The Frequency of Porcine Cysticercosis and Factors Associated with Taenia solium Infection in the Municipality of Tuchín-Córdoba, Colombia.

Taeniasis and cysticercosis are parasitic infections that affect humans and pigs. Their global distribution constitutes a serious public health issue with significant implications for pork production. The purpose of this study was to evaluate the presence of porcine cysticercosis in backyard swine from 42 indigenous communities throughout Tuchín-Córdoba, Colombia. Between December 2020 and March 2021, free-range pigs (n = 442) were assessed using the ELISA cysticercosis Ag test; 85 pigs were examined through sublingual visual evaluation, and 4 slaughtered pig carcasses were subjected to standard operation inspection. The collected cysticercus underwent histological and PCR analysis. Furthermore, 192 surveys of knowledge, attitudes, and practices (KAP) were used to identify the factors that facilitate infection transmission. Serological investigation revealed that 9.7% (46/472) of the animals were positive for cysticerci Ag. Sublingual inspection identified cysticercus in 28.7% (25/87) of the animals, while PCR analysis indicated that cysticercus corresponded to the T. solium American/African genotype. The factors associated with T. solium infection in the pigs in the surveyed areas numbered 14. The majority are associated with factors that promote the active persistence of Taenia solium's life cycle in an area, such as lack of environmental sanitation, a lack of coverage or care for drinking water and wastewater treatment services, and no solid waste disposal.

Factores influyentes en pacientes con periodontitis y diabetes mellitus tipo II / Influential Factors in Patients with Periodontitis and Diabetes Mellitus Type II

RESUMEN La enfermedad periodontal (EP) es un proceso multifactorial y progresivo que degenera en un tiempo determinado los tejidos alrededor de los dientes; esta se clasifica según su progresión en gingivitis y periodontitis, siendo la periodontitis la última y más agravante instancia de esta enfermedad. La diabetes es una enfermedad crónica e irreversible del metabolismo que afecta los niveles de azúcar del cuerpo; se clasifica en tipo I o insulinodependiente (más común en personas jóvenes), tipo II o no insulinodependiente (más común en personas adultas), y otra variedad conocida como diabetes gestacional (o del embarazo). Se cree que factores como estado socioeconómico, genética, tabaquismo y otras condiciones sistémicas tienen influencia en el control de la enfermedad periodontal y la diabetes, y se afirma que existe una relación bidireccional entre estas dos entidades. Este artículo de revisión pretende ser una herramienta de actualización para profesionales interesados en el tema. En la relación bidireccional que existe entre estas dos patologías hay una injerencia de ciertos factores como el tabaquismo; otras condiciones sistémicas como la obesidad y el embarazo; así como también algunas interacciones medicamentosas. La diabetes mellitus constituye un factor de riesgo para la periodontitis y, al mismo tiempo, el control metabó-lico de estos pacientes se hace difícil en presencia de periodontitis, poniendo de relieve no solo la relación entre estas dos entidades, sino la importancia de conocerla, con el fin de poder actuar dentro de un equipo interdisciplinario que conlleve a unos mejores resultados en salud para los pacientes afectados.

ABSTRACT Introduction: Periodontal disease is a multifactorial and progressive process that degenerates at a specific time the tissues around the teeth. This disease is classified according to its progression in gingivitis and periodontitis, being periodontitis the last and most aggravating instance of the disease. On the other hand, diabetes is a metabolic disorder that affects sugar levels in the body. Diabetes is classified as type I or insulin-dependent (more common in young people), type II or non-insulin-dependent (more common in adults) and another known variety like gestational diabetes (or pregnancy). It is believed that factors such as socioeconomic status, genetics, other systemic conditions, or influence of periodontal treatment, among others, are involved in the bidirectional relationship that exists between these two entities. This review article aims to be an updating tool for professionals interested in the subject. Conclusions: The bidirectional relationship that exists between these two pathologies is an interference of certain factors such as smoking, other systemic conditions such as obesity and pregnancy, as well as some drug interactions. Diabetes Mellitus constitutes a risk factor for periodontitis. At the same time, the metabolic control of these patients becomes difficult in the presence of periodontitis, highlighting not only the relationship between these two diseases, but also the importance of knowing it to be able to act within an interdisciplinary team that leads to better health outcomes for affected patients.

Regeneración de árboles en ecosistemas naturales y plantaciones de Pinus patula (Pinaceae) dentro de un gradiente altitudinal andino (Azuay, Ecuador) / Regeneration of trees in natural ecosystems and plantations of Pinus patula (Pinaceae), in an Andean altitudinal gradient (Azuay, Ecuador)

Resumen Los bosques y páramos andinos poseen alta riqueza de especies, pero están amenazados constantemente por deforestación. La regeneración natural arbórea de estos ecosistemas condiciona su estructura y funcionalidad en el futuro, pero ha sido escasamente evaluada. En Los Andes del sur del Ecuador, también existen plantaciones forestales de Pinus patula (pino) abandonadas, que podrían ser escenarios para promover la regeneración natural. En un gradiente altitudinal andino, se evaluó florísticamente parámetros de la regeneración arbórea en dos escenarios de estudio: ecosistemas naturales (páramos herbáceos y bosques naturales) y plantaciones de pino. Para ello la diversidad de la regeneración fue descrita mediante la riqueza de especies, índice de Shannon y composición florística. La abundancia a través del número de individuos; estos parámetros fueron comparados en ambos escenarios. También se determinó qué variables ambientales o predictoras de: cobertura de dosel, edáficas, estructura arbórea, distancia horizontal y fisiográficas, explicaron con mayor magnitud la variación en los parámetros de la regeneración. Para ello se realizó un análisis de partición de la variación. La riqueza y diversidad de especies fueron mayores en los ecosistemas naturales, la composición florística fue diferente y su abundancia fue similar. En los ecosistemas naturales, el área basal y la densidad arbórea explicaron mayormente la variación en la riqueza, diversidad y abundancia. No así en las plantaciones de pino en donde la distancia horizontal hacia los bosques nativos fue la predictora que mayormente las explicó. La mayor diversidad de regeneración en los ecosistemas naturales (bosques) está asociada con la existencia de biotipos arbóreos, arbustivos y disponibilidad de semillas, adicionando a la eficiencia en los procesos de dispersión a nivel de micro-hábitat, aspectos que son limitantes en las plantaciones de pino, en los cuales la dispersión o disponibilidad de semillas depende de la cercanía a los ecosistemas naturales.

Abstract Andean forests and paramo have high species richness, but constantly they are threatened by deforestation. Natural arboreal regeneration of these ecosystems will condition their structure and functionality in the future, but now it has been poorly evaluated. In the Andes of Southern Ecuador, there are also abandoned Pinus patula (pine) forest plantations, which could be scenarios to promote natural regeneration. In an Andean altitudinal gradient, we evaluated floristically parameters of tree regeneration between two study scenarios: natural ecosystems (herbaceous paramos and natural forests) and pine plantations. For this, the diversity of regeneration was described by species richness, Shannon index and floristic composition. Abundance with the number of individuals; these parameters were compared between two scenarios. We determined also that environmental variables or predictors of: canopy cover, soil, tree structure, horizontal distance and physiographic explained the variation in the parameters of regeneration with greater magnitude. For this, a partition analysis of the variation was carried out. Richness and diversity of species were greater in natural ecosystems, whereas floristic composition was different and its abundance was similar. In natural ecosystems, basal area and tree density explained mainly the variation in wealth, diversity and abundance. Not so in pine plantations where horizontal distance to the native forests was the predictor that mostly explained. The greatest diversity of regeneration in natural ecosystems (forests) is associated with the existence of arboreal, shrub and seed biotypes. It is adding to this, efficiency in dispersion processes at the micro-habitat level. These aspects are limiting in plantations of pine, in which the dispersion or availability of seeds depends on the proximity to natural ecosystems.

Diffuse alveolar hemorrhage syndrome secondary to bocavirus and rhinovirus infection in a pediatric patient / Síndrome de hemorragia alveolar difusa secundaria a coinfección por Rhinovirus y Bocavirus en un paciente pediátrico

Abstract The diffuse alveolar hemorrhage syndrome is characterized by the presence of blood in the pulmonary alveolus from arterioles, venules and pulmonary capillaries, as a consequence of the lesion of the alveolar wall and without an endobronchial alteration. Its presentation includes a classic triad of hemoptysis, anemia and diffuse alveolar infiltrates. It's a rare but potentially fatal entity and there are no clear data on its real incidence in the pediatric population. We present the case of a previously healthy pediatric patient, immunocompetent, who presented diffuse alveolar hemorrhage syndrome with secondary ventilatory failure. After discarding all possible etiologies, coinfection by Rhinovirus and human Bocavirus was detected through the polymerase chain reaction, determining them as causal factors of the event. Recently, viral infections have been postulated as causing serious lung disease, especially coinfection in immunocompromised patients, in this case Rhinovirus and human Bocavirus; however there are no reports on the syndrome caused by these viruses.

Resumen El síndrome de hemorragia alveolar difusa se caracteriza por la presencia de sangre los alveolos pulmonar procedente de arteriolas, vénulas y capilares pulmonares, como consecuencia de la lesión de la pared alveolar y sin identificársele una alteración endobronquial. Su presentación incluye una triada clásica de hemoptisis, anemia e infiltrados alveolares difusos. Es una entidad poco frecuente aunque potencialmente fatal y no hay datos claros de su real incidencia en la población pediátrica. Se presenta el caso de un paciente pediátrico previamente sano, inmunocompetente, quien presentó síndrome de hemorragia alveolar difusa con falla ventilatoria secundaria. Después de descartar todas las posibles etiologías, se detectó, a través de reacción en cadena de polimerasa, coinfeccion por Rhinovirus y Bocavirus humano, determinándolos como causales del evento. Recientemente se postula las infecciones virales como causantes de enfermedad pulmonar grave, en especial la coinfeccion en pacientes inmunocomprometidos, en este caso Rhinovirus y Bocavirus humano, sin embargo no existen reportes sobre el síndrome causada por estos virus.

Levels of Empathy Orientation after the Implementation of a New Curriculum

Objective: To compare the level of empathy orientation of the students in the Dentistry Program from the Universidad Metropolitana according to gender and levels of education after the implementation of a new curriculum. Material and Methods: An exploratory and transversal research was made. The studied population are the students from the first and the fifth academic year in the Dentistry Undergraduate Program from the Universidad Metropolitana (Barranquilla, Colombia) (n = 371, N = 482; 76.97% of the population) First: 92; Second: 83; Third: 60; Fourth: 71 and Fifth: 65, being females = 235 and males = 136. Data collection was done in March 2016 for the present study and in 2012. The Jefferson Scale of Physician Empathy was applied to participants. Results: For the "Academic Years" factor, the means in the first undergraduate years are similar with an increase in the last two undergraduate years; females have superior values than males. However, the behavior of these means is different when analyzing the combined levels of both factors. The female gender increases steadily in the first four years and decreases in the fifth year; The male gender goes down from first to second place and increases steadily until the fifth year surpassing the female in this last year. Conclusion: The general results obtained on empathy have improved compared to those results from 2012. The questions that obtained significant scores were those related to the cognitive component. This could be explained by the incorporation of a greater number of community activities into vulnerable population.

Oral Finasteride Presents With Sexual-Unrelated Withdrawal in Long-Term Treated Androgenic Alopecia in Men.

Side effects associated with oral finasteride (FT) (1 mg/d) and topical 5% minoxidil (M5) have been previously described. The authors have evaluated long-term adverse effects and causes of long-term therapy withdrawal in patients with androgenic alopecia (AGA) treated with M5+FT vs M5 without FT. A total of 130 AGA patients with a minimum 2-year follow-up volunteered to complete a questionnaire on side effects. Patients' responses were classified as "never," "rarely," "sometimes," "often," and "all the time." An adverse effect was considered in the presence of an "often" or "all the time" response. A total of 100 patients received combined M5+FT and were compared with 30 patients receiving single-therapy M5 according to the physician's clinical criteria. Erectile dysfunction (3%), diminished libido (4%), and reduced ejaculation (7%) were present in patients taking M5+FT but were absent in patients taking M5. Only 1 of 100 patients taking M5+FT quit long-term therapy due to sexual adverse effects (diminished libido). The main causes for therapy withdrawal in the FT group were lack of positive results in 11% and in the M5 group side effects in 4% (P < .02). Increased body hair was different between groups: with 6.6% in the M5 group and 4% in the M5+FT group (P < .03). FT demonstrates sexual-unrelated reasons as the main cause of therapy withdrawal in long-term treated AGA patients.

[Gastro-bronchial fistula major complication of sleeve gastrectomy]. / Fístula gastrobronquial: complicación mayor de manga gástrica.

BACKGROUND: Gastrobronchial fistula is a rare complication in gastroesophageal surgical procedures. It is difficult to diagnose and handling is complex. Therefore, there have been developments for non-surgical alternatives to obliterate minor fistula mortality. Endoscopic treatment is an option for patients with small fistulas or in serious condition. CLINICAL CASE: A 38 year old woman with evidence of gastrobronchial fistula postoperated of gastric sleeve, diagnosed during the postoperative period due to clinical variegated was initially handled as infectious respiratory symptoms; once the fistulous path was established, the intention was to close the path using endoclips. However, adding hemopneumothorax, drainage tube placement and thoracotomy were required. It was decided to chose a prosthetic esophageal endoscopic management of polytetraflouroethylene and fibrin as last therapy, because the patient had systemic inflammatory response syndrome, with favorable response to endoscopic management. DISCUSSION: Bariatric surgery has shown satisfactory results, however, the complexity of the procedure favors severe complications such as the present case. Gastrobronchial fistulas represent a diagnostic and therapeutic challenge, this is considering from a conservative management to endoscopic procedures, as in our patient. CONCLUSION: Although gastrobronchial fistulas are a rare complication, the use of endoscopy in resolution should be a first class weapon in its management, since it offers a lower morbidity in a patient with habitual respiratory symptoms that are difficult to control, with satisfactory results in the medium and long term.

[Spontaneous cholecystocutaneous fistula]. / Fístula colecistocutánea espontánea.

BACKGROUND: Spontaneous cholecystocutaneous fistula is defined as a gallbladder communication with the external environment through the abdominal wall rupture; the first reports were written in the seventeenth century by Thilesus. During the past 50 years 25 cases have been reported. CLINICAL CASE: We report a case of a 30-year-old woman presented with a five-year history of biliary colic, six months prior to medical assessment presents outlet of biliary material and gallstones spontaneously in the right upper quadrant. Fistulogram was performed without evidence of obstruction, subsequently cholecystectomy and resection of the fistula was performed. DISCUSSION: The biliary fistulas are an abnormal communication from the gallbladder into another surface, is a rare condition in our day as it only occurs in 10% of patients with gallbladder lithiasis; while spontaneous cholecystocutaneous fistula clinic is more than evident. It is imperative perform studies like ultrasound, tomography, and fistulogram. The mainstay of treatment is cholecystectomy, resection of the fistula and repair of abdominal wall defect. CONCLUSION: The incidence of cholecystocutaneous fistula today is minimal and it seems that the current trend is to become an entity anecdotal, the approach subcostal abdominal examination remains as the first choice. The laparoscopic approach is an option reserved for the experienced surgeon.

[Pancreatic pseudocyst. Case report and literature review]. / Pseudoquiste pancreático. Revisión y reporte de caso.

BACKGROUND: The most frequent etiology of pancreatic pseudocyst is acute pancreatitis and exacerbations of chronic pancreatitis, presenting spontaneous resolution in 50% of the cases. Treatment is indicated in symptomatic or complicated persistent pseudocysts. The OBJECTIVE of this article is to present a case and management options of pancreatic pseudocyst defined as a collection of fluid in the omental bursa. CLINICAL CASE: We present the case of a 59-year-old female patient with a history of laparoscopic cholecystectomy and necrotizing pancreatitis. She presented abdominal pain, early satiety, and nausea during the previous 2 months. Presence of pancreatic pseudocysts of 92 and 62 mm was demonstrated by computed tomography. The patient was submitted to a laparoscopic cyst-gastric anastomosis. CONCLUSIONS: Laparoscopic cyst-gastric anastomosis is the ideal treatment for pancreatic pseudocyst management because it offers continuous drainage, low rate of recurrence and few complications, exceeding the RESULTS of endoscopic management and imaging-guided drainage along with the benefits of a minimally invasive procedure.

ANTECEDENTES: la etiología más frecuente del quiste pancreático es la pancreatitis aguda y las agudizaciones de pancreatitis crónica; el 50% de los casos se alivia espontáneamente. El tratamiento se indica en pseudoquistes persistentes, sintomáticos o complicados. OBJETIVO: comunicar un caso y las opciones de tratamiento del pseudoquiste pancreático, definido como una colección de líquido en la transcavidad de los epiplones. Caso clínico: paciente femenina de 59 años de edad, con ANTECEDENTES de colecistectomía laparoscópica, pancreatitis necrotizante y en los últimos dos meses dolor abdominal, saciedad temprana y náuseas. La tomografía reveló un pseudoquiste pancreático de 92 y 62 mm, razón por la que se efectuó una cistogastroanastomosis laparoscópica. CONCLUSIONES: la cistograstroanastomosis laparoscópica es el tratamiento ideal para el tratamiento del pseudoquiste pancreático porque ofrece: drenaje continuo, bajo índice de recidiva y pocas complicaciones que superan al tratamiento endoscópico y al drenaje guiado por imagenología, junto con las ventajas de mínima invasión.

Acute telogen effluvium onset event is associated with the presence of female androgenetic alopecia: potential therapeutic implications.

Acute telogen effluvium (ATE) is often associated with female androgenetic alopecia (FAA), but predictive factors of ATE-FAA association and clinical factors or therapies that may influence the progression of ATE to chronic telogen effluvium (CTE) have not been reported. We have identified predictive factors of ATE-FAA association and retrospectively evaluated the impact of therapies on the progression to CTE. Conclusions are as follows: (i) Triggering cause is a significant independent factor that predicts association of ATE with FAA. (ii) Triggering causes with higher risk of concurrent FAA are severe diet, iron deficiency, and thyroid dysfunction. (iii) Patients suffering ATE may benefit from different therapeutic approaches (depending on which is the triggering cause) to prevent or treat the association with FAA. (iv) Minoxidil use shows a trend to lower the percentage of progression to CTE. (v) Apart from treating the precipitating cause, the different additional oral treatments used have not shown any correlation with progression to CTE.

Novel enzymatic assay predicts minoxidil response in the treatment of androgenetic alopecia.

Topical minoxidil is the most common drug used for the treatment of androgenetic alopecia (AGA) in men and women. Although topical minoxidil exhibits a good safety profile, the efficacy in the overall population remains relatively low at 30-40%. To observe significant improvement in hair growth, minoxidil is typically used daily for a period of at least 3-4 months. Due to the significant time commitment and low response rate, a biomarker for predicting patient response prior to therapy would be advantageous. Minoxidil is converted in the scalp to its active form, minoxidil sulfate, by the sulfotransferase enzyme SULT1A1. We hypothesized that SULT1A1 enzyme activity in the hair follicle correlates with minoxidil response for the treatment of AGA. Our preliminary retrospective study of a SULT1A1 activity assay demonstrates 95% sensitivity and 73% specificity in predicting minoxidil treatment response for AGA. A larger prospective study is now under way to further validate this novel assay.

[Perforated duodenal diverticula. Case report and treatment options]. / Divertículo duodenal perforado. Reporte de caso y opciones de tratamiento.

BACKGROUND: the presence of duodenal diverticula was first described in 1710 by Chromel. Duodenal diverticulum is the second most common site of diverticula in the digestive tract. Anatomically duodenal diverticula are located in 10 to 67% in the second portion of duodenum, and its finding in most cases incidental. About 90% of patients appear asymptomatic, manifesting symptoms mostly once established complications such as: gastrointestinal bleeding and perforation. CLINICAL CASE: 78-years-old woman who attended our Emergency department with dyspnea, moderate epigastralgia, abdominal bloating, constipation and difficulty to pass gas; Laparotomy was performed to identify duodenal diverticulum in the third portion of the duodenum with a perforation of 5 mm in its cupula. It proceeds with diverticulectomy. CONCLUSIONS: The diagnosis of duodenal diverticulum as a cause of acute abdomen must be considered in our differential diagnosis in acute abdomen supported by imaging and endoscopy. The surgical management of duodenal diverticulum, in particular the resection of the diverticulum, remains as the recommendation for treatment with less morbidity and a good recovery.

Antecedentes: los divertículos duodenales los describió por primera vez Chromel en 1710. El divertículo duodenal es el segundo sitio más frecuente de divertículos en el tubo digestivo, el diagnóstico se limita a los casos con complicaciones y síntomas. Los divertículos duodenales se localizan en 10- 67% en la segunda porción del duodeno. Su hallazgo en la mayoría de los casos es incidental. Cerca de 90% de los pacientes cursan asintomáticos y sólo se manifiestan cuando sobrevienen las complicaciones, como la hemorragia digestiva y la perforación. Caso clínico: paciente femenina de 78 años de edad, que acudió al hospital debido a disnea de medianos esfuerzos y epigastralgia moderada, distensión abdominal, constipación y dificultad para canalizar gases. La laparotomía identificó un divertículo duodenal con perforación en su cúpula de 5 mm que dio pie a la realización de la diverticulectomía. Conclusiones: el diagnóstico de divertículo duodenal, como etiología de abdomen agudo, debe contemplarse en cualquier diagnóstico diferencial con cuadro de abdomen agudo, apoyados siempre en la imagenología y endoscopia. El tratamiento quirúrgico del divertículo duodenal, en especial su resección, sigue siendo la recomendación dirigida a la menor morbilidad y mejor recuperación.

Molecular mechanisms of endothelial dysfunction: from nitric oxide synthesis to ADMA inhibition.

Endothelial dysfunction symbolizes several pathological conditions, including altered anticoagulant and anti-inflammatory properties of the endothelium, impaired modulation of vascular growth, and dysregulation of vascular remodeling. Nevertheless, this term has been used commonly to refer to an impairment of endothelium-dependent vasorelaxation caused by a loss of nitric oxide bioactivity. The clinical and scientific relevance of nitric oxide synthesis and bioavailability in endothelial dysfunction is based on the fact that it is a common factor in the pathogenesis of cardiovascular diseases. These alterations have been demonstrated in both animal models and humans, in the scope of dangerous pathological conditions such as cigarette smoking, hypertension, hypercholesterolemia, aging, diabetes, and heart failure. A decline in nitric oxide bioavailability may be caused by decreased expression of the endothelial nitric oxide synthase, a reduction of substrate or cofactors for this enzyme, alterations of cellular signaling, enzyme inhibition by asymmetric dimethyl arginine, and, finally, accelerated nitric oxide degradation by reactive oxygen species. The knowledge of the processes related to these alterations becomes of remarkable importance for understanding the generation of innovative and effective therapeutic strategies for cardiovascular diseases.

Pharmacologic management of isolated low high-density lipoprotein syndrome.

High-density lipoprotein (HDL) cholesterol is a heterogeneous group of lipoproteins exhibiting a variety of properties like prostacyclin production stimulation, decrease in platelet aggregation, endothelial cell apoptosis inhibition, and low-density lipoprotein oxidation blockade. Epidemiologic studies have shown an inverse relation between HDL cholesterol levels and cardiovascular risk. Low HDL cholesterol is associated with increased risk for myocardial infarction, stroke, sudden death, peripheral artery disease, and postangioplasty restenosis. In contrast, high HDL levels are associated with longevity and protection against atherosclerotic disease development. Given the evolving epidemic of obesity, diabetes mellitus, and metabolic syndrome, the prevalence of low HDL will continue to rise. In the United States, low HDL is present in 35% of men, 15% of women, and approximately 63% of patients with coronary artery disease. Data extracted from the Framingham study highlight that 1-mg increase in HDL levels decreases by 2% to 3% the risk of cardiovascular disease. There is no doubt regarding clinical importance about isolated low HDL, but relatively few clinicians consider a direct therapeutic intervention of this dyslipidemia. In this sense, lifestyle measures should be the first-line strategy to manage low HDL levels. On the other hand, pharmacologic options include niacin, fibrates, and statins. Fibrates appear to reduce risk preferentially in patients with low HDL with metabolic syndrome, whereas statins reduce risk across all levels of HDL. Torcetrapib, a cholesteryl esters transfer protein inhibitor, represented a hope to raise this lipoprotein; however, all clinical trials on this drug had ceased after ILLUMINATE, RADIANCE and ERASE trials had recorded an increase in mortality, rates of myocardial infarction, angina, and heart failure. In the near future, drugs as beta-glucans, Apo-A1 mimetic peptides, and ACAT inhibitors, are the new promises to treat this condition.

Homeostasis model assessment (HOMA) as surrogate insulinization criteria in patients with type 2 diabetes.

Type 2 diabetes mellitus is a metabolic disorder that results from defects in both insulin secretion and insulin action. Questions remain about when insulin therapy is indicated; thus, the aim of this study was to evaluate homeostasis model assessment beta-cell (HOMAbetacell) values as surrogate criteria for insulin therapy indication in patients with type 2 diabetes. A prospective study was performed involving 189 type 2 diabetic patients with deficient metabolic control assessed by clinical and laboratory parameters. All patients received nutritional intervention and combination therapy with metformin and glimepiride. Patients who did not respond were admitted to the next phase, which consisted of glimepiride + metformin + rosiglitazone oral therapy and revaluation after 3 months. Comparisons between responders and nonresponders in this phase were made in order to achieve differences in metabolic parameters and beta cell function. Of 189 patients studied, 150 (79.36%) were considered full responders in the first phase of this study. The remaining 39 patients were admitted in the second trial phase, in which 20 patients (51.28%) responded to triple oral therapy, while the other 19 (49.72%) required insulin therapy. Significant differences were found in fasting and postprandial glycemia (P < 0.001; P < 0.004) between the non-insulin-requiring group (200 +/- 12.0 mg/dL; 266.05 +/- 17,67 mg/dL) and the insulin-requiring group (291.5 +/- 17.6 mg/dL; 361.6 +/- 26.1 mg/dL). Likewise, significant differences were observed in homeostasis model assessment insulin resistance (HOMAIR) and HOMAbetacell values (P < 0.002; P < 0.04) between non-insulin-requiring patients (7.7 +/- 0.8; 24.5 +/- 1.3%) and insulin-requiring patients (12.6 +/- 1.2; 19.4 +/- 2.4%). Finally, significant differences were observed when comparing body mass index (non-insulin-requiring group, 29.2 +/- 0.4 kg/m, versus insulin-requiring group, 27.1 +/- 0.9 kg/m; P < 0.05). HOMAbetacell determination in clinical practice is a useful tool to determine when insulin therapy should be started for type 2 diabetic patients.

Biología molecular de los transportadores de glucosa: clasificación, estructura y distribución / Molecular biology of the transporters of glucose: classification, structures and distribution

Hexosas como la glucosa, galactosa y fructosa cumplen funciones importantes en las células eucarióticas. Estas moléculas son incapaces de difundir directamente a través de las membranas celulares por lo que requieren proteínas transportadoras especializadas para entrar al interior celular. Dichas biomoléculas pertenecen a un grupo de transportadores constituida por 2 familias de proteínas: la familia de los Glut´s (del inglés Glucose Transporters) y la familia de los co-transportadores de sodio y glucosa. Según la información obtenida de la secuencia de aminoácidos por medio de librerías de cADN todos poseen una estructura básica similar: 12 (Gluts) o 14 (SGLT) dominios trasmembrana. Igualmente todos parecen estar glicosilados en alguna de sus asas extracelulares. En los últimos siete años ha habido un explosivo incremento en la información sobre estos transportadores, de hecho, hasta hace diez años solo se conocían 6 transportadores pero esta familia ha crecido rápidamente hasta llegar a 14 miembros para los Gluts y 6 miembros para los SGLT´s. El impacto de estos descubrimientos se hace notar cuando se analizan los procesos en los que se involucran estas proteínas: Control de la glicemia basal y post-prandial; mecanismos de absorción de la glucosa y fructosa en el intestino delgado; absorción de fructosa en los espermatozoides; reabsorción de glucosa a nivel tubular renal y yeyuno; maduración de la expresión de Glut´s en la mama en lactación; incorporación de glucosa al músculo durante el ejercicio; mecanismo sensor en la secreción de insulina y respuestas adaptativa del metabolismo energético durante estados de estrés, etc.

Fármacos de primera línea utilizados en el tratamiento de la tuberculosis / First-line drugs used in tuberculosis treatmen

La tuberculosis ha emergido como un enorme problema de salud pública en las últimas décadas. A nivel mundial es la segunda causa infecciosa de muerte después de la infección por VIH de manera que la Organización Mundial de la Salud ha estimado que cada año aparecen 8 millones de nuevos casos y más de 2 millones mueren por esta enfermedad. Los objetivos de la terapia anti-tuberculosa son asegurar la cura sin recaídas además de prevenir la muerte y evitar la transmisión de la enfermedad previniendo la aparición de cepas multiresistentes. La terapia se inicia con un esquema de múltiples drogas que evite la aparición de resistencia y destruya los bacilos tuberculosos rápidamente. La tuberculosis requiere un tratamiento prolongado, de forma que la duración mínima de la terapia está alrededor de los 6 a 9 meses utilizando como base a la rifampicina, aunque en el caso de micobacterias resistentes a la terapia antimicrobiana requerir  una duración mayor. El tratamiento estándar de la tuberculosis tiene dos fases: la de iniciación, conocida también como fase bactericida o intensiva, y una segunda fase conocida como fase de continuación o esterilizante. El objetivo de este trabajo es estudiar las drogas anti-tuberculosas utilizadas en la terapia farmacológica estándar de esta enfermedad.

Tratamiento farmacólogico de la obesidad: presente, pasado y futuro / Treatment pharmacologic of the obesity: present, past and future

La obesidad es una enfermedad endocrino-metabólica caracterizada por excesiva acumulación de grasa en el tejido adiposo. La importancia en el estudio y tratamiento de la obesidad, radica no sólo en la alta incidencia de ésta patología en los últimos años, sino el alto riesgo en salud que ésta implica. El objetivo del tratamiento es revertir el balance energético positivo, y mejoramiento de las co-morbilidades asociadas, mediante la reducción de la ingesta de alimentos y el aumento del gasto energético. Los pilares de la terapéutica son modificar la conducta, dieta y ejercicios. Sin embargo estas no son herramientas que garantizan el mantenimiento de la pérdida de peso a largo plazo sin efecto rebote. Los fármacos constituyen una herramienta empleada en asociación con los anteriores y no como única medida. Los fármacos para el tratamiento de la obesidad, se clasifican en aquellos que reducen la ingesta de alimentos (agentes noradrenérgicos, serotoninérgicos y duales), disminuyen la absorción (orlistat) y los que incrementan la termogénesis (efedrina y cafeína). En la actualidad sólo sibutramina y orlistat se vislumbran como las únicas drogas cuya seguridad y eficacia demostrada permiten su aplicación clínica a largo plazo (2 años). Los avances en el estudio del balance energético y su regulación han postulado nuevos blancos para la fabricación de futuros fármacos más espec¡ficos y eficaces como los antagonistas de receptores endocanabinoides.

Trimetazidine diminishes fasting glucose in rats with fasting hyperglycemia: a preliminary study.

Trimetazidine is a drug with cardioprotective properties used in coronary artery disease. Its effect has been attributed to the inhibition of the long chain fatty acids intramitochondrial transport via carnitine-palmitoyl-transferase-1. Clinical evidence supports the possibility that trimetazidine is able to improve the fasting glycemia in diabetic patients. For this reason, the objective of the present study was to determine the effect of trimetazidine on serum glucose of Sprague-Dawley rats with fasting hyperglycemia. All animals received water and food "ad libitum." Blood glucose was measured weekly to confirm fasting hyperglycemia in rats. The rats were treated for 1 month with trimetazidine (1 mg/kg), and blood samples were collected (in the fasting period) on the last day of treatment (the 30th day); and then on the 15th day posttreatment, measurements of plasma glucose were taken. Fasting plasma levels after 30 days of trimetazidine administration decreased significantly from 141.2 +/- 3.3 mg/dL (pre-drug) to 120.9 +/- 5.8 mg/dL (P<0.01). 15 days after the end of treatment, fasting plasma glucose levels (137.0 +/- 7.0 mg/dL) were close to the pretreatment levels but significantly different (P<0.05) from levels on day 30 of treatment. These data suggest that trimetazidine improved blood glucose utilization in rats with fasting hyperglycemia.