Impacto de la desnutrición sobre la morbimortalidad y el tiempo de estancia en pacientes traumatizados

INTRODUCCIÓN: En pacientes traumatizadosgraves se ha descrito un rápido desarrollo de desnutriciónasociada a disfunción de órganos e infeccionesnosocomiales.OBJETIVOS: Evaluar el estado nutricional depacientes ingresados a un Centro de Referencia Nacionalde Trauma y su relación con la evolución.MATERIALES Y MÉTODOS: Estudio prospectivodonde se evaluaron los pacientes adultos ingresadosa los servicios de Terapia Intensiva, CirugíaGeneral, Cirugía Maxilofacial y Traumatología delCentro de Emergencias Médicas de Asunción-Paraguay,en forma consecutiva desde marzo del 2002 amarzo del 2004. Se determinó la prevalencia de desnutriciónempleando la Valoración Global Subjetiva(SGA). También se determinó el recuento de linfocitos(linfopénicos < 1500/mm3) y la albúmina (hipoalbuminémicos< 3.4 gr/dl). Se realizó el seguimientode los pacientes para determinar el tiempo de estancia,las complicaciones y la mortalidad hospitalaria.Los factores de riesgo analizados fueron: parámetrosnutricionales (hipoalbuminemia, linfopenia, SGA),edad, sexo, intervención quirúrgica, anemia, InjurySevery Score (ISS). Los datos fueron procesados conel EPIINFO 2002, el SPSS fue utilizado para realizarel análisis multivariado. Para la comparación de gruposse consideró una p<0,05 como significativa y losresultados se expresaron en riesgo relativo (RR) conintervalo de confianza de 95%.RESULTADOS: Fueron evaluados un total de161 pacientes con edad mediana de 27 (14-92), 6%de mujeres y 94% de varones. El 74% de los pacientesprovenían del interior y el 26% de la capital. Laslocalizaciones anatómicas del trauma más frecuentesfueron: traumatismo de cráneo 25%, trauma detórax 16,6%, traumatismo de extremidades 15.4%,traumatismo abdominal 14%. La mediana del ISSfue de 20 (1-39). El 40% de los pacientes se encontrabanmoderadamente desnutridos o en riesgo dedesnutrición según la SGA, 45% linfopénicos y un34% hipoalbuminémicos. Los factores de riesgo significativosluego del análisis multivariado fueron:para mortalidad la desnutrición según la SGA p 0,04RR 4 (1-15) e ingreso a UTI p 0,0001 RR 53 (12-234); para las complicaciones la desnutrición segúnla SGA p 0,003 RR 2,9 (1,4-5,8) e ISS mayor a 20 p0,001 RR 8,4 (2,3-29.9) y para el tiempo de estanciala desnutrición según la SGA p 0,01 RR 2,3 (1,2-4,7)e ISS mayor a 20 p 0,03 RR 2,8 (1-7,3).CONCLUSIÓN: La desnutrición en pacientestraumatizados es un hallazgo frecuente al ingreso.Es importante diagnosticarla ya que es un factor deriesgo independiente de morbimortalidad, y prolongacióndel tiempo de estancia hospitalaria

Ambient air pollutants are associated with morning serum cortisol in overweight and obese Latino youth in Los Angeles

Background Hypothalamic-pituitary-adrenal (HPA)-axis dysfunction has been associated with a variety of mental health and cardio-metabolic disorders. While causal models of HPA-axis dysregulation have been largely focused on either pre-existing health conditions or psychosocial stress factors, recent evidence suggests a possible role for central nervous system activation via air pollutants, such as nitrogen dioxide (NO2), ozone (O3) and particulate matter (PM). Therefore, in an observational study of Latino youth, we investigated if monthly ambient NO2, O3, and PM with aerodynamic diameter&thinsp;&le;&thinsp;2.5 (PM2.5) exposure were associated with morning serum cortisol levels. Methods In this cross-sectional study, morning serum cortisol level was assessed after a supervised overnight fast in 203 overweight and obese Latino children and adolescents (female/male: 88/115; mean age: 11.1&thinsp;&plusmn;&thinsp;1.7&thinsp;years; pre-pubertal/pubertal/post-pubertal: 85/101/17; BMI z-score: 2.1&thinsp;&plusmn;&thinsp;0.4). Cumulative concentrations of NO2, O3 and PM2.5 were spatially interpolated at the residential addresses based on measurements from community monitors up to 12&thinsp;months prior to testing. Single and multi-pollutant linear effects models were used to test the cumulative monthly lag effects of NO2, O3, and PM2.5 on morning serum cortisol levels after adjusting for age, sex, seasonality, social position, pubertal status, and body fat percent by DEXA. Results Single and multi-pollutant models showed that higher O3 exposure (derived from maximum 8-h exposure windows) in the prior 1&ndash;7&thinsp;months was associated with higher serum morning cortisol (p&thinsp;&lt;&thinsp;0.05) and longer term PM2.5 exposure (4&ndash;10&thinsp;months) was associated with lower serum morning cortisol levels (p&thinsp;&lt;&thinsp;0.05). Stratification by pubertal status showed associations in pre-pubertal children compared to pubertal and post-pubertal children. Single, but not multi-pollutant, models showed that higher NO2 over the 4&ndash;10&thinsp;month exposure period associated with lower morning serum cortisol (p&thinsp;&lt;&thinsp;0.05). Conclusions Chronic ambient NO2, O3 and PM2.5 differentially associate with HPA-axis dysfunction, a mechanism that may serve as an explanatory pathway in the relationship between ambient air pollution and metabolic health of youth living in polluted urban environments. Further research that uncovers how ambient air pollutants may differentially contribute to HPA-axis dysfunction are warranted. </div

The Human Cytomegalovirus UL76 Gene Regulates the Level of Expression of the UL77 Gene

Human cytomegalovirus (HCMV) can be reactivated under immunosuppressive conditions causing several fatal pneumonitis, hepatitis, retinitis, and gastrointestinal diseases. HCMV also causes deafness and mental retardation in neonates when primary infection has occurred during pregnancy. In the genome of HCMV at least 194 known open reading frames (ORFs) have been predicted, and approximately one-quarter, or 41 ORFs, are required for viral replication in cell culture. In contrast, the majority of the predicted ORFs are nonessential for viral replication in cell culture. However, it is also possible that these ORFs are required for the efficient viral replication in the host. The UL77 gene of HCMV is essential for viral replication and has a role in viral DNA packaging. The function of the upstream UL76 gene in the HCMV-infected cells is not understood. UL76 and UL77 are cistons on the same viral mRNA and a conventional 5' mRNA for UL77 has not been detected. The vast majority of eukaryotic mRNAs are monocistronic, i.e., they encode only a single protein.To determine whether the UL76 ORF affects UL77 gene expression, we mutated UL76 by ORF frame-shifts, stop codons or deletion of the viral gene. The effect on UL77 protein expression was determined by either transfection of expression plasmids or infection with recombinant viruses. Mutation of UL76 ORF significantly increased the level of UL77 protein expression. However, deletion of UL76 upstream of the UL77 ORF had only marginal effects on viral growth.While UL76 is not essential for viral replication, the UL76 ORF is involved in regulation of the level of UL77 protein expression in a manner dependent on the translation re-initiation. UL76 may fine-tune the UL77 expression for the efficient viral replication in the HCMV- infected cells

Freqüência de infecção por Toxocara em crianças atendidas em serviço público de Maringá, sul do Brasil

The lack of specific laboratorial diagnosis methods and precise symptoms makes the toxocariasis a neglected disease in Public Health Services. This study aims to determine the frequency of Toxocara spp. infection in children attended by the Health Public Service of Hospital Municipal de Maringá, South Brazil. To evaluate the association of epidemiological and clinical data, an observational and cross-section study was carried out. From 14,690 attended children/year aged from seven month to 12 years old, 450 serum samples were randomly collected from September/2004 to September/2005. A questionnaire was used to evaluate epidemiological, clinical and hematological data. An ELISA using Toxocara canis larval excretory-secretory products as antigen detected 130 (28.8%) positive sera, mainly between children from seven month to five years old (p = 0.0016). Significant correlation was observed between positive serology for Toxocara, and frequent playing in sandbox at school or daycare center (p = 0.011) and the presence of a cat at home (p = 0.056). From the families, 50% were dog owners which exposed soil backyards. Eosinophilia (p = 0.776), and signs and symptoms analyzed (fever p = 0.992, pneumonia p = 0.289, cold-like symptoms p = 0.277, cough p = 0.783, gastrointestinal problems p = 0.877, migraine p = 0.979, abdominal pain p = 0.965, joint pain p = 0.686 and skin rash p = 0.105) could not be related to the presence of anti-Toxocara antibodies. Therefore, two asthmatics children showed titles of 1:10,240 and accentuated eosinophilia (p = 0.0001). The authors emphasize the needs of prevention activities.A falta de métodos de diagnóstico laboratorial específico e sintomas específicos fazem da toxocaríase uma doença negligenciada nos serviços públicos de saúde. Este estudo teve por objetivo determinar a freqüência de infecção por Toxocara spp. em crianças atendidas no serviço público do Hospital Municipal de Maringá, sul do Brasil, e avaliar a associação com dados epidemiológicos e clínicos, em estudo observacional e transversal. De 14.690 crianças/ano atendidas, com idade entre sete meses a 12 anos, foram coletados 450 soros de setembro/2004 a setembro/2005. Um questionário foi utilizado para avaliar dados epidemiológicos, clínicos e hematológicos. Pelo teste ELISA, com antígeno de excreção/secreção de larvas de Toxocara canis, detectou-se 130 (28,8%) soros positivos, principalmente em crianças entre sete meses e cinco anos (p = 0,0016). Houve significante correlação entre sorologia positiva para Toxocara e freqüente recreação das crianças em caixas de areia da escola ou pré escola (p = 0,011) e presença do gato no domicilio (p = 0,056). Das famílias dessas crianças, 50% possuíam cachorros e o quintal com solo exposto. Eosinofilia (p = 0,776), sinais e sintomas (febre p = 0,992, pneumonia p = 0,289, resfriado p = 0,277, tosse p = 0,783, problema gastrointestinal p = 0877, dor de cabeça p = 0,979, dor abdominal p = 0,965, dores articulares p = 0,686, urticária p = 0,105) não se correlacionaram com a soropositividade. Todavia, duas crianças asmáticas apresentaram títulos de 1:10.240 (>; 1:320) e acentuada eosinofilia (p = 0.0001). Os autores enfatizam a necessidade de atividades preventivas

Therapeutic implications of improved molecular diagnostics for rare CNS-embryonal tumor entities: results of an international, retrospective study

BACKGROUND: Only few data are available on treatment-associated behavior of distinct rare CNS-embryonal tumor entities previously treated as "CNS-primitive neuroectodermal tumors" (CNS-PNET). Respective data on specific entities, including CNS neuroblastoma, FOXR2 activated (CNS NB-FOXR2), and embryonal tumor with multi-layered rosettes (ETMR) are needed for development of differentiated treatment strategies. METHODS: Within this retrospective, international study, tumor samples of clinically well-annotated patients with the original diagnosis of CNS-PNET were analyzed using DNA methylation arrays (n=307). Additional cases (n=66) with DNA methylation pattern of CNS NB-FOXR2 were included irrespective of initial histological diagnosis. Pooled clinical data (n=292) were descriptively analyzed. RESULTS: DNA methylation profiling of "CNS-PNET" classified 58(19%) cases as ETMR, 57(19%) as HGG, 36(12%) as CNS NB-FOXR2, and 89(29%) cases were classified into 18 other entities. Sixty-seven (22%) cases did not show DNA methylation patterns similar to established CNS tumor reference classes. Best treatment results were achieved for CNS NB-FOXR2 patients (5-year PFS: 63%±7%, OS: 85%±5%, n=63), with 35/42 progression-free survivors after upfront craniospinal irradiation (CSI) and chemotherapy. The worst outcome was seen for ETMR and HGG patients with 5-year PFS of 18%±6% and 22%±7%, and 5-year OS of 24%±6% and 25%±7%, respectively. CONCLUSION: The historically reported poor outcome of CNS-PNET patients becomes highly variable when tumors are molecularly classified based on DNA methylation profiling. Patients with CNS NB-FOXR2 responded well to current treatments and a standard-risk-CSI based regimen may be prospectively evaluated. The poor outcome of ETMR across applied treatment strategies substantiates the necessity for evaluation of novel treatments