Comparative Genomics of Pseudomonas aeruginosa Strains Isolated from Different Ecological Niches.

The Pseudomonas aeruginosa genome can change to adapt to different ecological niches. We compared four genomes from a Mexican hospital and 59 genomes from GenBank from different niches, such as urine, sputum, and environmental. The ST analysis showed that high-risk STs (ST235, ST773, and ST27) were present in the genomes of the three niches from GenBank, and the STs of Mexican genomes (ST167, ST2731, and ST549) differed from the GenBank genomes. Phylogenetic analysis showed that the genomes were clustering according to their ST and not their niche. When analyzing the genomic content, we observed that environmental genomes had genes involved in adapting to the environment not found in the clinics and that their mechanisms of resistance were mutations in antibiotic resistance-related genes. In contrast, clinical genomes from GenBank had resistance genes, in mobile/mobilizable genetic elements in the chromosome, except for the Mexican genomes that carried them mostly in plasmids. This was related to the presence of CRISPR-Cas and anti-CRISPR; however, Mexican strains only had plasmids and CRISPR-Cas. blaOXA-488 (a variant of blaOXA50) with higher activity against carbapenems was more prevalent in sputum genomes. The virulome analysis showed that exoS was most prevalent in the genomes of urinary samples and exoU and pldA in sputum samples. This study provides evidence regarding the genetic variability among P. aeruginosa isolated from different niches.

A Plasmid Carrying blaIMP-56 in Pseudomonas aeruginosa Belonging to a Novel Resistance Plasmid Family.

blaIMP and blaVIM are the most detected plasmid-encoded carbapenemase genes in Pseudomonas aeruginosa. Previous studies have reported plasmid sequences carrying blaIMP variants, except blaIMP-56. In this study, we aimed to characterize a plasmid carrying blaIMP-56 in a P. aeruginosa strain isolated from a Mexican hospital. The whole genome of P. aeruginosa strain PE52 was sequenced using Illumina Miseq 2 × 150 bp, with 5 million paired-end reads. We characterized a 27 kb plasmid (pPE52IMP) that carried blaIMP-56. The phylogenetic analysis of RepA in pPE52IMP and 33 P. aeruginosa plasmids carrying resistance genes reported in the GenBank revealed that pPE52IMP and four plasmids (pMATVIM-7, unnamed (FDAARGOS_570), pD5170990, and pMRVIM0713) were in the same clade. These closely related plasmids belonged to the MOBP11 subfamily and had similar backbones. Another plasmid (p4130-KPC) had a similar backbone to pPE52IMP; however, its RepA was truncated. In these plasmids, the resistance genes blaKPC-2, blaVIM variants, aac(6')-Ib4, blaOXA variants, and blaIMP-56 were inserted between phd and resolvase genes. This study describes a new family of plasmids carrying resistance genes, with a similar backbone, the same RepA, and belonging to the MOBP11 subfamily in P. aeruginosa. In addition, our characterized plasmid harboring blaIMP-56 (pPE52IMP) belongs to this family.

Systemic inflammation May limit the effect of protein supplement on nutritional status in peritoneal dialysis.

BACKGROUND: Malnutrition and inflammation are highly prevalent and associated with poor outcomes in continuous ambulatory peritoneal dialysis (CAPD). Nutritional supplements are commonly used; however, presence of systemic inflammation could limit their effect. AIM: To evaluate the impact of systemic inflammation on nutritional status of CAPD patients receiving an oral protein supplement. METHODS: Prospective observational study; 34 malnourished patients (subjective global assessment; SGA) received both nutritional counseling and oral egg albumin-based protein supplement. During 6-month of follow-up, patients had monthly clinical, and quarterly biochemical and inflammation [interleukin 6 and high sensitivity C-reactive protein (hsCRP)] evaluations. According to baseline hsCRP, patients were classified in two groups: Inflammation (>3 mg/L) and No-inflammation (≤3 mg/L). RESULTS: Comparing baseline vs final, macronutrient intake and SGA increased in both groups, however, improvement of SGA was more marked in the No-inflammation group at the end of the study: 70% improved, 25% no change and 5% worsened (p = 0.001); whereas in the Inflammation group results were: 50% improved, 36% no change and 14% worsened (p = 0.03). Additionally, at final evaluation, serum albumin tended to increase more in the No-inflammation (3.0 ± 0.9 vs 3.4 ± 1.1 g/dL, p = 0.08) than in Inflammation group (2.8 ± 0.6 vs 3.0 ± 0.9 g/dL, p = 0.66), and body mass index significantly increased in No-inflammation group (20.3 ± 3.0 vs 21.6 ± 3.3 kg/m2, p < 0.001) but not in Inflammation group (21.9 ± 3.0 vs 22.5 ± 3.3 kg/m2, p = 0.09). CONCLUSIONS: The presence of systemic inflammation in malnourished CAPD patients seemed to limit the trend for improvement on nutritional status observed with counseling and oral egg albumin-based protein supplement in patients without inflammation.

Research Ambassador Program: An innovative educational approach to addressing underrepresentation of minority populations in clinical research.

Clinical trial participation among historically underrepresented populations remains low in large part due to mistrust of academic institutions and research investigators. Mistrust may be ever greater today given misinformation related to COVID-19. The Research Ambassador Program is an interactive educational workshop delivered by Promotoras de Salud/Community Health Workers and designed to both address common myths, fears, and concerns about research and encourage research participation among underrepresented populations. An evaluation conducted with 819 Latino and Black participants demonstrated a change in behavior and intention to participate in a clinical trial, with half of participants enrolling in a clinical trial research registry.

Aspectos genéticos de los Feocromocitomas y Paragangliomas / Genetic aspects of Pheocromocytomas and Paragangliomas

Los Feocromocitomas (FCC) y Paragangliomas (PGG) son tumores derivados de células de la cresta neural, que secretan catecolaminas. El 80-85% de los FCC derivan de la médula adrenal, mientras el 15-20% de tejido cromafín extra adrenal. Avances en la investigación genética han permitido identificar múltiples genes implicados en la fisiopatogenia de estos tumores, de forma que podrían tener una mutación germinal subyacente. La existencia de mutaciones espontáneas, baja penetrancia, protección materna e interacciones entre genes o con el ambiente puede explicar en parte este hecho. Debe confirmarse, la existencia de una mutación en un paciente afecto antes de ofrecer estudio genético a sus familiares asintomáticos. El clínico debe considerar diversos factores como: la localización del tumor, producción hormonal, malignidad, multicentricidad e historia familiar antes de decidir que mutación debe estudiarse en primer lugar. Un diagnóstico precoz de estos tumores, acompañado de un correcto diagnóstico genético, debe ser una prioridad que permita un mejor tratamiento, la detección precoz de complicaciones, un correcto tamizaje de familiares y de otros tumores relacionados, así como una mejoría en el pronóstico global de estos pacientes. El brindar conocimiento de nuevos genes causantes de la enfermedad hereditaria ha supuesto un cambio en las recomendaciones sobre la necesidad de realizar estudio genético para brindar el tratamiento adecuado a tiempo.(AU)

Pheochromocytomas (FCC) and Paragangliomas (PGG) are tumors derived from neural crest cells, which secrete catecholamines. 80-85% of FCCs derive from the adrenal medulla, while 15-20% from extra-adrenal chromaffin tissue. Advances in genetic research have made it possible to identify multiple genes involved in the physiopathogenesis of these tumors, such that they could have an underlying germline mutation. The existence of spontaneous mutations, low penetrance, maternal protection and interactions between genes or with the environment can partly explain this fact. The existence of a mutation in an affected patient must be confirmed before offering a genetic study to their asymptomatic relatives. The clinician must consider several factors such as: tumor location, hormonal production, malignancy, multicentricity, and family history before deciding which mutation should be studied first. An early diagnosis of these tumors, accompanied by a correct genetic diagnosis, should be a priority that allows better treatment, the early detection of complications, a correct screening of relatives and other related tumors, as well as an improvement in the overall prognosis of these patients. Providing knowledge of new genes that cause hereditary disease has led to a change in the recommendations regarding the need for a genetic study to provide the appropriate treatment in time.(AU)

Laboring With the Heart: Promotoras' Transformations, Professional Challenges, and Relationships With Communities.

Little is known about promotoras' professional experiences engaging in Latinx health promotion. In this promotora-led community-based participatory study, we purposively recruited and interviewed 30 Spanish-speaking promotoras who worked in Los Angeles County and who had at least 5 years of experience as promotoras. Using a constructivist grounded theory approach, findings revealed promotoras self-identified as health professionals who offered unique, insider perspectives. Challenges arose as employers viewed promotoras as volunteer lay health workers, while promotoras desired opportunities for professional growth. Motivation to continue working as promotoras stemmed from their commitment to Latinx communities. We provide recommendations to strengthen community-based capacity for advancing Latinx health.

Parry-Romberg, a neurocutaneous syndrome: presentation of three cases. / Parry-Romberg, un síndrome neurocutáneo: presentación de tres casos.

BACKGROUND: Parry-Romberg syndrome is characterized by progressive hemiatrophy of the skin, subcutaneous tissue, muscle and bones of the skull. Its incidence is low, with a progressive and slow course. Its etiology is unknown, but it has been associated with several factors. Its clinical presentation involves dermatological, musculoskeletal and neuropsychiatric manifestations. The treatment consists of medical and surgical strategies. The use of steroids, alone or in combination with immunomodulators, has the objective of slowing down progression. The surgical treatment lies in facial reconstruction or volumetric regeneration, to correct the appearance and function of facial structures. The objective is to show three cases of Parry-Romberg syndrome with the representative characteristics of the disease. CLINICAL CASEs: 1) A 41-year-old woman with atrophy and right supraciliary hypochromia associated with seizures and headache. 2) A 43-year-old woman with parietal deformation and right supraciliary atrophy, associated with facial paralysis, depression and headache. 3) A 36-year-old woman with right hemifacial atrophy associated with ocular involvement and headache. The indicated treatment was based on a systemic steroid plus a cytostatic agent. The surgical treatment was evaluated according to the affection of facial structures. CONCLUSIONS: Parry-Romberg syndrome is a rare disease, characterized by progressive atrophy. Clinical manifestations determine the diagnosis and early start of medical and surgical treatment.

INTRODUCCIÓN: El síndrome de Parry-Romberg se caracteriza por hemiatrofia progresiva de la piel, el tejido subcutáneo, los músculos y los huesos del cráneo. Su incidencia es baja, y su curso es progresivo y lento. Se desconoce su etiología, pero se ha asociado a diversos factores. Su presentación clínica involucra manifestaciones dermatológicas, musculoesqueléticas y neuropsiquiátricas. El tratamiento consiste en estrategias médicas y quirúrgicas. El uso de esteroides, solos o en combinación con inmunomoduladores, tiene el objetivo de frenar la progresión. El tratamiento quirúrgico consiste en reconstrucción facial o regeneración volumétrica, a fin de corregir la apariencia y la función de las estructuras faciales. Se presentan tres casos de síndrome de Parry-Romberg con las características representativas de la enfermedad. CASOS CLÍNICOS: 1) Mujer de 41 años, con atrofia e hipocromía supraciliar derecha, asociadas a crisis convulsivas y cefalea. 2) Mujer de 43 años, con deformación parietal y atrofia supraciliar derecha, asociadas a parálisis facial, depresión y cefalea. 3) Mujer de 36 años, con atrofia hemifacial derecha asociada a afección ocular y cefalea. El tratamiento se basó en esteroide sistémico más un agente citostático. El tratamiento quirúrgico se valoró de acuerdo con la afectación de la estructuras faciales. CONCLUSIONES: El síndrome de Parry-Romberg es una enfermedad rara caracterizada por una atrofia progresiva. Las manifestaciones clínicas determinan el diagnóstico y el inicio temprano del tratamiento médico y quirúrgico.

Acquired hemophilia: clinical case of hemorrhage caused by inhibitors against factor VIII. / Hemofilia adquirida: caso clínico de hemorragia por inhibidores contra el factor VIII.

BACKGROUND: Acquired hemophilia is caused by antibodies against coagulation factors, especially against factor VIII. As it is a low prevalence disease, our objective is to present an idiopathic case of acquired hemophilia to facilitate decision-making in clinical practice for others, exposing the therapeutic modality used. CASE REPORT: 65 years old woman, started with non-trauma hematomas, with asthenia, adynamia and dyspnea. Laboratory studies showed anemia (hemoglobin 7.1 g/dl, hematocrit 21%, mean corpuscular volume 91 fl, mean corpuscular hemoglobin 29.6 pg) and long clotting times (activated partial thromboplastin time 100 seconds) and with prothrombin time and International Normalized Index (17 seconds and 1.2 seconds respectively). So, plasma dilution tests were performed with plasma, without aPTT correction (1:2, 76.6 seconds; 1: 4, 60 seconds; 1: 8, 45 seconds) evidencing the presence of the inhibitor. The diagnosis was confirmed by the decrease in factor VIII (1%) and the presence of the factor VIII inhibitor (256 UB). The treatment started with prednisone and cyclophosphamide. Due to the presence of severe bleeding, treatment with activated prothrombin complex concentrate (CCpa) was required. Subsequently, Rituximab was prescribed, with clinical improvement and increased levels of hgb and reduced aPTT from the first week of treatment. CONCLUSIONS: The approach of acquired hemophilia should include control of the bleeding, the search for the etiology ruling out of the main causes of malignant neoplasms according to age and gender, and the immediate initiation of immunosuppression to decrease inhibitor levels.

INTRODUCCIÓN: La hemofilia adquirida es ocasionada por anticuerpos contra los factores de la coagulación, en especial contra el factor VIII. Por ser de baja prevalencia, presentamos un caso de hemofilia adquirida idiopática exponiendo la modalidad terapéutica utilizada para facilitar a otros la toma de decisiones en la práctica clínica. CASO CLÍNICO: Mujer de 65 años que inició con hematomas no asociados a traumatismo, con astenia, adinamia y disnea. Los estudios de laboratorio mostraron anemia (hemoglobina 7.1 g/dl, hematocrito 21%, volumen corpuscular medio 91 fl, hemoglobina corpuscular media 29.6 pg) y tiempos de coagulación prolongados (tiempo de tromboplastina parcial activado [TTPa] 100 segundos), con tiempo de protrombina e INR (International Normalized Ratio) dentro de parámetros normales (17 y 1.2 segundos, respectivamente), por lo que se realizaron pruebas de dilución con plasma sin corrección del TTPa (1:2, 76.6 segundos; 1:4, 60 segundos; 1:8, 45 segundos), evidenciando la presencia del inhibidor. El diagnóstico se confirmó con la disminución del factor VIII (1%) y la presencia de inhibidor del factor VIII (256 UB). Se inició tratamiento con prednisona y ciclofosfamida. Por presentar hemorragia grave requirió tratamiento con concentrado de complejo de protrombina activado y posteriormente se indicó rituximab, con mejoría clínica, incremento en los niveles de hemoglobina y reducción del TTPa desde la primera semana de tratamiento. CONCLUSIONES: El abordaje de la hemofilia adquirida debe incluir el control de la hemorragia, la búsqueda de la etiología descartando las principales causas de neoplasias malignas de acuerdo con la edad y el sexo, y el inicio inmediato de inmunosupresión para disminuir los niveles de inhibidor.

Characterization of antimicrobial resistance mechanisms in carbapenem-resistant Pseudomonas aeruginosa carrying IMP variants recovered from a Mexican Hospital.

PURPOSE: Pseudomonas aeruginosa infections in hospitals constitute an important problem due to the increasing multidrug resistance (MDR) and carbapenems resistance. The knowledge of resistance mechanisms in Pseudomonas strains is an important issue for an adequate antimicrobial treatment. Therefore, the objective was to investigate other antimicrobial resistance mechanisms in MDR P. aeruginosa strains carrying bla IMP, make a partial plasmids characterization, and determine if modifications in oprD gene affect the expression of the OprD protein. METHODOLOGY: Susceptibility testing was performed by Kirby Baüer and by Minimum Inhibitory Concentration (presence/absence of efflux pump inhibitor); molecular typing by Pulsed-field gel electrophoresis (PFGE), resistance genotyping and integrons by PCR and sequencing; OprD expression by Western blot; plasmid characterization by MOB Typing Technique, molecular size by PFGE-S1; and bla IMP location by Southern blot. RESULTS: Among the 59 studied P. aeruginosa isolates, 41 multidrug resistance and carbapenems resistance isolates were detected and classified in 38 different PFGE patterns. Thirteen strains carried bla IMP; 16 bla GES and four carried both genes. This study centered on the 17 strains har-boring bla IMP. New variants of ß-lactamases were identified (bla GES-32, bla IMP-56, bla IMP-62) inside of new arrangements of class 1 integrons. The presence of bla IMP gene was detected in two plasmids in the same strain. The participation of the OprD protein and efflux pumps in the resistance to carbapenems and quinolones is shown. No expression of the porin OprD due to stop codon or IS in the gene was found. CONCLUSIONS: This study shows the participation of different resistance mechanisms, which are reflected in the levels of MIC to carbapenems. This is the first report of the presence of three new variants of ß-lactamases inside of new arrangements of class 1 integrons, as well as the presence of two plasmids carrying bla IMP in the same P. aeruginosa strain isolated in a Mexican hospital.

Conocimiento local del género Arceuthobium en un área natural protegida del centro de México / Local knowledge of Arceuthobium genus in a natural protected area of the centre of Mexico

El género Arceuthobium (muérdago enano) es una de las principales plagas en los bosques templados de México, con antecedentes de uso medicinal y forrajero. El objetivo de este trabajo fue documentar el conocimiento local sobre los usos del muérdago enano en el Área Natural Protegida Nevado de Toluca, México, bajo las perspectivas emic y etic, a través de la etnobotánica. Mediante entrevistas se identificó que ambas especies (A. vaginatum y A. globosum) son conocidas como muérdago y forman parte de la flora del bosque; sin embargo, los entrevistados desconocen los efectos negativos dentro de los ecosistemas forestales de esta plaga. Destacan los usos lúdicos, como juguete y tinta, y los medicinales para el tratamiento de afecciones respiratorias y del sistema nervioso, siendo éste el primer registro para dicho género localmente. Se requieren estudios que validen el conocimiento local para su inclusión en programas locales de manejo de plagas forestales.

Arceuthobium (dwarf mistletoe) genus is one of the main pests in temperate forests of Mexico, with records of medicinal and forage uses. The objective of this work was to document local knowledge regarding uses of dwarf mistletoe in the Natural Protected Area Nevado de Toluca, Mexico, under emic and etic perspectives, through ethnobotany. Throughout interviews it was identified that both species (A. vaginatum and A. globosum) are known as mistletoe and they are part of flora in forest, however, interviewees are not aware of negative effects within forest ecosystems of this pest. It stands out ludic uses as a toy and ink, and medicinal ones for treatment of respiratory diseases and nervous system, being this the first record for such genus locally. Studies are required to validate the local knowledge for its inclusion in local programmes for management of forest pests.

SGLT2 Inhibitors in Diabetes Mellitus Treatment.

Type 2 Diabetes Mellitus (T2DM) is a chronic illness with high prevalence in Mexico, Latin- America, and the world and is associated to high morbidity, disability, and mortality rate, especially in developing countries. T2DM physiopathology is very complex; insulin resistance in the muscle, liver, and adipose tissue, a reduction in the production of incretins (mainly GLP-1) in the intestine, increased glucagon synthesis, an insufficient response of insulin generation, and increased glucose reabsorption in the kidney lead all together to an hyperglycemic state, which has been closely associated with the development of micro and macrovascular complications. Sodium Glucose Linked Transporter 2 inhibitors (SGLT2i) are the most recent therapeutic class available for treating T2DM. SGLT2i central effect is a glycosuric action, and they can reverse the deleterious effect of tubular reabsorption of glucose in the diabetic patient resulting in greater hyperglycemia. Because their mechanism of action is completely different to current drugs, they can be considered as monotherapy or in combination with any other oral or parenteral medication, including different types of insulin or its analogues. This therapeutic synergy accomplishes a greater percentage of patients achieving glycemic control goals.

Comparación de la maduración ósea de vértebras cervicales utilizando los métodos de Baccetti y Lamparski en pacientes de 8 a 15 años / Comparison of bone maturation of cervical vertebrae using Baccetti and Lamparski methods in patients 8 to 15 years of age

La maduración se puede definir como un proceso gradual en el tiempo, presenta sucesivas modificaciones cualitativas en la organización anatómica y fisiológica durante la pubertad hasta el estado de madurez adulto. En el diagnóstico y tratamiento en ortodoncia es importante conocer los estadios de maduración ósea pues proporcionan información relevante que permite determinar ritmo y tiempo de maduración individual. El uso y la aplicación varían entre las técnicas y tienen un objetivo común, la clasificación de niños y adolescentes en estadios de maduración. El objetivo de este estudio fue comparar la maduración ósea de las vértebras cervicales utilizando los métodos de Baccetti y Lamparski en una población nayarita. La muestra fueron 298 radiografías laterales de cráneo de las edades de 8 a 15 años. Se compararon mediante t de Student los estadios de maduración de los grupos en el análisis CVM de Baccetti y el análisis de Lamparski; en hombres y mujeres. La población masculina de 8 y 10 años no presentaba diferencias significativas entre ambos análisis; la población femenina de 8 años y masculina de 9 años se encontraron diferencias, teniendo mayores valores el análisis CVM de Baccetti, en los demás grupos del estudio también se encontraron diferencias presentando mayores valores en el análisis Lamparski. Los estadios de maduración en los dos tipos de análisis mostraron una marcada diferencia en sus interpretaciones, siendo el análisis de Lamparski más confiable como método diagnóstico de la maduración ósea.

Maturation can be defined as a gradual process over time, presenting successive qualitative changes in the anatomical and physiological organization during puberty to the adult status maturity. In the diagnosis and treatment in orthodontics it is important to know the stages of bone maturation. This can provide us relevant information that allows us to determine pace and time of maturation individual. The use and application techniques vary between and have a common goal, the classification of children and adolescents in stages of maturation. The objective of the study was to compare bone maturation of the cervical vertebrae using the methods of Baccetti and Lamparski in a population of Nayarit. The sample consisted of 298 lateral radiographs of the skull between ages of 8­15 years old. The maturity stages of the groups of CVM and Lamparski method, in men and women, were compared using Student t test. In the masculine population between 8 and 10 years significant differences were not found between both analysis; in the 8-year-old female group and the 9-year-old males, differences were found, with the CVM Baccetti analysis having higher values. In the other study groups, differences were also found showing higher values in the Lamparski analysis. The stages of maturation in the two types of analysis showed a marked difference in their interpretations. Lamparski analysis being more reliable as a diagnostic method for bone maturation.

Unusual redo mitral valve replacement for bleeding in Glanzmann thrombasthenia.

We report the case of 23-year-old man with mitral valve regurgitation and Glanzmann thrombasthenia, who underwent mechanical mitral valve replacement. Warfarin therapy was devastating, causing bilateral hemothorax, pericardial effusion, gastrointestinal bleeding, and hematuria. Redo mitral valve replacement with a biological prosthesis was required to resolve this critical situation. To our knowledge, this is the first report of mitral valve replacement in Glanzmann thrombasthenia, highlighting the danger of oral anticoagulation in this pathology.

Ajuste por género del análisis de dentición de Moyers para la población de Nayarit / Gender-adjustment of Moyers dentition analysis for the Nayarit (Mexico) population

Uno de los elementos diagnósticos de las maloclusiones en edades tempranas son las tablas de percentiles de Moyers, éstas predicen el tamaño de caninos y premolares que aún no erupcionan. Material y métodos: La muestra fue de 180 modelos de estudio pretratamiento de ortodoncia de sexo masculino que cumplían los criterios de inclusión y 319 de sexo femenino, por lo que se seleccionaron de forma aleatoria 180 modelos de estudio pretratamiento de sexo femenino para igualar las muestras. Se calculó la estadística descriptiva, los percentiles 75 y 50 para cada sexo y se utilizó la prueba de t de Student para comparar los resultados de las tablas con los ajustes de los percentiles 75 y 50 de cada sexo con el resultado de las tablas de Moyers y con los valores de los modelos de estudio. Resultado: Se encontraron diferencias estadísticas entre los resultados de las tablas de Moyers y las realizadas para la población de Nayarit. El percentil 75 de las tablas de Nayarit sobrestima el valor de caninos y premolares en ambos sexos, con el percentil 50 no se encontraron diferencias estadísticas. Conclusiones: Se recomienda utilizar el percentil 50 del ajuste realizado para predecir el tamaño de caninos y premolares.

Moyers percentile tables are one of the diagnostic elements used for early age malocclusions. These tables predict the size of non erupted canines and premolars. Material and methods: The sample was composed of 180 male patients study models and 319 female patients study models used for orthodontic pre-treatment. Models met inclusion criteria. So as to match samples, 180 female study models were randomly selected. Descriptive statistics were calculated, percentiles 75 and 50 for each gender, t Student test was used to compare results of tables with adjustment of percentiles 75 and 50 for each gender with Moyers tables results and values of the study models. Result: Statistically significant differences were found when comparing Moyers' tables results with those of the Nayarit population. Percentile 75 of Nayarit tables over-estimated values of canines and premolars in both genders. No statistical differences were found with 50 percentile. Conclusions: It is recommended to use the 50 percentile of the conducted adjustment in order to predict size of canines and premolars.

Sugammadex, a neuromuscular blockade reversal agent, causes neuronal apoptosis in primary cultures.

Sugammadex, a γ-cyclodextrin that encapsulates selectively steroidal neuromuscular blocking agents, such as rocuronium or vecuronium, has changed the face of clinical neuromuscular pharmacology. Sugammadex allows a rapid reversal of muscle paralysis. Sugammadex appears to be safe and well tolerated. Its blood-brain barrier penetration is poor (< 3% in rats), and thus no relevant central nervous toxicity is expected. However the blood brain barrier permeability can be altered under different conditions (i.e. neurodegenerative diseases, trauma, ischemia, infections, or immature nervous system). Using MTT, confocal microscopy, caspase-3 activity, cholesterol quantification and Western-blot we determine toxicity of Sugammadex in neurons in primary culture. Here we show that clinically relevant sugammadex concentrations cause apoptotic/necrosis neuron death in primary cultures. Studies on the underlying mechanism revealed that sugammadex-induced activation of mitochondria-dependent apoptosis associates with depletion of neuronal cholesterol levels. Furthermore SUG increase CytC, AIF, Smac/Diablo and CASP-3 protein expression in cells in culture. Potential association of SUG-induced alteration in cholesterol homeostasis with oxidative stress and apoptosis activation occurs. Furthermore, resistance/sensitivity to oxidative stress differs between neuronal cell types.

Mammalian multidrug resistance lipopentasaccharide inhibitors from Ipomoea alba seeds.

As part of an ongoing project to identify inhibitors of multidrug efflux pumps, three new resin glycosides, albinosides I-III (1-3), were isolated from a CHCl(3)-soluble extract from the seeds of moon vine (Ipomoea alba). Their structures were established through NMR spectroscopy and mass spectrometry as partially acylated branched pentasaccharides derived from three new glycosidic acids, named albinosinic acids A-C (4-6). The same oligosaccharide core formed by two D-quinovose, one D-glucose, and two L-rhamnose units was linked to either convolvulinolic or jalapinolic acid for 1 and 3, respectively. They were partially esterified with (2R,3R)-3-hydroxy-2-methylbutanoic, acetic, or 2-methyl-2-butenoic acid. Compound 2 has two D-quinovose and three L-rhamnose units, linked to convolvulinolic acid, and its esterifying residues were characterized as two units of 2-methyl-2-butenoic acid. The aglycone lactonization site was located at C-2 of the terminal rhamnose unit (Rha) for 1, at C-3 of the terminal rhamnose unit (Rha') for 2, and at C-3 of the second saccharide unit (Glc) for 3. Reversal of multidrug resistance by this class of plant metabolites was also evaluated in vinblastine-resistant human breast carcinoma cells (MCF-7/Vin). The noncytotoxic compound 3 exerted the strongest potentiation effect of vinblastine susceptibility to over 2140-fold, while a moderate activity was observed for 1 (3.1-fold) and 2 (2.6-fold) at a concentration of 25 µg/mL.

Frecuencia de crisis epilépticas en pacientes pediátricos de la consulta externa de un hospital general / Seizures rate in pediatric outpatients at a general hospital in México City

Introducción. Las crisis epilépticas son la segunda enfermedad neurológica más común. Se identificó la proporción de crisis epilépticas y su distribución por tipo en pacientes pediátricos de la consulta externa de un hospital general. Métodos. Se registraron los pacientes con diagnóstico clínico de crisis epilépticas, realizado por el pediatra, atendidos en la consulta externa pediátrica durante un mes. Se determinó la proporción que representaba en el período y se calcularon intervalos de confianza (IC) del 95%. Se identificó la distribución por tipo de crisis convulsiva y se comparó la edad en los distintos tipos. Resultados. La proporción encontrada fue 11.5% (n =382, IC95% 8.31-14-69) a expensas principalmente de crisis tónico-clónico generalizadas 5.5% (47% de todas las crisis, n =44), la frecuencia de crisis epilépticas no difirió significativamente entre los diferentes grupos de edad (P =0.483). Las crisis febriles representaron sólo 0.8% (6.8% de todas las crisis, n =44). Conclusiones. La proporción encontrada fue alta; la proporción de crisis febriles fue menor a la reportada.

Introduction. Seizures are the second most common neurological disease. Objective: To identify the rate and type of seizures in pediatric outpatients of a general hospital. Methods. Patients with a clinical diagnosis of seizures attend-ing the outpatients Pediatrics clinic were enrolled in this one-month study. Rate ratios and 95% confidence intervals (CI) were calculated. Distributions of seizure type according to gender and age were calculated. Results. The rate ratio found was 11.5% (n =382, 95% CI 8.31-14.69); the most common seizure type was generalized tonic-clonic seizure 5.5% (47% of total seizures, n =44); seizure frequency did not show any statistical difference among age-group (P =0.483). Febrile seizures represented only 0.8% (6.8% of total seizures, n =44). Conclusions. The seizure rate observed was higher than the expected rate. The febrile seizure rate was lower than those reported in previous works.