Lead poisoning : differential diagnosis of chronic abdominal pain, case report and review

En este artículo se presenta el caso de un paciente con intoxicación crónica por plomo, cuya principal manifestación clínica fue dolor abdominal. Esta es una intoxicación que generalmente se presenta en pacientes que están en contacto laboral con este metal. En este artículo se revisan las manifestaciones clínicas más frecuentes y el manejo de esta patología, ya que de no identificarse y tratarse de forma oportuna, cursa con una alta morbimortalidad.Reporte caso199-207This article presents a case of chronic lead poisoning, which principal manifestation was abdominal pain. This usually occurs in patient who works with the metal. We reviewed the most frequent clinical manifestation and management. If is untreated this poisoning has a high morbidity and mortality

In Silico Design and Selection of New Tetrahydroisoquinoline-Based CD44 Antagonist Candidates

CD44 promotes metastasis, chemoresistance, and stemness in different types of cancer and is a target for the development of new anti-cancer therapies. All CD44 isoforms share a common N-terminal domain that binds to hyaluronic acid (HA). Herein, we used a computational approach to design new potential CD44 antagonists and evaluate their target-binding ability. By analyzing 30 crystal structures of the HA-binding domain (CD44HAbd), we characterized a subdomain that binds to 1,2,3,4-tetrahydroisoquinoline (THQ)-containing compounds and is adjacent to residues essential for HA interaction. By computational combinatorial chemistry (CCC), we designed 168,190 molecules and compared their conformers to a pharmacophore containing the key features of the crystallographic THQ binding mode. Approximately 0.01% of the compounds matched the pharmacophore and were analyzed by computational docking and molecular dynamics (MD). We identified two compounds, Can125 and Can159, that bound to human CD44HAbd (hCD44HAbd) in explicit-solvent MD simulations and therefore may elicit CD44 blockage. These compounds can be easily synthesized by multicomponent reactions for activity testing and their binding mode, reported here, could be helpful in the design of more potent CD44 antagonists

The barley a-thionin promotor is rich in negative regulatory motifs and directs tissue-specific expression of a reporter gene in tobacco.

The promoter of the barley α-thionin gene (1.6 kb) fused to the β-glucuronidase (GUS) gene directs temporally-controled, tissue-specific expression in the endosperm of transgenic tobacco. The nucleotide sequence of this promoter shows negative regulatory motifs which have been functionally analyzed in other gene

Is industrial ecology a proper way to introduce sustainability into technical universities

Industrial Ecology (IE) started as an emerging field in the seventies of the twentieth century in countries such as Japan and USA. Following this example, other countries have developed initiatives and methodologies in order to introduce Industrial Ecology principles in their academic backgrounds. In this manner, concepts of IE have been spreading continuously worldwide. Thus, a comparison is made among academic backgrounds of IE which are taught in technical universities of Europe and Latin America, by comparing technological universities of Sweden (Royal Institute of Technology), Italy (Politecnico di Torino), Spain (UPC of Catalonia) and Peru (Universidad Nacional Agraria La Molina and Universidad Nacional Del Santa). These universities are chosen because they are located in countries that represent different levels of implementation of IE policies, from the official educational backgrounds of north Europe to first attempts of Latin America. Our study is based on the quantification and qualification of diverse parameters. Such parameters include the existence of educational programmes, specialized departments and their projects, events and publications. Finally, an investigation of the existence of congress, conferences and public workshops is researched. This article aims to determine academic differences between Europe and Latin America to reveal a scale of implementation of actual methodologies. Moreover, we propose the means to improve a comparative methodology of study and the possibilities to develop a multidisciplinary and multicultural scientific discipline, which is Industrial Ecology, as a way to introduce sustainability concepts into programmes of technological universities.Peer Reviewe

General measures in the emergency department for pediatric patients poisoned

Introducción: La exposición a sustancias tóxicas es frecuente en pediatría. En Colombia, entre 2006 y 2008 se presentaron 40061 casos de intoxicaciones, de las cuales 19 723 correspondieron a menores de 14 años de edad. En 2009 se presentaron 187 muertes, lo que corresponde a una tasa de mortalidad de 0,6 casos por cada 100 000 habitantes y una tasa de letalidad de 9,48 por cada 100 000 casos de pacientes intoxicados. Objetivo: Evaluar en la literatura el papel de las medidas generales como tratamiento en el paciente pediátrico intoxicado y determinar cuáles han demostrado ser seguras y eficaces. Método: Selección de artículos (búsqueda en inglés y español en Medline, PubMed, Academic Search Complete, Science Direct y SciELO) y extracción de datos, según la aplicación de las medidas generales en el manejo de los pacientes intoxicados en el servicio de urgencias. Conclusiones: Es importante conocer el mecanismo de acción de las técnicas para disminuir la absorción o aumentar la eliminación de sustancias tóxicas y las indicaciones y contraindicaciones para su aplicación, y brindar un adecuado y efectivo tratamiento en los servicios de urgencias.Artículo de revisión154-165Introduction: Exposure to toxic substances is common in pediatrics. In Colombia in between the 2006 and 2008 there were 40 061 cases of poisoning, of which 19 723 were in younger than 14 years old. In 2009 there were a total of 187 deaths which corresponds to a mortality rate of 0.6 cases per 100000 inhabitants, and a fatality rate of 9.48 per 100 000 cases of poisoned patients. Objective: Evaluate in the literature the role of general measures for treatment in pediatric patients intoxicated and determine which are the measures that have proven safe and effective. Method: Selection articles (in English and Spanish, from Medline, PubMed, Academic Search Complete, Science Direct, and SciELO) and data extraction (focused on the implementation of general measures in the management of poisoned patients in the emergency department). Conclusions: Knowledge of the mechanism of action of different techniques to decrease absorption or enhance elimination of toxic substances, the indications and contraindications for use are important to provide adequate and effective treatment in the emergency department

Chemical Meningitis : a great simulator

Se ha reportado la meningitis química como una rara reacción adversa secundaria a la administración de un gran número de agentes farmacológicos, con una presentación clínica y unos hallazgos en el líquido cefalorraquídeo (LCR) muy variados que pueden llegar a confundir la etiología del cuadro clínico, donde el diagnóstico está basado en un proceso de exclusión de otras entidades del sistema nervioso central. El artículo presenta el caso de una mujer de 36 años de edad, con antecedente de intervenciones quirúrgicas para la resección de macroadenoma hipofisario, a quien se le quería descartar una fístula del LCR mediante la realización de un cisterno-TAC, con medio de contraste hidrosoluble. Posterior a la realización de este, presentó signos y síntomas sugestivos de meningitis, aun cuando se le descartó meningitis séptica.Reporte de caso374-380Paciente femeninoChemical meningitis has been reported as a rare adverse reaction secondary to the administration of a large number of pharmacological agents, with a clinical presentation and findings in the cerebrospinal fluid (CSF) which can confuse the etiology of the clinical picture, where the diagnosis is based on a process of exclusion of other entities in the central nervous system. The article presents the case of a 36-year-old woman with a history of surgery for resection of pituitary macroadenoma, who is wanted CSF fistula rule by performing a cisternoCT with water-soluble contrast, presenting after the accomplishment of this, signs and symptoms suggestive of meningitis, put away septic meningitis

Aging and delirium : an old known in the Emergency Department

on el aumento de la expectativa de vida, se está llegando a un incremento marcado de la patología geriátrica en los departamentos de urgencias; en el caso del delirium se ha demostrado en cerca del 14% de los ancianos hospitalizados y llegando a una incidencia variable entre el 10 al 52% en el grupo postquirúrgico de cadera. El delirium en los últimos 30 años ha presentado un interés marcado en la literatura médica como resultado del renacimiento como diagnostico en la unidades de urgencias y cuidados intensivos, seguramente como consecuencia de la aparición de especialidades médicas como la geriatría que han rescatado la patología del anciano; el presente artículo realiza una revisión del delirium en los departamentos de urgencias y su correlación con el envejecimiento de la población.Paciente adultoWith increasing life expectancy, it is coming to a marked increase of the geriatric diseases in emergency departments; multifactorial disease and increasingly of interest in the clinical setting. example of this reality is the delirium, which in the past 30 years has produced a marked interest in the medical literature as a result of the Renaissance as a diagnosis in the emergency units and intensive care, probably as a result of the emergence of medical specialties as geriatrics who have rescued the old man’s disease, this article presents a review of delirium in emergency departments and their correlation with the aging population.Revista Nacional - Indexad

Gastric Perforation and Phlegmon Formation by Foreign Body Ingestion

This is a case report of foreign body ingestion in a suicide attempt resulting in gastric perforation and phlegmon formation during a subsequent 6 month period that eventually required surgical intervention. The patient had a prolonged course because she did not report a history of foreign body ingestion and the initial evaluating physicians had no suspicion about possible foreign body ingestion and may have missed important findings on physical examination. Gastric perforation by a foreign object  may have a slow course rather than presenting acute abdomen. The realization of a proper physical examination in the emergency department is key to an accurate diagnosis

Tuberculosis, a risk for health workers

La tuberculosis es una enfermedad de gran impacto en nuestro país y en el mundo. Aunque las estrategias de la Organización Mundial de la Salud para controlarla pueden curar casi todos los casos, la resistencia a los medicamentos y el riesgo de transmisión, especialmente en los trabajadores del área de salud, cada día cobran un mayor valor. La tuberculosis representa un riesgo ocupacional significativo, con mayor incidencia en los trabajadores del área de salud sobre la población general, principalmente en los países en desarrollo. El personal de la salud es fundamental en la lucha contra la tuberculosis y, por lo tanto, debe estar protegido. Los factores de riesgo de contagio incluyen la frecuencia de pacientes con tuberculosis atendidos, la función y el lugar de trabajo del trabajador del área de salud, la demora en el diagnóstico, la presencia de pacientes con cepas multirresistentes, los inadecuados sistemas de ventilación, la falta de protección adecuada contra aerosoles y el personal con compromiso de su estado inmunológico o desnutrición.Los aspectos clave para el control y la prevención de la transmisión en hospitales, son la identificación precoz de los casos, las medidas de protección ambiental y los programas efectivos para el control del personal sanitario. Las guías sobre prevención en tuberculosis recomiendan aislamiento en salas ventiladas con presión negativa y el uso de protección respiratoria para todos los trabajadores de la salud en contacto.227-236The impact of tuberculosis in Colombia and in the world is important. Although WHO strategies to control it can cure almost all cases, drug resistance and the risk of transmission, especially to health care workers charge a hefty price. Tuberculosis represents an important occupational risk, with higher incidence amongst health care workers compared with general population, mainly indeveloping countries.The staff is crucial in the fight against tuberculosis and must be protected. Risk factors include the frequency of tuberculosis patients treated, the role and workplace of health workers, delayed diagnosis, presence of patients with multiresistant tuberculosis strains, inadequate ventilation, lack of adequate protection against aerosol and personal with altered immunological status or malnutrition.The key points for control and prevention of tuberculosis transmission in hospitals, are earl cases identification, environmental protection measures and an effective program for control of health personnel. Tuberculosis preventionguidelines recommend patient isolation in ventilated rooms with negative pressure and use of respiratory protection for all health workers in patient contact

Guidelines for induction and intubation sequence fast in emergency service

La secuencia de intubación rápida (SIR) es un procedimiento diseñado para minimizar el tiempo necesario en el aseguramiento de la vía aérea mediante la colocación de un tubo endotraqueal en pacientes con alto riesgo de broncoaspiración, especialmente en situaciones de emergencia. Teniendo claro este panorama, es indiscutible la importancia de la educación y el entrenamiento relacionado con la secuencia de intubación rápida que debe hacerse a los médicos responsables de las salas de reanimación, los servicios de urgencias y los paramédicos responsables del manejo de campo en emergencias y desastres. Este documento es una revisión actualizada del tema, cuyo objetivo es servir de guía para todos quienes estén interesados.Artículo original75-198The rapid sequence intubation (RSI) is a procedure designed to minimize the time spent in securing the airway by endotracheal tube placement in emergency situations in patients at high risk of aspiration. Being clear about this situation, it is unquestionable the importance of education and training related to rapid sequence intubation to be 176 Pérez P., Moreno A., Gempeler F.E. Guía para la secuencia de inducción e intubación rápida... made to the physicians responsible for the recovery rooms, emergency services and paramedics responsible for managing emergencies and disasters field. This document is a review of the literature that is intended as a guide for those interested in this important topic