RESUMEN
La artritis reumatoide (AR) es una de las patologías crónicas de origen autoinmune más frecuentes. Su prevalencia varía del 0,5 al 1%, con un compromiso primario a nivel articular, generando gran discapacidad por las deformidades secundarias derivadas de un estado inflamatorio persistente. Considerando el alto impacto en la calidad de vida de quienes la padecen, sumado al alto costo de las intervenciones terapéuticas, se vuelve imperativo para el personal de salud sumar todos los esfuerzos para promover un diagnóstico temprano y reconocer las potenciales complicaciones con el fin de impactar positivamente en los desenlaces clínicos. Alrededor del 50% de los pacientes con AR pueden tener compromiso extra articular, siendo el pulmón uno de los órganos más afectados. En época de pandemia por el virus SARS-CoV-2 es necesario recordar los tipos de compromiso pulmonar en pacientes con AR y tener en cuenta la susceptibilidad de estos pacientes a cuadros infecciosos que pueden generar una gran morbimortalidad.
Rheumatoid arthritis (RA) is one of the most frequent chronic autoimmune pathologies. It's prevalence varies from 0.5 to 1%, with a primary involvement at the joint, generating disability due to deformities secondary to persistent inflammation. Considering the high impact on the quality of life of those who suffer it, added to the high cost of therapeutic interventions, it becomes imperative for health personnel to join forces to promote early diagnosis and recognize potential complications, in order to impact positively on clinical outcomes. Around 50% of patients with RA may have extra-articular involvement, the lung being one of the most affected organs. In times of SARS-CoV-2 pandemic, it's necessary to remember the types of lung involvement in patients with RA and take into account the susceptibility of these patients to infectious conditions that can generate great morbidity and mortality.
Asunto(s)
Humanos , Artritis Reumatoide , Tuberculosis , Enfermedades Musculoesqueléticas , Artropatías , Neoplasias PulmonaresRESUMEN
The aim of the present work was to complete an exposure assessment in three Mexican indigenous communities using the community-based health risk assessment, which is the first step in the CHILD framework. We used 1-hydroxypyrene (1-OHP) as an exposure biomarker to polycyclic aromatic hydrocarbons (PAHs) and trans, trans-muconic acid (t,t-MA) as an exposure biomarker to benzene, persistent organic pollutants (POPs), lead, manganese, arsenic, and fluoride. Anthropometric measurements were also taken. In these communities, high percentages of children with chronic malnutrition were found (28 to 49 %) based on their weight and age. All communities showed a high percentage of children with detectable levels of four or more compounds (70 to 82 %). Additionally, our results showed that in indigenous communities, children are exposed to elevated levels of certain environmental pollutants, including manganese with 17.6, 16.8, and 7.3 µg/L from SMP, TOC, and CUA, respectively. Lead and HCB levels were similar in the indigenous communities (2.5, 3.1, and 4.2 µg/dL and 2.5, 3.1, and 3.7 ng/mL, respectively). 1-OHP and t,t-MA levels were higher in TOC (0.8 µmol/mol of creatinine, 476 µg/g of creatinine, respectively) when compared with SMP (0.1 µmol/mol of creatinine, 215.5 µg/g of creatinine, respectively) and CUA (0.1 µmol/mol of creatinine, 185.2 µg/g of creatinine, respectively). DDE levels were 30.7, 26.9, and 9.6 ng/mL in CUA, SMP, and TOC, respectively. The strength of this study is that it assesses exposure to pollutants with indications for the resultant risk before an intervention is made by the CHILD program to manage this risk in the indigenous communities. Considering the large number of people, especially children, exposed to multiple pollutants, it is important to design effective intervention programs that reduce exposure and the resultant risk in the numerous indigenous communities in Mexico.
Asunto(s)
Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminantes Ambientales/metabolismo , Pirenos/metabolismo , Arsénico/metabolismo , Benceno/metabolismo , Biomarcadores/metabolismo , Niño , Preescolar , Creatinina , Exposición a Riesgos Ambientales/análisis , Contaminantes Ambientales/análisis , Femenino , Humanos , Masculino , México , Hidrocarburos Policíclicos Aromáticos/metabolismo , Medición de Riesgo , Ácido Sórbico/análogos & derivados , Ácido Sórbico/metabolismoRESUMEN
A simple and rapid focused ultrasound extraction (FU) based method is presented for the determination of persistent organic pollutants (POPs) in soil using a gas chromatography coupled to a mass detector with electron impact ionization. The main experimental parameters affecting the FU step have been optimized by applying a PERMANOVA and PCO analysis allowing us to obtain a maximum amount of information with a minimum number of assays. The limits of detection for POPs fell within the 0.9-6.8 ng/g d.w. interval; a linear method was used with correlation coefficients (r) higher than 0.99. Recovery percentages at low concentrations (25 ng/g d.w.) were 75.8%-110%, and at high concentrations (75 ng/g d.w.) 82.3%-109%; the evaluated precision as RSD% of repeatability and reproducibility were within a range of 0.5%-11% and 0.3%-18%, respectively.
Asunto(s)
Contaminantes del Suelo/análisis , Cromatografía de Gases/métodos , Reproducibilidad de los Resultados , UltrasonidoRESUMEN
Desde la primera descripción de la asociación entre enfermedad renal crónica y enfermedad cardiaca, los estudios epidemiológicos han confirmado y extendido el conocimiento acerca de esta relación. El riesgo de enfermedad cardiovascular se incrementa al progresar la falla renal, probablemente por la suma de los factores de riesgo no tradicionales propios de la insuficiencia renal. No solamente es la patología cardiovascular más frecuente en esta población, sino que además es sub diagnosticada y sub tratada. Los pacientes y los miembros del equipo médico deben ser educados acerca de este mayor riesgo cardiovascular y de las implicancias que esto tiene en el cuidado.
Since the first description of the association between chronic kidney disease and heart disease, epidemiological studies have confirmed and extended the knowledge about this association. The risk of cardiovascular disease increases with progression of renal failure, probably by the sum of nontraditional risk factors own of renal failure. Not only cardiovascular disease is more common in this population, it is also underdiagnosed and undertreated. Patients and medical staff members should be educated about the increased cardiovascular risk and the implications for the care that entails.
Asunto(s)
Humanos , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/epidemiología , Insuficiencia Renal Crónica/complicaciones , Enfermedades Cardiovasculares/terapia , Factores de Riesgo , Medición de Riesgo , Diagnóstico Diferencial , Albuminuria , Insuficiencia Renal Crónica/clasificación , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Tasa de Filtración GlomerularRESUMEN
La enfermedad renal crónica (ERC) es un grave problema de salud pública. Se espera que el número de personas con insuficiencia renal que reciben tratamiento con diálisis y trasplante aumente dramáticamente en los próximos años. Los malos resultados de la ERC no se limitan a la insuficiencia renal terminal, sino que también incluyen a las complicaciones derivadas de una menor función renal, como hipertensión arterial, anemia, desnutrición, trastornos óseos y minerales, neuropatía, así como un mayor riesgo de enfermedad cardiovascular. El diagnóstico precoz basado en la presencia de proteinuria o una velocidad de filtración glomerular estimada reducida, puede permitir la intervención temprana para reducir: el riesgo de insuficiencia renal progresiva, los eventos cardiovasculares y la mortalidad que se asocian con la ERC. Las estrategias eficaces para frenar la progresión de la ERC y reducir el riesgo cardiovascular están disponibles en la actualidad. Los modelos clínicos de atención que faciliten la entrega de los aspectos diversos y complejos del tratamiento en forma simultánea, podrían mejorar la gestión y probablemente los resultados clínicos
Chronic kidney disease (CKD) is a serious public health problem. The number of persons with kidney failure who are treated with dialysis and transplantation is expected to rise dramatically in the coming years. The poor outcomes of CKD are not restricted to kidney failure but also include the complications of decreased kidney function, such as hypertension, anemia, malnutrition, bone and mineral disorders and neuropathy, as well as increased risk of cardiovascular disease. Early diagnosis on the basis of presence of proteinuria or reduced estimated glomerular filtration rate could permit early intervention to reduce the risk of: kidney failure, cardiovascular events and death that are associated with CKD. Effective strategies are available to slow the progression of CKD and reduce cardiovascular risk. Clinical models of care that facilitate delivery of the many complex aspects of treatment simultaneously could enhance management and probably the clinical outcomes
Asunto(s)
Humanos , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/prevención & control , Proteinuria , Enfermedades Cardiovasculares/prevención & control , Factores de Riesgo , Diagnóstico Precoz , Complicaciones de la Diabetes , Albuminuria , Insuficiencia Renal Crónica/complicaciones , Tasa de Filtración Glomerular , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Antihipertensivos/uso terapéuticoRESUMEN
Los pacientes con litiasis renal requieren de investigaciones para identificar las condiciones médicas subyacentes y otras anomalías metabólicas predisponentes. Los resultados de estas investigaciones se utilizan para guiar el tratamiento preventivo. La profundidad del estudio necesario depende de varios factores, incluyendo la edad, la historia clínica de la persona y el número y la frecuencia de los cálculos. Una variedad de factores dietéticos y metabólicos pueden contribuir o causar la formación de litiasis renal. Los factores dietéticos incluyen una alta ingesta de proteínas animales, oxalato y sodio, y una baja ingesta de líquidos y de productos cítricos que contienen potasio. Las alteraciones metabólicas más frecuentemente asociadas a litiasis son la hipercalciuria, la hipocitraturia, la gota, la hiperoxaluria y la hiperuricosuria. Las modificaciones en la dieta deben aplicarse en todos los pacientes con litiasis renal, y consisten en una elevada ingesta de líquidos, la restricción de oxalato y sodio, una dieta balanceada en proteínas animalesy complementadas por una ingesta adecuada de frutas y verduras. Cuando las modificaciones en la dieta no son suficientes en prevenir la formación de litiasis o en la presencia de alteraciones metabólicas importantes, es necesaria una intervención farmacológica especifica.
People who form kidney stones require investigations to identify underlying medical conditions and to detect other predisposing metabolic abnormalities. The results of these investigations can also be used to help guide therapy to prevent future stone formation. The extent of testing required dependson several factors including age and medical history of the person and the number and frequency of stones. A variety of dietary and metabolic factors may contribute or cause stone formation in nephrolithiasis. Dietary factors include a high intake of animal proteins, oxalate and sodium, and a low intake of fluids and potassium containing citrus products. Some of the metabolic causes of stones are hypercalciuria, hypocitraturia, gout, hyperoxaluria, and hyperuricosuria. Dietary modification, to be applied in all patients with stones includes a high fluid intake, restriction of oxalate and sodium, and balanced diet with animal proteins complemented by adequate intake of fruits and vegetables. When dietary modification is ineffective in controlling stone formation or in the presence of severe metabolic derangements, a pharmacologic intervention may be necessary.
Asunto(s)
Humanos , Estado Nutricional , Nefrolitiasis/diagnóstico , Nefrolitiasis/metabolismo , Nefrolitiasis/terapia , Cálculos Renales/diagnóstico , Cálculos Renales/metabolismo , Cálculos Renales/terapia , Factores de RiesgoRESUMEN
Se trata de una paciente de 58 años, sexo femenino, que se presenta con hematuria, proteinuria severa y función renal normal. Pocas semanas después, ella desarrolla una trombosis de vena renal, embolia pulmonar secundaria y un episodio de insuficiencia renal aguda. Este caso clínico ilustra las distintas presentaciones clínicas de una nefropatía por IgA grave, incluyendo hematuria, síndrome nefrótico y trombosis de vena renal. Además muestra otras complicaciones serias, como embolia pulmonar y falla renal aguda. La paciente fue sometida a 2 biopsias renales, que permitieron una correlación adecuada entre las manifestaciones clínicas y la patología renal.
This is a female, 58 years old patient, who presented with hematuria, heavy proteinuria and normal kidney function. Few weeks later she developed a renal venous thrombosis, pulmonary embolism and acute kidney injury. This clinical case illustrates the variable presenting features of a severe IgA nephropathy including hematuria, nephrotic syndrome and renal venous thrombosis. Further it shows its possible severe complications such as lung embolism and acute renal failure. The patient was kidney biopsied in two opportunities, which allows assessing the correlation between the variable clinical characteristics and the renal pathology.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Glomerulonefritis por IGA/diagnóstico , Glomerulonefritis por IGA/patología , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/patologíaRESUMEN
El trasplante de órganos sólidos se ha incorporado al tratamiento de pacientes portadores de una gran variedad de condiciones clínicas. La falta de una adecuada pesquisa de donantes así como su inadecuado manejo médico son factores relevantes para la ocurrencia de la actual gran carencia de órganos sólidos disponibles para ser trasplantados en nuestro País. En este artículo se presenta una revisión acotada de los términos usualmente empleados y luego se refiere primordialmente a los donantes fallecidos en muerte encefálica (DFME). Se hace énfasis en las ultimas cifras nacionales, las formas con las que contamos para poder predecir la capacidad generadora de potenciales donantes, cómo y dónde detectarlos, las principales estrategias para aumentar su detección, los aspectos fisiopatológicos subyacentes a esta particular condición. Finalmente se presentan algunas recomendaciones para el adecuado manejo del donante potencial, desde su detección hasta que se convierte en donante efectivo.
Solid organ transplantation has been incorporated as a valid treatment option for patients that suffer several conditions. The failure to identify potential cadaveric donors early and their subsequent inadequate treatment are undoubtedly relevant factors that go some way to explain the actual shortage of organs available to be transplanted in Chile. In this article we present a review and explanation of the terminology associated with organ donation before focusing on the legal criteria required for the clinical diagnosis of brain-stem death. We use data from other countries in order to predict how many donors should be available in our country as well as trying to anticipate their diagnoses and where they are usually located. The discussion then moves on to present the current reality in Chile before reviewing some measures that have been found useful in other countries to increase donation rates. Finally we present some suggestions on how the patient should be managed from the moment they are considered as a potential donor until they complete the donation process.
Asunto(s)
Humanos , Muerte Encefálica , Trasplante de Órganos , Obtención de Tejidos y Órganos , Selección de DonanteRESUMEN
Las interacciones farmacológicas representan un problema mayor en el manejo de los pacientes trasplantados. La comprensión de los distintos pasos del metabolismo de estos fármacos permite anticipar y prevenir complicaciones derivadas de su uso. Cada nuevo medicamento introducido en la terapia de estos pacientes debe ser acompañado de una revisión de las interacciones con los inmunosupresores y otros fármacos prescritos.
Drug interactions are a major problem in the management of transplant patients. Understanding the various steps in the metabolism of these drugs allows us to anticipate and prevent complications arising from their use. Each new drug introduced in the therapy of these patients should be followed by a review of interactions with immunosuppressive agents and other drugs prescribed.
Asunto(s)
Humanos , Ciclosporina/efectos adversos , Inmunosupresores/efectos adversos , Trasplante , Tacrolimus/efectos adversos , Interacciones FarmacológicasRESUMEN
OBJECTIVE: To estimate the health related quality of life in patients with chronic kidney disease without dialysis or transplant and your association with risk factors. DESIGN: It was a descriptive transversal study from a representative sample belongs to two Health Insurance Organizations. We applied the medical outcomes study 36-item short form and the scores were associated with some demographics and clinics variables. RESULTS: The median age was 70 years, 67% were men, 93% had hypertension and 67% were in stage three. The physical aspects of quality of life were more affected than mental components (Wilcoxon p < 0,001) and the physical functioning, role-physical and body pain domains were better in younger men. In addition, the Physical component was most associated with social-demographics and clinics conditions than mental component. Women older than 65 years old with chronic kidney disease and diabetes mellitus obtained lowest scores among all patients. There was no association between glomerular filtration rate and physical health when we fit them by age. There was a significant difference between physical component of quality of life by sex (p<0,001), which 12.5% of variance was explained by age. CONCLUSION: Physical component of quality of life was significantly reduced compared with mental component among patient with chronic kidney disease without dialysis and transplant. Their scores were lower than general population. The oldest women were the most affected.
Asunto(s)
Enfermedades Renales , Calidad de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Colombia , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Hyperkalemia is a complications of the use of angiotensin converting enzyme inhibitors, angiotensin receptor antagonists and aldosterone antagonists. These drugs are commonly used for the treatment of hypertension and cardiac failure. We report a 84 year-old female treated with losartan 50 mg/day and spironolactone 25 mg/day that presented with a hyperkalemia of 8.4 mEq/l and bradicardia, drowsiness and respiratory depression. She required hemodialysis and ventilatory assistance. She was discharged in good conditions five days after admission.
Asunto(s)
Anciano de 80 o más Años , Femenino , Humanos , Bloqueadores del Receptor Tipo 1 de Angiotensina II/efectos adversos , Antihipertensivos/efectos adversos , Hiperpotasemia/inducido químicamente , Losartán/efectos adversos , Espironolactona/efectos adversos , Hipertensión/tratamiento farmacológico , Índice de Severidad de la EnfermedadRESUMEN
Clínica Las Condes tiene un activo programa de trasplante hepático. Como parte de éste nos vemos enfrentados cada vez con mayor frecuencia a manejar pacientes con insuficiencias hepáticas fulminantes(IHF). Esta condición aún mantiene elevadísimos niveles de mortalidad. Ultimamente se han desarrollado nuevos procedimientos que buscan remover las toxinas involucradas en esta condición clínica, y así permitirle al paciente ganar tiempo vital a la espera de que su hígado se recupere o bien pueda ser reemplazado por otro órgano. Como parte de ellas se desarrolló el MARS (Molecular Adsorbent Recirculating System), que consiste en someter a la sangre del paciente a una diálisis con Albúmina, para así depurar las toxinas que se acumulan en las IHF. El presente artículo pretende, a través de una experiencia clínica vivida en nuestra institución, revisar el tema de la IHF, las técnicas actualmente disponibles para su manejo y comunicar al resto del equipo médico que contamos con una valiosa herramienta para manejar a los pacientes que no sean referidos con esta grave condición.
Asunto(s)
Humanos , Adulto , Femenino , Albúminas/administración & dosificación , Albúminas/uso terapéutico , Insuficiencia Hepática/sangre , Insuficiencia Hepática/terapia , Chile , Diálisis/métodos , Trasplante de Hígado , Soluciones para Diálisis/químicaRESUMEN
Desde hace años se sabe que los pacientes dializados presentan con mayor frecuencia patología cardiovascular (CV) en relación con la población general. Sólo recientemente se ha reconocido que este mayor riesgo CV se extiende también a grados moderados y leves de la insuficiencia renal crónica (IRC). Los estudios recientes han identificado a la velocidad de filtración glomerular (VFG) disminuida y a la albuminuria como factores asociados a mayor morbilidad y mortalidad CV. Este riesgo CV elevado se observa desde etapas precoces de la falla renal, por lo que es vital la determinación del Clearence de creatinina (como estimación de la VFG) y no basarse solamente en la creatinina sérica para diagnosticar la IRC. En los pacientes con IRC se presentan con mayor frecuencia los factores de riesgo CV tradicionales y además se manifiestan otros trastornos propios de la falla renal que pueden causar daño CV. El enfoque actual debe orientarse a manejar los factores de riesgo clásicos y específicos de estos pacientes, en los que se ha llamado estrategia de protección cardiorenal. La IRC debe reconocerse como un factor de riesgo CV similar a la diabetes, dónde la profilaxis CV es en realidad prevención secundaria. El manejo óptimo de estos pacientes debe ser realizado por un equipo multidisciplinario.
Asunto(s)
Humanos , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/patología , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapia , Albuminuria , Factores de RiesgoRESUMEN
The records of the first two Colombian patients with AIDS and paracoccidioidomycosis are presented. Both patients were males and had no known risk factors for HIV although in the past they had worked in the field where they could have been infected with the fungus. They exhibited the juvenile type of disease with multiple organ system involvement and symptoms of short duration. They were deeply immunodepressed as indicated by less than 100 CD4 T lymphocytes per mL; however, serologic tests revealed circulating anti-Paracoccidioides brasiliensis antibodies and in one patient the first diagnostic clue came from such tests. In one case, the mycosis preceded the AIDS diagnosis while in the other, both pathologies were discovered simultaneously. Antimycotic therapy with itraconazole was administered for over 10 months, with an initial dose of 200 mg/day followed by 100 mg/day; marked improvement of the mycotic signs and symptoms was soon noticed an there have been no signs of relapse. The patients improvement was also due to the combined retroviral treatment that was instituted. In spite of the rarity of the AIDS-paracoccidioidomycosis association, physicians practicing in endemic areas should consider the presence of the mycosis in immunosuppressed patients, since a prompt diagnosis and institution of combined antimycotic-anti-retroviral treatments would result in patient improvement and survival. It appears possible that the longer survival time of today's AIDS patients would give the quiescent fungus the opportunity to revive, multiply and cause overt disease.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Paracoccidioidomicosis/complicaciones , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Adulto , Fármacos Anti-VIH/uso terapéutico , Antifúngicos/uso terapéutico , Colombia , Humanos , Itraconazol/uso terapéutico , Masculino , Paracoccidioidomicosis/diagnóstico , Paracoccidioidomicosis/tratamiento farmacológico , Factores de RiesgoRESUMEN
BACKGROUND: Previous research has shown that symptomatic asthmatic patients have increased levels of norepinephrine, epinephrine, dopamine, free serotonin, and cortisol in plasma when compared with asymptomatic patients. OBJECTIVE: We investigated the relationship between plasma levels of catecholamines, free serotonin, and cortisol and clinical status and pulmonary function in symptomatic and asymptomatic patients with asthma. METHODS: We compared clinical severity, spirometry, and neuroendocrine factors at weeks 0, 1, 2, 3, and 4 in 57 symptomatic (forced expiratory volume in one second [FEV1] < 70%) and 72 asymptomatic (FEV1 > 80%) asthmatic patients. We used multiple analyses of variance (repeated measures) to interpret the data. In addition, we used the Pearson Product Moment Test to investigate correlations among the different variables. RESULTS: The clinical severity rating and levels of free serotonin, norepinephrine, epinephrine, dopamine, and cortisol were significantly higher in symptomatic asthmatic patients than those in asymptomatic patients (P < .001, in all cases). FEV1 was significantly lower in symptomatic patients than in asymptomatic patients. In symptomatic patients, the level of free serotonin correlated positively with the clinical severity rating (r = .564, P < .01) and negatively with FEV1 (r = -.959, P < .001). In addition, the clinical severity rating showed a negative correlation with FEV1 (r = -.359, P < .01). No significant correlations were found in asymptomatic patients. CONCLUSION: Our finding that free serotonin was the only neuroendocrine factor closely associated with clinical severity and pulmonary function suggests that this factor plays an important role in the pathophysiology of acute asthma.
Asunto(s)
Asma/sangre , Serotonina/sangre , Adolescente , Adulto , Niño , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Agregación PlaquetariaRESUMEN
BACKGROUND: Previous clinical research has shown that severely ill (somatic) as well as many psychosomatic patients show raised noradrenaline (NA), adrenaline (AD), cortisol, free serotonin (f5HT) and platelet aggregability. Conversely, they show reduced NA/AD plasma ratio and platelet serotonin (p5HT). They also show adrenal hyperresponsiveness to an oral glucose load. These findings are opposed to those observed in depressed patients who show adrenal gland sympathetic hyporesponsiveness and neural sympathetic hyperactivity. OBJECTIVE: To investigate adrenal gland and neural sympathetic systems as well as the other parameters in nondrepressed severely ill patients through the orthostasis exercise stress test which in normals triggers NA but no AD rise. METHODS: We investigated 35 severely ill patients and their age- and sex-paired controls. Systolic, diastolic pulse pressure (PP), heart rate and neuroendocrine parameters were measured supine (0 min), at orthostasis (1 min) and exercise (5 min). A second test was performed 2 weeks later, after atropine injection. Multivariate analysis of variance, paired t test and Pearson product-moment test were employed. RESULTS: The normal PP orthostasis fall was not observed in patients. At this period, an abnormal AD peak substituted the normal NA peak. The normal p5HT-f5HT orthostasis-exercise peaks were absent in patients. Cortisol and platelet aggregability were raised in patients. CONCLUSIONS: Severely ill (somatic) patients responded to the orthostasis-exercise stress test with adrenal and corticosuprarenal but not neural sympathetic activity. They did not show the normal parasympathetic activity at orthostasis. This adrenal gland sympathetic hyperactivity registered in somatic patients is similar to that observed in mammals which fail to cope with stress and contrary to the profile registered in depressed subjects who show NA but not AD rise.
Asunto(s)
Presión Sanguínea/fisiología , Neurotransmisores/sangre , Estrés Fisiológico/sangre , Estrés Fisiológico/fisiopatología , Adolescente , Adulto , Análisis de Varianza , Plaquetas/química , Plaquetas/fisiología , Estudios de Casos y Controles , Enfermedad Crónica , Depresión/fisiopatología , Dopamina/sangre , Epinefrina/sangre , Prueba de Esfuerzo , Femenino , Humanos , Hidrocortisona/sangre , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Norepinefrina/sangre , Serotonina/sangre , Posición Supina/fisiologíaRESUMEN
Measurements of anthropometry and total body water (TBW) were made in 99 women 19-44 y of age living in socioeconomically deprived circumstances in Cali, Colombia. TBW was measured by dilution of deuterium oxide. An empirical equation for estimating lean body mass (LBM) was derived and applied satisfactorily to an independent study group. Comparisons were also made with body-composition values obtained by the Durnin and Womersley equations and an equation derived from rural women living in Guatemala. Neither set of equations was suitable for use with the Colombian subjects because both significantly overestimated LBM and therefore underestimated body fat. Lower values of standing height in older women suggest that they may have been subjected to more severe undernutrition during their growth than the younger subjects. When compared with a group of US women, Colombian subjects were less physically fit and had greater subcutaneous-fat deposits, which were distributed over the trunk and limbs, whereas body mass indexes and waist-hip ratios were not significantly different.
Asunto(s)
Composición Corporal , Países en Desarrollo , Pobreza , Salud de la Mujer , Tejido Adiposo/anatomía & histología , Adulto , Factores de Edad , Análisis de Varianza , Antropometría , Índice de Masa Corporal , Agua Corporal , Colombia , Femenino , Humanos , Aptitud Física , Análisis de RegresiónRESUMEN
We report five consecutive cases of patients with acute pancreatitis resistant to conventional treatment who improved dramatically with clonidine. All patients showed greatly elevated noradrenaline, adrenaline and cortisol plasma levels (physiological indicators of stress) which fell abruptly upon initiation of clonidine therapy. The clonidine test performed in the patients showed a hyper-response in all, a reaction consistent with uncoping stress situation. Therefore, we postulate that stress might play a role in the pathogenesis of these patients pancreatic inflammatory disease.