RESUMEN
El uso de la ecografía clínica, entendida como una extensión de la exploración física que ayuda a la toma de decisiones clínicas en tiempo real, se ha generalizado en diversas especialidades médicas y quirúrgicas. En los últimos años, los avances tecnológicos han permitido disponer de ecógrafos de bolsillo, económicamente asequibles, que pueden ser utilizados en el propio domicilio del paciente. En esta revisión se describen las principales aplicaciones de la ecografía clínica en cuidados paliativos, un escenario de potencial utilidad tanto para mejorar la certeza en el diagnóstico de procesos agudos intercurrentes, que producen un impacto en la calidad de vida del paciente, como para guiar la realización de procedimientos invasivos sin necesidad de desplazamientos al medio hospitalario. Para la implantación de la ecografía clínica en cuidados paliativos son necesarios programas formativos con objetivos concretos, definiendo curvas de aprendizaje y estableciendo alianzas con sociedades científicas de reconocida trayectoria docente, asistencial e investigadora para la acreditación de competencias (AU)
Combined with a physical examination, clinical ultrasound offers a valuable complement that can help guide clinical decision-making. In various medical and surgical specialties, it is increasingly used for diagnostic and therapeutic purposes. Due to recent technological advances, smaller and more affordable ultrasound machines are now being developed for use in home hospice care. The purpose of this paper is to describe how clinical ultrasound may be applied in Palliative Care, where it can be a valuable tool to assist the clinician in making better clinical decisions and to assist in accurately guiding palliative procedures. Furthermore, it can be used to identify unnecessary hospitalizations and prevent them from occurring. Training programs with specific objectives are necessary to implement clinical ultrasound in Palliative Care, as well as defining learning curves and promoting alliances with scientific societies that recognize the teaching, care and research trajectory for accreditation of competencies (AU)
Asunto(s)
Humanos , Ultrasonografía/métodos , Cuidados Paliativos/métodos , Sistemas de Atención de PuntoRESUMEN
OBJECTIVE: Information from critically ill coronavirus disease 2019 (COVID-19) patients is limited and in many cases coming from health systems approaches different from the national public systems existing in most countries in Europe. Besides, patient follow-up remains incomplete in many publications. Our aim is to characterize acute respiratory distress syndrome (ARDS) patients admitted to a medical critical care unit (MCCU) in a referral hospital in Spain. DESIGN: Retrospective case series of consecutive ARDS COVID-19 patients admitted and treated in our MCCU. SETTING: 36-bed MCCU in referral tertiary hospital. PATIENTS AND PARTICIPANTS: SARS-CoV-2 infection confirmed by real-time reverse transcriptasepolymerase chain reaction (RT-PCR) assay of nasal/pharyngeal swabs. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. RESULTS: Forty-four ARDS COVID-19 patients were included in the study. Median age was 61.50 (53.25 - 67) years and most of the patients were male (72.7%). Hypertension and dyslipidemia were the most frequent co-morbidities (52.3 and 36.4% respectively). Steroids (1mg/Kg/day) and tocilizumab were administered in almost all patients (95.5%). 77.3% of the patients needed invasive mechanical ventilation for a median of 16 days [11-28]. Prone position ventilation was performed in 33 patients (97%) for a median of 3 sessions [2-5] per patient. Nosocomial infection was diagnosed in 13 patients (29.5%). Tracheostomy was performed in ten patients (29.4%). At study closing all patients had been discharged from the CCU and only two (4.5%) remained in hospital ward. MCCU length of stay was 18 days [10-27]. Mortality at study closing was 20.5% (n 9); 26.5% among ventilated patients. CONCLUSIONS: The seven-week period in which our MCCU was exclusively dedicated to COVID-19 patients has been challenging. Despite the severity of the patients and the high need for invasive mechanical ventilation, mortality was 20.5%
OBJETIVO: La información de pacientes críticos con enfermedad por coronavirus 2019 (COVID-19) es limitada y, en muchos casos, proviene de sistemas de salud diferentes a la organización pública de la mayoría de los países de Europa. Además, el seguimiento del paciente sigue siendo incompleto en muchas publicaciones. Nuestro objetivo es caracterizar a los pacientes con síndrome de distres respiratorio agudo (SDRA) ingresados en una unidad de cuidados críticos médicos (MCCU) en un hospital de referencia en España. DISEÑO: Serie retrospectiva de casos de pacientes consecutivos con SDRA por COVID-19 ingresados y tratados en nuestra MCCU. LUGAR: UCC de 36 camas en un hospital terciario de referencia PACIENTES Y PARTICIPANTES: Infección por SARS-CoV-2 confirmada por ensayo en tiempo real de la transcriptasa inversa-reacción en cadena de la polimerasa (RT-PCR) de hisopos nasales/faríngeos. INTERVENCIONES: Ninguna. PRINCIPALES VARIABLES DE INTERÉS: Se recopilaron datos demográficos y clínicos, incluidos datos sobre manejo clínico, insuficiencia respiratoria y mortalidad del paciente. RESULTADOS: Cuarenta y cuatro pacientes con SDRA por COVID-19 fueron incluidos en el estudio. La mediana de edad fue de 61.50 (53.25 - 67) años y la mayoría de los pacientes eran hombres (72.7%). La hipertensión y la dislipidemia fueron las comorbilidades más frecuentes (52,3 y 36,4%, respectivamente). Se administraron esteroides (1mg/kg/día) y tocilizumab en casi todos los pacientes (95,5%). El 77,3% de los pacientes necesitaron ventilación mecánica invasiva durante una mediana de 16 días [11-28]. La ventilación en posición prono se realizó en 33 pacientes (97%) con una mediana de 3 sesiones [2-5] por paciente. Se diagnosticó una infección nosocomial en 13 pacientes (29,5%). La traqueotomía se realizó en diez pacientes (29,4%). Al cierre del estudio, todos los pacientes habían sido dados de alta de la MCCU y solo dos permanecían hospitalizados. La estancia en MCCU fue de 18 días [10-27]. La mortalidad al cierre del estudio fue del 20,5% (n 9); 26.5% para pacientes ventilados. CONCLUSIONES: El período de siete semanas en el que nuestra MCCU se dedicó exclusivamente a pacientes con COVID-19 ha sido un gran desafío. A pesar de la gravedad de los pacientes y la elevada necesidad de ventilación mecánica invasiva, la mortalidad fue del 20,5%
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Ciencias de la Salud , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Síndrome Respiratorio Agudo Grave/etiología , Anticuerpos Monoclonales Humanizados/uso terapéutico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/terapia , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Hipertensión/epidemiología , Pronóstico , Respiración Artificial , España/epidemiología , Estudios RetrospectivosRESUMEN
OBJECTIVE: Information from critically ill coronavirus disease 2019 (COVID-19) patients is limited and in many cases coming from health systems approaches different from the national public systems existing in most countries in Europe. Besides, patient follow-up remains incomplete in many publications. Our aim is to characterize acute respiratory distress syndrome (ARDS) patients admitted to a medical critical care unit (MCCU) in a referral hospital in Spain. DESIGN: Retrospective case series of consecutive ARDS COVID-19 patients admitted and treated in our MCCU. SETTING: 36-bed MCCU in referral tertiary hospital. PATIENTS AND PARTICIPANTS: SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal/pharyngeal swabs. INTERVENTIONS: None MAIN VARIABLES OF INTEREST: Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. RESULTS: Forty-four ARDS COVID-19 patients were included in the study. Median age was 61.50 (53.25 - 67) years and most of the patients were male (72.7%). Hypertension and dyslipidemia were the most frequent co-morbidities (52.3 and 36.4% respectively). Steroids (1mg/Kg/day) and tocilizumab were administered in almost all patients (95.5%). 77.3% of the patients needed invasive mechanical ventilation for a median of 16 days [11-28]. Prone position ventilation was performed in 33 patients (97%) for a median of 3 sessions [2-5] per patient. Nosocomial infection was diagnosed in 13 patients (29.5%). Tracheostomy was performed in ten patients (29.4%). At study closing all patients had been discharged from the CCU and only two (4.5%) remained in hospital ward. MCCU length of stay was 18 days [10-27]. Mortality at study closing was 20.5% (n 9); 26.5% among ventilated patients. CONCLUSIONS: The seven-week period in which our MCCU was exclusively dedicated to COVID-19 patients has been challenging. Despite the severity of the patients and the high need for invasive mechanical ventilation, mortality was 20.5%.
Asunto(s)
COVID-19/complicaciones , Síndrome de Dificultad Respiratoria/etiología , SARS-CoV-2 , Anciano , Anticuerpos Monoclonales Humanizados/uso terapéutico , COVID-19/epidemiología , COVID-19/mortalidad , COVID-19/terapia , Comorbilidad , Enfermedad Crítica , Infección Hospitalaria/epidemiología , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pronóstico , Posición Prona , Respiración Artificial/métodos , Respiración Artificial/estadística & datos numéricos , Síndrome de Dificultad Respiratoria/mortalidad , Estudios Retrospectivos , España/epidemiología , Esteroides/uso terapéutico , Traqueostomía/estadística & datos numéricosRESUMEN
Objective: Information from critically ill coronavirus disease 2019 (COVID-19) patients is limited and in many cases coming from health systems approaches different from the national public systems existing in most countries in Europe. Besides, patient follow-up remains incomplete in many publications. Our aim is to characterize acute respiratory distress syndrome (ARDS) patients admitted to a medical critical care unit (MCCU) in a referral hospital in Spain. Design: Retrospective case series of consecutive ARDS COVID-19 patients admitted and treated in our MCCU. Setting: 36-bed MCCU in referral tertiary hospital. Patients and participants: SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal/pharyngeal swabs. Interventions: None. Main variables of interest: Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Results: Forty-four ARDS COVID-19 patients were included in the study. Median age was 61.50 (53.25 - 67) years and most of the patients were male (72.7%). Hypertension and dyslipidemia were the most frequent co-morbidities (52.3 and 36.4% respectively). Steroids (1mg/Kg/day) and tocilizumab were administered in almost all patients (95.5%). 77.3% of the patients needed invasive mechanical ventilation for a median of 16 days [11-28]. Prone position ventilation was performed in 33 patients (97%) for a median of 3 sessions [2-5] per patient. Nosocomial infection was diagnosed in 13 patients (29.5%). Tracheostomy was performed in ten patients (29.4%). At study closing all patients had been discharged from the CCU and only two (4.5%) remained in hospital ward. MCCU length of stay was 18 days [10-27]. Mortality at study closing was 20.5% (n 9); 26.5% among ventilated patients. Conclusions: The seven-week period in which our MCCU was exclusively dedicated to COVID-19 patients has been challenging. Despite the severity of the patients and the high need for invasive mechanical ventilation, mortality was 20.5%.
Objetivo: La información de pacientes críticos con enfermedad por coronavirus 2019 (COVID-19) es limitada y, en muchos casos, proviene de sistemas de salud diferentes a la organización pública de la mayoría de los países de Europa. Además, el seguimiento del paciente sigue siendo incompleto en muchas publicaciones. Nuestro objetivo es caracterizar a los pacientes con síndrome de distres respiratorio agudo (SDRA) ingresados en una unidad de cuidados críticos médicos (MCCU) en un hospital de referencia en España. Diseño: Serie retrospectiva de casos de pacientes consecutivos con SDRA por COVID-19 ingresados y tratados en nuestra MCCU. Lugar: UCC de 36 camas en un hospital terciario de referencia. Pacientes y participantes: Infección por SARS-CoV-2 confirmada por ensayo en tiempo real de la transcriptasa inversa-reacción en cadena de la polimerasa (RT-PCR) de hisopos nasales/faríngeos. Intervenciones: Ninguna. Principales variables de interés: Se recopilaron datos demográficos y clínicos, incluidos datos sobre manejo clínico, insuficiencia respiratoria y mortalidad del paciente. Resultados: Cuarenta y cuatro pacientes con SDRA por COVID-19 fueron incluidos en el estudio. La mediana de edad fue de 61.50 (53.25 - 67) años y la mayoría de los pacientes eran hombres (72.7%). La hipertensión y la dislipidemia fueron las comorbilidades más frecuentes (52,3 y 36,4%, respectivamente). Se administraron esteroides (1mg/kg/día) y tocilizumab en casi todos los pacientes (95,5%). El 77,3% de los pacientes necesitaron ventilación mecánica invasiva durante una mediana de 16 días [11-28]. La ventilación en posición prono se realizó en 33 pacientes (97%) con una mediana de 3 sesiones [2-5] por paciente. Se diagnosticó una infección nosocomial en 13 pacientes (29,5%). La traqueotomía se realizó en diez pacientes (29,4%). Al cierre del estudio, todos los pacientes habían sido dados de alta de la MCCU y solo dos permanecían hospitalizados. La estancia en MCCU fue de 18 días [10-27]. La mortalidad al cierre del estudio fue del 20,5% (n 9); 26.5% para pacientes ventilados. Conclusiones: El período de siete semanas en el que nuestra MCCU se dedicó exclusivamente a pacientes con COVID-19 ha sido un gran desafío. A pesar de la gravedad de los pacientes y la elevada necesidad de ventilación mecánica invasiva, la mortalidad fue del 20,5%.
RESUMEN
La eficacia de la endarterectomía carotídea (EC) en los accidentes cerebrovasculares producidos por estenosis carotídea puede ser evaluada mediante la tomografía computarizada de emisión de fotón único de perfusión cerebral, utilizando SPM (statistical parametric mapping mapas estadísticos paramétricos).Material y métodosSe incluyeron en el estudio 12 pacientes con estenosis significativa de la arteria carótida que fueron sometidos a endarterectomía. A todos se les realizó un estudio de perfusión cerebral con 99mTc-etilen cisteinato dietilester (ECD) basal tras la endarterectomía. Mediante los SPM se comparó de forma independiente el estudio basal/poscirugía con el grupo control formado por 20 pacientes y se obtuvieron los correspondientes SPM. Se valoraron los cambios tanto en extensión (o número de vóxeles) como en intensidad (cambio en el valor de T) de las zonas significativamente hipoperfundidas y el sentido de estos cambios.ResultadosEn el grupo de 12 pacientes se observó una mejoría de la perfusión cerebral posquirúrgica, en 5 pacientes con disminución en la extensión de las zonas hipoperfundidas del 50,56% y de intensidad del 30,9% de media. Cuatro pacientes mostraron un aumento en la extensión de la hipoperfusión cerebral del 85,53% y de la intensidad del 34,21% de media. En tres pacientes no se apreciaron cambios significativos entre ambos estudios.ConclusionesEl SPM ha demostrado ser una herramienta útil que permite objetivar los cambios de flujo sanguíneo cerebral que se producen tras la intervención quirúrgica, valorando los cambios en extensión e intensidad de las zonas significativamente hipoperfundidas(AU)
The efficacy of carotid endartectomy (CE) in cerebrovascular accidents produced by carotid stenosis can be evaluated with the cerebral perfusion with single photon emission tomography, using statistical parametric mapping (SPM).Material and methodsTwelve patients with significant carotid stenosis who underwent endartectomy were included in the study. All underwent a cerebral perfusion study with 99mTc-etilen cisteinato dietilester (ECD) at baseline and after the endartectomy. Using SPM, the baseline/post-surgery study was compared independently with the control group made up of 20 patients and the corresponding parametric statistical mappings were obtained. Changes in extension (kE or voxel number) and intensity (change in the T value) of the significantly hypoperfused zones and direction of these changes were evaluated.ResultsIn the group of 12 patients, improvement of the post-surgical cerebral perfusion was observed in 5 patients with an average 50.56% decrease in the extension of the hypoperfused zones and average 30.9% decrease of intensity. Four patients showed an average 85.53% increase in the extension of cerebral hypoperfusion and of 34.21% in intensity. No significant changes between both studies were found in three patients.ConclusionsSPM has been shown to be a useful tool that makes it possible to objectify the cerebral brain flow changes produced after the surgical intervention, evaluating the changes in extension and intensity of the significantly hypoperfused zones(AU)
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estadística como Asunto , Estadística como Asunto/métodos , Enfermedades de las Arterias Carótidas/complicaciones , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Endarterectomía/instrumentación , Endarterectomía/métodos , Endarterectomía/estadística & datos numéricos , Endarterectomía/tendencias , Endarterectomía Carotidea/estadística & datos numéricos , /métodos , Absorciometría de Fotón/instrumentación , Tomografía Computarizada de Emisión de Fotón Único/métodosRESUMEN
UNLABELLED: The efficacy of carotid endartectomy (CE) in cerebrovascular accidents produced by carotid stenosis can be evaluated with the cerebral perfusion with single photon emission tomography, using statistical parametric mapping (SPM). MATERIAL AND METHODS: Twelve patients with significant carotid stenosis who underwent endartectomy were included in the study. All underwent a cerebral perfusion study with 99mTc-etilen cisteinato dietilester (ECD) at baseline and after the endartectomy. Using SPM, the baseline/post-surgery study was compared independently with the control group made up of 20 patients and the corresponding parametric statistical mappings were obtained. Changes in extension (k(E) or voxel number) and intensity (change in the T value) of the significantly hypoperfused zones and direction of these changes were evaluated. RESULTS: In the group of 12 patients, improvement of the post-surgical cerebral perfusion was observed in 5 patients with an average 50.56% decrease in the extension of the hypoperfused zones and average 30.9% decrease of intensity. Four patients showed an average 85.53% increase in the extension of cerebral hypoperfusion and of 34.21% in intensity. No significant changes between both studies were found in three patients. CONCLUSIONS: SPM has been shown to be a useful tool that makes it possible to objectify the cerebral brain flow changes produced after the surgical intervention, evaluating the changes in extension and intensity of the significantly hypoperfused zones.
Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Estenosis Carotídea/cirugía , Circulación Cerebrovascular , Endarterectomía Carotidea , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Anciano , Anciano de 80 o más Años , Encéfalo/irrigación sanguínea , Isquemia Encefálica/etiología , Estenosis Carotídea/complicaciones , Estenosis Carotídea/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Compuestos de Organotecnecio , Complicaciones Posoperatorias/etiología , RadiofármacosRESUMEN
The axolotl MHC is composed of multiple polymorphic class I loci linked to class II B loci. In this report, evidence of the existence of one class II B locus (Amme-DAB) that codes for two different transcripts is given. A 2.1-kb transcript is translated to a complete beta chain and a shorter transcript of 1.8 kb encodes a molecule lacking the beta1 domain. For two complete class II B mRNA synthesized, up to one mRNA devoid of the beta1 domain is synthesized. Alternative splicing involving a peptide binding domain at a class II B locus evidenced in axolotl (Ambystoma mexicanum) is also observed for A. tigrinum, the tiger salamander. Very little variability is found among various axolotl MHC class II B cDNA sequences, and the same allele is obtained from inbred and wild axolotls. The transcription of one MHC class B locus in two class II B isoforms in thymic cells and in splenic lymphocytes may shed new light on the well-known deficient immune responder state of the axolotl.
Asunto(s)
Alelos , Empalme Alternativo , Ambystoma/inmunología , Genes MHC Clase II , Secuencia de Aminoácidos , Animales , Secuencia de Bases , ADN Complementario/análisis , ADN Complementario/química , Datos de Secuencia Molecular , Filogenia , Polimorfismo Genético , ARN Mensajero/análisisRESUMEN
Lymphocytes apoptosis was characterized in a urodele amphibian, the axolotl, by morphology using electron microscopy and by flow cytometry after propidium iodide staining, as well as by biochemical criteria with the detection of DNA ladders after glucocorticoid treatment. The morphological and biochemical features observed in treated axolotls are in accordance with the criteria of apoptosis found in different models of mammalian lymphocyte programmed cell death. The onset of natural apoptosis was then detected by DNA fragmentation in thymus and in spleen during lymphocyte development and ontogenesis. A typical DNA ladder characteristic of apoptosis is detectable in the thymus as early as 5 months; apoptosis increases and peaks at 8 months, and is no longer detected by 10 months or thereafter. The ability of a superantigen, Staphylococcus aureus enterotoxin B (SEB), to induce T lymphocyte apoptosis in larvae was investigated as well. In vivo exposure of young axolotl larvae to SEB induces, as in mammals, thymocyte apoptosis as indicated by the enhancement of DNA fragmentation. These last results, natural programmed cell death and SEB induced apoptosis during thymic ontogeny, are discussed in correlation with what is known during mammalian thymic selection and apoptosis.
Asunto(s)
Ambystoma , Apoptosis , Linfocitos T/citología , Animales , Diferenciación Celular , Enterotoxinas/farmacología , Hidrocortisona/farmacología , Larva , Linfocitos/citología , Linfocitos/efectos de los fármacos , Superantígenos/farmacología , Linfocitos T/efectos de los fármacosRESUMEN
Se estudio analiza las características de las prescripciones de hierro medicinal realizadasa 100 lactantes (50 anémicos y 50 controles), de edades comprendidas entre 6 y 30 meses, que consultaron el Hospital de Pediatría J. P. Garrahan durante 1997. Se encontraron diferencias significativas entre pacientes anémicos y controles en la siguientes variables: prescripción realizada, 29 anémicos y 42 controles (p: 0.008), prescripción correcta, 7 anémicos y 33 controles (p: 0.00001) y con aclaración de dar hierro lejos de la leche (p: 0.0017). No hubo diferencias en hacer la prescripción por escrito, ni en aclarar darlo con cítricos. En el aspecto socioeconómico, sólo hubo diferencias significativas en el antecedente de empleopermanente de los padres antes del año de vida del niño, 31 anémicos y 43 controles (p: 0.01). No se encontraron diferencias entre casos y controles en el Score de Graffar, en el número o sitio de los controles médicos realizados, ni en laespecialidad de los médicos que realizaron las prescripciones. Se observó un aumento promedio de 2.41 g/dl de hemoglobina en los pacientes anémicos luego de unmes de tratamiento oral con sulfato ferroso. Conclusión: la inadecuada o inexistente prescripción de hierro medicamentoso a lactantes, constituye un factor de riesgo de anemia ferropénica.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Factores de Riesgo , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/prevención & control , Hierro/administración & dosificación , Hierro/efectos adversos , Hierro/uso terapéuticoRESUMEN
Se estudio analiza las características de las prescripciones de hierro medicinal realizadasa 100 lactantes (50 anémicos y 50 controles), de edades comprendidas entre 6 y 30 meses, que consultaron el Hospital de Pediatría J. P. Garrahan durante 1997. Se encontraron diferencias significativas entre pacientes anémicos y controles en la siguientes variables: prescripción realizada, 29 anémicos y 42 controles (p: 0.008), prescripción correcta, 7 anémicos y 33 controles (p: 0.00001) y con aclaración de dar hierro lejos de la leche (p: 0.0017). No hubo diferencias en hacer la prescripción por escrito, ni en aclarar darlo con cítricos. En el aspecto socioeconómico, sólo hubo diferencias significativas en el antecedente de empleopermanente de los padres antes del año de vida del niño, 31 anémicos y 43 controles (p: 0.01). No se encontraron diferencias entre casos y controles en el Score de Graffar, en el número o sitio de los controles médicos realizados, ni en laespecialidad de los médicos que realizaron las prescripciones. Se observó un aumento promedio de 2.41 g/dl de hemoglobina en los pacientes anémicos luego de unmes de tratamiento oral con sulfato ferroso. Conclusión: la inadecuada o inexistente prescripción de hierro medicamentoso a lactantes, constituye un factor de riesgo de anemia ferropénica. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/prevención & control , Factores de Riesgo , Hierro/uso terapéutico , Hierro/administración & dosificación , Hierro/efectos adversosRESUMEN
Despite the fact that the axolotl (Ambystoma spp. a urodele amphibian) displays a large T-cell repertoire and a reasonable B-cell repertoire, its humoral immune response is slow (60 days), non-anamnestic, with a unique IgM class. The cytotoxic immune response is slow as well (21 days) with poor mixed lymphocyte reaction stimulation. Therefore, this amphibian can be considered as immunodeficient. The reason for this subdued immune response could be an altered antigenic presentation by major histocompatibility complex (MHC) molecules. This article summarizes our work on axolotl MHC genes. Class I genes have been characterized and the cDNA sequences show a good conservation of non-polymorphic peptide binding positions of the alpha chain as well as a high diversity of the variable amino acids positions, suggesting that axolotl class I molecules can present numerous antigenic epitopes. Moreover, class I genes are ubiquitously transcribed at the time of hatching. These class I genes also present an important polylocism and belong to the same linkage group as the class II B gene; they can be reasonably considered as classical class Ia genes. However, only one class II B gene has been characterized so far by Southern blot analysis. As in higher vertebrates, this gene is transcribed in lymphoid organs when they start to be functional. The sequence analysis shows that the peptide binding region of this class II beta chain is relatively well conserved, but most of all does not present any variability in the beta 1 domain in inbred as well as in wild axolotls, presuming a limited antigenic presentation of few antigenic epitopes. The immunodeficiency of the axolotl could then be explained by an altered class II presentation of antigenic peptides, putting into question the existence of cellular co-operation in this lower vertebrate. It will be interesting to analyze the situation in other urodele species and to determine whether our observations in axolotl represent a normal feature in urodele amphibians. But already two different models in amphibians, Xenopus and axolotl, must be considered in our search for understanding immune system and MHC evolution.
Asunto(s)
Ambystoma mexicanum/genética , Genes MHC Clase II , Genes MHC Clase I , Ambystoma mexicanum/inmunología , Secuencia de Aminoácidos , Animales , Secuencia de Bases , ADN Complementario , Antígenos de Histocompatibilidad Clase II/biosíntesis , Antígenos de Histocompatibilidad Clase II/inmunología , Humanos , Datos de Secuencia Molecular , Polimorfismo Genético , ARN Mensajero/biosíntesisRESUMEN
Proenkephalin peptides produced by endocrine and nervous tissues are involved in stress-induced immunosuppression. However, the role of peptides produced by immune cells remains unknown. The present study examines the effect of acute and chronic foot-shock stress on proenkephalin peptide content in bone marrow (BMMC), thymus (TMC), and spleen (SMC) rat mononuclear cells. Proenkephalin was not processed to met-enkephalin in BMMC, while in TMC and SMC met-enkephalin represented 10% and 26% of total met-enkephalin-containing peptides, respectively. Naive rats receiving a stress stimulus showed a significant decrease of proenkephalin derived peptides in BMMC, TMC and SMC. However, in chronically stressed rats that already showed basal low peptide levels, a new stress stimulus produced a differential response in each immune tissue. That is, in BMMC peptide levels reached control rats values; in TMC remained unmodified; and in SMC, although precursors content increased, met-enkephalin levels were even lower than those observed in acutely stressed rats. Free synenkephalin content paralleled met-enkephalin changes in SMC of acutely and chronically stressed rats. The in vitro release of met-enkephalin and free synenkephalin increased in SMC of stressed rats. Met-enkephalin produced in SMC and partially processed proenkephalin peptides detected in BMMC, were only found in macrophages. However, met-enkephalin only appeared in bone marrow macrophages after at least 4 h of cell culture. Altogether, these results suggest that a stress stimulus induced proenkephalin peptide release from immune tissue macrophages. The differential response observed in chronically stressed rats suggest an alternative activation of heterogeneous proenkephalin-storing macrophage subpopulations.
Asunto(s)
Células de la Médula Ósea/metabolismo , Encefalinas/metabolismo , Leucocitos Mononucleares/metabolismo , Precursores de Proteínas/metabolismo , Bazo/metabolismo , Estrés Fisiológico/metabolismo , Timo/metabolismo , Animales , Electrochoque , Encefalina Metionina/metabolismo , Macrófagos/metabolismo , Masculino , Ratas , Ratas Wistar , Bazo/citología , Timo/citologíaRESUMEN
While much evidence indicates a high degree of spatial organization in the nucleus, the underlying molecular structures that support it remain poorly characterized. By extracting with high concentrations of RNase A in a modification of the sequential extraction protocol of Penman, we have identified a novel intranuclear network in the mouse lymphoma cell line, EL-4. Micrographs of embedment-free sections of extracted cells reveal anastomosing filaments of two different diameters: 3-5 nm and 8-10 nm. The 3-5-nm filaments are interconnected in many junctions and appear to blend smoothly into each other. The 8-10-nm fibers frequently split into two 3-5-nm filaments. Some 3-5-nm fibers appear to be connected at 90 degrees angles with the 8-10-nm fibers. All junctions are smooth with no apparent junction protein. Flow cytometric analysis of RNase A- (and DNase I-) extracted nuclear matrices indicates that they do not contain significant amounts of protein that react with anti-actin and anti-vimentin monoclonal antibodies. Extraction of EL-4 nuclear matrices with high salt does not reveal 8-10-nm core filaments described after similar treatment of tumor cell lines of cervical and mammary origin. The novel characteristics of the core filaments in EL-4 lymphoma cells may reflect cell-type specificity of the nuclear matrix.
Asunto(s)
Linfoma , Matriz Nuclear/química , Matriz Nuclear/ultraestructura , Actinas/análisis , Actinas/inmunología , Animales , Especificidad de Anticuerpos , Citometría de Flujo , Proteínas de Filamentos Intermediarios/análisis , Proteínas de Filamentos Intermediarios/inmunología , Ratones , Microscopía Electrónica , Matriz Nuclear/inmunología , ARN/fisiología , Células Tumorales Cultivadas/ultraestructuraRESUMEN
Pro-enkephalin (PENK) mRNA and PENK-derived peptides have been reported in lymphocytes, monocytes, and macrophages. Met-enkephalin (ME) and/or synenkephalin (SYN)-containing peptides are produced and released by human peripheral blood lymphocytes (HPBL) activated with phytohemagglutinin (PHA). Furthermore, SYN (PENK 1-70) was cleaved to low-molecular-mass peptides in HPBL. In this work we studied the effect of a mouse monoclonal antibody (mAb) and a rabbit antiserum (pAb) against the C-terminal portion of SYN on DNA synthesis in PHA-activated HPBL. [3H]Thymidine incorporation into HPBL incubated with 0.1 microgram/ml of PHA was tested in the presence of different concentrations of mAb immunoglobulin (Ig) G or different dilutions of pAb. mAb induced a concentration-dependent decrease of [3H]thymidine incorporation into HPBL: 7%, 19%, 28%, and 35% of inhibition was observed with 0.1, 1, 1.5, and 2 micrograms IgG, respectively, reaching values of 65% with 10 micrograms IgG. Similarly, pAb dilutions of 1/500, 1/1000, 1/2000 and 1/4000 inhibited DNA synthesis by 63%, 61%, 43%, and 30%, respectively. The inhibitory effect of mAb and pAb was specific since it was not produced by non-immune mouse IgG or several non-immune rabbit sera and was completely reversed by 1 microM of the synthetic peptide [Tyr63](syn 63-70) synenkephalin. These results suggest that low-molecular-mass SYN-derived peptides released by PHA-activated HPBL may participate in the proliferative response of these cells. This is further evidence that the non-opioid portion of PENK--that is, SYN-derived peptides--may be involved in tissue development.
Asunto(s)
Encefalinas/inmunología , Leucocitos Mononucleares/citología , Precursores de Proteínas/inmunología , Secuencia de Aminoácidos , División Celular , Encefalinas/química , Humanos , Técnicas Inmunológicas , Técnicas In Vitro , Activación de Linfocitos , Datos de Secuencia Molecular , Neuroinmunomodulación , Precursores de Proteínas/químicaRESUMEN
Peripheral blood normal B lymphocytes were found to be poor stimulators in the mixed lymphocyte reaction (MLR), in contrast to normal activated B cells which were strong stimulators. This increased capacity to stimulate a strong MLR correlated with an increased expression of the ICAM-1 (CD54) molecule on the surface of these cells. Similarly, the capacity of leukaemic B cells to induce an allogenic stimulation in the MLR was limited to the ICAM-1 (CD54) positive leukaemic cells. The ability of normal activated or leukaemic B cells to induce an MLR was blocked by antibodies directed against ICAM-1.
Asunto(s)
Linfocitos B/inmunología , Moléculas de Adhesión Celular/análisis , Leucemia Linfocítica Crónica de Células B/inmunología , Prueba de Cultivo Mixto de Linfocitos , Adulto , Anticuerpos Monoclonales , Moléculas de Adhesión Celular/inmunología , Técnica del Anticuerpo Fluorescente , Humanos , Molécula 1 de Adhesión Intercelular , Antígeno-1 Asociado a Función de Linfocito/análisisRESUMEN
A 20-year old patient is presented with generalized lymphadenopathy, splenomegaly, hyperleukocytosis and a bone marrow biopsy showing panmyelosis with predominance of immature granulocytes. Lymph node biopsy showed a histopathological feature that was diagnosed as a chronic granulocytic leukemia in blast crisis. The cell surface phenotype of these blast cells showed predominance of immature CD1+, CD7+ T lymphocytes. The T cell lineage was confirmed by DNA rearrangement studies. In addition, the patient showed erythrocytosis, arterial O2 saturation of 92% and thrombocytosis, characteristics of polycythemia vera. After chemotherapy, the patient relapsed with similar symptoms and lymph node cells of similar immature T phenotype. With a revised diagnosis of immature T cell lymphoma associated to a myeloproliferative disorder and polyglobulia, the patient received a combined treatment of Cyclophosphamide-Adriamycin-Vincristine-VM26-Prednisone. Two months later, the patient relapsed again. He received the first phase of induction of the BFM protocol, with partial clinical remission. Five months later, the patient returned with fever, polyadenopathy and splenomegaly. Lymph node cells showed again immature T cell phenotype. The patient was next treated with the m-BACOD scheme, with no response and progression of the disease and he died few days later due to massive bleeding and cardiorespiratory failure.
Asunto(s)
Ganglios Linfáticos/patología , Linfoma de Células T/complicaciones , Policitemia Vera/complicaciones , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Crisis Blástica , Reordenamiento Génico , Humanos , Linfoma de Células T/tratamiento farmacológico , Linfoma de Células T/patología , Masculino , Policitemia Vera/diagnósticoRESUMEN
Se presenta un paciente de 20 años con poliadenopatías, esplenomegalia hiperleucocitosis y una biopsia de médula ósea que mostró una panmielosis con predominio d eelementos inmaduros. El estudio histopatológico de la biopsia de un ganglio linfático sugirió el diagnóstico de leucemia mieloide crónica en crisis blástica. El fenotipo inmunológico de las células blásticas mostró predominio de celulas T con fenotipo inmaduro CS1+, CD7+. El linaje celular T se confirmó por estudios de reordenamiento genético. Presenta además eritrocitosis, saturación arterial de O2 de 92% y trombocitosis, características de policitemia vera. Luego de quimioterapia Vincristina y Prednisona, recae a los dos meses con síntomas similares y con células de ganglio linfático del mismo fenotipo T inmaduro. Se replantea el diagnóstico como linfoma T asociado a un síndrome mieloproliferativo y policitemia, y se lo trata con Ciclofosfamida-Vincristina-VM26-Prednisona. Luego de una segunda recaída, dos meses después, se le indica un protocolo BFM, al que responde parcialmente. Cinco meses después el paciente presenta una tercera recaída, donde las células de ganglio muestran nuevamente fenotipo T inmaduro. No responde a un tratamiento con esquema m-BACOD, la enfermedad progresa, falleciendo luego de una hemorragia masiva por un paro cardiorespiratorio
Asunto(s)
Adulto , Humanos , Masculino , Ganglios Linfáticos/patología , Linfoma de Células T/complicaciones , Policitemia Vera/complicaciones , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Crisis Blástica , Reordenamiento Génico , Linfoma de Células T/tratamiento farmacológico , Linfoma de Células T/patología , Policitemia Vera/diagnósticoRESUMEN
A 20-year old patient is presented with generalized lymphadenopathy, splenomegaly, hyperleukocytosis and a bone marrow biopsy showing panmyelosis with predominance of immature granulocytes. Lymph node biopsy showed a histopathological feature that was diagnosed as a chronic granulocytic leukemia in blast crisis. The cell surface phenotype of these blast cells showed predominance of immature CD1+, CD7+ T lymphocytes. The T cell lineage was confirmed by DNA rearrangement studies. In addition, the patient showed erythrocytosis, arterial O2 saturation of 92
and thrombocytosis, characteristics of polycythemia vera. After chemotherapy, the patient relapsed with similar symptoms and lymph node cells of similar immature T phenotype. With a revised diagnosis of immature T cell lymphoma associated to a myeloproliferative disorder and polyglobulia, the patient received a combined treatment of Cyclophosphamide-Adriamycin-Vincristine-VM26-Prednisone. Two months later, the patient relapsed again. He received the first phase of induction of the BFM protocol, with partial clinical remission. Five months later, the patient returned with fever, polyadenopathy and splenomegaly. Lymph node cells showed again immature T cell phenotype. The patient was next treated with the m-BACOD scheme, with no response and progression of the disease and he died few days later due to massive bleeding and cardiorespiratory failure.
RESUMEN
Se presenta un paciente de 20 años con poliadenopatías, esplenomegalia hiperleucocitosis y una biopsia de médula ósea que mostró una panmielosis con predominio d eelementos inmaduros. El estudio histopatológico de la biopsia de un ganglio linfático sugirió el diagnóstico de leucemia mieloide crónica en crisis blástica. El fenotipo inmunológico de las células blásticas mostró predominio de celulas T con fenotipo inmaduro CS1+, CD7+. El linaje celular T se confirmó por estudios de reordenamiento genético. Presenta además eritrocitosis, saturación arterial de O2 de 92% y trombocitosis, características de policitemia vera. Luego de quimioterapia Vincristina y Prednisona, recae a los dos meses con síntomas similares y con células de ganglio linfático del mismo fenotipo T inmaduro. Se replantea el diagnóstico como linfoma T asociado a un síndrome mieloproliferativo y policitemia, y se lo trata con Ciclofosfamida-Vincristina-VM26-Prednisona. Luego de una segunda recaída, dos meses después, se le indica un protocolo BFM, al que responde parcialmente. Cinco meses después el paciente presenta una tercera recaída, donde las células de ganglio muestran nuevamente fenotipo T inmaduro. No responde a un tratamiento con esquema m-BACOD, la enfermedad progresa, falleciendo luego de una hemorragia masiva por un paro cardiorespiratorio (AU)
Asunto(s)
Adulto , Humanos , Masculino , Linfoma de Células T/complicaciones , Policitemia Vera/complicaciones , Ganglios Linfáticos/patología , Linfoma de Células T/patología , Linfoma de Células T/tratamiento farmacológico , Policitemia Vera/diagnóstico , Crisis Blástica , Reordenamiento Génico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéuticoRESUMEN
In the hematopoietic system a pluripotent stem cell generates precursors for lymphoid and myeloid lineages. Proenkephalin-derived peptides were previously detected in differentiated lymphoid cells. We have studied whether the proenkephalin system is expressed in a typical differentiated cell of the myeloid lineage, the neutrophil. Human peripheral polymorphonuclear cells contain and release proenkephalin-derived peptides. The opioid portion of proenkephalin (met-enkephalin-containing peptides) was incompletely processed, resulting in the absence of low molecular weight products. The nonopioid synenkephalin (proenkephalin 1-70) molecule was completely processed to a 1.0-kD peptide derived from the COOH-terminal. This molecule was characterized in neutrophils by biochemical and immunocytochemical methods. The chemotactic peptide FMLP and the calcium ionophore A23187 induced the release of the proenkephalin-derived peptides, and this effect was potentiated by cytochalasin B. The materials secreted were similar to those present in the cell, although in the supernatant a higher proportion corresponded to more processed products. The 1.0-kD peptide was detected in human, bovine, and rat neutrophils, but the chromatographic pattern of synenkephalin-derived peptides suggests a differential posttranslational processing among species. These findings demonstrate the existence of the proenkephalin system in human neutrophils and the production and release of a novel 1.0-kD peptide derived from the synenkephalin molecule. The presence of opioid peptides in neutrophils suggests their participation in the inflammatory process, including a local analgesic effect.