103 results on '"Luna, E."'
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2. Recuento de hongos y detección de micotoxinas en insumos y alimento balanceado provenientes de granjas porcinas de la provincia de Coronel Portillo, Ucayali, Perú
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Huatuco C., David, Rondón E., Juan, Germany G., Lluvis, Gavidia, César M., Luna E., Luis, and Rosadio A., Raúl
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- 2023
- Full Text
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3. Efecto de la administración oral de estreptomicina en la mortalidad de cuyes inoculados con una cepa virulenta de Salmonella Typhimurium
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Espinoza T., Miguel, Carhuaricra, Dennis, Maturrano H., Abelardo Lenin, Rosadio A, Raúl, and Luna E., Luis
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- 2023
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4. Niveles de IgA fecal en ratones inoculados con cepas atenuadas de Salmonella Typhimurium
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Changanaquí, Christian, Luna E., Luis, Carhuaricra H., Dennis, Maturrano H., Lenin, and Rosadio A., Raúl
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- 2022
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5. Requerimientos y pruebas del sistema de control de una microrred, de acuerdo con los estándares IEEE Std 2030- 7-2017 e IEEE Std 2030.8-2018
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Lefred-Rivera, E., Marlés-Sáenz, E., and Gómez-Luna, E.
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- 2022
- Full Text
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6. Vitreorretinopatía exudativa familiar, reporte de un caso asintomático con herencia autosómica dominante, detectado mediante análisis molecular de FZD4
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Montecinos-Contreras, C., Sepúlveda-Vázquez, H.E., Pelcastre-Luna, E., Zenteno, J.C., and Villanueva-Mendoza, C.
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- 2017
- Full Text
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7. Evaluación de la inmunogenicidad de una proteína recombinante de Pasteurella multocida para la prevención de la neumonía aguda en alpacas (Vicugna pacos)
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Moreno-Morales, Gerald, Maximiliano G., Jorge, Siuce M., Juan, Chero O., Ana, Medina S., Guido, Luna E., Luis, Rosadio A., Raúl, and Maturrano H., Lenin
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- 2021
- Full Text
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8. Detección de parvovirus canino tipo 2 (CPV-2) mediante PCR en perros de Lima Metropolitana
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Quino Q., Raquel, Rímac B., Rocío, Luna E., Luis, Maturrano H., Lenin, and Rosadio A., Raúl
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- 2018
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9. Detección molecular del virus del distemper canino en casos clinicos de caninos domesticos no vacunados y evaluacion de factores de riesgo
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Soto R., Andrea, Luna E., Luis R., Rosadio A., Raúl, and Maturrano H., Lenin
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- 2018
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10. Concentraciones de inmunoglobulina G serica en alpacas neonatas muertas por enterotoxemia
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Maximiliano G., Jorge, Maturrano H., Lenin, Castillo D., Hugo, Guzmán M., Karol, Pérez J., David, Luna E., Luis, Puray C., Nidia, and Rosadio A., Raúl
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- 2018
- Full Text
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11. Evaluación de la inmunogenicidad de una proteina recombinante de una Pasteurella multocida aislada de alpacas con neumonia
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Maximiliano G., Jorge, Maturrano H., Lenin, Luna E., Luis, Hurtado C., Raquel, Chero O., Ana, and Rosadio A., Raúl
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- 2018
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12. Analisis de Diversidad Genetica de Cepas de Pasteurella multocida Aisladas de Alpacas con Signos de Neumonia
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Rímac B., Rocío, Hurtado C., Raquel, Luna E., Luis, Rosadio A., Raúl, and Maturrano H., Lenin
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- 2017
- Full Text
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13. Analisis in vitro e in vivo de sobrenadantes crudos de clostridiumperfringens aislados de casos de enterotoxemia en alpacas
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Pérez J., David, Llanco A., Luis, Castillo D., Hugo, Véliz A., Álvaro, Carhuallanqui P., Iván, Luna E., Luis, Londoñe B., Pablo, Piazza F., Roxane, Rosadio A., Raúl, and Maturrano H., Lenin
- Published
- 2012
14. Genotipificacion, evaluacion toxigenica in vitro y sensibilidad a antibioticos de cepas de Escherichia coli aisladas de casos diarreicos y fatales en alpacas neonatas
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Luna E., Luis, Maturrano H., Lenin, Rivera G., Hermelinda, Zanabria H., Víctor, and Rosadio A., Raúl
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- 2012
15. Eimeriosis en crias de alpacas: prevalencia y factores de riesgo
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Rodríguez H., Antony, Casas A., Eva, Luna E., Luis, Gavidia Ch., César, Zanabria H., Víctor, and Rosadio A., Raúl
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- 2012
16. El complejo enterico neonatal en alpacas Andinas
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Rosadio A., Raúl, Maturrano H., Lenin, Pérez J., David, and Luna E., Luis
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- 2012
17. Avances en el estudio de la patogenesis y prevencion de la enterotoxemia de las alpacas
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Rosadio A., Raúl, Maturrano H., Lenin, Pérez J., David, Castillo D., Hugo, Véliz A., Álvaro, Luna E., Luis, Yaya L., Katherine, and Londoñe B., Pablo
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- 2012
18. Detección de parvovirus canino tipo 2 (CPV-2) mediante PCR en perros de Lima Metropolitana
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Quino Q, Raquel, Rímac B, Rocío, Luna E, Luis, Maturrano H, Lenin, and Rosadio A, Raúl
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PCR ,viruses ,diagnóstico clínico ,parvovirus canino ,canine parvovirus ,hisopados rectales ,clinic diagnosis ,rectal swabs - Abstract
El objetivo del estudio fue la detección de parvovirus canino tipo 2 (CPV-2) en perros jóvenes de la ciudad de Lima con/sin sintomatología clínica compatible con parvovirosis mediante la técnica de PCR, usando cebadores que pueden permitir la amplificación de un fragmento del gen codificante de la proteína VP2. Se colectaron hisopados rectales de 78 perros menores a un año y sin historia de vacunaciones previas, de los cuales 39 individuos tuvieron un diagnóstico clínico de parvovirosis canina y los otros 39 fueron animales clínicamente sanos. Para la extracción de ADN viral se usó el método fast boiling, donde las muestras fueron sometidas a un hervido a 100 °C por 10 minutos con posterior centrifugación para extraer el sobrenadante, el cual fue usado como molde para la reacción de PCR. Se usaron cebadores específicos que amplifican un fragmento de 1316 pares de bases del gen VP2 del virus CPV-2, utilizando como control positivo una vacuna comercial. El virus fue detectado en el 62% de animales con diagnóstico clínico de la enfermedad con PCR convencional, no siendo detectado en perros clínicamente sanos. La no detección de CPV-2 en animales con diagnóstico clínico compatibles a parvovirosis en el 38% de los casos indicaría la presencia de otro agente etiológico como causante del cuadro sintomatológico, recomendándose el uso de técnicas complementarias para el correcto diagnóstico de la enfermedad. The objective of the study was the detection of canine parvovirus type 2 (CPV-2) in young dogs of Lima city with and without clinical symptoms compatible with parvovirus by the PCR technique using primers that can allow the amplification of a fragment of the gene coding for the protein VP2. Rectal swabs were collected from 78 dogs younger than one year old and without a history of previous vaccinations, of which 39 individuals had a clinical diagnosis of canine parvovirus and the other 39 were clinically healthy animals. For the extraction of viral DNA, the fast boiling method was used. Samples were boiled at 100 °C for 10 minutes and then centrifuged to extract the supernatant, which was used as a template for the PCR reaction. Specific primers that amplify a 1316 base pair fragment of the VP2 gene of the CPV-2 virus were used, using a commercial vaccine as a positive control. The virus was detected in 62% of animals with clinical diagnosis of the disease with conventional PCR, not being detected in clinically healthy dogs. The non-detection of CPV-2 in animals with a clinical diagnosis compatible with parvovirus in 38% of cases would indicate the presence of another etiological agent as the cause of the clinical signs, and therefore, recommending the use of complementary techniques for the correct diagnosis of the disease.
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- 2018
19. Campaña de prevención del consumo de alcohol en jóvenes «3 × 1: sin alcohol disfrutarás el triple»
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Díaz González-Blanco, T. and MartÍn Luna, E.
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- 2002
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20. Hepatitis autoinmune con elevación de CA 19-9 y normalización con tratamiento inmunosupresor: reporte de caso y revisión de la literatura
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Calisto, JL, Tagle, M, Bedoya, P, Scavino, Y, Luna, E, Poletti, L, and Targarona, J
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Hepatitis autoinmune ,Hepatitis autoinmune, inmunoterapia ,immune therapy ,Autoimmune hepatitis ,inmunoterapia - Abstract
Describimos el caso de una mujer de 82 anos que se presento con ictericia, dilatación de colédoco, alteración de la bioquímica hepática y niveles elevados de CA-19.9 (741 UI). Se descartaron neoplasias pancreáticas e intestinales. La biopsia hepática mostró inflamación crónica, cirrosis y hallazgos consistentes con hepatitis autoinmune. La paciente recibió tratamiento con corticoides y tanto la enfermedad como los niveles de CA -19-9 regresaron a niveles normales. We describe the case of an 81 year old woman that presented with jaundice, bile duct dilation, hepatic liver tests abnormalities and elevated levels of CA-19-9 (741 UI). Intestinal and pancreatic neoplasia were ruled out. Hepatic biopsy revealed chronic inflammation, cirrhosis and findings consistent with autoimmune hepatitis. The patient was given a course of corticoids and the disease as well as levels of CA-19-9 returned to normal levels.
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- 2017
21. Genetic diversity analysis of pasteurella multocida isolates from alpacas with clinical signs of pneumonia
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Rímac B, Rocío, Hurtado C, Raquel, Luna E, Luis, Rosadio A, Raúl, and Maturrano H, Lenin
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alpaca ,Pasteurella multocida ,diversidad genética ,pneumonia ,neumonía ,genetic diversity ,BOX-PCR - Abstract
El propósito del estudio fue caracterizar cepas de Pasteurella multocida aisladas de pulmones de alpacas de 1 a 2 meses de edad con signos de neumonía, colectados en 2014. Se utilizó la técnica de BOX-PCR para demostrar la diversidad genética entre las cepas. Se aislaron 24 cepas de P. multocida de 46 animales mediante identificación bioquímica. El análisis por BOX-PCR demostró dos patrones de bandas amplificadas, donde 22 cepas fueron agrupadas en un clúster y dos cepas en otro clúster. El presente estudio demostró una homogeneidad genética en la mayoría de las cepas, evidenciando una fuente común de infección que afectó a los animales. The purpose of this study was to characterize strains of Pasteurella multocida isolated from lungs of 1-2 months old alpacas with signs of pneumonia, collected in 2014. The BOX-PCR technique was used to demonstrate genetic diversity among strains. Twenty-four strains of P. multocida were isolated from 46 animals through biochemical identification tests. The BOX-PCR analysis showed two amplified band patterns, where 22 strains were grouped in one cluster and two strains in another cluster. The present study showed genetic homogeneity in most of the strains, evidencing a common source of infection that affected the animals.
- Published
- 2017
22. Obtención de la respuesta en frecuencia en transformadores estando en servicio
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Gómez-Luna, E., Aponte M., G., and Pleite G., J.
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On-line frequency response ,monitoreo on-line ,Respuesta en frecuencia on-line ,procesamiento de señal ,señales transitorias ,transformadores ,transformers ,signal processing ,on-line monitoring ,transitory signal - Abstract
RESUMEN Este artículo presenta la obtención de la respuesta en frecuencia en transformadores de distribución, estando en servicio (prueba FRA on-line), mediante la inyección de señales controladas y empleando un novedoso algoritmo para el análisis de señales transitorias. Se usó un sistema hardware para inyectar los pulsos controlados sobre la onda de 60 Hz, el cual permitía cambiar la amplitud, el ancho y la fase del pulso generado sobre la onda de 60 Hz, asegurando un alto contenido espectral y un control del mismo. De acuerdo con los resultados obtenidos se pudo observar cómo el nuevo método propuesto ofrecía mayor confiabilidad en los resultados, por lo que, el poder llevar a cabo un monitoreo on-line confiable en transformadores por medio de la técnica FRA es algo innovador y de mucho interés para las empresas del sector eléctrico, debido a que en el momento de realizar la prueba FRA no es necesario interrumpir el suministro de energía eléctrica, eliminado los altos costos que se generan al tener que sacar el transformador de servicio del sistema de potencia, por otro lado, la importancia del sistema implementado es poder supervisar el transformador desde una red inteligente (Smart Grid) con el fin de tomar decisiones oportunas del estado real de operación basado en la condición del equipo. La metodología desarrollada se aplicó a transformadores piloto y a transformadores de una red de distribución del sistema de potencia con el objeto de validar el método propuesto. ABSTRACT This article presents obtaining the frequency response in transformers, in service (on-line FRA test), through the injection of controlled signals and employing a new algorithm for the analysis of transitory signals. A system hardware was used for the injection of controlled pulses on the 60 Hz; this system can inject signals and change its amplitude, width and phase, ensuring a high spectral content and control of it. According to the results, it was observed how the new method provided greater confidence in the results, so the place to bring a reliable on-line transformer monitoring through the FRA technique is innovative and much interest to electric utilities, because now in the FRA test will be not necessary to interrupt the power supply, eliminating the high costs generated by having to de energized the transformer, the importance of the implemented system is that is capable to monitor the transformer from a smart grid in order to make timely decisions in the actual state of operation based on the equipment condition.
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- 2017
23. Estado nutricio en pacientes de primer ingreso a hospitalización del Servicio de Hematología del Instituto Nacional de Cancerología
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Baltazar Luna, E., Omaña Guzmán, L. I., Ortiz Hernández, L., Ñamendis-Silva, S. A., and De Nicola Delfin, L.
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Cáncer hematológico ,Nutritional status ,Hematologic cancer ,Estado nutricio - Abstract
Objetivos: Determinar el estado de nutrición de los pacientes que ingresan por primera vez a hospitalización del servicio de hematología y que no han recibido tratamiento oncológico, conocer si el estado de nutrición evaluado por medio de la EGS-GP y por concentración sérica de Albúmina se relaciona con la mortalidad de los pacientes. Métodos: Estudio longitudinal, prospectivo, analítico. Por medio de EGS-GP se evaluó el estado nutricional de los pacientes, Se utilizó el paquete estadístico SPSS 19.0 para el análisis de datos. Resultados: Se evaluaron 119 pacientes, 52,1% mujeres y 47,9% hombres. El diagnóstico más común fue Linfoma no Hodgkin en el 43,7%. De acuerdo a la EGS-GP el 50,4% de los pacientes presentaba algún grado de desnutrición o estaba en riesgo de padecerla de los cuales: el 31,1% tenía desnutrición moderada y el 19,3% presentaba desnutrición severa. El 49,6% de los pacientes presentaba un adecuado estado nutricio. Del 30,3% de los pacientes que fallecieron el 37% tenía desnutrición severa y el 50% disminución severa de la concentración de albúmina. Conclusiones: La prevalencia de desnutrición en los pacientes hematológicos atendidos en el Instituto Nacional de Cancerología de México que aún no reciben tratamiento médico fue elevada. Existe una asociación entre el Estado Nutricio y la mortalidad de éste grupo de pacientes. Objectives: To determine the nutritional status of patients admitted to hospital for the first time the hematology service and who have not received treatment for cancer, to know if the nutritional status assessed by the EGS-GP and serum albumin related mortality of patients Methods: A longitudinal, prospective, analytical. EGS-Through GP assessed the nutritional status of patients, we used SPSS 19.0 for data analysis. Results: Evaluaron 119 patients, 52.1% female and 47.9% male. The most common diagnosis was non-Hodgkin lymphoma in 43.7%. According to the EGS-GP 50.4% of patients had some degree of malnutrition or was at risk of suffering of which: 31.1% had moderate and 19.3% had severe malnutrition. The 49.6% of patients had an adequate nutritional status. 30.3% of the patients who died, 37% had severe malnutrition and 50% severe decrease in albumin concentration. Conclusions: The prevalence of malnutrition in hematological patients treated at the National Cancer Institute of Mexico that have not received medical treatment was high. There is an association between nutritional status and mortality in this patient group.
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- 2013
24. Selección de una wavelet madre para el análisis frecuencial de señales eléctricas transitorias usando WPD
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Gómez-Luna, E, Silva, D, and Aponte, G
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descomposición wavelet por paquetes ,wavelet packet decomposition ,transient signals ,análisis frecuencial ,Transformada wavelet ,mother wavelet ,señales transitorias ,frequency analysis ,wavelet madre ,Wavelet transform - Abstract
Este artículo propone un método para seleccionar una wavelet madre adecuada para el análisis frecuencial de señales eléctricas transitorias, considerando sus propiedades y las necesidades del caso de aplicación. Se utilizó la descomposición wavelet por paquetes analizando las wavelets como filtros y para cuantificar la dispersión de información evaluando el desempeño de diferentes familias incluidas en las librerías de Matlab. Para validar el método propuesto se presenta un caso de aplicación donde se estima el valor eficaz (RMS) de una señal transitoria. El método de selección utilizado permite tener una visión clara de cómo aprovechar las propiedades de las wavelets para escoger una adecuada, dependiendo del caso de aplicación. This paper proposes a method to select an appropriate mother wavelet for the frequency analysis of electrical transient signals, based on the wavelet properties and considering the needs of the application case. The Wavelet Packet Decomposition (WPD) was used to analyze wavelets as filters and to quantify the information leakage by evaluating the performance of different families included in the Matlab's libraries. To validate the method proposed, an application case is presented where the effective value (RMS) is estimated for a transient signal. The selection method used provides a clear scope on how to exploit the wavelet properties to select the appropriate one depending on the particular application.
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- 2013
25. ANÁLISIS In vitro e in vivo DE SOBREDONANTES CRUDOS DE Clostridium perfringens AISLADOS DE CASOS DE ENTEROTOXEMIA EN ALPACAS
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Pérez J., David, Llanco A., Luis, Castillo D., Hugo, Véliz A., Álvaro, Carhuallanqui P, Iván, Luna E., Luis, Londoñe B., Pablo, Piazza F., Roxane, Rosadio A., Raúl, and Maturrano H., Lenin
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Clostridium perfringens ,Clostridium perfringen ,Cp-PLC ,enterotoxemia - Abstract
In the present study, 24 native supernatants isolated from enterotoxemia fatalities were evaluated to characterize lecitinase, hemolytic, in vitro cytotoxicity, and in vivo enterotoxicity activities of the phospholipase C (Cp-PLC) exotoxin. The lecitinase activity was monitored in microplates using egg white emulsifications, the hemolityc and perfringolisine in microplates using sheep and equine eritrocytes respectively, the cytotoxic activity was tested on HEp-2 cells and the enterotoxicity by inoculating within intestinal loops of rabbits. At the molecular level, all the isolates (12 vegetative and 12 sporulated) were found to contain the cpa gene (genotype A), while six also contained cpb2 gene but none had the cpe gene. These isolates were classified, according the lecitinase activity, as high, medium and low producer strains. Most of the vegetative (66.6%) isolates had high and medium Cp-PLC production profiles, whereas all of the sprorulated ones were low producers. All high lecitinase production strains were citotoxic to HeP2 cells and the highest hemolytic activities (24.0 ± 8.4 u.a.h). Although the 66.6% (n=16) of the isolates induced intestinal fluid accumulations (0.12-0.47 mL/cm) none of the 24 isolates was able to produce intestinal lesions similar to enterotoxemia. The native supernantants showed presence of other toxins with hemolytic, citotoxic and enterotoxin activities similar to the Cp-PLC, CPE and â2 toxin that warrant further investigation to elucidate their possible role in the etiopathogenecity of enterotoxemia in alpacas., Se reportan evaluaciones de sobrenadantes bacterianos (nativos) crudos obtenidos de 24 aislados de C. perfringens de casos fatales de enterotoxemia buscando caracterizar propiedades lecitinasas, hemolíticas, citotóxicas in vitro y enterotóxicas in vivo de la exotoxina fosfolipasa C (Cp-PLC). Los aislados (12 en estados vegetativos y 12 esporulados) contenían el gen cpa (genotipo A), y seis de ellos tenían además el gen cpb2, pero todos carecían del gen de la enterotoxina (cpe). Las actividades lecitinasas fueron evaluadas, en microplacas, usando emulsiones de yemas de huevo; las hemolíticas y perfringolisina en microplacas, usando eritrocitos de carnero y de equino respectivamente; las citotóxicas, en células HEp-2; y las enterotóxicas en conejos inoculados intraintestinalmente. Los aislados fueron clasificados, de acuerdo a los niveles de la actividad lecitinasa, en cepas de alta, mediana y baja producción de Cp-PLC. La mayoría de aislados (66.6%) en estados vegetativos mostraron perfiles de alta y mediana producción de Cp-PLC, mientras que la totalidad de los esporulados fueron de baja producción. Todos los aislados altamente productores de Cp-PLC fueron citotóxicos y mostraron las mayores actividades hemolíticas (24.0 ± 8.4 u.a.h). A pesar de que el 66.6% (n=16) de los aislados indujeron acumulación de fluido intestinal (0.12-0.47 mL/cm), ninguno fue capaz de generar lesiones intestinales en conejos, similares a las descritas en la enterotoxemia. Los sobrenadantes crudos de los aislados evidenciaron la presencia de otras toxinas tipo hemolisinas, citotoxinas y enterotoxinas, distintas a Cp-PLC, CPE y toxina â2, que necesitan ser investigadas a fin de elucidar su posible rol en la etiopatogénesis de la enterotoxemia en alpacas.
- Published
- 2012
26. Neonatal enteric complex in andean alpacas
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Rosadio A, Raúl, Maturrano H, Lenin, Pérez J, David, and Luna E., Luis
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alpacas ,Eimeria macusaniensis ,Clostridium perfringens ,enteritis neonatal ,neonatal enteritis ,E. coli ,Giardia intestinalis - Abstract
Se revisan avances de investigaciones sobre los principales agentes causales de morbilidad y mortalidad en alpacas neonatales asociadas a procesos entéricos en el sur peruano. Análisis microbiológicos confirman al Clostridium perfringens tipo A como el agente prevalente en fatalidades asociadas con enterotoxemia e identifican por primera vez la presencia del gen secundario β2. El análisis in vitro argumenta la existencia de cepas con tres perfiles en la actividad fosfolipídica (alta, mediana y baja), mostrando que las cepas de medianas y altas producciones fueron capaces de producir lesiones intestinales en conejos pero incapaces de producir similares lesiones en crías de alpacas. Estudios histopatológicos revelan la coexistencia de Clostridium y E. macusaniensis en lesiones de enteritis hemorrágica en muestras intestinales de crías muertas por enterotoxemia, sugiriendo a las infecciones coccidiales como posibles agentes desencadenantes de fatalidades conocidas como enterotoxemia. Por otro lado, estudios realizados en hisopados clínicos o contenidos intestinales han identificado molecularmente cepas de E. coli patogénicas (enteropatogénicas y enterohemorrágicas). Adicionalmente, en casos clínicos de diarreas neonatales, mediante inmunofluorescencia directa y PCR, se ha detectado Giardia intestinalis coexistiendo con cepas de E. coli enteropatogénicas, así como un coronavirus similar al virus bovino. Estos patógenos son potenciales causantes de procesos diarreicos en animales incluyendo a poblaciones humanas. Advances in research on the major causative agents of morbidity and mortality in newborn alpacas associated with enteric processes in southern Peru were reviewed. Microbiology and molecular analyses performed on intestinal samples from enterotoxemia fatalities confirmed the predominance of C. perfringens type A carrying only the gene coding for the major α exotoxin and identifiying for the first time the presence of the novel β2 toxin gene. In vitro studies have yielded three profiles for phospholipase activity (high, medium and low) with biological activity when high and medium strains were inoculated intraintestinally in mice and rabbits, but did not induce intestinal pathology in an alpaca cria. A detailed histopathological investigation has reveled that within necrotizing hemorrhagic enteritis Clostridium coexist with massive presence of Eimeria macusaniensis suggesting that primary parasite tissue destruction may well predispose overgrowth of clostridium and toxin production, triggering enteric fatalities. Additionally, studies on diarrheas intestinal swabs and/or intestinal contents identified Escherichia coli pathogenic strains (enteropathogenic and enterohemorrhagic). The immunofluorescent direct test and PCR revealed the presence of Giardia intestinalis coexisting with mostly enteropathogenic and enterohemorrhagic E. coli strains, as well as with a virus similar to bovine coronavirus. These microbes are potentially diarrheagenic pathogens and a possible infection source for Andean people.
- Published
- 2012
27. Advances on pathogenesis and prevention of enterotoxemia of alpacas
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Rosadio A., Raúl, Maturrano H., Lenin, Pérez J., David, Castillo D., Hugo, Véliz A., Álvaro, Luna E., Luis, Yaya L., Katherine, and Londoñe B, Pablo
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alpaca ,vacuna ,genotyping ,Clostridium perfringens ,vaccine ,genotipificación ,C. perfringens ,enterotoxemia - Abstract
Se revisan las investigaciones recientes realizadas por nuestro grupo de investigadores sobre enterotoxemia de las alpacas en el Perú. Estudios microbiológicos y moleculares demostraron que la mayoría de las cepas aisladas fueron de Clostridium perfringens y estas contienen únicamente el gen cpa de la toxina α(C. perfringens genotipo A) y solamente el 0.4% tienen genes cpa y cpb de las toxinas αy β(genotipo C). En análisis paralelo, se encontró que el 8.5% de los genotipos A contenían, adicionalmente, el gen cpb2, pero ninguna cepa tenía el gen cpe de la enterotoxina. Estos resultados evidencian que las exotoxinas secretadas, y no las endotoxinas (cpe), serían los probables factores de virulencia clostridiales en la enterotoxemia de la alpaca. Adicionalmente, en el análisis histopatológico de intestinos infectados, el 30.6% de las muestras presentó abundantes estructuras parasitarias inmaduras correspondientes a Eimeria macusaniensis, afectando la mucosa y epitelio de las glándulas crípticas intestinales, sugiriendo a las infecciones coccidiales como uno de los posibles factores desencadenantes o predisponentes de la enterotoxemia. Estos resultados microbiológicos permitieron diseñar, preparar y mejorar una vacuna convencional inactivada que contiene, mayoritariamente, componentes bacterianos y exotoxinas A, Aβ2 y C aislados de casos fatales de la enfermedad. Desde su introducción en una empresa alpaquera del sur peruano en 2001, la vacuna ha logrado reducir progresivamente los índices de mortalidad por enterotoxemia de 19.5% (2000, sin vacuna) hasta alcanzar tasas menores al 5% en 2006. The results of our recent research work on enterotoxemia in Peruvian alpacas are presented. Microbiological and molecular analyses found that the majority of the isolates corresponded to Clostridium perfringens and contained the cpa coding gene for αtoxin (A genotype) while 0.4% contained both the cpa and cpb genes of the αand βtoxins (C genotype). A parallel study revealed that 8.5% of the genotype A isolates also had cpb2, but the cpe (enterotoxin) gene was absent in all cases. These results highly suggest that the exotoxins secreted by C. perfringens are the virulent factors in enterotoxemia, rather than the endogenous enterotoxin. Additionally, an histopathological study of intestinal samples from fatal cases showed that 30.6% had abundant immature structures of Eimeria macusaniensis affecting deep mucosa and cryptic gland epithelia, primarily in the jejune and ileum, suggesting that eimeriosis is likely a triggering or predisposing factor for the development of enterotoxemia. The microbiological studies allowed the design and progressive improvement of an inactivated enterotoxemia vaccine containing primarily the bacterial component plus exotoxins of types A, Aβ2 and C isolated from natural fatal cases of the disease. During six years of field tests in southern Peru, the vaccine has steadily reduced specific neonatal mortality rates due to enterotoxemia from 19.5% (2000, without vaccine) to less than 5% in 2006.
- Published
- 2012
28. In vitro and in vivo analysis of clostridium perfringens supernatant isolates from alpaca enterotoxemia cases
- Author
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David Pérez J., Luis Llanco, Hugo Castillo D., Álvaro Véliz A., Iván Carhuallanqui P., Luis Luna E., Pablo Londoñe B., Roxane Piazza F., Raúl Rosadio A., and Lenin Maturrano H.
- Subjects
Clostridium perfringens ,Cp-PLC ,enterotoxemia - Abstract
Se reportan evaluaciones de sobrenadantes bacterianos (nativos) crudos obtenidos de 24 aislados de C. perfringens de casos fatales de enterotoxemia buscando caracterizar propiedades lecitinasas, hemolíticas, citotóxicas in vitro y enterotóxicas in vivo de la exotoxina fosfolipasa C (Cp-PLC). Los aislados (12 en estados vegetativos y 12 esporulados) contenían el gen cpa (genotipo A), y seis de ellos tenían además el gen cpb2, pero todos carecían del gen de la enterotoxina (cpe). Las actividades lecitinasas fueron evaluadas, en microplacas, usando emulsiones de yemas de huevo; las hemolíticas y perfringolisina en microplacas, usando eritrocitos de carnero y de equino respectivamente; las citotóxicas, en células HEp-2; y las enterotóxicas en conejos inoculados intraintestinalmente. Los aislados fueron clasificados, de acuerdo a los niveles de la actividad lecitinasa, en cepas de alta, mediana y baja producción de Cp-PLC. La mayoría de aislados (66.6%) en estados vegetativos mostraron perfiles de alta y mediana producción de Cp-PLC, mientras que la totalidad de los esporulados fueron de baja producción. Todos los aislados altamente productores de Cp-PLC fueron citotóxicos y mostraron las mayores actividades hemolíticas (24.0 ± 8.4 u.a.h). A pesar de que el 66.6% (n=16) de los aislados indujeron acumulación de fluido intestinal (0.12-0.47 mL/cm), ninguno fue capaz de generar lesiones intestinales en conejos, similares a las descritas en la enterotoxemia. Los sobrenadantes crudos de los aislados evidenciaron la presencia de otras toxinas tipo hemolisinas, citotoxinas y enterotoxinas, distintas a Cp-PLC, CPE y toxina â2, que necesitan ser investigadas a fin de elucidar su posible rol en la etiopatogénesis de la enterotoxemia en alpacas. In the present study, 24 native supernatants isolated from enterotoxemia fatalities were evaluated to characterize lecitinase, hemolytic, in vitro cytotoxicity, and in vivo enterotoxicity activities of the phospholipase C (Cp-PLC) exotoxin. The lecitinase activity was monitored in microplates using egg white emulsifications, the hemolityc and perfringolisine in microplates using sheep and equine eritrocytes respectively, the cytotoxic activity was tested on HEp-2 cells and the enterotoxicity by inoculating within intestinal loops of rabbits. At the molecular level, all the isolates (12 vegetative and 12 sporulated) were found to contain the cpa gene (genotype A), while six also contained cpb2 gene but none had the cpe gene. These isolates were classified, according the lecitinase activity, as high, medium and low producer strains. Most of the vegetative (66.6%) isolates had high and medium Cp-PLC production profiles, whereas all of the sprorulated ones were low producers. All high lecitinase production strains were citotoxic to HeP2 cells and the highest hemolytic activities (24.0 ± 8.4 u.a.h). Although the 66.6% (n=16) of the isolates induced intestinal fluid accumulations (0.12-0.47 mL/cm) none of the 24 isolates was able to produce intestinal lesions similar to enterotoxemia. The native supernantants showed presence of other toxins with hemolytic, citotoxic and enterotoxin activities similar to the Cp-PLC, CPE and â2 toxin that warrant further investigation to elucidate their possible role in the etiopathogenecity of enterotoxemia in alpacas.
- Published
- 2012
29. Celiac disease: descriptive study at the Anglo American Clinic
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Llanos, O., Matzumura, M., Tagle, M, Huerta-Mercado, J, Cedrón, H, Scavino, Y., and Luna, E.
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enfermedad celiaca, anti TTG, gluten ,gluten ,enfermedad celiaca ,anti TTG ,celiac disease - Abstract
INTRODUCCIÓN: La enfermedad celiaca (EC) es una condición en la que la ingesta de gluten desencadena una respuesta de autoinmunidad que genera aplanamiento de las vellosidades intestinales causando malabsorción. La prevalencia mundial es de aproximadamente 1%. En nuestro país no es conocida MATERIALES Y MÉTODOS: Estudio retrospectivo, descriptivo y observacional realizado en la Clínica Angloamericana entre Septiembre del 2004 y Febrero 2012. Se revisaron las historias clínicas, reportes endoscópicos y reportes de biopsias duodenales de los pacientes con anti Transglutaminasa tisular (TTG) positiva, mayores de 18 años. RESULTADOS: Se estudiaron 39 casos, siendo 26 (66.7%) mujeres y 13 (33.3%) varones. La edad media de diagnóstico fue 61.25 años. Los síntomas fueron diarrea crónica en 32 (82.1%), dolor abdominal en 22 (56.4%), distensión abdominal en 14 (35.9%) y otros en menor frecuencia. Ocho (20.5%) pacientes presentaron anemia. Solo 5 (12.8%) pacientes presentaron hallazgos endoscópicos compatibles con EC. La clasificación Marsh de las biopsias duodenales fueron 0: 5 (12.7%), I: 1 (2.6%), II: 0 (0%), III A: 20 (51.3%), III B: 12 (30.8%) y III C: 1 (2.6%). CONCLUSIONES: La EC debe ser considerada como diagnóstico diferencial de pacientes con síntomas gastrointestinales inespecíficos de larga data, teniendo en cuenta también sus manifestaciones extraintestinales. Para el diagnóstico debe utilizarse la anti TTG como prueba inicial y posteriormente realizar una biopsia duodenal para estadiaje. BACKGROUND: Celiac disease (CD) is a condition in which gluten intake develops an autoimmune response generating intestinal villous atrophy, causing malabsorption. Prevalence worldwide is approximately 1%, in our country it is not known. MATERIAL AND METHODS: Retrospective, descriptive, observational study in Anglo American Clinic between September 2004 and February 2012. We reviewed the medical charts, upper GI endoscopy reports and duodenal biopsy reports of all patients with positive anti TTG results, who were older than 18 years of age. RESULTS: We studied 39 cases, 26 (66.7%) women and 13 (33.3%) men. Mean age was 61.25 years. The symptoms were chronic diarrhea in 32 (82.1%), abdominal pain in 22 (56.4%), abdominal distention in 14 (35.9%), and others in lower frequency. Eight (20.5%) patients had anemia. Just 5 (12.8%) had upper endoscopy findings consistent with CD, and Marsh classification was: 0: 5 (12.7%), I: 1 (2.6%), II: 0 (0%), IIII A: 20 (51.3%), III B: 12 (30.8%) y III C: 1 (2.6%). CONCLUSIONS: CD should be considered as a differential diagnosis of patients with non-specific long-term gastrointestinal symptoms, extraintestinal symptoms should also be taken into account. Diagnosis should be made with anti TTG as the initial test and posteriorly with a duodenal biopsy for staging.
- Published
- 2012
30. Understanding the Selective Area Nucleation and Growth of GaN nanocolumns by MBE using Ti nanomasks
- Author
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Calleja Pardo, Enrique, Bengoechea Encabo, Ana, Albert, Steven, Sánchez García, Miguel Angel, Barbagini, Francesca, Luna, E., Trampert, Achim, Jahn, U., and Lefebvre, F.
- Subjects
Electrónica - Abstract
•Self- assembled Ga(In)N Nanorods and Nanostructures •Ordered growth of GaN Nanorods: masks issues •Ordered growth of GaN Nanorods: mechanisms •White NanoLEDs
- Published
- 2011
31. Prótesis Testiculares en la Infancia
- Author
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Capitan-Morales, Luis-Cristobal, Asensio García, J., Gamero de Luna, E., Chaves Pecero, F., and Universidad de Sevilla. Departamento de Cirugía
- Subjects
Anorchism ,Prótesis testiculares ,Testicular a trophy ,Atrofias testiculares ,Testicular prosthesis ,Anorquias - Abstract
Desde el advenimiento de las prótesis testiculares, éstas han sido utilizadas para paliar en gran medida los efectos estéticos derivados del anorquismo. Se presentan 35 casos de colocación de prótesis testiculares tras 32 atrofias secundarias a ectopias, dos secundarias a herniorrafías y una postorsión. En 26 niños se obtuvieron resultados excelentes y en ocho de ellos aparecieron algunas de estas complicaciones: intolerancia, ascenso de prótesis al pubis, posición horizontal u oblicua de la misma en la bolsa escrotal y molestias con prendas ajustadas. Since the advent of testicular prosthesis, these have been used to palliate to a large extent the esthetic effects of anorchism. Ihis is a presentation or 35 cases of testicular prosthesis placement following 32 cases of testicular atrophy secondary to ectopy, 2 secondary to herniorrhaphy and 1 secondary to torsion. Excellent results were obtained in 26 children, eight Children presented some of these complications: intolerance, upward displacement of the prosthesis to the pubic area, horizontal or oblique positioning of the prosthesis in the scrotum and discomfort when using tight clothes.
- Published
- 1990
32. Bases farmacologicas de la utilizacion clinica de las teofilinas de liberacion retardada
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Gil Luna, E., Azagra Ledesma, R., and Salva Miquel, J.A.
- Published
- 1986
- Full Text
- View/download PDF
33. Buscando el modo propio: El estudio de lo femenino en el ensayo (1972-1987) de Carmen Martín Gaite
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Sánchez Reizábal, Raquel, Eliberta Esther Martinez Luna, Tatiana Aguilar Alvarez Bay, Hector Manuel Perea Enriquez, and Martínez Luna, E. Esther
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4 [cti] ,Humanidades y Artes - Abstract
Fuente TESIUNAM
- Published
- 2017
34. Ignacio Manuel Altamirano y Guillermo Prieto : la crónica de espectáculos en el Siglo XIX (1841-1882)
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López Meneses, Zyanya Isabel and Martínez Luna, E. Esther
- Subjects
Humanidades y Artes - Published
- 2015
35. [Pharmacogenetics in primary care: a tool to prevent adverse reactions to drugs].
- Author
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Capilla Díaz S and Gamero de Luna EJ
- Subjects
- Humans, Pharmacogenetics, Primary Health Care, Drug-Related Side Effects and Adverse Reactions prevention & control
- Published
- 2024
- Full Text
- View/download PDF
36. [Genetic factors associated with long COVID].
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Gamero-de-Luna EJ and Sánchez-Jaén MR
- Subjects
- Humans, Forkhead Transcription Factors, Post-Acute COVID-19 Syndrome, COVID-19 genetics
- Abstract
Introduction: The variability in expression and evolution of COVID is not completely explained by clinical factors. In fact, genetic factors play an important role. Moreover, it is unknown whether the genetic factor that contribute to susceptibility and severity are also involved in the onset and evolution of long-COVID. The objective of this review is to gather information from literature to understand which genetic factors are involved in the onset of persistent COVID., Material and Methods: Systematic review in PubMed and bioRxiv and medRxiv repositories based on MeSH-descriptors and MeSH-terms related to COVID and genetic factors. Using these terms 2715 articles were pooled. An initial screening performed by authors independently, selected 205 articles of interest. A final deeper screening a total of 85 articles were chosen for complete reading and summarized in this review., Results: Although ACE2 and TMPSS6 are involved in COVID susceptibility, their involvement in long-COVID has not been found. On the other hand, the severity of the disease and the onset of long-COVID has been associated with different genes involved in the inflammatory and immune response. Particularly interesting has been the association found with the FOXP4 locus., Conclusions: Although studies on long-COVID are insufficient to fully comprehend the cause, it is clear that the current identified genetic factors do not fully explain the progression and onset of long-COVID. Other factors such as polygenic action, pleiotropic genes, the microbiota and epigenetic changes must be considered and studied., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
37. [Impact of training schoolchildren how to perform cardiopulmonary resuscitation using stories and animated cartoons].
- Author
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Pardo Ríos M, Alcázar Artero PM, Cánovas Martínez C, Salas Rodríguez JM, Cánovas Martínez M, Rodríguez Entrena MI, Ocampo Cervantes AB, Chicharro Luna E, and Juguera Rodríguez L
- Subjects
- Child, Humans, Educational Status, Schools, Students, Surveys and Questionnaires, Cardiopulmonary Resuscitation education
- Abstract
Background: We compared the outcome of training schoolchildren how to perform CPR by parents/legal guardians in the family environment versus by teachers at school., Methods: Randomized study of CPR learning in primary school children (1st and 2nd grades) in the Region of Murcia. Parents/legal guardians (family group) and teachers (teacher group) trained the children using didactic material adapted for that age population (one story and one cartoon video) from the educational series Jacinto y sus Amigos©. We evaluated eight theoretical knowledge items and five practical skills., Results: One hundred and sixty schoolchildren were selected and 116 completed the study; in the family group, 51.3% did not finish the study. Children trained by teachers obtained significantly higher median scores in comparison with the family group both in theoretical knowledge (6.7; IQR=1.8 vs 4.7; IQR=3.1, respectively; p < 0.001) and in all practical skills except for "recognizing an emergency situation". Children in the family group, learning CPR with one story and one cartoon video achieved significantly better scores in five theoretical knowledge items and four skills than with only the story., Conclusions: Using non-technological educational resources, e.g., stories and animated cartoons for teaching CPR to primary school students, increases their knowledge and skills. Schoolchildren trained in the educational environment acquired more knowledge and skills than those trained by parents. Within the family environment, CPR teaching was more effective through one story and one cartoon video than when only the story was used.
- Published
- 2023
- Full Text
- View/download PDF
38. The role of vagus nerve stimulation in the treatment of refractory epilepsy: Clinical outcomes and impact on quality of life.
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Martorell-Llobregat C, González-López P, Luna E, Asensio-Asensio M, Jadraque-Rodríguez R, García-March G, and Moreno-López P
- Subjects
- Humans, Anticonvulsants therapeutic use, Quality of Life, Treatment Outcome, Retrospective Studies, Seizures drug therapy, Drug Resistant Epilepsy drug therapy, Vagus Nerve Stimulation
- Abstract
Background: Vagus nerve stimulation (VNS) is used as a complementary therapy to pharmacological treatment in patients with refractory epilepsy. This study aims to evaluate the efficacy of VNS in reducing seizure frequency, severity, and duration; reducing the number of antiepileptic drugs administered; and improving patients' quality of life., Material and Methods: We analysed the clinical progression of 70 patients with refractory epilepsy treated with VNS at Hospital Universitario de Alicante and Hospital Clínico de Valencia. Data were collected before and after the procedure. The difference in seizure frequency pre- and post-VNS was classified using the McHugh scale. Data were also collected on seizure duration and severity, the number of drugs administered, and quality of life., Results: According to the McHugh classification, 12.86% of the patients were Class I, 44.29% were Class II, 40% were Class III, and the remaining 2.86% of patients were Class IV-V. A≥50% reduction in seizure frequency was observed in 57.15% of patients. Improvements were observed in seizure duration in 88% of patients and in seizure severity in 68%; the number of drugs administered was reduced in 66% of patients, and 93% reported better quality of life., Conclusions: VNS is effective for reducing seizure frequency, duration, and severity and the number of antiepileptic drugs administered. It also enables an improvement in patients' quality of life., (Copyright © 2019 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
39. [Mutations, variants and strains of SARS-CoV-2].
- Author
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Gamero-de-Luna EJ and Gamero-Estévez E
- Subjects
- COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 prevention & control, COVID-19 Testing, COVID-19 Vaccines, Global Health, Humans, SARS-CoV-2 pathogenicity, COVID-19 virology, Mutation, SARS-CoV-2 classification, SARS-CoV-2 genetics
- Published
- 2021
- Full Text
- View/download PDF
40. [Psychiatric disorders and their association with cyberbullying in a sample of Mexican adolescents].
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Flores-Rodríguez Y, Martínez-Aguilar O, Tapia-Guillen LG, Solís-Bravo MA, Gatica-Hernández A, Escoto-López JJ, Vargas-Rizo TL, Salinas-Torres LA, Navarro-Luna E, and Albores-Gallo L
- Subjects
- Adolescent, Child, Female, Humans, Male, Mexico epidemiology, Cyberbullying statistics & numerical data, Mental Disorders epidemiology
- Published
- 2020
- Full Text
- View/download PDF
41. Comorbidity burden in terms of disability in patients with osteoarthritis in Mexico. The IMPACTAR registry.
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Vega-Morales D, Esquivel-Valerio JA, Vázquez-Fuentes BR, Díaz-Borjón A, Arce-Salinas CA, Álvarez-Hernández E, Torres-Roldán JF, Aguilera-Zepeda JM, Toledo-Infanson V, Alcántar-Luna E, Aldrete-Velasco JA, Martínez Hernández JL, Gutiérrez-Gómez JJ, and Espinosa-Morales R
- Abstract
Objective: To determine the comorbidities associated with disability in patients with OA in Mexico (2013-2015)., Material and Methods: A cross-sectional, retrospective and multicentre IMPACTAR study (n=7703) in Mexican patients (2013-2015). Comorbidities associated with disability were identified in 4971 patients diagnosed with OA from the IMPACTAR registry (n=7073). An adjusted logistic regression analysis was carried out by demographic, economic, clinical and medical variables., Results: Mean age was 63 years; and 75% of the patients were women. Subjects with OA and presence of comorbidities are 42% more likely to develop disabilities than patients without associated comorbidity, considering age, sex, family income, OA diagnosis duration, and education level. The highest rate of people with disability (28.9%) was concentrated in Region 7, which corresponds to Mexico City. There are also significant differences between median family incomes, when the income of persons with disability is under $13 000 (IQR: 9000-16 000) Mexican pesos, compared to patients without disability. Almost half of the subjects (49.6%) reported having at least one comorbidity. Arterial hypertension was the risk factor with a statistically significant difference (32.8%) among those with disability (34.7%)., Conclusions: Programs and interventions for OA patients should take into consideration comorbidity factors, being female, family income, and the region of residence as variables that may increase the possibility of developing an OA-associated disability., (Copyright © 2020 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
42. Successful correction of metabolic acidosis is difficult to achieve in chronic kidney disease.
- Author
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Caravaca-Fontán F, Díaz-Campillejo R, Valladares J, López Arnaldo C, Barroso S, Luna E, and Caravaca F
- Subjects
- Acidosis etiology, Aged, Disease Progression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Potassium blood, Renal Insufficiency, Chronic metabolism, Retrospective Studies, Sodium Bicarbonate blood, Treatment Outcome, Acidosis drug therapy, Renal Insufficiency, Chronic complications, Sodium Bicarbonate therapeutic use
- Abstract
Introduction: Metabolic acidosis (MA) is a common complication of chronic kidney disease (CKD) and is associated with numerous adverse effects, which is why its correction is highly recommended. Oral sodium bicarbonate is the current treatment of choice., Objectives: To describe the prevalence of MA in advanced CKD patients and to determine the clinical and biochemical characteristics associated with its successful correction., Material and Methods: Retrospective, observational cohort study in adult patients with CKD stage 4-5. The inclusion criteria were: not being treated with alkali therapy at the time of inclusion, and to have at least three consecutive glomerular filtration rate (GFR) measurements and biochemical parameters during a minimum follow-up period of 3 months. Incident patients with serum bicarbonate<22 mEq/l were included in the follow-up study and treated with oral sodium bicarbonate. Correction was considered successful when more than half of the samples and the mean bicarbonate levels during individual follow-up were≥22 mEq/l., Results: The study group consisted of 969 patients (age 65±14 years, 507 males) with a mean GFR of 14.8±4.5ml/min/1.73 m
2 . At baseline, 530 patients (55%) had serum bicarbonate<22mEq/l. They were treated with sodium bicarbonate and followed for 15 months. Satisfactory correction of MA was only achieved in 133 patients (25%). By multivariate logistic regression analysis, the main characteristics of patients with adequate control of MA were: age (OR=1.03; 95% CI 1.01 - 1.05), baseline GFR (OR=1.07; 1.02 - 1.12), and treatment with proton-pump inhibitors (OR=1.61; 95% CI 1.06 - 2.44). Patients who achieved successful correction of MA showed slower CKD progression (-1.67±3.71 vs -4.36±4.56ml/min/1.73 m2 /year, P<.0001), and lower average serum potassium concentration (5.1±0.5 vs 5.3±0.5, P<.0001) than those who did not. However, there were no differences in the hospitalisation or mortality rate., Conclusion: MA is a common complication of advanced CKD but difficult to manage with current therapies. Due to the significant potential benefit of controlling MA, new, more effective therapies should be further researched., (Copyright © 2019 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2020
- Full Text
- View/download PDF
43. Renal potassium handling in chronic kidney disease: Differences between patients with or wihtout hyperkalemia.
- Author
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Caravaca-Fontán F, Valladares J, Díaz-Campillejo R, Barroso S, Luna E, and Caravaca F
- Subjects
- Aged, Bicarbonates blood, Cross-Sectional Studies, Female, Glomerular Filtration Rate, Humans, Hyperkalemia etiology, Linear Models, Male, Middle Aged, Potassium blood, Potassium urine, Renal Insufficiency, Chronic complications, Sodium blood, Sodium metabolism, Sodium urine, Hyperkalemia metabolism, Kidney metabolism, Potassium metabolism, Renal Insufficiency, Chronic metabolism
- Abstract
Introduction: Hyperkalemia (HK) is a common electrolyte disorder in chronic kidney disease (CKD), mainly in the advanced stages. A positive potassium balance due to reduced renal excretory capacity is likely the main pathogenic mechanism of HK. Research into the relative role of each pathogenic element in the development of HK in CKD may help to implement more suitable therapies., Objective: To investigate renal potassium handling in advanced CKD patients, and to determine the differences between patients with or without HK., Material and Methods: Cross-sectional observational study in adult patients with stage 4-5 CKD pre-dialysis. Selection criteria included clinically stable patients and the ability to collect a 24hour urine sample correctly. Blood and urinary biochemical parameters were analysed including sodium and potassium (K). Fractional excretion of K (FEK) and K load relative to glomerular filtration (Ku/GFR) were calculated. HK was defined as a serum K concentration ≥5.5mmol/l., Results: The study group consisted of 212 patients (mean age 65±14 years, 92 females) with a mean GFR of 15.0±4.2ml/min/1.73m
2 . 63 patients (30%) had HK. Patients with HK had lower mean bicarbonate levels with respect to patients with normal K levels (NK) (20.3±3.1 vs. 22.8±3.2 mEq/l, P<.0001), but no differences were noted in total urinary sodium and K excretion. While mean FEK values were lower in patients with HK (32.1±12.1% vs. 36.4±14.3%, P=.038), Ku/GFR values were significantly greater with respect to the NK subgroup (4.2±1.5 vs. 3.7±1.4 mmol/ml/min, P=0,049). FEK showed a strong linear correlation with Ku/GFR (R2 =0.74), and partial linear regressions demonstrated that at a similar Ku/GFR level, the FEK of patients with HK was lower than that of NK patients. By multivariate linear and logistic regression analyses, both FEK and Ku/GFR were shown to be the main determinants of K serum levels and HK., Conclusions: Although the K load relative to glomerular filtration (Ku/GFR) is an important determinant of HK in advanced CKD, the most noteworthy characteristic associated with HK in these patients was the limitation of compensatory urinary K excretion, as indicated by lower FEK., (Copyright © 2019 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2020
- Full Text
- View/download PDF
44. Detrimental effect of renin-angiotensin blockade on progression of chronic kidney disease at later stages: A matter of dosage adjustment?
- Author
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Caravaca-Fontán F, Valladares J, Díaz-Campillejo R, Barroso S, Luna E, and Caravaca F
- Subjects
- Angiotensin Receptor Antagonists administration & dosage, Angiotensin-Converting Enzyme Inhibitors administration & dosage, Drug Therapy, Combination adverse effects, Female, Humans, Kidney physiopathology, Linear Models, Longitudinal Studies, Male, Middle Aged, Angiotensin Receptor Antagonists adverse effects, Angiotensin-Converting Enzyme Inhibitors adverse effects, Disease Progression, Kidney drug effects, Renal Insufficiency, Chronic drug therapy, Renin-Angiotensin System drug effects
- Abstract
Introduction: The renoprotective effect of renin-angiotensin (RAS) blockers (angiotensin converting enzyme inhibitors and angiotensin receptor blockers) has been questioned in patients with advanced chronic kidney disease (CKD). Moreover, combination therapy (dual RAS blockade) can further accelerate renal function decline in some populations at risk. However, it is unknown whether this adverse outcome is due to a dose-dependent effect or if it can be attributed more specifically to a drug interaction. Aim This study aims to investigate if the rate of renal function decline in advanced CKD patients is associated to the doses of RAS blockers, and if dual RAS blockade worsens renal function independently of major confounding factors., Material and Methods: Retrospective, observational study in an incident cohort of adult patients with CKD stage 4 or 5 not on dialysis, treated with RAS blockers for at least 3 months prior to the study inclusion. Inclusion criteria were: having at least three consecutive measurements of estimated glomerular filtration rate (eGFR) in a follow-up period >3 months. Decline in renal function was estimated as the slope of the individual linear regression line of eGFR over follow-up time. Equipotent doses of RAS blockers were normalised for a body weight of 70kg or a body surface area of 1.73m
2 (END-RASI). Associations of END-RASI or dual RAS blockade with the rate of renal function decline were analysed by uni- or multivariate linear regression models, accounting for major confounding variables., Results: The study group consisted of 813 patients (mean age 64±14 years, 430 males) with a mean eGFR 14.9±4.2ml/min/1.73m2 ; 729 patients were on RAS blockade monotherapy and 84 on dual RAS blockade. Median END-RASI in the whole group was 0.91 (I.Q. ranges: 0.69-1.20). Patients on dual RAS blockade had significantly higher END-RASI than the rest of study patients (1.52±0.49 vs. 0.93±0.44; p<0.0001). In univariate linear regression, END-RASI were significantly correlated with eGFR decline (R=-0.149; p<0.0001). Patients on dual RAS blockade showed a significantly faster decline of renal function than the rest of the study patients (-6.19±5.57 vs. -3.04±5.37ml/min/1.73m2 /year, p<0.0001). By multivariate linear regression, while dual RAS blockade remained independent and significantly associated with faster renal function decline (beta=-0.094; p=0.005), END-RASI (normalised either for body weight or surface area) did not reach statistical significance., Conclusion: END-RASI are significantly associated with the rate of renal function decline in advanced CKD patients. However, the detrimental effect of dual RAS blockade on CKD progression seems to be independent of END-RASI and other major confounding factors., (Copyright © 2019 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2020
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45. Association of hyperkalemia with clinical outcomes in advanced chronic kidney disease.
- Author
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Caravaca-Fontán F, Valladares J, Díaz-Campillejo R, Barroso S, Luna E, and Caravaca F
- Subjects
- Aged, Bicarbonates blood, Disease Progression, Female, Glomerular Filtration Rate physiology, Hospitalization statistics & numerical data, Humans, Hyperkalemia blood, Hyperkalemia epidemiology, Hyperkalemia mortality, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Potassium blood, Prevalence, Renal Dialysis, Renal Insufficiency, Chronic blood, Renal Insufficiency, Chronic physiopathology, Retrospective Studies, Sex Factors, Time Factors, Hyperkalemia etiology, Renal Insufficiency, Chronic complications
- Abstract
Introduction: Patients with advanced chronic kidney disease (CKD) are at greatest risk of hyperkalemia (HK). The relationship between HK and negative outcomes (mortality or progression of renal insufficiency) in non-dialysis dependent CKD patients is controversial., Aims: To determine the incidence, prevalence, and factors related with HK in a cohort of CKD patients, and its relationship with mortality, hospitalization rate, CKD progression, and dialysis initiation., Material and Methods: A retrospective, observational study in an incident cohort of adult patients with stage 4 or 5 CKD not on dialysis. Inclusion criteria were: having at least three consecutive estimated glomerular filtration rate (eGFR) measurements in a follow-up period >3 months. Decline in renal function was estimated as the slope of the individual linear regression line of eGFR over follow-up time. HK was defined as serum K levels ≥5.5 meq/l. Associations of HK with outcomes were adjusted for major confounding variables in the multivariate analysis., Results: The study group consisted of 1079 patients (574 males, mean age: 65±14 years) with mean baseline eGFR 14.8±4.5 ml/min/1,73 m
2 . Mean follow-up time was 15 months with a median of 7 serum sample determinations per patient. HK was observed at baseline in 26% of patients; in at least one serum sample during the individual follow-up period in 68%; or chronically (>50% of samples) in 33% of patients. By multivariate logistic regression, the best determinants of chronic HK were: male sex (OR = 1.529; 95% CI [1.154-2.025], p = .003), serum bicarbonate (OR = 0.863 [0.829-0.900], p <.0001), diuretic treatment (OR = 0.743 [0.556-0.992], p = .044), and angiotensin converting enzyme inhibitor and/or angiotensin receptor blockers (OR = 4.412 [2.915-6.678], p <.0001). Patients whose serum K levels were in the upper quartile showed a significantly faster CKD progression (-4.05±5.22 vs. -2.69±5.61 ml/min/1.73 m2 /year, p <.0001), and more frequent dialysis initiation (63% vs. 57%, p = .115), though lower mortality (9% vs. 17%, p = .003) and hospitalization rates (2.68±5.94 vs. 3.16±6.77 days per year, p = .301) than the other study patients. However, in the multivariate analysis, average serum K levels were not independently associated with the clinical outcomes investigated., Conclusion: HK is a common biochemical finding in non-dialysis dependent CKD patients, mainly associated with prescribed medication. However, HK was not independently associated with major negative clinical outcomes., (Copyright © 2019 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2019
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46. Efficacy of respiratory muscle training in weaning of mechanical ventilation in patients with mechanical ventilation for 48hours or more: A Randomized Controlled Clinical Trial.
- Author
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Sandoval Moreno LM, Casas Quiroga IC, Wilches Luna EC, and García AF
- Subjects
- Adult, Aged, Double-Blind Method, Female, Humans, Male, Middle Aged, Muscle Strength, Respiratory Muscles physiology, Time Factors, Treatment Outcome, Breathing Exercises, Respiration, Artificial, Ventilator Weaning
- Abstract
Objective: To evaluate the efficacy of respiratory muscular training in the weaning of mechanical ventilation and respiratory muscle strength in patients on mechanical ventilation of 48hours or more., Design: Randomized controlled trial of parallel groups, double-blind. Ambit: Intensive Care Unit of a IV level clinic in the city of Cali., Patients: 126 patients in mechanical ventilation for 48hours or more., Interventions: The experimental group received daily a respiratory muscle training program with treshold, adjusted to 50% of maximal inspiratory pressure, additional to standard care, conventional received standard care of respiratory physiotherapy. MAIN INTEREST VARIABLES: weaning of mechanical ventilation. Other variables evaluated: respiratory muscle strength, requirement of non-invasive mechanical ventilation and frequency of reintubation., Analysis: intention-to-treat analysis was performed with all variables evaluated and analysis stratified by sepsis condition., Results: There were no statistically significant differences in the median weaning time of the MV between the groups or in the probability of extubation between groups (HR: 0.82 95% CI: 0.55-1.20 P=.29). The maximum inspiratory pressure was increased in the experimental group on average 9.43 (17.48) cmsH20 and in the conventional 5.92 (11.90) cmsH20 (P=.48). The difference between the means of change in maximal inspiratory pressure was 0.46 (P=.83 95%CI -3.85 to -4.78)., Conclusions: respiratory muscle training did not demonstrate efficacy in the reduction of the weaning period of mechanical ventilation nor in the increase of respiratory muscle strength in the study population. Registered study at ClinicalTrials.gov (NCT02469064)., (Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)
- Published
- 2019
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47. Changes in renal function after discontinuation of vitamin D analogues in advanced chronic kidney disease.
- Author
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Caravaca F, Caravaca-Fontán F, Azevedo L, and Luna E
- Subjects
- Aged, Calcium blood, Case-Control Studies, Chronic Kidney Disease-Mineral and Bone Disorder drug therapy, Chronic Kidney Disease-Mineral and Bone Disorder etiology, Creatinine blood, Female, Glomerular Filtration Rate drug effects, Humans, Kidney physiopathology, Kidney Function Tests, Male, Middle Aged, Proteinuria etiology, Recovery of Function, Renal Insufficiency, Chronic complications, Retrospective Studies, Vitamin D administration & dosage, Vitamin D analogs & derivatives, Vitamin D therapeutic use, Renal Insufficiency, Chronic physiopathology, Vitamin D adverse effects
- Abstract
Background: In routine clinical practice, the prescription of vitamin D analogues (VDA) in patients with chronic kidney disease (CKD) is often associated with a decline of the estimated renal function. The reason for this is not fully understood., Aims: To analyse the effects of VDA discontinuation in advanced CKD and to determine the factors associated with changes in renal function., Material and Methods: Retrospective cohort study of adult patients with advanced CKD. The case subgroup was treated with VDA and this medication was discontinued at baseline (the first visit). The control subgroup was not treated with VDA and they were selected according to comparability principles for CKD progression by propensity score matching. The primary outcome measure was a change to both the estimated glomerular filtration rate (MDRD-GFR) and the measured glomerular filtration rate (mGFR by combined creatinine and urea clearances). Baseline parameters related to mineral metabolism and creatinine generation were analysed as potential determinants of renal function changes., Results: The study sample consisted of 67 cases and 67 controls. Renal function improved in 67% of cases and worsened in 72% of controls (p<0.0001). Changes in MDRD-GFR for the case subgroup and the control subgroup were +0.455±0.997 vs. -0.436±1.103ml/min/1.73 m
2 /month (p<0.0001), respectively. Total creatinine excretion was slightly higher in cases than in controls but the difference was not significant. According to multivariate logistic and linear regression analyses, baseline total serum calcium was one of the best determinants of both renal function recovery (Odds ratio=3.49; p=0.001), and of the extent of renal function recovery (beta=0.276; p=0.001)., Conclusions: Discontinuation of VDA treatment in CKD patients is associated with significant recovery of estimated renal function. The extent of these changes is mainly associated with baseline total serum calcium., (Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2018
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48. [Comparison of neuromyelitis optica spectra according to AQP4 antibody serostatus in a Mexican referral centre].
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Antonio-Luna E, Acosta-Castillo GI, Ortiz-Maldonado JF, Estrada-Galindo A, Corona T, and Flores J
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Neuromyelitis Optica diagnosis, Retrospective Studies, Antibodies blood, Aquaporin 4 immunology, Neuromyelitis Optica blood, Neuromyelitis Optica immunology
- Abstract
Introduction: Recent studies report that patients with neuromyelitis optica (NMO) or seropositive NMO spectra disorders display clinical characteristics that are different from those of patients who are seropositive for the aquaporin-4 (AQP4) antibody., Aim: To analyse the clinical and paraclinical characteristics of patients with NMO according to their serum AQP4 status., Patients and Methods: We conducted a retrospective study of 100 patients with NMO who fulfilled the Wingerchuk criteria: 70 were positive for the AQP4 antibody and 30 were seronegative., Results: 70% of the subjects met the criteria for NMO, and 30% met criteria for NMO spectra disorders. The seropositive patients presented greater disability in the scores on the American Spinal Injury Association scale (ASIA) and the Expanded Disability Status Scale (p = 0.034 and 0.004, respectively) compared to seronegatives during the follow-up; in this same group there was greater visual involvement (p = 0.02), a higher number of relapses (p = 0.008) and a greater number of spinal segments involved (p = 0.003)., Conclusion: This study provides an overview of the clinical and paraclinical characteristics of patients with NMO according to the AQP4 antibody serostatus. Patients who are seropositive for the AQP4 antibody present greater clinical and imaging involvement.
- Published
- 2017
49. High levels of both serum gamma-glutamyl transferase and alkaline phosphatase are independent preictors of mortality in patients with stage 4-5 chronic kidney disease.
- Author
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Caravaca-Fontán F, Azevedo L, Bayo MÁ, Gonzales-Candia B, Luna E, and Caravaca F
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Retrospective Studies, Alkaline Phosphatase blood, Kidney Failure, Chronic blood, Kidney Failure, Chronic mortality, gamma-Glutamyltransferase blood
- Abstract
Introduction: High serum gamma-glutamyl transferase (GGT) levels are associated with increased mortality in the general population. However, this association has scarcely been investigated in patients with chronic kidney disease (CKD). This study aims to investigate the clinical characteristics of CKD patients with abnormally elevated serum GGT, and its value for predicting mortality., Material and Methods: Retrospective observational study in a population cohort of adults with stage 4-5 CKD not yet on dialysis. Demographic, clinical, and biochemical parameters of prognostic interest were recorded and used to characterise CKD patients with high levels of GGT (>36 IU/l). Cox proportional hazard regression models were used to analyse the influence of baseline serum GGT and alkaline phosphatase (ALP) levels on mortality for whatever reason., Results: The study group consisted of 909 patients (mean age 65±15 years). Abnormally elevated GGT or ALP levels at baseline were observed in 209 (23%) and 172 (19%) patients, respectively, and concomitant elevations of GGT and ALP in 68 (7%). High GGT levels were associated with higher comorbidity burden, and a biochemical profile characterised by higher serum concentration of uric acid, triglycerides, alanine aminotransferase, ferritin, and C-reactive. During the study period, 365 patients (40%) died (median survival time=74 months). In adjusted Cox regression models, high levels of GGT (hazard ratio [HR]=1.39;CI 95%: 1.09-1.78, P=.009) and ALP (HR=1.31; CI95%: 1.02-1.68, P=.038) were independently associated with mortality., Conclusion: High serum levels of GGT are independent predictors of mortality in CKD patients., (Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2017
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50. How to assess the efficacy of phosphate binders.
- Author
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Caravaca F, Caravaca-Fontán F, Azevedo L, and Luna E
- Subjects
- Aged, Female, Humans, Hyperphosphatemia etiology, Male, Renal Insufficiency, Chronic complications, Retrospective Studies, Treatment Outcome, Chelating Agents therapeutic use, Hyperphosphatemia drug therapy, Hyperphosphatemia metabolism, Phosphates metabolism, Renal Insufficiency, Chronic metabolism
- Abstract
Background and Aims: The efficacy of phosphate binders is difficult to be estimated clinically. This study analyzes the changes in serum phosphate and urinary phosphate excretion after the prescription of phosphate binders (PB) in patients with chronic kidney disease stage 4-5 pre-dialysis, and the usefulness of the ratio between total urinary phosphate and protein catabolic rate (Pu/PCR) for estimating the efficacy of PB., Methods: This retrospective observational cohort study included adult chronic kidney disease patients. Biochemical parameters were determined baseline and after 45-60 days on a low phosphate diet plus PB ("binder" subgroup=260 patients) or only with dietary advice ("control" subgroup=79 patients)., Results: Phosphate load (total urinary excretion) per unit of renal function (Pu/GFR) was the best parameter correlated with serum phosphate levels (R
2 =0.61). Mean±SD level of Pu/PCR was 8.2±2.3mg of urinary phosphate per each g of estimated protein intake. After treatment with PB, serum phosphate levels decreased by 11%, urinary phosphate 22%, protein catabolic rate 7%, and Pu/PCR 15%. In the control subgroup, Pu/PCR increased by 20%. Urinary phosphate and urea nitrogen excretion correlated strongly, both baseline and after PB or dietary advice., Conclusions: The proposed parameter Pu/PCR may reflect the rate of intestinal phosphate absorption, and therefore, its variations after PB prescription may be a useful tool for estimating the pharmacological efficacy of these drugs., (Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2017
- Full Text
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