Recuperation and characterization of calcium carbonate from residual oyster and clamshells and their incorporation into a residential finish.

The final disposal of waste generated by human activities has been turned into a great challenge; until now, little attention has been paid to organic waste, particularly from the restaurant sector. This work describes the process of obtaining calcium carbonate contained in oyster and clam shells re-collected in seafood restaurants. The IR absorption spectra of all the samples revealed the presence of characteristic bands of the carbonate group located at 872, 712 and 1414 cm-1; the peak at 1081 cm-1 of the clamshells confirms the presence of the aragonite phase. The SEM images allow observing a granular morphology whose agglomerates having a size within the range of 0.5-15 µm in brown shells, and a lower dispersion prevails in the grey species and oyster shells that go from 0.3 to 5.9 µm. All of the shells were found to be composed of carbon (C), oxygen (O2) and calcium (Ca) in different concentrations. The calcium carbonate obtained from clamshells has an orthorhombic crystalline structure, while the oyster carbonate has a rhombohedral structure as the calcium carbonate used in the construction industry; the morphology particles also coincide with each other. The material obtained combined with a mixture composed of resin, cellulose, and granules were used to prepare a paste, which was used as a residential finish.

Intimate partner violence and perinatal health: a systematic review.

BACKGROUND: Physical, psychological and sexual intimate partner violence (IPV) has been described in the literature as different types of IPV experienced by women during pregnancy all over the world. OBJECTIVES: To review and summarise systematically the empirical evidence on the links between IPV during pregnancy and the perinatal health of mothers and fetuses/neonates. SEARCH STRATEGY: MEDLINE (Ovid), CINAHL, Embase, Nursing@ovid (Ovid) and LILACS were searched (2008-2018). SELECTION CRITERIA: Observational studies that examined perinatal health outcomes (i.e. pre-term birth, low birthweight, miscarriage, perinatal death and premature rupture of membranes) in pregnant women exposed to IPV. DATA COLLECTION AND ANALYSIS: Information on study characteristics, type of IPV measured, study design, methodological quality and outcome variable extracted. RESULTS: Fifty studies were included. Twenty-nine analysed undifferentiated IPV (n = 25 489), 34 included physical IPV (n = 7333), 22 analysed psychological IPV (n = 7833) and 18 examined sexual IPV (n = 2388). Fifteen studies were from Asia, 12 from North America and Oceania, and 12 from Central and South America. The studies examined the association between IPV and 39 different perinatal health outcomes. The most frequent outcomes reported were pre-term birth (50%), low birthweight (46%), miscarriage (30%), perinatal death (20%) and premature rupture of membranes (20%). A significant association with perinatal health outcomes was reported by 12 of the studies analysing undifferentiated IPV, 18 physical IPV, six psychological IPV and two sexual IPV. CONCLUSIONS: The relation between IPV and perinatal health outcomes can be seen in different epidemiological designs and countries. In all, 39 different outcomes were identified and 29 were associated with IPV. TWEETABLE ABSTRACT: A variety of poor perinatal health outcomes are associated with psychological, physical and sexual IPV.

On-patient see-through augmented reality based on visual SLAM.

PURPOSE: An augmented reality system to visualize a 3D preoperative anatomical model on intra-operative patient is proposed. The hardware requirement is commercial tablet-PC equipped with a camera. Thus, no external tracking device nor artificial landmarks on the patient are required. METHODS: We resort to visual SLAM to provide markerless real-time tablet-PC camera location with respect to the patient. The preoperative model is registered with respect to the patient through 4-6 anchor points. The anchors correspond to anatomical references selected on the tablet-PC screen at the beginning of the procedure. RESULTS: Accurate and real-time preoperative model alignment (approximately 5-mm mean FRE and TRE) was achieved, even when anchors were not visible in the current field of view. The system has been experimentally validated on human volunteers, in vivo pigs and a phantom. CONCLUSIONS: The proposed system can be smoothly integrated into the surgical workflow because it: (1) operates in real time, (2) requires minimal additional hardware only a tablet-PC with camera, (3) is robust to occlusion, (4) requires minimal interaction from the medical staff.

Functional characterization of two new STAT3 mutations associated with hyper-IgE syndrome in a Mexican cohort.

Hyper-IgE syndrome (HIES) is an immunodeficiency disorder that is characterized by distinctive immunologic and non-immunologic manifestations. Although mutations in signal transducer and activator of transcription 3 (STAT3) have been associated with HIES, the exact nature of the relationship is unknown. Here, we characterized the functional activity of STAT3 and its mutations in 11 Mexican patients with autosomal dominant HIES. STAT3 phosphorylation was evaluated by flow cytometry, and in silico analyses were performed to estimate the impact of allelic mutations on the DNA binding and SH2 domains of the STAT3 protein. Electrophoretic mobility shift assays were used to assess whether the STAT3 mutants could bind to the consensus oligonucleotide target in vitro. Two novel mutations [g.58891A>T (Asn395Tyr) and g.59078A>T (Asn425Tyr)] as well as one possible somatic mosaicism were found in several of the patients who bore some remarkable features. However, there were no direct correlations between genotypes and HIES clinical features. STAT3 phosphorylation was found to be lower in the patient cohort than in healthy controls. Moreover, the mutated STAT3 proteins could bind to the Sp1, but not to the STAT3, consensus sequence. From these functional studies, the STAT3 mutations found in our patient cohort were concluded to be deleterious for normal STAT3 function.

Developing a new methodology to characterize in vivo the passive mechanical behavior of abdominal wall on an animal model.

The most common surgical repair of abdominal wall hernia goes through implanting a mesh that substitutes the abdominal muscle/fascia while it is healing. To reduce the risk of relapse or possible complications, this mesh needs to mimic the mechanical behavior of the muscle/fascia, which nowadays is not fully determined. The aim of this work is to develop a methodology to characterize in vivo the passive mechanical behavior of the abdominal wall. For that, New Zealand rabbits were subjected to pneumoperitoneum tests, taking the inner pressure from 0 mmHg to 12 mmHg, values similar to those used in human laparoscopies. Animals treated were divided into two groups: healthy and herniated animals with a surgical mesh (polypropylene Surgipro(TM) Covidien) previously implanted. All experiments were recorded by a stereo rig composed of two synchronized cameras. During the postprocessing of the images, several points over the abdominal surface were tracked and their coordinates extracted for different levels of internal pressure. Starting from that, a three dimensional model of the abdominal wall was reconstructed. Pressure-displacement curves, radii of curvature and strain fields were also analysed. During the experiments, animals tissue mostly deformed during the first levels of pressure, showing the noticeable hyperelastic passive behavior of abdominal muscles. Comparison between healthy and herniated specimen displayed a strong stiffening for herniated animals in the zone where the high density mesh was situated. Cameras were able to discern this change, so this method can be used to measure the possible effect of other meshes.

Maniobra del tapón especular para implante express / Bubble mirror technique for express shunt surgery

TÉCNICA QUIRÚRGICA: La maniobra del tapón especular o «bubble mirror technique» consiste en la estabilización de la cámara anterior con una combinación de aire y viscoelástico colocados estratégicamente. En la interfase aire-viscoelástico de este taponamiento surge una línea donde se refleja, como en un espejo, el ángulo camerular. DISCUSIÓN: El tapón especular aporta 3 beneficios a la cirugía del glaucoma con implante Ex-PRESS: 1) efecto tapón del viscoelástico, que proporciona estabilidad a la cámara anterior, impidiendo su colapso; 2) efecto tono de la burbuja de aire; y 3) efecto especular de la interfase, que permite al cirujano el control visual del ángulo camerular durante la implantación del Ex-PRESS

SURGICAL TECHNIQUE: The bubble mirror technique consists of the stabilization of the anterior chamber by means of a plug made with a combination of conveniently placed air and viscoelastic material. A line arises at interface between the air and viscoelastic where the anterior chamber angle reflected can be seen as in a mirror (bubble mirror). DISCUSSION: The viscoelastic-air plug offers three advantages in glaucoma surgery with the Ex-PRESS implant: 1) plug effect of viscoelastic, giving stability to the anterior chamber and preventing it from collapsing; 2) toning effect of the air bubble; and 3) specular effect at the interface, which allows the surgeon to visually control the chamber angle during the Ex-PRESS implantation

[Bubble mirror technique for express shunt surgery]. / Maniobra del tapón especular para implante express.

SURGICAL TECHNIQUE: The bubble mirror technique consists of the stabilization of the anterior chamber by means of a plug made with a combination of conveniently placed air and viscoelastic material. A line arises at interface between the air and viscoelastic where the anterior chamber angle reflected can be seen as in a mirror (bubble mirror). DISCUSSION: The viscoelastic-air plug offers three advantages in glaucoma surgery with the Ex-PRESS implant: 1) plug effect of viscoelastic, giving stability to the anterior chamber and preventing it from collapsing; 2) toning effect of the air bubble; and 3) specular effect at the interface, which allows the surgeon to visually control the chamber angle during the Ex-PRESS implantation.

Computer vision distance measurement from endoscopic sequences: prospective evaluation in laparoscopic ventral hernia repair.

BACKGROUND: Research in computer vision and mobile robotics has developed a family of popular algorithms known as Visual Simultaneous Localization And Mapping (Visual SLAM). These algorithms can provide 3D models of body cavities using the images obtained from standard monocular endoscopes. The 3D models can be used to estimate hernia defect measurements during laparoscopic ventral hernia repair (LVHR). METHODS: We conducted a descriptive and comparative prospective study to analyze results from 15 patients who underwent LVHR. Three methods of measurement were used in each patient: two classical methods (needle and tape) and a new visual SLAM measurement (VSM) method. The major and minor axes of the ellipse-shaped hernia defect were measured. RESULTS: Both axes could be measured using the VSM method in all patients except one (93%). The tape method measured 63% of the axes, but was difficult to perform because of patient comorbidities and because of limited range of motion of the laparoscopic tools. The needle method obtained 73% of measurements, because of patient comorbidities. The tape method was the most accurate (accuracy up to 0.5 cm because of tape resolution). The needle method was relatively inaccurate, with a mean error of >3 cm. The VSM method was as accurate as the tape method. The mean time taken to perform measurements was 40 s for the VSM method (range 29-60 s), 169 s for the needle method (range 66-300 s), and 186 s for the tape method (range 110-322 s). CONCLUSIONS: The needle method is relatively inaccurate and invasive. The tape method is accurate, but is not easy to perform and is relatively time consuming. The VSM method is noninvasive and fast and is as accurate as the tape method.

Visual SLAM for Handheld Monocular Endoscope.

Simultaneous localization and mapping (SLAM) methods provide real-time estimation of 3-D models from the sole input of a handheld camera, routinely in mobile robotics scenarios. Medical endoscopic sequences mimic a robotic scenario in which a handheld camera (monocular endoscope) moves along an unknown trajectory while observing an unknown cavity. However, the feasibility and accuracy of SLAM methods have not been extensively validated with human in vivo image sequences. In this work, we propose a monocular visual SLAM algorithm tailored to deal with medical image sequences in order to provide an up-to-scale 3-D map of the observed cavity and the endoscope trajectory at frame rate. The algorithm is validated over synthetic data and human in vivo sequences corresponding to 15 laparoscopic hernioplasties where accurate ground-truth distances are available. It can be concluded that the proposed procedure is: 1) noninvasive, because only a standard monocular endoscope and a surgical tool are used; 2) convenient, because only a hand-controlled exploratory motion is needed; 3) fast, because the algorithm provides the 3-D map and the trajectory in real time; 4) accurate, because it has been validated with respect to ground-truth; and 5) robust to inter-patient variability, because it has performed successfully over the validation sequences.

Duplication of the Miller-Dieker Critical Region in a Patient with a Subtelomeric Unbalanced Translocation t(10;17)(p15.3;p13.3).

Submicroscopic duplications in the Miller-Dieker critical region have been recently described as new genomic disorders. To date, only a few cases have been reported with overlapping 17p13.3 duplications in this region. Also, small deletions that affect chromosome region 10p14→pter are rarely described in the literature. In this study, we describe, to our knowledge for the first time, a 5-year-old female patient with intellectual disability who has an unbalanced 10;17 translocation inherited from the father. The girl was diagnosed by subtelomeric FISH and array-CGH, showing a 4.43-Mb heterozygous deletion on chromosome 10p that involved 14 genes and a 3.22-Mb single-copy gain on chromosome 17p, which includes the critical region of the Miller-Dieker syndrome and 61 genes. The patient's karyotype was established as 46,XX.arr 10p15.3p15.1(138,206-4,574,436)x1,17p13.3(87,009-3,312,600)x3. Because our patient exhibits a combination of 2 imbalances, she has phenotypic features of both chromosome abnormalities, which have been reported separately. Interestingly, the majority of patients who carry the deletion 10p have visual and auditory deficiencies that are attributed to loss of the GATA3 gene. However, our patient also presents severe hearing and visual problems even though GATA3 is present, suggesting the involvement of different genes that affect the development of the visual and auditory systems.

[Hemorrhagic Descemet's membrane detachment after viscocanalostomy]. / Desprendimiento hemorrágico de la membrana de Descemet tras viscocanalostomía.

INTRODUCTION: Viscocanalostomy is an option in the surgical treatment of glaucoma. This non-penetrating technique favours aqueous drainage through the Schlemm channel while avoiding filtering blebs and their related pathologies. Complications associated to this surgery are unusual, one of which is Decemet's membrane detachment (DMD) CLINICAL CASE: A 64 year-old female diagnosed with open-angle chronic glaucoma, whose had undergone a viscocanalostomy of the left eye. In the immediate postoperative period we noticed a hemorrhagic DMD in the lower temporal quadrant. After adopting a wait and see attitude, we did not find improvement 15 days after surgery and corneal edema was established with vision decrease. We proceeded to a surgical reapplication by means of Descemet's membrane micropuncture and SF6 injection into the anterior chamber and achieving an anatomical and functional improvement DISCUSSION: We believe that the intrusion of viscoelastic material into the supradescemetic was a consequence of the high-pressure during the high-density hyaluronate injection. Hemorrhagic DMD management is mainly determined by its location, size and evolution. In our case, the posterior endothelial micropuncture and descematopexy by means of 20% SF6 injection into the anterior chamber was useful in resolving this complication.

Desprendimiento hemorrágico de la membrana de Descemet tras viscocanalostomía / Hemorrhagic Descemet’s membrane detachment after viscocanalostomy

Introducción: La viscocanalostomía constituye una alternativa en el tratamiento quirúrgicodel glaucoma. Esta técnica no penetrante favorece el drenaje del acuoso a través del canalde Schlemm evitando la aparición de ampollas de filtración y de las patologías relacionadascon éstas. Las complicaciones asociadas a esta cirugía son escasas; una de ellas es eldesprendimiento de la membrana de Descemet (DMD).Caso clínico: Mujer de 64 años diagnosticada de glaucoma crónico de ángulo abierto cuyoojo izquierdo fue intervenido mediante viscocanalostomía. En el posoperatorio inmediatoapareció un DMD hemorrágico en el cuadrante temporal inferior. Tras adoptar inicialmenteuna actitud expectante, a los 15 días de la cirugía no se objetivó mejoría del DMD y seinstauró un edema corneal que produjo disminución de la visión. Se procedió a la reaplicaciónquirúrgica del defecto mediante micropunción de la membrana de Descemet e inyecciónde SF6 en cámara anterior. Se consiguió una mejoría anatómica y funcional delcuadro.Discusión: Pensamos que la salida del material viscoelástico al espacio supradesceméticofue consecuencia de la alta presión en el proceso de inyección del hialuronato de alta densidad.El manejo de un DMD hemorrágico está condicionado fundamentalmente por sulocalización, tamaño y evolución. La actuación diferida mediante micropunción endotelialy posterior descematopexia por medio de inyección en cámara anterior de SF6 al 20% resultóde utilidad para solucionar esta complicación(AU)

Introduction: Viscocanalostomy is an option in the surgical treatment of glaucoma. Thisnon-penetrating technique favours aqueous drainage through the Schlemm channel whileavoiding filtering blebs and their related pathologies. Complications associated to thissurgery are unusual, one of which is Decemet’s membrane detachment (DMD)Clinical case: A 64 year-old female diagnosed with open-angle chronic glaucoma, whose hadundergone a viscocanalostomy of the left eye. In the immediate postoperative period wenoticed a hemorrhagic DMD in the lower temporal quadrant. After adopting a wait and seeattitude, we did not find improvement 15 days after surgery and corneal edema wasestablished with vision decrease. We proceeded to a surgical reapplication by means ofDescemet’s membrane micropuncture and SF6 injection into the anterior chamber andachieving an anatomical and functional improvementDiscussion: We believe that the intrusion of viscoelastic material into the supradescemeticwas a consequence of the high-pressure during the high-density hyaluronate injection.Hemorrhagic DMD management is mainly determined by its location, size and evolution.In our case, the posterior endothelial micropuncture and descematopexy by means of 20%SF6 injection into the anterior chamber was useful in resolving this complication(AU)

Anti-CD43 and anti-galectin-1 autoantibodies in patients with systemic lupus erythematosus.

OBJECTIVES: Systemic lupus erythematosus (SLE) is characterized by the production of multiple autoantibodies and also by T-cell dysfunction. CD43 is expressed by most immune cells, is involved in lymphocyte adhesion and activation, and interacts with galectin-1 (Gal-1). The aim of this work was to evaluate the plasma levels of autoantibodies against CD43 and Gal-1 as well as the levels of soluble Gal-1 in SLE Mexican mestizo patients, with the aim of establishing a correlation between these parameters and the clinical profile. METHODS: Serum levels of immunoglobulin (Ig)G autoantibodies against CD43 and Gal-1 and levels of soluble Gal-1 were measured by enzyme-linked immunosorbent assay (ELISA) in 55 patients with SLE and 71 healthy controls. RESULTS: We found significantly enhanced titres of anti-CD43 and anti-Gal-1 antibodies in sera from SLE patients compared to controls. In addition, the serum levels of Gal-1 were significantly higher in SLE patients than in healthy individuals. However, we could detect no correlation of these parameters with disease activity [using the Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI)], age, or a variety of different clinical or laboratory features. Similarly, no significant correlation with immunosuppressive or glucocorticoid therapy was observed. By contrast, a significant association was found between anti-CD43 titres and time of disease evolution, complement levels, and the presence of anti-Gal-1 antibodies. CONCLUSIONS: As CD43 and Gal-1 participate in modulating the immune system, we suggest that the presence of autoantibodies against these molecules may contribute to the immune deregulation observed in SLE.

[Postoperative outcomes after combined glaucoma surgery. Comparison of ex-press miniature implant with standard trabeculectomy]. / Resultados postquirúrgicos en la cirugía combinada de glaucoma. Comparación del implante express con la trabeculectomía estándar.

PURPOSE: To evaluate postoperative outcomes and success after combined phacoemulsification and glaucoma surgery with Ex-PRESS miniature implant compared with combined surgery with standard trabeculectomy. METHODS: In this prospective series of 40 consecutive eyes we compared 20 eyes in 17 patients treated with combined phacoemulsification and glaucoma filtering surgery with the Ex-PRESS miniature glaucoma implant under a scleral flap with 20 matched control eyes in 20 patients who underwent combined cataract and glaucoma surgery with trabeculectomy. RESULTS: The average follow-up was 9.7 months (range 4.5 to 15) for the Ex-PRESS group and 10.3 months (range 3.5 to 14.5) for the trabeculectomy group. The mean IOP was significantly higher in the early postoperative period in the Ex-PRESS group compared with the trabeculectomy group. Complications rate in the early postoperative period was significantly higher in the trabeculectomy group. No significant differences were objectified in success between both groups after the first week. DISCUSSION: The Ex-PRESS implant is an effective and safe alternative to standard trabeculectomy in selected cases which makes possible to reduce remarkably the classic early postoperative complications associated with trabeculectomy.

Resultados postquirúrgicos en la cirugía combinada de glaucoma. Comparación del implante express con la trabeculectomía estándar / Postoperative outcomes after combined glaucoma surgery. Comparison of ex-press miniature implant with standard trabeculectomy

el éxito tras cirugía combinada mediante facoemulsificacióne implante Ex-PRESS comparado concirugía combinada con trabeculectomía estándar.Métodos: En esta serie prospectiva de 40 ojos consecutivoscomparamos 20 ojos de 17 pacientes tratadosmediante facoemulsificación combinada concirugía filtrante de glaucoma con implante de válvulaEx-PRESS bajo un colgajo escleral con 20ojos controles en 20 enfermos que fueron sometidosa facoemulsificación combinada con trabeculectomíaestándar.Resultados: El tiempo de seguimiento medio fuede 9,7 meses (rango: 4,5-15) en el grupo Ex-PRESSy 10,3 meses (rango 3,5-14,5) en el grupo trabeculectomía.La PIO media fue significativamentesuperior en el postoperatorio precoz en el grupo Ex- PRESS comparada con el de trabeculectomía. Latasa de complicaciones en dicho período resultósuperior en el grupo sometido a trabeculectomía.No se objetivaron diferencias significativas en latasa de éxito entre ambos grupos más allá de la primera semana.Conclusiones: El implante Ex-PRESS constituyeuna alternativa eficaz y segura a la trabeculectomíaen casos seleccionados que permite disminuir notablementelas clásicas complicaciones postquirúrgicasprecoces asociadas a la trabeculectomía(AU)

Purpose: To evaluate postoperative outcomes andsuccess after combined phacoemulsification andglaucoma surgery with Ex-PRESS miniatureimplant compared with combined surgery withstandard trabeculectomy.Methods: In this prospective series of 40 consecutiveeyes we compared 20 eyes in 17 patients treatedwith combined phacoemulsification and glaucomafiltering surgery with the Ex-PRESS miniatureglaucoma implant under a scleral flap with 20 matchedcontrol eyes in 20 patients who underwentcombined cataract and glaucoma surgery with trabeculectomy.Results: The average follow-up was 9.7 months(range 4.5 to 15) for the Ex-PRESS group and 10.3months (range 3.5 to 14.5) for the trabeculectomygroup. The mean IOP was significantly higher inthe early postoperative period in the Ex-PRESSgroup compared with the trabeculectomy group.Complications rate in the early postoperative periodwas significantily higher in the trabeculectomygroup. No significant differences were objectifiedin success between both groups after the first week. Discussion: The Ex-PRESS implant is an effectiveand safe alternative to standard trabeculectomy inselected cases which makes possible to reduceremarkably the classic early postoperative complicationsassociated with trabeculectomy(AU)

Association between sweetened beverage consumption and body mass index, proportion of body fat and body fat distribution in Mexican adolescents.

BACKGROUND/AIMS: It was the aim of this study to evaluate the relationships between sweetened beverage (SB) consumption and the following indicators of overweight/fatness among Mexican adolescents: body mass index, body composition and body fat distribution. METHODS: We performed a cross-sectional analysis of data from adolescents participating in the baseline assessment of the Health Workers Cohort Study. Information on sociodemographic conditions, sexual maturation, dietary patterns and physical activity was collected via self-administered questionnaires. SB consumption was evaluated through a validated semiquantitative food frequency questionnaire. Anthropometric measures were assessed with standardized procedures. The associations of interest were evaluated by means of multivariate regression and logistic regression models. RESULTS: A total of 1,055 adolescents, 10-19 years old (mean age 14.5+/-2.5 years), were evaluated. The overweight/obesity prevalence was 31.6% among girls and 31.9% among boys. We found that for each additional SB serving consumed daily, the subject's body mass index increased by on average 0.33 (p<0.001). Subjects consuming 3 daily servings of SB face a 2.1 times greater risk of proportionally excess body fat than those who consume less than 1 SB a day. CONCLUSIONS: Our data support the hypothesis that the consumption of SB increases the risk of overweight and/or obesity and encourages excess body fat and central obesity in Mexican adolescents.

[Lipid profile in untreated HIV positive patients. HIV infection: cardiovascular risk factor?]. / Perfil lipídico en pacientes VIH (+) no tratados. Infección VIH: ¿factor de riesgo cardiovascular?

INTRODUCTION: Some cases of HIV+ patients with unexplained vascular disease have been reported and many studies are being performed to determine whether HIV infected individuals have an increased cardio-vascular risk (CVR). We propose: to describe lipid profile of untreated HIV+ patients and to compare it with the HIV- and to assess whether any of the lipid abnormalities influence in CVR estimation. MATERIAL AND METHODS: 407 homosexual males: 251 untreated HIV+ and 156 HIV-. Biochemistry parameters: Total cholesterol (CHOL), HDL-cholesterol (HDL), VLDL-cholesterol, LDL-cholesterol (LDL), triglycerides (TG), apolipoproteins A1 and B (ApoA1 y ApoB) and lipoprotein A. Atherogenic rates: CHOL/HDL, LDL/HDL and log (TG/HDL). HIV+ patients were classified into three groups according to CD4 lymphocytes number. RESULTS: HIV+ patients had lower CHOL, HDL, and ApoA1 and higher CVR rates. These differences showed also between each HIV+ group according to CD4 number and control group HIV-. 76% of the HIV+ patients showed low levels of HDL (less than 40 mg/dL) as compared with 31% of HIV- subjects. CONCLUSION: Untreated HIV+ patients' lipid profile is different from the HIV- subjects; one. There are decreases in HDL and ApoA1 from the beginning of the infection that persis along all the CD4 levels. HDL decrease in HIV infection multiplies global CVR in HIV infected individuals, independently of other risk factors.

Perfil lipídico en pacientes VIH (+) no tratados. Infección VIH: ¿factor de riesgo cardiovascular? / Lipid profile in untreated HIV positive patients. HIV infection: cardiovascular risk factor?

Introducción: La publicación de casos de pacientes VIH (+) con enfermedad vascular inexplicada, ha puesto en marcha múltiples estudios para tratar de conocer si los pacientes VIH (+) presentan un incremento del Riesgo Cardiovascular (RCV). Nos hemos propuesto: caracterizar el perfil lipídico de pacientes VIH (+) no tratados comparándolo con el que presentan sujetos VIH (-) y valorar si alguna de las alteraciones halladas influye de forma directa sobre la estimación del RCV. Pacientes y métodos: 407 varones homosexuales: 251 VIH (+) no tratados, y 156 VIH (-). Determinaciones bioquímicas: colesterol total (COL), HDL-colesterol (HDL), VLDL-colesterol, LDL-colesterol (LDL), triglicéridos (TG), apolipoproteínas A1 y B (ApoA1 y ApoB) y Lipoproteína a. Cocientes de aterogénicos: COL/HDL, LDL/HDL y log (TG/HDL). Los pacientes VIH (+) se dividieron en 3 grupos según recuento de linfocitos CD4. Resultados: Los pacientes VIH (+) presentaron COL, HDL, y ApoA1 menores y cocientes de RCV mayores. Estas diferencias también se mostraron entre cada grupo de pacientes VIH (+) según recuento de CD4 y el grupo control VIH (-). Un 76% de los pacientes VIH (+) presentaban concentraciones bajas de HDL (menor de 40 mg/dL), frente a un 31% de los sujetos VIH (-). Conclusiones: El perfil lipídico de los pacientes VIH (+) no tratados difiere del que presentan sujetos VIH (-). Desde los estadios mas inmunoconservados de la infección existe una disminución marcada del HDL, paralela a la disminución de ApoA1 que se mantiene a lo largo de todos los niveles de CD4. El descenso de HDL en la infección VIH multiplica el RCV global de los sujetos infectados, independientemente de la presencia de otros factores de riesgo

Introduction: Some cases of HIV (+) patients with unexplained vascular disease have been reported and many studies are being performed to determine whether HIV infected individuals have an increased cardiovascular risk (CVR). We propose: to describe lipid profile of untreated HIV (+) patients and to compare it with the HIV (-) and to assess whether any of the lipid abnormalities influence in CVR estimation. Material and Methods: 407 homosexual males: 251 untreated HIV (+),and 156 HIV (-). Biochemistry parameters: Total Cholesterol (CHOL), HDL-Cholesterol (HDL), VLDL-Cholesterol, LDL-Cholesterol (LDL), Triglycerides (TG), Apolipoproteins A1 and B (ApoA1 y ApoB) and Lipoprotein a. Atherogenic rates: CHOL/HDL, LDL/HDL and log (TG/HDL). HIV (+) patients were classified into three groups according to CD4 lymphocytes number. Results: HIV (+) patients had lower CHOL, HDL, and ApoA1 and higher CVR rates. These differences showed also between each HIV (+) group according to CD4 number and control group HIV (-). 76% of the HIV (+) patients showed low levels of HDL (less than 40 mg/dL) as compared with 31% of HIV (-) subjects. Conclusion: Untreated HIV(+) patients´lipid profile is different from the HIV (-) subjects´one. There are decreases in HDL and Apo A1 from the beginning of the infection that persist along all the CD4 levels. HDL decrease in HIV infection multiplies global CVR in HIV infected individuals, independently of other risk factors

[Acute confusional syndrome associated with obstructive sleep apnea aggravated by acidosis secondary to oral acetazolamide treatment]. / Síndrome confusional agudo asociado a apnea-hipopnea obstructiva del sueño y agravado por acidosis metabólica secundaria a acetazolamida oral.

Acute confusional syndrome, or delirium, is a transitory mental state characterized by the fluctuating alteration of awareness and attention levels. We present the case of a patient with acute confusional syndrome associated with obstructive sleep apnea syndrome (OSAS) aggravated by metabolic acidosis induced by oral acetazolamide treatment.A 70-year-old man with no history of neurological disease was referred with a clinical picture consistent with acute confusional syndrome presenting between midnight and dawn. During the admission examination infectious, toxic, and neurologic causes, or those related to metabolic or heart disease were ruled out. Arterial blood gases measured during one of the nighttime episodes of acute confusional syndrome showed mild hypoxia and hypercapnia with mixed acidosis. Signs and symptoms suggestive of OSAS had been developing over the months prior to admission, with snoring, sleep apnea, and moderate daytime drowsiness. Polysomnography demonstrated severe OSAS with an apnea-hypopnea index of 38. Mean arterial oxygen saturation was 83%; time oxygen saturation remained below 90% was 44%. The attending physician ordered the withdrawal of oral acetazolamide, which was considered the cause of the metabolic component of acidosis. Treatment with continuous positive airway pressure was initiated at 9 cm H2O, after a titration polysomnographic study. The patient continued to improve.OSAS, for which very effective treatment is available, should be included among diseases that may trigger acute confusional syndrome.