Diferencias microbiológicas en pacientes con exacerbación severa de EPOC con o sin consolidación neumónica

La EPOC es una causa importante de morbilidad y mortalidad en el mundo y su prevalencia en Bogotá alcanza hasta 8,5%. Las exacerbaciones están asociadas a deterioro funcional y de la calidad de vida por lo que se consideran un factor cardinal de la enfermedad. En la literatura se ha descrito que las infecciones por bacterias y/o virus son las responsables del 78% de las exacerbaciones. Estos datos han sido descritos en poblaciones diferentes y no hay datos en la literatura que muestren cual es la epidemiología local de las exacerbaciones de EPOC y menos aún de aquellas que se asocian a consolidaciones neumónicas. Objetivo: Comparar la microbiología de las exacerbaciones severas de la EPOC que requieren ingreso a UCI con y sin infiltrados alveolares. Materiales y métodos: Estudio de corte transversal en el que se estudiaron pacientes con EPOC que ingresaron a la UCI Médica de la FCI-IC por exacerbación severa, asociada o no a infiltrados alveolares. Se tomaron muestras de microbiología, serológicas y radiografía de tórax para evaluar la etiología de la exacerbación, si se asocia a coinfección viral y a consolidación neumónica o no. Resultados: No se encontró una diferencia estadísticamente significativa en la microbiología de los diferentes grupos evaluados. Se encontró un resistencia global del 24% y llama la atención que hay una alta prevalencia de Serratia Marcescens AMPc entre los 2 grupos, germen que no está descrito como patógeno común en la literatura. Se encontraron diferencias en cuanto a factores de riesgo para presentar neumonía asociada como lo son un mayor índice de paquetes/año (55.1.6 vs. 36.3 paq/año, sig.=0.021). Así mismo se demostró que los pacientes con neumonía asociada presentan mayor necesidad de IOT (48.9 vs. 23.9, sig.=0.013). No hay diferencia significativa en desenlaces como mortalidad (20.5 vs. 13.0, sig.=0.346). Conclusiones: A pesar de no haber diferencia microbiológica entre los 2 grupos se encontraron variables como factores de riesgo y variables clínicas que pueden ayudar a proponer planes de manejo en los dos escenarios. El hecho de encontrar un paciente con neumonía asociada al cuadro de exacerbación no debe afectar en la toma de decisiones en relación al tratamiento antibiótico.

Manifestaciones renales en pacientes con síndrome de Alagille: Reporte de casos y revisión de la literatura.

El síndrome de Alagille es una condición autosómica dominante que se define clínicamente por alteraciones de cinco sistemas principales: escasez de ductos biliares con colestasis crónica, compromiso cardíaco (estenosis pulmonar), óseo (vétebras en mariposa), oftálmico (embriotoxon posterior) y de la cara (fascies dismórficas leves pero reconocibles). La afectación renal es común en estos pacientes; sin embargo, no hace parte de los criterios que definen el síndrome. Reportamos los casos de 3 pacientes con síndrome de Alagille y compromiso renal y realizamos una revisión de la literatura para establecer la importancia de incluir la evaluación de este sistema en el diagnóstico del síndrome. Concluimos que el compromiso renal es frecuente, y por lo tanto sugerimos que en todos los casos se evalúe la posibilidad de compromiso renal tanto a nivel estructural como funcional glomerular y tubular.

Effects of pulmonary rehabilitation program in a patient with severe asthma diagnosis

Objective: to present the effectiveness of pulmonary rehabilitation programs in the treatmentof a patient with asthma, this is the case of a young Caucasian girl —17 years old— with severe asthma diagnosis, with symptoms since she was eight years old, 10th grade student. Method: She was referred to the program of Pulmonary Rehabilitation after three hospitalizations during the last year due to asthmatic crises, dyspnoea in activities of daily living, and intolerance to physical exercise. In the initial evaluation, a patient with non-controlled asthma was found; she was receiving short-acting medication admitting that she was not complying with regular use and with a prescribed dose of the pharmacological treatment and that she ignored the importance of this commitment for optimal evolution. The patient expressed concern about the progressive deterioration at her respiratory and functional level during the last year and her fear and anxiety for not being able to breathe during activities befitting her age. Results: One month after receiving bronchodilators and long-acting steroids permanently and complying with recommendations about regular use and adequate inhalatory technique, the patient was included in a three-times a-week program of pulmonary rehabilitation during eight weeks for upper and lower extremity endurance and resistance training. Conclusion: This intervention showed significant changes in the patient at functional level and a greater social participation.

Uso de la matriz extracelular como material para ingeniería de tejidos

Introducción: La evaluación de injertos vasculares de submucosa de intestino delgado para la regeneración de vasos sanguíneos ha producido una permeabilidad variable (0-100%) que ha sido concurrente con la variabilidad en las técnicas de fabricación. Metodología: Investigamos los efectos de fabricación en permeabilidad y regeneración en un diseño experimental de 22factorial que combino: 1) preservación (P) o remoción (R) de la capa estratum compactum del intestino, y 2) deshidratada (D) o hidratada (H), dentro de cuatro grupos de estudio (PD, RD, PH, RH). Los injertos fueron implantados en las Arterias Carótidas de porcinos (ID 4.5mm, N=4, 7d). Permeabilidad, trombogenicidad, reacción inflamatoria, vascularización, infiltración de fibroblastos, perfil de polarización de macrófagos y fuerza tensil biaxial fueron evaluadas. Resultados: Todos los injertos PD permanecieron permeables (4/4), pero tuvieron escasa vascularización e infiltración de fibroblastos. El grupo RD permaneció permeable (4/4), presentó una extensa vascularización e infiltración de fibroblastos, y el mayor número del fenotipo de macrófagos (M2) asociado a regeneración. El grupo RH presentó menor permeabilidad (3/4), una extensa vascularización e infiltración de fibroblastos, y un perfil dominante de M2. El grupo PH presentó el menor grado de permeabilidad, y a pesar de mayor infiltración celular que PD, exhibió un fenotipo de macrófagos dominante adverso. La elasticidad de los injertos R evolucionó de una manera similar a las Carótidas nativas (particularmente RD, mientras que los injertos P mantuvieron su rigidez inicial. Discusión: Concluimos que los parámetros de fabricación afectan drásticamente los resultados, siendo los injertos RD los que arrojaron mejores resultados.

Polimorfismos del gen Butirilcolinesterasa responsables de reacciones adversas en pacientes consumidores de “cocaína”

La butirilcolinesterasa humana (BChE; EC 3.1.1.8) es una enzima polimórfica sintetizada en el hígado y en el tejido adiposo, ampliamente distribuida en el organismo y encargada de hidrolizar algunos ésteres de colina como la procaína, ésteres alifáticos como el ácido acetilsalicílico, fármacos como la metilprednisolona, el mivacurium y la succinilcolina y drogas de uso y/o abuso como la heroína y la cocaína. Es codificada por el gen BCHE (OMIM 177400), habiéndose identificado más de 100 variantes, algunas no estudiadas plenamente, además de la forma más frecuente, llamada usual o silvestre. Diferentes polimorfismos del gen BCHE se han relacionado con la síntesis de enzimas con niveles variados de actividad catalítica. Las bases moleculares de algunas de esas variantes genéticas han sido reportadas, entre las que se encuentra las variantes Atípica (A), fluoruro-resistente del tipo 1 y 2 (F-1 y F-2), silente (S), Kalow (K), James (J) y Hammersmith (H). En este estudio, en un grupo de pacientes se aplicó el instrumento validado Lifetime Severity Index for Cocaine Use Disorder (LSI-C) para evaluar la gravedad del consumo de “cocaína” a lo largo de la vida. Además, se determinaron Polimorfismos de Nucleótido Simple (SNPs) en el gen BCHE conocidos como responsables de reacciones adversas en pacientes consumidores de “cocaína” mediante secuenciación del gen y se predijo el efecto delos SNPs sobre la función y la estructura de la proteína, mediante el uso de herramientas bio-informáticas. El instrumento LSI-C ofreció resultados en cuatro dimensiones: consumo a lo largo de la vida, consumo reciente, dependencia psicológica e intento de abandono del consumo. Los estudios de análisis molecular permitieron observar dos SNPs codificantes (cSNPs) no sinónimos en el 27.3% de la muestra, c.293A>G (p.Asp98Gly) y c.1699G>A (p.Ala567Thr), localizados en los exones 2 y 4, que corresponden, desde el punto de vista funcional, a la variante Atípica (A) [dbSNP: rs1799807] y a la variante Kalow (K) [dbSNP: rs1803274] de la enzima BChE, respectivamente. Los estudios de predicción In silico establecieron para el SNP p.Asp98Gly un carácter patogénico, mientras que para el SNP p.Ala567Thr, mostraron un comportamiento neutro. El análisis de los resultados permite proponer la existencia de una relación entre polimorfismos o variantes genéticas responsables de una baja actividad catalítica y/o baja concentración plasmática de la enzima BChE y algunas de las reacciones adversas ocurridas en pacientes consumidores de cocaína.

Balance function following cochlear implantation

Imbalance is a risk of cochlear implantation. This is particularly important in patients receiving bilateral implants, who are often children. 25 adult and pediatric patients undergoing cochlear implantation were tested pre-operatively and post-operatively using tests of balance function. Results showed moderate losses in some test paradigms following implantation in the patient group as a whole. While changes in balance function due to cochlear implantation are not uncommon, their practical effect on function may be minor.

Temperature trends derived from Stratospheric Sounding Unit radiances: the effect of increasing CO2 on the weighting function

Stratospheric Sounding Units (SSU) on the NOAA operational satellites have been the main source of near global temperature trend data above the lower stratosphere. They have been used extensively for comparison with model-derived trends. The SSU senses in the 15 micron band of CO2 and hence the weighting function is sensitive to changes in CO2 concentrations. The impact of this change in weighting function has been ignored in all recent trend analyses. We show that the apparent trends in global mean brightness temperature due to the change in weighting function vary from about -0.4 K/decade to 0.4 K/decade depending on the altitude sensed by the different SSU channels. For some channels, this apparent trend is of a similar size to the trend deduced from SSU data but ignoring the change in weighting function. In the mid-stratosphere, the revised trends are now significantly more negative and in better agreement with model-calculated trends.

National and sub-national assessments of soil organic carbon stocks and changes: The GEFSOC modelling system

Soil organic carbon (SOC) plays a vital role in ecosystem function, determining soil fertility, water holding capacity and susceptibility to land degradation. In addition, SOC is related to atmospheric CO, levels with soils having the potential for C release or sequestration, depending on land use, land management and climate. The United Nations Convention on Climate Change and its Kyoto Protocol, and other United Nations Conventions to Combat Desertification and on Biodiversity all recognize the importance of SOC and point to the need for quantification of SOC stocks and changes. An understanding of SOC stocks and changes at the national and regional scale is necessary to further our understanding of the global C cycle, to assess the responses of terrestrial ecosystems to climate change and to aid policy makers in making land use/management decisions. Several studies have considered SOC stocks at the plot scale, but these are site specific and of limited value in making inferences about larger areas. Some studies have used empirical methods to estimate SOC stocks and changes at the regional scale, but such studies are limited in their ability to project future changes, and most have been carried out using temperate data sets. The computational method outlined by the Intergovernmental Panel on Climate Change (IPCC) has been used to estimate SOC stock changes at the regional scale in several studies, including a recent study considering five contrasting eco regions. This 'one step' approach fails to account for the dynamic manner in which SOC changes are likely to occur following changes in land use and land management. A dynamic modelling approach allows estimates to be made in a manner that accounts for the underlying processes leading to SOC change. Ecosystem models, designed for site scale applications can be linked to spatial databases, giving spatially explicit results that allow geographic areas of change in SOC stocks to be identified. Some studies have used variations on this approach to estimate SOC stock changes at the sub-national and national scale for areas of the USA and Europe and at the watershed scale for areas of Mexico and Cuba. However, a need remained for a national and regional scale, spatially explicit system that is generically applicable and can be applied to as wide a range of soil types, climates and land uses as possible. The Global Environment Facility Soil Organic Carbon (GEFSOC) Modelling System was developed in response to this need. The GEFSOC system allows estimates of SOC stocks and changes to be made for diverse conditions, providing essential information for countries wishing to take part in an emerging C market, and bringing us closer to an understanding of the future role of soils in the global C cycle. (C) 2007 Elsevier B.V. All rights reserved.

Prefrontal cortical-ventral striatal interactions involved in affective modulation of attentional performance: implications for corticostriatal circuit function

Anatomically segregated systems linking the frontal cortex and the striatum are involved in various aspects of cognitive, affective, and motor processing. In this study, we examined the effects of combined unilateral lesions of the medial prefrontal cortex (mPFC) and the core subregion of the nucleus accumbens (AcbC) in opposite hemispheres (disconnection) on a continuous performance, visual attention test [five-choice serial reaction-time task (5CSRTT)]. The disconnection lesion produced a set of specific changes in performance of the 5CSRTT, resembling changes that followed bilateral AcbC lesions while, in addition, comprising a subset of the behavioral changes after bilateral mPFC lesions previously reported using the same task. Specifically, both mPFC/AcbC disconnection and bilateral AcbC lesions markedly affected aspects of response control related to affective feedback, as indexed by perseverative responding in the 5CSRTT. These effects were comparable, although not identical, to those in animals with either bilateral AcbC or mPFC/AcbC disconnection lesions. The mPFC/AcbC disconnection resulted in a behavioral profile largely distinct from that produced by disconnection of a similar circuit described previously, between the mPFC and the dorsomedial striatum, which were shown to form a functional network underlying aspects of visual attention and attention to action. This distinction provides an insight into the functional specialization of corticostriatal circuits in similar behavioral contexts.

Research note: amendments to the model for predicting age at sexual maturity for growing pullets of layer strains following changes in photoperiod

A model was published by Lewis et al. (2002) to predict the mean age at first egg (AFE) for pullets of laying strains reared under non-limiting environmental conditions and exposed to a single change in photoperiod during the rearing stage. Subsequently, Lewis et al. (2003) reported the effects of two opposing changes in photoperiod, which showed that the first change appears to alter the pullet's physiological age so that it responds to the second change as though it had been given at an earlier age (if photoperiod was decreased), or later age (if photoperiod was increased) than the true chronological age. During the construction of a computer model based on these two publications, it became apparent that some of the components of the models needed adjustment. The amendments relate to (1) the standard deviation (S.D.) used for calculating the proportion of a young flock that has attained photosensitivity, (2) the equation for calculating the slope of the line relating AFE to age at transfer from one photoperiod to another, (3) the equation used for estimating the distribution of AFE as a function of the mean value, (4) the point of no return when pullets which have started spontaneous maturation in response to the current photoperiod can no longer respond to a late change in photoperiod and (5) the equations used for calculating the distribution of AFE when the trait is bimodal.

Intracellular signalling pathways regulating the adaptation of skeletal muscle to exercise and nutritional changes

The focus of the present review is to assimilate current knowledge concerning the differing signalling transduction cascades that control muscle mass development and affect skeletal muscle phenotype following exercise or nutritional uptake. Effects of mechanical loading on protein synthesis are discussed. Muscle growth control is regulated by the interplay of growth promoting and growth suppressing factors, which act in concert. Much emphasis has been placed on understanding how increases in the rate of protein synthesis are induced in skeletal muscle during the adaptive process. One key point to emerge is that protein synthesis following resistance exercise or increased nutrient availability is mediated through changes in signal transduction involving the phosphorylation of mTOR and sequential activation of downstream targets. On the other hand, AMPK activation plays an important role in the inhibition of protein synthesis by suppressing the function of multiple translation regulators of the mTOR signalling pathway in response to cellular energy depletion and low metabolic conditions. The effects of exercise and/or nutritional uptake on the activation of signalling molecules that regulate protein synthesis are highlighted, providing a better understanding of the molecular changes in the cell.

The role of polyphenolic compounds in the diet as inhibitors of platelet function

Platelets play a substantial role in cardiovascular disease, and for many years there has been a search for dietary components that are able to inhibit platelet function and therefore decrease the risk of cardiovascular disease. Platelets can be inhibited by alcohol, dietary fats and some antioxidants, including a group of compounds, the polyphenols, found in fruits and vegetables. A number of these compounds have been shown to inhibit platelet function both in vitro and in vivo. In the present study the effects of the hydroxycinnamates and the flavonoid quercetin on platelet activation and cell signalling in vitro were investigated. The hydroxycinnamates inhibited platelet function, although not at levels that can be achieved in human plasma by dietary intervention. However, quercetin inhibited platelet aggregation at levels lower than those previously reported. Quercetin was also found to inhibit intracellular Ca mobilisation and whole-cell tyrosine protein phosphorylation in platelets, which are both processes essential for platelet activation. The effect of polyphenols on platelet aggregation in vivo was also investigated. Twenty subjects followed a low-polyphenol diet for 3 d before and also during supplementation. All subjects were supplemented with a polyphenol-rich meal every lunchtime for 5 d. Platelet aggregation and plasma flavonols were measured at baseline and after 5 d of dietary supplementation. Total plasma flavonoids increased significantly after the dietary intervention period (P = 0.001). However, no significant changes in ex vivo platelet aggregation were observed. Further investigation of the effects of individual polyphenolic compounds on platelet function, both in vitro and in vivo, is required in order to elucidate their role in the relationship between diet and the risk of cardiovascular disease.

Lack of effect of foods enriched with plant- or marine-derived n-3 fatty acids on human immune function

Background: Greatly increasing dietary flaxseed oil [rich in the n-3 polyunsaturated fatty acid (PUFA) alpha-linolenic acid (ALA)] or fish oil [rich in the long-chain n-3 PUFAs eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids] can reduce markers of immune cell function. The effects of more modest doses are unclear, and it is not known whether ALA has the same effects as its long-chain derivatives. Objective: The objective was to determine the effects of enriching the diet with ALA or EPA+DHA on immune outcomes representing key functions of human neutrophils, monocytes, and lymphocytes. Design: In a placebo-controlled, double-blind, parallel study, 150 healthy men and women aged 25-72 y were randomly assigned to I of 5 interventions: placebo (no additional n-3 PUFAs), 4.5 or 9.5 g ALA/d, and 0.77 or 1.7 g EPA+DHA/d for 6 mo. The n-3 PUFAs were provided in 25 g fat spread plus 3 oil capsules. Blood samples were taken at 0, 3, and 6 mo. Results: The fatty acid composition of peripheral blood mononuclear cell phospholipids was significantly different in the groups with higher intakes of ALA or EPA+DHA. The interventions did not alter the percentages of neutrophils or monocytes engaged in phagocytosis of Escherichia coli or in phagocytic activity, the percentages of neutrophils or monocytes undergoing oxidative burst in response to E. coli or phorbol ester, the proliferation of lymphocytes in response to a T cell mitogen, the production of numerous cytokines by monocytes and lymphocytes, or the in vivo delayed-type hypersensitivity response. Conclusion: An intake of f less than or equal to9.5 g ALA/d or less than or equal to1.7 g EPA+DHA/d does not alter the functional activity of neutrophils, monocytes, or lymphocytes, but it changes the fatty acid composition of mononuclear cells.

Age-associated changes in protein oxidation and proteasome activities in rat brain: modulation by antioxidants

The free radical theory of ageing postulates that age-associated neurodegeneration is caused by an imbalance between pro-oxidants and antioxidants resulting in oxidative stress. The current study showed regional variation in brain susceptibility to age-associated oxidative stress as shown by increased lipofuscin deposition and protein carbonyl levels in male rats of age 15-16 months compared to control ones (3-5 months). The hippocampus is the area most vulnerable to change compared to the cortex and cerebellum. However, proteasomal enzyme activity was not affected by age in any of the brain regions studied. Treatment with melatonin or coenzyme Q10 for 4 weeks reduced the lipofuscin content of the hippocampus and carbonyl level. However, both melatonin and coenzyme Q10 treatments inhibited beta-glutamyl peptide hydrolase activity. This suggests that these molecules can alter proteasome function independently of their antioxidant actions. (c) 2005 Elsevier Inc. All rights reserved.

Testing temperature-induced proteomic changes in the plant-associated bacterium Pseudomonas fluorescens SBW25.

Traits used by bacteria to enhance ecological performance in natural environments are not well understood. Recognizing that the saprophytic plant-colonizing bacterium Pseudomonas fluorescens SBW25 experiences temperatures in its natural environment significantly cooler than the 28°C routinely used in the laboratory, we identified proteins differentially expressed between 28°C and the more environmentally relevant temperature of 14°C. Of 2102 protein isoforms, 32 were temperature responsive and identified by mass spectrometry. Seven of these (OmpR, MucD, GuaD, OsmY and three of unknown function, Tee1, Tee2 and Tee3) were selected for genetic and ecological analyses. In each instance, changes in protein expression with temperature were mirrored by parallel transcriptional changes. The fitness contribution of the genes encoding each of the seven proteins was larger at 14°C than 28°C and included two cases of trade-offs (enhanced fitness at one temperature and reduced fitness at the other – mucD and tee2 deletions). The relationship between the fitness effects of genes in vitro and in vivo was variable, but two temperature-responsive genes – osmY and mucD – contribute substantially to the ability of P. fluorescens to colonize the plant environment.