Improved ß2-Microglobulin and Phosphorous Removal with Expanded Hemodialysis and Online Hemodiafiltration versus High-Flux Hemodialysis: A Cross-Over Randomized Clinical Trial.

INTRODUCTION: Expanded hemodialysis (HDx) is expected to provide enhanced permeability of medium-sized molecules, selective solute retention, and better internal retrofiltration. The primary objective of this study was to compare the efficiency for removal of ß2-microglobulin with 3 different extracorporeal therapies (ETs): high-flux hemodialysis (HF), online hemodiafiltration (OL-HDF), and HDx. The secondary objective was to evaluate the efficiency of removal of other uremic toxins, including urea, phosphate, CRP, IL-6, IL-10, TNF-⍺, indoxyl sulfate, and p-cresol. METHODS: This single-center, randomized, and cross-over study was performed. Patients were randomized to determine the initial modality of treatment, each period lasted 4 weeks and between one modality and another, there was a washout period of 1 week. Reduction ratios (RRs) of different-size molecules and albumin were calculated for the different ET. RESULTS: Twenty-two patients were included, ß2-microglobulin RR was greater during both OL-HDF and HDx as compared to HF (RR 62% vs. 73% vs. 27%, respectively, p = <0.0001), and there was no significant difference between HDx and OL-HDF (p = 0.09). A decrease in serum phosphate levels was observed in the HDx and OL-HDF periods, contrary to an increase in HF (-0.79 mg/dL vs. -1.02 mg/dL vs. + 0.11 mg/dL, respectively, p = <0.0001). There was no difference in RRs of other molecules (BUN, CRP, IL-6, IL-10, TNF-⍺, indoxyl sulfate, and p-Cresol). There was no decrease in serum albumin in any ET. CONCLUSION: HDx provides enhanced removal of ß2-microglobulin and phosphate as compared to HF, and similar efficacy as with OL-HDF. HDx should be considered an alternative to chronic convective therapies.

Los floricultivos de la Sabana de Bogotá y su relación con la avifauna: una mirada desde los municipios de Madrid, El Rosal y Facatativá

La supervivencia de un alto número de especies de aves que se encuentran en la sabana de Bogotá, algunas de ellas endémicas, dependen, en gran medida, de las estrategias incorporadas en las actividades económicas desarrolladas, por ejemplo, las del sector floricultor -cultivos intensivos de flores-, que provee parte del alimento de la avifauna. En las últimas décadas, se evidencia un sostenido incremento en la región de las fincas de floricultivos, generando, en algunos casos, conflictos por traslapes territoriales con la avifauna. En tal sentido, el presente artículo procura analizar la expansión del sector floricultor, en tres municipios de la Sabana de Bogotá: Madrid, El Rosal y Facatativá, relacionándolos con las percepciones sociales de los trabajadores de emprendimientos de floricultivos y su rol en la protección ecológica de las diversas especies de aves, tanto endémicas como migratorias, que llegan a esta parte del territorio colombiano. La metodología implementada correspondió a un diseño mixto, sustentado en la aplicación de tres fases principales: la detección del incremento de los cultivos de flores en los municipios en estudio, mediante el análisis multitemporal de imágenes satelitales; la implementación de encuestas sociales a los trabajadores de los emprendimientos relacionadas con la avifauna presente en las fincas y el análisis socioambiental de la situación en el área de estudio. El fin del trabajo es el de evidenciar la responsabilidad de los emprendimientos floricultores en la protección de la avifauna de la Sabana de Bogotá.

The survival of a high number of bird species found in the Bogota Savanna, some of them endemic, depend to a great extent on the strategies incorporated in the economic activities developed, such as, those of the floriculture sector -intensive crops of flowers-, which provides part of the food of the birdlife. In recent decades, there has been a sustained increase in the region of floriculture farms, generating, in some cases, conflicts due to territorial overlaps with birdlife. In this sense, this article attempts to analyze the expansion of the floriculture sector in three municipalities of the Bogota Savanna: Madrid, El Rosal and Facatativá, relating them to the social representations of the workers of floricultural enterprises and their role in the ecological protection of the various species of birds, both endemic and migratory, that arrive in this part of the Colombian territory. The implemented methodology has had a mixed design based on the application of three main phases: the detection of the increase in flower crops in the municipalities under study through the multitemporal analysis of satellite images, the implementation of social surveys to the workers of the enterprises related to the avifauna present on the farms and the socio-environmental analysis of the situation in the municipalities of Madrid, El Rosal and Facatativá in relation to the topic discussed. The purpose of the work is to demonstrate the responsibility of flower companies in the protection of the birdlife of the Sabana de Bogotá

Economic Burden of Incident Unplanned Starts on Peritoneal Dialysis in a High Specialty Health Care Facility in Mexico City.

OBJECTIVES: Few studies have examined hospitalization costs for unplanned initiation of peritoneal dialysis (PD). We used data from a health care facility in Mexico to examine first hospitalization costs associated with the unplanned initiation of PD. METHODS: Descriptive analyses focusing on initial hospitalization costs during the unplanned initiation of PD were conducted. In addition, multivariate regression models examined the association of costs with requiring urgent hemodialysis (HD) at the time of starting PD, and the association of driving distance with requiring urgent HD. RESULTS: Of 195 patients hospitalized in 2010 for PD catheter placement, 51 patients met criteria for unplanned PD initiation and 25 of them required urgent HD prior to PD initiation. Ninety-two percent of the patients received 90% or greater government subsidy of hospital costs. Average inpatient costs for the first hospitalization related to the unplanned initiation of PD were 64,174 Mexican Pesos (MXN) (US $4,657). Costs were 78,683 MXN ($5,710) per patient for those requiring urgent HD and 50,225 MXN ($3,645) for those who did not, a difference (P<0.05) of roughly 28,000 MXN ($2,032), and regression results were similar. In addition, long driving distance to the institution was significantly associated with requiring urgent HD. CONCLUSIONS: Our findings highlight potential cost savings to payers for developing better strategies to manage PD starts in Mexico and should help inform policy regarding oversight and coverage of low-income patients at risk of dialysis.

[Is a calcineurin inhibitor required as part of the immunosuppression scheme in kidney transplant recipients that share 2-haplotypes with their donors?]. / Es necesario un inhibidor de calcineurina como parte del esquema de inmunosupresión en receptores de trasplante renal que comparten dos haplotipos con su donador?

INTRODUCTION: The recipients of HLA-identical live-donors grafts (RKT 2HP) have a low immunologic risk, and it is common to use immunosuppressive regimen with two medicaments excluding the calcineurin inhibitor. This study compares the long term outcomes of the double immunosuppressive therapy versus the triple therapy in RKT 2HP. MATERIALS AND METHODS: This study is a retrolective cohort. The patients were divided in two groups: (1) RKT 2HP who receive double immunosupresive therapy and (2) RKT 2HP with triple immunosupresive therapy. The outcomes evaluated were: renal function, acute rejection rate, lost of renal allograft, death rate, infections and hospitalization, change in the immunosupresive therapy and its causes. RESULTS: We analyzed 85 kidney transplant recipients who share two haplotypes, 60 in the group 1 and 25 in the group 2. The median of time of follow-up in the group 1 was 138 months (min 23 and max 302) and 55 months (min 12 and max 106) in the group 2. There were four cellular acute rejection and nine allograft lost in patients of the group 1. There wasn't any significant difference between the allograft outcome and the renal function at 60 months of follow out between the groups. 23 patients had change in the immunosuppressive therapy, 12 (53%) in the group 1 and 11 (47%) in the group 2. The major cause of change of therapy in the group 1 was leucopenia by azatioprin (five patients); and in the group 2 was nephrotoxicity for calcineurin inhibitor (six patients). DISCUSSION: Despite the evident nephrotoxicity, the use of calcineurin inhibitor is useful even in patients with low immunologic risk. According to the time of follow-up between the groups, even when the allograft survival was superior in group 2, the difference wasn't significative, it might be because the lower number of patients in group 1.

Condiloma acuminado gigante (tumor de Buschke-Löwenstein) / Giant condyloma acuminata (Buschke-Löwenstein tumour)

Los condilomas o verrugas genitales son producidos por el virus del papiloma humano. La infección típicamente ocurre cuando las células basales del huésped se exponen a la infección viral a través de una barrera epitelial dañada, como sucede durante el acto sexual o como producto de otras abrasiones dérmicas menores. Se necesita la presencia de otros factores asociados para producir la enfermedad, como son: promiscuidad sexual, mala nutrición, tabaquismo, multiparidad, depresión del sistema inmunológico y uso prolongado de anticonceptivos orales. Los condilomas acuminados constituyen una de las enfermedades de transmisión sexual más frecuentes y se vinculan, por lo general, con los tipos de cepas 6 y 11. En pocas ocasiones pueden evolucionar como un tumor invasivo con malignidad local, aunque sin metástasis, equivalente a un carcinoma verrucoso: es el síndrome de Buschke-Löwenstein (AU)

Condylomata or genital warts are produced by the human papilloma virus (HPV). The infection occurs typically when the basal cells of the host are exposed to the viral infection due to a damaged epithelial barrier, as happens during the sexual act or in minor skin abrasions. Other associating factors are required to produce the disease, such as: inappropriate sexual behaviour, smoking, malnutrition, multiparity, immune system depression and prolonged use of oral anticonceptives. Condyloma acuminatum is one of the most frequent sexual transmitted diseases and is generally associated with types HPV 6 and 11. On some occasions, it can progress to a local invasive tumor but without metastases, similar to a verrucous carcinoma: it is the Buschke-Löwenstein syndrome (AU)

Tuberculosis abdominal en el diagnóstico diferencial del cáncer de ovario: a propósito de un caso / Abdominal tuberculosis in the differential diagnosis of ovarian cancer: presentation of a case

Se presenta el caso clínico de una paciente de27 años con ascitis y elevación del Ca 125, que plantea el diagnóstico diferencial entra carcinoma ovárico y tuberculosis peritoneal (AU)

We present the case of a woman 27 years old with as cites and elevated serum CA 125 that established the differential diagnosis between ovarian carcinoma and peritoneal tuberculosis (AU)

Determination of the volatile and semi-volatile secondary metabolites, and aristolochic acids in Aristolochia ringens Vahl.

Volatile and semi-volatile secondary metabolites, as well as aristolochic acids (AA), present in leaves, stems, and flowers of Aristolochia ringens were determined by gas chromatography (GC)-mass spectrometry (MS) and high-performance liquid chromatography (HPLC) methods, respectively. Metabolite isolation was performed using different extraction techniques: microwave-assisted hydrodistillation (MWHD), supercritical fluid extraction, and headspace solid-phase microextraction (HS-SPME). The chemical composition of the extracts and oils was established by GC-MS. The determinations of AAI and AAII were conducted by methanolic extraction of different plant parts followed by HPLC analysis. Essential oil yields from leaves and stems were 0.008 +/- 0.0022% and 0.047 +/- 0.0026%, respectively. Aristolochia ringens flowers did not yield essential oil under MWHD. Sesquiterpene hydrocarbons (66%) were the main compounds in the essential oil isolated from leaves whereas monoterpene hydrocarbons (73%) predominated in the stems essential oil. Yields of extracts isolated by SFE from leaves, stems, and flowers were 4 +/- 1.8%, 1.2 +/- 0.25%, and 4 +/- 1.8%, respectively. In vivo HS-SPME of flowers isolated compounds with known unpleasant smells such as volatile aldehydes and short-chain carboxylic acids. HPLC analysis detected the presence of AAII in the flowers of Aristolochia ringens at a concentration of 610 +/- 47 mg/kg of dried flower.

Pneumonia case-finding in the RESPIRE Guatemala indoor air pollution trial: standardizing methods for resource-poor settings.

OBJECTIVE: Trials of environmental risk factors and acute lower respiratory infections (ALRI) face a double challenge: implementing sufficiently sensitive and specific outcome assessments, and blinding. We evaluate methods used in the first randomized exposure study of pollution indoors and respiratory effects (RESPIRE): a controlled trial testing the impact of reduced indoor air pollution on ALRI, conducted among children 90% of children meeting ALRI criteria, of whom about 70% attended a physician. Referrals for cough without respiratory signs and self-referrals contributed 19.0% and 17.9% of physician-diagnosed ALRI cases respectively. Intervention group attendance following ALRI referral was 7% higher than controls, a trend also seen in compliance with RSV tests and CXR. There was no evidence of bias by intervention status in fieldworker classification or physician diagnosis. Incidence of fieldworker ALRI (1.12 episodes/child/year) is consistent with high sensitivity and low specificity; incidence of physician-diagnosed ALRI (0.44 episodes/child/year) is consistent with comparable studies. CONCLUSION: The combination of case-finding methods achieved good sensitivity and specificity, but intervention cases had greater likelihood of reaching the physician and being investigated. There was no evidence of bias in fieldworkers classifications despite lack of concealment at home visits. Pulse oximetry offers practical, objective severity assessment for field studies of ALRI.

Estado actual nosológico de la esquizofrenia / The nosologic status of schizophrenia

Se revisó la ubicación nosológica de la esquizofrenia reparándose la terminología más usada: síndrome , trastorno, enfermedad. Debido a la dificultad que existe para comprender la etiología de este padecimiento se eligió el término de trastorno para referirse a él, entendiendo que se trata de una designación temporal. En base a los estudios neurorradiológicos, neuroquímicos y nuestro entendimiento fisiopatológico en esta entidad, tratamos de justificar nuestra preferencia por este término. Se revisaron, igualmente, las teorías más recientes que intentan explicar la fisiopatología de la esquizofrenia (AU)

Estado actual nosologico de la esquizofrenia / The nosologic status of schizophrenia

Se reviso la ubicacion nosologica de la esquizofrenia reparandose la terminologia mas usada: sindrome , trastorno, enfermedad. Debido a la dificultad que existe para comprender la etiologia de este padecimiento se eligio el termino de trastorno para referirse a el, entendiendo que se trata de una designacion temporal. En base a los estudios neurorradiologicos, neuroquimicos y nuestro entendimiento fisiopatologico en esta entidad, tratamos de justificar nuestra preferencia por este termino. Se revisaron, igualmente, las teorias mas recientes que intentan explicar la fisiopatologia de la esquizofrenia

Electroconvulsive therapy in Parkinson's disease

Para evaluar el efecto de la terapia electroconvulsivante (TEC) en pacientes con enfermedad de parkinson, Nosotros condujimos un estudio abierto con un curso de siete días de TEC en seis pacientes con enfermedades de parkinson idiopática. El deterioro motor mejoró en todos los casos durante TEC. Esta mejoría fue sostenida en tres pacientes después de 30 días, y persistió hasta el día 60 en un paciente; los registros de depresión mejoraron en cuatro pacientes y los niveles séricos de prolactina estuvieron elevados con cinco pacientes durante la TEC, disminuyendo establemente después. La respuesta a la TEC observada en las valoraciones motoras, congnoscitivas o afectivas pereció que era independiente una de otra. La mejor respuesta en la ejecución motora se observó en aquellos pacientes con una evolución más corta de la enfermedad y etapas más bajas de discapacidad. El método de TEC utilizado en este estudio fue seguro y evitó la apnea o las contracciones musculares. Nosotros concluímos que la electroterapia perece que induce una respuesta favorable aunque afímera en la enfermedad de parkinson. Sin embargo, se deben de hacer estudios controlados a largo plazo. Otros métodos de electroestimulación más selectivos de vías dopaminérgicas se deben de investigar.