Toxicidad cardiovascular y metabólica secundaria a sorafenib / Cardiovascular and metabolic toxicity secondary to sorafenib

Los inhibidores de la tirosinacinasa son una familia de fármacos quimioterápicos utilizados en primera y segunda línea de muchas neoplasias sólidas y hematológicas. Su toxicidad es relativamente baja, ya que el mecanismo de acción se fundamenta en la inhibición de algunas tirosinacinasas involucradas en la proliferación de las células neoplásicas. Sin embargo, este bloqueo no es selectivo, por lo que pueden producir efectos secundarios. Sorafenib se ha relacionado con la aparición de hipertensión arterial, alteraciones tiroideas, dolor abdominal o hiperamilasemia, entre otros. Deben conocerse los efectos secundarios de estos fármacos para una adecuada monitorización de los pacientes que evite la suspensión de estos agentes quimioterápicos. (AU)

Tyrosine kinase inhibitors are a family of chemotherapy drugs used in first and second line for many solid and hematological neoplasms. Its toxicity is relatively low, since the mechanism of action is based on the inhibition of some tyrosine kinases involved in the explosion of neoplastic cells. However, this blockade is not selective, so it can produce secondary effects. Sorafenib can produce arterial hypertension, thyroid disorders, abdominal pain or hyperamylasemia, among others. We must monitor these patients during treatment to avoid side effects. (AU)

[Cardiovascular and metabolic toxicity secondary to sorafenib]. / Toxicidad cardiovascular y metabólica secundaria a sorafenib.

Tyrosine kinase inhibitors are a family of chemotherapy drugs used in first and second line for many solid and hematological neoplasms. Its toxicity is relatively low, since the mechanism of action is based on the inhibition of some tyrosine kinases involved in the explosion of neoplastic cells. However, this blockade is not selective, so it can produce secondary effects. Sorafenib can produce arterial hypertension, thyroid disorders, abdominal pain or hyperamylasemia, among others. We must monitor these patients during treatment to avoid side effects.

Hypertension secondary to abdominal mass

Secondary arterial hypertension (HTN) can be caused by primary hyperaldosteronism, renovascular disease, sleep apnea syndrome, chronic kidney disease, drug use, etc. In addition, some urological disorders such as hydronephrosis can cause hypertension due to an increase in intraglomerular pressure that activates the renin angiotensin system.(AU)

La hipertensión arterial (HTA) secundaria engloba un amplio diagnóstico diferencial que incluye causas tan distintas como el hiperaldosteronismo primario, la enfermedad renovascular, el síndrome de apnea del sueño, la enfermedad renal crónica, el consumo de fármacos, etc. Existen, además, ciertos trastornos urológicos como la hidronefrosis que pueden producir HTA debido a un aumento de presión intraglomerular que active el sistema renina-angiotensina.(AU)

Hypertension secondary to abdominal mass.

Secondary arterial hypertension (HTN) can be caused by primary hyperaldosteronism, renovascular disease, sleep apnea syndrome, chronic kidney disease, drug use, etc. In addition, some urological disorders such as hydronephrosis can cause hypertension due to an increase in intraglomerular pressure that activates the renin angiotensin system.

Analysis and gonadal localization of Speedy A mRNA transcript, a novel gene associated with early germline cells in the scallop, Argopecten purpuratus.

The Speedy A (spdya) gene is a member of the Speedy/RINGO family, encoding a spdya protein associated with cellular cycle and meiosis in vertebrates. Results from genetic analyses indicated spdya conditional knockout mice are sterile, suggesting that this protein has essential functions in mammalian reproduction. There, however, are no published reports on the localization of spdya mRNA in the germline or in somatic cell lineages within the gonads from mollusks or other invertebrate species. Using a previously obtained transcriptome assembly from the scallop Argopecten purpuratus, an economically important hermaphroditic scallop species from Chile and Peru, there was identification of a complete coding sequence of the spdya mRNA. Phylogenetically spdya protein has sequence conservation homology with other scallops and mollusks. The relative mRNA transcript abundances at different gametogenic stages was assessed using quantitative PCR procedures. Results indicated there was an increase of spdya mRNA transcript abundance in testicular region samples at the late active stage, followed by a decrease in testis of reproductively mature individuals. To gain insight into the cellular localization of ap-spdya transcript within the gonads, specific RNA probes were synthesized for in situ hybridization analyses of gonad histological sections. Results indicated spdya mRNA is located exclusively in early germline (previtellogenic oocytes and spermatogonia) and somatic proliferative tissues of A. purpuratus ovarian and testicular regions. Overall, these results indicate there are putative functions of spdya in the early oogenesis and spermatogenesis of A. purpuratus and will contribute to furthering the understanding of gametogenesis in this species.

Hipertensión arterial en el paciente oncológico con tratamiento con anti-angiogénicos / Arterial hypertension in cancer patients treated with antiangiogenic agents

La mejora de la supervivencia de los pacientes con cáncer ha llevado consigo un incremento en la aparición de enfermedad cardiovascular (ECV). Esto es debido al aumento de la edad de los sujetos y a los efectos secundarios de los agentes antineoplásicos. La aparición de hipertensión arterial (HTA) en los pacientes tratados con fármacos anti-angiogénicos es un efecto adverso común, que puede obligar a reducir la dosis de quimioterapia o incluso a suspenderla. Presentamos los casos de tres personas tratadas con distintos anti-angiogénicos, y que desarrollaron HTA secundaria. (AU)

Survival of neoplasms has improved significantly in recent years. An increase in the incidence of cardiovascular disease has been observed. This is due to increasing age of patients and the side effects of chemotherapy. Anti-angiogenic drugs frequently cause hypertension. This may force the reduction or suspension of chemotherapy treatment. We present the cases of three patients treated with different anti-angiogenic drugs. All three developed secondary arterial hypertension. (AU)

[Arterial hypertension in cancer patients treated with antiangiogenic agents]. / Hipertensión arterial en el paciente oncológico con tratamiento con anti-angiogénicos.

Survival of neoplasms has improved significantly in recent years. An increase in the incidence of cardiovascular disease has been observed. This is due to increasing age of patients and the side effects of chemotherapy. Anti-angiogenic drugs frequently cause hypertension. This may force the reduction or suspension of chemotherapy treatment. We present the cases of three patients treated with different anti-angiogenic drugs. All three developed secondary arterial hypertension.

La disfunción autonómica en el paciente con enfermedad neurodegenerativa / Autonomic dysfunction in the patient with neurodegenerative disease

La disfunción autonómica es una enfermedad muy frecuente en las alfa-sinucleoinopatías (enfermedad de Parkinson, demencia por cuerpos de Lewy, atrofia multisistémica). A nivel cardiovascular puede producir síntomas como hipotensión ortostática, hipertensión supina o disminución de la respuesta de la frecuencia cardiaca a estímulos. Para el diagnóstico es fundamental una sospecha clínica y una exploración física minuciosa, tomando la presión arterial tanto en posición de decúbito supino como en bipedestación. El electrocardiograma puede mostrar un alargamiento de los intervalos PR y QT, mientras que la monitorización ambulatoria de presión arterial de 24 h aporta información sobre los patrones de presión arterial. La confirmación de la disfunción simpática cardiaca puede realizarse con una gammagrafía miocárdica de inervación con 123-I-metilbencilguanidina (123-I-MIBG), ya que refleja la captación noradrenérgica neuronal específica. A continuación presentamos el caso de un varón con enfermedad de Parkinson que tras un completo estudio fue diagnosticado de disfunción autonómica cardiovascular

Autonomic dysfunction is a common condition in the alpha-synucleinopathies (Parkinson's disease, dementia with Lewy bodies, multiple system atrophy). Cardiovascular symptoms may include orthostatic hypotension, supine hypertension or decreased heart rate response. A clinical suspicion and physical examination are essential for diagnosis, taking blood pressure in supine and standing positions. The electrocardiogram may show a prolongation of the PR and QT intervals, while 24-hour ambulatory blood pressure monitoring provides information on blood pressure patterns. Cardiac sympathetic dysfunction can be confirmed by an innervation myocardial scintigraphy with 123-I-methylbenzylguanidine (123-I-MIBG). This can reflect specific neuronal noradrenergic uptake.We present the case of a man with Parkinson's disease who was diagnosed with cardiovascular autonomic dysfunction after a complete study

[Autonomic dysfunction in the patient with neurodegenerative disease]. / La disfunción autonómica en el paciente con enfermedad neurodegenerativa.

Autonomic dysfunction is a common condition in the alpha-synucleinopathies (Parkinson's disease, dementia with Lewy bodies, multiple system atrophy). Cardiovascular symptoms may include orthostatic hypotension, supine hypertension or decreased heart rate response. A clinical suspicion and physical examination are essential for diagnosis, taking blood pressure in supine and standing positions. The electrocardiogram may show a prolongation of the PR and QT intervals, while 24-hour ambulatory blood pressure monitoring provides information on blood pressure patterns. Cardiac sympathetic dysfunction can be confirmed by an innervation myocardial scintigraphy with 123-I-methylbenzylguanidine (123-I-MIBG). This can reflect specific neuronal noradrenergic uptake. We present the case of a man with Parkinson's disease who was diagnosed with cardiovascular autonomic dysfunction after a complete study.

Effectiveness of disinfectant treatments for inactivating Piscirickettsia salmonis.

This short communication investigated in vitro differences between commercial disinfectants types (n = 36), doses of application, and time of action in the elimination of Piscirickettsia salmonis, the most important bacterium affecting farmed salmon in Chile. Seven different treatments were examined, including active and inactive chlorine dioxides, glutaraldehyde, hypochlorite disinfectants and detergents, peracetic acid, peroxides and other miscellaneous methods A 3 replicate set of each of the sample groups was stored at 20 °C and 95% relative humidity and retested after 1, 5 and 30 min with varying doses (low, recommended and high doses). Multiple comparison tests were performed for the mean log CFU/ml among different disinfectant types, dose (ppm) and time of exposure (minutes) on the reduction of P. salmonis. Overall, disinfection using peracetic acid, peroxides, and both active and inactive chlorine dioxides caused significantly higher reduction of >7.5 log CFU/ml in samples, compared to other tested sanitizers. The lowest reduction was obtained after disinfection with hypochlorite detergents. As expected, as doses and time of action increase, there was a significant reduction of the overall counts of P. salmonis. However, at lowest doses, only use of paracetic acids resulted in zero counts. Implementation of effective protocols, making use of adequate disinfectants, may enhance biosecurity, and ultimately, mitigate the impact of P. salmonis in farmed salmon.

Is a brief self-report version of the Columbia severity scale useful for screening suicidal ideation in Chilean adolescents?

BACKGROUND: Given the high rates of suicide in the adolescent population and the reluctance of this population to seek help, developing proactive and effective strategies to timely detect individuals at high risk for suicide in non-clinical contexts is a worldwide recognized need. A series of brief self-report questionnaires have been developed for this purpose, however there are few studies providing evidence on their capability to accurately classify suicidal risk levels in specific populations. One of the instruments frequently used to evaluate suicide risk is the Columbia-Suicide Severity Rating Scales (C-SSRS). The goal of this study is to provide psychometric evidence about the accuracy of the Suicidal Ideation subscale (SI) of the C-SSRS to classify suicidal risk levels in a sample of Chilean adolescents using Item Response Theory (IRT). METHODS AND MATERIALS: Through the two parameter logistic model (2-PLM), we analyzed the capability of a self-report questionnaire addressing suicidal ideation (SI) to differentiate and classify participants according to their SI severity levels. We tested two main parameters: difficulty (localization) and discriminating power of 6 items extracted and adapted from the Columbia-Suicide Severity Rating Scales (C-SSRS). We administered this questionnaire to a general sample of 1645 adolescents aged 13 to 18. RESULTS: Our results show that the items differentiate symptoms addressing suicidal thoughts according to their severity, providing an accurate classification of the SI risk level. CONCLUSIONS: These findings support the usage of the C-SSRS in Chilean adolescents. Further research is needed to test its predictive value in different populations.

Manifestaciones neurológicas asociadas a espina bífida en adultos / Neurological manifestations associated with spina bifida in adults

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The mutagenesis of a type IV secretion system locus of Piscirickettsia salmonis leads to the attenuation of the pathogen in Atlantic salmon, Salmo salar.

Piscirickettsiosis is a threatening infectious disease for the salmon industry, due to it being responsible for significant economic losses. The control of outbreaks also poses considerable environmental challenges. Despite Piscirickettsia salmonis having been discovered as the aetiological agent of the disease more than 25 years ago, its pathogenicity remains poorly understood. Among virulence factors identified so far, type four secretion systems (T4SS) seem to play a key role during the infection caused by the bacterium. We report here the genetic manipulation of P. salmonis by means of the transference of plasmid DNA in mating assays. An insertion cassette was engineered for targeting the icmB gene, which encodes a putative T4SS-ATPase and is carried by one of the chromosomal T4SS clusters found within the genome of P. salmonis PM15972A1, a virulent representative of the EM-90-like strain. The molecular characterization of the resulting mutant strain demonstrated that the insertion interrupted the target gene. Further in vitro testing of the icmB mutant showed a dramatic drop in infectivity as tested in CHSE-214 cells, which is in agreement with its attenuated behaviour observed in vivo. Altogether, our results demonstrate that, similar to other facultative intracellular pathogens, P. salmonis' virulence relies on an intact T4SS.

En enfermos ingresados en cuidados intensivos, ¿es efectiva la rehabilitación y la movilización activa en la mortalidad y capacidad funcional? / For patients in intensive care, are rehabilitation and active mobilisation effective in terms of mortality and functional capacity?

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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.

Comprehensive antibiotic susceptibility profiling of Chilean Piscirickettsia salmonis field isolates.

Antibiotics have been extensively used against infections produced by Piscirickettsia salmonis, a fish pathogen and causative agent of piscirickettsiosis and one of the major concerns for the Chilean salmon industry. Therefore, the emergence of resistant phenotypes is to be expected. With the aim of obtaining a landscape of the antimicrobial resistance of P. salmonis in Chile, the susceptibility profiles for quinolones, florfenicol and oxytetracycline (OTC) of 292 field isolates derived from main rearing areas, different hosts and collected over 5 years were assessed. The results allowed for the determination of epidemiological cut-off values that were used to characterize the pathogen population. This work represents the first large-scale field study addressing the antimicrobial susceptibility of P. salmonis, providing evidence of the existence of resistant types with a high incidence of resistance to quinolones. Remarkably, despite the amounts and frequency of therapies, our results disclosed that the issue of resistance to florfenicol and OTC is still in the onset.

Tuberculosis peritoneal con presentación clínica como cáncer ovárico avanzado: revisión de la literatura / Peritoneal tuberculosis with clinical presentation as advanced ovarian cancer

Se presenta el caso de paciente con ascitis, masa pelviana y CA 125 elevado, sugerentes de cáncer ovárico avanzado. Se realizó laparoscopía que demostró lesiones compatibles con tuberculosis peritoneal. La biopsia laparoscópica de las lesiones demostró granulomas, por lo que no se realizó más cirugía y se inició tratamiento antituberculoso específico con buena respuesta clínica. Se revisa en la literatura tuberculosis peritoneal y su dificultad con el diagnóstico diferencial con cáncer de ovario avanzado.

It is presented the case of a patient with ascites, pelvic mass and elevated CA 125, all suggested of advanced ovarian cancer. It was made a laparoscopy that evidenced lesions of peritoneal tuberculosis. The laparoscopic biopsy of the lesions demostrated granulomas, for that there was no more surgery made and antituberculosis specific treatment was started, with good clinical response. It is revisited in the literature peritoneal tuberculosis and its difficult differential diagnoses with advanced ovarian cancer.