Evaluation of bone densitometry by dual-energy x-ray absorptiometry as a fracture prediction tool in women with chronic kidney disease.

BACKGROUND: The 2017 KDIGO guidelines establish a 2B grade recommendation in favor of testing Bone Mineral Density (BMD) by DXA to assess osteoporotic fracture (OPF) risk in patients with CKD G3a-G5D. Still, controversy remains because large studies evaluating it for this particular population are lacking. AIM: To establish the clinical performance of BMD measured by DXA in the evaluation of fracture risk in women with CKD. METHODS: We conducted a 43 year retrospective cohort study with 218 women ≥18 years-old with CKD and BMD measurement by DXA of total hip and lumbar spine. Clinical (age, year of CKD onset, comorbidities, BMI, transplant status, treatment), and biochemical (PTH, corrected calcium, phosphate, vitamin D [25 (OH) D3], creatinine, and albumin), parameters were collected from hospital records. All osteoporotic fractures (as defined by the WHO) found in the clinical and radiologic files were registered. RESULTS: 218 women with a median age of 60 years (40-73 IQ range) and a CKD evolution time of 12 years (7-18 IQ range) were evaluated. Forty-eight (28.23%) presented an OPF. These women were older (57 vs 69 years, p =0.0072) and had a lower BMD. CKD stage did not influence fracture incidence. In the multivariate analysis we found that for each standard deviation decrease in hip and lumbar spine T-Score, the overall fracture risk was 2.7 and 2.04 times higher, respectively. More than 50% of fractures took place within the first ten years of follow-up, especially with GFR <30 mL/min/m2 and osteoporosis. Diabetes and hypothyroidism accelerated fracture onset, while renal transplant delayed it. In the ROC analysis, the AUC was largest with the total hip (0.7098, p = 0.000) and lumbar spine (0.6916, p = 0.000). CONCLUSIONS: BMD measured by DXA is a useful fracture prediction tool for women with CKD, having a sensibility and specificity similar to that in the general population. It seems to be appropriate for the diagnosis, treatment decisions, and follow-up of patients with renal failure.

Clinical scenarios for the use of S100ß as a marker of hepatic encephalopathy.

AIM: To evaluate the association between serum concentrations of S100ß in patients with cirrhosis and the presence of low grade hepatic encephalopathy (HE). METHODS: This was a cross-sectional study. The population was categorized into four groups healthy subjects, cirrhosis without HE, cirrhosis with covert hepatic encephalopathy (CHE) and cirrhosis with overt HE. Kruskal-Wallis, Mann Whitney's U with Bonferroni adjustment Spearman correlations and area under the ROC were used as appropriate. RESULTS: A total of 61 subjects were included, 46 cirrhotic patients and 15 healthy volunteers. S100ß values were different among all groups, and differences remained significant between groups 1 and 2 (P < 0.001), and also between groups 2 and 3 (P = 0.016), but not between groups 3 and 4. In cirrhotic patients with HE S100ß was higher than in patients without HE [0.18 (0.14-0.28) ng/mL vs 0.11 (0.06-0.14) ng/mL, P < 0.001]. There was a close correlation between serum concentrations of S100ß and psychometric hepatic encephalopathy score in patients with cirrhosis without HE compared to the patients with cirrhosis with CHE (r = -0.413, P = 0.019). ROC curve analysis yielded > 0.13 ng/mL as the best cutoff value of S100ß for the diagnosis of HE (sensitivity 83.3%, specificity 63.6%). CONCLUSION: Serum concentrations of S100ß are higher in patients with cirrhosis than in healthy volunteers, and are further increased in the presence of hepatic encephalopathy. The results suggest that serum biomarkers such as S100ß could help in the correct characterization of incipient stages of HE.

Influence of 4,4'-azobis (4-cyanopentanoic acid) in Transmission and Reflection Gratings Stored in a PVA/AA Photopolymer.

Holographic transmission gratings with a spatial frequency of 2658 lines/mm and reflection gratings with a spatial frequency of 4553 lines/mm were stored in a polyvinyl alcohol (PVA)/acrylamide (AA) based photopolymer. This material can reach diffraction efficiencies close to 100% for spatial frequencies about 1000 lines/mm. However, for higher spatial frequencies, the diffraction efficiency decreases considerably as the spatial frequency increases. To enhance the material response at high spatial frequencies, a chain transfer agent, the 4,4'-azobis (4-cyanopentanoic acid), ACPA, is added to the composition of the material. Different concentrations of ACPA are incorporated into the main composition of the photopolymer to find the concentration value that provides the highest diffraction efficiency. Moreover, the refractive index modulation and the optical thickness of the transmission and reflection gratings were obtained, evaluated and compared to procure more information about the influence of the ACPA on them.

[Drugs having latex and therapeutic alternatives in hospital formulary]. / Medicamentos con látex y alternativas en guía farmacoterapéutica.

OBJETIVE: To analyze the latex content of drugs in hospital formulary and establish possible therapeutic alternatives. METHODS: All drugs susceptible of having latex were selected and written information was obtained from manufacturers. A therapeutic alternative was found for each of them, if possible. RESULTS: Written information from manufacturer was obtained for 605 (97.9%) and from label information for 8 of 632 selected drugs. For 43.9% of not safe drugs (total 57) on patients with latex allergy, a therapeutic alternative was found in hospital formulary. CONCLUSIONS: Knowing drugs having latex improve the prescription security, while the therapeutic alternatives chart eases the validation. The published data updates the scarce and variable information for patients and healthcare professionals.

Objetivo: Analizar el contenido en látex de los medicamentos en la guía farmacoterapéutica y establecer alternativas en un hospital de tercer nivel. Método: Se seleccionaron los medicamentos susceptibles de contener látex en su material de acondicionamiento, se solicitó al laboratorio fabricante información y se buscaron posibles alternativas incluidas en guía farmacoterapéutica. Resultados: De las 618 especialidades seleccionadas se obtuvo información escrita del laboratorio para 605 (97.9%) y en ficha técnica para 8. De las 57 (9,2%) especialidades con riesgo en pacientes con alergia al látex se encontró una alternativa en guía para el 43,9%. Conclusiones: Conocer las especialidades con látex aumenta la seguridad en la prescripción, mientras que la disponibilidad de una tabla de equivalencias terapéuticas facilita la validación. Los datos publicados vienen a actualizar la información del contenido en látex de los medicamentos para pacientes y personal sanitario, generalmente escasa y variable.

Medicamentos con látex y alternativas en guía farmacoterapéutica / Drugs having latex and therapeutic alternatives in hospital formulary

Objetivo: Analizar el contenido en látex de los medicamentos en la guía farmacoterapéutica y establecer alternativas en un hospital de tercer nivel. Método: Se seleccionaron los medicamentos susceptibles de contener látex en su material de acondicionamiento, se solicitó al laboratorio fabricante información y se buscaron posibles alternativas incluidas en guía farmacoterapéutica. Resultados: De las 618 especialidades seleccionadas se obtuvo información escrita del laboratorio para 605 (97.9%) y en ficha técnica para 8. De las 57 (9,2%) especialidades con riesgo en pacientes con alergia al látex se encontró una alternativa en guía para el 43,9%. Conclusiones: Conocer las especialidades con látex aumenta la seguridad en la prescripción, mientras que la disponibilidad de una tabla de equivalencias terapéuticas facilita la validación. Los datos publicados vienen a actualizar la información del contenido en látex de los medicamentos para pacientes y personal sanitario, generalmente escasa y variable (AU)

Objetive: To analyze the latex content of drugs in hospital formulary and establish possible therapeutic alternatives. Methods: All drugs susceptible of having latex were selected and written information was obtained from manufacturers. A therapeutic alternative was found for each of them, if possible. Results: Written information from manufacturer was obtained for 605 (97.9%) and from label information for 8 of 632 selected drugs. For 43.9% of not safe drugs (total 57) on patients with latex allergy, a therapeutic alternative was found in hospital formulary. Conclusions: Knowing drugs having latex improve the prescription security, while the therapeutic alternatives chart eases the validation. The published data updates the scarce and variable information for patients and healthcare professionals (AU)

Identification of a cluster of HIV-1 controllers infected with low replicating viruses.

Long term non-progressor patients (LTNPs) are characterized by the natural control of HIV-1 infection. This control is related to host genetic, immunological and virological factors. In this work, phylogenetic analysis of the proviral nucleotide sequences in env gene from a Spanish HIV-1 LTNPs cohort identified a cluster of 6 HIV-1 controllers infected with closely-related viruses. The patients of the cluster showed common clinical and epidemiological features: drug user practices, infection in the same city (Madrid, Spain) and at the same time (late 70's-early 80's). All cluster patients displayed distinct host alleles associated with HIV control. Analysis of the virus envelope nucleotide sequences showed ancestral characteristic, lack of evolution and presence of rare amino-acids. Biological characterization of recombinant viruses with the envelope proteins from the cluster viruses showed very low replicative capacity in TZMbl and U87-CD4/CCR5 cells. The lack of clinical progression in the viral cluster patients with distinct combinations of protective host genotypes, but infected by low replicating viruses, indicate the important role of the virus in the non-progressor phenotype in these patients.

Analysis of holographic reflection gratings recorded in polyvinyl alcohol/acrylamide photopolymer.

Holographic reflection gratings in a polyvinyl alcohol/acrylamide based photopolymer were stored using symmetrical geometry in three different thicknesses of the material. The advantage of symmetrical geometry is that exact expressions for transmittance, reflectance, and electric fields can be obtained analytically. Using these expressions, experimental data were fitted to obtain parameters such as refractive index modulation, spatial period of the grating, optical thickness or shrinkage of the material.

Videoconferencia entre los servicios de prevención: una nueva forma de comunicación y transmisión de experiencias en el marco de un convenio de colaboración / No disponible

Objetivos: Intercambio del conocimiento, compartir equipos técnicos e incrementar la actividad científica. Metodología: Dado que parte de las tareas de los profesionales de los SPP son: evaluación de las condiciones de trabajo y la elaboración, aplicación y desarrollo de los protocolos técnicos y sanitarios, se hace imprescindible el trabajo entre los SPP, que enriquece el conocimiento y permite la transferencia científica. En julio de 2010, se aprobó un convenio de colaboración entre los SPP de los hospitales de la Santa Creu i Sant Pau (Barcelona) y la Corporació Parc Taulí (Sabadell). Resultados: Se han compartido equipos de mediciónpara la evaluación de parámetros de higiene, con criterios técnicos y asistenciales y protocolos de vigilancia de la salud. Se han instaurado las videoconferencias como sesiones periódicas entre los servicios para estrechar los vínculos y reafirmar la colaboración. Conclusiones: El trabajo entre los dos SPP permite y promueve el trabajo transversal. En sí mismo, trabajar en equipo, es un conocido factor amortiguador del riesgo psicosocial que en el caso de los equipos de los SPP, no es menospreciable. Las nuevas tecnologías ya disponibles en hospitales como herramientas de comunicación son claves para llevar a término el trabajo y la colaboración entre dos equipos diferentes, separados por la distancia. Permiten la asistencia simultánea de los dos equipos, la discusión compartida y el consenso (AU)

No disponible

Study of reflection gratings recorded in polyvinyl alcohol/acrylamide-based photopolymer.

High-spatial-frequency fringes associated with reflection holographic optical elements are difficult to obtain with currently available recording materials. In this work, holographic reflection gratings were stored in a polyvinyl alcohol/acrylamide photopolymer. This material is formed of acrylamide photopolymer, which is considered interesting material for optical storage applications such as holographic memories. The experimental procedure for examining the high-spatial-frequency response of this material is explained, and the experimental results obtained are presented. With the aim of obtaining the best results, the performance of different material compositions is compared.

A dual superinfection and recombination within HIV-1 subtype B 12 years after primoinfection.

To analyze superinfection in an HIV-1-infected patient showing high-risk practices, viral quasispecies were analyzed in pol and env genes in several plasma samples. Phylogenetic analysis in the reverse transcriptase fragment in pol gene identified a single virus in the first 3 samples analyzed, but 12 years after primoinfection, 3 different viral strains were detected in the patient quasispecies. This result suggests a superinfection with 2 HIV-1 strains, one of which showed the T215Y + M184V resistance mutations. The analysis in the env gene confirmed the existence of 3 different strains in the viral population, one of them a recombinant. This study illustrates that events of superinfection and recombination contribute to the viral genetic variability observed in HIV-1-infected individuals.

Effects of magnesium sulfate on lipid peroxidation and blood pressure regulators in preeclampsia.

OBJECTIVES: To investigate the status of lipid peroxidation and serum levels of several vasoactive substances in preeclamptic (PE) pregnant women before and during treatment with magnesium sulfate (MgSO(4)). DESIGN AND METHODS: The study population included 16 PE women. Circulating levels of malondialdehyde (MDA), endothelin 1 (ET-1), nitric oxide (NO) metabolites, and calcitonin gene-related peptide (CGRP) were measured before (at admission) and during MgSO(4) treatment (at delivery and 24 h postpartum). RESULTS: At admission systolic and diastolic blood pressures were 157 +/- 3 mm Hg and 106 +/- 2 mm Hg, respectively, and decreased significantly during treatment at delivery and 24 h postpartum (P < 0.0001). Before treatment, serum MDA concentrations were 0.383 +/- 0.037 micromol/L, and decreased significantly during MgSO(4) administration at delivery and 24 h postpartum (P < 0.0001). In contrast, serum ET-1 levels at 24 h postpartum were significantly higher as compared with those observed before treatment (79 +/- 3 versus 65 +/- 2 pg/mL, P = 0.002). Serum NO metabolite concentrations were 26 +/- 3 micromol/L, and no significant changes were observed during treatment. Serum levels of CGRP were 50 +/- 3 pg/mL at admission, and increased significantly at partum (P < 0.001). Serum ET-1 correlated negatively with NO metabolites before treatment (r = -0.69, P = 0.002), but not during treatment. In contrast, ET-1 correlated positively with serum CGRP levels during treatment (r = 0.73, P = 0.002 and r = 0.71, P = 0.002, at delivery and 24 h postpartum, respectively), but not before treatment. CONCLUSIONS: This study demonstrates that MgSO(4) administration to PE pregnant women induced significant changes in lipid peroxidation, production of ET-1 and CGRP.

[Assay validation for determining nitrites and nitrates in biological fluids]. / Valoración de un método para determinar nitritos y nitratos en muestras biológicas.

INTRODUCTION: Nitric oxide is an important modulator of numerous physiological and pathophysiological processes. An indirect form to detect NO production has been the quantification of its stable end products, nitrites and nitrates (NO2- + NO3-). These metabolites can be detected with a commercial kit, but it is somewhat expensive and not accessible to some laboratories in our country. OBJECTIVE: To validate an easy, accessible and less expensive assay for detecting nitrates and nitrites in biological fluids. MATERIAL AND METHODS: In this study we determined nitrates and nitrites by reducing nitrates enzymatically with nitrate reductase, followed by nitrites quantification using the Griess reagent. To validate the assay, NO3- concentration was evaluated in aliquots with known amounts of sodium nitrate, also NO2- + NO3- concentrations were detected in plasma containing known amounts of sodium nitrate, finally NO2- + NO3- levels were evaluated in plasma (n = 17) and ascites (n = 11) samples of cirrhotic patients. In samples of patients, NO2- + NO3- levels were also detected by using a commercial kit. RESULTS: The assay that we describe here detects nitrates in the range between 25 to 400 microM/L and nitrites between 25 to 100 microM/L. When specific concentrations of nitrates were added to plasma samples, the recovery percentage in most cases was greater than 95%. In plasma samples of cirrhotic patients, average concentrations of NO2- + NO3- was 44.6 +/- 22.4 microM (mean +/- SD), similar to that found using the commercial kit, 40.9 +/- 18.3 microM/L (p = 0.107). In ascitis samples, similar results using both methods were seen, 64.5 +/- 42.0 vs. 58.2 +/- 39.3 microM/L (p = 0.172) respectively. CONCLUSIONS: Our results suggest that the method described here could be considered as an alternative instead of commercial kits to determine NO2- + NO3- in plasma and ascites samples. In addition, this assay results more attractive because, it does not, require special equipment, it is very accessible to most laboratories, it may be use to assay one or more samples at any given time, but the most important advantage, is its cost effectiveness; thus each sample determination is about one fifth of the cost using the commercial kit.

Administración sanitaria: unidades docentes como estrategía del programa de educación para la salud / Health administration: teaching units as strategy of the educational program for health

El objeto de este estudio es contribuir al conocimiento de las Unidades Docentes como estrategia del Programa Educación para la Salud y además detectar los contenidos programáticos y su operatividad en cuanto a la relación que pueda tener con ellas el personal de la Dirección de Promoción Social para la Salud. Este conocimiento de las Unidades Docentes permite describir algunos factores que inciden en el adiestramiento de personal y en el señalamiento de funciones y objetivos

Evaluación del programa educativo de Fisiología II / Evaluation of educative program Physiology II

Esta investigación en Servicios de Educación Médica se propuso evaluar la calidad de los programas educativos de pregrado que imparte el colectivo de Fisiología. Para él se recolectó y analizó la información emanada de las fases de planificación, ejecución y resultados del Programa de Fisiología II, mediante las técnicas y análisis de documentos, caracterización de la población destinataria, revisión de infraestructura material, medios de ense;anza y de análisis de rendimiento docente y la aplicación de pruebas de diagnóstico y cuestionarios. De este modo se encontró efectivo el nuevo programa de la asignatura, debe trabajarse en la dinámica del proceso, la efectividad de los medios de enseñanza y el sistema evaluativo, lo que hace necesario elevar la formación académica de los docentes, este sistema de conocimientos nos permitirá perfeccionar el programa en estudio y profundizar su impacto en la formación de los recursos humanos en la enseñanza de pregrado(AU)

Procedimientos activos en la enseñanza de los grupos sanguíneos / Active procedures at the teaching of the sanguine groups

Se realizó un estduio descriptivo acerca del comportamiento de los grupos sanguíneos del sistema ABO y Rh, según raza en los estudiantes de Licenciatura en Enfermería Curso Regular por Encuentros, de la Universidad Médica de Guantánamo, a los 24 sujetos que conforman el universo de trabajo, se les realizó por la técnica de porta objeto, la tipificación de los grupos sanguíneos, los cuales se relacionaron con la raza, según la clasificación aportada por el libro de Medicina Legal, teniendo en cuenta la prevalecia de la misma en nuestri medio. Se diseñó por parte de los estudiantes un juego didáctico que sirvió como soporte material creativo, para la interpretación del fundamento fisiológico de las transfusiones sanguíneas y la enfermedad hemolítica del recién nacido, lo cula permitió además el desarrollo de habilidades, independencia, capacidad creativa y adquisición de conocimientos en estos estudiantes(AU)

Propuesta de un juego didáctico para el prendizaje de la / Proposal of didactic game for the psychology learning of visual system

Se elaboró un juego didáctico relacionado con uno de los sistemas sensoriales especiales: Sistema Visual Humano, tomando como base un esquema integrador de la vía óptica, teniendo en cuenta la complejidad y la importancia de este contenido en la Fisiología I, y para la formación integral del egresado. A través del juego diseñado se logró recrear la realidad, elevar el nivel motivacional, desarrolar capacidad creativa, predictiva, de evaluación y autoevaluación, emocionalidad al proceso docente educativo, así como facilitó el aprendizaje, el mismo se utiliza en todas las formas de enseñanza de la asignatura y constituye un valioso medio de enseñanza(AU)

Problemas bioéticos de la clonación / Bioethic problems of the clonation

Se realiza una revisión bibliográfica con el objetivo de analizar los problemas éticos que se derivan de la clonación de un ser humano, donde abordamos algunos aspectos técnicos de la clonación, sus fines, problemas éticos y morales que dentro de ellos encontramos: problemas éticos que pudieran derivarse de las técnicas de la clonación hasta ahora desarrollada como la creación de la vida fuera del organismo humano, separación de la procreación de la unión sexual, gran costo de la técnica y poca accesibilidad a todos los que necesitan, dar lugra a la práctica de la Eugenesia con el objetivo de perfeccionar y orientar la especie humana hacia determinados prototipos de hombres orientados hacia determinados trabajos, intelectual, manual, etc. Finalmente se aborda sobre algunas concepciones éticas de la clonación. Concluyéndode que a pesar de ser imposible frenar la aplicación de esta técnica en el ser humano, en caso de realizarse debe ser solo cuando estén establecidos códigos morales que no violen los principios éticos del hombre y garanticen la protección de la seguridad del material genético humano (AU)