Beber y conducir en Medellín: prevalencia y caracterización de patrones de consumo, 2014 / Drinking and driving in Medellín: prevalence and consumption patterns, 2014

Incidentes viales causan al año 1,3 millones de muertes, lesiones a 50 millones y pérdida de 40 millones de años de vida saludable; según la Organización Mundial de la Salud el 25% de incidentes viales se asocian con embriaguez. METODOLOGIA:para estimar la prevalencia y caracterizar patrones de consumo de alcohol en conductores de Medellín se hizo una medición aleatoria, transversal y estratificada en enero de 2014. En 32 puestos de control se aforaron 23.856 vehículos y se detuvieron 1.611: 845 (52,4%) autos y 766 (47,6%) motos. RESULTADOS: positivo con alcoholemia de 24 a 300 mg de etanol/100 ml; 7 clasificaron en grado cero, 8 en primero, ninguno en segundo y uno en tercero; expandida a conductores de la ciudad esto equivale aproximadamente a 4.985 personas conduciendo bajo efectos del alcohol, cada día. Un tercio de conductores fue detenido antes en algún puesto de control; entre éstos, uno de cuatro en el último mes; 36% perciben alta y 26% media la probabilidad de detención. La mayoría (60%) reportó no beber y conducir, pero 19% consideró que beber un trago es compatible con conducción segura; aunque 45% afirmó nunca beber y conducir, 48% condujo bebido alguna vez en la vida, un 7% muchas veces y 25% en el último año: 26% con un trago, 13% con dos, tres o cuatro tragos y 30% con cinco o más tragos. CONCLUSION: la prevalencia y patrones identificados señalan pertinente monitorear aleatoria y sistemáticamente este comportamiento en Medellín.

Every year road incidents kill 1.3 million people, cause severe injuries to 20 million and are the reason behind the loss of 40 million years of healthy life all over the world. The World Health Organization estimates that 25% of road incidents and their effects are associated with drunkenness. METHODOLOGY: to estimate the prevalence and characterize the consumption patterns of the drivers in Medellín, a random, cross-sectional and stratified measurement was taken in January 2014. During the 32 control checks 23,856 vehicles were tested; 1,611 were arrrested. A total of 845 (52,4%) were cars, while 766 (47,6%) were motorcycles. RESULTS :of the 1,569 individuals tested for alcohol in their breath, 16 (1%) tested positive and their blood alcohol level varied from 0,24 to 3 mg of ethanol. Similarly, 7 individuals showed degree 0, 8 first degree, 0 second degree and 1 third degree. One third of the individuals had been arrested before and one in four of them had been arrested in the last month. Additionally, 36% considered they had a high probability of being arrested and 26% considered to have a moderate probability. Most drivers (60%) reported not drinking and driving, but one fifth (19%) considered that having one drink is compatible with safe driving and, even though 45% stated never drinking and driving, the other half (48%) had driven while drunk at least once in their lives. Similarly, 7% had done so several times and 25% of them did it in the last year. Finally, 26% of the individuals drove while drunk after one drink, 13% after two, three or four and remaining 30% after 5 or more drinks. CONCLUSION: the prevalence and patterns identified make evident the need to monitor and control the drink-and-drive behavior.

Validación del método analítico para la determinación de glimepirida en plasma humano por HPLC/UV con adición de estándar emplenado glibenclamida como estándar interno / Validation of analytical method for the determination of glimepiride in human plasma by HPLC/UV with addition standard using glibenclamide as an internal standard

Se desarrolló un método para la detección y cuantificación de Glimepirida en plasma humano, conelución isocrática por cromatografía líquida de fase reversa, con detección ultravioleta a 231 nm,empleando el método de adición de estándar. Se utilizó Glibenclamida como estándar interno. Estemétodo involucra una extracción líquida de los principios activos (Glimepirida y Glibenclamida) usandouna mezcla de diclorometano:dietiléter (30:70 v/v). La separación se realizó en una columna C18 en fasereversa y la fase móvil consistió de una mezcla de acetonitrilo:agua (45:55 v/v) ajustado a pH 3.3+/-0.1con ácido acético glacial. El método se validó en el rango de concentraciones de 0.001 a 1.0 mg/mL conadición de estándar de Glimepirida de 0.25 mg/mL. La curva de calibración fue lineal en el rango deconcentraciones establecido. Se evaluó la reproducibilidad, estabilidad y porcentaje de recuperación delmétodo. El método para la determinación de Glimepirida en plasma humano por HPLC/UV fue precisoy exacto, con un límite de cuantificación de 0.2025 mg/mL. Este método fue suficientemente sensiblepara su aplicación en estudios farmacocinéticos de glimepirida

A method for detection and quantification of Glimepiride in human plasma has been developed using anisocratic elution on reversed phase liquid chromatography with ultraviolet detection at a single wavelength(231 nm) and the addition standard method. Glibenclamide was used as an internal standard. This methodinvolves a liquid-liquid drug extraction (Glimepiride and Glibenclamide) from plasma using dichloromethanediethylether (30:70%v/v). Separation was achieved on a C18 reversed phase column and the mobile phaseconsisted of 45% acetonitrile and 55% water (adjusted to pH 3.3+/-0.1 with acetic acid glacial). The assayhas been validated over a concentration range of 0.001 to 1.0 mg/mL with addition of Glimepiride 0.25mg/mL. Calibration curve was linear in the described concentration range. The reproducibility, stabilityand recovery of the method were evaluated. Determination of Glimepiride in human plasma by HPLC/UV method was accurate and precise with a quantitation limit of 0.2025 mg/mL. The method wassufficiently sensitive for pharmacokinetic studies of Glimepiride in human plasm

[Introduction of Bacillus sphaericus strain-2362 (GRISELESF) for biological control of malaria vectors in Guatemala]. / Introducción del Bacillus sphaericus cepa-2362 (GRISELESF) para el control biológico de vectores maláricos en Guatemala.

Malaria continues to be an important health problem in a number of countries of Central and South America where it is considered as a highly prevent endemic disease. The objective of this paper is to assess the entomo-epidemiological impact of a pilot program for the biological control of malaria-transmitting vectors, which was implemented in 1998 in Escuintla, Republic of Guatemala. This program was based on the use of 20,000 L of biolarvicide Bacillus sphaericus- strain-2362 (GRISELESF) which was applied in the 46 localities of highest epidemiological risk at a rate of 10 mL/m2 of effective area of breeding. The entomologic effectiveness of this biolarvicide was monitored from the first 72 hours to 4 months after the application. There was a total larval reduction of 94.57 in the maturity stage of the water phase of Anopheles albimanus vector. The epidemiological analysis was carried out by comparing the rate of malaria prevalence (per 1000 pop) during 1997 and 1998. The five treated municipalities showed a statistically significant reduction of 50% (p 0.01). The results obtained in this paper coincided with those reported by comparable studies, so, this allowed us to recommend the use of the biolarvicide Bacillus sphaericus (strain-2362) as part of a comprehensive program of malaria-transmitting vector control in the Republic of Guatemala and other countries of the region.

Actualización en liquen plano oral / Update in oral lichen planus

El liquen plano LP es un desorden inflamatorio del epitelio escamoso estratificado relativamente común. Las lesiones pueden afectar la piel y membranas mucosas. El Liquen Plano Oral LPO, usualmente, presenta una morfología y distribución característica, pudiendo mostrar una disposición confusa de patrones y formas de tal manera que otros desórdenes pueden simularlo clínicamente. El LP es probablemente de origen multifactorial, algunas veces es inducido por drogas o materiales dentales, a menudo idiopático y con una inmunopatogénesis que involucra a las células T en particular. La etiopatogénesis parece ser compleja con interaccioes entre factores genéticos, ambientales y de estilo de vida, aunque en la actualidad se han aclarado varios aspectros acerca de los mecanismos involucrados y han surgido nuevas asociaciones interesantes con otras enfermedades. El manejo del LP aún no es satisfactorio, pues hasta ahora no existe un tratamiento definitivo y aunque no hay método curativo disponible, la inmunomodulación puede controlar la condición. Clásicamente se ha considerado como una entidad premaligna, pero estudios recientes sugieren que existe una condición conocida como displasia liquenoide que requiere diagnóstico diferencial con el LP. Se precisa más investigación en los aspectos genéticos, ambientales, potencial maligno, asociación con otros desórdenes y más estudios clínicos acerca de su terapia

An animal model of necrotizing enterocolitis induced by infant formula and ischemia in developing piglets.

BACKGROUND/AIMS: The lipid component of piglet formula (0.5% fat) causes increased mucosal permeability in 1-day-old piglets after ischemia/reperfusion. The present study examined if luminal exposure to infant formulas (3.5% fat) and ischemia/reperfusion result in an animal model of necrotizing enterocolitis and if injury is dependent on the formula fat composition. METHODS: Plasma-to-lumen clearance of 51Cr-ethylenediamine-tetraacetic acid was measured, and morphology was evaluated during luminal perfusion with preterm, term, and delipidated preterm cow milk-based infant formulas before and after ischemia/reperfusion in 1-day-old and 1-month-old piglet jejunoileum. In a separate set of experiments, a 1-2-cm segment of ileum was exteriorized and opened to expose the mucosal surface, and the villi were superfused with the above formulas (no ischemia). RESULTS: Before ischemia, clearances were markedly higher for intestinal loops perfused with preterm formula than for loops perfused with term and delipidated formulas in 1-day-old animals. After ischemia, clearances in loops perfused with preterm formula were significantly greater and grossly hemorrhagic and histologically necrotic compared with loops perfused with delipidated formula (minimal injury). Superfusion with preterm formula caused diffuse hyperemia and hemorrhage into intestinal villi. CONCLUSIONS: Luminal perfusion of 1-day-old piglet jejunoileum with predigested and bile acid-solubilized preterm infant formula, in combination with ischemia/reperfusion, produces an animal model of necrotizing enterocolitis, but only if the lipid fraction of the formula is present.

Developing intestine is injured during absorption of oleic acid but not its ethyl ester.

Although lipids are essential nutrients in the mammalian diet, we have shown that fatty acids are injurious to epithelial cells of developing piglet intestine during luminal perfusion. Furthermore, the intestine of young animals sustains greater injury than that of older piglets. In an effort to understand the mechanism for this developmental injury, we investigated whether changes in the chemical configuration of oleic acid would alter this damage. Mucosal permeability, as quantitated by the plasma-to-lumen clearance of 51chromium EDTA, was evaluated during luminal perfusion with oleic acid as compared with its ethyl (ethyl oleate) and glyceryl (glycerol-1-mono-oleate) esters, solubilized with taurocholic acid, in jejunum of 1-d-, 3-d-, 2-wk-, and 1-mo-old piglets. 51Chromium EDTA clearance increased significantly during oleic acid and glycerol-1-mono-oleate perfusion, but did not increase during perfusion with ethyl oleate or saline. This result was not secondary to failure of absorption of ethyl oleate, as [14C]oleic acid and ethyl [1-14C]oleate were absorbed to a similar extent. Furthermore, developing intestine was able to remove the ethyl group and then re-esterify the fatty acid to form triacyglycerol. These studies indicate that oleic acid-induced mucosal injury can be abolished when the carboxylic group of the fatty acid is esterified with an ethyl, but not a glycerol, group. Since the ethyl ester is also absorbed and metabolized similarly to the free fatty acid, this may provide a means of supplying long-chain fatty acids to developing intestine without causing mucosal damage.

Fatty acid-induced injury in developing piglet intestine: effect of degree of saturation and carbon chain length.

Luminal perfusion with the long-chain fatty acid (LCFA) oleate in concentrations similar to that found in premature infant formula produces a dose- and age-dependent mucosal injury in developing intestine. To investigate whether this lipid-induced phenomenon is a function of the degree of saturation and/or chain length of the fatty acid, 51Cr-EDTA plasma-to-lumen clearance was measured in jejunum and ileum of 1-d-, 3-d-, 2-wk-, and 1-mo-old piglets after perfusion with 5-mM solutions of different medium-chain saturated fatty acids and saturated and unsaturated LCFA. Mono- and polyunsaturated LCFA produced significant increases in jejunal permeability. In general, this effect was greater in piglets < or = 2 wk old compared with 1-mo-old animals, but no differences were observed among the unsaturated LCFA within an age group. In contrast, the alterations in mucosal permeability induced by medium-chain fatty acids were overall more attenuated than those induced by LCFA. Our results suggest that developing intestine is vulnerable to the injurious effect of dietary fatty acids and that the lipid-induced changes in mucosal permeability appear to be a function of the fatty acid chain length. The degree of saturation of the fatty acid does not alter its cytotoxic effects.

Oleic acid-induced mucosal injury in developing piglet intestine.

A role for luminal nutrients, in particular products of lipid digestion, in the pathogenesis of mucosal injury to developing intestine has been postulated. We evaluated changes in mucosal permeability and light and electron microscopic histology induced by luminal perfusion with the long-chain fatty acid oleate in developing piglet intestine as a function of age and concentration of the fatty acid. 51Cr-labeled EDTA plasma-to-lumen clearance was measured in jejunum and ileum of 1-day-, 3-day-, 2-wk-, and 1-mo-old piglets during sequential perfusion with saline control (20 min); 0, 1, 5, and 10 mM oleic acid/10 mM taurocholate in saline (20 min); and normal saline (60 min). The jejunum of piglets < or = 2 wk showed significantly greater increases in mucosal permeability compared with 1-mo-old animals after perfusion with oleic acid. This effect was dependent on the luminal concentration of the fatty acid and was associated with mucosal injury evident under light and electron microscopy. In contrast, the overall response in ileum was more attenuated compared with jejunum. Thus oleic acid, a common dietary fatty acid, induces dose- and age-dependent injury in developing piglet intestine. Investigation of the mechanisms of this injury may provide the basis for dietary modifications directed at decreasing the risk of mucosal injury during enteral feeding in neonatal intestine.

Trasplante simultaneo de pancreas y rinon con pancreaticoduodenocistostomia / Simultaneous kidney and pancreas transplantation with pancreatic duodedum cystostomy

Se presentan 4 casos de trasplante simultaneo de pancreas y rinon con pancreaticoduodenocistostomia. El caso numero 1 se constituyo en el primer trasplante de este tipo realizado en Colombia, el 26 de marzo de 1988 en un paciente de 36 anos quien desde los 17 sufria una diabetes mellitus tipo I, y presentaba una insuficiencia renal terminal. Despues del trasplante estuvo insulinoindependiente por 3 semanas; la funcion renal no se recupero y fallecio el 21 de abril de 1988. El caso numero 2 es el de un paciente de 38 anos quien desde los 18 anos de edad sufria una diabeles millitus tipo I, y durante los ultimos 10 anos presentaba una retinopatia diabetica, asociada, hace 8 anos, con insuficiencia renal cronica. El 1 de noviembre de 1988 se le practico rasplante simultaneo de pancreas y rinon; 17 meses mas tarde se encuentra insulinoindependiente y con buena funcion renal. El caso numero 3 es el de un paciente de 36 anos quien tenia diabetes millitus tipo I durante los ultimos 18 anos, con falla renal desde hace 1 1/2 ano, a quien el 25 de septiembre de 1989 se le practico trasplante simultaneo de pancreas y rinon; 7 meses mas tarde se encuentra insulino independiente y con buena funcion renal. El caso 4 fue un paciente de 36 anos con diabetes tipo I, con hipertension arterial, retinopatia grado III e insuficiencia renal cronica. El 27 de marzo de 1990 se le trasplantaron simultaneamente el pancreas y un rinon de un nino de 9 anos con resultados hasta el momento satisfactorios; se halla insulinindependiente, bajo terapia triconjugada de inmunosupresion

Trasplante hepatico: experiencia en Medellin / Hepatic transplantation: experience in Medellin

Presentamos los primeros trasplantes hepaticos, variedad ortotopica, hechos en Medellin. La indicacion mas comun entre nosotros fue la cirrosis biliar primaria. Sin embargo, no hemos practicado trasplantes en menores de 1 ano, en los cuales la indicacion mas frecuente es la atresia de las vias biliares. Los factores que motivaron la decision del trasplante fueron en su orden: varices esofagicas con episodios de sangrado recurrente, en 8 casos: encefalopatias, en 5; y prurito intratable, en 3. Hubo dos casos en los cuales se usaron higados con grupo sanguineo diferente, uno de ellos sobrevivio 2 meses y el otro, mas de 4 anos. Las complicaciones biliares posoperatorias se presentaron en el 30% de los pacientes y fueron: necrosis del coledoco, necrosis vesicular y moldes biliares. Las vasculares se presentaron en el 40% e incluyeron: dos trombosis de la arteria hepatica, una ruptura de falso aneurisma con hemobilia y un embolismo aereo cerebral. Esto nos obliga a depurar mas la tecnica quirurgica. En el 70% de los casos empleamos tratamiento inmunosupresor triconjugado con ciclosporina, azatioprina y corticoides. Todos los episodios de rechazo se controlaron bien con bolos de metilprednisolona; no hubo casos de rechazo hiperagudo o acelerado en los pacientes que sobrevivieron un lapso prolongado. El empleo de la derivacion venosa solo se necesito en un 20% de los casos. La sobrevida a 1 y 2 anos es del 29%, aunque tenemos un caso que sobrevivio 4 anos y 3 meses

Lethal paralytic shellfish poisoning in Guatemala.

An outbreak of paralytic shellfish poisoning occurred in Champerico, on the Pacific coast of Guatemala, July-August 1987. Of 187 people affected with characteristic neurologic symptoms, 26 died. A case study implicated a species of clam, Amphichaena kindermani, harvested from local beaches as the vehicle of the neurotoxins (saxitoxins). Children less than 6 years old had a higher fatality rate (50%) than people greater than 18 years of age (7%). The minimum lethal dose for 1 child was estimated to have been 140 mouse units of toxin/kg body weight; thus children may be more sensitive to the saxitoxins than are adults. This is the first large outbreak of paralytic shellfish poisoning recognized in Guatemala.

Extraccion multiple de organos para trasplantes de corazon, higado y rinones: primer caso / Multiple organ procurement for heart, kidney and liver transplants: first case

Se presenta un caso de extraccion multiple de organos (corazon, higado y los dos rinones) de un donante con trauma craneoencefalico en estado de muerte cerebral, en quien se efectuo el procedimiento el 19 de marzo de 1988, mediante un protocolo y una tecnica preestablecidos en forma multidisciplinaria por el equipo de trasplantes del Hospital Universitario San Vicente de Paul de Medellin, habiendose logrado trasplantar con exito los cuatro organos obtenidos, en otros tantos receptores. Se hace una descripcion detallada de la tecnica quirurgica empleada en la obtencion de los organos que fueron trasplantados precozmente

Preservacion de organos solidos / Solid organ's preservation

El concepto mismo del mantenimiento artificial de organos fue expresado por Legallois hace mas de 150 anos, pero su implantacion exitosa es reciente por la complejidad que ella supone. La hibernacion animal como fenomeno natural ha sido un punto de referencia importante para los investigadores que han dedicado sus esfuerzos a la disciplina de la preservacion de organos

Angiomiolipoma renal: diagnostico y enfoque terapeutico / Kidney angiomyolipoma: diagnosis and therapeutic approach

Se describen tres pacientes con angiomiolipomas o hemartomas del rinon, uno de ellos asociado a esclerosis tuberosa. Se destaca la importancia del ultrasonido y mas especificamente de la tomografia axial computarizada (TAC), en el diagnostico. Igualmente se revisa la terapia actual, en la que la embolizacion arterial juega papel predominante sobre los procedimientos quirurgicos.

Experiencia con trasplante hepatico en humanos / Experience with hepatic transplantation in humans

Presentamos los primeros tres casos de trasplante hepatico en humanos realizado en Colombia: El primero de ellos se practico el 14 de agosto de 1979 y murio a los 81 dias en un cuadro septicemico secundario a una complicacion tecnica de la colecistoduodenostomia. El segundo, operado el 27 de fecbrero de 1983, murio al cuarto dia por una arritmia ventricular y un edema pulmonar, pero la autopsia revelo que el higado se encontraba sano; y el tercer paciente, una mujer de 24 anos de edad trasplantada el 11 de septiembre de 1985, se encuentra en buen estado de salud y reintegrada a sus actividades normales, 8 meses despues del trasplante