Valor predictivo de la procalcitonina en niños con sospecha de sepsis

ResumenIntroducciónEl uso de biomarcadores podría constituir una herramienta en el diagnóstico, pronóstico y estratificación en la sepsis. El objetivo fue analizar el valor de la procalcitonina (PCT), proteína C reactiva (PCR) y lactato en la predicción de shock séptico, mortalidad y en la estratificación en niños con sospecha de sepsis.Pacientes y métodoEstudio prospectivo en 81 pacientes en los cuales se midió niveles plasmáticos de PCT, PCR y lactato al ingreso en la unidad de cuidados intensivos. Los pacientes se categorizaron en síndrome de respuesta inflamatoria sistémica, sepsis, sepsis grave y shock séptico.ResultadosLas concentraciones de la PCT (ng/mL) aumentaron significativamente de acuerdo a la gravedad de la sepsis: 0,36 (0-1,2) para síndrome de respuesta inflamatoria sistémica; 1,96 (0,4-3,5) para sepsis; 7,5 (3,9-11,1) en sepsis grave; y 58,9 (35,1-82,7) para shock séptico (p<0,001). Comparada con la PCR y el lactato, el área bajo la curva ROC reveló un poder discriminativo favorable de la PCT para predecir shock séptico y mortalidad: 0,91 (IC95%: 0,83-0,97) y 0,80 (IC95%: 0,69-0,88), respectivamente.ConclusionesA diferencia de la PCR y el lactato, la determinación de la PCT al ingreso en la unidad de cuidados intensivos es un buen predictor de shock séptico y mortalidad, y permite estratificar a los pacientes de acuerdo a la gravedad de la sepsis.AbstractIntroductionThe use of biomarkers could be a tool for diagnosis, prognosis and stratifying children with sepsis. Our main goal was to analyze the value of procalcitonin (PCT), C reactive protein (CRP) and lactate in predicting mortality, septic shock and the stratification in children with suspected sepsisPatients and methodProspective study in 81 patients. Plasma levels of PCT, CRP and lactate were measured at admission in the pediatric intensive care unit. Patients were categorized into systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock.ResultsConcentrations of PCT (ng/mL) increased significantly according to the severity of sepsis: 0.36 (0-1.2) for systemic inflammatory response syndrome; 1.96 (0.4-3.5) for sepsis; 7.5 (3.9-11.1) for severe sepsis; and 58.9 (35.1-82.7) for septic shock (P<.001). Compared to CRP and lactate, the area under the ROC curve revealed a good discriminative power of PCT to predict septic shock and mortality, 0.91 (95% CI: 0.83-0.97) and 0.80 (95% CI: 0.69-0.88), respectively.ConclusionsIn contrast to CRP and lactate, the determination of PCT in pediatric intensive care unit admission is a good predictor of mortality and septic shock and can stratify patients according to severity of sepsis

Human papillomavirus and Epstein-Barr virus infections in breast cancer from chile

<p>Abstract</p> <p>Background</p> <p>Human papillomavirus (HPV) and Epstein Barr virus (EBV) have been found in breast carcinomas (BCs) around the world. In this study, fifty-five BCs from Chile were analyzed for HPV and EBV presence. In addition, HPV-16 viral load/physical status and E6/E7 expressions were determined.</p> <p>Results</p> <p>The amplification of a housekeeping gene showed that 46/55 samples (84%) had amplifiable DNA. HPV-16 was detected in 4/46 BCs (8.7%) and EBV was detected in 3/46 (6.5%) BCs. The analysis of HPV-16 physical status showed that this virus was integrated in all of the tumors with a relatively low viral load (range: 0.14 to 33.8 copies/cell). E6 and E7 transcripts, however, were not detected in any HPV-16 positive specimens. Using a Cox-regression model, we found a statistically significant association between EBV presence and poor survival (p = 0.013).</p> <p>Conclusions</p> <p>The findings in this study suggest that it is unlikely that HPV and/or EBV play a direct role in the etiology of BC.</p

Sexualidad e histerectomía: diferencias entre un grupo de mujeres con y sin ooforectomía

Antecedentes: La ooforectomía bilateral, al momento de la histerectomía, es comprendida como una medida profiláctica para cáncer de ovario convirtiéndose en el órgano sano más frecuentemente extraído. La extracción profiláctica de ovarios alcanza una frecuencia del 40-55% de los casos de histerectomía. Se ha demostrado que las mujeres con histerectomía y ooforectomía muestran con mayor frecuencia deterioro de la función sexual que aquellas con sólo histerectomía. Objetivo: Comparar las características de la función sexual de un grupo de mujeres histerectomizadas, con y sin extracción de ovarios, a los 6 meses posteriores a la cirugía. Método: Estudio analítico, longitudinal, prospectivo en 67 mujeres: 35 histerectomizadas (GH) y 32 histerectomizadas con ooforectomía (GH-O). Para la recolección de los datos se aplicó un cuestionario al tercer día posterior a la cirugía, y repetido a los 6 meses para determinar las características de la función sexual. Resultados: Después del control de variables basales, se produce una diferencia significativa entre el GH-O y el GH en cuanto a prevalencia y frecuencia de dispareunia al sexto mes, frecuencia de orgasmo, frecuencia de relaciones sexuales y grado de excitación sexual. Conclusiones: La decisión de realizar una ooforectomía debe ser enfrentada con precaución en el caso de las mujeres con bajo riesgo de cáncer de ovario, considerando el riesgo individual de alteraciones sexuales, así como también, el riego inherente a la cirugía.Background: Bilateral oophorectomy, practiced at the time of hysterectomy, is understood as a prophylactic measurement for ovarian cancer, becoming the most frequently extracted healthy organ. Prophylactic oophorectomy has been reported at a frequency of 40-55% cases of hysterectomy. It has been demonstrated that women show a decrease of the sexual function after hysterectomy with bilateral oophorectomy more frequently than the women with hysterectomy only. Aim: To compare the characteristics of the sexuality in a group of women with and without oophorectomy, at the time of surgery and at 6 months postoperative. Method: Analytical, longitudinal and prospective study of 67 women, 35 with hysterectomy (GH) and 32 hysterectomized and oophorectomized (GH-O). Two surveys, at the time of surgery and six months later were carried out to determine the sexual function. Results: A significant difference was found between the GH-O group and the GH group in prevalence and frequency of dispareunia, frequency of orgasm, frequency of intercourse, and sexual excitation. Conclusions: The decision for oophorectomy must be made with caution in the case of the women with low risk of ovarian cancer, considering the individual risk of sexual dysfunction as well as the risks inherent in the surgery

Beneficial effects of mineralocorticoid receptor blockade in experimental non-alcoholic steatohepatitis

BackgroundTherapeutic options to treat Non-alcoholic steatohepatitis (NASH) are limited. Mineralocorticoid receptor (MR) activation could play a role in hepatic fibrogenesis and its modulation could be beneficial for NASH. AimTo investigate whether eplerenone, a specific MR antagonist, ameliorates liver damage in experimental NASH. MethodsC57bl6 mice were fed a choline-deficient and amino acid-defined (CDAA) diet for 22weeks with or without eplerenone supplementation. Serum levels of aminotransferases and aldosterone were measured and hepatic steatosis, inflammation and fibrosis scored histologically. Hepatic triglyceride content (HTC) and hepatic mRNA levels of pro-inflammatory pro-fibrotic, oxidative stress-associated genes and of MR were also assessed. ResultsCDAA diet effectively induced fibrotic NASH, and increased the hepatic expression of pro-inflammatory, pro-fibrotic and oxidative stress-associated genes. Hepatic MR mRNA levels significantly correlated with the expression of pro-inflammatory and pro-fibrotic genes and were significantly increased in hepatic stellate cells obtained from CDAA-fed animals. Eplerenone administration was associated to a reduction in histological steatosis and attenuation of liver fibrosis development, which was associated to a significant decrease in the expression of collagen-1, collagen type III, alpha 1 and Matrix metalloproteinase-2. ConclusionThe expression of MR correlates with inflammation and fibrosis development in experimental NASH. Specific MR blockade with eplerenone has hepatic anti-steatotic and anti-fibrotic effects. These data identify eplerenone as a potential novel therapy for NASH. Considering its safety and FDA-approved status, human studies are warranted