Miocarditis inducida por Clozapina: Revisión y protocolo de Screening

Clozapina, el gold standard en esquizofrenia refractaria, presenta algunos efectos adversos que ocasionalmente pueden ser graves. Entre ellos, la miocarditis precoz es un efecto cardiovascular severo poco frecuente que puede aparecer en las primeras 4-6 semanas. Las cifras de incidencia oscilan entre el 0,015-0.188% en el mundo, siendo más altas en Australia. La etiología es desconocida, postulándose hipersensibilidad mediada por Ig E; hipereosinofilia y hiperadrenergia. Múltiples investigaciones avalan a la ecocardiografía como una de las técnicas más útiles para el diagnóstico. La biopsia endomiocárdica es definitoria pero no viable. Existen, asimismo, criterios de RNM indicativos de inflamación miocárdica. Para facilitar el diagnóstico, se han propuesto criterios clínicos y analíticos de screening (hemograma, ECG, CK, PCR, troponinas). En caso de sospecha de miocarditis, el cese de clozapina y el tratamiento de soporte es la actitud a seguir, habitualmente con buenos resultados.

Although Clozapine is the gold standard treatment in resistant-schizophrenia, severe or even life-threatening adverse effects must be taked into account. Early myocarditis, a severe but unusual cardiovascular effect, can appear in the first 4-6 weeks of initiation. Incidence rates of myocarditis are about 0,015-0,188% around the world, being more elevated in Australia. Aethiology is unknown, suggesting Ig E mediated hipersensibility, hiperaeosinophilia and hiperadrenergy. Echocardiography seems to be one of the most helpful tools for diagnosing myocarditis. Endomyocardial biopsy is definitive, but not usually available. A role for cardiac magnetic resonance imaging (MRI) also has been proposed (findings of inflammation). In order to make an early diagnosis, several screening-criteria, considering clinical and laboratory ones, have been proposed: aeosinophylia, creatininkinase, C Reactive Proteine, troponin, and EKG. If we suspected clozapine-induced myocarditis, the drug must be removed and support medical treatment must be indicated.

Tumor neuroendocrino Tipo 1: reporte de un caso y revisión de la literatura / Localized neuroendocrine tumor of the stomach: a case report and literature review

Resumen Introducción: Los tumores neuroendocrinos (TNE), son tumores compuestos por células productoras de péptidos y aminas. Los TNE gástricos, representan el 1% de todas las neoplasias, sin embargo su incidencia ha ido en aumento. Son generalmente asintomáticos y no funcionantes. El tratamiento es generalmente la resección local. Caso Clínico: paciente de 48 años con sospecha de cáncer gástrico; su estudio demuestra un TNE gástrico bien diferenciado tipo 1. Se realiza etapificación y se define en comité oncológico la vigilancia endoscópica. El hallazgo de un TNE, en el estudio de cáncer gástrico, es un hallazgo poco frecuente. Debido al aumento progresivo en la realización de endoscopías digestivas altas, secundario a la alta prevalencia de cáncer gástrico en nuestro país, se espera que aumenten hallazgos como un TNE. Es por esto que realizamos una revisión de la literatura y planteamos algunas conclusiones al respecto.

Introduction: Neuroendocrine tumors (NETs) are composed of cells that produce peptides and amines. Gastric NETs represent 1% of all neoplasms; however their incidence has been increasing. They are usually asymptomatic and non-functioning. The treatment is usually local resection. Case Report: We present the case of a 48-year-old patient who was suspected of gastric cancer; her study shows a well-differentiated type 1 gastric NET. Staging is performed and endoscopic surveillance is defined in the oncology board. The finding of a NET, in the study of gastric cancer, is a rare finding. Due to the progressive increase in the performance of upper gastrointestinal endoscopies, secondary to the high prevalence of gastric cancer in our country, it is expected to increase findings as a NET. That is why we conducted a review of the literature and made some conclusions about it.

[Mortality within 30 days of receiving systemic chemotherapy at a regional oncology unit]. / Mortalidad a 30 días posterior a la administración de quimioterapia sistémica en una unidad oncológica regional.

BACKGROUND: The use of systemic chemotherapy has survival and palliation benefits in oncological patients. Mortality at 30 days after the administration of systemic chemotherapy is considered as a quality and safety indicator of oncological patient care. The international mortality threshold is 5%, which is the figure used to compare institutions. AIM: To assess mortality at 30 days after the administration of ambulatory systemic chemotherapy in a regional referral center in adult cancer patients. MATERIAL AND METHODS: Retrospective observational study of patients receiving ambulatory systemic chemotherapy in the oncology service of a regional public hospital during 2018. The 30-day mortality rate was calculated. Demographic characteristics, baseline disease and the treatment received were recorded. RESULTS: During the study period, 690 patients received ambulatory systemic chemotherapy. Chemotherapy was palliative in 76% of patients and 53% received a first line treatment. Seventeen (2.5%) died within 30 days of treatment administration. Nine deaths (52.9%) were definitely related to treatment and sepsis was the most frequent cause. CONCLUSIONS: Our mortality rates are similar to international data. This type of audit reviews local outcomes and identifies factors contributing to mortality aiming to improve standards of care.

Enfermedad diverticular: nuevas perspectivas en el tratamiento dieto-terapéutico / Diverticular disease: new perspectives in diet-therapeutic treatment

La enfermedad diverticular corresponde a una condición habitual en el territorio occidental, siendo el hallazgo más frecuente en población de zonas urbanizadas. Respecto a su origen, se ha planteado la influencia de factores ambientales y genéticos, incluyendo en su etiología una inadecuada ingesta de fibra dietética, disbiosis de la microbiota intestinal y niveles alterados de vitamina D. A su vez, la enfermedad diverticular sintomática no complicada (EDNC) corresponde a un tipo de diverticulosis crónica cuyas características asemejan al síndrome de intestino irritable, lo que resalta la importancia en la comprensión de esta condición. Recientemente, se ha discutido la forma en que se aborda la enfermedad diverticular y en el siguiente escrito se expondrá evidencia sobre la patogénesis y su actual manejo.

Diverticular disease corresponds to a habitual condition in the western territory, being frequently found among the population of urban areas. Regarding its origin, the influence of environmental and genetic factors, including the etiology of dietary fiber intake, intestinal microbiota dysbiosis and altered levels of vitamin D have been recognized. Symptomatic uncomplicated diverticular disease corresponds to a type of chronic diverticulosis whose characteristics resemble irritable bowel syndrome, highlighting the importance of understanding this condition. Recently, the treatment of the disease has been discussed and the following review presents evidence on pathogenesis and its management.

Mortalidad a 30 días posterior a la administración de quimioterapia sistémica en una unidad oncológica regional / Mortality within 30 days of receiving systemic chemotherapy at a regional oncology unit

Background: The use of systemic chemotherapy has survival and palliation benefits in oncological patients. Mortality at 30 days after the administration of systemic chemotherapy is considered as a quality and safety indicator of oncological patient care. The international mortality threshold is 5%, which is the figure used to compare institutions. Aim: To assess mortality at 30 days after the administration of ambulatory systemic chemotherapy in a regional referral center in adult cancer patients. Material and Methods: Retrospective observational study of patients receiving ambulatory systemic chemotherapy in the oncology service of a regional public hospital during 2018. The 30-day mortality rate was calculated. Demographic characteristics, baseline disease and the treatment received were recorded. Results: During the study period, 690 patients received ambulatory systemic chemotherapy. Chemotherapy was palliative in 76% of patients and 53% received a first line treatment. Seventeen (2.5%) died within 30 days of treatment administration. Nine deaths (52.9%) were definitely related to treatment and sepsis was the most frequent cause. Conclusions: Our mortality rates are similar to international data. This type of audit reviews local outcomes and identifies factors contributing to mortality aiming to improve standards of care.

The FACT-G7: a rapid version of the functional assessment of cancer therapy-general (FACT-G) for monitoring symptoms and concerns in oncology practice and research.

BACKGROUND: Health-related quality-of-life (HRQOL) assessments in research and clinical oncology settings are increasingly important. HRQOL instruments need to be rapid and still maintain the ability to capture the most relevant patient issues in a valid and reliable manner. The current study develops and validates the FACT-G7, a rapid version of the Functional Assessment of Cancer Therapy-General (FACT-G). PATIENTS AND METHODS: Oncology patients with advanced cancer (N = 533) from 11 diseases sites ranked the symptoms and concerns they viewed as 'the very most important' when undergoing cancer treatment, completed the FACT-G, and additional HRQOL measures. Oncology patients' scores were referenced across a general US population sample (N = 2000). RESULTS: We selected the highest priority cancer-related symptoms and concerns endorsed by patients for inclusion in the FACT-G7. Fatigue and ability to enjoy life were ranked the most highly. The results provide preliminary support for the FACT-G7's internal consistency reliability (α = 0.74) and validity as evidenced by moderate-to-strong relationships with expected criteria. The references for the general population are summarized. CONCLUSIONS: The FACT-G7 can be used to assess top-rated symptoms and concerns for a broad spectrum of advanced cancers in clinical practice and research.

Enfermedad de Behçet ocular: Estudio retrospectivo / Ocular Behçet disease. retrospective study

Objetivo: Estudiar las características clínicas, pronóstico visual y respuesta terapéutica a fármacos inmunosupresores en pacientes con Enfermedad de Behçet Ocular (EB). Pacientes y método: Estudio retrospectivo desde Mayo de 1996 a Mayo de 2003, donde fueron analizadas las historias clínicas de 17 pacientes (33 ojos) con enfermedad de Behçet. Resultados: La relación entre hombre/mujer fue de 12/5. Las manifestaciones extraoculares más frecuentes fueron las úlceras orales (100%) y lesiones cutáneas (88%). A nivel ocular: uveítis anterior en un 59%, uveítis posterior en 76% y panuveítis en un 88%. La agudeza visual mejoró en 11 (33,3%) ojos, se mantuvo estable en 18 (54,5%) ojos y cuatro (12,1%) ojos perdieron dos líneas o más de visión. El tratamiento más utilizado fue con colchicina y ciclosporina (59%). Siete (41,1%) pacientes tuvieron que recibir tres fármacos simultáneamente. Conclusiones: La EB puede producir pérdida irreversible de la visión, sin embargo el pronóstico visual es bueno (85%) de mediar tratamiento inmnosupresor(AU)

Objective: To study clinical features, visual prognosis and response to immunosuppressive drugs in patients with ocular Behçet Disease (BD). Patients and methods: clinical data of 17 patients (33 eyes) were retrospectively reviewed from May 1996 to May 2003. Results: The male/female ratio was 12/5. The commonest manifestations were oral ulceration (100%) and skin lesions (88%). Anterior uveitis was present in 59%, posterior uveitis was in 76% and panuveitis was in 88.1%. Visual acuity improved in 11 (33.3%) eyes, remind stable in 18 (54.5%) eyes and four (12.1%) eyes lost two or more lines. Main drug therapy consisted of colchicine and cyclosporine (59%). Seven patients had received three drugs simultaneously. Conclusions: BD can lead to an irreversible visual loss; however, the visual prognosis is good (85%) if immunosuppressor treatment is implemented(AU)

[Ocular Behçet disease. Retrospective study]. / Enfermedad de Behçet ocular. Estudio retrospectivo.

OBJECTIVE: To study clinical features, visual prognosis and response to immunosuppressive drugs in patients with ocular Behçet Disease (BD). PATIENTS AND METHODS: clinical data of 17 patients (33 eyes) were retrospectively reviewed from May 1996 to May 2003. RESULTS: The male/female ratio was 12/5. The commonest manifestations were oral ulceration (100%) and skin lesions (88%). Anterior uveitis was present in 59%, posterior uveitis was in 76% and panuveitis was in 88.1%. Visual acuity improved in 11 (33.3%) eyes, remind stable in 18 (54.5%) eyes and four (12.1%) eyes lost two or more lines. Main drug therapy consisted of colchicine and cyclosporine (59%). Seven patients had received three drugs simultaneously. CONCLUSIONS: BD can lead to an irreversible visual loss; however, the visual prognosis is good (85%) if immunosuppressor treatment is implemented.

Hernioplastia inguinal con cono protésico bajo anestesia local en pacientes ambulatorios / Inguinal hernioplasty with mesh-pulg under local anesthesia in ambulatory patients

Determinar la tolerancia de la hernioplastia inguinal colocando cono protésico, con anestesia local en condición ambulatoria. Durante 2 años 73 pacientes portadores de hernias inguinales reunieron los criterios de inclusión y se les practicó hernioplastia inguinal con cono protésico según la técnica de Rutkow y Robbins bajo anestesia local y de forma ambulatoria. En éstos pacientes se midió la tolerancia basándose en los requerimientos de anestésico local y en la valoración subjetiva del paciente por el equipo quirúrgico, durante el procedimiento. El seguimiento se realizó por un año. Del total de 73 pacientes evaluados cuyas edades estuvieron comprendidas entre 13 y 76 años con una media de 38,62, se realizaron 63 herniorráfias en hombres y 10 en mujeres. El 97 por ciento (71) de las hernias eran primarias y solo 3 por ciento (2) recidivadas. El tipo de hernia más frecuente fue la directa con 37 pacientes lo que representó un 50,7 por ciento de todos los casos que conformaron la serie. La media de unidades de anestesia requerida durante el procedimiento fue de 6,7 unidades, la tolerancia según este criterio fue excelente en 35 por ciento (26) de los pacientes, buena en 21,9 por ciento (16) de los pacientes, regular en 32,9 por ciento (24) y mala en 9,6 por ciento (7). La tolerancia basada en la observación dl equipo quirúrgico fue excelente en 33 por ciento (24), buena en 52 por ciento (38), regular en 14 por ciento (10) y mala en 1 por ciento. La tasa de complicaciones fue del 16 por ciento y se presentó una sola recidiva lo que presentó el 1 por ciento. La hernioplastia por técnica de libre tensión con cono protésico según la técnica de Rutkow y Robbins es un procedimiento bien tolerado con anestesia local y en condición ambulatoria. En nuestro estudio obtuvimos niveles bajos de complicaciones y recidiva.

Experimental model of corneal haze in chickens.

PURPOSE: To develop an experimental animal model of corneal haze following photorefractive keratectomy (PRK). METHODS: Fifteen Iber Braun hens underwent unilateral PRK for -9.00 D of myopia. The animals were sacrificed at 1, 3, and 6 months postoperatively, and light microscopy was performed. RESULTS: Slit-lamp microscopy showed haze in the PRK-treated eyes. Histopathologic study disclosed epithelial hyperplasia, basement membrane abnormalities, and extensive anterior stromal disorganization. CONCLUSIONS: An easy and inexpensive model of haze after PRK was developed in an animal with Bowman's layer. This new model could be useful to understand the pathophysiology and pharmacologic modulation of corneal haze.

[BCG at birth: a discussion of its convenience at the present time]. / BCG al nacimiento: discusión sobre su conveniencia en el momento actual.

To clarify the importance of vaccination with BCG and its' real value in relationship to tuberculosis prevention authors have studied 53 cases admitted in the last six years, paying special attention to epidemiological data. The number of serious types of tuberculosis in not vaccinated children with BCG is statistically significant (p less than 0.05). It is also remarkable in 45.3% of the cases the presence of a bacilar focus in the family as well as the high index of infection greater than 7% in our infantile population. These results and absence of a good epidemiological study in our country lead us to advice the maintenance of BCG vaccination in the newborn.

[Use of Boyer's score in the differential diagnosis of meningitis]. / Aplicación del "score" de Boyer para el diagnóstico diferencial de las meningitis.

Authors have studied reliability of Boyer's score for diagnosis of bacterial versus aseptic meningitis. This score is based upon clinical and biological data easily available in few hours since the patient's admission to hospital. They their have reviewed all cases of meningitis in hospital during the last four years. Boyer's score was very useful and its specificity (100%) and sensitivity (96,50%) were very high. Authors consider this test convenient and reliable for the presumptive diagnosis of the type of meningitis with its' therapeutic implications.

Inhibicion de la migracion de los leucocitos de recien nacidos y adultos con albumina bovina y PPD. / Inhibition of leukocyte migration in newborn infants and adults with albumin and PPD

Se estudio la inhibicion de la migracion de los leucocitos de la sangre de 28 muestras de cordon umbilical y de 21 adultos sanos frente a la albumina serica bovina (ASB) y la proteina purificada derivada del bacilo tuberculoso (PPD), segun tecnica de Rosenberg y David. Un 53 y 64% de los recien nacidos mostraron inhibicion de la migracion leucocitaria con la ASB y con el PPD respectivamente. Un 66 y 90% de los adultos tambien mostraron inhibicion de la migracion leucocitaria a esos antigenos en ese orden, no obstante que entre ellos no habia ningun caso con manifestaciones clinicas de intolerancia a los alimentos que pudieran contener ASB. Se discuten los posibles mecanismos de sensibilizacion de los linfocitos T y ademas, los mecanismos de su transmision transplacentaria

[Probable antigenic relation between Entamoeba histolytica and alpha-fetoprotein]. / Probable relación antigénica entre Entamoeba histolytica y alfafetoproteína.

The findings of alpha fetoprotein antigens are reported in raw extracts of Entamoeba histolytica and also, on the membranes of trophozoites obtained from an axenic culture medium. This was confirmed through two techniques: Ouchterlony's immunodiffusion and indirect immunofluorescence using an antialpha fetoprotein rabbit antiserum. Previously, it was shown that this last antiserum did not recognize antigens of bovine albumin. The presence of alpha fetoprotein antigens in E. histolytica suggest that they may be a product of the metabolism of the ameba and that their concentration and localization might have a biological significance. Those antigens may appear because enzymes of the ameba degrade the bovine albumin from the culture medium. It is proposed that in the host with invasive amebiasis, alpha fetoprotein could also be found around E. histolytica and thus, inhibit the reactivity of the lymphocytes that attempt to attack it. In this manner, the capacity of ameba to form alpha feto protein would be an important mechanism in the relationship host--parasite.

Probable relacion antigenica entre Entamoeba histolytica y alfafetoproteina. / Possible antigenic relationship between Entamoeba histolytica and alpha fetoprotein

Se informa sobre el hallazgo de antigenos de alfafetoproteina en los extractos crudos de Entamoeba histolytica y tambien sobre las membranas de los trofozoitos obtenidos de un medio de cultivo axenico. Esto se comprobo por medio de dos tecnicas, la inmunodifusion segun Ouchterlony y la inmunoflurescencia indirecta, utilizando un antisuero de conejo antialfafetoproteina. Previamente se demostro que este antisuero no reconocia los antigenos de la albumina bovina. La presencia de antigenos de alfafetoproteina en E. histolytica, sugiere que estos pueden ser un producto del metabolismo de la amiba y que su concentracion y localizacion pueden tener un significado biologico. Esos antigenos pueden aparecer porque las enzimas de la amiba degradan la albumina bovina del medio de cultivo. Se propone que en el huesped con amibiasis invasora, la alfafetoproteina tambien podria encontrarse alrededor de E. histolytica y por esto, inhibir la reactividad de los linfocitos que tratan de atacarla. De esto modo, la capacidad de la amiba para formar alfafetoproteina seria un mecanismo importante en la relacion huesped-parasito

Proteinas de fase aguda en el suero de pacientes con absceso hepatico amibiano. / Acute phase proteins in serum of patients with amebic liver abscess

Por inmunodifusion radial se investigo la concentracion de ceruloplasmina, alfa 1 antitripsina y alfa 1 glicoproteina acida en 23 sueros de pacientes con absceso hepatico amibiano y en 31 sueros de personas sanas. La enfermedad no modifico la cantidad de ceruloplasmina en el suero, pero la alfa 1 antitripsina y la alfa glocoproteina acida se encontraron significativamente elevadas (p < 0.001). Seguramente el dano hepatico provoco el aumento en la concentracion de estas dos proteinas de fase aguda. Probablemente ellas participan como mecanismos defensivos que han sido poco estudiados en la amibiasis invasora

[Protein electrophoresis and immunoglobulin concentration in the serum of children with amebic liver abscess]. / Electroforesis de proteínas y concentración de inmunoglobulinas en el suero de niños con absceso hepático amibiano.

The concentration of immunoglobulins G and M plus the electrophoretic profile of proteins was studied in the serum of 14 children with amebic liver abscess. There were different degrees of weight loss and of liver necrosis in all of them. The concentration of total proteins of the serum was subjected to different factors and resulted with wide individual variations. The same was obtained when the values of the fractions separated by electrophoresis were expressed in g/dl. On the other hand, percentual values gave a similar profile for all of the patients. Besides the significant increases of IgG. an inversion of the albumin/globulins ratio was found and an increase of the percentages of alpha-1, alpha-2 and gamma fractions. The importance that proteolytic anti-enzyme mechanisms may bear in the evolution of the lesion brought about in the liver by the enzymes liberated by the protozoa, is speculated.