Protective Effects of Raspberry Crude Polysaccharides on UVB-Induced Photodamage in HaCaT Cells / 中国生物化学与分子生物学报

Polysaccharide is one of the functional components of the raspberry, which has various pharmacological effects such as anti-inflammatory, antioxidant, anti-fatigue, hypoglycemic and immunomodulatory. However, whether raspberry polysaccharides have protective effects on UV-induced photodamage to skin cells has not been reported. This study aims to investigate the protective effect of Raspberry Crude Polysaccharide on Ultraviolet B (UVB) -induced photodamage of human immortalized keratinocytes (H a C a T). The photodamage model of HaCaT cells was established by UVB irradiation. To evaluate the anti-UVB activity of R C P, the cell viability was determined by the CCK-8 method, and the Enzyme-linked immunosorbent assays (ELISA) and microplate method were used to measure the contents of matrix metalloproteinase, inflammatory and antioxidant factors in the photodamaged HaCaT cells. The antioxidant activity of RCP was detected by radical scavenging assays against D P P H radical (D P P H •) and ABTS radical (ABTS •

Innovative training of university students in cardiac arrest in clinical Ssimulation / Entrenamiento innovador de estudiantes universitarios en parada cardíaca en simulación clínica

Introduction: Statistics show nowadays, bystanders provided Cardiopulmonary Resuscitation (CPR) in 40-46% of all out-of-the-hospital cardiac arrests. Strategies must focus on specialized training for non-medical personnel. Engaging new generations in self-care depends on the development of new approaches to address the issue. The objective of this study was to assess the efficacy of an innovative training in CPR through the perception of the participants. Material and methods: This study considered a quantitative approach with a descriptive and correlational design. This study had a convenience sample of 103 participants from undergraduate programs in different disciplines: Engineering, Health, Law, and Design with participated voluntarily in the innovate training. To understand the efficacy of the innovative training data was collected of the participants through a self-assessment rubric. While participants were taken part in the training, an expert assessor was observing the performance and scored the procedure using a similar rubric. Both rubrics use a 5-point Likert scale to assess the level of agreement with each sentence. Results: Self-assessment results show that students excel on identifying if a patient has a pulse (mean=4.47) and if a patient is breathing (mean=4.52). The results of the expert assessment indicate a higher level of performance in hand positioning (mean=4.75) and compression-ventilation coordination (mean=4.77).Discussion: These results are encouraging as participants gained confidence on basic procedures, the main challenges are still on skills that rely deeply on practice. Therefore, this training might need to be offered periodically, as any certification offered for health professionals. This study is a first attempt to design an innovative short term and effective training that universities can replicate to prepare their students for these life-saving skills.

Introducción:Las estadísticas muestran que hoy en día los transeúntes realizan la reanimación cardiopulmonar (RCP) en el 40-46% de las paradas cardíacas extrahospitalarias. Las estrategias deben centrarse en la formación especializada del personal no médico, por lo que es importante desarrollar; nuevos enfoques para abordar el tema y comprometer a las generaciones más jóvenes en el autocuidado. El objetivo de este estudio fue evaluar la eficacia de un entrenamiento innovador en RCP a través de la percepción de los participantes.Ma-terial y métodos: Se utilizó un diseño cuantitativo para correlacionar ambas medidas de rendimiento. Este estudio consideró un enfoque cuantitativo con un diseño descriptivo y correlacional. Este estudio tuvo una muestra de conveniencia de 103 participantes de programas de pregrado en diferentes disciplinas: Ingeniería, Salud, Derecho y Diseño con participación voluntaria en el entrenamiento innovador. Para entender la eficacia de la formación innovadora se recogieron datos de los participantes a través de una rúbrica de autoevaluación. Mien-tras los participantes participaban en la formación, un evaluador experto observaba la actuación y puntuaba el procedimiento utilizando una rúbrica similar. Ambas rúbricas utilizan una escala Likert de 5 puntos para evaluar el nivel de acuerdo con cada frase.Resultados: Los resultados de la autoevaluación muestran que los estudiantes destacan en la identificación de si un paciente tiene pulso (media=4,47) y si un paciente respira (media=4,52). Los resultados de la evaluación de expertos indican un mayor nivel de rendimiento en la colocación de las manos (media=4,75) y en la coordinación compresión-ventilación (media=4,77). Discusión: Estos resultados son alentadores, ya que los participantes ganaron confianza en los procedimientos básicos; los principales retos siguen siendo las habilidades que dependen en gran medida de la práctica. Por lo tanto, es posible que esta formación deba ofrecerse periódicamente, como cualquier certificación ISSN: 0719-1855 © Dirección de Extensión y Educación Continua, Escuela de Medicina, Pontificia Universidad Católica de Chile. http://arsmedica.cl26ARS MEDICA Revista de Ciencias Médicas Volumen 46 número 3 año 2021Segura et al.ofrecida a los profesionales de la salud. Este estudio es un primer intento de diseñar una formación innovadora, eficaz y de corta duración, que las universidades pueden replicar para preparar a sus estudiantes en estas habilidades que salvan vidas.

A Study of Clinical Outcome in 30 Patients of Common Bile Duct Stone

Introduction: Management of common bile duct stones(CBDS) presents a surgical challenge since it is the majorcause of hepatobiliary morbidity and complications. The aimof the study was to evaluate the clinical outcome for CBDstone and evaluate the treatment modality.Material and Methods: This retrospective study was done in30 cases of Common bile duct stone for period of 1 year. All 30patients included in the study were appropriately investigatedby laboratory investigations, USG, CT scan and MRCP.Results: Out of 30 patients included in the study, 26 hadundergone successful ERCP and had successful clearance ofCBD which were followed by Laparoscopic cholecystectomy.2 patients had failed ERCP clearance, out of which 1 patienthad undergone re-ERCP with successful clearance of the stone.The other 1 patient had to undergo Open CBD explorationfollowed by cholecystectomy. 2 patients with CBD stonegreater than 2 cm had to undergo direct CBD explorationwithout undergoing ERCPConclusion: Appropriate identification of CBD stone size,location, number and CBD diameter associated with featuresof cholangitis, jaundice and pancreatitis is essential. It isa complicated procedure requiring a step-wise strategicapproach. The gold standard for the removal of CBD stoneis ERCP followed by laparoscopic cholecystectomy.Commonbile duct exploration is considered in patients with failedclearance of CBD following ERCP OR CBD stone size > 2cm.

Climate change and potential distribution of zoonotic cutaneous leishmaniasis in Central Iran: Horizon 2030 and 2050

Objective: To investigate and predict the effects of climate change on the potential distribution of the main vector and reservoir hosts of the disease in Yazd province in the future. Methods: Distribution data for vector and reservoir hosts of zoonotic cutaneous leishmaniasis in Yazd province were obtained from earlier studies conducted in the area. MaxEnt ecological niche modeling was used to predict environmental suitability. BCC-CSM1-1(m) model and two climate change scenarios, RCP 4.5 and RCP 8.5 were used for horizons 2030 and 2050 climate projections. Future projections were based on data of a regional climate change model. Results: With both scenarios in 2030 and 2050, the results of jackknife test indicated that the mean temperature of wettest quarter and temperature annual range had the greatest effect on the model for the vector and the reservoir hosts, respectively. Conclusions: The climate conditions are the major determinants of zoonotic cutaneous leishmaniasis incidence rate in Yazd Province. These climate conditions provide favorable habitats for ease transmission of zoonotic cutaneous leishmaniasis in this endemic area. Habitats suitability for the vector and reservoir will be expanding in the coming years compared with the current conditions, such that, in horizon 2030 & 2050, the probability of the presence of the vector and reservoir within 38 580 and 37 949 km

Climate change and potential distribution of zoonotic cutaneous leishmaniasis in Central Iran: Horizon 2030 and 2050

Objective: To investigate and predict the effects of climate change on the potential distribution of the main vector and reservoir hosts of the disease in Yazd province in the future. Methods: Distribution data for vector and reservoir hosts of zoonotic cutaneous leishmaniasis in Yazd province were obtained from earlier studies conducted in the area. MaxEnt ecological niche modeling was used to predict environmental suitability. BCC-CSM1-1(m) model and two climate change scenarios, RCP 4.5 and RCP 8.5 were used for horizons 2030 and 2050 climate projections. Future projections were based on data of a regional climate change model. Results: With both scenarios in 2030 and 2050, the results of jackknife test indicated that the mean temperature of wettest quarter and temperature annual range had the greatest effect on the model for the vector and the reservoir hosts, respectively. Conclusions: The climate conditions are the major determinants of zoonotic cutaneous leishmaniasis incidence rate in Yazd Province. These climate conditions provide favorable habitats for ease transmission of zoonotic cutaneous leishmaniasis in this endemic area. Habitats suitability for the vector and reservoir will be expanding in the coming years compared with the current conditions, such that, in horizon 2030 & 2050, the probability of the presence of the vector and reservoir within 38 580 and 37 949 km2, respectively, from Yazd province is above 60%. Moreover, an increase is predicted in the presence of the vector in the western parts and the reservoir in the northern and central parts of the province in the future. Understanding the role of environmental and bioclimatic factors in zoonotic cutaneous leishmaniasis occurrence can provide a guide for policy-makers in the creation and implementation of more effective policies for prevention and control.

Nuevas áreas de vida ­ Revisión muerte súbita 2018 / New areas of life ­ Sudden death review 2018

Una de cada cinco muertes en adultos en países desarrollados se debe a causas cardiovasculares; la mitad de esas muertes se produce de forma súbita y un gran porcentaje en el ámbito extrahospitalario. Las medidas de prevención se dividen en: aquellas destinadas a prevenir en primer lugar que el evento de muerte súbita cardíaca suceda, y aquellas cuyo objetivo es actuar en el momento en que el evento de muerte súbita está sucediendo. Las primeras tienen como objetivo disminuir las principales causas de muerte súbita en países desarrollados: las cardiopatías estructurales (cuya principal causa es la enfermedad coronaria). En este sentido, con el fin de intentar paliar el desarrollo de una cardiopatía que predisponga a la aparición de arritmias fatales y la MSC, se implementan medidas de prevención primarias higiénico-dietéticas y farmacológicas (con el objetivo de disminuir y el controlar los factores de riesgo) y, en aquellos con enfermedad cardiovascular ya establecida, se implementan las estrategias secundarias farmacológicas y/o quirúrgicas (revascularización, reemplazo valvular, etc.). El segundo abordaje surge del hecho de que, a pesar de todas estas medidas, un gran número de pacientes presentará eventos arrítmicos en el ámbito extrahospitalario (MSCEH), ya sea porque aunque recibieron el tratamiento óptimo presentan aún un elevado riesgo de MSC, porque no fueron diagnosticados a tiempo o porque a pesar de haber hecho estudios complementarios el diagnóstico es muy dificultoso. Existen dos estrategias: la primera son los dispositivos de cardiodesfibrilación implantables (o, más recientes, los chalecos vestibles). Estos aparatos están indicados para una población seleccionada, sea por haber presentado ya un episodio de muerte súbita abortado, o por presentar una cardiopatía (estructural o genética) que predisponga a una mayor probabilidad de sufrir un evento. La segunda estrategia es la educación y el desarrollo de programas de salud pública que permitan capacitar a la población general en la realización de RCP y el uso de desfibriladores automáticos externos (DEAs), los cuales deberían estar disponibles en cualquier lugar público. Múltiples estudios demostraron que el acceso de la población general al aprendizaje de maniobras de RCP sencillas y pragmáticas y la presencia de DEAs se traduce en un gran aumento de sobrevida sin secuelas en víctimas de MSCEH. (AU)

One of every five deaths in adults is due to cardiovascular causes, in developed countries, and half of these deaths will occur suddenly. A large percentage occur in the out of hospital setting, so measures to prevent it are divided into: those designed to prevent, in the first place, the sudden cardiac death event from happening and those whose purpose is to act when the sudden death event that has already occurred and it´s ongoing. The first aims to reduce the main causes of sudden death in developed countries: structural heart disease (with coronary heart disease as its main cause). In this regard, with the purpose to mitigate the development of a heart disease that predisposes the occurrence of fatal arrhythmias and SCD, we have primary prevention measures, like healthy life style conduct with or without pharmacological treatment, (whose objective is the reduction and control of cardiovascular risk factors) and, in those with cardiovascular disease already established, there is an implementation of pharmacological and / or surgical strategies (Revascularization, valve replacement, etc.). The second objective arises from the fact that, despite all these preventive and therapeutic measures, a large number of patients will present out-of-hospital cardiac arrest (OHCA) either because although they received optimal treatment they still remain in high risk of SCD, even because they were not diagnosed on time, or because despite having complementary studies made the diagnosis is very difficult. There are two well strategies: the first are implantable cardio-defibrillation devices (or, more recently, wearable vests). These are indicated for a selected population, either because they have already presented an episode of sudden aborted death, or because they have heart disease (structural or genetic), which predisposes to a greater probability of suffering an event. The second strategy is the education and development of public health programs that enable the general population to be trained in CPR and the use of external automatic defibrillators. (AEDs) should be available in any public place. Multiple studies showed that access to the general population for learning simple and pragmatic CPR maneuvers and the presence of AEDs is making an impact on a significant increase in survival without consequences in OHCA victims. (AU)

Afianzamiento del conocimiento y manejo del paro cardiorrespiratorio usando simuladores clínicos en estudiantes de Medicina

Introducción: El paro cardiorrespiratorio es la documentación de la pérdida del pulso y respiración. La resucitación cardiopulmonar (RCP) está compuesta por compresiones torácicas interpuestas por ventilaciones, las cuales pueden producir el retorno de circulación espontánea, un ritmo y pulso viable. Los parámetros de cómo realizar RCP están definidas por guías consensuadas, pero estos no son rutinariamente medidos, por lo que la calidad es desconocida. Objetivos: Determinar el grado de conocimiento teórico y práctico del manejo del paro cardiorrespiratorio en estudiantes de 6to. año de la Facultad de Medicina de la Universidad Francisco Marroquín utilizando simuladores clínicos. Metodología: Estudio descriptivo y abierto, donde se incluyeron 26 estudiantes usando simuladores de alta fidelidad de RCP, las cuales proveen respuestas fisiológicas realísticas, por medio de algoritmos matemáticos generados por programas en computadoras. Resultados: De los 26 estudiantes 0% aprobó el examen teórico con un promedio de 77.4 puntos; en la evaluación práctica ninguna pareja logró una efectividad mayor al 80%. El promedio de la profundidad de las compresiones fue de 3.38 cm, el promedio de liberación post-compresión fue de 51% y el promedio de tiempo de interrupción total fue 79 segundos. El análisis estadístico demostró que no hay relación entre los resultados del test teórico y la efectividad en las compresiones y ventilaciones en el manejo del paro cardiorrespiratorio. Conclusiones: Se pudo evidenciar que los estudiantes no tienen la competencia apropiada en Soporte Vital Básico y Avanzado, por lo que se recomienda enfocar los cursos de Advance Cardiac Life Support (ACLS) a un mayor abordaje práctico con simuladores fisiológicos y que los estudiantes realicen el curso en periodos de tiempo más seguidos. Palabras clave: Paro Cardiorrespiratorio, Simulaciones fisiológicas, compresiones efectivas, ventilaciones efectivas, ACLS, RCP

A cardiorespiratory arrest is the documentation of absence of pulse and respiration. The cardiopulmonary resuscitation (CPR) is composed of chest compressions interposed by ventilations that will increase the probability of spontaneous circulation return and a viable pulse and rhythm. The parameters of how of perform CPR are defined by consensus guides but these aren't routinely measured in the practice setting, so the quality thereof is unknown. Objective: Determine the degree of theoretical and practical knowledge of the management of cardiorespiratory arrest in students coursing 6th year of Medical School at the University Francisco Marroquín using clinical simulators. Methodology: Descriptive, open study with 26 students using RCP high fidelity simulators providing real physiologic responses throw the use of mathematic algorithms generated by computerized programs. Results: Of the 26 students, 0% approved the theoretical test, with an average grade of 77.4 points. In the practical evaluation, none of the couples achieved greater effectiveness than 80% when doing compressions or ventilations. The average of compression depth was 3.38cm, the post-compression release average was 51%; and the total interruption time average was 79 seconds. The statistical analysis showed there wasn't a relationship between the grades of the theoretical test and the effectiveness of compressions and ventilations in the management of a cardiorespiratory arrest. Conclusions: It is evident that the students don't have proper competition in the management of the Basic and Advance Life Support. It's recommended to focus ACLS courses to a more practical approach with physiological simulators and encourage students to take the course at least once a year while in their hospital rotations. Keywords: Cardiorespiratory arrest, effective compressions, effective ventilations, clinical simulators, ACLS, CPR

Enfermedad de Chagas del sistema nervioso central en un paciente con SIDA demostrada por métodos cuantitativos moleculares / Chagas disease affecting the central nervous system in a patient with AIDS demonstrated by quantitative molecular methods

Although infrequent, Trypanosoma cruzi reactivation is possible among patients with HIV/AIDS infection that develop a tumor-like or granulomatous lesion in the CNS. We report the case of a 60 years old male patient with HIV/AIDS and low CD4 lymphocytes count with cerebellar symptoms and mild paresis, associated to supra and infratentorial hypodense lesions and positive serology tests both to T. gondii and Trypanosoma cruzi. Empirical therapy against toxoplasmosis was prescribed together with antiretroviral therapy but without a favorable response. Brain Chagas disease was confirmed by quantitative PCR in the CSF but he died despite nifurtimox treatment. Despite its rare occurrence, Chagas disease affecting the CNS is possible among patients with HIV/AIDS infection. Epidemiological exposure, a positive Chagas serological test and the image pattern of brain lesions support the suspicion. Diagnosis can be confirmed by molecular test in CSF samples, including new quantitative methods. Despite an adverse prognosis, specific therapy can be attempted besides antiretroviral treatment.

La reactivación de la infección por Trypanosoma cruzi es un diagnóstico infrecuente pero posible en pacientes con infección por VIH/SIDA y una lesión de tipo tumoral o granulomatosa en el sistema nervioso central. Presentamos el caso clínico de un paciente de 60 años con VIH/SIDA y recuentos bajos de linfocitos CD4, con síntomas cerebelosos y paresia leve, lesiones hipodensas supra e infratentoriales y serología positiva para Toxoplasma gondii y T. cruzi. Se trató empíricamente como una toxoplasmosis cerebral y con terapia antiretroviral, sin respuesta clínica. La enfermedad de Chagas cerebral se confirmó por RPC cuantitativa en el LCR. El paciente falleció a pesar de recibir terapia con nifurtimox. Apoyan la posibilidad de un Chagas cerebral en pacientes con VIH/SIDA, la exposición epidemiológica, la serología positiva y el patrón de distribución de las lesiones en las imágenes. El diagnóstico puede mejorarse con técnicas moleculares cuantitativas en LCR. A pesar de su mal pronóstico, se puede intentar una terapia específica junto al tratamiento antiretroviral.

Interacting of receptor component protein and G protein in static pressure-induced proliferation of VSMC / 中国药理学通报

Aim To explore the effect of receptor component protein(RCP)in the signal transduction of vascular smooth muscle cell(VSMC)proliferation induced by static pressure.Methods The mouse-derived vascular smooth muscle cell line(A10VSMC)was employed in the experiment.Cells were exposed to static pressure,and MTT assay was used to detect the cell viability.Western blot was used to determine the expressions of PCNA,RCP and p-Akt,RCP mRNA was tested by RT-PCR,and co-immunoprecipitation was used to test the interaction between RCP and G proteins.Results The cell viability,expressions of PCNA and RCP increased with the elevation of static pressure and reached their peaks at 120 mmHg,and after 6 hours they got a plateau.The static pressure significantly increased the level of p-Akt,meanwhile,the binding of RCP and Gαs significantly decreased.However,the binding of RCP and Gβ increased in response to static pressure after stimuli of static pressure,but Gγ was obscure.Conclusion Static pressure can induce VSMC proliferation and expression of RCP,which may involve G protein signal transduction model.

Plasmid-mediated fluoroquinolone-resistance qnrA and qnrB genes among Escherichia coli from cattle in Ado-Ekiti, Nigeria / Genes qnrA y qnrB de la resistencia a la fluoroquinolona mediada por plásmidos entre las bacterias Escherichia coli del ganado en Ado-Ekiti, Nigeria

OBJECTIVE: This is to investigate the implication of fluoroquinolone usage in veterinary practice and the food chain system. SUBJECTS AND METHODS: Five hundred isolates of commensal E coli were recovered from the faeces of apparently healthy cattle in Ado-Ekiti, Nigeria. The susceptibility of the bacteria was tested using standard laboratory procedures. Polymerase chain reaction (PCR) was carried out to detect the presence of qnrA and qnrB genes, which were selected on the basis of their fluoroquinolone-resistant patterns. RESULTS: The agar disc diffusion technique revealed that the representative isolates showed multiple fluoroquinolone-resistance and this formed the basis for their selection for PCR amplification. The PCR revealed that ten of the 17 quinolone-resistant representative isolates showed distinct bands which are specific for the qnrB gene; in addition, only one strain of the 20 representative isolates of commensal E coli carried plasmids on which the qnrA gene was detected. CONCLUSION: This study has confirmed that plasmid-mediated quinolone resistance is a possible mechanism among the fluoroquinolone-resistant commensal E coli isolated from faeces of apparently healthy cattle in the study location.

OBJETIVO: El propósito de este trabajo es investigar las implicaciones del uso de las fluoroquinolonas en la práctica veterinaria y el sistema de la cadena alimentaría. SUJETOS Y MÉTODOS: Quinientos aislados de E Coli comensales fueron obtenidos de las heces de ganado ostensiblemente sano en Ado-Ekiti, Nigeria. Se sometió a prueba la susceptibilidad de las bacterias usando los procedimientos de laboratorio normales. Se llevó a cabo una reacción en cadena de la polimerasa (RCP) a fin de detectar la presencia de genes qnrA y qnrB, los cuales fueron seleccionados sobre la base de sus patrones de resistencia a la fluoroquinolona. RESULTADOS: La técnica de difusión con disco en agar reveló que los aislados representativos mostraban resistencia múltiple a la fluoroquinolona, lo cual constituyó la base para su selección a fin de amplificar la RCP. La RCP reveló que 10 de cada 17 asilados representativos de la resistencia a la quinolona, mostraban bandas claramente específicas del gen qnrB. Además, sólo una cepa de 20 aislados representativos de las E Coli portaba plásmidos en los que el gen qnrA fue detectado. CONCLUSIÓN: Este estudio confirmó que la resistencia a la quinolona mediada por plásmidos, es un posible mecanismo entre las E Coli comensales aisladas de la haces del ganado sano en la localidad del estudio.

Purification and characterization of riboflavin carrier protein from egg white of South Indian spotted owlet (athene brama).

Riboflavin carrier protein has been isolated and purified from the Indian spotted owlet. The protein was purified to its homogeneity. Purification was achieved successfully by DEAE_ Sepharose column chromatography and gel filtration chromatography on Sephadex G-100. The protein content was estimated with Lowry method. The purity of the proteins was judged by SDS-PAGE technique. The molecular weight of the protein was found to be 29 Kd. The protein was characterized using absorption, fluorescence and CD spectral analysis. Significance of the above results are discussed in the present communication.

Orden de no reanimar, consideraciones sobre este problema / Don not resuscitate order: some considerations about this problem

El artículo define aspectos y significados clínicos y éticos sobre Paro Cardiorrespiratorio (PCR), Maniobras de Reanimación Cardiopulmonar y Orden de No resucitación Cardiopulmonar (No-RCP). Enfatiza la diferencia entre el cese de la función cardiorrespiratoria por muerte natural (p.ej. por enfermedad crónica irreversible), distinguiéndolo de el PCR súbito, reversible. Se examinan estas situaciones a la luz de los “Fines de la Medicina” (Hastings Center, 1996).Se analizan los principales problemas, comenzando por las dificultades según los diferentes escenarios (servicio de urgencia, pabellón de maternidad, sala de hospitalizados, unidad de intensivo, pabellones quirúrgicos); se analiza la incertidumbre sobre el pronóstico de cada pacientes y sobre quién(es) deben tomar las decisiones sobre el fin de la vida. Idealmente debe ser el paciente autónomo quien tome la decisión, pero en otros casos se requieren alternativas, una de ellas es la Orden Unilateral. Otros problemas son la Validez de las órdenes de no-RCP en los diferentes tiempos evolutivos, el problema de la Futilidad y la Validez de las “Directivas Anticipadas”, en este grupo resalta el enfoque POLST (Physician’s Order for Life Sustaining Treatment) como más comprehensivo; como complemento ha surgido también el concepto AND (Allow Natural Death), que podría estar destinado a remplazar la orden de no-RCP (DNR).

This article examines the ethical and clinical significance of Cardiopulmonary Arrest, Cardiopulmonary Resuscitation maneuvers and Do Not Resuscitate Order (DNR). It emphasizes Cardiopulmonary Arrest, Cardiopulmonary Resuscitation maneuvers and Do Not Resuscitate Order (DNR). It emphasizes the difference between the cessation of cardiorespiratory function by natural death (e.g. by chronic irreversible disease) as different from the sudden, reversible cardiopulmonary arrest. It considers these situations under the light of the “Goals of Medicine” (Hastings Center, 1996). We look through the main problems, in first place the specific difficulties according to different scenarios (emergency room, maternity ward, hospital room, intensive care unit, surgical blocks); second we analyzes the uncertainty about patients prognosis and third the controversial issue about who should take charge the end of life decisions. The autonomous patient should ideally be who takes the decisions. Other cases need alternatives ways, one of them is the “Unilateral Order”. Other problems are the validity of the DNR orders in different clinical times, the problem of futility and the value of Advance Directives; in this last point POLST (Physician’s Order for Life Sustaining Treatment) approach appears as more comprehensive; at last, the new concept AND (allow natural death) could be destined to replace the DNR order.

Detección del virus Epstein-Barr en lesiones de liquen plano bucal / Detection of Epstein-Barr virus in oral lichen planus

El objetivo del estudio fue detectar la presencia de Virus Epstein-Barr (VEB) en pacientes con lesiones de Liquen Plano Bucal (LPB) usando la Reacción en Cadena de la Polimerasa (PCR), y relacionarlo con el consumo de cigarrillo en un grupo de pacientes Venezolanos.En el estudio se incluyeron 20 pacientes con LPB y un grupo control de 10 individuos con mucosa bucal sana sin antecedentes de LPB. Las muestras fueron divididas en tres fragmentos; uno se incluyó en parafina para el diagnóstico histopatológico, otra porción de tejido no-ulcerado para inmunofluorescencia directa, usando anticuerpos policlonales anti-fibrinógeno y otra fue congelada a -70°C para el análisis molecular. En los pacientes con LPB se presentó un predominio del género femenino (95%). En el análisis histopatológico se observó que el 90% de los tejidos de LPB presentaban acantosis, y 80% degeneración hidrópica del epitelio, 50% Cuerpos de Civatte y papilomatosis respectivamente, 35% hiperparaqueratosis y 30% hiperortoqueratosis. Todas las muestras mostraron infiltrado inflamatorio linfocítico a lo largo de la unión corión-epitelio. La localización de las lesiones fue más frecuente en cara interna de carrillo (85%). El análisis molecular demostró la presencia del genoma de VEB en 50% (10/20) de los pacientes con LPB. En el grupo control, solo un caso fue positivo (10%), siendo la diferencia entre los dos grupos estadísticamente significativa (P<.0005). De los 10 pacientes con LPB positivos para la infección por VEB, el 40% (4/10) eran fumadores y el único paciente positivo para VEB en el grupo control resultó no fumador. Se observó una mayor frecuencia de infección por VEB en los pacientes con LPB en relación al grupo control. No se encontró diferencia estadísticamente significativa entre los pacientes LPB/VEB+ y LPB/VEB-. No se encontró relación entre el hábito tabáquico y la presencia de VEB ya que el 60% de los pacientes VEB positivos no eran fumadores

The aim of this work was to detect the presence of EBV in Oral Lichen Planus (OLP) lesions using the Polymerase Chain Reaction (PCR), and to correlate with cigarette smoking in a OLP Venezuelan population. A group of 20 OLP patients were included. A control group consisted of 10 individuals with healthy oral mucosa and with no history of OLP. Three fragments of the sample were obtained; one for histological diagnosis, another placed in saline solution (fresh not-ulcerated tissue) for direct immunofluorescence with polyclonal antibodies anti- fibrinogen, and the other frozen at -70°C in liquid nitrogen for molecular analysis. We found a predominance of the female gender in the OLP group (95%). The acantosis was presented in 90% (18/20) of the cases, following by epithelial hydropic degeneration (16/20), civatte´s bodies (10/20) papillomatosis (10/20) hyperparaqueratosis (7/2)0, hyperorthoqueratosis (6/20). All the samples showed inflammatory infiltrate spread into the chorion-epithelial join as the principal histological feature. The more frequent location was the mucosa of the cheek (85%).The presence of the EBV genome was observed in 10/20 (50%) of OPL patients. In the control group only one case was positive (10%). There were statistical significant differences (P<.0005). Of the 10 OLP positive EBV patients, 40% (4/10) were cigarettes smokers, and the only positive patient in the control group was not. there is no correlation between the use of cigarettes and the presence of EBV in OPL patients. We found a major frequency of the VEB infection in the OLP group than in the control group. There was no statistical differences between the groups OLP/EBV+ and OLP/EBV-. There is no relation between tobaccos consumed and the presence of the virus, cause 60% of the EBV positives patients were no smoking

Evaluación, mediante RCP, de la infección por el virus de papiloma humano en muestras de pacientes con diagnóstico clínico o citológico / Evaluation, using PDR, of the infection for human palilloma virus in samples of patients with clinical cytological diagnostic

Detección y tipificación del VPH mediante Reacción en Cadena de la polimerasa con iniciadores genéricos MY09 y MY11 y RCP-Múltiple, en muestras de pacientes con diagnóstico citológico de coilocitosis y lesión intraepitelial escamosa de bajo grado, diagnóstico clínico de condilomatosis papilomatosis. Se procesaron 70 muestras citológicas del área genital a las que se realizó extracción de ADN y detección y tipificación viral mediante técnicas moleculares (RCP y RCP múltiple). Laboratorio de Genética Molecular del Instituto de Oncología Hematología. De las muestras evaluadas, 31 resultaron positivas en la detección molecular del VPH. De éstas, 29 correspondieron a VPH de bajo riesgo (tipos 11 y/o 6), una a infección mixta con bajo y alto riesgo (tipos 6 y 33) y otra a coinfección con virus de alto riesgo (tipos 18 y 33). Los resultados obtenidos resaltan la utilidad de la RCP en el diagnóstico y tipificación del VPH y ponen en evidencia una relación, ya establecida, entre VPH de bajo riesgo y displasias leves, así como la posible sobrestimación de infección por VPH en los diagnósticos de referencia.

Influência do subsídio financeiro e do local da realização do curso de suporte avançado de vida em cardiologia, no aprendizado da emergência cardiovascular / Influence of financial subsidy and venue on advanced cardiac life support courses, in the learning of cardiovascular emergency

FUNDAMENTO: O sucesso no aprendizado da emergência depende de muitos fatores que podem ser resumidos como: aluno, instrutores e curso. OBJETIVO: Avaliar a influência do subsídio financeiro e do local da realização do curso no aprendizado da emergência cardiovascular. MÉTODOS: Analisaram-se dados referentes aos cursos de Suporte Avançado de Vida em Cardiologia (ACLS) no período de dezembro de 2005 a dezembro de 2006. De acordo com o subsídio financeiro, foram divididos em: grupo 1 - subsídio integral; grupo 2 - subsídio de 50 por cento; e grupo 3 - sem subsídio. Quanto ao local do curso, foram divididos em: local A - curso em cidade com > 1 milhão de habitantes; e local B - curso em cidade com < 1 milhão de habitantes. Compararam-se a aprovação prática e teórica e a média teórica. RESULTADOS: Participaram do ACLS 819 alunos: 199 (24 por cento) no grupo 1, 122 (15 por cento) no 2 e 498 (61 por cento) no 3. A aprovação prática e teórica e a média na prova teórica foram maiores no grupo 3 que nos demais grupos (p<0,05). Quatrocentos e oitenta e dois fizeram o curso no local A (59 por cento) e 337 (41 por cento) no local B. A aprovação prática foi semelhante para ambos os grupos (p = 0,33), entretanto a aprovação teórica foi maior no local A (73 por cento vs. 65 por cento - p = 0,021 - OR = 1,44 e IC: 1,05 - 1,97). A média teórica foi maior no local A (87,1 ± 10,4 e 86 ± 11, respectivamente p<0,05). CONCLUSÃO: O subsídio financeiro e o local da realização do curso influenciaram na aprovação teórica e prática.

BACKGROUND: The success in learning of emergency depends on many factors that can be summarized as: student, instructors and course. OBJECTIVE: To evaluate the influence of financial subsidy and venue of course in learning cardiovascular emergency. METHODS: Data were analyzed regarding the courses of Advanced Cardiac Life Support (ACLS) in the period from December 2005 to December 2006. In agreement with the financial subsidy, they were divided in: group 1 - integral subsidy; group 2 - subsidy of 50 percent; and group 3 - without subsidy. As for the venue of the course, they were divided in: locality A - study in city with> 1 million inhabitants; and locality B - study in city with <1 million inhabitants. The practical and theoretical approval and the theoretical average were compared. RESULTS: 819 students participated in ACLS: 199 (24 percent) in group 1, 122 (15 percent) in 2 and 498 (61 percent) in 3. The practical and theoretical approval and the average in the theoretical exam were greater in group 3 than in other groups (p <0.05). Four hundred and eighty two (482) took the course in venue A (59 percent) and 337 (41 percent) in venue B. The practical approval was similar for both groups (p = 0.33), however the theoretical approval was greater in venue A (73 percent vs. 65 percent - p = 0.021 - OR = 1.44 and IC: 1.05 - 1.97). The theoretical average was greater in venue A (87.1 ± 10.4 and 86 ± 11, respectively p <0.05). CONCLUSION: The financial subsidy and venue of the course had influence in the theoretical and practical approval.

Detection of Legionella pneumophila rcp Virulence Gene by Polymerase Chain Reaction / 环境与健康杂志

Objective To establish a polymerase chain reaction method for the detection of the rcp virulence gene of L. pneumophila. Methods Sixteen strains of Legionella pneumophila, L. dumiffii, L. bozemanii and L. Longbeachae isolated from the cooling towers of the centralized air-conditioning systems in Tianjin form 2005 to 2007 were detected by polymerase chain reaction method using L. pneumophila rcp virulence gene-specific primer according to GenBank published nucleotide sequence. Results The 900 bp rcp genetic fragment was amplified in three strains of L. pneumophila, while others not. Conclusion The rcp virulence gene-based polymerase chain reaction method for the detection of L. pneumophila has been successfully established and is the foundation for the studies of Legionella virulence.

Identificación diferencial de aislados clínicos de mycobacterium tuberculosis y mycobacterium bovis por un ensayo de rcp múltiple / Differential Identification of Mycobacterium tuberculosis and Mycobacterium bovis Clinical Isolates by Multiplex PCR Assay

Mycobacterium tuberculosis es el agente causal de tuberculosis en humanos, sin embargo, la transmisión zoonótica de Mycobacterium bovis de animales a humanos, principalmente a individuos inmunocomprometidos, es de gran impacto en salud pública. La necesidad de diseñar métodos rápidos y precisos que permitan diferenciar entre M. tuberculosis y M. bovis ha conducido al desarrollo de estrategias de identificación genotípica. El objetivo de este estudio fue evaluar el poder discriminatorio de un ensayo de reacción en cadena de la polimerasa en formato múltiple para diferenciar entre aislados clínicos de M. tuberculosis y M. bovis. Se estandarizaron condiciones para amplificación simultánea con oligonucleótidos dirigidos a secuencias de genes Rv0577 y Rv1510. Rv0577 es específico de micobacterias del Complejo M. tuberculosis y Rv1510 se localiza en regiones polimórficas (RD4) del genoma de cepas del complejo M. tuberculosis, ausentes en M. bovis y M. bovis BCG, permitiendo diferenciar entre estas dos especies del complejo M. tuberculosis. Para evaluar la especificidad del ensayo se analizaron 46 aislados clínicos. El amplicón correspondiente a Rv0577 se detectó en todos los aislados clínicos del complejo M. tuberculosis, mientras que el producto de 1033 pb Rv1510 (RD4), se observó exclusivamente en M. tuberculosis, pero no en M. bovis, ni en M. bovis BCG, demostrando la especificidad de este ensayo de RCP para identificar micobacterias del complejo M.tuberculosis y diferenciar entre M. tuberculosis y M. bovis en una única reacción de amplificación. Dada la especificidad del ensayo, éste puede ser aplicado para la identificación y diferenciación de micobacterias del complejo M. tuberculosis en muestras clínicas, para hacer control de calidad de productos derivados de animales con sospechas de infección y desarrollar estudios a gran escala de transmisión zoonótica de M. bovis en poblaciones vulnerables.

Mycobacterium tuberculosis is the causal agent of tuberculosis in humans, however, the zoonotic transmission of Mycobacterium bovis from animals to humans, mainly immunocompromised individuals, is of great impact in public health. The necessity to design rapid and precise methods to differentiate between M. tuberculosis and M. bovis has lead to the development of strategies of genotypic identification. The aim of this study was to evaluate the discriminatory power of a multiplex PCR assay to differentiate between M. tuberculosis and M. bovis clinical isolates. Conditions for simultaneous amplification with oligonucleótidos targeted Rv0577 and Rv1510 genes sequences were standardized. Rv0577 is specific of M. tuberculosis complex mycobacteria and Rv1510 is located in polymorphic regions (RD4) of the mycobacterial genome of M. tuberculosis complex, but is absent in M. bovis and M. bovis BCG, allowing to differentiate between M. tuberculosis complex strains. To evaluate the specificity of the PCR assay, 46 clinical isolates were analyzed. The amplicon from Rv0577 gene was detected in all of the clinical isolates from M. tuberculosis complex, whereas the 1033 pb product from Rv1510 (RD4), was exclusively observed in M. tuberculosis and was absent in M. bovis and M. bovis BCG, showing the specificity of this PCR assay to identify mycobacteria of the M. tuberculosis complex and to differentiate between M. tuberculosis and M. bovis in a single-step assay. This multiplex PCR assay can be applied to the identification and differentiation of mycobacteria of M. tuberculosis complex in clinical samples, to the quality control of products derived from animals with infection suspicions and to develop studies on great scale of zoonotic transmission of M. bovis in susceptible populations.

Estudio de correlación entre cepas Escherichia coli sorbosa negativa y su capacidad de producir enterotoxinas / Study of correlation between negative sorbose E. coli strains and their enterotoxin-producing capacity

Se estudiaron 50 cepas de Escherichia coli sorbosa negativas, aisladas de niños con diarreas líquidas de aparición espontánea. La identificación hasta especie se realizó por métodos convencionales, incluidos los marcadores fenotípicos sorbosa y sorbitol. Las técnicas de reacción en cadena de la polimerasa e hibridación de ADN, fueron realizadas para confirmar la capacidad de producción de enterotoxinas. Se obtuvo muy buena correlación entre las cepas de Escherichia coli sorbosa negativas y su capacidad de elaborar enterotoxinas termolábil y termoestable. El estudio demostró un alto porcentaje de estas cepas con fragmentos de genes codificadores, 94 y 44 % respectivamente, predominando la enterotoxina termoestable. Se obtuvieron los principales biotipos primarios de importancia taxonómica y epidemiológica. Se demostró que el método de la sorbosa posee cualidades que lo distinguen como marcador fenotípico, con 100 % de sensibilidad y 88 % de especificidad, revelándose como método de diagnóstico presuntivo práctico y de gran utilidad para los Laboratorios de Microbiología Clínica.

Fifty negative sorbose Escherichia coli strains isolated from children who suffered spontaneously occurring fluid diarrheas were studied. Identification up to the level of species was performed by conventional methods including phenotypical markers known as sorbose and sorbitol. The PCR and DNA gene hybridization were applied to confirm the enterotoxin-producing capacity. A good correlation between negative sorbose Escherichia coli and their capacity of producing heat-labile and heat -stable enterotoxin was observed. The study showed a high percentage of these strains with encoding gene fragments, 94 and 44% respectively, being heat-stable enterotoxin the predominant. The main primary biotypes of taxonomic and epidemiological importance were obtained. It was demonstrated that the sorbose method has certain qualities that make it stand out as a phenotypical marker, with 100% sensitivity and 88% specificity, and as a practical presumptive diagnostic method that is very useful for Clinical Microbiology Laboratories.