Resveratrol exerts anti-oxidant and anti-inflammatory actions and prevents oxaliplatin-induced mechanical and thermal allodynia.

Chemotherapy-induced peripheral neuropathic pain (CIPNP) is a frequent and devastating side effect of cancer therapy. No preventive strategies are currently available. We investigated the use of resveratrol (RESV) in the prevention of CIPNP and evaluated key components of the antioxidant defense system and neuroinflammatory factors as possible mediators contributing to RESV actions. Male rats were injected with oxaliplatin (OXA) and received daily oral RESV. Paw mechanical and thermal allodynia, oxidative stress, antioxidant, pro-inflammatory and neuronal injury/activation markers were evaluated in the sciatic nerve (SN), lumbar dorsal root ganglia (DRG) and spinal cord (SC). OXA-injected animals developed mechanical and thermal allodynia, while those receiving OXA + RESV showed patterns of response similar to control animals. Higher TBARS levels and lower GSH/GSSG ratios were observed in the SN of animals receiving OXA. The mRNA levels of the transcription factor NFκB and the pro-inflammatory cytokine TNFα were found to be upregulated both in lumbar DRG and SC. In addition, the antioxidant enzymes NQO-1 and HO-1 and the neuronal injury marker ATF3 showed increased levels of expression in lumbar DRG. In the dorsal SC the neuronal activation marker c-fos and the transcription factor Nrf2, main regulator of antioxidant defenses, were found to be upregulated. RESV early and sustained administration prevented NFκB, TNFα, ATF3 and c-fos upregulation, while increasing the expression of Nrf2, NQO-1, HO-1 and the redox-sensitive deacetylase SIRT1. RESV treatment was also able to restore TBARS levels and GSH/GSSG ratio. Thus, RESV administration resulted in the upregulation of antioxidant mediators, suppression of pro-inflammatory parameters and prevention of OXA-induced mechanical and thermal allodynia.

[Resident of emergency attitude towards patients-physician relationship at the Hospital de Clínicas- Asunción, Paraguay]. / Actitud de residentes de urgencias hacia la relación médico-paciente en el Hospital de Clínicas- Asunción, Paraguay.

INTRODUCTION: The doctor-patient relationship is reaching great importance in recent times, is highlighted their importance in areas as varied as satisfaction, compliance, perception of professional competence, the frequency of legal issues relating to malpractice and even the prognosis of the disease or the general health of the patient. OBJECTIVE: To evaluate the doctor-patient relationship from the point of view of residents of emergency unit. METHODS: An observational, descriptive study. The sample consisted of 36 doctors from different areas of the Emergency Rooms of the Hospital de Clínicas- Asunción, Paraguay. The patient-physician relationship was evaluated using an instrument developed by RA Chavarria-Islas et al. with four indicators: Respect, Information, Consent and Dedication. RESULTS: 69.4% of residents have a regular patient-physician relationship; despite the 2.78% has a good relationship, 25% bad relationship and 2.78% a very bad relationship. CONCLUSION: Gaps in doctor-patient relationship were found in this study.. It is interesting to invest greater efforts to enhance the doctor-patient relationship as one of the edges to improve health care, which is vital in emergency care.

Se estudiaron retrospectivamente pacientes con diagnóstico de lupus eritematoso sistémico (LES) de acuerdo a criterios ACR 1982, con nefritis lúpica (NL) durante el período comprendido desde 2005 al 2012 y que fueran sometidos a una biopsia renal repetida. El número total de pacientes con NL atendidos fue de 120, de los cuales 18 (15%) pacientes fueron sometidos a biopsia renal repetida, 18 con 2 biopsias renales y 6 con 3 biopsias. 3 (16,7%) de los pacientes fueron fumadores; 1 (5,6%) poseía antecedentes de DBT previa, 2 (11,1%) poseían antecedentes de HTA; y 3 (16,7%) pacientes tenían obesidad previa. El tiempo de diagnóstico de LES al momento del estudio fue de 96 meses ± 15; el tiempo transcurrido entre la 1° y la 2° biopsia fue de 45 ± 11 meses y el tiempo entre la 2° y 3° biopsia fue de 56 ± 12 meses. Las indicaciones de la biopsia repetida fueron proteinuria en 10 biopsias (41,6%); proteinuria con alteración de la función renal en 2 biopsias (8,3%); proteinuria con sedimento patológico en 8 biopsias (33,3%); y proteinuria con sedimento patológico y alteración de la función renal en 4 biopsias (16,6%). Los cambios histológicos más frecuentes encontrados entre las primeras y las biopsias repetidas fueron: de clase IV a clase III: 2 (8,2%); clase IV a clase IV: 8 (33,3%), clase IV a clase III+V: 2 (8,2%); clase IV a clase IV+V: 3 (12,5%); clase IV a clase V: 2 (8,2%). Los cambios en las biopsias de NL proliferativas con índices de actividad y cronicidad (A/C) fueron: de A a A/C: 7 (29,1%), A/C a A/C: 7 (29,1%). La intensidad de la terapia inmunosupresora aumentó en 79,1%, se mantuvo el tratamiento inmunosupresor en 16.6%. Con respecto al cambio de medicación 7 (20%) pacientes recibieron Ciclofosfamida 1 gr cada 30 días, 9 (26%) Ciclofosfamida 500 mg cada 15 días, 8 (23%) tratamiento de reinducción con Micofenolato mofetil; Rituximab 8 (23%); y 3 (8%) Ciclosporina A. El tratamiento de mantenimiento se realizó con micofenolato mofetil en 23 casos (55%); con azatioprina en 11 (26%) casos; ciclosporina en 3 (7%) oportunidades y rituximab en 5 (12%). En todos los casos se utilizó hidroxicloroquina.

Liposucción en Cirugía Reparadora (desengrasamiento de colgajos cutáneos y miocutáneos, exéresis de acúmulos grasos y autotransplante de grasa) / Liposuction in reconstructive surgery (undermine of cutaneous and miocutaneous flaps, exeresis of fat deposits and autologous fat transplantation)

La liposucción es una técnica quirúrgica de gran utilidad para la remodelación de acúmulos grasos y para el desgrasamiento de los colgajos cutáneos, miocutáneos o musculares. Para el desgrasamiento de los colgajos la realizamos después del año de efectuado el colgajo. También la empleamos en acúmulos grasos, en la reconstrucción mamaria postmastectomía, y acúmulos grasos periféricos en la reducción mamaria. Igualmente en el tratamiento de cicatrices deprimidas con prominencia de tejidos vecinos. En zonas deprimidas la realización del autotransplante de grasa nos ha dado buenos resultados (AU)

Surgery of the forms is an important part of plastic surgery. Occasionally, the presence of adipose masses will interfere in certain reconstructive procedures. This is specifically true for breast surgery in reductive or reconstructive techniques. Suction lipectomy is an interesting procedure for the exeresis of fat deposits, and can also be used as an ancillary treatment in many other procedures. It is also of great use in the remodeling of skin flaps performed with a pedicle or microsurgically, as well as for myocutaneous and muscular flaps. In performing the remodeling, it is also convenient to undermine and release the edges of the flap from the peripheral scar, in order to facilitate the "lifting" procedure. The instrument set for the transplantation of autologus adipose tissue is presented. The trasnplant of fat can fill and raise depressed areas, and it must be done in an over-corrective fashion by injection into a closed preformed pouch. Thse adipose trasnplants have been followed and controlled by external assessment and biopsy, revealing a 20-30o per cent resorption of transplanted tissue, and capsule formation (AU)

The oxidative stress induced in vivo by Shiga toxin-2 contributes to the pathogenicity of haemolytic uraemic syndrome.

Typical haemolytic uraemic syndrome (HUS) is caused by Shiga toxin (Stx)-producing Escherichia coli infections and is characterized by thrombotic microangiopathy that leads to haemolytic anaemia, thrombocytopenia and acute renal failure. Renal or neurological sequelae are consequences of irreversible tissue damage during the acute phase. Stx toxicity and the acute inflammatory response raised by the host determine the development of HUS. At present there is no specific therapy to control Stx damage. The pathogenic role of reactive oxygen species (ROS) on endothelial injury has been largely documented. In this study, we investigated the in-vivo effects of Stx on the oxidative balance and its contribution to the development of HUS in mice. In addition, we analysed the effect of anti-oxidant agents as therapeutic tools to counteract Stx toxicity. We demonstrated that Stx induced an oxidative imbalance, evidenced by renal glutathione depletion and increased lipid membrane peroxidation. The increased ROS production by neutrophils may be one of the major sources of oxidative stress during Stx intoxication. All these parameters were ameliorated by anti-oxidants reducing platelet activation, renal damage and increasing survival. To conclude, Stx generates a pro-oxidative state that contributes to kidney failure, and exogenous anti-oxidants could be beneficial to counteract this pathogenic pathway.

Calidad de vida en pacientes con cáncer de mama en tratamiento oncológico ambulatorio en el Instituto de Previsión Social en el año 2010 / Quality of life in patients with breast cancer undergoing ambulatory oncologic treatment at the Social Security Institute in 2010

El cáncer de mama es un problema de salud pública debido a su frecuencia y porque su diagnóstico y tratamiento alteran la calidad de vida de las mujeres afectadas en las dimensiones físicas, psicológicas, sociales y sexuales. En Paraguay, existen pocos estudios realizados sobre la calidad de vida de pacientes oncológicos. El objetivo de este estudio fue evaluar la calidad de vida de 125 mujeres, entre 25 y 90 años con cáncer de mama, que fueron sometidas a mastectomía y quimioterapia ambulatoria en el Hospital Día del Servicio de Hematología del Hospital Central del Instituto de Previsión Social. Se les administró un cuestionario genérico de la calidad de vida de la Organización Europea para la Investigación y Tratamiento del Cáncer (EORTC QLQ-C30), y uno específico: módulo de cáncer de mama (QLQ-BR23). Las mujeres reportaron malestar físico (dolor, insomnio, cansancio), malestar psicológico y dificultades en sus relaciones sexuales. Se observó una buena correlación entre ambos instrumentos (r=0,77; valor p <0,0001), el QLQBR23 arrojó puntuaciones menores que el QLQ30 (68,0±13,4 frente 79,9±14,0). La dimensión salud general tuvo el promedio más bajo. Ninguna persona calificó su salud general como excelente. La etapa de la enfermedad y presencia de linfedema se relacionaron con menor puntuación de la calidad de vida. En general, las mujeres afirmaron que su salud general y calidad de vida eran buenas; demostrando capacidad para desempeñar actividades laborales o del hogar y sociales. Se concluye que la calidad de vida relacionada a la salud es favorable en las pacientes estudiadas

Brote de encefalitis de St. Louis en la provincia de Córdoba

La encefalitis de Saint Louis (ESL) es una enfermedad viral transmitida al humano por mosquitos del género culex spp. El agente causal es un arbovirus miembro de la familia flaviviridae. En Argentina es una infección de distribución amplia con una prevalencia serológica del 10-68%. Está demostrada su circulación en aves. Entre los meses de enero y abril de 2005 se presentaron en la provincia de Córdoba 48 casos de ESL. En nuestra experiencia asistimos 9 casos de esta encefalitis.

Brote de encefalitis de St. Louis en la provincia de Córdoba

La encefalitis de Saint Louis (ESL) es una enfermedad viral transmitida al humano por mosquitos del género culex spp. El agente causal es un arbovirus miembro de la familia flaviviridae. En Argentina es una infección de distribución amplia con una prevalencia serológica del 10-68%. Está demostrada su circulación en aves. Entre los meses de enero y abril de 2005 se presentaron en la provincia de Córdoba 48 casos de ESL. En nuestra experiencia asistimos 9 casos de esta encefalitis.(AU)

Outbreak of carbapenem-resistant Pseudomonas aeruginosa producing VIM-8, a novel metallo-beta-lactamase, in a tertiary care center in Cali, Colombia.

The prevalence of imipenem resistance among Pseudomonas aeruginosa isolates at a 195-bed tertiary care medical center in Cali, Colombia, rose from 2% in 1996 to 28% in 1997 and to over 40% in 2003. Many isolates showed high-level multiresistance, and phenotypic characterization suggested the spread of a predominant strain with minor variants. Sixty-six resistant isolates collected between February 1999 and July 2003 from hospitalized patients (n = 54) and environmental samples (n = 12) were subjected to a fuller analysis. Genetic fingerprints were compared by pulsed-field gel electrophoresis (PFGE) of SpeI-digested genomic DNA, and bla(IMP) and bla(VIM) genes were sought by PCR. PFGE and serotyping indicated that 52 of the 66 isolates belonged to a single strain, with 82% similarity; the PFGE pattern for this organism was designated pattern A. Two further pairs of isolates represented single strains; the remaining nine isolates were unique, and in the case of one isolate, no satisfactory PFGE profile could be obtained. The pattern A isolates were mostly of serotype O12 and were highly resistant to imipenem (MICs, 32 to >256 microg/ml), with this resistance decreased eightfold or more in the presence of EDTA. They yielded amplicons with bla(VIM)-specific primers, and sequencing of DNA from a representative isolate revealed bla(VIM-8), a novel allele with three polymorphisms compared with the sequence of bla(VIM-2). Two of these nucleotide changes were silent, but the third determined a Thr139Ala substitution. Only 4 of 13 resistant isolates (2 clinical isolates and 2 environmental isolates) assigned to other PFGE types carried bla(VIM) alleles, whereas the others were less multiresistant and mostly had lower levels of imipenem resistance (MICs, < or =32 microg/ml) which was not significantly reduced by EDTA. No bla(IMP) alleles were detected. During 2003, when the environmental study was undertaken, serotype O12 isolates with bla(VIM) were recovered from sinks and stethoscopes in the most-affected units, although not from the hands of staff; the problem declined once these reservoirs were disinfected and hygienic precautions were reinforced.

Effects of extracellular nucleotides and their hydrolysis products on regulatory volume decrease of trout hepatocytes.

In trout hepatocytes, hypotonic swelling is followed by a compensatory shrinkage called regulatory volume decrease (RVD). It has been postulated that extracellular ATP and other nucleotides may interact with type 2 receptors (P(2)) to modulate this response. In addition, specific ectoenzymes hydrolyze ATP sequentially down to adenosine, which may bind to type 1 receptors (P(1)) and also influence RVD. Accordingly, in this study, we assessed the role of extracellular nucleoside 5'-tri- and diphosphates and of adenosine on RVD of trout hepatocytes. The extent of RVD after 40 min of maximum swelling was denoted as RVD(40), whereas the initial rate of RVD was called v(RVD). In the presence of hypotonic medium (60% of isotonic), hepatocytes swelled 1.6 times followed by v(RVD) of 1.7 min(-1) and RVD(40) of 60.2%. ATP, UTP, UDP, or ATPgammaS (P(2) agonists; 5 microM) increased v(RVD) 1.5-2 times, whereas no changes were observed in the values of RVD(40). Addition of 100 microM suramin or cibacron blue (P(2) antagonists) to the hypotonic medium produced no effect on v(RVD) but a 53-58% inhibition of RVD(40). Incubation of hepatocytes in the presence of either 5 microM [gamma-(32)P]ATP or [alpha-(32)P]ATP induced the extracellular release of [gamma-(32)P]P(i) (0.21 nmol.10(-6) cells(-1).min(-1)) and [alpha-(32)P]P(i) ( approximately 8 x 10(-3) nmol.10(-6) cells(-1).min(-1)), suggesting the presence of ectoenzymes capable of fully dephosphorylating ATP. Concerning the effect of P(1) activation on RVD, 5 microM adenosine, both in the presence and absence of 100 microM S-(4-nitrobenzil)-6-tioinosine (a blocker of adenosine uptake), decreased RVD(40) by 37-44%, whereas 8-phenyl theophylline, a P(1) antagonist, increased RVD(40) by 15%. Overall, results indicate that ATP, UTP, and UDP, acting via P(2), are important factors promoting RVD of trout hepatocytes, whereas adenosine binding to P(1) inhibits this process.

Severe digestive pathology associated with chronic Chagas' disease in Ecuador: report of two cases.

DNA extracted from peripheral blood of two Ecuadorian patients showing severe digestive pathology was amplified by the polymerase chain reaction using a Trypanosoma cruzi specific oligonucleotide primers derived from the primary sequence of a cDNA encoding for a 24 kDa excretory/secretory protein. The positive PCR results together with the clinical findings confirmed that both patients had a digestive pathology due to Chagas' disease. This pathology could be more frequent than previously described in the chagasic endemic regions of Andean countries.

Severe digestive pathology associated with chronic Chagas' disease in Ecuador: report of two cases

DNA extracted from peripheral blood of two Ecuadorian patients showing severe digestive pathology was amplified by the polymerase chain reaction using a Trypanosoma cruzi specific oligonucleotide primers derived from the primary sequence of a cDNA encoding for a 24 kDa excretory/secretory protein. The positive PCR results together with the clinical findings confirmed that both patients had a digestive pathology due to Chagas' disease. This pathology could be more frequent than previously described in the chagasic endemic regions of Andean countries.

DNA obtido do sangue periférico de dois pacientes equatorianos, que apresentavam severa patologia digestiva, foi amplificado pela "polymerase chain reaction" (PCR) utilizando os oligonucleotídoes específicos do Trypanosoma cruzi, derivados de uma seqüência primária de cDNA codificado de 24 kDa proteína excretória/secretória. Os resultados positivos da PCR junto com os achados clínicos confirmam que os dois pacientes tinham uma patologia digestiva de origem chagásica. Esta patologia poderia ser mais freqüente que a descrita previamente nas regiões endêmicas chagásicas das cidades dos Andes.

[Evaluation of blood cultures in anaerobiosis]. / Evaluación de los hemocultivos en anaerobiosis.

BACKGROUND: The rate of processed blood cultures from anaerobic bottles was checked and the number of isolates from anaerobic microorganisms and other non anaerobic ones from processed bottles was established. Next, we studied the relationship between bacteremia caused by anaerobic organisms and the clinical history. METHODS: A total of 3.540 blood cultures have been checked for a period of 21 months; all of them were processed using Bactec NR 730 system. Those patients suffering bacteremia caused by anaerobic microorganisms had their medical histories revised. There is neither Gynecology nor Pediatrics Services at our Medical Center. RESULTS: Eleven episodes of bacteremias caused by anaerobic microorganisms have been detected since we started our research 21 months ago. Three aerobic microorganisms grew only in the two processed bottles in anaerobiosis, being their respective aerobic cultures negative. In all cases of bacteremia caused by anaerobic bacteria, the clinical history was compatible with this infection. CONCLUSIONS: We consider it is worth keeping the anaerobic bottles, because the number of anaerobic microorganisms isolates is considerable and clinically significant. A 2.76% incidence, where there is not gynecologist hospitalization, seems to be a high and relevant one. An alternative approach is to perform them only under certain clinical circumstances, although the process of collecting samples would make it a difficult task.