Correlación de los días de estancia hospitalaria con el índice neutrófilo-linfocítico en pacientes con diagnóstico de angina de Ludwig / Correlation of the days of hospital stay with the neutrophillymphocyte ratio in patients with a diagnosis of Ludwig's angina: pilot study

Introducción: El objetivo del presente estudio es correlacionar los días de estancia hospitalaria con el índice neutrófilo-linfocitico (INL) como biomarcador, en los pacientes con diagnóstico de angina de Ludwig que fueron admitidos en urgencias. Pacientes y métodos: Se realizó una búsqueda en los expedientes clínicos del hospital, donde solo se obtuvieron los que tenían diagnóstico de angina de Ludwig desde junio de 2016 hasta junio de 2020, y que cumplieran con los criterios de selección. Posteriormente se recabaron los datos sociodemográficos, días de hospitalización, biometría hemática y valores de neutrófilos y linfocitos para su posterior análisis estadístico. Resultados: Obtuvimos 21 pacientes (9 mujeres y 12 hombres). La edad promedio fue de 43,1 años (rango: 27-70 años). Se transformó la variable de días de hospitalización: en corta estancia hospitalaria aquellos pacientes que estuvieron hospitalizados 5 días o menos; y los de larga estancia hospitalaria aquellos pacientes que estuvieron hospitalizados 6 días o más, para el INL se consideró un índice alto aquellos pacientes que se encontraran con un INL ≥ 6 y un índice bajo aquellos pacientes con un índice ≤ 5, tomando en cuenta el punto de corte con respecto a estudios previamente realizados. Se observó que aquellos pacientes con un INL alto tuvieron una estancia hospitalaria larga, y de acuerdo con los resultados obtuvimos significación estadística (p = 0,02). Conclusiones: El INL parece ser un buen biomarcador para predecir los días de estancia hospitalaria de los pacientes con angina de Ludwig. Sin embargo, se necesitan más estudios para confirmar nuestros resultados. (AU)

Introduction: The aim of this study is to correlate the number of days of hospital stay with the neutrophil-lymphocyte index (NLI) as a biomarker in patients diagnosed with Ludwig's angina who were admitted to the emergency department. Patients and methods: A search was conducted in the hospital's medical records, where only those with a diagnosis of Ludwig's angina from June 2016 to June 2020 and that met the selection criteria were obtained. Afterwards, sociodemographic data, days of hospitalization, hematological parameters, and values of neutrophils and lymphocytes were collected for subsequent statistical analysis. Results: We obtained 21 patients (9 females and 12 males). The average age was 43.1 years (range: 27-70 years). The variable of days of hospitalization was transformed into: short hospital stay for patients who were hospitalized for 5 days or less, and long hospital stay for patients who were hospitalized for 6 days or more. For the NLI, a high index was considered for patients with an NLI ≥ 6 and a low index for patients with an NLI ≤ 5, taking into account the cut-off point with respect to previously conducted studies. We observed that patients with a high NLI had a long hospital stay and according to the results, we obtained statistical significance (p = 0.02). Conclusions: The NLI appears to be a good biomarker for predicting the number of days of hospital stay for patients with Ludwig's angina. However, more studies are needed to confirm our results. (AU)

Prevención de la transmisión vertical y efectos secundarios de la terapia anti-retroviral en hijos nacidos de madres seropositivas para VIH en el área Sur-Oriente de Santiago, Chile: perspectiva de 15 años / Prevention of vertical transmission and side effects of antiretroviral therapy in children born to HIV-positive South Eastern area of Santiago, Chile: 15-years perspective

Antiretroviral therapy (ART) has shown to be an effective measure in decreasing HIV vertical transmission (VT). Nevertheless, it is not free from adverse effects in the newborn: risk of prematurity, low birth weight, metabolic disorders, among others. Despite the importance of the subject, there are few national data that analyze the problem. We performed a retrospective analysis of a cohort of HIV positive mother/child binomial, followed between 1995 and 2010. Ninety-four pregnancies and 96 children (2 twin pregnancies) were analyzed. The rate of VT was 2.1%. Adverse effects attributed to ART were found on 85.4% of the newborn; highlighting the presence of anemia (70.8%) and several metabolic disorders [elevated lactate without acidosis (29.2%), lactic acidosis (12.5%), hyperkalemia (14.6%), metabolic acidosis (9.4%)]. Maternal exposure to protease inhibitors proved to be an independent risk factor for the development of metabolic disorders in newborns (OR 0.15 [0.04-0.48], p < 0.01). In our series, ART was effective in reducing the VT, however exposed newborns showed a high frequency of adverse effects, so it is advisable to implement programs for monitoring these patients to prevent sequelae.

La terapia anti-retroviral (TARV) es efectiva en disminuir la transmisión vertical (TV) del VIH, pero no está exenta de efectos adversos en los recién nacidos: riesgo de prematurez, bajo peso al nacer, alteraciones metabólicas y otros. Pese a lo relevante del tema, existen pocos datos nacionales que analicen el problema. Realizamos un estudio observacional, retrospectivo, de una serie de binomios madre infectada por VIH/hijo atendidos entre los años 1995 y 2010. Se analizaron 94 embarazos y 96 hijos (2 embarazos gemelares). La tasa de TV fue 2,1%. De los recién nacidos, 85,4% presentó efectos adversos atribuibles a la exposición a TARV destacando la presencia de anemia (70,8%) y alteraciones metabólicas varias [hiperlactacidemia sin acidosis (29,2%), acidosis láctica (12,5%), hiperkalemia (14,6%) y acidosis metabólica (9,4%). La exposición materna al uso de IP demostró ser un factor de riesgo independiente para el desarrollo de alteraciones metabólicas en los recién nacidos (OR 4 [1,58-10,12], p 0,003). En nuestra serie, la TARV demostró ser efectiva en reducir la TV. Sin embargo, los recién nacidos expuestos presentaron alta frecuencia de efectos adversos, por lo que es recomendable la implementación de programas de seguimiento de estos pacientes para prevenir secuelas.

[Prevention of vertical transmission and side effects of antiretroviral therapy in children born to HIV-positive South Eastern area of Santiago, Chile: 15-years perspective]. / Prevención de la transmisión vertical y efectos secundarios de la terapia anti-retroviral en hijos nacidos de madres seropositivas para VIH en el área Sur-Oriente de Santiago, Chile: perspectiva de 15 años.

Antiretroviral therapy (ART) has shown to be an effective measure in decreasing HIV vertical transmission (VT). Nevertheless, it is not free from adverse effects in the newborn: risk of prematurity, low birth weight, metabolic disorders, among others. Despite the importance of the subject, there are few national data that analyze the problem. We performed a retrospective analysis of a cohort of HIV positive mother/child binomial, followed between 1995 and 2010. Ninety-four pregnancies and 96 children (2 twin pregnancies) were analyzed. The rate of VT was 2.1%. Adverse effects attributed to ART were found on 85.4% of the newborn; highlighting the presence of anemia (70.8%) and several metabolic disorders [elevated lactate without acidosis (29.2%), lactic acidosis (12.5%), hyperkalemia (14.6%), metabolic acidosis (9.4%)]. Maternal exposure to protease inhibitors proved to be an independent risk factor for the development of metabolic disorders in newborns (OR 0.15 [0.04-0.48], p < 0.01). In our series, ART was effective in reducing the VT, however exposed newborns showed a high frequency of adverse effects, so it is advisable to implement programs for monitoring these patients to prevent sequelae.

Abnormal expression and function of Dectin-1 receptor in type 2 diabetes mellitus patients with poor glycemic control (HbA1c>8%).

Dectin-1 is a key innate receptor involved in various cellular responses and may have a direct role in chronic inflammatory conditions such as type 2 diabetes mellitus. The aim of this work was to evaluate the expression and function of Dectin-1 in peripheral blood mononuclear cells from T2D patients. Dectin-1 expression was analyzed by flow cytometry and RT-PCR in monocytes and lymphocyte subpopulations from T2D patients (n=34) and healthy subjects (n=29). Functional assays were used to assess cytokine synthesis, ROS levels and oxidative stress ratio. We found increased expression (MFI) of Dectin-1 in monocytes from T2D patients. Significantly higher Dectin-1 expression was also detected in CD4(+) T, CD8(+) T, B cells and NK cells from T2D patients compared to controls. In contrast, monocytes from T2D patients with poor glycemic control (HbA1c>8%) showed a diminished percentage of Dectin-1(+)/TLR2(+) cells. Negative correlations between the percent of Dectin-1(+)/TLR2(+) cells and fasting plasma glucose levels (FPG) and HbA1c levels were found. A significant reduction in basal levels of IL-10 was observed in patients with poor glycemic control (HbA1c>8%) compared to patients with appropriate glycemic control (HbA1c≤6.5%) and healthy controls, an effect that was not observed in monocytes stimulated with zymosan. Higher ROS levels in zymosan-stimulated cells from patients with poor glycemic control positively correlated with FPG levels, and the oxidative stress ratio was higher in T2D cells compared with controls. Our data indicate that Dectin-1 may be involved in the abnormal immune responses that are observed in patients with T2D.

Visibilidad de la web hospitalaria iberoamericana. Perspectiva de su actividad científica en internet / Visibility of the scientific activity of the Iberoamerican Hospitalary net via the web site

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[Neurosyphilis in the patients with and without HIV infection: description and comparison of two historical cohorts]. / Neurosífilis en pacientes portadores y no portadores de VIH: descripción y comparación de dos cohortes históricas.

Neurosyphilis follows a more aggressive and different clinical course in HIV-infected patients compared to patients with normal immunity. Two historical series of patients with a diagnosis of neurosyphilis between 1995 and 2008 were compared: they included a group of 15 patients with y and 28 patients without HIV infection. Probability of neurosyphilis in patients with positive serum VDRL was increased in patients infected with HIV compared to HIV negative patients (OR: 62.37 IC:95% (32.1-119.1) p value:< 0,001). Predominant clinical manifestations in neurosyphilis in the HIV negative group were ocular abnormality, vascular encephalic and spinal cord lesions. In the HIV positive group, they were fever, ocular abnormalities and headache. There were no differences in cerebrospinal fluid characteristics between both groups. Neurosyphilis was diagnosed even in patients with blood VDRL of < 1:32, that happened in 17.8% of the HIV positive patients with blood and in 60% of t he HIV negative patients. Penicillin sodium given at dose >or= than 18.000.000 IU/day IV during 14 days was the most common treatment. In patients with clinical neurosyphilis, 93% of HIV negative group, and 54.2% of HIV positive group had persistent neurological after-effects. Three HIV positive patients died due to causes not related to neurosyphilis.