Disfunción crónica de órganos en pacientes con drepanocitosis. Parte II: manifestaciones renales, neurológicas y sensoriales / Chronic organ dysfunction in patients with sickle cell disease. Part II: renal, neurological and sensory manifestations

Introducción: El aumento de la expectativa de vida de pacientes con drepanocitosis, provoca que se sumen comorbilidades y disfunción crónica de órganos a las manifestaciones clínicas de la enfermedad. Objetivos: Analizar las alteraciones renales, neurológicas y sensoriales que aparecen en pacientes con drepanocitosis como manifestaciones de la disfunción orgánica crónica. Métodos: Se realizó una revisión de artículos publicados en los últimos 10 años con el uso de los buscadores PubMed, SciELO y Google Académico. Los términos de búsqueda fueron: drepanocitosis, disfunción orgánica, mortalidad, proteinuria, enfermedad renal crónica, infarto cerebral silente, trastornos neurocognitivos, retinopatía, sordera neurosensorial. Análisis y síntesis de la información: El efecto combinado de afectación glomerular, tubular e intersticial acarrea una disminución paulatina de la función renal. La progresión a la enfermedad renal crónica terminal es común y se asocia a incremento de la mortalidad. Las complicaciones del sistema nervioso central también pueden tener un impacto negativo en la supervivencia o provocar secuelas que influyen en la calidad de vida de los enfermos. Las afectaciones sensoriales tienen repercusiones biopsicosociales. Se describen aspectos relacionados con la prevalencia, diagnóstico y tratamiento de estas complicaciones. Conclusiones: Un seguimiento de los pacientes basado en estrategias para prevenir y diagnosticar de forma precoz las manifestaciones de disfunción crónica de órganos, puede disminuir las consecuencias desfavorables de estas complicaciones(AU)

Introduction: The increase in life expectancy of patients with sickle cell disease causes co-morbidities and chronic organ dysfunction to be added to the clinical manifestations of the disease. Objectives: To analyze the renal, neurological and sensory alterations that appear in patients with sickle cell disease as manifestations of chronic organic dysfunction. Methods: A review of the articles published in the last ten years was carried out using the search engines PubMed, SciELO and Google Scholar. The search terms were: sickle cell disease, organ dysfunction, mortality, proteinuria, chronic kidney disease, silent cerebral infarction, neurocognitive disorders, retinopathy, sensorineural deafness Analysis and synthesis of information: The combined effect of glomerular, tubular and interstitial involvement leads to a gradual decline in kidney function. Progression to end-stage chronic kidney disease is common and is associated with increased mortality. Central nervous system complications can also have a negative impact on survival or cause sequelae that influence the quality of life of patients. Sensory impairments have biopsychosocial repercussions. Aspects related to the prevalence, diagnosis and treatment of these complications are described. Conclusions: A follow-up of patients based on strategies to prevent and diagnose early the manifestations of chronic organ dysfunction can reduce the unfavorable consequences of these complications(AU)

Possible predictors of poor angiogenesis after hematopoietic stem cell autograft for lower limb ischemia.

INTRODUCTION: The therapeutic potential of adult stem cells in coronary and peripheral arterial diseases has been proposed in recent years. However, factors possibly predictive of unfavorable angiogenic results have not been clearly identified as yet. OBJECTIVES: Identify candidate predictors of poor angiogenesis, as indicated by need for amputation, after autologous hematopoietic stem cell transplantation for chronic lower limb ischemia. METHODS: A retrospective analytical case-series study was carried out to detect factors possibly associated with hematopoietic stem cell autograft failure due to low angiogenic potential. The study universe was composed of 47 patients (19 women, 28 men) with critical lower limb ischemia in Fontaine stages IIb, III and IV, who received autologous stem cell transplantation at the Dr Gustavo Aldereguía Lima University General Hospital in Cienfuegos, Cuba, from January 2007 through December 2010. Variables studied were sex, age, medical history (high blood pressure, ischemic cardiomyopathy, diabetes mellitus and chronic renal insufficiency), Fontaine ischemia stage, intermittent claudication, pain score on a 1-10 scale, ankle-brachial pressure index in the affected extremity, presence of ulcers, and smoking. Laboratory variables included: blood concentrations of hemoglobin, glucose, creatinine, liver enzymes, cholesterol, triglycerides and LDH; as well as leukocyte and platelet counts, stem cell viability, prothrombin time and erythrocyte sedimentation rate. The main response variable was amputation, an indicator of poor angiogenesis. Using logistic regression, a prognostic score of 1 to 4 was developed for each risk factor and scores added to create a risk prediction scale. Predicted risk for amputation and observed amputation rates were compared for patients in three risk groups: low, 0-4; medium, 5-8; and high, 9-12. RESULTS: Factors identified as possibly predictive of poor angiogenesis were: final leukocyte count <20 x 109/L after mobilization with granulocyte colony stimulating factor; age ≥60 years; pain scale score of 10; glycemia of >6 mmol/L; and triglycerides of >1.8 mmol/L. Patients who scored low on predicted amputation risk scale were spared amputation in 90.9% (10/11) of cases, versus 16.7% (2/12) in patients scoring high. CONCLUSIONS: Five possible prognostic factors for low angiogenic potential in stem cell autotransplantation were identified and a preliminary scale established to predict in which patients autotransplantation would be more likely to be successful.

Formation of the imidazolinone ring under mild conditions in the presence of sodium hydride.

Substituted imidazolinones containing heterocyclic carboxylic acids as substituents and possessing herbicidal properties were synthesized by cyclization of 2-amino-2,3-dimethylbutyramide with heterocyclic ethyl dicarboxylates under mild conditions. The use of NaH as base leads to a significant increase in the reaction rate and allows the preparation of the target compounds in high yields.