Simple one-step treatment for saccharification of mango peels using an optimized enzyme cocktail of Aspergillus niger ATCC 9642.

Developing efficient microbiological methods to convert polysaccharide-rich materials into fermentable sugars, particularly monosaccharides, is vital for advancing the bioeconomy and producing renewable chemicals and energy sources. This study focused on optimizing the production conditions of an enzyme cocktail from Aspergillus niger ATCC 9642 using solid-state fermentation (SSF) and assessing its effectiveness in saccharifying mango peels through a simple, rapid, and efficient one-step process. A rotatable central composite design was employed to determine optimal conditions of moisture, time, and pH for enzyme production in SSF medium. The optimized enzyme cocktail exhibited cellulase activity (CMCase) at 6.28 U/g, filter paper activity (FPase) at 3.29 U/g, and pectinase activity at 117.02 U/g. These optimal activities were achieved with an SSF duration of 81 h, pH of 4.66, and a moisture content of 59%. The optimized enzyme cocktail effectively saccharified the mango peels without the need for chemical agents. The maximum saccharification yield reached approximately 81%, indicating efficient conversion of mango peels into sugars. The enzyme cocktail displayed consistent thermal stability within the tested temperature range of 30-60°C. Notably, the highest sugar release occurred within 36 h, with glucose, arabinose, galactose, and xylose being the primary monosaccharides released during saccharification. This study highlights the potential application of Aspergillus niger ATCC 9642 and SSF for enzymatic production, offering a simple and high-performance process for monosaccharide production. The optimized enzyme cocktail obtained through solid-state fermentation demonstrated efficient saccharification of mango peels, suggesting its suitability for industrial-scale applications.

CYP2D6 and CYP2C19 Genes Associated with Tricontinental and Latin American Ancestry of Pe-ruvians.

Precision medicine seeks to individualize the dose from the beginning of phar-macological therapy based on the characteristics of each patient, genes involved in the metabolic phenotype, ethnicity or miscegenation, with the purpose to minimize adverse effects and optimize drug efficacy. The objective was to re-view studies that describe the association of the CYP2D6 and CYP2C19 genes with the tricontinental and Latin American ancestry of Peruvians. A biblio-graphic search was carried out in PubMed/Medline and SciELO, with various descriptors in Spanish and English. The results of this review confirm that the ethnic origin of Peruvians is triconti-nental due to European (mainly Spanish), African and Asian migration, in addi-tion to Latin American migration, being 60.2% mixed, 25.8% Amerindian, 5.9% white, 3.6% African descent, 1.2% Chinese and Japanese descent, and 3.3% unspecified. Studies on CYP2C19*3, CYP2D6*2, *3 and *6 have been reported in Peruvians, and the frequency is similar to that studied in Ecuadori-ans and Colombians. The CYP2C19*3, CYP2D6*3, and CYP2D6*6 alleles found in Peruvians are common in Europeans, Africans, and Asians; while CYP2D6*4 in Africans and CYP2D6*2 related to Asians. In some studies, the ethnic/gene association has not been demonstrated; while others have shown a significant association, which is why further investigation is warranted. It is concluded that the studies on CYP2D6 and CYP2C19 genes associated with the tricontinental and Latin American ancestry of Peruvians are little, and ac-cording to what has been investigated, the CYP2C19*3, CYP2D6*2, *3, *4 and *6 alleles have more related to their ancestry.

Potential polymorphic CYP1A2 and CYP2D6-mediated pharmacokinetic interactions between risperidone or olanzapine and selected drugs intended to treat COVID-19.

Risperidone/olanzapine are antipsychotics used in Peru to control symptoms of psychosis. The objective was to review the available evidence on potential pharmacokinetic interactions mediated by CYP1A2 and CYP2D6 polymorphic genes between risperidone or olanzapine and selected drugs for the treatment of COVID-19. A bibliographic search was conducted in SciELO and PubMed/Medline. The selection criteria included all types of articles in English and Spanish languages. In this review, the CYP1A2/CYP2D6/CYP3A4 genes that encode their respective enzymes have been described. The olanzapine/risperidone association increases the risk of prolonging the QT interval; chloroquine/hydroxychloroquine decreases metabolism and increases plasma concentration of risperidone; ritonavir decreases metabolism and increases plasma levels of hydroxychloroquine and lopinavir with the risk of prolonging the QT interval of the cardiac cycle and with a tendency to progression towards Torsades de Pointes. Ritonavir increases metabolism and decreases plasma levels of olanzapine. A low incidence of adverse effect was found between risperidone/azithromycin and olanzapine with azithromycin and hydroxychloroquine. Regarding the association of genes: CYP1A2*1D increases and CYP1A2*1F decreases the plasma concentration of olanzapine. Risperidone plasma levels are increased in CYP2D6 intermediate and poor metabolizers compared with normal metabolizers. Other studies indicate no significant association between poor metabolizers of CYP1A2 and CYP2D6 with increased pharmacokinetic parameters. It is concluded that there are potential risks of prolonging the QT interval due to pharmacokinetic interactions mediated by polymorphic genes CYP1A2 and CYP2D6 between risperidone or olanzapine and the drugs selected for the treatment of COVID-19.

Estudio del índice nivel/dosis de la fenitoína en pacientes epilépticos voluntarios de Mérida / Study of the level/dose index of phenytoin in volunteer epileptic patients from Mérida

INTRODUCCIÓN La fenitoína es usada con mucha frecuencia en nuestro medio, por lo que se requiere hacer estudios de monitorización terapéutica, que contribuya a minimizar los efectos adversos y optimizar la terapia farmacológica. En ese contexto, nuestro objetivo ha sido determinar el índice nivel/dosis de la fenitoína en pacientes epilépticos voluntarios de Mérida. MÉTODOS Se realizó un estudio descriptivo, observacional y por reclutamiento consecutivo concurrente, conformado por 30 pacientes voluntarios con diagnóstico de epilepsia. Las muestras de suero se obtuvieron en niveles mínimos de pacientes que estaban en tratamiento con fenitoína durante 1 mes. Los niveles del fármaco se cuantificaron por el método de Inmunoensayo de enzima donante clonada en el equipo Indiko Thermo Scientific. RESULTADOS El índice nivel/dosis fue de 1,4 y 1,6, la concentración plasmática de 4,8mg/l y 8,0mg/l, la capacidad metabólica de 388,4 y 462,9mg/día, respectivamente en mujeres y hombres. Mientras que el nivel de la concentración plasmática en el estado estacionario fue de 6,5mg/l y 5,5mg/l, la dosis de carga máxima de 237,3mg y de 395,6mg, respectivamente en mujeres y hombres con epilepsia de la ciudad de Mérida. CONCLUSIONES Nuestros resultados sugieren que se debe individualizar la dosis en base al índice nivel/dosis de cada paciente, ya que no se puede extrapolar para todos los pacientes con epilepsia, debido a diversos factores como al fenotipo metabólico y al uso de fármacos inductores e inhibidores enzimáticos.

INTRODUCTION Phenytoin is used very frequently in our environment, so it is necessary to do studies of therapeutic monitoring, which helps to minimize adverse drug reaction and optimize pharmacological therapy. In this context, our objective was to determine the level/dose index of phenytoin in volunteer epileptic patients from Mérida. METHODS A descriptive, observational and consecutive concurrent recruitment study was carried out, consisting of 30 volunteer patients with a diagnosis of epilepsy. The serum samples were obtained in minimum levels from patients who were in treatment with phenytoin for 1 month. The levels of the drug were quantified by the method of donor enzyme immunoassay cloned in the Indiko Thermo Scientific equipment. RESULTS The level/dose index was 1,4 and 1,6, the plasma concentration of 4,8mg/l and 8,0mg/l, the metabolic capacity of 388,4 and 462,9mg/day, respectively in women and men. While the level of plasma concentration at steady state was 6,5mg/l and 5,5mg/l, the maximum loading dose of 237,3mg and 395,6mg, respectively in women and men with epilepsy of the city of Mérida. CONCLUSIONS Our results suggest that the dose should be individualized based on the level/dose index of each patient, since it can not be extrapolated for all patients with epilepsy, due to various factors such as the metabolic phenotype and the use of enzyme-inducing drugs and inhibitors.

Study of the allelic variants CYP2C9*2 and CYP2C9*3 in samples of the Peruvian mestizo population / Estudio de las variantes alélicas CYP2C9*2 y CYP2C9*3 en muestras de población mestiza peruana

Introduction: CYP2C9 metabolizes approximately 15% of the prescribed drugs. Its gene has alleles whose frequencies differ between ethnic groups and populations. The alleles CYP2C9*2 and CYP2C9*3 account for an enzyme with decreased activity and their frequencies have not been determined in the Peruvian mestizo population. Objective: To characterize the frequencies of the allelic variants *2 (rs1799853) and *3 (rs1057910) of CYP2C9 gen in the Peruvian mestizo population from Lima, Tacna y Junín. Materials and methods: We conducted an observational, prospective cross-sectional study with non-probabilistic, by convenience, and incidental sampling. We included 218 subjects according to the inclusion and exclusion criteria, all of whom had signed the informed consent. We obtained the genomic DNA from oral mucosa swab. For the detection of the CYP2C9*2 and CYP2C9*3 genotypes, we used real-time-polymerase chain reaction with TaqMan® probes. Results: The genotyping revealed that CYP2C9*2 and CYP2C9*3 variants have low frequencies (0.046 and 0.062, respectively). The frequency of intermediate metabolizers was 15.13% (CYP2C9*1/*2: 5.96%; CYP2C9*1/*3: 9.17%) and that of slow metabolizers was 3.22% (CYP2C9*2/*2: 1.38%; CYP2C9*3/*3: 1.38%; CYP2C9*2/*3: 0.46%). Conclusions: It was possible to determine the genotypic and allelic frequencies for the variants *2 and *3 of the CYP2C9 gene in a non-probabilistic sample of the Peruvian mestizo population. The frequencies obtained (0.046 and 0.062, respectively) corresponded to those expected for a South American mestizo population with Amerindian, European, African and Asian ancestry.

Introducción. El citocromo CYP2C9 metaboliza, aproximadamente, el 15 % de los fármacos prescritos. Su gen presenta alelos cuyas frecuencias difieren entre grupos étnicos y poblaciones. Los alelos CYP2C9*2 y CYP2C9*3 dan cuenta de una enzima con actividad disminuida cuya frecuencia no ha sido determinada en la población mestiza peruana. Objetivo. Caracterizar la frecuencia de las variantes *2 (rs1799853) y *3 (rs1057910) del gen CYP2C9 en muestras de población mestiza peruana provenientes de Lima, Tacna y Junín. Materiales y métodos. Se hizo un estudio descriptivo, observacional y prospectivo, con muestreo no probabilístico, por conveniencia e incidental. Se incluyeron 218 sujetos según los criterios de inclusión y exclusión; todos los participantes otorgaron su consentimiento informado. El ADN genómico se obtuvo mediante hisopado de mucosa oral, y la detección de los genotipos para los alelos CYP2C9*2 y CYP2C9*3 se hizo mediante reacción en cadena de la polimerasa (PCR) en tiempo real, utilizando sondas TaqMan™. Resultados. Las variantes de CYP2C9*2 y CYP2C9*3 están presentes en la población mestiza peruana con frecuencias de 0,046 y 0,062, respectivamente. El análisis de las frecuencias genotípicas observadas permitió predecir que la frecuencia de fenotipos metabolismo intermedio sería del 15,13 % (CYP2C9*1/*2: 5,96 %; CYP2C9*1/*3: 9,17 %), y la de fenotipos de metabolismo lento, del 3,22 % (CYP2C9*2/*2: 1,38 %; CYP2C9*3/*3: 1,38 %; CYP2C9*2/*3: 0,46 %). Conclusiones. Se lograron determinar las frecuencias genotípicas y alélicas para las variantes *2 y *3 del gen CYP2C9 en una muestra no probabilística de población mestiza peruana.

Estudio de las variantes alélicas CYP2C9*2 y CYP2C9*3 en muestras de población mestiza peruana / Study of the allelic variants CYP2C9*2 and CYP2C9*3 in samples of the Peruvian mestizo population

Resumen Introducción. El citocromo CYP2C9 metaboliza, aproximadamente, el 15 % de los fármacos prescritos. Su gen presenta alelos cuyas frecuencias difieren entre grupos étnicos y poblaciones. Los alelos CYP2C9*2 y CYP2C9*3 dan cuenta de una enzima con actividad disminuida cuya frecuencia no ha sido determinada en la población mestiza peruana. Objetivo. Caracterizar la frecuencia de las variantes *2 (rs1799853) y *3 (rs1057910) del gen CYP2C9 en muestras de población mestiza peruana provenientes de Lima, Tacna y Junín. Materiales y métodos. Se hizo un estudio descriptivo, observacional y prospectivo, con muestreo no probabilístico, por conveniencia e incidental. Se incluyeron 218 sujetos según los criterios de inclusión y exclusión; todos los participantes otorgaron su consentimiento informado. El ADN genómico se obtuvo mediante hisopado de mucosa oral, y la detección de los genotipos para los alelos CYP2C9*2 y CYP2C9*3 se hizo mediante reacción en cadena de la polimerasa (PCR) en tiempo real, utilizando sondas TaqMan™. Resultados. Las variantes de CYP2C9*2 y CYP2C9*3 están presentes en la población mestiza peruana con frecuencias de 0,046 y 0,062, respectivamente. El análisis de las frecuencias genotípicas observadas permitió predecir que la frecuencia de fenotipos metabolismo intermedio sería del 15,13 % (CYP2C9*1/*2: 5,96 %; CYP2C9*1/*3: 9,17 %), y la de fenotipos de metabolismo lento, del 3,22 % (CYP2C9*2/*2: 1,38 %; CYP2C9*3/*3: 1,38 %; CYP2C9*2/*3: 0,46 %). Conclusiones. Se lograron determinar las frecuencias genotípicas y alélicas para las variantes *2 y *3 del gen CYP2C9 en una muestra no probabilística de población mestiza peruana. Las frecuencias obtenidas (0,046 y 0,062, respectivamente) están entre las esperadas para una población mestiza sudamericana con ascendencia amerindia, europea, africana y asiática.

Abstract Introduction: CYP2C9 metabolizes approximately 15% of the prescribed drugs. Its gene has alleles whose frequencies differ between ethnic groups and populations. The alleles CYP2C9*2 and CYP2C9*3 account for an enzyme with decreased activity and their frequencies have not been determined in the Peruvian mestizo population. Objective: To characterize the frequencies of the allelic variants *2 (rs1799853) and *3 (rs1057910) of CYP2C9 gen in the Peruvian mestizo population from Lima, Tacna y Junín. Materials and methods: We conducted an observational, prospective cross-sectional study with non-probabilistic, by convenience, and incidental sampling. We included 218 subjects according to the inclusion and exclusion criteria, all of whom had signed the informed consent. We obtained the genomic DNA from oral mucosa swab. For the detection of the CYP2C9*2 and CYP2C9*3 genotypes, we used real-time-polymerase chain reaction with TaqMan® probes. Results: The genotyping revealed that CYP2C9*2 and CYP2C9*3 variants have low frequencies (0.046 and 0.062, respectively). The frequency of intermediate metabolizers was 15.13% (CYP2C9*1/*2: 5.96%; CYP2C9*1/*3: 9.17%) and that of slow metabolizers was 3.22% (CYP2C9*2/*2: 1.38%; CYP2C9*3/*3: 1.38%; CYP2C9*2/*3: 0.46%). Conclusions: It was possible to determine the genotypic and allelic frequencies for the variants *2 and *3 of the CYP2C9 gene in a non-probabilistic sample of the Peruvian mestizo population. The frequencies obtained (0.046 and 0.062, respectively) corresponded to those expected for a South American mestizo population with Amerindian, European, African and Asian ancestry.

State of Art of Cancer Pharmacogenomics in Latin American Populations.

Over the past decades, several studies have shown that tumor-related somatic and germline alterations predicts tumor prognosis, drug response and toxicity. Latin American populations present a vast geno-phenotypic diversity due to the great interethnic and interracial mixing. This genetic flow leads to the appearance of complex characteristics that allow individuals to adapt to endemic environments, such as high altitude or extreme tropical weather. These genetic changes, most of them subtle and unexplored, could establish a mutational profile to develop new pharmacogenomic therapies specific for Latin American populations. In this review, we present the current status of research on somatic and germline alterations in Latin America compared to those found in Caucasian and Asian populations.

Comparación de los usos del chuchuhuasi (Maytenus macrocarpa) entre indígenas Bora-Bora de Loreto y chamanes de Lima (Perú) / Comparison uses chuchuhuasi (Maytenus macrocarpa) between Bora-Bora of Loreto and shamans of Lima (Peru)

Objetivo: Comparar los conocimientos y costumbres sobre el uso del chuchuhuasi (Maytenus macrocarpa), entre los pobladores de la etnia amazónica Bora-Bora de Iquitos, Loreto, y los chamanes o curanderos que residen en Lima-Perú. Materiales y Métodos: Este estudio transversal, se realizó mediante participación voluntaria, de un grupo de indígenas Bora-Bora, residentes en Iquitos, y a una muestra de chamanes o curanderos limeños, a quienes se les realizo una entrevista que indagó sobre los conocimientos y costumbres en el uso del chuchuhuasi. Resultados: Curanderos o chamanes de Lima, aunque en un contexto exclusivamente comercial, indicaron usar el chuchuhuasi, para los siguientes fines: curar el asma, dolores articulares, y problemas sexuales; asimismo, con fines místicos, mágicos, y religiosos, para sesiones de curación. Los indígenas de la etnia amazónica Bora-Bora, emplean el chuchuhuasi con fines medicinales, y refieren su uso particular para los dolores fuertes, dolor después del parto, para detener hemorragias post parto, y contra las diarreas. Conclusiones: Existen diferencias, en el uso del chuchuhuasi, entre nativos amazónicos Bora-Bora, y los chamanes o curanderos limeños AU)

Aim: To compare the knowledge and custom about the chuchuhuasi (Maytenus macrocarpa) uses between native ethnic Bora-Bora Amazon populations (Iquitos, Loreto) and the healers living in Lima, Peru. Methods: The study was performed through oral interviews to a number of native Bora-Bora and healers from Lima, who voluntarily agreed to participate. We collected information about knowledge and custom in the use of chuchuhuasi. Results: Although on a purely commercial context, the healers from Lima reported to use chuchuhuasi for the following purposes: to cure asthma, as analgesic, and for sexual problems; and also they used it for mystical, magical, and religious purposes during healing sessions. The Amazonian Bora-Bora indigenous use chuchuhuasi for medicinal purposes, particularly for severe pain, postpartum pain, to stop postpartum bleeding, and as antidiarrheal. Conclusions: There are differences in the use of chuchuhuasi between native Bora-Bora Amazonian population, and healers in Lima, Peru (AU)

Implementation of a focused curriculum on flexible ureteroscopic surgery: a multi-institutional collaborative effort.

INTRODUCTION: Flexible ureteroscopy with Holmium:YAG laser lithotripsy (Flex URS/Laser) has a known learning curve; although this laser is the safest flexible intracorporeal lithotrite, complications have been reported to occur with greater frequency early in its adoption. Herein, we review the implementation of a didactic and practical curriculum to introduce the Holmium:YAG laser for flexible URS. Following the initial tutorial period, we assessed procedure outcomes and complications. METHODS: In September 2009 a 15 Watt Holmium:YAG laser was introduced to the operating suite at Hospital Punta Pacifica, a newly developed hospital affiliated with Johns Hopkins Medicine International. We developed a curriculum that included both classroom-based lectures and live surgical experience. The lectures were designed to review the laser's properties as well as its surgical applications; live surgeries were then performed, initially as demonstrations and then as mentored procedures. The medical records of all patients undergoing Flex URS/Laser in the 12 months following this program were reviewed, to assess for outcomes and complications. RESULTS: A total of 32 Flex URS/Laser procedures were performed. Mean age was 44.1 years, and there were 19 males, 13 females. Five stones were located in the ureter, with the remainder in the kidney. All stones were accessed and fragmented with the laser, and no peri-operative or post-operative complications were encountered. CONCLUSIONS: A focused didactic and practical curriculum can simplify the introduction of Flex URS/Laser, and permit the rapid achievement of acceptable results. An emphasis on limiting active fragment extraction will reduce the likelihood of ureteral injuries, a potentially devastating complication which may be more likely to occur early in the adoption of Flex URS/Laser.

Purple corn (Zea mays L.) phenolic compounds profile and its assessment as an agent against oxidative stress in isolated mouse organs.

This study was designed to determine the contents of total polyphenols, flavonoids, flavonols, flavanols, and anthocyanins of purple corn (Zea mays L.) extracts obtained with different methanol:water concentrations, acidified with 1% HCl (1 N). Another objective was to determine the antioxidant activity by 1,1-diphenyl-2-picrylhydrazyl (DPPH), 2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), ferric reducing antioxidant power (FRAP), and deoxyribose assay, individual phenolic compounds by high-performance liquid chromatography (HPLC), and endogenous antioxidant enzyme (superoxide dismutase [SOD], catalase [CAT], and total peroxidase [TPX]) activity and lipid peroxidation activity (thiobarbituric acid-reactive substances [TBARS] assay) in isolated mouse organs. Overall, the highest total content of polyphenols, anthocyanins, flavonoids, flavonols, and flavanols was obtained with the 80:20 methanol:water extract, acidified with 1% HCl (1 N). The 50% inhibitory concentration values obtained by the DPPH and ABTS assays with this extract were 66.3 µg/mL and 250 µg/mL, respectively. The antioxidant activity by the FRAP assay was 26.1 µM Trolox equivalents/g, whereas the deoxyribose assay presented 93.6% inhibition. Because of these results, the 80:20 methanol:water extract, acidified with 1% HCl (1 N), was used for the remaining tests. Eight phenolic compounds were identified by HPLC: chlorogenic acid, caffeic acid, rutin, ferulic acid, morin, quercetin, naringenin, and kaempferol. Furthermore, it was observed that the purple corn extract was capable of significantly reducing lipid peroxidation (lower malondialdehyde [MDA] concentrations by the TBARS assay) and at the same time increasing endogenous antioxidant enzyme (CAT, TPX, and SOD) activities in isolated mouse kidney, liver, and brain. On the basis of the results, it was concluded that the purple corn extract contained various bioactive phenolic compounds that exhibited considerable in vitro antioxidant activity, which correlated well with the decreased MDA formation and increase in activity of endogenous antioxidant enzymes observed in the isolated mouse organs. This warrants further in vivo studies with purple corn extracts to assess its antioxidant activity and other bioactivities.

C-reactive protein and complement components but not other acute-phase reactants discriminate between clinical subsets and organ damage in systemic lupus erythematosus.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by tissue injury mediated by inflammatory mechanisms. Nonetheless, several acute-phase proteins may remain normal or are decreased. We explore the association of diverse biomarkers with selected clinical features, disease activity, and organ damage in SLE. METHODS: One hundred and fifteen SLE patients were analyzed for clinical manifestations, disease activity, and organ damage. Serum C-reactive protein (CRP), complement C3, C4 and CH50%, alpha-1-antitrypsin (AAT), transferrin (Tf), procalcitonin, erythrosedimentation rate (ESR), and interleukin-6 were measured in patients and twenty-six healthy blood donors. Statistics include chi-square, Kruskal-Wallis (post hoc by Mann-Whitney) or one-way ANOVA tests (post hoc by t tests) as appropriate. Associations were evaluated by the Spearman's correlation coefficient (p). RESULTS: SLE patients have lower C3 (85 vs. 110 mg/dL; p < 0.0001) and C4 (14.2 vs. 24.2 mg/dL; p < 0.0001) than controls, while CRP (4.1 vs. 1.4 mg/L; p = 0.005) and AAT (147 vs. 138 mg/dL; p = 0.03) were higher, other biomarkers were irrelevant. Disease activity score positively correlated with ESR (p = 0.23, 95 % CI 0.04 to 0.4; p = 0.01) and CRP (p = 0.19, 0.0007 to 0.36; p = 0.04), while inverse correlations with C3 (p = -0.26, -0.43 to -0.08; p = 0.004), C4 (p = -0.18, -0.36 to 0.005; p = 0.04), CH50 % (p = -0.20, -0.38 to -0.01; p = 0.02), and Tf (p = -0.35, -0.53 to -0.12; p = 0.002) were found. According to clinical manifestations, patients with arthritis showed higher levels of ESR (34 vs. 20 mm/h), CRP (10 vs. 2.8 mg/L), and AAT (179 vs. 145 mg/dL), but lower Tf (192 vs. 226 mg/dL) than those without arthritis; whereas active nephritis was characterized by lower serum concentrations of complement C3 (73 vs. 92 mg/dL), C4 (10 vs. 15 mg/dL), CH50% (80 vs. 160 U/mL) and Tf (196 vs. 232 mg/dL) than those patients without this manifestation. No other significant differences were found. CONCLUSIONS: In patients with SLE, acute-phase proteins behave differently depending on the kind of organ damage evaluated. Serum complement proteins remained as the most reliable laboratory markers for nephritis, while CRP was determined the best in patients with arthritis. The muted CRP response seen in SLE patients with active nephritis could have important pathogenic implications.

[Predictive factors of failure extubation among preterm infants]. / Factores predictores de falla en la extubación en recién nacidos de pretérmino.

OBJECTIVE: To determine the factors that lead to extubation failure among preterm newborns (PTN). MATERIAL AND METHODS: Failure was determined when patients had to be reintubated during the first 72 hours. Critically-ill preterm newborns needing mechanical assisted ventilation at least during 24 hours were studied prospectively. Two groups were included: Group A, who failed in extubation for the first time and Group B, a control group who did not fail. Significance was set a p <0.05. RESULTS: Gestational age and birth weight showed significant differences in Group B (control group). Significant factors in the multivariate analysis were gestational age < 32 weeks, caloric intake < or = 100 calories/kg/day and mean airway pressure (MAP) > or = [corrected] 4.5 cm H2O. CONCLUSIONS: According to our results, an extubation should be planned whenever a patient is a PTN, has a gestational age of <32 weeks, a caloric intake >100 cal/kg/day, and its ventilator MAP is <4.5 cm H2O.

Factores predictores de falla en la extubación en recién nacidos de pretérmino / Predictive factors of failure extubation among preterm infants

Objetivo: Determinar los factores que originan la falla en la extubación en recién nacidos de pretérmino (RNPT). Material y métodos: Se consideró falla en la extubación cuando hubo necesidad de reintubar al paciente en las primeras 72 horas. Se estudiaron en forma prospectiva a los RNPT críticamente enfermos que habían estado con asistencia mecánica ventilatoria durante por lo menos 24 horas. Se integraron 2 grupos: un grupo A (casos) con RNPT que tuvieron fallas en la primera extubación y un grupo B (control) con RNPT que no tuvieron fallas en la extubación. Se consideró zona de significancia con p menor a 0.05. Resultados: La edad gestacional y el peso al nacer mostraron diferencias significativas a favor del grupo B (control). Los factores que mostraron significancia en el análisis multivariado, fueron la edad gestacional (< 32 semanas), el aporte calórico (≤ 100 cal/Kg/ día) y la presión media de vías aéreas (PMVA) (≥ 4.5 cm H2O). Conclusiones: De acuerdo con lo encontrado en este estudio, antes de realizar la extubación habrá que considerar si el RNPT tiene menos de 32 semanas de edad gestacional, por lo menos un aporte calórico superior a 100 cal/Kg/día y una PMVA en el ventilador menor a 4.5 cm H2O.

OBJECTIVE: To determine the factors that lead to extubation failure among preterm newborns (PTN). MATERIAL AND METHODS: Failure was determined when patients had to be reintubated during the first 72 hours. Critically-ill preterm newborns needing mechanical assisted ventilation at least during 24 hours were studied prospectively. Two groups were included: Group A, who failed in extubation for the first time and Group B, a control group who did not fail. Significance was set a p <0.05. RESULTS: Gestational age and birth weight showed significant differences in Group B (control group). Significant factors in the multivariate analysis were gestational age < 32 weeks, caloric intake < or = 100 calories/kg/day and mean airway pressure (MAP) > or = [corrected] 4.5 cm H2O. CONCLUSIONS: According to our results, an extubation should be planned whenever a patient is a PTN, has a gestational age of <32 weeks, a caloric intake >100 cal/kg/day, and its ventilator MAP is <4.5 cm H2O.

Hallazgos angiográficos y resultados de la embolización arterial uterina en hemorragias graves del posparto: Arteriografía y embolización de la hemorragia posparto / Angiographic findings and results of uterine artery embolization in severe postpartum hemorrhage: arteriography and embolization of postpartum hemorrhage

Objetivo: La hemorragia grave del posparto (HGP) es una de las principales causas de morbi-mortalidad materna y que impone la acción coordinada y rápida de múltiples especialistas. Esta intervención multidisciplinaria incluyendo la embolización arterial uterina (EU) se ha reportado permite mejorar dicho tratamiento. El objeto de este trabajo es mostrar la semiología angiográfica y el beneficio del tratamiento de las HGP incontrolables empleando EU para lograr hemostasia. Material y métodos: Se registraron los hallazgos arteriográficos, obtención de hemostasia, presencia de shock, volumen de reposición e histerectomía de 47 pacientes con HGP sin respuesta al tratamiento inicial y posteriormente embolizadas en forma urgente. La arteriografía y la EU generalmente consistieron en la oclusión bilateral de arterias uterinas empleando partículas de spongostan. Resultados: El sangrado activo (38%) y los signos de atonía (34%) fueron los hallazgos angiográficos más frecuentes. Se logró hemostasia en todos los casos sin mortalidad materna y baja morbilidad (complicaciones n=3). La embolización fue eficaz y segura con 91,5% de hemostasia definitiva; el fracaso de 8,5% ocurrió en 4 pacientes que resangraron y requirieron resolución quirúrgica post EU (roturas vaginales y uterinas desapercibidas). Conclusión: La integración de la EU al tratamiento de la HGP incontrolables ofreció excelentes resultados de hemostasia. El conocimiento de los hallazgos arteriográficos permitió guiar y controlar la realización de esta terapéutica.

Prolapso genital incidencia y casuística: Hospital Naval de Guayaquil 1995-2000 / Incidence of genital prolapse and casuistry: Naval Hospital of Guayaquil 1995-2000

El prolapso es motivo frecuente de consulta para en Ginecología y la mayoría de las mujeres que lo padecen sobrepasan los 50 años.Se realizó un estudio retrospectivo, descriptivo y longitudinal desde 1995 al 2000 en el hospital Naval de Guayaquil.El objetivo: Conocer los factores causales más comunes.Comprobar la importancia de la relación entre los antecedentes gineco-obstétricos y el desarrollo del prolapso genital.Identificar el tipo de tratamiento quirúrgico y las complicaciones que se presentaron al momento de la resolución en las pacientes internadas en el hospital Naval de Guayaquil (HOSNAV).Se encontraron 65 casos en el estudio de 6 años, la edad media de presentación fue 57 años 8 meses, se demostró que mientras más se acerquen a la etapa del climaterio, la incidencia de prolapso genital aumenta en forma proporcional. El factor causal que se relaciona al desarrollo de prolapsos es la multiparidad y los partos distócicos.

Prolapse is frequent reason of consultation to the gynecologist and most common in women over 50 years. We carried out a retrospective, descriptive and longitudinal study between the years of 1995 to 2000 in the Naval Hospital of Guayaquil with the objective of finding out the most common risk factors, to check the importance of the relationship between the Gynecologic clinical history and the development of the genital prolapse, and to identify the type of surgical treatment and the complications that were presented.There were 65 cases in the 6 year-old study, the age of presentation was 57 years 8 months, it was demonstrated that while more they come closer to the stage of the climaterium, the incidence of genital prolapse increased. The risk factor that is related to the development of prolapse is the multiparty and the distosic childbirths.

Ureteroscopia: experiencia y resultados / Ureteroscopy: experience and results

La ureteroscopía es un procedimiento de Endourología que se viene practicando a nivel mundial en los grandes centros de urología. Nuestra experiencia ha sido satisfactoria, no sólo por el trabajo en conjunto y coordinado, sino por los resultados obtenidos en beneficio de los pacientes, que volvieron a su vida normal a corto plazo. Como todo procedimiento, tiene una fase de aprendizaje que se va a dar luego de adquirido el entrenamiento adecuado y la vivencia dará la clave para adquirir más destreza. Igualmente la tecnología radiológica y el desarrollo de instrumentos de diámetro menor así como accesorios que permitan fácil acceso al uréter y la extracción de los cálculos, en caso de litiasis

Desnutrición en áreas rurales marginadas de la Republica Mexicana: epidemiología y programa de control / Malnutrition in rural marginated areas in México: epidemiology and control programs

Durante el período 1983-1985, en el ámbito de trabajo del Programa IMSS-COPLAMAR, se efectuó conjuntamente con la comunidad a) la búsqueda de casos de desnutrición entre los menores de 5 años; b) el tratamiento y control de los casos confirmados de desnutrición, y c) la capacitación de la comunidad sobre la manera de alimentarse mejor e impulsar la producción de alimento. Como resultado de lo anterior, se observaron avances en el período mencionado, y en 1985 se valoró el estado nutricional del 63,6% de los niños de 0 a 4 años de edad amparados por el Programa. En el grupo estudiado, 34,5% tenía algún grado de desnutrición. La frecuencia de este padecimiento fue mayor en las entidades federativas con alto grado de marginación, donde se encontró una cifra de 45,5% de desnutridos, que constrasta con el porcentaje de 17,7 resgistrado en los estados con marginación media baja. De los casos sometidos a tratamiento, 15,8% se recuperó con recursos existentes en su hogar. En cuanto a la capacitación, 20,8% de las mujeres de 15 a 49 años de edad participó en cursos sobre la manera de mejorar la dieta familiar. Finalmente, sólo se logró que 3,6% y 2,0% de las familias se involucra en la producción de alimentos (huertos familiares y granjas de especies menores, respectivamente)