Rol del nivel leucocitario en el diagnóstico de apendicitis aguda en el Hospital Emergencias Grau - Essalud. Enero - diciembre 2013

Publicación a texto completo no autorizada por el autorDetermina el rol del nivel leucocitario en el diagnóstico de apendicitis aguda en el Tópico de Cirugía de Emergencia del Hospital Emergencias Grau durante el periodo enero-diciembre 2013, Lima-Perú. El estudio es de tipo observacional, descriptivo, retrospectivo. Se recogieron los datos de 621 historias clínicas de pacientes con sospecha de apendicitis aguda que fueron sometidos a cirugía, que cumplieron criterios de inclusión y exclusión. Se analizaron en distribución de frecuencias, medidas de tendencia central y dispersión. El performance diagnóstico del nivel de leucocitos totales, abastonados y neutrófilos, fue analizado mediante el uso de Curvas ROC. De los pacientes con apendicitis, 59.8% (n=332) eran hombres y 40.2% (n=223) mujeres. El grupo etáreo más afectado fue de 20 a 29 años (23.6%). El índice de apendicectomia con apéndice sin alteraciones significativas fue de 10.6%. Se confirmó apendicitis aguda mediante histopatología en el 92.6% (n=428) de pacientes con nivel de leucocitos totales elevado, en el 93.4% de pacientes con nivel de abastonados >500 cel/mm3 y en el 92.7% de pacientes con nivel de neutrófilos elevado. La media del conteo de leucocitos totales (17604 ± 4708), abastonados (958 ± 1081) y neutrófilos (13991 ± 4276) fue mayor en los pacientes con apendicitis aguda gangrenada. Para diferenciar entre pacientes con y sin apendicitis el punto de corte con mejor performance de leucocitos totales fue 12,320 cel/mm3 (S: 70.45%; E: 69.70% y ABC=0.708), de abastonados fue 384 cel/mm3 (S: 53.15%; E: 75.76% y ABC=0.655), y de neutrófilos fue 10,260 cel/mm3 (S: 63.60%; E: 77.27% y ABC=0.717); para diferenciar entre pacientes con apéndice normal y apendicitis no perforada (simple y gangrenada) el punto de corte de leucocitos totales fue 12,870 cel/mm3 (S: 64.97%; E: 74.24% y ABC=0.707), de abastonados fue 384 cel/mm3 (S: 52.45%; E: 75.76% y ABC=0.649), y de neutrófilos fue 10,260 cel/mm3 (S: 63.01%; E: 77.27% y ABC=0.714); y para diferenciar entre pacientes con apendicitis perforada vs pacientes con apéndice normal y apendicitis no perforada, el punto de corte de leucocitos totales fue 12,640 cel/mm3 (S: 81.82%; E: 37.78% y ABC=0.539), de abastonados fue 187 cel/mm3 (S: 88.64%; E: 36.05% y ABC=0.574), y de neutrófilos fue 9,468 cel/mm3 (S: 81.82%; E: 35.88% y ABC=0.557). Se concluye que los niveles de leucocitos totales, abastonados y/o neutrófilos no pueden ser utilizados como test diagnóstico ni marcadores de severidad del cuadro de apendicitis aguda, sin embargo estos niveles elevados sí apoyan al diagnostico de apendicitis aguda. Además un nivel de leucocitos totales mayor a 17604 cel/mm3, abastonados mayor a 958 cel/mm3, y/o de neutrófilos mayor a 13991 cel/mm3, apoyan al diagnóstico de apendicitis aguda gangrenada.Tesi

Autoimmune neurological conditions associated with Zika virus infection

Zika virus (ZIKV) is an emerging flavivirus rapidly spreading throughout the tropical Americas. mosquitoes is the principal way of transmission of the virus to humans. ZIKV can be spread by transplacental, perinatal, and body fluids. ZIKV infection is often asymptomatic and those with symptoms present minor illness after 3 to 12 days of incubation, characterized by a mild and self-limiting disease with low-grade fever, conjunctivitis, widespread pruritic maculopapular rash, arthralgia and myalgia. ZIKV has been linked to a number of central and peripheral nervous system injuries such as Guillain-Barré syndrome (GBS), transverse myelitis (TM), meningoencephalitis, ophthalmological manifestations, and other neurological complications. Nevertheless, mechanisms of host-pathogen neuro-immune interactions remain incompletely elucidated. This review provides a critical discussion about the possible mechanisms underlying the development of autoimmune neurological conditions associated with Zika virus infection

The effects of UV radiation on photosynthesis estimated as chlorophyll fluorescence in Zygnemopsis decussata (Chlorophyta) growing in a high mountain lake (Sierra Nevada, Southern Spain)

The effect of increased UV radiation on photosynthesis estimated as in vivo chlorophyll fluorescence i.e. optimal quantum yield (Fv/Fm) and electron transport rate (ETR) in the green filamentous alga Zygnemopsis decussata (Streptophyta, Zygnematales) growing in the high mountain lake "La Caldera" (Sierra Nevada, Spain) at 3050 m altitude was evaluated. Two sets of in situ experiments were conducted: (1) On July 2006, Fv/Fm was measured throughout the day at different depths (0.1, 0.25, 0.5 and 1 m) and in the afternoon, ETR and phenolic compounds were determined. In addition, in order to analyze the effect of UV radiation, Fv/Fm was determined in algae incubated for 3 days at 0.5m under three different light treatments: PAR+UVA+UVB (PAB), PAR+UVA (PA) and PAR (P). (2) On August 2007, Fv/Fm was determined under PAB, PA and P treatments and desiccation/rehydration conditions. Fv/Fm decreased in algae growing in surface waters (0.1 m) but also at 1 m depth compared to that at 0.5 m depth. The decrease of Fv/Fm at noon due to photoinhibition was small (less than 10%) except in algae growing at 1 m depth (44%). The maximal electron transport rate was 3.5-5 times higher in algae growing at 0.25-0.5 m respectively than that at 0.1 and 1 m depth. These results are related to the accumulation of phenolic compounds: i.e. the algae at 0.25-0.5 m presented respectively about a 3-5 times higher concentration of phenolic compounds than that of algae at 0.1-1 m depth. The protection mechanisms seem to be stimulated by UVB radiation, since Fv/Fm was higher in the presence of UVB (PAB treatment) compared to PA or P treatments. UVA exerts the main photoinhibitory effect, not only at midday, but also in the afternoon. UVB radiation also had a protective effect in algae grown under desiccation conditions for three days. During re-hydration, the rapid increase of Fv/Fm (after 1 h) was higher in the UVB-grown algae than in algae grown under UVA radiation. After 5 h, Fv/Fm values were similar in algae submitted to desiccation/rehydration under PAB and P treatments as they were in the control (submerged algae). The combined effect of desiccation and UVA produced the greatest decrease of photosynthesis in Z. decussata. Thus UVB, in contrast to other species, may support the recovery process. Z. decussata can acclimate to severe stress conditions in this high mountain lake by the photoprotection mechanism induced by UVB radiation through dynamic photoinhibition and the accumulation of phenolic compounds (UV screen and antioxidant substances).This research was supported by the Spanish Ministries of Environment (PN2003/25) and Education and Science (CGL2005/01564, AGL2005/02655, CGL 2008/01127, CGL 2008/05407) and Consejería de Innovación, Ciencia y Empresa, Junta de Andalucía (Excelencia project P07-CVI-02598)

Secondary phytohaemagglutinin (PHA) swelling response is a good indicator of T-cell-mediated immunity in free-living birds

El phytohaemagglutinin (PHA) se prueba para medir la inmunidad adquirida y es uno de los métodos más utilizados; actualmente, está siendo debatido a raíz de los nuevos conocimientos sobre la compleja fisiología del proceso. Como respuesta secundaria reiterada a los mayores desafíos vinculados a los aumentos de los niveles de linfocitos T circulantes sería indicativo de una respuesta inmune mediada por células, se realizó por primera vez un experimento bajo condiciones naturales con repetidas PHA desafíos en libre-viviendo los pájaros adultos y polluelos para arrojar luz sobre este tema. Hemos encontrado significativamente más fuerte respuesta a PHA inyección secundaria independiente del sexo o la edad, mientras que el control de la condición corporal, la segunda respuesta es en promedio 90% más grande que el primero. Igualmente, los recuentos de linfocitos fueron significativamente superiores en el segundo reto de PHA, mientras que no se encontraron diferencias significativas entre las aves no tratadas. Las correlaciones positivas significativas entre la PHA respuesta y ambos recuentos de linfocitos y los niveles de proteínas plasmáticas (principalmente albúmina, globulina (precursor) fueron recuperados, mientras que no hubo diferencias significativas en los niveles de proteínas plasmáticas recuperados entre los retos. Nuestros resultados son consistentes con las aves cautivas, apoyando la validez del PHA de la hinchazón de la piel como prueba precisa de haber adquirido células T como la inmunidad en aves.The validity of using the phytohaemagglutinin (PHA) test to measure acquired immunity, one of the most widely used methods, is currently being debated due to new knowledge on the complex physiology of the process. As a greater secondary response to repeated challenges linked to increases of circulating lymphocyte levels would be indicative of a T-cell-mediated immune response, we performed for the first time an experiment under natural conditions with repeated PHA challenges in free-living adult birds and chicks to shed light on this topic. We found significantly stronger secondary response to PHA injection independent of sex or age, while controlling for body condition, the second response being on average 90% larger than the first. Likewise, lymphocyte counts were significantly higher in the second PHA challenge, whereas no significant differences were found among untreated birds. Significant positive correlations between the PHA response and both lymphocyte counts and plasma protein levels (mainly albumin, globulin (precursor) were recovered, whereas no significant differences were recovered in plasma protein levels between challenges. Our results are consistent with those from captive birds, supporting the validity of the PHA skin-swelling test as an accurate gauge of acquired T-cell-mediated immunity in birds.Trabajo patrocinado por: Fondo Mejicano para Conservación de la Naturaleza. Proyecto PIE 2012 A-P-C-IGSI-12-12 Gobierno de Extremadura. CONACYT (I010/176/2012) y becas PO10014 y RE12002 Gobierno de Extremadura. Dirección General de Vida Silvestre. SGPA/ DGVS/08559/11peerReviewe

Automatización y Puesta en Operación de un Reactor Biodiesel

La producción de biodiesel en reactores batch resulta efectiva, aunque es muy costosa, es por ello que en este trabajo se presenta la automatización y puesta en operación de un reactor tipo batch, empleado en la producción de biodiesel. Con esto, se busca mejorar la productividad de este proceso.Se realizó la instrumentación de la temperatura y nivel de líquido en el reactor. Para la automatización y monitoreo del proceso, se empleó una plataforma Arduino como sistema de adquisición y procesamiento de los datos, y como vínculo entre el proceso y una computadora. Además, se desarrolló una interfaz gráfica

Alzheimer’s disease and type 2 diabetes mellitus: Pathophysiologic and pharmacotherapeutics links

At present, Alzheimer’s disease (AD) and type 2 diabetes mellitus (T2DM) are two highly prevalent disorders worldwide, especially among elderly individuals. T2DM appears to be associated with cognitive dysfunction, with a higher risk of developing neurocognitive disorders, including AD. These diseases have been observed to share various pathophysiological mechanisms, including alterations in insulin signaling, defects in glucose transporters (GLUTs), and mitochondrial dysfunctions in the brain. Therefore, the aim of this review is to summarize the current knowledge regarding the molecular mechanisms implicated in the association of these pathologies as well as recent therapeutic alternatives. In this context, the hyperphosphorylation of tau and the formation of neurofibrillary tangles have been associated with the dysfunction of the phosphatidylinositol 3-kinase and mitogen-activated protein kinase pathways in the nervous tissues as well as the decrease in the expression of GLUT-1 and GLUT-3 in the different areas of the brain, increase in reactive oxygen species, and production of mitochondrial alterations that occur in T2DM. These findings have contributed to the implementation of overlapping pharmacological interventions based on the use of insulin and antidiabetic drugs, or, more recently, azeliragon, amylin, among others, which have shown possible beneficial effects in diabetic patients diagnosed with AD

Psycho-Neuro-Endocrine-Immunological Basis of the Placebo Effect: Potential Applications beyond Pain Therapy

The placebo effect can be defined as the improvement of symptoms in a patient after the administration of an innocuous substance in a context that induces expectations regarding its effects. During recent years, it has been discovered that the placebo response not only has neurobiological functions on analgesia, but that it is also capable of generating effects on the immune and endocrine systems. The possible integration of changes in different systems of the organism could favor the well-being of the individuals and go hand in hand with conventional treatment for multiple diseases. In this sense, classic conditioning and setting expectations stand out as psychological mechanisms implicated in the placebo effect. Recent advances in neuroimaging studies suggest a relationship between the placebo response and the opioid, cannabinoid, and monoaminergic systems. Likewise, a possible immune response conditioned by the placebo effect has been reported. There is evidence of immune suppression conditioned through the insular cortex and the amygdala, with noradrenalin as the responsible neurotransmitter. Finally, a conditioned response in the secretion of different hormones has been determined in different studies; however, the molecular mechanisms involved are not entirely known. Beyond studies about its mechanism of action, the placebo effect has proved to be useful in the clinical setting with promising results in the management of neurological, psychiatric, and immunologic disorders. However, more research is needed to better characterize its potential use. This review integrates current knowledge about the psycho-neuro-endocrine-immune basis of the placebo effect and its possible clinical applications

Experiencia y manejo de dos casos de gangrena de Fournier en pacientes pediátricos en el Instituto Nacional de Salud del Niño - San Borja

La gangrena de Fournier es una patología que se encuentra predominantemente en varones adultos y extremadamente rara en niños. Se han descrito múltiples factores predisponentes en los niños, incluyendo la circuncisión, la dermatitis del pañal, la presencia de abscesos, traumatismos anorrectales y deficiencias inmunológicas. Los signos y síntomas característicos incluyen edema e hiperemia de rápida evolución en la región perineal acompañados de dolor intenso y fiebre. Una vez que se diagnostica la gangrena de Fournier, se debe instaurar tratamiento de forma inmediata, antibióticos endovenosos de amplio espectro y debridamiento quirúrgico temprano del tejido desvitalizado. A continuación presentamos un reporte de casos que incluye las características clínicas y epidemiológicas de dos pacientes pediátricos con gangrena de Fournier que recibieron tratamiento médico y quirúrgico en el Instituto Nacional de Salud del Niño de San Borja

Insights of Active Extension Within a Collisional Orogen From GNSS (Central Betic Cordillera, S Spain)

The coexistence of shortening and extensional tectonic regimes is a common feature in orogenic belts. The westernmost end of the Western Mediterranean is an area undergoing shortening related to the 5 mm/yr NNW‒SSE convergence of the Nubia and Eurasia Plates. In this region, the Central Betic Cordillera shows a regional ENE‒WSW extension. Here, we present GNSS-derived geodetic data along a 170 km-long transect orthogonal to the main active normal faults of the Central Betic Cordillera. Our data indicate that the total extension rate along the Central Betic Cordillera is 2.0 ± 0.3 mm/yr. Extension is accommodated in the eastern (0.8 ± 0.3 mm/yr in the Guadix-Baza Basin) and western (1.3 ± 0.3 mm/yr in the Granada Basin) parts of the Central Betic Cordillera, while no extension is recorded in the central part of the study area. Moreover, our data permit us to quantify, for the first time, short-term fault slip rates of the Granada Fault System, which is one of the main seismogenic sources of the Iberian Peninsula. We deduce a fault slip rate of ∼1.3 ± 0.3 mm/yr for the whole Granada Basin, with 0.9 ± 0.3 mm/yr being accommodated in the Granada Fault System and 0.4 ± 0.3 mm/yr being accommodated in the southwestern sector of the Granada Basin, where no active faults have been previously described at the surface. The heterogeneous extension in the Central Betic Cordillera could be accommodated by shallow high-angle normal faults that merge with a detachment at depth. Part of the active extension could be derived from gravitational instability because of underlying over-thickened crust.This research was funded by the Generalitat Valenciana (Valencian Regional Government, Research project AICO/2021/196), Spanish Ministry of Science, Innovation and University (Research Projects RTI2018-100737-B-I00 and PID2021-127967NB-I00), the University of Alicante (Research Project VIGROB053), the University of Jaén (POAIUJA 2021–2022, CEACTEMA and Programa Operativo FEDER Andalucía, 2014–2020—call made by UJA, 2018, Ref. 1263446), P18-RT-3275 (Junta de Andalucía/FEDER), and the Junta de Andalucía regional government (RNM282 and RNM 148 research groups). The Institut Cartogràfic Valencià, Agencia Valenciana de Seguridad y Respuesta a las Emergencias (Generalitat Valenciana), Consorcio Provincial para el Servicio de Prevención y Extinción de Incendios y Salvamento de Alicante, Excelentísimas Diputaciones Provinciales de Alicante y Castellón, and the Ayuntamiento de Almoradí also provided partial funding

Long-Term Outcomes After Autologous Versus Allogeneic Stem Cell Transplantation in Molecularly-Stratified Patients With Intermediate Cytogenetic Risk Acute Myeloid Leukemia: A PETHEMA Study

PETHEMA (Programa Español de Tratamientos en Hematología) and GETH (Grupo Espa~nol de Trasplante Hematopoyético y Terapia Celular) Cooperative GroupsAcute myeloid leukemia (AML) with intermediate risk cytogenetics (IRcyto) comprises a variety of biological entities with distinct mutational landscapes that translate into differential risks of relapse and prognosis. Optimal postremission therapy choice in this heterogeneous patient population is currently unsettled. In the current study, we compared outcomes in IRcyto AML recipients of autologous (autoSCT) (n = 312) or allogeneic stem cell transplantation (alloSCT) (n = 279) in first complete remission (CR1). Molecular risk was defined based on CEBPA, NPM1, and FLT3-ITD mutational status, per European LeukemiaNet 2017 criteria. Five-year overall survival (OS) in patients with favorable molecular risk (FRmol) was 62% (95% confidence interval [CI], 50-72) after autoSCT and 66% (95% CI, 41-83) after matched sibling donor (MSD) alloSCT (P = .68). For patients of intermediate molecular risk (IRmol), MSD alloSCT was associated with lower cumulative incidence of relapse (P < .001), as well as with increased nonrelapse mortality (P = .01), as compared to autoSCT. The 5-year OS was 47% (95% CI, 34-58) after autoSCT and 70% (95% CI, 59-79) after MSD alloSCT (P = .02) in this patient subgroup. In a propensity-score matched IRmol subcohort (n = 106), MSD alloSCT was associated with superior leukemia-free survival (hazard ratio [HR] 0.33, P = .004) and increased OS in patients alive 1 year after transplantation (HR 0.20, P = .004). These results indicate that, within IRcyto AML in CR1, autoSCT may be a valid option for FRmol patients, whereas MSD alloSCT should be the preferred postremission strategy in IRmol patients.Supported by a Río Hortega academic clinical fellowship (CM19/00194) from the Instituto de Salud Carlos III, Spain (E.R.A.). Additional funding has been provided by CIBERONC grants to J.P.S. (CB16/12/00480), M.M.S. (CB16/12/00369) and B.V. (CB16/12/00233)