Hipoacusia sensorioneural unilateral: Revisión de los manejos posibles en nuestra realidad nacional / Unilateral sensorineural hearing loss: Review of possible management in our national reality

La hipoacusia unilateral (HUL) definida como la pérdida auditiva de cualquier grado en un solo oído tiene prevalencias en edad escolar de 3% a 6%. La etiología es desconocida en la mayoría de los casos, pero destacan las anormalidades anatómicas severas a diferencia de las hipoacusias bilaterales, lo que le otorga importancia al estudio de imágenes. También se recomienda realizar evaluación oftalmológica. El impacto de la HUL se observa en la localización sonora, reconocimiento del habla, desarrollo del lenguaje, desempeño social y conducta, pero por sobre todo en el rendimiento académico. En este sentido es relevante mencionar que además de existir mayor probabilidad de repitencia de curso, es necesario mayor apoyo educacional individualizado para evitar dicha repitencia o lograr mismo éxito académico que un normoyente. En relación al diagnóstico aún faltan normas o protocolos, siendo éste un desafío en las zonas donde no hay screening universal. Se discute la importancia de las encuestas para realizar evaluaciones y seguimiento en estos casos. Finalmente se abordan las estrategias de intervención disponibles, además de un plan individualizado considerando al niño, su familia y sus expectativas, particularmente se discuten las características o factores a tomar en cuenta en el momento de la adaptación, para así lograr un tratamiento tendiente al éxito.

Unilateral hearing loss (UHL) defined as hearing loss of any degree in only one ear has a school-age prevalence of 3% to 6%. The etiology is unknown in most cases, but severe anatomical abnormalities stand out as opposed to bilateral hearing loss, which gives importance to the study of images. Ophthalmological evaluation is also recommended. The impact of UHL is observed in sound localization, speech recognition, language development, social performance and behavior, but above all in academic performance. In this sense, it is relevant to mention that in addition to having a higher probability of repeating the course, it is necessary to have more individualized educational support to avoid this repetition or achieve the same academic success as a normal listener. Regarding the diagnosis, there are still missing norms or protocols, this being a challenge in areas where there is no universal screening. The importance of surveys to carry out evaluations and follow-up in these cases is discussed. Finally, the available intervention strategies are discussed, in addition to an individualized plan considering the child, his family and his expectations, particularly, the factors to be taken into account at the time of adaptation, in order to achieve a success treatment.

[Arthroscopy after hip joint injury. Case studies and indications]. / Arthroskopie nach Trauma des Hüftgelenks. Fallbeispiele und Indikationen.

Intra-articular injuries are common after dislocation and fracture of the hip joint and can be addressed using hip arthroscopy. The most common indications for this procedure are loose bodies, labral tears and chondral defects. In addition, preexisting femoroacetabular impingement can be addressed at the time of surgery. Arthroscopically guided fracture reduction and fixation has been described. We present two case reports of intra-articular lesions after traumatic hip dislocation. The first is a case of a man with an anterior labral tear and loose bodies after closed hip reduction. The second case is a man with a large anterior labral tear with preexisting femoroacetabular impingement. Both of them were treated by arthroscopic debridement of the unstable labrum. In addition loose bodies were removed in the first patient and a femoral osteoplasty was performed in the second patient. Hip arthroscopy has proven to be a safe and effective surgical technique for treating specific post-traumatic lesions and preexisting femoroacetabular impingement. The current case reports provide an overview of the indication for hip arthroscopy following traumatic injuries to the hip.

Osteotomía cervical cuneiforme femoral para el tratamiento de la secuela de epifisiolisis / Cuneiform osteotomy of femoral neck as treatment for slipped capital femoral epiphysis sequelae

Introducción. La alteración anatómica de la epifisiolisis no tratada, prototipo de la deformidad del pinzamiento femoro-acetabular tipo cam, causa degeneración articular precoz de la cadera. Objetivo. Describir una técnica original de osteotomía cervical cuneiforme (OCC) para reposicionar anatómicamente la epífisis femoral, en la secuela de epifisiolisis. Material y método. Se operaron 7 caderas en 6 pacientes masculinos, con secuela de epifisiolisis severa; edad promedio de 15 años (13-16), cuyo motivo de consulta fue coxalgia y claudicación severa de 9,2 meses promedio. Todos con cierre del cartílago fisiario femoral al momento de la consulta. Técnica quirúrgica y resultados . En todos los casos se efectuó una OCC y reposición de la epífisis femoral. Se realizó disección y elevación del periostio cervical para proteger los vasos epifisiarios de la cabeza femoral; a continuación se ejecutó la OCC, se reposicionó la epífisis femoral en la ubicación anatómica y se realizó una osteosíntesis. Se logró una corrección del ángulo eje epifisiario desde 66° preoperatorio a 11° postoperatorio. El seguimiento promedio fue 37 meses (4-59). Conclusión. La OCC femoral, propuesta en pacientes con secuela de epifisiólisis, es una alternativa de tratamiento, que logra buenos resultados anatómicos y radiológicos en pacientes jóvenes (AU)

Introduction: Abnormal hip anatomy of untreated Slipped Capital Femoral Epiphysis (SCFE), a prototype of cam impingement deformity, is a cause of early hip degeneration. Objective: To describe an original technique of cuneiform osteotomy of the femoral neck to relocate femoral epiphysis in patients with sequelae of SCFE. Methods: Seven hips in 6 male patients with sequelae of severe SCFE, with a mean age of 15 years (13-16), and with a mean of 9.2 months of hip pain and severe limp, were treated. All of the cases had closed growth cartilage at the time of consultation. Surgical technique and results: In all cases we performed a cuneiform osteotomy of the femoral neck with relocation of epiphysis. A dissection and elevation of cervical periosteum to protect the epiphyseal vessels of the femoral head was performed. Then, the cuneiform osteotomy of the femoral neck was performed with relocation of the femoral epiphysis to the anatomical position and osteosynthesis. We achieved an epiphyseal-shaft angle correction from 66◦ preoperative to 11◦ postoperative. The mean follow up was 37 months (4-59). Conclusion: Cuneiform osteotomy of the femoral neck proposed in patients with sequelae of SCFE is an alternative treatment that achieves good anatomical and imaging results in young patients (AU)

[Arthroscopic treatment of an intra-articular tumor of the hip joint]. / Arthroskopische Therapie eines intraartikulären Tumors am Hüftgelenk.

We present the clinical case of an 18-year-old woman who complained of acute hip pain. MRI showed an intra-articular tumor 4 cm in size with osteolysis (18 mm) on the distal region of the femoral head-neck junction. Focal pigmented villonodular synovitis infiltrating the bone was diagnosed. A complete resection of the tumor including the osteolytic area was done by an arthroscopic procedure. There was no sign of relapse after 8 months of follow-up, with no pain and complete function of the hip. Arthroscopic treatment has the advantage of minimal surgical trauma and good mid-term results for treating a focal lesion in selected cases.

The importance of the olfactory sense in the human behavior and evolution.

Not long ago it was believed that the human olfactory sense had a low importance, a vision which turned into the exploration of the environment. Recent studies have shown that, despite the weak representation of the olfactory receptor common in other species too, the cortical areas of integration of the olfactory sensations are very large and have important interconnections with memory, language, and neuro-vegetative areas. In humans, olfaction has a small contribution in identifying objects or other people, but plays an important social and emotional part. People learn to love or to hate certain foods or objects only by appreciating their odor and this proved to be a very important economic factor. The most significant role of olfactory signals in humans appears to be the modulation of their behavior and interpersonal relationships, of their affiliation to certain groups or social classes, having a major influence in their tastes and personality. signal that will be sent to the specialized areas in their tastes and personality.

Serum levels of tissue polypeptide specific antigen are correlated with hepatocyte cytokeratin expression in alcoholic liver disease.

BACKGROUND: Serum levels of the tumor marker tissue polypeptide specific antigen (TPS, cytokeratin 18 fragments) are increased in patients with alcoholic liver disease, particularly in cases of alcoholic hepatitis. Mallory bodies, characteristic of alcoholic hepatitis, are cytokeratin 8 and 18 aggregates. The study was aimed at investigating the possible relationship of serum TPS levels with hepatocyte cytokeratin expression in patients with alcoholic liver disease. METHODS: Twenty-four patients with alcoholic liver disease were studied. Immunohistochemical staining for cytokeratins 8 and 18 was performed in liver specimens by means of CAM 5.2 monoclonal antibody. The number of hepatocytes containing CAM 5.2-reactive cytokeratin inclusions was compared with serum TPS levels. MAIN RESULTS AND CONCLUSIONS: The vast majority of alcoholics (95%) showed increased (>100 units/liter) serum TPS levels. Serum TPS levels were significantly correlated with the number of hepatocyte cytokeratin inclusions. Serum TPS levels can predict hepatocyte cytokeratin expression in patients with alcoholic liver disease.

Increased serum tissue polypeptide specific antigen (TPS) in alcoholics: a possible marker of alcoholic hepatitis.

BACKGROUND: Serum tissue polypeptide specific antigen (TPS) is widely used as a tumor proliferation marker. There is some evidence of an increase in serum TPS in benign liver diseases. The aim of the study was to evaluate serum TPS levels in alcoholics. METHODS: Seventy-seven alcoholics (64 men and 13 women) admitted to the hospital with ethanol withdrawal syndrome entered the study. Twenty-three patients were biopsied (12 of them had alcoholic hepatitis and 11 steatosis or fibrosteatosis). Serum TPS was determined by enzyme immunoassay in all cases. Results were compared with those of 24 healthy controls. RESULTS: Serum TPS levels were significantly increased in alcoholic patients compared with controls (median 365 units/liter and range 41-6400 units/liter versus median 79 units/liter and range 19-235 units/ liter, respectively, p < 0.0001). Seventeen alcoholics (22%) had a TPS value 10 times higher than the upper normal threshold level (> or = 1000 units/liter). Among alcoholics, serum TPS levels were higher in patients with alcoholic hepatitis than in those with steatosis or fibrosteatosis (median 1486 units/liter and range 176-5023 units/liter versus median 106 units/liter and range 41-221 units/liter, respectively, p = 0.0001), offering a better discriminant value for the diagnosis of alcoholic hepatitis than usual liver function parameters. Serum TPS values showed significant correlation with liver cell necrosis and Mallory's hyaline degeneration. TPS values decreased after alcohol abstinence during hospital admission. CONCLUSIONS: Serum TPS is frequently increased in alcoholics and may be a marker of alcoholic hepatitis. Specificity of this molecule as a tumor marker is limited in alcoholics.

[Serum lipids and vitamin A, C and E concentrations in an adult population of Caracas City]. / Lípidos séricos y niveles de las vitaminas A, C y E en una población adulta de la ciudad de Caracas.

Lipid profiles as well as vitamins A, C and E were determined in a sample of 90 men and 151 women with ages within 35 and 50 years old. Comparing the lipid profiles obtained in the study with the limits established by the National Cholesterol Education Program, resulted that a little more than 60% of the group had total cholesterol and LDL cholesterol levels in the desirable range, 20 to 30% had levels in the marginal range while 10 to 15% had levels in the high risk range. This distribution of the risk is more favorable than that observed in populations with a high risk of heart diseases such us the British or American populations, which show a substantially higher segment of the people in the high risk level. When the protective effect of the HDL cholesterol was included in the estimation of the risk by calculating the indexes: Total cholesterol/HDL chol., LDL Chol/HDL chol. or Total Chol-HDL chol. 65 to 80% of the population had values within the normal range and the first of these indexes, indicated that the men had a higher risk than the women. Integrating both methods of estimating the risk and considering that the risk of the individuals in the marginal range defined by the National Cholesterol Education Program is minimal unless they have two additional risk factors, it appears that an important segment (20-30%) of the studied population may benefit from programs aiming to reduce other risk factors such as smoking, high blood pressure, diabetes or overweight. The vitamin levels measured in this study indicated that the vast majority of the population had their levels in the safe range but an important segment had vitamin C serum levels indicative of poor consumption of this vitamin. Since vitamin C is high in fruits and vegetables we concluded that the studied population had a low consumption of these foods. Due to the existing evidence of a protective effect of fruits and vegetables in heart and other chronic diseases it was concluded that institutions such as the one studied here should engage in preventive campaigns emphasizing a reduction of both risk factors and the consumption of saturated fats. The results of this study also indicate that the consumption of fruits and vegetables should be encouraged.

Crystal structures of the catalytic domain of HIV-1 integrase free and complexed with its metal cofactor: high level of similarity of the active site with other viral integrases.

Human immunodeficiency virus (HIV) integrase is the enzyme responsible for insertion of a DNA copy of the viral genome into host DNA, an essential step in the replication cycle of HIV. HIV-1 integrase comprises three functional and structural domains: an N-terminal zinc-binding domain, a catalytic core domain and a C-terminal DNA-binding domain. The catalytic core domain with the F185H mutation has been crystallized without sodium cacodylate in a new crystal form, free and complexed with the catalytic metal Mg2+. The structures have been determined and refined to about 2.2 A. Unlike the previously reported structures, the three active-site carboxylate residues (D,D-35-E motif) are well ordered and both aspartate residues delineate a proper metal-binding site. Comparison of the active binding site of this domain with that of other members from the polynucleotidyl transferases superfamily shows a high level of similarity, providing a confident template for the design of antiviral agents.

The catalytic domain of human immunodeficiency virus integrase: ordered active site in the F185H mutant.

We solved the structure and traced the complete active site of the catalytic domain of the human immunodeficiency virus type 1 integrase (HIV-1 IN) with the F185H mutation. The only previously available crystal structure, the F185K mutant of this domain, lacks one of the catalytically important residues, E152, located in a stretch of 12 disordered residues [Dyda et al. (1994) Science 266, 1981-1986]. It is clear, however, that the active site of HIV-1 IN observed in either structure cannot correspond to that of the functional enzyme, since the cluster of three conserved carboxylic acids does not create a proper metal-binding site. The conformation of the loop was compared with two different conformations found in the catalytic domain of the related avian sarcoma virus integrase [Bujacz et al. (1995) J. Mol. Biol. 253, 333-346]. Flexibility of the active site region of integrases may be required in order for the enzyme to assume a functional conformation in the presence of substrate and/or cofactors.

Establecimiento de un cultivo discontinuo para la producción del factor de crecimiento epidérmico humano en levaduras: caracterización del producto / A bacth process for production of epidermal grow factor in yeast: product characterization

Se describe un proceso discontinuo para la producción del factor de crecimiento epidérmico humano (EGF-h) en Saccharomyces cerevisiae, con el promotor de la gliceraldehido 3-fosfato deshidrogensa (GAP) y el sistema de secreción del factor alfa. La proteina se excreta al medio de cultivo lo que facilita la purificación. Utilizando separaciones cromatográficas de intercambio iónico y exclusión molecular se obtuvo un producto de pureza superior al 95% según los análisis en cromtografía de fase inversa y electroforesis en geles SDF poliacrilamida. El proceso mostró un rendimiento de 36%. Se demostró que el producto obtenido fue biológicamente activo

Tratamientos analíticos de muestras de IFN alfa 2b h-rec, para su cuantificación por ELISA / Analyticaltreatments of rec-h alpha 2b interferon samples for their quantitation by ELISA

La obtención de interferón 2b humanos recombinante (IFN alfa 2b hr) en E. coli, en forma insoluble, hace necesario el estudio del ratamiento de las muestras para su cuantificación mediante un sistema inmunoenzimático tipo ELISA. De los sistemas analíticos ensayados para la extracción de proteina insoluble, el óptimo resultó una modificación del tapón L aemmli con un 1 % de SDS y 2,5 % de 2-merceptoetanol. Las proteinas de la cepa productora y la mayoría de los sistemas tampones empleados no influyeron sobre el reconocimiento inmunológico del interferón a diluciones mayores de 1/500

ß- galactosidasa de alta pureza obtenida por cromatografía de interacción hidrofóbica / High purity ß galactosidase obtained by hidrophobic interaction chromatography

Se presenta un procedimiento de obtención de ß-galactosidasa recombinante en Escherichia coli con una pureza superior al 95 % basado en dos pasos de purificación y solo uno de ellos cromatográficos. Se combinaron en el trabajo la precipitación salina y la cromatografía de interacción hidrofóbica en Fractogel TSK butilo 650 M, alcanzándose en esta última una alta resolución mediante el ajuste efectivo de los parámetros determinantes en esta operación

ß- galactosidasa de alta pureza obtenida por cromatografía de interacción hidrofóbica / High purity ß galactosidase obtained by hidrophobic interaction chromatography

Se presenta un procedimiento de obtención de ß-galactosidasa recombinante en Escherichia coli con una pureza superior al 95

basado en dos pasos de purificación y solo uno de ellos cromatográficos. Se combinaron en el trabajo la precipitación salina y la cromatografía de interacción hidrofóbica en Fractogel TSK butilo 650 M, alcanzándose en esta última una alta resolución mediante el ajuste efectivo de los parámetros determinantes en esta operación (AU)

Control del proceso de purificación del factor de crecimiemto epidérmico humano recombinante (r-hEGF) mediante diferentes métodos analíticos / Control of the process of purification of the recombinant human epidermal growth factor with different analytical methods

Se aplicaron diferentes métodos analíticos al control del proceso de purificación del Factor de Crecimiento Epidérmico humano recombinante (r-hEGF). El radioinmunoensayo en fase liquida con anticuerpos policlonales permitió con sensibilidad de 0,5 ng/ml cuantificar la proteína durante el proceso de producción. Se demostró la factibilidad del uso de anticuerpos monoclonales en sistemas en solución y en fase sólida para sustitución de los anticuerpos policlonales. La separación con interacción hidrofóbica permitió la caracterización cromatográfica del r-hEGF evidenciando dos especies moleculares. Se estudió el comportamiento electroforético y se establecieron las condiciones óptimas para aplicar los sistemas elecforéticos en geles de poliacrilamida con dodecil sulfato de sodio (SDS-PAGE) como críterio de pureza del producto final

Purificación rápida de anticuerpos monoclonales empleando un gel TSK -butilo 650 (S) / Rapid purification of monoclonal antibodies using TSK -butil 650 (S) gel

Se evaluó la cromatografía hidrofóbica de alta resolución a nivel analítico como método alternativo en la purificación de anticuerpos monoclonales (AcM) anti interferón alfa 2b humano recombinante. Como soporte fue utilizado un gel TSK-butilo 650(S) de alta rigidez. Se optimizaron las condiciones de corrida para obtener la maxima pureza del AcM anti interferón alfa 2b recombinante CB-IFNA2.1. Resultó necesario modificar el gradiente de elución para purificar otros AcM del mismo isotipo y especificidad, evidenciándose que el gel de butilo muestra una capacidad adicional de diferenciación entre inmunoglobulinas del tipo IgG1. La eliminación de pasos de diálisis y de dasalinización, así como la alta pureza de los anticuerpos obtenidos son las principales características de la purificación utilizando este tipo de matriz

Purificación rápida de anticuerpos monoclonales empleando un gel TSK -butilo 650 (S) / Rapid purification of monoclonal antibodies using TSK -butil 650 (S) gel

Se evaluó la cromatografía hidrofóbica de alta resolución a nivel analítico como método alternativo en la purificación de anticuerpos monoclonales (AcM) anti interferón alfa 2b humano recombinante. Como soporte fue utilizado un gel TSK-butilo 650(S) de alta rigidez. Se optimizaron las condiciones de corrida para obtener la maxima pureza del AcM anti interferón alfa 2b recombinante CB-IFNA2.1. Resultó necesario modificar el gradiente de elución para purificar otros AcM del mismo isotipo y especificidad, evidenciándose que el gel de butilo muestra una capacidad adicional de diferenciación entre inmunoglobulinas del tipo IgG1. La eliminación de pasos de diálisis y de dasalinización, así como la alta pureza de los anticuerpos obtenidos son las principales características de la purificación utilizando este tipo de matriz (AU)

Prednisone-induced bone loss in sarcoidosis: a risk especially frequent in postmenopausal women.

The incidence of glucocorticoid-induced osteoporosis is reported in about 40 to 50% of treated patients, but it has never been extensively studied in sarcoidosis. We have studied Vertebral Cancellous Mineral Content (VCMC) of the lumbar spine by Quantitative Computed Tomography (QCT) in 190 normal subjects, 7 patients with sarcoid on no treatment and 64 patients with sarcoid on treatment with prednisone. As compared to the 190 normal subjects and the 7 untreated patients, VCMC was reduced in 46 of 64 patients with sarcoid on treatment with prednisone. Loss of VCMC in the patients varied directly with dose and duration of prednisone treatment. It is concluded that - in sarcoid patients and especially in postmenopausal females - long-term prednisone therapy results in bone mineral loss more frequently than elsewhere reported for other groups of patients. It is not clear if this difference is due to the sarcoidosis itself or to the better sensitivity of Computed Tomography compared to former techniques.