Viability and characterization trial of a novel method as an alternative to formaldehyde and Walter-Thiel cadaveric preservation for medical education and surgical simulation / Viabilidad y prueba de caracterización de un nuevo método como alternativa al formaldehído y la solución de Walther-Thiel para la preservación de cadáveres para educación médica y simulación quirúrgica

Introduction Despite its toxic and carcinogenic nature, formaldehyde is a widely used reactant for specimen preservation. With the need of specimens for both anatomical and surgical training, alternative preservation solutions (PS) have been proposed, however, their use is limited due to high costs and complexity. Hence, a new formaldehyde-free solution (FFS) is evaluated as a potential alternative for anatomical and surgical training. Methods Qualitative and Quantitative data were acquired. Specimens preserved using three different methods were selected. Flexibility was measured by joints goniometry and pneumoperitoneum pressures were evaluated followed by an exploratory laparoscopy. Undergraduate student's perceptions on cadavers preserved with different PS were obtained using surveys and focus groups. Results The main reason why cadaveric specimens were considered as useful tools was the perceived interaction with real tissues and the ‘practical’ concept of getting in touch with what students would be facing in the future as physicians, what we call “hands on” activities. FFS treated specimens showed better joint-movement ranges in comparison to other methods and pneumoperitoneum was acquired after 5mmHg CO2 pressure. Students appreciated working with corpses regardless the technique used, however FFS specimens were defined as less uncomfortable, while presenting no sensory discomfort. Conclusions Even though alternative PS are effective, high costs and complexity restrict their usage. Cadavers preserved with FFS had similar range of movements compared with Thiel. Students preferred to work with FFS rather than FF due to flexibility, color, and no sensorial hassles. Thus, we propose FFS as viable alternative to traditional PS (AU)

Introducción A pesar de su naturaleza carcinogénica y tóxica, el formaldehido continúa siendo utilizado para preservar especímenes. Debido a la necesidad de especímenes para entrenamiento anatómico y quirúrgico, se han propuesto soluciones preservadoras (SP) alternativas; sin embargo, su uso es limitado debido a los altos costos y a su complejidad. En consecuencia, se evalúa una nueva solución libre de formol (FFS) como una alternativa para el uso en entrenamiento anatómico y quirúrgico. Métodos Se obtuvieron datos cualitativos y cuantitativos. Se seleccionaron especímenes preservados utilizando diferentes métodos y se analizaron biopsias de cada uno. Se midió la flexibilidad mediante goniometría, y se evaluó la presión del neumoperitoneo. Utilizando encuestas y grupos focales se obtuvo la percepción de estudiantes de pregrado respecto a cadáveres preservados con diferentes soluciones. Resultados Los principales motivos por los que los estudiantes refirieron percibir los cadáveres como herramientas útiles fueron poder interactuar con tejidos reales y el concepto de «practicidad» generado por actividades percibidas como similares a la práctica como médicos profesionales. Los especímenes tratados con FFS demostraron mejor movimiento articular en comparación con otras soluciones, además de lograr neumoperitoneo con 5mmHg de CO2. Los estudiantes refirieron sentir menos molestias sensoriales al utilizar cadáveres preservados con FFS. Conclusiones Aunque otras SP son efectivas, los altos costos y la complejidad restringen su uso. Cadáveres preservados con FFS presentan arcos de movimiento similares a Thiel. Los estudiantes prefirieron trabajar con FFS en vez de FF, debido a la flexibilidad, el color y la ausencia de molestias sensoriales. Proponemos FFS como una alternativa viable a las SP tradicionales (AU)

Excess Calcium, Magnesium and Phosphorus Deposition in the Epigastric Artery of Dialysis Patients Undergoing Renal Transplantation

ABSTRACT Objective: Vascular calcification contributes to cardiovascular disease on dialysis patients. Arterial mineral content is modified but not well defined. We aim to define what is the concentration of calcium, magnesium and phosphorus in the epigastric artery of adult dialysis patients undergoing renal transplantation. Methods: All renal allograft recipients who underwent surgery at our centre between May 2003 and December 2005 and consented to be taken small samples of epigastric artery were included in our cross-sectional study. Histological, radiological and spectrometric methods were used to measure vascular calcification, deposits and concentrations of calcium, phosphorus and magnesium in epigastric artery, which were correlated with clinical and biochemical characteristics. Mineral vascular content was compared with corresponding samples from cadaveric renal donors free from renal disease (control group). Results: Calcium and magnesium concentrations in epigastric artery were much higher in recipients (n = 100) than in donors (n = 30). Histologically confirmed calcifications were more frequent in recipients. Calcium and magnesium content in epigastric artery were correlated directly with recipient age, pre-transplant serum P and Ca × P product. A high content of calcium and magnesium in this artery was observed in recipients with media and intimal calcification. Multivariate logistic regression showed that dialysis vintage > 3.5 years and calcium concentration in epigastric artery ≥ 4500 mg/kg wet weight were independent predictors of histological calcification. Conclusion: Excess mineral deposition is observed in the epigastric artery of dialysis patients, where the recipient's age, serum P, Ca × P product and time on dialysis play a decisive role.

Knowing Patients Better After a Stroke and Secondary Prevention.

The habits and lifestyles are the fundamental factors in the control of cardiovascular risk. Patients who have had a cerebrovascular accident (CVA) have a high risk of having a new event with similar characteristics. The exponentially growing success, penetration and adherence of the new communication technologies, based on applications (APPs), allows to use them to obtain information and influence the risk factors. We propose that empowering patients in their disease can make a more efficient management of it. For this reason, we designed and developed a system which integrates a mobile application and a web application. This system also makes use of peripheral devices to monitor patients and allow the automatic acquisition of information to enable the characterization of this kind of patients in relation to habits and lifestyle. At the same time, the system can also empower these patients with their disease to do secondary prevention.

Epidemiología de la patología tumoral en el trasplante renal / Epidemiology of tumoral pathology in renal transplantation

Introducción: La patología tumoral (PT) implica una morbimortalidad no despreciable después del trasplante renal, siendo la inmunosupresión un factor de riesgo potencialmente responsable de su desarrollo. El objetivo de nuestro estudio es determinar la prevalencia de malignidad durante el trasplante y estudiar su posible asociación con el uso de anticuerpos antilinfocitarios, infección por citomegalovirus y el antecedente de rechazo agudo. Métodos: Se trata de un estudio de cohorte, retrospectivo, en 1034 receptores de trasplante renal en el que se revisaron los eventos tumorales acontecidos entre abril de 1981 y marzo de 2010. Se consignaron el uso de anticuerpos antilinfocitarios (AAL), infección por CMV y episodios de rechazo agudo (RA), relacionando estas variables con el desarrollo posterior de patología tumoral. Resultados: NO se detectó mayor frecuencia de PT maligna en aquellos que recibieron AAL (13,8% vs. 17,6%, p=0,094) p=0,094). No hubo mayor frecuencia de PT en pacientes con infección por CMV (16,3% vs. 15,2%, p=0,69). Por último, hubo mayor frecuencia de PT en aquellos con antecedentes de RA, si bien con significación limítrofe (19,5% vs. 14,3%, p=0,05). Conclusiones: La patología tumoral maligna se ve potencialmente favorecida por la inmunosupresión cada vez más potente y duradera. No hemos encontrado asociación entre la administración de AAL, infección y / o enfermedad por CMV; si bien esta se ve ligeramente incrementada en aquellos pacientes con el antecedente de RA.

Introduction: Tumoral pathology (TP) implies morbidity which is significant after the renal transplantation; Immunosuppression is a risk factor which is potentially responsible for tumoral development. The aim of our study is to determine the prevalence of malignancy during transplantation and to study its possible relation with the usage of antillymphocvte antibodies, cytomegalovirus infection and the history of acute rejection. Methods: It is a cohort study, retrospective, in 1014 receptors of Kidney transplantation in which tumoral events were revised between April 1981 and March 2010. The development of tumoral pathology in recipients was related with the usage of AAL, CMV infection and AR episodes. Results: a greater frequency of malign TP was no recorded in those who received AAL (13.8% vs. 17.6%, p=0.094). There was not greater frequency of TP in patients with infection due to CMV (16,3% vs, 15.2%, p=0.69). Finally, there was greater frequency of TP in those with antecedent of AR, though with bordering significance (19.5%, vs. 14.3% p=0.05). Conclusions: Malign tumoral pathology is potentially favored by immunosuppression increasingly powerful lasting. We have not found any relationship between AAL use, infection and/ or disease due to CMV, although this is slightly increased in those patients with AR history.

Epidemiología de la patología tumoral en el trasplante renal / Epidemiology of tumoral pathology in renal transplantation

Introducción: La patología tumoral (PT) implica una morbimortalidad no despreciable después del trasplante renal, siendo la inmunosupresión un factor de riesgo potencialmente responsable de su desarrollo. El objetivo de nuestro estudio es determinar la prevalencia de malignidad durante el trasplante y estudiar su posible asociación con el uso de anticuerpos antilinfocitarios, infección por citomegalovirus y el antecedente de rechazo agudo. Métodos: Se trata de un estudio de cohorte, retrospectivo, en 1034 receptores de trasplante renal en el que se revisaron los eventos tumorales acontecidos entre abril de 1981 y marzo de 2010. Se consignaron el uso de anticuerpos antilinfocitarios (AAL), infección por CMV y episodios de rechazo agudo (RA), relacionando estas variables con el desarrollo posterior de patología tumoral. Resultados: NO se detectó mayor frecuencia de PT maligna en aquellos que recibieron AAL (13,8% vs. 17,6%, p=0,094) p=0,094). No hubo mayor frecuencia de PT en pacientes con infección por CMV (16,3% vs. 15,2%, p=0,69). Por último, hubo mayor frecuencia de PT en aquellos con antecedentes de RA, si bien con significación limítrofe (19,5% vs. 14,3%, p=0,05). Conclusiones: La patología tumoral maligna se ve potencialmente favorecida por la inmunosupresión cada vez más potente y duradera. No hemos encontrado asociación entre la administración de AAL, infección y / o enfermedad por CMV; si bien esta se ve ligeramente incrementada en aquellos pacientes con el antecedente de RA.(AU)

Introduction: Tumoral pathology (TP) implies morbidity which is significant after the renal transplantation; Immunosuppression is a risk factor which is potentially responsible for tumoral development. The aim of our study is to determine the prevalence of malignancy during transplantation and to study its possible relation with the usage of antillymphocvte antibodies, cytomegalovirus infection and the history of acute rejection. Methods: It is a cohort study, retrospective, in 1014 receptors of Kidney transplantation in which tumoral events were revised between April 1981 and March 2010. The development of tumoral pathology in recipients was related with the usage of AAL, CMV infection and AR episodes. Results: a greater frequency of malign TP was no recorded in those who received AAL (13.8% vs. 17.6%, p=0.094). There was not greater frequency of TP in patients with infection due to CMV (16,3% vs, 15.2%, p=0.69). Finally, there was greater frequency of TP in those with antecedent of AR, though with bordering significance (19.5%, vs. 14.3% p=0.05). Conclusions: Malign tumoral pathology is potentially favored by immunosuppression increasingly powerful lasting. We have not found any relationship between AAL use, infection and/ or disease due to CMV, although this is slightly increased in those patients with AR history.(AU)

Successful kidney transplantation reduces hyperplastic parathyroid gland.

INTRODUCTION: In dialysis patients, the parathyroid glands (PTGs) may increase progressively, producing abnormal bone metabolism. Changes in PTG volume among patients with hyperplastic PTGs are not well known after kidney transplantation. This study investigated PTG volume by ultrasound (US). METHODS: US of PTG was performed immediately (US-0) and 12 months after (US-12) transplantation to identify glands in all recipients. We calculated the percentage reduction in PTG volume (R%PTG). We declared it significant when it was > or =35%. Bone biochemical markers and renal function were recorded sequentially. RESULTS: Among engrafted patients, parathyroid US-0 was performed in 47 and US-0 and US-12 in 36. Some visible gland was observed upon US-0 in 13 recipients, a group that showed higher pretransplantation parathyroid hormone (PTH) levels than the remaining 34 patients with no visible glands (627 +/- 360.0 vs 280 +/- 240.9 pg/mL; P < .05). Of 36 recipients with US-0 and US-12, the baseline study identified PTGs in 12 patients (p+ group), while the remaining 24 had no identified glands (p- group). In the p+ group, no PTG, at US-12 were visible in four patients, and a significant R%PTG was observed in three at this time, representing a reduction in gland volume after transplantation among 58.3% of p+ patients. There was a progressive reduction in PTH among both groups. Patients with glandular volume reduction displayed better renal function: serum creatinine 1.7 +/- .79 versus 2.9 +/- .74 mg/dL (P < .05). CONCLUSIONS: Transplantation reversed hyperparathyroidism and PTG volume among recipients who achieved nearly normal renal function.

[ROC curve analysis of factors predictive of non-response to interferon treatment in patients with chronic hepatitis C, genotype 1]. / Análisis mediante curvas ROC de los factores predictivos de no respuestaal tratamiento con interferón en pacientescon hepatitis crónica C genotipo 1.

The objectives of this study included: 1) to identify pretreatment variables predictive of absence of response in 107 patients with chronic hepatitis C, genotype 1, treated with interferon-a (IFN-a) at a dose of 3 MU three times weekly for 3-12 months and classified into two groups: group A, nonresponders vs. patients with a complete response, and group B, nonresponding and relapsing patients vs. patients with a sustained response; and 2) to establish a prognostic index using ROC curve analysis. The rate of sustained response was 6. 5% at the 24-month follow-up. The pretreatment characteristics with predictive value using ROC curves were as follows: in group A, age, GGT, serum ferritin, viral load, and grade and stage of the histological lesion; and in group B, known duration of infection, GPT, GGT, serum ferritin, viral load, and grade and stage of the histological lesion. In both group A and group B the positive predictive value (the probability of predicting an absence of response when the variable is present) was greater than the negative predictive value (mean: 84.3% vs. 41.1%, 99% vs. 16.5%, respectively). In group A, based on the prognostic index, the positive predictive value when three variables were present was 96% and the sensitivity was 63.5%, with the test being unequivocal in 6.5%, whereas when four or five variables were present, the positive predictive value was 97% and 100% and the sensitivity was 40.5% and 18%, respectively. In group B, the positive predictive value when two variables were present was 100% and the sensitivity was 87%, whereas when three, four, five and six variables were present the sensitivity was between 73% and 28%. In group A, age, GGT and ferritin were the predictive variables independently associated with an absence of response, with a relative risk of 6.5, 4.8 and 3.1, respectively, whereas in group B we did not find variables independently associated with an absence of response. It was concluded that in patients with genotype 1, it is possible to predict the absence of response to IFN therapy with a high degree of reliability.

[Comparative analysis of viral load by bDNA HCV RNA-2.0 and amplicor HCV monitor in patients with hepatitis C infection]. / Análisis comparativo de la carga viral mediante bDNA HCV RNA-2.0 y Amplicor HCV Monitor, en pacientes infectados por el virus de la hepatitis C.

BACKGROUND: Two standardized techniques, Quantiplex (bDNA-2.0) and Amplicor Monitor have been evaluated for the quantification of virus load of HCV with these objectives: a) determinate the relationship between virus load and genotype, and b) evaluate the virus load in serial serum samples and in patients with normal or slightly increased liver enzymes in an area with a high prevalence of genotype 1. RESULTS: A significant correlation of 0.7 (p < 0.0001) in virus load has been observed by both methods, but the virus load is smaller by Monitor than by Quantiplex and does not depend on genotype. The relationship Monitor/Quantiplex is smaller in patients with non-1 genotype than in patients with genotype 1a (p = 0.01) and 1b (p = 0.005). Virus characteristics are similar in patients with normal or slightly increased enzymes than in patients with high enzymes. Virus load by both methods is not related to the age, sex, know duration of the infection, transmission manner of the infection neither to the histologic activity index. CONCLUSION: The virus load not depends on genotype. The determination of virus load in a single serum sample adequately reflects the virus load are in several serum samples in patients with chronic HCV infection. The genotype and the virus load are similar in patients with normal enzymes than in patients with high enzymes.

Análisis mediante curvas ROC de los factores predictivos de no respuestaal tratamiento con interferón en pacientescon hepatitis crónica C genotipo 1 / ROC curve analysis of factors predictive of no response to interferon treatment in patients with chronic hepatitis C, genotype 1

Los objetivos del estudio fueron: 1) identificar variables pretratamiento predictivas de no respuesta en 107 pacientes con hepatitis crónica C con genotipo 1 tratados con IFN-a con una dosis de 3 MU tres veces por semana durante 3-12 meses distribuidos en dos grupos: grupo A, no respondedores frente a pacientes con respuesta completa, y grupo B, no respondedores más recaedores frente a los pacientes con respuesta sostenida; y 2) establecer un índice pronóstico mediante análisis de las curvas ROC. La tasa de respuesta sostenida fue del 6,5 por ciento a los 24 meses de seguimiento. En el grupo A, la edad, la GGT, la ferritina sérica, la carga viral, el grado y el estadio de la lesión histológica, y en el grupo B la duración conocida de la infección, la GPT, la GGT, la ferritina sérica, la carga viral, el grado y el estadio de la lesión histológica, fueron las características pretratamiento con valor predictivo según las curvas ROC. El valor predictivo positivo (probabilidad de predecir la ausencia de respuesta cuando la variable está presente) fue mayor que el valor predictivo negativo (media 84,3 por ciento vs. 41,1 por ciento, 99 por ciento vs. 16,5 por ciento, respectivamente) en ambos grupos. En el grupo A, según el índice pronóstico, el valor predictivo positivo cuando estaban presentes tres variables fue del 96 por ciento y la sensibilidad del 63,5 por ciento, siendo la prueba inequívoca en un 6,5 por ciento, mientras que cuando estaban presentes cuatro o cinco variables el valor predictivo positivo fue del 97 por ciento y el 100 por ciento, y la sensibilidad del 40,5 por ciento y 18 por ciento. En el grupo B, el valor predictivo positivo cuando estaban presentes dos variables fue del 100 por ciento y la sensibilidad del 87 por ciento, mientras que cuando estaban presentes tres, cuatro, cinco o seis variables la sensibilidad fue del 73 por ciento al 28 por ciento. En el grupo A, la edad, la GGT y la ferritina fueron las variables con asociación pronóstica independiente con la ausencia de respuesta, con un riesgo relativo de 6,5, 4,8 y 3,1, respectivamente, mientras que en el grupo B no encontramos variables asociadas independientemente con la ausencia de respuesta. Se concluye que en los pacientes con genotipo 1 es posible predecir, con una elevada fiabilidad, la ausencia de respuesta al tratamiento con IFN (AU)

[Serology against Toxoplasma gondii in pregnant women. Development of prevalence rates in the course of 4 years]. / Serología frente a Toxoplasma gondii en mujeres gestantes. Evolución de las tasas de prevalencia a lo largo de cuatro años.

Sera from 1,221 pregnant women were screened for antibodies against Toxoplasma gondii. The prevalence rate of antibodies was 38.9%. We have observed specific IgM antibodies 15 pregnant women (1.2%). The prevalence rate was not increased significantly with the age and number of pregnancies. The seropositivity was reduced significantly in the 4th year studied. The high rate of seronegativity observed in the pregnant women represent a high risk of Toxoplasma infestation.

Prevalencia de marcadores sericos del virus de la hepatitis B en el personal femenino de un hospital general / Prevalence of serum markers of hepatitis B virus in female personnel of a general hospital

Hemos determinado los marcadores del virus de la hepatitis B a 209 mujeres del personal de un hospital general: 12 Médicos, 90 ATS, 70 Auxiliares de clínica y de laboratorio y 37 personas de Personal de limpieza y office. La prevalencia fue del 15,31% (32 personas). Cuatro personas (1,91%) presentaron HBs-Ag. La prevalencia fue más baja que las encontradas por otros autores de nuestro país. Las prevalencias más altas se encontraron en el personal de limpieza y office, seguido de los ATS. Por Servicios, las prevalências más altas se encontraron en el personal en contacto con sangre y hemoderivados. No se encontraron marcadores en el personal de la UVI. La prevalencia aumentó y generalmente con la edad y la antigüedad. Asociamos los bajos índices de prevalencia encontrados por nosotros con los elevados porcentajes de personal joven (33,49%) tienen menos de 30 años y con poca antigüedad en el hospital (26,31% con menos de 4 años

Prevalencia de marcadores sericos del virus de la hepatitis B en el personal femenino de un hospital general / Prevalence of serum markers of hepatitis B virus in female personnel of a general hospital

Hemos determinado los marcadores del virus de la hepatitis B a 209 mujeres del personal de un hospital general: 12 Médicos, 90 ATS, 70 Auxiliares de clínica y de laboratorio y 37 personas de Personal de limpieza y office. La prevalencia fue del 15,31% (32 personas). Cuatro personas (1,91%) presentaron HBs-Ag. La prevalencia fue más baja que las encontradas por otros autores de nuestro país. Las prevalencias más altas se encontraron en el personal de limpieza y office, seguido de los ATS. Por Servicios, las prevalÛncias más altas se encontraron en el personal en contacto con sangre y hemoderivados. No se encontraron marcadores en el personal de la UVI. La prevalencia aumentó y generalmente con la edad y la antig³edad. Asociamos los bajos índices de prevalencia encontrados por nosotros con los elevados porcentajes de personal joven (33,49%) tienen menos de 30 años y con poca antig³edad en el hospital (26,31% con menos de 4 años (AU)

[Prevalence of serum markers of hepatitis B virus in the female personnel at a general hospital]. / Prevalencia de marcadores séricos del virus de la hepatitis B en el personal femenino de un hospital general.

We have determined hepatitis B virus markers to 208 female personnel of a general hospital: 12 physicians 90 nursing personnel, 70 assistants of clinic and laboratory and 37 cleanliness, and office personnel. The prevalence was 15.31% (31 persons). Four persons (1.91%) presented HBs-Ag. The prevalence was more low that the prevalences found by other authors of our country. The highest prevalences were found in the cleanliness and office personnel, pursued of nursing personnel. Among different services, the highest prevalences were found in the personnel in contact with blood and its derivates. Not were found markers in the intensive care unit personnel. The prevalence increased generally with age and with years in occupation. We associated the low young personnel (33.49% are more low of 30 years age) and with short years occupation in the hospital (26.31% are more low of 4 years).

Prevalencia de marcadores séricos del virus de la hepatitis B en el personal femenino de un hospital general. / [Prevalence of serum markers of hepatitis B virus in the female personnel at a general hospital]

We have determined hepatitis B virus markers to 208 female personnel of a general hospital: 12 physicians 90 nursing personnel, 70 assistants of clinic and laboratory and 37 cleanliness, and office personnel. The prevalence was 15.31

(31 persons). Four persons (1.91

) presented HBs-Ag. The prevalence was more low that the prevalences found by other authors of our country. The highest prevalences were found in the cleanliness and office personnel, pursued of nursing personnel. Among different services, the highest prevalences were found in the personnel in contact with blood and its derivates. Not were found markers in the intensive care unit personnel. The prevalence increased generally with age and with years in occupation. We associated the low young personnel (33.49

are more low of 30 years age) and with short years occupation in the hospital (26.31

are more low of 4 years).