Hemorragia postparto en pacientes con obesidad y/o anemia durante el embarazo: revisión sistemática

Introducción: actualmente la anemia y la obesidad durante el embarazo se consideran factores de riesgo modificables para hemorragia postparto. Estos pueden ser evitados desde el control prenatal y su manejo preconcepcional contribuye de una forma importante en la reducción de la morbimortalidad materno y perinatal. Metodología: se realizó una revisión sistemática de literatura con componente meta-analítico según la evidencia disponible hasta la fecha. Los términos mesH incluyeron postpartum hemorrhage, severe anemia, overweight, obesity entre otros. Todos los artículos fueron clasificados por su evidencia antes de calcular el componente meta-analítico. Resultados: se encontraron un total de 321 artículos relacionados con anemia, y 276 para obesidad, de los cuales 8 y 14 respectivamente cumplieron criterios para su selección. La mayoría de artículos fueron clasificados como evidencia IV para anemia y II-III para obesidad. Las causas más frecuentes de exclusión fueron el título y el tipo de estudio. Tanto la anemia como la obesidad (clasificada por IMC) muestran OR conjuntos no estadísticamente significativo y con intervalos de confianza amplios, aunque la tendencia de riesgo conjunto es a mayor peso, mayor riesgo de hemorragia. Discusión: los resultados de la revisión sistemática permiten mostrar tanto a la anemia como la obesidad como factores que muestran una tendencia al riesgo para hemorragia postparto, sin resultados estadísticamente significativos. Faltan más estudios sobre el tema en el país.MetodologíaSe realizó una revisión sistemática de literatura con componente meta-analítico según la evidencia disponible hasta la fecha. Los términos mesH incluyeron postpartum hemorrhage, severe anemia, overweight, obesity entre otros. Todos los artículos fueron clasificados por su evidencia antes de calcular el componente meta-analítico. ResultadosSe encontraron un total de 321 artículos relacionados con anemia, y 276 para obesidad, de los cuales 8 y 14 respectivamente cumplieron criterios para su selección. La mayoría de artículos fueron clasificados como evidencia IV para anemia y II-III para obesidad. Las causas más frecuentes de exclusión fueron el título y el tipo de estudio. Tanto la anemia como la obesidad (clasificada por IMC) muestran OR conjuntos no estadísticamente significativo y con intervalos de confianza amplios, aunque la tendencia de riesgo conjunto es a mayor peso, mayor riesgo de hemorragia. DiscusiónLos resultados de la revisión sistemática permiten mostrar tanto a la anemia como la obesidad como factores que muestran una tendencia al riesgo para hemorragia postparto, sin resultados estadísticamente significativos. Faltan más estudios sobre el tema en el país.

Infecciones en pacientes tratados con citorreducción peritoneal mas quimioterapia hipertérmica intraperitoneal

Introducción:Los individuos en quienes se realiza el sugarbaker tienen diagnósticos tumorales bien caracterizados. Actualmente no se dispone en la literatura médica universal de comparadores previos que permitan estimar la morbilidad relacionada específicamente con procesos infecciosos en pacientes sometidos al procedimiento, por tanto se presenta la caracterización de procesos febriles e infecciosos en el postoperatorio de la cohorte de pacientes intervenidos en la FSFB y de los factores de riesgo asociados a su manifestación. Métodos:Estudio descriptivo con componente analítico de una cohorte ambidireccional compuesta por pacientes intervenidos en la FSFB mediante el procedimiento de Sugarbaker. Resultados:En total se incluyeron en el estudio 53 pacientes consecutivos (37mujeres y 16hombres), quienes fueron llevados al procedimiento de peritonectomía radical más quimioterapia hipertérmica intraperitoneal entre el mes de nov/2007 y jun/2012 en el Hospital-Universitario Fundación Santa Fe de Bogotá. Los desenlaces de morbilidad asociada al procedimiento fueron caracterizados, indicando que las principales causas de morbilidad son los eventos tromboticos y las infecciones. Se caracterizaron como estadísticamente significativos para estancia hospitalaria el requerimiento transfusional (r=0,451, p=0,001), colecistectomía (p=0,016), el riesgo anestésico ASA≥3 (p=0,03), entre otros. El perfil de infección mostró relación estadísticamente significativa con resecciones de órganos específicas (p<0,05 para colectomía derecha [OR=5,3], colecistectomía [OR=21,8] y esplenectomía [OR=4,2]), el riesgo anestésico ASA≥3 (OR=1,2, p=0,036), anemia (OR=7,1, p=0,004), fístula (OR=5,2, p=0,036), entre otros. Conclusiones: El procedimiento de Sugarbaker es eficaz y seguro en nuestra institución. Se requiere de más estudios en poblaciones diversas que permitan comprender el comportamiento de las infecciones en la población sometida al procedimiento.

Niveles de hemoglobina en los que se indica transfundir en el Hospital Universitario Fundación Santa Fe de Bogotá

Introducción: En los pacientes críticamente enfermos la terapia transfusional es una práctica común. Dentro de los estudios realizados no se han incluido a las ciudades a mayor altura. Este estudio pretende determinar los niveles de hemoglobina sobre los cuales se está transfundiendo a los pacientes en la unidad de cuidados intensivos del Hospital Universitario Fundación Santa Fe de Bogotá a 2600 metros sobre el nivel del mar, para determinar si los niveles de hemoglobina a los que se transfunde a nuestra altura son los óptimos. Métodos: Se realizó un estudio descriptivo retrospectivo, de los pacientes que fueron hospitalizados en la Unidad de Cuidado Intensivo del Hospital Universitario Fundación Santa Fe de Bogotá a partir del 01 de Junio de 2011 y hasta el 31 de Mayo de 2012. Resultados: Del total de los registros analizados el 13,8% de los pacientes presentaron una hemoglobina ≤ 7 y todos fueron transfundidos con glóbulos rojos; y en el rango de 7,1-9 se presentó el mayor porcentaje de transfusión. Se observó que los pacientes con hemoglobina ≤ 7 tienen 18,8 veces mayor riego de fallecimiento, lo que fue estadísticamente significativo (p:0,000). Conclusiones: Encontramos que la terapia transfusional en la unidad de cuidado intensivo, se realiza de acuerdo a recomendaciones dadas por las guías de manejo universalmente aceptadas. Dentro de los resultados de nuestro estudio podemos resaltar una tasa de mortalidad más alta en los pacientes en los cuales se instaura terapia transfusional con un nivel de hemoglobina por debajo de 7g/dl.

Infectious aspects and the etiopathogenesis of rheumatoid arthritis

Infections are believed to contribute to the maturation of the immune system from the innate to the adaptive phases and therefore may take part in the induction of autoimmune conditions. In the current study, we present an extensive analysis conducted on sera samples of patients with rheumatoid arthritis in order to seek evidence of previous or coexisting infectious processes using the Bio-Rad BioPlex immunoassay analyzer. We detected higher rates of serological evidence of infections with Epstein–Barr virus and cytomegalovirus viruses. Our findings may indicate a role of these viruses in the pathogenesis of RA.

Structural Chromosomal Alterations Induced by Dietary Bioflavonoids in Fanconi Anemia Lymphocytes

Introduction Fanconi anemia is an autosomal recessive disease characterized by a variety of congenital abnormalities, progressive bone marrow failure, increased chromosomal instability and higher risk to acute myeloid leukemia, solid tumors. This entity can be considered an appropriate biological model to analyze natural substances with possible genotoxic effect. The aims of this study were to describe and quantify structural chromosomal aberrations induced by 5 flavones, 2 isoflavones and a topoisomerase II chemotherapeutic inhibitor in Fanconi anemia lymphocytes in order to determine chromosomal numbers changes and/ or type of chromosomal damage. Materials and methods Chromosomes stimulated by phytohaemagglutinin M, from Fanconi anemia lymphocytes, were analysed by conventional cytogenetic culture. For each chemical substance and controls, one hundred metaphases were evaluated. Chromosomal alterations were documented by photography and imaging analyzer. To statistical analysis was used chi square test to identify significant differences between frequencies of chromosomal damage of basal and exposed cell cultured a P value less than 0.05. Results There were 431 chromosomal alterations in 1000 metaphases analysed; genistein was the more genotoxic bioflavonoid, followed in descendent order by genistin, fisetin, kaempferol, quercetin, baicalein and miricetin. Chromosomal aberrations observed were: chromatid breaks, chromosomal breaks, cromatid and chromosomal gaps, quadriratials exchanges, dicentrics chromosome and complex rearrangements. Conclusion Bioflavonoids as genistein, genistin and fisetin, which are commonly present in the human diet, showed statistical significance in the number of chromosomal aberrations in Fanconi anemia lymphocytes, regarding the basal damage.

Palm-plantar pallor as a diagnostic method of mild-moderate anemia

Objective: to determine the palm-plant paleness’ characteristics in Colombian infant rural population, as a diagnostic method of anemia, and to establish a correlation between the finding of palm-plant paleness and the Hematocrit values. Methodology: a cross sectional study was used to evaluate 169 boys and girls, between 2 months and 12 years old, of the rural area of San Vicente del Caguan, who entered into a Health Campaign. Following the signature of an informed consent, parents accept their children to participate in the study. Those with acute or chronic pathologies were excluded. The presence of palm-plant paleness was determined by observers trained in the Integrated Management of Childhood Illness (IMCI) Strategy. Hematocrit was measured to all children, as well as a peripheral blood smear. Interrater concordance evaluation (Kappa index) was determined through a pilot test and a validation (sensitivity, specificity) was performed, using Hematocrit as the standard. Results: 93 of the participants were male and 77 were female. 45% of them had palm paleness. The Hematocrit showed anemia in 34.1% of the children. The validation analysis demonstrated a 67.2% of sensibility, a 66.6% of specificity, a 51.3% of positive predictive values and a 79.5% of negative predictive values. Hypochromic and Eosinophilia were found in most of the peripheral blood smears’ children with anemia. Conclusions: although this tool presents a low sensibility and specificity for low/moderated anemia, it is useful for excluding it in infants without palm paleness.

Factores asociados a anemia y déficit de hierro en niños colombianos menores de 5 años

Introducción: La anemia y la deficiencia de hierro son problemas de salud pública a nivel mundial que afectan principalmente a niños menores de 5 años, con repercusiones en su desarrollo. Este estudio pretende determinar prevalencia y factores asociados (micronutrientes, características del niño y características sociodemográficas) a anemia y ferropenia en niños colombianos entre 1 y 5 años. Metodología: Estudio observacional de corte transversal con 4130 niños, utilizando datos de la encuesta nacional de situación nutricional (ENSIN-2010). Variables dependientes: anemia, ferropenia, niveles de hemoglobina y ferritina. Se realizaron correlaciones bivariadas y regresiones cuantílicas para determinar factores asociados a niveles de hemoglobina y ferritina. Se realizaron chi cuadrados y regresiones logísticas binomiales para determinar factores asociados anemia y ferropenia. Resultados: Prevalencia de anemia: 13,8% (IC 95%: 12.8- 14.8) y de ferropenia: 10.9% (IC95% 10.7-11.1).Los factores asociados a anemia fueron vivienda en área rural, altitud de vivienda, etnia afro descendiente, quintil del índice de riqueza, peso y presencia de ferropenia. El16.3 % de los pacientes anémicos padecían ferropenia. Los factores relacionados con ferropenia fueron: edad, etnia indígena, región Pacífica y no afiliación a seguridad social. Conclusiones: La presencia de anemia en nuestra población es una condición multifactorial que amerita el estudio de otras etiologías además de la ferropenia. Los factores de riesgo encontrados son condiciones que pueden relacionarse con mayor pobreza e inseguridad alimentaria, por lo cual además de la ejecución de programas de suplencia nutricional se recomienda implementar políticas públicas encaminadas a mejorar las condiciones socioeconómicas de grupos de riesgo

Equine conceptus development : a mini review

Many aspects of early embryonic development in the horse are unusual or unique; this is of scientific interest and, in some cases, considerable practical significance. During early development the number of different cell types increases rapidly and the organization of these increasingly differentiated cells becomes increasingly intricate as a result of various inter-related processes that occur step-wise or simultaneously in different parts of the conceptus (i.e., the embryo proper and its associated membranes and fluid). Equine conceptus development is of practical interest for many reasons. Most significantly, following a high rate of successful fertilization (71-96%) (Ball, 1988), as many as 30-40% of developing embryos fail to survive beyond the first two weeks of gestation (Ball, 1988), the time at which gastrulation begins. Indeed, despite considerable progress in the development of treatments for common causes of sub-fertility and of assisted reproductive techniques to enhance reproductive efficiency, the need to monitor and rebreed mares that lose a pregnancy or the failure to produce a foal, remain sources of considerable economic loss to the equine breeding industry. Of course, the potential causes of early embryonic death are numerous and varied (e.g. persistent mating induced endometritis, endometrial gland insufficiency, cervical incompetence, corpus luteum (CL) failure, chromosomal, genetic and other unknown factors (LeBlanc, 2004). However, the problem is especially acute in aged mares with a history of poor fertility in which the incidence of embryonic loss between days 2 and 14 after ovulation has been reported to reach 62-73%, and in which embryonic death is due primarily to embryonic defects rather than to uterine pathology (Ball et al., 1989; Carnevale & Ginther, 1995; Ball, 2000).

Contribuição para o estudo das transfusões sanguíneas no cão e no gato : situação em Portugal e estudo de 61 transfusões

Os avanços na área da Medicina transfucional, nomeadamente a descoberta de nova informação sobre os grupos sanguíneos de várias espécies, a introdução rotineira da tipificação sanguínea e das provas de compatibilidade eritrocitária, o estudo das reacções transfusionais adversas, o despiste de doenças infeciosas no dador e a aplicação da terapia por componentes, têm contribuído para aumentar a segurança da transfusão sanguínea em Medicina Veterinária e, por consequência, a sua utilização é cada vez mais frequente. O presente trabalho é constituído por três objectivos: perspectivar a medicina transfusional em Portugal através da análise dos resultados de um inquérito, dirigido aos CAMV, nomeadamente sobre o uso da terapia por componentes, as principais indicações de transfusão e a ocorrência de reacções transfusionais; caracterizar a população de gatos e cães receptores de transfusões sanguíneas, com enfoque na prevalência dos diferentes grupos sanguíneos, na indicação para a realização da transfusão e tipo de produto administrado; determinar a ocorrência de reacções transfusionais através da monotorização do doente antes, durante e após a administração das transfusões. No presente estudo, 86% dos Centros de Atendimento Médico Veterinário (CAMV) inquiridos recorrem à transfusão sanguínea como terapia complementar. Destes, 54.7% utiliza sangue total e produtos do sangue, 41.3% apenas sangue total e 4% apenas produtos do sangue. Os produtos do sangue mais utilizados são o concentrado de glóbulos vermelhos e o plasma fresco congelado (34.2% e 31.6% respectivamente). A anemia constitui o principal motivo para a realização de transfusões sanguíneas e a hipertermia a reacção transfusional mais frequente. Relativamente à caracterização da população de cães e gatos que receberam transfusão sanguínea conclui-se que 77.8% dos cães pertenciam ao grupo DEA 1.1 negativo e 22.2% ao grupo DEA 1.1 positivo. Todos os gatos incluídos neste estudo pertenciam ao grupo sanguíneo A. A anemia por hemorragia foi a indicação predominante para a administração de sangue nos cães (54.3%). Nos gatos a anemia por não produção de eritrócitos prevalece (60%). No que respeita às reacções transfusionais, das 61 transfusões realizadas apenas se registou uma dispneia num gato.

All Hands on Deck: Transdisciplinary Approaches to Emerging Infectious Disease

The increasing burden of emerging infectious diseases worldwide confronts us with numerous challenges, including the imperative to design research and responses that are commensurate to understanding the complex social and ecological contexts in which infectious diseases occur. A diverse group of scientists met in Hawaii in March 2005 to discuss the linked social and ecological contexts in which infectious diseases emerge. A subset of the meeting was a group that focused on ‘‘transdisciplinary approaches’’ to integrating knowledge across and beyond academic disciplines in order to improve prevention and control of emerging infections. This article is based on the discussions of that group. Here, we outline the epidemiological legacy that has dominated infectious disease research and control up until now, and introduce the role of new, transdisciplinary and systems-based approaches to emerging infectious diseases.Wedescribe four cases of transboundary health issues and use them to discuss the potential benefits, as well as the inherent difficulties, in understanding the social–ecological contexts in which infectious diseases occur and of using transdisciplinary approaches to deal with them.

Estimating numbers of infectious units from serial dilution assays

The paper concerns the design and analysis of serial dilution assays to estimate the infectivity of a sample of tissue when it is assumed that the sample contains a finite number of indivisible infectious units such that a subsample will be infectious if it contains one or more of these units. The aim of the study is to estimate the number of infectious units in the original sample. The standard approach to the analysis of data from such a study is based on the assumption of independence of aliquots both at the same dilution level and at different dilution levels, so that the numbers of infectious units in the aliquots follow independent Poisson distributions. An alternative approach is based on calculation of the expected value of the total number of samples tested that are not infectious. We derive the likelihood for the data on the basis of the discrete number of infectious units, enabling calculation of the maximum likelihood estimate and likelihood-based confidence intervals. We use the exact probabilities that are obtained to compare the maximum likelihood estimate with those given by the other methods in terms of bias and standard error and to compare the coverage of the confidence intervals. We show that the methods have very similar properties and conclude that for practical use the method that is based on the Poisson assumption is to be recommended, since it can be implemented by using standard statistical software. Finally we consider the design of serial dilution assays, concluding that it is important that neither the dilution factor nor the number of samples that remain untested should be too large.

Cell cycle perturbations induced by infection with the coronavirus infectious bronchitis virus and their effect on virus replication

In eukaryotic cells, cell growth and division occur in a stepwise, orderly fashion described by a process known as the cell cycle. The relationship between positive-strand RNA viruses and the cell cycle and the concomitant effects on virus replication are not clearly understood. We have shown that infection of asynchronously replicating and synchronized replicating cells with the avian coronavirus infectious bronchitis virus (IBV), a positive-strand RNA virus, resulted in the accumulation of infected cells in the G(2)/M phase of the cell cycle. Analysis of various cell cycle-regulatory proteins and cellular morphology indicated that there was a down-regulation of cyclins D1 and D2 (G(2) regulatory cyclins) and that a proportion of virus-infected cells underwent aberrant cytokinesis, in which the cells underwent nuclear, but not cytoplasmic, division. We assessed the impact of the perturbations on the cell cycle for virus-infected cells and found that IBV-infected G(2)/M-phase-synchronized cells exhibited increased viral protein production when released from the block when compared to cells synchronized in the Go phase or asynchronously replicating cells. Our data suggested that IBV induces a G(2)/M phase arrest in infected cells to promote favorable conditions for viral replication.

Mass spectroscopic characterization of the coronavirus infectious bronchitis virus nucleoprotein and elucidation of the role of phosphorylation in RNA binding by using surface plasmon resonance

Phosphorylation of the coronavirus nucleoprotein (N protein) has been predicted to play a role in RNA binding. To investigate this hypothesis, we examined the kinetics of RNA binding between nonphosphorylated and phosphorylated infectious bronchitis virus N protein with nonviral and viral RNA by surface plasmon resonance (Biacore). Mass spectroscopic analysis of N protein identified phosphorylation sites that were proximal to RNA binding domains. Kinetic analysis, by surface plasmon resonance, indicated that nonphospborylated N protein bound with the same affinity to viral RNA as phosphorylated N protein. However, phosphorylated N protein bound to viral RNA with a higher binding affinity than nonviral RNA, suggesting that phosphorylation of N protein determined the recognition of virus RNA. The data also indicated that a known N protein binding site (involved in transcriptional regulation) consisting of a conserved core sequence present near the 5' end of the genome (in the leader sequence) functioned by promoting high association rates of N protein binding. Further analysis of the leader sequence indicated that the core element was not the only binding site for N protein and that other regions functioned to promote high-affinity binding.