Actualización en estado epiléptico en niños. Definición, clasificación y tratamiento / Update on status epilepticus in children. Definition, clas sification and treatment

Resumen El estado epiléptico (SE) es la emergencia neurológica más frecuente en neuropediatría. Es el resultado de la falla de los mecanismos responsables en terminar una crisis epiléptica o del inicio, que conduce a una crisis epiléptica prolongada. La incidencia estimada entre 3-42 casos por cada 100.000 personas por año. Tiene una distribución bimodal afectando a los extremos de la vida; niños y ancianos, las estimaciones de mortali dad son variables en función de la edad y la etiología, en los niños la mortalidad podría ser más baja que en adultos pero alcanza una alta morbilidad hasta un 66%. La definición ha cambiado en el transcurso de los años con el fin de especificar inicio de tratamiento y comple mentar con los datos científicos se ha establecido un tiempo t1 y un t2. El tiempo (t1) es el momento cuando el tratamiento debe comenzar, que varía dependiendo de la semiología, a los 5 minutos para una crisis con vulsiva tónico clónica generalizada y a los 10 minutos para una crisis focal. El segundo tiempo (t2) se refiere al daño neuronal. El tratamiento rápido y eficaz disminuye los riesgos de complicaciones cardíacas y respiratorias, ingreso a unidades de cuidados intensivos y muerte.

Abstract Status epilepticus (SE) is the most frequent neuro logical emergency in neuropediatrics. It is the result of the failure of the mechanisms responsible for terminat ing an epileptic seizure or its onset, which leads to a prolonged epileptic seizure. The estimated incidence between 3-42 cases per 100,000 people per year. It has a bimodal distribution, affecting children and the elderly at the extremes of life. Mortality estimates are variable depending on age and etiology. Mortality in children could be lower than in adults, but it reaches a high morbidity of up to 66%. The definition has changed over the years in order to specify the start of treatment and to complement it with the scientific data, a time t1 and a t2 have been established. The time (t1) is the moment when treatment should begin, which varies depending on the semiology, at 5 minutes for a generalized tonic-clonic seizure and at 10 minutes for a focal seizure. The second time (t2) refers to neuronal damage. Prompt and effective treatment decreases the risks of cardiac and respiratory complications, admission to intensive care units, and death.

Evaluación cuantitativa de un modelo SEIR para predecir casos de COVID-19 / Quantitative evaluation of a SEIR model for forecasting COVID-19 cases

Resumen Introducción : Los modelos epidemiológicos han sido ampliamente utilizados durante la pandemia de COVID-19, aunque la evaluación de su desempeño ha sido limitada. El objetivo del presente trabajo fue evaluar de forma retrospectiva un modelo SEIR para la predicción de casos a corto plazo (1 a 3 semanas), cuantificando su desempeño real y potencial, me diante la optimización de los parámetros del modelo. Métodos : Se realizaron proyecciones para cada día de la primera ola de casos (31 de julio de 2020 al 11 de marzo de 2021) en el municipio de General Pueyrredón (Argentina), cuantificando el desempeño del modelo en términos de incertidumbre, inexactitud e imprecisión. La evaluación se realizó con los parámetros originales del modelo (utilizados en proyecciones que fueron oportunamente publicadas), y luego variando distintos parámetros a fin de identificar valores óptimos. Resultados : El análisis del desempeño del modelo mostró que valores alternativos de algunos parámetros, y la corrección de los valores de entrada utilizando un filtro de "media móvil" para eliminar las variaciones semanales en los reportes de casos, habrían otorgado mejores resultados. El modelo con los parámetros opti mizados logró disminuir desde casi 40% a menos de 15% la incertidumbre, con valores similares de inexactitud, y con una imprecisión levemente mayor. Discusión : Modelos epidemiológicos sencillos, sin grandes requerimientos para su implementación, pue den ser de utilidad para la toma de decisiones rápi das en localidades pequeñas o con recursos limitados, siempre y cuando se tenga en cuenta la importancia de su evaluación y la consideración de sus alcances y limitaciones.

Abstract Introduction : Epidemiological models have been widely used during the COVID-19 pandemic, although performance evaluation has been limited. The objec tive of this work was to thoroughly evaluate a SEIR model used for the short-term (1 to 3 weeks) predic tion of cases, quantifying its actual past performance, and its potential performance by optimizing the model parameters. Methods : Daily case forecasts were obtained for the first wave of cases (July 31, 2020 to March 11, 2021) in the district of General Pueyrredón (Argentina), quantifying the model performance in terms of uncertainty, inac curacy and imprecision. The evaluation was carried out with the original parameters of the model (used in the forecasts that were published), and also varying different parameters in order to identify optimal values. Results : The analysis of the model performance showed that alternative values of some parameters, and the correction of the input values using a "mov ing average" filter to eliminate the weekly variations in the case reports, would have yielded better results. The model with the optimized parameters was able to reduce the uncertainty from almost 40% to less than 15%, with similar values of inaccuracy, and with slightly greater imprecision. Discussion : Simple epidemiological models, without large requirements for their implementation, can be very useful for making quick decisions in small cities or cities with limited resources, as long as the importance of their evaluation is taken into account and their scope and limitations are considered.

Prevalência de comorbidades em indivíduos infectados por Covid-19 em um município de porte médio / Prevalence of commodities in individuals infected by covid-19 in a medium-size city / Prevalencia de productos básicos en individuos infectados por covid-19 en una ciudad de tamaño medio

Os primeiros relatos de infecção pelo vírus SARS-CoV-2 ocorreram no final do ano de 2019. A infecção e o desenvolvimento da doença COVID-19 estão diretamente relacionados com as características particulares do indivíduo, como sexo, idade e comorbidades. Ademais, indivíduos que possuíam algum tipo de doença crônica, expressaram uma maior taxa de complicações decorrente da infecção. O presente estudo teve como objetivo verificar a prevalência de comorbidades em indivíduos infectados por COVID- 19 no município de Jaraguá do Sul, Santa Catarina no período de março de 2020 a dezembro de 2021. A pesquisa apresentou um delineamento transversal, descritivo, analítico e de abordagem quantitativa, realizada por meio de dados secundários utilizando o sistema de informação Olostech da Secretaria de Saúde do Município. Os resultados mostraram que 40.010 sujeitos foram infectados no período do estudo, destes 39.574 (98,9%) foram recuperados e 436 foram a óbito (1,1%). Observou-se no grupo recuperados a predominância do sexo feminino (52,3%) e no de óbitos o sexo masculino (59,2%). A faixa etária predominante no grupo de recuperados foi a de 20-59 anos (n=31.636; 79,9%) e no grupo de óbitos foi maior ou igual a 60 anos (n=269; 61,7%). No ano de 2021 ocorreram mais casos de recuperados (n=26.040; 65,1%) e óbitos (n=342; 78,4%) quando comparados ao ano de 2020. A média de idade no grupo de recuperados foi 37,5 ± 15,8 anos e no grupo de óbitos foi 63,2 ± 15,7 anos. Os dados mostraram o perfil dos inidvíduos infectados e a prevalência das principais doenças crônicas: hipertensão, diabetes e obesidade. Sugerem-se ações e estratégias voltadas a minimizar estas comorbidades, objetivando a melhor qualidade de vida dos indivíduos deste município.

The first reports of SARS-CoV-2 virus infection occurred in late 2019. Infection and the development of COVID-19 disease are directly related to the particular characteristics of the individual, such as gender, age, and comorbidities. Moreover, indi- viduals who had some type of chronic disease expressed a higher rate of complications arising from the infection. This study aimed to verify the prevalence of comorbidities in individuals infected by COVID-19 in the city of Jaraguá do Sul/SC from March 2020 to December 2021. The research presented a cross-sectional, descriptive, analytical design with a quantitative approach, carried out through secondary data using the Olostech in- formation system of the Health Department of the municipality. The results showed that 40,010 subjects were infected during the study period, of which 39,574 (98.9%) were recovered and 436 died (1.1%). It was observed a predominance of females in the recov- ered group (52.3%) and males in the deceased group (59.2%). The predominant age group in the group of recovered patients was 20-59 years (n=31,636; 79.9%) and in the group of deaths it was 60 years or older (n=269; 61.7%). In the year 2021 there were more cases of recovered (n=26,040; 65.1%) and deaths (n=342; 78.4%) when compared to the year 2020. The mean age in the recovered group was 37.5 ± 15.8 years and in the death group was 63.2 ± 15.7 years. The data showed the profile of infected individuals and the prev- alence of the main chronic diseases: hypertension, diabetes and obesity. We suggest ac- tions and strategies aimed at minimizing these comorbidities, aiming at a better quality of life for individuals in this city.

Los primeros informes de infección por el virus SARS-CoV-2 se produje- ron a finales de 2019. La infección y el desarrollo de la enfermedad por COVID-19 están directamente relacionados con las características particulares del individuo, como el sexo, la edad y las comorbilidades. Además, los individuos que presentaban algún tipo de enfer- medad crónica expresaron una mayor tasa de complicaciones derivadas de la infección. Este estudio tuvo como objetivo verificar la prevalencia de comorbilidades en individuos infectados por COVID-19 en la ciudad de Jaraguá do Sul/SC de marzo de 2020 a diciem- bre de 2021. La investigación presentó un diseño transversal, descriptivo, analítico, con abordaje cuantitativo, realizado a través de datos secundarios utilizando el sistema de in- formación Olostech de la Secretaría de Salud del municipio. Los resultados mostraron que 40.010 sujetos fueron infectados durante el período de estudio, de los cuales 39.574 (98,9%) fueron recuperados y 436 fallecieron (1,1%). Se observó un predominio de mu- jeres en el grupo recuperado (52,3%) y de hombres en el grupo fallecido (59,2%). El grupo de edad predominante en el grupo de pacientes recuperados fue de 20-59 años (n=31.636; 79,9%) y en el grupo de fallecidos fue de 60 años o más (n=269; 61,7%). En el año 2021 hubo más casos de recuperados (n=26.040; 65,1%) y fallecidos (n=342; 78,4%) en comparación con el año 2020. La edad media en el grupo de recuperados fue de 37,5 ± 15,8 años y en el grupo de fallecidos fue de 63,2 ± 15,7 años. Los datos mostra- ron el perfil de los individuos infectados y la prevalencia de las principales enfermedades crónicas: hipertensión, diabetes y obesidad. Sugerimos acciones y estrategias dirigidas a minimizar estas comorbilidades, visando una mejor calidad de vida de los individuos de esta ciudad.

Isolation and quantification of a 17-epi-dammarane triterpenoid rhuslactone from roots of Rhus chinensis and its preventive effects on coronary heart disease and thrombosis in zebrafish / 中国中药杂志

Based on mass spectrometry(MS)-guided separation strategy, compound 1 was obtained from the roots of Rhus chinensis. By comprehensive analysis of high resolution-electrospray ionization-mass spectrometry(HR-ESI-MS), nuclear magnetic resonance(NMR) data, and quantum chemical calculation of NMR(qcc-NMR) parameters, compound 1 was elucidated as rhuslactone, a 17-epi-dammarane triterpenoid with a rare 17α-side chain. An HPLC-ELSD method for its quantification in R. chinensis was established and adopted for the quantification of rhuslactone in different batches of R. chinensis. Rhuslactone displayed a good linear relationship within the range of 0.021 3-1.07 μmol·mL~(-1 )(r=0.997 6), and the average recovery was 99.34% [relative standard deviation(RSD) 2.9%). Moreover, the results of the evaluation test of the preventive effects of rhusalctone on coronary heart disease(CHD) and thrombosis showed that rhuslactone(0.11 nmol·mL~(-1)) significantly alleviated heart enlargement and venous congestion and increased cardiac output(CO), blood flow velocity(BFV), and heart rate, thereby reducing thrombus formation in zebrafish with CHD. The effects of rhuslactone on CO and BFV were superior to that of digoxin(1.02 nmol·mL~(-1)), and its effect on improving heart rate was comparable to that of digoxin. This study provides experimental references for the isolation, identification, quality control, and application of rhuslactone from R. chinensis against CHD. It is worth mentioning that this study has discussed some omissions in the determination of the stereochemistry of C-17 in dammarane triterpenoids in the present coursebook Chemistry of Chinese Medicine and some research papers, that is, the compound may be 17-epi-dammarane triterpenoid. This paper has also proposed steps for the establishment of C-17 stereochemistry.

Structural characterization, in vivo toxicity and biological activity of two new pyro-type diterpenoid alkaloids derived from 3-acetylaconitine / 中西医结合学报

OBJECTIVE@#The transformations that occur in diterpenoid alkaloids during the process of sand frying for Chinese herbal medicine preparation have yet to be clarified. This study investigated the structural changes that take place in 3-acetylaconitine during a simulation of heat-processing and evaluated the toxicity and biological activity of the pyrolysis products.@*METHODS@#The diterpenoid alkaloid 3-acetylaconitine was heated at 180 °C for 15 min to simulate the process of sand frying. The pyrolysis products were separated using column chromatography, and their structures were investigated using high-resolution electrospray ionization mass spectroscopy and nuclear magnetic resonance spectroscopy. Further, in vivo cardiotoxicity and acute toxicity of 3-acetylaconitine and its pyrolysis products were compared, and the aconitine-induced arrhythmia model was employed to evaluate the antiarrhythmic effect of the pyrolysis products.@*RESULTS@#Two new diterpenoid alkaloids, pyroacetylaconitine and 16-epi-pyroacetylaconitine, a pair of epimers at C-16, were isolated. After comparing the structures of these compounds, possible transformation pathways were proposed. Compared with the prototype compound, 3-acetylaconitine, the cardiotoxicity and acute toxicity of the heat-transformed products were significantly decreased. In the biological activity assay, the two pyrolysis products exhibited an effective increase in ventricular premature beat latency, a reduction in the occurrence of ventricular tachycardia, as well as an increase in the rate of arrhythmia inhibition, implying strong antiarrhythmic activity.@*CONCLUSION@#Compared with 3-acetylaconitine, its pyrolysis products displayed lower toxicity and good antiarrhythmic effects; thus, they have potential for being developed into antiarrhythmic medicines. Please cite this article as: Wang YJ, Wang Y, Tao P. Structural characterization, in vivo toxicity and biological activity of two new pyro-type diterpenoid alkaloids derived from 3-acetylaconitine. J Integr Med. 2023; 21(3): 302-314.

Lamivudine-based two-drug regimens with dolutegravir or protease inhibitor: Virological suppression in spite of previous therapy failure or renal dysfunction

Abstract Background Two-Drug Regimens (2DR) have proven effective in clinical trials but real-world data, especially in resource-limited settings, is limited. Objectives To evaluate viral suppression of lamivudine-based 2DR, with dolutegravir or ritonavir-boosted protease inhibitor (lopinavir/r, atazanavir/r or darunavir/r), among all cases regardless of selection criteria. Patients and methods A retrospective study, conducted in an HIV clinic in the metropolitan area of São Paulo, Brazil. Per-protocol failure was defined as viremia above 200 copies/mL at outcome. Intention-To-Treat-Exposed (ITT-E) failure was considered for those who initiated 2DR but subsequently had either (i) Delay over 30 days in Antiretroviral Treatment (ART) dispensation, (ii) ART changed or (iii) Viremia > 200 copies/mL in the last observation using 2DR. Results Out of 278 patients initiating 2DR, 99.6% had viremia below 200 copies/mL at last observation, 97.8% below 50 copies/mL. Lamivudine resistance, either documented (M184V) or presumed (viremia > 200 copies/mL over a month using 3TC) was present in 11% of cases that showed lower suppression rates (97%), but with no significant hazard ratio to fail per ITT-E (1.24, p= 0.78). Decreased kidney function, present in 18 cases, showed of 4.69 hazard ratio (p= 0.02) per ITT-E for failure (3/18). As per protocol analysis, three failures occurred, none with renal dysfunction. Conclusions The 2DR is feasible, with robust suppression rates, even when 3TC resistance or renal dysfunction is present, and close monitoring of these cases may guarantee long-term suppression.

USUAL VALUES OF GLOMERULAR FILTRATION RATE BY THE CG, MDRD AND CKD-EPI METHODS IN A SENEGALESE ADULT POPULATION

The estimation of the glomerular ?ltration rate (GFR), whose formulas are usually based on serum creatinine, is a fundamental data in clinical nephrology. The concept of “reference” or usual values adopted by health professionals is essential because of the paucity of research on the usual values of GFR in black Africa. The Modi?cation of Diet in Renal disease (MDRD) and Chronik Kidney disease-Epidemiology collaboration (CKDEpi) equations were determined in non-African populations. Usual values speci?c to the black African population by the evaluation of the formulas of Cockroft and Gault (CG), MDRD and CKD-Epi must be rigorous and are the subject of this study. The GFR was determined using the CG, MDRD and CKD-Epi formulas in a sample of 233 presumed healthy Senegalese adults (118 men, 115 women). SPSS and Excel 2016 software were used for statistical analysis. A value of P<0.05 was considered statistically signi?cant. The determination of the GFR by the Cockcroft method overestimates the CKD values by 10.24 (9.82 - 14.53) with p=0.001 and that of the MDRD by 7.47 (5.91 - 9.03) the CKD values with p=0.001. For a GFR measurement uncertainty of +/- 10%, the CG and CKD formulas cannot be superimposed with a low correlation coef?cient r = 0.52 and a coef?cient of determination R² = 0.28; whereas those of MDRD and CKD-Epi are on the other hand superimposable with r = 0.79 and R² = 0.63. Thus, the CKD-Epi formula should be preferred for determining the usual value of GFR in a healthy person.

Clinical Efficacy of Pancreatin Minimicrospheres Supplementation in Patients with Exocrine Pancreatic Insufficiency (EPI) : Real-world Evidence

Background : Exocrine pancreatic insufficiency (EPI), characterized by reduced secretion or activity of pancreatic enzymes, causes improper absorption of food, excessive fat excretion in the stool, and malnourishment. Methods : In this observational, real-world evidence study, patients with one or more of the following condition were enrolled: abdominal pain, acidity, diarrhea, nausea, or dyspepsia (as per ROME III criteria). Patients had either been diagnosed with gallstones, hypertriglyceridemia, alcohol consumption or undergone abdominal surgery. Patients were prescribed capsule EnzigestTM10000 (pancreatin minimicrospheres) for one month.The severity and frequency of various gastric symptoms was measured at day 0 and day 30. Results : 540 patients were enrolled with a mean age of 51.6 years. Enzigest significantly reduced the severity of functional dyspepsia by 88.67% (p<0.001) as per Rome III Criteria. There is significant improvement in frequency of symptoms (83.80%), abdominal pain severit(81.58%), epigastric pain (83.09%), nausea (84.35%) and vomiting by 89.62% (all P<0.001). The overall improvement in symptoms was significant (p<0.001). Enzigest was well tolerated.Conclusion : Enzigest improved abdominal pain, dyspepsia, and acidity in patients with exocrine pancreatic insufficiency due to alcohol consumption, gallstones, hypertriglyceridemia, diuretic (Furosemide or Thiazide) or abdominal surgery. Enzigest containing pancreatin minimicrospheres can be an easy therapeutic option to counteract EPI.

Screening de enfermedad renal crónica en pacientes diabéticos de larga evolución de la UMF (unidad de medicina familiar) 222

Contexto: la nefropatía diabética es la primera causa de enfermedad renal crónica en el mundo, sin embargo, no existe información de la prevalencia de Enfermedad Renal Crónica (ERC) en estadios tempranos en México. Una tarea fundamental del primer nivel de atención es la detección oportuna de enfermedades y la ERC en pacientes diabéticos es subdiagnosticada en estadios tempranos al ser asintomática. Objetivo: determinar la frecuencia y la estadificación de ERC en pacientes con diabetes mellitus tipo 2 de larga evolución en una unidad de primer nivel de atención, en el estado de México. Metodología: estudio transversal descriptivo. Se incluyeron 263 pacientes calculados por fórmula de población finita y selección aleatoria simple. Se incluyeron pacientes con diabetes tipo 2, ≥ 5 años de evolución, sin encontrarse en terapia sustitutiva de la función renal que cumplieran los criterios de inclusión. Las variables de estudio: características sociodemográficas y la estimación de la tasa de filtración glomerular por la ecuación CKD-EPI fueron descritas en frecuencias y porcentajes para variables categóricas y las variables continuas se reportaron medias y de desviación estándar, la diferencia entre grupos fue establecida por medio de prueba de Chi cuadrado o prueba exacta de Fisher y distribución t de student, de acuerdo con el tipo de variable. Un valor de p ˂ 0,05 fue considerado estadísticamente significativo. Resultados: la clasificación Kdigo presenta seis estadios y los resultados con respecto al grado de filtrado glomerular fueron: estadio 1 con 39,5 % (IC 95 %, 34,2-45,6), estadio 2 con 38,8 % (IC 95 %, 32,7-44,5), estadio 3a con 8 % (IC 95 %, 4,9-11,4), estadio 3b con 5,7 % (IC 95 %, 3,4-8,7), estadio 4 con 6,8 % (IC 95 %, 3,8-9,9) y el estadio 5 con 1,1 % (IC 95 % 0,0-2,7). El promedio de edad fue 69,26 ±11,01 en el grupo con ERC, en la segmentación por género estuvo: masculino en el grupo con ERC con 59,6 % y femenino con 40,3 %. Con respecto a comorbilidades, hipertensión arterial y tratamiento al analizarlas en grupos con ausencia de ERC y presencia de ERC fueron estadísticamente significativas, lo mismo en los resultados de laboratorio. Conclusiones: la prevalencia de sospecha de ERC en nuestra población es de 21 %, al menos 1 de cada 5 pacientes diabéticos con ≥ 5 años de evolución padecen una disminución del FG, sin embargo, no podemos considerarla ERC hasta que se valore la presencia de daño renal y corroborarlo a los tres meses.

Background: Diabetic nephropathy is the main cause of chronic kidney disease (CKD), however, there are no data available about the prevalence of chronic kidney disease in the early stages in Mexico. A key role in first level attention consists in performing timely screenings for diseases such as CKD. In most cases CKD is underdiagnosed in early stages, because it is asymptomatic. Purpose: To determine the frequency of CKD in long-standing diabetes type 2 Methods: This was a cross-sectional descriptive study. We included 263 patients with diabetes type 2 with at least 5 years of evolution, not undergoing renal function replacement therapy. The variables of this study were: sociodemographic characteristics and estimation of the glomerular filtration rate through the CKD-EPI equation. Categorical variables were summarized as frequencies and percentages. For continuous variables, mean and standard deviation were reported. The significance of differences between groups was assessed by Student's t-test or square chi or Fisher's exact test, and p-value ≤ 0.05 was considered statistically significant. Results: the KDIGO classification has 5 stages. The results regarding the degree of glomerular filtration: stage 1 with 39.5% (95% CI, 34.2-45.6) , stage 2 with 38.8% ( 95% CI, 32.77-44.5),stage 3a with 8% ( 95% CI, 4.9-11.4), stage 3b with 5.7% (95% CI, 3.4-8.7), grade 4 with 6.8% (95% CI, 3.8-9.9) and stage 5 with 1.1% (95% CI 0.0-2.7). The average age was 69.26 ± 11.01 in the group with CKD. Male gender predominated in the group CKD with 34 (59.6%) and 23 (40.3%), for female. Regarding comorbidities, hypertension arterial and treatment when analyzed for either absence or presence of CKD were statistically significant. The same findings can be obtained in laboratory results. Conclusion: The prevalence of suspected CKD in our population is 21%, at least 1 in 5 diabetic patients with ≥5 years of evolution suffer a decrease in GFR; however, we cannot consider it to be CKD until the presence of kidney damage is assessed and confirmed at 3 months.

Estimación de la tasa de filtración glomerular: concordancia de la ecuación del European Kidney Function Consortium de 2020 con CKD-EPI y FAS en adultos jóvenes

Contexto: la TFG es un indicador de la función renal y se estima por ecuaciones TFGe, la mayoría son aplicables en un rango etario, aunque se producen discrepancias en los valores al cambiar de fórmula por cruzar un límite de edad. Así, la ecuación CKD-EPI sobreestima la TFG en adultos jóvenes, mientras que la ecuación FAS la sobreestima para creatininemias bajas. Para minimizar sus limitaciones, el European Kidney Function Consortium propuso la ecuación EKFC combinando características de diseño de FAS y CKD-EPI. Objetivo: evaluar el comportamiento de las ecuaciones EKFC vs. CKD-EPI y FAS en jóvenes, las diferencias en TFGe y la concordancia en asignación a categorías de TFG. Metodología: estudio analítico aprobado por el Comité Asesor de Ética y Seguridad de la Investigación de la Facultad de Bioquímica y Ciencias Biológicas de la UNL, con una muestra de 157 estudiantes voluntarios, de entre 18 y 37 años. Para la medición de la creatininemia se utilizó el método Jaffé cinético trazable a Isotopic Dilution Mass Spectroscopy, con el programa estadístico MedCalc. Resultados: EKFC: TFGe menores que CKD-EPI y FAS, total y por sexo. Media de las diferencias (mL/min/1,73 m2): (CKD-EPI - EKFC) totales = 10,42; 18-20 años = 11,91; 21-30 años = 11,10; 31-37 años = 8,96 / (FAS-EKFC) totales = 2,79; FAS ≤ 110 mL/min/1,73 m2 y mayor: 1,1 y 9,0 respectivamente. Asignación a categorías G: kappa menores EKFC vs. CKD-EPI que vs. FAS. Recategorización: 13,4 % en G1 por CKD-EPI categorizados G2 por EKFC; 0,6 % respecto a FAS en igual sentido. Asignación a categorías ≥ 75mL/min/1,73 m2 o menor: buena concordancia. Conclusiones: en la muestra, EKFC cumple los objetivos de su diseño. La sobreestimación de TFGe por CKD-EPI en adultos jóvenes disminuyó, más fuertemente hacia los 18 años, y corrigió la de FAS para creatininemias bajas. Es importante desarrollar estimadores de TFG basados en creatininemia que cubran todo el rango de edades y estados de función renal.

Introduction: GFR is a kidney function indicator. The estimation of the GFR (eGFR) is carried out by equations. Most of them are applicable with in an age range. Discrepancies between the values are found when crossing a limit of age. CKD-EPI overestimates GFR in young adults; FAS overestimates it for low creatininemias. To minimize these limitations, the European Kidney Function Consortium proposed the EKFC equation that combines design features of FAS and CKD-EPI. Objective: The performance of EKFC vs. CKD-EPI and FAS in young people was evaluated: differences in eGFR and agreement in the allocation to GFR categories were found. Methods: Analytical study approved by the Ethics Committee. Sample: 157 volunteer students, 18-37 years old. Creatininemia: kinetic Jaffé method traceable to Isotopic Dilution Mass Spectroscopy. Program: MedCalc. Results: EKFC: eGFR lower than CKD-EPI and FAS, total and by sex. Means of the differences (mL/min/1.73m2): total (CKD-EPI - EKFC) = 10.42; 18-20 years = 11.91; 21-30 years = 11.10; 31-37 years = 8.96 // (FAS-EKFC) total = 2.79; FAS≤ 110 mL/min/1.73m2 and higher: 1.1 and 9.0 respectively. Allocation to G categories: lower kappa EKFC vs. CKD-EPI than vs. FAS. Recategorization: 13.4% in G1 by CKD-EPI categorized G2 by EKFC; 0.6% compared to FAS, in the same sense. Allocation to categories ≥75mL/min/1.73 m2 or less: good agreement. Conclusions: In the sample, EKFC meets the objectives of its design. The overestimation of eGFR by CKD-EPI in young adults decreased, even more around 18 years of age, and corrected that of FAS for low creatininemias. It is important to develop GFR estimators based on creatininemia that cover the entire range of ages and renal function status.

Tetradenia riparia leaves, flower buds, and stem essential oils to control of Aedes aegypti larvae

Abstract Tetradenia riparia (Hochst.) Codd (Lamiaceae) is a species native to the African continent and used as an insect repellent. The objective of the study was to evaluate the larvicidal potential of essential oils (EOs) from the leaves, flower buds, and stem of T. riparia, collected in winter against Aedes aegypti larvae. The EOs were extracted by hydrodistillation (3 h) and identified by GC/MS. The EOs were tested against larvae of A. aegypti at concentrations ranging from 12500 to 1.5 µg/mL for 24 h. The insecticide activity was evaluated by probit analysis, and the anticholinesterase activity was determined by bioautographic method. The results of the class projection indicated sesquiterpenes as the majority class, corresponding to 60.66% (leaves), 64.70% (flower buds) and 83.99% (stem), and the bioassays on A. aegypti larvae indicated LC50 of 1590, 675 and 665 µg/mL, respectively. The anticholinesterase activity indicated that the EO of the leaves inhibited the enzyme at a concentration of 780 µg/mL, and those from the flower buds and stem inhibited up to 1560 µg/mL. The results indicated weak activity of essential oils against A. aegypti larvae.

RNA m / 中国生物化学与分子生物学报

The central nervous system controls high-level neural activities such as perception, movement, language, and cognition. As the most important part of the human nervous system, its normaldevelopment and functional activities are very important in the process of human development. A betterunderstanding of the essential molecular pathways that regulate the development of the nervous systemmay improve diagnoses and treatments for neurologic diseases, as well as basic biological understanding ofthe brain. The dynamic changes of the modified state of RNA N

The application and value evaluation of assisted diagnosis system for five fundus lesion based on artificial intelligence combined with optical coherence tomography / 中华眼底病杂志

Objective:To establish an artificial intelligence robot-assisted diagnosis system for fundus diseases based on deep learning optical coherence tomography (OCT) and evaluate its application value.Methods:Diagnostic test studies. From 2016 to 2019, 25 000 OCT images of 25 000 patients treated at the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were used as training sets and validation sets for the fundus intelligent assisted diagnosis system. Among them, macular epiretinal membrane (MERM), macular edema, macular hole, choroidal neovascularization (CNV), and age-related macular degeneration (AMD) were 5 000 sheets each. The training set and the verification set are 18 124 and 6 876 sheets, respectively. Through the transfer learning Attention ResNet structure algorithm, the OCT image was characterized by lesion identification, the disease feature was extracted by a specific procedure, and the given image was distinguished from other types of disease according to the statistical characteristics of the target lesion. The model algorithms of MERM, macular edema, macular hole, CNV and AMD were initially formed, and the fundus intelligent auxiliary diagnosis system of five models was established. The performance of each model-assisted diagnosis in the fundus intelligent auxiliary diagnostic system was evaluated by applying the subject working characteristic curve, area under the curve (AUC), sensitivity, and specificity.Results:With the intelligent auxiliary diagnosis system, the diagnostic sensitivity of the MERM was 93.5%, the specificity was 99.23%, and AUC was 0.983 7; the diagnostic sensitivity of macular edema was 99.02%, the specificity was 98.17%, and AUC was 0.994 6; the diagnostic sensitivity of macular hole was 98.91%, the specificity was 99.91%, AUC was 0.996 2; the diagnostic sensitivity of CNV was 97.54%, the specificity was 94.71%, AUC was 0.987 5; the diagnostic sensitivity of AMD was 95.12%, the specificity was 97.09%, AUC was 0.985 3.Conclusions:The artificial intelligence robot-assisted diagnosis system for fundus diseases based on deep learning for OCT images has accurate and efficient diagnostic performance for assisting the diagnosis of MERM, macular edema, macular hole, CNV, and AMD.

Correlación entre las ecuaciones para la estimación del filtrado glomerular (MDRD, CKD-EPI,) y la depuración de creatinina en orina de 24 horas en pacientes oncológicos / Correlation between the equations for the estimation of the filtering glomerular (MDRD, CKD-EPI,) and creatinine clearance in 24-hour urine in cancer patients

Demostrar la correlación entre las ecuaciones MDRD, CKD-EPI con la depuración de creatinina de 24 horas en pacientes oncológicos. Estudio transversal realizado en el Instituto Oncológico Nacional Dr Juan Tanca Marengo durante el periodo de tiempo comprendido entre el mes de agosto 2019 a agosto de 2020. Al evaluar las distintas variable MDRD obtuvo un valor promedio de 44,81 ml/min/m2 con un intervalo de 41,07 ­ 48,55 ml/min/m2 , la variable CKD-EPI el valor promedio fue 43,59 + 18,09 ml/min/m2 con un intervalo de 40,01 ­ 47,18 ml/min/m2 , para el estándar de referencia depuración de creatinina de 24 horas el promedio fue de 54ml/min/m2 Al evaluar la relación entre los dos estimadores de TFG se encontró que ambos presentan una fiabilidad regular presentando una correlación intraclase de 0,43 (p<0,05) entre los estimadores CKD-EPI y MDRD en relación con la TFG de creatinina de 24horas. Cuando se evaluó pacientes con tumores sólidos y hematológicos, se encontró una mayor correlación intraclase con la escala MDRD-4 0,60 (0,25 ­ 0,82) < 0,05 en tumores hematológicos en comparación con CKD-EPI. En la población general, CKD-EPI es la fórmula recomendada, y se está recomendado con mayor frecuencia en pacientes oncológicos. Nuestro estudio demostró que la ecuación MDRD es la fórmula que mejor se correlaciona con la depuración de creatinina de 24 horas, siendo mejor en el grupo de tumores hematológicos, pero no existe diferencia estadísticamente significativa entre las dos ecuaciones.

To demonstrate the correlation between the MDRD, CKD-EPI equations with the 24-hour creatinine clearance in cancer patients. Cross-sectional study carried out at the National Oncological Institute Dr Juan Tanca Marengo during the period of time between the month of August 2019 to August 2020. When evaluating the different MDRD variables, an average value of 44.81 ml / min / m2 was obtained with an interval of 41.07 ­ 48.55 ml / min / m2, the CKD-EPI variable the average value was 43.59 + 18 , 09 ml / min / m2 with an interval of 40.01 ­ 47.18 ml / min / m2, for the reference standard creatinine clearance of 24 hours the average was 54 ml / min / m2 When evaluating the relationship between the two estimators of GFR, it was found that both present a regular reliability, presenting an intraclass correlation of 0.43 (p <0.05) between the CKD-EPI and MDRD estimators in relation to the 24-hour creatinine GFR. When patients with solid and hematological tumors were evaluated, a higher intraclass correlation was found with the MDRD-4 scale 0.60 (0.25 ­ 0.82) <0.05 in hematological tumors compared to CKD-EPI. In the general population, CKD-EPI is the recommended formulation, and it is more frequently recommended in cancer patients. Our study showed that the MDRD equation is the formula that best correlates with 24-hour creatinine clearance, being better in the group of hematological tumors, but there is no statistically significant difference between the two equations.

Medidas de prevenção e controle da infecção por vírus respiratórios a serem adotadas pelos responsáveis pela comercialização de produtos alimentícios em restaurantes populares, restaurantes tipo self-services, cafés, bares, lanchonetes, delivery e food trucks / Infection prevention and control measures by respiratory viruses to be adopted by the responsible for marketing products food at popular restaurants, self-service restaurants, cafes, bars, snack bars, delivery and food trucks

O Brasil e o mundo se deparam com o grande desafio imposto pelo novo coronavirus (SARS- Cov-2) de combate à doença Covid-19. A Vigilância Sanitária tem papel fundamental no enfrentamento da pandemia, devido à sua capacidade de promover ações capazes de eliminar, diminuir ou prevenir riscos à saúde e de intervir nos problemas sanitários decorrentes do meio ambiente, da produção e circulação de bens e da prestação de serviços de interesse da saúde. Neste manual, serão abordadas orientações para os responsáveis técnicos e funcionários, de restaurantes, cafés, bares, lanchonetes e alimentos comercializados sobre rodas quanto às medidas de prevenção da disseminação do novo coronavírus e demais vírus respiratórios.

Medidas de prevenção e controle da infecção por vírus respiratórios a serem adotadas pelos responsáveis pela comercialização de produtos alimentícios em feiras livres / Measures to prevent and control the respiratory virus infection to be adopted by those responsible for product marketing food at fairs

O comércio de alimentos frescos é primordial para uma alimentação saudável e nutricionalmente equilibrada. Durante a Emergência de Saúde Pública de Importância Internacional (ESPII) relacionada ao novo coronavírus (SARS-CoV-2), e também para a prevenção do contágio por demais vírus respiratórios, a Superintendência de Vigilância Sanitária da Secretaria de Estado de Saúde do Rio de Janeiro (SUVISA/SES-RJ) reforça as orientações sobre procedimentos a serem adotados pelas Vigilâncias Sanitárias Municipais para a segurança dos feirantes e de seus clientes. Este manual tem como objetivo contribuir para desenvolver e aprimorar as medidas de prevenção e controle para mitigar a disseminação de vírus respiratórios, dentre eles, o novo coronavírus. Para isso, o documento aborda orientações mínimas para feirantes e clientes, que devem ser seguidas por todos os envolvidos no transporte, venda e compra dos produtos.

Biossegurança laboratorial na pandemia do SARS-CoV-2 / Laboratory biosafety in the SARS-CoV-2 pandemic

Devido à emergência do SARS-CoV-2, os laboratórios necessitaram se adequar na mes-ma velocidade em que a pandemia se instalou para atender com segurança à crescentedemanda pelos testes diagnósticos. Com o alto potencial de disseminação do vírus, o contato com pacientes e o manuseio laboratorial das amostras tornou-se um desafio sem precedentes para os laboratórios. A necessidade de práticas de biossegurança nunca foi globalmente tão enfatizada como nas circunstâncias atuais da pandemia. O objetivo desta revisão narrativa foi destacar medidas para prevenção da contaminação pelo SARS-CoV-2 nos laboratórios clínicos, utilizando como referência a literatura publicada em livros, artigos científicos, orientações técnicas de autoridades sanitárias e científicas, e na análise crítica e pessoal da autora. Alguns temas abordados foram: compreensão dos riscos, medidas de biossegurança, níveis de biossegurança, barreiras de contenção, uso correto dos equipamentos de proteção individual (EPI), desinfecção das áreas de laboratório, descarte seguro de resíduos, e biossegurança nas fases pré-analítica e analítica. As orientações são baseadas em evidências limitadas e frequentemente fracas, oriundas de opiniões, estudos observacionais ou extrapolações de epidemias anteriores causadas por outros coronavírus. As boas práticas de biossegurança destacadas foram estabelecidas muito antes do surgimento da COVID-19. No entanto, a pandemia trouxe à tona, aos profissionais de laboratório e à população em geral, boas práticas que estavam esquecidas, como a higienização das mãos, a etiqueta respiratória e a forma correta de paramentação e desparamentação dos EPI. Na pandemia, os laboratórios com poucos recursos necessitaram adaptar soluções seguras e econômicas para garantir a segurança laboral.

Due to the emergence of SARS-CoV-2 the laboratories had to adapt, as quickly as the pandemic was installed, to safely meet the growing demand for the diagnostic tests. The high potential for virus spread, contact with patients and laboratory handling of samples has become an unprecedented challenge for laboratories. The need for biosafety practices has never been more globally emphasized as in the current circumstances of the pandemic. The purpose of this narrative review was to highlight strategies to prevent contamination by SARS-CoV-2 in clinical laboratories, using as reference the literature published in books, scientific articles, technical guides from health and scientific authorities, and the critical and personal analysis of the author. Some topics that were covered: understanding risks, biosafety strategies, biosafety levels, containment barriers, correct use of personal protective equipment (PPE), disinfection of laboratory areas, safe disposal of waste, and biosafety in the pre-analytical and analytical phases.The orientations are based on limited and often weak evidence arising from opinions, observational studies or extrapolations from the previous epidemics coronaviruses. The highlighted good practices on biosafety were established long before the emergence of COVID-19. However, the pandemic brought up to the laboratory professionals and population in general, good practices that had been forgotten, such as hands hygiene, respiratory etiquette and the correct way of donning and doffing PPE. In the pandemic, laboratories with limited resources had to adapt safe and economical solutions to ensure safety in the clinical laboratory.

Características clínicas y epidemiológicas del infarto de miocardio agudo en un hospital peruano de referencia / Clinical and epidemiological characteristics of acute myocardial infarction in a referral peruvian hospital

RESUMEN Con el objetivo de determinar las características clínicas y epidemiológicas de los pacientes con infarto de miocardio agudo (IMA), se realizó un estudio descriptivo en 175 pacientes de un hospital peruano de referencia. La edad promedio de los pacientes fue de 68,7 años y el 74,8% fueron de sexo masculino. La principal estrategia de reperfusión utilizada fue la angioplastia coronaria transluminal percutánea + stent, aunque su uso primario resultó ser bajo; además, el porcentaje de revascularización quirúrgica fue alto. Casi el 60% de los pacientes tuvo una estancia hospitalaria mayor a siete días. La mortalidad intra hospitalaria fue de 3,4%, siendo el shock cardiogénico la causa más frecuente de muerte. Se concluye que el IMA afecta principalmente a varones mayores de 60 años y que la principal estrategia de reperfusión es la angioplastia, además, los tiempos para la realización de la reperfusión son mayores a lo recomendado con porcentajes altos de revascularización quirúrgica.

ABSTRACT To determine the epidemiological and clinical characteristics of patients with acute myocardial infarc tion, a descriptive study was conducted in 175 patients in a referral hospital in Lima. The average age of the patients was 68.7 ± 10.8 years and 74.8% were male. The main reperfusion strategy used was percutaneous transluminal coronary angioplasty + stent, however, the use of primary angioplasty was low (19.5% of patients with ST elevation myocardial infarction). Time to reperfusion therapies (angio plasty or fibrinolysis) were longer than recommended and the percentage of surgical revascularization was high. Almost 60% of the patients had a length of stay longer than seven days. In-hospital mortality was 3.4%, with cardiogenic shock being the most frequent cause of death. Myocardial infarction mainly affects men over 60 years, the clinical and epidemiological variables are like other regional reports. The main reperfusion strategy is angioplasty, although the use of primary angioplasty is low. Time to perfor ming reperfusion is longer than recommended and the percentage of surgical revascularization is high.

Effects of rhein derivatives 4 a containing amide structure on migration and invasion in ovarian cancer cells / 中国药理学通报

Aim To investigate the effect of Rhein derivative 4a containing amide structure on migration and invasion in ovarian cancer SKOV3 cells and its possible mechanism. Methods Ovarian cancer SK0V3 cells were used as target cells. Molecular docking and West-em blot were used to detect the regulatory effect of derivative 4a on Racl protein. CCK8, HE staining, Scratch and Transwell assay were used to detect the effects of derivative 4a on the proliferation, morphology , migration and invasion of SK0V3 cells, respectively. Western blot was employed to determine the expression of matrix metalloproteinases and EMT-related proteins. Results Derivative 4a could effectively bind to Racl protein, and the binding energy was-29. 10 kcal • mol"1, which was significantly lower than that of Rhein; it also could down-regulate the expression of Racl protein in SK0V3 cells. Derivative 4a could significantly inhibit the proliferation, invasion and migra tion of SKOV3 cells, and induce a large amount of cellular vacuolation; derivative 4a could also down-regu-\ late the expression of MMP-2 and MMP-9, up-regulate the expression of EMT epithelial marker protein E-ca-derin but down-regulate the expression of vimentin and j3-cantenin. Conclusions Derivative 4 a can inhibit the proliferation, migration and invasion of ovarian cancer SK0V3 cells. The mechanism may relate to its targeted regulation of Racl, thereby inhibiting the secretion of matrix metalloproteinases, up-regulating the expression of key molecule E-caderin and down-regula-ting the expression of Vimentin and (3-cantenin in EMT i process.•.

Study on sesquiterpenoids from Aquilaria sinensis / 中草药

Objective: To investigate the sesquiterpenoid constituents from Aquilaria sinensis. Methods: The chemical constituents were isolated and purified by various separation techniques such as silica gel, ODS, Sephadex LH-20, and preparative high- performance liquid chromatography, and their structures were determined according to their physicochemical properties, MS, 1D, and 2D NMR. The antibacterial activity of the obtained compounds against methicillin-resistant Staphylococcus aureus was tested by 96-well plate microdilution method. Results: Seven sesquiterpenoids were obtained from 95% ethanol aqueous extract of Aquilaria sinensis and their structures were identified as (+)-4a,5-dimethyl-3-(prop-1-en-2yl)-octahydronaphthalene-2β,8a-diol (1), baimuxinic acid (2), baimuxinol (3), vetaspira-2(11),6-dien-14-al (4), baimuxinal (5), (-)-10-epi-γ-eudesmol (6), and 9β-hydroxyl-α-agarofuran (7). The minimum inhibitory concentration (MIC) of compound 1 against methicillin-resistant Staphylococcus aureus was 210 μmol/L. Conclusion: Compound 1 is a new compound named as 2β,8aα-dihydroxy-11-en-eremophilane, which has a good inhibitory effect against methicillin-resistant Staphylococcus aureus.