Obesidad y resistencia a la insulina en adolescentes de Chiapas / Obesity and insulin resistance among adolescents from Chiapas

Objetivo: El objetivo del presente estudio fue valorar la asociación de sobrepeso y obesidad con la resistencia a la insulina, la hipertensión, y las hiperlipidemias en un grupo de adolescentes de 12 a 15 años de escuelas privadas y públicas de Chiapas. Métodos: Estudio transversal mediante selección aleatoria de 259 jóvenes de 12 a 15 años de edad de escuelas públicas y privadas. Mediante métodos convencionales se midieron el peso, la estatura, la presión arterial, y se valoraron después de ayuno de 14 horas, glucosa, lípidos totales, colesterol total, colesterol LDL, triglicéridos, insulina. Se estimaron el colesterol HDL y el HOMA-IR. Las percentiles de peso para edad, talla para edad e IMC para edad se calcularon utilizando las tablas de crecimiento dela CDC. Para valorar la diferencia de prevalencia de sobrepeso y obesidad entre sexo y tipos de escuelas se realizó la X2 y el t-test para diferencias entre promedios delos marcadores bioquímicos entre los que presentaban peso normal y obesidad. Se utilizó la prueba de Mann-Whitney para valorar diferencias entre presión arterial. Resultados: Se observó alta prevalencia de sobrepeso(19%) y obesidad (13%) sin diferencias significativas portipo de escuela, género o grupo de edad, y alta prevalencia de hipercolesterolemia (26%), colesterol LDL (7%), triglicéridos(10%), de hipolipoproteinemia de alta densidad(3%), presión arterial sistólica (6%) y síndrome metabólico (1,6%). El IMC se asoció positivamente con los lípidos totales, el colesterol total, la insulina, y la HOMA-IR, y negativamente con el colesterol HDL. Los adolescentes con sobrepeso y obesidad tuvieron niveles más altos de insulina, Homa-IR, triglicéridos, y presión arterial y más bajos de colesterol HDL (AU)

Objective: The aim of this study was to assess the association of overweight and obesity with insulin resistance, hypertension, and hyperlipidemic among 12 to 15 year olds from private and public schools in Chiapas. Methods: This was a cross-sectional study with a random selection of 259, 12 to 15 year old teenagers from private and public middle schools. Conventional methods were used to measure body weight, height and blood pressure. After a 14-hour fasting period, a blood sample was taken for glucose, total lipids, total cholesterol, LDL-cholesterol, triglycerides and insulin levels. HDL-cholesterol and HOMA-IR were estimated. Weight-for-age, height for-age and BMI-for-age were calculated using the CDC tables for growth. To assess the difference between overweight and obesity by gender and type of school a X2 and t-test was performed in order to evaluate the mean difference between biochemical indicators of normal and overweight adolescents. The Mann-Whitney test was conducted to assess differences in blood pressure. Results: Observations included high prevalence of overweight (19%) and obesity (13%) with no difference between type of school, gender, or group of age (Table 2).High prevalence of hypercholesterolemia (26%), LDL cholesterol(7%), HDL hypolipoproteinemia (3%), triglycerides(10%), systolic blood pressure (6%), and metabolic syndrome (1.6%) were also observed. The BMI was associated to total lipid, total cholesterol, insulin, and HOMA-IR levels. The Overweight and obese had higher levels of insulin, HOMA-IR, triglycerides, and blood pressure and lower levels of HDL-cholesterol (AU)

Empleo del recuperador de sangre. Artroplastia total de rodilla / Use of a blood recuperating device. Total knee arthroplasty

Se valora la implantación de un protocolo de recuperación de sangre de los drenajes en cirugías de prótesis de rodilla. Estudio prospectivo con 19 pacientes diagnosticados de artrosis de rodilla y sometidos a cirugía de ATR, de septiembre a junio (2006-2007). El dispositivo utilizado fue Bellovac® de Astral Tech. No hubo diferencia de sexo y/o edad entre los pacientes transfundidos y no. En la URPA recibieron transfusión homóloga cuatro pacientes (21,50%). Previo a la implantación de este protocolo la incidencia de transfusión fue de 37%. La hemoglobina en el preoperatorio no fue factor de riesgo de transfusión homóloga. Éste se asoció, con el volumen drenado y reinfundido. Los pacientes transfundidos habían drenado 450 cc o más. No se registró ninguna complicación con el uso del recuperador. El uso del mismo permite disminuir la transfusión de sangre homóloga(AU)

The authors evaluate the adoption of a protocol to recuperate blood from drainage during surgery for knee prosthesis. They carried out a prospective study on 19 patients diagnosed with knee arthrosis and who underwent surgery for Total Knee Arthroplasty from September 2006 through June 2007. The medical instrument used was Bellovac®, produced by Astral Tech. In the Post anesthesia Reanimation Unit, four patients received a homologous transfusion (21.50%). Prior to the adoption of this protocol, the rate of transfusion was 37%. Hemoglobin during preoperative procedures was not a risk factor for a homologous transfusion. This is associated with the volume drained and reinserted. Patients who received a transfusion had drained 450 cc or more. The study did not record any complication due to the use of the recuperating device. The use of this device made it possible to decrease homologous blood transfusions(AU)

Transformación osteosarcomatosa de tumor phyllodes mamario / Osteosarcomatous transformation of phyllodes tumor of the breast: a clinical case

Antecedentes: El tumor phyllodes (TP) es un tumor poco común y aunque el 34,5-63,7 por ciento son benignos, el resto tienen un comportamiento borderline o maligno. Caso clínico: Paciente de 47 años derivada a nuestro centro para valoración por TP recidivante operado previamente tres veces con el resultado de TP de bajo grado con márgenes afectados. Al llegar a nuestro centro presenta un nódulo subcicatricial que se trata mediante escisión con el diagnóstico anatomopatológico de osteosarcoma osteoblástico de alto grado NI/ IV. Al estar con los márgenes afectados se trata posteriormente con cuadrantectomía más quimioterapia. Al terminar el tratamiento se objetivan en el TC torácico múltiples nódulos pulmonares compatibles con metástasis y se decide iniciar quimioterapia con otro esquema pero la paciente no responde y fallece por complicaciones derivadas de la progresión de su enfermedad pulmonar. Discusión: La cirugía es la base del tratamiento del TP, siendo la escisión local con márgenes suficientes, superiores a 1 -2 cm, el tratamiento de elección. La enucleación tumoral se considera insuficiente. La afectación tumoral de la axila ocurre en menos de 5-10 por ciento de las pacientes por lo que la exploración quirúrgica de la axila no se recomienda de rutina. Conclusión: La transformación osteosarcomatosa es una situación poco común, pero una cirugía incompleta en un TP maligno permite la desdiferenciación del componente estromal en sarcoma, incluso si el tumor inicial es de bajo grado. El pronóstico se ensombrece mucho, sobre todo si la transformación sarcomatosa contiene componentes heterólogos, como en este caso.

Background: Phyllodes tumor (TP) is a rare tumor. The majority of them have been described as benign, with the reminder divided between borderline and malignant tumors. Case description: 47-year-old patient derived to our hospital to evaluate a recurrent TP after three local failures. Surgical removal of tumor had positive margins in the previous surgeries. She presented to our service with a nodule in the scar that was resected. The pathology diagnosis revealed a poor differentiated osteosarcoma. As surgical margins were cióse, the treatment was completed with a wide local reexcision and adequate surgical margins plus chemotherapy. Multiple pulmonary nodules compatible with metastasis were targeted in the thoracic TC during follow-up and another chemotherapy scheme was initiated. The patient did not respond and died due to the progression of her pulmonary disease. Discussion: Surgical removal is the mainstay of TP treatment and wide excision with adequate margins superior to 1 -2 cm remains the treatment of choice. Lymphatic spread is uncommon and axillary metastases occur in less than 5-10 percent of patients, and therefore routine axillary dissection is not necessary. Conclusion: An incomplete resection in a malignant TP favours stromal overgrowth and sarcomatous transformation, which has very poor prognostic features.

Mechanism of the hydrolysis of 4-methylumbelliferyl-beta-D-glucoside by germinating and outgrowing spores of Bacillus species.

AIMS: To determine the mechanism of the hydrolysis of 4-methylumbelliferyl-beta-D-glucopyranoside (beta-MUG) by germinating and outgrowing spores of Bacillus species. METHODS AND RESULTS: Spores of B. atrophaeus (formerly B. subtilis var. niger, Fritze and Pukall 2001) are used as biological indicators of the efficacy of ethylene oxide sterilization by measurement of beta-MUG hydrolysis during spore germination and outgrowth. It was previously shown that beta-MUG is hydrolysed to 4-methylumbelliferone (MU) during the germination and outgrowth of B. atrophaeus spores (Chandrapati and Woodson 2003), and this was also the case with spores of B. subtilis 168. Germination of spores of either B. atrophaeus or B. subtilis with chloramphenicol reduced beta-MUG hydrolysis by almost 99%, indicating that proteins needed for rapid beta-MUG hydrolysis are synthesized during spore outgrowth. However, the residual beta-MUG hydrolysis during spore germination with chloramphenicol indicated that dormant spores contain low levels of proteins needed for beta-MUG uptake and hydrolysis. With B. subtilis 168 spores that lacked several general proteins of the phosphotransferase system (PTS) for sugar uptake, beta-MUG hydrolysis during spore germination and outgrowth was decreased >99.9%. This indicated that beta-MUG is taken up by the PTS, resulting in the intracellular accumulation of the phosphorylated form of beta-MUG, beta-MUG-6-phosphate (beta-MUG-P). This was further demonstrated by the lack of detectable glucosidase activity on beta-MUG in dormant, germinated and outgrowing spore extracts, while phosphoglucosidase active on beta-MUG-P was readily detected. Dormant B. subtilis 168 spores had low levels of at least four phosphoglucosidases active on beta-MUG-P: BglA, BglH, BglC (originally called YckE) and BglD (originally called YdhP). These enzymes were also detected in spores germinating and outgrowing with beta-MUG, but levels of BglH were the highest, as this enzyme's synthesis was induced ca 100-fold during spore outgrowth in the presence of beta-MUG. Deletion of the genes coding for BglA, BglH, BglC and BglD reduced beta-MUG hydrolysis by germinating and outgrowing spores of B. subtilis 168 at least 99.7%. Assay of glucosidases active on beta-MUG or beta-MUG-P in extracts of dormant and outgrowing spores of B. atrophaeus revealed no enzyme active on beta-MUG and one enzyme that comprised > or =90% of the phosphoglucosidase active on beta-MUG-P. Partial purification and amino-terminal sequence analysis of this phosphoglucosidase identified this enzyme as BglH. CONCLUSIONS: Generation of MU from beta-MUG by germinating and outgrowing spores of B. atrophaeus and B. subtilis is mediated by the PTS-driven uptake and phosphorylation of beta-MUG, followed by phosphoglucosidase action on the intracellular beta-MUG-P. The major phosphoglucosidase catalyzing MU generation from beta-MUG-P in spores of both species is probably BglH. SIGNIFICANCE AND IMPACT OF THE STUDY: This work provides new insight into the mechanism of uptake and hydrolysis of beta-MUG by germinating and outgrowing spores of Bacillus species, in particular B. atrophaeus. The research reported here provides a biological basis for a Rapid Readout Biological Indicator that is used to monitor the efficacy of ethylene oxide sterilization.

Studies on the mechanism of the osmoresistance of spores of Bacillus subtilis.

AIMS: To determine the reason that spores of Bacillus species, in particular Bacillus subtilis, are able to form colonies with high efficiency on media with very high salt concentrations. METHODS AND RESULTS: Spores of various Bacillus species have a significantly higher plating efficiency on media with high salt concentration (termed osmoresistance) than do log or stationary phase cells. This spore osmoresistance is higher on richer media. Bacillus subtilis spores lacking various small, acid-soluble spore proteins (SASP) were generally significantly less osmoresistant than were wild-type spores, as shown previously (Ruzal et al. 1994). Other results included: (a) spore osmoresistance varied significantly between species; (b) the osmoresistance of spores lacking SASP was not restored well by amino acid osmolytes added to plating media, but was completely restored by glucose; (c) the osmoresistance of spores lacking SASP was restored upon brief germination in the absence of salt in a process that did not require protein synthesis; (d) significant amounts of amino acids generated by SASP degradation were retained within spores upon germination in a medium with high but not low salt; (e) slowing but not abolishing SASP degradation by loss of the SASP-specific germination protease (GPR) did not affect spore osmoresistance; (f) sporulation at higher temperatures produced less osmoresistant spores; and (g) spore osmoresistance was not decreased markedly by the absence of the stress sigma factor for RNA polymerase, sigmaB. CONCLUSIONS: Spore osmoresistance appears as a result of three major factors: (1) specific characteristics of spores and cells of individual species; (2) the precise sporulation conditions that produce the spores; and (3) sufficient energy generation by the germinating and outgrowing spore to allow the spore to adapt to conditions of high osmotic strength; the substrates for this energy generation can come from either the endogenous generation of amino acids by SASP degradation or from the spore's environment, in the form of a readily taken up and metabolized energy source such as glucose. SIGNFICANCE AND IMPACT OF STUDY: These results provide information on the mechanisms of spore osmoresistance, a spore property that can be of major applied significance given the use of high osmotic strength with or without high salt as a means of food preservation.

Studies on the mechanisms of the sporicidal action of ortho-phthalaldehyde.

AIMS: To determine the mechanism of killing of spores of Bacillus subtilis by ortho-phthalaldehyde (OPA), an aromatic dialdehyde currently in use as an antimicrobial agent. METHODS AND RESULTS: OPA is sporicidal, although spores are much more OPA resistant than are vegetative cells. Bacillus subtilis mutants deficient in DNA repair, spore DNA protection and spore coat assembly have been used to show that (i) the coat appears to be a major component of spore OPA resistance, which is acquired late in sporulation of B. subtilis at the time of spore coat maturation, and (ii) B. subtilis spores are not killed by OPA through DNA damage but by elimination of spore germination. Furthermore, OPA-treated spores that cannot germinate are not recovered by artificial germinants or by treatment with NaOH or lysozyme. CONCLUSIONS: OPA appears to kill spores by blocking the spore germination process. SIGNIFICANCE AND IMPACT OF THE STUDY: This work provides information on the mechanism of spore resistance to, and spore killing by, the disinfectant, OPA.