

Background: Excessive sodium intake is associated with increased cardiovascular morbidity and mortality. Daily sodium intake is usually inferred from sodium excretion in a 24-hour urine collection, which is cumbersome and prone to errors. Different formulas have attempted to estimate 24-hour urinary sodium from a spot urine sample. Unfortunately, their concordances are insufficient and have not been tested in our population. Aim: To develop an equation to predict 24-hour urine sodium from parameters in plasma and spot urine samples. To validate the equation and compare it with other formulas in Chilean population. Material and Methods: Analysis of 24-hour urine collections, plasma sample and spot urine sample from 174 adult outpatients (81% females) with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73m2. These were collected between 2015 and 2019 using standardized methods and educating patients about the correct method to collect 24 h urine samples. In all these patients, creatinine and electrolytes were measured in plasma and urine. A new equation was developed using a multiple linear regression model. Results: Twenty-four-hour urine sodium excretion was significantly correlated with age, weight, height, eGFR, plasma osmolarity, urine electrolytes and parameters obtained from spot urine sample, among others. The new equation had a linear correlation with 24-hour natriuresis of 0.91 and the concordance was 0.9. The predictive capacity of the new equation was better than the existing formulas. Conclusions: We developed a formula to accurately predict daily natriuresis in the Chilean population.

Uso de la cistatina C como biomarcador para estimar la tasa de filtración glomerular / Use of cystatin C to estimate glomerular filtration rate

Glomerular filtration rate (GFR) is routinely estimated using endogenous biomarkers due to the complexity of direct measurement methods. Cystatin C is a protease inhibitor produced in all nucleated cells. It is freely filtered and then catabolized by renal tubular cells. Therefore, plasma concentration of cystatin C depends primarily on GFR. Serum cystatin C is less affected by muscle mass, diet, race, gender and age than creatinine. In the general population, equations to estimate GFR based on cystatin C do not have a better performance than those based on creatinine. However, formulas that combine creatinine and cystatin C are more accurate and precise. Estimation of GFR based on cystatin C could be useful in populations in which creatinine value may be biased, such as people with extremely low or high muscle mass, cirrhosis and chronic cardiorenal syndrome. Due to its higher cost in comparison to creatinine, we recommend measuring cystatin C on these clinical situations and when a more accurate estimation of GFR is required.

Cetoacidosis por estrés: caso clínico en paciente con atrofia muscular espinal / Stress induced ketoacidosis in spinal muscular atrophy: report of one case

Spinal muscular atrophy is an uncommon cause of ketoacidosis, where there is a decrease in muscle mass, an abnormal metabolism of glucose and fatty acids, and changes in neuroendocrine function. These conditions favor the accumulation of keto acids and the development of metabolic acidosis. We report a 26-year-old female, with a history of spinal muscular atrophy type III, consulting for abdominal pain and vomiting lasting one week. She was admitted to the emergency service somnolent and poorly perfused. She had a pH of 6.98, HCO3- of 3.8 mmol/L, pCO2 of 16.4 mmHg, BE of -26 mmol/L, delta ratio of 1.05, anion gap of 31 mEq/L, creatinine of 0.37 mg/dL, sodium of 147 mEq/L, potassium of 3.7 mEq/L, chloride of 112 mEq/L, lactate of 1.2 mmol/L, glucose of 108 mg/dL, albumin of 4.2 g/dL, ketonemia +++, ketonuria +, measured plasma osmolality of 322 mOsm/kg, estimated osmolality of 314 mOsm/kg, toxilab negative, salicylate levels < 3 µg/mL, acetaminophen levels < 1.2 µg/mL. Intravenous hydration and bicarbonate were started, without satisfactory response. Interpreting the clinical picture as a ketoacidosis induced by stress in a patient with spinal muscular atrophy, it was handled with glucose, amino acids, vitamins and trace elements, with a favorable response.

Intoxicación por etilenglicol, fisiopatología y enfrentamiento clínico / Ethylene glycol poisonin: an update

Toxic alcohols can produce severe poisoning with multiple organic involvement and even death. The most common form is ethylene glycol. The diagnosis can be extremely difficult if there is no history of its consumption. Its clinical presentation can simulate other conditions. Ethylene glycol poisoning is characterized by an initial rise in plasma osmolal gap that decreases during the evolution, while alcohol is metabolized to acids. This last condition causes a metabolic acidosis with elevated anion gap. The clinical manifestations are diffuse neurological involvement initially, followed by hemodynamic alterations due to myocardial damage associated with hypocalcemia and acidemia. Subsequently, severe tubular renal damage appears, which may require renal replacement therapy, and finally, focal neurological alterations. To treat this poisoning, it is necessary to inhibit the transformation of alcohol into acids, increase the metabolism of the latter or withdraw them directly with hemodialysis.

Recurrencia de Síndrome de Goodpasture con negativización de anticuerpos anti-membrana basal glomerular: caso clínico / Recurrence of goodpasture syndrome with negative antiglomerular basement antibodies: report of one case

Goodpasture Syndrome is described as a single episode disease entity. It is diagnosed with the demonstration of antiglomerular basement (anti-GBM) antibodies in plasma or renal tissue. Although the recurrence of anti-GBM disease is rare, it has been reported in up to 3% of cases. Recurrence with negative anti-GBM antibodies in plasma is even less frequent We report a 63 years old male in whom anti-GBM disease recurred without detectable anti-GBM antibodies in plasma, despite having positive antibodies at the onset.

Síndrome hemolítico urémico atípico / Atypical hemolytic uremic syndrome

Atypical hemolytic uremic syndrome (aHUS) is a rare thrombotic microangiopathy, characterized by microangiopathic hemolytic anemia, thrombocytopenia and renal involvement. It causes end stage renal disease requiring dialysis in most affected patients. It mainly affects young adults (contrary to what was thought years ago). When aHUS is primary, the cause is a genetic mutation in the alternative complement pathway. Instead, secondary aHUS is caused by external factors that trigger the disease by themselves or in combination with a genetic vulnerability. The type of mutation determines the severity of the disease, prognosis, response to therapy and renal transplantation. Advances in the understanding of renal diseases associated with complement defects and the development of specific biologic therapies changed the course of this disease. Eculizumab is internationally approved for the treatment of primary aHUS. Its inhibitory action on the complement cascade leads to hematologic remission and restoration of renal function. We present a review of aHUS detailing its etiology, pathogenesis, clinical presentation, diagnosis and treatment.

Creatinina y su uso para la estimación de la velocidad de filtración glomerular / Estimation of glomerular filtration rate with creatinine

Glomerular filtration rate (GFR) is the best approximation to global renal function and its estimation is of great relevance for clinical practice. Since the measurement of GFR by reference methods is complex, costly and not widely available, its routine evaluation is performed using endogenous biomarkers. Within these, creatinine is the most commonly used. It allows the estimation of GFR by means of its clearance or by formulas based on its concentration on plasma. Creatinine measurement should be performed using enzimatic methods as they confer more accurate values than Jaffe methods, especially for normal and low creatinine levels.

Síndrome hemolítico urémico atípico en tratamiento con eculizumab: casos clínicos / Atypical hemolytic uremic syndrome: report of two cases treated with Eculizumab

Hemolytic uremic syndrome (HUS) is a type of thrombotic microangiopathy where organic damage predominates in the kidney. Atypical HUS (aHUS) is a rare disease that affects young adults and causes terminal chronic renal failure ending in dialysis, in most cases. It also recurs after kidney transplantation. aHUS is associated with genetic defects of the alternative complement pathway or its activation by other factors such as drugs, autoimmune diseases, infections, malignant hypertension and ischemia-reperfusion. We report two women aged 17 and 25 years old with catastrophic aHUS. In both cases, complement amplifying factors (drugs and infections) were added and acted on a genetic vulnerability to precipitate complement activation and produce aHUS. Both patients developed terminal renal failure and had to undergo hemodialysis. Fortunately, after a broad etiological study, it was possible to make the diagnosis of aHUS and start treatment with Eculizumab, a monoclonal antibody that changed the natural history of aHUS. It inhibits complement activity controlling microangiopathy and preventing the development of end-stage renal disease. It also improves the success rate in kidney transplantation. In the case of our patients, both discontinued dialysis after chronic treatment with Eculizumab.

Relevant chemistry topics for the clinical practice of a physiotherapist / Tópicos de química relevantes para la práctica clínica de un fisioterapeuta / Tópicos químicos relevantes para a prática clínica de um fisioterapeuta

Physiotherapist is a discipline whose aim is to preserve, restore, and improve the health status of individuals with motor disturbances or at risk of developing and to improve the quality of life of people and community. The aim of this article was to determine which are the most important topics of general organic and biological chemistry courses within the physiotherapist undergraduate career at the University Bernardo O´Higgins. For this purpose we followed a model of qualitative study, applied in two different groups of people: educators of the physiotherapist career (PE) and clinical physiotherapist (CP), who were asked about the importance of topics related to chemistry courses, general, organic and biological (GOB courses). Each participant must choose a category for each topic: "important", "relevant" or "not important" for a physiotherapist clinical activity. Results show that the more frequently topics considered as "important" in both groups were from biological chemical course: proteins and its metabolism. Secondly, none of the interviewed subjects considered any of the topics of the course of organic chemistry as "important" for the clinical activity of a physiotherapist. Thus, the aim of the study is widely fulfilled and it might be concluded that future studies are required involving a larger sample size in these and other universities that will generate results for a good curricular articulation.

La fisioterapia es una disciplina cuyo objetivo es conservar, restaurar y mejorar la salud de los individuos que presentan o tienen riesgo de tener alteraciones motoras. El objetivo de este artículo fue determinar cuáles son los tópicos más importantes de química general, orgánica y biológica para la práctica clínica en la carrera de fisioterapia en la Universidad Bernardo O´Higgins. Para lo anterior se siguió un modelo de estudio cualitativo aplicado en dos grupos de personas: educadores de la carrera de fisioterapia (PE) y fisioterapistas clínicos (CP) que fueron encuestados en relación a los tópicos de los cursos de química general, orgánica y biológica, denominados cursos GOB. Cada participante debía elegir una categoría: "importante", "relevante" y "no importante" de acuerdo a la práctica clínica para cada uno de los tópicos preguntados. Los tópicos que presentaron mayor frecuencia como "importante" en ambos grupos entrevistados fueron tópicos del curso de química biológica: proteínas y su metabolismo. Además, ninguno de los encuestados consideró ninguno de los tópicos del curso de química orgánica como "importante" para la actividad clínica de los fisioterapistas. El objetivo del estudio se cumplió completamente y se puede concluir que son necesarios estudios a futuro que involucren mayor cantidad de encuestados de esta y otras universidades, de este modo se generarán más resultados para una buena articulación curricular.

A terapia física é uma disciplina cujo objetivo é conservar, restaurar e melhorar a saúde dos indivíduos que têm um estado de risco de comprometimento motor. O objetivo deste artigo foi determinar quais são os temas mais importantes da química geral, orgânica e biológica para a prática clínica na carreira de fisioterapia na Universidade Bernardo O'Higgins. Para o anterior efetuo-se um estudo qualitativo aplicado a dois grupos de pessoas: educadores da carreira de fisioterapia (PE) e fisioterapeutas clínicos (CP). Eles foram entrevistados em relação aos temas dos cursos de química geral, orgânica e biológica, chamados cursos GOB. Cada participante devia escolher uma categoria: "importante", "relevante" e "sem importância" de acordo com a prática clínica para cada um dos temas questionados. Os temas mais frequentemente apresentados como "importante" em ambos grupos entrevistados foram os temas do curso de química biológica: proteínas e metabolismo. Além disso, nenhum dos inquiridos considerou qualquer dos tópicos do curso em química orgânica como "importante" para a atividade clínica dos fisioterapeutas. O objetivo do estudo foi completamente cumprido, e pode-se concluir que são necessários estudos futuros envolvendo um maior número de entrevistados nesta e em outras universidades, desse jeito se gerarão mais resultados para uma boa articulação curricular.

Dieta DASH y menopausia: más allá de los beneficios en hipertensión arterial / DASH diet and menopause: beyond the benefits on control of blood pressure

La disminución en la producción de estrógenos durante la menopausia favorece una disminución en la función endotelial y en la mineralización ósea, además de cambios en la distribución de la grasa corporal. Estos cambios favorecen un aumento en la prevalencia de hipertensión arterial en mujeres mayores de 50 años, junto con un aumento en otros factores de riesgo cardiovascular y una disminución de la densidad ósea (DO). La terapia de reemplazo hormonal utilizada en estas mujeres para mitigar los cambios descritos, se ha asociado a un mayor riesgo de desarrollar nefrolitiasis. La dieta DASH ha demostrado ser efectiva en reducir la presión arterial y en este trabajo se discuten otros beneficios de esta dieta asociados a otros factores de riesgo, a la DO y en la mantención de la homeostasis urinaria. Por este motivo, se discute si la dieta DASH sería efectivamente beneficiosa en este grupo de mujeres independiente de sus efectos en la presión arterial.

Decreased production of estrogens after menopause produces endothelial dysfunction and a decrease in bone mineralization, as well as changes in body fat distribution. These changes favor an increase in the prevalence of hypertension in women older than 50 years old, along with an increase in other cardiovascular risk factors and decreased bone density. Hormone replacement therapy mitigates the changes described above, but it has been associated with a higher risk of nephrolithiasis. DASH diet has been shown to be effective in reducing blood pressure along with other benefits such as increasing bone density and maintaining urinary homeostasis. Here, we discuss whether DASH diet would actually benefit menopausal women independently of its effects on blood pressure.

Feocromocitoma :presentación como síndrome coronario agudo: Reporte de un caso / Presentation of a pheochromocytoma as an acute coronary syndrome: Report of one case

The typical symptoms of pheochromocytoma are palpitations, sweating, headaches and hypertension. We report a 70-year-old female admitted to the hospital due to a sudden onset of precordial pain with electrocardiographic changes. After admission the patient evolved with recurrent chest pain accompanied by hypertensive paroxysms and a pheochromocytoma was suspected. Measurement of catecholamines and metanephrines confirmed the diagnosis and an abdominal magnetic resonance localized the tumor. The patient underwent surgery with successful removal of the pheochromocytoma and was discharged in good conditions.

¿Sirven los marcadores de riesgo no tradicionales en la diferenciación del riesgo cardiovascular en adultos jóvenes con exceso de peso? / Carotid intima media thickness and C reactive protein among overweight or obese subjects without metabolic syndrome

Background: Recognizing cardiovascular risk in overweight adults is challenging, as they usually have a low Framingham risk score (FRAM). In these subjects, non-traditional biomarkers could improve risk stratification. Aim: To assess carotid intima media thickness (CIMT) and ultrasensitive C-reactive protein (usCRP) among overweight and obese subjects without metabolic syndrome (MetSyn). Subjects and Methods: In 1558 asymptomatic participants (816 women, 45 ± 11 years) we measured body mass index (BMI), waist circumference, blood pressure, lipid profile, blood glucose, FRAM, usCRP and CIMT. For analytical purposes, we divided the subjects in three groups according to BMI and number of ATPIII-MetSyn risk factors (RF): 1) BMI < 25 and < 3RF, 2) BMI ≥ 25 and < 3RF and 3) BMI ≥ 25 and ≥ 3RF. Results: Participants of group 2 (BMI ≥ 25 and < 3RF) had a low FRAM (8%). Compared with participants of group 1, they had a higher CIMT (0.61 ± 0.1 and 0.57 ± 0.09 mm, respectively, p < 0.01) and usCRP (2.1 ± 2.1 and 1.5 ± 1.9 mg/L respectively, p < 0.01). Conclusions: This study shows that although subjects with overweight/obesity without MetSyn have low cardiovascular risk based on FRAM, they have higher CIMT and usCRP than their normal weight counterparts.

Relación colesterol total a HDL y colesterol no HDL: los mejores indicadores lipídicos de aumento de grosor de la íntima media carotidea / Total/HDL cholesterol ratio and non HDL cholesterol as predictors for increased intima media thickness

Background: LDL, HDL cholesterol and triglycerides, are the most commonly used lipid cardiovascular risk predictor indicators. However population based studies have shown that non-HDL cholesterol and total/HDL cholesterol ratio are better predictors, are easy to measure and do not require fasting. Aim: To determine which lipid indicators are better determinants of subclinical atherosclerosis, measured by intima media thickness (IMT) among subjects without demonstrated atherosclerosis. Material and Methods: Lipid profile, height, weight, blood pressure and bilateral IMT, measured by ultrasound with automatic border recognition software, were assessed in 770 men and 854 women aged 45 ± 11 years, in Santiago de Chile. Results: Mean total cholesterol was 202, HDL 50, LDL 121, triglycerides 157 and non-HDL cholesterol 152 mg/dl. Total/HDL cholesterol ratio was 4.3. MeanIMTwas 0.62 mm. All lipid markers were significantly correlated with IMT. This correlation was higher for non-HDL cholesterol (r = 0.24, p < 0.0001) and total/HDL cholesterol ratio(r = 0.23, p < 0.0001). In both men and women, total/HDL cholesterol ratio was the best predictor of having an IMT over the 75th percentile (odds ratio 1.21, 95% confidence intervals 1.09-1.35, p < 0.01). Conclusions: Total/HDL cholesterol ratio was the best determinant of subclinical atherosclerosis.

Microalbuminuria y excreción urinaria de albúmina en la práctica clínica / Microalbuminuria and urinary albumin excretion in clinical practice

Background: Microalbuminuria is a new tool in the management of patients with diabetes mellitus or hypertension. Microalbuminuria is an easily measured biomarker in a urine sample. Urinary albumin to creatinine ratio in first morning urine sample correlates with 24 hours urinary albumin excretion, but it is easier to obtain, and can identify hypertensive or diabetic patients with high risk for cardiovascular events. Therapeutic interventions such as renin angiotensin system blockade have demonstrated their usefulness in reducing urinary albumin excretion in clinical studies. It would be advisable to incorporate urinary albumin to creatinine ratio to the routine clinical monitoring of patients with cardiovascular risk, such as those with hypertension and diabetes mellitus.

Perfil de riesgo cardiovascular en adultos jóvenes asintomáticos con grosor íntima media carotídeo elevado / Cardiovascular risk factors among young subjects with high carotid intima media thickness

Background: Cardiovascular risk factor (RF) assessment is essential to prevent and predict cardiovascular disease. The presence of RF at early ages, are determinant for the presence of atherosclerosis later in life. Aim: To determine the RF profile of young subjects with high carotid intima media thickness (CIMT). Material and Methods: We studied 689 subjects (50 percent women, mean age 36±6 years) from Santiago, Chile. We determined body mass index (BMI), waist circumference, blood pressure, fasting serum lipids, blood glucose and C-reactive protein. CIMT was assessed by ultrasound using an automatic border recognition software. Results: Body mass index, waist circumference, blood pressure and serum lipids were significantly higher among subjects located in the higher CIMT quartile. Also, subjects in the higher quartile of CIMT had a higher prevalence of three or more RF compared with the lower quartile (p = 0.01). Finally, individuals with three or more RF showed three times more risk of being in the higher CIMT quartile, than subjects with no RF (odds ratio = 3.1, p < 0.01). Conclusions: There is a negative influence of cardiovascular RF on CIMT among young subjects.

Hipertensión arterial: el factor de riesgo más importante para grosor íntima-media carotídeo elevado y placa carotídea en adultos de Santiago / Risk factors for a high carotid intima media thickness among healthy adults

Background: Carotid intima media thickness (CIMT) is a marker of cardiovascular damage that can be modified by traditional risk factors. Aim: To determine attributable risk factors for a high CIMT among healthy adults. Material ana Methods: A sample of 1270 individuáis (636 males and 634 femóles) aged 44 ±11 years, was studied. Blood pressure, weight, height, lipidprofile and blood glucose were measured in all. CIMT and thepresence of atheroscleroticplaques were determined by carotid ultrasound. Standard criteria were used to define hypertension, dyslipidemia and diabetes. Results: Mean CIMT in the sample studied was 0.62 ± 0.01 mm and percentile 75 was 0.67. The most important risk factor for a CIMT over percentile 75 and thepresence of atherosclerotic plaques was hypertension with attributable risks of 54 and 57 percent, respectively. Conclusions: In this sample, the main risk factor for a high CIMT was hypertension.

Hipokalemia, hipovolemia y repercusión electrocardiográfica secundarias a ingesta prolongada de furosemida: Caso clínico / Hypokalemia, hypovolemia and electrocardiographic changes due to furosemide abuse: Report of one case

Hypokalemia (serum K+ < 3.5 mEq/1) is a potentially serious adverse effect of diuretic ingestión. We report a 27 year-old woman admitted with muscle weakness, a serum potassium of 2.0 mEq/1, metabolic alkalosis and EKG abnormalities simulating cardiac ischemia, that reverted with potassium chloride administration. She admitted high dose furosemide self-medication for edema. Glomerular filtration rate, tubular sodium reabsortion, potassium secretion, the renin-aldosterone system, total body water distribution and capillary permeability, were studied sequentially until 90 days after her admission. There was hyperactivity of the renin-aldosterone axis, reduction in extracellular and intracellular volumes, normal capillary permeability and high sodium tubular reabsorption, probably explained by a "rebound" salt retention associated with her decreased extracellular volume.

Non traditional risk factors for atherosclerosis

During the last 10 years, several "non-traditional" risk markers for atherosclerosis have been identified. Among them, new markers of lipoprotein metabolism (ie lipoprotein [a]), endothelial dysfunction (ie homocysteine), hemostasis (ie fibrinogen) and inflammation (ie C-reactive protein) have been linked to an excessive risk of cardiovascular disease. These factors should help the clinician to better identify individuals at risk of premature atherosclerotic disease and/or improve the predictive value of established risk factors for atherosclerosis. Finally, these factors are expected to improve the knowledge in the pathophysiology of cardiovascular diseases, and perhaps to impact future therapeutic decisions. In this review article, we will analyze the markers in which there are at least some evidence to support their acceptance as "non-traditional risk factors" for atherosclerotic disease