Morbimortalidad asociada a transfusiones de glóbulos rojos en una unidad de cuidados intensivos pediátricos de Bogotá

Determinar si las transfusiones de glóbulos rojos en niños en cuidados intensivos se asocian a aumento de la morbimortalidad. Materiales y Métodos: Estudio observacional analítico de cohorte. Se incluyeron niños con anemia de 1 mes a 18 años de edad en un periodo de 10 meses. Resultados: 134 niños con anemia fueron incluidos. En el 51.5% la anemia se desarrolló posterior a su ingreso. De éstos, 66 niños recibieron una transfusión de glóbulos rojos y la mediana de hemoglobina pretransfusión fue de 7.5 g/dl. El 6% de los pacientes transfundidos presentó una Reacción adversa. Entre el grupo de pacientes expuesto a transfusión y los no expuestos existió diferencia significativa en la hemoglobina de ingreso, cantidad de sangre extraída y edad en el análisis bivariado. Los pacientes transfundidos tuvieron mayor mortalidad (15.2% vs. 2.9%, p =0.013). El desarrollo de falla multiorgánica también fue más frecuente en el grupo transfundido (62.1% vs. 16.2%, p < 0.001). La mediana de los días de estancia en la UCI y el tiempo de ventilación mecánica fue mayor en los niños transfundidos que en los no transfundidos, 8 vs. 4 días p< 0.001, y 6 vs. 3 días p<0.001 respectivamente. Un análisis multivariado mostró asociación de transfusión de glóbulos rojos con mortalidad y falla multiorgánica. Conclusión: Las transfusiones de glóbulos rojos se asocian con un aumento en la Mortalidad y en el desarrollo de falla multiorgánica. La estancia en la UCI y el tiempo de ventilación mecánica fue mayor en los niños transfundidos.

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

Morbimortalidad asociada a transfusiones de glóbulos rojos. Unidad de Cuidados Intensivos, Clínica Infantil Colsubsidio

Objetivos: Determinar si las transfusiones de glóbulos rojos en niños en cuidados intensivos se asocian a aumento de la morbimortalidad. Materiales y Métodos: Estudio observacional analítico de cohorte. Se incluyeron niños con anemia de 1 mes a 18 años de edad en un periodo de 13 meses. Resultados: 156 niños con anemia fueron incluidos. En el 51.5% la anemia se desarrolló posterior a su ingreso. De éstos, 77 niños recibieron una transfusión de glóbulos rojos y la mediana de hemoglobina pretransfusión fue de 7.5 g/dl. El 6.5% de los pacientes transfundidos presentó una Reacción adversa. Entre el grupo de pacientes expuesto a transfusión y los no expuestos existió diferencia significativa en la hemoglobina de ingreso, cantidad de sangre extraída y edad en el análisis bivariado. Los pacientes transfundidos tuvieron mayor mortalidad (12.9% vs. 2.5%, p =0.014). El desarrollo de falla multiorgánica también fue más frecuente en el grupo transfundido (57.1% vs. 13.9%, p < 0.001). La mediana de los días de estancia en la UCI y el tiempo de ventilación mecánica fue mayor en los niños transfundidos que en los no transfundidos, 8 vs. 4 días p< 0.001, y 6 vs. 3 días p<0.001 respectivamente. Un análisis multivariado mostró asociación de transfusión de glóbulos rojos con mortalidad y falla multiorgánica. Conclusión: Las transfusiones de glóbulos rojos se asocian con un aumento en la Mortalidad y en el desarrollo de falla multiorgánica. La estancia en la UCI y el tiempo de ventilación mecánica fue mayor en los niños transfundidos.

Valores de referencia de hemoglobinemia en población Colombiana de 1 a 18 años por género y altitud

Introducción: La concentración de hemoglobina total es uno de los indicadores más comúnmente medidos en sangre. Sin embargo, sus valores varían de acuerdo con la altitud, sexo y edad, entre otros, por lo cual es necesario contar con valores de referencia ajustados para estas condiciones con el fin de establecer adecuadamente el diagnóstico tanto de anemia como eritrocitosis. El objetivo de este estudio fue establecer los valores de referencia para hemoglobinemia en la población colombiana entre 1 y 18 años, de acuerdo con la edad, sexo y altitud del lugar de residencia. Materiales y métodos: A partir de la encuesta nacional de salud (ENDS) y de situación nutricional (ENSIN) Colombia 2010, se analizaron los valores de hemoglobinemia provenientes de los individuos de 1 a 18 años, tras haber excluido a los sujetos con condiciones inflamatorias (proteína C reactiva >1,2 mg/ml) y con depleción de las reservas de hierro (ferritina sérica <22 μg/l), de acuerdo con la edad, sexo y altitud del lugar de residencia, utilizando el paquete estadístico IBM SPSS Statistics 21.0. Resultados y discusión: En la población seleccionada se encontró una prevalencia de anemia ferropénica entre 0% y 50%; una prevalencia de anemia no ferropénica de 0% a 18,8%. Se observaron incrementos significativos en la hemoglobinemia de acuerdo con edad, sexo y altitud a partir de 500 msnm, y para estos últimos los valores encontrados fueron superiores a los establecidos por la Organización Mundial de Salud. También se encontraron diferencias significativas en la hemoglobinemia de acuerdo con la etnia.

Pulsioximetría de pacientes en hemodiálisis, de la unidad de terapia renal – fundación cardioinfantil, análisis para establecer recomendaciones

Introducción. En Colombia, el 80% de los pacientes con enfermedad renal crónica en hemodiálisis tienen fístula arteriovenosa periférica (FAV) que asegura el flujo de sangre durante la hemodiálisis (1), la variabilidad en el flujo de sangre en el brazo de la FAV hacia la parte distal, puede afectar la lectura de la oximetría de pulso (SpO2) (2), llevando a la toma de decisiones equivocadas por el personal de salud. El objetivo de este estudio es aclarar si existe diferencia entre la SpO2 del brazo de la FAV y el brazo contralateral. Materiales y métodos. Se realizó un estudio de correlación entre los valores de SpO2 del brazo con FAV contra el brazo sin FAV, de 40 pacientes que asistieron a hemodiálisis. La recolección de los datos se llevó a cabo, con un formato que incluyó el resultado de la pulsioximetria y variables asociadas, antes, durante y después de la hemodiálisis. Se comparó la mediana de los deltas de las diferencias con pruebas estadísticas T Student – Mann Whitney, aceptando un valor significativo de p < 0,05. Resultados. No se encontraron diferencias estadísticamente significativas de la SpO2 entre el brazo con FAV y el brazo sin FAV, antes, durante y después de la diálisis, sin embargo si se apreció una correlación positiva estadísticamente significativa. Conclusiones. Se encontró correlación positiva estadísticamente significativa, donde no hubo diferencias en el resultado la pulsioximetría entre el brazo con FAV y brazo sin FAV, por lo tanto es válido tomar la pulsioximetría en cualquiera de los brazos.

Neurobehavioral Development in Children With Potential Exposure to Pesticides

Children may be at higher risk than adults from pesticide exposure, due to their rapidly developing physiology, unique behavioral patterns, and interactions with the physical environment. This preliminary study conducted in Ecuador examines the association between household and environmental risk factors for pesticide exposure and neurobehavioral development. We collected data over 6 months in the rural highland region of Cayambe, Ecuador (2003–2004). Children age 24–61 months residing in 3 communities were assessed with the Ages and Stages Questionnaire and the Visual Motor Integration Test. We gathered information on maternal health and work characteristics, the home and community environment, and child characteristics. Growth measurements and a hemoglobin finger-prick blood test were obtained. Multiple linear regression analyses were conducted. Current maternal employment in the flower industry was associated with better developmental scores. Longer hours playing outdoors were associated with lower gross and fine motor and problem solving skills. Children who played with irrigation water scored lower on fine motor skills (8% decrease; 95% confidence interval 9.31 to 0.53), problem-solving skills (7% decrease; 8.40 to 0.39), and Visual Motor Integration test scores (3% decrease; 12.00 to 1.08). These results suggest that certain environmental risk factors for exposure to pesticides may affect child development, with contact with irrigation water of particular concern. However, the relationships between these risk factors and social characteristics are complex, as corporate agriculture may increase risk through pesticide exposure and environmental contamination, while indirectly promoting healthy development by providing health care, relatively higher salaries, and daycare options.

Sociodemographic and nutritional correlates of neurobehavioral development: a study of young children in a rural region of Ecuador

To identify and describe the sociodemographic and nutritional characteristics associated with neurobehavioral development among young children living in three communities in the northeastern Andean region of Cayambe-Tabacundo, Ecuador. Women in the study communities who had a child 3 to 61 months of age completed a questionnaire about maternal and child health and sociodemographic characteristics. The Ages and Stages Questionnaire (ASQ) was directly administered to 283 children by two trained interviewers. Growth measurements and a hemoglobin finger-prick blood test were obtained in 2003–2004. Prevalence of developmental delay was calculated, and associations between child development and maternal, child, and household characteristics were explored. High frequencies of developmental delay were observed. Children 3 to 23 months old displayed delay in gross motor skills (30.1%), and children 48 to 61 months old displayed delay in problem-solving skills (73.4%) and fine motor skills (28.1%). A high frequency of both anemia (60.4%) and stunting (53.4%) was observed for all age groups. Maternal educational level was positively associated with communication and problem-solving skills, and monthly household income was positively associated with communication, gross motor, and problem-solving skills. The results suggest a high prevalence of developmental delay and poor child health in this population. Child health status and the child’s environment may contribute to developmental delay in this region of Ecuador, but sociodemographic factors affecting opportunities for stimulation may also play a role. Research is needed to identify what is causing high percentages of neurobehavioral developmental delay in this region of Ecuador.

Heme-induced biomarkers associated with red meat promotion of colon cancer are not modulated by the intake of nitrite

Red and processed meat consumption is associated with the risk of colorectal cancer. Three hypotheses are proposed to explain this association, via heme-induced oxidation of fat, heterocyclic amines, or N-nitroso compounds. Rats have often been used to study these hypotheses, but the lack of enterosalivary cycle of nitrate in rats casts doubt on the relevance of this animal model to predict nitroso- and heme-associated human colon carcinogenesis. The present study was thus designed to clarify whether a nitrite intake that mimics the enterosalivary cycle can modulate hemeinduced nitrosation and fat peroxidation. This study shows that, in contrast with the starting hypothesis, drinking water added with nitrite to mimic the salivary nitrite content did not change the effect of hemoglobin on biochemicalmarkers linked to colon carcinogenesis, notably lipid peroxidation and cytotoxic activity in the colon of rat. However, ingested sodium nitrite increased fecal nitrosocompounds level, but their fecal concentration and their nature (iron-nitrosyl) would probably not be associated with an increased risk of cancer.We thus suggest that the rat model could be relevant for study the effect of red meat on colon carcinogenesis, in spite of the lack of nitrite in the saliva of rats.

Temporal coupling between stimulus-evoked neural activity and hemodynamic responses from individual cortical columns

Using previously published data from the whisker barrel cortex of anesthetized rodents (Berwick et al 2008 J. Neurophysiol. 99 787–98) we investigated whether highly spatially localized stimulus-evoked cortical hemodynamics responses displayed a linear time-invariant (LTI) relationship with neural activity. Presentation of stimuli to individual whiskers of 2 s and 16 s durations produced hemodynamics and neural activity spatially localized to individual cortical columns. Two-dimensional optical imaging spectroscopy (2D-OIS) measured hemoglobin responses, while multi-laminar electrophysiology recorded neural activity. Hemoglobin responses to 2 s stimuli were deconvolved with underlying evoked neural activity to estimate impulse response functions which were then convolved with neural activity evoked by 16 s stimuli to generate predictions of hemodynamic responses. An LTI system more adequately described the temporal neuro-hemodynamics coupling relationship for these spatially localized sensory stimuli than in previous studies that activated the entire whisker cortex. An inability to predict the magnitude of an initial 'peak' in the total and oxy- hemoglobin responses was alleviated when excluding responses influenced by overlying arterial components. However, this did not improve estimation of the hemodynamic responses return to baseline post-stimulus cessation.

Thr54 allele carriers of the Ala54Thr variant of FABP2 gene have associations with metabolic syndrome and hypertriglyceridemia in urban South Indians

The intestinal fatty acid-binding protein gene is proposed as a candidate gene for diabetes because the protein it codes is involved in fatty acid absorption and metabolism. This study investigates the association of the Ala54Thr variant of the intestinal fatty acid-binding protein gene on type 2 diabetes mellitus and other related metabolic traits in Asian Indians. Ala54Thr polymorphism was genotyped by using polymerase chain reaction-restriction fragment length polymorphism in unrelated 773 type 2 diabetic and 899 normal glucose-tolerant (NGT) subjects, randomly chosen from the Chennai Urban Rural Epidemiology Study, an ongoing population-based study in South India. The Ala54Thr polymorphism was not associated with type 2 diabetes mellitus or obesity. However, genotype-phenotype study revealed that the NGT subjects carrying the Thr54 allele had significantly higher 2-hour plasma glucose (P = .007), glycated hemoglobin (P = .004), 2-hour insulin (P = .027), and fasting low-density lipoprotein cholesterol (P = .032) levels compared with those with the Ala54 allele. Normal glucose-tolerant subjects with Ala54Thr and Thr54Thr genotypes had significantly higher fasting serum triglyceride levels (P = .003) compared with those with Ala54Ala. The subjects were stratified into those with hypertriglyceridemia (serum triglyceride levels >or=150 mg/dL) and those without. The odds ratio for hypertriglyceridemia for the individuals carrying the Ala54Thr genotype was 1.491 (95% confidence interval [CI], 1.22-1.83, P < .0001), and for those carrying the Thr54Thr genotype, it was 1.888 (95% CI, 1.34-2.67; P < .0001). Subjects were also stratified into those with metabolic syndrome (MS) and those without, according to modified Adult Treatment Panel III guidelines. The odds ratio (adjusted for age and sex) for MS for the individuals carrying the Ala54Thr genotype was 1.240 (95% CI, 1.02-1.51; P = .03), whereas for those carrying the Thr54Thr genotype, it was 1.812 (95% CI, 1.28-2.57; P = .001). Carriers of the Thr54 allele have associations with MS and hypertriglyceridemia in this urban South Indian population.

Association of low adiponectin levels with the metabolic syndrome--the Chennai Urban Rural Epidemiology Study (CURES-4)

The aim of the study was to assess the relation of adiponectin levels with the metabolic syndrome in Asian Indians, a high-risk group for diabetes and premature coronary artery disease. The study was conducted on 100 (50 men and 50 women) type 2 diabetic subjects and 100 age and sex matched subjects with normal glucose tolerance selected from the Chennai Urban Rural Epidemiology Study, an ongoing population study in Chennai in southern India. Metabolic syndrome was defined using modified Adult Treatment Panel III (ATPIII) guidelines. Adiponectin values were significantly lower in diabetic subjects (men: 5.2 vs 8.3 microg/mL, P=.00l; women: 7.6 vs 11.1 microg/mL, P<.00l) and those with the metabolic syndrome (men: 5.0 vs 6.8 microg/mL, P=.01; women: 6.5 vs 9.9 microg/mL, P=.001) compared with those without. Linear regression analysis revealed adiponectin to be associated with body mass index (P<.05), waist circumference (P<.01), fasting plasma glucose (P=.001), glycated hemoglobin (P<.001), triglycerides (P<.00l), high-density lipoprotein (HDL) cholesterol (P<.001), cholesterol/HDL ratio (P<.00l), and insulin resistance measured by homeostasis assessment model (P<.00l). Factor analysis identified 2 factors: factor 1, negatively loaded with adiponectin and HDL cholesterol and positively loaded with triglycerides, waist circumference, and insulin resistance measured by homeostasis assessment model; and factor 2, with a positive loading of waist circumference and systolic and diastolic blood pressure. Logistic regression analysis revealed adiponectin to be negatively associated with metabolic syndrome (odds ratio [OR], 0.365; P<.001) even after adjusting for age (OR, 0.344; P<.00l), sex (OR, 0.293; P<.001), and body mass index (OR, 0.292; P<.00l). Lower adiponectin levels are associated with the metabolic syndrome per se and several of its components, particularly, diabetes, insulin resistance, and dyslipidemia in this urban south Indian population.

A central role for heme iron in colon carcinogenesis associated with red meat intake

Epidemiology shows that red and processed meat intake is associated with an increased risk of colorectal cancer. Heme iron, heterocyclic amines and endogenous N-nitroso compounds (NOC) are proposed to explain this effect, but their relative contribution is unknown. Our study aimed at determining, at nutritional doses, which is the main factor involved and proposing a mechanism of cancer promotion by red meat. The relative part of heme iron (1% in diet), heterocyclic amines (PhIP+MeIQx, 50+25 μg/kg in diet) and NOC (induced by NaNO2+NaNO3 0.17+0.23 g/l of drinking water) was determined by a factorial design and preneoplastic endpoints in chemically-induced rats and validated on tumors in Min mice. The molecular mechanisms (genotoxicity, cytotoxicity) were analyzed in vitro in normal and Apc- deficient cell lines and confirmed on colon mucosa. Heme iron increased the number of preneoplastic lesions but dietary heterocyclic amines and NOC had no effect on carcinogenesis in rats. Dietary hemoglobin increased tumor load in Min mice (control diet: 67±39 mm2; 2,5% hemoglobin diet: 114±47 mm2, p=0.004). In vitro, fecal water from rats given hemoglobin was rich in aldehydes and was cytotoxic to normal cells, but not to premalignant cells. The aldehydes 4-hydroxynonenal and 4-hydroxyhexenal were more toxic to normal versus mutated cells and were only genotoxic to normal cells. Genotoxicity was also observed in colon mucosa of mice given hemoglobin. These results highlight the role of heme iron in the promotion of colon cancer by red meat and suggest that heme iron could initiate carcinogenesis through lipid peroxidation.

Separating heart and brain: on the reduction of physiological noise from multichannel functional near-infrared spectroscopy (fNIRS) signals

Objective. Functional near-infrared spectroscopy (fNIRS) is an emerging technique for the in vivo assessment of functional activity of the cerebral cortex as well as in the field of brain–computer interface (BCI) research. A common challenge for the utilization of fNIRS in these areas is a stable and reliable investigation of the spatio-temporal hemodynamic patterns. However, the recorded patterns may be influenced and superimposed by signals generated from physiological processes, resulting in an inaccurate estimation of the cortical activity. Up to now only a few studies have investigated these influences, and still less has been attempted to remove/reduce these influences. The present study aims to gain insights into the reduction of physiological rhythms in hemodynamic signals (oxygenated hemoglobin (oxy-Hb), deoxygenated hemoglobin (deoxy-Hb)). Approach. We introduce the use of three different signal processing approaches (spatial filtering, a common average reference (CAR) method; independent component analysis (ICA); and transfer function (TF) models) to reduce the influence of respiratory and blood pressure (BP) rhythms on the hemodynamic responses. Main results. All approaches produce large reductions in BP and respiration influences on the oxy-Hb signals and, therefore, improve the contrast-to-noise ratio (CNR). In contrast, for deoxy-Hb signals CAR and ICA did not improve the CNR. However, for the TF approach, a CNR-improvement in deoxy-Hb can also be found. Significance. The present study investigates the application of different signal processing approaches to reduce the influences of physiological rhythms on the hemodynamic responses. In addition to the identification of the best signal processing method, we also show the importance of noise reduction in fNIRS data.

New insights into the impact of Lactobacillus population on host-bacteria metabolic interplay

We aimed at evaluating the association between intestinal Lactobacillus sp. composition and their metabolic activity with the host metabolism in adult and elderly individuals. Faecal and plasma metabolites were measured and correlated to the Lactobacillus species distribution in healthy Estonian cohorts of adult (n=16; <48 y) and elderly (n=33; >65 y). Total cholesterol, LDL, C-reactive protein and glycated hemoglobin were statistically higher in elderly, while platelets, white blood cells and urinary creatinine were higher in adults. Aging was associated with the presence of L. paracasei and L. plantarum and the absence of L. salivarius and L. helveticus. High levels of intestinal Lactobacillus sp. were positively associated with increased concentrations of faecal short chain fatty acids, lactate and essential amino acids. In adults, high red blood cell distribution width was positively associated with presence of L. helveticus and absence of L. ruminis. L. helveticus was correlated to lactate and butyrate in faecal waters. This indicates a strong relationship between the composition of the gut Lactobacillus sp. and host metabolism. Our results confirm that aging is associated with modulations of blood biomarkers and intestinal Lactobacillus species composition. We identified specific Lactobacillus contributions to gut metabolic environment and related those to blood biomarkers. Such associations may prove useful to decipher the biological mechanisms underlying host-gut microbial metabolic interactions in an ageing population.

Salivary Interleukin-6, Matrix Metalloproteinase-8, and Osteoprotegerin in Patients With Periodontitis and Diabetes

Background: Diabetes and periodontitis produce a protein discharge that can be reflected in saliva. This study evaluates the salivary concentrations of interleukin (IL)-6, matrix metalloproteinase (MMP)-8, and osteoprotegerin (OPG) in patients with periodontitis with type 2 diabetes. Methods: Whole saliva samples were obtained from 90 subjects who were divided into four groups: healthy (control; n = 22), untreated periodontitis (UPD; n = 24), diabetes mellitus (DM; n = 20), and UPD + DM (n = 24) groups. Clinical and metabolic data were recorded. Salivary IL-6, MMP-8, and OPG concentrations were determined by a standard enzyme-linked immunosorbent assay. Results: The UPD and UPD + DM groups exhibited higher salivary IL-6 than the control and DM groups (P <0.01). The salivary MMP-8 concentrations in all diseased groups (UPD, DM, and UPD + DM) were higher than in the control group (P <0.01). The salivary OPG concentrations in the DM group were higher than in the UPD and control groups (P<0.05). In the UPD + DM group, salivary IL-6 was correlated with glycated hemoglobin (HbA1c) levels (r = 0.60; P<0.05). The regression analysis indicated that the number of remaining teeth, clinical attachment level, and IL-6 might have influenced the HbA1c levels in patients with diabetes. Conclusions: Salivary 1L-6 concentrations were elevated in patients with periodontitis with or without diabetes. Salivary MMP-8 and OPG concentrations were elevated regardless of periodontal inflammation in patients with diabetes. Therefore, periodontitis and diabetes are conditions that may interfere with protein expression and should be considered when using saliva for diagnoses. J Periodontol 2010;81:384-391.