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Resumen OBJETIVO Analizar el efecto en México de la mortalidad producida por la enfermedad renal crónica secundaria a la diabetes mellitus. MATERIAL Y MÉTODO Estudio observacional efectuado de 1998 a 2014, en el que se tomó como base un registro nacional correspondiente a un lapso relativamente prolongado de 17 años, reconociendo a esta enfermedad en tanto entidad nosológica diferenciada, utilizando como metodología de análisis la minería de datos, y evitando en lo posible las ambigüedades o limitaciones detectadas en los estudios previamente publicados. RESULTADOS En las dos últimas décadas se han duplicado la prevalencia y las tasas de mortalidad por enfermedad renal crónica en la República Mexicana, lo que supone un elevado costo humano y financiero, además de que esta enfermedad reduce significativamente la calidad y la esperanza de vida de la población adulta mexicana. CONCLUSIONES Es necesario optimizar las estrategias de atención del paciente con enfermedad renal crónica sin descartar el uso de estrategias de prevención eficaces, dirigidas a la población general.
Abstract OBJECTIVE To analyze the impact in Mexico of the mortality produced by chronic renal failure secondary to diabetes mellitus. MATERIAL AND METHOD An observational study was done from 1998 to 2014 on the basis of a national registry corresponding to a relatively long period of 17 years, recognizing this pathology as a differentiated nosological entity, using the data mining as methodology of analysis, and avoiding as far as possible the ambiguities or limitations detected in previously published studies. RESULTS In the last two decades, the prevalence and mortality rates for chronic renal failure has doubled in Mexico, which means a high human and financial cost, in addition to the fact that this disease significantly reduces the quality of life and the life expectancy of the Mexican adult population. CONCLUSION It is necessary to optimize the care strategies for patients with chronic renal failure, without ruling out the use of effective prevention strategies focused on the general population.
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The breeding of South American camelids is the main economic activity of the high Andean region of South America and it, is potentially, the most profitable resource in of the Puna environmental conditions of the Puna. The duration of the gestation in alpaca is 339.7 ± 12 days. The objective of the present work was to macroscopically and microscopically describe the ontogenic development of the splanchnic cavities of the alpaca and to determine the gestational time in which the post-cranial ossification centers are observed in the embryos/fetuses of this species, from day 21 to 107 of gestation. The documentation of normal ontogenic development, which is vacant for this period, is of the utmost importance to understand the consequences of the alterations at the different gestational times, as well as for the estimation of the gestational age in the case of abortions. Forty-seven alpaca specimens of both sexes, at different times of their gestational development, collected during slaughter at local slaughterhouses of the Department of Huancavelica, Peru, were evaluated. Specimens were assigned to seven groups according to their morphological characteristics. The embryogenesis in the alpaca was characterized by a series of changes comparable to those occurring in other mammals with similar gestational periods. Despite these similarities, species differences were found in some organs as stomach, which are observed too in adult individuals.
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Camelídeos Americanos/embriologia , Embrião de Mamíferos/anatomia & histologia , Animais , Desenvolvimento Embrionário , Feminino , Idade Gestacional , Masculino , Osteogênese , Gravidez , Estômago/embriologiaRESUMO
Resumen INTRODUCCIÓN: El cannabis se erige como la droga ilícita más consumida en el mundo. Actualmente no existen alternativas farmacológicas específicas para el tratamiento de su adicción, por lo que se ha postulado la utilidad del uso de cannabinoides como herramienta terapéutica. Ellos actuarían principalmente a través de la disminución de síntomas de abstinencia y craving (deseo o compulsión por consumir), pero su efectividad aún no está clara. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos siete revisiones sistemáticas que en conjunto incluyeron 15 estudios primarios, de los cuales cuatro corresponden a ensayos aleatorizados. Concluimos que el uso de cannabinoides podría resultar en poco o nulo aumento en la abstinencia al finalizar el tratamiento, y probablemente aumenta los efectos adversos.
Abstract INTRODUCTION: Cannabis stands as the most used illegal drug in the world. Currently there are no pharmacologic alternatives to treat its addiction, so the use of Cannabinoids has been postulated as a therapeutic tool. They would act mainly through decrease in abstinence and craving symptoms but its effectiveness remains unclear. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified seven systematic reviews including 15 studies, of which four were randomized trials. We concluded the use of cannabinoids might result in little or no increase in abstinence at the end of treatment, and it probably increases adverse effects.
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Humanos , Canabinoides/uso terapêutico , Abuso de Maconha/tratamento farmacológico , Canabinoides/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Bases de Dados Factuais , Resultado do TratamentoRESUMO
South American camelids have several biological, morphological and behavioural adaptations that allow them to live in geographical areas dominated by high altitudes. The liver has hematopoietic functions during the prenatal life, which could be modified in response to the unfavorable habitat. However, there are no previous data on the prenatal development of the liver in these species. In the present work, a study on the macroscopic and microscopic morphology of the liver of the alpaca during ontogeny was performed. Forty-one animals ranging in age from 20 days of embryonic development to adults were studied. Macroscopic and microscopic observations were performed on samples subjected to different techniques. Less than 7-g specimens were studied with stereoscopic magnifying glass. The general characteristics of the prenatal liver are similar to those of other mammals, and the structures related to hematopoietic function follow an ontogenic pattern similar to that of previously studied precocial species. However, there are differences in morphology when compared to descriptions for the Old World camelids, including the absence of relation between the caudate lobe and the right kidney and the lack of interlobular connective tissue.
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Camelídeos Americanos/embriologia , Fígado/anatomia & histologia , Fígado/embriologia , Microscopia/veterinária , Animais , Camelídeos Americanos/anatomia & histologia , Embrião de Mamíferos/anatomia & histologia , Rim/anatomia & histologiaRESUMO
Objetivos: Determinar la actividad citotóxica selectiva de muricin H en la línea celular H460 (cáncer de pulmón de células grandes). Materiales y métodos: Las líneas H460 y 3T3 (fibroblastos normales de ratón), fueron expuestas a seis concentraciones de muricin H (62,5, 15,6, 3,9, 0,98, 0,24, 0,06 ªÌg/mL), e iguales concentraciones de 5-fluorouracilo(5-FU) usado como control positivo. Se hallaron los porcentajes de crecimiento en 48 horas, luego se determinó laconcentración inhibitoria de crecimiento 50 (CI50) mediante análisis de regresión linear y se obtuvieron los coeficientesde correlación de Pearson. Finalmente se calculó el índice de selectividad de cada muestra. Resultados: Los CI50en ªÌg/mL de muricin H fueron <0,06 (r = -0,96; p<0,005) para H460; y 6,16 (r = -0,96; p<0,025) para 3T3. Los CI50de 5-fluorouracilo fueron 0,46 (r = -0,95; p<0,005) para H460 y 0,29 (r = -0,88; p =0,01) para 3T3. Los índices de selectividad para muricin H y 5-FU fueron: >102,6 y 0,63 respectivamente. Conclusiones: Se demostró la acción citotóxica selectiva in vitro del muricin H, porque tuvo mayor efecto citotóxico para la línea H460, y menor para la línea3T3 en relación con el 5-fluorouracilo.
Objectives: To determine the selective cytotoxic activity of muricin H on a H460 cell line (non-small cell lung cancer). Materials and methods: H460 and 3T3 cell lines (normal murine fibroblasts) were exposed to six concentrations of muricin H (62,5; 15,6; 3,9; 0,98; 0,24; 0,06 µg/mL) and to equal concentrations of 5-fluorouracil (5-FU) used as a positive control. Growth percentages at 48 hours were measured, and then the half-maximal inhibitory concentration (IC50) was determined using linear regression analysis, and Pearson correlation coefficients were calculated. Finally, the selectivity index for each sample was calculated. Results: IC50 values for muricin H, expressed in µg/mL were as follows: <0,06 (r= -0,96; p<0,05) for the H5460 cell line, and 6,16 (r= -0,96; p<0,025) for the 3T3 cell line. IC50 with 5-FU were 0,46 (r= 0,95; p<0,005) for H460, and 0,29 (r= -0,88 P= 0,01) for 3T3. Selectivity indexes for muricin H and 5-FU were <102,6 and 0,63, respectively. Conclusions: In vitro selective cytotoxic activity of muricin H was proven, since it had a greater cytotoxic effect for H460 cell line, and lesser effect upon the 3T3 cell line when compared to 5-FU.
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Fitoterapia , Neoplasias Pulmonares , Plantas MedicinaisRESUMO
The organisms of Rickettsia species are Gram (-) bacteria that cause severe illnesses in humans and are an important health problem in several countries around the world, including Mexico. The presence of different antigens between species and also in different strains of the same specie is an obstacle for vaccine development and serological diagnosis. There are important advances in the knowledge of the rickettsial antigenic structure and the resulting immune response in infected hosts, including humans. This review covers these topics and provides an overview about the development of vaccines and accessible diagnostic methods for diseases caused by Rickettsia (Rev Méd Chile 2004; 132: 381-7).
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Humanos , Infecções por Rickettsia/imunologia , Infecções por RickettsiaRESUMO
OBJECTIVE: To assess the fresh-frozen plasma (FFP) transfusion indications in a Mexican hospital. SETTING: A general hospital for federal government employees located in the city of Morelia, State of Michoacan, Mexico. MATERIAL AND METHODS: We evaluated all FFP transfusions between February and August, 1998 classifying them as appropriate or inappropriate according to the recent FFP-transfusion guidelines: correction of known coagulation factor deficiencies with bleeding and correction of microvascular bleeding when prothrombin and activated partial thromboplastin time are > 1.6 times normal (coagulation index o CI), urgent reversal of warfarin therapy, antithrombin III deficiency, thrombotic thrombocytopenic purpura treatment, liver transplant and acute disseminated intravascular coagulation. RESULTS: 78 patients with 292 FFP units transfused were analyzed: in 20 patients the indication was clotting support, 16 with CI < 1.5 and four with CI > 1.6, one with blood loss and one with surgical procedure; hypoalbuminemia in 10; hypovolemia in eight; unidentified reason in 33 and others in seven patients. Eleven units (3.76%) were considered properly transfused whereas 281 (96.23%) were inadequately indicated.
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Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Plasma , Anticoagulantes/efeitos adversos , Transtornos da Coagulação Sanguínea/terapia , Testes de Coagulação Sanguínea , Transfusão de Componentes Sanguíneos/efeitos adversos , Perda Sanguínea Cirúrgica , Coagulação Intravascular Disseminada/terapia , Hemorragia/terapia , Hospitais Gerais/estatística & dados numéricos , Humanos , Transplante de Fígado , Auditoria Médica , México , Cuidados Pré-Operatórios , Púrpura Trombocitopênica Trombótica/terapia , Varfarina/efeitos adversosRESUMO
We report two insulin dependent diabetic patients with a past history of 21 and 30 years complicated with retinopathy, neuropathy and nephropathy with arterial hypertension and kidney failure. Simultaneous pancreas-kidney transplantation was done 8 and 18 months after starting hemodialysis, performing a double intraperitoneal implant with pancreato-duodeno-vesical anastomosis and contralateral kidney grafting with uretero vesical anastomosis using antireflux techniques. In the second case, a second kidney transplant from the same donor was needed, due to a thrombosis of renal vein. There was one rejection episode in each case but renal or pancreatic function was not impaired. Other observed complications were metabolic acidosis and hyperkalemia due to urine loss of bicarbonate, moderate arterial hypertension and bacterial and fungal infections. There was a graft dysfunction due to the association of vancomycin and cyclosporin. In conclusion, in the two presented patients, simultaneous pancreas-kidney transplantations were successful and they remain free of insulin or dialytic therapy 4 and 9 months after the operation.
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Diabetes Mellitus Tipo 1/cirurgia , Transplante de Rim/reabilitação , Transplante de Pâncreas/reabilitação , Adulto , Feminino , Humanos , Transplante de Rim/métodos , Masculino , Transplante de Pâncreas/métodos , PrognósticoRESUMO
Hemolytic disease of the newborn develops mainly when an Rh negative (D-) mother becomes sensitized and produces anti-Rh positive (anti-D) antibodies capable of hemolysing D+ fetal erythrocytes. Maternal alloimmunization can be prevented by the administration of anti-D gamma-globulin immediately after the birth of each Rh positive child. In order to identify the frequency of prevention of alloimmunization at the Instituto Mexicano del Seguro Social (IMSS), the amount of mothers at risk of sensitization from 1985 to 1995 was estimated from Rh and ABO blood group frequencies and with the number of deliveries and abortions at the Medical Institutions. Also, information in regard to the dose of gamma-globulin units purchased by the Institute of Social Security from 1985 to 1993 was obtained. The number of mothers at risk steadily increased from 16,616 in 1985 to 21,071 in 1995, amounting to a total of 203,203 in the 10-year period, while only 120,800 gamma-globulin units were purchased in that same period. The findings in this study suggest the need to define reasonable policies for the acquisition of gamma-globulin lots to prevent alloisoimmunization of mothers at risk.
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Academias e Institutos , Eritroblastose Fetal/prevenção & controle , Imunização Passiva/estatística & dados numéricos , Isoanticorpos/uso terapêutico , Isoimunização Rh/epidemiologia , Sistema do Grupo Sanguíneo Rh-Hr/imunologia , Previdência Social , gama-Globulinas/provisão & distribuição , Sistema ABO de Grupos Sanguíneos/análise , Aborto Espontâneo/epidemiologia , Tipagem e Reações Cruzadas Sanguíneas , Parto Obstétrico/estatística & dados numéricos , Eritroblastose Fetal/etiologia , Feminino , Frequência do Gene , Humanos , Recém-Nascido , México , Gravidez , Prevalência , Grupos Raciais/genética , Sistema do Grupo Sanguíneo Rh-Hr/genética , Imunoglobulina rho(D)RESUMO
Two diabetic patients with unusual high levels of glycosylated hemoglobin measured by ion exchange chromatography are described. Further studies revealed a persistence of fetal hemoglobin in both cases. This condition produces falsely high levels of glycosylated hemoglobin, when ion exchange chromatography is used. These cases may be overtreated with risk of hypoglycemia. Patients with inappropriate levels of glycosylated hemoglobin should be investigated for hemoglobinopathies.