El niño plateado: Síndrome de Chediak-Higashi / The Silver Child: Chediak-Higashi Syndrome

El Síndrome de Chediak-Higashi (SCH) es una patología de herencia autosómica recesiva debido principalmente a mutaciones del gen regulador del tráfico lisosómico (LYST), causando grados dermatológicamente diferentes de albinismo óculocutáneo, infecciones recurrentes, disfunción fagocítica primaria, en el desarrollo y proliferación de todas las líneas celulares. Se presenta caso de preescolar masculino de 2 años de edad, ingresado por aumento de volumen bilateral en región cervical y fiebre, en malas condiciones generales, con áreas de hiperpigmentación en piel, cabello y cejas de coloración grisácea, adenopatías generalizadas y visceromegalias; leucocitosis con linfocitosis y neutropenia, anemia, trombocitopenia, hipoalbuminemia, hipertrigliceridemia e hiperferritinemia; en vista de la infrecuente coexistencia de dichas características con albinismo óculocutáneo; es evaluado por hematología y dermatología evidenciándose inclusiones citoplasmáticas y melanosomas gigantes, respectivamente, compatibles con SCH, confirmándose diagnóstico. El conocimiento del SCH es importante para la oportuna sospecha clínica-diagnóstica e inicio de protocolos terapéuticos en consenso, que garanticen un manejo eficaz para su sobrevida(AU)

Chediak-Higashi syndrome (SCH) is an auto somal recessive in herited pathology mainly due to mutations ofthe LYST gene, causing dermatologically different degrees of oculocutaneous albinism, recurrent infections, primary phagocytic dysfunction, in the development and proliferation of all cell lines. We present a case of a 2-year-old male preschool, admitted due to bilateral volume increase in thecervical region and fever, in poor general conditions, with areas of hyperpigmentation in skin, hair and eyebrows of grayish coloration, generalized lymphadenopathy and visceromegaly; leukocytosis with lymphocytosis and neutropenia, anemia, thrombocytopenia, hypoalbuminemia, hypertriglyceridemia,and hyperferritinemia; in view of the infrequent coexistence of these characteristics with oculocutaneous albinism; it isevaluated by hematology and dermatology, showing cytoplasmicinclusions and giant melanosomes, respectively, compatiblewith SCH, confirming the diagnosis. Knowledge of SCH is important for timely clinical-diagnostic suspicion and initiation of consensus therapeutic protocols that guarantee effective management for survival(AU)

Asociación entre lesiones periapicales y diabetes mellitus

Las lesiones periapicales son procesos inflamatorios que generan la reabsorción de los tejidos mineralizados. En pacientes diabéticos este proceso puede verse afectado. Este trabajo tiene como objetivo identificar la asociación entre la diabetes mellitus y las lesiones periapicales y conocer si los pacientes diabéticos presentan mayor prevalencia y severidad. Se realizó una revisión amplia de la literatura disponible, de tipo narrativa. Se consultaron las bases de datos PubMed (Medline) y SciELO y los recursos Timbó y Google Scholar. Los criterios de exclusión fueron: trabajos anteriores al año 2010 y reportes de caso Se incluyeron artículos anteriores a la fecha de exclusión por considerarse relevantes para el trabajo. A pesar que la evidencia científica continúa siendo insuficiente y el diseño de los estudios debe mejorarse, se demuestra asociación entre lesiones periapicales y diabetes mellitus. Esto implica que los pacientes diabéticos podrían presentar mayor prevalencia y severidad de lesiones.

As lesões periapicais são processos inflamatórios que geram a reabsorção de tecidos mineralizados. Em pacientes diabéticos este processo pode ser afetado. Este trabalho tem como objetivo identificar a associação entre diabetes mellitus e lesões periapicais e saber se os pacientes diabéticos apresentam maior prevalência e gravidade. Foi realizada uma revisão abrangente da literatura disponível, do tipo narrativa. Foram consultadas as bases de dados PubMed (Medline) e SciELO e os recursos Timbó e Google Acadêmico. Os critérios de exclusão foram: trabalhos anteriores ao ano de 2010 e relatos de casos.Os artigos anteriores à data de exclusão foram incluídos por serem considerados pertinentes ao trabalho. Apesar de as evidências científicas ainda serem insuficientes e o delineamento dos estudos precisar ser aprimorado, foi demonstrada uma associação entre lesões periapicais e diabetes mellitus. Isso implica que os pacientes diabéticos podem ter maior prevalência e gravidade das lesões.

Summary Periapical lesions are inflammatory processes that generate the resorption of mineralized tissues. In diabetic patients this process may be affected. This work aims to identify the association between diabetes mellitus and periapical lesions and to know if diabetic patients have a higher prevalence and severity. A comprehensive review of the available literature, of a narrative type, was carried out. The PubMed (Medline) and SciELO databases and the Timbó and Google Scholar resources were consulted. The exclusion criteria were: works prior to the year 2010 and case reports. Articles prior to the exclusion date were included, as they were considered relevant to the work. Despite the fact that the scientific evidence is still insufficient and the design of the studies should be improved, an association between periapical lesions and diabetes mellitus has been demonstrated. This implies that diabetic patients could have a higher prevalence and severity of lesions.

Recomendaciones para la práctica clínica: hipoglucemia en personas con diabetes mellitus / Recommendations for clinical practice: hypoglycemia in people with diabetes mellitus

En la hipoglucemia secundaria, el tratamiento de la diabetes mellitus (DM) se define ante un valor de glucemia por debajo de 70 mg/dl, pudiendo manifestarse por síntomas autonómicos y neuroglucopénicos, con consecuencias a corto y largo plazo, como el deterioro de las funciones cognitivas y el aumento del riesgo cardiovascular, entre otras. La hipoglucemia en personas con DM1 es más frecuente que en aquellas con DM2. Los factores que incrementan su riesgo son: el retraso en la ingesta de comida, el alcohol, el ejercicio intenso, el ayuno y la neuropatía autonómica. Por otro lado, las hipoglucemias inadvertidas se asocian con un mayor riesgo de hipoglucemia grave. Los niños y adultos mayores son un grupo vulnerable a estos eventos que, en muchos casos, presentan síntomas difíciles de distinguir. A su vez, la hipoglucemia durante el embarazo se asocia con mayor riesgo de complicaciones. Otro grupo importante para detectar estos episodios son los pacientes hospitalizados a fin de disminuir la morbimortalidad asociada a los mismos. La calidad de vida está claramente afectada en los pacientes que sufren episodios de hipoglucemia, por lo cual resulta esencial instaurar estrategias de prevención como la educación, el monitoreo glucémico, realizar modificaciones en la dieta y el ejercicio, y ajustar la medicación. El tratamiento, en caso de no presentar pérdida de conciencia, será por vía oral, de lo contrario, se recurrirá a glucosa endovenosa o glucagón intramuscular.

Hypoglycemia due to treatment of diabetes mellitus (DM) is defined by a blood glucose value below 70 mg/dl, which can manifest itself by autonomic and neuroglycopenic symptoms, with short- and long-term consequences, such as impaired cognitive functions and increased cardiovascular risk, among others. Hypoglycemia in people with DM1 is more frequent than in those with DM2. Factors that increase its risk are: delayed food intake, alcohol, intense exercise, fasting and autonomic neuropathy. On the other hand, inadvertent hypoglycemia is associated with an increased risk of severe hypoglycemia. Children and older adults are a vulnerable group to these events that, in many cases, present symptoms that are difficult to distinguish. Hypoglycemia during pregnancy is associated with an increased risk of complications. Another important group to detect these episodes are hospitalized patients in order to reduce the morbimortality associated with them. Quality of life is clearly affected in patients who suffer episodes of hypoglycemia, so it is essential to implement prevention strategies such as education, glycemic monitoring, dietary and exercise modifications, and medication adjustment. Treatment, if there is no loss of consciousness, will be oral, otherwise, intravenous glucose or intramuscular glucagon will be used.

Recomendaciones para la práctica clínica: hipoglucemia en personas con diabetes mellitus / Recommendations for clinical practice: hypoglycemia in people with diabetes mellitus

Resumen En la hipoglucemia secundaria, el tratamiento de la diabetes mellitus (DM) se define ante un valor de glucemia por debajo de 70 mg/dl, pudiendo manifestarse por síntomas autonómicos y neuroglucopénicos, con consecuencias a corto y largo plazo, como el deterioro de las funciones cognitivas y el aumento del riesgo cardiovascular, entre otras. La hipoglucemia en personas con DM1 es más frecuente que en aquellas con DM2. Los factores que incrementan su riesgo son: el retraso en la ingesta de comida, el alcohol, el ejercicio intenso, el ayuno y la neuropatía autonómica. Por otro lado, las hipoglucemias inadvertidas se asocian con un mayor riesgo de hipoglucemia grave. Los niños y adultos mayores son un grupo vulnerable a estos eventos que, en muchos casos, presentan síntomas difíciles de distinguir. A su vez, la hipoglucemia durante el embarazo se asocia con mayor riesgo de complicaciones. Otro grupo importante para detectar estos episodios son los pacientes hospitalizados a fin de disminuir la morbimortalidad asociada a los mismos. La calidad de vida está claramente afectada en los pacientes que sufren episodios de hipoglucemia, por lo cual resulta esencial instaurar estrategias de prevención como la educación, el monitoreo glucémico, realizar modificaciones en la dieta y el ejercicio, y ajustar la medicación. El tratamiento, en caso de no presentar pérdida de conciencia, será por vía oral, de lo contrario, se recurrirá a glucosa endovenosa o glucagón intramuscular.

Abstract Hypoglycemia due to treatment of diabetes mellitus (DM) is defined by a blood glucose value below 70 mg/dl, which can manifest itself by autonomic and neuroglycopenic symptoms, with short- and long-term consequences, such as impaired cognitive functions and increased cardiovascular risk, among others. Hypoglycemia in people with DM1 is more frequent than in those with DM2. Factors that increase its risk are: delayed food intake, alcohol, intense exercise, fasting and autonomic neuropathy. On the other hand, inadvertent hypoglycemia is associated with an increased risk of severe hypoglycemia. Children and older adults are a vulnerable group to these events that, in many cases, present symptoms that are difficult to distinguish. Hypoglycemia during pregnancy is associated with an increased risk of complications. Another important group to detect these episodes are hospitalized patients in order to reduce the morbimortality associated with them. Quality of life is clearly affected in patients who suffer episodes of hypoglycemia, so it is essential to implement prevention strategies such as education, glycemic monitoring, dietary and exercise modifications, and medication adjustment.

Perfil antibiótico de estreptococos del grupo viridans aislados de cavidad oral en individuos con uso prolongado de antibióticos / Antibiotic profile of viridans streptococci group isolated of oral cavity from patients with prolonged use of antibiotics

RESUMEN Los estreptococos del grupo viridans (EGV) son un grupo heterogéneo de bacterias saprófitas anaerobias facultativas que forman parte de la flora normal de cavidad oral. El incremento de la resistencia antibiótica de este grupo de bacterias cobra importancia en pacientes hospitalizados con terapia antibiótica prolongada, en los cuales estos microorganismos pueden ser sustituidos por bacterias multirresistentes. Objetivos: Determinar el porcentaje de cepas de EGV aisladas de cavidad oral resistentes a los antibióticos utilizados en el tratamiento de diversas patologías infecciosas hospitalarias. Material y Métodos: Estudio observacional descriptivo en el que se incluyeron 60 pacientes hospitalizados con historia de terapia antibiótica por más de 3 semanas. Las muestras se procesaron siguiendo protocolos estandarizados de recolección, aislamiento e identificación para EGV de cavidad oral y un protocolo de pruebas de sensibilidad antibiótica. Los resultados se muestran en tablas y gráficas de frecuencia. Resultados: La principal indicación para terapia antibiótica intrahospitalaria fue infección orofacial: 28,33%. La penicilina fue el antibiótico más utilizado ya sea en terapia única, combinada o múltiple en todos los pacientes. Se aislaron en total 108 cepas de EGV, con un promedio de 1,8 cepas por paciente. La especie predominantemente identificada fue S. mutans. El 96,3% de las cepas de EGV fue sensible a todos los antibióticos incluidos en el panel. Conclusiones: El uso de distintas combinaciones y modalidades de terapia antibiótica no tiene efecto en la susceptibilidad de EGV aislados de cavidad oral en pacientes hospitalizados, independiente de la duración del tratamiento.

ABSTRACT Viridans group streptococci (VGS) are a heterogeneous group of saprophytic facultative anaerobic bacteria that are part of the normal flora of the oral cavity. The increased resistance to multiple antibiotics in this group of bacteria becomes important in prolonged antibiotic therapies inpatient where these common microorganisms are replaced by multi-resistant bacteria. Objectives: To determine the percentage of VGS strains isolated from oral cavity resistant to antibiotics used in hospital infectious diseases. Material and methods: This is a descriptive cross-sectional study that included 60 hospitalized patients with a history of antibiotic therapy for more than 3 weeks. The samples were processed following standardized protocols for collection, isolation and identification of oral cavity VGS and a protocol of antibiotic susceptibility testing. The results are shown in tables and graphics of absolute and relative frequencies. Results: The main indication for antibiotic therapy was orofacial infection with a 28.33%. Penicillin was the antibiotic further used either in single, combined or multiple therapies in all patients. A total of 108 samples (1.8 per patient swabs) were collected. The predominantly identified specie was Streptococcus mutans. The 96.3% of all VGS strains were sensitive to all antibiotics included in the panel. Conclusion: Using different combinations and types of antibiotic therapy inpatient has no effect on the susceptibility of VGS isolated from oral cavity separate from treatment.

Processed and ultra-processed foods consumption in adults and its relationship with quality of life and quality of sleep / Consumo de alimentos processados e ultraprocessados em adultos e sua relação com qualidade de vida e qualidade do sono

ABSTRACT Objective: To evaluate the consumption of processed and ultra-processed foods in Paraguayan adults and its relationship with quality of life and sleep quality. Methods: A cross-sectional descriptive observational study was carried out on Paraguayan adults in May 2022. An online survey was applied in which sociodemographic data, frequency of food consumption using the NOVA classification and Pan American Health Organization criteria, quality of life evaluated by the European Quality of Life-5 Dimensions and report of hours of sleep were collected. Results: A total of 273 Paraguayan adults were included in the study, of which 71.1% were female, 51.6% lived in the capital, 53.1% were single, 66% had a university educational level and the average age was 36.48±13.2. Regarding the consumption of processed and ultra-processed foods, the critical nutrients most consumed daily were free sugars by 34.0%, and fats by 23.4% of the population. The global quality of life index was low (0,58±0,05) and 69.0% reported insufficient hours of sleep. Statistically significant relationships were found between the consumption of processed and ultra-processed foods with quality of life and quality of sleep (p<0.05 for both). Conclusion: The most consumed critical nutrients in the Paraguayan adult population are free sugars and fats, finding a significant relationship between the consumption of processed and ultra-processed foods with quality of life and quality of sleep.

RESUMO Objetivo: Avaliar o consumo de alimentos processados e ultraprocessados em adultos paraguaios e sua relação com a qualidade de vida e qualidade do sono. Métodos: Foi realizado um estudo observacional descritivo transversal em adultos paraguaios em maio de 2022. Foi aplicado um questionário online onde foram questionados datos sociodemográficos, frequência de consumo alimentar pela classificação NOVA e critérios da Organização Pan-Americana da Saúde, qualidade de vida avaliada pelo Qualidade de Vida Europeia-5 Dimensões - foram coletados e relato de horas de sono. Resultados: Foram incluídas no estudo 273 paraguaios, das quais 71,1% eram do sexo feminino, 51,6% residiam na capital, 53,1% eram solteiras, 66,0% tinham nível universitário e a média de idade foi de 36,48±13,2 anos. Em relação ao consumo de alimentos processados e ultraprocessados, os nutrientes críticos mais consumidos diariamente foram os açúcares livres por 34.0% e as gorduras por 23,4% da população. O índice global de qualidade de vida foi baixo (0,58±0,05) e 69.0% relataram horas insuficientes de sono. Foram encontradas relações estatisticamente significativas entre o consumo de alimentos processados e ultraprocessados com qualidade de vida e qualidade do sono (p<0,05 para ambos). Conclusão: Os nutrientes críticos mais consumidos na população adulta paraguaia são os açúcares e gorduras livres, encontrando uma relação significativa entre o consumo de alimentos processados e ultraprocessados com a qualidade de vida e qualidade do sono.

Desenlace de craniectomía descompresiva primaria y secundaria en pacientes con trauma craneoencefálico severo en la Clínica Universidad de La Sabana / Outcomes of Primary and Secondary Decompressive Craniectomy in Patients with Severe Traumatic Brain Injury at Clínica de la Universidad de La Sabana

RESUMEN Objetivos: El propósito de este estudio fue determinar el desenlace en el egreso y en el seguimiento a un año de los pacientes con trauma craneoencefálico severo sometidos a craniectomía descompresiva primaria y secundaria en la Clínica de la Universidad de La Sabana, en un periodo de cinco años. Pacientes y métodos: Se llevó a cabo una serie de casos retrospectiva de pacientes con trauma craneoencefálico severo sometidos a craniectomía descompresiva entre 2008 y 2013. Los desenlaces primarios fueron la sobrevida y el estado funcional medido por la escala de desenlace de Glasgow al momento del egreso hospitalario y al año de seguimiento. Como desenlaces secundarios se incluyeron el tiempo de latencia para la realización de la craniectomía, las complicaciones intra- y postoperatorias, días de hospitalización y estancia en la unidad de cuidados intensivos, tiempo de ventilación, resultados de la craneoplastia y causa de muerte. Resultados: Treinta y cinco pacientes con trauma craneoencefálico severo fueron sometidos a craniectomía descompresiva en el periodo de estudio, 29 primarias y 6 secundarias, con una latencia mediana de 5 horas y 57 horas, respectivamente. Se observó una sobrevida del 51,4 % de los pacientes, de los cuales 39 % presentó recuperación funcional satisfactoria en la escala de desenlace de Glasgow en el momento del egreso y al año. Conclusiones: En este grupo de pacientes sometidos a craniectomía descompresiva primaria o secundaria, junto con un manejo interdisciplinario y rehabilitación precoz, se presentaron desenlaces funcionales favorables en el seguimiento a largo plazo.

ABSTRACT Aim: The purpose of this study was to determine the outcome, at discharge and at one-year follow-up, of patients with severe traumatic brain injury undergoing primary and secondary decompressive craniectomy at Clinica Universidad de La Sabana, over a period of five years. Patients and methods: We conducted a retrospective case series of patients with severe traumatic brain injury undergoing decompressive craniectomy between 2008 and 2013. Te primary outcomes were survival and functional status, measured by the Glasgow Outcome Scale, both at discharge, and at the one year follow-up. Secondary outcomes included latency time for craniectomy, intra and postoperative complications, days of hospitalization and intensive care unit stay, ventilation time, cranioplasty results, and cause of death. Results: Thirty-five patients with severe traumatic brain injury underwent decompressive craniectomy in the study period, 29 of which were primary and 6, secondary, with a median latency of 5 hours and 57 hours, respectively. A survival of 51.4% of the patients was observed, of which 39% presented satisfactory functional recovery on the Glasgow outcome scale at the time of discharge and one year later. Conclusions: In this group of patients who underwent primary or secondary decompressive craniectomy, together with interdisciplinary management and early rehabilitation, favorable functional outcomes were found in the long-term follow-up.

Evaluación de comorbilidades y pronóstico de la neumonía por COVID-19: revisión de la literatura

La infección por COVID-19 presenta una elevada mortalidad respecto a otros virus respiratorios. En este artículo buscamos definir las comorbilidades que están asociadas a la elevada mortalidad o a las complicaciones que requieren mayor soporte ventilatorio en unidades de cuidados intensivos. Se ha diseñado una búsqueda bibliográfica con respecto a las comorbilidades y/o alteraciones en los exámenes de laboratorio y los estudios radiológicos que se han asociado a la presencia de mortalidad, especialmente en los casos descritos en China.

Mortality due to SARS-CoV-2 is high compared to that caused by other respiratory viruses. This article aims to define the comorbidities associated with high mortality rates or complications that require ventilatory support in intensive care units. A bibliographic search has been performed with respect to comorbidities and/or alterations in laboratory tests and radiographic exams that have been associated with mortality, especially those described in China.

Coronavirus persistence in human respiratory tract and cell culture: An overview

ABSTRACT Emerging human coronaviruses, including the recently identified SARS-CoV-2, are relevant respiratory pathogens due to their potential to cause epidemics with high case fatality rates, although endemic coronaviruses are also important for immunocompromised patients. Long-term coronavirus infections had been described mainly in experimental models, but it is currently evident that SARS-CoV-2 genomic-RNA can persist for many weeks in the respiratory tract of some individuals clinically recovered from coronavirus infectious disease-19 (COVID-19), despite a lack of isolation of infectious virus. It is still not clear whether persistence of such viral RNA may be pathogenic for the host and related to long-term sequelae. In this review, we summarize evidence of SARS-CoV-2 RNA persistence in respiratory samples besides results obtained from cell culture and histopathology describing long-term coronavirus infection. We also comment on potential mechanisms of coronavirus persistence and relevance for pathogenesis.

Toxoplasmosis y Enfermedad de Chagas: seroprevalencia y factores de riesgo en embarazadas del HUC

La Toxoplasmosis y la Enfermedad de Chagas (ECh) son infecciones parasitarias frecuentes en Latinoamérica, capaces de ser transmitidas verticalmente durante el embarazo. Este trabajo tiene como objetivo determinar la seroprevalencia ante Trypanosoma cruzi (T. cruzi) y Toxoplasma gondii (T. gondii), en las embarazadas de la consulta prenatal del Ambulatorio Docente del Hospital Universitario de Caracas. Estudio analítico, prospectivo de corte transversal, realizado en 300 pacientes, en el lapso comprendido entre enero 2018 ­ marzo 2019. El 31,66 % de la población estudiada presentó seropositividad para anticuerpos IgG específicos para T. gondii, avidez de IgG mayor al 50 % e IgM negativa en todas, resultados compatibles con la fase crónica de la infección. Al correlacionar con los factores de riesgo habituales para la transmisión de T. gondii destacaron el contacto con heces de gato (46,3 %) y el consumo de agua directamente del grifo (32,6 %). En el caso de la ECh se demostró la presencia de factores de riesgo en la población estudiada, como contacto con triatominos (51,45 %) y viviendas cercanas a vegetación (49 %), sin embargo, solo una embarazada (0,33 %) demostró seropositividad para T. cruzi sin presentar relación con los factores de riesgo estudiados. Se evidenció una seroprevalencia muy frecuente para T. gondii y menor para T. cruzi, con factores de riesgo para la trasmisión vectorial cutánea y oral muy altos, constituyéndo una amenaza tanto para la embarazada como para al feto. Se recomienda educar a la población para reducir su exposición a factores de riesgo.

Toxoplasmosis and Chagas Disease (ChD) are frequent parasitic infections in Latin America, capables of vertical transmission during pregnancy. The purpose of this article is to determine the seroprevalence against Trypanosoma cruzi (T. cruzi) and Toxoplasma gondii (T. gondii), in pregnant women attending the prenatal clinic of the "Hospital Universitario de Caracas". Analytical, prospective study of a transversal cohort, carried out in 300 patients, during the period January 2018 - March 2019. The 31.66 % of the analyzed population showed seropositivity for IgG specific antibodies for T. gondii, all displaying an avidity IgG greater than 50 % and negative IgM, corresponding to a chronic stage of the infection. When correlating with the usual risk factors for the transmission of T. gondii, it was highlighted the presence of contact with cat feces (46.3 %) and the consumption of water directly from the tap (32.6 %). While with Chagas Disease (ChD), the presence of risk factors for acquiring the infection were highly demonstrated in the population, such as contact with triatomines (51.45 %) and living close to vegetation (49 %), however, only one pregnant woman (0.33 %) presented seropositivity for T. cruzi, without being related to the known risk factors. We conclude that T. gondii presents a high seroprevalence and T. cruzi an infrequent seroprevalence in the covered population, with high risk factors for cutaneous and oral vector transmission, representing a threat for the mother and the fetus. We recommend educating the population to reduce their exposure to risk factors.

Mercado del Cannabis medicinal en Colombia: una oportunidad para el sector salud que requiere lineamientos estratégicos del gobierno nacional y la academia / Medical Marijuana market in Colombia: an opportunity for the health sector that requires strategic guidelines from the national government

Resumen Los resultados de las investigaciones sobre cannabis medicinal han traído a las mesas de gobierno discusiones sobre su potencial terapéutico y las medidas a tomar para controlar su producción, comercialización y utilización. En Colombia, desde el 2017, el mercado del cannabis medicinal se encuentra regulado; sin embargo, existen brechas entre la norma, disponibilidad y acceso de los pacientes a productos farmacéuticos con derivados del cannabis, aprobados por el ente regulatorio y que cumplan con los estándares de calidad. Desde esta perspectiva, se considera necesario que el gobierno nacional lidere, en coordinación con la academia y el sector productivo, el desarrollo de preparados farmacéuticos a base de cannabis; además de establecer e implementar medidas estratégicas y concertadas, orientadas a mejorar el acceso y la utilización adecuada de los productos farmacéuticos de cannabis medicinal, en especial para los casos en los que se pueda establecer una clara relación riesgo/beneficio. Con ello, se contribuye a mejorar las condiciones de salud de pacientes que se pueden beneficiar de estas opciones, al igual que al desarrollo y consolidación de un sector promisorio para el país. MÉD. UIS.2020;33(1):53-8.

Abstract The results of medical marijuana research have brought to the government tables discussions about their therapeutic potential and the measures to be taken to control their production, commercialization and use. In Colombia, since 2017, the medical cannabis market is regulated; however, there are gaps between the laws, availability and the access of patients to pharmaceutical products with cannabis derivatives approved by the regulatory entity and that comply with the standards of quality. From this perspective, it is necessary for the national government to lead, in coordination with the academy and the productive sector, the development of pharmaceutical preparations based on cannabis and to establish and implement strategic and concerted measures, aimed to improve access and proper use of medical marijuana pharmaceutical products, mainly for cases in which a clear risk/benefit relationship can be established. This would help to improve the health conditions of patients who can get benefits from these options, as well as the development and consolidation of a promising sector for the country. MÉD.UIS.2020;33(1):53-8.

Actividad antimicrobiana de wira wira y cerraja contra estafilococo, enterococo, pseudomonas y escherichia / Antimicrobial activity of wira wira and cerraja against staphylococcus, enterococcus, pseudomonas and escherichia

INTRODUCCIÓN: el uso de plantas con diversos fines etnomedicinales es una práctica ancestral y actualmente común en una vasta parte de la población de Bolivia. OBJETIVO GENERAL: identificar si la wira wira y cerraja de nuestro medio poseen actividad antimicrobiana contra bacterias patógenas y determinar su toxicidad a través del bioensayo de pruebas biológicas. MATERIALES Y MÉTODOS: estudio descriptivo; Universo, Wira Wira recolectada del Valle Alto de Cochabamba y Cerraja de Cercado; Muestra, se obtuvo de forma aleatoria un kilogramo de Wira Wira y Cerraja respectivamente; Métodos, se emplearon diferentes técnicas para la extracción de los principios activos, se realizaron pruebas biológicas para determinar la toxicidad de los mismos y se determinó la actividad antimicrobiana por el método de difusión en agar. RESULTADOS: Wira wira demostró actividad antimicrobiana con 4 extractos; alcohólico de tallo, flor y alcohólico agotado de hojas frente a E. faecalis y S. aureus, y acuoso de hojas frente a P. aeruginosa y S. aureus. Por otro lado no se evidencio actividad antibacteriana de los extractos de cerraja. CONCLUSIONES: Wira wira es candidata para estudios posteriores destinados a la identificación del o los compuestos activos puros con actividad antibacteriana, hecho respaldado por los resultados obtenidos en esta y otras investigaciones. Los extractos de cerraja, a diferencia de los resultados obtenidos de otros trabajos, no presentaron actividad antimicrobiana, demostrando la posibilidad y vinculación de la variación en los compuestos de la planta con el ecosistema en el que se desarrolla.(AU)

INTRODUCTION: the use of plants with various ethnomedicinal purposes is an ancestral practice and currently common in a vast part of the population of Bolivia. GENERAL OBJECTIVE: to identify if the extracts of both plants present in our environment have antimicrobial activity against pathogenic bacteria and to determine their toxicity through the bioassay of biological tests. MATERIALS AND METHODS: descriptive study; Universe, Wira Wira collected from Valle Alto in Cochabamba and Cerraja collected from Cercado; Sample, we obtained one kilogram of each, Wira Wira and Cerraja randomly; Methods, different techniques were used to extract the active ingredients, biological tests were performed to determine their toxicity and antimicrobial activity was determined by the agar diffusion method. RESULTS: Wira Wira demonstrated antimicrobial activity with 4 extracts; stem alcoholic, flower and alcoholic depleted of leaves against E. faecalis and S. aureus, and aqueous of leaves against P. aeruginosa and S. aureus. On the other hand, there was no evidence of antibacterial activity with the cerraja extracts. CONCLUSIONS: Wira Wira is a candidate for further studies aimed at the identification of the pure active compound (s) with antibacterial activity, all this backed up by the positive results in the agar diffusion tests grown with pathogenic bacteria. Unlike the results that demonstrate the antibacterial activity of the Cerraja in research carried out in other parts of the world, it is not the case of the one in our territory, whose extracts did not present any antimicrobial activity, demonstrating the possibility and linking the variation in plant compounds with the ecosystems in which it develops.

Systemic Th17 response in the presence of periodontal inflammation

Abstract The relationship between periodontitis and the pathogenesis of other inflammatory diseases, such as diabetes, rheumatoid arthritis and obesity has been an important topic of study in recent decades. The Th17 pathway plays a significant role in how local inflammation can influence systemic inflammation in the absence of systemic pathology. Objective: To determine Th17 biased-cells in systemically healthy patients in the presence of generalized chronic periodontitis. Methodology: A total of 28 patients were recruited without systemic inflammatory pathology, which was determined by clinical history, the Health Assessment Questionnaire (HAQ) and rheumatoid factor detection. Of these patients, 13 were diagnosed as healthy/gingivitis (H/G) and 15 as generalized chronic periodontitis (GCP). Th17 (CD4+CD161+) cells and Th17IL23R+ (CD4+CD161+IL-23R+) cells were quantified by flow cytometry, based on the total cells and on the lymphocyte region, termed the "enriched population" (50,000 events for each). Results: The percentages of Th17 cells of the H/G and periodontitis groups were similar on total cells and enriched population (19 vs 21.8; p=4.134 and 19.6 vs 21.8; p=0.55). However, Th17IL23R+ cells differ significantly between periodontally healthy patients and generalized chronic periodontitis patients in both total cell (0.22% vs 0.65%; p=0.0004) and enriched populations (0.2% vs 0.75%; p=0.0266). Conclusions: GCP patients (otherwise systemically healthy) were characterized by increased Th17-proinflammatory cell phenotype positive for the IL-23 receptor in peripheral blood. The proportion of Th17 cells that are negative for the IL-23 receptor in the peripheral blood of systemically healthy patients seemed to be unaffected by the presence or absence of chronic periodontitis.

Evaluación del estado metabólico, el peso vivo y la condición corporal durante la gestación en vacas de carne en la Altillanura colombiana / Evaluation of the metabolic status, live weight and body condition during pregnancy in beef in the Colombian Altillanura cows / Avaliação do estado metabólico, peso vivo e condição corporal durante a gestação em vacas de corte no Altillanura colombiana

Resumen El objetivo de este estudio, fue conocer los valores promedios de diferentes metabolitos, la variación del peso vivo (PV) y la condición corporal (CC) en vacas Cebú (C) y Simmental x Cebú (SC) bajo pastoreo extensivo en una finca de la Altillanura colombiana. Se utilizaron 19 vacas multíparas y durante cada trimestre de la gestación, se evaluaron los niveles de Glucosa (Glu), Colesterol (Col), Proteína totales (Ptt), Albúmina (Alb), Globulinas (Glo), Hemoglobina (Hb), Hematocrito (Hto), Nitrógeno en sangre (BUN), Cobre (Cu), Zinc (Zn), Calcio (Ca), Magnesio (Mg), Fósforo (P), y Aspartato aminotransferasa (AST). Los niveles de Glu, Hb, Hto, BUN, Ca, presentaron variaciones significativas durante los trimestre evaluados (P<0,05), con deficiencias de Cu y Zn. El PV y la CC presentaron una relación lineal en función del avance de la gestación. Se reconoce la importancia de los perfiles metabólicos (PM) como una herramienta para identificar los posibles imbalances nutricionales y la manera de corregir las deficiencias, con el propósito de hacer mas eficiente el sistema productivo.

Abstract The objective of this study was to know the average values ​​of different metabolites, the variation of live weight (LW) and body condition (CC) in Cebu (C) and Simmental x Cebu (SC) cows under extensive grazing in a farm of the Colombian Altillanura. We used 19 multiparous cows and during each trimester of pregnancy, we evaluated the levels of Glucose (Glu), Cholesterol (Col), Total Protein (Ptt), Albumin (Alb), Globulins (Glo), Hemoglobin (Hb), Hematocrit (Hto), Nitrogen in blood (BUN), Copper (Cu), Zinc (Zn), Calcium (Ca), Magnesium (Mg), Phosphorus (P), and Aspartate aminotransferase (AST). The levels of Glu, Hb, Hto, BUN, Ca presented significant variations during the quarter evaluated (P <0.05), with deficiencies of Cu and Zn. The PV and CC presented a linear relationship based on the progress of pregnancy. The importance of metabolic profiles (PM) is recognized as a tool to identify possible nutritional imbalances and how to correct deficiencies, in order to make the productive system more efficient.

Resumo O objetivo deste estudo foi conhecer os valores médios dos diferentes metabólitos, a variação do peso vivo (PV) e a condição corporal (CC) em vacas Cebu (C) e Simmental x Cebu (SC) sob pastejo intenso numa fazenda da Altillanura colombiana. Foram utilizadas 19 vacas multíparas e, durante cada trimestre da gestação, foram avaliados os níveis de glicose (Glu), colesterol (Col), proteína total (Ptt), albumina (Alb), globulinas (Glo), hemoglobina (Hb) e hematócrito (Hto), nitrogênio sanguíneo (BUN), cobre (Cu), zinco (Zn), cálcio (Ca), magnésio (Mg), fósforo (P) e aspartato aminotransferase (AST). Os níveis de Glu, Hb, Hto, BUN, Ca apresentaram variações significativas durante os trimestres avaliados (P <0,05), com deficiências de Cu e Zn. O PV e o CC apresentaram uma relação linear com o progresso da gravidez. A importância dos perfis metabólicos (MP) é reconhecida como uma ferramenta para identificar possíveis desequilíbrios nutricionais e como corrigir deficiências, a fim de tornar o sistema de produção mais eficiente.

Muscle strength training program in nonagenarians - a randomized controlled trial

SUMMARY OBJECTIVES: The study aims to improve the functional capacity and quality of life (QOL) of nonagenarian women by implementing an individualized muscle strength training program in a geriatric residential care home. STUDY DESIGN: A randomized controlled trial METHODS: Twenty-six elderly women were randomized into a control group (CG) and an intervention group (SG). The SG carried out a strength program with TheraBands® for 12 weeks, with two weekly sessions. The assessment tools that we used pre- and post-intervention were the Barthel index of daily living activities, the five times sit-to-stand test (FTSTS) and timed up and go (TUG) test with wiva® sensors. RESULTS: The SG maintained the Barthel index scores for activities of daily living and improved in the FTSTS; the CG showed a significant decrease on both tests. The dynamic balance test showed significant differences between groups for the variables sit to stand, peak angular velocity, anterior-posterior range, turning, stand to sit, total time, and speed. CONCLUSIONS: Individualized muscle strength training programs may help promote healthy lifestyles in such populations by maintaining autonomy, improving function and balance.

RESUMO OBJETIVO: O objetivo do estudo é melhorar a capacidade funcional e a qualidade de vida (QV) de nonagenários por meio da implementação de um programa de treinamento aeróbico e de força individualizado em um centro geriátrico residencial. DESENHO DO ESTUDO: Estudo controlado randomizado. METODOLOGIA: Vinte e seis mulheres idosas foram randomizadas em grupo controle (CG) e grupo intervenção (SG). O SG realizou um programa de força com 12 semanas de duração de duas sessões semanais. As ferramentas de avaliação usadas antes e após a intervenção foram o Índice de Barthel das atividades da vida diária, o teste Five-to-Stand (FTSTS) e o Timed Up and Go (TUG) com sensores Wiva®. RESULTADOS: O SG manteve as pontuações no Índice de Barthel e melhora no FTSTS; o GC apresentou redução significativa nos dois testes. O teste de equilíbrio dinâmico mostrou diferenças significativas entre os grupos para as variáveis: Sit to Stand, pico da velocidade angular, amplitude anteroposterior, giro, posição sentada, tempo total e velocidade. CONCLUSÕES: Os programas de intervenção de força muscular podem ajudar a promover estilos de vida saudáveis nesta população para a manutenção da autonomia, a melhora da função e o equilíbrio.