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Some experiences demonstrate a direct correlation between attention capacity and reaction capacity. However, the evidence from adolescents enrolled in the Chilean school system is scarce. The purpose of this study was to determine the relationship between attention capacity and hand-eye reaction time (RT) in adolescents between 15 and 18 years of age. Thirty-one adolescents participated voluntarily in this study. The variables were: attention capacity, evaluated through the Evalúa-10 battery (item 1.1), and hand-eye RT, assessed through a simple RT test (SRT) and complex RT (CRT). The relationship between the variables was performed through Pearson's correlation. Comparisons between males and females were performed with the t-test for independent samples (p Ë 0.05). There was a moderate correlation between attention and CRT (r = -0.43), a very high correlation between attention and SRT in males (r = -0.73), and between attention and CRT in females (r = -0.73). Between males and females, there was no difference in attention (p Ë 0.05), while males showed better RT in all tests (p Ë 0.05). Attention positively influences hand-eye RT in both males and females. Likewise, male adolescents present better hand-eye RT than their female peers.
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Atenção , Mãos , Adolescente , Chile , Feminino , Humanos , Masculino , Grupo Associado , Tempo de ReaçãoRESUMO
Hereditary transthyretin amyloidosis is a multisystemic autosomal dominant genetic disorder characterized by progressive distal sensory-motor polyneuropathy or restrictive cardiomyopathy, secondary to amyloid deposits. Its pathogenesis lies in the TTR gene mutation, and the Val50Met mutation is the most frequent. Patients have significant differences in the onset and severity of clinical presentation according to their country of origin. The diagnosis of this pathology is complex, even more in countries where it is not considered endemic. However, early suspicion and management are essential to improve survival and avoid unnecessary diagnostic and therapeutic strategies. We report a 69-year-old woman who presented a sensory-motor polyneuropathy, predominantly sensory, associated with distal neuropathic pain and bilateral vitritis. The history of her Italian father with polyneuropathy of unspecified etiology stood out. A vitreous biopsy identified amyloid substance deposits (congo red positive). These were also confirmed on a superficial peroneal nerve biopsy. During the etiological study of her polyneuropathy, an increased Kappa/Lambda index of 2.55 mg/L stood out. Therefore, light chain amyloidosis was suspected, and chemotherapy treatment was indicated without favorable response. After 10 years of progressive neurological and ophthalmological involvement, a genetic study confirmed the first case of late-onset hereditary transthyretin amyloidosis Val50Met with polyneuropathy in Chile.
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Humanos , Feminino , Idoso , Polineuropatias/etiologia , Polineuropatias/genética , Neuropatias Amiloides Familiares/complicações , Neuropatias Amiloides Familiares/diagnóstico , Neuropatias Amiloides Familiares/genética , Pré-Albumina/genética , MutaçãoRESUMO
Hereditary transthyretin amyloidosis is a multisystemic autosomal dominant genetic disorder characterized by progressive distal sensory-motor polyneuropathy or restrictive cardiomyopathy, secondary to amyloid deposits. Its pathogenesis lies in the TTR gene mutation, and the Val50Met mutation is the most frequent. Patients have significant differences in the onset and severity of clinical presentation according to their country of origin. The diagnosis of this pathology is complex, even more in countries where it is not considered endemic. However, early suspicion and management are essential to improve survival and avoid unnecessary diagnostic and therapeutic strategies. We report a 69-year-old woman who presented a sensory-motor polyneuropathy, predominantly sensory, associated with distal neuropathic pain and bilateral vitritis. The history of her Italian father with polyneuropathy of unspecified etiology stood out. A vitreous biopsy identified amyloid substance deposits (congo red positive). These were also confirmed on a superficial peroneal nerve biopsy. During the etiological study of her polyneuropathy, an increased Kappa/Lambda index of 2.55 mg/L stood out. Therefore, light chain amyloidosis was suspected, and chemotherapy treatment was indicated without favorable response. After 10 years of progressive neurological and ophthalmological involvement, a genetic study confirmed the first case of late-onset hereditary transthyretin amyloidosis Val50Met with polyneuropathy in Chile.
Assuntos
Neuropatias Amiloides Familiares , Polineuropatias , Humanos , Feminino , Idoso , Pré-Albumina/genética , Neuropatias Amiloides Familiares/complicações , Neuropatias Amiloides Familiares/diagnóstico , Neuropatias Amiloides Familiares/genética , Mutação , Polineuropatias/etiologia , Polineuropatias/genéticaRESUMO
ABSTRACT Introduction: The combination of non-vascularized iliac crest bone graft and distraction osteogenesis in a second surgical intervention has only been described to achieve alveolar ridge augmentation. This technique is not recommended to treat bone defects of the jaws caused by firearm projectile. Case presentation: 40-year-old woman with a segmental mandibular defect in the mandible body caused by the impact of a firearm projectile at the age of 1 year. The patient developed a severe Class II dentofacial anomaly that required a two-stage treatment; she underwent mandibular reconstruction with free iliac crest bone graft followed by a bilateral mandibular distraction at the level of the iliac crest bone graft. With these interventions, a remarkable improvement of the patient's malformation was achieved. Conclusion: Horizontal distraction of the free iliac crest bone graft is a safe and predictable procedure to treat dentolabial anomalies requiring mandibular reconstruction. This procedure was performed in the patient without complications. Further studies on the effectiveness of this technique are required.
RESUMEN Introducción. La combinación del injerto de la cresta ilíaca no vascularizado y la distracción osteogénica del injerto en una segunda intervención quirúrgica solo ha sido descrita para lograr un aumento del reborde alveolar. Esta técnica no se recomienda para tratar defectos óseos en la mandíbula causados por proyectil de arma de fuego. Presentación del caso. Mujer de 40 años con un defecto mandibular segmentario en el cuerpo mandibular causado por el impacto de un proyectil de arma de fuego a la edad de 1 año. La paciente desarrolló una anomalía dentofacial grave Clase II que requirió dos tratamientos en diferentes momentos: en primer lugar, se le practicó una reconstrucción mandibular con injerto de cresta ilíaca libre y posteriormente, una distracción mandibular bilateral que incluyó un injerto libre de cresta ilíaca. Con estas intervenciones se logró una mejoría notable de la malformación de la paciente. Conclusión. La distracción horizontal del injerto de cresta ilíaca libre es un procedimiento seguro y predecible para tratar anomalías dentolabiales que requieran reconstrucción de la mandíbula; no obstante, es necesario realizar más estudios sobre la efectividad de la técnica frente este tipo de malformaciones.
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Resumen: El ayuno preoperatorio es fundamental como requisito previo a la mayoría de cirugías tanto para las electivas como para las urgencias relativas. Sin embargo, no siempre se cumplen las condiciones idóneas al momento de abordar a un paciente y la falta de ayuno es una condición que puede poner en riesgo la vida del mismo, siendo un factor de riesgo mayúsculo para la broncoaspiración del contenido gástrico. Hasta el momento se cuenta con un reducido arsenal farmacológico de medicamentos que con distinta función e intensidad aceleran el vaciamiento gástrico; la eritromicina no se encuentra en esta lista de manera oficial. A pesar de que ya ha sido utilizada ampliamente con este fin en el ámbito de los procedimientos endoscópicos, no existen aún suficientes reportes en los que se haya puesto a prueba su eficacia procinética en cirugía de urgencia, específicamente una cesárea. Este artículo, además de ofrecer un breve sumario de dicho macrólido, presenta el caso de una paciente embarazada con ingesta alimenticia reciente, en la cual se obtuvieron las condiciones idóneas para cirugía tan sólo cuatro horas después de la administración de la eritromicina.
Abstract: Preoperative fasting is essential as a prerequisite for most surgeries, either elective procedures or relative emergencies. However, the ideal conditions for surgery are not always fulfilled at the time of approaching a patient, and the lack of fasting is a factor that could endanger patient's life, being a major risk factor for bronchoaspiration of gastric content. Until now there is a small pharmacological list of medications that with different function and intensity accelerate gastric emptying, erythromycin is not officially on this list. Despite the fact that it has already been widely used for this purpose in the field of endoscopic procedures, there are not enough reports about its efficacy in emergency surgery, specifically C-section. This article, in addition to offering a brief summary of this macrolide, presents a case in which after erythromycin administration to a pregnant patient with a recent food intake, the ideal conditions for surgery were obtained only four hours later.
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RESUMEN: La cardiomiopatía amiloide por transtiretina (CATTR) es una enfermedad caracterizada por depósito extracelular de fibrillas amiloides en el miocardio, a partir de transtiretina mal plegada, generando una miocardiopatía restrictiva. Esta proteína mal plegada puede tener origen hereditario o adquirido, siendo más frecuente en adultos mayores. La CA-TTR ha surgido como una causa subdiagnosticada de insuficiencia cardíaca con fracción de eyección preservada (IC FEp). El pilar fundamental para su diagnóstico es la alta sospecha clínica, basada en diversas banderas de alerta ya que la sintomatología que provoca suele ser inespecífica. Como veremos en esta revisión, el diagnóstico puede sustentarse con la cintigrafía ósea, reservando para situaciones particulares la toma de biopsia. Con el advenimiento de nuevas terapias que impactan en la sobrevida de esta enfermedad, el tiempo para realizar el diagnóstico certero y la diferenciación de otras causas de amiloidosis cardíaca como la de cadenas livianas, se ha tornado crucial.
ABSTRACT: Transthyretin amyloid cardiomyopathy (AT-TR-CM) is a disease characterized by extracellular deposition of amyloid fibrils in the myocardium, from misfolded transthyretin, generating a restrictive cardiomyopathy. This misfolded protein may be inherited or acquired, and is more prevalent in elderly patients. ATTR-CM has emerged as an underdiagnosed cause of heart failure with preserved ejection fraction (HF-PEF). The fundamental pillarfor its diagnosis is high clinical suspicion since the symptoms are usually nonspecific. The diagnosis can be made from bone scintigraphy, reserving myocardial biopsy for particular situations. With the advent of new therapies that affect the survival of these patients, a timely diagnosis has become crucial.
Assuntos
Humanos , Neuropatias Amiloides Familiares/diagnóstico , Neuropatias Amiloides Familiares/terapia , Cardiomiopatias/diagnóstico , Cardiomiopatias/terapia , Pré-Albumina , Diagnóstico Diferencial , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapiaRESUMO
Microbes have developed mechanisms to resist the host immune defenses and some elicit antitumor immune responses. About 6 million people are infected with Trypanosoma cruzi, the protozoan agent of Chagas' disease, the sixth neglected tropical disease worldwide. Eighty years ago, G. Roskin and N. Klyuyeva proposed that T. cruzi infection mediates an anti-cancer activity. This observation has been reproduced by several other laboratories, but no molecular basis has been proposed. We have shown that the highly pleiotropic chaperone calreticulin (TcCalr, formerly known as TcCRT), translocates from the parasite ER to the exterior, where it mediates infection. Similar to its human counterpart HuCALR (formerly known as HuCRT), TcCalr inhibits C1 in its capacity to initiate the classical pathway of complement activation. We have also proposed that TcCalr inhibits angiogenesis and it is a likely mediator of antitumor effects. We have generated several in silico structural TcCalr models to delimit a peptide (VC-TcCalr) at the TcCalr N-domain. Chemically synthesized VC-TcCalr did bind to C1q and was anti-angiogenic in Gallus gallus chorioallantoic membrane assays. These properties were associated with structural features, as determined in silico. VC-TcCalr, a strong dipole, interacts with charged proteins such as collagen-like tails and scavenger receptors. Comparatively, HuCALR has less polarity and spatial stability, probably due to at least substitutions of Gln for Gly, Arg for Lys, Arg for Asp and Ser for Arg that hinder protein-protein interactions. These differences can explain, at least in part, how TcCalr inhibits the complement activation pathway and has higher efficiency as an antiangiogenic and antitumor agent than HuCALR.
Assuntos
Moduladores da Angiogênese/metabolismo , Antineoplásicos/metabolismo , Calreticulina/metabolismo , Doença de Chagas/imunologia , Complemento C1q/metabolismo , Proteínas de Protozoários/metabolismo , Trypanosoma cruzi/fisiologia , Moduladores da Angiogênese/química , Animais , Antineoplásicos/química , Calreticulina/química , Células Cultivadas , Doença de Chagas/parasitologia , Embrião de Galinha , Ativação do Complemento , Interações Hospedeiro-Parasita , Humanos , Simulação de Dinâmica Molecular , Estrutura Molecular , Domínios e Motivos de Interação entre Proteínas , Proteínas de Protozoários/química , Alinhamento de SequênciaRESUMO
ABSTRACT Background: Immunoglobulin light chain (AL) amyloidosis is a rare and underdiagnosed entity. Aim: To characterize patients with AL amyloidosis in Chilean public health centers. Material and Methods: We conducted a retrospective, multicenter study. Public centers of the Chilean Monoclonal Gammopathies Cooperative Group were asked to search for patients with AL amyloidosis in their databases. Epidemiological, clinical and laboratory characteristics were evaluated. Results: Forty-two patients aged 22 to 84 years were found. Twenty four percent had localized AL amyloidosis; 64% had a lambda light chain clone; 47% were associated with multiple myeloma and 9% with non-Hodgkin lymphoma. The most commonly involved organ was the kidney (76%). Serum free light chains were measured in 31% and an echocardiogram was performed in 74% of patients. Seventeen percent of patients received only palliative care, 17% were treated with bortezomib, 21% with thalidomide, and 40% with melphalan. No patient was transplanted. The mean overall survival (OS) of the group was 19 months. The 5-year OS was 28%. Conclusions: It is important to obtain these realistic, national data to initiate strategies to improve early diagnosis and proper management of this disease.
La amiloidosis AL es una entidad poco frecuente y subdiagnosticada. Mientras todo el mundo discute sobre las nuevas herramientas diagnósticas y terapéuticas, en Chile y en América Latina en general, estamos lejos de esa realidad. El objetivo del presente estudio fue caracterizar a los pacientes con amiloidosis AL en centros del sistema público de nuestro país. Se realizó un estudio retrospectivo, multicéntrico, descriptivo. Los centros públicos del grupo cooperativo hematológico chileno buscaron en sus bases de datos pacientes diagnosticados con amiloidosis AL. Se evaluaron las características epidemiológicas, clínicas y de laboratorio. La edad media fue de 65 años. A 24% de los pacientes se les diagnosticó amiloidosis AL localizada; 64% tuvo paraproteína con cadena ligera lambda; 47% se asoció con mieloma múltiple y 9% con linfoma no Hodgkin. El órgano afectado con mayor frecuencia fue el riñón (76%). Las cadenas ligeras libres de suero se realizaron en 31% y ecocardiograma en 74%. El 17% recibió solo cuidados paliativos, 17% recibió tratamiento con bortezomib, 21% con talidomida y 40% con melfalán. Ningún paciente fue trasplantado. La media de sobrevida global (SG) del grupo fue de 19 meses. La SG a 5 años fue de 28%. Es importante reportar estos resultados nacionales para iniciar estrategias que mejoren tanto el diagnóstico temprano como el tratamiento de esta patología. Por lo tanto, mejorar la sospecha diagnóstica es crucial.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Setor Público/estatística & dados numéricos , Amiloidose de Cadeia Leve de Imunoglobulina/epidemiologia , Serviços de Saúde/estatística & dados numéricos , Fatores de Tempo , Eletroforese das Proteínas Sanguíneas , Chile/epidemiologia , Estudos Retrospectivos , Cadeias lambda de Imunoglobulina , Estimativa de Kaplan-Meier , Amiloidose de Cadeia Leve de Imunoglobulina/fisiopatologiaRESUMO
BACKGROUND: Immunoglobulin light chain (AL) amyloidosis is a rare and underdiagnosed entity. AIM: To characterize patients with AL amyloidosis in Chilean public health centers. MATERIAL AND METHODS: We conducted a retrospective, multicenter study. Public centers of the Chilean Monoclonal Gammopathies Cooperative Group were asked to search for patients with AL amyloidosis in their databases. Epidemiological, clinical and laboratory characteristics were evaluated. RESULTS: Forty-two patients aged 22 to 84 years were found. Twenty four percent had localized AL amyloidosis; 64% had a lambda light chain clone; 47% were associated with multiple myeloma and 9% with non-Hodgkin lymphoma. The most commonly involved organ was the kidney (76%). Serum free light chains were measured in 31% and an echocardiogram was performed in 74% of patients. Seventeen percent of patients received only palliative care, 17% were treated with bortezomib, 21% with thalidomide, and 40% with melphalan. No patient was transplanted. The mean overall survival (OS) of the group was 19 months. The 5-year OS was 28%. CONCLUSIONS: It is important to obtain these realistic, national data to initiate strategies to improve early diagnosis and proper management of this disease.
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Serviços de Saúde/estatística & dados numéricos , Amiloidose de Cadeia Leve de Imunoglobulina/epidemiologia , Setor Público/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletroforese das Proteínas Sanguíneas , Chile/epidemiologia , Feminino , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/fisiopatologia , Cadeias lambda de Imunoglobulina , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
Objective. The aim of this study was to provide molecular evidence of C. burnetii in sheep and goats from some herds of Valledupar, Cesar, Colombia. Materials and methods. Fifteen herds of sheep and goats were chosen by convenience to investigate the infection by C. burnetii, during March and April of 2013. 328 female goats and 66 sheep from 15 herds were included in this study. Milk from ewes and vaginal mucus samples from goats were analyzed by Polymerase Chain Reaction for DNA detection of transposase gene (IS1111) of C. burnetii. Results. DNA of C. burnetii in 6% (4/66) of sheep's milk and 0.6% (2/328) vaginal mucus from goats was found. 13% (2/15) of the herds had at least one infected animal. Discussion. Our findings suggest the circulation of C. burnetii in sheep and goats from some herds of Valledupar, Colombia, and it highlights the possibility of occurrence of infections in humans and animals. Conclusions. The detection of C. burnetii in sheep milk could represent a public health risk factor for people who consuming raw milk, cheeses or people associated to agriculture and livestock handling. Further studies are necessary to evaluate other routes such as tick's bite, feces, milk from goats and vaginal mucus from sheep of this region of Colombia.
Objetivo. El objetivo de este estudio fue proporcionar evidencia molecular de infección por C. burnetii en ovinos y caprinos de algunos rebaños de Valledupar, Cesar, Colombia. Materiales y métodos. Quince rebaños de ovinos y caprinos fueron seleccionados a conveniencia para investigar la infección por C. burnetii, durante marzo y abril de 2013. En este estudio se incluyeron 328 caprinos y 66 ovinos de 15 rebaños. La leche procedente de ovinos y muestras de moco vaginal de caprinos fueron analizados mediante PCR (Reacción en Cadena de Polimerasa) para la detección de ADN del gen transposasa (IS1111) de C. burnetii. Resultados. Se encontró ADN de C. burnetii en 6% (4/66) de leche de oveja y 0,6% (2/328) de moco vaginal de cabras. El 13% (2/15) de los rebaños tenían al menos un animal infectado. Discusión. Nuestros hallazgos sugieren la circulación de C. burnetii en ovinos y caprinos de algunos rebaños de Valledupar, Colombia, y destaca la posibilidad de ocurrencia de infecciones en humanos y animales. Conclusiones. La detección de C. burnetii en la leche de oveja podría representar un factor de riesgo para la salud pública de las personas que consumen con frecuencia leche cruda, quesos o personas que trabajan en la agricultura y manipulación de ganado. Otros estudios son necesarios para evaluar otras rutas como la mordedura de la garrapata, las heces, la leche de las cabras y el moco vaginal de las ovejas de esta región de Colombia.
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Animais , Bovinos , Febre Q , Zoonoses , Doenças Transmissíveis , Coxiella burnetii , Ruminantes , Colômbia , Leite , Vetores de Doenças , Educação , Pesquisa sobre Serviços de SaúdeRESUMO
Here we propose a model of a peripheral axon with a great deal of autonomy from its cell body-the autonomous axon-but with a substantial dependence on its ensheathing Schwann cell (SC), the axon-SC unit. We review evidence in several fields and show that (i) axons can extend sprouts and grow without the concurrence of the cell body, but regulated by SCs; (ii) axons synthesize their proteins assisted by SCs that supply them with ribosomes and, probably, with mRNAs by way of exosomes; (iii) the molecular organization of the axoplasm, i.e., its phenotype, is regulated by the SC, as illustrated by the axonal microtubular content, which is down-regulated by the SC; and (iv) the axon has a program for self-destruction that is boosted by the SC. The main novelty of this model axon-SC unit is that it breaks with the notion that all proteins of the nerve cell are specified by its own nucleus. The notion of a collaborative specification of the axoplasm by more than one nucleus, which we present here, opens a new dimension in the understanding of the nervous system in health and disease and is also a frame of reference to understand other tissues or cell associations.
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Potenciais de Ação/fisiologia , Axônios/metabolismo , Regeneração Nervosa/fisiologia , Redes Neurais de Computação , Ribossomos/metabolismo , Células de Schwann/metabolismo , Animais , Axônios/ultraestrutura , Transporte Biológico , Comunicação Celular , Exossomos/metabolismo , Humanos , Microtúbulos/metabolismo , Microtúbulos/ultraestrutura , Fenótipo , RNA Mensageiro/metabolismo , Ratos , Células de Schwann/ultraestrutura , Transdução de Sinais , Nervo Sural/lesões , Nervo Sural/metabolismoRESUMO
The structural homeostasis is challenging for neurons, whose axons extend up to meters in large animals, and the axoplasmic mass reaches over a thousand times that of the cell body. Thus, the protein demand may overcome the capacity of the cell body to supply the right protein species, to the right place, in the right time. In this context, a body of evidence indicates that glial cells support the axonal maintenance and regenerative responses by diverse mechanisms of intercellular communication. We showed recently that Schwann cells (SC) transfer ribosomes to axons and also enhance regeneration by means of extracellular vesicles known as exosomes that contain mRNAs, miRNAs and proteins. These findings strongly suggest that the nucleus of the SC supports the machinery for protein synthesis of the axon and participates in the specification of the phenotype of the underlying axon. That the genetic programs of many nuclei modulate the axoplasm on a local basis is akin to a syncytium but at variance with it, the nuclei belong to satellite cells. We propose that the SC-axon unit is a functional syncytium. This intercellular organization opens a novel understanding of the nervous system and a new avenue of research into its physiology and disorders © 2016 Wiley Periodicals, Inc.
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Axônios/metabolismo , Evolução Molecular , Células Gigantes/metabolismo , Proteínas do Tecido Nervoso , Células de Schwann/metabolismo , Animais , Núcleo Celular/genética , Núcleo Celular/metabolismo , Células Gigantes/citologia , Humanos , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Ribossomos/genética , Ribossomos/metabolismo , Células de Schwann/citologiaRESUMO
INTRODUCTION: The Caribbean area of Colombia has been severely affected by a Chikungunya virus (CHIKV) outbreak since 2014. METHODOLOGY: The study was carried out on 100 patients during a fever outbreak from August to September 2014 in two small rural villages in the northern Caribbean area of Colombia. The molecular assays performed by reverse transcription polymerase chain reaction (RT-PCR) on acute patient sera were collected within one to five days of the appearance of symptoms. Sequence analyses were carried out based on phylogenetic analyses of genes NS1 and E2. For serological assays, 49 (49%) patients at ≥ 6 days of disease onset were tested with NovaLisa Chikungunya IgG/IgM µ-capture enzyme-linked immunosorbent assay (ELISA). RESULTS: The main signs or symptoms associated with Chikungunya infection were arthralgia of the lower limbs (96%), fever (91%), arthralgia of the upper limbs (85%), rash (64%), and headache (57%). Ninety-four percent (46/49) of patients were positive for either IgM or IgG; the remaining three (6%) patients were seronegative. Viral loads were detected in 25 patients. Based on phylogenetic analysis of NS1 and E2, the characterization of the Colombian CHIKV indicated that it was a strain closely related to the British Virgin Islands strain and to the Asian genotype. CONCLUSIONS: This study shows the phylogenetic and clinical description of CHIKV in Colombia. The main symptoms shown were: arthralgia, fever, and rash. CHIKV sequences detected in Colombian patients were within the Asian genotype and closely related to the British Virgin Islands strain.
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Febre de Chikungunya/epidemiologia , Febre de Chikungunya/patologia , Vírus Chikungunya/classificação , Vírus Chikungunya/isolamento & purificação , Surtos de Doenças , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Região do Caribe/epidemiologia , Vírus Chikungunya/genética , Criança , Colômbia/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Filogenia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de DNA , Homologia de Sequência , Adulto JovemRESUMO
Background: Q fever is a zoonotic disease caused by Coxiella burnetii. In Colombia it is not a notifiable disease in humans and is most likely under diagnosed. There are no studies about its prevalence in important reservoir species, such as cattle. Objective: the aim of this study was to investigate the frequency of C. burnetii infection in cattle farms and determine the frequency of antibodies in farm workers at risk in rural areas of Montería, Córdoba (Colombia). Methods: eleven cattle farms were randomly chosen to investigate the infection by C. burnetii. Bulk tank milk samples of each farm were analyzed by conventional PCR for DNA detection of transposase gene IS1111 of C. burnetii. Serum samples from 61 apparently healthy people living in eight farms were analyzed by indirect inmunofluorescence against phase II IgG antibodies to C. burnetii. Results: we report the presence of C. burnetii DNA in 45% of bulk tank milk samples from cattle farms and a 61% frequency of antibodies (IgG phase II ≥1/64) in farm workers at risk. Conclusion: our results demonstrate the circulation of this bacterium in the studied farms in Montería, Colombia, showing that at-risk farm workers have a high antibody frequency.
Antecedentes: la fiebre Q es una zoonosis causada por Coxiella burnetii. En Colombia no es una enfermedad notificable en humanos y probablemente es subdiagnosticada. De otro lado, no se han realizado estudios acerca de su prevalencia en importantes reservorios como los bovinos. Objetivos: el objetivo de este estudio fue determinar la frecuencia de infección por C. burnetii en fincas de ganado bovino y determinar la frecuencia de la presencia de anticuerpos en trabajadores de fincas en riesgo en áreas rurales del municipio de Montería, Córdoba (Colombia). Métodos: once fincas de ganado bovino fueron aleatoriamente seleccionadas para investigar la frecuencia de infección por C. burnetii. Muestras de leche de tanque de cada finca fueron analizadas mediante PCR convencional para detección del gen transposasa IS1111 de C. burnetii. Asimismo, se colectaron muestras de suero sanguíneo de 61 personas aparentemente saludables que vivían en ocho de las fincas estudiadas, las cuales fueron analizadas mediante el ensayo de inmunofluorescencia indirecta para detección de anticuerpos IgG contra fase II de C. burnetii. Resultados: en este estudio se reporta la presencia de ADN de C. burnetii en 45% de las muestras de leche de tanque de las fincas ganaderas estudiadas y una frecuencia de anticuerpos contra C. burnetii (IgG Fase II ≥1/64) del 61% en trabajadores de fincas en riesgo. Conclusiones: los resultados de este estudio demuestran la circulación de C. burnetii en las fincas estudiadas de un área de Montería, Colombia. También, los trabajadores de fincas en situación de riesgo presentan una alta frecuencia de anticuerpos contra este patógeno.
Antecedentes: a febre Q é uma zoonose causada por Coxiella burnetii. Na Colômbia não é uma doença de notificação obrigatória em seres humanos e é provavelmente subdiagnosticada. Além disto, não há estudos sobre sua prevalência nas principais espécies de reservatórios, como os bovinos. Objetivos: determinar a frequência de infecção por C. burnetii em fazendas de gado de leite e determinar a frequência de anticorpos em trabalhadores rurais em risco do município de Montería, Córdoba (Colômbia). Métodos: 11 fazendas de gado leiteiro foram selecionadas aleatoriamente para investigar a frequência de infecção por C. burnetii. Amostras de leite do tanque de cada fazenda foram analisadas por PCR convencional para a detecção do gene IS1111 transposase de C. burnetii. Além disso, amostras de soro de 61 pessoas aparentemente saudáveis que vivem em oito das propriedades estudadas foram analisadas por imunofluorescência indireta para a detecção de anticorpos IgG contra C. burnetii fase II. Resultados: neste estudo, o DNA de C. burnetii foi encontrado em 45% das amostras de leite do tanque, e uma frequência de anticorpos contra C. burnetii (fase II IgG ≥ 1/64) de 61% em trabalhadores rurais em risco. Conclusões: os resultados deste estudo demonstram a circulação de C. burnetii em algumas fazendas de gado em uma área de Montería, Colômbia. Além disso, os trabalhadores rurais em situação de risco têm uma alta frequência de anticorpos contra este patógeno.
RESUMO
Q fever is a zoonosis caused by Coxiella burnetii. In Colombia, there have been very few human cases reported to date. This report describes the case of a 56-year-old patient with a background in agriculture and livestock handling. An indirect immunofluorescence assay (IFA) showed high titers of IgG for C. burnetii anti-phase I (1: 256) and anti-phase II (1:1024). For the next six months the patient's IgG antibody titers remained high, and after treatment with doxycycline, the IgG antibody titers decreased to 50% (anti-phase I 1:128 and anti-phase II 1:512); this profile suggests an infection of C. burnetii.
Assuntos
Doenças dos Trabalhadores Agrícolas/epidemiologia , Febre Q/epidemiologia , Doenças dos Trabalhadores Agrícolas/sangue , Doenças dos Trabalhadores Agrícolas/diagnóstico , Doenças dos Trabalhadores Agrícolas/tratamento farmacológico , Criação de Animais Domésticos , Animais , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Doenças Assintomáticas , Colômbia/epidemiologia , Doxiciclina/uso terapêutico , Técnica Indireta de Fluorescência para Anticorpo , Microbiologia de Alimentos , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Leite/microbiologia , Exposição Ocupacional , Febre Q/sangue , Febre Q/diagnóstico , Febre Q/tratamento farmacológico , Ruminantes/microbiologia , População RuralRESUMO
Highly enantiopure (1-aryl)- and (1-naphthyl)-1-ethylamines were synthesized by the borane-mediated reduction of single-isomeric (E)- and (Z)-O-benzyloxime ethers using the stable spiroborate ester derived from (S)-diphenyl valinol and ethylene glycol as the chiral catalyst. Primary (R)-arylethylamines were prepared by the reduction of pure (Z)-ethanone oxime ethers in up to 99% ee using 15% of catalyst. Two convenient and facile approaches to the synthesis of new and known calcimimetic analogues employing enantiopure (1-naphthalen-1-yl)ethylamine as chiral precursor are described.
Assuntos
Aminas/síntese química , Boratos/química , Calcimiméticos/síntese química , Oximas/química , Compostos de Espiro/química , Aminas/química , Calcimiméticos/química , Catálise , Estrutura Molecular , Oxirredução , EstereoisomerismoRESUMO
INTRODUCTION: Palatal torus, or torus palatinus, is a benign bone alteration that may cause some discomfort during phonation or swallowing. When its growth or persistent exposition produces unpleasant symptoms, it must be surgically removed. CASE PRESENTATION: We treated an 82-year-old female patient who consulted for a painful ulcerous lesion she had had for a year and which produced halitosis and discomfort when swallowing. During the oral cavity physical exam we observed a hard protuberance on the midline. It showed a perforation and ulceration of the lateral posterior palatal mucosa on the left side. We considered the following diagnosis: palatal torus, osteoma, pyogenic granuloma, or a soft-tissue neoplasia. We decided to surgically remove it and to perform a histopathological examination. Clinical evolution was satisfactory with complete resolution one month after surgery. The histopathological examination showed hyperostosis along with chronic inflammation of the soft tissues and a simple hyperplasia of the mucosa, which in turn indicated a palatal torus. DISCUSSION: We report an unusual case of spontaneous exposition of a palatal torus which took up almost all of the hard palate area. Its resection is described and we inform the histopathological findings. In the literature review, we did not find a previous report of a spontaneous exposition of a palatal torus.
Assuntos
Exostose/complicações , Mandíbula/anormalidades , Úlceras Orais/etiologia , Palato Duro/anormalidades , Idoso de 80 Anos ou mais , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Diagnóstico Diferencial , Exostose/diagnóstico , Exostose/patologia , Exostose/cirurgia , Feminino , Granuloma Piogênico/diagnóstico , Halitose/etiologia , Halitose/cirurgia , Humanos , Mandíbula/patologia , Mandíbula/cirurgia , Neoplasias Bucais/diagnóstico , Úlceras Orais/cirurgia , Osteoma/diagnóstico , Palato Duro/patologia , Palato Duro/cirurgiaRESUMO
Introducción. El torus , o rodete, palatino es una alteración ósea benigna que puede generar molestias en la fonación y en la deglución. Cuando su crecimiento o exposición persistente producen síntomas molestos, debe ser resecado quirúrgicamente. Presentación del caso. Se trata de una paciente de 82 años de edad, que consultó por una lesión ulcerativa de un año de evolución, que producía dolor, halitosis y molestia a la deglución. En el examen físico de la cavidad oral, se observó una prominencia de consistencia dura en la línea media, con perforación y ulceración de la mucosa palatina en su porción lateral posterior izquierda. Se consideraron los diagnósticos de torus palatino, osteoma, granuloma piógeno y neoplasia de tejidos blandos. Se decidió resecarla quirúrgicamente y hacer el estudio histopatológico. La evolución clínica fue satisfactoria, con resolución completa un mes después de la cirugía. En el estudio de histopatología se observó hiperostosis ósea con inflamación crónica de los tejidos blandos e hiperplasia simple de la mucosa, que corresponden a un torus palatino. Discusión. Se reporta un inusual caso de exposición espontánea de un torus palatino que ocupaba casi toda la bóveda palatina, se describe su resección quirúrgica y se informan los hallazgos de histopatología. En la revisión bibliográfica realizada, no se encontró un reporte previo de exposición espontánea de torus palatino.
Introduction: Palatal torus, or torus palatinus, is a benign bone alteration that may cause some discomfort during phonation or swallowing. When its growth or persistent exposition produces unpleasant symptoms, it must be surgically removed. Case presentation: We treated an 82-year-old female patient who consulted for a painful ulcerous lesion she had had for a year and which produced halitosis and discomfort when swallowing. During the oral cavity physical exam we observed a hard protuberance on the midline. It showed a perforation and ulceration of the lateral posterior palatal mucosa on the left side. We considered the following diagnosis: palatal torus, osteoma, pyogenic granuloma, or a soft-tissue neoplasia. We decided to surgically remove it and to perform a histopathological examination. Clinical evolution was satisfactory with complete resolution one month after surgery. The histopathological examination showed hyperostosis along with chronic inflammation of the soft tissues and a simple hyperplasia of the mucosa, which in turn indicated a palatal torus. Discussion: We report an unusual case of spontaneous exposition of a palatal torus which took up almost all of the hard palate area. Its resection is described and we inform the histopathological findings. In the literature review, we did not find a previous report of a spontaneous exposition of a palatal torus.
Assuntos
Idoso de 80 Anos ou mais , Feminino , Humanos , Exostose/complicações , Mandíbula/anormalidades , Úlceras Orais/etiologia , Palato Duro/anormalidades , Diagnóstico Diferencial , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Exostose/diagnóstico , Exostose/patologia , Exostose/cirurgia , Granuloma Piogênico/diagnóstico , Halitose/etiologia , Halitose/cirurgia , Mandíbula/patologia , Mandíbula/cirurgia , Neoplasias Bucais/diagnóstico , Úlceras Orais/cirurgia , Osteoma/diagnóstico , Palato Duro/patologia , Palato Duro/cirurgiaRESUMO
Coordinated multidisciplinary care (MDC) could improve management and outcomes of patients with chronic kidney disease (CKD). We opened a nurse-led, MDC CKD clinic in Guadalajara, Mexico. We report the clinic's results between March 2008 and July 2011. The records of 353 patients with CKD stage 3 and 4 were reviewed. Data were collected prospectively. Mean age was 59.1±15.5 years; 54.4% were female and 63.7% were diabetic. We observed significant changes in the quality of care between baseline and follow-up. Compliance with practice guidelines for angiotensin II receptor blockers (ARB) and beta blockers increased from 30.6% to 46.6%, and from 11% to 19%, respectively; for statins from 41.4% to 80.3% for erythropoietin and calcium binders from 10.5% to 23.4%, and from 41.9 to 82.6%, respectively. At last visit, 90% of patients were on ACE inhibitors/ARB. Blood pressure <130/80 mm Hg increased from 23% to 38%. Serum glucose ⩽130 mg/dl increased from 54.4% to 67.7%. Serum cholesterol >160 mg/dl decreased from 64.8% to 60.3%. At last visit, 70% of the patients had a serum Hgb ⩾11.0 g/dl, and 80.1% and 65.1% had a normal serum calcium and serum phosphate, respectively. In conclusion, we observed a trend in the improvement of quality of care of CKD patients similar to those reported by other MDC programs in the developed world. Our study demonstrated that a nurse-led MDC program could be successfully implemented in developing countries.
RESUMO
Objetivo: Analizar la utilidad y seguridad de la maniobra de retrovisión en ciego y colon realizada en una serie de 20 pacientes. Sede: Centro Hospitalario del Estado Mayor Presidencial y Hospital Ángeles Lomas. Tipo de estudio: Prospectivo, comparativo, transversal y observacional. Análisis estadístico: Por porcentajes. Pacientes y método: Veinte pacientes con indicación de colonoscopia. Las variables evaluadas fueron: factibilidad de realizar la maniobra, complicaciones presentadas y comparación de lesiones localizadas con la endoscopia convencional y por medio de la retrovisión. Resultados: Edad promedio de 53 años (33 a 72 años); 12 mujeres y 8 varones. La maniobra de retrovisión fue factible en l6 de las colonoscopias (80%). La complicación más frecuentemente observada fue erosión leve de la mucosa por fricción de la punta del endoscopio en el ciego, en cuatro enfermos (20%), lo que no ameritó ningún tratamiento. No hubo perforación ni sangrado en caso alguno. La maniobra de retrovisión aportó un diagnóstico endoscópico adicional en tres enfermos (15%), siendo dos pólipos pequeños y un divertículo del ciego. Conclusiones: La maniobra de retrovisión en ciego fue útil y segura, ya que permitió diagnosticar un 15% más de lesiones que no fueron observadas antes de realizar la maniobra; esto sin presentar complicaciones.
Objective: To analyze the usefulness and safety of the retrograde-viewing maneuver in the cecum and colon performed in a series of 20 patients. Setting: Third level health care center. Type of study: Prospective, comparative, cross-sectional, and observational. Statistical analysis: Percentages. Patients and method: Twenty patients with indication for colonoscopy. Assessed variables were: feasibility of the maneuver. Complications and comparison of injuries localized with conventional endoscopy and by means of the retrograde-viewing device. Results: Average age was 53 years (33 to 72 years), 12 women and 8 men. The retrograde viewing maneuver was feasible in 16 of the colonoscopies (80%). The most frequent complication observed was slight erosion of the mucosa due to the friction caused by the tip of the endoscope in the cecum in four patients (20%), which did not need any treatment. There was no perforation or bleeding in any case. The retrograde-viewing maneuver provided an additional endoscopic diagnosis in three patients (15%), being these small polyps and a diverticulum in the cecum. Conclusions: Retrograde-viewing in the cecum was useful and safe, as it allowed to diagnose 15% more lesions than those observed before performing the maneuver; without presenting complications.