Resumen Definimos acidosis láctica en presencia de pH<7,35, lactato en sangre >2,0 mmol/ly PaCO2 <42 mmHg. Por otro lado, la definición de acidosis láctica grave es controvertida. La causa principal de acidosis láctica grave es el estado de choque. La acidosis láctica pormetformina es rara, pero alcanza una mortalidad del 50%. La acidosis metabólica, incluyendo a la acidosis láctica, puede recibir tratamiento específico o tratamiento general con bicarbonato de sodio, trihidroxiaminometano, carbicarb o hemodiafiltracion continua. El éxito del tratamiento de la acidosis láctica yace en el control de la fuente etiológica; la terapia de reemplazo renal intermitente o continua está perfectamente justificada, y el argumento para decidir cuál utilizar es el estado de choque. Presentamos el informe de un caso de un paciente masculino con intoxicación por metformina como intento suicida, quien desarrolló acidosis láctica y falla orgánica múltiple; la base para el éxito del caso fue el tratamiento con hemodiafiltración continua.

Abstract Lactic acidosis is defined as the presence of pH <7.35, blood lactate >2.0 mmol/L and PaCO2 <42 mmHg. However, the definition of severe lactic acidosis is controversial. The primary cause of severe lactic acidosis is shock. Although rare, metformin-related lactic acidosis is associated with a mortality as high as 50%. The treatment for metabolic acidosis, including lactic acidosis, may be specific or general, using sodium bicarbonate, trihydroxyaminomethane, carbicarb or continuous haemodiafiltration. The successful treatment of lactic acidosis depends on the control of the aetiological source. Intermittent or continuous renal replacement therapy is perfectly justified, shock being the argument for deciding which modality to use. We report a case of a male patient presenting with metformin poisoning as a result of attempted suicide, who developed lactic acidosis and multiple organ failure. The critical success factor was treatment with continuous haemodiafiltration.

INTRODUCTION: Chronic kidney disease is a serious health problem in El Salvador. Since the 1990s, there has been an increase in cases unassociated with traditional risk factors. It is the second leading cause of death in men aged >18 years. In 2009, it was the first cause of in-hospital death for men and the fifth for women. The disease has not been thoroughly studied. OBJECTIVE: Characterize clinical manifestations (including extrarenal) and pathophysiology of chronic kidney disease of nontraditional causes in Salvadoran farming communities. METHODS: A descriptive clinical study was carried out in 46 participants (36 men, 10 women), identified through chronic kidney disease population screening of 5018 persons. Inclusion criteria were age 18 - 59 years; chronic kidney disease at stages 2, 3a and 3b, or at 3a and 3b with diabetes or hypertension and without proteinuria; normal fundoscopic exam; no structural abnormalities on renal ultrasound; and HIV-negative. Examinations included social determinants; psychological assessment; clinical exam of organs and systems; hematological and biochemical parameters in blood and urine; urine sediment analysis; markers of renal damage; glomerular and tubular function; and liver, pancreas and lung functions. Renal, prostate and gynecological ultrasound; and Doppler echocardiography and peripheral vascular and renal Doppler ultrasound were performed. RESULTS: Patient distribution by chronic kidney disease stages: 2 (32.6%), 3a (23.9%), 3b (43.5%). Poverty was the leading social determinant observed. Risk factor prevalence: agrochemical exposure (95.7%), agricultural work (78.3%), male sex (78.3%), profuse sweating during work (76.3%), malaria (43.5%), NSAID use (41.3%), hypertension (36.9%), diabetes (4.3%). General symptoms: arthralgia (54.3%), asthenia (52.2%), cramps (45.7%), fainting (30.4). Renal symptoms: nycturia (65.2%), dysuria (39.1%), foamy urine (63%). Markers of renal damage: macroalbuminuria (80.4%), β2 microglobulin (78.2%), NGAL (26.1%). Renal function: hypermagnesuria (100%), hyperphosphaturia (50%), hypernatriuria (45.7%), hyperkaluria (23.9%), hypercalciuria (17.4%), electrolyte polyuria (43.5%), metabolic alkalosis (45.7%), hyponatremia (47.8%), hypocalcemia (39.1%), hypokalemia (30.4%), hypomagnesemia (19.6%). Imaging: Ultrasound showed fatty liver (93.5%) and vascular Doppler showed tibial artery damage (66.7%). Neurological symptoms: abnormal tendon reflexes (45.6%), Babinski sign and myoclonus (6.5%), sensorineural hearing loss (56.5%). CONCLUSIONS: This chronic kidney disease studied behaves clinically like chronic tubulointerstitial nephropathy, but with systemic manifestations not attributable to kidney disease. While male agricultural workers predominated, women and adolescents were also affected. Findings support a hypothesis of multifactorial etiology with a key role played by nephrotoxic environmental agents.

Maize (Zea mays L.) is an important crop in Mexico, which is often affected by the presence of pathogenic fungi. The objective of this paper was to determine the protective effect of chitosan in maize seedlings subjected to biotic stress. The experiment was conducted at the School of Advanced Studies Cuautitlán, UNAM, in 2008. In order to achieve the aim, after some quality tests, three groups of seeds were separately subjected to attacks by Aspergillus flavus and Fusarium moniliforme. A first group was considered as a positive control, another was coated with chitosan solution and, a final group was mechanically damaged before application of the biopolymer. For five weeks, the seedling growth was evaluated by measuring the total length, length of leaves, stems and, their thickness. There was no significant increase in the size of seedlings from seeds coated with chitosan when compared to the other groups, but, the absence of diseases in the seedlings treated with the biopolymer was quite evident. In the fifth week of growth, leaf structures of the seedlings were planted in agar PDA in order to determine the presence of stresful-fungi. It was found that, leaves from the seeds treated with chitosan developed no fungal burden, suggesting that, chitosan acts as an activator of defense mechanisms in maize seedlings, preventing infection by the pathogenic fungi.

El maíz (Zea mays L.) es un cultivo importante en México, que es a menudo afectado por la presencia de hongos patógenos. El objetivo de este estudio fue determinar el efecto protector del quitosán en plántulas de maíz sometidas a estrés biótico. El experimento se llevó a cabo en la Facultad de Estudios Superiores Cuautitlán, UNAM, durante 2008. Para cumplir el objetivo, después de algunas pruebas de calidad, tres grupos de semillas fueron sometidos por separado a los ataques de Aspergillus flavus y Fusarium moniliforme. Un primer grupo fue considerado como testigo positivo, otro fue recubierto con solución de quitosán y un último grupo fue dañado mecánicamente antes de la aplicación del biopolímero. Durante cinco semanas, el crecimiento de las plántulas se evaluó midiendo la longitud total, longitud de las hojas, de los tallos y el grosor de estos. No hubo incremento significativo en el tamaño de las plántulas, provenientes de semillas recubiertas con quitosán al compararse con el resto de los grupos; sin embargo, la ausencia de enfermedades en las plántulas tratadas con el biopolímero fue evidente. En la quinta semana de crecimiento, las estructuras foliares de las plántulas se sembraron en agar PDA, para determinar la presencia de los hongos estresantes. Se encontró que las hojas provenientes de las semillas tratadas con quitosán, desarrollaron carga fúngica nula, lo que sugiere que el quitosán actúa como un activador de mecanismos de defensa en plántulas de maíz, impidiendo la infección por los hongos patógenos utilizados.

The natural vegetation of well drained fields of Southern Santa Fe (Argentina) are a different kind of communities characterized by the abundance of several species of Stipa. When agricultural lands are abandoned, they are often recolonized by the original vegetation. The object of this paper is to analize the first ten years of secondary succession on a field under a long time of agriculture abandoned after a wheat crop. On the first year, wheat with annual weeds (Chenopodium album and Portulaca oleracea) appeared. After the first year, one plot was colonized by Baccharis salicifolia and the others by Carduus acanthoides, Cerastium glomeratum, Ammi majus, etc. The last years constitute another stage where diversity is reduced and a strong dominance of Baccharis salicifolia or Carduus acanthoides becomes visible. Johnson grass appeared at the begining of the succession and stayed for the whole period with high abundance values. So far no species of the natural communities have established on this field, possibly because not enough time has elapsed yet or because they are absent from the seed bank or in the neighbourhood.

La vegetación prístina de los campos altos del sur de Santa Fe (Argentina) son distintos tipos de flechillares caracterizados por la abundancia de varias especies del género Stipa. Cuando un campo agrícola se abandona suele revertir a las comunidades prístinas. El objeto de este trabajo es analizar los diez primeros años de la sucesión secundaria de un campo sometido a agricultura durante largo tiempo que se abandonó después de un cultivo de trigo (Triticum aestivum). En el primer año aparece trigo acompañado de malezas anuales (Chenopodium album y Portulaca oleracea); después del primer año una parcela fue colonizada por Baccharis salicifolia y las otras por Carduus acanthoides, Cerastium glomeratum, Ammi majus, etc. Los últimos años constituyen una etapa en la que disminuye la diversidad y se establece una fuerte dominancia de Baccharis salicifolia o Carduus acanthoides. El Sorgo de Alepo (Sorghum halepense) aparece en las etapas tempranas y perdura durante todo el período con valores altos de abundancia. Aún, prácticamente no han aparecido especies de los flechillares, por lo tanto se concluye que no ha transcurrido suficiente tiempo para que se regenere el flechillar, o porque sus especies no se encuentran en los bancos de semillas o en las proximidades.