Manejo nutricional en pacientes con Trasplante hepático / Nutritional management in liver transplant patients

En 1983 el National Institutes of Health USA (NIH) declaró que el trasplante hepático orto tópico (THO) era una alternativa tera-péutica eficaz para pacientes con enfermedades hepáticas avan-zadas. Desde entonces, se han realizado cerca de 100 000 THO en el mundo, en más de 200 centros distintos. El THO (tanto en hepatopatías crónicas avanzadas como en hepatitis fulminante) tiene por objetivo primordial prolongar la sobrevida de los pa-cientes afectados, logrando una buena calidad de vida posterior al trasplante. Las tasas promedio de sobrevida actuarial de pacientes a 1 y 5 años son de aproximadamente 85% y 80% respectivamente. Los resultados generales del THO dependen de la causa primaria del daño hepático del receptor y del estado clínico del paciente al momento de la operación1. El trasplante hepático como tratamiento permite mejorar la ca-lidad de vida de pacientes con hepatopatías en fase terminal, está considerado en algunos pacientes con hepatopatía crónica avanzada de diferente etiología y en pacientes con insuficiencia hepática aguda grave no reversible con las medidas de trata-miento convencional. Las principales patologías que son motivo de trasplante hepático son: cirrosis hepática de diversa etiología (59% de los pacientes trasplantados), tumores hepáticos (21%), cuadros colestásicos (5%) e insuficiencia hepática aguda grave (3%)2. Por todo lo anteriormente mencionado, la Unidad Técnica de Nutrición del Hospital de Especialidades Carlos Andrade Marín ha visto la necesidad de realizar el siguiente protocolo con el fin de estandarizar un adecuado manejo nutricional para la preven-ción, tratamiento y complicaciones de pacientes en estadio cirró-tico terminal que requieran un trasplante hepático.

In 1983 the NIH (National Institutes of Health, USA) declared that orthotopical liver transplantation (ORT) was an effective therapeutic alternative for patients with advanced liver diseases. Since then, nearly 100,000 OLTs have been performed world-wide, in more than 200 different centers. OLT (both in advanced chronic liver disease and in fulminant hepatitis) has the primary objective of prolonging the survival of affected patients, achie-ving a good quality of life after transplantation.The average 1-year and 5-year actuarial patient survival rates are approximately 85% and 80%, respectively. The general re-sults of OLT depend on the primary cause of the recipient's liver damage and the clinical status of the patient at the time of the operation1.Liver transplantation as a treatment improves the quality of life of patients with end-stage liver disease. It is considered in some patients with advanced chronic liver disease of different etiolo-gies and in patients with severe acute liver failure that is not reversible with conventional treatment measures. The main pa-thologies that are the reason for liver transplantation are: liver cirrhosis of various etiologies (59% of transplant patients), liver tumors (21%), cholestatic conditions (5%) and severe acute liver failure (3%)2.For all of the above, the Technical Nutrition Unit of the Carlos Andrade Marin Specialty Hospital has seen the need to carry out the following protocol in order to standardize adequate nu-tritional management for the prevention, treatment and complications of patients in the terminal cirrhotic stage who re-quire a liver transplant.

Enteroendocrine cells in the Echinodermata.

Enteroendocrine cells are endocrine-like cells found in the luminal epithelia of the digestive tract. These cells have been described in most animal phyla. In echinoderms, the cells have been described mainly in organisms of the class Asteroidea (sea stars) and Holothuroidea (sea cucumbers). Here, we describe what is known about the enteroendocrine cells of the Echinodermata, including the cell types, their distribution in the digestive tract, their neuropeptide content and their regeneration and compare them to what has been found in other animal species, mainly in vertebrates. We also discuss the newly described view of enteroendocrine cells as chemical sensors of the intestinal lumen and provide some histological evidence that similar functions might be found within the echinoderms. Finally, we describe the temporal regeneration of the enteroendocrine cells in the holothurian intestine.

Linking Endotoxins, African Dust PM10 and Asthma in an Urban and Rural Environment of Puerto Rico.

African Dust Events (ADE) are a seasonal phenomenon that has been suggested to exacerbate respiratory and proinflammatory diseases in Puerto Rico (PR). Increases in PM10 concentration and the effects of biological endotoxins (ENX) are critical factors to consider during these storms. ENX promote proinflammatory responses in lungs of susceptible individuals through activation of the Toll-like receptors (TLR2/4) signaling pathways. The objective of the study was to evaluate the toxicological and proinflammatory responses stimulated by ADE PM10 ENX reaching PR using human bronchial epithelial cells. PM10 organic extracts from a rural and urban site in PR (March 2004) were obtained from ADE and non-ADE and compared. A retrospective data analysis (PM10 concentration, aerosol images, and pediatric asthma claims) was performed from 2000 to 2012 with particular emphasis in 2004 to classify PM samples. Urban extracts were highly toxic, proinflammatory (IL-6/IL-8 secretion), and induced higher TLR4 expression and NF-κB activation compared to rural extracts. ENX were found to contribute to cytotoxicity and inflammatory responses provoked by urban ADE PM10 exposure suggesting a synergistic potency of local and natural ENX incoming from ADE. The contribution of ADE PM10 ENX is valuable in order to understand interactions and action mechanisms of airborne pollutants as asthma triggers in PR.

Natural Sesquiterpene Lactones Induce Oxidative Stress in Leishmania mexicana.

Leishmaniasis is a worldwide parasitic disease, caused by monoflagellate parasites of the genus Leishmania. In the search for more effective agents against these parasites, the identification of molecular targets has been attempted to ensure the efficiency of drugs and to avoid collateral damages on the host's cells. In this work, we have investigated some of the mechanisms of action of a group of natural sesquiterpene lactones that are effective against Leishmania mexicana mexicana promastigotes. We first observed that the antiproliferative effect of mexicanin I (Mxc), dehydroleucodine (DhL), psilostachyin (Psi), and, at lesser extent, psilostachyin C (Psi C) is blocked by 1.5 mM reduced glutathione. The reducing agent was also able to reverse the early effect of the compounds, suggesting that lactones may react with intracellular sulfhydryl groups. Moreover, we have shown that all the sesquiterpene lactones, except Psi C, significantly decreased the endogenous concentration of glutathione within the parasite. Consistent with these findings, the active sesquiterpene lactones increased between 2.7 and 5.4 times the generation of ROS by parasites. These results indicate that the induction of oxidative stress is at least one of the mechanisms of action of DhL, Mxc, and Psi on parasites while Psi C would act by another mechanism.

Co-occurrence patterns along a regional aridity gradient of the subtropical Andes do not support stress gradient hypotheses.

The stress gradient hypothesis posits that facilitation and stress are positively correlated. The hump-shaped hypothesis, on the contrary, proposes that facilitation is greater at intermediate stress levels. The relationship between facilitation and environmental stress is commonly studied at small spatial scales and/or considering few species; thus, the implications of facilitation at a community level remain poorly understood. Here, we analyzed local co-occurrence patterns of all plant species at 25 sites within the subtropical Andes to evaluate the role of facilitation and competition as drivers of community structure. We considered a wide latitudinal gradient (19-26°S) that incorporates great variation in aridity. No previous studies have attempted to study these patterns across such a broad scale in warm deserts. Each locality was sampled at two scales (quadrat and patch), and co-occurrence was analyzed via null models. Furthermore, we tested for a relationship between plant co-occurrences and environmental aridity. Resulting patterns depended on life form. When all species were considered, negative associations were found, indicating competition. Woody/cactus life forms tended to be associated across communities, suggesting that there is facilitation between these life forms. Additionally, and unlike previous studies, we found positive associations among shrubs. The strength of the association between woody species changed non-monotonically with aridity. Herbs showed an inverted hump-shaped relationship, albeit ranging mostly among neutral values. Independent of the association type exhibited by different life forms, our community level results do not support current stress gradient hypotheses.

Study of some physicochemical and functional properties of quinoa (chenopodium quinoa willd) protein isolates.

The amino acid composition and the physicochemical and functional properties of quinoa protein isolates were evaluated. Protein isolates were prepared from quinoa seed by alkaline solubilization (at pH 9, called Q9, and at pH 11, called Q11) followed by isoelectric precipitation and spray drying. Q9 and Q11 had high levels of essential amino acids, with high levels of lysine. Both isolates showed similar patterns in native/SDS-PAGE and SEM. The pH effect on fluorescence measurements showed decreasing fluorescence intensity and a shift in the maximum of emission of both isolates. Q9 showed an endotherm with a denaturation temperature of 98.1 degrees C and a denaturation enthalpy of 12.7 J/g, while Q11 showed no endotherm. The protein solubility of Q11 was lower than that of Q9 at pH above 5.0 but similar at the pH range 3.0-4.0. The water holding capacity (WHC) was similar in both isolates and was not affected by pH. The water imbibing capacity (WIC) was double for Q11 (3.5 mL of water/g isolate). Analysis of DSC, fluorescence, and solubility data suggests that there is apparently denaturation due to pH. Some differences were found that could be attributed to the extreme pH treatments in protein isolates and the nature of quinoa proteins. Q9 and Q11 can be used as a valuable source of nutrition for infants and children. Q9 may be used as an ingredient in nutritive beverages, and Q11 may be used as an ingredient in sauces, sausages, and soups.

Update on brow and forehead lifting.

PURPOSE OF REVIEW: The purpose of this review is to provide the latest findings in the constantly changing field of brow and forehead lifting. Significant articles published in the last 24 months are reviewed and discussed based on the personal experience of the senior author (F.P.). RECENT FINDINGS: Important anatomical findings have been made over the last few years which will have an impact on plastic surgery of the upper third of the face, with new ligamentous structures of the forehead and more precise landmarks of the supraorbital neurovascular bundle being described. The short-term efficacy of a new device for periosteal fixation has been evaluated and new data have been collated about the time required for forehead periosteal readhesion. SUMMARY: In the last few years there have been important anatomical findings which will allow the development of more detailed and safe techniques for forehead lift surgery. New absorbable materials are available that allow efficient mechanical fixation of the soft tissues. The senior author of this review has extensive personal experience involving more than 400 cases. In addition to commenting on recent articles, we detail the methods we have used over the last 8 years, especially regarding the fixation technique.

Validación del indice I/T como prueba diagnostica en infecciones neonatales / Values of the I/T radio of inmature to total neutrophils in neonatal-sepsis

PREGUNTA DE INVESTIGACIÓN ¿Cuál es la sensibilidad, especificidad y valores predictivos de la prueba diagnóstica del índice I/T en el diagnóstico de infecciones neonatales en recién nacidos pretérmino, término y post-término? OBJETIVO GENERAL: determinar los valores de sensibilidad, especificidad y valores predictivos en la prueba diagnóstica del índice I/T para infecciones neonatales en niños atendidos en el Servicio de Neonatología del Hospital de la Mujer de la ciudad de La Paz - Bolivia DISEÑO DE LA INVESTIGACIÓN: estudio de Test diagnóstico LUGAR IINSAD, Servicio de Neonatologia del Hospital de la Mujer, Instituto de Genética POBLACIÓN 268 recién nacidos, que provenían del Servicio de Neonatología del Hospital de la Mujer, los años 2002 a 2004 MÉTODOS Se tomó la muestra de sangre venosa de la región antecubital previa antisepsia de la piel, en un volumen de 3 mL: 2mL para hemocultivo de acuerdo a normas estandarizadas en el Laboratorio de Bacteriología de INLASA. 1 mL con anticoagulante (EDTA) para el hemograma y el recuento total de leucocitos y plaquetas, análisis de los cambios morfológicos del citoplasma de los neutrofilos identificando la vacuolización y granulaciones tóxicas. Se obtuvo información clínica de los pacientes con relación al peso de nacimiento, sexo, edad gestacional, complicaciones maternas y durante el embarazo y se anotó el puntaje de Apgar. RESULTADOS: la sensibilidad obtenida en el nuevo test, con gold estándar, hemocultivo y clínica nos muestra 55 y 63% respectivamente, para la especificidad 64 y 70%, en valor predictivo positivo 36 y 63%, en valor predictivo negativo 79 y 71%, lo cual demuestra que el índice I/T es más especifico y sensible cuando se relaciona con el diagnóstico clínico. CONCLUSIONES: conociendo la sensibilidad, especificidad y valor predictivo del índice I/T, es una prueba que ayuda al diagnóstico clínico de sepsis neonatal por ser prueba rápida y de bajo costo.

RESEARCH QUESTION: which are the sensitivity, specificity and predictive values of the I/T ratio of immature to total neutrophils in neonatal Sepsis of preterm, term or post term newbornsg? METHODS: we collected blood samples for cultures and for I/T relationship, we follow the protocol of the National Committee for Clinical Laboratory Standards on Cellular Morphology. Clinical informationwere collected from each neonate including birth weight, sex, gestational age, maternal complications, intrapartum complications and apgar scores. RESULTS: the sensitivity obtainedf with the new test, the gold Standard, blood cultures and clinical signs was 55 and 63% respectively. OBJECTIVE: to determine the sensitivity, specificity and predictive values of the I/T ratio of immature to total neutrophils in neonatal sepsis. DESIGN: diagnostic test PARTICIPANTS: 268 preterm, term and post term neonates attended in the Neonatal Service of the Hospital de la Mujer with the clinical diagnosis of neonatal sepsis during the year 2002-04. PLACE: INLASA, Genetic Institute and IINSAD ­ UMSA The especificity was 64 and 70%. The positive predictive value was 36 and 63% and the negative was 79 and 71%. So, the I/T index is more specific when it is related to the clinical signs. CONCLUSIONS: The sensitivity, specificity and predictive values of the I/T test helps in the diagnosis of neonatal sepsis; it is a low cost rapid test.