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Background: Parkinson's disease is poorly studied in Colombia. It is pharmacologically managed, but for refractory cases, surgery is a therapeutic option, positively impacting on quality of life. Objective: To determine the impact of deep brain stimulation as management in the control of progression in patients with Parkinson's disease attended our institution between the years 2014 to 2020. Method: Descriptive retrospective study, with patients collected between 2014 and 2020 undergoing deep brain stimulation surgery. The MDS-UPDRS (Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale) was applied in the pre- and postoperative period, and the results were compared. Results: 21 patients were included and the UPDRS was applied, finding a decrease in scores in the postoperative period. One patient had an operative site infection. Conclusions: There was an improvement in the MDS-UPDRS score, with a low rate of complications. The procedure time was prolonged from the preoperative evaluation. Deep brain stimulation is the management of choice for refractory Parkinson's disease. The patients in this series showed improvement in their symptoms. Unfortunately, there are limitations to perform this procedure in Colombia, such as the delay in the authorization of the procedure.
Antecedentes: La enfermedad de Parkinson está poco estudiada en Colombia. Es de manejo farmacológico, pero para casos refractarios la cirugía es una opción terapéutica que impacta positivamente en la calidad de vida. Objetivo: Determinar el impacto de la estimulación cerebral profunda como manejo en el control de la progresión en pacientes con enfermedad de Parkinson atendidos nuestra institución entre los años 2014 a 2020. Método: Estudio descriptivo de corte retrospectivo con pacientes recolectados entre los años 2014 y 2020 sometidos a cirugía de estimulación cerebral profunda. Se aplicó la MDS-UPDRS (Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale) en el pre- y el posoperatorio, y se compararon los resultados. Resultados: Se incluyeron 21 pacientes y se les aplicó la MDS-UPDRS, encontrando una disminución en las puntuaciones en el posoperatorio. Un paciente presentó infección del sitio operatorio. Conclusiones: Hubo mejoría en la puntuación de la MDS-UPDRS, con baja tasa de complicaciones. El tiempo de realización del procedimiento fue prolongado desde la valoración preoperatoria. La estimulación cerebral profunda es el manejo de elección para la enfermedad de Parkinson refractaria. Los pacientes de esta serie mostraron mejoría en sus síntomas. Desafortunadamente, existen limitaciones para la realización de este procedimiento en Colombia, como el retraso en la autorización del procedimiento.
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Tropical montane communities host the world's highest beta diversity of birds, a phenomenon usually attributed to community turnover caused by changes in biotic and abiotic factors along elevation gradients. Yet, empirical data on most biotic factors are lacking. Nest predation is thought to be especially important because it appears to be common and can change selective pressures underlying life history traits, which can alter competitive interactions. We monitored 2538 nests, 338 of which had known nest predators, to evaluate if nest predation changes along a tropical elevational gradient. We found that nest predation decreased with elevation, reflecting the loss of lowland predators that do not tolerate colder climates. We found different "super" nest predators at each elevation that accounted for a high percentage of events, suggesting that selection pressures exerted by nest predator communities may be less diffuse than has been hypothesized, at least for birds nesting in the understory.
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Comportamento de Nidação , Comportamento Predatório , Animais , AvesRESUMO
Objectives To evaluate the surgical management outcomes in pediatric patients with diffuse intrinsic pontine gliomas (DIPGs) who underwent intended biopsies and partial resections in a middle-income country, highlighting the barriers and challenges of these procedures for further investigation. Methods A retrospective review of a prospective acquired series of patients who underwent biopsy or resection for DIPG between January 2012 and June 2018 at our institution was performed. Results A total of 43 patients with posterior fossa tumors were identified. From these, seven pediatric DIPG cases were enrolled. Five were males. The median age was 5 years (range: 1-12 years). Only one patient (14.3%) had a ganglioglioma, while the others presented pilocytic and diffuse astrocytomas. Two (28.6%) patients had an intentional biopsy, and the other five (71.4%) had a partial resection. In the three (28.6%) patients who presented with associated hydrocephalus, the endoscopic third ventriculostomy was performed in the same surgical time. The median preoperative Lansky play-performance scale (LPPS) was 80 (range: 60-100), while the median postoperative LPPS was 23 (range: 7-52). Conclusion A decrease in overall survival was noted compared with data reported in other series. Multifactorial barriers were discussed including the social, geographic, and economic features that may influence on final outcomes.
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BACKGROUND: The consumption of artificially sweetened beverages (ASBs) has been linked to metabolic alterations. The effect of reducing the regular consumption of these beverages on the metabolism is currently unknown. OBJECTIVE: To evaluate the effect of reducing consumption of ASBs on the metabolism in overweight young adults. DESIGN: A randomised, single-blind, controlled, 12-week, clinical trial was performed in overweight young adults who regularly consume ASBs. The 45 subjects who participated in the study were randomly divided into two groups: (1) control group (n=21) and (2) intervention group (no intake of ASBs, n=24). Body weight and composition, fasting plasma concentrations of glucose, triglycerides, insulin, cholesterol, low-density lipoproteins and high-density lipoproteins were measured at the beginning and end of the study. and the HOMA-IR was calculated. RESULTS: At the end of 12 weeks, the intervention group showed a significant decrease (as opposed to an increase in the control group) in the percentage of change in body weight (-1.22% vs 1.31%, p<0.004), body fat (-6.28% vs 6.15%, p<0.001) and insulin resistance index (-12.06 vs 38.21%, p<0.00002), as well as in levels of glucose (-4.26% vs 0.51%, p<0.05), triglycerides (-14.74% vs 19.90%, p<0.006), insulin (-8.02% vs 39.23%, p<0.00005), cholesterol (-8.71% vs 0.77%, p<0.01) and LDL (-9.46% vs 9.92%, p<0.004). CONCLUSION: A reduction in habitual consumption of ASBs in overweight young adults decreases biochemical measurements, body weight and composition, suggesting a participation in the metabolic processes.
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Sobrepeso , Edulcorantes , Bebidas Adoçadas Artificialmente , Peso Corporal , Fatores de Risco Cardiometabólico , Colesterol , Glucose , Humanos , Insulina , Método Simples-Cego , Edulcorantes/efeitos adversos , Triglicerídeos , Adulto JovemRESUMO
BACKGROUND: The consumption of artificially sweetened beverages (ASBs) has been linked to metabolic alterations. The effect of reducing the regular consumption of these beverages on the metabolism is currently unknown. OBJECTIVE: To evaluate the effect of reducing consumption of ASBs on the metabolism in overweight young adults. DESIGN: A randomised, single-blind, controlled, 12-week, clinical trial was performed in overweight young adults who regularly consume ASBs. The 45 subjects who participated in the study were randomly divided into two groups: (1) control group (n=21) and (2) intervention group (no intake of ASBs, n=24). Body weight and composition, fasting plasma concentrations of glucose, triglycerides, insulin, cholesterol, low-density lipoproteins and high-density lipoproteins were measured at the beginning and end of the study. and the HOMA-IR was calculated. RESULTS: At the end of 12 weeks, the intervention group showed a significant decrease (as opposed to an increase in the control group) in the percentage of change in body weight (-1.22% vs 1.31%, p<0.004), body fat (-6.28% vs 6.15%, p<0.001) and insulin resistance index (-12.06 vs 38.21%, p<0.00002), as well as in levels of glucose (-4.26% vs 0.51%, p<0.05), triglycerides (-14.74% vs 19.90%, p<0.006), insulin (-8.02% vs 39.23%, p<0.00005), cholesterol (-8.71% vs 0.77%, p<0.01) and LDL (-9.46% vs 9.92%, p<0.004). CONCLUSION: A reduction in habitual consumption of ASBs in overweight young adults decreases biochemical measurements, body weight and composition, suggesting a participation in the metabolic processes.
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Background: Chronic periodontitis (CP), caused by bacteria and fungi, appears in up to 66% of HIV-patients. The impact and association of HIV-treatment (HAART) and Candida itself has not been properly evaluated in the development and progression of CP. The immunopathogenesis is characterized by CD4+ T-cells activation and the balance between the T-helper 1 (Th1) and T-helper 2 (Th2) or a mixed cytokine profile. Currently, the associated causes of an immune response in HIV-patients with CP is controversial. Our aims were the determination of Candida spp. and cytokine profile in oral samples from HIV-positive patients with CP, considering the CD4+ T cells levels and HAART use. Methods: From 500 HIV-positive patients evaluated, 228 patients were enrolled. Patients were separated in groups: (A) n = 53 (≤200 CD4+ T-cells on HAART); (B) n = 57 (≤200 CD4+ T-cells without HAART); (C) n = 50 (>200 CD4+ T-cells without HAART); (D) n = 68 (>200 CD4+ T-cells on HAART). Candida spp. were isolated from the oral biofilm and crevicular fluid in CHROMagar and confirmed by endpoint PCR. Cytokine levels were measured by beads-based immunoassay in saliva by flow cytometry. Results: 147 patients (64.5%) were positive to Candida spp. and 204 strains were isolated; 138 (67.6%) were C. albicans and the remaining C. non-albicans species (C. glabrata>C. tropicalis>C. krusei>C. dubliniensis). In this study, CHROMagar showed good sensitivity (95%) but poor specificity (68%); since of the 152 samples identified as C. albicans, only 131 were confirmed by PCR; from the 10 samples identified as C. glabrata, only six were confirmed. Finally, of the 42 samples detected as C. tropicalis, only five were confirmed. When evaluating Candida spp. presence, group A and D had higher isolation, while group B had the highest species diversity. Whereas, group C had a significant reduction of Candida spp. Despite the presence of Candida and HAART, we found a Th1/Th2 hybrid profile in the saliva of patients with low CD4+ T-cell count (group A). Conclusion: Abundance and diversity of the Candida spp. detected in HIV-patients with CP could be related to HAART and low CD4+ T-cells levels. Also, the immunosuppression might promote a local Th1/Th2 hybrid cytokine profile.
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Candida/imunologia , Candidíase Bucal/imunologia , Periodontite Crônica/imunologia , Citocinas/imunologia , Infecções por HIV/imunologia , Células Th1/imunologia , Células Th2/imunologia , Adulto , Terapia Antirretroviral de Alta Atividade , Linfócitos T CD4-Positivos/efeitos dos fármacos , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD4-Positivos/virologia , Candida/classificação , Candida/fisiologia , Candidíase Bucal/microbiologia , Periodontite Crônica/microbiologia , Periodontite Crônica/virologia , Citocinas/metabolismo , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Saliva/efeitos dos fármacos , Saliva/imunologia , Saliva/metabolismo , Especificidade da Espécie , Células Th1/microbiologia , Células Th1/virologia , Células Th2/microbiologia , Células Th2/virologiaRESUMO
BACKGROUND: Heart failure (HF) patients develop important changes in body composition, but only a small number of studies have evaluated the associations between these changes and functional class deterioration in a prospective manner. OBJECTIVE: The aim of this study was to evaluate whether changes in bioimpedance parameters were associated with NYHA functional class deterioration over six months. METHODS: A total of 275 chronic stable HF patients confirmed by echocardiography were recruited. Body composition measurements were obtained by whole body bioelectrical impedance with multiple frequency equipment (BodyStat QuadScan 4000). We evaluated functional class using the New York Heart Association (NYHA) classification at baseline and after six months. RESULTS: According to our results, 66 (24%) subjects exhibited functional class deterioration, while 209 improved or exhibited no change. A greater proportion of patients exhibited higher extracellular water (> 5%), and these patients developed hypervolemia, according to location on the resistance/reactance graph. A 5% decrease in resistance/height was associated with functional class deterioration with an OR of 1.42 (95% CI 1.01-2.0, p = 0.04). CONCLUSIONS: Body composition assessment through bioelectrical impedance exhibited a valuable performance as a marker of functional class deterioration in stable HF patients.
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Composição Corporal , Impedância Elétrica , Insuficiência Cardíaca/patologia , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Água Extravascular Pulmonar/metabolismo , Feminino , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
AIMS: To analyse the clinical involvement of the amino acid N-acetyl-L-aspartate (NAA) and the peptide N-acetyl-aspartyl-glutamate (NAAG) regarding their diagnostic and prognostic value by means of magnetic resonance spectroscopy. To conduct a review of the metabolism of NAA and NAAG, bearing in mind their chemical structure and physiology, in terms of the variations in their concentration and the correlation with the clinical features. DEVELOPMENT: The review is divided into two parts: in one it was found that the only site where NAA synthesis takes place is in the neuronal mitochondria, while the second part addresses magnetic resonance and, especially, spectroscopic techniques. An array of pathologies were analysed in search of criteria that allow diagnostic and prognostic guidelines. CONCLUSIONS: The study of the most abundant amino acid in the central nervous system (NAA) together with a product of its metabolism, NAAG, allows the diagnosis and follow-up of a variety of pathologies. At the same time, it makes it easier to obtain data about the density of the cell population and its vitality, thus also providing access to the functional status of the synapses.
TITLE: Metabolismo del N-acetil-L-aspartato: valor diagnostico y pronostico.Objetivos. Analizar la implicacion clinica del aminoacido N-acetil-L-aspartato (NAA) y el peptido N-acetil-aspartil-glutamato (NAAG) en relacion con su valoracion diagnostica y pronostica mediante espectroscopia de resonancia magnetica. Realizar una revision del metabolismo del NAA y del NAAG, considerando su estructura quimica y fisiologia, en relacion con las variaciones de su concentracion y en correlacion con la clinica. Desarrollo. La revision se divide en dos partes: en una se comprobo que el unico sitio de sintesis del NAA es la mitocondria neuronal, y del NAAG, el citoplasma neuronal; la segunda parte aborda las tecnicas de resonancia magnetica y, particularmente, la espectroscopia. Se analizan diversas patologias en busca de criterios que posibiliten obtener pautas diagnosticas y pronosticas. Conclusiones. El estudio del aminoacido mas abundante del sistema nervioso central (NAA) junto con un producto de su metabolismo, el NAAG, permite en patologias de diversos origenes su diagnostico y seguimiento y facilita la obtencion de datos de densidad de la poblacion celular y vitalidad de esta, de manera que se accede, ademas, al estado funcional de las sinapsis.
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Ácido Aspártico/análogos & derivados , Encefalopatias/diagnóstico , Encefalopatias/metabolismo , Espectroscopia de Ressonância Magnética , Animais , Ácido Aspártico/metabolismo , Ácido Aspártico/fisiologia , Humanos , PrognósticoRESUMO
Because predation is the main cause of avian nest failure, selection should favor strategies that reduce the probability of nest predation. We describe apparent Batesian mimicry in the morphology and behavior of a Laniocera hypopyrra nestling. On hatching, the nestling had a distinctive bright orange color and modified feathers all over its body, and 6 days after hatching, it started to move its head very slowly from side to side (in a "caterpillar" movement) when disturbed. These traits gave it a resemblance to a hairy, aposematic caterpillar. This species has a long nestling period for its size (20 days), perhaps due to slow provisioning rates (about one feeding per hour). We argue that the slow growth rate, combined with high nest predation, favors the evolution of antipredation mechanisms such as the unique morphological and behavioral characteristics of L. hypopyrra nestlings.
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Comportamento de Nidação , Passeriformes/anatomia & histologia , Passeriformes/fisiologia , Animais , Evolução Biológica , Cor , Plumas , Comportamento PredatórioRESUMO
INTRODUCTION: Type 1 hepatorenal syndrome (HRS) is a functional renal failure that complicates end-stage cirrhosis. The vasopressin analogue terlipressin has been associated with improved renal function in patients with type 1 HRS. AIM: To evaluate the effectiveness of an infusion of terlipressin plus albumin in reversing type 1 HRS, its tolerability, and its adverse effects. METHODS: Thirteen consecutive patients with cirrhosis and type 1 HRS were included in the study. All patients received terlipressin plus albumin as treatment for HRS. The patients were divided in two groups. Group 1 contained eight patients in whom HRS was reversed with treatment, who were classified as responders. Group 2 contained five patients who were nonresponders. RESULTS: Sixty-one percent of the patients who received terlipressin plus albumin responded to therapy and underwent HRS reversal. In two patients, treatment with terlipressin was stopped because of adverse events. No relapse of HRS after terlipressin withdrawal was observed in this study. CONCLUSION: The rate of successful treatment with terlipressin plus albumin was 61%, similar to that in previously reported controlled trials. However, this is the first experience reported in Mexico. A cardiovascular evaluation is required before the start of treatment with terlipressin. This treatment appears to be an effective therapy for improving renal function in patients with type 1 HRS.
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Albuminas/uso terapêutico , Síndrome Hepatorrenal/tratamento farmacológico , Síndrome Hepatorrenal/etiologia , Cirrose Hepática/complicações , Lipressina/análogos & derivados , Creatinina/sangue , Quimioterapia Combinada , Feminino , Síndrome Hepatorrenal/epidemiologia , Humanos , Lipressina/uso terapêutico , Masculino , México , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Terlipressina , Resultado do Tratamento , Vasoconstritores/uso terapêuticoRESUMO
La historia de la fisiología y fisiopatología del líquido raquídeo (LCR) es larga y se halla llena de afirmaciones y contradicciones; conceptos que han gobernado el pensamiento científico por años se desvanecen frente a nuevos trabajos. En 1965 Hakin y Adams publican una entidad clínica a la que denominan hidrocefalia con presión normal de LCR que desde entonces generan innumerables y polémicos trabajos científicos. El objetivo de este trabajo es poder establecer criterios neurorradiológicos que permitan realizar un diagnóstico de certeza de las alteraciones de la fisiología del LCR cuya principal expresión es el aumento de la presión y del pulso de presión del LCR y poder diagnosticar mediante imágenes estados hiperdinámicos del LCR. Para ello hemos estudiado 25 pacientes: 10 adultos jóvenes sanos a fin de establecer criterios de normalidad, 10 personas mayores de 60 años hipertensos con algunos de los elementos que constituyen la tríada de Hakim y 5 pacientes con clínica manifiesta de hidrocefalia normotensiva. Creemos que los pacientes con clínica e imagen en secciones axiales y en especial en T2, no bastan para calificar "si es o no un Hakim". Nuestra experiencia nos marca que el diagnóstico con cine, a nivel del acueducto es una condición crucial a la hora de caracterizar a los pacientes
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Feminino , Masculino , Humanos , Pessoa de Meia-Idade , Pressão do Líquido Cefalorraquidiano/fisiologia , Imageamento por Ressonância Magnética/métodos , Pressão Intracraniana/fisiologia , Líquido Cefalorraquidiano/fisiologia , Espectroscopia de Ressonância Magnética , Hidrocefalia/diagnóstico , Hidrocefalia , Hidrocefalia de Pressão Normal , Hidrocefalia de Pressão Normal/diagnóstico , Imageamento por Ressonância Magnética/instrumentação , Líquido Cefalorraquidiano , Espectroscopia de Ressonância Magnética/métodosRESUMO
La historia de la fisiología y fisiopatología del líquido raquídeo (LCR) es larga y se halla llena de afirmaciones y contradicciones; conceptos que han gobernado el pensamiento científico por años se desvanecen frente a nuevos trabajos. En 1965 Hakin y Adams publican una entidad clínica a la que denominan hidrocefalia con presión normal de LCR que desde entonces generan innumerables y polémicos trabajos científicos. El objetivo de este trabajo es poder establecer criterios neurorradiológicos que permitan realizar un diagnóstico de certeza de las alteraciones de la fisiología del LCR cuya principal expresión es el aumento de la presión y del pulso de presión del LCR y poder diagnosticar mediante imágenes estados hiperdinámicos del LCR. Para ello hemos estudiado 25 pacientes: 10 adultos jóvenes sanos a fin de establecer criterios de normalidad, 10 personas mayores de 60 años hipertensos con algunos de los elementos que constituyen la tríada de Hakim y 5 pacientes con clínica manifiesta de hidrocefalia normotensiva. Creemos que los pacientes con clínica e imagen en secciones axiales y en especial en T2, no bastan para calificar "si es o no un Hakim". Nuestra experiencia nos marca que el diagnóstico con cine, a nivel del acueducto es una condición crucial a la hora de caracterizar a los pacientes (AU)
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Feminino , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Líquido Cefalorraquidiano/fisiologia , Espectroscopia de Ressonância Magnética/diagnóstico , Pressão do Líquido Cefalorraquidiano/fisiologia , Pressão Intracraniana/fisiologia , Imageamento por Ressonância Magnética/métodos , Líquido Cefalorraquidiano/diagnóstico por imagem , Hidrocefalia/diagnóstico , Hidrocefalia/diagnóstico por imagem , Hidrocefalia de Pressão Normal/diagnóstico , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Espectroscopia de Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/instrumentaçãoRESUMO
Por cuanto los autores se fijan como objetivo, exponer los fundamentos bioestructurales aplicados a la interpretación de la microcirugía transantromaxilar de la FPP, desarrollan la investigación en material cadavérico y en estudios por imágenes seccionantes en el vivo. La interpretación de topografía, situación, ubicación y particularidades regionales otorga como resultado, la posibilidad de sistematizar todos los elementos conexos al diseño de la vía y demostrarlos en una secuencia de: cabezas óseas, huesos aislados, tacos óseos y reconocimientos de partes blandas. Para ello, la sección y disección adecuada son la metodología empleada. Los resultados del estudio del material cadavérico y sus conclusiones se correlacionan con imágenes tomográficas de individuos sin patología aparente regional, a fin de efectuar un aporte de una anatomía quirúrgica aplicada y demostrativa de las indicaciones, trayecto y destino del abordaje. Hipotéticamente, por el entorno anatómico, se plantea la factibilidad de la extensión de la vía a otras regiones
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Humanos , Adulto , Crânio , Maxila , Maxila/anatomia & histologia , Maxila/cirurgia , Microcirurgia/instrumentação , Tomografia Computadorizada por Raios X/métodosRESUMO
Por cuanto los autores se fijan como objetivo, exponer los fundamentos bioestructurales aplicados a la interpretación de la microcirugía transantromaxilar de la FPP, desarrollan la investigación en material cadavérico y en estudios por imágenes seccionantes en el vivo. La interpretación de topografía, situación, ubicación y particularidades regionales otorga como resultado, la posibilidad de sistematizar todos los elementos conexos al diseño de la vía y demostrarlos en una secuencia de: cabezas óseas, huesos aislados, tacos óseos y reconocimientos de partes blandas. Para ello, la sección y disección adecuada son la metodología empleada. Los resultados del estudio del material cadavérico y sus conclusiones se correlacionan con imágenes tomográficas de individuos sin patología aparente regional, a fin de efectuar un aporte de una anatomía quirúrgica aplicada y demostrativa de las indicaciones, trayecto y destino del abordaje. Hipotéticamente, por el entorno anatómico, se plantea la factibilidad de la extensión de la vía a otras regiones