Sex-related differences of fatty acid-binding protein 4 and leptin levels in atrial fibrillation.

AIMS: Adiposity plays a key role in the pathogenesis of atrial fibrillation (AF). Our aim was to study the sex differences in adipokines levels according to AF burden. METHODS AND RESULTS: Two independent cohorts of patients were studied: (i) consecutive patients with AF undergoing catheter ablation (n = 217) and (ii) a control group (n = 105). (i) Adipokines, oxidative stress, indirect autonomic markers, and leucocytes mRNA levels were analysed; (ii) correlation between biomarkers was explored with heatmaps and Kendall correlation coefficients; and (iii) logistic regression and random forest model were used to determine predictors of AF recurrence after ablation. Our results showed that: (i) fatty acid-binding protein 4 (FABP4) and leptin levels were higher in women than in men in both cohorts (P < 0.01). In women, FABP4 levels were higher on AF cohort (20 ± 14 control, 29 ± 18 paroxysmal AF and 31 ± 17 ng/mL persistent AF; P < 0.01). In men, leptin levels were lower on AF cohort (22 ± 15 control, 13 ± 16 paroxysmal AF and 13 ± 11 ng/mL persistent AF; P < 0.01). (ii) In female with paroxysmal AF, there was a lower acetylcholinesterase and higher carbonic anhydrase levels with respect to men (P < 0.05). (iii) Adipokines have an important role on discriminate AF recurrence after ablation. In persistent AF, FABP4 was the best predictor of recurrence after ablation (1.067, 95% confidence interval 1-1.14; P = 0.046). CONCLUSION: The major finding of the present study is the sex-based differences of FABP4 and leptin levels according to AF burden. These adipokines are associated with oxidative stress, inflammatory and autonomic indirect markers, indicating that they may play a role in AF perpetuation.

Radiofarmacia Hospitalaria en Argentina durante la pandemia de COVID-19. Criterios y fundamentos para la organización del trabajo / Hospital Radiopharmacy in Argentina during the COVID-19 pandemic. Criteria and rationale for the organization of work

En esta publicación se presentan criterios y fundamentos para la organización del trabajo en la práctica segura de la Radiofarmacia Hospitalaria, a fin de minimizar el riesgo de transmisión viral durante la pandemia de COVID-19, en una instalación de referencia de la Comisión Nacional de Energía Atómica de Argentina, mientras se continúan desempeñando servicios esenciales para el sistema de salud. Con este fin se consultaron como referencia documentos de la Comisión Nacional de Energía Atómica, OIEA, la OMS y otras publicaciones científicas. Estas recomendaciones se encuentran en proceso de revisión constante y son actualizadas de manera permanente. En este marco se propone el presente modelo de organización laboral para esta actividad esencial incluyendo recomendaciones generales, particulares y su fundamento epidemiológico e inmunológico

This publication presents criteria and bases for the work organization in the safe practice of Hospital Radiopharmacy, in order to minimize the risk of viral transmission during the COVID-19 pandemic, in a reference facility of the National Energy Commission Atomic of Argentina, while continuing to perform essential services for the health system. For this purpose, documents from the National Energy Commission Atomic, IAEA, WHO and other scientific publications were consulted as reference. These recommendations are under constant review and are permanently updated. Within this framework, the present model of work organization for this essential activity is proposed, including general and specific recommendations and its epidemiological and immunological basis

Hospital Radiopharmacy in Argentina during the COVID-19 pandemic. Criteria and rationale for the organization of work. / Radiofarmacia Hospitalaria en Argentina durante la pandemia de COVID-19. Criterios y fundamentos para la organización del trabajo.

This publication presents criteria and bases for the work organization in the safe practice of Hospital Radiopharmacy, in order to minimize the risk of viral transmission during the COVID-19 pandemic, in a reference facility of the National Energy Commission Atomic of Argentina, while continuing to perform essential services for the health system. For this purpose, documents from the National Energy Commission Atomic, IAEA, WHO and other scientific publications were consulted as reference. These recommendations are under constant review and are permanently updated. Within this framework, the present model of work organization for this essential activity is proposed, including general and specific recommendations and its epidemiological and immunological basis.

Síndrome de Gitelman y condrocalcinosis. Revisión de un caso clínico / Gitelman syndrome and Chondrocalcinosis. A clinical case review

El síndrome de Gitelman es una tubulopatía de herencia autosómica recesiva que cursa, entre otras manifestaciones, con hipomagnesemia e hipocalciuria. Se presenta el caso de una paciente mujer de 68 años que acudió a consulta por artritis de grandes articulaciones en ausencia de otra sintomatología. En el estudio radiológico se observaron depósitos de pirofosfato cálcico en rodillas, sínfisis púbica y otras articulaciones. En la analítica destacaba hipomagnesemia e hipocalciuria compatibles con síndrome de Gitelman que se confirmó tras estudio genético (AU)

Gitelman syndrome is a tubulopathy of autosomal recessive inheritance which presents with, among other manifestations, hypomagnesemia and hypocalciuria. We present the case of a woman of 68 years of age who came for a consultation due to arthritis in the large joints, in the absence of other symptomology. The X-ray study showed deposits of calcium pyrophosphate in the knees, pubic symphysis and other joints. Blood tests revealed hypomagnesemia and hypocalciuria compatible with Gitelman syndrome, which was confirmed following a genetic study (AU)

Definición y biomarcadores de daño renal agudo: nuevas perspectivas / Definition and biomarkers of acute renal damage: New perspectives

Los criterios del RIFLE y del AKIN han ayudado definitivamente a llamar la atención sobre la relación entre un deterioro de la función renal que produce un pequeño incremente de la concentración sérica de creatinina y un peor pronóstico. Sin embargo, la utilidad clínica concreta del uso de estos criterios permanece por definir. Se cree que la principal utilidad de estos criterios reside en su uso en estudios epidemiológicos y en ensayos clínicos, para definir criterios de inclusión y objetivos de una intervención. La adopción del término DRA, reemplazando a la antigua terminología de IRA, resulta apropiada para designar la condición clínica caracterizada por daño del órgano, de la misma forma que se utiliza el término daño pulmonar agudo para describir la situación de lesión pulmonar que todavía no ha progresado a una situación de insuficiencia del órgano (disfunción). Los biomarcadores séricos y urinarios (creatinina, urea, diuresis) actualmente en uso no son sensibles ni específicos para la detección de daño renal, limitando las opciones terapéuticas y potencialmente comprometiendo el pronóstico. Nuevos biomarcadores se encuentran en estudio con el objeto de diagnosticar de una forma más precoz y específica el DRA, con el potencial de cambio de los criterios de definición y estadificación del DRA, actualmente basados en la diuresis y la concentración sérica de creatinina

The RIFLE and AKIN criteria have definitely help out to draw attention to the relationship between a deterioration of renal function that produces a small increase in serum creatinine and a worse outcome. However, the specific clinical utility of using these criteria remains to be well-defined. It is believed that the main use of these criteria is for the design of epidemiological studies and clinical trials to define inclusion criteria and objectives of anintervention.AKI adopting term, re-summoning former ARF terminology, it is appropriate to describe the clinical condition characterized by damage to kidney, in the same way as the term is used to describe acute lung damage where the lung injury situation still has not increased to a situation of organ failure (dysfunction).The serum and urine biomarkers (creatinine, urea, and diuresis) currently in use are not sensitive or specific for detecting kidney damage, limiting treatment options and potentially compromising the outcome. New biomarkers are being studied in order to diagnose an earlier and more specific AKI, with the potential to change the definition criteria of AKI with different stages, currently based in diuresis and serum creatinine

[Definition and biomarkers of acute renal damage: new perspectives]. / Definición y biomarcadores de daño renal agudo: nuevas perspectivas.

The RIFLE and AKIN criteria have definitely help out to draw attention to the relationship between a deterioration of renal function that produces a small increase in serum creatinine and a worse outcome. However, the specific clinical utility of using these criteria remains to be well-defined. It is believed that the main use of these criteria is for the design of epidemiological studies and clinical trials to define inclusion criteria and objectives of an intervention. AKI adopting term, re-summoning former ARF terminology, it is appropriate to describe the clinical condition characterized by damage to kidney, in the same way as the term is used to describe acute lung damage where the lung injury situation still has not increased to a situation of organ failure (dysfunction). The serum and urine biomarkers (creatinine, urea, and diuresis) currently in use are not sensitive or specific for detecting kidney damage, limiting treatment options and potentially compromising the outcome. New biomarkers are being studied in order to diagnose an earlier and more specific AKI, with the potential to change the definition criteria of AKI with different stages, currently based in diuresis and serum creatinine.

Mujer de 67 años con artritis y ausencia de pulsos / A 67-year old woman with arthritis and absence of pulse

No disponible

Pseudoaneurisma micótico por Mycobacterium tuberculosis / Mycotic pseudoaneurysm by Mycobacterium tuberculosis

La tuberculosis puede afectar a cualquier órgano de la economía, incluidas las arterias. Habitualmente esta afectación se produce por contigüidad de la arteria a un foco infeccioso adyacente, originándose fundamentalmente pseudoaneurismas.Describimos un caso de pseudoaneurisma tuberculoso de arteria ilíaca en probable relación con una peritonitis tuberculosa, que debutó como fiebre de origen desconocido. El diagnóstico de pseudoaneurisma se fundamentó en CT, confirmándose mediante estudio anatomopatológico y microbiológico obtenido en una primera intervención quirúrgica. A pesar del tratamiento tuberculostático, el paciente presentó rotura del pseudoa neurisma, lo que obligó a implantar un injerto. Creemos que no debe olvidarse la posibilidad de una afectación tuberculosa en un aneurisma micótico (AU)

Neumotórax en pacientes infectados por el virus de inmunodeficiencia humana / Pneumothorax in human immunodeficiency virus (HIV) infected patients

Objetivo: Se describen con cierta frecuencia pacientes infectados por VIH, que desarrollan neumotórax. Esta complicación aparece fundamentalmente en el contexto de coinfección por Pneumocystis carinii (NPC), pero también asociada a profilaxis con pentamidina inhalada, coinfección por otros gérmenes y a maniobras traumáticas.Método: Revisamos los aspectos más importantes de los neumotórax objetivados en nuestra población infectada por VIH a lo largo de ocho años, antes del inicio de terapia HAART generalizada.Durante este tiempo 97 pacientes fueron diagnosticados de NPC de certeza o probable y 148 pacientes fueron sometidos a profilaxis con pentamidina inhalada mensual. Hemos recogido sólo 14 episodios de neumotórax en 13 pacientes. En diez ocasiones estuvieron en relación a maniobras agresivas, en tres a infección pulmonar concomitante, no estando en relación a patología pulmonar concreta en uno.En cuanto a las maniobras agresivas consistieron en: cateterización de vena subclavia en seis (uno de estos tenía NPC de certeza y otro neumonía por neumococo), en un paciente tras biopsia transbronquial (también con NPC de certeza), en dos agresiones con arma blanca y en el último post-PAAF de adenopatía axilar.Resultados: Las tres infecciones pulmonares concomitantes consistieron respectivamente en tres enfermos en: NPC de certeza (siendo este el único caso con antecedente de profilaxis con pentamidina inhalada), tuberculosis pulmonar activa e infección pulmonar por Pseudomonas a.Todos los pacientes, menos uno, fueron sometidos a drenaje pleural.Nueve se resolvieron tras aspiración. Dos de los tres pacientes con infección pulmonar concomitante, así como el espontáneo, necesitaron pleurodesis, siendo necesaria resección quirúrgica para la resolución del neumotórax asociado a tuberculosis. En el momento de concluir esta revisión habían fallecido seis pacientes (media 7 meses) entre los cuales estaban los tres con NPC de certeza en el momento del neumotórax, el intervenido por tuberculosis y el afecto de infección por Pseudomonas a, presentando todos ellos cifras de CD4 < 100 en el momento del neumotórax, cifra que sólo se apreció en dos de los siete restantes.Conclusiones: El neumotórax es frecuente en pacientes infectados por VIH con coinfección por NPC, pero puede verse durante otras coinfecciones y sobre todo por maniobras agresivas. El neumotórax supone un dato de mal pronóstico en la infección por VIH (AU)

[Prevalence of antiphospholipid syndrome in patients under 65 years of age with acute myocardial infarction]. / Prevalencia del síndrome antifosfolípido en pacientes menores de 65 años con infarto agudo de miocardio.

BACKGROUND: The antiphospholipid antibody syndrome (AAS), which is characterized by thromboembolic events and/or fetal loss and/or low platelet count associated with antiphospholipid antibodies, may evolve with acute myocardial infarction (AMI). The presence of AAS among young patients with AMI ranges from 14% to 21%, and this condition implies specific therapeutic attitudes as new thrombotic events may occur, according to some authors. MATERIALS AND METHODS: A prospective study was undertaken with 25 patients aged > or = 65 years with AMI that were admitted to our institution during one year who were compared with control patients with similar risk factors. IgG and IgM anticardiolipin antibodies (ACA) were measured in the first 24 hours since the onset of AMI symptoms and three months later. RESULTS: The follow-up ranged from three months to one year. Among patients, ACA positivity in the two measurements was higher (12%) than that observed in the control group (5%) (p = 0.36). ACA positivity on two occasions was not a risk factor for new thrombotic events. CONCLUSION: ACA positivity is higher among AMI patients (measured early and at three months) than among the general population although the presence of such antibodies does not increase the risk for new post-infarction thrombotic events.

Prevalencia del síndrome antifosfolípido en pacientes menores de 65 años con infarto agudo de miocardio / Prevalence of anti-phospholipid syndrome among patients aged less than 65 years with acute myocardial infarction

Introducción. El síndrome antifosfolípido (SAFL), caracterizado por fenómenos trombóticos y/o pérdidas fetales y/o plaquetopenia asociados a anticuerpos antifosfolípidos, puede cursar con infarto agudo de miocardio (IAM). La presencia de SAFL en pacientes jóvenes con IAM oscila entre el 14 por ciento y el 21 por ciento, patología que conlleva actitudes terapéuticas específicas al presentar en su evolución nuevos eventos trombóticos según algunos autores. Material y métodos. Se realiza un estudio prospectivo en 25 pacientes con IAM y edad inferior o igual a 65 años que ingresaron en nuestro centro a lo largo de un año, comparándolos con controles con factores de riesgo similares. Se determinan anticuerpos anticardiolipina (ACA) IgG e IgM en las primeras 24 horas desde el inicio de la clínica de IAM y a los tres meses. Resultados. El seguimiento osciló entre tres meses y un año. En el grupo de pacientes, la positividad de ACA en las dos determinaciones fue superior (12 por ciento) a la del grupo control (5 por ciento) (p = 0,36). La positividad de ACA en dos ocasiones no fue un factor de riesgo para nuevos eventos trombóticos. Conclusión. La positividad de ACA es superior en el grupo de pacientes con IAM (determinados precozmente y a los tres meses) que en la población general, si bien la presencia de dichos anticuerpos no incrementa el riesgo de nuevos eventos trombóticos postinfarto (AU)

[Pneumothorax in patients infected by the human immunodeficiency virus]. / Neumotórax en pacientes infectados por el virus de inmunodeficiencia humana.

OBJECTIVE: Patients with HIV who develop pneumothorax have been previously described. Pneumocystis carinii pneumonia (PCN) is the leading cause of this complication, but infection by other pulmonary microorganism, inhaled pentamidine therapy and lung invasive manoeuvres have also been associated with pneumothorax in HIV infected patients. METHOD: We review the most relevant clinical aspects of pneumothorax in HIV-infected persons, gathered in our hospital along eight years, before HAART therapy was started. During this time, 97 patients with PCN were diagnosed and 148 patients received prophylaxis with inhaled pentamidine. Only 14 episodes of pneumothorax in 13 patients, were recorded. In ten occasions pneumothorax was related to pulmonary invasive manoeuvres, pulmonary infections were found in three and was considered spontaneous in one. The pulmonary invasive manoeuvres were: subclavia vein catheterisation in six cases (one of them was diagnosed of proved PCN and the other has pneumococcal pneumonia); transbronchial biopsy in one patient (also with proved PCN), knife chest trauma in two cases and after fine needle aspiration of an axillary lymph node in one patient. RESULTS: The pulmonary infections associated with pneumothorax in three patients were: proved PCN (this patient was the only one in the group with inhaled pentamidine prophylaxis who developed pneumothorax), active pulmonary infection by mycobacterium tuberculosis and Pseudomonas aeruginosa pneumonia. A drainage chest tube was placed in 12 patients with complete resolution in nine. In the other two patients pleurodesis was necessary and surgical repair was carried out in the other one (who had pulmonary tuberculosis). During the follow up six patients died (median time to death: 7 months). Among patients who died, five had pulmonary infections when the pneumothorax was diagnosed: PCN in three cases, pulmonary tuberculosis and pseudomonas pneumonia in the other two; all of them with less than 100 CD4 lymphocytes. CONCLUSIONS: Pneumothorax is frequent in HIV-infected patients with PCN, but other lung infections and, above all pulmonary invasive manoeuvres, can cause this complication. In our experience, HIV-infected patients who develop pneumothorax have a bad prognosis.

[Mycotic pseudoaneurysm caused by Mycobacterium tuberculosis]. / Pseudoaneurisma micótico por Mycobacterium tuberculosis.

Mycobacterium tuberculosis can involve any organ of the body, including the arteries. Usually the mycobacteria infects the arterial wall spreading from a contiguous foci. We report a case of tuberculous pseudoaneurysm involving the iliac artery clinically manifested as fever of unknown origin. The diagnosis relied on abdominal CT-scanning. Tuberculous etiology was confirmed postoperatively by microbiologic and microscopic study. The antituberculous therapy was early started, but the patient died three months later as a consequence of a non-infectious abdominal aortic rupture. Clinicians should consider tuberculous etiology when the diagnosis of mycotic pseudoaneurysm is being entertained.

Prevalencia de hemocromatosis en trabajadores sanos. Importancia de añadir en la analítica de perfil bioquímico una saturación de transferrina / Prevalence of hereditary hemochromatosis among healthy workers: diagnostic value of transferrin saturation assay

Objetivo: La hemocromatosis es la enfermedad genética más común en la población blanca (dos a ocho casos por mil habitantes). Está caracterizada por una absorción excesiva de hierro, que conlleva a un acúmulo del mismo en diversos órganos. Su diagnóstico precoz, con la instauración de sangrías periódicas, condiciona que estos enfermos puedan igualarse a la población sana, tanto en calidad de vida como en sobrevivencia. Esto hace muy aconsejable la realización de despistaje de esta enfermedad en la población aparentemente sana. Aunque se han hecho grandes avances en los estudios genéticos de esta población, sigue siendo una saturación de transferrina (ST) elevada (superior a 60 porciento) el test más utilizado para iniciar una aproximación diagnóstica de la enfermedad. Nosotros realizamos ST a un grupo de trabajadores sanos para confirmar en nuestro medio la utilidad de este test en el diagnóstico de hemocromatosis. Método: Estudio prospectivo sobre 1.131 trabajadores activos que acuden a una revisión anual a un Centro Oficial de Seguridad e Higiene, practicándoseles a todos ST. Si ésta resulta elevada son derivados a un Centro Hospitalario para continuar con la aproximación diagnóstica de la hemocromatosis. Resultados: La ST resultó elevada en 22 trabajadores, de los cuales son estudiados 21 en un Centro Hospitalario. En once se normaliza la ST después de abstinencia de alcohol o al repetir el análisis. A nueve se les propone biopsia hepática, realizándose en seis. De estos seis se confirmó la hemocromatosis en tres, lo que hace una prevalencia confirmada, al menos, de 2.6 por mil habitantes. Conclusiones: Creemos que la saturación de transferrina es útil para iniciar el despistaje de hemocromatosis y que debería imponerse como parte del perfil bioquímico de analítica rutinaria. Otros métodos diagnósticos menos engorrosos que la biopsia hepática son necesarios para confirmar la enfermedad (AU)

[Prevalence of hereditary hemochromatosis among healthy workers. Diagnostic value of transferrin saturation assay]. / Prevalencia de hemocromatosis en trabajadores sanos. Importancia de añadir en la analítica de perfil bioquímico una saturación de transferrina.

AIM: Hereditary hemochromatosis is the most common inherited disorder in white population (2-8 cases per 1000 habitants). Hemochromatosis is characterized by increased intestinal absorption of iron leading to its deposition into multiple organs. An early diagnosis and proper management with frequent phlebotomies are known to improve life expectancy and quality of life. Diagnosis is suggested by an elevated Transferrin saturation (TS) (more than 60%). METHOD: Prospective study of the level of TS among 1131 healthy workers, who came to the Security and Hygiene Official Centre for their annual revision had been undertaken. RESULTS: Twenty-wo workers had high TS; in 10 of them the increase of TS was confirmed on repeated determinations. Liver biopsy was performed in six (and refused by the other four), eventually a diagnosis of hemochromatosis was confirmed in three (in-group prevalence of 2.6 per 1000 people). CONCLUSIONS: In our experience, TS is the most appropriate initial screening test for detecting hereditary hemochromatosis in a normal population.

Incorporation of a controlled-release glass into a calcium phosphate cement.

A so-called controlled-release glass was synthesized occurring in the system CaO-Na2O-P2O5. A certain sieve fraction of this glass was incorporated in a calcium phosphate cement, of which the powder contained alpha-tricalcium phosphate (alpha-TCP), dicalcium phosphate (DCP) and precipitated hydroxyapatite (HA). The glass appeared to retard the cement setting slightly and it reduced considerably the compressive strength after aging in aqueous solutions which were continuously refreshed. Scanning electron microscope (SEM) pictures and X-ray diffraction (XRD) patterns of the samples after 5 weeks of aging showed that the glass was not dissolved but that large brushite crystals were formed. Thereby, aging in CaCl2 solutions resulted in more brushite formation than aging in NaCl solutions. The brushite crystals did not reinforce the cement. Neither was the aged glass-containing cement weaker than it was before the brushite formation right after complete setting. In conclusion, the incorporation of controlled-release glasses into a calcium phosphate cement and subsequent aging in aqueous solutions did not result in the formation of macropores in the cement structure, but that of brushite crystals. This incorporation reduced the compressive strength of the cement considerably.

Neurons located in the trigeminal sensory complex and the lateral pontine tegmentum project to the oculomotor nucleus in the rabbit.

Neurons located in the trigeminal sensory complex (TSC) and the lateral pontine tegmentum (LPT) have been reported to project to both the accessory abducens and the facial nuclei, which innervate the retractor bulbi and orbicularis oculi muscles respectively, in order to control the nictitating membrane (NM) and eyelid defensive reflex. Since muscles innervated by the oculomotor nucleus (OCM) also appear to be involved in this reflex, retrograde and anterograde tracers were used in this study to determine whether there are projections from the TSC and LPT to the OCM in the rabbit. Injections of horseradish peroxidase (HRP) in the OCM nucleus labeled neurons in the LPT surrounding the trigeminal motor nucleus dorsally, laterally and ventrally. Only a few scattered neurons were found in the principal and spinal trigeminal nuclei. Injection of biocytin in the LPT area containing most of the HRP-labeled neurons caused anterograde labeling of fibers that crossed the midline and ascended just dorsal to the contralateral medial lemniscus. A proportion of these fibers coursed in a dorsal direction to enter and terminate within the OCM contralateral to the injection site. The location of the motoneuronal groups innervating the different extraocular muscles was studied by retrograde transport of HRP, and compared with the distribution of biocytin-labeled terminals. It was found that the terminals were located in the superior rectus and the levator palpebrae zone of the nucleus. We discuss the functional significance of this projection for the eyelid and NM response.