Introduction and scaling up of new drugs for drug-resistant TB: experiences from the Americas.

The number of multidrug-resistant tuberculosis (MDR-TB) cases reported in the Americas has increased by 21.2%, from 3737 in 2016 to 4791 in 2018. The WHO has been recommending changes on the treatment of DR-TB, moving from long-duration treatment with injectables to a short oral regimen with new drugs such as bedaquiline (BDQ) and delamanid (DLM), in selected cases and only under programmatic conditions. Injectables are no longer recommended by the WHO due to lower efficacy and the increasing seriousness of adverse events. The introduction of new oral drugs for DR-TB received a boost with a global donation of BDQ to some eligible countries, which continues with the countries purchasing drugs through the Pan American Health Organization Strategic Fund. The main challenges in the scaling up of new drugs for DR-TB include low DR-TB detection rate, the slow pace in transitioning to molecular testing and delays in the introduction of new oral short regimens for MDR-TB. The Americas need to accelerate the scale up of new oral treatments, improve detection rates, increase molecular diagnosis of resistance, and ensure the registration and introduction of the shorter treatment regimen in national MDR-TB guidelines.

Implante express en síndrome de Urrets-Zavalía post descemet stripping automated endothelial keratoplasty / Express implant in Urrets-Zavalia syndrome after descemet's stripping automated endothelial keratoplasty

CASO CLÍNICO: Presentamos el primer caso descrito de una paciente que cursó con un síndrome de Urrets-Zavalía (SUZ) tras la realización de Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) en el que se ha utilizado un implante ExPRESS. DISCUSIÓN: El implante ExPRESS es una herramienta útil para casos complejos de glaucoma posquirúrgico donde los pacientes requieren un postoperatorio con menor inflamación y riesgos (pacientes con trasplante de córnea). Asimismo tiene gran utilidad para casos con alta posibilidad de fibrosis por cirugías previas

CASE REPORT: The first case is described on a patient with Urrets-Zavalía syndrome after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in whom an ExPRESS implant was used. DISCUSSION: The ExPRESS implant is a useful tool for complex cases of post-surgical glaucoma where patients need to avoid post-operative inflammation and risks (corneal transplant patients). It is also very useful in cases with a high risk of fibrosis due to previous interventions

Express implant in Urrets-Zavalia syndrome after descemet's stripping automated endothelial keratoplasty.

CASE REPORT: The first case is described on a patient with Urrets-Zavalía syndrome after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in whom an ExPRESS implant was used. DISCUSSION: The ExPRESS implant is a useful tool for complex cases of post-surgical glaucoma where patients need to avoid post-operative inflammation and risks (corneal transplant patients). It is also very useful in cases with a high risk of fibrosis due to previous interventions.

Landau renormalizations of superfluid density in the heavy-fermion superconductor CeCoIn5.

The formation of heavy-fermion bands can occur by means of the conversion of a periodic array of local moments into itinerant electrons via the Kondo effect and the huge consequent Fermi-liquid renormalizations. Leggett predicted for liquid (3)He that Fermi-liquid renormalizations change in the superconducting state, leading to a temperature dependence of the London penetration depth Λ quite different from that in BCS theory. Using Leggett's theory, as modified for heavy fermions, it is possible to extract from the measured temperature dependence of Λ in high quality samples both Landau parameters F(0)(s) and F(1)(s); this has never been accomplished before. A modification of the temperature dependence of the electronic specific heat C(el), related to that of Λ, is also expected. We have carefully determined the magnitude and temperature dependence of Λ in CeCoIn(5) by muon spin relaxation rate measurements to obtain F(0)(s) = 36 ± 1 and F(1)(s) = 1.2 ± 0.3, and we find a consistent change in the temperature dependence of C(el). This, the first determination of F(1)(s) with a value ≪ F(0)(s) in a heavy-fermion compound, tests the basic assumption of the theory of heavy fermions, that the frequency dependence of the self-energy is much more important than its momentum dependence.

Magnetic transition and spin fluctuations in the unconventional antiferromagnetic compound Yb3Pt4.

Muon spin rotation and relaxation measurements have been carried out on the unconventional antiferromagnet Yb3Pt4. Oscillations are observed below T(N) = 2.22(1) K, consistent with the antiferromagnetic (AFM) Néel temperature observed in bulk experiments. In agreement with neutron diffraction experiments the oscillation frequency ω(µ)(T)/2π follows an S = 1/2 mean-field temperature dependence, yielding a quasistatic local field of 1.71(2) kOe at T = 0. A crude estimate gives an ordered moment of ∼ 0.66 µ(B) at T = 0, comparable to 0.81 µ(B) from neutron diffraction. As T-->T(N) from above the dynamic relaxation rate λ(d) exhibits no critical slowing down, consistent with a mean-field transition. In the AFM phase a T-linear fit to λ(d)(T), appropriate to a Fermi liquid, yields highly enhanced values of λ(d)/T and the Korringa constant K(µ)(2)T/λ(d), with K(µ) the estimated muon Knight shift. A strong suppression of λ(d) by applied field is observed in the AFM phase. These properties are consistent with the observed large Sommerfeld-Wilson and Kadowaki-Woods ratios in Yb3Pt4 (although the data do not discriminate between Fermi-liquid and non-Fermi-liquid states), and suggest strong enhancement of q≈0 spin correlations between large-Fermi-volume band quasiparticles in the AFM phase of Yb3Pt4.

Decreased peripheral health service utilisation during an outbreak of Marburg haemorrhagic fever, Uíge, Angola, 2005.

In 2005, a Marburg haemorrhagic fever (MHF) outbreak occurred in Uíge province, Angola, which had its epicentre in Uíge municipality. Concurrently, a health facility located a considerable distance from the outbreak's epicentre reported a drastic reduction in attendance, possibly due to a remote effect of the ongoing MHF outbreak. Health officials should devise strategies to ensure that communities far from a filovirus haemorrhagic fever epicentre are not adversely affected by interventions at the epicentre and, to the greatest extent possible, ensure that these peripheral communities receive essential medical care during an epidemic.

Obesidad: aspectos patogénicos, alteraciones cardiovasculares asociadas y estrategias terapéuticas / Obesity: pathogenic issues, associated cardiovascular illness, and therapeutic approach

La obesidad es la alteración metabólica más frecuente delos seres humanos. Esta enfermedad aparece debido al excesode tejido adiposo que se produce por la acumulación progresivade grasa en sus reservorios debido a un desequilibrio dela homeostasis calórica donde la ingestión excede el gastoenergético. Afecta aproximadamente al 33% de los adultos ycada año se invierten en alimentos especiales y programas parareducir el peso corporal cerca de 30 millones de dólares; sinembargo, los tratamientos empleados han sido ineficaces y casiel 90% de las personas que bajan de peso, aumentan nuevamenteel peso perdido. En este artículo presentamos una revisiónsobre la obesidad, haciendo especial énfasis en ladefinición y su epidemiología, su patogenia, la relación conenfermedades cardiovasculares y el tratamiento actualizado

Obesity is the most frequent metabolic disturbance thataffects human beings. This disease appears due to the excessof fatty tissue which is produced because of progressive accumulationof fat on its reservoirs, as a response to misbalanceon caloric homeostasis where food intake exceedsenergetic needs. Obesity affects around 33% of adult population,and near 30 million dollars is inverted each year onspecial foods, and programs to reduce body weight; however,treatments applied have been unsuccessful, and almost90% of people who loose weight, gain the lost weight again.This article shows a review about obesity where we mainlyemphasis in concept and epidemiology, pathophysiology, itsrelation with cardiovascular diseases, and current treatment

[Giant atherosclerotic aneurysm. A case report]. / Aneurisma aterosclerótico gigante. Presentación de un caso.

INTRODUCTION: Intracraneal aneurysms are frequent in medical practice, most of them never produce symptoms, that is why occasionally, they are not diagnosed before death. Sacular is the most frequent aneurysm, and atherosclerotic aneurysm is rare. CASE REPORT: In this article we present the case of a 75 year old woman who has been suffering from high blood pressure and coronary artery disease since more than 20 years and in the last four months she had been complaining of dysphagia and dysartria. She was taken to the hospital because 24 hours ago mild headache started accompanied by vertigo, nausea and vomiting. On neurological exam we found sleepiness, dysartria, and right braguio crural hemiparesis, therefore we decided admitt her, but after 48 hours left braquio crural hemiparesis was added and later respiratory sepsis appeared. The patient died due to an acute respiratory failure. CONCLUSION: Necropsy revealed a huge atherosclerotic intracraneal aneurysm (31 mm) located on basilar artery. The case has been discussed and images were shown.

Muon spin relaxation and isotropic pairing in superconducting PrOs4Sb12.

Transverse-field muon-spin rotation measurements in the vortex-lattice of the heavy-fermion (HF) superconductor PrOs4Sb12 yield a temperature dependence of the magnetic penetration depth lambda indicative of an isotropic or nearly isotropic energy gap. This is not seen to date in any other HF superconductor and is a signature of isotropic pairing symmetry, possibly related to a novel nonmagnetic "quadrupolar Kondo" HF mechanism in PrOs4Sb12. The T=0 relaxation rate sigma(s)(0)=0.91(1) micros(-1) yields an estimated magnetic penetration depth lambda(0)=3440(20) A, which is considerably shorter than in other HF superconductors.

29Si NMR and hidden order in URu2Si2.

Below T(N) approximately 17 K the 29Si NMR line in URu2Si2 exhibits a previously unobserved field-independent nearly isotropic contribution to the linewidth, which increases to approximately 12 G as T-->0. We argue that this feature does not arise from static freezing of the U-spin magnetization, but is due to coupling between 29Si spins and a hidden order parameter. We discuss time-reversal symmetry-breaking orbital antiferromagnetism and indirect nuclear spin-spin interactions as possible coupling mechanisms. Further NMR experiments and theoretical calculations are suggested.

Glassy spin dynamics in non-fermi-liquid UCu5-xPdx, x = 1.0 and 1.5.

Local f-electron spin dynamics in the non-Fermi-liquid heavy-fermion alloys UCu5-xPdx, x = 1.0 and 1.5, have been studied using muon spin-lattice relaxation. The sample-averaged asymmetry function G(t) indicates strongly inhomogeneous spin fluctuations and exhibits the scaling G(t,H) = G(t/H(gamma)) expected from glassy dynamics. At 0.05 K gamma(x = 1.0) = 0.35+/-0.1, but gamma(x = 1.5) = 0.7+/-0.1. This is in contrast to inelastic neutron scattering results, which yield gamma = 0.33 for both concentrations. There is no sign of static magnetism approximately greater than 10(-3)(B)/U ion in either material above 0.05 K. Our results strongly suggest that both alloys are quantum spin glasses.

&mgr;(+) knight shift measurements in U0.965Th0.035Be13 single crystals

Muon spin rotation ( &mgr;SR) measurements of the temperature dependence of the &mgr;(+) Knight shift in single crystals of U0. 965Th0.035Be13 have been used to study the static spin susceptibility chi(s) below the transition temperatures T(c1) and T(c2). While an abrupt reduction of chi(s) with decreasing temperature is observed below T(c1), chi(s) does not change below T(c2) and remains at a value below the normal-state susceptibility chi(n). In the normal state we find an anomalous anisotropic temperature dependence of the transferred hyperfine coupling between the &mgr;(+) spin and the U 5f electrons.

Metástasis óseas de adenocarcinoma de próstata / Bone metastases from prostate adenocarcinoma

No disponible

Two cases of nonconvulsive status epilepticus in association with tiagabine therapy.

We report two patients with intractable partial seizures who developed generalized nonconvulsive status epilepticus (NCSE) after receiving tiagabine (TGB). Neither had a history of absence seizures or generalized epileptic discharges on prior EEG monitoring. Clinicians need to be aware of a possible association between TGB and NCSE.

Citología cervical en pacientes del Hospital Moreno Vásquez, Gualaceo / Cervical cytology in patients of the Hospital Moreno Vásquez, Gualaceo

Presenta la incidencia de cáncer de cuello de útero in situ o intraepitelial en las usuarias del Hospital Moreno Vásquez de Gualaceo, con el propósito de aumentar la cobertura en su detección precoz en la población femenina de riesgo. Esta patología que comienza intraepitelialmente, demora hasta 10 años en generalizarse, por lo que su detección precoz y tratamiento, aumenta las posibilidades de curación o de supervivencia de las pacientes.

Efficacy of dantrolene sodium in management of tetanus in children.

The effectiveness of dantrolene sodium in controlling tetanic spasms was evaluated in 21 children (aged 4 days-13 years) with tetanus. These dantrolene-treated patients were compared with an historical control group of 26 children previously treated for tetanus by traditional means at the same institution. The groups were comparable in terms of age, other treatments, and severity of disease. All patients received standard treatments for tetanus, including sedatives, antibiotics, and tetanus-immune globulin. Patients in the dantrolene-treated group also received dantrolene, either intravenously (Dantrium Intravenous) or orally, in divided doses totalling 4-6 mg/kg/day. Mortality was 73% (neonates 83%, non-neonates 50%) in the control group, compared with 33% (neonates 50%, non-neonates 0%) in the dantrolene-treated group. Dantrolene did not cause additional respiratory depression when administered alone or in combination with other drugs routinely used to treat tetanus. In this study, the use of dantrolene with traditional conservative therapy significantly reduced mortality from tetanus.

Tetanos. Experiencia hospitalaria. / Tetanus. Hospital experience

Se presentan 30 casos con diagnostico clinico de tetanos admitidos en el Hospital del Nino DIF, Sinaloa, de Diciembre de 1980 a Junio de 1982. Veinte casos fueron recien nacidos; 1 lactante; 4 preescolares; 2 escolares y 3 adolescentes. Su gravedad fue establecida con una nueva clasificacion, segun las caracteristicas clinicas al ingreso de los pacientes. Entre los recien nacidos hubo 15 casos graves y 5 moderados; en el grupo de no recien nacidos, 4 graves y 6 moderados. En ninguno de los 2 grupos hubo casos leves. Se dan datos epidemiologicos de la localidad y la situacion geografica con la mayor frecuencia de la enfermedad. El manejo fue convencional y no especializado (Terapia Intensiva) en el 90% de los casos. La mortalidad total fue del 66% con predominio en el grupo de recien nacidos y alcanzo 80%