Percepción e intención de practicar la lactancia materna en adolescentes del noreste de México / Perception and intention to practice breastfeeding in adolescents in northeastern Mexico

Resumen: Objetivo: Analizar la percepción e intención de práctica de la lactancia materna (LM) en adolescentes de ambos sexos que aún no han sido padres. Material y métodos: Se efectuó un estudio cualitativo basado en la teoría fundamentada y siguiendo el criterio de la saturación empírica. Se realizaron 21 entrevistas semiestructuradas a estudiantes entre 15 y 18 años de edad en preparatorias de la ciudad de Monterrey, Nuevo León, México. Resultados: Se identificaron cuatro patrones sobre la percepción e intención de practicar la LM: tradicional; indecisa; rechazo; e igualitarista. Conclusiones: La intención de apoyar o practicar la LM se relaciona a identidades de género y al proyecto de tener hijos y/o un proyecto de desarrollo personal-laboral. Existe convergencia entre distintas percepciones e intenciones de practicar la LM en el futuro, lo cual apunta a revisar las políticas en la materia.

Abstract: Objective: To analyze the perception and intention to practice breastfeeding (BF) in adolescents of both genders who have not yet been parents. Material and Methods: This was a qualitative study based on grounded theory with empirical saturation. Twenty-one semi-structured interviews were conducted with students between 15 and 18 years of age in preparatory schools in Monterrey, Nuevo León, Mexico. Results: Four patterns on the perception and intention of practicing breastfeeding were identified: traditional; undecided; rejection; and egalitarian. Conclusions: The intention to support or practice BF is related to gender identities and the project of having children and / or a personal- labor development project. There is convergence between different perceptions and intentions to practice BF in the future, which aims to review policies in this area.

Percepciones maternas sobre las prácticas alimentarias en escolares de Monterrey, México

RESUMEN El objetivo de este estudio fue explorar las percepciones maternas sobre las prácticas alimentarias de niños en edad escolar que presentan diferente estado nutricional residentes en el área metropolitana de Monterrey, Nuevo León, México. Se realizó un estudio cualitativo fenomenológico, mediante entrevistas semi-estructuradas a 91 madres de familia con un hijo entre 6 y 11 años de edad, durante el año 2015 y 2017. Los resultados evidenciaron que las madres de familia fueron las responsables de la adquisición y preparación de las comidas aun cuando tuvieran un empleo. Para la elaboración de los alimentos la madre cocinó según los gustos de la familia siendo esto una forma de expresarles su cariño. Las emociones de las madres con respecto a la aceptación de los alimentos, los gustos, rechazos y el número de comidas diarias que realizan los hijos, varió dependiendo del estado nutricional. La alimentación durante los días de la semana fue diferente a la de los fines de semana. Las prácticas alimentarias fueron parte de acontecimientos y significados sociales aprendidos por las madres de familia y que no siempre estuvieron acorde con los cánones nutricionales establecidos por los expertos.

ABSTRACT The objective of this study was to explore maternal perceptions of the feeding practices of school-age children with different nutritional status living in the metropolitan area of Monterrey, Nuevo Leon, Mexico. A qualitative phenomenological study was carried out, through semi-structured interviews with 91 mothers with a child between 6 and 11 years of age, during the years 2015 and 2017. The results evidenced that mothers were responsible for purchasing and preparing meals even when they had a job. For food preparation, mothers cooked according to the tastes of the family, this being a way of expressing her affection. Mothers' emotions regarding food acceptance, tastes, rejections and the number of daily meals of children varied depending on the nutritional status. Eating on weekdays was different from eating on weekends. Food practices were part of events and social meanings learned by mothers and are not always in accordance with the nutritional canons established by experts.

First Clinical Cases of OXA-48-Producing Klebsiella pneumoniae in Peru / Primeros casos clínicos de infecciones por Klebsiella pneumoniae productora de OXA-48 en Perú

Background: Carbapenemase-producing Enterobacteriaceae(CPE) represents a global public health concern and systemic infectionsassociatedwithOXA-48 carbapenemase are increasingly being reported in Latin America. Here, we present the first 2 cases of systemic infections by OXA-48-ProducingKlebsiellapneumoniaein Peru. A favorable clinical response was observed after targeted treatment with colistin as a backbone.

Introducción: Las enterobacterias productoras de carbapenemasas (EPC) representan un problema de salud pública y cada vez hay más reportes de infecciones sistémicas asociadas con la carbapenemasa OXA-48 en America Latina. Presentamos los primeros 2 casos de infecciones sistémicas por Klebsiella pneumoniae productora de OXA-48 en Perú. Se observó una respuesta clínica favorable luego del tratamiento dirigido con colistina como base.

Uso racional de antimicrobianos en tiempos de COVID-19 en Perú: rol de los programas de optimización del uso de antimicrobianos e intervenciones desde el punto de vista de control de infecciones

La resistencia antimicrobiana (RAM) es una pandemia adicional de lenta evolución que precede a la pandemia de COVID-19 y continuará cuando esta termine. Sin embargo, en países como Perú, donde existe un alto consumo y prescripción inadecuada de antimicrobianos, puede pasar desapercibida y se puede esperar, en el futuro, un escenario más desafiante. Los programas de optimización de uso de antimicrobianos (PROA) son equipos multidisciplinarios de profesionales que tienen como objetivo retardar la aparición de organismos multirresistentes a través de estrategias como la auditoría de prescripciones o la creación de algoritmos de tratamiento antimicrobiano basados en las tasas locales de RAM. La dificultad en el diagnóstico oportuno de coinfecciones o superinfecciones en el curso clínico y progresión de la COVID-19 predisponen al uso inadecuado de antimicrobianos, lo que obliga a los PROA a adaptar sus estrategias en este panorama cambiante. En Latinoamérica, los PROA no solo tienen que fomentar el cambio de comportamiento en los prescriptores de antimicrobianos, sino también luchar contra la epidemia de información falsa (infodemia) y las campañas de desinformación sobre la COVID-19. Además, la pobre cultura local de prevención y control de infecciones obliga a revisar estrategias para mitigar el impacto posterior en la RAM.

Antimicrobial resistance (AMR) is an additional slow-evolving pandemic that precedes the COVID-19 pandemic and will continue when it ends. However, in countries like Peru, where high consumption and inadequate prescription of antimicrobials occur, AMR may go unnoticed and a more challenging future scenario can be expected. Antimicrobial stewardship programs (ASPs) consist of multidisciplinary teams of professionals that aim to slow down the emergence of multidrug-resistant organisms through strategies such as prescription auditing or creation of antimicrobial treatment guidelines based on local AMR rates. The difficulty in the timely diagnosis of co-infections or superinfections in the clinical course and progression of COVID-19 leads to inappropriate use of antimicrobials, forcing ASPs to adapt their strategies in this changing scenario. In Latin America, ASPs not only have to promote behavior change in antimicrobial prescribers but also fight the epidemic of false information (infodemic) and disinformation campaigns on COVID-19. Furthermore, poor-quality infection prevention and control principles require evaluating strategies to mitigate the subsequent impact on AMR.

Vacinação contra COVID-19 em pacientes portadores de angioedema hereditário: recomendações do Grupo de Estudos Brasileiro em Angioedema Hereditário (GEBRAEH) / COVID-19 vaccination in patients with hereditary angioedema: recommendations from the Brazilian Group for the Study on Hereditary Angioedema (GEBRAEH)

No curso da pandemia da COVID-19, o desenvolvimento rápido de vacinas seguras e eficazes é a principal estratégia de saúde pública para conter a propagação da doença. Nesse contexto, esclarecimentos em relação à prioridade e segurança da vacinação contra COVID-19 em pacientes portadores de angioedema hereditário (AEH), assim como de outras doenças, são necessários. Todos os pacientes devem receber a vacina seguindo a estratégia do Ministério da Saúde e manter as medidas de higiene, uso de máscaras e distanciamento social até o controle da pandemia.

During the COVID-19 pandemic, the rapid development of safe and effective vaccines is the main public health strategy to avoid the spread of the disease. In this context, clarifications regarding the priority and safety of vaccination against COVID-19 in patients with hereditary angioedema (HAE), as well as other diseases, are needed. All patients should receive the vaccine according to the Brazilian Ministry of Health strategy and adhere to measures such as maintaining general hygienic measures, wearing masks, and keeping social distance until the pandemic is controlled.

Enfermedad por hemoglobina H: primer caso de dobles heterocigotos hemoglobina Constant Spring / Sudeste Asiático en Costa Rica / Hemoglobin H disease: first case of double heterozygous hemoglobin Constant Spring / Southeast Asian in Costa Rica

Resumen La enfermedad por hemoglobina H es un cuadro clínico que se presenta en las alfa talasemias, las cuales son enfermedades que cursan con anemia microcítica hipocrómica, debidas principalmente a deleciones en el gen de alfaglobina, lo que disminuye la producción de la cadena de alfa globina y promueve la formación de variantes de hemoglobina. Cuando se detectan variantes de hemoglobina en las alfa talasemias, por lo general, se debe a genotipos homocigotas o dobles heterocigotas para mutaciones y deleciones del gen de alfa globina coheredadas. En este artículo se describe el primer caso en Costa Rica, de dos hermanos con enfermedad por hemoglobina H, que fenotípicamente presentaron las variantes de hemoglobina H y hemoglobina Constant Spring en el análisis electroforético de la hemoglobina, y cuyo análisis molecular del gen de alfa globina detectó tanto la deleción sudeste asiático como la mutación para hemoglobina Constant Spring, siendo diagnosticados como dobles heterocigotos por alfa talasemia (genotipo --SEA/ααCS).

Abstract Hemoglobin H disease occurs in patients with alpha thalassemia, diseases associated with hypochromic microcytic anemia, mainly due to deletions in the alpha globin gene, which decreases the production of the alpha globin chain and promotes the formation of hemoglobin variants. When hemoglobin variants are detected in alpha thalassemias it is usually due to homozygoys or doublé heterozygous genotypes, for mutations and deletions of the alpha globin gene. This article describes the first case in Costa Rica of two siblings with hemoglobin H disease, who phenotypically presented the hemoglobin H and Constant Spring hemoglobin variants in the electrophoretic analysis of the hemoglobin, and whose molecular DNA analysis of the alpha globin gene detected both, the Southeast Asian deletion and the mutation for Constant Spring Hemoglobin, being diagnosed as compound heterozygous for alpha thalassemia (genotipe --SEA/ααCS).

Study of angiopoietin and plasminogen genes in hereditary angioedema

SUMMARY OBJECTIVE To investigate the presence of the Angiopoietin 1 (ANGPT1) and Plasminogen (PLG) mutations in patients with Hereditary Angioedema (HAE) and normal C1 esterase inhibitor (C1-INH) levels, who do not harbor the F12 gene mutation. METHODS Patients clinically diagnosed with HAE but without C1-INH deficiency or dysfunction and F12 gene mutation were evaluated. DNA extraction, quantification, and dilution were performed at a concentration of 100 ng/µL, followed by a DNA amplification (PCR) for molecular evaluation of exon 2 of the ANGPT1 gene and exon 9 of the PLG gene for identification of mutations c.807G>T / p.A119S and c.988A>G / p.K330E, respectively. The PCR product was evaluated in 1% agarose gel electrophoresis. Sequencing was performed using the Sanger method. The electropherograms were analyzed using the FASTA® program. RESULTS DNA samples from 15 women were sequenced. Their ages ranged from 10 to 60 years and the normal C1 esterase and C4 inhibitor serum levels ranged from 22 to 39 mg/dL and from 10 to 40 mg/dL, respectively. No mutations were detected in the analyzed exons of ANGPT1 and PLG. However, a single-nucleotide polymorphism (SNP) was detected in two homozygotic and five heterozygotic patients. CONCLUSION Further studies are needed to evaluate these SNPs and scrutinize their potential for use as molecular markers of HAE and as novel therapeutic targets.

RESUMO OBJETIVO Investigar a presença das mutações no gene Angiopoietina (ANGPT1) e gene Plasminogênio (PLG) em pacientes com Angioedema Hereditário (AEH) com inibidor C1 esterase (C1-INH) normal e negativos para mutação do gene F12. MÉTODOS Foram avaliados pacientes com diagnóstico clínico de AEH sem deficiência ou disfunção de C1-INH e negativos para mutação do gene F12. Realizou-se extração, quantificação e diluição do DNA a uma concentração de 100 ng/uL, em seguida amplificação do DNA (PCR) para avaliação molecular do exon 2 do gene ANGPT1 e do exon 9 do gene PLG para identificação das mutações c.807G>T.p.A119S e c.988A>G p.K330E, respectivamente. O produto da PCR foi avaliado em eletroforese em gel de agarose 1%. Foi realizado o sequenciamento pelo método de Sanger. As análises dos eletroferogramas foram realizadas pelo programa FASTA®. RESULTADOS Foram sequenciadas amostras de 15 mulheres, idade entre 10 e 60 anos, com níveis séricos de inibidor de C1 esterase e C4 normais variando de 22 a 39mg/dL e 10 a 40mg/dL, respectivamente. Não foram identificadas mutações nos éxons analisados dos genes ANGPT1 e PLG. Entretanto no gene PLG foram encontrados polimorfismo de nucleotídeo único (SNP), em duas pacientes homozigotas e cinco heterozigotas. CONCLUSÃO Mais estudos sobre SNP são necessários para esclarecer estes achados pois eles podem ser utilizados como marcadores moleculares do AEH e alvo para novos tratamentos.

Inmunotolerancia en un paciente hemofílico pediátrico en Costa Rica / Immunotolerance induction in a pediatric hemophilic patient in Costa Rica

Resumen La hemofilia A es una enfermedad ligada al cromosoma X que predispone al sangrado. Se trata con Factor VIII, ya sea profilaxis o a demanda. La mayoría de países en el resto del mundo utilizan profilaxis, lo cual a la larga es más barato que tratar los pacientes cuando están con un sangrado activo. La producción de inhibidores del factor VIII es la complicación más común y seria del tratamiento. La inmunotolerancia (ITI) es la única opción de tratamiento que ha demostrado satisfactoriamente erradicar esta condición en los pacientes que desarrollan inhibidores, disminuyendo de esta manera no solo los inhibidores sino los costos del tratamiento. Se presenta un caso de inducción satisfactoria de inmunotolerancia con bajas dosis de factor VIII (FVIII) en un paciente pediátrico con hemofilia A severa. A pesar de que la inmunotolerancia se ha practicado antes en Costa Rica, un caso de estos nunca antes había sido publicado.

Abstract Hemophilia A is an X - linked bleeding disorder. It can be treated with Factor VIII prophylaxis or on demand treatment. Most countries in the world use prophylaxis as it is less expensive than treating patients when they are bleeding. The production of factor VIII inhibitors is the most common and serious complication of the treatment. Immune tolerance induction (ITI) is the only option of treatment when patients develop inhibitors proven to be successful to eradicate this condition, therefore decreasing inhibitors and costs. A case of a successful immune tolerance induction with low doses of factor VIII (FVIII) in a pediatric patient with severe hemophilia A and FVIII inhibitors is presented. Even though inmunotolerance has been practice before in our country, a case like this has never been published.

Patología rara en pediatría: Enfermedad de Rosai Dorfman / (Unusual disease in pediatrics: Rosai Dorfman disease)

Resumen La enfermedad de Rosai Dorfman es una entidad rara caracterizada por linfadenopatías no dolorosas de predominio cervical y submandibular. En el pasado se había considerado como una reticuloendoteliosis maligna, hasta que fue descrita como una entidad clinico-patológica, aislada en 1969 por Rosai y Dorfman. Se presenta el caso de una niña de 4 años de edad, conocida sana, con un cuadro agudo de sensación febril, masa cervical y leucocitosis. Los estudios de laboratorio no identificaron malignidad, ni infección como etiología. Recibió tratamiento con antibióticos sin resolución de su adenopatía, lo cual motivó a que se efectuara una biopsia excisional. El estudio histológico reveló una histiocitosis sinusal con linfoadenopatía masiva. Se decidió dar manejo conservador ya que tuvo una resección completa.

Abstract Rosai Dorfman's disease is a rare entity characterized by non-painful lymphadenopathies predominantly cervical and submandibular. In the past it had been considered a malignant reticuloendotheliosis, until it was described as a clinical-pathological entity, isolated in 1969 by Rosai and Dorfman. We present the case of a 4-year-old girl, known to be healthy, with an acute condition of febrile sensation, cervical mass and leukocytosis. Laboratory studies did not identify malignancy or infection as an etiology. She was treated with antibiotics without resolution of his adenopathy, which led to an excisional biopsy. The histological study revealed a sinus histiocytosis with massive lymphadenopathy. It was decided to give conservative management since it had a complete resection.

Brazilian Guidelines for Hereditary Angioedema Management - 2017 Update Part 1: Definition, Classification and Diagnosis

Hereditary angioedema is an autosomal dominant disease characterized by recurrent angioedema attacks with the involvement of multiple organs. The disease is unknown to many health professionals and is therefore underdiagnosed. Patients who are not adequately diagnosed and treated have an estimated mortality rate ranging from 25% to 40% due to asphyxiation by laryngeal angioedema. Intestinal angioedema is another important and incapacitating presentation that may be the main or only manifestation during an attack. In this article, a group of experts from the "Associação Brasileira de Alergia e Imunologia (ASBAI)" and the "Grupo de Estudos Brasileiro em Angioedema Hereditário (GEBRAEH)" has updated the Brazilian guidelines for the diagnosis and treatment of hereditary angioedema.

Diretrizes brasileiras para o diagnóstico e tratamento do angioedema hereditário ­ 2017 / Brazilian guidelines for the diagnosis and treatment of hereditary angioedema ­ 2017

O angioedema hereditário é uma doença autossômica dominante caracterizada por crises de edema com o envolvimento de múltiplos órgãos. A doença é desconhecida por muitos profissionais da área da saúde e, portanto, subdiagnosticada. Os pacientes que não são diagnosticados e tratados adequadamente têm uma mortalidade estimada de 25% a 40%, devido ao angioedema da laringe, resultando em asfixia. O angioedema de alças intestinais é outra manifestação importante e incapacitante, que pode ser a principal ou a única durante uma crise da doença. Neste cenário, um grupo de especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e do Grupo de Estudos Brasileiro em Angioedema Hereditário (GEBRAEH) atualizou as diretrizes para o diagnóstico e terapia do angioedema hereditário.

Hereditary angioedema is an autosomal dominant disease characterized by edema attacks with the involvement of multiple organs. The disease is unknown to many health professionals and is therefore underdiagnosed. Patients who are not adequately diagnosed and treated have an estimated mortality rate ranging from 25% to 40%, due to laryngeal angioedema, which results in asphyxia. Angioedema affecting bowel loops is another important, incapacitating presentation that may be the main or only manifestation during a crisis. In this scenario, a group of experts affiliated with Associação Brasileira de Alergia e Imunologia (ASBAI) and Grupo de Estudos Brasileiro em Angioedema Hereditário (GEBRAEH) has updated the guidelines for the diagnosis and treatment of hereditary angioedema.

A quantitative PCR approach for determining the ribosomal DNA copy number in the genome of Agave tequila Weber

Background: Agave tequilana has a great economic importance in Mexico in order to produce alcoholic beverages and bioenergy. However, in this species the structure and organization of the rDNAs in the genome are limited, and it represents an obstacle both in their genetic research and improvement as well. rDNA copy number variations per eukaryotic genome have been considered as a source of genetic rearrangements. In this study, the copy number of 18S and 5S rDNAs in the A. tequilana genome was estimated, and an absolute quantitative qPCR assay and genome size was used. In addition, an association between the rDNAs copy number and physical mapping was performed to confirm our results. Results: The analysis were successfully applied to determine copy number of 18S and 5S rDNAs in A. tequilana genome, showing high reproducibility with coefficient of variation (CV) values of 0.014-0.0129%, respectively. A variation of 51 times in the copy number the 18s regarding 5s rDNA was found, thus contributing to genome size of 1.47 and 8.38 x 10-3%, respectively. Similarly, data show a linear relationship (R [2] = 0.992) between rDNA copy number and the detected signals for each of the loci by FISH. The comparison of the rDNA copy number of agave showed differential relationship with other organisms and it may be due to evolutionary ecology.Conclusions: Results show that the proposed method a) can correctly detect the rDNA copy number, b) could be used as species-specific markers and c) might help in understanding the genetic diversity, genome organization and evolution of this species.

Determinación de riesgo cardiovascular y edad vascular según el score de Framingham en pacientes del Hospital Nacional Arzobispo Loayza / Determination of cardiovascular risk and vascular age by the Framingham score in patients at the Arzobispo Loayza Hospital

Las enfermedades cardiovasculares ocupan el cuarto lugar de carga de enfermedad en Perú, y en los últimos 7 años, la población de alto riesgo cardiovascular se ha incrementado. OBJETIVO: Determinar el riesgo cardiovascular y edad vascular según el score de Framingham de los pacientes del Hospital Nacional Arzobispo Loayza así como determinar su factor de riesgo más prevalente. Y las características clínicas de los pacientes con mediano y alto riesgo. MATERIAL Y MÉTODOS: Estudio descriptivo, observacional, transversal. Se encuestaron a 238 pacientes hospitalizados en el Servicio de Medicina Interna del hospital. Se consideró: edad, género, diabetes, tabaquismo, IMC y presión arterial. Los datos fueron analizados con el programa SPSS v.21. RESULTADOS: Se encontró que el mayor porcentaje de la población de estudio presentó mediano y alto riesgo, siendo el factor más prevalente la diabetes y la mayoría hombres. La diferencia entre la edad cronológica y la edad vascular fue en promedio 6,9 años. CONCLUSIÓN: La población estudiada tuvo mediano y alto riesgo por lo que se deberían tomar medidas de prevención primaria y secundaria.

Cardiovascular diseases rank fourth place of disease burden in Peru, and in the last 7 years, the population of high cardiovascular risk has increased. OBJECTIVE: Determine the cardiovascular risk and vascular age according to the Framingham score in patients attending the "Hospital Nacional Arzobispo Loayza", as well as to determine the most prevalent factor. Furthermore, to determine the clinical characteristics of patients with mild and high risk. MATERIAL AND METHODS: This is a descriptive, observational, cross-sectional study. 238 hospitalized patients in internal medicine wards were surveyed. Variables such as age, gender, diabetes, smoking, BMI and blood pressure were considered. The data were analyzed using SPSS v.21. RESULTS: The highest percentage of the population was found within the mild and high risk categories, with diabetes being the most prevalent factor. The average difference between chronological age and vascular age was 6.9 years. CONCLUSION: The majority of the population has mild and high risk, thus primary and secondary prevention measures should be taken. (Horiz Med 2015; 15(2): 27-34)

Reabilitação vestibular na qualidade de vida e sintomatologia de tontura de idosos / Vestibular rehabilitation in the quality of life and the symptomatology of dizziness among the elderly

O objetivo do artigo é analisar o efeito de um protocolo estruturado de reabilitação vestibular na sintomatologia de tontura e qualidade de vida de idosos. Participaram nove idosos, quatro do gênero masculino e cinco do feminino. Utilizou-se para avaliação da qualidade de vida o Dizziness Handicap Inventory - DHI e para a sintomatologia de tontura, a escala de quantificação de tontura. Desenvolveu-se um protocolo de reabilitação vestibular constituído de atividades em grupo. Para a análise dos dados, utilizou-se o teste de Wilcoxon e teste T de Student. Utilizou-se o Coeficiente de Correlação de Spearman para analisar a relação entre qualidade de vida e sintomatologia de tontura. O nível de significância utilizado foi de 5%. Observou-se melhora significativa da sintomatologia de tontura, da qualidade de vida geral e dos aspectos físicos, emocionais e funcionais após a realização do programa. Verificou-se ainda, uma boa correlação positiva entre sintomatologia de tontura e qualidade de vida. Conclui-se que os participantes do programa obtiveram uma melhora significativa da tontura, qualidade de vida geral e dos seus respectivos aspectos pós-reabilitação vestibular. Observou-se ainda uma boa correlação entre sintomatologia de tontura e qualidade de vida geral.

The scope of this paper was to analyze the effect of a structured protocol of vestibular rehabilitation in the symptomatology of dizziness and the quality of life among the elderly. Nine elderly individuals were attended, namely four males and five females. The Dizziness Handicap Inventory (DHI) was used to assess quality of life and the dizziness quantification scale for the symptomatology of dizziness. A protocol for vestibular rehabilitation consisting of group activities was then developed. The Wilcoxon test and Student t-test were used for data analysis. The Spearman correlation coefficient was used to analyze the relationship between quality of life and the symptomology of dizziness. The significance level used was 5%. There was significant improvement in the symptomatology of dizziness, overall quality of life and physical, emotional and functional aspects after completion of the program. There was also a good positive correlation between the symptomatology of dizziness and quality of life. The conclusion reached was that program participants had a significant improvement of dizziness, general quality of life and their respective vestibular rehabilitation aspects. There was also a good correlation between symptomatology of dizziness and overall quality of life.

Alérgenos recombinantes: papel no diagnóstico e na imunoterapia alérgeno-específica / Recombinant allergens: role in diagnosis and in allergen-specific immunotherapy

Nos últimos 30 anos tem havido um avanço notável na identificação, purificação e expressão recombinante de alérgenos relevantes das mais variadas fontes, incluindo ácaros, insetos, mamíferos, polens, alimentos, fungos, látex e outras fontes. Estes avanços resultaram na utilização crescente de alérgenos purificados, naturais ou recombinantes, para melhorar o diagnóstico de alergia pelos métodos que dispomos, incluindo os testes cutâneos de hipersensibilidade imediata, e os métodos in vitro para medida de anticorpos IgE específicos, como ImmunoCAP, ImmunoCAP-ISAC, ELISA e MARIA. Mais recentemente, o uso de alérgenos recombinantes de pólen de bétula (rBet v 1) e de gramas (coquetel de 5 alérgenos) em imunoterapia foi relatado como seguro e eficaz, com resultados comparáveis aos obtidos usando extratos naturais, em pacientes com rinoconjuntivite alérgicos a polens. No presente artigo, apresentamos revisão atualizada do uso de alérgenos recombinantes em diagnóstico de alergia e em imunoterapia alérgeno-específica, incluindo novas estratégias de imunoterapia. Focalizamos na avaliação crítica de estudos que investigaram sensibilidade, especificidade, reatividade cruzada e valor prognóstico de métodos diagnósticos com uso de alérgenos recombinantes versus extratos naturais; nas recomendações atuais para o uso destes novos métodos na prática clínica; e na revisão de estudos clínicos com imunoterapia usando alérgenos recombinantes realizados até o momento.

Over the past 30 years, a great deal of progress has been made in the identification, purification,and recombinant expression of relevant allergens from various sources, including mites, insects,mammals, pollens, foods, fungi, latex, and other sources. These new developments have resultedin an increasing use of purified allergens, either natural or recombinant, to improve the diagnosisof allergy via the methods currently available, including skin tests and in vitro tests for measuringspecific IgE antibodies, e.g., ImmunoCAP, ImmunoCAP-ISAC, ELISA, and MARIA. More recently,the use of recombinant allergens from birch pollen (rBet v 1) and from grass pollen (a cocktailof five allergens) in immunotherapy has been reported to be safe and effective, with resultscomparable to those obtained with natural extracts in patients with rhino-conjunctivitis due topollen allergy. In the present article, we present an up-to-date review on the use of recombinantallergens in the diagnosis of allergy and in allergen-specific immunotherapy, including newstrategies for immunotherapy. We focus on the critical analysis of studies that have investigatedsensitivity, specificity, cross-reactivity, and the prognostic value of diagnostic methods that includerecombinant allergens versus natural extracts; on current recommendations for the use of thesenew methods in clinical practice; and on the review of clinical studies using immunotherapy withrecombinant allergens performed to date.

Primer reporte de empleo de marcadores AFLP en Asteraceae en Cuba / First report of the employment of AFLP markers in Asteraceae in Cuba

Rhodogeron coronopifolius Griseb., es una especie vegetal de la familia Asteraceae, que se encuentra en peligro crítico de extinción. Es endémico de la provincia Villa Clara en la región central de Cuba. Habita en el matorral xeromorfo sub espinoso sobre serpentina. Existen solo cinco poblaciones naturales dentro de un área protegida, la principal causa de amenaza es la fragmentación de su hábitat por acciones antrópicas. Debido a su situación de conservación, se hace necesario realizar estudios de la diversidad genética de las poblaciones naturales para así generar información básica y diseñar una estrategia de conservación. El objetivo de este trabajo fue analizar de manera preliminar la diversidad genética de cuatro poblaciones de esta especie utilizando marcadores AFLP (Polimorfismo de Longitud de Fragmentos Amplificados). Se emplearon dos combinaciones de iniciadores y se evaluó el porcentaje de polimorfismo así como la similitud entre los individuos. Se obtuvieron 165 loci de los cuales el 78,7 % fueron polimórficos. La población de mayor polimorfismo fue Corojito con 85,2%, de manera general el polimorfismo fue alto con valores entre 75 y 87%. La similitud entre los individuos también fue alta con un promedio de 0,74. El agrupamiento genético fue independiente a la población de procedencia, lo que sugiere que existe intercambio genético entre las poblaciones y que estas comparten más del 80 % de los alelos que fueron analizados. Los resultados obtenidos son importantes para el mantenimiento in situ de la especie y para tomar decisiones en aras de su conservación.

Rhodogeron coronopifolius Griseb., is a specie of Asteraceae family, in critical danger of extinction. It is an endemic of Villa Clara city in the central region of Cuba. Its inhabits sub thorny xeromorphic heath on serpentine soil. Only five natural populations exist included in a protected area, the main threat cause is the fragmentation of its habitat for antropics activities. Due to their conservation status, it becomes necessary to analyze the genetic diversity of the natural populations in order to generate basic information usefull to apply a conservation strategy. The main goal of this work was to evaluate in a preliminary manner the genetic diversity of four populations of this specie using AFLP markers (Amplified Fragment Length Polymorphism). Two primer combinations were used and the polymorphism percentage was evaluated as well as the similarity among the individuals. A total of 165 loci were obtained of which 78,7% were polymorphic. The population with higher polymorphism was Corojito with 85,2%. High level of polymorphism was observed among population showing values between 75 and 87%. The similarity among the individuals was also high with an average of 0,74. The genetic grouping was independent to the origin of the population. This suggesting that gene flow exists among the populations, those which share more than 80% of the alleles analyzed. This is important for the in situ maintenance of the specie and to take decisions for their conservation.

Indicación de cssárea en el instituto materno ifantil (imi) bogotá - Colombia.. serie de casos / Indication of caesarea in the Instituto Materno Infantil (IMI) Colombia - Bogotá. Case series

Antecedentes. La cesárea es una intervención quirúrgica que tiene sus indicaciones y que como cualquier otra cirugía tiene riesgos, máxime cuando están involucrados la madre y su fruto. Esta serie de casos describe las principales indicaciones de cesárea en el Instituto Materno Infantil de Bogotá durante los meses de enero a abril de 2011; hasta el momento no se habían documentado estas indicaciones en este centro hospitalario obstétrico y perinatal. Se realiza una revisión de la literatura con el fin de comparar estos datos. Objetivo. Describir los diagnósticos asociados a la cesárea en el Instituto Materno Infantil de Bogotá Colombia. Materiales y métodos. Diseño del estudio, serie de casos. Población: pacientes sometidas a cesárea durante los meses de enero a abril de 2011, pertenecientes al régimen subsidiado de atención en salud, atendidas en un centro de referencia distrital de tercer nivel materno y perinatal. Se revisaron la base de datos Embase y las librerías electrónicas PubMed y Medline con las palabras clave cesarean delivery, cesarean section, idioma inglés, limitada a los últimos 12 años. Muestreo secuencial consecutivo del libro de registros de procedimientos quirúrgicos del Instituto Materno Infantil de Bogotá. Se tomaron como variables a medir los diagnósticos asociados a las cesáreas, no hubo criterios de exclusión. Análisis estadístico descriptivo. Resultados. El diagnóstico de cesárea anterior correspondió al 26,4% de las cesáreas realizadas en el IMI; siguieron en orden de frecuencia: estado fetal insatisfactorio 15,5%, trastornos hipertensivos del embarazo 15,5%, detención secundaria de la dilatación y el descenso 5,5%, ruptura prematura de membranas 4,7%. Conclusión. La cesárea anterior constituyó la indicación de cesárea más frecuente en esta institución. Los trastornos hipertensivos del embarazo y la ruptura prematura de membranas se encontraron dentro de los diagnósticos más frecuentes que llevaron a la cesárea en el IMI, diagnósticos que no se reportan en los registros internacionales.

Background. Caesarean section is a surgical procedure that has its indications and any other surgery is not without risk, especially when involving the mother and its fruit. This case series describes the main indications for cesarean section in the Instituto Materno Infantil in Bogotá during the months of January to April of 2011, so far no such indications were documented in this hospital obstetric and perinatal. A review of the literature in order to compare these data. Objective. To describe the diagnosis associated with cesarean section in the Instituto Materno Infantil (IMI) in Bogotá Colombia. Materials and methods. Study design, case series. Population, patients undergoing cesarean section during the months of January to April of 2011, belonging to the subsidized health care and who atended a district referral center tertiary maternal and perinatal. We reviewed the database Enbase and PubMed and Medline electronic libraries with keywords cesarean delivery, cesarean section, in English, limited to the last 12 years. Sequential sampling logbook consecutive of surgical procedures of the Instituto Materno Infantil in Bogotá. Were taken as variables to measure the diagnoses associated with Csections, there were no exclusion criteria. Descriptive statistics analysis. Results. The diagnosis of previous cesarean corresponded to 26,4% of cesareans in IMI, followed in order of frequency: 15,5% unsatisfactory fetal status, hypertensive disorders of pregnancy 15,5%, secondary detention of dilatation and decline 5,5%, premature rupture of membranes 4,7%. Conclusion. Previous caesarean section was the most frequent indication for cesarean section in this institution. Hypertensive disorders of pregnancy and premature rupture of membranes were found within the most common diagnoses leading to caesarean section in IMI, diagnoses leading to caesarean section in IMI, diagnoses that are not reported in the international registers.

APROPIACIÓN SOCIAL E INVESTIGACIÓN PARTICIPATIVA EN INGENIERÍA EN REHABILITACIÓN / SOCIAL APPROPRIATION AND PARTICIPATORY RESEARCH IN REHABILITATION ENGINEERING

La ingeniería en rehabilitación tiene entre sus objetivos principales el desarrollo de soluciones que mejoren la calidad de vida de las personas con discapacidad, las cuales, si son desarrolladas a través de metodologías de investigación y diseño participativo, pueden presentar ventajas significativas como productos que dan mejor respuesta a las necesidades de la comunidad, mayor aceptación de los resultados por parte de la misma y el hallazgo de fuentes y nichos potenciales de innovación. Adicionalmente, dichas metodologías permiten que los beneficios para esta población no se asocien solamente a los resultados o productos generados, sino que complementariamente se logren desde los mismos procesos investigativos a través de la inclusión y participación auténticas, generando un mayor impacto social. Este artículo propone un enfoque metodológico para el desarrollo de productos de habilitación y rehabilitación en el cual convergen las tendencias de investigación participativa, el diseño y la voz de la comunidad que pide ser copartícipe en los proyectos, en unión a las estrategias para la apropiación social del conocimiento. Adicionalmente se exponen ejemplos, barreras y dificultades, retos y recomendaciones para llevar a cabo una investigación según el enfoque participativo. Las reflexiones planteadas pueden además ser aplicadas a otras áreas del saber.

One of the main goals of rehabilitation engineering is improving the quality of life of people with disabilities through developing solutions for their specific needs. When participatory methodologies for research and design are applied, the resulting solutions show advantages such as products that better address the needs of the community, solutions that are better accepted by the community, and the identification of potential sources and niches for innovation. In addition, participatory methodologies provide benefits that are not only associated with the generated results and products but with the processes themselves. When research processes are inclusive and promote authentic participation a higher social impact can be obtained. This paper proposes a methodological approach for the development of habilitation and rehabilitation products that allows the convergence of participatory research tendencies, design tendencies and the voice of the community that claims for co-participation. This approach also incorporates strategies for the social appropriation of knowledge. Examples, barriers, difficulties, challenges and recommendations for conducting research with a focus on participation are also presented. The reflections herein presented may also be applied to other fields.

Características clínicas de los pacientes de la unidad de cuidados intensivos del Hospital Universitario de San Ignacio con insuficiencia renal aguda y factores asociados con mortalidad / Clinical characteristics of the intensive care patients at the Hospital Universitario de San Ignacio with acute renal failure and factors associated with mortality

Introducción: la insuficiencia renal aguda (IRA) es una de las complicaciones más frecuentes en las Unidades de Cuidado Intensivo (UCI), por lo cual, la identificación de los factores de riesgo y su manejo temprano y oportuno, implicarían optimización de recursos, mejoría en la calidad de la atención y disminución de complicaciones y morbimortalidad. Objetiv describir las características clínicas de los pacientes que ingresaron a la unidad de cuidados intensivos del Hospital Universitario San Ignacio (HUSI) con IRA y cuáles podrían ser los factores de riesgo asociados a mortalidad. Materiales y métodos: se realizó un estudio prospectivo de una serie de casos, de una muestra por conveniencia de todos los pacientes mayores de 15 años que ingresaron a la UCI del HUSI de Bogotá y desarrollaron IRA. Se definió IRA com niveles de creatinina sérica mayor de 1.4 mg/ dL (hombre) y mayor de 1.2 mg/dL (mujer) o cuando desarrollaron oliguria; gasto urinario menor de 400 cc en 24 horas, o aumento del 50% de la creatinina con respecto a su ingreso. Las variables incluidas al ingreso de los pacientes fueron: edad, sexo, Apache, TISS, SOFA, indicación de UCI, morbilidades asociadas o presentes, infección, sitio de infección, valores de azoados, electrolitos: sodio y potasio, gases arteriales (pH y bicarbonato), relación entre la presión arterial de oxígeno y la fracción inspirada de oxígeno, uso de vasopresores: (dopamina dosis > de 5 µg/kg/min, noradrenalina dosis > 0.1 µg/kg/min) y cuantificación de diuresis. Resultados: entre junio 1o. y diciembre 1o. de 2006 se estudiaron 253 pacientes que ingresaron a la UCI que luego desarrollaron IRA, de los cuales el 56% fueron hombres y 60.3% requirió soporte vasopresor. Los diagnósticos de ingreso más frecuentes fueron choque séptico y síndrome coronario agudo en 35 pacientes (13.83%) en cada patología. La mortalidad fue de 13.4% en este grupo. El análisis exploratorio de las variables al ingreso a UCI mostró aumento de la mortalidad por la presencia de soporte ventilatorio, infección pulmonar, uso de vasopresores, específicamente noradrenalina, alteraciones en los niveles de sodio y potasio, niveles de APACHE mayores de 20 y de SOFA mayor de seis, así como la presencia de morbilidades asociadas. Conclusiones: después de ajustar un modelo de regresión logística controlado por otras variables independientes, las únicas variables asociadas con mortalidad fueron: necesidad de ventilación mecánica, Apache mayor de 20, SOFA mayor de 6 y anormalidades en sodio (Acta Med Colomb 2011: 36: 168-172).

Introduction: acute renal failure (ARF) is one of the most frequent complications found in the Intensive Care Unit (ICU). In order to optimize resources, to improve the quality of patient care, and to reduce complications and morbidity-mortality, it is therefore important to identify risk factors and to implement early and timely management measures. Objective: to identify the clinical characteristics of patients admitted to the ICU of Hospital Universitario de San Ignacio (HUSI) with ARF, as well as the risk factors possibly associated with mortality. Materials and methods: a prospective study of a convenience sample of all patients aged 15 years or older admitted to the ICU of HUSI who developed ARF. ARF was defined as serum creatinin levels greater than 1.4 mg/dL (male) or greater than 1.2 mg/dL (female), or when the patient developed oliguria (urine output less than 400 ml in 24 hours), or a 50% increase in creatinin levels with respect to admission. The variables included at the moment of admission were: age, sex, APACHE, TISS, SOFA, indication for admission to ICU, comorbidities, infection, site of infection, azotemia values, electrolytes (sodium and potassium), arterial blood gases (pH and bicarbonate), relationship between PaO2 and FiO2, use of vasopressors (dopamine > 5 µg/kg/min, noradrenalin > 0.1 µg/kg/min), and urine output. Results: during the period from June 1 to December 1 2006, 253 patients admitted to the ICU who afterwards developed ARF were studied. 56% were males and 60.3% required vasopressors. The most frequent diagnoses on admission were septic shock and acute coronary syndrome, with 35 patients each (13.83%). Mortality was 13.4% in this group. Exploratory analysis of the variables on admission to the ICU showed increased mortality associated with mechanical ventilation, pulmonary infection, use of vasopressors (specifically noradrenalin), altered sodium and potassium levels, APACHE scores greater than 20 and SOFA greater than 6, as well as comorbidities. Conclusions: after adjusting a logistic regression model controlled by other independent variables, the only variables found to be associated with mortality were: need for mechanical ventilation, APACHE score greater than 20, SOFA score greater than 6, and abnormal sodium levels. (Acta Med Colomb 2011: 36: 168-172).