Burden of respiratory failure in pediatric patients: Analysis of a prospective multicenter cohort in Bogotá, Colombia.

Background and Aims: The approach to the burden of disease is a demographic, economic, and a health problem, which requires the design and application of specific measures of cost of the disease, such as disability-adjusted life years (DALYs), to establish better public health policies in the pediatric population. The aim of this study is to approach the burden of disease in children with acute respiratory failure (ARF) through the calculation of DALYs. Methods: This study was conducted in the framework of a prospective, multicenter cohort in Bogotá, Colombia. Inclusion criteria were all pediatric patients admitted to the emergency department, hospitalization, and intensive care unit with respiratory distress; eligible patients were all those who developed ARF between April 2020 and December 2021. They were followed-up during hospitalization, at 30 and 60 days after admission. The Infant/Toddler Quality of Life Questionnaire and KIDSCREEN quality of life scales were applied for follow-up according to the age group. The results were used to calculate DALYs. Results: Six hundred and eighty-five eligible patients, 296 (43.08%) developed ARF, of these 22 (6.08%) patients died (mortality rate = 7.43%). The total DALYs was 277.164 years. For younger than 9 years, the DALYs were 302.64 years, while for older than 10 years were 40.49 years. Conclusion: ARF is one of the main causes of preventable mortality in pediatrics, its progression to respiratory failure is a highly prevalent condition in pediatric age, a condition that has a great impact on mortality, morbidity, and disability in our patients.

Use of high-flow cannula in pediatric patients with respiratory failure: A prospective cohort study in three high-altitude hospitals.

Background and Aims: Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high-flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high-flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals. Methods: It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an HFNC. The study was carried out between April 2020 and December 2021. The follow-up was carried out at 1, 6, and 48 h after starting the management. Results: Of 685 patients included in the study, 296 developed ARF. The prevalence of patients with ARF who required management with HFNC was 48%. The frequency of the pathologies that cause the ARF was: Bronchiolitis was the most frequent pathology (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%). The average time of use of HFNC was 81.6 h. Regarding treatment failure with HFNC, 15 patients presented torpid evolution and required invasive mechanical ventilation, with a prevalence of therapeutic failure of the HFNC of 10.6%. Conclusion: The use of HFNC is more frequent in patients with bronchiolitis, in children under 2 years of age and in males, which is in line with what has been reported in the literature. In addition, the failure rate of HFNC is low (10.6%), and it may be useful in other pathologies besides bronchiolitis, such as asthma, pneumonia, among others. It opens the possibility to continue evaluating the role of HFNC in pediatric pathology in new studies.

Incidence, etiology, sociodemographic and clinical characterization of acute respiratory failure in pediatric patients at a high-altitude city: A multicenter cohort study.

Background: Acute respiratory failure is a life-threatening medical condition, associated with a variety of conditions and risk factors, including acute respiratory diseases which are a frequent cause of pediatric morbidity and mortality worldwide. In Colombia, the literature related to ARF is scarce. Objective: To determine the incidence, causes, and sociodemographic and clinical characteristics of ARF in three hospitals in Bogota, a high-altitude city located in Colombia, during the COVID-19 pandemic. Methods: A multicenter prospective cohort study called the FARA cohort was developed between April 2020 - December 2021. Patients older than one month and younger than 18 years with respiratory distress who developed ARF were included. Results: 685 patients with respiratory distress were recruited in 21 months. The incidence density of ARF was found to be 41.7 cases per 100 person-year CI 95%, (37.3-47.7). The median age was 4.5 years.. Most of the patients consulted during the first 72 h after the onset of symptoms. Upon admission, 67.2% were potentially unstable. The most frequent pathologies were asthma, bronchiolitis, pneumonia, and sepsis. At admission, 75.6% of the patients required different oxygen delivery systems, 29,5% a low-flow oxygen system, 36,8% a high-flow oxygen system, and 9,28% invasive mechanical ventilation. SARS-COV-2, respiratory syncytial virus, rhinovirus/enterovirus, and adenovirus were the most frequently isolated viral agents. The coinfection cases were scarce. Conclusions: This multicenter study, the FARA cohort, developed at 2,600 meters above sea level, shows the first data on incidence, etiology, sociodemographic and clinical characterization in a pediatric population with ARF that also concurs with the COVID-19 pandemic. These results, not only have implications for public health but also contribute to the scientific and epidemiological literature on a disease developed at a high altitude.

Powdered coconut water (ACP 406®) as an alternative base culture medium for in vitro culture of goat preantral follicles enclosed in ovarian tissue.

This study evaluated a powdered coconut water solution (ACP 406®) as a base culture medium on the in vitro survival and development of in situ goat preantral follicles. The ovarian fragments were either immediately fixed in Carnoy solution (non-cultured control) or individually cultured for 2 or 6 days. The following culture media (all containing 100 µg/mL penicillin and 100 µg/mL streptomycin) were evaluated: α-MEM (α-MEM alone, without additional supplementation); α-MEM+ (supplemented α-MEM); ACP (ACP®406 alone); or ACP+ (supplemented ACP®406). Additional supplementation includes: 1.25 mg/mL bovine serum albumin, 10 µg/mL insulin, 5.5 µg/mL transferrin, 5 ng/mL selenium, 2 mM glutamine, and 2 mM hypoxanthine. The endpoints (i) follicular morphology; (ii) development; (iii) estradiol production; and (iv) reactive oxygen species (ROS) were recorded. Data were analyzed using chi-square, Turkey, t-test or One-Way ANOVA. Differences were considered significant when P < 0.05. At day 2 of culture, a greater (P < 0.05) percentage of morphologically normal follicles was observed between ACP+ and ACP treatments. Moreover, at day 2 of culture, no hormonal difference (P < 0.05) was observed between ACP+ and both α-MEM treatments. At day 6 of culture when ACP and α-MEM treatments were compared the percentage of healthy follicles were similar (P > 0.05) among treatments. Overall, all treatments had lower primordial follicles (P < 0.05) accompany by greater developing follicles (P < 0.05) percentages than non-cultured control treatment, indicating primordial follicle activation. However, at day 6 of culture, the percentage of primordial follicle development were similar (P > 0.05) among the treatments. Likewise, no differences (P > 0.05) were observed for ROS production and follicular and oocyte diameters among treatments. Therefore, ACP+ has the equivalent efficiency to MEM+ in maintaining the survival and development of goat preantral follicles, representing an alternative plant-based low-cost culture medium for in vitro culture.

Microcystin-LR Detected in a Low Molecular Weight Fraction from a Crude Extract of Zoanthus sociatus.

Cnidarian constitutes a great source of bioactive compounds. However, research involving peptides from organisms belonging to the order Zoanthidea has received very little attention, contrasting to the numerous studies of the order Actiniaria, from which hundreds of toxic peptides and proteins have been reported. In this work, we performed a mass spectrometry analysis of a low molecular weight (LMW) fraction previously reported as lethal to mice. The low molecular weight (LMW) fraction was obtained by gel filtration of a Zoanthus sociatus (order Zoanthidea) crude extract with a Sephadex G-50, and then analyzed by matrix-assisted laser desorption/ionization time-of-flight/time-of-flight (MALDI-TOF/TOF) mass spectrometry (MS) in positive ion reflector mode from m/z 700 to m/z 4000. Afterwards, some of the most intense and representative MS ions were fragmented by MS/MS with no significant results obtained by Protein Pilot protein identification software and the Mascot algorithm search. However, microcystin masses were detected by mass-matching against libraries of non-ribosomal peptide database (NORINE). Subsequent reversed-phase C18 HPLC (in isocratic elution mode) and mass spectrometry analyses corroborated the presence of the cyanotoxin Microcystin-LR (MC-LR). To the best of our knowledge, this finding constitutes the first report of MC-LR in Z. sociatus, and one of the few evidences of such cyanotoxin in cnidarians.

[Prevalence of birth defects in Risaralda, 2010-2013].

INTRODUCTION: The data regarding birth defects at local levels in developing countries like Colombia are scarce. OBJECTIVE: To describe the profile of congenital abnormalities in the province of Risaralda, Colombia. MATERIALS AND METHODS: We included the information on infants with structural and functional abnormalities at birth between June, 2010, and December, 2013, from records of the Instituto Nacional de Salud, and compared it with those of children born in the same period in a local clinic participating in the Collaborative Study of Congenital Malformations. We analyzed the data using Stata 10®. RESULTS: We found a prevalence of nine defects per 1,000 newborns from the total live births in Risaralda. The local clinic registered in the Collaborative Study of Congenital Malformations registered a prevalence of 34 defects per 1,000 births. Most frequent defects were heart defects, followed by cleft lip and palate, abdominal wall defects, skeletal dysplasia, hydrocephalus, polydactyly and Down syndrome. CONCLUSIONS: Having a baseline on the prevalence of congenital defects in Risaralda is very useful in the design of prevention policies oriented to decrease congenital defects incidence and severity. Inclusion of maternity hospitals in the Collaborative Study of Congenital Malformations strengthens national recording and reporting of birth defects.

Prevalencia de defectos congénitos en Risaralda, 2010-2013 / Prevalence of birth defects in Risaralda, 2010-2013

Resumen Introducción. Los datos sobre defectos congénitos en el ámbito regional de los países en desarrollo como Colombia son escasos. Objetivo. Describir la prevalencia de anomalías congénitas en el departamento de Risaralda, Colombia. Materiales y métodos. Se incluyeron los neonatos con defectos estructurales y funcionales entre junio de 2010 y diciembre de 2013, cuyos casos fueron notificados al Instituto Nacional de Salud por ser de interés en salud pública. Se compararon con los nacidos en el mismo periodo en una clínica de la región inscrita en el Estudio Colaborativo de Malformaciones Congénitas. Los datos se analizaron con el programa Stata 10(r). Resultados. La prevalencia entre los nacidos vivos en el periodo de estudio fue de nueve casos por cada 1.000 recién nacidos en el departamento. En la clínica inscrita en el Estudio Colaborativo de Malformaciones Congénitas, se encontró una prevalencia de 34 casos por cada 1.000 nacimientos; el primer lugar lo ocuparon las cardiopatías, seguidas por el labio y paladar hendido, los defectos de la pared abdominal (no especificados), la displasia esquelética, la hidrocefalia, la polidactilia y el síndrome de Down. Conclusión. El establecimiento de una línea de base sobre la prevalencia de los defectos congénitos en Risaralda es de gran utilidad para la adopción de políticas preventivas que lleven a la disminución de la incidencia y de la gravedad de las discapacidades; la inclusión de los hospitales materno-infantiles en la red del Estudio Colaborativo de Malformaciones Congénitas mejora el registro nacional y la notificación de los defectos congénitos.

Abstract Introduction: The data regarding birth defects at local levels in developing countries like Colombia are scarce. Objective: To describe the profile of congenital abnormalities in the province of Risaralda, Colombia. Materials and methods: We included the information on infants with structural and functional abnormalities at birth between June, 2010, and December, 2013, from records of the Instituto Nacional de Salud, and compared it with those of children born in the same period in a local clinic participating in the Collaborative Study of Congenital Malformations. We analyzed the data using Stata 10(r). Results: We found a prevalence of nine defects per 1,000 newborns from the total live births in Risaralda. The local clinic registered in the Collaborative Study of Congenital Malformations registered a prevalence of 34 defects per 1,000 births. Most frequent defects were heart defects, followed by cleft lip and palate, abdominal wall defects, skeletal dysplasia, hydrocephalus, polydactyly and Down syndrome. Conclusions: Having a baseline on the prevalence of congenital defects in Risaralda is very useful in the design of prevention policies oriented to decrease congenital defects incidence and severity. Inclusion of maternity hospitals in the Collaborative Study of Congenital Malformations strengthens national recording and reporting of birth defects.

Leptospirosis in an urban setting: cases diagnosed at a private medical center of Western Colombia, 2008-2012.

INTRODUCTION: Leptospirosis has reemerged as significant threat particularly in developing countries, including those in Latin America. Data from Colombia is still limited and there are no published studies in the Western area of the country. METHODS: Data on suspected cases were collected over the study period (2008- 2012). Cases were diagnosed clinically and confirmed by ELISA IgG and microscopic agglutination test (MAT) (titers ≥1:400). RESULTS: During the study period 264 suspected cases of leptospirosis were found. From those, 8.33% (22 cases) were microbiologically confirmed. Number of suspected cases increased in the period from 20 (2008) (40 cases/100,000 consultations) to 58 (2012) (120 cases/100,000 consultations). Regard sex distribution, 62.5% were males, 14% in the age group 21-30 y-old, from confirmed cases 95% live in urban areas of Pereira, 25.7% own dogs and 13.2% cats, 32.3% reporting rats at home as well 22.7% at work places. From confirmed cases 72.7% were hospitalized. Clinical findings found were: fever (60.2%), myalgias (47%), and headache (41.9%), among others. All the cases corresponded to Leptospira interrogans. Regard the serovars, in these patients 6 were identified: Australis (54.5%), Icterohaemorrhagiae (45.5%), Canicola (45.5%), Panama (45.5%), Pomona (36.3) and Grippotyphosa (1%). Thirty nine percent of the patients received antimicrobial therapy, 50% ceftriaxone. No deaths occurred. CONCLUSION: Leptospirosis is an emerging infectious disease that has changed from an occupational disease of veterinarians, farmers, butchers, and other animal handlers to a cause of epidemics in poor and decayed urban communities in developing countries, including those in Latin America such as Colombia.

Insights into the toxicological properties of a low molecular weight fraction from Zoanthus sociatus (Cnidaria).

The phylum Cnidaria is an ancient group of venomous animals, specialized in the production and delivery of toxins. Many species belonging to the class Anthozoa have been studied and their venoms often contain a group of peptides, less than 10 kDa, that act upon ion channels. These peptides and their targets interact with high affinity producing neurotoxic and cardiotoxic effects, and even death, depending on the dose and the administration pathway. Zoanthiniaria is an order of the Subclass Hexacorallia, class Anthozoa, and unlike sea anemone (order Actiniaria), neither its diversity of toxins nor the in vivo effects of the venoms has been exhaustively explored. In this study we assessed some toxicological tests on mice with a low molecular weight fraction obtained by gel filtration in Sephadex G-50 from Zoanthus sociatus crude extract. The gel filtration chromatogram at 280 nm revealed two major peaks, the highest absorbance corresponding to the low molecular weight fraction. The toxicological effects seem to be mostly autonomic and cardiotoxic, causing death in a dose dependent manner with a LD50 of 792 µg/kg. Moreover, at a dose of 600 µg/kg the active fraction accelerated the KCl-induced lethality in mice.

Low molecular weight compounds from Zoanthus sociatus impair insulin secretion via Ca(+2) influx blockade and cause glucose intolerance in vivo.

Cnidarians comprise a taxon with a high biodiversity of cytolitic, neurotoxic and cardiotoxic compounds, which have not been studied on insulin release. We tested the effect of a crude extract of Zoanthus sociatus (Ellis, 1767) and the low molecular weight fraction of this extract on insulin secretion in isolated rat ß-cells and also in a glucose tolerance test in vivo. We observed that the extract inhibited insulin release by reducing the amount secreted by individual ß-cells and also by silencing a fraction of the secreting population. This effect coincided with a diminished rise of intracellular Ca(+2) in response to high glucose and high K+ -induced depolarization. Moreover intraperitoneal administration of the low molecular weight fraction produced glucose intolerance in adult rats. The active fraction exhibited molecular weights similar to the neurotoxins described in the phylum. Our results broaden the toxic effects of cnidarian venoms and show evidence of potential modulators of voltage-gated Ca(+2) channels in this group.

Discovery and characterization of cnidarian peptide toxins that affect neuronal potassium ion channels.

Peptides have been isolated from several species of sea anemones and shown to block currents through various potassium ion channels, particularly in excitable cells. The toxins can be grouped into four structural classes: type 1 with 35-37 amino acid residues and three disulphide bridges; type 2 with 58-59 residues and three disulphide bridges; type 3 with 41-42 residues and three disulphide bridges; and type 4 with 28 residues and two disulphide bridges. Examples from the first class are BgK from Bunodosoma granulifera, ShK from Stichodactyla helianthus and AsKS (or kaliseptine) from Anemonia sulcata (now A. viridis). These interfere with binding of radiolabelled dendrotoxin to synaptosomal membranes and block currents through channels with various Kv1 subunits and also intermediate conductance K(Ca) channels. Toxins in the second class are homologous to Kunitz-type inhibitors of serine proteases; these toxins include kalicludines (AsKC 1-3) from A. sulcata and SHTXIII from S. haddoni; they block Kv1.2 channels. The third structural group includes BDS-I, BDS-II (from A. sulcata) and APETx 1 (from Anthropleura elegantissima). Their pharmacological specificity differs: BDS-I and -II block currents involving Kv3 subunits, while APETx1 blocks ERG channels. The fourth group comprises the more recently discovered SHTX I and II from S. haddoni. Their channel blocking specificity is not yet known but they displace dendrotoxin binding from synaptosomal membranes. Sea anemones can be predicted to be a continued source of new toxins that will serve as molecular probes of various K(+) channels.

Functional characterization of estrogen receptor subtypes, ERalpha and ERbeta, mediating vitellogenin production in the liver of rainbow trout.

The estrogen-dependent process of vitellogenesis is a key function on oviparous fish reproduction and it has been widely used as an indicator of xenoestrogen exposure. The two estrogen receptor (ER) subtypes, ERalpha and ERbeta, are often co-expressed in the liver of fish. The relative contribution of each ER subtype to modulate vitellogenin production by hepatocytes was studied using selected compounds known to preferentially interact with specific ER subtypes: propyl-pyrazole-triol (PPT) an ERalpha selective agonist, methyl-piperidino-pyrazole (MPP) an ERalpha selective antagonist, and diarylpropionitrile (DPN) an ERbeta selective agonist. First, the relative binding affinity of the test compounds to estradiol for rainbow trout hepatic nuclear ER was determined using a competitive ligand binding assay. All the test ligands achieved complete displacement of specific [(3)H]-estradiol binding from the nuclear ER extract. This indicates that the test ligands have the potential to modify the ER function in the rainbow trout liver. Secondly, the ability of the test compounds to induce or inhibit vitellogenin production by primary cultures of rainbow trout hepatocytes was studied. Estradiol and DPN were the only compounds that induced a dose-dependent increase on vitellogenin synthesis. The lack of vitellogenin induction by PPT indicates that ERalpha could not have a role on this reproductive process whereas the ability of DPN to induce vitellogenin production supports the participation of ERbeta. In addition, this hypothesis is reinforced by the results obtained from MPP plus estradiol. On one hand, the absence of suppressive activity of MPP in the estradiol-induced vitellogenin production does not support the participation of ERalpha. On the other hand, once blocked ERalpha with MPP, the only manifestation of agonist activity of estradiol would be achieved via ERbeta. In conclusion, the present results indicate that vitellogenin production is mainly mediated through ERbeta, implying, furthermore that compounds which only exhibit ERalpha selectivity are not detected by vitellogenin bioassay.

Endocrine disruption mechanism of o,p'-DDT in mature male tilapia (Oreochromis niloticus).

The aim of the present study was to evaluate, in vivo, the potential of o,p'-DDT to disrupt the endocrine system of mature male tilapia. In particular, the possibility that o,p'-DDT effects were mediated directly via the estrogen receptor (ER). Compounds with known ability to bind to the ER were employed: estradiol to induce and tamoxifen to inhibit the estrogenic effects result of the activation of the ER. In addition, an aromatase inhibitor, 4-hydrxyandrostenedione (4-OHA), was used to assess the ability of o,p'-DDT to induce estrogenic effects in a surrounding of low estradiol concentration. The effects of estradiol and o,p'-DDT were studied alone or in the presence of tamoxifen or 4-OHA at the end of a 12-day period of exposure. The main endpoints measured were plasma alkaline-labile phosphorous (ALP; an indirect indicator of vitellogenin), estradiol, testosterone and o,p'-DDT. It was found that o,p'-DDT was able to induce the vitellogenesis (measured as plasma ALP increase) and decrease the circulating levels of estradiol and testosterone. Interestingly, o,p'-DDT kept this ability in whole fish with low concentrations of estradiol which would exclude endogenous estradiol as indirect mediator of the estrogenic effects induced by o,p'-DDT. In addition, the plasma concentration of o,p'-DDT, instead of that of estradiol, was closely related to the plasma ALP increase induced by o,p'-DDT. This indicates that o,p'-DDT could have directly activated the vitellogenesis. The antiestrogenic action of tamoxifen to inhibit the vitellogenesis and the decrease on plasma estradiol induced by o,p'-DDT indicates that o,p'-DDT can bind directly to the ER. In conclusion, this in vivo study shows that o,p'-DDT has the potential to disrupt the endocrine system and strongly supports that the estrogenic actions of o,p'-DDT involve binding to the ER.

Role of pulse pressure on cardiovascular risk in chronic kidney disease patients.

Epidemiologic studies have emphasized the close relationship between high BP and cardiovascular disease (CVD). Recently published prospective studies have focus on systolic and pulse pressure (PP). Systolic BP seems to be a more important factor than diastolic BP on cardiovascular and all-cause mortality in older patients. PP reflects stiffness of the large arteries and increases with age. Increasingly, PP is recognized as an independent predictor of myocardial infarction, congestive heart failure, and cardiovascular death, even in hypertensive patients who undergo successful antihypertensive drug therapy, especially in older individuals. Chronic kidney disease (CKD) is a major public health problem. The progression of kidney disease and its associated cardiovascular complications are the major causes of morbidity and mortality. This holds true for all stages of kidney disease, including ESRD that requires renal replacement therapy. Most of the traditional CVD risk factors are highly prevalent in CKD, and several nontraditional factors also are associated with atherosclerosis in CKD. The burden of hypertension is present at all stages of CKD. Several studies have shown that PP is a reliable prognostic factor for mortality and CVD in patients who have CKD and are on hemodialysis and in renal transplant patients. The purpose of this review is to show the importance of PP on cardiovascular risk in patients with CKD, including kidney transplant recipients.

[HIV-infection and its implications on allergic diseases]. / Infección por VIH y sus implicaciones en enfermedades alérgicas.

INTRODUCTION: In 1980 AIDS appeared in the USA in the homosexual community. CHARACTERISTICS OF THE VIRUS: A particle of HIV is formed by two identical RNA chains that are packed within a center of viral proteins, and surrounded by a double layer of fosfolipids derived from the cellular membrane of the host. CLINICAL SYMPTOMS: It starts with a severe infection, evolving in a progressive chronic infection reaching a final phase with a T CD4+ cellular count under 200 cells per mm3, with incident infections, neoplasias, consumption syndrome, renal dysfunction, and degeneration of the central system. CONSEQUENCES IN ALLERGIC REACTION: Reactions to the use of drugs are the most frequent form of hypersensitivity caused by HIV compared to the general population. In this condition, a profile of TH2 cytocines are produced and they induce the synthesis of IgE against the drugs. IgE levels have been related to the progression of this condition. CONCLUSION: The increase of IgE is a risk factor to allergic reactions against these medications, as well as a severity index.

An aromatase inhibitor and tamoxifen decrease plasma levels of o,p'-DDT and its metabolites in Nile tilapia (Oreochromis niloticus).

The objective of this study was to determine if tamoxifen or an aromatase inhibitor (4-hydroxyandrostenedione; 4-OHA) affected plasma concentrations of o,p' -DDT and its metabolites, o,p'-DDD and o,p'-DDE, in mature tilapia. Male and female tilapia were injected 6 times intraperitoneally with o,p'-DDT (40 mg/kg) alone or in combination with 4-OHA (2 mg/kg) over a 12 day period. An additional group of male fish was injected with tamoxifen (5 mg/kg) plus o,p'-DDT. At the end of the treatment period, plasma samples were extracted and analyzed by GC/ECD. Females injected only with o,p'-DDT had significantly higher levels of o,p'-DDT compared with males. Interestingly, females and males treated concomitantly with o,p'-DDT and 4-OHA or tamoxifen had significantly lower concentrations of plasma o,p'-DDT (about 50%) compared with fish treated with only o,p'-DDT. These initial results suggest that an interaction between endocrine-active compounds occurs in vivo in tilapia and may involve alterations in metabolism of o,p'-DDT.

[Nasal remodeling in patient with perennial allergic rhinitis]. / Remodelación nasal en pacientes con rinitis perenne alérgica.

BACKGROUND: Remodeling is considered a new or different reconstruction of tissues. The airway remodeling is a consequence of changes induced by endothelial cells and extra-cellular matrix as a result of chronic inflammation. OBJECTIVE: To show histological changes into mucosa in patients with perennial allergic rhinitis. MATERIAL AND METHODS: We studied 26 patients with perennial allergic rhinitis, with evolution of 3 to 6 years, between 20 to 40 years old, without medical or immunological treatment. A turbinate biopsy was taken in all of them. RESULTS: We found enlargement of the basal membrane in 92.3%, subepithelial fibrosis in 92.4%, neutrophils in 100% of the cases, eosinophils in 100%, lymphocytes in 100%, edema in 46.2%, fragmented reticular fibers in 19.2%, and vascular dilatation in 11.1%. CONCLUSION: These results suggest nasal remodeling in patients with allergic rhinitis, although more structural studies about this pathology are necessary.

[Remodeling in asthma: review of the literature]. / La remodelación en el asma: revisión de la literatura.

Remodeling, understood as a new or different reconstruction, has been observed in every organ after a chronic inflammatory response. In allergy, it has very important clinical consequences. As an example, in asthma this process is responsible for functional deterioration. In this case, the myofibroblasts play a central role in the process, together with a succession of products that are involved. In this bibliographic review we analyze the most important factors.

[Common variable immunodeficiency. Report of 2 cases]. / Inmunodeficiencia común variable. Reporte de dos casos.

We report two cases with common variable immunodeficiency. Both of them had gammaglobulin concentration lower than 300 mg/dL and evolved differently. The first one had three pneumonic episodes that responded satisfactorily to antibiotics. Today, this patient presents only two or three sinusitis clinical schemes per year, and has a good response to treatment. The second one has a bad evolution and presents hematological problems like thrombocytopenia and neutropenia. She also suffers lymphoid nodular hyperplasia in the intestinal tract and atrophy in the intestinal. These cases illustrate the wide clinical, immunological and genetic variety of the syndrome.

O,p'-DDT induction of vitellogenesis and its inhibition by tamoxifen in Nile tilapia (Oreochromis niloticus).

In order to investigate the mechanism by which o,p'-DDT disrupts endocrine functioning of Nile tilapia in vivo, the estrogenicity of o,p'-DDT was investigated in conjunction with 17beta-estradiol (E2) and tamoxifen. Mature, male tilapia were treated intraperitoneally with o,p'-DDT (60 mg/kg, one dose) or E2 (5 mg/kg, four doses) in the presence or absence of tamoxifen (5 mg/kg, six doses) for 12 days and then plasma vitellogenin (Vtg) (measured as alkaline-labile phosphorous), E2, and testosterone (T) were measured. Vtg levels were increased dramatically by E2 (1,744 +/- 171 microg/ml) and moderately by o,p'-DDT (82 +/- 15 microg/ml) compared with controls (23 +/- 3.5 microg/ml). Tamoxifen alone had no effect on Vtg production, but inhibited both E2 and o,p'-DDT stimulated vitellogenesis. T levels were reduced with E2 administration (1,688 +/- 383 pg/ml) and declined further with the combined treatment of E2 and tamoxifen (281 +/- 70 pg/ml), compared with controls (6,558 +/- 1,438 pg/ml). Tamoxifen or o,p'-DDT alone did not affect T levels, but their combined treatment did (2,069 +/- 647 pg/ml). The results of this study suggest that o,p'-DDT is weakly estrogenic in male tilapia, and that this activity may be mediated through the estrogen receptor.