Manejo nutricional de ascitis quilosa: Serie de casos y revisión de la literatura

RESUMEN Las ascitis quilosa (AQ) es una entidad poco común producida por el acúmulo de linfa en la cavidad peritoneal. Su incidencia se describe en aumento progresivo, asociándose a una mortalidad de 40-70%. Se incluyeron 3 pacientes con diagnóstico de AQ evaluados en la visita de asistencia nutricional del Hospital Clínico de la Universidad Católica (UC) durante el año 2019. Caso 1: Paciente mujer de 47 años, consulta por dolor abdominal agudo realizándose apendicectomía. Estudio de líquido peritoneal con triglicéridos (TG) de 1.362 mg/dL. Inicia Nutrición Parenteral Total (NPTC) progresando luego a régimen oral. Estudio no revela lesiones de vasos linfáticos ni otras causas. Caso 2: Paciente varón de 68 años con cirrosis por alcohol, Child Pugh B. Ingresa por disnea y ascitis refractaria. Estudio de líquido ascítico y pleural, con TG de 439 mg/dL y 592 mg/dL respectivamente. Se manejó con toracocentesis y paracentesis evacuadoras, tratamiento con régimen hipograso y aporte de triglicéridos de cadena media (MCT) vía oral. Evolución tórpida requiriendo apoyo con NPTC, realizándose drenajes sucesivos, por lo que se instala TIPS. Caso 3: Paciente mujer de 63 años consulta por dolor hipogástrico con masa palpable subcostal derecha. Estudio confirma masa pancreática por lo que se realiza Whipple. Reingresa por náuseas y vómitos profusos, evidenciándose líquido ascítico con TG de 251 mg/dl. Se inicia NPTC, escasos débitos del drenaje iniciándose realimentación progresiva por vía oral. El análisis del líquido tras la paracentesis establece el diagnóstico de AQ pues la clínica es inespecífica. Las principales complicaciones están dadas por la pérdida de quilo: desnutrición, infecciones y sepsis. Las opciones de tratamiento incluyen: medidas dietéticas, fármacos e intervenciones percutáneas o quirúrgicas; siempre orientadas al alivio sintomático, con foco en tratar la causa. Si la tolerancia oral es óptima la primera medida es la supresión de la grasa y la suplementación con MCT para evitar déficit energético. Con el empleo de estas medidas se ha reportado el cierre espontáneo de fístulas y/o defectos de vasos linfáticos en un 75%-80%. Se concluye que no hay guías de recomendación y los estudios se basan en series de pocos casos clínicos. La ascitis quilosa es una entidad patológica rara, que representa una situación clínica crítica con consecuencias inmunológicas y nutricionales; y el tratamiento debe ser etiológico y el paso clave inicial es optimizar el estado nutricional del paciente.

ABSTRACT Chylous ascites (CA) is an uncommon entity caused by the accumulation of lymph in the peritoneal cavity, its incidence has been gradually increasing; being associated with a mortality of 40-70%. This work includes 3 patients with CA diagnosis evaluated by the Nutritional Assistance team in the Hospital Clínico of the Universidad Católica, Chile during 2019. Case 1: 47-year-old female, with acute abdominal pain that resulted in an appendectomy. Peritoneal fluid study showed triglycerides (TG) of 1362 mg/dL. Total Parenteral Nutrition (TPN) was initiated with successive changes to an oral regimen. The case was negative for lymphatic vessel injuries or other causes of AQ. Case 2: 68-year-old male with alcoholic cirrhosis, Child-Pugh B. The patient was admitted for dyspnea and refractory ascites. Ascites and pleural fluid study showed TG of 439 mg/dL and 592 mg/dL, respectively, whichwas managed with thoracentesis and evacuating paracentesis, treatment with a low-fat regimen, and oral medium chain triglycerides (MCT). Case 2 had a poor evolution requiring TPN and successive evacuations, with TIPS installed. Case 3: A 63-year-old female patient with hypogastric pain and palpable right subcostal mass. Study confirmed a pancreatic tumor and Whipple Surgery was performed. Case 3 was readmitted for nausea and vomiting, showing ascitic fluid with TG of 251 mg/dl. TPN was started, with decrease in drainage fluids and successful progressive oral refeeding. The analysis of the paracentesis fluid established the diagnosis of CA since the symptoms were nonspecific. The main complications were due to the loss of chyle: malnutrition, infections and sepsis. Treatment options included: dietary measures, drugs, and percutaneous or surgical interventions; always oriented to symptomatic relief, focused on etiologic treatment. If oral tolerance is optimal, the first measure should be fat suppression and supplementation with MCT to avoid energy deficit. With the use of these measures, spontaneous closure of fistulas and / or lymphatic vessel defects has been reported in 75% -80% of patients. There are no recommendation guidelines for CA and studies are based on series of a few clinical cases. CA is a rare disease, representing a critical clinical situation with immunological and nutritional consequences. Etiologic treatment must be prioritized with a focus on optimization of the nutritional status of the patient

Effects of different periodontal treatments in changing the prevalence and levels of Archaea present in the subgingival biofilm of subjects with periodontitis: A secondary analysis from a randomized controlled clinical trial.

OBJECTIVE: The aim of this randomized double-blind and placebo-controlled study was to assess if periodontal treatment with or without systemic antibiotic would change the mean level of Archaea. METHODS: Fifty-nine (59) subjects were randomly assigned to receive scaling and root planing (SRP) alone or combined with metronidazole (MTZ; 400 mg/TID) or either with MTZ and amoxicillin (AMX; 500 mg/TID) for 14 days. Clinical and microbiological examinations were performed at baseline and at 6 months post-SRP. Six subgingival plaque samples per subject were analysed for the presence and levels of Archaea using quantitative polymerase chain reaction. RESULTS: Scaling and root planing alone or combined with MTZ or MTZ + AMX significantly reduced the prevalence of subjects colonized by Archaea at 6 months post-therapy, without significant differences among groups (P > .05). Both therapies led to a statistically significant decrease in the mean percentage of sites colonized by Archaea (P < .05). The MTZ and MTZ + AMX group had a significantly lower mean number of sites colonized by Archaea and lower levels of these micro-organisms at sites with probing depth ≥5 mm at 6 months compared with SRP group (P < .05). CONCLUSION: Periodontal treatments including adjunctive MTZ or MTZ + AMX are more effective than mechanical treatment alone in reducing the levels and prevalence of sites colonized by Archaea in subjects with chronic periodontitis.

Una presentación atípica de disección aórtica aguda en departamento de emergencias / An atypical presentation of acute aortic dissection in the emergency department

La disección de un aneurisma aórtico es una emergencia cuyo pronóstico depende de un diagnóstico rápido y certero. Se caracteriza por la disección de los planos laminares de la media, con la formación de un canal dentro de la pared aórtica, que con frecuencia puede causar una hemorragia masiva. Los síntomas clásicos son: dolor intenso y repentino de pecho que se extiende hacia el cuello o la espalda, disnea y síntomas neurológicos tales como pérdida de visión, debilidad o parálisis de un lado del cuerpo. La mortalidad de la disección aórtica es alta; según la mayoría de los autores más de un tercio de los pacientes mueren en las primeras 24 horas y casi el 95% mueren en el primer mes. Presentamos el caso de un paciente masculino de 81 años de edad con una presentación atípica de disección de aneurisma de aorta torácica atendido por un episodio sincopal recuperado, sin dolor, disnea ni síntomas neurológicos (AU)

The dissection of an aortic aneurysm is an emergency whose prognosis depends on a prompt and accurate diagnosis. It is characterized by the dissection of the laminar planes of the media, with the formation of a channel within the aortic wall, which can cause massive hemorrhage. The classic symptoms are: sudden and severe chest pain that extends to the neck or back, dyspnea and neurological symptoms such as vision loss, weakness or paralysis of one side of the body. Mortality is high with more than a third of patients dying within the first 24 hours and almost 95% during the first month. We present the case of an 81-year-old male patient with an aortic thoracic aneurysm dissection who first presented with a full recovered syncopal episode without pain, dyspnea or neurological symptoms. (AU)

Hábitos alimentarios y condición física en estudiantes de pedagogía en educación física / Eating habits and physical condition of physical education students

Objective: To determinate dietary habits and physical condition of physical activity students from the Autonomous University of Chile, Temuco, relating these to their fitness level. Methods: An observational cross-sectional study was conducted among 239 students (76.5 % males). Assessment included a food questionnaire, anthropometric measurements and physical condition. Results: In a sample of 239 students, 35.6% of them were overweight or obese as well as having unhealthy dietary habits independent of the academic year at university. Only 4.7 % of the students used the national recommendations for fruit intake and only 30% ate breakfast daily. In men weight, waist circumference and BMI were negatively associated with the Nvette Course test (R = -0.203, R= -0.249 and R= -0.196, p<0.01 respectively). Conclusion: Physical activity education students have poor dietary habits throughout the university academic years while their fitness decreases irregularly as studies progress. This is a major concern since they will become healthy life style role models for their future students.

Objetivo: Determinar los hábitos alimentarios y condición física de los estudiantes de pedagogía en educación física de la Universidad Autónoma de Chile, sede Temuco y relacionarlos con el nivel de condición física. Sujetos y métodos: Estudio transversal observacional, se evaluaron 239 estudiantes de educación física, de los cuales 76,5% eran hombres, aplicándoles una encuesta alimentaria, antropometría y evaluación de la condición física. Resultados: El 35,6% de los estudiantes presentaba sobrepeso/obesidad, además tenían malos hábitos alimentarios independientes del año de ingreso. Sólo 4,7% consumía las recomendaciones de frutas y 30% tomaba desayuno todos los días. En hombres el peso, la circunferencia de la cintura e IMC correlacionan negativamente con la prueba de Course navette (R=-0,203; R=-0,249; R=-0,196, p<0,01 respectivamente). Conclusión: Los estudiantes universitarios presentan malos hábitos alimentarios durante toda la carrera universitaria, mientras que su condición física disminuye de manera irregular a medida que avanzan los estudios, situación preocupante ya que ellos se transformaran en modelos de estilos de vida saludable especialmente a nivel escolar.

Evaluation of lead toxicity in Erica andevalensis as an alternative species for revegetation of contaminated soils.

Although revegetation using native flora is a low cost way to stabilize soil and restore the landscape contaminated with metals, little is known regarding the Pb-tolerance of many of these species. For this purpose, we evaluated the tolerance of Erica andevalensis to Pb by growing plants in nutrient solutions with increasing concentrations of Pb (up to 100 microM). Plant growth and different physiological parameters were determined to ascertain tolerance to metal stress. Additionally, an electron microscopy study coupled with EDX-analysis was performed to get clues on the Pb uptake and translocation from roots into stem and leaves. The LOEC (the lowest observed effect concentration) of Pb was 40 microM while the IC50 (inhibition concentration) was 80 microM Pb. Chemical analysis revealed a root > stem > leaf accumulation pattern. There was a severe reduction in fresh biomass and chlorophyll concentration at the highest Pb dose. The SEM-EDX study indicated that Pb was mostly located in root epidermal tissues. The blockage of Pb on the root probably avoided its toxic effects by limiting Pb transport to other tissues.

[AIDS mortality in Switzerland: its characteristics and its impact on overall mortality]. / La mortalité par sida en Suisse: ses caractéristiques et son impact sur la mortalité générale.

The AIDS epidemic has transformed not only the mortality at some younger ages, but also the perception of the needs in health that we may have, since the rapid spread of HIV/AIDS, coupled with a prognosis fatal disease until the mid-1990s. The eyes of demography, here allows to highlight the characteristics of AIDS mortality in Switzerland, and changes the pattern of mortality that Switzerland experienced by AIDS. The author also suggests, drawing on traditional demographic tools, a method to attempt to measure the impact of AIDS mortality on life expectancy at birth in Switzerland. A parallel with the analysis of mortality from tumors reinforces the importance of the impact of AIDS mortality.

Stress responses of Erica andevalensis Cabezudo & Rivera plants induced by polluted water from Tinto River (SW Spain).

The effects of Tinto River water on Erica andevalensis growth, biochemical indicators and elemental concentration and distribution were investigated under laboratory conditions. High levels of toxic elements such as B, Fe and S and acidic pH characterized the river water. Plant analysis revealed that the concentration of Al, B, S and Fe increased in all plant organs reaching in some cases values in the toxicity range. Plants transferred into river water stopped growing and stress was manifested by plant water loss, increase in peroxidase activity and decrease of chlorophyll a concentration. Significant decreases of free amino acid concentration were found in shoots and roots of plants grown in diluted river water. The results indicated that Tinto River water acidity and its excess in soluble elements produced altogether severe alterations in roots affecting plant water and nutrient uptake and leading to the massive entry of some metals (e.g. Fe, Al) with toxic effects. Scanning-electron microscopy (cryoSEM and ESEM) observations showed that E. andevalensis had not exclusion mechanisms of Cu, Fe and S therefore it was not able to reduce translocation to aerial parts.

Accumulation and in vivo tissue distribution of pollutant elements in Erica andevalensis.

Erica andevalensis is an endemic shrub from an area in the southwest of Spain (Andalucia) characterized by acidic and contaminated soils. Scanning electron microscopy (SEM) of samples after conventional or cryo-fixation preparation protocols was used for morphological and anatomical studies. SEM coupled with EDX-analysis was employed to localise and quantify different elements within plant parts (leaves, stems and roots) in samples collected in the field. Morphological studies revealed that the species has typical adaptive structures to drought-stress such as rolled needle-like leaves, sunken stomata and a thick waxy cuticle on the upper epidermis. Roots were associated with fungi which formed intra and extra-cellular mycelia. The SEM studies showed that Cu was not sequestrated into the root tissues and was uniformly distributed in leaf tissues. Meanwhile, Pb was only localised within epidermal root tissues which indicates that its sequestration in an external matrix might represent a tolerance mechanism in this species. Iron was uniformly distributed throughout the leaves, while in roots it was predominantly retained on the epidermal cell walls. The exclusion and tolerance mechanisms adopted by this species to survive in mining areas indicate that it can be used successfully in the re-vegetation of contaminated areas.

Strategies of heavy metal uptake by plants growing under industrial emissions.

Total concentrations of Al, Ba, Ca, Cr, Cu, Fe, K, Mg, Mn, Pb and Zn have been estimated in soil (A-horizon) and in leaves and stem samples of two Mediterranean species (Nerium oleander L. and Pinus pinea L.) growing in an industrial area in Spain (Huelva). Both species showed a different behaviour for the elements studied. Bark and leaves of both species acted as excluders of Al, Ba, Cr, Fe and Pb, N. oleander acted as indicator of Cu and Zn and, needles and bark of P. pinea behaved as accumulators of Cu. The enrichment ratio data indicated that Cu in soil and plant was enhanced with anthropogenic activities, with industrial activities being the primary contributor for Cu. All the other elements studied were controlled by natural source variations, but Pb could also be anthropogenically enhanced. Wood did not accumulate pollutants, with the translocation from bark being rather reduced. Uptake patterns of metals into foliage and bark tissues were more or less the same in both species for almost all the studied elements, which indicates that both plant parts could be indifferently used as biomonitors.

Uso del DIU con levenorgestrel como alternativa a la histerectomía en pacientes con alto riesgo quirúrgico / Levonorgestrel-releasing intrauterine device (LNG-IUD) as an alternative to hysterectomy in high-risk-surgical patients

Presentamos nuestra experiencia de 6 pacientes con metrorragia a repetición, portadoras de patologías médicas que representaban un riesgo desde el punto de vista anestésico y quirúrgico, en las cuales se insertó DIU-LNG como alternativa a la histerectomía. Todas evolucionan satisfactoriamente y sin complicaciones, con disminución significativa de las pérdidas hemáticas desde el tercer mes de uso, objetivadas por pictogramas. Se concluye que el DIU-LNG es un excelente método para el control de metrorragias en pacientes con patologías médicas relevantes.

We present our experience with 6 patients with menorrhagia and medical conditions considered high risk patients for anaesthesia and surgical procedures. We inserted LNG-IUD as alternative to hysterectomy. Three months later, all of them reduced menstrual blood loss as it was shown by pictorial charts, without complications. LNG-IUD is an excellent alternative to hysterectomy in this group of patients.

Automatic and controlled semantic processing: a masked prime-task effect.

A classical definition of automaticity establishes that automatic processing occurs without attention or consciousness, and cannot be controlled. Previous studies have demonstrated that semantic priming can be reduced if attention is directed to a low-level of analysis. This finding suggests that semantic processing is not automatic since it can be controlled. In this paper, we present two experiments that demonstrate that semantic processing may occur in the absence of attention and consciousness. A negative semantic priming effect was found when a low-level prime-task was required and when a masked lexical decision prime-task was performed (Experiment 1). This paper also discusses the limitations of the inhibitory mechanism involved in negative semantic priming effect.

Ligustrum lucidum Ait. f. leaves as a bioindicator of the air-quality in a Mediterranean city.

The concentration of 11 elements, Ba, Cd, Cr, Cu, Fe, Mg, Mn, Ni, Pb, Zn and V, have been determined in leaves of Ligistrum lucidum Ait. f. growing in Palermo, by simultaneous inductively coupled plasma mass spectrometry. A total of 72 samples from six different sites were investigated to deduce the bioindicator ability of this species. Differences were found in the element concentrations in the leaves from the different sites and, in general, anthropogenic pollutant patterns match traffic levels. This paper describes and discusses the spatio-variations of the different elements. Cluster analyses established three different groups giving an idea about the origins of the elements. Results demonstrate that this species is useful as a bioindicator in a Mediterranean climate, especially as it has the added advantage of being an evergreen tree.

Diagnóstico antenatal de hipoplasia pulmonar fetal por ultrasonografía 3D: aplicación de Software VOCAL: casos clínicos / Antenatal diagnosis of fetal pulmonary hypoplasia by 3D ultrasound: VOCAL application software: clinical cases

Se evalúa el cálculo de volumen pulmonar fetal con ultrasonografía 3D y la aplicación del software VOCAL (Virtual Organ Computer Aided-Analysis) en dos casos clínicos. Uno de ellos corresponde a un hidrops fetal e hidrotórax bilateral y el segundo caso de rotura prematura de membranas a las 22 semanas de gestación. Correlacionándolo con el resultado postnatal.

Improvement of the synthesis of diphenylmethyl 7beta-(o-hydroxy)benzylideneamino-3-hydroxymethyl-3-cephem-4-carboxylate.

The title product (I) is synthesized currently from 7-aminocephalosporanic acid, and diphenyldiazomethane (DDM) is used as a protective reagent of the acid function for further reactions. When DDM was prepared from benzophenone hydrazone by reaction with chloramine T, it was resulted impure by p-toluenesulfonamide, formed as side product, which cannot be removed during the final purification step carried out according to the literature procedure. Two simple methods are proposed here to obtain I with the suitable degree of purity necessary for a drug.

Synthesis of (Z)-2-(2-formamido-4-thiazolyl)-2-(substituted alkoxyimino) acetic acids.

(Z)-2-(2-formamido-4-thiazolyl)-2-(substituted alkoxyimino) acetic acids were synthesized by a new method based on the following sequence of reactions: treatment of the tert-butyl acetoacetate with sodium nitrite, alkylation of the oxime formed with an appropriate alkyl halide, halogenation of methyl alpha-keto group and simultaneous cleavage of tert-butyl ester with sulfuryl chloride, protection of the obtained acid function with diphenyldiazomethane, formation of the 2-aminothiazole ring by the Hantzsch method with thiourea, formylation of the amino group and selective final cleavage of the diphenylmethyl ester by treatment with trifluoroacetic acid and anisol. The developed procedure allows the synthesis of (Z)-2-(2-formamido-4-thiazolyl)-2-(substituted alkoxyimino) acetic acids, with an ester function in the alkoxyimino group employing a simple method and obtaining higher yields in comparison with the habitually used classic method.

[The association of beta zero-thalassemia and Hb D Punjab in a family of Indian origin. The second case reported in Spain]. / Asociación de beta zero-talasemia y Hb D-Punjab en una familia de origen hindú. Segundo caso descrito en España.

The present report described the hematologic and molecular study of the second case of Hb D-Punjab associated with a beta zero-thalassemia found in Spain and the first case in which the mutations have been identified at molecular level. A family from India is studied, which is constituted by mother (I2) and 3 children (II1, II2 and II3). The molecular characterization of the hemoglobinopathy was made by electrophoretic and chromatographic techniques and confirmed by sequencing of the beta-globin gene. The mutation causer of the beta-thalassemia was studied by PCR-ARMS. The mother (I2) and one of her child (II2) are carriers of the gene for beta zero-thalassemia owing to the frameshift CD 8/9 mutation (+ G). Other of them (II1) is heterozygous for Hb D-Punjab without beta-thalassemia association. The third child (II3) knows a double heterozygote state for Hb D-Punjab/beta zero-thalassemia (hemoglobin D-thalassemia). In spite of the patient with hemoglobin D-thalassemia has 94.5% of Hb D, without Hb A, the hematologic picture belongs to thalassemia trait with moderate haemolytic anemia, intense microcytosis and hypochromia and numerous target cells. This hematologic picture discloses the mildness of the Hb D-Punjab, but the reliable responsible for the phenotype is the disbalance in the synthesis of globin chains, because of frameshift CD 8/9 mutation (+ G) beta zero-thalassemia mutation.

[Treatment of status epilepticus with rectally administered diazepam]. / Tratamiento del estado epiléptico con diazepam por vía rectal.

Rectal administration of diazepam is a good alternative to intravenous acute treatment in severe epileptic crises, but there is scarce information about its usefulness in status epilepticus. Treatment with rectal diazepam, 0.6 to 0.8 mg x kg of body weight as a single drug, in 10 children with 13 episodes of status epilepticus, defined as epileptic crises lasting 30 or more minutes (ten of these were generalized tonic and clonic, two were unilateral tonic and clonic, and one was of the partial complex type) is described. Nine status epilepticus episodes subsided at an average 4.4 minutes after the drug was given; in 3 cases there were no favourable effects, and one case recurred after initial response. There were no significant complications, with the exception of slight respiratory depression in a patient with encephalitis. In spite of the small size of the sample, these results suggest that rectal diazepam is an effective alternative to intravenous drug administration in the management of status epilepticus whenever venous access is difficult.