RESUMEN
El síndrome de Turner es un desorden cromosómico, generado por la pérdida parcial o total de un cromosoma X. Las mujeres que lo presentan, pueden tener una serie de altera- ciones físicas y funcionales. El objetivo de este estudio es exponer el caso de una paciente con diagnóstico de síndrome de Turner, hipotonía muscular y maloclusión severa que fue tratada con terapia muscular craneofacial, combinada con ortodoncia en la Unidad de Malformación Craneofacial de la Facultad de Odontología de la Universidad de Chile.
The Turner Syndrome is a chromosome disorder produced by the total or partial absent of an X chromosome. The women who presents Turner syndrome can have a series of physical and functional alterations. The aim of this study is to present the case of a patient diagnosed with Turner syndrome, muscular hypotony and severe malocclusio treated with craneofacial muscular therapy combined with orthodontics at the Craneo- facial Malformations Unit of the Faculty of Dentistry, University of Chile.
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El hígado graso no alcohólico (HGNA) es una complicación asociada a la obesidad, debido a la acumulación excesiva de grasa en el hígado. Con el objetivo de determinar la frecuencia de hígado graso no alcohólico diagnosticado por ecografía abdominal en pacientes que asisten a la Unidad del Manejo Integral del Paciente Obeso del Hospital de Clínicas, FCM UNA, se realizó un estudio observacional descriptivo retrospectivo que incluyó a 188 pacientes, de los cuales 146 fueron mujeres y 42 hombres, la edad media en los pacientes con diagnóstico de HGNA fue de 41,3±11,4 años con un rango de edad de 20 a 65 años. Los resultados señalan la frecuencia de HGNA con el 56,9% (n=107) por ecografía abdominal, siendo 39,9% (n=75) mujeres y 17% (n=32) hombres, mientras que 43,1% (n=81) presentó hígado de aspecto normal. El 43,9% (n=47) de los pacientes con HGNA exhibió obesidad grado III. Al comparar la circunferencia abdominal en los 107 pacientes con HGNA se obtuvo una media de 139,1±97,8 cm. Con respecto al grado de esteatosis el 43,1% (n=81) mostró grado 0, 31,9% (n=60) grado 1, 20,7% (n=39) grado 2 y 4,3% (n=8) grado 3. Se observaron en los datos de laboratorio elevación de las transaminasas GPT 35,5% (n=38), 25,2% (n=27) en la GOT y 24,3% (n=26) FA, se notó aumento en los valores de las bilirrubinas directa e indirecta, 65,4% (n=70) BD y 69,2% (n=74) BI, por otra parte el 47,7% (n=51) enseñó CT elevado, 49% (n=45,7) HDL disminuido, 36,4% (n=39) LDL elevado y 29% (n=31) con triglicéridos elevados. Se halló que el 69,1% (n=74) de los pacientes con HGNA tienen HTA. Al realizar la comparación de las variables mencionadas entre los pacientes con y sin HGNA, arrojó que las transaminasas GPT, GOT y triglicéridos estuvieron en niveles más altos en los pacientes con HGNA. Se evidenció que la obesidad es un factor determinante para el desarrollo de HGNA, la caracterización del perfil hepático y lipídico, asimismo la presión arterial constituyen puntos fundamentales para asociar el aumento de estos con la presencia de HGNA.
Nonalcoholic fatty liver disease (NAFLD) is a complication associated with obesity, due to excessive accumulation of fat in the liver. In order to determine the frequency of NAFLD diagnosed by abdominal ultrasound in patients attending the unit Comprehensive Patient Management Obese the Hospital of Clinics, FCM - UNA, a retrospective observational study involving performed in 188 patients, of which 146 were women and 42 men, average age in patients with NAFLD diagnosis was 41,3±11,4 years with an age range of 20 - 65 years. The results indicate the frequency of NAFLD with 56,9% (n=107) for abdominal ultrasound, being 39,9% (n=75) women and 17% (n=32) were men, while 43,1% (n=81) presented liver normal. 43.9% (n=47) of patients with NAFLD showed grade III obesity. By comparing the abdominal circumference in 107 patients with NAFLD an average of 139,1±97,8 cm was obtained. With respect to the degree of steatosis 43,1% (n=81) showed grade 0, 31,9% (n=60) grade 1, 20,7% (n=39) grade 2 and 4,3% (n=8) grade 3 were observed in laboratory data GPT transaminases elevation of 35,5% (n=38), 25.2% (n=27) in the GOT and 24,3% (n=26) FA, increased values of direct and indirect bilirubin, 65,4% (n = 70) BD and 69.2% (n=74) BI was noted, moreover 47,7% (n=51) CT taught high, 49% (n=45,7) decreased HDL, 36,4% (n=39) high LDL and 29% (n=31) with elevated triglycerides. It was found that 69,1% (n=74) of patients with NAFLD have hypertension. When comparing the variables mentioned among patients with and without NAFLD, he threw the GPT, GOT transaminases and triglycerides were at higher levels in patients with NAFLD. It was evident that obesity is a determining factor NAFLD development, characterization of liver and lipid profile, blood pressure also are key points to associate these increased with the presence of NAFLD.
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PURPOSE: To converge on an expert opinion to define aggressive disease in patients with HER2-negative mBC using a modified Delphi methodology. METHODS: A panel of 21 breast cancer experts from the Spanish Society of Medical Oncology agreed upon a survey which comprised 47 questions that were grouped into three sections: relevance for defining aggressive disease, aggressive disease criteria and therapeutic goals. Answers were rated using a 9-point Likert scale of relevance or agreement. RESULTS: Among the 88 oncologists that were invited to participate, 81 answered the first round (92%), 70 answered the second round (80%), and 67 answered the third round (76%) of the survey. There was strong agreement regarding the fact that identifying patients with aggressive disease needs to be adequately addressed to help practitioners to decide the best treatment options for patients with HER2-negative mBC. The factors that were considered to be strongly relevant to classifying patients with aggressive HER2-negative mBC were a high tumor burden, a disease-free interval of less than 12-24 months after surgery, the presence of progressive disease during adjuvant or neoadjuvant chemotherapy and having a triple-negative phenotype. The main therapeutic goals were controlling symptoms, improving quality of life and increasing the time to progression and overall survival. CONCLUSIONS: High tumor burden, time to recurrence after prior therapy and having a triple-negative phenotype were the prognostic factors for which the greatest consensus was found for identifying patients with aggressive HER2-negative mBC. Identifying patients with aggressive disease leads to different therapeutic approaches.
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Neoplasias de la Mama/clasificación , Neoplasias de la Mama/patología , Oncología Médica/normas , Consenso , Técnica Delphi , Femenino , Humanos , Receptor ErbB-2 , Sociedades MédicasRESUMEN
PURPOSE: The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients. METHODS: We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots. RESULTS: 171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7-14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes. CONCLUSION: Despite FN's clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN.
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Neutropenia Febril/etiología , Neutropenia Febril/patología , Infecciones/complicaciones , Neoplasias/complicaciones , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Adulto JovenRESUMEN
Human respiratory syncytial virus (HRSV) is a member of the Paramyxoviridae family, which causes lower respiratory tract infections in neonates and children younger than 5 years. Here, we report the complete genome sequence of HRSV, isolated from a nasopharyngeal swab of a pregnant woman with cardiac complications.
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Three microorganisms were assayed to evaluate the microbiological quality in the seawater at a resort on the Mexican Pacific coast, and to test for possible associations among the titers of the various bacteria, their possible correlations with environmental conditions, and with the location of potential wastewater outflows. Significant microorganism levels were found (at Caletilla beach, Hornos beach, and Papagayo beach, respectively: for Enterococcus 157, 153, and 149, for C. perfringens 35, 89, and 56, for S. aureus 244,137, and 279CFU/100ml), often in excess of the presently set guideline values. In general, bacterial titers were higher during rainy season than in dry season. For S. aureus, in both seasons, highest concentrations were found at 3pm, the time of highest tourist presence at the beaches. Our results argue for the use of these three microorganisms as part of a set of indicators in the routine microbiological evaluation of Mexican beachwaters.
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Playas/estadística & datos numéricos , Clostridium perfringens/crecimiento & desarrollo , Enterococcus/crecimiento & desarrollo , Agua de Mar/microbiología , Staphylococcus aureus/crecimiento & desarrollo , Microbiología del Agua , Calidad del Agua/normas , Playas/normas , México , Contaminación Química del Agua/estadística & datos numéricosRESUMEN
Based on the distinctiveness of their mitochondrial haplotypes and other biological features, several recent publications have proposed that some Echinococcus granulosus strains should be regarded as separate species. However, the genetic cohesion of these species has not been extensively evaluated using nuclear markers. We assess the degree of polymorphism of the partial mitochondrial cox1 (366bp), the nuclear mdh (214bp) and EgAgB4 (281-283bp) genes of E. granulosus sensu lato isolates collected from areas where different strains occur sympatrically. Five distinct mitochondrial haplotypes were determined by direct sequencing (G1, G2, G5, G6 and G7). The mdh genotypes were first screened by SSCP: three alleles were identified (Md1-Md3), which were further confirmed by nucleotide sequencing. For EgAgB4, which was analysed by direct sequencing the PCR products, two groups of sequences were found: EgAgB4-1 and EgAgB4-2. No haplotype-specific mdh or EgAgB4 sequences occur. Nevertheless, alleles Md1 and Md2 and type 1 sequences of EgAgB4 showed a higher frequency within the group of haplotypes G1-G2, while allele Md3 and EgAgB4-2 are most frequent in the G5-G7 cluster. By AMOVA it is shown that 79% of the total genetic variability is found among haplotype groups. These findings are compatible with two not mutually exclusive evolutionary hypotheses: (a) that haplotypes share an ancestral polymorphism, or (b) that the reproductive isolation between parasites with distinct haplotypes is not complete, leading to gene introgression. The biologic and epidemiologic consequences of our findings are discussed.
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Equinococosis/parasitología , Echinococcus granulosus/genética , Lipoproteínas/genética , Malato Deshidrogenasa/genética , Argelia/epidemiología , Animales , Argentina/epidemiología , Brasil/epidemiología , Camelus , Bovinos , Equinococosis/epidemiología , Echinococcus granulosus/clasificación , Echinococcus granulosus/enzimología , Echinococcus granulosus/inmunología , Frecuencia de los Genes , Variación Genética , Genotipo , Haplotipos , Humanos , Polimorfismo Conformacional Retorcido-Simple , Rumanía/epidemiología , Ovinos , PorcinosRESUMEN
The T-cell-mediated immune response exhibits a crucial function in the control of the intrahepatic proliferation of Echinococcus multilocularis larvae in mice and humans, both being natural intermediate hosts of the parasite. Antigen B (AgB), a metabolized Echinococcus spp. lipoprotein, contributes to the modulation of the T-cell immune response, and distinct sites of the corresponding AgB1, AgB3 and AgB4 genes were shown to be under positive selection pressure. Since several AgB gene variants are present in a single Echinococcus metacestode, we used secondary E. multilocularis infections in BALB/c and in athymic nude mice (devoid of T-cell responses) to analyze the effect of the cellular immune response on the expression and diversity of EmAgB1-EmAgB4 genes. We demonstrated hereby that EmAgB transcripts were less abundant in nude mice during the early phase of infection (at one month post-infection), and that EmAgB2 is simultaneously down-regulated when compared to the other three genes. A negative relationship exists between the level of transcription and diversity of EmAgB genes. Moreover, no excess of non-synonymous substitutions was found among the distinct EmAgB alleles from a single host. Together, these results pointed to the effect of purifying selection, which seemed to eliminate the detrimental AgB variants generated during the development of the metacestode within the peritoneal cavity of its intermediate host.
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Variación Antigénica/genética , Equinococosis/parasitología , Echinococcus multilocularis/genética , Epítopos de Linfocito T/genética , Expresión Génica , Proteínas del Helminto/genética , Lipoproteínas/genética , Animales , Variación Antigénica/inmunología , Equinococosis/inmunología , Equinococosis/transmisión , Femenino , Variación Genética , Inmunidad Celular , Ratones , Ratones Endogámicos BALB C , Ratones Desnudos , Modelos Biológicos , Mutación PuntualRESUMEN
Numerous genetic variants of the Echinococcus antigen B (AgB) are encountered within a single metacestode. This could be a reflection of gene redundancy or the result of a somatic hypermutation process. We evaluate the complexity of the AgB multigene family by characterizing the upstream promoter regions of the 4 already known genes (EgAgB1-EgAgB4) and evaluating their redundancy in the genome of 3 Echinococcus species (E. granulosus, E. ortleppi and E. multilocularis) using PCR-based approaches. We have ascertained that the number of AgB gene copies is quite variable, both within and between species. The most repetitive gene seems to be AgB3, of which there are more than 110 copies in E. ortleppi. For E. granulosus, we have cloned and characterized 10 distinct upstream promoter regions of AgB3 from a single metacestode. Our sequences suggest that AgB1 and AgB3 are involved in gene conversion. These results are discussed in light of the role of gene redundancy and recombination in parasite evasion mechanisms of host immunity, which at present are known for protozoan organisms, but virtually unknown for multicellular parasites.
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Echinococcus/genética , Evolución Molecular , Conversión Génica , Genes de Helminto , Variación Genética , Proteínas del Helminto/genética , Lipoproteínas/genética , Alelos , Animales , Antígenos Helmínticos/genética , Secuencia de Bases , ADN de Helmintos , Datos de Secuencia Molecular , Familia de Multigenes , Reacción en Cadena de la Polimerasa/métodos , Selección Genética , Alineación de Secuencia , Homología de Secuencia de Ácido Nucleico , Especificidad de la EspecieRESUMEN
Twenty-seven PCR-derived antigen B (AgB) nucleotide sequences from four Echinococcus species (Echinococcus granulosus, Echinococcus multilocularis, Echinococcus oligarthrus and Echinococcus vogeli) were aligned with 78 already published sequences, to generate a maximum likelihood phylogeny of the AgB multigene family. The phylogenetic analysis confirms that the family is constituted by four groups of genes present in each one of the four species (AgB1, AgB2, AgB3 and AgB4), and suggests that it originated by ancient duplication events preceding speciation within the genus. AgB5 sequences, which had been formerly suggested to correspond to a putatively new AgB subunit, cluster with AgB3. Likelihood tests suggest that AgB gene evolution may have been driven by heterogeneous selection pressures acting on particular AgB1, AgB3 and AgB4 codons. No selection is detected in AgB2. We discuss implications of our findings in terms of AgB biology and its use as a diagnostic tool.
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Adaptación Fisiológica/genética , Antígenos Helmínticos/genética , Echinococcus/genética , Evolución Molecular , Genes de Helminto , Proteínas del Helminto/genética , Lipoproteínas/genética , Secuencia de Aminoácidos , Animales , Echinococcus/clasificación , Echinococcus/inmunología , Datos de Secuencia Molecular , Familia de Multigenes , Selección Genética , Especificidad de la EspecieRESUMEN
Echinococcus granulosus larvae secret a polymeric lipoprotein known as antigen B (AgB) into the metacestode hydatid fluid. Three similar AgB subunits have been previously identified (AgB1, AgB2, and AgB3), and their respective genes isolated, but the actual number of genes encoding AgB subunits remains uncertain. In this study, we characterize the variability of genes encoding the AgB2 subunit, using PCR and RT-PCR followed by cloning and sequencing. We have analyzed 32 cDNA and 34 genomic sequences from a single metacestode, showing a high degree of sequence polymorphism. In addition, we have identified a possibly new AgB subunit, which we call AgB4. Additionally, we describe an AgB2 genomic clone lacking (i) a segment corresponding to the intron and (ii) a short, 45 bp sequence within exon II. The 45 bp segment encompasses the conserved splicing signals and corresponds to a highly conserved insect promoter motif.
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Echinococcus granulosus/genética , Echinococcus granulosus/inmunología , Variación Genética , Proteínas del Helminto/genética , Lipoproteínas/genética , Animales , Antígenos Helmínticos/genética , Antígenos de Superficie/genética , Secuencia de Bases , Clonación Molecular , ADN Complementario/química , ADN de Helmintos/química , Datos de Secuencia Molecular , Reacción en Cadena de la Polimerasa , ARN Mensajero/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Alineación de SecuenciaRESUMEN
Las fístulas arteriovenosas (FAV) son complicaciones infrecuentes pero potencialmente letales tanto de la cirugía laparoscópica como de la cirugía de discos intervertebrales. Reportamos el caso de una mujer de 54 años de edad que se presentó a nuestro centro de sintomatología compatible con insuficiencia cardiaca de alto flujo y soplo abdominal continuo. En su historia destacaba el antecedente de haber sido sometida a cirugía de discos intervertebrales y más tarde a una colescistectomía laparoscópica. La arteriografía reveló una FAV entre la arteria iliaca común derecha y vena ilíca ipsilateral. El defecto fue reparado quirúrgicamente mediante la instalación de una endoprótesis, con lo cual remiten completamente sus síntomas.
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Humanos , Femenino , Persona de Mediana Edad , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/etiología , Fístula Arteriovenosa/terapia , Colecistectomía Laparoscópica , Arteria Ilíaca , Vértebras Lumbares/cirugíaRESUMEN
Recent studies have demonstrated that the Echinococcus granulosus antigen B (AgB) interferes with the intermediate hosts' immune response and is encoded by a multigene family. The number of members within the family is still uncertain, but there are several evidences of a large genetic variability. The E. granulosus AgB genomic sequences available in nucleotide databases can be grouped into four clades, corresponding to genes EgAgB1, EgAgB2, EgAgB3 and EgAgB4. In the present study, we use PCR amplifications followed by cloning and sequencing to evaluate the genetic variability for AgB isoforms. Two pairs of primers were independently used for PCR amplification. Both PCR reactions from each of three isolated protoscolex (larvae) were cloned in a plasmid vector and the plasmid inserts of 30 colonies from each cloning experiment were sequenced. Using phylogenetic tools, the 113 EgAgB clones are classified as follows: 25 are related to EgAgB1, 24 to EgAgB2, 9 to EgAgB3 and 39 to EgAgB4. The remaining 16 clones form a separate cluster, which we name EgAgB5, more closely related to EgAgB3 than to any of the other genes. Within each gene group, a number of variant sequences occur, which differ from one another by one or few nucleotides. One EgAgB3 clone has a premature stop codon (pseudogene) and an EgAgB2 clone lacks the region corresponding to the intron. The overall variation cannot be explained by differences among the asexual protoscoleces, or by experimental artifacts. Using Echinococcuss AgB genes from other species/strains as outgroups, neutrality is rejected for EgAgB2, and balancing selection is detected for EgAgB5, which also seems to be involved in gene conversion. We suggest that EgAgB1-EgAgB5 represent a family of contingency genes, that is, genes that are variably expressed, so that some but not others are expressed in each individual parasite. Contingency genes are common in parasitic protozoa and other microparasites, but the EgAgB family is the first set identified in a multicellular parasite.
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Echinococcus/genética , Evolución Molecular , Conversión Génica , Proteínas del Helminto/genética , Lipoproteínas/genética , Selección Genética , Alelos , Animales , Antígenos Helmínticos/genética , Secuencia de Bases , Clonación Molecular , ADN de Helmintos/química , ADN de Helmintos/genética , Echinococcus/inmunología , Datos de Secuencia Molecular , Filogenia , Polimorfismo Genético , Alineación de Secuencia , Análisis de Secuencia de ADN , Homología de Secuencia de Ácido NucleicoRESUMEN
A sample of 114 isolates of Echinococcus granulosus (Cestoda: Taeniidae) collected from different host species and sites in Argentina has been sequenced for 391 bp from the mitochondrial cytochrome c oxidase subunit I gene to analyze genetic variability and population structure. Nine different haplotypes were identified, 5 of which correspond to already characterized strains. Analysis of molecular variance and nested clade analysis of the distribution of haplotypes among localities within 3 main geographic regions indicate that geographic differentiation accounts for the overall pattern of genetic variability in E. granulosus populations. Significant geographic differentiation is also present when the sheep strain alone is considered. Our results suggest that geographic patterns are not due to actual restricted gene flow between regions but are rather a consequence of past history, probably related to the time and origin of livestock introduction in Argentina.
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Animales Domésticos/parasitología , Equinococosis/veterinaria , Echinococcus/genética , Complejo IV de Transporte de Electrones/genética , Variación Genética , Análisis de Varianza , Animales , Argentina/epidemiología , Secuencia de Bases , Bovinos , ADN de Helmintos/química , Perros , Equinococosis/epidemiología , Equinococosis/parasitología , Echinococcus/clasificación , Echinococcus/enzimología , Cabras , Haplotipos , Humanos , Mitocondrias/enzimología , Mitocondrias/genética , Datos de Secuencia Molecular , Reacción en Cadena de la Polimerasa/veterinaria , Polimorfismo Genético , Alineación de Secuencia/veterinaria , Ovinos , PorcinosRESUMEN
Objetivo: Evaluar las variaciones de peso, talla e índice de masa corporal. Se compararon estos parámetros en una muestra de 1940 varones jóvenes (18+-0,8 años) paraguayos nacidos en un periodo de 15 años entre 1960 a 1984 al ingreso al servicio militar. Los sujetos fueron seleccionados por muestreo aleatorio estratificando por año de nacimiento en cantidad suficiente para detectar un coeficiente de regresión mínimo de 0,20. Se observó un sostenido aumento, altamente significativo, con coeficiente de regresión de 0,36, 0,24 y 0,27 para el peso, la talla y el índice de masa corporal, respectivamente, en el periodo de estudio. Estos incrementos también se evidenciaron mediante el análisis estratificado por quin quenios, resultando más importantes en los periodos 1975-1979 y 1980-1984. Adicionalmente, se observó que los menores valores de los parámetros estudiados se observan en los sujetos de menor nivel educativo y provenientes del entorno rural. Esta primera comprobación de las variaciones antropométricas seculares de la población joven de Paraguay debe seguirse por un cuidadoso estudio de sus probables causas y de sus potenciales consecuencias para la salud.
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Antropometría , Índice de Masa Corporal , Pesos y Medidas Corporales , Conducta Alimentaria , ParaguayRESUMEN
Objetivo. Determinar la resistencia bacteriana y su evolución de gérmenes más frecuentes en infecciones nosocomiales (IN) en UCIA.Estudio de cohorte, retrospectivo. Se aislaron 408 gérmenes en 321 infecciones: neumonías 36,5 pto, infección urinaria 25,7pto, infección por cáteter 24pto, bacteremia primaria 7,3pto. Los gérmenes más frecuentes fueron: acinetobacter spp, P. aeruginosa, K pneumoniae, Enterobacter spp, staphylococcus aureus y estafilococos coagulasa negativa (ECN). Comparando ambos periodos los porcentajes de resistencia del Acinetobacter spp. fueron: cefotaxima 100 pto vs 100pto, ciprofloxacina 95 pto vs. 100 pto, imipenen 2.7 pto vs. 3,5 pto, amikacina 82 pto vs 43 pto gentamicina 77 pto vs 33 pto, ceftazidima 80 pto vs 40 pto(todos con NS). Para P. aeruginosa fueron: ciprofloxacina 38 pto vs 75 pto, imipenem 5 pto vs. 31pto y piperacilina+tazobactam 10 vs 12 pto, cefoperazona+sulbactam 57 pto vs 33 pto, amikacina 31pto vs 9 pto (p=NS), Para K pneumoniae fueron: gentamicina 12pto vs 80pto, ciprofloxacina 8pto vs 40pto, ceftazidima 25 vs 50pto (p=NS), sin resistencia a carbapenen. Para Enterobacter spp. fueron: ciprofloxacina 42,1pto vs 41,6pto, gentamicina 50 vs 43pto, imipenem 4 vs 0pto (p=NS), amikacina12 vs. 50 pto. Tanto S aureus como el ECN aumentaron su resistencia a oxacilina: 61 vs 71pto y 70 vs 87Pto respectivamente (p=NS), sin resistencia a vancomicina. Conclusión: Observamos un aumento de resistencia a antimicrobianos de los principales gérmenes aislados en IN, con un perfil evolutivo similar a lo descrito en la literatura.
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Infección Hospitalaria , Farmacorresistencia MicrobianaRESUMEN
We have analyzed 75 isolates of Plasmodium falciparum, collected in Venezuela during both the dry (November) and rainy (May-July) seasons, with a range of genetic markers including antigen genes and 14 random amplified polymorphic DNA (RAPD) primers. Thirteen P. falciparum stocks from Kenya and four other Plasmodium species are included in the analysis for comparison. Cross-hybridization shows that the 14 RAPD primers reveal 14 separate regions of the parasite's genome. The P. falciparum isolates are a monophyletic clade, significantly different from the other Plasmodium species. We identify three RAPD characters that could be useful as "tags" for rapid species identification. The Venezuelan genotypes fall into two discrete genetic subdivisions associated with either the dry or the rainy season; the isolates collected in the rainy season exhibit greater genetic diversity. There is significant linkage disequilibrium in each seasonal subsample and in the full sample. In contrast, no linkage disequilibrium is detected in the African sample. These results support the hypothesis that the population structure of P. falciparum in Venezuela, but not in Africa, is predominantly clonal. However, the impact of genetic recombination on Venezuelan P. falciparum seems higher than in parasitic species with long-term clonal evolution like Trypanosoma cruzi, the agent of Chagas' disease. The genetic structure of the Venezuelan samples is similar to that of Escherichia coli, a bacterium that propagates clonally, with occasional genetic recombination.
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Plasmodium falciparum/clasificación , Animales , Genotipo , Desequilibrio de Ligamiento , Filogenia , Plasmodium falciparum/genética , Polimorfismo Genético , Técnica del ADN Polimorfo Amplificado Aleatorio , Estaciones del Año , VenezuelaRESUMEN
Three pregnant women with 5 +/- 1.7 weeks of pregnancy and mitral stenosis are described. Their valve area were < 1.0 cm2. They received medical treatment with little improvement and were included in our valvotomy percutaneous mitral (VPM) program with Inoue technique before their 30th week of pregnancy. Before they were treated with low molecular weight heparin (LMWH), Enoxiparin) as prophylaxis of intracavitary thrombus formation transthoracic and transesophageal echocardiogram demonstrated the absence of thrombus. We used 40 mgs. subcutaneous injection once a day during 16 weeks. Repeated transthoracic and transesophageal echocardiogram during VPM showed no evidence of intracavitary thrombus. Complete blood count and coagulation parameters remained within normal limits. The three cases delivered a healthy products. In conclusion, although this series is small, we show that the LMWH can be used in the first trimester of pregnancy as prophylactic treatment instead of oral anticoagulant treatment.
Asunto(s)
Anticoagulantes/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Estenosis de la Válvula Mitral/tratamiento farmacológico , Complicaciones Cardiovasculares del Embarazo/tratamiento farmacológico , Adulto , Recuento de Células Sanguíneas , Coagulación Sanguínea/efectos de los fármacos , Ecocardiografía Transesofágica , Electrocardiografía/efectos de los fármacos , Femenino , Humanos , Recién Nacido , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/diagnóstico por imagen , Embarazo , Trombosis/prevención & controlRESUMEN
We studied the therapeutic effect of standard heparin (HS) compared with low-molecular-weight (HBPM) in two homogeneous groups of 14 patients heparin selected at random, with clinical history and electrocardiographic signs of unstable angina pectoris. Patients received the conventional treatment with platelets' inhibitors, nitrates, adrenergic beta-blockers or calcium antagonists. Both heparins, separately, showed statistical therapeutic effect on the symptoms and signs of unstable angina pectoris. They decreased to zero the number and duration of symptomatic myocardial ischemic events observed by ambulatory electrocardiogram (EKG-Holter). The symptoms of the angina pectoris disappeared at the same elapsed time: in 51.9 +/- 20.2 min. for the HS, and in 48.14 +/- 20.7 min. for the HBPM. They decreased the frequency of the silent myocardial ischemia observed at the EKG-Holter: 9 events decreased to 4 with the HS, and 8 events decreased to 3 with the HBPM. They decreased the total elapsed time of the silent ischemia from 52 min. to 15 min., and the mean elapsed time of the silent ischemia decreased from 3.71 +/- 3.29 min. to 1.07 +/- 1.81 min. with the HS (P < 0.001). With HBPM it decreased the total elapsed time of the silent ischemia from 60 min to 10 min, and the mean elapsed time of the silent ischemia decreased from 4.28 +/- 4.49 min. to 0.71 +/- 1.43 min. (P < 0.02). Both heparins considerably decreased the frequency of the lethal arrhythmias. Although in this study we did not find statistical differences in the therapeutic action of either heparins, HBPM reduced rapidly angina symptoms and the events associated to angina pectoris, cardiac arrhythmias, specially lethal extrasystolia, conduction defects and atrial paroxysmal tachycardia. Compared to HS, HBPM is easily applied, does not produce side effects on coagulation or bleeding time.