Elevated Vitamin B12, Risk of Cancer, and Mortality: A Systematic Review.

Vitamin B12 (B12) is a molecule involved in several biological. Abnormally high levels are frequently found, but their causes can be multiple, and consequences have not been clearly elucidated. The objective of this review was to summarize the current evidence on the associations of elevated B12 and the development of cancer, and all-cause mortality in adults. Six references looking at mortality and seven looking at cancer risk were included. The evidence suggests an association between elevated B12 with a higher risk of cancer, with risk ratios ranging 1,88 to 5,9. There was less consistent evidence linking vitamin B12 and mortality.

Elevated B12 levels exceeding 1000 pg/L, if sustained and unexplainable, warrant a comprehensive individual assessment of each patient. This evaluation should encompass various potential factors contributing to the elevation, aiming to effectively guide the diagnostic process of neoplastic diseases.Clinical longitudinal observational studies have suggested a potential link between heightened B12 levels and the risks of cancer and mortality. Nonetheless, these studies have been retrospective cohort studies, and lack a defined threshold point of B12 levels.Studies have documented a positive correlation between elevated levels of B12 and the incidence of lung, pancreatic, and liver cancers, as well as certain hematological neoplasms, particularly those related to the myeloid lineage. Conversely, a consistent negative association has been observed in the context of breast cancer. Findings concerning neoplasms of the lower gastrointestinal tract and prostate display contradictory outcomes.The diagnostic significance of elevated B12 levels among patients already diagnosed with cancer remains uncertain and could potentially be linked to reverse causality.

Cut-off points of neck and waist circumference as predictors of obstructive sleep apnea in the Colombian population: a comparison with polysomnography

ABSTRACT BACKGROUND: Neck circumference (NC) is a useful anthropometric measure for predicting obstructive sleep apnea (OSA). Ethnicity and sex also influence obesity phenotypes. NC cut-offs for defining OSA have not been established for the Latin American population. OBJECTIVES: To evaluate NC, waist circumference (WC), and body mass index (BMI) as predictors of OSA in the Colombian population and to determine optimal cut-off points. DESIGN AND SETTING: Diagnostic tests were conducted at the Javeriana University, Bogota. METHODS: Adults from three cities in Colombia were included. NC, WC, and BMI were measured, and a polysomnogram provided the reference standard. The discrimination capacity and best cut-off points for diagnosing OSA were calculated. RESULTS: 964 patients were included (57.7% men; median age, 58 years) and 43.4% had OSA. The discrimination capacity of NC was similar for men and women (area under curve, AUC 0.63 versus 0.66, P = 0.39) but better for women under 60 years old (AUC 0.69 versus 0.57, P < 0.05). WC had better discrimination capacity for women (AUC 0.69 versus 0.57, P < 0.001). There were no significant differences in BMI. Optimal NC cut-off points were 36.5 cm for women (sensitivity [S]: 71.7%, specificity [E]: 55.3%) and 41 cm for men (S: 56%, E: 62%); and for WC, 97 cm for women (S: 65%, E: 69%) and 99 cm for men (S: 53%, E: 58%). CONCLUSIONS: NC and WC have moderate discrimination capacities for diagnosing OSA. The cut-off values suggest differences between Latin- and North American as well as Asian populations.

Cut-off points of neck and waist circumference as predictors of obstructive sleep apnea in the Colombian population: a comparison with polysomnography.

BACKGROUND: Neck circumference (NC) is a useful anthropometric measure for predicting obstructive sleep apnea (OSA). Ethnicity and sex also influence obesity phenotypes. NC cut-offs for defining OSA have not been established for the Latin American population. OBJECTIVES: To evaluate NC, waist circumference (WC), and body mass index (BMI) as predictors of OSA in the Colombian population and to determine optimal cut-off points. DESIGN AND SETTING: Diagnostic tests were conducted at the Javeriana University, Bogota. METHODS: Adults from three cities in Colombia were included. NC, WC, and BMI were measured, and a polysomnogram provided the reference standard. The discrimination capacity and best cut-off points for diagnosing OSA were calculated. RESULTS: 964 patients were included (57.7% men; median age, 58 years) and 43.4% had OSA. The discrimination capacity of NC was similar for men and women (area under curve, AUC 0.63 versus 0.66, P = 0.39) but better for women under 60 years old (AUC 0.69 versus 0.57, P < 0.05). WC had better discrimination capacity for women (AUC 0.69 versus 0.57, P < 0.001). There were no significant differences in BMI. Optimal NC cut-off points were 36.5 cm for women (sensitivity [S]: 71.7%, specificity [E]: 55.3%) and 41 cm for men (S: 56%, E: 62%); and for WC, 97 cm for women (S: 65%, E: 69%) and 99 cm for men (S: 53%, E: 58%). CONCLUSIONS: NC and WC have moderate discrimination capacities for diagnosing OSA. The cut-off values suggest differences between Latin- and North American as well as Asian populations.

Hemofilia A adquirida: un diagnóstico de infarto / Acquired Hemophilia A: a heart attacking diagnosis

Resumen La hemofilia A adquirida es una entidad poco reportada y potencialmente fatal, que se asocia con la aparición de autoanticuerpos contra el factor VIII de la coagulación. Si bien puede estar subestimada, se calcula una incidencia aproximada de 1 a 1.5 casos por millón de habitantes con una mortalidad reportada entre el 9 y el 33%. Se manifiesta con equimosis extensas espontáneas y sangrado en mucosas, tracto gastrointestinal o en el periodo postparto. Se debe sospechar en adultos a partir de la cuarta década de la vida con sangrados espontáneos y un tiempo parcial de tromboplastina prolongado en ausencia de anticoagulante lúpico. Se reporta el caso de un adulto mayor con cardiopatía isquémica, en quien, en el contexto de un evento coronario agudo, se diagnosticó hemofilia A adquirida ante la presencia de sangrado subcutáneo extenso en cuello, con compresión de faringe y laringe que amenazó su vida representando un verdadero reto terapéutico.

Abstract Acquired hemophilia A is an underreported and potentially fatal entity that is associated with the formation of autoantibodies against coagulation factor VIII. Although it may be underestimated, the estimated incidence is between 1-1.5 cases per million people with a reported mortality between 9 and 33%2. It presents with extensive spontaneous ecchymosis, mucosal, gastrointestinal, or postpartum bleeding. It should be suspected in adults from the fourth decade of life with spontaneous bleeding and prolonged TPT in the absence of lupus anticoagulant. We report the case of an older adult with ischemic heart disease in the context of an acute coronary syndrome, who was diagnosed with acquired hemophilia A and presented with significant cervical subcutaneous bleeding with pharyngeal and laryngeal compression that threatened his life, constituting a real therapeutic challenge.

Evaluación de la variabilidad fenotípica en Simarouba amara Aubl., mediante descriptores cualitativos y cuantitativos / Assessment of phenotypic variability in Simarouba amara Aubl., through qualitative and quantitative descriptors / Avaliação da variabilidade fenotípica em Simarouba amara Aubl.,usando descritores qualitativos e quantitativos

Resumen Dentro de las estrategias de evaluación de especies forestales nativas por parte de la Corporación Colombiana de Investigación Agropecuaria - AGROSAVIA, se encuentra la caracterización fenotípica. Con el propósito de validar el uso de descriptores morfológicos y determinar la variabilidad fenotípica de la colección de trabajo del Centro de Investigación La Libertad ubicado en el piedemonte llanero (Villavicencio, Meta); se evaluaron 121 individuos de machaco (Simarouba amara Aubl.) de 6.2 años de edad, por medio de 34 descriptores de planta, hoja y fruto. Los datos cualitativos y cuantitativos se analizaron mediante análisis de correspondencias múltiples y análisis de componentes principales respectivamente, con el fin de reducir la dimensionalidad de los datos, seguido de análisis de conglomerados, utilizando el algoritmo de WARD para el agrupamiento de los individuos. Los resultados obtenidos permitieron identificar que el volumen de tronco presentó la mayor variabilidad (31.13%) y las variables cuantitativas asociadas al tamaño y diámetro de la copa, diámetro de fuste, volumen del tronco, longitud y ancho de la hoja, altura total y de copa presentaron las mayores correlaciones con los tres primeros componentes principales (57.82%). Se obtuvieron nueve conglomerados que reúnen el 95.73% de la variabilidad original y en los cuales se encontraron individuos potencialmente útiles con fines maderables, arboricultura y sistemas agroforestales. La forma del fuste, la altura de ramificación y de bifurcación, el tipo de corteza y el hábito de fructificación presentaron mínima variación en los individuos, contrario a la rectitud del fuste y la forma de la copa.

Abstract Phenotyping is one of the strategies used by Corporación Colombiana de Investigación Agropecuaria (AGROSAVIA) for evaluating native forest species. One hundred and twenty-one 6.2 year-old mountain damson/stavewood/bitterwood/paradise trees (Simarouba amara Aubl. commonly known as machaco in Colombia) were evaluated using 34 plant, leaf and fruit descriptors to validate the use of morphological descriptors and determine the phenotype variability of AGROSAVIA's La Libertad Research Centre's working collection. The centre is located in the foothills of Colombia's eastern plains (Villavicencio, Meta). Multiple correspondence analysis (MCA) was used for analysing qualitative data and principal component analysis (PCA) for +data to reduce dataset dimensionality; this was followed by cluster analysis, using Ward's method (minimum variance method or Ward's minimum - agglomerative algorithm) for hierarchical cluster analysis for grouping the trees. The results led to identifying that the wood volume descriptor had the greatest variability (31.13%) and the quantitative variables associated with crown size and diameter, stem diameter, trunk volume, leaf length and width, total and crown height had the greatest correlation with the first three components (57.82%). Nine clusters were obtained (accounting for 95.73% of original variability) and in which trees were found for timber, arboriculture and agroforestry system purposes. The trees' stem shape, branch height and bifurcation, the type of bark and fruiting habits had minimum variation, contrary to the that found regarding stem straightness and crown shape.

Resumo Dentro das estratégias de avaliação de espécies florestais nativas pela Colombian Agricultural Research Corporation - AGROSAVIA, está a caracterização fenotípica. A fim de validar o uso de descritores morfológicos e determinar a variabilidade fenotípica da coleção de trabalhos do Centro de Pesquisa La Libertad localizado no sopé da planície, (Villavicencio, Meta); 121 indivíduos de machaco (Simarouba amara Aubl.) de 6,2 anos de idade foram avaliados por meio de 34 descritores de planta, folha e fruto. Os dados qualitativos e quantitativos foram analisados por meio da análise de correspondência múltipla e da análise de componentes principais, respectivamente, a fim de reduzir a dimensionalidade dos dados, seguida da análise de cluster, por meio do algoritmo WARD, para agrupamento dos indivíduos. Os resultados obtidos permitiram identificar que o volume do tronco apresentou a maior variabilidade (31,13%) e as variáveis quantitativas associadas ao tamanho e diâmetro da copa, diâmetro do caule, volume do tronco, comprimento e largura da folha, total a altura e a copa apresentaram as maiores correlações com os três primeiros componentes principais (57,82%). Foram obtidos nove aglomerados que atendem a 95,73% da variabilidade original e nos quais foram encontrados indivíduos potencialmente úteis para fins madeireiros, arboricultura e sistemas agroflorestais. O formato do caule, a altura da ramificação e bifurcação, o tipo de casca e o hábito de frutificação apresentaram variação mínima nos indivíduos, ao contrário da retidão do caule e do formato da copa.

Tuberculosis peritoneal, un diagnóstico diferencial para ascitis en cirrosis / Peritoneal tuberculosis, a differential diagnosis for ascites in cirrhosis

Resumen Se presenta el caso de un paciente con antecedente de consumo crónico de alcohol, que consultó por dolor abdominal inespecífico, fiebre intermitente no cuantificada y pérdida de peso, con posterior aumento del perímetro abdominal. Se encontró ascitis y hallazgos en imágenes que sugerían cirrosis. El estudio del líquido ascítico fue no hipertensivo con predominio de linfocitos y niveles de adenosina-desaminasa (ADA) elevados. La ecografía y tomografía de abdomen mostraron el engrosamiento del peritoneo y la biopsia peritoneal por laparoscopia fue compatible con enfermedad granulomatosa, con reacción en cadena de la polimerasa (PCR) positiva para Mycobacterium tuberculosis en un paciente sin otras causas de inmunosupresión. Este caso muestra la necesidad de mantener una alta sospecha clínica de TB en patologías abdominales con clínica inespecífica, aun en pacientes sin inmunocompromiso claro.

Abstract This is the case of a patient with a history of chronic alcohol consumption, who consulted for nonspecific abdominal pain, intermittent fever, and weight loss, with subsequent increase in the abdominal perimeter. Ascites and imaging findings suggestive of cirrhosis were found. The study of ascitic fluid was non-hypertensive with a predominance of lymphocytes and elevated adenosine deaminase (ADA) levels. Ultrasound and abdominal tomography showed peritoneal thickening. Laparoscopic peritoneal biopsy was compatible with granulomatous disease, with positive PCR for Mycobacterium tuberculosis in a patient with no other causes of immunosuppression. This report shows the importance of keeping a high index of suspicion for TB in patients with abdominal pathology, even in those without evident inmunocompromise.

Sensitivity and specificity of four screening sleep-disordered breathing tests in patients with and without cardiovascular disease.

OBJECTIVES: Polysomnogram is the gold standard for the diagnosis of sleep-disordered breathing (SDB); a sensitive and specific alternative strategy would be ideal, due to its low availability, and screening patients at high risk of OSA is very important. This study aimed to determine the operating characteristics of screening tests in patients with and without cardiovascular disease (CVD). MATERIAL AND METHODS: Epworth sleepiness scale (ESS), Berlin, STOP-bang and Pittsburgh sleep quality index (PSQI) were applied in adults with and without cardiovascular disease in three Colombian cities, as well as anthropometric measurements and a polysomnogram. Operating characteristics were calculated for each test and the best cut-off values in patients with and without CVD were obtained. RESULTS: 964 patients (median age: 58), 662 with and 302 without CVD were included. The prevalence for SDB (AHI =5) were 43.4 % (OSA), 16.2% (central apnea), and 12.4 % (other). In patients without CVD, the highest sensitivity for OSA and central apnea was for PSQI (80-85%). The highest specificity was for STOP-bang (68%) and Berlin (78.6%). In CVD the best sensitivity was for PSQI (81.9%) followed by Berlin (71.9%) and the best specificity for STOP-bang (82.1%). No isolated questionnaire showed good diagnostic performance (AUC=0.6) and the cut-off values had no variations except for ESS. CONCLUSION: Screening tests showed low operating characteristics for the diagnosis to SDB, but better performance in patients with CVD. They are not recommended as the only diagnostic test, but they can be useful to guide the initial diagnostic process.

Síndrome de apnea/hipopnea obstructiva del sueño y su asociación con las arritmias cardíacas. Una revisión narrativa de la literatura / Obstructive sleep apnoea / hypopnoea syndrome and its relationship with cardiac arrhythmias. A narrative review of the literature

Resumen El Síndrome de apnea - hipopnea obstructiva del sueño es una enfermedad con compromiso multisistémico, con especial repercusión en el sistema cardiovascular y por tanto con alto impacto en la morbimortalidad general. Se han demostrado múltiples mecanismos fisiopatológicos que explican y sugieren una asociación directa y proporcional al daño generado por esta entidad, en especial para las taquiarritmias, específicamente para fibrilación auricular y también para las bradiarrimias, con mejoría demostrada tras el tratamiento con presión positiva continua de la vía aérea. La asociación con aleteo auricular y arritmias ventriculares ha mostrado resultados contradictorios en algunos estudios, por lo que aún no es tan clara.

Abstract Obstructive sleep apnoea / hypopnoea syndrome is a disease of multisystemic involvement, with particular repercussions on the cardiovascular system, and thus a high impact on morbidity and mortality. Several pathophysiological mechanisms have been demonstrated that explain and suggest a direct and proportional relationship to the damaged caused by the condition, especially for tachyarrhythmias, specifically for atrial fibrillation, and also for bradyarrhythmias, with a demonstrated improvement with continuous positive airway pressure. As the association with atrial flutter and ventricular arrhythmias has shown contradictory results in some studies, the relationship is still not clear.

Benefits of the humidified low-flow oxygen therapy in infants with mild-moderate bronchiolitis.

AIMS AND OBJECTIVES: To investigate the clinical benefits of using humidification in low-flow oxygen therapy. Specific objectives were to investigate via an assessment of the number of nasal lavages whether humidification can help to decrease the nasal mucus viscosity, to determine whether it can relieve feeding difficulties by comparing the weight gain in infants, to ascertain whether it can relieve respiratory distress by assessing the heart and respiratory rates and contribute to improved clinical outcomes, measured by the length of stay and oxygen requirements. BACKGROUND: There is no evidence to support the use of humidification in low-flow oxygen therapy as a usual clinical practice in the management of bronchiolitis. DESIGN: A controlled quasi-experimental study. METHODS: A total of 97 infants were included, aged ≤6 months, with bronchiolitis, low-flow oxygen therapy and bronchodilators nebulised with hypertonic saline 3%. Data from the control group (nonhumidified) were gathered from 2010-2012 (49 infants), and data from the group with humidification from 2012-2014 (48 infants). Linear and Poisson regressions were performed adjusting for relevant characteristics of patients. RESULTS: Humidification was shown to be associated with significant reductions in the number of nasal lavages in infants with Sant Joan de Déu Bronchiolitis Scores of BROSJOD≤7, in the heart rate of infants with mixed bronchodilators treatment, and in the length of stay and oxygen requirements of infants with Score BROSJOD≤5. No differences in weight and respiratory rate were found. CONCLUSIONS: Humidification in low-flow oxygen therapy is an effective nursing intervention to improve the clinical outcomes of infants with mild-moderate bronchiolitis. RELEVANCE TO CLINICAL PRACTICE: Humidifying the nasal mucosa can help to reduce the need for professional procedures, oxygen requirements and hospitalisation length. Further research into the economic savings involved is recommended.

Low testosterone levels are related to oxidative stress, mitochondrial dysfunction and altered subclinical atherosclerotic markers in type 2 diabetic male patients.

INTRODUCTION: Low testosterone levels in men are associated with type 2 diabetes and cardiovascular risk. However, the role of testosterone in mitochondrial function and leukocyte-endothelium interactions is unknown. Our aim was to evaluate the relationship between testosterone levels, metabolic parameters, oxidative stress, mitochondrial function, inflammation and leukocyte-endothelium interactions in type 2 diabetic patients. MATERIALS AND METHODS: The study was performed in 280 male type 2 diabetic patients and 50 control subjects. Anthropometric and metabolic parameters, testosterone levels, reactive oxygen species (ROS) production, mitochondrial membrane potential, TNFα, adhesion molecules and leukocyte-endothelium cell interactions were evaluated. RESULTS: Testosterone levels were lower in diabetic patients. Total and mitochondrial ROS were increased and mitochondrial membrane potential, SOD and GSR expression levels were reduced in diabetic patients. TNFα, ICAM-1 and VCAM-1 levels, leukocyte rolling flux and adhesion were all enhanced in diabetic patients, while rolling velocity was reduced. Testosterone levels correlated negatively with glucose, HOMA-IR, HbA1c, triglycerides, nonHDL-c, ApoB, hs-CRP and AIP, and positively with HDL-c and ApoA1. The multivariable regression model showed that HDL-c, HOMA-IR and age were independently associated with testosterone. Furthermore, testosterone levels correlated positively with membrane potential and rolling velocity and negatively with ROS production, VCAM-1, rolling flux and adhesion. CONCLUSIONS: Our data highlight that low testosterone levels in diabetic men are related to impaired metabolic profile and mitochondrial function and enhanced inflammation and leukocyte-endothelium cell interaction, which leaves said patients at risk of cardiovascular events.

The associations between sleep disorders and anthropometric measures in adults from three Colombian cities at different altitudes.

BACKGROUND: Sleep disorders are common but underdiagnosed conditions, which are associated with obesity. In Colombia, the distribution of sleep disorders remains unclear. We aimed to describe the distribution of sleep disorders, according to demographic, geographic and anthropometric characteristics, in adult Colombian populations. METHODS: A multicenter study was conducted with 5474 participants recruited from three Colombian cities at different altitudes. A two-stage cluster sampling method was applied. Participants' mean age was 40.2 years and 53.8% were female. Collected data included demographic information and anthropometric characteristics of adiposity such as body mass index, neck circumference and waist circumference, as well as participants' scores on five scales used to assess sleep disorders. Disorders included sleepiness, obstructive sleep apnea (OSA), insomnia, poor sleep quality and restless legs syndrome; the scales were the Epworth Sleepiness Scale, Berlin questionnaire, STOP-Bang questionnaire, Pittsburgh Sleep Quality Index and diagnostic criteria for the restless legs syndrome set out by the International Restless Legs Syndrome Study Group. RESULTS: Nearly two-thirds of the population reported at least one sleep disorder according to their results on the five scales (59.6% [95%CI 57.4; 61.81)]. This proportion was similar by sex. Prevalence of overweight was 34.8% and of obesity was 14.4%. Sleep disorders were more frequent among those aged 65 years or more (91.11 [95%CI 86.1; 94.43]), those who were obese (83.71% [95%CI 78.94; 87.56]) and those who resided in the cities at the lowest altitude (72.4% [95%CI 70.2; 74.5]). Waist circumference showed a stronger association with sleep disorders among women than among men. CONCLUSIONS: Sleep disorders are common in Colombia, irrespective of sex and geographical location. They are associated with obesity. Abdominal obesity could explain the high frequency of sleep disorders among women. We believe that this part of the study will substantially contribute to the understanding of sleep disorders. Further research is needed to identify key factors behind the high prevalence rates of sleep disorders and obesity in Colombia.

Miopericarditis como manifestación inicial de enfermedad de Still del adulto / Myopericarditis as initial manifestation of adult-onset Still's disease

Se presenta el caso de un hombre de 25 años de edad con cuadro febril persistente, leucocitosis, mialgias y artralgias, en quien se documenta miopericarditis con falla cardiaca aguda asociada. Tras un exhaustivo estudio de fiebre de origen desconocido se hace diagnóstico de enfermedad de Still del adulto.

We report the case of a 25 year-old man with persistent fever, leukocytosis, myalgias and arthralgias; in whom myopericarditis associated with acute heart failure was documented. After an exhaustive study of fever of unknown origin he was diagnosed as adult Still's disease.

Pancreatitis aguda grave: curso clínico, manejo y factores asociados con mortalidad / Severe acute pancreatitis: Clinical course, management, and mortality-associated factors

Objetivo. Describir el curso clínico de los pacientes con pancreatitis aguda en un centro hospitalario de cuarto nivel y explorar los factores de riesgo asociados con la mortalidad. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de cohortes de 71episodios de pacientes que cumplieron los criterios de pancreatitis aguda grave según el consenso internacional de Atlanta de 1992. Se evaluó la información demográfica, los factores de gravedad, el manejo quirúrgico y médico, las complicaciones y la mortalidad. Resultados. La pancreatitis aguda grave corresponde al 42.7 % de los diagnósticos de pancreatitis aguda, una de las mayores reportadas en la literatura científica mundial. Al ingreso, los pacientes presentaron un puntaje de Ranson de 1,9 (desviación estándar, DE, 1,7), un APACHE II de 12,1 (DE, 5,8) y un promedio del índice tomográfico de gravedad (Tomography Severity Index, IST) de 3,5. El 29 % de los pacientes requirió estancia en la unidad de cuidados intensivos y, el 50 %, asistencia respiratoria mecánica; el 52% requirió soporte vasopresor, el 82 % recibió nutrición entérica y el 46,5 % se sometió a cirugía. La mortalidad fue de 32,4 %. Los factores de riesgo relacionados con la muerte fueron falla orgánica al ingreso, necesidad de asistencia respiratoria mecánica, necesidad de hemodiálisis, uso de vasopresores e ingreso a la unidad de cuidado intensivo en las primeras 48 horas. En el análisis multivariado, el uso de vasopresores fue un factor de riesgo independiente para la muerte. Conclusión. Los pacientes con pancreatitis aguda grave requieren un diagnóstico temprano para recibir un manejo precoz e integral que incluya la nutrición entérica. La mortalidad está relacionada con la necesidad de soporte avanzado por falla orgánica.

Objective. To describe the clinical course of patients with acute pancreatitis at a four level of care medical center and to explore mortality-associated factors. Material and methods. Retrospective study of cohorts of 71 episodes of pancreatitis fulfilling the Atlanta 1992 international consensus severe acute pancreatitis criteria. Demographic information, severity factors, surgical and medical management, complications and mortality rate were evaluated. Results. Severe acute pancreatitis represented 42.7% of the diagnoses of acute pancreatitis, one of the highest figures in the world literature. Upon admission, patients presented Ranson criteria of 1.9 (standard deviation, SD, 1.7), APACHE II index of 2.1 (SD, 5.8), and Tomography Severity Index of 3.5. Intensive care unit care was required by 29% of patients, and 50% demanded mechanical respiratory support; 52% required vasopressor hemodynamic support; 82% received enteral nutrition; 45% were submitted to surgery. Mortality rate was 32.4%, a value higher than the reported world scientific literature. Related mortality risk factors were organ failure upon admission, hemodialysis requirement, mechanical ventilatory support requirement, and use of vasopressor agents on admission to the ICU and during the first 48 hours. In the multivariate analysis, the use of vasopressor agents appeared as an independent mortality risk factor. Conclusion. Patients with severe acute pancreatitis demand an early diagnosis in oprder to receive prompt and efficient care, which includes enteral nutrition. Mortality is related with the early requirement of advanced vital support for their organ failure.

Sesquiterpenoid metabolites with antiplasmodial activity from a Caribbean gorgonian coral, Eunicea sp.

A chemical investigation of the Caribbean gorgonian octocoral Eunicea sp. collected along the northwest coast of Puerto Rico has afforded seven new secondary metabolites, 1-7, belonging to several types of sesquiterpenes, including elemane, eudesmane, and germacrane types, along with the known steroidal glycoside 8. Some of the new metabolites, 4-7, carry an unusual ester side chain at the C-6 position. The structures of all compounds, including their relative stereochemistry, were determined by combined spectroscopic methods. The present compounds exhibited a significant inhibitory effect upon the growth of the malarial parasite Plasmodium falciparum.

Rapid onset of Wernicke's encephalopathy following gastric restrictive surgery.

A patient with severe vomiting following gastric banding developed Wernicke's encephalopathy. All neurological disorders disappeared with thiamine treatment. This complication may be prevented by keen awareness, early diagnosis and treatment, in patients with persistent vomiting. Vitamin and mineral supplementation must be taken in patients following bariatric surgery.

Plakortides M and N, bioactive polyketide endoperoxides from the Caribbean marine sponge Plakortis halichondrioides.

From a small specimen of the marine sponge Plakortis halichondrioides collected in Puerto Rico we have isolated the known unsaturated ester methyl (2Z,6R,8R,9E)-3,6-epoxy-4,6,8-triethyl-2,4,9-dodecatrienoate (1) along with the known cyclic peroxide plakortide F (2). In addition, the structures of two new polyketide endoperoxides, namely, plakortide O (3) and plakortide P (4), were fully characterized by spectroscopic and chemical methods. The absolute stereochemistry of plakortide O methyl ester (3a) has been determined by analysis of the (R)- and (S)-MTPA esters of the acyclic derivative 5 obtained by hydrogenolysis. Plakortide O (3) and plakortide P (4) exhibited potent cytotoxicity in the NCI human cancer screening program, whereas plakortide O methyl ester, 3a, displayed strong antimalarial activity against Plasmodium falciparum [corrected].

Massive triiodothyronine intoxication: efficacy of hemoperfusion?

A case of massive accidental triiodothyronine intoxication (1000-fold the usual therapeutic dose, for 8 days) is reported with important disturbances of cardiovascular and central nervous systems that required intensive care support. Serum free triiodothyronine levels were 4789 pmol L(-1) on admittance (normal values, 3.5-6.5 pmol x L(-1)). In the absence of a specific treatment, hemoperfusions were performed but failed to accelerate significantly the decay of blood levels of free triiodothyronine (apparent half-life 25.9 hours; 95% confidence interval: 19.8-37.4 hours). The patient, a young woman, made a satisfactory recovery, in spite of important clinical complications.