RESUMEN

BACKGROUND: Surgical management of congenital heart disease (CHD) has increased worldwide, but healthcare-associated infections (HAIs) can threaten these efforts. AIM: To analyse the incidence of HAI, the impact of preventive interventions, and microbiological profiles in a paediatric cardiovascular surgery programme. METHODS: Cohort study including children aged <12 years with CHD who underwent cardiovascular surgery between 2010 and 2021 in Medellín, Colombia (a middle-income setting). Data were collected from medical and laboratory records and infection control programme databases. Impact of various preventive interventions was assessed using a Poisson model. P < 0.05 was considered statistically significant. FINDINGS: A total of 2512 surgeries were analysed. Incidence of surgical site infection (SSI) was 5.9%, followed by central line-associated bloodstream infection (CLABSI; 4.7%), catheter-associated urinary tract infection (CAUTI; 2.2%), and ventilator-associated pneumonia (VAP; 1.4%). Most of the strategies focused on preventing SSI, resulting in a reduction from 9.5% in 2010 to 3.0% in 2021 (P = 0.030). Antibiotic prophylaxis based on patient weight and continuous infusion had an impact on reducing SSI (RR: 0.56; 95% CI: 0.32-0.99). Vacuum-assisted closure (VAC) in clean wounds reduced 100% of infections. No significant risk reduction was observed for other HAI with the implemented interventions. CONCLUSION: Preventive strategies effectively reduced SSI but no other infections, emphasizing the need for targeted approaches to address a broader spectrum of HAI successfully.

Asunto(s)

Infección de la Herida Quirúrgica , Humanos , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/epidemiología , Masculino , Femenino , Preescolar , Colombia/epidemiología , Lactante , Niño , Incidencia , Procedimientos Quirúrgicos Cardiovasculares/efectos adversos , Estudios de Cohortes , Control de Infecciones/métodos , Recién Nacido , Profilaxis Antibiótica/métodos

RESUMEN

BACKGROUND/OBJECTIVES: Obesity is a metabolic disorder that predisposes patients to numerous diseases and has become a major global public-health concern. Animal models of diet-induced obesity (DIO) are frequently used to study obesity, but which DIO model most accurately reflects the pathology of human obesity remains unclear. In this study, we designed a diet based on the human Western diet (WD) and compared it with the cafeteria diet (CAF) and high-fat diet (HFD) in order to evaluate which diet most closely mirrors human obesity. METHODS: Wistar rats were fed four different diets (WD, CAF, HFD and a low-fat diet) for 18 weeks. Metabolic parameters and gut microbiota changes were then characterized. RESULTS: Rats fed the four different diets exhibited completely different phenotypes, highlighting the importance of diet selection. This study also revealed that WD most effectively induced obesity and obesity-related disorders, and thus proved to be a robust model of human obesity. Moreover, WD-fed rats developed obesity and obesity-related comorbidities independent of major alterations in gut microbiota composition (dysbiosis), whereas CAF-fed rats developed the greatest dysbiosis independent of obesity. We also characterized gut microbiota after feeding on these four different diets and identified five genera that might be involved in the pathogenesis of obesity. CONCLUSIONS: These data suggest that diet, and not the obese state, was the major driving force behind gut microbiota changes. Moreover, the marked dysbiosis observed in CAF-fed rats might have resulted from the presence of several additives present in the CAF diet, or even a lack of essential vitamins and minerals. Based on our findings, we recommend the use of the prototypic WD (designed here) in DIO models. Conversely, CAF could be used to investigate the effects of excessive consumption of industrially produced and highly processed foods, which are characteristic of Western society.

Asunto(s)

Dieta Occidental , Microbioma Gastrointestinal/fisiología , Enfermedades Metabólicas/metabolismo , Obesidad/metabolismo , Obesidad/microbiología , Animales , Dieta Alta en Grasa , Modelos Animales de Enfermedad , Disbiosis/metabolismo , Comida Rápida , Masculino , Obesidad/fisiopatología , Ratas , Ratas Wistar

RESUMEN

To study central nervous system airborne PM related subchronic toxicity, SD male rats were exposed for eight weeks to either coarse (32 µg/m³), fine (178 µg/m³) or ultrafine (107 µg/m³) concentrated PM or filtered air. Different brain regions (olfactory bulb, frontal cortex, striatum and hippocampus), were harvested from the rats following exposure to airborne PM. Subsequently, prooxidant (HO-1 and SOD-2), and inflammatory markers (IL-1ß and TNFα), apoptotic (caspase 3), and unfolded protein response (UPR) markers (XBP-1S and BiP), were also measured using real-time PCR. Activation of nuclear transcription factors Nrf-2 and NF-κB, associated with antioxidant and inflammation processes, respectively, were also analyzed by GSMA. Ultrafine PM increased HO-1 and SOD-2 mRNA levels in the striatum and hippocampus, in the presence of Nrf-2 activation. Also, ultrafine PM activated NF-κB and increased IL-1ß and TNFα in the striatum. Activation of UPR was observed after exposure to coarse PM through the increment of XBP-1S and BiP in the striatum, accompanied by an increase in antioxidant response markers HO-1 and SOD-2. Our results indicate that exposure to different size fractions of PM may induce physiological changes (in a neuroanatomical manner) in the central nervous system (CNS), specifically within the striatum, where inflammation, oxidative stress and UPR signals were effectively activated.

Asunto(s)

Contaminantes Atmosféricos/toxicidad , Fármacos del Sistema Nervioso Central/toxicidad , Cuerpo Estriado/efectos de los fármacos , Neuronas/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Material Particulado/toxicidad , Respuesta de Proteína Desplegada/efectos de los fármacos , Contaminantes Atmosféricos/química , Animales , Biomarcadores/metabolismo , Fármacos del Sistema Nervioso Central/química , Cuerpo Estriado/inmunología , Proteínas de Unión al ADN/biosíntesis , Proteínas de Unión al ADN/genética , Proteínas de Unión al ADN/metabolismo , Chaperón BiP del Retículo Endoplásmico , Proteínas de Choque Térmico/biosíntesis , Proteínas de Choque Térmico/genética , Proteínas de Choque Térmico/metabolismo , Hemo Oxigenasa (Desciclizante)/biosíntesis , Hemo Oxigenasa (Desciclizante)/genética , Hemo Oxigenasa (Desciclizante)/metabolismo , Masculino , México , Proteínas del Tejido Nervioso/biosíntesis , Proteínas del Tejido Nervioso/genética , Proteínas del Tejido Nervioso/metabolismo , Neuronas/inmunología , Tamaño de la Partícula , Material Particulado/química , Ratas , Ratas Sprague-Dawley , Factores de Transcripción del Factor Regulador X , Superóxido Dismutasa/biosíntesis , Superóxido Dismutasa/genética , Superóxido Dismutasa/metabolismo , Factores de Transcripción/biosíntesis , Factores de Transcripción/genética , Factores de Transcripción/metabolismo , Regulación hacia Arriba/efectos de los fármacos , Proteína 1 de Unión a la X-Box

RESUMEN

Platelet-derived growth factor (PDGF) and its receptor system regulate mesenchymal cell proliferation. We recently reported that emission-source fly-ash particles and asbestos fibers induce the PDGF alpha-receptor through a macrophage-dependent pathway, and upregulation of this receptor greatly enhances the mitogenic response of lung myofibroblasts to PDGF (Lindroos and colleagues, Am. J. Respir. Cell Mol. Biol. 1997;16:283-292). In the present study we investigated the effect of particulate matter <= 10 micrometers in size (PM10) from the southern, central, and northern regions of Mexico City on PDGF receptor induction and compared these urban, ambient particles with Mt. St. Helen's volcanic ash particles as a negative control. All Mexico City PM10 samples, but not volcanic ash, stimulated rat alveolar macrophages to secrete a soluble, upregulatory factor(s) for the PDGF alpha-receptor on early passage rat lung myofibroblasts. The macrophage-derived upregulatory activity was blocked by the interleukin (IL)-1 receptor antagonist. The ability of PM10 to stimulate IL-1beta release was blocked in part by a recombinant endotoxin neutralizing protein (rENP). Lipopolysaccharide/endotoxin (LPS) and vanadium, both constituents that were present within these PM10 samples, also stimulated macrophages to secrete factor(s) that upregulated PDGF-Ralpha on lung myofibroblasts. Direct exposure of myofibroblasts to PM10 also elicited upregulation of the PDGF alpha-receptor, and this effect was blocked by rENP and mimicked by LPS, but not vanadium. These findings suggest that PM10 particles induce expression of the PDGF receptor system through macrophage-dependent and -independent mechanisms involving endotoxin and metals.

Asunto(s)

Contaminantes Atmosféricos/farmacología , Pulmón/inmunología , Receptores del Factor de Crecimiento Derivado de Plaquetas/inmunología , Contaminantes Atmosféricos/inmunología , Animales , Líquido del Lavado Bronquioalveolar/química , Líquido del Lavado Bronquioalveolar/citología , Líquido del Lavado Bronquioalveolar/inmunología , Ciudades , Medios de Cultivo Condicionados/farmacología , Endotoxinas/inmunología , Fibroblastos/efectos de los fármacos , Fibroblastos/inmunología , Fibroblastos/metabolismo , Interleucina-1/inmunología , Interleucina-1/metabolismo , Pulmón/química , Macrófagos Alveolares/inmunología , Macrófagos Alveolares/metabolismo , Masculino , México , Ratas , Ratas Sprague-Dawley , Receptores del Factor de Crecimiento Derivado de Plaquetas/análisis , Regulación hacia Arriba/inmunología , Compuestos de Vanadio/inmunología , Compuestos de Vanadio/farmacología , Erupciones Volcánicas

RESUMEN

Mexicali dust (MD) is a mixture of particles of potassium aluminum silicates (98%) and sodium dioxide (2%) that induces pulmonary damage under experimental conditions, and is capable of inducing in vitro chromosomal alterations in exposed lymphocytes. It has been proposed as an atmospheric contaminant with pathogenic potential. Among the chromosomal alterations observed, numeric alterations were predominant. The present study was designed to evaluate the capacity of MD to induce anaphasic changes in the Balb c 3T3 cell line. Chrysotile asbestos was used as a positive control. MD was found to induce abnormal anaphases, and the percentage of abnormalities increased as the dose increased (27.41% with 20 mg/mL, 29.60% with 40 mg/mL and 37.10% with 80 mg/mL). Multipolar anaphases constituted the most frequent alteration (69.1-78.8%), followed by lagging chromosomes (18.2-29.5%) and anaphasic bridges (1.51-5.9%). The anaphasic alterations induced by MD showed differences in comparison to those observed with asbestos, especially for anaphasic bridges (10.4% vs. 1.51%, p<0.05). The capacity of MD to induce alterations reported in the process of chromosomal disjunction could explain the numeric aberrations reported previously by the authors of this paper. Therefore, these data support that MD could act as a clastogenic agent.

Asunto(s)

Contaminantes Atmosféricos/toxicidad , Compuestos de Aluminio/toxicidad , Anafase/efectos de los fármacos , Aberraciones Cromosómicas , Óxidos/toxicidad , Compuestos de Potasio/toxicidad , Silicatos/toxicidad , Compuestos de Sodio/toxicidad , Células 3T3 , Animales , Polvo , México , Ratones , Ratones Endogámicos BALB C

RESUMEN

Ferruginous bodies (FB) were quantified in lung digests from 270 autopsy cases over 20 years of age. The cases were autopsied in three different hospitals of the Secretaria de Salud, Mexico, DF. Two hundred seventy samples of peripheral lung tissue were digested in commercial bleach, and all morphologic types of ferruginous bodies were quantified. The results showed that numbers of ferruginous bodies per gram of dry tissue increased over the years: 4.2 FB/g in cases from 1975 to 42.5 FB/g in cases from 1988 (r = 0.86). Higher counts of ferruginous bodies were seen in males, smokers, and Mexico City dwellers. However, more than 70% of them presented less than 100 FB/g. Our study demonstrates that most of our cases had a nonoccupational exposure to fibers.

Asunto(s)

Amianto/análisis , Exposición a Riesgos Ambientales/análisis , Enfermedades Pulmonares/patología , Metaloproteínas/análisis , Adulto , Anciano , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Exposición Profesional/análisis , Población Rural , Factores Sexuales , Factores de Tiempo , Población Urbana

RESUMEN

The correlation between high counts of ferruginous bodies (FB) and pulmonary cancer was investigated. Autopsy cases between 1982 and 1988 were chosen, and studied at Instituto Nacional de Enfermedades Respiratorias. Two grams of lung tissue were digested with sodium hypochlorite. We found no differences in the histologic types of cancer: 18.0 FB per gram (FB/g) for the adenocarcinoma group and 16.0 FB/g for both the epidermoid and anaplastic groups. The asbestos core was predominant in all FB analysed (greater than 85%). Males, Mexico city residents and smokers showed to higher amounts of FB. We concluded that there is an environmental exposure to particles in the cases studied.

Asunto(s)

Adenocarcinoma/química , Carcinoma de Células Pequeñas/química , Carcinoma de Células Escamosas/química , Neoplasias Pulmonares/química , Metaloproteínas/análisis , Adulto , Amianto/análisis , Autopsia , Carcinoma de Pulmón de Células no Pequeñas/química , Femenino , Técnicas Histológicas , Humanos , Masculino , Factores Sexuales , Fumar , Hipoclorito de Sodio , Población Urbana

RESUMEN

There is no doubt autopsies are still a powerful source of medical information. At the Instituto Nacional de Cardiología de México 50% of deaths are autopsied. About half are limited cardiothoracic studies. Since no previous evaluation of the utility of the information obtained from those limited necropsies, we decided to test how well they allowed for a good clinical and anatomical correlation of main disease and a cause of death, as well as their potential to respond clinical questions relevant to the case. We analyzed the medical and autopsy records from 50 cases and determined autopsy type (limited or total), age, sex, main disease and cause of death. It was also included a list of questions made by the attending physician who asked for autopsy. Twenty-six cases corresponded to limited autopsies. In 96.1% there was a good anatomical and clinical correlation of main disease. In 69.2% the cause of death had also a good correlation and in 92.3% of the cases the clinician's question were answered appropriately. Based in our results we support the idea that cardiovascular limited autopsies are an alternative way to obtain useful information, when otherwise, total autopsies result expensive or difficult to obtain.

Asunto(s)

Academias e Institutos , Cardiología , Enfermedades Cardiovasculares/patología , Autopsia , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Encuestas y Cuestionarios

RESUMEN

Lung disease caused by nonoccupational exposures to inorganic particles from the soil has been reported in several areas of the world. We tested the toxic potential of dust samples from a Mexican city (Mexicali) that is frequently affected by dust storms and is geographically related to the area of San Diego, CA, where constituents of the soil have been reported to be fibrogenic. We found that samples of Mexicali dust are a mixture of approximately 75% potassium aluminum silicates (illite) and approximately 20% silica. Respirable size particles were highly hemolytic and induced lactic dehydrogenase release from alveolar macrophages exposed in vitro. Animals instilled intratracheally with the dust developed a multifocal interstitial lung disease associated with deposits of the aluminum silicates, which were identified by X-ray microanalysis. Inhalation studies in rats demonstrated that the majority of particles were deposited preferentially at the first alveolar duct bifurcations. Twenty-four hours later, numerous particles had been ingested by alveolar macrophages that had migrated to those sites of deposition. It is proposed that alveolar macrophages are attracted to the deposited particles by complement fragments since Mexicali dust is capable of activating complement proteins from both serum and bronchoalveolar lavage. Activation resulted in alveolar macrophage chemotaxis. Mexicali dust induced biological activities and lung changes similar to those of asbestos and silica, suggesting that this material could be an etiologic agent of pulmonary fibrosis in exposed individuals.

Asunto(s)

Compuestos de Aluminio , Silicatos de Aluminio/efectos adversos , Polvo/efectos adversos , Exposición a Riesgos Ambientales , Pulmón/citología , Macrófagos Alveolares/citología , Compuestos de Potasio , Silicatos , Dióxido de Silicio/efectos adversos , Silicatos de Aluminio/inmunología , Animales , Líquido del Lavado Bronquioalveolar/citología , Supervivencia Celular , Células Cultivadas , Quimiotaxis , Activación de Complemento , Microanálisis por Sonda Electrónica , Hemólisis , Macrófagos/inmunología , Macrófagos/fisiología , Macrófagos Alveolares/inmunología , Macrófagos Alveolares/fisiología , Masculino , México , Ratas , Ratas Endogámicas , Dióxido de Silicio/inmunología , Difracción de Rayos X

RESUMEN

Autopsies have long been viewed as a biased source of information with regard to the mortality statistics that prevail in the hospital and community. This bias could be of either a demographic or clinical nature. Our objective was to define the autopsy characteristics from the National Cancer Institute of Mexico and determine how representative they were of hospital mortality. Age, sex, place of residence, socioeconomic status, and tumor location were obtained from the Hospital Mortality Registry (1985 and 1987). During these two years, 451 deaths were registered; in 290 of these cases (64.3%), an autopsy was performed. Discrepancies of 9.8 percent were found between autopsy diagnosis and mortality registry data. Our results indicate that autopsy examinations effectively reflect total hospital mortality, and represent a useful tool for epidemiological cancer studies in Mexico. Furthermore, we believe that mortality statistics should be based on autopsy results.

Asunto(s)

Autopsia , Hospitales , Neoplasias/mortalidad , Adolescente , Adulto , Femenino , Humanos , Masculino , México , Persona de Mediana Edad

Asunto(s)

Pruebas de Aglutinación/métodos , Ensayo de Inmunoadsorción Enzimática , Heces/microbiología , Gastroenteritis/diagnóstico , Infecciones por Rotavirus/diagnóstico , Gastroenteritis/microbiología , Humanos

RESUMEN

The value of an autofluorescence method for the early diagnosis of myocardial infarction was evaluated in humans and experimental animals. The hearts from 15 rats and 18 dogs that had undergone coronary occlusion, and those obtained from 29 human autopsy cases with clinical evidence of myocardial infarction were studied. Routine and frozen sections stained and unstained were observed under fluorescence microscopy. In all the cases, ischemic areas exhibited fibres with a bright yellow autofluorescence. There was some variations in fluorescence intensity from routine stained and unstained to frozen stained and unstained sections. These results demonstrate that the fluorescence method can be used to defect early myocardial ischemic injury. The intracellular alterations induced by ischemia could be responsible for light absorption and thus characteristic autofluorescence.

Asunto(s)

Microscopía Fluorescente , Infarto del Miocardio/patología , Animales , Perros , Eosina Amarillenta-(YS) , Estudios de Evaluación como Asunto , Hematoxilina , Humanos , Ratas , Rayos Ultravioleta

RESUMEN

Se trata de establecer en animales de experimentacion y en humanos el valor del metodo de autofluorescencia para el diagnostico temprano de lesion miocardica isquemica. Para tal efecto se estudiaron los corazones de 15 ratas y 18 perros sometidos a periodos variables de isquemia, asi como los de 29 pacientes autopsiados con diagnostico de infarto del miocardio. De todos ellos se obtuvieron cortes por congelacion y en parafina que fueron observados, tanto tenidos como sin tenir, en un microscopio de fluorescencia convencional.En todos los corazones estudiados se demostro la presensica de fibras con fluorescencia amarillo brillante en las zonas isquemicas, aun antes de que esta se manifestara objetivamente en forma de necrosis de coagulacion. Esta positividad se reprodujo en todas las muestras estudiadas aunque con menor intensidad en los cortes sin tenir obtenidos por congelacion. Nuestros resultados confirman la utilidad del metodo para el reconocimiento temprano de lesion isquemica y al mismo tiempo permiten surgerir que las alteraciones intracelulares secundarias a la isquemia "per se" pueden explicar la absorcion de la luz que se manifesta en la florescencia caracteristica

Asunto(s)

Humanos , Animales , Perros , Ratas , Fluorescencia , Infarto del Miocardio , Secciones por Congelación