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In recent years, numerous attempts have been made to reduce the mortality associated with septic shock, both from the point of view of early diagnosis and treatment optimization. New developments in the treatment include the use of vitamin C and thiamine associated with hydrocortisone, with several observational studies having been shown to improve survival and decrease in vasopressor use. However, this new clinical trial calls into question the role of vitamin C and thiamine, without finding significant differences between hydrocortisone monotherapy and the combination of all three., En los últimos años, se han realizado numerosos intentos para lograr disminuir la mortalidad asociada al shock séptico, tanto desde el punto de vista del diagnóstico precoz como de optimización del tratamiento. Entre las novedades en el tratamiento se incluye el uso de vitamina C y tiamina asociado a hidrocortisona, habiéndose comprobado en varios estudios observacionales la mejoría de la supervivencia y la disminución del uso de vasopresores. Sin embargo, este nuevo ensayo clínico pone en duda el papel de la vitamina C y la tiamina, sin encontrar diferencias significativas entre la monoterapia con hidrocortisona y la combinación de las tres.

RESUMEN: Introducción: La hiperplasia suprarrenal congénita (HSC) es la alteración adrenal más común en la infancia, condición heredada, caracterizada por la deficiencia enzimática en la síntesis de esteroides suprarrenales. Objetivo: describir las características clínicas y de laboratorio de los pacientes pediátricos con HSC. Materiales y métodos: Estudio observacional descriptivo longitudinal. Se revisaron historias clínicas de la consulta de endocrinología pediátrica de cuatro instituciones en Medellín-Colombia (enero 2013–diciembre 2018). Resultados: Se incluyeron 132 pacientes (65% femenino). La mediana de edad al diagnóstico fue 2 meses, 44,7% diagnóstico neonatal. Se documentaron 79 niños con HSC clásica perdedora de sal (HSC-PS), 31 virilizante simple (HSC-VS) y 22 no clásica. La mediana de 17-OHP al diagnóstico fue 4820ng/dl. El 47% presentó trastorno de diferenciación sexual y el 48% crisis salina (CS) al diagnóstico. La mediana de edad de la primera CS fue 15 días. La dosis de inicio equivalente en Hidrocortisona fue 15,7 mg/m2/día. Noventa y tres pacientes requirieron fludrocortisona y 32 presentaron CS posterior al diagnóstico y tratamiento. Más del 60% presentó androstenediona y/o testosterona elevada en la última cita. Conclusiones: Las características sociodemográficas y clínicas son similares a las reportadas en la literatura. El 48% de pacientes debutaron con CS, por lo que la tamización neonatal es importante ya que permitiría un diagnóstico temprano. En el seguimiento la mayoría de pacientes presentaron testosterona total y androstenediona elevadas, sugiriendo pobre adherencia al tratamiento ABSTRACT: Introduction: Congenital adrenal hyperplasia (HSC) is the most common adrenal disorder in childhood. It is an inherited condition characterized by enzyme deficiency in the adrenal steroid’s synthesis. Objective: To describe the clinical and laboratory characteristics of pediatric patients with HSC. Materials and methods: Observational descriptive longitudinal study. Medical records from the pediatric endocrinology outpatients from four institutions in Medellín- Colombia (January 2013 - December 2018) were reviewed. Results: 132 patients (65% female) were included. Median age at diagnosis was 2 months, 44.7% neonatal diagnosis. Seventy-nine children with classical salt-losing HSC (HSC-PS), 31 simple virilizing (HSC-VS) and 22 non-classical were documented. Median 17-OHP at diagnosis was 4820ng/dl. 47% presented sexual differentiation disorder and 48% adrenal crisis (AC) at diagnosis; the median age of the first AC was 15 days. The equivalent starting dose for hydrocortisone was 15.7 mg/m2/day. Ninety-three patients required fludrocortisone and 32 patients presented AC after diagnosis and treatment. Median height/age (last appointment): -0.49 SD, difference between bone and chronological age: 26 months (median). More than 60% of patients had androstenedione and/or elevated testosterone at the last appointment. Conclusions: Sociodemographic and clinical characteristics are similar to those reported in the literature. 48% of patients debuted with CS, making neonatal screening very important. At follow-up, important percentage of high total testosterone and high androstenedione, which suggest poor adherence to treatment

Across the years, multiple definitions for stress have been generated, but a satisfactory consensus has not yet been reached; in general, it is perceived as a threat that risks the internal harmony. This condition generates in response a series of physiological changes (adaptive response) that seek to maintain the balance; with the underlying activation of axes such as the hypothalamus-pituitaryadrenal, whose released substances have an impact on several systems, which would explain the development of some diseases and justify the use of biomarkers for the objective measurement of stress. The resident physicians in training have been identified as a population at risk for presenting stress, specifically job stress or burnout, which is possible to measure subjetively by applying questionnaires such as the Maslach Burnout Inventory Human Services Survey (MBI), which demonstrated a high prevalence of this condition; however, there is not a consensus yet regarding objective measurement strategies. The present review aims to explore the available literature on biomarkers as tools for measuring job stress in residents., A través del tiempo, se han generado múltiples definiciones para estrés, pero aún no se logra un consenso satisfactorio; en general, es percibido como una amenaza que pone en riesgo la armonía interna. Esta condición genera como respuesta una serie de cambios fisiológicos (respuesta adaptativa) que buscan mantener el equilibrio; con la activación subyacente de ejes como el hipotálamo-hipófisis-suprarrenal, cuyas sustancias liberadas tienen impacto en varios sistemas, lo que explicaría el desarrollo de ciertas enfermedades y justifica el uso de biomarcadores para la medición objetiva del estrés. Los médicos residentes en formación se han identificado como una población en riesgo para presentar estrés, específicamente estrés laboral o burnout (en inglés), el cual es posible medir de manera subjetiva mediante la aplicación de cuestionarios como el Maslach Burnout Inventory Human Services Survey (MBI), y a través del cual se ha identificado alta prevalencia de la condición; sin embargo, aún no existe consenso respecto a las estrategias de medición objetiva. La presente revisión pretende explorar la literatura existente sobre los biomarcadores como herramientas de medición de estrés laboral en residentes.

Resumen La insuficiencia adrenal es una endocrinopatía cuya principal causa se debe a la deficiencia en la producción de hormona adrenocorticotrópica, generalmente explicada por factores iatrogénicos y en menor número de casos al defecto primario de la glándula adrenal (enfermedad de Adisson). Su diagnóstico y la búsqueda de una etiología específica es muy importante, dado las implicaciones a largo plazo que conlleva por necesidad de suplencia hormonal, manejo en condiciones críticas, riesgo de muerte y compromiso de la actividad laboral. Presentamos el caso de una mujer quien consultó por ganancia excesiva de peso, signos de hipercortisolismo e hipertensión, se documentó una probable fuente exógena de esteroides, encontrando un cortisol sérico suprimido. Dos años antes estaba recibiendo artrivid PLUS, un producto natural para el manejo del dolor articular. Después de suspender ésta medicación presentó síntomas compatibles con insuficiencia adrenal, requiriendo el reinicio de prednisolona, con mejoría clínica y logrando su desmonte gradual posterior. (Acta Med Colomb 2017; 42: 243-246). Abstract Adrenal insufficiency is an endocrinopathy whose main cause is due to the deficiency in the production of adrenocorticotropic hormone, usually explained by iatrogenic factors and in a smaller number of cases to the primary defect of the adrenal gland (Adisson's disease). Diagnosis and the search for a specific etiology is very important, given the long-term implications involved by the need of hormone replacement, management in critical conditions, risk of death and the compromise of work activity. The case of a woman who consulted for excessive weight gain, signs of hypercortisolism and hypertension, is presented. A probable exogenous source of steroids was documented, finding a suppressed serum cortisol. Two years before she was receiving artrivid PLUS, a natural product for joint pain management. After stopping this medication, she presented symptoms compatible with adrenal insufficiency, requiring the resumption of prednisolone, with clinical improvement and achieving its subsequent gradual removal. (Acta Med Colomb 2017; 42: 243-246).

Treinta y siete vaquillonas fueron alojadas en un corral con acceso a un tambo robotizado. Poseían sombras de red en el comedero y en los lugares de descanso. Desde las 18:00 hs hasta las 08:00 hs tenían acceso a una pastura. Se registró el comportamiento semanalmente durante 24 horas. Dos veces por semana en 5 horarios, se observó la frecuencia respiratoria. La producción individual se registró diariamente. Semanalmente se analizó la composición de la leche.En dos fechas se realizaron toma de sangre para evaluar el nivel de cortisol. La frecuencia respiratoria media fue de 70 ±12 rpm. La producción de leche fue de 28 ± 1,6 L v-1 d-1. El cortisol presento valores entre 10 y 48 ng ml-1. Los animales destinaron 25,1 % y 26,1 % a las conductas de comer y rumiar respectivamente y sólo 0,7% a beber. Los resultados preliminares indicarían la factibilidad de introducir sistemas robotizados combinados con métodos de mitigación del estrés. Thirty-seven heifers were housed in a pen with access to a robotic dairy farm. They had shadows in the feeder and resting places. From 18:00 hs to 08:00 hs had access a pasture. Behavior was recorded weekly for 24 hours. Twice a week at 5 times the respiratory rate was observed individual production was recorded daily. Weekly dairy control was performed. Two dates blood collection were performed to evaluate the level of cortisol. The average respiratory rate was 70 rpm. Milk production was 28 l v-1 d-1. The present cortisol values between 10 and 48 ng ml-1. Animals des-tined to 25, 1 % and 26, 1 % eating and ruminating behaviors and only 0.7% respectively to drink. The results are preliminary; indicate the feasibility of introducing automated systems combined with stress mitigation methods. EEA Rafaela Fil: Leva, Perla E. Universidad Nacional del Litoral. Facultad de Ciencias Agrarias; Argentina Fil: Ghiano, Jorge Emanuel Jesús. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Rafaela; Argentina Fil: Toffoli, Guillermo D. Universidad Nacional del Litoral. Facultad de Ciencias Agrarias; Argentina Fil: Fernández, Guillermo B. Universidad Nacional del Litoral. Facultad de Ciencias Agrarias; Argentina. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias; Argentina Fil: Sosa, Jorge Luis. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias; Argentina Fil: García, María Soledad. Universidad Nacional del Litoral. Facultad de Ciencias Agrarias; Argentina Fil: Taverna, Miguel Angel. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Rafaela; Argentina Fil: Walter, Emilio Gerardo. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Rafaela; Argentina

Glucocorticoids (cortisol in humans) are essential for numerous biological functions. Among critically ill patients, therapy with cortisol has gained strength in recent years, but clinical results have been mixed. A series of events, that may explain the diversity of clinical responses, occur from the synthesis of cortisol in the adrenal gland to the activation of the cortisol receptor by the hormone when it enters the nucleus of the target cell. Some of these events are revised; a proposition for identifying critically ill patients who may benefit with this therapy is suggested.

Glucocorticoids (cortisol in humans) are essential for numerous biological functions. Among critically ill patients, therapy with cortisol has gained strength in recent years, but clinical results have been mixed. A series of events, that may explain the diversity of clinical responses, occur from the synthesis of cortisol in the adrenal gland to the activation of the cortisol receptor by the hormone when it enters the nucleus of the target cell. Some of these events are revised; a proposition for identifying critically ill patients who may benefit with this therapy is suggested.

Corticosteroid hypersensitivity is a complex phenomenon in which many factors interact, such as idiosyncrasy, intolerance or allergic reactions. The prevalence of immediate hypersensitivity reactions to corticosteroids is 0.2%-0.5%. Corticosteroids have major therapeutic implications; thus, when hypersensitivity is suspected, in-vitro and/or in-vivo testing can be performed to confirm diagnosis, being the drug challenge the gold standard. After definitive diagnosis, cross-reactivity among the different corticosteroid groups should be considered, to choose wisely if corticosteroid therapy is still required. In Coopman classification, steroids belonging to groups A, B and D2 have high cross-reactivity, however, more studies are needed to determine the degree of cross-reaction among these drugs. This paper presents the case of a woman, in who hypersensitivity to hydrocortisone succinate was confirmed by drug challenge test.La hipersensibilidad a corticoesteroides es un fenómeno complejo en el que interactúan múltiples factores como idiosincrasia, intolerancia o alergia. La prevalencia de las reacciones de hipersensibilidad inmediata a corticoesteroides es de 0.2 a 0.5%. Debido a la relevancia terapéutica de los esteroides, es importante confirmar el diagnóstico de hipersensibilidad con pruebas in vivo, in vitro, o ambas, el patrón de referencia es la prueba de reto con el fármaco implicado. Una vez realizado el diagnóstico y en caso de que se requiera continuar con el tratamiento con esteroides, deberá considerarse la reactividad cruzada entre los diferentes grupos propuestos en la clasificación de Coopman, en la que los corticoesteroides pertenecientes a los grupos A, B y D2 tienen una elevada reactividad cruzada entre sí; sin embargo, hacen falta más estudios para determinar el grado de reactividad cruzada entre estos fármacos. Comunicamos el caso de una paciente en la que se confirmó el diagnóstico de hipersensibilidad a succinato de hidrocortisona con la prueba de reto.

A fin de valorar el estrés en toros, se seleccionaron al azar de un matadero de la región centro occidental de Venezuela, un total de 40 toros mestizos Brahman (16 de Brasil y 24 de Venezuela). Se tomaron muestras de sangre para realizar el recuento leucocitario. Igualmente, se determinó la concentración de cortisol mediante la técnica del ELISA competitivo. Los datos fueron analizados usando la prueba no paramétrica U de Mann Whitney. Los resultados del estudio muestran que hubo un incremento no estadísticamente significativo en el recuento diferencial de neutrófilos (53,13% y 43,19%) en toros venezolanos y brasileños, respectivamente. Al mismo tiempo, los toros venezolanos arrojaron un valor de cortisol que fue superior (59,44 ng/dL) y estadísticamente significativo (P≤0,05), cuando se comparó con el de los toros brasileños (40,50 ng/dL). Además, se produjo una disminución no significativa, en el recuento diferencial de eosinófilos (eosinopenia) en ambos grupos, con un promedio de 0,78%. Por otra parte, el recuento diferencial de linfocitos solamente disminuyó significativamente (P≤0,05), en los toros venezolanos (43,25%), mientras que el porcentaje correspondiente a linfocitos de los toros brasileños, se ubicó dentro de los valores normales para la especie (56,19%). Se concluye que los valores elevados de cortisol y neutrófilos, así como también, la eosinopenia y linfopenia encontradas en los toros venezolanos, sugieren un leucograma de estrés, compatible con la conducta nerviosa observada en esos animales. El estrés en los toros brasileños sólo se asoció con una alteración (aumento) de las concentraciones de cortisol y en los valores de eosinófilos. La procedencia y/o tiempo de transporte afectó por igual las concentraciones de cortisol, especialmente en los toros venezolanos. Los cambios sociales observados en los toros venezolanos y brasileños, sugieren la presencia de estrés agudo en los primeros y de estrés crónico en los segundos. A study was conducted to assess stress in bulls. A total of 40 crossbred Brahman bulls (16 from Brazil and 24 from Venezuela) were selected at random from a slaughterhouse in the Midwestern region of Venezuela. Blood samples were taken for leukocytes count. Also, the cortisol concentration was determined by competitive ELISA technique. Data were analyzed using the nonparametric Mann Whitney U test. The results of the present study show that there was a non-statistically significant increase in neutrophil count (53.13% and 43.19%) in Venezuelan and Brazilian bulls, respectively. At the same time, Venezuelan bulls showed a higher (59.44 ng / dL) cortisol value that was statistically significant (P≤ 0.05), when compared with the Brazilian bulls (40.50 ng/dL). There was also a non- significant decrease in the differential eosinophil count (eosinopenia) in both groups, with an average of 0.78%. On the other hand, the lymphocytes differential count significantly diminished (P≤0.05) in Venezuelan bulls (43.25%) only, while in Brazilian bulls, the percentage corresponding to lymphocytes, was within the normal range for the species (56.19%). It is concluded that that the elevated cortisol and neutrophils levels, as well as the eosinopenia and lymphopenia found in Venezuelan bulls, suggest a stress leukogram, compatible with the nervous behavior observed in those animals. Stress in Brazilian bulls was only associated with an alteration (increase) in cortisol concentrations and in eosinophil values. Both the origin and/or transport time equally affected cortisol concentrations, especially in the Venezuelan bulls. Social changes observed in the Venezuelan and Brazilian bulls, suggest the presence of acute stress in the first and of chronic stress in the latter.

Se produjeron 3 formulaciones diferentes de tabletas de acetato de cortisona (25 mg) a escala de laboratorio, con el objetivo de obtener una formulación que cumpla con los parámetros establecidos en la Farmacopea Británica (2000), específicamente el parámetro de disolución con el cual no cumple la formulación actual. En las 3 formulaciones estudiadas se sustituyó la solución aglutinante de la formulación actual (gelatina-almidón) por la polivinilpirrolidona en solución alcohólica y se adicionó desintegrante extragranular (acdisol), entre otras variaciones. Las tabletas se analizaron teniendo en cuenta las características tecnológicas y analíticas según las especificaciones de calidad de las farmacopeas oficiales; se realizaron además el ensayo de uniformidad de contenido, con el empleo de un método espectrofotométrico previamente validado. Se estudió la estabilidad física y química de las 3 formulaciones ensayadas por un período de 3 a. Todas las formulaciones cumplieron con los parámetros de calidad establecidos, recién fabricadas y durante el período de vida útil estudiado, lo cual soporta la factibilidad para su producción a escala piloto.Three different formulations of cortisone acetate tablets (25 mg) were produced at laboratory scale aimed at obtaining a formulation that fulfills the parameters established by the British Pharmacopoeia (2000), specifically the dissolution parameter that is not fulfilled by the current formulation. In the 3 studied formulations the agglutinant solution of the present formulation (gelatin-starch) was substituted by polyvynilpyrrolidone in alcoholic solution and extragranular disintegrator (acdisol) was added, among other variations. The tablets were analyzed taking into account the technological and analytical characteristics according to the quality specifications of the official pharmacopoeias. The content uniformity trial was also carried out by using a spectrophotometric method previously validated. The physical and chemical stability of the 3 assayed formulations was studied during 3 years. All the formulations met the quality parameters established when they were newly manufactured and during the studied period of useful life, which supports the feasibility for their production at a pilot scale.

En este artículo se presenta una revisión narrativa sobre la relación entre los procesos biológicos que median la respuesta al estrés - limitándonos en este caso al eje hipotálamo - hipófisis - corteza adrenal - y los modelos internos de trabajo derivados de las relaciones tempranas de apego en lo que respecta a los infantes. Se explican las sucesivas fases de la respuesta biológica frente a un evento estresante y se enfatiza la importancia de comprender cómo dichos modelos internos pueden correlacionarse con síntomas de estrés crónico, estados de disregulación del eje HHA y situaciones de hiper o hipocortisolismo funcional. En este sentido, se evidencian datos contradictorios al intentar relacionar disfunciones del eje HHA y estilos específicos de apego. Sí parece haber evidencia acerca de la importancia de la naturaleza del agente estresor cómo causante de diferentes patrones de respuesta y posterior sensibilización. Se requiere más investigación con el objeto de diseñar intervenciones más adaptadas. This article presents a narrative review of the relationship between the biological processes that mediate the stress response - in this case, limiting ourselves to the hypothalamic - pituitary - adrenal cortex - and internal working models derived from early attachment relationships in with respect to infants. It explains the successive phases of the biological response against a stressful event and emphasizes the importance of understanding how these internal models can be correlated with symptoms of chronic stress, states of dysregulation of the HPA axis and hyperor hypocortisolism situations functional. In this sense, contradictory data are evident when trying to relate dysfunctions of said shaft and specific attachment styles. It does seem to be evidence of the relationship between the nature of the stressor and different patterns of response and subsequent sensitization. More research is needed in order to design more psychotherapeutic interventions tailored to different attachment styles.

Los profesores universitarios se enfrentan a diferentes factores generadores de estrés laboral. Objetivo: Explorar la asociación entre los factores de riesgo psicosocial intralaboral y los niveles séricos de cortisol. Materiales y métodos: Se realizó un estudio exploratorio correlacional. La información se obtuvo de 116 profesores a quienes se aplicó un instrumento estandarizado, se realizó un examen médico y se tomó una muestra de sangre para medir los niveles de cortisol. Resultados: El 51.8% de los docentes analizados presentó riesgo psicosocial alto o muy alto asociado con la actividad desarrollada, un 31% no mostró riesgo y un 17.2% presentó riesgo bajo. No se encontró relación entre los niveles de riesgo intralaboral y los niveles séricos de cortisol de los participantes. Conclusiones: Este estudio no encontró relación entre ningún parámetro de riesgo evaluado y los niveles séricos de cortisol en la población estudiada. The professors face up different generating job stress factors. Objective: To explore the association between the factors of psicosocial intralaboral risk and the blood levels of cortisol. Materials and methods: A correlacional exploratory study had carried out. The information was obtained of 116 professors, a standardized instrument was applied to them, a medical examination was carried out and a sample of blood was tooked to measure the levels of cortisol. Results: 51.8% of the participants qualified on high or very high risk, in these two cases with 25.9% respectively; the 31% qualified without risk (17%) or low risk (14.8%) and 16.3% corresponded to medium risk. One did not find relation between the levels of risk intralaboral and the levels séricos of cortisol of the participants. Conclusions: This study did not find relation between any evaluated risk parameter and the blood levels of cortisol in the study population.

Los profesores universitarios se enfrentan a diferentes factores generadores de estrés laboral. Objetivo: Explorar la asociación entre los factores de riesgo psicosocial intralaboral y los niveles séricos de cortisol. Materiales y métodos: Se realizó un estudio exploratorio correlacional. La información se obtuvo de 116 profesores a quienes se aplicó un instrumento estandarizado, se realizó un examen médico y se tomó una muestra de sangre para medir los niveles de cortisol. Resultados: El 51.8% de los docentes analizados presentó riesgo psicosocial alto o muy alto asociado con la actividad desarrollada, un 31% no mostró riesgo y un 17.2% presentó riesgo bajo. No se encontró relación entre los niveles de riesgo intralaboral y los niveles séricos de cortisol de los participantes. Conclusiones: Este estudio no encontró relación entre ningún parámetro de riesgo evaluado y los niveles séricos de cortisol en la población estudiada. The professors face up different generating job stress factors. Objective: To explore the association between the factors of psicosocial intralaboral risk and the blood levels of cortisol. Materials and methods: A correlacional exploratory study had carried out. The information was obtained of 116 professors, a standardized instrument was applied to them, a medical examination was carried out and a sample of blood was tooked to measure the levels of cortisol. Results: 51.8% of the participants qualified on high or very high risk, in these two cases with 25.9% respectively; the 31% qualified without risk (17%) or low risk (14.8%) and 16.3% corresponded to medium risk. One did not find relation between the levels of risk intralaboral and the levels séricos of cortisol of the participants. Conclusions: This study did not find relation between any evaluated risk parameter and the blood levels of cortisol in the study population.

Background: Patients with postural orthostatic tachycardia syndrome (POTS) report dizziness, lightheadedness, weakness, blurred vision, and fatigue upon standing. The diagnosis of the syndrome is made when an orthostatic intolerance and tachycardia appear in the standing position. Aim: To report 15 patients with POTS. Material and Methods: Review of Tilt test reports in a period of 15 years. Those reports in which orthostatic postural tachycardia and symptoms compatible with POTS appeared, were selected for analysis. Results: We identified 15 patients (3.1% of all positive Tilt test reports) with compatible signs and symptoms. There was a lag of 8 -10 years between the onset of symptoms and the time of diagnosis. Most patients complained of orthostatic intolerance, dizziness and frequent fainting. Orthostatic tachycardia and symptoms occurred on average after 2.9 and 6.1 minutes, respectively,of staying in the standing position. These patients had a high frequency of family history of syncope orpresyncope (66% frequency) and hyper mobility syndrome (53% prevalence). Only 33% of the patients reported relief of their symptoms after being treated (most of them with fludrocortisone). Most patients that reported little or no relief, did not use medications or were treated for a short period. Conclusions: POTS syndrome is uncommon but disturbs quality of life of those who suffer it. Its association with hyper mobility syndromes must be investigated.

Los procesos inflamatorios con irritación que afectan al manto cutáneo son denominados dermatitis y estas son producidas por infinidad de procesos tanto intrínsecos como extrínsecos (temperatura corporal o ambiental, viento, agentes químicos, traumatismos), pero centrándonos en el tema referente a la piel perilesional, que afecta los alrededores de las heridas agudas o crónicas, puede estar alterada según las condiciones de humedad, y con ello aparece la maceración, ya sea por un contacto prolongado de los exudados de la herida, la fricción, debido a vendajes compresivos, lo que produce una perdida de su función barrera y facilita la posible colonización bacteriana. En este trabajo se presenta los resultados de 179 casos clínicos que presentaban lesiones periulcerosas como eccema seco, húmedo o alérgico, maceración y piel frágil, tratadas según su estadio con cremas barreras de oxido de zinc, eosina acuosa al 2%, crema de hidrocortisona al 1%, películas barrera y ácidos grasos hiperoxigenados. The inflammatory processes with irritation that affect to the cutaneous cloth dermatitis plows denominated and these they it plows produced by infinity of processes so much intrinsic ace extrinsic (corporal or environmental temperature, wind, chemical agents, traumatisms), but centering us to the topic with respect to the skin around you ulcerate them that affects the surroundings of the sharp or chronic wounds, dog be affected according to the conditions of humidity and with it maceration for to lingering contact of those perspired of the wound, the friction in many marries originating traumatisms epidermal first floor of compressive bandages and losing its function barrier facilitating the possible bacterial contamination. In this work it i presented the results of 179 clinical you marry that presented lesions around you ulcerate yourself them like dry or humid eczema and allergic, maceration and fragile skin and tried according to their stadium with cream barriers of I oxidize of zinc, watery eosin to 2%, cremates from hydrocortisone to 1%, movies barrier and fatty acids hydrogen. Enfermería

BACKGROUND: Salivary cortisol measurement is recommended as a screening mea-sure when a Cushing Syndrome is suspected. The proposed cut-off point for a probably diagnosis is 0.16 ug/dL. AIM: To determine salivary cortisol concentrations during the day inpatients with and without Cushing syndrome and with depression. MATERIAL AND METHODS: Salivary cortisol was measured by competitive enzyme immuno assay (EIA), in samples obtained at 8:00,15:00 and 23:00 h in 78 patients without Cushing syndrome, aged 40 +/- 15 years (28 males), 30 patients with depression aged 40 +/- 12 years (nine males) and four females with Cushing syndrome aged 42 +/- 17 years. RESULTS: Salivary cortisol was higher among patients with Cushing syndrome than the rest of patients. A salivary cortisol over the cut-off value of O.16 ug/dL was found in 42% of subjects without Cushing syndrome and in 33% of patients with depression. Median values among patients without Cushing syndrome, depression and with Cushing syndrome were 0.21 (range < 0.1-1.42), 0.2 (range 0,12-0.9) and 0.58 (range 0.37-1.1) ug/dL, respectively CONCLUSIONS: Salivary cortisol measured by EIA method was higher among patients with Cushing syndrome but there was a great overlap with values obtained in subjects without the syndrome.

Background: Salivary cortisol measurement is recommended as a screening mea-sure when a Cushing Syndrome is suspected. Theproposed cut-offpointfor aprobable diagnosis is 0.16 ug/dL. Aim: To determine salivary cortisol concentrations during the day inpatients with and without Cushing syndrome and with depression. Material and Methods: Salivary cortisol was measured by competitive enzyme immuno assay (EIA), in samples obtained at 8:00,15:00 and 23:00 h in 78 patients without Cushing syndrome, aged 40 ± 15years (28 males), 30 patients with depression aged 40 ± 12years (nine males) and four jemales with Cushing syndrome aged 42 ± 17 years. Results: Salivary cortisol was higher among patients with Cushing syndrome than the rest of patients. A salivary cortisol over the cut-off value of O.16 ug/dL was found in 42% of subjects without Cushing syndrome and in 33% of patients with depression. Median values among patients without Cushing syndrome, depression and with Cushing syndrome were 0.21 (range < 0.1-1.42), 0.2 (range 0,12-0.9) and 0.58 (range 0.37-1.1) ug/dL, respectively Conclusions: Salivary cortisol measured by EIA method was higher among patients with Cushing syndrome but there was a great overlap with values obtained in subjects without the syndrome.

Background: Phlebodium Decumanum is a type of fern that could have an immune or stress response modulating action. Aim: To evaluate if the consumption of a preparation obtained from Phlebodium Decumanum, modifies the changes induced by exercise in plasma levels of testosterone and cortisol. Material and methods: Fourteen male subjects aged 22 ± 2 years were randomized to consume Phlebodium Decumanum and 10 subjects, aged 23 ± 1 years were ascribed to consume a placebo. Both groups performed a standard exercise program, three times a week during one month. Plasma free testosterone and cortisol levels were measured before and 48 hours after the last session of the exercise program. Results: Cortisol levels increased significantly from 18.9 ± 6.8 to 26.2 ± 5.9 fig/dl, in the control group. In the group consuming the study product, no changes were detected (20.0 ±4.6 and 20.9 ± 5.9) fig/dl before and after the exercise program, respectively). Plasma free testosterone decreased significantly in both groups from 36.1 ± 11.04 to 20.7 ±4.3 pg/ml in the control group and from 33.7 ± 10.0 pg/ml to 18.6 ± 4.9 pg/ml in study group. Conclusions: The cortisol levels increased significantly in the control group but not in the study group. Therefore we can suggest that consumption of Phlebodium Decumanum would be able to modulate the response of this hormone to physical stress.

Background: Melatonin receptors are widely distributed in human tissues but they have not been reported in human adrenal gland. Aim: To assess if the human adrenal gland expresses melatonin receptors and if melatonin affeets cortisol response to ACTH in dexamethasone suppressed volunteers. Material and methods: Adrenal glands were obtained from 4 patients undergoing unilateral nephrectomy-adrenalectomy for renal cáncer. Expression of mRNA MT1 and MT2 melatonin receptors was measured by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). The effect of melatonin on the response to intravenous (i.v.) ACTH was tested (randomized cross-over, double-blind, placebo-controlled tríal) in eight young healthy males pretreated with dexamethasone (1 mg) at 23:00 h. On the next day at 08:00 h, an i.v. Une was inserted, at 08:30 h, and after a blood sample, subjeets ingested 6 mg melatonin or placebo. At 09:00 h, 1-24 ACTH (Cortrosyn, 1µg/1.73 m² body surface área) was injected, drawing samples at 0, 15, 30, 45 and 60 minutes after. Melatonin, cortisol, cortisone, progesterone, aldosterone, DHEA-S, testosterone and prolactin were measured by immunoassay. Results: The four adrenal glands expressed only MT1 receptor mRNA. Melatonin ingestión reduced the cortisol response to ACTH from 14.6+1.45µg/dl at 60 min in the placebo group to 10.8+1.2µg/dl in the melatonin group (p

Background: Cortisol has been implicated in hypertension and lately reported to be regulated at the pre-receptor level by the 11ßHSD1 enzyme, which converts cortisone (E) to cortisol (F). Over expression ofthis enzyme in adipose tissue could determine an increase in available cortisol that interacts with the mineralocorticoid receptor (MR) in renal, brain and heart tissue, leading to similar hypertensive effects as in 11ßHSD2 impaired patients. Severa! polymorphisms have been reported in HSDl IB 1 gene (CAI5, CAI9 and InsA83557), which could modify HSDl IB 1 gene expression or activity. Aun: To determine the distribution and prevalence of CAI5, CAI9 and InsA83557 in the HSDl IBl gene, and to correlate these results with biochemical parameters in cortisol/ ACTH (HPA) and renin-angiotensin-aldosterone (RAA) axis in patients with essential hypertension (EH). Patients and Methods: We studied 113 EHpatients (76 non-obese and 37 obese, with a body mass índex >30 kg/m²) and 30 normotensive adults (NT). In each patient, we measured serum levéis of E E, serum aldosterone (SA), plasma renin activity (PRA), adrenocorticotrophic hormone (ACTH), the urinary free cortisol/creatinine (UFF/Cr), F/ACTH and SA/PRA ratios. Each polymorphism was studied by PCR and 8% polyacrylamide gel electrophoresis. Statistical associations were evaluated by Pearson correlations and the genetic equilibñum by the Hardy-Weinberg (H-W) equation. Results: We found all three polymorphisms in the EH and the NT group, both in genetic equilibñum. In obese essential hypertensives, the CAI5polymorphism showed association with SA/PRA ratio (r =0.189, p =0.012) and F/ACTH (r =0.301, p 0.048); CA19 also showed correlation with F/ACTH in obese EH (r = 0.220, p 0.009). The InsA83557polymorphism correlated with UFF/Cr in both EH (r =0.206; p =0.03), and in obese EH (r =0.354; p =0.05). Conclusions: The CAI5 and CAI9 polymorphism correlated with changes in biochemical parameters in HPA and RAA axis of obese essential hypertensives. These changes mayresult of modifications in the expression of 11ßHSD1, leading to increased cortisol and aldosterone levéis independent of ACTH and renin control, respectively

La hipocapnia/alcalosis es una situación que se presenta como consecuencia de diversas patologías pulmonares o metabólicas. El objetivo de este estudio fue determinar si el aumento de la tasa de filtración de liquido (TFL) que ocurre bajo estas circunstancias, está determinado por la hipocapnia, la alcalosis o la suma de ambas. Se realizaron 7 grupos (n=36), utilizando pulmones aislados de conejos. Grupo 1: Control (PCO2 6%, pH: 7,35-7,45); Grupo 2 (n=6): Hipocapnia/Alcalosis (CO2 1%, pH: 7,9); Grupo 3 (n=6): Hipocapnia/Normo-pH (CO2 1% pH 7,35-7,45), Grupo 4 (n=6) Normocapnia/Alcalosis (CO2 6%, pH: 7,9). En los grupos 5, 6 y 7 (n=4), todos bajo condición de Normocapnia/Alcalosis se añadió fenoterol, papaverina, e hidrocortisona respectivamente. La TFL y la presión de arteria pulmonar (Pap) fueron considerablemente mayores en el grupo 2 que en el control (TFL:1,92g/min ± 0,6 vs 0,0g/min ± 0,006), observándose una marcada influencia del pH, al comparar el grupo 3 y el grupo 4 (TFL: 0,02g/min ± 0,009 vs 2,3g/min ± 0,9) y (Pap: 13,5 cmH2O ± 1,4 vs 90 cmH2O ± 15). Se observó una disminución del efecto en los grupos 5 y 6 (papaverina e hidrocortisona) y su abolición total con fenoterol (grupo 7) (TFL: 0,001 ± 0,0003 g/min y Pap: 14 ± 0,8 cmH2O). El edema pulmonar inducido por Hipocapnia/Alcalosis es consecuencia principalmente de la alcalosis y no de la hipocapnia. Dicho efecto podría ser debido a un daño inflamatorio a nivel del parénquima y a la vasoconstricción causada por la alcalosis. Hypocapnia/alkalosis is a consequence of several lung and metabolic pathologies. The aim of this study was to determine whether the increase of fluid filtration rate (FFR) that occurs during Hypocapnia/alkalosis circumstances is determined by hypocapnia, alkalosis or both. 7 groups were formed (N=36) using isolated rabbit lungs. Group 1: Control (PCO2 6%, pH: 7.35-7.45); Group 2 (n=6): Hypocapnia/Alkalosis (CO2 1%, pH: 7.9); Group 3 (n=6): Hypocapnia/Normo-pH (CO2 1% pH 7.35-7.45), Group 4 (n=6) Normocapnia/Alcalosis (CO2 6%, pH: 7.9). Fenoterol, papaverine and hydrocortisone were added to Groups 5, 6 and 7 (n=4) respectively, all under Normocapnia/Alkalosis. FFR and Pulmonary Arterial Pressure (Pap) were considerably higher in group 2 than in control (FFR:1.92g/min ± 0.6 vs 0.0g/min ± 0.006). A strong influence exerted by pH was observed when Group 3 and group 4 were compared (FFR: 0.02g/min ± 0.009 vs 2.3g/min ± 0.9) and (Pap: 13.5 cmH2O ± 1.4 vs 90 cmH2O ± 15). A reduced effect was observed in groups 5 and 6 (papaverine and hydrocorisone) and a totally abolished effect was observed in group 7 (fenoterol) (FFR: 0.001 ± 0.0003 mL/min and Pap: 14±0.8 cmH2O). Pulmonary edema induced by Hypocapnia/alkalosis is a consequence of alkalosis and not of hypocapnia. This effect could be due to inflammatory damage in the lung parenchyma and alkalosis-mediated vasoconstriction.

Background: The use of inhaled steroids is common in the treatment of bronchial asthma in children. Aim: To assess adrenocortical function in children with severe asthma receiving inhaled budesonide for six or more months. Material and methods: Children with severe asthma that required 800 µg/day or more of inhaled budesonide and that did not required systemic steroids for more than six days in the last four months to control their disease, were studied. Serum cortisol was measured one hour after administration of 0.25 mg of ACTH (Cosyntropin®) intravenously. The test was considered normal if post stimulation serum cortisol was over 18 µg/ml. Results: Twenty children (aged 5 to 14 years, 15 males), were studied. The stimulation test was normal in 17 children. Conclusions: Alterations in adrenal function are present in a small proportion of asthmatic children who require 800 µg/day of inhaled budesonide (Rev Med Chile 2006; 134: 60-4). (Key words: Adrenal cortex function tests; Asthma; Budesonide; Hydrocortisone)

Background: The use of inhaled steroids is common in the treatment of bronchial asthma in children. Aim: To assess adrenocortical function in children with severe asthma receiving inhaled budesonide for six or more months. Material and methods: Children with severe asthma that required 800 µg/day or more of inhaled budesonide and that did not required systemic steroids for more than six days in the last four months to control their disease, were studied. Serum cortisol was measured one hour after administration of 0.25 mg of ACTH (Cosyntropin®) intravenously. The test was considered normal if post stimulation serum cortisol was over 18 µg/ml. Results: Twenty children (aged 5 to 14 years, 15 males), were studied. The stimulation test was normal in 17 children. Conclusions: Alterations in adrenal function are present in a small proportion of asthmatic children who require 800 µg/day of inhaled budesonide

Background: Glucocorticoids play a key role in blood pressure (BP) control and are associated with hypertension in patients with Cushing's syndrome. A number of reports indicate that cortisol (F) may be involved in etiology of essential hypertension (EH). F can bind to the mineralocorticoid receptor, triggering both sodium and water reabsorption in kidney, increase BP and cause renin suppression. Aim: To evaluate urinary free cortisol (UFF) excretion as a potential intermediate phenotype of essential hypertension and correlate F level with plasma renin activity (PRA) and serum aldosterone (SA). Patients and Methods: We recruited 132 EH patients and 16 normotensive healthy controls. Blood samples and 24 hours urine were collected for PRA, SA and UFF analysis. Differences in UFF excretion between sexes were normalized by urinary creatinine (Creat) excretion. The upper limit of UFF/Creat was determined in normotensives considering the mean value plus 2 standard deviations. According to this value, subjects were classified as having high or normal UFF. Results: In EH patients and in normotensives, the UFF/Creat was 36.9±17.0 µg/gr and 30.9±8.8 µg/gr, respectively. The upper limit was set at 48.5 µg/gr. A high UFF/Creat was found in 20/132 EH (15%) patients and 0/16 normotensive subjects. EH patients with high UFF showed lower PRA levels than patients with normal cortisol levels (0.78±0.47 vs. 1.13±0.66 ng/ml*h, respectively, p=0.027) and lower SA values (4.52±1.65 vs 6.34±3.37 ng/dl, respectively, p=0.018). There was a negative correlation between UFF and PRA (r=-0.176, p=0.044) and between UFF and SA (r=-0.183, p=0.036). Conclusions: We have identified a subgroup of EH patients with increased UFF excretion. Patients with the highest UFF showed lower renin and aldosterone levels. These data suggest a potential influence of cortisol in the genesis of hypertension (Rev Méd Chile 2004; 132: 1053-9)

Background: Glucocorticoids play a key role in blood pressure (BP) control and are associated with hypertension in patients with Cushing's syndrome. A number of reports indicate that cortisol (F) may be involved in etiology of essential hypertension (EH). F can bind to the mineralocorticoid receptor, triggering both sodium and water reabsorption in kidney, increase BP and cause renin suppression. Aim: To evaluate urinary free cortisol (UFF) excretion as a potential intermediate phenotype of essential hypertension and correlate F level with plasma renin activity (PRA) and serum aldosterone (SA). Patients and Methods: We recruited 132 EH patients and 16 normotensive healthy controls. Blood samples and 24 hours urine were collected for PRA, SA and UFF analysis. Differences in UFF excretion between sexes were normalized by urinary creatinine (Creat) excretion. The upper limit of UFF/Creat was determined in normotensives considering the mean value plus 2 standard deviations. According to this value, subjects were classified as having high or normal UFF. Results: In EH patients and in normotensives, the UFF/Creat was 36.9±17.0 µg/gr and 30.9±8.8 µg/gr, respectively. The upper limit was set at 48.5 µg/gr. A high UFF/Creat was found in 20/132 EH (15%) patients and 0/16 normotensive subjects. EH patients with high UFF showed lower PRA levels than patients with normal cortisol levels (0.78±0.47 vs. 1.13±0.66 ng/ml*h, respectively, p=0.027) and lower SA values (4.52±1.65 vs 6.34±3.37 ng/dl, respectively, p=0.018). There was a negative correlation between UFF and PRA (r=-0.176, p=0.044) and between UFF and SA (r=-0.183, p=0.036). Conclusions: We have identified a subgroup of EH patients with increased UFF excretion. Patients with the highest UFF showed lower renin and aldosterone levels. These data suggest a potential influence of cortisol in the genesis of hypertension (Rev Méd Chile 2004; 132: 1053-9)

espanolObjetivo: Presentacion de una nueva forma de terapia ocular al tratamiento de rechazo de queratoplastia mediante microinyecciones intracorneanas. Material y metodos: Analizamos 33 pacientes manejados por uno de los autores (EAA), desde enero 1998 a diciembre de 2000. Resultados: El tipo de cirugia mas comun fue queratoplastia penetrante (n=26), seguida de queratoplastia lamellar (n=5) y homoplastia (n=2). El tipo de rechazo mas comun fue epitelial (n=20); de rechazo mixto (n=11) y dos casos de endotelial puro. En 18 de los 33 casos (54,54%) no usamos ningun tratamiento topico asociado en el resto se adiciono algun tipo de medicamento inducido principalmente por la ansiedad de la paciente. La gran mayoria de los pacientes (81%) presento mejoria clinica pocos dias despues de la inyeccion. Se requirieron de una a cinco dosis en 54% de los casos, en el resto se aplicaron mas de cinco sesiones. Los pacientes seguidos por un tiempo mayor de 6 meses (n=31) no han presentado catarata, glaucoma u otras complicaciones alusivas al corticoide. Conclusiones: La inyeccion intracorneal de corticosteroides reemplaza o potencializa el tratamiento de rechazo en queratoplastia. EnglishPurpose: To introduce a new type of therapy for corneal rejection after keratoplasty with the microinjection of intrastromal depot cortisone in single or multiple doses. Methods: Thirty-three consecutive eyes with corneal graft rejection were diagnosed and treated by one of the authors (EA) between January 1998 and November 2000. Results: Of the 33 eyes, 26 were submitted to Penetrating Keratoplasty (PK), five to lamellar, and two to homoplastic keratoplasty. The most common rejection type was epithelial in 20 eyes, 11 eyes showed mixed rejection types and two eyes, endothelial. In 18 of the cases (54.54%) treatment consisted solely of intraestromal injection; in the other 15 cases some other medications were added mostly because of patient anxiety. The vast majority of the cases (81%) improved clinically within a few days after the injection. Fifty-four percent of the cases required a number of doses ranging from one to five; the rest of the cases had a greater number of sessions. Thirty-one cases have been followed up for a period longer than six months without showing increase in intraocular pressure or development of steroid lens opacities. Conclusion: Intrastromal depot cortisone injection is a new alternative for the treatment of corneal graft rejections after keratoplasty.

We report a 10 years old boy, admitted with a history of asthenia, anorexia and weight loss of 4 kg. Initial laboratory work up showed metabolic acidosis and hyponatremia. The patient had no circadian rhythm of serum cortisol and an adrenal stimulation test confirmed the presence of adrenal insufficiency. Anti-adrenal antibodies were positive. Treatment with cortisol and fluorocortisone resulted in a complete remission of symptoms (Rev Méd Chile 2002; 130: 901-6).

We report a 10 years old boy, admitted with a history of asthenia, anorexia and weight loss of 4 kg. Initial laboratory work up showed metabolic acidosis and hyponatremia. The patient had no circadian rhythm of serum cortisol and an adrenal stimulation test confirmed the presence of adrenal insufficiency. Anti-adrenal antibodies were positive. Treatment with cortisol and fluorocortisone resulted in a complete remission of symptoms (Rev Méd Chile 2002; 130: 901-6).

Laparoscopic adrenalectomy, if done by skilled surgeons, is now the first choice for treating most adrenal tumors, including bilateral pheochromocytoma. We report two women, aged 35 and 34 years old, with bilateral adrenal pheochromocytoma successfully excised by laparoscopic surgery. Both had severe hypertension, high urinary catecholamine values (epinephrine + norepinephrine: 528 and 1083 ug/24h) and bilateral adrenal tumors at CT scan. After 4 weeks of doxazosin treatment, a laparoscopic transperitoneal adrenalectomy was done (Gugner’s technique), with surgical times of 7 and 5 hours respectively. Both patients received hydrocortisone and only the second one required one unit of packed cells. Postoperative evolution was uneventful and both patients were discharged at the fifth postoperative day. At two months of follow up, both patients are asymptomatic and normotensive (Rev Med Chile 2001; 129: 91-94)

Objetivo: Comparar los efectos terapéuticos y colaterales de dos esquemas de tratamiento en la crisis asmática: la asociación de fenoterol 100 ug en microdosificador inhalatorio (MDI) con aerocámara más dexametasona endovenosa vs salbutamol 100 ug en MDI con aerocámara más hidrocortisona endovenosa. Materiales y métodos: En un estudio prospectivo, randomizado, multicéntrico y abierto, se incluyó 60 niños con crisis asmática leve-moderada (30 para cada grupo). Ambos grupos fueron comparables al ingreso. Resultados: En la evolución no hubo diferencia significativa en la frecuencia respiratoria, puntaje clínico, pico respiratorio forzado (PEF) y tremor (p>0.05), hallándose mayor taquicardia en los primeros 30 y 60 minutos en el grupo que recibió Fenoterol - Dexametasona. No se encontró diferencia significativa en la proporción de altas al final del estudio. Conclusiones: Se concluye que la asociación Fenoterol - Dexametasona y Salbutamol - Hidrocortisona son igualmente efectivas en el manejo de la crisis asmática leve - moderada en niños (Ref Med Hered 1997; 8: 5-10) Objective: To compare the clinical and side effects of two therapeutics schedules in the treatment of asthmatic crisis: The association of fenoterol 100 ug Metered Dose Inhaler (MDI) with spacer device plus dexamethasone IV and salbutamol 10 ug MDI with spacer device plus hydrocortisone IV. Material and Methods: In a ramdomized, prospective, longitudinal, open and multicentric trial we included 60 children with mild-moderate asthmatic crisis (30 for each group). Both groups were comparables at initial evaluation. Results: There were no significative difference in respiratory rate, clinical score, peak expiratory flow rate (PEF), and tremor (p>0.05). We found more heart rate at first 30 and 60 minutes in Fenoterol - Dexamethasone group (p