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Microglia, the resident immune cells of the CNS, surveil, detect, and respond to various extracellular signals. Depending on the nature of these signals, an integrative microglial response can be triggered, resulting in a phenotypic transformation. Here, we evaluate whether hypercapnia modifies microglia phenotype in brainstem respiratory-related nuclei. Adult C57BL/6 inbred mice were exposed to 10% CO2 enriched air (hypercapnia), or pure air (control), for 10 or 30 min and immediately processed for immunohistochemistry to detect the ubiquitous microglia marker, ionized calcium binding adaptor molecule 1 (Iba1). Hypercapnia for thirty, but not 10 min reduced the Iba1 labeling percent coverage in the ventral respiratory column (VRC), raphe nucleus (RN), and nucleus tractus solitarius (NTS) and the number of primary branches in VRC. The morphological changes persisted, at least, for 60 min breathing air after the hypercapnic challenge. No significant changes were observed in Iba1+ cells in the spinal trigeminal nucleus (Sp5) and the hippocampus. In CF-1 outbred mice, 10% CO2 followed by 60 min of breathing air, resulted in the reduction of Iba1 labeling percent coverage and the number and length of primary branches in VRC, RN, and NTS. No morphological change was observed in Iba1+ cells in Sp5 and hippocampus. Double immunofluorescence revealed that prolonged hypercapnia increased the expression of CD86, an inflammatory marker for reactive state microglia, in Iba1+ cells in VRC, RN, and NTS, but not in Sp5 and hippocampus in CF-1 mice. By contrast, the expression of CD206, a marker of regulatory state microglia, persisted unmodified. In brainstem, but not in hippocampal microglia cultures, hypercapnia increased the level of IL1ß, but not that of TGFß measured by ELISA. Our results show that microglia from respiratory-related chemosensory nuclei, are reactive to prolonged hypercapnia acquiring an inflammatory-like phenotype.
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The co-occurrence of COVID-19 with endemic diseases is a public health concern that may affect patient prognosis and outcomes. The objective of this study was to describe the clinical characteristics of patients with dengue virus (DENV) and SARS-CoV-2 co-infections and compare their outcomes against those of COVID-19 patients without dengue. A cross-sectional study was conducted in patients with SARS-CoV-2 infection who attended a single center in Cali, Colombia, from March 2020 to March 2021. All patients who were tested by both real-time polymerase chain reaction for SARS-CoV-2 and IgM/NS1 for DENV were included. Dengue was diagnosed as having either an IgM- or an NS1- positive test. A total of 90 patients were included (72 with COVID-19 only and 18 with co-infection). Patients with co-infection had more dyspnea (61.1% versus 22.2%; P = 0.003) as well as higher oxygen desaturation (53.3% versus 13.4%; P = 0.002) and neutrophil-to-lymphocyte ratio (5.59 versus 3.84; P = 0.038) than patients with COVID-19 alone. The proportion of patients classified with moderate to severe COVID-19 was higher in the co-infection group (88.3% versus 47.8%; P = 0.002). Also, co-infection was associated with an increased need for mechanical ventilation (P = 0.06), intensive care unit (ICU) initial management (P = 0.02), and ICU admission during hospitalization (P = 0.04) compared with COVID-19 only. The ICU mortality rate was 66.6% in patients with co-infection versus 29.4% in patients infected with only SARS-CoV-2 (P < 0.05). The possibility of DENV and SARS-CoV2 co-infection occurred in the convergence of both epidemic waves. Co-infection was associated with worse clinical outcomes and higher mortality in ICU-admitted patients than in patients with the COVID-19 only.
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COVID-19 , Coinfecção , Vírus da Dengue , Dengue , Humanos , SARS-CoV-2 , COVID-19/epidemiologia , Vírus da Dengue/genética , Coinfecção/epidemiologia , Colômbia/epidemiologia , Estudos Transversais , RNA Viral , Dengue/complicações , Dengue/epidemiologia , Imunoglobulina MRESUMO
Selective serotonin reuptake inhibitors (SSRIs) are usually prescribed to treat major depression and anxiety disorders. Fetal brain development exhibits dependency on serotonin (5-hydroxytryptamine, 5-HT) from maternal, placental, and fetal brain sources. At very early fetal stages, fetal serotonin is provided by maternal and placental sources. However, in later fetal stages, brain sources are indispensable for the appropriate development of neural circuitry and the rise of emergent functions implied in behavior acquisition. Thus, susceptible serotonin-related critical periods are recognized, involving the early maternal and placental 5-HT synthesis and the later endogenous 5-HT synthesis in the fetal brain. Acute and chronic exposure to SSRIs during these critical periods may result in short- and long-term placental and brain dysfunctions affecting intrauterine and postnatal life. Maternal and fetal cells express serotonin receptors which make them susceptible to changes in serotonin levels influenced by SSRIs. SSRIs block the serotonin transporter (SERT), which is required for 5-HT reuptake from the synaptic cleft into the presynaptic neuron. Chronic SSRI administration leads to pre- and postsynaptic 5-HT receptor rearrangement. In this review, we focus on the effects of SSRIs administered during critical periods upon placentation and brain development to be considered in evaluating the risk-safety balance in the clinical use of SSRIs.
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Transtorno Depressivo Maior , Inibidores Seletivos de Recaptação de Serotonina , Feminino , Gravidez , Humanos , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Serotonina/farmacologia , Placenta , EncéfaloRESUMO
Smoking during pregnancy is associated with multiple undesirable outcomes in infants, such as low birth weight, increased neonatal morbidity and mortality, and catastrophic conditions like sudden infant death syndrome (SIDS). Nicotine, the most addictive and teratogenic substance in tobacco smoke, reaches and crosses the placenta and can be accumulated in the amniotic fluid and distributed by fetal circulation, altering the cholinergic transmission by acting on the nicotinic acetylcholine receptors (nAChRs) expressed from very early gestational stages in the placenta and fetal tissue. Because nAChRs influence the establishment of feto-maternal circulation and the emergence of neuronal networks, prenatal nicotine exposure can lead to multiple alterations in newborns. In this mini-review, we discuss the undeniable effects of nicotine in the placenta and the respiratory neural network as examples of how prenatal nicotine and smoking exposition can affect brain development because dysfunction in this network is involved in SIDS etiology.
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Efeitos Tardios da Exposição Pré-Natal , Receptores Nicotínicos , Morte Súbita do Lactente , Lactente , Gravidez , Recém-Nascido , Feminino , Humanos , Nicotina/efeitos adversos , Morte Súbita do Lactente/etiologia , Placenta , FumarRESUMO
RESUMEN INTRODUCCIÓN: El ACV es uno de los eventos cardiovasculares más prevalentes en el mundo, en Colombia es la segunda causa de muerte y la primera de discapacidad. Uno de los factores de riesgo más importantes para tener en cuenta es el control del colesterol, la reducción de los niveles de C-LDL, principalmente por medio del tratamiento con estatinas y otros fármacos hipolipemiantes. MATERIALES Y MÉTODOS: En esta revisión narrativa de la literatura se ha recogido la información más relevante sobre el uso y los beneficios de este tratamiento y algunas consideraciones adicionales. CONCLUSIÓN: Los hallazgos de esta revisión demuestran el efecto protector de esta terapia cuando se consiguen reducir los niveles de C-LDL y colesterol, además, las otras terapias como ezetimiba o inhibidores de PSCK9. Por otro lado, los estudios mencionan posibles efectos beneficiosos en el contexto de ACV pero se requieren más ensayos clínicos.
ABSTRACT INTRODUCTION: Stroke is one of the most prevalent cardiovascular events in the world, in Colombia it is the second cause of death and first in disability. One of the most important risk factors to consider is cholesterol control, the reduction of LDL-C and cholesterol levels, mainly through treatment with statins and other lipid-lowering drugs. MATERIALS AND METHODS: The most relevant information on the use and benefits of this treatment and some additional considerations have been collected in this narrative review of the literature. CONCLUSION: The results of this narrative review show the protective effect of this therapy when it is possible to reduce LDL-C and cholesterol levels, in addition to other therapies such as ezetimibe or PSCK9 inhibitors. On the other hand, studies mention possible beneficial effects in the context of stroke but more clinical trials are required.
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Inibidores de Hidroximetilglutaril-CoA Redutases , Acidente Vascular Cerebral , LDL-Colesterol , HipolipemiantesRESUMO
Congenital generalized lipodystrophy (CGL) is an autosomal recessive rare disease, with a worldwide prevalence of around 1 in every 12 million people. There are several case reports of patients with CGL in Piura, a region in northern Peru; however its regional prevalence is unknown. The objective was to determine the prevalence of CGL in the region of Piura, Peru during the years 2000-2017. A descriptive, observational study was carried out. A search of clinical histories of patients with the diagnosis of CGL attended between 2000 and 2017 in the pediatric and endocrinology services of the reference hospitals of the department of Piura and in the genetic and endocrinology services of the "Instituto Nacional de Salud del Niño". A patient was considered to have CGL if they met the clinical criteria and or if they had a molecular diagnosis, in addition to patients with CGL from the department of Piura reported in previous publications. A total of 23 cases of CGL were found in Piura, the highest prevalence was in 2014 with 1.2 per 100,000 people, and by 2017 the prevalence was 0.86 per 100,000 people. In conclusion, the department of Piura has a high prevalence of CGL.
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Knowledge of the genetic units of species is fundamental to the conservation of biodiversity. This is true for all regions, including the Neotropics where the Earth has its greatest diversity, including roughly 34% of primate species, a group that has almost 60% of its taxa threatened with extinction. The untufted (gracile) capuchins are medium-sized Neotropical primates, traditionally classified in four species: Cebus albifrons, C. capucinus, C. olivaceus, and C. kaapori. They have a very confusing intra-specific systematics with a large number of fragmented and isolated populations throughout their geographical distributions. We sequenced a large sample of gracile capuchins, including all of the recognized species, to offset the paucity of phylogenic and phylogeographic data regarding this group and to try to understand their phylogeny and evolution. A set of 189 gracile and robust capuchins were sequenced for their mitogenomes whereas another set of 394 gracile and robust capuchins were sequenced at two individual mitochondrial genes (mtCOI-COII). Additionally, 41 Colombian gracile capuchins were geno typified at eight nuclear DNA microsatellites. Our main findings are as follows: (1) Nineteen different groups of gracile capuchin were detected with the mitogenomics data set and more than twenty significant groups and sub-groups were identified with the mtCOI-COII genes; (2) The temporal splits of the older gracile capuchin haplogroups expanded between 2 and 4 million years ago (MYA), during the Pliocene; (3) The two most northern taxa of Colombian C. albifrons (malitiosus and hypoleucus) are the same taxon (C. a. hypoleucus) as was claimed by Cabrera. This taxon represents an old colonization event from the Amazon to current northern Colombia. It is intensely hybridized (evidence from both mitochondrial and nuclear genes) with a haplogroup of C. capucinus (H3) and also has an influx of robust capuchins; (4) Three different and independent migrations of C. albifrons from the Amazon arrived to northern Colombia giving rise to C. a. hypoleucus (including malitiosus), C. a versicolor (including leucocephalus, cesarae, and pleei), and C. a. adustus; (5) On the Caribbean island of Trinidad, two different gracile capuchin taxa exist, one autochthonous, which could correspond to a fourth migration into northwestern South America (C. a. trinitatis) and probably another one, introduced more recently (C. olivaceus brunneus); (6) The values of the genetic distance analyses, the inexistence of reciprocal mitochondrial monophylia for many clades of gracile capuchins and the strong hybridization detected with nuclear microsatellites, especially among hypoleucus (malitiosus), C. capucinus-H3, versicolor, and cesarae, support that all the gracile capuchins belong to one unique superspecies: C. capucinus (senior name for all the gracile capuchins).
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Cebus/classificação , Cebus/genética , Genoma Mitocondrial/genética , Repetições de Microssatélites/genética , Filogenia , Animais , ColômbiaRESUMO
A mild chronic inflammatory state, like that observed in aged individuals, affects microglial function, inducing a dysfunctional phenotype that potentiates neuroinflammation and cytotoxicity instead of neuroprotection in response to additional challenges. Given that inflammatory activation of microglia promotes increased release of D-serine, we postulate that age-dependent inflammatory brain environment leads to microglia-mediated changes on the D-serine-regulated glutamatergic transmission. Furthermore, D-serine dysregulation, in addition to affecting synaptogenesis and synaptic plasticity, appears also to potentiate NMDAR-dependent excitotoxicity, promoting neurodegeneration and cognitive impairment. D-serine dysregulation promoted by microglia could have a role in age-related cognitive impairment and in the induction and progression of neurodegenerative processes like Alzheimer's disease.
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Envelhecimento/fisiologia , Sistema Nervoso Central/metabolismo , Microglia/metabolismo , Serina/metabolismo , Animais , Humanos , Doenças Neurodegenerativas/metabolismoRESUMO
We analyzed 156 specimens of diverse howler monkey taxa (Alouatta; Atelidae, Primates) for different mitochondrial genes (5,567 base pairs), with special emphasis on A. palliata and related taxa. Our results showed no relevant differences among individuals of different putative taxa, A. p. palliata, A. p. aequatorialis, A. coibensis coibensis, and A. c. trabeata. We found no spatial differences in genetic structure of A. p. palliata throughout Costa Rica, Nicaragua, and Honduras. A. p. mexicana (genetic distance: 1.6-2.1%) was the most differentiated taxon within A. palliata. Therefore, we postulate the existence of only 2 clearly defined subspecies within A. palliata (A. p. palliata and A. p. mexicana). A. palliata and A. pigra (traditionally considered a subspecies of A. palliata) are 2 clearly differentiated species as was demonstrated by Cortés-Ortiz and colleagues in 2003, with a temporal split between the 2 species around 3.6-3.7 million years ago (MYA). Our results with the Median Joining Network procedure showed that the ancestors of the cis-Andean Alouatta gave rise to the ancestors of the trans-Andean Alouatta around 6.0-6.9 MYA. As Cortés-Ortiz et al. showed, A. sara and A. macconnelli are differentiable species from A. seniculus, although the first 2 taxa were traditionally considered subspecies of A. seniculus. Our findings agree with the possibility that the ancestor of A. sara gave rise to the ancestor of A. pigra in northern South America. In turn, the ancestor of A. pigra originated the ancestor of A. palliata. Two of our results strongly support the hypothesis that the South American A. palliata (the putative A. p. aequatorialis) was the original population of this species; it has high genetic diversity and no evidence of population expansion. The Central America A. palliata is the derived population. It has low genetic diversity and there is clear evidence of population expansion. However, A. palliata and A. pigra probably migrated into Central America by 2 different routes: the Isthmus of Panama (A. palliata) and Caribbean island arch (A. pigra). Finally, the red howler monkeys from the island of Trinidad in the Caribbean Sea were not A. macconnelli (= A. s. stramineus) as Groves maintained in his influential 2001 publication on primate taxonomy. This taxon is more related to A. s. seniculus, although it formed a monophyletic clade. Future molecular and karyotypic studies will show if the Trinidad red howler monkeys should be considered as an extension of the Venezuelan taxon, A. arctoidea, as a subspecies of A. seniculus(A. s. seniculus), or, in the case of extensive chromosomal rearrangements, even a new species.
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Alouatta/genética , Genes Mitocondriais/genética , Filogenia , Alouatta/classificação , Distribuição Animal , Animais , América Central , Feminino , Variação Genética , Filogeografia , América do SulRESUMO
The mechanisms responsible for the onset of respiratory activity during fetal life are unknown. The onset of respiratory rhythm may be a consequence of the genetic program of each of the constituents of the respiratory network, so they start to interact and generate respiratory cycles when reaching a certain degree of maturation. Alternatively, generation of cycles might require the contribution of recently formed sensory inputs that will trigger oscillatory activity in the nascent respiratory neural network. If this hypothesis is true, then sensory input to the respiratory generator must be already formed and become functional before the onset of fetal respiration. In this review, we evaluate the timing of the onset of the respiratory rhythm in comparison to the appearance of receptors, neurotransmitter machinery, and afferent projections provided by two central chemoreceptive nuclei, the raphe and locus coeruleus nuclei.
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Desenvolvimento Fetal/fisiologia , Locus Cerúleo/fisiologia , Neurônios/fisiologia , Núcleos da Rafe/fisiologia , Respiração , Mecânica Respiratória/fisiologia , Potenciais de Ação/fisiologia , Animais , HumanosRESUMO
Desde el 2012 se desarrolla en Córdoba una experiencia de formación preprofesional interdisciplinaria propiciada por el Departamento de Medicina Familiar (UNC). En el ámbito de consultorio, los estudiantes deben entrevistar y examinar al paciente para luego presentar la situación clínica a un tutor, quien orienta la resolución de la misma. El objetivo general de este trabajo es describir la percepción de los estudiantes sobre la pre-consulta como estrategia de enseñanza-aprendizaje en la práctica clínica, y los específicos son identificar facilitadores y obstaculizadores del aprendizaje y los aportes de la misma para la incorporación de componentes del Proceso Clínico Centrado en la Persona (PCCP). Se realizó un estudio cualitativo con 19 entrevistas semiestructuradas y un grupo focal. El contenido se analizó desde las teorías del aprendizaje. La pre-consulta se percibe como una estrategia que brinda aportes significativos al aprendizaje de la práctica clínica y motiva el auto aprendizaje. Facilitadores: constituir un desafío para el estudiante al confrontarse con sus propias habilidades y la interacción con el tutor docente. Obstaculizadores: incomodidad sentida por las interrupciones en la atención de los pacientes. La incorporación de componentes del PCCP es potenciado con la utilización de un instrumento de registro estructurado para las consultas. La pre-consulta es percibida como una metodología útil para el proceso enseñanza-aprendizaje en la práctica clínica. Es recomendable porque propicia el saber hacer en la atención integral de las personas.
Since 2012 an interdisciplinary experience of pre-professional practices has been developing in the city of Córdoba. Such practices are propitiated by the Department of Family Medicine (UNC) . The students must examine and interview the patient and then present the clinical situation to a tutor who guides its resolution. The primary aim of this study was to describe the perception of students about the pre-consultation as a teaching-learning strategy in clinical practice, and the secondary aims were to identify obstacles and facilitators in the learning process and its contributions in the incorporation of the Person-Centered Clinical Method (PCCP). A qualitative study was carried out, with 19 interviews and one focus group. Content analysis was done from learning theories. The preconsultation is perceived as a strategy that provides significant clinical practice learning and encourages self-learning. Facilitators: it poses a challenge to the student when he/she is confronted with their own skills and interaction with the teacher or tutor. Obstacles: interruptions in patient care discomfort. The incorporation of PCCP components is enhanced with the use of a structured instrument for recording the consultations. Pre-consultations are perceived as a useful method for the teachinglearning process in clinical practice. It is recommended as it encourages the know-how in the comprehensive care of people.
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Humanos , Aprendizagem Baseada em Problemas , Ensino , Entrevistas como Assunto , Materiais de Ensino , Visitas de PreceptoriaRESUMO
To explore the possible influence of heavy metal mining on incidence of Parkinson's disease (PD), global DNA methylation was assessed in blood samples from a population of PD patients (n = 45) and control subjects (n = 52) in Antofagasta neighborhood, a Chilean city built for exclusive use of mining companies. Comparisons were made with PD subjects (n = 52) and control subjects (n = 59) from Santiago Chile, a city having little association with mining. All subjects were assessed by two neurologists and PD diagnosis was based on UK Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria. From blood samples obtained from each individual, a decrease in global DNA methylation was observed in PD patients either exposed (49% of control, P < 0.001) or not exposed (47% of control, P < 0.001) to mining activity. Although there was no difference in levels of DNA methylation between PD patients from the two cities, there was a lower level of DNA methylation in control subjects from Santiago versus Antofagasta.
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Metilação de DNA/genética , Exposição Ambiental , Epigênese Genética , Doença de Parkinson/epidemiologia , Análise de Variância , Chile/epidemiologia , Feminino , Humanos , Incidência , Masculino , Mineração , Doença de Parkinson/sangue , Sulfitos/metabolismoRESUMO
Astrocytes perform various homeostatic functions in the nervous system beyond that of a supportive or metabolic role for neurons. A growing body of evidence indicates that astrocytes are crucial for central respiratory chemoreception. This review presents a classical overview of respiratory central chemoreception and the new evidence for astrocytes as brainstem sensors in the respiratory response to hypercapnia. We review properties of astrocytes for chemosensory function and for modulation of the respiratory network. We propose that astrocytes not only mediate between CO2/H+ levels and motor responses, but they also allow for two emergent functions: (1) Amplifying the responses of intrinsic chemosensitive neurons through feedforward signaling via gliotransmitters and; (2) Recruiting non-intrinsically chemosensitive cells thanks to volume spreading of signals (calcium waves and gliotransmitters) to regions distant from the CO2/H+ sensitive domains. Thus, astrocytes may both increase the intensity of the neuron responses at the chemosensitive sites and recruit of a greater number of respiratory neurons to participate in the response to hypercapnia.
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Astrócitos/fisiologia , Dióxido de Carbono/metabolismo , Células Quimiorreceptoras/fisiologia , Hipercapnia/metabolismo , Neurônios/fisiologia , Centro Respiratório/fisiologia , Aminoácidos/metabolismo , Animais , Astrócitos/citologia , Sinalização do Cálcio , Células Quimiorreceptoras/citologia , Humanos , Hipercapnia/fisiopatologia , Locus Cerúleo/citologia , Locus Cerúleo/fisiologia , Núcleos da Rafe do Mesencéfalo/citologia , Núcleos da Rafe do Mesencéfalo/fisiologia , Neurônios/citologia , Neurotransmissores/metabolismo , Prótons , Centro Respiratório/citologia , Serotonina/metabolismo , Transmissão SinápticaRESUMO
Nicotine may link maternal cigarette smoking with respiratory dysfunctions in sudden infant death syndrome (SIDS). Prenatal-perinatal nicotine exposure blunts ventilatory responses to hypercapnia and reduces central respiratory chemoreception in mouse neonates at Postnatal Days 0 (P0) to P3. This suggests that raphe neurons, which are altered in SIDS and contribute to central respiratory chemoreception, may be affected by nicotine. We therefore investigated whether prenatal-perinatal nicotine exposure affects the activity, electrical properties, and chemosensitivity of raphe obscurus (ROb) neurons in mouse neonates. Osmotic minipumps, implanted subcutaneously in 5- to 7-day-pregnant CF1 mice, delivered nicotine bitartrate (60 mg kg(-1) d(-1)) or saline (control) for up to 28 days. In neonates, ventilation was recorded by head-out plethysmography, c-Fos (neuronal activity marker), or serotonin autoreceptors (5HT1AR) were immunodetected using light microscopy, and patch-clamp recordings were made from raphe neurons in brainstem slices under normocarbia and hypercarbia. Prenatal-perinatal nicotine exposure decreased the hypercarbia-induced ventilatory responses at P1-P5, reduced both the number of c-Fos-positive ROb neurons during eucapnic normoxia at P1-P3 and their hypercapnia-induced recruitment at P3, increased 5HT1AR immunolabeling of ROb neurons at P3-P5, and reduced the spontaneous firing frequency of ROb neurons at P3 without affecting their CO2 sensitivity or their passive and active electrical properties. These findings reveal that prenatal-perinatal nicotine reduces the activity of neonatal ROb neurons, likely as a consequence of increased expression of 5HT1ARs. This hypoactivity may change the functional state of the respiratory neural network leading to breathing vulnerability and chemosensory failure as seen in SIDS.
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Nicotina/toxicidade , Efeitos Tardios da Exposição Pré-Natal/etiologia , Núcleos da Rafe/patologia , Morte Súbita do Lactente/etiologia , Animais , Animais Recém-Nascidos , Modelos Animais de Doenças , Feminino , Humanos , Lactente , Troca Materno-Fetal , Camundongos , Gravidez , Núcleos da Rafe/efeitos dos fármacos , Fumar/efeitos adversos , Morte Súbita do Lactente/patologiaRESUMO
El síndrome de Oclusión Intestinal representa entre un 20 % y 30 % de los cuadros de Abdomen Agudo. El objetivo es relacinar edad, sexo, riesgo ASA, altura de la oclusión, retardo en el tratamiento quirúrgico con mortalidad, complicaciones médicas y quirúrgicas. Se realizú en el Servicio de Guardia Central H:N:C. UNC.. Diseño: estudio prospectivo y protocolizado. Material y métodos: entre enero de 2004 y enero de 2007, se operaron 52 pacientes con un cuadro de oclusión intestinal. Del total 32 de ellos fueron hombres y 20 mujeres; el promedio de edad correspondió a 52,11 años. Riesgo Quirúrgico: el 46,15 % de los pacientes presentó riesgo A.S.A. III, 38,69 % riesgo A.S.A. II, 11,53 % riesgo A.S.A. I y 9,61 % riesgo A.S.A. IV. Los síntomas mós frecuentes fueron dolor abdominal y distensión abdominal y los signos de distensión abdominal y timpanismo abdominal. Resultados: en las Oclusiones altas las Bridas fueron la causa más frecuente y en Oclusiones bajas el Cáncer de sigmoides. La mortalidad global fue de 13,45 %. Respecto de las Complicaciones médicas postquirúrgicas, 14 pacientes en total las presentron, la más frecuente fue la Insuficiencia Renal Aguda con 9 casos. respecto de las complicaciones del acto quirúrgico, 12 pacientes en toal las presentron; las más frecuentes fueron las infecciones de la herida quirúrgica con 7 casos. Conclusiones: el riesgo A.S.A. elevado mostró ser uno de los factores predictivos más importantes respecto del incremento de la mortalidad en cuadros oclusivos de urgencia, junto con la edad y el retraso de la indicación quirúrgica.
Bowel obstruction syndrome represents 20 to 30 % of acute abdominal consult. Objectives: to relate age, gender, ASA risk, large or smal intestinal obstruction, opportunity chirurgic treatment, medical and clinic complications. Establishment: Central Guard Service of N.C.H. of the C.N.U. Design: protocolized and prospective study. Methods and materials: between January 2004 and January 2007 it has been operated 52 patients with acute bowel obstruction, 32 of them were males and 20 females. The middle age eas 52,11 years. Chirurgic risk: 46,15 % had ASA risk III, 38,69 % had ASA risk II, 11,53 % had ASA risk I, and 9,61 % had ASA risk IV. Most common sympotom was abdominal pain and abdominal distension, and the most common signs were distension and tympanic abdominal. Results: the most common cause of small bowel obstruction sigmoid cancer. Global mortality was 13,45 %. Post chirurgic complications: 9 patients had acute renal failure and 7 had wound surgery infection. Conclusions: the most important factors that increase mortality on acute bwel obstructions are elevated risk ASA, age adn retard of surgery treatment.
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Humanos , Masculino , Feminino , Abdome Agudo/patologia , Aderências Teciduais/complicações , Morbidade , Obstrução Intestinal/cirurgia , Obstrução Intestinal/complicações , Obstrução Intestinal/mortalidade , Obstrução Intestinal/patologia , Estudos Prospectivos , Síndrome da Alça Aferente/complicaçõesRESUMO
El síndrome de Oclusión Intestinal representa entre un 20 % y 30 % de los cuadros de Abdomen Agudo. El objetivo es relacinar edad, sexo, riesgo ASA, altura de la oclusión, retardo en el tratamiento quirúrgico con mortalidad, complicaciones médicas y quirúrgicas. Se realizú en el Servicio de Guardia Central H:N:C. UNC.. Diseño: estudio prospectivo y protocolizado. Material y métodos: entre enero de 2004 y enero de 2007, se operaron 52 pacientes con un cuadro de oclusión intestinal. Del total 32 de ellos fueron hombres y 20 mujeres; el promedio de edad correspondió a 52,11 años. Riesgo Quirúrgico: el 46,15 % de los pacientes presentó riesgo A.S.A. III, 38,69 % riesgo A.S.A. II, 11,53 % riesgo A.S.A. I y 9,61 % riesgo A.S.A. IV. Los síntomas mós frecuentes fueron dolor abdominal y distensión abdominal y los signos de distensión abdominal y timpanismo abdominal. Resultados: en las Oclusiones altas las Bridas fueron la causa más frecuente y en Oclusiones bajas el Cáncer de sigmoides. La mortalidad global fue de 13,45 %. Respecto de las Complicaciones médicas postquirúrgicas, 14 pacientes en total las presentron, la más frecuente fue la Insuficiencia Renal Aguda con 9 casos. respecto de las complicaciones del acto quirúrgico, 12 pacientes en toal las presentron; las más frecuentes fueron las infecciones de la herida quirúrgica con 7 casos. Conclusiones: el riesgo A.S.A. elevado mostró ser uno de los factores predictivos más importantes respecto del incremento de la mortalidad en cuadros oclusivos de urgencia, junto con la edad y el retraso de la indicación quirúrgica.(AU)
Bowel obstruction syndrome represents 20 to 30 % of acute abdominal consult. Objectives: to relate age, gender, ASA risk, large or smal intestinal obstruction, opportunity chirurgic treatment, medical and clinic complications. Establishment: Central Guard Service of N.C.H. of the C.N.U. Design: protocolized and prospective study. Methods and materials: between January 2004 and January 2007 it has been operated 52 patients with acute bowel obstruction, 32 of them were males and 20 females. The middle age eas 52,11 years. Chirurgic risk: 46,15 % had ASA risk III, 38,69 % had ASA risk II, 11,53 % had ASA risk I, and 9,61 % had ASA risk IV. Most common sympotom was abdominal pain and abdominal distension, and the most common signs were distension and tympanic abdominal. Results: the most common cause of small bowel obstruction sigmoid cancer. Global mortality was 13,45 %. Post chirurgic complications: 9 patients had acute renal failure and 7 had wound surgery infection. Conclusions: the most important factors that increase mortality on acute bwel obstructions are elevated risk ASA, age adn retard of surgery treatment.(AU)
Assuntos
Humanos , Masculino , Feminino , Abdome Agudo/patologia , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Obstrução Intestinal/complicações , Obstrução Intestinal/mortalidade , Morbidade , Aderências Teciduais/complicações , Síndrome da Alça Aferente/complicações , Estudos ProspectivosRESUMO
Intrathecal injection of phenol (ITP) has been used to control intractable pain and spasticity. Direct caustic nerve damage has been postulated as the mechanism of analgesia. Sensation is commonly recovered, suggesting that a spontaneous regeneration process takes place. There is, however, a lack of mechanistic information on ITP therapy. To define morphologically the neurolysis and regeneration phenomena produced by ITP, anesthetized rats were subjected to laminectomy at L5; 5 microl of 22% phenol in saline solution or vehicle (control) was injected. Light and electron microscopy studies of nerve roots were performed at 2, 14, and 60 days after injection. Rats given ITP showed at the early stage a variable amount of roots with signs of infarction characterized by loss of axon-myelin units and thrombosis of intra-root vessels. At 14 days, abundance of macrophages removing debris, open vessels, and nerve sprouts was identified in damaged roots. At this time, non-myelinating glial fibrillary acidic protein-positive Schwann cells were observed in both damaged and apparently undamaged roots. At 60 days, abundance of 2',3'-cyclic nucleotide 3'-phosphodiesterase-positive Schwann cells myelinating newly formed axons was observed in damaged roots. Control rats did not show signs of neural or vascular pathology. Attempting to prevent thrombosis, another group of rats received heparin before ITP; these anti-coagulated rats developed radicular thrombosis, neurolysis, and hemorrhage. In conclusion, neurolysis produced by ITP is associated with acute ischemia (not prevented by heparin) and is followed by vascular, nerve, and myelin regeneration. Our results help understand the lack of efficacy of and some complications by ITP clinical therapy.