Microsurgical reconstruction in limb salvage due to a giant cell tumor of the distal radius. Case report.

The giant cell tumor of bone is one of the most controversial neoplasms due to growth patterns that may present. The case reported shows a very aggressive tumor in a classic location, but key to hand function. Rather than treat with radical surgery, was planned and performed a wide resection with an ulnar-carpus arthrodesis and microsurgical reconstruction of the defect throught an anterolateral thigh flap. The multidisciplinary approach of bone neoplasms produce a positive impact on patients.

El tumor óseo de células gigantes es una de las neoplasias más controversiales debido a los patrones de crecimiento que pueden presentar. El caso reportado muestra un tumor muy agresivo en una localización clásica, pero clave para la función de la mano. En lugar de tratarla mediante cirugía radical, se planeó y realizó una resección amplia con artrodesis cúbito-carpiana y la reconstrucción microquirúrgica del defecto mediante un colgajo anterolateral de muslo. El abordaje multidisciplinario de las neoplasias óseas repercute positivamente en los pacientes.

Manejo y administración de hemoderivados por personal de enfermería en un hospital de segundo nivel / Handling and management of blood-derived products by the nursing staff in a second level hospital

Introducción: El manejo y administración de hemoderivados es una actividad que realiza el personal de enfermería, por lo cual es de gran importancia tener presente que un uso inadecuado de éstos puede tener consecuencias graves en los pacientes, siendo fundamental el buen desempeño del personal de enfermería para la práctica segura. Objetivo: Evaluar el desempeño de enfermería en el manejo y administración de hemoderivados en un hospital de segundo nivel. Métodos: Estudio de diseño transversal. Se incluyeron enfermeras durante el 1º Enero al 30 junio del 2013. Se utilizó un instrumento validado que consta de 4 criterios con 27 ítems de respuestas dicotómicas para identificar el desempeño en el manejo y ministración de hemoderivados. La población fue dividida por categoría contractual. Análisis estadístico: prueba Chi-cuadrada y/ exacta de Fisher. Resultados: Se incluyeron un total de 110 observaciones a personal de enfermería que administró hemoderivados. Se obtuvo un índice de eficiencia global parcial (IEG) parcial a excelente de 64.5%. No se encontró asociación en el turno (p=0.16), servicio (p=0.31) y/o categoría contractual (p=0.25). Los porcentajes de excelente en el IEF fueron bajos (por turno: matutino y nocturno de 10 y 13 respectivamente, medicina interna y cirugía general 5 y 7%, y conforme a la categoría contractual, la enfermera general obtuvo en excelente sólo el 7.5%). Conclusiones: Nuestros resultados nos alertan para implantar programas de capacitación a enfermeras, para otorgar atención de calidad, disminuyendo los riesgos que comprometan la vida del paciente.

Introduction: Handling and managing blood-derived products is a nursing staff activity and thus, it is very important to keep in mind that an inadequate handling of these products can have serious consequences on patients. Therefore, a safe practice from the nursing staff is fundamental. Objective: To assess the nursing performance related to the handling and management of blood-derived products in a second level hospital. Methods: A transversal study design. Nurses were observed from January 1 to June 30, of 2013. A validated instrument with 27 dichotomy-items, and based on 4 criteria, to assess the handling and management of blood-derived products was used. The population was divided by contractual category. Statistical analysis: Chi square and/or Fisher exact test. Results: A total of 110 observations to the nursing staff handling and managing blood-derived products were included. An index of global efficiency (IGE) of partial to excellent of 64.5% was obtained. No associations were found with shift (p=.16), service (p=.31) and/or contractual category (p=.25). The percentages of excellent in the IEF were low (per shift: morning and night of 10 and 13 respectively; per service: internal medicine and general surgery 5 and 7%, and according to the contractual category, overall excellent nurse obtained only 7.5%). Conclusions: Our results encourage us to foster training programs for nurses in order to enhance the quality of care and also decrease the life risks on the patients.

Aislamiento y caracterización de las células madre mesenquimales de la pulpa dentaria humana / Isolation and characterization of stem cells mesenchymal of human dental pulp

Las células madre mesenquimales de la pulpa dentaria han surgido como una herramienta promisoria en la medicina regenerativa. El objetivo de la presente investigación es establecer el cultivo de las células madre mesenquimales de la pulpa dentaria humana. Estas fueron aisladas de terceros molares retenidos de pacientes entre 15 y 24 años, con técnica de disgregación enzimática y cultivadas en medio DMEM-F12, suplementado con 15% de SFB , 100 ?M L-ácido ascórbico 2-fosfato, 2 mM L-glutamina, 100 U/mL de penicilina, 100 µg/mL de estreptomicina y 2 µg/mL de anfotericina B . Las células fueron observadas diariamente bajo microscopio. Pruebas inmunohistoquímicas mostraron en las poblaciones de células aisladas la existencia de células mesenquimales STRO-1+, marcador de células madre mesenquimales, también expresaron CD146+ y no expresaron CD45-, marcador de células hematopoyéticas. Las células aisladas mostraron capacidad de autorrenovación y eficiencia de formación de colonias. En el presente estudio, en las poblaciones de células aisladas se identificaron células con características de células madre mesenquimales, como su capacidad de adherirse a las placas plásticas en cultivo, formar colonias altamente proliferativas, su morfología fusiforme y la expresión consistente de marcadores de superficie que caracteriza células madre mesenquimales adultas de pulpa dentaria. Sin embargo, faltaría determinar su capacidad de diferenciación para cumplir con los criterios básicos para definirlas como células madre

Mesenchymal stem cells dental pulp-derived have emerged as a promising tool in regenerative medicine. The objective of the present investigation is to establish the culture of mesenchymal stem cells of dental pulp human. The dental pulp mesenchymal cells were isolated from impacted third molars of patients between 15-24 year-old. The dental pulp tissue was extracted, enzymatic digestion technique and culture in medium DMEM-F12, supplemented with 15% de SFB , 100 ?M L-ascorbic acid 2- phosphate, 2 mM L-glutamine, 100 U/mL de penicillin, 100 µg/mL de streptomycin y 2 µg/mL de amphotericin B. Cells were observed daily under microscope. Immunocytochemistry tests showed cells STRO-1+ mesenchymal stem cell marker. These cells also expressed CD146+ and no expressed CD45- hematopoietic stem cell marker. The isolated cells showed self-renewal capabilities and colony-forming efficiency. In this study, isolated cell populations were identified cells with mesenchymal stem cell characteristics, such as its ability to adhere to plastic culture plates, highly proliferative colony forming, fusiform morphology and consistent expression of surface markers characterized adult mesenchymal stem cells from dental pulp. However, missing differentiating their ability to meet the basic criteria to define them as stem cells

Immunogenetics of atopic asthma: association of DRB1*1101 DQA1*0501 DQB1*0301 haplotype with Dermatophagoides spp.-sensitive asthma in a sample of the Venezuelan population.

BACKGROUND: Genes linked to the major histocompatibility complex (MHC), have been implicated in atopic asthma. Asthma is highly prevalent in the Venezuelan population (estimated at 20%) and genetic markers are needed to identify populations at risk and plan intervention strategies. OBJECTIVE: To study the influence of the MHC class I and class II genes in the susceptibility to atopic asthma. METHODS: MHC-class I HLA-A, -C, -B and MHC-class II HLA-DR, -DQ, -DP gene haplotype frequencies were determined in 135 Venezuelan mestizos, 71 belong to 20 atopic asthmatic families and 64 unrelated controls. The index cases were 20 atopic asthmatics with positive skin-prick tests and specific serum immunoglobulin E (IgE) for Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Der f). To ascertain the genes associated with susceptibility to atopy and/or asthma, two control groups were studied, 41 non-atopic subjects with skin-prick negative test, and undetectable levels of specific IgE and 23 non-asthmatic atopic subjects with detectable specific IgE to Der p and Der f. A linkage analysis was performed in those families with two or more atopic siblings (with or without asthma). RESULTS: MHC-class I genes analysis showed that HLA-Cw7 was absent in the asthmatic patients studied, whereas the frequency of this allele was 14.3% in non-atopic controls (P = 0.0 17, PC = 0.19) and 20.8% in the atopic controls (P = 0.0066, PC = 0.07). MHC-class II gene analysis showed a significant increase of the HLA-DRB1*11 in the asthmatic patients compared with non-atopic controls (allele frequencies of 25.6 vs 4.4% P = 0.0017, PC = 0.02). There were no significant differences among asthmatic and atopic controls in the frequency of HLA-DRB1*11 (25.6 vs 17.4%). In contrast, the HLA-DRB1*1101+ haplotypes were significantly higher in asthmatics compared with atopic and non-atopic controls (19.6% vs 2.2% vs 2.3%, PC<0.05). The HLA-DRB1*1101, DQA1*0501, DQB1*0301 haplotype was found significantly increased in the patients vs non-atopic controls (15.4 vs 1.1%, PC< 0.01). The serum levels of specific IgE were detectable in both atopic asthmatics and atopic controls; however, it was higher in atopic asthmatics vs atopic controls Der p (median, 58.7 vs 2.7 kU/L, P<0.001) and Der f (median, 46.9 vs 2.7 kU/L, P<0.001). No linkage between MHC genes and mite-atopy could be documented on informative families with two or more atopic siblings. CONCLUSIONS: We have identified an association between the haplotype HLA-DRB1*1101, DQA1*0501, DQB1*0301 and atopic asthma that confers susceptibility to develop mite-sensitive asthma to atopics (relative risk, RR 8.2), and to non-atopic controls (RR = 15.8) that carry this haplotype. Conversely, the allele HLA-Cw7 was absent in the asthmatics studied and had higher frequencies in the atopic (RR = 0.05) and non-atopic (RR = 0.08) controls. Thus, it may have a protective role for developing atopic asthma in the population studied.

[Metabolic markers of chronic liver disease]. / Marcadores metabólicos de enfermedad hepática crónica.

The association between chronic liver disease and plasmatic lipids and glucidic metabolism was studied. The liver was evaluated with biochemical variables, ultrasound and upper gastrointestinal endoscopy. 12 chronic liver diseases patients and 10 normal were studied. 83.3% of patients showed lipidic abnormalities, 66.6% on the cholesterol levels and 41.7%, reduced HDL. When patients received 100 gr of glucose the response was abnormal in 83.3%. These results were compared with other "liver function test". 75% had abnormal bilirubin, 58.3% abnormal albumin, prothrombin time 58.3%, aminotransferases 75%. Esophageal verices were found in 75% of cases and ultrasound abnormalities in 91.6% (27.3% cirrhosis, 54.4% diffuse abnormal patter and 18.2% splenomegaly). These findings show that lipidic and glucidic metabolism, and ultrasound, in chronic liver diseases are the more frequent abnormalities.

Hydrophile-lipophile balance of alkyl ethoxylated surfactants as a function of intermolecular energies.

The semiempirical MNDO method has been used in order to examine the variation of the molecular properties of hydrocarbons CnH2n + 2 (with 1 < or = n < or = 19) and ethylene oxide chains CH3(CH2CH2O)mCH3 (with 1 < or = m < or = 19) as a function of their molecular length. Least-square fits of those properties have been calculated, along with two mathematical relations between the hydrophile-lipophile balance of alkyl-phenol ethoxylated surfactants and (1) the ratio of molecular lengths between their lipophilic and hydrophilic branches; (2) the intermolecular energies between the molecules of surfactant, water and hexane.

[Epidemiology of viral hepatitis in Venezuela: preliminary results of phase 1. Prevalence in the metropolitan area]. / Epidemiología de la hepatitis viral en Venezuela: resultados preliminares de la etapa 1. Prevalencia en el área metropolitana.

Two different areas of metropolitan zone in Venezuela were studied in relationship to the immunological condition associated with A, B, C and D viral hepatitis in 557 healthy subjects. We performed clinical history with personal information, that was subsequently correlated with results of the hepatitis markers. General results show prevalence different from previous reports: Anti-HAV: 90.84%, HBsAg: 1.62%, Anti-HBc: 10.6%, Anti-HCV: 0.36% y Anti HDV: 0%.

[Comparative efficacy of intradermal and intramuscular active immunization against hepatitis B with a recombinant vaccine. Preliminary results]. / Eficacia comparativa de las vías intradérmica e intramuscular en la inmunización activa contra la hepatitis B con una vacuna recombinante. Resultados preliminares.

Preliminary results of a prospective, comparative and randomized study on 119 sero-negative volunteers with increased risk to acquire hepatitis B, aimed to evaluate the comparative efficacy of a recombinant vaccine administered either intramuscularly or intradermally, are discussed. A short vaccination schedule of three consecutive doses given on months 0, 1 and 2 was used. Distribution by sex and age for both groups was similar. Seroconversion and seroprotection rates were comparable (96% and 96% Vs. 98% and 93%, respectively). The geometric mean titre of anti-HBsAg in individuals immunized via I.M. (155 IU/L) was significantly higher to that of the I.D. group (71 IU/L). On the other hand, the rate of good response (> 100 IU/L) was also higher in the I.M. group (67% Vs. 39%). The percentage of good responder in women was consistently higher than in men for both groups (75% Vs. 13%, respectively). In 68 vaccinees, samples were obtained one year later. The levels of anti-HBsAg and the anamnesic response after a booster of the vaccine are currently being assayed.

[The pH of feces in children with acute diarrhea during the first hours of oral rehydration]. / El pH de las heces en los niños con diarrea aguda durante las primeras horas de rehidratación oral.

We studied 108 children between 3 and 36 months of age with acute diarrhea and dehydration when their diarrhea continued more than 24 hours following initiation of ORT and in whom we measured pH and glucose of stools with strips in all evacuations. According to the average stool pH and glucose in the first six hours, the patients were grouped in pH < or = 5.5 and > 5.5 and a glucose < or = 1+ and > 1+. The pH of stools < or = 5.5 increased significantly (P < or = .0005) in children between > 6-12 hours and by 48 hours, it was similar to those with an initial average pH 6.6 Stool glucose declined considerably between > 12 and 24 hours. Contrary to what we expected to find, children with pH > 5.5 excreted more stools and had a higher ORT intake in the first 24 hours. The systematic studies of pH and glucose of stools did not appear to be useful for children with acute diarrhea who had a satisfactory evolution.