Insuficiencia renal aguda inducida por mordedura de serpiente Bothrops

Mujer de 58 años de edad, remitida a urgencias por presentar cuadro clínico de insuficiencia renal aguda (IRA) secundaria a mordedura de serpiente (Bothrops Atrox). Ingresa hipotensa con elevación de azoados e hiperkalemia, ecografía renal dentro de parámetros normales. Se maneja terapia dialítica con lo cual presenta mejoría clínica. En este reporte se detallan aspectos del diagnóstico, manejo clínico y posibles mecanismos fisiopatológicos que explican el daño renal

Reactivity Indexes and Structure of Fullerenes

The discovery of fullerenes and their production in measurable quantities launched many studies about their reactivity and possible applications. Their peculiar structure opened possibilities for their study, initially replacing carbon atoms with alternative atoms. The surface also offers the possibility of attaching several species and the interior of their hollow structure represents a challenge because of the possibility of confining elements or molecules that may become less stable when attached to the exterior of the cage. These modifications may considerably affect both chemical and physical properties. In this chapter, we propose the encapsulation of 3–10 nitrogen atoms as aggregates inside the C70 cage. We also study the structures and reactivity indexes and the stabilization conferred as a result of being part of the fullerene. These aggregates are mainly of interest because of their possible application as energetic materials

Informe final de pasantía: cuidado de la persona con lesiones de piel

Las úlceras de pierna pueden definirse como pérdida de la integridad de la piel debajo de la rodilla, en la pierna o en el pie que lleva más de seis semanas en sanar. La etiología más frecuente de este tipo de heridas es de origen vascular: venoso (70 %), arterial (10%) y mixta (10-15%), otras causas (2.5%) incluyen enfermedades metabólicas como la diabetes que da origen a enfermedad arterial y neuropatía. Las úlceras de pierna, son un problema de salud importante que pueden afectar sustancialmente la calidad de vida de las personas que las padecen, pueden tomar mucho tiempo en curar, restringiendo la movilidad, causando ansiedad y depresión. Objetivo: Brindar cuidado de enfermería a la persona con lesiones de piel de diversa etiología. Método: trabajo de grado en modalidad de pasantía relacionada con el cuidado de la persona con lesiones de piel en un Consultorio de Enfermería: Clínica de heridas. Resultados: Se realizó la caracterización de los pacientes que acuden a consulta identificando que en su mayoría fueron mujeres con edad promedio de 62,5 años; las heridas más prevalentes fueron las Úlceras Venosas (81,9%), seguidas de lesiones por Pie Diabético (6,56%), Úlceras Arteriales (4,92%), Úlceras Mixtas (4,92%) y otros tipos de heridas (1,64%), cuyos principales factores asociados eran la insuficiencia venosa, arterial, hipertensión arterial, diabetes mellitus y presencia de obesidad. De acuerdo a las necesidades encontradas en la revisión de documentos de la clínica, se elaboró un protocolo de admisión de pacientes para estandarizar dicho proceso y orientar desde el ingreso las intervenciones del (la) enfermero (a); se realizaron tres rotafolios informativos dirigidos a los pacientes y sus cuidadores, con las características y cuidados más importantes de las patologías más prevalentes en la institución. Al mismo tiempo, se elaboró una guía de práctica clínica para la intervención y cuidado de personas con úlceras por presión o con riesgo de padecerlas. Conclusiones: Es fundamental realizar esfuerzos desde la educación en prevención, pues la mayoría de los casos de heridas de pierna se dan por desconocimiento de acciones preventivas y mitigación de factores de riesgo prevenibles asociados; esta pasantía permitió a los estudiantes afianzar y poner en práctica los conocimientos adquiridos, así como desarrollar habilidades para el cuidado de la persona con alteración de los tejidos, y cumplir con un rol propio de enfermería como lo es la educación a la persona y su familia o cuidador.Abstract. Leg ulcers can be defined as loss of integrity of the skin below the knee, leg or foot over six weeks to heal. The most common cause of this type of injury is of vascular origin: venous (70%), arterial (10%) and mixed (10-15%), other causes (2.5%) include metabolic diseases such as diabetes which gives origin to artery disease and neuropathy. Leg ulcers are an important health problem that may substantially affect the quality of life of people who suffer, can take a long time to heal, restricting mobility, causing anxiety and depression. Objective: Provide nursing care to the person with skin lesions of diverse etiology. Method: undergraduate work in form of internship related to the care of people with skin lesions on Nursing Clinic: Clinic wounds. Results: Characterization of patients seeking consultation was conducted, identifying most of whom were women with a mean age of 62.5 years; the most prevalent injuries were Venous Ulcers (81.9%), followed by diabetic foot lesions (6.56%) Arterial Ulcers (4.92%), Ulcers Mixed (4.92%) and other types of wounds (1.64%), whose main factors associated, were venous and arterial insufficiency, hypertension, diabetes mellitus and obesity status. According to the requirements found in the review of documents from the clinic, was developed a protocol for admission of patients to standardize this process and guidance from admission nurse interventions; three information flipcharts directed to patients and their caregivers, with key features and care of the most prevalent diseases in the institution were conducted. At the same time, a clinical practice guideline was developed for intervention and care of people with pressure ulcers or at risk of suffering. Conclusions: It is essential to strive for prevention education, as most cases of leg injuries occur due to lack of preventive measures and mitigation of preventable risk factors associated; this internship or experience allowed students to consolidate and apply the acquired knowledge and to develop skills to care for the person with impaired tissues, and to comply with its own nursing role is education as a person and your family or caregiver.Pregrad

Development of tomatillo (Physalis ixocarpa Brot.) autotetraploids and their chromosome and phenotypic characterization

The tomatillo, Physalis ixocarpa Brot. (2n = 2x = 24), is an important crop in Mexico, and it is becoming appreciated in other countries. Polyploidy induction is expected to increase its breeding potential. The objective of this work was to develop and characterize tomatillo autotetraploids through colchicine-based induction. Young seedlings of the Rendidora cultivar were treated for 24 h with colchicine in concentrations ranging from 0.04% to 0.20%, and ploidy levels were tested by cytological and flow cytometry techniques. Autotetraploidy was induced with colchicine concentrations of 0.12% and 0.16%, with success rates of 67% and 65%, respectively. Presence of univalents, bivalents and multivalents was observed in prophase I and metaphase I. The basic genome size was not altered in the third generation progeny from treated plants. Autotetraploid plants were fertile and productive, but their pollen development was lower than their diploid counterpart. The polyploid plants showed higher values for life cycle length, plant height, fruit weight and equatorial diameter, fruits per plant, and soluble solid concentration. This is the first report of an autopolyploid cultivated tomatillo. Its genome duplication is readily induced with production of fertile plants, and may be valuable to introduce genetic plasticity in this crop

Capillary refill time response to a fluid challenge or a vasopressor test:an observational, proof-of-concept study

Background: Several studies have validated capillary refill time (CRT) as a marker of tissue hypoperfusion, and recent guidelines recommend CRT monitoring during septic shock resuscitation. Therefore, it is relevant to further explore its kinetics of response to short-term hemodynamic interventions with fluids or vasopressors. A couple of previous studies explored the impact of a fluid bolus on CRT, but little is known about the impact of norepinephrine on CRT when aiming at a higher mean arterial pressure (MAP) target in septic shock. We designed this observational study to further evaluate the effect of a fluid challenge (FC) and a vasopressor test (VPT) on CRT in septic shock patients with abnormal CRT after initial resuscitation. Our purpose was to determine the effects of a FC in fluid-responsive patients, and of a VPT aimed at a higher MAP target in chronically hypertensive fluid-unresponsive patients on the direction and magnitude of CRT response. Methods: Thirty-four septic shock patients were included. Fluid responsiveness was assessed at baseline, and a FC (500 ml/30 mins) was administered in 9 fluid-responsive patients. A VPT was performed in 25 patients by increasing norepinephrine dose to reach a MAP to 80–85 mmHg for 30 min. Patients shared a multimodal perfusion and hemodynamic monitoring protocol with assessments at at least two time-points (baseline, and at the end of interventions).Results: CRT decreased significantly with both tests (from 5 [3.5–7.6] to 4 [2.4–5.1] sec, p = 0.008 after the FC; and from 4.0 [3.3–5.6] to 3 [2.6 -5] sec, p = 0.03 after the VPT. A CRT-response was observed in 7/9 patients after the FC, and in 14/25 pts after tobjehe VPT, but CRT deteriorated in 4 patients on this latter group, all of them receiving a concomitant low-dose vasopressin. Conclusions: Our findings support that fluid boluses may improve CRT or produce neutral effects in fluid-responsive septic shock patients with persistent hypoperfusion. Conversely, raising NE doses to target a higher MAP in previously hypertensive patients elicits a more heterogeneous response, improving CRT in the majority, but deteriorating skin perfusion in some patients, a fact that deserves further research.</p

Ripening-related cDNAs in guava fruit (Psidium guajava L.). Characterization and expression analysis

"En este estudio se presentan los análisis bioinformáticos y de la expresión de cuatro clonas de ADNc que codifican para una poligalacturonasa (PG), para ácido 1-aminociclopropano-1-carboxílico oxidasa (ACCo), y para dos α-expansinas (a-Exp) en guayaba (Psidium guajava L.). Mediante RT-PCR se obtuvo un fragmento parcial de 301 pb (PgPGl) correspondiente a una PG que se expresa a partir de fruto maduro, uno de 320 pb (PgACOl) para una ACCo de fruto sobremaduro, y dos para α-expansinas: uno de 466 pb (PgEXP2) de fruto sobremaduro y otro de 362 pb (PgEXP3) de pedúnculo. El análisis bioinformático de los ADNc mostró que codifican para proteínas putativas con una alta homología con proteínas relacionadas. La secuencia de aminoácidos de la proteína parcial PgPG1 contiene regiones características y conservadas de las PGs en plantas superiores y está relacionada con la maduración de frutos; PgACO1 mostró características presentes en todas las ACCo y está relacionada con la maduración; PgEXP2 y PgEXP3 contienen parte de los dos dominios presentes de las expansinas, y están agrupadas filogenéticamente con las α-expansinas. Los estudios de expresión mediante Dot Blot mostraron que el gen PgPGl fue visible en todos los estadios de maduración del fruto, con mayor intensidad durante el estadio maduro; el gen PgACO1 fue visible en los cinco estadios de maduración del fruto y presentó su expresión más alta durante el estadio de transición, cuando comienza el cambio de color verde al amarillo (estos dos genes muestran comportamientos similares a los reportados en frutos climatéricos); en PgEXP2 la expresión génica se detectó en todos los tejidos, con un incremento a partir del estadio verde 2 al sobremaduro, similar al comportamiento reportado en frutos no climatéricos; para PgEXP3 la expresión fue visible en cuatro estadios de maduración del fruto y en pedúnculo, con mayor intensidad en el estadio maduro que en todos los demás.""Bioinformatics analysis and gene expression studies of four clones of guava cDNA encoding for a polygalacturonase (PG), an acid 1-aminocyclopropane-1-carboxylate oxidase (ACCo), and two α-expansins (a-Exp) in guava (Psidium guajava L.), is presented here. Using RT-PCR, a partial cDNA fragment of 301 bp (PgPGl) was associated to a PG from mature fruit, one of 320 bp (PgACOl) for an ACCo in overriped fruit, and two fragments for α-expansins: a 466 bp (PgEXP2) of overripe fruit and a 362 bp of peduncle (PgEXP3). cDNA analysis showed that these fragments encode putative proteins with high homology with related proteins. The aminoacid sequence of PgPG1 contains particular features and conserved regions of the PGs in higher plants and is related to fruit ripening; PgACO1 showed features present in all the ACCo and is related to fruit maturation; PgEXP2 and PgEXP3 partially contain two domains present in expansins; and they are phylogenetically grouped with α-expansins. Dot Blot expression studies showed that gene PgPGl was visible in all stages of fruit ripening, with higher intensity during mature stage. Gene PgACOl was visible in the five stages of fruit ripening, and was highest during the transition stage (these two genes displayed behaviors similar to those reported in climacteric fruits); PgEXP2 gene expression was detected in all tissues, with an increase from the Green Stage 2 to Overripe Stage 1, as it has been reported in non-climacteric fruits; for PgEXP3 the expression was visible in four stages of fruit ripening and at peduncle, with highest intensity at the mature stage.

Capillary refill time response to a fluid challenge or a vasopressor test:an observational, proof-of-concept study

Background: Several studies have validated capillary refill time (CRT) as a marker of tissue hypoperfusion, and recent guidelines recommend CRT monitoring during septic shock resuscitation. Therefore, it is relevant to further explore its kinetics of response to short-term hemodynamic interventions with fluids or vasopressors. A couple of previous studies explored the impact of a fluid bolus on CRT, but little is known about the impact of norepinephrine on CRT when aiming at a higher mean arterial pressure (MAP) target in septic shock. We designed this observational study to further evaluate the effect of a fluid challenge (FC) and a vasopressor test (VPT) on CRT in septic shock patients with abnormal CRT after initial resuscitation. Our purpose was to determine the effects of a FC in fluid-responsive patients, and of a VPT aimed at a higher MAP target in chronically hypertensive fluid-unresponsive patients on the direction and magnitude of CRT response. Methods: Thirty-four septic shock patients were included. Fluid responsiveness was assessed at baseline, and a FC (500 ml/30 mins) was administered in 9 fluid-responsive patients. A VPT was performed in 25 patients by increasing norepinephrine dose to reach a MAP to 80–85 mmHg for 30 min. Patients shared a multimodal perfusion and hemodynamic monitoring protocol with assessments at at least two time-points (baseline, and at the end of interventions).Results: CRT decreased significantly with both tests (from 5 [3.5–7.6] to 4 [2.4–5.1] sec, p = 0.008 after the FC; and from 4.0 [3.3–5.6] to 3 [2.6 -5] sec, p = 0.03 after the VPT. A CRT-response was observed in 7/9 patients after the FC, and in 14/25 pts after tobjehe VPT, but CRT deteriorated in 4 patients on this latter group, all of them receiving a concomitant low-dose vasopressin. Conclusions: Our findings support that fluid boluses may improve CRT or produce neutral effects in fluid-responsive septic shock patients with persistent hypoperfusion. Conversely, raising NE doses to target a higher MAP in previously hypertensive patients elicits a more heterogeneous response, improving CRT in the majority, but deteriorating skin perfusion in some patients, a fact that deserves further research.</p

Longitudinal Neuroimaging Analysis in Mild-Moderate Alzheimer's Disease Patients Treated with Plasma Exchange with 5% Human Albumin

Altres ajuts: This study was funded by Grifols. [...] James T. Becker (Department of Psychiatry, Neurology and Psychology. University of Pittsburgh, Pittsburgh PA, USA) read and commented on an earlier draft of the manuscript. Jordi Bozzo PhD, CMPP (Grifols) is acknowledged for medical writing and editorial assistance in the preparation of the manuscript.Recently, modifications of Aβ levels in CSF and plasma associated with improvement in memory and language functions have been observed in patients with mild-moderate Alzheimer's disease (AD) treated with plasma exchange (PE) with albumin replacement. To detect structural and functional brain changes in PE-treated AD patients as part of a Phase II clinical trial. Patients received between 3 and 18 PE with albumin (Albutein ® 5%, Grifols) or sham-PE (controls) for 21 weeks (divided in one intensive and two maintenance periods) followed by 6-month follow-up. Brain perfusion assessed by SPECT scans using an automated software (NeuroGam ®) and brain structural changes assessed by MRI were performed at weeks 0 (baseline), 21, and 44 (with additional SPECT at weeks 9 and 33). Statistical parametric mapping (voxel-based analysis, SPM) and Z-scores calculations were applied to investigate changes to baseline. 42 patients were recruited (39 evaluable; 37 analyzed: 18 PE-treated; 19 controls). There was a trend toward decreasing hippocampi and total intracranial volume for both patient groups during the study (p < 0.05). After six months, PE-treated patients had less cerebral perfusion loss than controls in frontal, temporal, and parietal areas, and perfusion stabilization in Brodmann area BA38-R during the PE-treatment period (p < 0.05). SPM analysis showed stabilization or absence of progression of perfusion loss in PE-treated patients until week 21, not observed in controls. Mild-moderate AD patients showed decreased brain volume and impairment of brain perfusion as expected for the progression of the disease. PE-treatment with albumin replacement favored the stabilization of perfusion