RESUMEN
The therapeutic potential of medicinal plants is known as an alternative in treatment of human affections; in effect, the conventional application of these medicinal sources has several limitations like low bioavailability, solubility and stability, which affect its pharmacological efficacy. In recent decades, extraordinary advances have been made in new drug delivery systems using nanocarriers. This work consisted in determining the in vitro antifungal activity of the methanolic extract of Euphorbia tirucalli formulated in polymeric nanoparticles. The antifungal activity was determined by the microdilution method in 96-well microplates, applying nanoparticles loaded with plant extract (NP-Ext) obtained by nanoprecipitation on clinical isolates of Trichophyton rubrum and T. interdigitalis. Regarding the nanoparticles, the lots used did not present significant differences in their physicochemical characteristics, with a size of 91.885 ± 1.621nm, polydispersity index of 0.152 ± 0.025 and Z-potential of -6.047 ± 0.987. The quantification of the extract in the polymeric matrix was determined by infrared spectroscopy (FTIR), where an efficiency and encapsulation percentage of 22.15 ± 0.82 and 2.95 ± 0.11, respectively, were obtained. The in vitro antifungal activity of the crude and formulated extract was obtained calculating the Minimum Inhibitory Concentration (MIC) of each one; a MIC of 125 µg/mL was obtained against T. rubrum and T. interdigitalis with the crude extract, while a MIC value of 55.55 and 0.1 µg/mL was obtained with NP-Ext, respectively, against these same. Conclusions: biological activity is closely linked to the phytochemical profile of the extract; while the improvement of said potential with the NP-Ext with the dosage form was directly related to the physicochemical characteristics of the nanocarrier.
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Antifúngicos , Euphorbia , Pruebas de Sensibilidad Microbiana , Nanopartículas , Extractos Vegetales , Euphorbia/química , Antifúngicos/farmacología , Antifúngicos/química , Extractos Vegetales/farmacología , Extractos Vegetales/química , Nanopartículas/química , Espectroscopía Infrarroja por Transformada de Fourier , Trichophyton/efectos de los fármacos , Polímeros/farmacología , Polímeros/química , ArthrodermataceaeRESUMEN
Anaplasma platys is a tick-transmitted rickettsial pathogen, which is known to be the etiologic agent for cyclic thrombocytopenia in its primary canine host. Infections with this pathogen are also reported in cats, cattle and people. Similarly, Ehrlichia canis is another tick-borne rickettsial pathogen responsible for canine monocytic ehrlichiosis and is also reported to cause infections in people. We describe infections in dogs with these two pathogens on the Caribbean island of Grenada, West Indies by detection using molecular methods. We utilized a 16S rRNA gene-based PCR assay to detect both Ehrlichia and Anaplasma species by screening 155 canine blood samples from asymptomatic dogs. We found 18.7 % of the dogs to be positive for A. platys and 16.8 % for E. canis. Samples that tested positive for A. platys were further assessed by sequence analysis targeting 16S rRNA, 23S rRNA, citrate synthase (gltA) and heat shock protein (groEL) genes. Phylogenetic analysis revealed high correlation of A. platys 16S rRNA and gltA gene sequences with the geographic origins, while 23S rRNA and groEL gene sequences clustered independent of the geographic origins. This study represents an important step in defining the widespread distribution of active rickettsial infections in Caribbean dogs with no apparent clinical signs, thus posing a high risk for canine health and to a lesser extent to humans, as most dogs in the Caribbean are free-roaming.
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Anaplasma/aislamiento & purificación , Anaplasmosis/epidemiología , Enfermedades de los Perros/epidemiología , Ehrlichia canis/aislamiento & purificación , Ehrlichiosis/veterinaria , Anaplasma/enzimología , Anaplasma/genética , Anaplasmosis/microbiología , Animales , Proteínas Bacterianas/análisis , Chaperonina 60/análisis , Citrato (si)-Sintasa/análisis , Enfermedades de los Perros/microbiología , Perros , Ehrlichia canis/enzimología , Ehrlichia canis/genética , Ehrlichiosis/epidemiología , Ehrlichiosis/microbiología , Grenada/epidemiología , Prevalencia , ARN Bacteriano/análisis , ARN Ribosómico 16S/análisis , ARN Ribosómico 23S/análisisRESUMEN
INTRODUCCIÓN Y OBJETIVOS: La deficiencia de vitamina D es muy prevalente durante la gestación, siendo cada vez más numerosos los estudios que relacionan esta condición con peores resultados perinatales. El objetivo del presente trabajo es describir los resultados perinatales y el curso del embarazo de una cohorte de gestantes deficitarias en vitamina D durante el primer trimestre del embarazo, suplementándolas con colecalciferol, así como establecer una comparación entre los resultados perinatales de aquellas pacientes con déficit o insuficiencia que lograron niveles normales de vitamina D en el tercer trimestre frente a aquellas que no lo lograron. Como objetivo secundario se describe el curso del embarazo de una cohorte de pacientes que durante el mismo periodo de tiempo del estudio presentaban normovitaminosis al inicio de la gestación. MÉTODOS: La cohorte de 190 pacientes analizada procede de casos consecutivos en la primera consulta de embarazo. Se determinaron los niveles de 25-hidroxivitamina D (25-OH-D) en la analítica del primer trimestre de 190 gestantes diferenciando entre valores normales (>30ng/mL), insuficiencia (30-15 ng/mL) y deficiencia (<15 ng/mL). Las pacientes con insuficiencia se suplementaron con 1000 UI/día de colecalciferol y las pacientes con deficiencia con 2000 UI/día. En el tercer trimestre se determinaron de nuevo los niveles de 25-OH-D en las pacientes suplementadas, suspendiendo la prescripción en caso de haberse normalizado los valores. Se comparan estadísticamente los resultados perinatales entre aquellas pacientes que mejoraron con la suplementación frente a aquellas que no lo hicieron. RESULTADOS: De las 190 pacientes analizadas, un 45% presentaban insuficiencia; un 27,5% deficiencia; y un 27,5% valores normales. De forma global, un 61% de las pacientes suplementadas habían normalizado sus niveles de vitamina D en la analítica del tercer trimestre, suspendiéndose la prescripción. De ese 61% normalizado, un 63% pertenecían al grupo de insuficiencia y un 37% al de deficiencia. Dentro del grupo suplementado con colecalciferol, un 1,4% de las pacientes desarrollaron hipertensión arterial, mientras que un 33% desarrollaron diabetes en el embarazo, de las cuales un 87% la controlaron exclusivamente con dieta y un 13% precisaron insulina. Un 3,6% de las gestaciones cursaron con retraso del crecimiento y la tasa de prematuridad fue igualmente del 3,6%. La tasa de cesáreas fue del 23%, de las cuales un 77% fueron indicadas intraparto y un 23% cesáreas programadas. El peso medio al nacimiento fue 3205g. Dentro del grupo con valores normales de 25-OH-D en el primer trimestre de la gestación, ninguna paciente desarrolló hipertensión arterial, mientras que un 15% presentaron diabetes gestacional controlada con dieta. Un 3,8% de dichas gestaciones cursaron con retrasos del crecimiento y la tasa de prematuridad fue del 1,9%. La tasa de cesáreas fue del 23%, de las cuales un 50% fueron indicadas intraparto y el 50% restante programadas. El peso medio al nacimiento fue de 3280g. En el análisis comparativo de los resultados perinatales entre el grupo de pacientes suplementadas que normalizaron sus cifras de vitamina D y aquellas que no lo hicieron, no se hallan diferencias estadísticamente significativas para ninguno de los parámetros analizados. CONCLUSIONES: La elevada tasa de hipovitaminosis D en la muestra analizada apoya la extensión del cribado y suplementación a todas las embarazadas y no solamente a aquellas con factores de riesgo. Dado que no se observaron diferencias estadísticamente significativas entre los niveles de vitamina D en el tercer trimestre y las variables perinatales estudiadas, podemos concluir que en nuestro estudio la suplementación con vitamina D no se ha comportado como factor protector de eventos obstétricos adversos.
INTRODUCTION AND OBJECTIVES: Vitamin D deficiency is highly prevalent during pregnancy, with an increasing number of studies linking this condition with worse perinatal outcomes. The objective of this present work is to describe the perinatal results and the course of pregnancy in a cohort of pregnant women deficient in vitamin D during the first trimester of pregnancy, supplementing them with cholecalciferol, as well as to establish a comparison between perinatal results of those patients with deficiencnieve or insufficiency who achieved normal levels of vitamin D in the third trimester compared to those who did not. As a secondary objective, the course of pregnancy is described in a cohort of patients who presented normal levels at the beginning of gestation during the same period of time of the study. METHODS: The cohort of 190 patients analyzed comes from consecutive cases in the first pregnancy visit. The levels of 25-hydroxyvitamin D (25-OH-D) were determined in the analysis of the first trimester of 190 pregnant women, differentiating between normal values (> 30ng / mL), insufficiency (30-15 ng / mL) and deficiency (<15 ng / mL). Patients with insufficiency were supplemented with 1000 IU/day of cholecalciferol and patients with deficiency with 2000 IU/day. In the third trimester, the 25-OH-D levels were determined again in the supplemented patients, suspending the prescription if the values had normalized. Perinatal outcomes are statistically compared between those patients who improved with supplementation versus those who did not. RESULTS: Of the 190 patients analyzed, 45% had insufficiency; 27.5% deficiency; and 27.5% normal values. Overall, 61% of the supplemented patients had normalized their vitamin D levels in the third trimester analysis, suspending the prescription. Within that 61% normalized, 63% belonged to the insufficiency group and 37% to the deficiency group. In the group supplemented with cholecalciferol, 1.4% of the patients developed arterial hypertension, while 33% developed diabetes in pregnancy, of which 87% controlled it exclusively with diet and 13% required insulin. 3.6% of pregnancies had intrauterine growth restriction and the prematurity rate was also 3.6%. The caesarean section rate was 23%, of which 77% were indicated intrapartum and 23% scheduled caesarean sections. The mean weight at birth was 3205g. Within the group with normal 25-OH-D values in the first trimester of pregnancy, no patient developed hypertension, while 15% had diet-controlled gestational diabetes. 3.8% of these pregnancies had intrauterine growth restriction and the prematurity rate was 1.9%. The cesarean section rate was 23%, of which 50% were indicated intrapartum and the remaining 50% scheduled. The mean weight at birth was 3280g. In the comparative analysis of the perinatal results between the group of supplemented patients who normalized their vitamin D levels and those who did not, no statistically significant differences were found for any of the parameters analyzed. CONCLUSIONS: The high rate of hypovitaminosis D in the analyzed sample supports the extension of screening and supplementation to all pregnant women and not only to those with risk factors. Since no statistically significant differences were observed between vitamin D levels in the third trimester and the perinatal outcomes studied, we can conclude that in our study vitamin D supplementation has not behaved as a protective factor against adverse obstetric events.
Asunto(s)
Humanos , Femenino , Embarazo , Deficiencia de Vitamina D/tratamiento farmacológico , Resultado del Embarazo , Colecalciferol/uso terapéutico , Tercer Trimestre del Embarazo , Primer Trimestre del Embarazo , Vitamina D/sangre , Vitamina D/uso terapéutico , Deficiencia de Vitamina D/sangre , Estudios de Cohortes , Suplementos DietéticosRESUMEN
RESUMEN Mediante el análisis mecanístico teórico, ha sido evaluada la posibilidad del empleo del oxihidróxido de vanadio como modificador de electrodo para la detección electroquímica de sacarina. El proceso electroanalítico se realiza a través de un proceso catódico. El modelo matemático correspondiente ha sido analizado mediante la teoría de estabilidad lineal y análisis de bifurcaciones. El análisis del modelo ha mostrado que el oxihidróxido de vanadio puede ser un modificador eficiente para la detección electroquímica de la sacarina en las condiciones del pH suficientemente ácido para mover el proceso, pero insuficiente para disolver el oxihidróxido. Las causas de los comportamientos oscilatorio y monotónico también fueron estipuladas.
SUMMARY By means of the theoretical mechanistic analysis, the possibility of the use of vanadium oxyhydroxide as electrode modifier for saccharin electrochemical determination has been evaluated. The electroanalytical process is realizing by a cathodic route. The correspondent mathematical model has been analyzed by means of the linear stability theory and bifurcation analysis. The analysis of the model has shown that the vanadium oxyhydroxide is an efficient electrode modifier for saccharin electrochemical detection in pH sufficiently low to maintain the process, but insufficiently acidic to dissolve the oxyhydroxide. The causes for the oscillatory and monotonic instabilities have also been derived.
RESUMEN
INTRODUCTION: To date, most studies of natural variation and metabolite quantitative trait loci (mQTL) in tomato have focused on fruit metabolism, leaving aside the identification of genomic regions involved in the regulation of leaf metabolism. OBJECTIVE: This study was conducted to identify leaf mQTL in tomato and to assess the association of leaf metabolites and physiological traits with the metabolite levels from other tissues. METHODS: The analysis of components of leaf metabolism was performed by phenotypying 76 tomato ILs with chromosome segments of the wild species Solanum pennellii in the genetic background of a cultivated tomato (S. lycopersicum) variety M82. The plants were cultivated in two different environments in independent years and samples were harvested from mature leaves of non-flowering plants at the middle of the light period. The non-targeted metabolite profiling was obtained by gas chromatography time-of-flight mass spectrometry (GC-TOF-MS). With the data set obtained in this study and already published metabolomics data from seed and fruit, we performed QTL mapping, heritability and correlation analyses. RESULTS: Changes in metabolite contents were evident in the ILs that are potentially important with respect to stress responses and plant physiology. By analyzing the obtained data, we identified 42 positive and 76 negative mQTL involved in carbon and nitrogen metabolism. CONCLUSIONS: Overall, these findings allowed the identification of S. lycopersicum genome regions involved in the regulation of leaf primary carbon and nitrogen metabolism, as well as the association of leaf metabolites with metabolites from seeds and fruits.
Asunto(s)
Hojas de la Planta/genética , Sitios de Carácter Cuantitativo/genética , Solanum lycopersicum/genética , Mapeo Cromosómico/métodos , Frutas/genética , Cromatografía de Gases y Espectrometría de Masas/métodos , Solanum lycopersicum/metabolismo , Metaboloma/genética , Metabolómica/métodos , Fenotipo , Hojas de la Planta/química , Hojas de la Planta/metabolismo , Semillas/genéticaRESUMEN
Tick-borne bacteria, Ehrlichia canis, Anaplasma platys, and Ehrlichia chaffeensis are significant pathogens of dogs worldwide, and coinfections of E. canis and A. platys are common in dogs on the Caribbean islands. We developed and evaluated the performance of a multiplex bead-based assay to detect antibodies to E. canis, A. platys, and E. chaffeensis peptides in dogs from Grenada, West Indies, where E. canis and A. platys infections are endemic. Peptides from outer membrane proteins of P30 of E. canis, OMP-1X of A. platys, and P28-19/P28-14 of E. chaffeensis were coupled to magnetic beads. The multiplex peptide assay detected antibodies in dogs experimentally infected with E. canis and E. chaffeensis, but not in an A. platys experimentally infected dog. In contrast, the multiplex assay and an in-house enzyme-linked immunosorbent assay (ELISA) detected A. platys antibodies in naturally infected Grenadian dogs. Following testing of 104 Grenadian canine samples, multiplex assay results had good agreement with commercially available ELISA and immunofluorescent assay for E. canis antibody-positive dogs ( K values of 0.73 and 0.84), whereas A. platys multiplex results had poor agreement with these commercial assays ( K values of -0.02 and 0.01). Prevalence of seropositive E. canis and A. platys Grenadian dogs detected by the multiplex and commercial antibody assays were similar to previous reports. Although the multiplex peptide assay performed well in detecting the seropositive status of dogs to E. canis and had good agreement with commercial assays, better antigen targets are necessary for the antibody detection of A. platys.
Asunto(s)
Enfermedades de los Perros/diagnóstico , Ehrlichiosis/veterinaria , Anaplasma/inmunología , Anaplasma/aislamiento & purificación , Animales , Anticuerpos Antibacterianos/sangre , Enfermedades de los Perros/sangre , Enfermedades de los Perros/microbiología , Perros , Ehrlichia canis/inmunología , Ehrlichia canis/aislamiento & purificación , Ehrlichia chaffeensis/inmunología , Ehrlichia chaffeensis/aislamiento & purificación , Ehrlichiosis/diagnóstico , Ensayo de Inmunoadsorción Enzimática/veterinaria , Grenada , Valor Predictivo de las PruebasAsunto(s)
Aterosclerosis/tratamiento farmacológico , Azetidinas/administración & dosificación , Biomarcadores/sangre , Endotelio Vascular/metabolismo , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Anticolesterolemiantes/administración & dosificación , Aterosclerosis/sangre , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Ezetimiba , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
In September 2007, rhizomorphs with morphological characteristics of Armillaria were collected from woody hosts in forests of Mexico State, Veracruz, and Oaxaca, Mexico. Based on pairing tests, isolates were assigned to five somatically compatible genets or clones (MEX7R, MEX11R, MEX23R, MEX28R, and MEX30R). These genets were all identified as Armillaria gallica based on somatic pairing tests against known tester isolates and nucleotide sequences of the translation elongation factor 1α (tef-1α; GenBank Accession Nos. KF156772 to 76). Sequences of tef-1α for all genets showed a max identity of 97 to 99% to A. gallica (ST23, JF313125) (3,4). However, A. gallica comprises a genetically diverse complex that likely represents multiple cryptic species (3). In Mexico, this species has been previously reported in northeastern Morelos on Quercus sp., eastern Mexico State on Pinus hartwegii, and southwestern Mexico State on Prunus persica (1,2). This study identified associations with 10 new hosts within three states of Mexico, but only five hosts were diseased. Genet MEX7R comprised seven isolates collected in the University of Chapingo forest near Texcoco, Mexico State (19°18'10.764â³ N, 98°42'14.147â³ W, elevation 3441 m). Four MEX7R isolates were collected from diseased Alnus sp. including the root ball of a 130 cm dbh, root-disease killed tree, one isolate from a symptomless Senecio sp. s.l. (Roldana sp.) shrub and two isolates from symptomless Abies religiosa. Genet MEX11R comprised four isolates from a cloud forest near Xalapa, Veracruz (19°31'14.628â³ N, 96°59'22.812â³ W, elevation 1496 m). MEX11R isolates were collected from the roots of a root-disease killed Carpinus caroliniana, and from trees with no obvious symptoms (Miconia mexicana, Quercus xalapensis, and Liquidambar styraciflua). Two isolates of genet MEX23R were collected from the Jardin Botanico Francisco Javier Clavijero, Instituto de Ecologia, A.C., Xalapa, Veracruz (19°30'49.067â³ N, 96°56'32.999â³ W, elevation 1344 m). These isolates were from root-diseased Eriobotrya japonica (non-native fruit tree) that showed obvious symptoms (flaccid, chlorotic, and senescing leaves) and from an adjacent, infected Platanus mexicana that did not show readily observable symptoms. Two collections near Oaxaca, Oaxaca, included a single isolate MEX28R from the root ball of a recently root disease-killed Arbutus xalapensis within a small root disease center at Peña Prieta, in Parque La Cumbre, near Ixtepeji (17°09'42.084â³ N, 96°38'15.936â³ W, elevation 2853 m) and a single isolate MEX30R from the base of an asymptomatic Alnus acuminata near the El Carrizal fish hatchery 10 km northeast of San Miguel del Valle (17°06'45.036â³ N, 96°24'03.743â³ W, elevation 2594 m). Armillaria gallica has a circumpolar distribution with an extremely wide host range, and its ecological behavior varies greatly. Continued surveys are needed to better understand the distribution and ecological impacts of this pathogen in relation to Armillaria root disease in Mexico and the potential influences of climate change. Although A. gallica displays diverse ecological behavior, trees infected with A. gallica are less likely to survive the stresses of human activity and a changing climate (4). References: (1) D. Alvarado-Rosales and R. A. Blanchette. Phytopathology 84:1106, 1994. (2) R. D. Elias-Roman et al. For. Pathol. 43:390, 2013. (3) M.-S. Kim et al. Phytopathology 102:S4.63, 2012. (4) B. Marcais and N. Breda. J. Ecol. 94:1214, 2006.
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OBJETIVO: Determinar si el uso de Cefazolina como profilaxis antibiótica produce una disminución significativa de las infecciones en pacientes cirróticos con sangrado digestivo, comparado con Ciprofloxacino. Material y MétodoS: Ensayo Clínico aleatorizado. Se incluyeron a pacientes cirróticos mayores de 18 años, con sangrado digestivo, que ingresaron entre Julio del 2008 a julio del 2010 a la Unidad de hemorragia Digestiva del HNERM, sin evidencia clínica ni de laboratorio de infección al momento del ingreso y que no hubieran recibido tratamiento antibióticolas últimas 2 semanas. A un grupo se le administró Ciprofloxacino 200 mg bid EV y al otro Cefazolina 1 g tid EV.x 7 dias. RESULTADOS: Fueron incluidos 98 pacientes, 53 pacientes en el grupo de Cefazolina y 45 en el grupo de Ciprofloxacino. El promedio de edad fue 66 +/- 10 años, 61 % varones; 59,2 % tuvieron ascitis, la frecuencia de infecciones en la población total fue de 14,3% (14/98). El resangrado fue 8,1% y la mortalidad general 4,1%. No hubo diferencias significativas entre los grupos en relación a edad, sexo, estadio Child, ascitis, encefalopatía, ni en promedio de Bilirrubina, TP, Creatinina y niveles de Albúmina. El grupo que usó Cefazolina tuvo 11,3 % de infecciones, comparado con el 17,8% de infecciones en el grupo que recibió Ciprofloxacino (p= 0,398) IC 95%. Cuando se excluyó del análisis los pacientes cirróticos Child A y aquellos sin ascitis, se encontró: 22,2 % de infecciones en el grupo de cefazolina y 26,9 % en el grupo de Ciprofloxacino (p=0,757 IC 95%).
AIM: To determine if prophylaxis with cefazolin produces a significant reduction in infections in cirrhotic patients with gastrointestinal bleeding when compared with ciprofloxacin. METHODS: Randomized clinical trial. Patients 18 years or older with diagnosis of cirrhosis, gastrointestinal bleeding and no clinical or laboratory evidence of infection who were admitted to the gastrointestinal bleeding unit of HNERM between July 2008 and July 2010 were included. Patients were allocated to receive either i.v. ciprofloxacin 200 mg bid or i.v. cefazolin 1 gm tid for 7 days. RESULTS: 98 patients were included, 53 in the cefazolin group and 45 in the ciprofloxacinone. Age average was 66 +/- 10 years, 61% were male, 59,2% had ascites. Overall rate of infections was 14,3% (14/98). Rebleeding rate was 8,1% and mortality 4,1%. There were nodifferences in age, sex, Child Pugh score, ascites, hepatic encephalopathy nor in billirubin, albumin, PT and creatinine levels between the study groups. Infection rate in the cefazolin groups was 11,3% while in the ciprofloxacin one 17,8% (p=0,398). When Child-Pugh A and patients without ascites were excluded of the analysis, the cefalozin group had 22,2% of infections and 26,9% in the ciprofloxacin one (p=0,757).
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Cefazolina/uso terapéutico , Ciprofloxacina/uso terapéutico , Fibrosis/terapia , Hemorragia Gastrointestinal/terapiaRESUMEN
Artificial neural networks (ANNs) have been used for the recognition of non-linear patterns, a characteristic of bioprocesses like wine production. In this work, ANNs were tested to predict problems of wine fermentation. A database of about 20,000 data from industrial fermentations of Cabernet Sauvignon and 33 variables was used. Two different ways of inputting data into the model were studied, by points and by fermentation. Additionally, different sub-cases were studied by varying the predictor variables (total sugar, alcohol, glycerol, density, organic acids and nitrogen compounds) and the time of fermentation (72, 96 and 256 h). The input of data by fermentations gave better results than the input of data by points. In fact, it was possible to predict 100% of normal and problematic fermentations using three predictor variables: sugars, density and alcohol at 72 h (3 days). Overall, ANNs were capable of obtaining 80% of prediction using only one predictor variable at 72 h; however, it is recommended to add more fermentations to confirm this promising result.
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Fermentación , Redes Neurales de la Computación , Vino , Alcoholes/química , Algoritmos , Aminoácidos/química , Industria de Alimentos , Glicerol/química , Modelos Estadísticos , Nitrógeno/química , Compuestos Orgánicos/química , Curva ROC , Reproducibilidad de los Resultados , Programas Informáticos , Factores de TiempoRESUMEN
AIM: To determine if prophylaxis with cefazolin produces a significant reduction in infections in cirrhotic patients with gastrointestinal bleeding when compared with ciprofloxacin. METHODS: Randomized clinical trial. Patients 18 years or older with diagnosis of cirrhosis, gastrointestinal bleeding and no clinical or laboratory evidence of infection who were admitted to the gastrointestinal bleeding unit of HNERM between July 2008 and July 2010 were included. Patients were allocated to receive either i.v. ciprofloxacin 200 mg bid or i.v. cefazolin 1 gm tid for 7 days. RESULTS: 98 patients were included, 53 in the cefazolin group and 45 in the ciprofloxacin one. Age average was 66 +/- 10 years, 61% were male, 59,2% had ascites. Overall rate of infections was 14,3% (14/98). Rebleeding rate was 8,1% and mortality 4,1%. There were no differences in age, sex, Child Pugh score, ascites, hepatic encephalopathy nor in billirubin, albumin, PT and creatinine levels between the study groups. Infection rate in the cefazolin groups was 11,3% while in the ciprofloxacin one 17,8% (p=0,398).When Child-Pugh A and patients without ascites were excluded of the analysis, the cefalozin group had 22,2% of infections and 26,9% in the ciprofloxacin one (p=0,757). CONCLUSION: there were no differences in infection rates between patients with prophylaxis with cefazolin and ciprofloxacin after an episode of gastrointestinal bleeding.
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Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Infecciones Bacterianas/prevención & control , Cefazolina/uso terapéutico , Ciprofloxacina/uso terapéutico , Hemorragia Gastrointestinal/complicaciones , Cirrosis Hepática/complicaciones , Anciano , Infecciones Bacterianas/etiología , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Background: The prevalence obesity, type 2 diabetes (DM2) and glucose intolerance among children is increasing worldwide. Aim: To assess the frequency of DM2 and GI among severely obese children and adolescents. Patients and methods: Cross sectional study of 69 children and adolescents aged 12 +/- 3 years with a mean body mass index (BMI) z score of 2.9 +/- 0.6. An oral glucose tolerance test (OGTT) was performed, measuring fasting and 120 minutes blood glucose and insulin. According to these results two patients had diabetes mellitus and 4 had glucose intolerance. Previously studied patients, five with diabetes mellitus and two with glucose intolerance were incorporated to the present study. These 13 participants were compared with the remaining 63 children without abnormalities in glucose metabolism, considered as controls. Results: Body mass index among children with glucose intolerance, diabetes mellitus and controls was 33.8 +/- 6.4, 26.7 +/- 5.1 and 29.4 +/- 4.5 kg/m2, respectively, p = 0.03. Basal and 120 min insulin levels were also significantly higher among children with glucose intolerance compared with diabetics and controls. Homeostasis model assessment for insulin resistance was significantly lower in controls than in children with diabetes or glucose intolerance. Conclusions: Eight percent of this group of obese children and adolescents had DM2 or glucose intolerance. Oral glucose tolerance test should be included in the routine assessment of obese children to diagnose abnormalities of glucose metabolism.
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Humanos , Masculino , Femenino , Niño , Adolescente , /epidemiología , Intolerancia a la Glucosa/epidemiología , Obesidad/epidemiología , Análisis de Varianza , Índice de Masa Corporal , Estudios Transversales , Chile/epidemiología , Estado Prediabético/epidemiología , Prueba de Tolerancia a la Glucosa , Incidencia , Resistencia a la Insulina , Insulina/sangre , Lípidos/sangreAsunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Diabetes Mellitus Tipo 1/prevención & control , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Anticuerpos Monoclonales/uso terapéutico , /inmunología , Células Secretoras de Insulina , Diabetes Mellitus Tipo 1/cirugía , Diabetes Mellitus Tipo 1/inmunología , Glutamato Descarboxilasa/uso terapéutico , Trasplante de Islotes Pancreáticos , Insulina/uso terapéutico , Niacinamida/uso terapéutico , Trasplante de Páncreas , Páncreas ArtificialRESUMEN
We investigate the evolution of random positive linear maps with various type of disorder by analytic perturbation and direct simulation. Our theoretical result indicates that the statistics of a random linear map can be successfully described for long time by the mean-value vector state. The growth rate can be characterized by an effective Perron-Frobenius eigenvalue that strongly depends on the type of correlation between the elements of the projection matrix. We apply this approach to an age-structured population dynamics model. We show that the asymptotic mean-value vector state characterizes the population growth rate when the age-structured model has random vital parameters. In this case our approach reveals the nontrivial dependence of the effective growth rate with cross correlations. The problem was reduced to the calculation of the smallest positive root of a secular polynomial, which can be obtained by perturbations in terms of Green's function diagrammatic technique built with noncommutative cumulants for arbitrary n -point correlations.
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Background: Medical treatment of obesity requires a multidisciplinary approach including dietary, exercise and behavioral interventions. Aim: To report the results of a multidisciplinary program for the treatment of obesity in children. Patients and Methods: Three hundred twenty four children (155 males), aged between 5 and 18 year, were treated with diet, exercise and behavioral modification, between 1999 and 2006. At baseline and at the end of follow up, weight, height, z score for body mass index (BMI), blood pressure and features of the metabolic syndrome were assessed. Results: z scores for IMC decreased by 0.28 points (95 percent confidence intervals: -0.31 to -0.25). Sixty percent of patients achieved a weight reduction of 5 percent of more of their initial weight. In a multiple linear regression model, weight loss was directly associated with the follow up time and inversely associated with the initial waist circumference. Patients had a reduction of 0.05 z score points of BMI per month (95 percent confidence intervals 0.07 to 0.025; p < 0.001), while adhering to the program. The overall compliance with the three months treatment period was 59 percent. Conclusions: In children and teenagers, a multidisciplinary management of obesity achieves a sustained weight loss, that ifs proportional to the lapse of adherence to the program.
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Obesidad/terapia , Evaluación de Programas y Proyectos de Salud , Índice de Masa Corporal , Dieta , Ejercicio Físico , Índice Glucémico , Resistencia a la Insulina , Estado Nutricional , Grupo de Atención al Paciente , Cooperación del Paciente , Estudios Prospectivos , Apoyo Social , Sobrepeso/terapia , Relación Cintura-Cadera , Pérdida de PesoRESUMEN
Insulinoma is a very uncommon tumor in children, with an incidence in adults of 2 per million inhabitants. Clinical manifestations include neuroglycopenic or autonomic manifestations due to hypoglycemia. We describe 2 pediatric patients with insulinoma, characterized by repeated episodes of hypoglycemia associated to high insulin serum levels and presence of a small mass in the pancreas by imaging studies. The diagnosis was very prompt in one case and delayed in the other, emphasizing the need for an appropriate diagnosis of hypoglycemia during childhood.
El insulinoma es un tumor muy infrecuente en la edad pediátrica y la incidencia reportada en adultos es de 2 casos por millón de habitantes. La presentación de la enfermedad consiste en la presencia de síntomas neuroglicopénicos y autonómicos desencadenados por los episodios de hipoglicemia. Se describen dos pacientes con insulinoma esporádico. El cuadro clínico consistió en episodios repetidos de hipoglicemia asociados a niveles aumentados de insulina sérica y a imágenes sugerentes de un tumor pancreático. El diagnóstico fue muy oportuno en uno de los casos y muy tardío en el otro, lo que resalta la necesidad de estar muy alerta ante casos de hipoglicemia durante la niñez.
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Humanos , Masculino , Adolescente , Hipoglucemia/etiología , Hipoglucemia/terapia , Insulinoma/complicaciones , Insulinoma/diagnóstico , Neoplasias Pancreáticas , Evolución Clínica , Glucagón/administración & dosificación , Glucemia/análisis , Insulina/sangre , Signos y SíntomasRESUMEN
Somatotrophic deficiency (SDMT) can be due to a deficiency of growth hormone releasing hormone(GHRH), growth hormone (GH) or insulin like growth factor I (IGF-I). Although its clinical features have been thoroughly described, the diagnosis is still controversial. Now there is an effective treatment with GH or IGF-I for these patients. AIM: To analyze the main clinical, etiological and laboratory characteristics of 75 SD patients (44 males), aged 9.4 + 4.5 years, with severe growth retardation. The diagnosis was confirmed by the lack of response to two GH stimulation tests (Clonidine, Glugagon or Insulin) and low levels of IGF-I or insulin-like growth factor binding protein- 3 (IGFBP-3). RESULTS: In 34 patients (46 percent), the cause of DSMT was considered idiopathic (DSMT-I), in 31 (41 percent) there was an organic cause (DSMT-O), most commonly caused by malformations or pituitary tumors and in 10 (13 percent), it was genetic (DSMT-G) (three patients with Laron's Syndrome, five with mutations of GH gene and 2 with probable mutations of Prop-1 and Pit-1 genes). IGF-1 levels, were significantly lower in DSMT-O and DSMT-G thanin DSMT-I (21.2 +/- 46.1, 23.4 +/-30.3 ng/mL and 50.2 +/- 48.3 ng/mL, respectively). The lowest height score corresponded to DSMT-G, compared to DSMT-O and DSMT (5.7 +/- 0.9, -4.0 +/- 1.6 and 4.3 +/- 1.2 DS, respectively) CONCLUSIONS: The high percentage of organic and genetic etiologies in our patients can be due to the systematic search of these diseases. DSMT-G (Laron, mutations in GH and Pit-1 genes) had the most severe growth retardation.
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Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Estatura , Hormona del Crecimiento/deficiencia , Trastornos del Crecimiento/diagnóstico , Trastornos del Crecimiento/etiología , Antropometría , Chile , Enanismo/etiología , Estudios Retrospectivos , Factor I del Crecimiento Similar a la Insulina/análisis , Hormona del Crecimiento/análisis , Hormona del Crecimiento/genética , Mutación , Peso Corporal , /análisis , Trastornos del Crecimiento/genéticaRESUMEN
BACKGROUND: Liver cirrhosis is an important cause of morbidity and mortality all around the world. In Peru it is the 5th cause of general mortality and the 2nd one between all those related to gastrointestinal and hepatobiliary diseases. At HNERM it is the principal etiology between all the cases that need hospitalization in gastroenterology. It is clear that we need to know all the clinical and epidemiologic characteristics to propose national actions to try to control and prevent this disease. MATERIAL AND METHODS: The present is a descriptive, transversal and observational study to clarify the clinical and epidemiological profile of patients with cirrhosis hospitalized in the Liver unit at the Edgardo Rebagliati Martins National Hospital between january 2001 and june 2004. RESULTS: 475 patients were included, 45.1% were female, medium age was 63.4 years (r =26-93). The most frequent causes of cirrhosis were alcoholism (28%), chronic hepatitis B (15.2%), and chronic hepatitis C (11.8%). According to Child-Pugh score 42.3% was in stage B, and 42.5% en C. The main cause for hospitalization was upper gastrointestinal bleeding related to portal hypertension, followed by ascitis and encephalopathy. The principal infections were urinary, pulmonar and spontaneous bacterial peritonitis. Hepatocellullar carcinoma was found in 7.9% of the cases. CONCLUSIONS: Liver cirrhosis affects principally males. The principal causes are alcoholism and chronic viral hepatitis. The principal cause of hospitalization is upper gastrointestinal bleeding. Most of the patients have an advanced disease at the moment of diagnosis. Principal infections are urinary, Pneumonia and SBP.
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Cirrosis Hepática/diagnóstico , Cirrosis Hepática/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Unidades Hospitalarias , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Three labdane diterpenes 15,16-epoxy-6-hydroxylabda-5,8,13(16),14-tretraen-7-one (leojaponin), (9alpha,13S);15,16-diepoxy-7beta-hydroxylabd-14-en-6-one (13-epi-preleoheterin), and (9alpha,13R);15,16-diepoxy-6beta-hydroxylabd-14-en-7-one (iso-preleoheterin) were isolated from the leaves of Leonurus japonicus, in addition to the previously reported preleoheterin. The structure elucidations were made based on analysis of their spectroscopic data.
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Diterpenos/química , Leonurus/química , Diterpenos/aislamiento & purificación , Conformación Molecular , Extractos Vegetales/química , Hojas de la Planta/químicaRESUMEN
BACKGROUND: The lack of catch up growth (CUG) in small for gestational age (SGA) children may be related to a reduced sensitivity to insulin growth factor 1 (IGF-I). AIM: To assess the sensitivity to IGF-I in small for gestational age children, measuring basal and post IGF-I nocturnal profile of growth hormone (GH). PATIENTS AND METHODS: We studied 34 prepubertal SGA children aged 4 to 11 years. Twenty three had CUG and 11 did not have CUG. As an IGF-I sensitivity test, nocturnal GH levels were measured every 20 minutes from 23:00 h to 07:00 h, both under baseline conditions and after the administration of a subcutaneous bolus of 1 mg/kg/body weight of the IGF-I + IGFBP-3 complex (Somatokine). RESULTS: At the time of the study, the Z scores for height among children with and without CUG were -1.55 +/- 0.22 and -3.24 +/- 0.28, respectively (p <0.0001). There were no statistical differences between CUG + vs CUG- patients in mean basal GH (6.6 +/- 0.5 and 5.6 +/- 0.6 ng/ml, respectively). After Somatokine administration, mean GH, and the mean GH area under the curve (AUC) decreased significantly in both groups. However, mean overnight GH AUC decreased in all SGA children with CUG, after Somatokine administration, whereas 3 out of 11 SGA children without CUG had an increase in their mean GH AUC in response to Somatokine. CONCLUSIONS: These findings suggest that pituitary sensitivity to IGF-I may be decreased in some SGA children without CUG.