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BACKGROUND: A fistulous tract in the mitro-aortic intervalvular fibrosa (MAIVF) is a rare entity, which presents as a complication of endocarditis or surgical trauma. Generally, it is associated to a pseudoaneurysm of the MAIVF (p-MAIVF) or aortic abscesses. MAIVF fistulas could potentially lead to devastating complications and a high mortality rate. This condition is managed surgically, either by a percutaneous closure or an open surgical approach. Herein we report the complex case of a patient with a MAIVF fistula secondary to bacterial endocarditis. Further clinical deterioration was caused by severe aortic valve insufficiency and hemodynamic compromise, requiring surgical intervention. CASE PRESENTATION: A 74-year-old male patient was admitted to a primary care center with complaints of malaise, asthenia, adynamia, hyporexia, and lower limb edema over the past eight days. His past medical history is positive for arterial hypertension and being monorenal. A transesophageal echocardiogram (TEE) was performed, exhibiting a 56% left ventricle ejection fraction (LVEF) and complicated aortic valve endocarditis. Surgical management through an open approach included vegetation resection, valve replacement, and closure of the MAIVF fistula. After completing antibiotic therapy, the patient was discharged without complications. During postoperative follow-up, the patient remained asymptomatic, and the control echocardiogram showed no signs of MAIVF fistula.4. CONCLUSIONS: The clinical case of a patient with a MAIVF fistula secondary to endocarditis by Streptococcus Anginous was presented. The fistulous tract was not associated to p-MAIVF or aortic abscess, findings which further deteriorate the patient's condition and increase the likelihood of fatality. This case reinforces the importance of a prompt diagnosis through cardiac imaging and timely surgical closure of the defect.
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Valva Aórtica , Endocardite Bacteriana , Valva Mitral , Humanos , Masculino , Idoso , Endocardite Bacteriana/complicações , Endocardite Bacteriana/cirurgia , Endocardite Bacteriana/microbiologia , Valva Aórtica/cirurgia , Valva Mitral/cirurgia , Ecocardiografia Transesofagiana , Fístula/cirurgiaRESUMO
The physical and functional interaction between transient receptor potential channel ankyrin 1 (TRPA1) and neuronal calcium sensor 1 (NCS-1) was assessed. NCS-1 is a calcium (Ca2+) sensor found in many tissues, primarily neurons, and TRPA1 is a Ca2+ channel involved not only in thermal and pain sensation but also in conditions such as cancer and chemotherapy-induced peripheral neuropathy, in which NCS-1 is also a regulatory component.We explored the interactions between these two proteins by employing western blot, qRT-PCR, co-immunoprecipitation, Ca2+ transient monitoring with Fura-2 spectrophotometry, and electrophysiology assays in breast cancer cells (MDA-MB-231) with different levels of NCS-1 expression and neuroblastoma cells (SH-SY5Y).Our findings showed that the expression of TRPA1 was directly correlated with NCS-1 levels at both the protein and mRNA levels. Additionally, we found a physical and functional association between these two proteins. Physically, the NCS-1 and TRPA1 co-immunoprecipitate. Functionally, NCS-1 enhanced TRPA1-dependent Ca2+ influx, current density, open probability, and conductance, where the functional effects depended on PI3K. Conclusion: NCS-1 appears to act not only as a Ca2+ sensor but also modulates TRPA1 protein expression and channel function in a direct fashion through the PI3K pathway. These results contribute to understanding how Ca2+ homeostasis is regulated and provides a mechanism underlying conditions where Ca2+ dynamics are compromised, including breast cancer. With a cellular pathway identified, targeted treatments can be developed for breast cancer and neuropathy, among other related diseases.
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Neoplasias da Mama , Proteínas Sensoras de Cálcio Neuronal , Neuropeptídeos , Canal de Cátion TRPA1 , Feminino , Humanos , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Cálcio/metabolismo , Sinalização do Cálcio , Linhagem Celular Tumoral , Proteínas Sensoras de Cálcio Neuronal/metabolismo , Proteínas Sensoras de Cálcio Neuronal/genética , Neurônios/metabolismo , Neurônios/efeitos dos fármacos , Neuropeptídeos/metabolismo , Neuropeptídeos/genética , Fosfatidilinositol 3-Quinases/metabolismo , Transdução de Sinais , Canal de Cátion TRPA1/metabolismo , Canal de Cátion TRPA1/genéticaRESUMO
K+ channel Kir7.1 expressed at the apical membrane of the retinal pigment epithelium (RPE) plays an essential role in retinal function. An isoleucine-to-threonine mutation at position 120 of the protein is responsible for blindness-causing vitreo-retinal dystrophy. We have studied the molecular mechanism of action of Kir7.1-I120T in vitro by heterologous expression and in vivo in CRISPR-generated knockin mice. Full-size Kir7.1-I120T reaches the plasma membrane but lacks any activity. Analysis of Kir7.1 and the I120T mutant in mixed transfection experiments, and that of tandem tetrameric constructs made by combining wild type (WT) and mutant protomers, leads us to conclude that they do not form heterotetramers in vitro. Homozygous I120T/I120T mice show cleft palate and tracheomalacia and do not survive beyond P0, whereas heterozygous WT/I120T develop normally. Membrane conductance of RPE cells isolated from WT/WT and heterozygous WT/I120T mice is dominated by Kir7.1 current. Using Rb+ as a charge carrier, we demonstrate that the Kir7.1 current of WT/I120T RPE cells corresponds to approximately 50% of that in cells from WT/WT animals, in direct proportion to WT gene dosage. This suggests a lack of compensatory effects or interference from the mutated allele product, an interpretation consistent with results obtained using WT/- hemizygous mouse. Electroretinography and behavioral tests also show normal vision in WT/I120T animals. The hypomorphic ion channel phenotype of heterozygous Kir7.1-I120T mutants is therefore compatible with normal development and retinal function. The lack of detrimental effect of this degree of functional deficit might explain the recessive nature of Kir7.1 mutations causing human eye disease.NEW & NOTEWORTHY Human retinal pigment epithelium K+ channel Kir7.1 is affected by generally recessive mutations leading to blindness. We investigate one such mutation, isoleucine-to-threonine at position 120, both in vitro and in vivo in knockin mice. The mutated channel is inactive and in heterozygosis gives a hypomorphic phenotype with normal retinal function. Mutant channels do not interfere with wild-type Kir7.1 channels which are expressed concomitantly without hindrance, providing an explanation for the recessive nature of the disease.
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Isoleucina , Retina , Camundongos , Humanos , Animais , Isoleucina/metabolismo , Retina/metabolismo , Cegueira/metabolismo , Mutação/genética , Treonina/metabolismoRESUMO
Introducción: Las hernias de la pared abdominal afectan entre el 10% al 15% de la población mundial, siendo hasta el 60% de estas hernias inguinales. Las hernias inguinales gigantes son poco comunes, pero con una gran carga de enfermedad para el paciente. Caso Clínico: Se presenta el caso de un paciente de 51 años, con antecedente de diabetes mellitus tipo II, proveniente de zona rural aislada, por cuatro días de evolución consistente en quemadura escrotal por metal caliente, relacionada a una hernia inguinoescrotal derecha gigante. Es llevado a intervención quirúrgica por cirugía general y urología. Por adecuada evolución clínica se da de alta al 5° día posoperatorio. Discusión: Las hernias inguinales gigantes son raras y frecuentemente se presentan en pacientes de bajo estrato socioeconómico, procedencia rural y cierto grado de negligencia. El reto del equipo quirúrgico consiste en lidiar con los posibles efectos adversos de la reducción del contenido herniario en un abdomen con diversos grados de pérdida del dominio. Se puede requerir resección o debulking del contenido abdominal o la expansión de la cavidad abdominal mediante frenectomía, neumoperitoneo progresivo perioperatorio o la creación de hernias ventrales mediante maniobras avanzadas. La reparación con malla libre de tensión disminuye el riesgo de recurrencia. Conclusión: La hernia inguinal gigante es una patología rara. El cirujano general está llamado a conocer el abanico de opciones que existen en caso de enfrentarse a estos pacientes, lo cual ayuda a reducir la elevada morbimortalidad y altas tasas de recurrencia.
Introduction: Abdominal wall hernias affect between 10% to 15% of the world population and up to 60% of these are inguinal hernias. Giant inguinal hernias are rare, but have high burden of disease for the patients. Clinical Case: We present the case of a 51-year-old patient, with a history of type II diabetes mellitus, from an isolated rural area, with four days of a scrotal burn by hot metal, related to a giant right inguinoscrotal hernia. He is taken to surgical intervention by general surgery and urology. Due to adequate clinical evolution, he was discharged on the 5th postoperative day. Discussion: Giant inguinal hernias are rare and frequently occur in patients of low socioeconomic status, rural origin and a certain degree of neglect. The challenge for the surgical team consist in dealing with the potential adverse effects of reducing hernia contents in an abdomen with varying degrees of loss of normal capacity. Resection or debulking of the abdominal contents or expansion of the abdominal cavity by frenectomy, perioperative progressive pneumoperitoneum, or the creation of ventral hernias by advanced maneuvers may be required. Tension-free mesh repair decreases the risk of recurrence. Conclusion: Giant inguinal hernia is a rare pathology. The general surgeon is called to know the range of options that exist in the event of facing these patients, which helps to reduce the high morbidity and mortality and high rates of recurrence.
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Objetivo. Analizar las diferencias en la presentación de variables clínico-patológicas, de acuerdo con la expresión proteica de GRB7, en tumores HER2 positivos en mujeres colombianas con cáncer de mama invasivo, diagnosticado entre los años 2013 y 2015 en el Instituto Nacional de Cancerología E.S.E (INC). Métodos. Se incluyeron 158 pacientes con diagnóstico confirmado de cáncer de mama ductal invasivo. Se evaluó la expresión de los receptores hormonales (receptor de estrógeno (RE) y de progesterona (RP)), HER2, Ki67 y GRB7, mediante inmunohistoquímica (IHQ), y a partir de estos, se clasificaron los tumores en subtipos intrínsecos. Los análisis estadísticos incluyeron las pruebas de Chi-cuadrado/test exacto de Fisher para las variables categóricas, y la prueba U Mann Whitney/ Kruskal Wallis para las variables cuantitativas. Se evaluó la supervivencia global (SG) y libre de enfermedad (SLR) según la coexpresión de HER2/GRB7 usando el método de Kaplan-Meier y el test de log-rank. Resultados. La expresión de GRB7 se observó exclusivamente en tumores HER2-positivos (luminal B/HER2+ y HER2-enriquecidos: p<0,001). Los casos HER2+/GRB7+ mostraron una mayor expresión de Ki67 (40% vs. 27,5%, p=0,029), pero una tendencia a presentar un menor tamaño tumoral (30 mm vs. 51 mm, p=0,097), comparado con los tumores HER2+/GRB7-. No obstante, no se observaron diferencias en la supervivencia según la coexpresión de HER2/GRB7 (SG: p=0,6; SLR: p=0,07). Conclusiones. En nuestra muestra de estudio, la expresión de GRB7 en tumores HER2+ no se asoció con características clínico-patológicas de pronóstico desfavorable.
Objective: To analyze differences in the presentation of clinicopathological variables according to GRB7 protein expression in HER2-positive tumors in Colombian patients with invasive ductal breast carcinomas diagnosed between 2013 and 2015 at the Instituto Nacional de Cancerología (Bogotá, Colombia).Methods: A total of 158 breast cancer patients were included with a confirmed diagnosis of invasive ductal carcinoma. A single pathologist evaluated the protein expression of hormone receptors (estrogen (ER) and progesterone receptor (PR)), HER2, Ki67, and GRB7 by immunohistochemistry (IHC). The chi-square and Fisher's exact tests were used to assess differences between categorical variables, as well as the Mann-Whitney/Kruskal-Wallis U test for numerical variables. Overall (OS) and disease-free (DFS) survival were evaluated according to HER2/GRB7 co-expression using the Kaplan-Meier method and log-rank test.Results:GRB7 expression was observed exclusively in HER2-positive tumors (luminal B/HER2+ and HER2-enriched: p<0.001). HER2+/GRB7+ cases showed higher Ki67 expression (40% vs. 27.5%, p=0.029) and a tendency to present a smaller tumor (30 mm vs. 51 mm, p=0.097) compared to HER2+/GRB7- tumors. However, no differences in OS or DFS were observed by HER2/GRB7 co-expression (OS: p=0.6; DFS: p=0.07).Conclusions:Our results in Colombian patients indicate that GRB7 expression in HER2-positive breast tumors is not associated with unfavorable clinicopathological features.
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Feminino , Receptor ErbB-2 , Antígeno Ki-67 , Proteína Adaptadora GRB7RESUMO
La enfermedad por coronavirus (COVID-19) producida por el SARS-CoV-2 ha sido un reto para los servicios de salud en todo el mundo. La pandemia se ha extendido ampliamente con más de 80 millones de casos confirmados y más de un millón de muertes a nivel mundial, por lo que ha estado bajo constante investigación para entender todos los aspectos de la enfermedad. Recientemente se han reportado varios casos de pacientes con síndrome de Guillain-Barré asociado a COVID-19 como manifestación principal, convirtiéndola en la primera enfermedad neurológica autoinmune desencadenada por SARS-CoV-2; sin embargo, es necesario obtener más información para entender completamente los mecanismos inmunopatogénicos implicados en esta asociación.
The coronavirus disease (COVID-19) caused by SARS-CoV-2 has been a challenge for health services around the world. The pandemic has spread widely, with more than 80 million confirmed cases and more than one million deaths globally. There have been many studies to understand all aspects of the disease. Recently, several cases have been reported of patients with Guillain-Barré syndrome associated with COVID-19 as the main manifestation. As it may be one of the first autoimmune neurological diseases triggered by SARS-CoV-2, it is necessary to obtain more information to fully understand the immunopathogenic mechanisms involved in this association.
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Humanos , Masculino , Feminino , Idoso , Vírus de RNA , Vírus , Coronavirus , Doenças Autoimunes do Sistema Nervoso , Síndrome de Guillain-Barré , Doenças do Sistema NervosoRESUMO
Resumen Introducción: La cardiopatía isquémica es un problema de salud pública y puede tratarse por medio de la revascularización miocárdica. Objetivo: Estructurar el primer perfil epidemiológico y clínico de los pacientes intervenidos en Tolima. Materiales y método: Es un estudio de corte transversal, de 183 pacientes mayores de 18 años programados para revascularización miocárdica entre septiembre de 2018 y septiembre de 2019. Se eligieron variables clínicas y demográficas. Se realizó un análisis descriptivo, un análisis bivariado para mortalidad y circulación extracorpórea, y una regresión logística para la mortalidad intrahospitalaria. Resultados: La edad media de los pacientes fue de 66.7 años y un 68.85% correspondió a la población femenina. Se presentó HA en 80.33%, tabaquismo en 49.18%, dislipidemia en 44.81% y DM en 40.98%. Se registró mayor proporción de complicaciones en los pacientes intervenidos sin CEC, como complicaciones pulmonares, FA de novo y una estancia intrahospitalaria y posoperatoria mayor. Los pacientes que fallecieron tuvieron mayor proporción de complicaciones, mayor estancia hospitalaria, mayor cantidad de reintervenciones y tiempo de ventilación mecánica. El modelo de regresión reveló una relación con mortalidad para los pacientes que tuvieron requerimiento de diálisis (OR = 8.7) complicaciones pulmonares (OR = 10.5) y desarrollo de FA de novo (OR = 11.3). Conclusiones: Este estudio caracteriza a la población para generar marcos de referencia en un grupo poco estudiado como el tolimense. De modo adicional, se presentaron mejores desenlaces en los pacientes llevados a revascularización miocárdica con circulación extracorpórea, y unas relaciones claras de mortalidad y complicaciones posoperatorias.
Abstract Introduction: The ischemic cardiopathy is a public health issue, that can be treated with a coronary artery bypass grafting (CABG). Objective: To present the first clinical and epidemiological profile of CABG treated patients in Tolima, Colombia. Materials and method: We conduct a cross sectional study, including 183 patients driven to a CABG procedure, between September 2018-2019. We chose clinical and demographic variables. And posteriorly, performed a descriptive and bivariate analysis, including mortality and extracorporeal circulation. Besides, we completed a logistic regression for intrahospital mortality. Results: The average age of our patients was 66,7 years, and 68.85% were female. They presented in an 80.33% arterial hypertension, smoked an 49.18%, had dyslipidemia and diabetes 44.81% and 40.95% respectively. There were more complications in patients who were drove into on pump CABG, primarily pulmonary complications, atrial fibrillation, mayor intrahospital and post-operatory stay. The patients who died, present more complications, intrahospital stay, reinterventions and mechanic ventilation time. Our regression model evidenced mortality association with post-operatory dialysis (OR = 8.7), pulmonary complications (OR = 10.5) and new atrial fibrillation (OR = 11.3). Conclusions: This study aim to characterize the Tolima's population, creating a reference in this less studied population. On the other side, the study discuss the better outcomes in patients taken to myocardial bypass with extracorporeal membrane oxygenation. And the association between dead and certain postoperative complications.
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RESUMEN INTRODUCCION: El ataque cerebrovascular (ACV) de etiología isquémica es una patología cuya incidencia y mortalidad aumentaron en la última década. Cuando se maneja oportunamente, mediante trombólisis como terapia inicial, mejora su desenlace y funcionalidad. En el departamento del Tolima (Colombia) no hay registros de esta patología y en el país la bibliografía al respecto es limitada. El objetivo de este estudio es evaluar los desenlaces clínicos del manejo agudo con r-tPA en los pacientes que presentaron ACV isquémico en dos instituciones de la ciudad de Ibagué, capital de dicho departamento, entre junio del 2019 y junio del 2020, e identificar los tiempos de atención hospitalaria y las principales variables asociadas con el grupo de pacientes que fallecieron. MATERIALES Y METODOS: Estudio descriptivo de corte transversal del manejo del ACV isquémico con r-tPA, en el que se describen las variables sociodemográficas, la escala NIHSS como evaluación neurológica inicial, los tiempos de atención (inicio-aguja, puerta-tac y puerta-aguja), los desenlaces postoperatorios y el Rankin modificado al egreso. RESULTADOS: Se incluyeron 38 pacientes con una media de 67,37 años, el 60,53 % fueron mujeres. La escala NIHSS al ingreso fue 13,47 puntos (DE 5,24). Los tiempos de atención fueron 183 minutos (DE 72,63) inicio-aguja, 41 minutos (RIQ 17-72) puerta-TAC y 101,50 minutos (RIQ 77 - 137,25) puerta-aguja. La mortalidad fue del 23,68 %. CONCLUSION: La mortalidad y el desenlace funcional del ACV en nuestra población fueron similares a los reportados en la literatura nacional e internacional, sin embargo, es preciso implementar protocolos de atención del infarto cerebral para incrementar el número de pacientes con desenlace favorable, acortando los tiempos de atención en toda la cadena del tratamiento adecuado del infarto cerebral.
ABSTRACT INTRODUCTION: Ischemic stroke is a growing disease in the last decade, increasing both its incidence and its mortality. However, timely thrombolysis management as initial therapy can improve both disease progression as well as an individual's functionality. In Tolima, there are no registries of this disease and in Colombia in general, the literature is limited. The objective of this study is to investigate the clinical outcomes of the acute management of ischemic stroke using r-tPA as well as identifying in-hospital treatment times, at two institutions in Ibague between 2019 and 2020. METHODS AND MATERIALS: Using a cross-sectional descriptive study, we describe the management of ischemic stroke using r-tPA, describing sociodemographic variables, NIHSS scale as the initial neurological evaluation, in-hospital treatment times (symptoms-to-needle, door-to-TAC, door-to-needle), the clinical outcomes, and lastly the modified Rankin score upon discharge. RESULTS: We included 38 patients with median age of 67,37 years, 60,53 % were females. The initial average NIHSS scale upon admission was 13,47 (DE 5,24). In-hospital attention time averages were: symptoms-to-needle 183 minutes (DE 72,63), door-to-CAT 41 minutes (RIQ 17-72), and door-to-needle 101,50 minutes (RIQ 77-137,25). Overall the rate of mortality was 23,68 %. CONCLUSIONS: Mortality and functionality outcomes of the stroke population observed was similar to previously reported, both nationally and internationally. However, protocols should be implemented for the timely ischemic stroke management to improve the number of patients with favorable outcomes, by reducing the in-hospital attention times in all areas of the management chain.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , AVC Isquêmico/tratamento farmacológico , Fatores de Tempo , Atenção Terciária à Saúde , Estudos Transversais , Colômbia/epidemiologia , AVC Isquêmico/mortalidade , OctogenáriosRESUMO
Background: Our previous study reported higher mRNA levels of the human epidermal growth factor receptor 2 (HER2)-amplicon genes ERBB2 and GRB7 in estrogen receptor (ER)-positive breast cancer patients with relatively high Indigenous American (IA) ancestry from Colombia. Even though the protein expression of HER2 and GRB7 is highly correlated, they may also express independently, an event that could change the patients' prognosis. In this study, we aimed to explore the differences in ER, HER2 and GRB7 protein expression according to genetic ancestry, to further assess the clinical implications of this association. Methods: We estimated genetic ancestry from non-tumoral breast tissue DNA and assessed tumoral protein expression of ER, HER2, and GRB7 by immunohistochemistry in a cohort of Colombian patients from different health institutions. We used binomial and multinomial logistic regression models to test the association between genetic ancestry and protein expression. Kaplan-Meier and log-rank tests were used to evaluate the effect of HER2/GRB7 co-expression on patients' survival. Results: Our results show that patients with higher IA ancestry have higher odds of having HER2+/GRB7- breast tumors, compared to the HER2-/GRB7- subtype, and this association seems to be stronger among ER-positive tumors (ER+/HER2+/GRB7-: OR=3.04, 95% CI, 1.47-6.37, p<0.05). However, in the multivariate model this association was attenuated (OR=1.80, 95% CI, 0.72-4.44, p=0.19). On the other hand, it was observed that having a higher European ancestry patients presented lower odds of ER+/HER2+/GRB7- breast tumors, this association remained significant in the multivariate model (OR=0.36, 95% CI, 0.13 - 0.93, p= 0.0395). The survival analysis according to HER2/GRB7 co-expression did not show statistically significant differences in the overall survival and recurrence-free survival. Conclusions: Our results suggest that Colombian patients with higher IA ancestry and a lower European fraction have higher odds of ER+/HER2+/GRB7- tumors compared to ER+/HER2-/GRB7- disease. However, this association does not seem to be associated with patients' overall or recurrence-free survival.
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ABSTRACT The coronavirus disease 2019 (COVID-19) produced by SARS-CoV-2 has taken on great importance in recent months, and is under constant investigation by different areas of medicine, including rheumatology, in search of the best scientific evidence. In the case of the pediatric population, it is particularly important as it was first thought that the impact of the pan-demic in this population would be less due to the low presence of severe cases. Evidence is now being reported of clinical pictures in children with a diagnosis of COVID-19 who are characterized by an altered inflammatory state consisting of a storm of pro-inflammatory cytokines that produces manifestations similar to those presented in autoimmune diseases, such as Kawasaki disease. It has been called Multisystemic Inflammatory Syndrome in children, temporarily associated with SARS-CoV-2 which, in many cases requires hospitalization in pediatric intensive care units and multidisciplinary management by various specialties.
RESUMEN La enfermedad por coronavirus 2019 (COVID-19), producida por el SARS-CoV-2, ha tomado una gran importancia en los últimos meses y se encuentra bajo constante investigación por distintas áreas de la medicina, incluida la reumatología, en la búsqueda de la mejor evidencia científica. En el caso de la población pediátrica cobra especial importancia puesto que en un principio se pensaba que el impacto de la pandemia en esta población sería menor, debido a la baja presencia de casos severos, pero la evidencia actual reporta la existencia de cuadros clínicos en niños con diagnóstico de COVID-19 que se caracterizan por un estado inflamatorio alterado consistente en una tormenta de citocinas proinflamatorias que produce manifestaciones similares a las presentadas en enfermedades autoinmunes como la enfermedad de Kawasaki. Se le ha denominado síndrome inflamatorio multisistémico en ninos asociado temporalmente con SARS-CoV-2, el cual en muchos casos precisa internación en unidades de cuidados intensivos pediátricos y el manejo multidisciplinario por diversas especialidades.
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Humanos , Masculino , Feminino , Criança , Pediatria , Infecções Respiratórias , COVID-19 , Ocupações em Saúde , Infecções , MedicinaRESUMO
Resumen La sepsis neonatal constituye una de las principales causas de mortalidad neonatal en los países en desarrollo. Los neonatos, en particular los prematuros, tienen un mayor riesgo de infecciones bacterianas, por lo que el manejo con antibióticos constituye la terapia más frecuente en la Unidad de Cuidado Intensivo Neonatal (UCIN), estimándose en hasta un 70%. La presentación clínica de la sepsis neonatal es inespecífica en muchas ocasiones, lo que hace que la antibioticoterapia empírica se inicie tempranamente para evitar consecuencias deletéreas para los pacientes; su inespecificidad la caracteriza como un reto diagnóstico, por lo que diferentes autores han diseñado estrategias para determinar neonatos candidatos a terapia antimicrobiana. La microbiología permanece en contacto estrecho con la clínica ya que conocer los gérmenes frecuentemente asociados a la sepsis neonatal ayuda a determinar el espectro antibiótico a usar. De igual forma, el conocimiento de la farmacología antibiótica es clave puesto que el tratamiento antibiótico no es inocuo y puede asociarse a aumento de morbilidad o mortalidad. El tiempo de evolución y los factores de riesgo maternos están asociados a los gérmenes responsables esperados, ya descritos por múltiples estudios descriptivos a nivel mundial. El uso indiscriminado de antibióticos de amplio espectro para el manejo de infecciones en los recién nacidos ha generado un aumento en la resistencia antibiótica, lo que a su vez lleva a tasas más altas de fallo terapéutico con el uso de las terapias antibióticas empíricas. A razón de lo anterior, los Programas de Vigilancia de Uso de Antibióticos juegan un papel determinante para monitorear el cambio en la resistencia a nivel local para ajustar y homogeneizar la práctica médica que logre regular el uso de antibióticos y mitigar la emergente resistencia bacteriana.
Abstract Neonatal sepsis constitutes one of the main causes of neonatal mortality in developing countries. Newborns, particularly premature newborns, have a higher risk of bacterial infections that result in frequent administration of antibiotics in the Neonatal Intensive Care Units (NICU), which is estimated to be as high as 70%. The clinical presentation of neonatal sepsis is nonspecific, prompting the early use of empirical antibiotic prescription to avoid adverse consequences in the patients. Its non-specificity characterizes it as a challenging diagnostic, this aspect led several authors to design strategies to determine which newborns are true candidates for antimicrobial therapy. Microbiology is closely linked to clinical practice. Thus, knowing the most frequent bacteria associated with neonatal sepsis will be closely related to the antibiotic spectrum that should be used to treat it. Furthermore, knowledge on basic pharmacology is key inasmuch as the antimicrobial treatment is not innocuous and can be related to an increase in mortality and morbidity. Clinical course and maternal risk factors are associated with the expected responsible germs that are already described in multiple descriptive studies worldwide. Indiscriminate use of broad-spectrum antibiotics for the management of newborn infections is leading to antibiotic resistance increase. At the same time, this is related to even higher rates of therapeutic failure with empiric antimicrobial treatment. Based on this, Antimicrobial Stewardship Programs play a determinant role to monitor the changes in local resistance to adjust and homogenize medical practice to regulate the use of antibiotics and mitigate the emergent and threatening antimicrobial bacterial resistance.
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BACKGROUND: During the COVID 19 pandemic, direct-to-consumer telehealth (DTC) services allowed patients real-time virtual access to healthcare providers, especially those with an established relationship. In Colombia, this care modality was implemented between 2019 and 2020, under national considerations, it was implemented for outpatient care in a highly complex university hospital in Cali, Colombia. METHODS: A descriptive study with prospective information collection was used to describe the implementation of the outpatient teleconsultation care model for patients. We constructed the clinical and process indicators with which we evaluated the model. FINDINGS: A total of 56,560 patients from our institution were treated by virtual outpatient consultation during the first nine months of the health emergency declared by COVID 19 in Colombia. The strategy made it possible to achieve coverage more significant than 100% in Cali and the departments of Colombia. Attention by teleconsultation was 19% of the total ambulatory care. The effectiveness in carrying out scheduled teleconsultations had an overall result of 91.5%. The accessibility results demonstrated the need to strengthen connectivity and accessibility to payments and strengthen technology adoption in the institution, health personnel, and patients. INTERPRETATION: Implementing an outpatient teleconsultation model allowed the continuity of the management with comprehensive coverage nationwide from a highly complex hospital in southwestern Colombia. The indicators' analysis should help strengthen the policies of access to telemedicine, especially with the consequences of the pandemic in low- and middle-income countries. Latin American evidence is necessary to establish the safety profile of telemedicine and the costs associated with the provision.
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COVID-19 , Consulta Remota , Assistência Ambulatorial , Colômbia/epidemiologia , Hospitais , Humanos , Pandemias , Estudos Prospectivos , SARS-CoV-2RESUMO
Various families of ion channels have been characterized in mesenchymal stem cells (MSCs), including some members of transient receptor potential (TRP) channels family. TRP channels are involved in critical cellular processes as differentiation and cell proliferation. Here, we analyzed the expression of TRPM8 channel in human bone marrow MSCs (hBM-MSCs), and its relation with osteogenic differentiation. Patch-clamp recordings showed that hBM-MSCs expressed outwardly rectifying currents which were increased by exposure to 500 µM menthol and were partially inhibited by 10 µM of BCTC, a TRPM8 channels antagonist. Additionally, we have found the expression of TRPM8 by RT-PCR and western blot. We also explored the TRPM8 localization in hBM-MSCs by immunofluorescence using confocal microscopy. Remarkably, hBM-MSCs treatment with 100 µM of menthol or 10 µM of icilin, TRPM8 agonists, increases osteogenic differentiation. Conversely, 20 µM of BCTC, induced a decrease of osteogenic differentiation. These results suggest that TRPM8 channels are functionally active in hBM-MSCs and have a role in cell differentiation.
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BACKGROUND: Breast cancer clinical management requires the assessment of hormone receptors (estrogen (ER) and progesterone receptor (PR)), human epidermal growth factor receptor 2 (HER2) and cellular proliferation index Ki67, by immunohistochemistry (IHC), in order to choose and guide therapy according to tumor biology. Many studies have reported contradictory results regarding changes in the biomarker profile after neoadjuvant therapy (NAT). Given its clinical implications for the disease management, we aimed to analyze changes in ER, PR, HER2, and Ki67 expression in paired core-needle biopsies and surgical samples in breast cancer patients that had either been treated or not with NAT. METHODS: We included 139 patients with confirmed diagnosis of invasive ductal breast carcinoma from the Colombian National Cancer Institute. Variation in biomarker profile were assessed according to NAT administration (NAT and no-NAT treated cases) and NAT scheme (hormonal, cytotoxic, cytotoxic + trastuzumab, combined). Chi-squared and Wilcoxon signed-rank test were used to identify changes in biomarker status and percentage expression, respectively, in the corresponding groups. RESULTS: We did not find any significant variations in biomarker status or expression values in the no-NAT group. In cases previously treated with NAT, we did find a statistically significant decrease in Ki67 (p < 0.001) and PR (p = 0.02605) expression. When changes were evaluated according to NAT scheme, we found a significant decrease in both Ki67 status (p = 0.02977) and its expression values (p < 0.001) in cases that received the cytotoxic treatment. CONCLUSIONS: Our results suggest that PR and Ki67 expression can be altered by NAT administration, whereas cases not previously treated with NAT do not present IHC biomarker profile variations. The re-evaluation of these two biomarkers after NAT could provide valuable information regarding treatment response and prognosis for breast cancer patients.
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Antineoplásicos/administração & dosagem , Biomarcadores Tumorais/análise , Neoplasias da Mama/terapia , Carcinoma Ductal de Mama/terapia , Terapia Neoadjuvante , Biomarcadores Tumorais/metabolismo , Biópsia com Agulha de Grande Calibre , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Imuno-Histoquímica , Mastectomia , Prognóstico , Receptor ErbB-2/análise , Receptor ErbB-2/metabolismo , Receptores de Estrogênio/análise , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/análise , Receptores de Progesterona/metabolismo , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Due to their capacity to proliferate, migrate, and differentiate, mesenchymal stem cells (MSCs) are considered to be good candidates for regenerative medicine applications. The mechanisms underlying proliferation and differentiation of MSCs have been studied. However, much less is known about the mechanisms regulating the migration of MSCs. Platelet lysate (PL), a supplement used to promote cell expansion, has been shown to promote MSCs migration; however, the underlying mechanism are unknown. Here, by using adipose-derived rat MSCs (rMSCs) and the scratch assay in the absence and presence of various BK channels modulators, we evaluated the role of BK channels in mediating the PL-stimulated migration of rMSCs. We found that 5% PL increased rMSCs migration, and this effect was blocked by the addition of the BK channel selective antagonist Iberiotoxin (IBTX). In the absence of PL, the BK channel agonist NS1619, stimulated rMSCs migration to similar level as 5% PL. Addition of both NS1619 and 5% PL resulted in an increase in rMSCs migration, that was higher than when either one was added individually. From whole-cell recordings, it was found that the addition of 5% PL increased the magnitude of BK current density. By using Western blot and flow cytometry, it was found that PL did not affect the expression of BK channels. Together, our results indicate that as shown in other cell types, activation of BK channels by themselves also promote rMSC migration, and show that activation of BK channels contribute to the observed PL-induced increase in migration of rMSC.
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Resumen Presentamos el caso de una paciente de 83 años sin antecedentes de importancia, a quien se le realizó una colonoscopia de tamización 3 h antes del inicio de la sintomatología. La paciente consultó al servicio de urgencias por presentar dolor en la fosa ilíaca derecha de 12 h de evolución. En efecto, durante el examen físico, se encontró un dolor localizado en la fosa ilíaca derecha. Ante la sospecha de una complicación relacionada con la colonoscopia, se ordenó una tomografía de abdomen, la cual mostró signos tomográficos de apendicitis. Se realizó entonces una apendicetomía por laparoscopia, sin complicaciones, pero se evidenció un apéndice cecal perforado.
Abstract We present the case of an 83-year-old patient who had no significant medical history. A screening colonoscopy had been performed three 3 hours before onset of pain in the right iliac fossa. Twelve hours later, the patient to the emergency department. Physicians suspected that the pain was a complication related to colonoscopy and ordered an abdominal CT scan which showed tomographic signs of appendicitis. A laparoscopic appendectomy was performed and removed a perforated cecal appendix without complications.
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Humanos , Feminino , Idoso de 80 Anos ou mais , Apendicite , Colonoscopia , Literatura , Pacientes , Apêndice , Sinais e SintomasRESUMO
ABSTRACT Introduction: Colonic lipomas are low-risk lesions that require endoscopic or surgical management depending on their size and symptoms. However, diagnosing a lipomatous lesion in the colon is a difficult task, as the clinical or imaging findings point to a low prevalence of these lesions and a higher frequency in the female sex. The laparoscopic approach is the current method of choice as it represents fewer traumas and, therefore, a faster clinical recovery. Case presentation: 43-year-old female patient, Caucasian, from the city of Bogotá, housewife, without any medical history. She presented with acute abdominal pain associated with tarry stools. Diagnostic imaging tests were performed, finding colo-colonic intussusception, originated in a lipomatous lesion located in the transverse colon. This patient underwent an enlarged laparoscopic right hemicolectomy. Discussion: This case describes how colonic intussusception constitutes a preoperative complication that requires surgical management since its diagnosis considering the associated mortality rates. Conclusion: The analysis of this case is part of the scientific evidence indispensable to improve the diagnostic and therapeutic approach to colonic intussusception, as local and international literature have not addressed this condition sufficiently.
RESUMEN Introducción. Los lipomas en el colon son lesiones con pocos riesgos de malignización que, según su tamaño y sintomatologia, pueden requerir manejo endoscópico o quirúrgico. Sin embargo, es difícil establecer el diagnóstico de una lesión lipomatosa en el colon: los hallazgos clínicos o imagenológicos solo describen que la prevalencia de estas lesiones es baja y que es una patología común en el género femenino. Debido a que el abordaje laparoscópico causa menores traumas y por tanto la recuperación clínica es más rápida, en la actualidad suele elegirse esta opción. Presentación de caso. Paciente femenino de 43 años, raza blanca, procedente de Bogotá D.C., ama de casa y sin antecedentes médicos. La sintomatología que presentó fue dolor abdominal de instauración aguda asociado a deposiciones melénicas, por lo que fue llevada a toma de imágenes diagnósticas donde se documentó intususcepción colocolónica originada en una lesión lipomatosa y localizada en el colon transverso. Se le practicó hemicolectomía derecha ampliada por vía laparoscópica. Discusión. A partir de este caso se describe cómo la intususcepción colónica constituye una complicación preoperatoria que demanda la realización de un manejo quirúrgico desde el mismo diagnóstico dado el margen de los porcentajes de mortalidad. Conclusión. El análisis del presente caso constituye parte de la evidencia científica indispensable para mejorar el abordaje diagnóstico y terapéutico de la intususcepción colónica que la literatura nacional e internacional no ha tratado suficientemente.
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Microarray technology is widely recognized as one of the most important tools when it comes to understanding genetic expression in biological processes. In light of the thousands of gene expression level measurements (including measurements across a number of conditions), identifying differentially expressed genes necessarily implies data mining or large-scale multiple testing procedures. To date, advances with regard to this field have been multivariate-descriptive or inferential-univariate in nature and therefore have important limitations regarding the biological validity of detected genes. In the present article, we present a new multivariate inferential method designed to detect active differentially expressed genes in gene expression data. The proposed method estimates false discovery rates using artificial components. Our method excels when applied to the most common gene expression data structures, providing new insights into differentially expressed genes. The method described herein was programmed in an R-Bioconductor package called acde that has been available since 2015.
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Algoritmos , Bases de Dados de Ácidos Nucleicos , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Modelos Genéticos , Análise de Sequência com Séries de Oligonucleotídeos , Interpretação Estatística de DadosAssuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/genética , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Mutação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Colômbia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Introduction: Intravenous rescue analgesia in the postoperative anesthesia care unit (PACU) is the most effective method for reducing postoperative pain (POP) when perioperative multimodal analgesia fails to control it. Appropriate analgesia during these first postoperative hours may prevent morbidity associated with pain. Objective: To compare the effectiveness of intravenous morphine versus fentanyl in the PACU for reducing severe POP. Methods: Randomized, prospective, double blind trial that included patients with severe POP using VAS in the PACU. Rescue was performed on one group with 01 mg/kg morphine and with another with 1 mcg/kg of fentanyl every 5 min intravenously until pain was reduced from severe to mild (VAS<4). 30 patients were included in both groups. Results: There were no significant differences in the percentage of patients with reduction of severe POP to mild 5 min after the injection of morphine or fentanyl, or in the subsequent rescue analgesia intervals (p > 0.05). Similarly, there were no significant differences in mean VAS (95% CI) in morphine or fentanyl groups beginning 5 min after the first analgesic dose (p > 0.05) between the groups. There were no significant differences in side effects such as respiratory depression, nausea, vomiting or pruritus (p = 1.0). There was a high satisfaction in both groups (p > 0.05). Conclusions: Morphine and fentanyl were equally effective in treating severe POP after 5 min and following intervals after rescue analgesia was initiated, during 25 min at PACU, with no differences in efficacy or adverse effects between groups Register # NCT02145975 clinical-trials.gov, prospective.
Introducción: La analgesia intravenosa de rescate en la unidad de cuidados postanestesicos (UCPA), es la forma más efectiva de reducir el dolor POP, cuando la analgesia mutimodal perioperatoria falla en controlarlo. Una adecuada analgesia en las primeras horas previene la morbilidad asociada al dolor. Objetivo: Compararla efectividad para reducir el dolor POP severo de fentanilo versus morfina en recuperación postanestésica. Metodología: Estudio aleatorizado, prospectivo, doble ciego, en pacientes con dolor severo POP medido con la escala EVA. El rescate se hizo con un grupo morfina a 0,1 mg/kg versus fentanilo a 1 mcg/kg, cada 5 minutos, vía intravenosa, hasta reducir el dolor de severo a leve (EVA <4). Se incluyeron 30 pacientes en el grupo morfina y 30 en el grupo fentanilo. Resultados: No se observaron diferencias en porcentaje de pacientes con reducción del dolor severo a leve desde los 5 minutos luego del rescate entre morfina o fentanilo, ó en los intervalos restantes (p>0,05). Similarmente, no se encontraron diferencias significativas en la media de EVA (IC 95%) desde los 5 minutos luego del rescate (p > 0.05) entre los grupos. No hubo diferencias en efectos adversos como depresión respiratoria, náuseas, vómitos o prurito entre grupos (p = 1,0). La satisfacción fue comparable en ambos grupos (p >0,05). Conclusiones: La morfina y el fentanilo fueron igualmente efectivos para el rescate en dolor severo desde los primeros 5 minutos, sin diferencias en los efectos adversos en ambos grupos. Registro # NCT02145975 (clinicaltrials.gov, prospectivo).