Association and predictive value of biomarkers with severe outcomes in hospitalized patients with SARS-CoV-2 infection

This study analyzed the levels at admission of biomarkers for their association with and ability to predict risk of severe outcomes, including admission to the ICU, need for invasive mechanical ventilation (IMV), need for vasopressor use (VU), and in-hospital mortality (IHM) in 700 patients hospitalized with COVID-19. Biomarker data split by outcomes was compared using Mann-Whitney U tests; frequencies of biomarker values were compared using Chi-square tests and multivariable logistic regression analysis was performed to look at the impact of biomarkers by outcome. Patients that suffered IHM were more likely to have reduced platelet numbers and high blood urea nitrogen (BUN) levels among patients admitted to the ICU. Risk factors for mortality were related to hyper-coagulability (low platelet count and increased D-dimer) and decreased respiratory (PaO₂/FiO₂ ratio) and kidney function (BUN). Association with risks of other severe outcomes were as follows: ICU with hyper-inflammation (IL-6) and decreased respiratory function; IMV with low platelet count, abnormal neutrophil–lymphocyte ratio with reduced respiratory function, VU with inflammatory markers (IL-6), and low platelet count with respiratory function. Our studies confirmed the association of biomarkers of hematological, inflammatory, coagulation, pulmonary and kidney functions with disease severity. Whether these biomarkers have any mechanistic or causal role in the disease progress requires further investigation.

The elevated systemic cytokine levels in HIV patients are not associated with an elevated pulmonary cytokine environment

BACKGROUND

HIV-positive patients on anti-retroviral therapy (ART) are at higher risk of developing many non-AIDS related chronic diseases, including chronic obstructive pulmonary disease (COPD), compared to HIV-negative individuals. While the mechanisms are not clear, a persistent pro-inflammatory state appears to be a key contributing factor. The aims of this study were to investigate whether HIV-positive patients without COPD present evidence of potentially predisposing abnormal pulmonary cytokine/chemokine environment and to explore the relationship between pulmonary and systemic cytokine levels.

METHODS

This study included 39 HIV-seropositive and 34 HIV-seronegative subjects without COPD. All were subjected to outpatient bronchoscopy with bronchoalveolar lavage fluid (BALF) aspiration and blood sample collection. The levels of 21 cytokines and chemokines were measured in plasma and BALF using a bead-based multi-analyte assay.

RESULTS

In plasma, HIV-infected patients showed significantly increased circulating levels of pro-inflammatory (TNFα) and Th1-associated cytokines (IL-12p70) as well as several chemokines (CXCL11 and CX3CL1). However, no statistically significant differences were found in the numbers of cells, the concentrations of protein and urea as well as cytokine levels in the BALFs of HIV-positive patients when compared to controls. Correlation analysis indicated a potential modulatory effect of the BMI in HIV-seropositive individuals.

CONCLUSIONS

While our results are consistent with the existence of a systemic pro-inflammatory state in HIV-infected patients, they did not detect significant differences in cytokine levels and other inflammatory markers in the lungs of HIV-positive individuals when compared to HIV-negative controls.

Future Research Directions in Pneumonia. NHLBI Working Group Report

Pneumonia is a complex pulmonary disease in need of new clinical approaches. Although triggered by a pathogen, pneumonia often results from dysregulations of host defense that likely precede infection. The coordinated activities of immune resistance and tissue resilience then dictate whether and how pneumonia progresses or resolves. Inadequate or inappropriate host responses lead to more severe outcomes such as acute respiratory distress syndrome and to organ dysfunction beyond the lungs and over extended time frames after pathogen clearance, some of which increase the risk for subsequent pneumonia. Improved understanding of such host responses will guide the development of novel approaches for preventing and curing pneumonia and for mitigating the subsequent pulmonary and extrapulmonary complications of pneumonia. The NHLBI assembled a working group of extramural investigators to prioritize avenues of host-directed pneumonia research that should yield novel approaches for interrupting the cycle of unhealthy decline caused by pneumonia. This report summarizes the working group's specific recommendations in the areas of pneumonia susceptibility, host response, and consequences. Overarching goals include the development of more host-focused clinical approaches for preventing and treating pneumonia, the generation of predictive tools (for pneumonia occurrence, severity, and outcome), and the elucidation of mechanisms mediating immune resistance and tissue resilience in the lung. Specific areas of research are highlighted as especially promising for making advances against pneumonia.

Precooling treatments induce resistance of Anastrepha ludens eggs to quarantine treatments of high-pressure processing combined with cold

High-pressure processing (HPP) combined with heat or cold has been proposed as an alternative quarantine process for Mexican fruit fly Anastrepha ludens Loew (Diptera: Tephritidae). HPP conditions at levels higher than 100 MPa applied to destroy eggs and larvae can also affect the postharvest physiology of the fruits. HPP at pressure levels in the range of 50-100 MPa is recommended. Eggs have been reported as being more resistant to HPP than larvae. Therefore, the objective of this study was to assess the effect of a precooling treatment on the biological viability of A. ludens eggs treated by HPP at 0 degrees C. The capability of nondestroyed eggs to develop and reproduce was also evaluated. One-, 2-, 3-, and 4-d-old eggs were precooled in ice water for 0 (control) 3, 6, 12, or 24 h and then pressurized at 50, 70, or 90 MPa for 0, 3, 6, or 9 min at 0 degrees C. The hatching capability of pressurized eggs was evaluated. The most lethal effect of HPP on nonprecooled eggs (0 h) was obtained at 90 MPa for 9 min, destroying all eggs except for the 3-d-old ones, which showed an 11.8% hatch rate. Precooling treatment improved the hatch rate of eggs ranging from 4 to 50% depending on precooling conditions. The main effect was observed after 6 h. These results suggest that precooling modified the biochemistry and physiology of eggs, improving their resistance to HPP treatments.

Effect of high hydrostatic pressure on the physiology of Manila mango

Manila mangoes (Mangifera indica L.) have sensory characteristics that make them attractive for consumption as a fresh fruit. A large portion of the annual yield of this fruit is infested by the Mexican fruit fly (Anastrepha ludens), adversely impacting the quality of the crop. Hence, it is necessary to develop economically viable postharvest treatments to reduce the damage caused by this insect. Currently, high hydrostatic pressures are used to guarantee the safety of many processed foods. The objective of this work was to assess the effects of high hydrostatic pressure on mangoes at their physiological maturity. High hydrostatic pressures were applied to mangoes at three levels: 50, 100 and 200 megapascals applied for four different time periods (0, 5, 10 and 20 min). Physiologically mature mangoes were more resistant to changes in response to the pressure of 50 MPa. Reduction of physiological activity by application of high hydrostatic pressure opens a new avenue for the research on treatments intended to enhance preservation of whole fresh fruit.

Association of serum pepsinogen with atrophic body gastritis in Costa Rica

Individuals with atrophic gastritis (AG), especially atrophic body gastritis (ABG), are at increased risk of developing gastric cancer. Serum concentrations of pepsinogens (PG) have been proposed as markers for ABG. The aim of this study was to determine the risk factors for AG and ABG and the potential of using serum PG concentrations to detect ABG in a dyspeptic population in Costa Rica, which is one of the countries with the highest incidence and mortality rates of gastric cancer in the world. Seven biopsy specimens, a fasting blood sample and a questionnaire concerning sociodemographic factors were obtained from 501 consecutive dyspeptic patients. The serum PGI level and the PGI/PGII ratios were significantly lower in patients with ABG than in other groups (P<0.000). A cut-off point of 3.4 led to a sensitivity of 91.2% in identifying ABG, a negative predictive value of 98.1%, but a positive predictive value of only 11.2%. Helicobacter pylori were present in 93% of the patients and all those with peptic ulcers were positive. AG was associated with increased age, lower body mass index, high alcohol intake and low fruit consumption. ABG was associated with age, alcohol consumption and PGI/PGII<3.4. In dyspeptic patients with a high prevalence of H. pylori infection, serum PG levels provide an assessment of ABG but it is necessary to introduce other serological and genetic markers in order to achieve a better specificity. Those markers could be serum antibodies to H. pylori-CagA, cytokine gene polymorphisms or others.

Normal Anatomical Imaging of the Thorax in Three Dogs: Computed Tomography and Macroscopic Cross Sections with Vascular Injection

The purpose of this study was to provide a new reference for interpretation of the normal anatomy of the canine thorax as imaged using computed tomography (CT). Three mature dogs, all mixed breed males, were used for this study. The dogs were sedated, anaesthetized and maintained in sternal recumbency. CT study from the first to the thirteen thoracic vertebra was performed with a TOSHIBA 600 HQ scanner (third generation equipment). Dogs were killed and vascular-injection technique was performed: red latex and blue latex filled vascular system. Injected dogs were frozen and sectioned with an electric bandsaw, the cuts matched as closely as possible to the CT images. The CT images from this study are intended as a reference for clinical CT imaging studies of the thoracic cavity of the dog and for interpreting lesions of the thorax and associated structures.

Valsartan-Induced Hematocrit Changes in Renal Transplant Patients

BACKGROUND

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor type 1 blockers (ARB) are frequently prescribed for renal transplant patients. The main reasons for their use are that their antihypertensive and antifibrogenic effects may prevent chronic renal allograft dysfunction, potentially improving transplant survival. Furthermore, ACE and ARB have been used to reduce the hematocrit in patients with posttransplant erythrocytosis. We evaluated the effects of the ARB valsartan on the evolution of hematocrit in stable renal transplant patients treated with cyclosporine (CsA), azathioprine (Aza), and prednisone.

PATIENTS AND METHODS

Twenty-six stable renal transplant patients treated with valsartan 80 mg/d orally were followed for 6 months. Evaluations were performed prior to as well as at 3 and 6 months following the initiation of valsartan.

RESULTS

The hematocrit levels decreased significantly at 3 months (46.1 +/- 7.3 vs 39.9 +/- 5.8 ; P < .0001) in patients with a normal hematocrit, namely a level over 38%, with no further reduction at 6 months. In recipients with an hematocrit less than 38%, there was no significant reduction, either at 3 or 6 months follow-up. Valsartan was well tolerated without significant side effects.

CONCLUSION

We postulate that inhibition of the proerythropoietic effects of angiotensin II and/or the reduction in hypoxia within the renal tubulointerstitium as well as the vasodilator effects on the efferent arterioles, represent possible mechanisms for the reduction and stabilization of the hematocrit in stable renal transplant patients.

Anatomy of the Cranioencephalic Structures of the Camel (Camelus dromedarius L.) by Imaging Techniques: A Magnetic Resonance Imaging Study

The objective of this study was to define the anatomy of the cranioencephalic structures and associated formations in camel using magnetic resonance imaging (MRI). MR images were acquired in sagittal, transverse and oblique dorsal planes, using spin-echo techniques, a magnet of 1.5 T and a standard human body coil. MR images were compared with corresponding frozen cross-sections of the head. Different anatomic structures were identified and labelled at each level. The resulting images provided excellent soft tissue contrast and anatomic detail of the brain and associated structures of the camel head. Annotated MR images from this study are intended to be a reference for clinical imaging studies of the head of the dromedary camel.

Processes of care for community-acquired pneumonia

Clinical and economic outcomes in hospitalized patients with CAP directly are related to the way that certain processes of care are executed at the local-hospital level. For each process of care, a clear and evidence-based recommended course of action should be stated. Having an unambiguous action plan helps to develop process-of-care indicators and to educate healthcare workers. Improving processes of care is a secure way to improve outcomes in hospitalized patients with CAP.

Worldwide Perspective of the Quality of Care Provided to Hospitalized Patients with Community-Acquired Pneumonia: Results from the CAPO International Cohort Study

National organizations from multiple countries have developed evidence-based recommendations for the management of hospitalized patients with community-acquired pneumonia (CAP). Good quality of care in CAP can be defined as patient care provided in compliance with evidence-based recommendations. To evaluate the quality of care provided to hospitalized patients with CAP, an international network of investigators is collecting local data on quality indicators from 36 hospitals in 14 countries. Participating countries in four regions are performing worldwide benchmarking: North America (region I), Europe (region II), Latin America (region III), and Asia and Africa (region IV). The quality of care provided to 2750 hospitalized patients with CAP was evaluated in the following areas: diagnosis, hospitalization, respiratory isolation, microbiological workup, empirical therapy, switch therapy, hospital discharge, and prevention. The greatest opportunities for improvement were identified in the areas of prevention of CAP, initial empirical therapy, and switch from intravenous to oral antibiotics. This study indicates that the care recommended by national guidelines is not being appropriately delivered to adults in all regions of the world. New interventions to advance quality of care are necessary to improve clinical and economic outcomes in CAP.

Effect of Moderate Pressure Treatments on Microstructure, Texture, and Sensory Properties of Stirred-Curd Cheddar Shreds

A moderate high-pressure processing (HPP) treatment is proposed to accelerate the shredability of Cheddar cheese. High pressure processing (345 and 483 MPa for 3 and 7 min) applied to unripened (1 d old) stirred-curd Cheddar cheese yielded microstructure changes that differed with pressure level and processing time. Untreated and pressure-treated cheese shredded at d 27 and 1, respectively, shared similar visual and tactile sensory properties. The moderate (345 MPa) and the higher (483 MPa) pressure treatments reduced the presence of crumbles, increased mean shred particle length, improved length uniformity, and enhanced surface smoothness in shreds produced from unripened cheese. High-pressure processing treatments did not affect the mechanical properties of ripened cheese or the proteolytic susceptibility of milk protein. It was concluded that a moderate HPP treatment could allow processors to shred Cheddar cheese immediately after block cooling, reducing refrigerated storage costs, with expected savings of over 15 US dollars/1000 lb cheese, and allowing fewer steps in the handling of cheese blocks produced for shredding.

Synthesis and bioactivity of natural and C-3 fluorinated biosynthetic precursors of 28-homobrassinolide

In this paper we describe the synthesis of two new fluorinated brassinosteroids: (22R,23R)-22,23-dihydroxy-3alpha-fluorostigmastan-6-one and (22R,23R)-22,23-dihydroxy-3beta-fluorostigmastan-6-one. Their bioactivities were evaluated in the rice lamina inclination test and compared with that of 28-homocastasterone, 28-homotyphasterol and 28-homoteasterone, possible biosynthetic precursors of 28-homobrassinolide. Results confirmed expected similarities between the biosynthesis of 24-ethylbrassinosteroids (named as the 28-homo series) and that described for 24-methylbrassinosteroids, and also indicated that these precursors might exhibit per se activities.

Magnetic resonance imaging of two normal equine brains and their associated structures

Magnetic resonance images were obtained from two isolated horses' heads. Ten mm thick, T1-weighted images were taken with a 1.5 Tesla magnet and a body coil, and compared with the corresponding frozen cross-sections of the heads, relevant structures being identified and labelled at each level. The images should provide reference material for clinical magnetic imaging studies of horses' heads.

Computed tomography of normal cranioencephalic structures in two horses

The purpose of this investigation was to define the anatomy of the cranioencephalic structures in horses using computed tomography (CT). Transverse images of two isolated equine cadaver heads were obtained using a Toshiba 600 HQ (third-generation equipment TCT). CT images were compared to corresponding frozen cross-sections of the cadaver head. Relevant anatomical structures were identified and labelled at each level. The resulting images provided excellent anatomic detail of the structures of the central nervous system and associated formations. Annotated CT images from this study are intended as a reference for clinical CT imaging studies of the equine head.

Magnetic resonance imaging and cross sectional anatomy of the normal equine sinuses and nasal passages

The purpose of this investigation was to define the magnetic resonance imaging anatomy of the rostral part of the equine head. 10 mm-thick, T1-weighted images of two isolated equine cadaver heads were obtained using a 1.5 Tesla magnet and a body coil. MR images were compared to corresponding frozen cross-sections of the cadaver head. Relevant anatomic structures were identified and labeled at each level. The resulting images provided excellent anatomic detail of the oral and nasal cavities, paranasal sinuses and associated structures. Annotated MR images from this study are intended as a reference for clinical MR imaging studies of the equine head.

Synthesis and bioactivity evaluation of brassinosteroid analogs

Four new analogs of 28-homocastasterone have been synthesized and completely characterized for the first time from stigmasterol. (22R, 23R,24S)-3beta-acetoxy-22,23-dihydroxy-5alpha-stigmastan+ ++-6-one (17), (22R,23R,24S)-3beta-bromo-22,23-dihydroxy-5alpha-stigmast an-6-one (18), (22R,23R,24S)-3beta-acetoxy-5,22, 23-trihydroxy-5alpha-stigmastan-6-one (20), and (22R,23R, 24S)-3beta-bromo-5,22,23-trihydroxy-5alpha-stigmastan-6-one (21), were obtained through a synthetic route based on regioselective Delta(5) epoxidation. Compounds 17 and 18, bearing a 5alphaH moiety, were prepared through a reductive opening of the 5beta,6beta epoxy precursor, and compounds 20 and 21, analogs with a 5alphaOH moiety were obtained by hydrolytic opening of a mixture of 5alpha,6alpha and 5beta,6beta epoxy precursors. Known compounds 19 and 22 were also obtained following the described synthetic routes, respectively. The new compounds were tested with the traditional auxin-like bioassay for brassinosteroids with 19 and 22 as standards. All compounds were comparatively evaluated for their inhibitory effect on the replication of DNA (HSV-1) virus.

[Epileptic crisis and multiple sclerosis: anatomo-clinical correlation]

INTRODUCTION

The prevalence of epilepsy in multiple sclerosis (MS) is low and the occurrence of an epileptic seizure as a first sign of this illness is even more infrequent. The relationship between both these illnesses is not clear; as epilepsy is a common condition, a coincidental association only could exist between the two diseases.

OBJECTIVE

To establish a nexus of causality between epilepsy an MS. Clinical case. We present one case of epileptic seizures as the first manifestation of MS. The patient was a woman of 25 years old. The only result of the clinical examination was a right homonymous inferior cuadrantanopsy. The patient presented a high Tibbling index, lesions of demyelination in the subcortical occipital region and semioval centrum in the MRI and a pathological electroencephalogram; also, the visual and auditory evoked potential latency were delayed.

CONCLUSIONS

We related he results of the neuroimaging, the clinical examination and the complementary tests of the patient. The appears to be a causal association between epilepsy and MS.

[The tilt-table test in assessing syncope of unknown origin: do differences exist between children and adults?]

BACKGROUND AND OBJECTIVES

Little is known about the differences between children and adults in the results of head-up tilt test. This study sought to investigate the potential differences concerning: a) the clinical profile and circumstances of spontaneous syncope; b) the overall diagnostic performance of the test, and c) the type of positive response obtained.

MATERIAL AND METHODS

We studied 31 children and 123 adults with unexplained syncope. If baseline test (tilting at 70 degrees for 30 min) resulted negative, it was repeated under isoprenaline low-dose infusion.

RESULTS

There were no differences in either clinical profile, except for severe traumatism more frequent in adults (25% vs. 3% in children; p < 0.05), or overall diagnostic performance (39% in children vs. 33% in adults; p = NS). However, the way the test rendered positive (via basal tilting in 92% of children vs. 50% in adults; p < 0.05) and the rate of cardioinhibitory response (42% in children vs 8% in adults; p < 0.01) were significantly different.

CONCLUSIONS

In this study children, in contrast to adults, rarely have a positive response in tilting under isoprenaline infusion. They also present a much higher rate of cardio-inhibitory response than adults.

Magnetic resonance imaging of the normal canine larynx

The purpose of this study was to define the normal anatomic structures in the canine larynx with magnetic resonance images. TI-weighted images were taken in the sagittal and transverse planes. The MR images were obtained comparing MR images to dissection planes. Magnetic resonance imaging provides excellent anatomic detail of laryngeal structures. Therefore, it is of value of diagnostic imaging of some respiratory diseases in the dog.

[Usefulness of the angiographic examination of the left internal mammary artery in patients candidates for coronary bypass surgery]

BACKGROUND AND OBJECTIVE

The usefulness of preoperative angiographic evaluation of the internal mammary artery (IMA) is controversial. The aim of this study is to evaluate the problem by a basic cost-benefit analysis.

METHODS

One hundred and twenty-one patients whose coronary findings (left main disease and/or severe stenosis of the left anterior descending artery) made use of the IMA as a bypass graft a consideration were studied. The IMA was cannulated by the same right Judkins catheter used in the coronarography; the specific catheter was only used if the cannulation was not successful with the right Judkins. We measured the time it took for a good angiography of the IMA to be obtained; the anatomy and the size for each IMA were studied and compared with the size of the left anterior descending artery.

RESULTS

An optimal angiographic picture of the IMA was obtained in 119 cases (98.3%); a specific catheter was used only in 3 patients. The mean of the time employed was 170 seconds (8-900 s) and no complications were related to IMA cannulations. Angiography findings relevant to any planned surgery were demonstrated in 15 patients (12%): large proximal branches (10); occlusion stenosis or a caliber insufficient for IMA (3); and occlusion or proximal subclavian stenosis (2).

CONCLUSIONS

We have observed that the relation between the cost and the obtained information is adequate to warrant its performance, because angiographic findings relevant to planned surgery can be very important, even though they are fairly infrequent. Moreover, these findings can be achieved rapidly without additional cost.

Cyclic voltammetric analysis of pH-dependent complex formation equilibria in anion coordination chemistry

A procedure to analyze pH-dependent complex formation equilibria from cyclic voltammetry is described. Application to adduct formation equilibria between [Fe(CN)(6)](4-) and [Fe(CN)(6)](3-) with different polyammonium receptors is discussed. Extension to the interaction of substrates such as ATP, NAD(+), NADP(+), and carboxylate ions with these receptors by means of competitive interaction with hexacyanoferrate(II) ion is presented.

The value of exercise electrocardiography testing in the identification of coronary restenosis: a probability analysis

We studied by means of probability analysis the role of exercise ECG in identifying coronary restenosis. A total of 213 patients were independently evaluated by clinical history, conventional assessment of the exercise ECG ('yes or no' statement), D score (a discriminant function derived from exercise ECG), and coronariography, 5.4 +/- 2.8 months after successful coronary angioplasty. The initial probability of restenosis (30%), that is, the prevalence of the condition, was radically changed by the result of clinical history (77% for patients with angina vs. 17% for those without angina). By contrast, ECG binary assessment, due to its low accuracy (70% vs 82% of clinical history, P < 0.005), was unable to significantly change the established probabilities after symptomatic evaluation. Finally, D score, which greatly enhanced specificity (92% vs. 76% of bivariate assessment, P < 0.0001), proved to be useful in changing the probability (from 32% to 76% or to 25%) of patients (n = 34) with a discordant result (no angina/positive exercise ECG). When this stepwise approach was tested in 46 new patients, predicted and observed probabilities were actually very similar. We conclude that exercise ECG has a very limited role in identifying coronary restenosis if positive responses are not adjusted with a weighted score which takes into account other exercise derived factors.

Serum factors inhibitory for in vitro development of Plasmodium falciparum blood-stage parasites

Sera from 29 individuals residing in a malaria-endemic region of Colombia were evaluated by an inhibition assay for their capacity to retard the growth of Plasmodium falciparum in vitro. The inhibitory activity was found to be independent of antibody activity. Furthermore, the degree of inhibition of parasite development was variable, depending on the parasite isolate used for the assay and the season of malaria transmission. We selected sera with high inhibitory activity and carried out partial analytical characterization by anion exchange fast protein liquid chromatography (FPLC) to identify the chemical nature of the inhibitory factor(s). The results suggested that the in vitro inhibitory activity might result from the additive effect of different molecules. It appears that these molecules could be non-specifically induced by stimulation of the immune system, they seem to play a role in the immunity to malaria.

Mycoplasma pneumoniae infections in schoolchildren of a tropical community

Information about Mycoplasma pneumoniae infections in tropical countries is scarce. This study reports the prevalence of anti-M. pneumoniae antibodies among schoolchildren from the tropical community of Palmares, Costa Rica. The serum samples were collected in July 1983 from 2021 children who represented 99% of the county's schoolchildren. Immunofluorescence (IFA) and in some cases ELISA serological methods were applied. IFA seropositivity was high (53%) and ranged from 22% to 79% depending on the district. Marked differences in the prevalence of antibodies in children attending schools of neighboring communities, suggest that the school may be epidemiologically important as a focus to spread mycoplasma infections among children. The presence of a low percentage of antibodies (IgG, IgM and IgA) against the 168 kd- M. pneumoniae antigen suggested that there were few cases of active or recent infections.

[Aortico-left ventricular tunnel. Clinical and surgical considerations]

We report the case of an infant operated on at 11 months, having been clinically, echocardiographically and hemodynamically diagnosed when 2 days at the age. In the Echo-Doppler study the visualisation of the tunnel and the presence of aortic regurgitation within it and in the left ventricular outflow tract confirmed the diagnosis. Surgical access to both orifices, aortic and left ventricular, through the tunnel (after incision in the same) allowed it to be closed with two Goretex patches from its external face. This technique has a double advantage: a) it avoids annular distortions or aortic valvular lesions, b) excluding the tunnel (partial resection of edges and subsequent continuous suture) any possibility of subpulmonary stenosis through compression is eradicated.

[Continuous ambulatory peritoneal dialysis (CAPD): an alternative for the treatment of children with terminal chronic renal insufficiency in Argentina]

Twenty three children aged 0.4 to 15 years, (x 7.5 years) with end-stage renal disease were treated with continuous ambulatory peritoneal dialysis (CAPD) over 46 months. The mean time of treatment for the group was 13 months (range 1.0 to 31 months). Sixty five percent of the patients had readmission after catheter placement; 53% were for peritonitis. Nine out of 23 patients (39%), presented 20 episodes of peritonitis, an incidence of one episode per 15 patient months. Gram positive organisms were culture in 60% of these episodes. A total of 26 peritoneal catheters were placed in 23 patients. Of the five catheters that required replacement, three were for peritonitis. Seven out of 23 patients had nephrotic syndrome when admitted to CAPD, four of which develop peritonitis. Although no difference was seen between nephrotic and non nephrotic patients in relation to CAPD initiation and peritonitis development, nephrotic patients without peritonitis and non nephrotic had significantly higher initial growth index for height and iron binding capacity than those with nephrotic syndrome and peritonitis (-1.71 +/- 0.90 vs -2.29 +/- 0.27, P less than 0.05, and 265 +/- 50.5 vs 175 +/- 5.0 mg/dL, P less than 0.0005, respectively). No difference in mean plasma gamma globulin concentration was seen between patients with and without peritonitis. In 14 patients followed for a period greater than to 6 months, the delta growth index for weight and height and was: -0.13 +/- 0.31 and -0.31 +/- 0.46, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)