A multisensory mindfulness experience: exploring the promotion of sensory awareness as a mindfulness practice.

Objectives: In this preliminary and multidisciplinary exploratory study, we assessed whether a mindfulness practice could be enhanced through a multisensory experience design that mimics the "beginner's mind," relying on sensory awareness and biofeedback processes as participants interact with the experience. Methods: We piloted and designed two conditions, being (a) a guided mindfulness practice based on the senses as an anchor to the present moment, using audio instruction only; and (b) an experience of mindfulness practice with successive sensory stimulation (olfactory, audio, and visual stimulation) followed by an interactive experience with biofeedback that provides a visual representation of the person's heartbeat in real-time. For each of the conditions we assessed anxiety (state and trait), as well as other psychological variables pre- and post-experience. Additionally, we measured the heart rate variability (HRV) at baseline, during each stage of the experience as well as post intervention. Results: We collected valid data for a total of 68 individuals. Both groups were similar regarding mean age, sex, and occupation and had similar prior experience with mindfulness. There were no significant differences regarding prior state or trait anxiety between the groups. Analysis of the physiological variables showed that for both groups there was an increase in the parasympathetic activity after the multisensory experience, with small differences in the conditions of stimulation. We did not observe significant differences between the pre and post measures for state of test anxiety. The observed parasympathetic activity variations after both experiences compared with pre and post-surveys demonstrate the importance of physiological vs psychological inspection beyond the common human rational experience that is not always resonate with the body's response and impacts the needed literacy to self-awareness of emotional well-being. Conclusion: Participants in both conditions could effectively connect with the experience, while achieving a physiological response different from their baseline state. The acceptance of the designed stimuli was very high, although more research is still needed to uncover its full potential. In sum, the design of multisensory experiences using technology to create an interactive connection with the sensory stimulus, is a promising field in mindfulness and especially in practices involving sensory awareness through the monitoring of parasympathetic activity as an inference indicator of the present-moment connection.

Lesiones no intencionales en menores de 18 años / Unintentional Injuries in Children under Eighteen Years of Age

Introducción: Las lesiones no intencionales se consideran un problema de salud en el mundo, las tasas se elevan de forma marcada. En Cuba ocupan una de las primeras causas de morbilidad en la edad pediátrica. Objetivo: Describir las principales características epidemiológicas de las lesiones no intencionales en menores de 18 años en Matanzas. Métodos: Se realizó un estudio descriptivo en Matanzas entre el 2013 y el 2018. El universo estuvo constituido por las 4464 lesiones no intencionales ocurridas en menores de 18 años durante el periodo analizado. Para el análisis de las variables se utilizaron tasas crudas por 10 000 habitantes. Resultados: Las tasas de morbilidad en la provincia estuvieron entre 45,2 y 58,2 por 10 000 habitantes. Los municipios de mayor riesgo resultaron Matanzas y Limonar. La mayoría de las lesiones no intencionales ocurrieron en el hogar, las caídas fueron las más frecuentes y provocaron lesiones leves. Conclusiones: Las lesiones no intencionales constituyen un problema de salud. Es necesario evaluar y controlar los factores de riesgo en los distintos tipos de accidentes para prevenir o disminuir su incidencia a través de estrategias de información, educación y comunicación. Lograr que las familias estén conscientes de la vulnerabilidad de los niños es un factor esencial y básico en todos los esfuerzos que tengan como objetivo la prevención de las lesiones no intencionales en esta etapa de la vida(AU)

Introduction: Unintentional injuries are considered a health concern worldwide. Their rates rise drastically. In Cuba, they occupy one of the leading causes of morbidity in pediatric age. Objective: To describe the main epidemiological characteristics of unintentional injuries in children under 18 years of age in Matanzas. Methods: A descriptive study was carried out in Matanzas, between 2013 and 2018. The universe consisted of 4464 unintentional injuries experienced, during the period analyzed, by children under 18 years of age. Crude rates per 10 000 inhabitants were used for the analysis of the variables. Results: The morbidity rates in the province were between 45.2 and 58.2 per 10 000 inhabitants. The municipalities with the highest risk were Matanzas and Limonar. Most of the unintentional injuries occurred at home. Falls were the most frequent and caused minor injuries. Conclusions: Unintentional injuries constitute a health concern. It is necessary to assess and control the risk factors for the different types of accidents, in order to prevent or reduce their incidence, through information, education and communication strategies. Making families aware of the vulnerability of children is an essential and basic aspect in all efforts aimed at preventing unintentional injuries at this stage of life(AU)

Monocyte chemoattractant protein-1 (MCP-1) and fibroblast growth factor-21 (FGF-21) as biomarkers of subclinical atherosclerosis in women.

BACKGROUND: Atherosclerosis is a primary risk factor for cardiovascular disease (CVD). Proinflammatory biochemical factors can influence vascular health; monocyte chemoattractant protein-1 (MCP-1) is elevated in patients with CVD while fibroblast growth factor-21 (FGF-21) acts directly on cardiac tissue to reduce infarction damage. However, the relationship between plasma concentrations of MCP-1, FGF-21 and subclinical CVD indices remains equivocal. AIM: To determine the association between MCP-1, FGF-21 and subclinical atherosclerosis [i.e., carotid intima-media thickness (cIMT)] in women without clinical evidence of CVD. METHODS: A cross-sectional analysis of 140 women without history of CVD was performed. Anthropometrics were collected, serum concentrations of MCP-1 and FGF-21 were determined by enzyme-linked immunosorbent assay, and cIMT was quantified (B-mode ultrasonography). The correlations between MCP-1, FGF-21 and the presence of clinical and laboratory of subclinical atherosclerosis (i.e., cIMT ≥0.70 mm), comparison intergroup and odd ratio with multiple logistic regression were analyzed. RESULTS: MCP-1, but not FGF-21 correlated with some obesity indicators. In median comparison among groups, subclinical atherosclerosis showed higher serum concentrations of MCP-1and lower serum concentrations of FGF-21. In postmenopausal women, there were significant differences MCP-1 (p = 0.001), and FGF-21 (p = 0.010). Multiple logistic regression analysis in postmenopausal women with subclinical atherosclerosis, between MCP-1 (p = 0.001) and FGF-21 (p = 0.037) showed association with cIMT, along with age. CONCLUSIONS: MCP-1 and FGF-21 levels are associated with subclinical atherosclerosis disease severity (i.e., cIMT) in postmenopausal women without CVD. Further efforts focused on characterizing the relationship between novel blood-borne markers of early CVD pathology are warranted and should be pursued.

[Asociación del estado hormonal con el riesgo cardiovascular evaluado por Globorisk en mujeres mexicanas].

INTRODUCTION: Cardiovascular disease is the main cause of mortality worldwide. In women, its incidence increases at the sixth decade of life, coinciding with postmenopause. Whether this effect is due to menopause-related hormonal changes is not known. OBJECTIVE: To evaluate the differences in cardiovascular risk in pre- and postmenopausal women by means of the Globorisk risk scale, the triglyceride/high-density lipoproteins cholesterol (Tg/HDL-C) ratio and metabolic syndrome (MS) criteria. METHOD: Cross-sectional study that included 408 women from 40 to 60 years of age; anthropometric measurements and biochemical determinations were performed. The participants were classified as premenopausal and postmenopausal. Cardiovascular risk was assessed using the MS criteria, the Globorisk risk calculator and the Tg/HDL-C ratio. RESULTS: Postmenopausal women showed a significant increase in waist circumference, total cholesterol and triglycerides in comparison with premenopausal women. Significant associations were found between hormonal state and Globorisk measured cardiovascular risk (OR = 2.50; 95 % CI = 1.67-3.74) and the Tg/HDL-C ratio (OR = 1.66; 95 % CI = 1.09-2.52). CONCLUSION: Cardiovascular risk factors have a higher prevalence in postmenopause. The Globorisk scale and Tg/HDL-C ratio identify cardiovascular risk in postmenopausal women.

INTRODUCCIÓN: La enfermedad cardiovascular es la principal causa de mortalidad en el mundo. En la mujer se incrementa en la sexta década de la vida, coincidiendo con la posmenopausia. Se desconoce si este efecto se debe a cambios hormonales relacionados con la menopausia. OBJETIVO: Evaluar diferencias del riesgo cardiovascular en mujeres pre y posmenopáusicas mediante la escala de riesgo Globorisk, el índice triglicéridos/c-HDL (Tg/c-HDL) y los criterios de síndrome metabólico (SM). MÉTODOS: Estudio transversal que incluyó a 408 mujeres de 40 a 60 años; se realizaron mediciones antropométricas y bioquímicas. Las participantes se clasificaron en premenopáusicas y posmenopáusicas. El riesgo cardiovascular se evaluó utilizando los criterios de SM, calculadora de riesgo Globorisk y el índice Tg/c-HDL. RESULTADOS: Las mujeres en etapa posmenopáusica presentaron incremento significativo en la circunferencia de cintura, de colesterol total y triglicéridos, en comparación con las mujeres premenopáusicas. Se encontraron asociaciones significativas del estado hormonal con el riesgo cardiovascular evaluado por Globorisk (RM = 2.50, IC 95 % = 1.67-3.74) y con el índice Tg/c-HDL (RM = 1.66, IC 95 % = 1.09-2.52). CONCLUSIÓN: Los factores de riesgo cardiovascular tienen mayor prevalencia en la posmenopausia. La escala Globorisk y el índice Tg/c-HDL identifican el riesgo cardiovascular en la mujer posmenopáusica.

Parasitismo intestinal en niños de círculos infantiles de un Consejo popular. Matanzas. 2014-2015 / Intestinal parasitism in children assisting day care centers of one popular council. Matanzas. 2014-2015

RESUMEN Introducción: la prevalencia de las infecciones parasitarias intestinales en niños no ha variado mucho en Cuba en los últimos años. Objetivo: determinar la prevalencia de las infecciones parasitarias intestinales e identificar los factores asociados en los círculos infantiles de un Consejo popular de Matanzas. Materiales y métodos: se realizó un estudio analítico, transversal, entre octubre de 2014 y abril de 2015 en el cual se incluyeron niños que asistían a esos círculos infantiles. Se utilizó un muestreo sistemático para la selección. La información se recogió a través de una entrevista estructurada y sé colectaron dos muestras fecales, en días alternos. Cada muestra fue procesada con dos métodos coproparasitológicos. Se estudiaron variables sociodemográficas y factores higiénicos sanitarios. En el procesamiento estadístico se calcularon las frecuencias absolutas, relativas y el Odds Ratio. Se realizó un análisis bivariado y se controlaron los posibles factores de confusión utilizando la regresión logística del programa SPSS. Resultados: 93 niños estaban infectados por algún parásito o comensal. Blastocystis sp., Giardia lamblia y E. histolytica/ E. dispar resultaron los parásitos más frecuentes. La calidad del agua de consumo, comerse las uñas o chuparse el dedo, así como el no lavado de las manos fueron identificados como factores asociados al parasitismo, el resto de los factores resultaron de confusión. Conclusiones: la mitad de los niños se encontraban parasitados, lo que demuestra que las condiciones higiénicas y la educación sanitaria en estas instituciones están aún por debajo del nivel deseado por el sistema nacional de salud (AU).

ABSTRACT Introduction: the prevalence of intestinal parasitic infections in children has not changed in Cuba in the last years in spite of the efforts made by the National Public Health System. Objective: to determine the prevalence of the intestinal parasitic infections and to identify the factors associated to them in the day care centers of the Popular Council Matanzas. Material and methods: a cross-sectional, analytical study was carried out in the period from October 2014 till April 2015 in children assisting those day care centers. The sample was chosen by a systematic sampling. Information was gathered through a structured interview and two stool samples were collected after a day. Each stool sample was processed using two different stool parasitological methods. Socio-demographic variables and hygienic-sanitary factors were studied. Odds ratio, relative and absolute frequencies were calculated during statistic processing. A bivariate analysis was made and the main possible confusion variants were controlled using the SPSS program logistic regression. Results: 93 children were infected by any parasite or commensal, predominating monoparasitism. Blastocystis sp., Giardia lamblia and E. histolytica /E. dispar were the most frequent parasites. Drinking water quality, nails biting or fingers sucking, as well as no hand washing were identified as factors associated to parasitism; the rest of the factors were confusing. Conclusions: half of the patients were found parasite carriers, showing that hygienic conditions and sanitary education in these institutions are still under the level desired by the National Health System (AU).

Manejo quirúrgico del linfedema escrotal severo / Surgical management of severe scrotal lymphedema

Resumen:El linfedema consiste en la retención de líquido linfático en los tejidos, causada por una obstrucción del sistema linfático. El sistema linfático devuelve el líquido intersticial al conducto torácico y este luego al torrente sanguíneo, y de allí se recircula a los tejidos. Puede ser un fenómeno aislado o no, tal como manifestación de una displasia linfática congénita (primaria), desarrollada durante la etapa tardía de linfangiogénesis; o puede ser secundario, es decir, causado por una lesión u obstrucción en los vasos linfáticos, ya sea por disección quirúrgica radical, irradiación, malignidad, linfangitis con linfagioesclerosis, trauma o causa idiopática. Los síntomas pueden incluir fatiga grave, edema focal o generalizado en algunas regiones del cuerpo, así como descoloración de la piel que recubre el linfedema y, finalmente, la deformidad, que en el caso de las extremidades inferiores se llama elefantiasis. El linfedema no solo puede causar desfiguración, sino también limitación del estilo de vida, e incluso trastornos psicológicos. Se presenta el caso de un paciente de 45 años, portador de linfedema severo (elefantiasis) de miembros inferiores crónico y del saco escrotal, valorado y manejado quirúrgicamente en el Servicio de Cirugía Plástica y Reconstructiva del Hospital México.

Abstract:Lymphedema is a localized retention of lymphatic fluid in the tissues, usually caused by a blockage of the vessels that carry lymph. The lymphatic system returns the interstitial fluid to the thoracic duct and this in turn, brings it to the bloodstream, where it is recirculated to the tissues. It may be an isolated phenomenon or not, as a manifestation of a congenital lymphatic dysplasia (primary) developed during the late stage of lymphangiogenesis; or it may be secondary, caused by an injury or blockage to the lymphatic vessels, either by radical surgical dissection, irradiation, malignancy, lymphangitis with lymphangiosclerosis, trauma or of an idiopathic cause. Symptoms may include severe fatigue, focal or generalized edema of some regions of the body, as well as discoloration of the skin overlying the affected area, and eventually deformity, which is called elephantiasis when it refers to the lower limbs. Lymphedema not only may cause disfiguration, but also can limit lifestyle, and even cause psychological disorders. We present the case of a 45-year old patient with severe chronic lower limb (elephantiasis), and scrotal sac lymphedema, who was evaluated and successfully treated by the Department of Plastic and Reconstructive Surgery at the Hospital Mexico.

Urban Chagas disease in children and women in primary care centres in Buenos Aires, Argentina

The primary objective of this study was to estimate the prevalence of this disease in women of childbearing age and children treated at health centres in underserviced areas of the city of Buenos Aires. Demographic and Chagas disease status data were collected. Samples for Chagas disease serology were obtained on filter paper and the reactive results were confirmed with conventional samples. A total of 1,786 subjects were screened and 73 positive screening results were obtained: 17 were from children and 56 were from women. The Trypanosoma cruziinfection risk was greater in those individuals who had relatives with Chagas disease, who remember seeing kissing bugs, who were of Bolivian nationality or were born in the Argentine province of Santiago del Estero. The overall prevalence of Chagas disease was 4.08%. Due to migration, Chagas disease is currently predominantly urban. The observed prevalence requires health programme activities that are aimed at urban children and their mothers. Most children were infected congenitally, which reinforces the need for Chagas disease screening of all pregnant women and their babies in Argentina. The active search for new cases is important because the appropriate treatment in children has a high cure rate.

Urban Chagas disease in children and women in primary care centres in Buenos Aires, Argentina.

The primary objective of this study was to estimate the prevalence of this disease in women of childbearing age and children treated at health centres in underserviced areas of the city of Buenos Aires. Demographic and Chagas disease status data were collected. Samples for Chagas disease serology were obtained on filter paper and the reactive results were confirmed with conventional samples. A total of 1,786 subjects were screened and 73 positive screening results were obtained: 17 were from children and 56 were from women. The Trypanosoma cruzi infection risk was greater in those individuals who had relatives with Chagas disease, who remember seeing kissing bugs, who were of Bolivian nationality or were born in the Argentine province of Santiago del Estero. The overall prevalence of Chagas disease was 4.08%. Due to migration, Chagas disease is currently predominantly urban. The observed prevalence requires health programme activities that are aimed at urban children and their mothers. Most children were infected congenitally, which reinforces the need for Chagas disease screening of all pregnant women and their babies in Argentina. The active search for new cases is important because the appropriate treatment in children has a high cure rate.

Estudio exploratorio sobre los intereses profesionales en estudiantes de la carrera de psicología de la uca / Exploratory study based on professional interests of psychology students at uca

Interests are measured with Vocational Interests Test, to guide in choosing professional careers by Frederick Kuder and other authors. This research paper aims to identify the predominant interests in a same Psychology group of students; in 2010 and 2011 following Kuder's proposal as a basis for being professionals within Salvadorian context. The first measure introduces fash-ion more in Social Service (Mo=59), Persuasive (Mo=40), Literary (Mo=20) and Office work (Mo=51). And Social Service (Mo=64), Persuasive (Mo=42) and Literary (Mo=21) appears on the second measure. There were not significant differences between students who received guidance processes prior to access. The career begins with traditional views, even though the three expected interests based on the formation of a contemporary psychologist are required.

Frederick Kuder y otros autores midieron los intereses para orientar profesiones, a partir de la Prueba de Intereses Vocacionales de Kuder. Siguiendo su propuesta, en este artículo de investigación, se propone identificar los intereses predominantes en un mismo grupo de estudiantes de Psicología, en 2010 y 2011, como base de trabajo para la formación de profesionales en el contexto salvadoreño. La primera medida presenta moda mayor en Servicio Social (Mo=59), Persuasivo (Mo=40), Literario (Mo=20) y Trabajo de Oficina (Mo=51). En la segunda medida, aparece Servicio Social (Mo=64), Persuasivo (Mo=42) y Literario (Mo=21). No se encontraron diferencias significativas entre estudiantes que recibieron procesos de orientación antes de ingresar. La carrera se inicia con visiones tradicionales, aun cuando en la formación de un psicólogo contemporáneo se requieren los tres intereses esperados.

Cuidado de los pies en usuarios que viven con diabetes en el estado de México: bases para la sistematización de la asistencia de enfermería

Se trata de un estudio de tipo descriptivo y transversal con enfoque cuantitativo, realizado en una población de 20 usuarios del estado de México, en 2009. Con el objetivo de identificar la información del paciente con diabetes en relación con el cuidado de los pies. Se utilizó un instrumento impreso para la recogida de datos que contienen aspectos sociodemográficos y el cuidado de los pies de los pacientes. Se constató que 55% de los pacientes está centralizado en la edad de más de 60 años, 85% eran mujeres, casadas dedicadas a las actividades del hogar. Un alto porcentaje señaló los cuidados básicos, lavado, secado, lubricación y el corte de uñas. La población de este estudio no tiene información clara de su enfermedad, por eso requiere información básica para prevenir el pie diabético y las amputaciones y el profesional de enfermería necesita perfeccionar los métodos de enseñanza de acuerdo al grado de escolaridad de la población para garantizar el éxito de la prevención a fin de minimizar o evitar la aparición de lesiones...

Trata-se de um estudo do tipo descritivo transversal com abordagem quantitativa, realizado numa população de 20 usuários do estado do México em 2009, com o objetivo de identificar as informações do paciente em relação ao cuidado com o pé diabético. Utilizou-se como instrumento de coleta um formulário, com dados sociodemográficos e questões sobre o cuidado com o pé dos pacientes. Verificou-se que 55% dos pacientes estão centralizados na idade acima de 60 anos, 85% eram do sexo feminino, casados, envolvidos em atividades do lar. Uma alta porcentagem desses conhece os cuidado básicos, lavagem, secagem, lubrificação e corte de unhas. A população deste estudo não tem informação clara sobre sua doença e necessita de orientações básicas para evitar a amputação do pé diabético. O enfermeiro precisa aperfeiçoar os métodos de ensino, segundo o nível de escolaridade da população, para garantir o êxito da prevenção, a fim de minimizar ou evitar o aparecimento de lesões...

This is a descriptive and quantitative study, performed in a population of 20 users of the Health Center in San Pedro Cholula State of Mexico, between February and May 2009 aiming to identify patient’s knowledge in relation to diabetic foot care. A printed form was used as the instrument for data collection, it contains sociodemographic and foot care for diabetic patients. It was found that 55% of patients were at an age over than 60; 85% were female, married and envolved with household activities. A high percentage of them know the basic care: washing, drying, lubrication and cutting nails. The population of this study has no clear information about their disease, thus they require the information to prevent diabetic foot amputations. The nurse needs to improve the teaching methods according to the level of education of the population to ensure the success of prevention to minimize or prevent the onset of injury...

[Research on conventional and molecular epidemiology of tuberculosis in Orizaba, Veracruz, 1995-2008]. / Investigación sobre epidemiología convencional y molecular de tuberculosis en Orizaba, Veracruz, 1995-2008.

This study describes the achievements of the Mexican Consortium against Tuberculosis, in the Sanitary District of Orizaba, Veracruz, Mexico between 1995 and 2008. In brief, the main results can be classified as follows: 1) Conventional and molecular epidemiology (measurement of burden of disease, trends, risk factors and vulnerable groups, consequences of drug resistance, identification of factors that favor nosocomial and community transmission); 2) Development of diagnostic techniques to detect drug resistance, description of circulating clones and adaptation of simple techniques to be used in the field; 3) Evaluation of usefulness of tuberculin skin test, immunologic responses to BCG, impact of directly observed therapy for tuberculosis (DOTS), and study of immunological biomarkers and 4) Comments on ethical aspects of tuberculosis research. Additionally, we describe the impact on public policies, transference of technology, capacity building and future perspectives.

Antiproliferative effect of sera from chagasic patients on Trypanosoma cruzi epimastigotes. Involvement of xanthine oxidase.

Serum from asymptomatic or symptomatic (with cardiovascular manifestations) chagasic patients depleted of the complement system displayed an antiproliferative effect on Trypanosoma cruzi epimastigotes, RA strain, when added to the growth medium. This effect was also observed when patient's serum was depleted of specific antibodies. The antiproliferative effect was both time and concentration dependent. It was confined to the non-dialyzable, high molecular weight, fraction of the serum. This effect was abrogated by allopurinol and catalase, and enhanced by N-ethylmaleimide. Xanthine oxidoreductase and xanthine oxidase activities were increased in the chagasic sera, while catalase activity remained unchanged. Parasites exposed to chagasic sera showed a decrease in Fe/superoxide dismutase activity as well as an increase in membrane lipoperoxidation. Our data provides evidence to support the idea that the antiproliferative activity observed in sera from chagasic patients may be due, at least partially, to a direct effect of hydrogen peroxide on the epimastigotes of T. cruzi. The increase of hydrogen peroxide to antiproliferative levels might result from an increase in xanthine oxidase activity in the serum of patients infected with the parasite.

Investigación sobre epidemiología convencional y molecular de tuberculosis en Orizaba, Veracruz, 1995-2008 / Research on conventional and molecular epidemiology of tuberculosis in Orizaba, Veracruz, 1995-2008

Se describen los resultados de investigación del Consorcio Mexicano contra la Tuberculosis, en la Jurisdicción Sanitaria de Orizaba, Veracruz, entre 1995 y 2008. Las aportaciones principales de los trabajos se refieren a los siguientes rubros: 1. Epidemiología convencional y molecular (medición de la carga de la enfermedad, tendencias, factores de riesgo y grupos vulnerables; descripción de las consecuencias de la farmacorresistencia e identificación de factores que favorecen la transmisión en la comunidad y en los hospitales). 2. Desarrollo de técnicas rápidas para conservación de muestras respiratorias que permitan el aislamiento y diagnóstico de farmacorresistencia de M. tuberculosis en campo. 3. Evaluación de la prueba tuberculínica, respuesta inmunológica al Bacilo de Calmette-Guerin (BCG), biomarcadores de la respuesta inmunitaria y medidas de control. 4. Comentarios en torno a aspectos éticos de la investigación en tuberculosis. Además se describe el impacto en políticas públicas, la transferencia de tecnología, la formación de recursos humanos y las perspectivas a futuro.

This study describes the achievements of the Mexican Consortium against Tuberculosis, in the Sanitary District of Orizaba, Veracruz, Mexico between 1995 and 2008. In brief, the main results can be classified as follows: 1) Conventional and molecular epidemiology (measurement of burden of disease, trends, risk factors and vulnerable groups, consequences of drug resistance, identification of factors that favor nosocomial and community transmission); 2) Development of diagnostic techniques to detect drug resistance, description of circulating clones and adaptation of simple techniques to be used in the field; 3) Evaluation of usefulness of tuberculin skin test, immunologic responses to BCG, impact of directly observed therapy for tuberculosis (DOTS), and study of immunological biomarkers and 4) Comments on ethical aspects of tuberculosis research. Additionally, we describe the impact on public policies, transference of technology, capacity building and future perspectives.

Carcinomas renales poco frecuentes / Infrequent renal tumors

En los últimos 10 años se han descrito algunos tumores renales poco frecuentes, algunos de los cuales se han incluido en la nueva clasificación de tumores renales de la Organización Mundial de la Salud (2004); otros, como el carcinoma tubuloquístico, no han sido bien caracterizados y estudiados, en gran parte por lo poco frecuentes, y por lo tanto no se han incluido en dicha clasificación. En este artículo revisamos el conocimiento actual acerca de tres de estos tumores: carcinoma renal mucinoso tubular y de células fusiformes, carcinoma de células renales asociado a la translocación Xp11.2/gen de fusión TFE3 y carcinoma tubuloquístico.

Quilty effect areas are frequently associated with endocardial C4d deposition.

BACKGROUND: The meaning and clinical implications of the Quilty effect (QE) are not entirely clear. In some biopsies we have found complement split C4d deposition in QE areas, but we do fully comprehend the frequency or pathogenic relationships involved. The objective of this study was to gain insight into the immunologic events involved in the QE, and to understand if and how it relates to complement activation. METHODS: Protocol allograft biopsies (January to December 2005) with evidence of the QE, without cellular rejection or changes suspicious for antibody-mediated rejection, were selected for C4d, CD3, CD20 and CD68 immunohistochemistry. RESULTS: Among 128 allograft biopsies (42 patients), 17 (11 patients) fulfilled the inclusion criteria. Eleven of the 17 biopsies (64.7%), from 8 patients, showed C4d deposition in the endocardium; the positivity was interestingly linear in the endocardium and surrounded by the lymphocytes forming the Quilty lesion. In some cases, the linear C4d deposition extended to the endocardium surrounding the QE area. This pattern was not detected in any of 66 heart allograft biopsies without the QE. B cells were second to T cells in their contribution to the QE, comprising a median of 40% (range, 20% to 50%) of the cells. C4d deposition was not associated with clinical alterations. CONCLUSIONS: The QE is frequently associated with C4d deposition in the endocardium of patients without evidence of rejection. This event suggests a pathogenic relationship between the QE and complement activation. It is possible that the simultaneous presence of both features in an allograft heart biopsy, without evidence of rejection, indicates better adaptation of allograft to host ("accommodation"); however, the precise meaning and implications are not yet known.

Polyamines as a defense mechanism against lipoperoxidation in Trypanosoma cruzi.

The polyamines, spermine and spermidine--organic polycations that are absolutely required for eukaryotic cell growth--are shown here to function in Trypanosoma cruzi epimastigotes, as protectors of membrane lipoperoxidation by reactive oxygen species generated either by H2O2/Fe2+ or nifurtimox. In vitro, spermine and spermidine inhibited lipoperoxidation in a dose dependent manner. Spermine was more efficient than spermidine in its inhibitory effect. Lipid peroxidation induced by H2O2 showed an IC50 of 0.55 mM for spermine and 0.9 mM for spermidine while an IC50 of 0.8 mM for spermine and 1.5 mM for spermidine were observed when lipoperoxidation was elicited by nifurtimox. Likewise in vivo, both exogenously added spermine and spermidine or endogenous increase of spermine levels induced by phorbol ester, protected against lipoperoxidation and decreased citotoxicity provoked by nifurtimox. Putrescine and cadaverine, also present in T. cruzi had no effect at all. None of the polyamines had any effect neither on the scavenging of superoxide anion nor on the regulation of antioxidant enzymes such as superoxide dismutase and peroxidases involved in H2O2 detoxification. Here we point out that spermine, by acting as a protector of membrane lipoperoxidation might contribute to survival of T. cruzi continuously exposed to oxidative stress.

[Pleura's solitary fibrous tumor. Clinical pathology analysis of 17 cases]. / Tumor fibroso solitario de la pleura. Análisis clínico-patológico de 17 casos.

INTRODUCTION: Solitary fibrous tumor of the pleura (SFTP) is a rare neoplasm that usually originates from the visceral pleura, but it can occur in a wide range of tissues. Approximately 12% of pleural cases are malignant tumors and surgical excision usually become curative. The objective of this study is to present 17 new cases of SFTP and analyze the morphological characteristics that help to identify tumors with a malignant behavior. MATERIAL AND METHODS: We did a retrospective review of the patients who had primary pleural tumors from January 1995 to August 2005. RESULTS: Among a total of 94 primary pleural tumors, 17 patients were enrolled in this study, 8 men and 9 women, with a mean age of 63 years. Thirteen cases (76%) were benign and four cases (23%) were malignant. Local recurrences occurred in three cases. There were no metastases found. Recurrences occurred only in malignancy tumors. All malignant tumors were high cellularity and had hemiangiopericitic pattern, more than 4 mitoses per 10 high power fields, and moderate to marked polymorphism. CONCLUSIONS: SFTP shows a benign biologic outcome in most of the cases. There are some histological characteristics that led to distinguish between benign and malign neoplasm.

Programa de uso racional de antimicrobianos en el Hospital de Emergencias Grau, EsSalud / Program of rational use of antimicrobial in the Emergency Hospital Grau, ESSalud

Se evalúa el Programa de uso Racional de Antimicrobianos de Reserva que se ejecutó en el Hospital Grau-Essalud, Lima Perú, de enero a diciembre del 2001, teniendo en cuenta tres aspectos: Patrón de consumo de cinco Antimicrobianos de Reserva, Identificación de prescripciones inadecuadas más frecuentes de AMR e impacto económico de la intervención, estimado ahorro en cinco Antimicrobianos de Reserva: ceftriaxona, ceftazidina, ciprofloxacina E.V vancomicina e imipenem/cilastatina. La Neumonía (31 por ciento), la ITU (15.2 por ciento) y la Sepsis severa sin diagnóstico de origen (14.1 por ciento) fueron las razones más frecuentes para requerir el uso de AMR. Los diagnósticos básicos de enfermedad: Accidente Cerebro Vascular (14.3 por ciento), diabetes (13.8 por ciento), cardiomiopatía de diversas causas (5.4 por ciento), Infección por VIH (4.9 por ciento), Neoplasia Maligna (4.6 por ciento), Enfermedad Pulmonar Obstructiva Crónica (EPOC) (4.2 por ciento) y Postración Crónica con el 3.8 por ciento; totalizando el 50.8 por ciento de los casos. El Programa logró una reducción del gasto inencesario de S/.633.838 nuevos soles en el año 2001 equivalentes a $181,256 dólares americanos. No hubo diferencia significativa entre estancia, egresos ni mortalidad comparados antes y después de la intervención. Los usos inadecuados observados frecuentemente, fueron identificados y enlistados en cuadros para cada uno de los cinco antimicrobianos evaluados.