Caracterización de las alteraciones en la función renal, la presión arterial y las malformaciones anatómicas renales- urinarias y cardiovasculares en pacientes con Sindrome de Turner en la Fundación Cardioinfantil entre 1999 y 2009

Se caracterizan las malformaciones renales y urinarias (MRU), y cardiovasculares (CV), así como la función renal (FR) y la presión arterial (PA) en pacientes con Sindrome de Turner (ST) mediante un estudio retrospectivo entre 1999 y 2009 en Bogotá. Se encontró 10 pacientes con algún grado de insuficiencia renal crónica (IRC). Además 4 pacientes presentaron prehipertensión arterial, y 5 (HTA); en ellos se encontró hidronefrosis y riñón poliquístico. Las MRU más frecuentes fueron únicas; en ellas las mayores alteraciones cromosómicas son la monosomía y el mosaicismo. La mayor malformación CV fué la válvula aórtica bicúspide. El ST amerita seguimiento de FR y PA para prevenir complicaciones a largo plazo por IRC e HTA.

Evaluación a largo plazo en mujeres tratadas con laser para depilación facial en uniláser medica

El vello facial no deseado es un problema común en las mujeres, los tratamientos láser han mostrado efectividad para su manejo. Objetivo: Evaluar los resultados de la depilación láser en cara de las pacientes tratadas a largo plazo (20 sesiones o más ) luego de un seguimiento de 6 meses durante los años 1997 y 2012. Metodología: 55 mujeres que con tipo de piel II a V recibieron 20 o más sesiones de láser con seguimiento mayor a 6 meses posterior al la última sesión. Resultados: la edad promedio fue (32 ± 9,3 años), el 18,2 % presentaban SOP o Hiperandrogenismo el número de sesiones en cara fue de (30,84 ± 12,132), un promedio de disparos de (6,330 ± 7,804), los Kilojulios acumulados tuvieron un promedio de (126,5 ± 161,4) la fluencia promedio fue (18,5 ± 3,2 Julios/cm2), el láser de Alexandrita fue utilizado en el 98% de las pacientes. Se encontró cambios significativos entre el conteo inicial y el final de vello facial (484,9 ± 568.9 (med=300) vs. 103,33± 138,63 (med=60), p<0.001, Test de Wilcoxon). El 32.7% mostraron reducción > 90% (5,5% reducción del 100%). Conclusión : El tratamiento con de depilación con láser mostro una reducción significativa del vello facial, en mujeres mayores de 14 años con un tratamiento a largo plazo (20 sesiones o más), con una tasa de reducción mayor del 90% en 32.7% de las pacientes y un promedio de reducción del grupo de 79,36 ±15,51 %, similar a lo reportado en los diferentes estudios (77%).

¿Qué factores inciden en la hospitalización de pacientes con cálculos ureterales menores a 10 mm en Fundación Santa Fe?

Debido a que el 12% de la población tendrá un cálculo en uréter hacia la mitad de su vida y a que las tasas de recurrencia en los que ya lo presentan son del 50% es necesario estudiar esta patología para aproximarse a un manejo adecuado en el servicio de urgencias. La literatura identifica un conjunto de factores que pueden contribuir a un cambio en el manejo médico. Objetivo: El objetivo de este estudio fue determinar los factores demográficos y clínicos asociados a manejo hospitalario en los pacientes con diagnóstico de cálculo ureteral menor de 10 mm. Métodos: Se diseñó un estudio de casos y controles no emparejados. Un caso fue definido como un paciente de 18 o más años con diagnóstico de urolitiasis con cálculo menor a 10 mm realizado por urotac que consultó (por primera vez para ese episodio) al servicio de urgencias de la Fundación Santa Fe de Bogotá entre el 1 de marzo de 2007 y 30 de abril de 2012. Se indagaron factores como edad, sexo, tamaño y localización del cálculo, respuesta a los analgésicos, evidencia de obstrucción e infección urinaria, además de otros antecedentes medicamentosos y clínicos. Se utilizó regresión logística no condicional bivariada y multivariada para evaluar la asociación entre tipo de manejo (hospitalario o ambulatorio) y las variables recolectadas, calculando odds ratio (OR) e intervalos de confianza al 95% (IC95%). Resultados: El riesgo de hospitalización se incrementó con: 1. La localización del cálculo en tercio superior o medio (OR=1.49; IC95%: 0.751-2.966) al comparar con el inferior, 2. El aumento del tamaño del cálculo (OR=1.49; IC95%: 0.751-2.966, por cada milímetro de incremento), y 3: Por la evidencia de obstrucción o infección urinaria y elevación de azoados. Por el contrario, hubo menos riesgo de hospitalización en aquellos pacientes con una respuesta analgésica apropiada en urgencias.

Prevalencia de insuficiencia renal crónica en niños con displasia renal multiquística, Fundación Cardioinfantil de Bogotá

Introducción: La displasia renal multiquistica es una variante de displasia renal, anomalía congénita frecuente del tracto urinario, con una prevalencia del 2.9 - 50 % de insuficiencia renal crónica; frecuentemente asociada a otras malformaciones urinarias, sin datos en bogotá sobre prevalencia y comportamiento clínico. Objetivo: Evaluar la prevalencia de insuficiencia renal crónica en niños con displasia renal multiquistica valorados en consulta de nefrología en Fundación Cardioinfantil, instituto de cardiología de Bogotá. Metodología: Estudio de corte transversal, en niños con displasia renal multiquistica, confirmado por ecografía, valorados en consulta de Nefrología Pediátrica en los últimos diez años. Se realizó un análisis descriptivo de las variables, cálculos de prevalencia de Insuficiencia renal crónica. Resultados: Se revisó información de 70 pacientes, encontrando una prevalencia de IRC de 22.85% (IC 95 % 13.0 %-35.1 %); mayor frecuencia mujeres 12.85 %; 14.28% con otras malformaciones renales; 5.71 % en involución parcial, 4.28% en pacientes con involución completa del tamaño del riñón displásico. Se encontró 31.4% proteinuria; 22.8 % hiperfiltración; 4.28% hipertrofia compensadora del riñón sano; 24.2% involución parcial, 31.4 % involución completa del tamaño renal; frecuencia de HTA de 7,1% (IC95% 1%-9%). El 87.14% tuvo diagnóstico prenatal (IC 95% 81.0%-96.0%). Discusión: La prevalencia se encuentra dentro de los rangos de la literatura mundial, mayor a la colombiana y suramericana, predominando en pacientes con otras malformaciones renales asociadas, con mayor prevalencia de hipertensión arterial, que requiere estudios multicéntricos para determinar causalidad o presencia de otros factores.

Lupus nephritis: an overview of recent findings

Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematosus (SLE) since it is the major predictor of poor prognosis. In susceptible individuals suffering of SLE, in situ formation and deposit of immune complexes (ICs) from apoptotic bodies occur in the kidneys as a result of an amplified epitope immunological response. IC glomerular deposits generate release of proinflammatory cytokines and cell adhesion molecules causing inflammation. This leads to monocytes and polymorphonuclear cells chemotaxis. Subsequent release of proteases generates endothelial injury and mesangial proliferation. Presence of ICs promotes adaptive immune response and causes dendritic cells to release type I interferon. This induces maturation and activation of infiltrating T cells, and amplification of Th2, Th1 and Th17 lymphocytes. Each of them, amplify B cells and activates macrophages to release more proinflammatory molecules, generating effector cells that cannot be modulated promoting kidney epithelial proliferation and fibrosis. Herein immunopathological findings of LN are reviewed.

Diagnostico de la resistencia a la insulina en mujeres con síndrome de ovario poliquistico: revisión sistemática

La resistencia a la insulina definida como una disminución de la respuesta de la glucosa a una determinad cantidad de insulina es un estado que representa un factor de riesgo para desarrollar diabetes mellitus, enfermedad coronaria e hipertensión arterial a largo plazo. La evaluación de la insulina que es una hormona que facilita la homeostasis de la glucosa en el organismo a través de diferentes modelos matemáticos complejos cuya especificidad y sensibilidad han sido cuestionadas, ha obligado a los investigadores a descubrir métodos mas exactos que permitan un calculo mas sencillo en pacientes con síndrome de ovario poliquistico.

Uretero-uretero anastomosis: una alternativa para pacientes con patología asociada a doble sistema colector

Introducción El doble sistema colector es la alteración renal más frecuente y presenta una incidencia 1/500 individuos. Hay varias opciones de tratamiento para el uréter con reflujo o severamente dilatado cuando se asocia a un sistema duplicado, entre ellas la uretero-uretero anastomosis. El objetivo es dar a conocer nuestra experiencia en la realización de este procedimiento para pacientes pediátricos. Materiales y métodos: Se presenta una serie de casos entre Enero 2010 y Abril 2014, se revisaron 214 historias clínicas de pacientes con doble sistema colector y patologías asociadas; 10 fueron sometidos a uretero-uretero anastomosis. El Seguimiento posopertorio fue de 12 meses promedio. Resultados: Se incluyeron 10 pacientes. El 70% fueron género femenino, la edad promedio al momento de la cirugía fue 5 años . Todos cursaban con infección urinaria y 10% presentaban incontinencia urinaria. En el postoperatorio, en 40% se encontró uréter ectópico, 30% ureterocele intravesical y 30% reflujo vesicoureteral al sistema inferior. Se realizaron siete anastomosis del sistema superior al inferior y tres del inferior al superior, todos por una incisión de 2cm a nivel inguinal y fueron derivados con catéter doble J sin complicaciones postoperatorias. Al tiempo de seguimiento la totalidad de los pacientes se encontraron sin profilaxis antibiótica, con dilatación resuelta, sin infecciones urinarias ni incontinencia. Conclusión: La uretero-uretero anastomosis es una alternativa fiable, segura y con mínima morbilidad para el tratamiento de pacientes con patología asociada a doble sistema colector. Estudios adicionales, con mayor número de pacientes y seguimiento serán necesarios para ver evolución a largo plazo.

Hallazgos radiológicos de la enfermedad pulmonar en pacientes Colombianos con esclerodermia

La esclerosis sistémica (ES) es una enfermedad autoinmune multisistémica que afecta principalmente la piel, los pulmones, el tracto gastrointestinal, el corazón y los riñones. La enfermedad pulmonar, presente en casi el 100% de los casos, es el factor con mayor influencia en la mortalidad. El propósito de este estudio es realizar un análisis detallado de la enfermedad pulmonar por tomografía computarizada de alta resolución(TCAR) en pacientes Colombianos con ES, para lo cual se realizó un estudio de prevalencia analítica en 44 pacientes con ES valorados en el Hospital Universitario Mayor Méderi en los últimos 7 años. Los resultados mostraron características demográficas y clínicas similares a las previamente descritas. La prevalencia de enfermedad pulmonar intersticial fue alta, y los hallazgos de fibrosis pulmonar como vidrio esmerilado y panal de abejas se asociaron con la presencia del autoanticuerpo antiSCL70. La medida del diámetro esofágico por TCAR fue mayor en los pacientes con disfagia, antiSCL 70 y linfopenia, los cuales son marcadores de mal pronóstico.

Developmental programming: Deficits in reproductive hormone dynamics and ovulatory outcomes in prenatal, testosterone-treated sheep

Prenatal testosterone excess leads to neuroendocrine, ovarian, and metabolic disruptions, culminating in reproductive phenotypes mimicking that of women with polycystic ovary syndrome (PCOS). The objective of this study was to determine the consequences of prenatal testosterone treatment on periovulatory hormonal dynamics and ovulatory outcomes. To generate prenatal testosterone-treated females, pregnant sheep were injected intramuscularly (days 30-90 of gestation, term = 147 days) with 100 mg of testosterone-propionate in cottonseed oil semi-weekly. Female offspring born to untreated control females and prenatal testosterone-treated females were then studied during their first two breeding seasons. Sheep were given two injections of prostaglandin F-2alpha 11 days apart, and blood samples were collected at 2-h intervals for 120 h, 10-min intervals for 8 h during the luteal phase (first breeding season only), and daily for an additional 15 days to characterize changes in reproductive hormonal dynamics. During the first breeding season, prenatal testosterone-treated females manifested disruptions in the timing and magnitude of primary gonadotropin surges, luteal defects, and reduced responsiveness to progesterone negative feedback. Disruptions in the periovulatory sequence of events during the second breeding season included: 1) delayed but increased preovulatory estradiol rise, 2) delayed and severely reduced primary gonadotropin surge in prenatal testosterone-treated females having an LH surge, 3) tendency for an amplified secondary FSH surge and a shift in the relative balance of FSH regulatory proteins, and 4) luteal responses that ranged from normal to anovulatory. These outcomes are likely to be of relevance to developmental origin of infertility disorders and suggest that differences in fetal exposure or fetal susceptibility to testosterone may account for the variability in reproductive phenotypes.

Expression of metallothionein genes I and II in bank vole clethrionomys glareolus populations chronically exposed in situ to heavy metals

The expression of two metallothionein genes (Mt-I and Mt-II) in the liver, kidney, and gonad of bank voles collected at four metal-contaminated sites (Cd, Zn, Pb, and Fe) were measured using the quantitative real-time PCR method (QPCR). Relative Mt gene expression was calculated by applying a normalization factor (NF) using the expression of two housekeeping genes, ribosomal 18S and beta-actin. Relative Mt expression in tissues of animals from contaminated sites was up to 54.8-fold higher than those from the reference site for Mt-I and up to 91.6-fold higher for Mt-II. Mt-II gene expression in the livers of bank voles from contaminated sites was higher than Mt-I gene expression. Inversely, Mt-II expression in the kidneys of voles was lower than Mt-I expression. Positive correlations between cadmium levels in the tissues and Mt-I were obtained in all studied tissues. Zinc, which undergoes homeostatic regulation, correlated positively with both Mt-I and Mt-II gene expression only in the kidney. Results showed that animals living in chronically contaminated environments intensively activate detoxifying mechanisms such as metallothionein expression. This is the first time that QPCR techniques to measure MT gene expression have been applied to assess the impact of environmental metal pollution on field collected bank voles.

Metallothionein I and II gene expression as a response to metal contamination in bank vole Clethrionomys glareolus

The expression of two metallothionein genes (Mt-I and Mt-II) in the liver, kidney, and gonad of bank voles collected at four metal-contaminated sites (Cd, Zn, Pb, and Fe) were measured using the quantitative real-time PCR method (QPCR). Relative Mt gene expression was calculated by applying a normalization factor (NF) using the expression of two housekeeping genes, ribosomal 18S and beta-actin. Relative Mt expression in tissues of animals from contaminated sites was up to 54.8-fold higher than those from the reference site for Mt-I and up to 91.6-fold higher for Mt-II. Mt-II gene expression in the livers of bank voles from contaminated sites was higher than Mt-I gene expression. Inversely, Mt-II expression in the kidneys of voles was lower than Mt-I expression. Positive correlations between cadmium levels in the tissues and Mt-I were obtained in all studied tissues. Zinc, which undergoes homeostatic regulation, correlated positively with both Mt-I and Mt-II gene expression only in the kidney. Results showed that animals living in chronically contaminated environments intensively activate detoxifying mechanisms such as metallothionein expression. This is the first time that QPCR techniques to measure MT gene expression have been applied to assess the impact of environmental metal pollution on field collected bank voles.

Increased serum androstenedione in adults with autism spectrum conditions

Molecular and behavioural evidence points to an association between sex-steroid hormones and autism spectrum conditions (ASC) and/or autistic traits. Prenatal androgen levels are associated with autistic traits, and several genes involved in steroidogenesis are associated with autism, Asperger Syndrome and/or autistic traits. Furthermore, higher rates of androgen-related conditions (such as Polycystic Ovary Syndrome, hirsutism, acne and hormone-related cancers) are reported in women with autism spectrum conditions. A key question therefore is if serum levels of gonadal and adrenal sex-steroids (particularly testosterone, estradiol, dehydroepiandrosterone sulfate and androstenedione) are elevated in individuals with ASC. This was tested in a total sample of n=166 participants. The final eligible sample for hormone analysis comprised n=128 participants, n=58 of whom had a diagnosis of Asperger Syndrome or high functioning autism (33 males and 25 females) and n=70 of whom were age- and IQ-matched typical controls (39 males and 31 females). ASC diagnosis (without any interaction with sex) strongly predicted androstenedione levels (p<0.01), and serum androstenedione levels were significantly elevated in the ASC group (Mann-Whitney W=2677, p=0.002), a result confirmed by permutation testing in females (permutation-corrected p=0.02). This result is discussed in terms of androstenedione being the immediate precursor of, and being converted into, testosterone, dihydrotestosterone, or estrogens in hormone-sensitive tissues and organs.

Systemic multicompartmental effects of the gut microbiome on mouse metabolic phenotypes

To characterize the impact of gut microbiota on host metabolism, we investigated the multicompartmental metabolic profiles of a conventional mouse strain (C3H/HeJ) (n=5) and its germ-free (GF) equivalent (n=5). We confirm that the microbiome strongly impacts on the metabolism of bile acids through the enterohepatic cycle and gut metabolism (higher levels of phosphocholine and glycine in GF liver and marked higher levels of bile acids in three gut compartments). Furthermore we demonstrate that (1) well-defined metabolic differences exist in all examined compartments between the metabotypes of GF and conventional mice: bacterial co-metabolic products such as hippurate (urine) and 5-aminovalerate (colon epithelium) were found at reduced concentrations, whereas raffinose was only detected in GF colonic profiles. (2) The microbiome also influences kidney homeostasis with elevated levels of key cell volume regulators (betaine, choline, myo-inositol and so on) observed in GF kidneys. (3) Gut microbiota modulate metabotype expression at both local (gut) and global (biofluids, kidney, liver) system levels and hence influence the responses to a variety of dietary modulation and drug exposures relevant to personalized health-care investigations.

Sustained polymeric delivery of gene silencing antisense ODNs, siRNA, DNAzymes and ribozymes: in vitro and in vivo studies

Small interfering RNA (siRNA), antisense oligonucleotides (ODNs), ribozymes and DNAzymes have emerged as sequence-specific inhibitors of gene expression that may have therapeutic potential in the treatment of a wide range of diseases. Due to their rapid degradation in vivo, the efficacy of naked gene silencing nucleic acids is relatively short lived. The entrapment of these nucleic acids within biodegradable sustained-release delivery systems may improve their stability and reduce the doses required for efficacy. In this study, we have evaluated the potential in vitro and in vivo use of biodegradable poly (d,l-lactide-co-glycolide) copolymer (PLGA) microspheres as sustained delivery devices for ODNs, ribozyme, siRNA and DNA enzymes. In addition, we investigated the release of ODN conjugates bearing 5′-end lipophilic groups. The in vitro sustained release profiles of microsphere-entrapped nucleic acids were dependent on variables such as the type of nucleic acid used, the nature of the lipophilic group, and whether the nucleic acid used was single or double stranded. For in vivo studies, whole body autoradiography was used to monitor the bio-distribution of either free tritium-labelled ODN or that entrapped within PLGA microspheres following subcutaneous administration in Balb-c mice. The majority of the radioactivity associated with free ODN was eliminated within 24 h whereas polymer-released ODN persisted in organs and at the site of administration even after seven days post-administration. Polymer microsphere released ODN exhibited a similar tissue and cellular tropism to the free ODN. Micro-autoradiography analyses of the liver and kidneys showed similar bio-distribution for polymer-released and free ODNs with the majority of radioactivity being concentrated in the proximal convoluted tubules of the kidney and in the Kupffer cells of the liver. These findings suggest that biodegradable PLGA microspheres offer a method for improving the in vivo sustained delivery of gene silencing nucleic acids, and hence are worthy of further investigation as delivery systems for these macromolecules.

The development of a real-time PCR to detect pathogenic Leptospira species in kidney tissue

A LightCycler(R) real-time PCR hybridization probe-based assay that detects a conserved region of the 16S rRNA gene of pathogenic but not saprophytic Leptospira species was developed for the rapid detection of pathogenic leptospires directly from processed tissue samples. In addition, a differential PCR specific for saprophytic leptospires and a control PCR targeting the porcine beta-actin gene were developed. To assess the suitability of these PCR methods for diagnosis, a trial was performed on kidneys taken from adult pigs with evidence of leptospiral infection, primarily a history of reproductive disease and serological evidence of exposure to pathogenic leptospires (n = 180) and aborted pig foetuses (n = 24). Leptospire DNA was detected by the 'pathogenic' specific PCR in 25 tissues (14%) and the control beta-actin PCR was positive in all 204 samples confirming DNA was extracted from all samples. No leptospires were isolated from these samples by culture and no positives were detected with the 'saprophytic' PCR. In a subsidiary experiment, the 'pathogenic' PCR was used to analyse kidney samples from rodents (n = 7) collected as part of vermin control in a zoo, with show animals with high microagglutination titres to Leptospira species, and five were positive. Fifteen PCR amplicons from 1 mouse, 2 rat and 14 pig kidney samples, were selected at random from positive PCRs (n = 30) and sequenced. Sequence data indicated L. interrogans DNA in the pig and rat samples and L. inadai DNA, which is considered of intermediate pathogenicity, in the mouse sample. The only successful culture was from this mouse kidney and the isolate was confirmed to be L. inadai by classical serology. These data suggest this suite of PCRs is suitable for testing for the presence of pathogenic leptospires in pig herds where abortions and infertility occur and potentially in other animals such as rodents. Crown Copyright (C) 2007 Published by Elsevier Ltd. All rights reserved.