Renoportal Anastomosis and Its Complications: A Complex Case Report.

BACKGROUND: Renoportal anastomosis (RPA) is an effective technique in cases of complex portal vein thrombosis with the presence of a splenorenal shunt. The objective of this report is to describe the possible complications related to RPA. CASE REPORT: A 50-year-old man with alcohol-related and hepatitis C-related cirrhosis and 2 hepatocellular carcinomas underwent liver transplant. He presented a portal vein thrombosis Yerdel IV, a splenorenal shunt, and another shunt between the inferior mesenteric vein (IMV) and the perirectal plexus. During surgery, the flow of the left renal vein was 891 mL/min, and this rose to 1050 mL/min after IMV clamping. RPA was made through iliac vein graft interposition, and the IMV was ligated. Portal flow was 832 mL/min but drastically decreased because of mesenteric root compression. After finishing the liver transplant, a renoiliac graft percutaneous transhepatic stent was put in place. The patient presented graft dysfunction and acute kidney injury. On postoperative day +18, a second stent was put in place because of a thrombosis in the splenomesenteric confluence. The patient subsequently presented partial distal rethrombosis and a pancreaticoduodenal arteriovenous fistula, which required several embolizations. The patient developed ascites, recurrent gastrointestinal bleeding, and persistent bacterial peritonitis. Finally, a modified Sugiura procedure (without splenectomy) was performed, achieving a portal flow of 1800 mL/min. However, the patient developed sepsis and multiorgan failure, and died on postoperative day +70. CONCLUSIONS: Despite long-term patient and graft survival within accepted limits after LT, RPA is a challenging technique not exempt from complications.

Nonsplenorenal Spontaneous Portosystemic Shunts in Liver Transplant Attitude and Outcomes: A Single-Center Series.

BACKGROUND: Management of nonsplenorenal spontaneous portosystemic shunts (NSRSPSS) in liver transplant (LT) is controversial. Reports on the influence of its ligation suggest improvements in morbidity and survival. METHODS: Retrospective study of a single-center series. The objective was to analyze the outcomes and post-LT survival after the closure of NSRSPSS. RESULTS: Between January 2005 and April 2021 a total of 23 patients with NSRSPSS underwent LT. The shunt was superior mesenteric vein-vena cava in 12 (52.2%), inferior mesenteric vein-vena cava in 6 (26.1%), through the left gastric vein in 4 (17.4%), and portocava in 1 (4.3%). Seven patients presented portal vein thrombosis, with thrombectomy being performed in 5. Moreover, 21 patients had portoportal anastomosis, 1 patient required portal reconstruction at the splenomesenteric confluence, and 1 had a coronary-portal anastomosis. The NSRSPSS was closed in 22 cases (95.7%). The mean (SD) portal flow before and after the closure of NSRSPSS was 1395 (572) mL/min and 1773 (583) mL/min (104.4 [47.9] mL/min/100 g and 127.9 [4.9] mL/min/100 g, respectively). Six patients (26.1%) presented primary graft dysfunction, 13 (56.5%) acute kidney injury, and 9 (39%) ascites. Three arterial stenoses (13%), 2 biliary stenoses (8.6%), and 1 intrahepatic portal thrombosis (4.3%) occurred. Median intensive care unit and hospital stay was 5 days (range, 3-8 days) and 15 days (range, 13-21 days). After a mean follow-up of 5.18 (3.2) years, all patients except 1 are alive. CONCLUSIONS: The closure of the NSRSPSS during LT can optimize portal flow, with potential influence in morbidity and survival rates.

Kallikrein-related Peptidase 5 (KLK5) Expression and Distribution in Canine Cutaneous Squamous Cell Carcinoma.

Cutaneous squamous cell carcinoma (cSCC) is one of the most common types of malignant skin cancer in dogs, representing 3.9-10.4% of all canine skin tumours. Although the metastatic potential of cSCC is debated, it appears to mimic that observed in man. In man, predictive histopathological features for metastasis include tumour depth, lesions >5-6 mm in depth, and invasion of muscle, cartilage or bone. In dogs, some reports have focused on the clinical features and long-term progression of cSCC, but a gold standard treatment has not yet been developed. We explored the protein expression of kallikrein-related peptidase 5 (KLK5), an important modulator of skin homeostasis, in normal canine skin and in examples of cSCC. KLK5 was highly expressed in the upper stratum granulosum, stratum corneum, hair follicles and sweat glands, skin sites where human KLK5 has been shown to be involved in physiological processes including keratinocyte desquamation, antimicrobial defence, lipid permeability and pigmentation. In cSCC, tumour cells at the deep margin, as well as those in the centre of keratin pearls, displayed cytoplasmic expression of KLK5. Some of the KLK5 immunoreactive cells also expressed vimentin, suggesting that they may be undergoing epithelial-mesenchymal transition and therefore have a more invasive behaviour than those expressing only KLK5. KLK5 may be a novel molecular biomarker useful for predicting prognosis of cSSC in dogs.

Análisis de aspectos relacionados con la equidad en salud y la insuficiencia renal crónica para el caso de la mujer en México / Healthcare equity and chronic renal failure in Mexico: an analysis for the case of women

INTRODUCCIÓN La insuficiencia renal crónica es una enfermedad que se encuentra en un estado de constante crecimiento. La discapacidad que genera esta enfermedad debe considerar efectos físicos y sociales, dada la falta de atención y a las condiciones socioeconómicas que la generan. Por lo tanto, el acceso a los servicios para tratar la insuficiencia renal crónica está condicionado a factores de tipo social y de tipo biológico. OBJETIVO Analizar el efecto de los componentes sociales en la insuficiencia renal crónica en un sector de la población de México que padece la enfermedad, en particular para el caso de la mujer. MÉTODOS Se aplicó el modelo lineal generalizado de Poisson, seleccionando las variables relacionadas con la equidad en la aplicación de los servicios de salud. Se tomaron datos estadísticos reportados en mujeres por el Instituto Nacional de Estadística y Geografía de México en el periodo 2009-2015. Las variables consideradas fueron grado de escolaridad, ocupación, acceso a la salud, región geográfica y zona habitable, así como le etapa de vida. RESULTADOS La mayor tasa de incidencia para la insuficiencia renal crónica corresponde a la mujer adulta intermedia, que trabaja en servicios informales excluidos legalmente de la cobertura institucional de salud, tiene baja escolaridad y vive en un área rural de la zona centro; mientras que la mujer adulta joven que vive en una metrópoli urbana de la zona norte presenta el perfil de menor incidencia. CONCLUSIONES Los determinantes económicos derivados de la actividad de las personas, así como la edad, el nivel educativo y el entorno en el que habitan, influyen tanto en el padecimiento de la enfermedad como en las posibilidades de enfrentarla con éxito.

INTRODUCTION Kidney chronic disease patients are being increasingly identified. The disability generated by this disease must consider physical and social effects given the lack of attention and the socioeconomic conditions that generate it. Therefore, access to services to treat kidney chronic disease is determined by social and biological factors. OBJECTIVE To analyze the effect of the social components on kidney chronic disease in a sector of the Mexican population that suffers from the disease, particularly in the case of women. METHODS The Poisson generalized linear model was applied, selecting the variables related to equity in the administration of health services. Statistical data reported by the National Institute of Statistics and Geography of Mexico in the period 2009-2015 in women was taken. The variables considered were the level of schooling, occupation, access to health, geographical region and habitable zone, as well as stage of life. RESULTS The highest incidence rate for kidney chronic disease is attributed to the intermediate adult woman, who works in informal services legally excluded from institutional health coverage, has low schooling and lives in a rural area of the Center zone, while the young adult woman that lives in an urban metropolis in the North zone presents lowest incidence profile. CONCLUSION The economic determinants derived from people's activities, as well as their age, the educational level and the environment in which they live influence both the acquisition of the disease and the possibilities of managing it successfully.

Dynamics of 45S rDNA sites in the cell cycle: fragile sites and chromosomal stability in Lolium and Festuca.

Analyses carried out with fluorescence in situ hybridization (FISH) in C-metaphases of the Lolium-Festuca complex have shown the occurrence of spontaneous fragile sites (FSs) in 45S rDNA regions. FSs are expressed as gaps but they do not result in breaks or chromosomal fragments in these species. These gaps have high DNA condensation observed as thin chromatin fibers that connect the apparent segments of the fragile chromosome, allowing for genomic stability. Assessing the behavior of these regions in the cell cycle of Lolium and Festuca species may lead to a better understanding of the dynamics that preserve stability during cell division. Furthermore, it is interesting to track the dynamics of chromosomes bearing 45S rDNA sites in the cell cycle as well as to observe the expression of FSs with no effect of the mitotic block. We observed variation in both the number and size of 45S FISH signals from the S/G2 phases of interphase and from prophase to anaphase where gaps in 45S rDNA sites also were observed. The change in the degree of condensation of the 45S site begins in the S/G2 phase and appears to be related to the transcriptional demand. Taking into account that the number of 45S rDNA sites tends to be re-established when cells reach telophase, we suggest that the chromatin fiber goes back to the normal condensation level to the anaphase (after segregation), allowing for the approximation of chromosome segments and ensuring dynamics that favor the genomic stability of these species.

Prevalence, geographic distribution and phenotypic differences of Piscirickettsia salmonis EM-90-like isolates.

Early reports accounted for two main genotypes of Piscirickettsia salmonis, a fish pathogen and causative agent of piscirickettsiosis, placing the single isolate EM-90 apart from the prototypic LF-89 and related isolates. In this study, we provide evidence that, contrary to what has been supposed, the EM-90-like isolates are highly prevalent and disseminated across Chilean marine farms. Molecular analysis of 507 P. salmonis field isolates derived from main rearing areas, diverse hosts and collected over 6 years, revealed that nearly 50% of the entire collection were indeed typed as EM-90-like. Interestingly, these isolates showed a marked host preference, being recovered exclusively from Atlantic salmon (Salmo salar) samples. Although both strains produce undistinguishable pathological outcomes, differences regarding growth kinetics and susceptibility to the antibiotics and bactericidal action of serum could be identified. In sum, our results allow to conclude that the EM-90-like isolates represent an epidemiologically relevant group in the current situation of piscirickettsiosis. Based on the consistency between genotype and phenotype exhibited by this strain, we point out the need for genotypic studies that may be as important for the Chilean salmon industry as the continuous surveillance of antimicrobial susceptibility patterns.

Evaluación de indicación de linfadenectomía en prostactectomía radical laroscópica según grupo de riesgo y capra -score / Evaluation of indication of lymphadenectomy in radical laparoscopy proststectomy risk gropu and capra-Score

Introducción. El beneficio de la linfadenectomía en el cáncer de próstata sigue siendo controversial. Es el único procedimiento que permite un estadiaje anatomopatológico más preciso. Antiguamente se indicaba en pacientes de riesgo intermedio o mayor. Actualmente utilizamos el Score de CAPRA sobre 2 para indicar el procedimiento con el fin de seleccionar de mejor manera los pacientes que se beneficiarían de este procedimiento. Objetivo. Analizar la utilidad de CAPRA-Score para indicar la linfadenectomía. Pacientes y Métodos. Estudio prospectivo de carácter descriptivo. De un universo de 155 Pacientes sometidos a prostatectomía radical laparoscópica entre 2003-2013 por un único cirujano, se analizaron 34 pacientes a los que se le realizó linfadenectomía . Los datos se recopilaron en el momento de la cirugía y controles postoperatorios. Se agruparon datos: edad, PSA, Estadio Clínico, Gleason y porcentaje de cilindros (+) en biopsia TR. Se agruparon según indicación por Riesgo o CAPRA-S y se compararon los resultados obtenidos en la histología de los ganglios extraídos (linfadenectomías +). Los datos se analizaron considerando p<0,05 estadísticamente significativo según prueba de T de Student. Resultados. Se incluyeron en total 34 pacientes. Hasta el año 2010 un total de 23 linfadenectomía indicadas a grupo de riesgo intermedio-alto, el 78 por ciento (18) indicado por Gleason. Se sacó en promedio 12 ganglios por paciente, 72 por ciento linfadenectomía ampliadas. Ningún paciente tuvo ganglios (+). Desde el año 2011 un total de 11 linfadenectomía por CAPRA-Score >2, sacándose promedio 15 ganglios, 9 fueron linfadenectomías ampliadas. Se obtuvo 18 por ciento linfadenectomías (+) para compromiso metastásico. Conclusiones. De los pacientes previo a CAPRA-Score, un 17 por ciento pacientes estarían sobreindicados según éste y coincide con la negatividad del resultado histológico. Hubo diferencia estadísticamente significativa en la aparición de ganglios (+) en pacientes que se aplicó CAPRA-Score. (P<0.05). Según la serie de pacientes presentados, CAPRA-Score seleccionaría mejor los pacientes que se beneficiarían con una linfadenectomía, sin embargo se requieren estudios de mayor cantidad de pacientes.AU

Introduction. The benefit of lymphadenectomy in prostate cancer remains controversial. It is the only procedure that allows a more accurate anatomopathological staging. It was formerly indicated in patients of intermediate or greater risk. We currently use the CAPRA Score of 2 to indicate the procedure in order to better select patients who would benefit from this procedure. Objective. Analyze the utility of CAPRAScore to indicate lymphadenectomy. Patients and Methods. Prospective descriptive study. From a universe of 155 patients who underwent laparoscopic radical prostatectomy between 2003 and 2013 by a single surgeon, 34 patients who underwent lymphadenectomy were analyzed. Data were collected at the time of surgery and postoperative controls. Data were grouped: age, PSA, Clinical Stage, Gleason and percentage of cylinders (+) in TR biopsy. They were grouped according to indication by Risk or CAPRA-S and the results obtained were compared in the histology of the extracted ganglia (lymphadenectomies +). Data were analyzed considering p <0.05 statistically significant according to Student's T test. Results. A total of 34 patients were included. Until the year 2010 a total of 23 lymphadenectomy Original Works indicated to group of intermediate-high risk, 78% (18) indicated by Gleason. An average of 12 lymph nodes per patient, 72% enlarged lymphadenectomy. No patient had lymph nodes (+). Since 2011 a total of 11 lymphadenectomy for CAPRAScore> 2, with a mean of 15 lymph nodes, 9 were enlarged lymphadenectomies. We obtained 18% lymphadenectomies (+) for metastatic compromise. Conclusions. Of the patients prior to CAPRA-Score, 17% patients would be over-reported according to this and coincides with the negativity of the histological result. There was a statistically significant difference in the appearance of lymph nodes (+) in patients who underwent CAPRA-Score. (P <0.05). According to the series of patients presented, CAPRAScore would better select patients who would benefit from lymphadenectomy, however, more studies are required.AU

Determinación del índice facial total y cono facial en individuos chilenos / Total facial index and facial cone in Chilean individuals

El estudio fue realizado en 68 estudiantes, adultos, Chilenos, de ambos sexos, con edades entre 17 y 32 años, oriundos de la Región de la Araucanía, Chile. En cada uno se registraron el diámetro vertical (Nasion-Gnation, Na-Gn) y diámetros transversales (bigoníaco y bicigomático, Go-Go y Cig-Cig, respectivamente) y se calculó el índice facial total (IFT). Para la obtención del cono facial se compararon los anchos Go-Go y Cig-Cig. Se analizó la relación entre: IFT v/s cono facial; IFT v/s sexo; cono facial v/s sexo. Para el análisis estadístico se utilizó las pruebas de chi-cuadrado, Pearson y coeficiente de correlación de Spearman, considerándose significativo p<0,05. La altura de la cara (Na-Gn) fue de 117,5 mm en hombres y de 110,3 mm en mujeres; el ancho superior de la cara (Cig-Cig) fue de 126,9 mm en los hombres y de 124,4 mm en las mujeres. La altura facial es diferente para hombres y mujeres, siendo mayor en hombres. El IFT fue calculado a partir de las medidas registradas y se obtuvo lo siguiente: en hombres hubo 4 casos (5,9 %) euriprosopos, 4 (5,9 %) mesoprosopos y 17 (25 %) leptoprosopos; en mujeres hubo 12 casos (17,6 %) euriprosopos, 12 (17,6 %) mesoprosopos y 19 (27,9 %) leptoprosopos. Concluimos que en individuos adultos chilenos la altura facial es diferente para hombres y mujeres, siendo mayor en hombres. El tipo leptoprosopo y la cara de forma triangular son más frecuentes en hombres. Los datos obtenidos son un aporte al conocimiento antropológico de un grupo de individuos del Sur de Chile.

The study was conducted on 68 students, Chilean adults, of both sexes, between 17 and 32 years old, originally from the Region de la Araucanía, Chile. The vertical diameter (Nasion-Gnation, Na-Gn) and transverse diameter (bigoníac and bizygomatic; Go-Go and Zig-Zig, respectively) were recorded and total facial index (TFI) was calculated. To obtain the facial cone widths Go-Go and Zig-Zig were compared. We analyzed the relationship between: TFI v/s facial cone; TFI v/s sex; facial cone v/s sex. For statistical analysis the chi-square test, Pearson and Spearman correlation coefficient was used, considering significant p <0.05. The face height (Na-Gn) was 117.5 mm in men and 110.3 mm in women; the width of the upper face (Zg-Zg) was 126.9 mm in men and 124.4 mm in women. The facial height is different for men and women, being higher in men. The TFI was calculated from the measurements recorded and the following is obtained: in men there were 4 cases (5.9 %) euriprosopic, 4 (5.9 % ) mesoprosopic and 17 (25 %) leptoprosopic; in women there were 12 cases (17.6 %) euriprosopic, 12 (17.6 %) mesoprosopic and 19 (27.9%) leptoprosopic. We hereby conclude that in Chilean adults the facial height is different for men and women, being higher in men. The leptoprosopic type and triangular face is more common for men. The data obtained is a contribution to anthropological knowledge of a group of individuals in the South of Chile.

Verification and characterization of chromosome duplication in haploid maize.

Doubled haploid technology has been used by various private companies. However, information regarding chromosome duplication methodologies, particularly those concerning techniques used to identify duplication in cells, is limited. Thus, we analyzed and characterized artificially doubled haploids using microsatellites molecular markers, pollen viability, and flow cytometry techniques. Evaluated material was obtained using two different chromosome duplication protocols in maize seeds considered haploids, resulting from the cross between the haploid inducer line KEMS and 4 hybrids (GNS 3225, GNS 3032, GNS 3264, and DKB 393). Fourteen days after duplication, plant samples were collected and assessed by flow cytometry. Further, the plants were transplanted to a field, and samples were collected for DNA analyses using microsatellite markers. The tassels were collected during anthesis for pollen viability analyses. Haploid, diploid, and mixoploid individuals were detected using flow cytometry, demonstrating that this technique was efficient for identifying doubled haploids. The microsatellites markers were also efficient for confirming the ploidies preselected by flow cytometry and for identifying homozygous individuals. Pollen viability showed a significant difference between the evaluated ploidies when the Alexander and propionic-carmin stains were used. The viability rates between the plodies analyzed show potential for fertilization.

Changes in metal contents in shrimp cultured in NW Mexico (2000-2010).

This study shows the concentrations of Cd, Cu, Pb, and Zn in the muscle and hepatopancreas of Pacific white shrimps, Litopenaeus vannamei, cultured during 2010 in 26 commercial farms of the three main producer states of the Mexican NW, Sonora, Sinaloa, and Nayarit and compares the results to those obtained in 2000 using samples collected in16 farms of the same states. No significant changes were detected in Cd concentrations, but the 2010 Zn levels were significantly higher in all states in the hepatopancreas and in Sinaloa in the case of the muscle. Cu showed a tendency to higher hepatopancreas values in 2010, but differences were significant only in Sonora and for the global mean value. In contrast, Pb was one order of magnitude lower in both organs in 2010, possibly because of the almost 15 years since leaded gasoline was discontinued in Mexico.

Estudio de índices faciales en alumnos de la Universidad de La Frontera, Chile / Facial indices study in students of the Universidad de La Frontera, Chile

Las características faciales de los seres humanos le otorgan una individualidad especial, que permiten identificarlos dentro de un grupo determinado, así como también grupos de personas tienen características que le diferencian de otros grupos. Con el fin de determinar características faciales de nuestra población, se estudiaron dos índices faciales, en individuos adultos (18-35 años), de ambos sexos, estudiantes de la Universidad de La Frontera, Chile. Los índices investigados fueron el Facial Superior (IFS), que relaciona altura morfológica de la parte superior de la cara con el diámetro bicigomático máximo y el índice nasal (IN), que relaciona altura del segmento nasal y el ancho nasal. El promedio del IFS fue de 46,8 (DS 4,0), con límites máximo de 62,1 y mínimo de 38,0, clasificando a los individuos estudiados como euriónicos (cara ancha) en 41 porciento de los casos, como hipereuriónicos (cara muy ancha) en 35 porciento, como mesenos (cara mediana) en 23 por ciento y como Leptenos (cara angosta) en 1 por ciento. El promedio del IN fue de 43,5 (DS 5,1), con límites máximo de 86,2 y mínimo de 50,2, clasificando a los individuos como leptorrinos (nariz angosta) en 77,4 por ciento de los casos, como mesorrinos (nariz mediana) en 17,4 por ciento y como camerrinos (nariz ancha) en un 1,7 por ciento. Los resultados obtenidos muestran que la mayoría de nuestra población es de cara ancha y de nariz delgada, datos que complementarán el conocimiento de las características antropométricas de nuestra región.

Facial features of human beings give a special individuality, which can identify within a group, as well as groups of people with characteristics that differentiate them from other groups. In order to determine facial characteristics of our population, two facial indices were studied in adult individuals (18-35 years), of both sexes, students from the Universidad de La Frontera, Chile. The indexes investigated were the Superior Facial (SFI), which relates height of the upper face morphology with the maximum bizygomatic diameter and the nasal index (NI), which relates height and width nasal segment. The SFI average was 46.8 (SD 4.0), with maximum limits of 62.1 and minimum of 38.0, classifying individuals studied as Euryonics (wide face) in 41 percent of cases, as Hypereuryonics (face too wide) in 35 percent, as Meson (medium face) in 23 percent and as Lepton (narrow face) in 1 percent. The NI average was 43.5 (SD 5.1), with maximum limits of 86.2 and minimum of 50.2, classifying individuals as leptorrhine (narrow nose) in 77.4 percent of cases, as mesorrhine (median nose) in 17.4 percent and catarrhine (wide nose) in 1.7 percent. The results show that the majority of our population is of broad face and thin nose, data to complement the knowledge of the anthropometric features in our region.

Índice Cefálico en Alumnos de la Universidad de La Frontera, IX Región, Chile / Cephalic Index in Students from the Universidad de La Frontera, IX Region, Chile

La cabeza es una parte de nuestro cuerpo en donde se manifiestan de manera más expresiva las diferencias morfológicas que caracterizan a los grupos étnicos. La forma de la cabeza y la capacidad del cráneo han sido consideradas, desde los inicios de la antropología físico-biológica en el siglo XIX, como factores determinantes a la hora de clasificar los grupos étnicos. El objetivo de este estudio fue clasificar de acuerdo al índice cefálico a un grupo de la población de la IX Región de Chile, evaluando su grado de homogeneidad y las características morfológicas cefálicas propias de ellos. El estudio se realizó en 115 individuos adultos, chilenos, de ambos sexos, 60 femeninos y 55 masculinos, de edades comprendidas entre 18 y 35 años. En ellos se midieron diámetros cefálicos y se determinó el Índice cefálico horizontal (ICH), relacionando el diámetro cefálico transverso máximo y el diámetro cefálico anteroposterior máximo. El ICH tuvo como valor mínimo 61,21 clasificando a este individuo como hiperdolicocéfalo y el valor máximo 92,73 clasificándolo como ultrabraquicéfalo. El promedio fue 78,10 (DS: 4,73), lo que determinó una población mesocéfala (cabezas medianas).

The head is a part of our body wherein the morphological differences that characterize ethnic groups are most revealing. Since the beginning of physical-biological anthropology in the XIX century, the shape of the head and the capacity of the cranium have been considered determinant factors at the time of classifying ethnic groups. The aim of this study was to classify a group of the population of the XI Región of Chile, according to cephalic index, thereby evaluating the degree of homogeneity and the group's unique morphological characteristics. The study was realized in 115 Chilean adult subjects of both sexes, 60 women and 55 men between 18 and 35 years of age. Cephalic diameters were measured and the horizontal cephalic index (HCI) was determined, relating the maximum transverse cephalic diameter and maximum anteroposterior cephalic diameter. The HCI showed a minimum value of 61.21, classifying this subject as hyper brachicephalic, with the maximum value of 92.73, classifying it as ultra brachicephalic. The average was 78.10 (D: 4.73), which determined a mesocephalic (medium size head) population.

Espontánea reversibilidad de un síndrome de parkinson tardío y de alteraciones cognitivas frontales; después de una intoxicación aguda con órganofosforados / Reversible parkinson syndrome and cognitive impairments due organophosphate acute poisoning

Clásicamente, la intoxicación aguda por órganofosforados produce una crisis colinérgica, que con frecuencia es continuada con un cuadro de debilidad muscular, expresión de un síndrome intermedio. La génesis de estos cuadros está relacionada con la inactivación de la acetilcolinesterasa por el insecticida. Mecanismos diferentes darían origen a polineuropatías y síndromes extrapiramidales tardíos. Se describe un paciente intoxicado agudamente con órganofosforados, que desarrolló una florida crisis colinérgica, que requirió ventilación mecánica invasiva. Después de tres semanas, ya recuperado de una neumonía y del síndrome colinérgico, se pudo definir un daño cognitivo de apariencia frontal, y se apreció la progresiva aparición de hipomimia, rigidez generalizada, bradikinesia y temblor, que configuraron un síndrome de Parkinson. Esta condición clínica se mantuvo al menos por dos semanas, siendo seguida de manera espontánea por una progresiva y completa mejoría del cuadro extrapiramidal y cognitivo. La literatura ha reportado, sólo por excepción casos similares, en los que se destacó tanto la aparición tardía del cuadro parkinsoniano, como su completa y espontánea remisión. Aunque la patogenia del cuadro parkinsoniano no está completamente establecida, existen evidencias experimentales que demuestran que los órganofosforados producen modificaciones en el transporte y en la recaptación de la dopamina. En este paciente se confirmó la doble acción patogénica de los órganofosforados, que habiéndose iniciado con un síndrome colinérgico agudo, finalizó con un compromiso dopaminérgico tardío. La completa recuperación de ambos efectos, permite encasillar a estos insecticidas como generadores de alteraciones funcionales, más que de gestores de daños o cambios estructurales.

Acute organophosphate poisoning usually produces a cholinergic crisis followed by muscular weakness or intermediate syndrome. The basis for these clinical manifestations is inactivation of acetylcholinesterase at the nicotinic and muscarinic nerve terminals and junctions. Different mechanism might lead to polyneuropathy and late extrapyramidal syndromes. We report a case of a male patient who ingested organophosphate with suicidal intentions. He developed a typical cholinergic crisis and required invasive mechanical ventilation. Three weeks later, frontal cognitive impairment was noticed and masklike face, generalized rigidity, bradykinesia and tremor progressively developed until a Parkinson syndrome was established. After his clinical condition had remained stable for at least two weeks, overt spontaneous improvement in motor and cognitive functions was observed. Similar reports in literature are infrequent. Although the pathophysiology that underlies extrapyramidal manifestations due organophosphate poisoning remains unclear, experimental evidence demostróte that organophosphate compounds impair dopamine transport and uptake. This case report suggests that organophosphate might act through a double pathogenic action i.e an initial acute cholinergic syndrome and a delayed disfunction in dopaminergic pathways. Complete spontaneous resolution of both effects allow us to classify organophosphate substances as a cause of functional impairment in the basal ganglia.

Persistencia de movimientos en espejo congénitos en una hemiplejía por infarto cerebral / Persistance of congenital mirror movements in the hemiplejic side after ischemic stroke

The simultaneous and involuntary displacement of the opposite limb during a volitional movement is called mirror movements. They mimic the gesture, partly or wholly. They can be congenital, familiar or installed in various CNS pathologies. We present a 64 years old woman with familiar history of mirror movements that affect their hands, since childhood. At admission presented confused with left hemiplegia and homolateral sensory involvement. The brain CT defined a right ischemic stroke affecting the posterior limb of the internal capsule, lenticular nucleus, sub insular region and par ventricular white matter. The paretic left hand, unable to perform voluntary movements, presented mirror movements during volitional movements of the contra lateral hand. Neurophysiologic studies have suggested that mirror movements are due the activation of the direct corticospinal pathway or simultaneous discharge of both motor cortexes due inhibitory pathways failures. Cortical origin seems unlikely for the movements in this patient, due to the injury of the internal capsule. Our case could be interpreted by the simultaneously brain innervations on both anterior horns, together with a congenital deregulation of the Central Pattern Generator Networks.

Se denomina movimiento en espejo (ME) el desplazamiento involuntario, imitativo y simultáneo de la extremidad opuesta al de un movimiento volitivo. Los ME pueden tener un origen congénito y familiar o generarse por patologías diversas del sistema nervioso central. Se presenta una mujer de 64 años con el antecedente de ME desde la infancia de carácter familiar. Ingresa en estado confusional y presentando una hemiplejía y hemihipoestesia faciobraquicrural izquierda. La tomografía cerebral mostraba compromiso del brazo posterior de la cápsula interna, núcleo lenticular, región subinsular y de la sustancia blanca paraventricular. La mano izquierda pléjica que era incapaz de realizar movimientos voluntarios, se movía en espejo al mover la mano derecha. Esta curiosa manifestación hace necesario una más ajustada interpretación neurofisiológica de los movimientos en espejo. Se ha postulado una activación de la vía corticoespinal directa, o la descarga simultánea de ambas cortezas motoras por fallas en la natural inhibición transcortical. En este caso parece improbable un origen cortical contralateral de los movimientos, debido a la lesión de la cápsula. Tal vez podrían comprenderse los ME de esta paciente, si se demostrara una doble inervación de ambas astas anteriores, asociada a una falla en la inhibición normal por desregulación congénita de los Circuitos Generadores Centrales.

Manifestaciones muco-cutáneas de la infección por Mycoplasma pneumoniae: Presentación de cuatro casos / Mucocutaneous findings of the Mycoplasma pneumoniae infection: Presentation of four cases

The mucocutaneous manifestations oí Mycoplasma pneumoniae infection appear in approximately 20 percent of all the infections produced by this microorganism. Maculopapular rash, vesicular or urticarial exanthemas, are frequent manifestations that can constitute Erythema multiforme or more rarely, Stevens - Johnson syndrome or epidermal toxic necrolisis. We describe the clinical evolution, diagnosis and treatment of four children with mucous and cu-taneous manifestations associated to infection by Mycoplasma pneumoniae and a review of the medical literature.

El compromiso muco-cutáneo de la infección por Mycoplasma pneumoniae se presenta en aproximadamente 20 por ciento de todas las enfermedades producidas por este microorganismo. Frecuentemente se manifiesta con lesiones máculo-papulares, vesiculosas o urticariales, que pueden constituir el eritema multiforme, más raramente síndrome de Stevens-Johnson o necrosis epidérmica tóxica. Describimos la evolución clínica, diagnóstico y el tratamiento administrado a cuatro niños que presentaron manifestaciones de piel y mucosas en relación a la infección por Mycoplasma pneumoniae. Se efectuó además una revisión de la literatura médica.

Utilidad diagnóstica de un cuestionario de sueño y de la escala de somnolencia de Epworth en el síndrome de apneas/hipopneas obstructivas del sueño (SAHOS) / The usefulness of a sleep questionnaire and the epworth sleep scale in the diagnosis of obstructive sleep apnea syndrome (OSAS)

Introduction: Obstructive sleep apnea syndrome (OSAS) is a common disease associated with significant morbidity, including excessive daytime sleepiness, cardiovascular disease and stroke. Method: We studied prospectively the patients sent to our sleep laboratory for polysomnography (PSG) during 6 months. One-hundred patients were interviewed with a sleep questionnaire, 3 of them were ruled out because the lacking of PSG and 2 who no completed the Epworth sleep scale (ESS). Results: Out of the 95 patients, there were 85 men and 10 women, with a mean age of 47.4 +/- 12.5 years, obesity was found in 42.5 percent, an ESS greater than 11 points was found in 56.8 percent, loud snoring in 93.7 percent, breathing cessation in 68.4 percent, excessive daytime somnolence in 57.9 percent. PSG revealed no OSAS in 14.7 percent, slight OSAS in 27.4 percent, moderate OSAS in 21 percent y severe OSAS in 36.8 percent. Body mass index and breathing cessation reported by the couple had the highest discriminative power with a sensibility of 87 percent and specificity of 50 percent for ruled out severe OSAS. Conclusion: A severe OSAS is less probable when there is absence of breathing cessation during sleep reported by the couple and an IMC <30 Kg/m².

Introducción: El SAHOS presenta una alta prevalencia en estudios internacionales, con importantes repercusiones en los sistemas cardio, cerebrovascular y en la calidad de vida de las personas. Método: Estudiamos prospectivamente a los pacientes enviados para Polisomnografia (PSG) a nuestro laboratorio de sueño, en un período de 6 meses. Previo consentimiento informado, se les aplicó la Escala de Somnolencia de Epworth (EE) y un Cuestionario de Sueño. Fueron entrevistados 100 pacientes, excluyéndose 3 por no haberse realizado PSG y 2 que no completaron la EE. Resultados: Se analizaron 95 pacientes, 89,5 por ciento hombres, edad promedio 47,4 +/- 12,5 años, obesidad en 49,5 por ciento, EE mayor de 11 en 56,8 por ciento, ronquido en 93,7 por ciento, pausas respiratorias en 68,4 por ciento, somnolencia diurna excesiva en 57,9 por ciento, cansancio al despertar en 86,3 por ciento. La PSG no demostró SAHOS en 14,7 por ciento, hubo 27,4 por ciento con SAHOS leve, 21 por ciento> moderado y 36,8 por ciento> severo. Las variables presencia de pausas respiratorias observadas por la pareja e índice de masa corporal (IMC) predicen la ausencia de SAHOS severo, con una sensibilidad de 87 por ciento y especificidad de 50 por ciento. Conclusión: En la evaluación de pacientes con sospecha de SAHOS, la no observación de pausas respiratorias durante el sueño por parte de la pareja y el IMC menor de 30 Kg/m² hacen menos probable que exista un SAHOS severo.