El rol del laboratorio en los hallazgos de intoxicación y exposición a monóxido de carbono / The role of the laboratory in findings of carbon monoxide poisoning and exposure

El monóxido de carbono es un gas altamente tóxico que se origina principalmente por la combustión incompleta de combustibles fósiles. La intoxicación presenta síntomas inespecíficos que solapan otras patologías y por lo tanto es indispensable la confirmación mediante la medición de la carboxihemoglobina en sangre. El laboratorio incorporó la determinación en el informe del estado ácido base a partir de octubre del 2018, debido a que previamente el médico debía solicitarla frente a la sospecha de una intoxicación. El objetivo del trabajo fue evaluar si esta medida implementada por el laboratorio contribuyó a mejorar el diagnóstico de intoxicación por CO, analizar las características de los pacientes con COHb mayor o igual a 5% y definir un valor de reporte inmediato para la COHb. El 46% de los casos con COHb mayor o igual a 5% no se relacionaban con una intoxicación y/o exposición a CO. De los casos de intoxicación se encontró que el 77% fueron diagnosticados a partir de la sospecha médica y un 23% por hallazgo del laboratorio. Se concluyó que es de mucha utilidad el rol del laboratorio en detectar aquellos casos que no fueron evidentes clínicamente. Existen ciertas patologías como las oncológicas o la enfermedad de Wilson donde se vieron valores elevados de COHb sin presentar intoxicación y se definió finalmente, como valor de reporte inmediato 7% para la COHb. (AU)

Carbon monoxide is a highly toxic gas that originates mainly from incomplete combustion of fossil fuels. Intoxication causes nonspecific symptoms that overlap with other conditions and, therefore, confirmation by measuring blood carboxyhemoglobin is essential. The laboratory incorporated the measurement in the acid-base status report as of October 2018, as it was previously required to be requested by the physician in case of suspected intoxication. The aim of this study was to evaluate whether this measure implemented by the laboratory contributed to the improvement of the diagnosis of CO intoxication, to analyze the characteristics of patients with COHb greater than or equal to 5% and to define an immediate reporting value for COHb. Overall, 46% of the cases with COHb greater than or equal to 5% were not related to CO poisoning and/or exposure. Of the cases of intoxication, 77% were diagnosed based on medical suspicion and 23% on laboratory findings. It was concluded that the laboratory has a useful role in detecting cases that were not clinically evident. There are certain diseases including different types of cancer or Wilson's disease where elevated COHb values were seen without intoxication and finally, 7% for COHb was defined as the immediate reporting value (AU)

Robotic-assisted versus laparoscopic living donor nephrectomy for renal transplantation: a systematic review and meta-analysis.

INTRODUCTION: Renal transplantation remains the definitive treatment for end-stage renal disease. Currently employed minimally invasive techniques include robotic-assisted laparoscopy and laparoscopy. This study aims to determine whether either method provides an advantage. METHODS: Following PRISMA guidelines, a systematic review was conducted. Data were analysed using Review Manager 5.3. RESULTS: A total of 12 studies were included. Operative time and operative bleeding were similar between both approaches, with a mean difference (MD) of 16min (95% confidence interval (CI) -4.06, 37.38; p = 0.11) and 10.44ml (95% CI -43.89, 64.78; p = 0.71), respectively. Robotics had longer warm ischemia time (MD 1.14min; 95% CI 0.65, 1.63; p = 0.00001) but reduced length of stay (LOS) (MD -0.23days; 95% CI -0.45, -0.01; p = 0.04) and pain (MD -1.26 VAS; 95% CI -1.77, 0.75). Similar complication and conversion rates were seen among groups. CONCLUSIONS: Robotic approaches provide a viable alternative to laparoscopic surgery. Operative time, bleeding volumes, complications and conversion rates are similar between both techniques; apparent robotic advantages on LOS and Pain need to be better analysed by future studies.

Operative safety of orthotopic liver transplant in patients with prior transjugular intrahepatic portosystemic shunts: A 20-year experience.

INTRODUCTION AND AIMS: Orthotopic liver transplant (OLT) is the definitive treatment of most types of liver failure. Transjugular intrahepatic portosystemic shunt (TIPS) and portocaval shunt placement procedures reduce the systemic vascular complications of portal hypertension. TIPS placement remains a "bridge" therapy that enables treatment of refractory symptoms until transplantation becomes available. The aim of the present study was to describe the operative impact of TIPS prior to OLT. MATERIALS AND METHODS: A retrospective review was conducted on patients that underwent liver transplant at the Hospital San José within the timeframe of 1999 and February 2020. RESULTS: We reviewed a total of 92 patients with OLT. Sixty-six patients were male and 26 were female, with a mean age of 52 years. Nine (9.8%) of the 92 patients had a TIPS, before the OLT. Preoperative Child-Pugh class, MELD score, and sodium and platelet levels were similar between groups. We found no difference in the means of intensive care unit stay, operative time, or blood transfusions for liver transplant, with or without previous TIPS. There was no significant difference between groups regarding vascular and biliary complication rates or the need for early intervention. The overall one-year mortality rate in the TIPS group was 11%. CONCLUSIONS: TIPS is an appropriate therapeutic bridge towards liver transplant. We found no greater operative or postoperative complications in patients with TIPS before OLT, when compared with OLT patients without TIPS. The need for transfusion, operative time, and ICU stay were similar in both groups.

Proceso de eliminación del mercurio en un hospital público de alta complejidad / Process of mercury elimination from a public tertiary-care hospital

El mercurio (Hg) es un tóxico metálico, ubícuo, con alto impacto en la salud humana y en los ecosistemas. Los efectos adversos sobre la población infantil dependen de la vulnerabilidad de este grupo etario. La toxicidad se manifiesta principalmente por sus conocidos efectos sobre el neurodesarrollo a partir del momento de la concepción hasta la adolescencia. El sector de la salud es una de las principales fuentes de emisión de Hg a nivel mundial. El Hg está presente en gran cantidad de insumos y dispositivos de uso médico en los establecimientos de salud. La rotura y el descarte de estos insumos producen pequeños derrames ocasionando así que este sector contribuya no sólo a alterar la calidad del ambiente laboral sino también, la carga global del tóxico. Un grupo multidisciplinario de profesionales de diferentes áreas comprometido en el cuidado del medio ambiente y la salud infantil trabajó para reemplazar el uso del mercurio en el Hospital Garrahan. Se describe el desarrollo de este proceso en cinco etapas: 1) Diagnóstico; 2) Concientización del personal; 3) Segregación del HG; 4) Reemplazo de insumos; 5) Monitoreo continuo.

Proceso de eliminación del mercurio en un hospital público de alta complejidad / Process of mercury elimination from a public tertiary-care hospital

El mercurio (Hg) es un tóxico metálico, ubícuo, con alto impacto en la salud humana y en los ecosistemas. Los efectos adversos sobre la población infantil dependen de la vulnerabilidad de este grupo etario. La toxicidad se manifiesta principalmente por sus conocidos efectos sobre el neurodesarrollo a partir del momento de la concepción hasta la adolescencia. El sector de la salud es una de las principales fuentes de emisión de Hg a nivel mundial. El Hg está presente en gran cantidad de insumos y dispositivos de uso médico en los establecimientos de salud. La rotura y el descarte de estos insumos producen pequeños derrames ocasionando así que este sector contribuya no sólo a alterar la calidad del ambiente laboral sino también, la carga global del tóxico. Un grupo multidisciplinario de profesionales de diferentes áreas comprometido en el cuidado del medio ambiente y la salud infantil trabajó para reemplazar el uso del mercurio en el Hospital Garrahan. Se describe el desarrollo de este proceso en cinco etapas: 1) Diagnóstico; 2) Concientización del personal; 3) Segregación del HG; 4) Reemplazo de insumos; 5) Monitoreo continuo

[Irritable bowel syndrome: frequency and phylogenetic relationship of Blastocystis sp. from Mexican patients]. / Síndrome de intestino irritable: frecuencia y relación filogenética de Blastocystis sp. de pacientes mexicanos.

INTRODUCTION: Recent studies reported increased presence of Blastocystis in patients with Irritable Bowel Syndrome (IBS) and an etiologic role has been proposed. The pathogenic role of Blastocystis is controversial, because it is frequently found not only in individuals with enteric symptoms but also in healthy and asymptomatic subjects. Furthermore, there are few studies of blastocistosis in Mexico. OBJECTIVE: To assess the frequency of Blastocystis sp. in IBS patients using molecular techniques and to describe its phylogenetic relationship with sequences of other countries. METHODS: IBS patients according to Rome III criteria were enrolled. In all patients evaluations included: colonoscopies, coproparasitoscopic studies, coproculture, fecal virus screening. PCR and sequencing for Blastocystis sp. were also performed. RESULTS: We recruited 11 men and 51 women with a mean age of 45.6 (SD ± 15.7) years. Eighty-six percent of the IBS patients presented a normal colonoscopy, 8% showed polyps and 6% diverticular disease. Blastocystis sp. was identified in 25% patients (all of them with normal colonoscopy), while two patients had Endolimax nana and Entamoeba histolytica/E. dispar, respectively. Phylogenetic analysis showed that major sequences of Mexican carriers clustered together with sequences of parasites from Japan and Denmark; furthermore, two sequences from IBS patients were grouped in a single cluster. CONCLUSIONS: Blastocystis sp. was identified in 25% of the IBS patients. Our data support the hypothesis of clonal lineages in distinct geographical areas in the world.

Taenia solium: current understanding of laboratory animal models of taeniosis.

Neurocysticercosis is a public health problem in many developing countries and is the most frequent parasitic disease of the brain. The human tapeworm carrier is the main risk factor for acquiring neurocysticercosis. Since the parasite lodges only in the human intestine, experimental models of Taenia solium taeniosis have been explored. Macaques, pigs, dogs, cats and rabbits are unsuccessful hosts even in immunodepressed status. By contrast, rodents are adequate hosts since tapeworms with mature, pregravid and, in some cases, gravid proglottids develop after infection. In this review, information that has been generated with experimental models of taeniosis due to T. solium is discussed. Initially, the use of the model for immunodiagnosis of human taeniosis and evaluation of intervention measures is summarized. Next, descriptions of tapeworms and comparison of hamsters, gerbils and other mammals as experimental models are discussed, as well as data on the humoral immune response, the inflammatory reaction and the production of cytokines associated to Th1 and Th2 responses in the intestinal mucosa. Finally, evaluation of protection induced against the development of tapeworms by recombinant T. solium calreticulin in hamsters is summarized and compared to other studies.

Predictores de mortalidad intrahospitalaria y hospitalización prolongada en la insuficiencia cardíaca: resultados preliminares del registro nacional de insuficiencia cardíaca. Grupo ICARO / Predictors of hospital death and prolonged hospitalization in patients with cardiac failure in Chilean hospitals

Background: Heart failure (HF) is one of the most common causes for hospital admission. Aim: To evaluate clinical predictors of mortality and prolonged hospital stay among patients admitted for HF in Chilean hospitals. Patients and Methods: Prospective registry of 14 centers. Patients admitted for HF in functional class III and IV were included. Epidemiological, clinical data, functional class, decompensation cause, electrocardiogram, echocardiogram, treatment and evolution were registered. The endpoint was hospital death and hospital stay greater than 10 days. Results: Data from 646 patients (mean age 69±13 years, 56 percent men) was collected. The main etiologies of HF were hypertensive in 29.6 percent, ischemic in 27.1 percent and valvular in 20 percent. Mean hospital stay was 10±9 days and mortality was 5.6 percent. Independent predictors of death and prolonged hospital stay were serum sodium <130 mEq/L at admission (odds ratio (OR) 2.6, confidence interval (CI)= 1.2-5.9), serum albumin <3 g/dL (OR 3.2, CI= 1.42-7.2) and a history of hypertension (OR 1.98, CI=1.1-3.85). The model predicted correctly the occurrence of the endpoint in 67 percent of cases. Conclusions: In patients admitted for worsening HF, low serum sodium, decreased serum albumin on admission and a history of hypertension increase the risk for in-hospital death and prolonged hospital stay.

[Clinical-pathologic characteristics of uveal melanoma in Mexican patients under thirty years old]. / Características clínico-patológicas del melanoma uveal en pacientes mexicanos menores de 30 años de edad.

PURPOSE: To analyze the clinicopathologic characteristics of uveal melanoma in Mexican patients under thirty years old. METHODS: We reviewed the cases from the Service of Ophthalmic Pathology with histopathologic diagnosis of uveal melanoma from 1957 to March 2002. The data analyzed were: age, gender, affected eye, clinical diagnosis, size, cellular type, mitotic index, lymphocytic infiltrate, vascular pattern, necrosis, vascular and/or intraocular invasion and orbital extension. RESULTS: We reviewed 122 cases diagnosed with uveal melanoma, and 14 patients were younger than 30 years old (11.4%). The mean age was 21.7 years, with female preponderance. Preoperative clinical diagnoses were uveal melanoma in 92.8%, most of the cases originated from choroid. The most frequent cellular type was spindle cells and 3 and 4 Folberg's vascular patterns. CONCLUSIONS: Our results suggest that the clinicians should consider uveal melanoma more frequently as another differential diagnosis in patients under thirty years with an intraocular tumor. The histological characteristics found have been correlated with a better prognosis.

Características clínico-patológicas del melanoma uveal en pacientes mexicanos menores de 30 años de edad / Clinical-Pathologic characteristics of uveal melanoma in mexican patients under thirty years old

Objetivo: Determinar las características clínicopatológicas del melanoma uveal en pacientes mexicanos menores de treinta años. Métodos: Se revisaron los casos del Servicio de Patología Oftálmica con diagnóstico histopatológico de melanoma uveal de 1957 a marzo de 2002. Se analizaron: edad, sexo, ojo afectado, diagnóstico clínico, tamaño, tipo celular, índice mitótico, infiltrado linfocitario, patrón vascular, necrosis, invasión vascular y/o de estructuras intraoculares así como extensión orbitaria. Resultados: De 122 casos con diagnóstico de melanoma uveal, 14 correspondieron a pacientes menores de 30 años (11,4%). La edad promedio fue de 21,7 años, con predominio en mujeres. El diagnóstico clínico preoperatorio fue melanoma uveal en un 92,85 %, originándose en coroides en la mayoría de los casos. El tipo celular más frecuente fue el de células fusiformes, con predominio de los patrones vasculares 3 y 4 de Folberg. Conclusiones: Nuestros resultados sugieren que los clínicos deben considerar el melanoma uveal como un diagnóstico diferencial más en pacientes menores de 30 años con un tumor intraocular. Las características histológicas observadas se han correlacionado con un mejor pronóstico(AU)

Purpose: To analyze the clinicopathologic characteristics of uveal melanoma in Mexican patients under thirty years old. Methods: We reviewed the cases from the Service of Ophthalmic Pathology with histopathologic diagnosis of uveal melanoma from 1957 to March 2002. The data analyzed were: age, gender, affected eye, clinical diagnosis, size, cellular type, mitotic index, lymphocytic infiltrate, vascular pattern, necrosis, vascular and/or intraocular invasion and orbital extension. Results: We reviewed 122 cases diagnosed with uveal melanoma, and 14 patients were younger than 30 years old (11.4%). The mean age was 21.7 years, with female preponderance. Preoperative clinical diagnoses were uveal melanoma in 92.8%, most of the cases originated from choroid. The most frequent cellular type was spindle cells and 3 and 4 Folberg´s vascular patterns. Conclusions: Our results suggest that the clinicians should consider uveal melanoma more frequently as another differential diagnosis in patients under thirty years with an intraocular tumor. The histological characteristics found have been correlated with a better prognosis(AU)

Variations in rat biochemical parameters after buckshot implant.

Twenty eight albino Wistar rats were implanted with two 100 mg lead spheres: 14 received the implant in the peritoneum (P) and 14 in the thigh (T). Variations in the activity of delta-aminolevulinic dehydratase (ALAD), of urinary delta-aminolevulinic acid (ALAU), of hematoporphyrins (HP) and of lead blood levels (BPb) were then determined at 30, 60 and 90 days with respect to basal values. Parallel determinations were performed by the same schedule in 7 rats implanted with two glass beads and in 8 sham animals receiving surgical incision alone. Techniques employed for ALAD were Berlin and Schaller; for ALAU, Tomokuni and Ogata; for HP, Piomelli; and for BPb, atomic absorption spectrophotometry. As indicators of lead presence, HP and ALAU proved better, both in P and in T rats. The replacement of lead buckshot for small game hunting by other less toxic elements is recommended.

[Radical hysterectomy in stage 1-B-1 cervical cancer]. / Histerectomía radical en cáncer de cérvix estadio 1-B-1.

From 1980 to 1991 were received 6,295 patients diagnosed as invasive cervical cancer at the Instituto Nacional de Cancerología of México; from this group, 884 cases were considered as stage IB (12.76%) and 133 cases, adenocarcinoma in 10, adenosquamous carcinoma in 6 and minimal deviation adenocarcinoma (malignant adenoma) in one case. Eighty percent of cases had a less than 2 cm tumor size. Thirteen cases had metastatic pelvic lymph nodes. Mean age 46 years (range 28-64 years), mean operatory time 4:50 hours (range 3-15 hours), average of hemorrhage 1,500 ml (range 300 to 5,000 ml). One patient died from no related cause. Bladder malfunction was observed in 8.4% and uro-vaginal fistula in 6.9% of the cases. Thirteen patients experimented tumor relapsing after 8 to 22 months of follow up. Only 3 out of 7 from that with tumor relapsing were saved with whole pelvic radiotherapy. One hundred-fifteen patients are alive and well after 63 months mean follow-up. Radical hysterectomy plus bilateral lymphadenectomy is an optimal surgical procedure in managing early invasive carcinoma of the cervix uteri.

An oligopeptide transporter is expressed at high levels in the pancreatic carcinoma cell lines AsPc-1 and Capan-2.

Carcinomas of the exocrine pancreas are poorly understood and have a poor prognosis because of their highly malignant nature. Using two human pancreatic cancer cell lines, AsPc-1 and Capan-2, we have investigated avenues that might be useful in targeting the delivery of antineoplastic agents to such cancers. Qualitative RNA PCRs established the presence of the oligopeptide transporter PEPT 1 in these pancreatic cell lines. Northern analysis confirmed the presence of a 3.3-kb transcript. The transporter is normally expressed primarily in small intestinal epithelial cells for nutrient absorption. It is also expressed in a human intestinal cell line, Caco-2. High levels of PEPT 1 protein expression in AsPc-1 and Capan-2, as multiple glycosylated forms (Mr approximately 90,000-120,000), were confirmed by Western immunoblotting, when compared with Caco-2 cell cultures. Absorption of the model dipeptide glycyl-L-sarcosine by AsPc-1 and Capan-2 cells was similar to glycyl-L-sarcosine absorption by Caco-2 cells and a Chinese hamster ovary cell line expressing human PEPT 1 (CHO-PEPT 1). Uptake was pH dependent and inhibited by several di/tripeptides and bestatin, but it remained unaffected by glycine and tetraglycine. Peptide solute transport by AsPc-1 and Capan-2 cells exhibited binding affinities (Kms) similar to those previously reported for PEPT 1, whereas the transport maximal velocity (Vmax) of the AsPc-1 cells was much greater than those of the Capan-2 and Caco-2 cells. Immunomicroscopy demonstrated PEPT 1 protein localized at the plasma membrane and in intracellular vesicular structures, similar to that observed for Caco-2 and CHO-PEPT 1 cells. These data suggest that the pancreatic cancer cells AsPc-1 and Capan-2 express surprisingly high levels of a solute transporter that was previously thought to be restricted in function to the absorption of nutrients from the small intestine.

Excreción urinaria de mercurio en sujetos sanos no expuestos laboralmente: valores en la población del área de Buenos Aires (Argentina) / Mercury urinary excretion in healthy people not occupationally exposed population values in Buenos Aires (Argentina)

Se estudiaron los niveles de excreción urinaria de mercurio en 220 sujetos sanos, de ambos sexos, no expuestos laboralmente a dicho metal. Las determinaciones se efectuaron por Espectrofotometría de Absorción Atómica, técnica del vapor frío. Los valores obtenidos fueron procesados por un test no paramétrico, obteniendose un rango de 0 a 14 *g/l para el 95%de la población estudiada

Excreción urinaria de mercurio en sujetos sanos no expuestos laboralmente: valores en la población del área de Buenos Aires (Argentina) / Mercury urinary excretion in healthy people not occupationally exposed population values in Buenos Aires (Argentina)

Se estudiaron los niveles de excreción urinaria de mercurio en 220 sujetos sanos, de ambos sexos, no expuestos laboralmente a dicho metal. Las determinaciones se efectuaron por Espectrofotometría de Absorción Atómica, técnica del vapor frío. Los valores obtenidos fueron procesados por un test no paramétrico, obteniendose un rango de 0 a 14 *g/l para el 95%de la población estudiada

The capacity to develop maternal behavior is enhanced during aging in rats.

The induction of maternal behavior (MB) in response to stimulation by pups was studied in aged rats (19-20 months old). We used virgin female rats, neonatally androgenized female rats and male rats. Both groups of female rats showed a constant estrous vaginal smear. Maternal responsiveness was compared with that of young rats (3-4 months old). Normal and androgenized female aged rats showed a very high percentage of immediate maternal responsiveness and 100% of the rats were fully maternal within 24 hr of testing. The percentage of cyclic and androgenized young rats showing MB were significantly lower. Chronic ovariectomy performed 17 months before testing but not acute ovariectomy abolished MB. Estrogen treatment (5 micrograms 15 hours before pup presentation) to chronically ovariectomized aged rats was not sufficient to reestablish significantly the capacity of the normal female aged rats to become short-latency maternal. Young and aged male rats showed no difference in maternal responsiveness to the presence of foster pups. The percentage of maternal aged male rats was significantly lower than that of the normal and androgenized aged female rats, whereas young male and female rats showed a similar level of MB, indicating a sex difference in the development of MB with age. In conclusion the high percentage of rats becoming maternal and the short-latency maternal responsiveness in aged female rats appears to be the result of a prolonged estrogen and/or prolactin stimulation.

Maternal behavior in cyclic and androgenized female rats: role of ovarian hormones.

A comparative study on the induction of maternal behavior (MB) in response to pups was carried out in cyclic and androgenized rats. Moreover, the effects of exposure to ovarian hormones on the induction of MB in response to pups were studied in cyclic and androgenized rats. A high percentage of androgenized and proestrus rats displayed MB after 48 hr of exposure to pups (87.9% and 87.5% respectively). Diestrus day-1 rats were significantly less maternal (37.5%). Ovariectomy did not impair MB in androgenized rats. High serum progesterone levels induced in androgenized rats by treatment with 10 I.U. of HCG (40 hours before pup presentation) or with progesterone silastic implants prevented the onset of MB. Ovariectomy performed 8 hours before HCG administration restored MB. When behavioral testing began 72 hours after HCG treatment, 75% of the rats were maternal 12 hr after exposure to pups. This rapid onset of MB in proestrus and androgenized rats appeared to be estrogen dependent. The presence of progesterone inhibited the maternal response of androgenized rats.