COVID-19: presentación clínica inicial y su correlación con la gravedad de la enfermedad / COVID-19: initial clinical presentation and its correlation with the severity of the disease

Los pacientes con COVID-19 tienen un amplio espectro de presentación clínica y las tasas de mortalidad en los casos graves son relativamente altas. La identificación tem prana de los factores de riesgo que se relacionan con la gravedad de la enfermedad es de vital importancia. Con el objetivo de correlacionar los síntomas iniciales de COVID-19 con la gravedad de la enfermedad, se realizó el presente estudio de cohorte transversal retrospectivo y observacional de 413 pacientes con diagnóstico de COVID-19 entre enero y marzo 2021. De todos los síntomas iniciales estudiados, la disnea (p < 001), fiebre (p 0,001), tos (p 0,002), odinofagia (p 0,01), cefalea (p 0,01) y síntomas gastrointestinales (p 0,03), se asociaron con el desarrollo de una enfermedad grave. Las comorbilidades que se asociaron con peor pronóstico fueron: hipertensión arterial (p < 0,001), obesidad (p < 0,001), EPOC (p < 0,001), extabaquismo (p < 0,001), diabetes (p 0,01), enfermedad cardiovascular previa (p 0,03), y enfermedad oncológica activa (p 0,04). En conclusión, los pacientes con diagnóstico de COVID-19, cuya manifestación inicial es disnea, fiebre, tos, odinofagia, cefalea y síntomas gastrointestinales, deben ser monitoreados de cerca para prevenir el deterioro de la enfermedad.

Patients with COVID-19 have a broad spectrum of clinical presentations, and mortal ity rates are relatively high in severe cases. Early identification of risk factors that are related to the severity of the disease is of vital importance. In order to correlate the initial symptoms of COVID-19 with disease severity, the present retrospective, cross-sectional, observational cohort study was conducted, including 413 patients diagnosed with COVID-19 between January and March, 2021. Of all the initial symptoms that were studied, dyspnea (p < 001), fever (p 0.001), cough (p 0.002), odynophagia (p 0.01), headache (p 0.01), and gastrointestinal symptoms (p 0.03) were associated with the development of severe illness. The comorbidities that were associated with the worst prognoses were: arterial hypertension (p < 0.001), obesity (p < 0.001), COPD (chronic obstructive pulmonary disease) (p < 0.001), former smoking (p < 0.001), diabetes (p 0.01), previous cardiovascular disease (p 0.03), and active oncological disease (p 0.04). In conclusion, patients diagnosed with COVID-19 whose initial manifestations include dyspnea, fever, cough, odynophagia, headache, and gastrointestinal symptoms should be closely monitored to prevent disease deterioration.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

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Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

Perfil clínico-patológico de pacientes con cáncer hepatobiliar en dos hospitales de referencia en Lima, Perú / Clinicopathological profile of patients with hepatobiliary cancers at two main referral hospitals in Lima, Peru

RESUMEN Objetivo: El objetivo del estudio fue describir las características clínico-patológicas de individuos diagnosticados de cáncer de hígado, vías biliares o vesícula. Materiales y métodos: Entre el 2006 y 2017, se diagnosticaron 89 pacientes (57% mujeres; media: 62 años) con estos canceres en dos hospitales nacionales de Lima, Perú. Resultados: Los resultados mostraron que, independientemente del tipo de cáncer, 64% de los participantes habían sido diagnosticados en estadios avanzados. La anemia fue más frecuente en los pacientes con cáncer de vías biliares e hígado y en estadios avanzados. Se observó mayor frecuencia (32%) de hipertensión arterial (HTA) en el grupo con cáncer de hígado. El análisis por edad mostró que en los pacientes mayores de 50 años la HTA fue más frecuente. Asimismo, sujetos menores de 50 años reportaron antecedentes de infecciones previas en mayor frecuencia (50%), siendo Hepatitis B (HBV) la más común. Conclusiones: Este estudio describe las características clínico-patológicas de base de una neoplasia poco estudiada en el ámbito nacional.

ABSTRACT Objective: The aim of the study was to describe the clinicopathological profile of patients diagnosed with liver, bile ducts or gallbladder cancer. Materials and methods: Between 2006 and 2017, 89 patients (57% female; mean age: 62 years-old) with these cancers were diagnosed at two national hospitals in Lima, Peru. Results: Most patients (64%) had advanced stages of disease. Anemia was more frequent in patients with bile duct and liver cancer and in advanced stages. Hypertension (HTN) was frequent among liver cancer patients (32%). The analysis by age showed that HTN was more frequent in patients over 50 years. Likewise, people under 50 years had more frequent history of previous infections (50%), Hepatitis B (HBV) being the most common. Conclusions: This study describes the baseline clinicopathological characteristics of a malignancy poorly studied in Peru.

Prevención de desnutrición aguda moderada con un suplemento alimenticio listo para consumir en niños preescolares de comunidades rurales / Moderate acute malnutrition prevention with a ready-to-use therapeutic food in pre-school children from rural communities

Resumen Introducción: La desnutrición infantil en México alcanza prevalencias de 27.5 % en zonas rurales. Objetivo: Evaluar la efectividad de un suplemento alimenticio listo para consumir (SALC) para corregir desnutrición aguda leve y prevenir desnutrición aguda moderada en preescolares de comunidades rurales. Método: Ensayo clínico aleatorizado por grupos: con y sin SALC (g-SALC y g-S/SALC); se incluyeron niños de dos a cinco años, con puntuaciones-Z de peso para la talla (pZ-P/T) mayor de −2 y menor de −1 y nivel socioeconómico bajo. Todos recibieron educación sobre nutrición, salud e higiene dos veces al mes; los niños del g-SALC debieron consumir diariamente una porción del suplemento. Se evaluó pZ-P/T al inicio y a los cuatro, seis y 12 meses. La comparación entre grupos se realizó con el modelo de riesgos proporcionales de Cox. Resultados: Respecto a la recuperación de desnutrición aguda leve, en g-SALC se observó 68.7 versus 52.1% en el grupo control en el análisis de intención para tratar, con una razón de riesgo (HR) = 1.25; en el análisis por protocolo del primer semestre se observó una HR = 1.48 y en el segundo semestre, HR = 1.56. Un paciente progresó a desnutrición aguda moderada. Conclusiones: El g-SALC mostró resolución significativamente mayor de desnutrición aguda leve.

Abstract Introduction: Child malnutrition in Mexico reaches a prevalence as high as 27.5 % in rural areas. Objective: To assess the effectiveness of a ready-to-use supplementary food (RUSF) to correct mild acute malnutrition and prevent moderate acute malnutrition in preschool children from rural communities. Method: Randomized clinical trial, with assignment to two groups: group with RUSF (RUSF-g) or group without it (non-RUSF-g); children aged from two to five years, with weight-for-height Z-scores (WHZ) between -2 and -1 and low socioeconomic status were included. All received education on nutrition, health and hygiene twice monthly; the RUSF-g children had to consume four biscuits of the supplement every day. WHZ was assessed at baseline and at four, six, and 12 months. The comparison between groups was carried out with Cox proportional hazards model. Results: With regard to mild acute malnutrition correction in the RUSF-g, 68.7 versus 52.1 % in the control group was observed in the intent-to-treat analysis, with a hazard ratio (HR) = 1.25; in the per-protocol analysis of first semester, a HR = 1.48 was observed, and in the second semester, HR = 1.56. One patient progressed to moderate acute malnutrition. Conclusions: The RUSF-g showed a significantly higher resolution of mild acute malnutrition.

Morphological and molecular differences between the Amphiamerican populations of Antillesoma (Sipuncula: Antillesomatidae), with the description of a new species

Introduction: The sipunculans are a group of marine invertebrates that have been little studied in the tropical eastern Pacific (TEP). Antillesoma antillarum is a species belonging to the monospecific family Antillesomatidae, considered widely distributed in tropical and subtropical localities across the globe. Objective: The main objective of this work was to examine the morphological and molecular differences between specimens from both coasts of tropical America to clarify the taxonomy of this species. Methods: We examined the morphology with material from the Mexican Caribbean and southern Mexican Pacific. To perform molecular analyses, two sequences of the COI molecular marker were obtained from specimens collected in Panteón Beach, Oaxaca, southern Mexican Pacific, and compared with four sequences identified as A. antillarum in GenBank, all of them from different localities. A phylogenetic reconstruction was performed with the maximum likelihood method and genetic distances were calculated with the Kimura 2P model and compared to reference values. Results: The phylogenetic analysis revealed three different lineages of Antillesoma that are well supported by bootstrap values: Antillesoma antillarum sensu stricto from the Caribbean Sea and Florida; a sister group to the one represented by our samples from the Mexican Pacific; and a third group from Thailand. Conclusion: Based on morphological traits and molecular data, Antillesoma mexicanum sp. nov. is described from the Mexican Pacific, differing from A. antillarum in the trunk papillae, color patterns and, additionally, the specimens from the Caribbean attain significantly bigger trunk sizes than the ones Pacific.

Introducción: Los sipúnculos son un grupo de gusanos marinos sin segmentación poco estudiados en el Pacífico oriental tropical (POT). Antillesoma antillarum es una especie perteneciente a la familia monoespecífica Antillesomatidae la cual se consideraba que se distribuía ampliamente en distintas localidades tropicales y subtropicales del mundo. Objetivo: El objetivo principal del trabajo fue examinar las diferencias morfológicas y moleculares entre ejemplares de ambas costas de América. Métodos: Para el análisis morfológico se revisó material del Caribe mexicano y del Pacífico sur de México. Para los análisis moleculares se obtuvieron secuencias del marcador mitocondrial COI de ejemplares de A. mexicanum sp. nov. de la playa de Panteón en Puerto Ángel, Oaxaca del Pacífico sur de México; también se incluyeron cuatro secuencias de GenBank de A. antillarum de diferentes localidades para la comparación filogenética con el método de Máxima Verosimilitud. Se calcularon las distancias genéticas con el modelo Kimura 2P y fueron comparadas con valores de referencia. Resultados: El análisis filogenético evidenció tres linajes diferentes: Antillesoma antillarum sensu stricto del Mar Caribe y Florida, el grupo hermano representado por nuestra recolecta en el Pacífico mexicano y un tercer grupo de Tailandia. Conclusión: Basados en datos morfológicos y moleculares, Antillesoma mexicanum sp. nov. fue descrita para el Pacífico mexicano, que difiere de A. antillarum en las papilas del tronco, el patrón de coloración y, adicionalmente, los ejemplares del Caribe fueron significativamente más grandes que los del Pacífico mexicano.

Uso de drogas em adolescentes participantes do projeto segundo tempo em João Pessoa-PB: importância do esporte e da família / Use of drugs in adolescents participating in the "programa segundo tempo" in João Pessoa-PB: importance of sport and family

O Programa Segundo Tempo é um programa do Governo Federal que busca democratizar o acesso à prática e à cultura do esporte. Além de ser um instrumento de inclusão social e formação cidadã, o esporte proporciona uma melhor compreensão do corpo. Assim, o esporte pode ser um importante instrumento para tratamento e prevenção do uso de drogas. Nesta perspectiva, este estudo analisou a prevalência do uso de drogas ilícitas em participantes do Programa Segundo Tempo da cidade de João Pessoa-PB e fatores socioeconômicos e do contexto familiar associados. Em um estudo transversal, 62 adolescentes, com idade entre 12 e 16 anos e frequência de 3x/semana nas atividades, responderam um questionário sobre informações pessoais, socioeconômicas e culturais, além de questões objetivas relacionadas ao tema do estudo. Os resultados apontaram que 35,0% dos adolescentes usavam algum tipo de droga ilícita. O uso de drogas guardou relação significante com a prática de esporte no tempo livre, estado civil dos pais e parente que reside (P<0,05). A prática esportiva ocupou o maior tempo livre dos adolescentes em relação a outras atividades. O uso de drogas ilícitas por adolescentes parece estar mais relacionado às variáveis do contexto familiar e, mais discretamente, relacionado à atividade realizada no tempo livre. Além de suporte familiar, é preciso dialogar dentro dos projetos sociais e desenvolver trabalhos multidisciplinares para elaboração de intervenções com intuito de proporcionar menor exposição e vulnerabilidade ao uso de drogas por adolescentes....(AU)

The "Programa Segundo Tempo" is a program of the Federal Government that seeks to democratize access to sport, through a partnership with the Secretariats of Sports and Leisure. In addition to being an instrument of social inclusion and citizen training, sport provides a better understanding of the body. Thus, sport can be an important tool for treatment and prevention of drug use. In this perspective, this this study analyzed the prevalence of illicit drug use among participants of the Programa Segundo Tempo of João Pessoa-PB city and associated socioeconomic and family context factors. In a crosssectional study, 62 adolescents, aged between 12 and 16 years and at a frequency of 3x/week in the activities, answered a questionnaire about personal, socioeconomic and cultural information, as well as objective questions related to the aims of the study. Results showed 35.0% of adolescents used some type of illicit drug. Drug use had a significant relationship with free time sports, marital status of parents and relatives living with the adolescent (P<0.05). Sports practice occupied the greatest free time for adolescents compared to other activities. Use of illicit drugs seems to be more related to variables of the family context and, more discreetly, related to the activity performed in the free time of adolescents. In addition to family support, it is necessary to dialogue within social projects and to develop multidisciplinary work to elaborate interventions with the purpose of providing less exposure and vulnerability to the use of drugs by adolescents....(AU)

Etiology and Short-term Outcome of First Seizure in Hospitalized Infants.

We enrolled 75 consecutive infants presenting with history of first seizure at a tertiary-care hospital in New Delhi, India. Clinical and biochemical work-up for etiology, and electroencephalography were performed in all infants. Developmental assessment was done 3-month after discharge. 72% had generalized seizures, and fever was the commonest co-morbidity (57.3%). 68% had provoked seizures, mainly due to hypocalcemia (34.3%) or neuro-infections (29.3%). Seven (9.3%) infants died during hospital stay; mostly those with neuro-infections. 13 (20.3%) infants had developmental delay.

Modelo de simulación para la transmisión del VIH y estrategias de control basadas en diagnóstico / A simulation model for HIV transmission and diagnosis-based control strategies

Se construyen dos modelos para la transmisión del VIH considerando exclusivamente transmisión sexual entre pacientes sanos e infectados en una población mezclada; es decir, que no se hace distinción de edad, género ni orientación sexual. El primer modelo es sin control y se consideran tres poblaciones según su estado de infección, la primera corresponde al número promedio de individuos sanos susceptibles de adquirir la infección, la segunda al número promedio de portadores del VIH sin diagnosticar y por último el número promedio de portadores enfermos sin diagnosticar, se asume que las personas susceptibles adquieren el virus por contacto sexual con portadores sanos y con portadores enfermos. En el segundo modelo se incluye control por diagnóstico, en éste se consideran dos poblaciones adicionales que son el número promedio de portadores sanos diagnosticados y el número promedio de portadores enfermos diagnosticados. Con esto se pretende estudiar si es posible el control de la enfermedad exclusivamente por diagnóstico, además se asume que a pesar del diagnóstico, aún es posible que las personas susceptibles adquieran el VIH por contacto con portadores sanos y enfermos, tanto diagnosticados como sin diagnosticar. Finalmente se observa que las simulaciones numéricas brindan evidencia suficiente para determinar que la mejor estrategia de diagnóstico, es decir, con una efectividad del 100 %, no es lo suficientemente efectiva como para reducir significativamente la transmisión del VIH.

Two models were constructed for sexually-transmitted HIV between healthy and infected patients in a mixed population, i.e. no discrimination was made between age, gender or sexual orientation. The first model had no control and considered three populations according to their infection status; the first concerned the average number of susceptible individuals, the second the average number of undiagnosed HIV infected people and the third was concerned with the average number of undiagnosed infected patients (assuming that susceptible people might acquire HIV from diagnosed and undiagnosed infected patients). The second model included control through diagnosis; it considered two additional populations: the average number of diagnosed healthy carriers and diagnosed HIV infected carriers. This was aimed at studying whether the disease can be controlled by diagnosis only. It was also assumed that, despite diagnosis, susceptible people may acquire HIV from both diagnosed and undiagnosed infected patients. It was noted that numerical simulation provided sufficient evidence for determining that the best diagnostic strategy (i.e. having 100 % effectiveness) was not effective enough to significantly reduce HIV transmission.

Modelo matemático para la dinámica de transmisión del VIH/SIDA en una población sexualmente activa / A mathematical model representing HIV/AIDS transmission dynamics in a sexually-active population

Se presenta un nuevo modelo que explica la dinámica de transmisión de la enfermedad del Síndrome de Inmunodeficiencia Adquirida entre parejas heterosexualmente activas. Se incluyen los supuestos, las variables, las ecuaciones diferenciales ordinarias, el análisis de sensibilidad del modelo y las estrategias de control. Los datos fueron obtenidos del Departamento Nacional de Estadísticas y se llevaron a cabo diferentes simulaciones sin control y con control en el sistema, utilizando el código del programa MAPLE. Los resultados obtenidos en las simulaciones permiten concluir que el control con preservativos es relevante en el modelo, así se lleve a cabo sobre la población de hombres o mujeres y sin importar la proporción de hombres y mujeres sexualmente activa.

This article presents a new model explaining acquired immunodeficiency syndrome (AIDS) transmission dynamics amongst heterosexually active couples. It covers the assumptions made, the variables analysed, the model's sensitivity and the ordinary differential equations and control strategies used. The information was obtained from the Colombian state Statistics Department (DANE) and applied to different simulations in the system (with and without control), using the MAPLE programme code. Simulation results led to concluding that control using condoms was relevant in the model. It was not important if control were applied in women or men, nor was the percentage of sexually-active men and women.

Factores asociados al intento suicida e ideación suicida persistente en un Centro de Atención Primaria. Bogotá, 2004-2006 / Factors associated with suicide attempts and persistent suicidal ideation at a Primary Care Unit in Bogotá, 2004-2006

Objetivos Caracterizar pacientes con intento suicida atendidos en Psiquiatría en la Unidad Primaria de Atención (UPA) La Estrella entre octubre-2004 y octubre-2005 y determinar la persistencia de ideación suicida, los factores asociados así como factores predictores. Métodos Caracterización inicial de pacientes con intento suicida (n=156). Diseño posterior de casos y controles (n=77) según persistencia de ideación suicida (n=27). Se determinaron los factores asociados y la predicción del riesgo suicida con un modelo multivariado. Resultados Los casos aumentaron de 6 en octubre-2004 hasta 10 en octubre-2005, con promedio mensual: 12 ± 3,6 casos. El 80 por ciento tenía 30 años o menor edad, 66,7 por ciento eran mujeres, 24,4 por ciento estudiantes y 20,5 por ciento desempleados. Como desencadenantes: disfunción familiar y conflictos de pareja en 35,2 por ciento cada uno. El 49 por ciento consumió alcohol previo al intento suicida. La persistencia de ideación suicida se asoció con tener 31 años o más, desempleo, más de un intento suicida previo, conflictos sin resolver y disfunción familiar. La no resolución de conflictos, OR=106,7 (IC 95 por ciento: 6,8, 1668,4) y la disfunción familiar, OR=11,05 (IC95 por ciento: 1,7, 71,2) fueron predictores de la persistencia de ideación suicida en el modelo de regresión logística. Conclusión La no resolución de conflictos y la disfunción familiar, predictores de la persistencia de ideación suicida en sujetos con intento suicida, el consumo de alcohol y otros factores asociados podrían controlarse con programas de prevención y promoción de salud mental.

Objective Characterising patients attempting suicide who were evaluated by psychiatry at the Primary Care Unit (PCU) " La Estrella " from October/2004 to October/2005 and determining persistent suicidal ideation and associated factors. Methods An initial description of attempted suicide patients (n=156). A subsequent case control study (n=77) determined persistent suicidal ideation cases (n=27). A multivariate model was used for determining the remaining factors associated with persistent suicide ideation. Results Cases increased from 6 in October/2004 to 10 in October/2005, average 12 ± 3,6 cases monthly. 80 percent were aged 30 or younger, 66,7 percent were female, 24,4 percent were students and 20,5 percent were unemployed. 35,2 percent suffered family dysfunction and 35.2 percent had conflicts between couples as precipitant factors. 49 percent had consumed alcohol prior to the suicide attempt. Persistent suicidal ideation was associated with being 31 years old or older, being unemployed and having a higher number of previous suicide attempts, unresolved conflicts and family dysfunction. Logistical regression revealed unresolved conflicts (OR=106.7; 6,8; 1 668,4 95 percent CI) and family dysfunction (OR=11.05; 1,7; 71,2 95 percent CI) as predictor variables for persistent suicidal ideation. Conclusion Unresolved conflicts and family dysfunction were found to be predictor factors for persistent suicidal ideation in subjects who had attempted suicide. Consuming alcohol and other associated factors should be controlled by mental health prevention and promotion programmes.

Characterization of the long-terminal repeat single-strand tail-binding site of Moloney-MuLV integrase by crosslinking

Processing of viral DNA by retroviral integrase leaves a dinucleotide single-strand overhang in the unprocessed strand. Previous studies have stressed the importance of the 5' single-stranded (ss) tail in the integration process. To characterize the ss-tail binding site on M-MuLV integrase, we carried out crosslinking studies utilizing a disintegration substrate that mimics the covalent intermediate formed during integration. This substrate carried reactive groups at the 5' ss tail. A bromoacetyl derivative with a side chain of 6 A was crosslinked to the mutant IN 106-404, which lacks the N-terminal domain, yielding a crosslinked complex of 50 kDa. Treatment of IN 106-404 with N-ethylmaleimide (NEM) prevented crosslinking, suggesting that Cys209 was involved in the reaction. The reactivity of Cys209 was confirmed by crosslinking of a more specific derivative carrying maleimide groups that spans 8A approximately. In contrast, WT IN was not reactive, suggesting that the N-terminal domain modifies the reactivity of the Cys209 or the positioning of the crosslinker side chain. A similar oligonucleotide-carrying iodouridine at the 5'ss tail reacted with both IN 106-404 and WT IN upon UV irradiation. This reaction was also prevented by NEM, suggesting that the ss-tail positions near a peptide region that includes Cys209.

Duodenal villous adenoma.

Duodenal villous adenomas are extremely rare (1/5th of small bowel tumors). In view of their strategic position and risk of malignancy, they require definitive management in specialized care units. We report a case of a 35 year old female patient with a large duodenal (5 cm) villous adenoma causing intussusception of duodenum (a phenomenon rare because of its anatomic location & fixation).

Efecto del día de transferencia embrionaria sobre la tasa de implantación de blastocistos humanos desarrollados en co-cultivo / Effect on the day of embryonic tranfer on the rate of installation of human blastocysts developed in co-cultivation

Se ha descripto que la técnica de co-cultivo tendría un efecto beneficioso sobre los procedimientos de Fertilización In Vitro (FIV) mejorando tanto la calidad embrionaria como así también la tasa de desarrollo hasta el estadio de blastocisto. Hemos estudiado dos grupos de pacientes a las que se transfirieron blastocistos obtenidos luego de 5 a 6 días en co-cultivo. Los resultados indicaron que se logra una elevada tasa de implantación y embarazo luego de transferir blastocistos expandidos de día 5º. No se obtuvo implantación ni embarazo en pacientes que recibieron blastocistos de día 6º. El co-cultivo permite identificar con más certeza a aquellos preembriones con mayor potencial de viabilidad