Novel Biomarkers for the diagnosis of diabetic nephropathy.

Diabetes mellitus and its complications are a known public health problem nowadays. Diabetic nephropathy is one of the main complications and the result of multiple mechanisms, including: activation of the renin-angiotensin-aldosterone system, formation of advanced glycation end products and chronic inflammation that led to glomerular and tubulo-interstitial damage producing mesangial expansion and glomerulosclerosis, which finally results in chronic kidney disease. Early detection of diabetic nephropathy is essential for adequate intervention to stop, or at least slow down its progression. Multiple markers have been described, not only the classic ones such as serum creatinine, urea, and albuminuria, but at this point also novel biomarkers such as neutrophil gelatinase-associated lipocalin, tumor necrosis factor 1 receptor and monocyte chemoattractant protein-1, among others. The aim of this article was to provide an update review of the role of biomarkers in the diagnosis of diabetic nephropathy.

SARS-CoV-2 effect on male infertility and its possible pathophysiological mechanisms.

First case of COVID-19 was reported in Wuhan, China in December 2019. As of now, May 2021, a total of 164,189,004 people were infected, and 3,401,990 deaths have occurred caused by SARS-CoV-2. As SARS-CoV-2 virus cell entry mainly depends on the ACE2 and TMPRSS2 proteins, the presence of high expression levels of both ACE2 and TMPRSS2 in testes highlights the possible vulnerability of men to the virus. Other RNA viruses frequently induce orchitis and result in male infertility. This review evaluates the decline in male fertility and a total of 48 original articles were included for the analysis. We investigated the effects of COVID-19 on male reproductive health and male fertility.  There is a strong association between the high number of ACE2 receptors in the testes and the COVID-19 viral loads. SARS-CoV-2 infection negatively affects the male reproductive tract. Human biological tissues, including body fluids and excretions, tissues, and organs showed positive results tests for SARS-CoV-2. A disruption in the balance of male reproductive system hormones is also observed. Male gonads may be potentially vulnerable to SARS-CoV-2 infection, suggesting caution to follow-up and evaluate infected men that have plans to conceive. Further studies are required to determine if this impairment is temporary or permanent, elucidate SARS-CoV-2's entrance strategies into the testis and how it can affect the semen quality and quantity. We recommend a post-infection follow-up, especially in male patients of reproductive age already having fertility issues.

Usefulness of prolonged renal replacement therapy in patients with acute kidney injury requiring dialysis.

Acute kidney injury (AKI) requiring dialysis is becoming more common. Several types of renal replacement therapies have been used, including continuous, intermittent, and prolonged intermittent renal replacement therapy (PIRRT). There is no clear difference between those therapies in terms of patient survival. The aim of this study was to describe a form of PIRRT (shift continuous veno-venous hemodialysis [CVVHD]) and the results of this technique in a population of patients with AKI requiring dialysis in a tertiary care center. We studied 302 patients with AKI requiring dialysis over a 3-year period. All patients were treated in the intensive care unit. There were 1709 treatments in the study. Shift CVVHD was done for 8 h daily using NxStage machines, with a bicarbonate base dialysate at a rate of 5 L/h. Demographics and laboratory data were obtained from the electronic medical record. Dialysis data were obtained from the dialysis run sheets. Patient mortality was 51.3%.The dialysis time was close to 8 h and the blood flow was 310 (± 43) mL/min. The mean arterial pressure was stable before and after the dialysis. The total ultrafiltration averaged 2934 mL per treatment; the ultrafiltration rate was 4.1 (± 3.1) mL/kg/h, and the ultrafiltration per hour was 359 (± 257.8) mL/h. The average dialysate potassium used was 2.9 mEq/L. The dose of dialysis was 57 (± 19) mL/kg/h. The urea reduction ratio was 48% (± 15%), the standardized KT/V (a measure of dialysis dose obtained by urea kinetic modeling) was 3.5 (± 0.9), and the equivalent renal urea clearance (EKR) was 9.8 (± 4.1) mL/min. The method produced a consistent reduction in the levels of blood urea nitrogen, creatinine, potassium, and phosphorous. The delivered dose of dialysis was stable during the observation period. In conclusion, shift CVVHD is effective in treating patients with AKI requiring dialysis and has a survival similar to that of continuous therapies with less intensive use of resources.

Actividades para la educación en el trabajo de estudiantes de la carrera de Medicina / Activities for education at work for Medical students

Fundamento: las demandas crecientes de un profesional de la salud que combine el estudio y el trabajo, la escuela con la vida y la enseñanza-aprendizaje en la Atención Primaria y Secundaria de salud constituyen un problema social actual para el país.Objetivo: diseñar un conjunto de actividades para la educación en el trabajo de los estudiantes de primer año de la carrera de Medicina desde el consultorio médico de la familia, para contribuir a la promoción de salud y prevención de enfermedades en la comunidad, contribuyendo a la formación integral del futuro médico. Métodos: se diseñó la programación, por áreas de trabajo, para la enseñanza integrada de las disciplinas biomédicas en su contribución a la promoción de salud y prevención de enfermedades, en el policlínico Dr. Gustavo Aldereguía Lima de Las Tunas. Se realizó el análisis historiográfico del problema; se observaron modos de actuación de estudiantes, docentes y miembros de la comunidad; se aplicaron entrevistas y encuestas para explorar conocimientos y vivencias de estudiantes y profesionales de la salud, sobre la promoción de salud en la educación en el trabajo; se realizaron talleres de opinión crítica y elaboración colectiva, que permitieron socializar con docentes y otros profesionales de la salud la programación propuesta para su rediseño sobre la base de la crítica colectiva.Resultados: se caracterizaron las insuficiencias provocadas por la fragmentación de los contenidos de las asignaturas y disciplinas biomédicas en la educación en el trabajo, y se diseñó la programación por áreas de trabajo, para contribuir a eliminar las insuficiencias que se producen en la educación en el trabajo, determinadas por las orientaciones generales para su realización, sin indicaciones específicas (AU)

Background: the growing demands of a health professional that combines study and work, school with life and teaching-learning in primary and secondary health care constitute a current social problem for the country.Objective: to design a set of activities for education at work for first year medical students, from the family doctor's office, to contribute to health promotion and disease prevention in the community, favoring the integral formation of future doctors.Methods: the program was designed in work areas for the integrated teaching of biomedical disciplines for contributing to health promotion and disease prevention in Dr. Gustavo Aldereguía Lima polyclinic in Las Tunas. It carried out the historic and graphical analysis of the problem; students, professors and community members behaviors were observed; interviews and surveys were applied to explore knowledge and experiences of students and health professionals on the promotion of health education at work; workshops on critical opinion and collective elaboration were carried out and permitted to socialize with other teachers and health professionals the proposed program for its redesign based on collective criticism.Results: the shortcomings caused by the fragmentation of subject contents and biomedical disciplines in education at work were characterized and the plan to help to eliminate the inadequacies that occur in education at work was designed by work areas and determined by the general guidelines for its implementation, without specific indications.Conclusions: the clinical method was applied its pedagogical dimension, allowing the coordination between the traditional methods of teaching-learning and for diagnosing, to contribute to eliminate the spontaneous character in the development of education in the workplace. The program of activities was designed by work areas (AU)

Survival after acute kidney injury requiring dialysis: long-term follow up.

Data on long-term follow up after acute kidney injury (AKI) requiring dialysis are scarce. The aim of this study was to describe and identify factors associated with survival, recovery of kidney function at discharge, and long-term follow up of renal function in AKI patients requiring dialysis. All AKI patients requiring dialysis during calendar year 2000-2011 treated with conventional hemodialysis and daily shift continuous venovenous hemodialysis (8-hour 40 L dialysate) were included. The data were mean and SD. The results were: 65.8% male; 33.9% diabetic; 75% dipstick positive proteinuria on admission; 72.5% medical AKI; and 27.6% surgical AKI of those (14.2%) who had postcardiovascular surgery. At discharge mortality by cause of AKI: medical 25%, surgical 29.8%; and at the end of study: medical 35.3%, surgical 43.6%. Two-hundred thirty-four patients were discharged alive (mortality 26%). Forty-two died after discharge; 50% in the first 156 days post discharge. Mortality at the end of study was 37.8%. Follow-up (F/U) (1-86 m). At discharge, 200 recovered from kidney function (63.2%), and of those who died in the hospital 80.5% did not recover from kidney function (died dialysis dependent). Baseline serum creatinine was 1.33 mg/dL (0.64), estimated glomerular filtration rate (eGFR) 63.4 mL/minute (29.3), peak creatinine 6.3 mg/dL (2.9), and peak blood urea nitrogen 88.1 mg/dL (39.9). At discharge, serum creatinine was 3.1 mg/dL (2.1) and eGFR was 31.6 mL/minute (27.4); at 6 months, creatinine was 1.66 mg/dL (1.1) and eGFR was 60.8(36); at all F/U times, the creatinine was higher and eGFR was lower than the baseline values (P < 0.05). Of the nonsurvivors, the only significant difference was a lower albumin at baseline (2.9 vs. 3.1 g/dL) (P < 0.05) and lower peak creatinine (5.5 vs. 6.8 mg/dL) (P < 0.05). The mean survival time was 45.4 months. The survival of the patients who recovered from kidney function at discharge was longer than the ones who did not recover (59.7 vs. 16 m, P < 0.05). By Cox regression, the factors significant for survival were peak creatinine and status at discharge. During follow up (data up to 54 months), the percentage of patients with eGFR < 60 mL/minute decreased from 90.9% at discharge to 63.6% at 24 months, then increased to 81.8% at 30 months and longer. The percentage of patients with eGFR < 30 mL/minute decreased from 45.4% at discharge to 18.2% at 24 months to increase at a later date (27-36%). The percentage of patients with eGFR < 15 mL/minute decreased from 45.45% at discharge to 18% until 24 months of follow up (to increase to 27.7% at later dates). AKI requiring dialysis has a significant effect on GFR with almost 80% of the survivors having chronic kidney disease stage 3 or worse. Furthermore, progression was observed on the long-term follow up. Factors affecting the survival included peak creatinine and status of recovery of kidney function at discharge.

Caracterización del ingreso a las carreras de las ciencias médicas del curso regular diurno (2007- 2012) / Characterization of the Admission to Medical Sciences Studies in the Regular Daytime Course (2007- 2012)

En el presente trabajo de realiza un análisis del comportamiento del ingreso a las carreras de Medicina y Estomatología desde el curso 2007- 2008 hasta el curso 2012- 2013. Se evidenció un incumplimiento mantenido del plan de plazas aprobado para cada provincia en la carrera de Medicina, en los últimos seis años; la carrera de Estomatología mostró un cumplimiento superior. Se mencionan las principales causas que han afectado el plan de ingreso según criterio de expertos.

The current paper presents an analysis of the admission to medical and dentistry undergraduate studies from the 2007-2008 course to the 2012-2013 course. A continuous failure to fulfil the approved admission plan for each province was observed in medical degrees during the last six years whereas dentistry studies showed greater fulfillment. The major causes affecting such plan according the expert criteria are mentioned.

Metformin intoxication requiring dialysis.

Metformin (MTF) is one of the most common oral agents used to treat diabetes mellitus. Intoxication is associated with lactic acidosis and has significant clinical consequences. We report 12 cases requiring dialytic intervention. Twelve patients were analyzed from 2005 to 2010; 10 of these patients were treated with dialysis. Conventional hemodialysis (HD) and continuous veno-venous hemodialysis treatments with bicarbonate dialysis were used, and the results were presented as mean and standard deviation. The results are as follows: 33% of the patients were male, hospital stay was 9.3 (± 12) days, average MTF dose 1.7 g/day, mortality was 25%. Baseline glomerular filtration rate for these patients was 51.5 mL/min, with an average age of 64 (± 11) years. On presentation, all had acute kidney injury with blood urea nitrogen/creatinine 75 (± 30)/8.1 (± 3.7) mg/dL, lactic acid 12.4 (± 8.1) mmol/L, pH 7.04 (± 0.19), bicarbonate 7.2 (± 4.5) mmol/L. Metformin level was 25 (± 17) µg/mL; anion gap was 28 (± 9), and serum potassium was 5.4 (± 1.3) mEq/L. Seventy percent of patients were treated with conventional HD. Patients required 4 (± 5) dialysis treatments at blood flow QB 330 (± 53), dialysis flow QD 571 (± 111) for 305 (± 122) minutes. Postdialysis, the acidosis parameters improved: bicarbonate 19.2 (± 4.1) mmol/L, lactic acid 6 (± 4) mmol/L and MTF levels decreased 8.9 (± 5.7) µg/mL. Metformin percentage removal was calculated to be 60% (± 24). No difference was found between HD and continous veno-venous hemodialysis. The only difference between survivors was the age 53 (± 7) vs. 78 (± 10) (P < 0.05). Metformin toxicity is a serious clinical condition and causes severe lactic acidosis and significant mortality. Hemodialysis is an efficient method to treat MTF intoxication and correct the metabolic abnormalities.

Brain edema dynamics in patients with overt hepatic encephalopathy A magnetic resonance imaging study.

UNLABELLED: The aim of our study was to investigate the dynamics of brain water content assessed by magnetic resonance imaging (MRI) applications in patients with cirrhosis and overt episodic hepatic encephalopathy (HE). METHODS: Twenty-four patients with cirrhosis and overt HE, 9 healthy controls and 9 controls with cirrhosis but without HE were included. All patients underwent laboratory analysis, MRI and (1)H MRS in the first 24h after the diagnosis of encephalopathy. Five of them were studied again 5days after the resolution of HE. RESULTS: The values of glutamine/glutamate (Glx) increased progressively (healthy controls: 1.8; cirrhotic controls: 2.4; HE: 4.4; p=0.0001). Values of myo-inositol were lower among cirrhotics than in healthy controls (healthy: 0.6; cirrhotic: 0.3; HE: 0.4; p=0.01). Patients with overt HE showed a decrease in MTR in several brain locations. A significant correlation was observed between MTR values and Glx/creatine ratios (r=-0.54; P=0.004). Five days after the resolution of HE, there were no changes in brain Glx/Cr or MTR but a significant decrease of median ADC in parietal grey matter was observed (acute HE: 121.9 vs. 5days later: 100.5; p<0.05). CONCLUSIONS: Cirrhotic patients with overt HE have a disturbance in the brain osmolyte homeostasis, reflecting a low-grade brain edema. Shortly after the clinical resolution of the episode of HE low-grade brain edema still persists, but there is a decrease in the ADC value in the parietal grey matter, suggesting water flux from extracellular to intracellular compartments and the existence of a vasogenic brain edema.

Calidad de vida en personas con insuficiencia renal crónica en tratamiento dialítico en el Hospital Dr Ernesto Guevara de la Serna / Life Quality in People with Chronic Renal Insufficiency under Dialysis Treatment at Dr Ernesto Guevara de la Serna Hospital

Los aspectos diversos relacionados con la calidad de vida de los individuos, familias, y comunidad en general, constituyen prioridades, tanto para personas naturales como jurídicas, del estado cubano. En correspondencia con ello y con el objetivo de introducir en la práctica médica del sistema local de salud las posibilidades actuales de operacionalizar este complejo tema, se realizó un estudio descriptivo transversal, con un universo de 31 pacientes con insuficiencia renal crónica bajo tratamiento dialítico previo a la modernización tecnológica de Servicio de Hemodiálisis del Hospital Provincial de Las Tunas Dr Ernesto Guevara de la Serna. A los enfermos se les aplicó el cuestionario SF 36. Los resultados obtenidos para las diferentes dimensiones de la calidad de vida indicaron que se estaba ante un evento de salud que tiene serias repercusiones para los individuos afectados por el síndrome. En todos los casos se obtuvieron puntuaciones inferiores a 50, siendo el rol emocional y la función física los más críticos, con puntuaciones de 10 y 12, respectivamente(AU)

A descriptive and transversal study was carried out with a universe of 31 patients with chronic renal insufficiency under dialytic treatment before the technological modernization of the Hemodialysis Service at Dr Ernesto Guevara de la Serna Hospital of Las Tunas. The SF 36 questionnaire was applied to the sick patients. The results obtained for the different dimensions of life quality shows that one is in presence of a health condition with serious repercussions for the people affected by the syndrome. In all cases scores under 50 were obtained and the most critical indicators were the emotional role and the physical function with scores of 10 and 12, respectively (AU)

Hypoparathyroidism associated with severe mineral bone disease postrenal transplantation, treated successfully with recombinant PTH.

Chronic kidney disease (CKD) is commonly, if not universally, associated with derangements in bone and mineral metabolism, characterized by hyperphosphatemia, low calcitriol levels, and secondary hyperparathyroidism. The spectrum of these disorders is termed renal osteodystrophy or chronic kidney disease-mineral bone disease complex. Aggressive phosphorus control is the cornerstone of management to prevent debilitating complications. Dietary control, phosphate binders, and administration of active vitamin D analogues is the most common initial therapy. Frequently parathyroidectomy is required to reverse or slow the pathological changes when medical management fails. The most common adverse effect of parathyroidectomy is hypocalcemia. We describe a case report of severe hypocalcemia (secondary to surgical hypoparathyroidism) and "hungry bone syndrome," treated successfully with teriparatide (Forteo) in a patient who underwent renal transplantation following subtotal parathyroidectomy.

Primary hyperoxaluria causing ESRD and gangrene of extremities leading to amputation.

Primary hyperoxaluria is an uncommon, inherited metabolic disorder due to hepatic enzyme deficiencies with consequent hepatic oxalate overproduction and attendant systemic complications. The diagnosis is established on a combination of clinical parameters, elevated urinary excretion of oxalate and glycolate and determination of alanine glyoxylate aminotransferase in the liver tissue. We describe a 45-year-old female with end-stage renal disease secondary to nephrolithiasis, who presented with a fulminating vascular syndrome before confirming the diagnosis of primary hyperoxaluria. This case illustrates that in this infrequent clinical entity, the diagnosis is often delayed with incorrect initial management.

Hipertensión Arterial: su comportamiento en dos consultorios médicos de la familia del Policlínico Aquiles Espinosa / Arterial Hypertension: its Unfolding in Two Family Doctor Offices of Aquiles Espinosa Policlinic

Con el objetivo de conocer algunos aspectos clínicos - epidemiológico de la hipertensión arterial en dos consultorios médicos de la familia del GBT 1 del Policlínico Aquiles Espinosa del municipio Tunas, se estudiaron 181 pacientes con este diagnóstico, comprendido entre el 4 de septiembre del 2005 y el 4 de abril del 2006, la raza negra, el sexo femenino y el grupo etáreo de 56 años y más fueron los más afectados. El cumplimiento del tratamiento médico indicado es irregular en el 72 por ciento de los casos. La retinopatía hipertensiva fue la complicación que predominó, solo el 42 por ciento de los pacientes se encuentran controlados(AU)

With the objective to know some clinical-epidemiological aspects of arterial hypertension in two family doctor's offices of GBT 1 of “Aquiles Espinosa” Policlinic in Las Tunas, 181 hypertensive patients were studied in the period from September 4 th 2005 to April 4 th 2006. Black race, female sex and the age group of 56 years old and over were the most affected ones. The prescribed medical treatment was irregular in 72 per cent of the cases. Hypertensive retinopathy was the predominant complication and 42 per cent of them are controlled by the doctor(AU)

An atypical presentation of visual hallucinatory experiences following prolonged blindness.

We report a patient with long-standing blindness experiencing both simple and complex visual hallucinations secondary to a cortical arteriovenous malformation (AVM). The hallucinations were located in the right visual field corresponding to the contra-lateral site of cortical damage. This case contributes to our understanding of neurophysiological mechanisms underlying visual hallucinations and ongoing research investigating the phenomenology of hallucinations with respect to the cause and localization of neural damage.

Valor de la coronariografía por resonancia magnética en el diagnóstico del origen anómalo de las arterias coronarias. A propósito de un caso / The value of magnetic resonance coronariography in the diagnosis of anomalous origin of the coronary arteries. A case report

La incidencia de anomalías congénitas de las arterias coronarias oscila, en las distintas series coronariográficas publicadas, entre el 0,3 y el 1,3%. Inicialmente, estas anomalías se consideraron simples hallazgos, sin que se les asignara ninguna significación clínica. Esta creencia se deshizo posteriormente al describirse casos de síncope, angina, infarto agudo de miocardio y muerte súbita asociados a su presencia. Se conoce que las complicaciones clínicas pueden estar en relación con el trayecto que sigue la arteria coronaria anómala. Presentamos un caso de anomalía congénita de la arteria coronaria izquierda con nacimiento en el seno coronario derecho, en una mujer de 74 años con angina inestable prolongada, en el que la resonancia magnética demostró ser definitiva en la determinación del trayecto exacto de dicha coronaria anómala

The incidence of congenital anomalies of the coronary arteries reported in different series ranges from 0.3 to 1.3%. These anomalies were initially considered to be findings with no clinical significance. Later reports of syncope, angina, acute myocardial infarction and sudden death related to their presence changed this belief. Clinical complications are known to be related to the course of the anomalous coronary artery. We present a case of a congenital anomaly of the left coronary artery arising from the right coronary sinus in a 74-year-old woman with long-standing unstable angina in which magnetic resonance imaging provided the definitive determination of the exact course of this coronary anomaly

Trombosis y hemorragia muscular espontánea secuenciales en el síndrome antifosfolipídico primario / Sequential thrombosis and spontaneous muscular haemorrhage in the primary antiphospholipid syndrome

No disponible

Comportamiento de la Hipertensión Arterial en mujeres hospitalizadas en el servicio de Medicina Interna / Behavior of arterial hypertension in inpatient women at Internal Medicine Service

Se realizó un estudio retrospectivo acerca del comportamiento de la Hipertensión Arterial en mujeres hospitalizadas en el Servicio de Medicina Interna del Hospital General Docente Dr Ernesto Guevara de la Serna de Las Tunas, en el trienio 1999-2001. El universo estuvo constituido por el total de mujeres que ingresaron con el diagnóstico de Hipertensión Arterial. Para obtener la información se confeccionó un modelo de vaciamiento donde se relacionaron las variables a estudiar. Fueron revisados los expedientes clínicos de las pacientes en el Departamento de Archivo para obtener los datos que posteriormente fueron tabulados de forma computarizada. Se concluyó que la edad más frecuente fue el grupo 45-64 años, la raza blanca, la Hipertensión Arterial moderada y la etapa post-menopausia. La Cardiopatía Isquémica fue la enfermedad asociada más frecuente, el Corazón, el órgano diana más afectado y la ingestión de café el hábito tóxico que predominó. La Retinopatía Hipertensiva grados I y II fue el hallazgo más frecuente en el Fondo de Ojo. Los complementarios más frecuentes alterados fueron el Electrocardiograma y el Ecocardiograma (AU)

A retrospective study about the behaviour of arterial hypertension in hospitalized women at Internal Medicine Service of the General Teaching Hospital Dr Ernesto Guevara de la Serna in Las Tunas among 1999, 2000 and 2001 was carried out the study population was constituted by the total number of women hospitalized with the diagnosis of arterial hypertension. It was prepared a model to obtain the information, there were related the variables to be studies. The clinical histories of the patients were reviewed to obtain the data that later were tabulated by computer. It was concluded that the most frequently age was the group among 45-64 years old, the white race, moderade arterial hypertension and post menopausic stage. Ischaemic Cardiopathy was the more frequently associated disease, the heart was the more affectec organ and coffee ingestion was the toxic habit that predominated. Hipertensive retinopathy grades I and II was the more frequent finding in the eyeground. The complementary tests more frequently altered were the electrocardiograms and the echocardiogram (AU)

Implications of glucose transporter protein type 1 (GLUT1)-haplodeficiency in embryonic stem cells for their survival in response to hypoxic stress.

Glucose transporter protein type 1 (GLUT1) is a major glucose transporter of the fertilized egg and preimplantation embryo. Haploinsufficiency for GLUT1 causes the GLUT1 deficiency syndrome in humans, however the embryo appears unaffected. Therefore, here we produced heterozygous GLUT1 knockout murine embryonic stem cells (GT1+/-) to study the role of GLUT1 deficiency in their growth, glucose metabolism, and survival in response to hypoxic stress. GT1(-/-) cells were determined to be nonviable. Both the GLUT1 and GLUT3 high-affinity, facilitative glucose transporters were expressed in GT1(+/+) and GT1(+/-) embryonic stem cells. GT1(+/-) demonstrated 49 +/- 4% reduction of GLUT1 mRNA. This induced a posttranscriptional, GLUT1 compensatory response resulting in 24 +/- 4% reduction of GLUT1 protein. GLUT3 was unchanged. GLUT8 and GLUT12 were also expressed and unchanged in GT1(+/-). Stimulation of glycolysis by azide inhibition of oxidative phosphorylation was impaired by 44% in GT1(+/-), with impaired up-regulation of GLUT1 protein. Hypoxia for up to 4 hours led to 201% more apoptosis in GT1(+/-) than in GT1(+/+) controls. Caspase-3 activity was 76% higher in GT1(+/-) versus GT1(+/+) at 2 hours. Heterozygous knockout of GLUT1 led to a partial GLUT1 compensatory response protecting nonstressed cells. However, inhibition of oxidative phosphorylation and hypoxia both exposed their increased susceptibility to these stresses.

Experiencia clínica inicial en la estadificación del mieloma múltiple mediante técnicas de resonancia de todo el cuerpo / Initial clinical experience in multiple myeloma staging by means of whole-body resonance techniques

Objetivos: Desarrollar una técnica de exploración de resonancia magnética (RM) equivalente a la serie ósea radiológica (SOR) y comparar su precisión en la estadificación de pacientes con mieloma múltiple (MM). Material y métodos: Se desarrollaron secuencias TSE T1 Y STIR en plano coronal con adquisición múltiple. Se incluyeron 10 voluntarios sanos y 11 pacientes con diagnóstico de mieloma múltiple. Se comprobó la visualización de estructuras óseas en el estudio, con especial referencia a las que se incluirían en una SOR, y en el caso de los pacientes se comparó la capacidad diagnóstica de las secuencias de RM. Resultados: La RM visualizó un número significativamente mayor (p < 0,05) de elementos óseos que la SOR, gracias al desplazamiento secuencial de la mesa de exploración, abarcando al menos desde la cabeza hasta el tercio proximal de las piernas. La resonancia magnética detectó a su vez un número significante mayor (p < 0,05) de lesiones y evidenció una mayor extensión de éstas, llegando incluso a suponer cambios de estadificación en el 18 por ciento de los pacientes. Conclusiones: La aplicación de técnicas de RM de todo el cuerpo en enfermos de mieloma múltiple es factible y prometedora clínicamente. La RM resulta más sensible y específica para la evolución de las lesiones óseas en el MM que la SOR, constituyendo actualmente una alternativa a validar en grupos más numerosos de pacientes (AU)