Hospital Carmen y Severo Ochoa

ObjectivesUrinary acidification plays a crucial role in acid-base homeostasis, its evaluation being necessary in the differential diagnosis of metabolic acidosis. The practical limitations of the functional tests required to confirm an acidification disorder point out the need for a simple screening method for urinary acidification assessment in spot urine. The best candidates are urine pH and ammonium (NH4+), but there are few data on their reference values in spot urine in children.MethodsOur study measured urine pH and NH4+/creatinine ratio in the first morning fasting urine of 135 healthy children aged between 5 and 14 years. pH was measured by dipstick and potentiometry, concluding that only potentiometric measures were appropriated for assessing urinary acidification in acid-base diseases.ResultsMedian urine pH was 5.67 (interquartile range 5.44–6.01), ranging from 4.90 to 7.60. Median NH4+/creatinine ratio was 4,869 μmol/mmol (interquartile range 3,528–5,918). The reference interval for urine pH ranged from 5.01 to 6.88 and the reference interval for NH4+/creatinine ratio ranged from 1,646 μmol/mmol to 9,799 μmol/mmol.ConclusionsThese results supply, for the first time, paediatric reference values for both parameters simultaneously, standardizing the sample and method of choice and providing a clinically useful tool for a preliminary evaluation of urinary acidification.

Colorectal cancer (CRC) development is a gradual process in which progressive histological alterations of the intestinal mucosa damage occur over years. This process can be influenced by modifiable external factors such as lifestyle and diet. Most CRC cases (>80%) originate from conventional adenomas through the adenomatous pathway and usually harbour dysplastic cells, whereas the serrated pathway is less frequent (<20% cases) and comprises hyperplastic polyps and other polyps containing dysplastic cells. The aim of the present work was to shed light on alterations of the faecal metabolome associated with hyperplastic polyps and conventional adenomas. Metabolites were analysed by Reversed-Phase High-Performance Liquid Chromatography-Quadrupole-Time of Flight Mass Spectrometry (RP/HPLC-Q/TOF-MS/MS) and Hydrophilic Interaction Liquid Chromatography-Quadrupole-Time of Flight Mass Spectrometry (HILIC-Q/TOF-MS/MS) and the results were integrated. Comparisons were performed between controls without mucosal lesions and the polyps' group, hyperplastic polyps versus conventional adenomas, and hyperplastic polyps or conventional adenomas versus controls. Alterations of metabolites in specific biochemical modules differentiated hyperplastic polyps and conventional adenomas. The metabolome of the hyperplastic polyps was characterized by an enrichment in glycerophospholipids and an altered metabolism of the degradation pathways of xanthines/purines and pyrimidines, whereas the enrichment in some phenolic compounds and disaccharides, all of them from exogenous origin, was the main differential faecal signature of conventional adenomas. Further research could help to elucidate the contribution of diet and the intestinal microbiota to these metabolomics alterations.

Introducción: El abdomen agudo es una de las patologías más comunes en el servicio de urgencias las cuales pueden o no requerir tratamiento quirúrgico, en ocasiones el diagnóstico diferencial es amplio y puede involucrar desde patologías benignas hasta las más mortales. El dolor abdominal representa del 5 al 10% de las visitas al servicio de urgencias. Las patologías a nivel abdominal son variadas y requieren del interrogatorio exhaustivo para poder establecer los diagnósticos diferenciales de acuerdo con su proprio mecanismo fisiopatológico. Presentación de caso: presentamos un caso de abdomen agudo secundario a quiste de uraco infectado el cual es uno de los diagnósticos diferenciales en el abordaje y protocolo de estudio del abdomen agudo. Conclusiones: El quiste de uraco es una patología poco frecuente la cual produce sintomatología inespecífica, puede manifestarse como dolor abdominal difuso e inclusive localizado. Dentro de las complicaciones que se pueden presentar son el quiste de uraco infectado (más frecuente) las cuales pueden simular patologías infecciosas intraabdominales, así como síntomas urinarios

Acute kidney injury (AKI) in patients with cirrhosis is a diagnostic challenge due to multiple and sometimes overlapping possible etiologies. Many times, diagnosis cannot be made based on case history, physical examination or laboratory data, especially when the nephrologist is faced with AKI with a hemodynamic basis, such as hepatorenal syndrome. In addition, the guidelines still include generalized recommendations regarding withdrawal of diuretics and plasma volume expansion with albumin for 48 h, which may be ineffective and counterproductive and may have iatrogenic effects, such as fluid overload and acute cardiogenic pulmonary edema. For this reason, the use of new tools, such as hemodynamic point-of-care ultrasound (PoCUS), allows us to phenotype volume status more accurately and ultimately guide medical treatment in a noninvasive, rapid and individualized manner.

Objetivos. Comprobar la efectividad de la educación-demostrativa en dialecto Wanka de las bondades de productos andinos en la disminución de la anemia en niños menores de 36 meses en el Centro Poblado Menor de Santa Cruz De Laria-Colca-Huancayo, Perú. Materiales y métodos. Se realizó un estudio pre-experimental, no aleatorizado, se consideró a niños/as menores de 36 meses con diagnóstico de anemia en sus distintos niveles entre leve, moderado y severo; de 7 niños/as, 3 fueron considerados para el estudio previo asentimiento informado. Se emplearon el instrumento de lista de cotejo y análisis de hemoglobina (Hb) y hematocrito (Hto) donde se detectó a los niños con anemia y, en las madres de los niños/as se realizó la demostración de los productos su preparación y consumo de las mismas durante 4 meses y lograr hábitos sostenibles, para mejorar las actuales y futuras generaciones. Resultados. Se encontró 3 niños con anemia haciendo un 43%, y luego del tratamiento donde se utilizó productos de la zona como el yuyo, atajo yerbas aromáticas, pasteles de sangrecita, adicionando harina de coca en diferentes tipos de pasteles que se brindó, y concientizando en idioma Wuanka para el uso de los mismos se logró que el 100% de los niños salieran de la anemia como consta en la tabla que se presenta y también se adjunta anexos; este resultado es luego de 4 meses de tratamiento ininterrumpidos. Conclusiones: La educación demostrativa fue efectiva al lograr aumentar significativamente el nivel de concentración de hemoglobina como indicador básico de la anemia.

Abstract Background Despite the development and application of vaccines against SARS-CoV-2 around the world, the scientific community still tried to find some therapies to avoid or ameliorate the fatal evolution of the COVID-19. Since the publication of the potential use of Ivermectin as a treatment against the disease, a pleiad of information about it has been published. However, the evidence is not strong or weak enough to conclude its usefulness in the clinical evolution of patients infected with SARS-CoV-2. We evaluate the efficacy and safety of ivermectin in the treatment of Mexican patients with asymptomatic and mild COVID-19 in a three-day administration in comparison to placebo. Methods A randomized, double-blind, placebo-controlled trial was carried out in 66 adults with asymptomatic and mild COVID-19. Patients were randomly assigned 1:1 ratio to Ivermectin plus acetaminophen or placebo plus acetaminophen. The primary endpoint was the proportion of subjects without a disease progression to severity according to COVID-19 guidelines by the National Institutes of Health (NIH) since randomization to 14 days. Results None of the participants presented progression to a severe state in either group. Viral load was measured on Days 1, 5 and 14. No significant differences were observed in baseline or 14-day between groups (p = 0.720 and 0.362, respectively). However, on Day 5, a significant difference in viral load was observed between groups (p = 0.039). The frequency of symptoms was similar between groups, and no significant differences were observed. The most frequent symptom was cough. One severe adverse event associated with SARS-CoV-2 infection was observed in the ivermectin group. Conclusions At standard doses, ivermectin is not effective in the progression to severe state and reducing symptoms in adults with asymptomatic and mild COVID-19. Trial registration The study was registered with ClinicalTrial.gov (NCT04407507)

Objective: To describe the clinical, social and demographic characteristics of the patients hospitalized at the Coronary Care Unit (CCU) and define their influence on 6-month prognosis. Materials and methods: A prospective observational registry was carried out at Hospital El Carmen including patients between July 1, 2019 and December 31, 2019, of those patients who entered the coronary unit with the main diagnosis of acute heart failure. Data were collected on the characteristics of patients, type of acute heart failure, social variables, auxiliary tests and treatment prior to admission, hospital and pre-discharge. Follow-up was carried out until June 30, 2020 by telephone, face-to-face in the office and through the digital clinical history system of the medical insurance of public employees(SISAO per its acronym in Spanish) to analyze therapeutic adherence and re-hospitalizations for heart failure. Statistical analysis: Qualitative variables are expressed as percentages and 95% confidence interval (95% CI). Quantitative variables were expressed as mean and standard deviation for the variables with Gaussian distribution or median and interquartile range, for variables with non-Gaussian distribution. Discrete variables were analyzed through contingency tables and continuous variables by t-test. A value of p &lt;0.05 was considered significant. Epi Info 7.2 and SPSS 25 were used. Results: There were 23 patients admitted. The mean age was 70.5 years (SD 9). From them, 91% were retired, 52% were married or living with a partner and the rest divorced, separated or widowed. Regarding the level of education, 86% had only a primary stage. Regarding economic income, 65% received less than 25 thousand pesos per month. All the patients had a family member to go to for emergency help; 63% fulfilled the characteristics of social vulnerability. It is noted that the main form of presentation was decompensated chronic heart failure, the predominant etiology of heart failure was ischemic and the main reason for decompensation was due to disease progression and discontinuation of medication. Hospital mortality was 8.7%. At the completion of the follow-up period, 89.47% of the patients complied with the medication prescribed at discharge or equivalent (that is, therapeutic adherence) and the rate of re-hospitalizations for acute HF was 13.64%. Conclusion: Heart failure continues to be a challenge for clinical management today, since patients are an elderly population, polymedicated and with important variables of social vulnerability that influence the number of re-hospitalizations, and thus become a factor to have in mind when treating our patients.