Características epidemiológicas de los pacientes que inician hemodiálisis crónica en el Hospital Alberto Sabogal Sologuren 2015 / Epidemiological characteristics of patients starting chronic hemodialysis in the Alberto Sabogal Sologuren Hospital 2015

Objetivo: Identificar las características epidemiológicas de los pacientes que inician hemodiálisis crónica durante el año2015 en el Hospital de EsSalud Alberto Sabogal Sologuren. Callao, Perú.Material y Métodos: Estudio observacional y descriptivo de corte transversal. La población de estudio fueron 30 pacientesque iniciaron terapia de hemodiálisis crónica en el Hospital de EsSalud, Alberto Sabogal Sologuren. Se obtuvo información através de una ficha elaborada por el investigador mediante 2 fuentes; historia clínica y referencia del mismo paciente y/ofamiliar. Las principales variables epidemiológicas recogidas fueron: datos personales y clínicos, haciendo hincapié en esteúltimo sobre el control previo en estadío pre diálisis, es decir si tuvo alguna preparación por un equipo de profesionales desalud renal para su ingreso programado a diálisis.Resultados: La edad media fue 62.3 años, y 53.3% de los pacientes fueron mayores de 60 años. La modalidad de ingreso fue73.3% por emergencia, 13.3% por consultorio y hospitalización. Tipo de acceso utilizado fue 86.7% catéter temporal, 10%fístula arteriovenosa y 3.3% catéter tunelizado. Diabetes e hipertensión con 36.7% y 33.3% respectivamente fueron lascausas más comunes de la ERC.Conclusión: La mitad de los pacientes que iniciaron hemodiálisis superan la sexta década de la vida, acuden en malascondiciones clínicas, gasométricas y bioquímicas. Una gran proporción de pacientes ingresan por las salas de urgencias conel consiguiente impacto negativo en la economía y la supervivencia de pacientes. El acceso vascular más frecuente parahemodiálisis fue el catéter temporal.

Objective: to identify the epidemiological characteristics of patients starting chronic hemodialysis during 2015 in the Alberto Sabogal Sologuren, EsSalud Hospital. Callao, Peru. Material and Methods: Observational and descriptive cross-sectional study. The study population consisted of 30 patients who started chronic hemodialysis therapy in the Alberto Sabogal Sologuren, Hospital EsSalud. Information was obtained through a form developed by the researcher through two sources; medical history and by reference of the same patient and / or family. The main epidemiological variables collected were: personal and clinical data, emphasizing the latter on the previous control in pre dialysis stage, that is, if the patients had some preparation by a team of renal dialysis health professionals for their scheduled entry for dialysis. Results: The mean age was 62.3 years, and 53.3% of patients were older than 60 years. The mode of admission was by emergency: 73.3%, and 13.3% for surgery and hospitalization. The type of access used 86.7% temporary catheter; 10% arteriovenous fistula and 3.3% tunneled catheter. Diabetes and hypertension with 36.7% and 33.3% respectively were the most common causes of CKD. Conclusion: Half of patients, who started hemodialysis were beyond the sixth decade of life and came in poor clinical, gasometry and biochemical conditions. A large proportion of patients admitted for emergency rooms with the consequent negative impact on the economy and survival of patients. The most common vascular access for hemodialysis was the temporary catheter.

GreA and GreB proteins revive backtracked RNA polymerase in vivo by promoting transcript trimming.

The GreA and GreB proteins of Escherichia coli show a multitude of effects on transcription elongation in vitro, yet their physiological functions are poorly understood. Here, we investigated whether and how these factors influence lateral oscillations of RNA polymerase (RNAP) in vivo, observed at a protein readblock. When RNAP is stalled within an (ATC/TAG)(n) sequence, it appears to oscillate between an upstream and a downstream position on the template, 3 bp apart, with concomitant trimming of the transcript 3' terminus and its re-synthesis. Using a set of mutant E.coli strains, we show that the presence of GreA or GreB in the cell is essential to induce this trimming. We show further that in contrast to a ternary complex that is stabilized at the downstream position, the oscillating complex relies heavily on the GreA/GreB-induced 'cleavage-and-restart' process to become catalytically competent. Clearly, by promoting transcript shortening and re-alignment of the catalytic register, the Gre factors function in vivo to rescue RNAP from being arrested at template positions where the lateral stability of the ternary complex is impaired.

[Nutritional evaluation of Lepidium meyenii (MACA) in albino mice and their descendants]. / Evaluación nutricional de Lepidium meyenii (MACA) en ratones albinos y su descendencia.

The Maca (Lepidium meyenii) is a Peruvian hypocotyl that grows exclusively between the 3700 and 4500 masl at the Peruvian Andes. Traditionally it is attributed nutritional, energizing, fertilizing properties among others. With the purpose of evaluate scientifically the nutritional property of Maca, we carried out a controlled study in two generations of albino Swiss mice (parents and breeding). The parents were aleatorily assigned to one of three nutritional schedules. The food of each group was prepared based on powder from a commercial balanced food (CBF) of which 30% was replaced by raw or cooked Maca according to the corresponding group or pure CBF in the control group. The groups were this way: 1) Raw Maca Group; 2) Cooked Maca Group; and, 3) Control Group. The results showed that the curves of growth were similar and adequate for the three groups. However, the cooked Maca group showed the best curve. These data were better observable in the second generation of animals, with significant statistical difference (p < 0.05). The CBF group had a better growth than raw Maca group. No signs of malnutrition nor overweight were observed in none of the groups. The serum values of total proteins and albumin were statistically superior for the mice group eating cooked Maca than that of the raw Maca and CBF groups. This study demonstrates, in a scientifical evaluation, one of the traditionally attributed properties of Maca, the nutritional capability.

HMG boxes of DSP1 protein interact with the rel homology domain of transcription factors.

Formation of the dorsoventral axis in Drosophila melanogaster is mediated through control of the expression of several genes by the morphogen Dorsal. In the ventral part of the embryo Dorsal activates twist and represses zen amongst others. Recently, several proteins have been shown to assist Dorsal in the repression of zen, one of which is DSP1, a HMG box protein that was isolated as a putative co-repressor of Dorsal. In this report we used a DSP1 null mutant to ascertain in vivo the involvement of DSP1 in Dorsal-mediated repression of zen but not in the activation of twist. We show that Dorsal has the ability to interact with DSP1 in vitro as well as with rat HMG1. Using truncated versions of the proteins we located the domains of interaction as being the HMG boxes for DSP1 and HMG1 and the Rel domain for Dorsal. Finally, studies of the zen DNA binding properties of Dorsal and another related Rel protein (Gambif1 from Anopheles gambiae) revealed that their DNA binding affinities were increased in the presence of DSP1 and HMG1.

DSP1 gene of Drosophila melanogaster encodes an HMG-domain protein that plays multiple roles in development.

DSP1 is an HMG-box containing protein of Drosophila melanogaster which was first identified as a co-repressor of the Dorsal protein. Recently, the analysis of the structure of the gene has led us to propose that DSP1 is the Drosophila equivalent of the ubiquitous vertebrate HMG 1/2 proteins. In the present paper, the patterns of expression of DSP1 protein and RNA in adult flies and during development are reported. In the adults DSP1 protein is located in nurse cells of ovaries and in brain. During eggs development uniform expression of DSP1 protein persists until the end of germband retraction. At later stages, expression is restricted to the ventral nerve chord and brain. Using P-element mutagenesis, we have isolated a mutant deficient in DSP1 functions. Genetic studies of this mutant show that DSP1 protein is essential for the growth and the development of Drosophila. In addition to be a co-repressor of the transcriptional activator Dorsal our results provide compelling evidence that DSP1 is a regulator involved in several pathways necessary for the development of the fly.

[Cholelithiasis in patients with liver cirrhosis]. / Colelitiasis en pacientes con cirrosis hepática.

We retrospectively studied 67 cirrhotic patients hospitalized in the service of gastroenterology of Hospital Daniel A. Carrión, Callao, Perú, between June 1993 and July 1995, aimed to determine the frequency of cholelithiasis and its main clinical and epidemiological features. Twelve out of 67 cirrhotic patients (17.91%) had cholelithiasis. 24% of women and 14.3% of men were affected (p > 0.05). The mean age of women and men were 57.33 and 57.5 years old respectively (range: 41-67 years old). The frequency of cholelithiasis did not increase with age and the proportionally most affected age group was 41-50 years (33.33%). Alcoholic etiology was the most often in cirrhotic patients with cholelithiasis (41.67%). The severity of liver disease influenced in the cholelithiasis frequency (p = 0.001) and 33.33% of patients with gallstones were in grade C of Child Pugh Score. Two thirds of patients were asymptomatic. We conclude: 1. Cholelithiasis in our cirrhotic patients more prevalent than in general population (17.91% vs 0.7-5%). 2. Age did not influence in cholelithiasis prevalence in our cirrhotic patients. 3. The severity of liver disfunction influenced in highly significant way (p = 0.001) on cholelithiasis prevalence. 4. Cirrhotic patients with gallstones had mostly (66.67%) an asymptomatic course.

[Peptic ulcer in patients with cirrhosis]. / Enfermedad ulcerosa péptica en pacientes cirróticos.

This study was carried out at the of gastroenterology service from Hospital Nacional "Daniel A. Carrión" Callao-Peru, between June 1993 and May 1994, in order to determine the incidence, as well as, the clinical and endoscopic features of peptic ulcer disease in cirrhotic patients. 24 out of 46 (52.17%) hospitalized cirrhotic patient during this period, had peptic ulcer disease. The male:female ratio was 1:1. The mean age was 63.54 years, ranging from 44 to 90. There was statistical association (p < 0.05) between the severity of liver disease determined by Child Pugh Score and the presence of gastric ulcer. Regarding symptomatology, 54.16% had hematemesis and/or melena and 37.5% were asymptomatic. 6 patients had 2 or more ulcers, presenting the total series as a whole 35 ulcers, whose size ranged from 0.4 a 1.2 cm. Gastric antrum was the most often location (60%) followed by duodenal bulb (20%). We conclude that peptic ulcer disease in our cirrhotic patients is more frequent than reported by international literature (5-32%). Severity of liver disease was associated to gastric ulcer.

[Pediatric colonoscopic polypectomy]. / Polipectomía colonoscópica pediátrica.

Colorectal polyps are relatively frequent in infancy and constitute one of the main causes of bleeding per rectum. Endoscopic polypectomy, with its lower morbidity and mortality, has revolutionized its treatment. Between October 1, 1985 and May 31, 1994, 122 polypectomies were done in 88 pediatric patients. Forty five patients (51.1%) were male and 43 female (48.9%). Forty four patients (50%) were between 1 and 5 years of age. Ninety five polyps (77.9%) were found more frequently in the rectum. Regarding the size, 63 polyps (51.6%) measured between 1 and 2 cm. Seventy three patients (83%) had a single polyp, 10 patients (11.4%) had 2 polyps and 1 patient had 12 polyps. Ninety six polyps (78.7%) were pedunculated, being this the more frequent form found. Histologically the most common was the juvenile polyp, found in 106 cases (87.6%). The polypectomies was carried out without using general anesthesia and is performed as an outpatient procedure. We had no experience of endoscopic complications. It is concluded that colonoscopy polypectomy is a useful, simple and safe procedure for treating colorectal polyps in children.

Factores asociados al pronóstico del paciente con insuficiencia renal crónica terminal (IRCT) en la ciudad de Lima / Associated factors at prognosis of patient with kidney failure chronic terminal (IRCT) in the Lima city

Se presentan los resultados de 619 pacientes con Insuficiencia Renal Crónica Terminal (IRCT) evaluados mediante dos cortes de tipo transversal realizados en enero de 1990 y enero de 1991 en todos los Sistemas de atención hospitalaria de Salud de Lima (Ministerio de Salud, Instituto Peruano de Seguridad Social-IPSS, Centro Privados de Hemodiálisis, Hospitales Militares y Clínicas Privadas). Se seleccionaron 619 de 782 pacientes evaluados en enero 1990 que completaron la siguiente información: Centro de atención en enero 1990 (CA), cobertura económica de atención en enero 1990 (CE), edad, causa de la IRCT (DX), ciudad de procedencia y estado final en enero 1991 (FIN). Los datos se evaluaron con análisis univariado, regresión múltiple, y ANOVA, usando el paquete estadístico EPI INFO V5. El 82 por ciento de los atendidos en Centros Privados de hemodiálisis, el 55.5 por ciento de le IPSS, el 48 por ciento en los Hospitales Militares y/o Clínicas Privadas, y 4 por ciento en los Hospitales del Ministerio de Salud estuvieron vivos en enero de 1991 (p<0.0001). El 65 por ciento de los que contaban con Seguro Social y el 33 por ciento de pacientes con sustento económico propio estuvieron vivos en enero del 91; mientras que ninguno de los que contaban con Seguro Particular o Institucional estuvieron vivos a la misma fecha. El 83 por ciento del grupo de edad de <20 años, el 64 por ciento entre 21-40 años, el 62 por ciento entre 41-60 y el 52 por ciento >60 años, estuvieron vivos en enero del 91. El 72 por ciento de los casos en Enfermedad Glomerular Primaria, el 63 por ciento de Nefropatía Intersticial sin enfermedad sistémica, el 58 por ciento con diagnóstico desconocido y el 46 por ciento con Nefropatía asociada a enfermedad sistémica, estuvieron vivos en enero del 91. Los resultados mostraron que el centro de atención, la cobertura económica de atención, la edad y la causa de insuficiencia renal crónica influyeron significativamente sobre el estado final (p<0.01).

Diagnóstico laparoscópico: un estudio retrospectivo de 259 casos / Laparoscopic diagnostic: a retrospective review of 259 cases

El rol que se le asigna a la laparoscopía en el manejo de las enfermedades hepáticas ha cambiado debido al uso de la biopsia dirigida por imágenes. La laparoscopía, sin embargo, permite la inspección directa de la superficie hepática y de la cavidad abdominal así como también la toma de biopsia. Con la finalidad de evaluar la utilidad de la laparoscopía y específicamente el valor diagnóstico de la visualización directa de la superficie hepática, nosotros retrospectivamente recolectamos información en 259 pacientes que se les realizó endoscopía. Se evaluó la contribución de los hallazgos laparoscópicos para el manejo de los pacientes y el valor del diagnóstico laparoscópico comparado con la histología. La laparoscopía tuvo un rendimiento diagnóstico de 74 por ciento. El diagnóstico visual fue más exacto en pacientes con cáncer hepático (86 por ciento), pero fue moderado en los pacientes con peritonitis tuberculosa (78.5 por ciento) y cirrosis (69 por ciento). Nosotros concluimos que la laparoscopía continúa siendo un procedimiento de gran valor diagnóstico especialmente en los casos donde se requiere evaluar exactamente la arquitectura hepática, con baja morbilidad y sin mortalidad

Pseudo obstrucción intestinal asociada a lupus eritematoso. / Lupus eritematosus with associated intestinal pseudo-obstruction.

Se presenta el caso de una paciente atendida en el Hospital Base Cayetano Heredia, que tuvo el diagnóstico de Lupus Eritematoso sistémico (LES) que en el curso de su enfermedad se complica con un pseudo-obstrucción intestinal. En relación con este caso, se revisaron todos lo pacientes del Servicio de Reumatología con diagnóstico de LES que presentaron complicación semejante, con resultados negativos; se revisa el tema sobre pseudo-obstrucción intestinal y el compromiso que el LES tiene sobre el tracto digestivo..