Neurodevelopmental delay in children exposed to maternal SARS-CoV-2 in-utero.

It is unclear if SARS CoV-2 infection during pregnancy is associated with adverse neurodevelopmental repercussions to infants. We assessed pediatric neurodevelopmental outcomes in children born to mothers with laboratory-confirmed SARS CoV-2 infection during pregnancy. Neurodevelopmental outcomes of in-utero exposed children were compared to that of pre-pandemic control children in Los Angeles (LA), CA, USA and Rio de Janeiro, Brazil. Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III), the gold standard tool for evaluating neurodevelopment until 36 months of age and Ages and Stages Questionnaires (ASQ-3), a frequently used screening instrument for evaluating neurodevelopment in this same age group were the assessment tools used. Developmental delay (DD) was defined as having a score < - 2 SD below the norm (< 70) in at least one of three Bayley-III domains, (cognitive, motor or language) or a score below the cut-off (dark zone) in at least one of five ASQ-3 domains (communication, gross motor, fine motor, problem solving, personal-social). Exposed children were born between April 2020 and December 2022 while control children were born between January 2016 to December 2019. Neurodevelopmental testing was performed in 300 children total: 172 COVID-19 exposed children between 5-30 months of age and 128 control children between 6-38 months of age. Bayley-III results demonstrated that 12 of 128 exposed children (9.4%) had DD versus 2 of 128 controls (1.6%), p = 0.0007. Eight of 44 additional exposed children had DD on ASQ-3 testing. Fully, 20 of 172 exposed children (11.6%) and 2 of 128 control children (1.6%), p = 0.0006 had DD. In Rio, 12% of exposed children versus 2.6% of controls, p = 0.02 had DD. In LA, 5.7% of exposed children versus 0 controls, p = 0.12 had DD. Severe/critical maternal COVID-19 predicted below average neurodevelopment in the exposed cohort (OR 2.6, 95% CI 1.1-6.4). Children exposed to antenatal COVID-19 have a tenfold higher frequency of DD as compared to controls and should be offered neurodevelopmental follow-up.

Escenarios para el diagnóstico de encefalopatía hipóxico isquémica e inicio de tratamiento con hipotermia controlada en recién nacidos con asfixia perinatal / Scenarios for the diagnosis of hypoxic-ischemic encephalopathy and initiation of therapeutic hypothermia treatment in newborns with perinatal asphyxia / Cenários para o diagnóstico da encefalopatia hipóxico-isquemia e início de tratamento de hipotermia terapêutica a recém-nascidos com asfixia perinatal

La hipoxia isquemia perinatal y su complicación más temida, la encefalopatía hipóxica isquémica, continúa siendo uno de los principales motivos de ingreso a las unidades de cuidados neonatales. En la actualidad la hipotermia controlada es el tratamiento recomendado para los pacientes con encefalopatía moderada a severa, dado su carácter de neuroprotección ante la injuria cerebral hipóxico isquémica. Si bien los criterios de inclusión en esta terapia han sido bien establecidos, aún hay dificultades tanto en la identificación precoz de aquellos que pueden verse beneficiados, como en la toma de decisiones ante situaciones de controversia entre la evidencia disponible y la que se está gestando en estudios en curso. Este artículo pretende aportar herramientas al clínico para abordar diferentes escenarios que surgen de la práctica diaria.

Perinatal hypoxic ischemia and its most feared complication, hypoxic ischemic encephalopathy, remain one of the main reasons for admission to neonatal care. Controlled hypothermia is currently the recommended treatment for patients with moderate to severe encephalopathy, given its neuroprotective nature against hypoxic-ischemic brain injury. Although the inclusion criteria for this therapy have been well established, there are still difficulties both in the early identification of those who may benefit, and in making decisions regarding situations of controversy between the available evidence and that being developing in ongoing studies. This paper aims at providing tools so that clinicians can address different scenarios that arise during their daily practice.

A hipóxia isquêmica perinatal e sua complicação mais temida, a encefalopatia hipóxico-isquêmica, continuam sendo um dos principais motivos de internação em unidades de cuidados neonatais. A hipotermia controlada é atualmente o tratamento recomendado para pacientes com encefalopatia moderada a grave, dada a sua natureza neuroprotetora contra lesão cerebral hipóxico-isquêmica. Embora os critérios de inclusão dessa terapia estejam bem estabelecidos, ainda há dificuldades tanto na identificação precoce daqueles que podem se beneficiar, quanto na tomada de decisões em situações de controvérsia entre as evidências disponíveis e aquelas que estão se desenvolvendo em estudos em andamento. Este paper tem como objetivo fornecer ferramentas aos clínicos para abordar diferentes cenários que surgem da prática diária.

Implementación de paquete de medidas de conductas perinatales en recién nacidos con gastrosquisis congénita / Implementation of a perinatal bundles measures in newborns with congenital gastroschisis / ¿Implementação de um pacote de medidas comportamentais perinatais em recém-nascidos com gastrosquise congénita

Introducción: la gastrosquisis congénita (GC) es una patología con creciente demanda asistencial. Atentos a esto, en el Centro Hospitalario Pereira Rossell (CHPR) se implementó un protocolo de cuidados llevado adelante por un equipo multidisciplinario. En este trabajo nos proponemos evaluar el impacto en la sobrevida y morbilidad a partir de su aplicación. Material y método: estudio comparativo tipo antes y después de pacientes portadores de GC (n = 47), 29 de una cohorte histórica (GH) y 18 de una cohorte posaplicación de protocolo (GP). Con edad gestacional ≥ 36 semanas y peso al nacer ≥ 2500 g, asistidos en el CHPR entre los años 2016 y 2021. Resultados: no se observaron diferencias perinatales entre ambos grupos, ni en la incidencia de GQ complicadas. En el GP se observó mayor incidencia de cierre abdominal precoz (p < 0,01), menor necesidad de realización de silo quirúrgico (p < 0,01), menor tiempo de administración de ventilación mecánica (p = 0,03), de uso total de opioides (p < 0,01), de administración de nutrición parenteral (p = 0,03), e inicio más temprano de la alimentación enteral (p = 0,03). Sin diferencias en la sobrevida al egreso hospitalario. Conclusiones: la aplicación de un protocolo estandarizado se asoció a una reducción significativa en el tiempo de cierre abdominal, de ventilación mecánica, nutrición parenteral y de opioides, con inicio más precoz de la nutrición enteral.

Introduction: congenital gastroschisis is an increasingly demanded pathology, therefore a care protocol was implemented at the Pereira Rossell Pediatric Hospital (CHPR), and it has been carried out by a multidisciplinary team. In this paper, we aim at assessing the morbidity and mortality impact of survival and morbidity of this application. Materials and Methods: comparative before and after study of a historical cohort (GH, n=29) versus a post-protocol application cohort (GP, n=18), in patients with a gestational age ≥36 weeks and birth weight ≥2500 grams assisted in CHPR between 2016-2021. Results: no perinatal differences were observed between both groups or in the incidence of complicated GQ. In the GP, a higher incidence of early abdominal closure was decreased (GH 3.4% vs GP 67%, p<0.01), less need to perform a surgical silo (GH 100% vs GP 33%, p<0.01 ), shorter mechanical ventilation administration time (GH 2 days vs GP 0.5 days, p=0.03), total use of opioids (GH 3.5 days vs GP 7 days, p<0.01) , of administration of parenteral nutrition (GH 24.5 days vs GP 20 days, p=0.03), and earlier start of enteral feeding (GH 11 days vs GP 7 days, p=0.03). No differences in survival after hospital discharge (93% vs 89%, p=0.63). Conclusions: the application of a standardized protocol was linked to a significant reduction in the time of abdominal closure, mechanical ventilation, parenteral nutrition, and opioids, with earlier initiation of enteral nutrition.

Introdução: a gastrosquise congênita (GC) é uma patologia com demanda crescente de atendimento e, porém, foi implementado um protocolo de atendimento por equipe multidisciplinar no Centro Hospitalar Pediátrico Pereira Rossell (CHPR). Neste trabalho propomos avaliar o impacto na mortalidade e morbidade depois de sua aplicação. Material e Métodos: estudo comparativo antes e depois de pacientes com CG (n=47), sendo 29 de uma coorte histórica (GH) e 18 de uma coorte pós-aplicação de protocolo (GP). Idade gestacional ≥ 36 semanas e peso ao nascer ≥ 2.500 gramas atendidos no CHPR entre os anos de 2016-2021. Resultados: não foram observadas diferenças perinatais entre os dois grupos ou na incidência de QG complicada. No GP observou-se maior incidência de fechamento abdominal precoce (p<0,01), menor necessidade de silos cirúrgicos (p<0,01), menor tempo de administração de ventilação mecânica (p=0,03) e uso total de opioides. (p<0,01), administração de nutrição parenteral (p=0,03) e início mais precoce da alimentação enteral (p=0,03). Não houve diferenças na sobrevivência até a alta hospitalar. Conclusões: a aplicação de protocolo padronizado foi associada à redução significativa do tempo de fechamento abdominal, ventilação mecânica, nutrição parenteral e opioides, com início mais precoce da nutrição enteral.

Neuromotor repertoires in infants exposed to maternal COVID-19 during pregnancy: a cohort study.

OBJECTIVE: To evaluate neuromotor repertoires and developmental milestones in infants exposed to antenatal COVID-19. DESIGN: Longitudinal cohort study. SETTING: Hospital-based study in Los Angeles, USA and Rio de Janeiro, Brazil between March 2020 and December 2021. PARTICIPANTS: Infants born to mothers with COVID-19 during pregnancy and prepandemic control infants from the Graz University Database. INTERVENTIONS: General movement assessment (GMA) videos between 3 and 5 months post-term age were collected and clinical assessments/developmental milestones evaluated at 6-8 months of age. Cases were matched by gestational age, gender and post-term age to prepandemic neurotypical unexposed controls from the database. MAIN OUTCOME MEASURES: Motor Optimality Scores Revised (MOS-R) at 3-5 months. Presence of developmental delay (DD) at 6-8 months. RESULTS: 239 infants were enrolled; 124 cases (83 in the USA/41 in Brazil) and 115 controls. GMA was assessed in 115 cases and 115 controls; 25% were preterm. Median MOS-R in cases was 23 (IQR 21-24, range 9-28) vs 25 (IQR 24-26, range 20-28) in controls, p<0.001. Sixteen infants (14%) had MOS-R scores <20 vs zero controls, p<0.001. At 6-8 months, 13 of 109 case infants (12%) failed to attain developmental milestones; all 115 control infants had normal development. The timing of maternal infection in pregnancy (first, second or third trimester) or COVID-19 disease severity (NIH categories asymptomatic, mild/moderate or severe/critical) was not associated with suboptimal MOS-R or DD. Maternal fever in pregnancy was associated with DD (OR 3.7; 95% CI 1.12 to 12.60) but not suboptimal MOS-R (OR 0.25; 95% CI 0.04 to 0.96). CONCLUSIONS: Compared with prepandemic controls, infants exposed to antenatal COVID-19 more frequently had suboptimal neuromotor development.

Intravenous infusion of mesenchymal stem cells for refractory systemic sclerosis management: TWo-year follow-up

Systemic sclerosis is an autoimmune disease whose etiology remains unknown. Some patients prove refractory and require other therapies. Recently, the use of mesenchymal stem cells (MSC) for the treatment of disease refractory to conventional treatments has been considered. We present a case of refractory systemic sclerosis; Wharton's jelly mesenchymal stem cell was given in response. Decrease in perioral wrinkles, reduced telangiectasia and decrease in modified Rodnan skin score were observed two years later. A decrease in brain natriuretic peptide and improved pulmonary function were also found. And improvement of pulmonary fibrosis on high resolution tomography and capillaroscopy changes. In conclusion, MSC infusion seems to be effective and safe treatment of refractory scleroderma

La esclerosis sistémica es una enfermedad autoinmune de etiología desconocida y difícil manejo. Algunos casos que se tornan refractarios requieren terapias alternativas, como las células madre mesenquimales (MSC). Presentamos un caso de esclerosis sistémica refractaria que se llevó a terapia con MSC de gelatina de Wharton. Tras dos años, se observó ∗ Corresponding disminución en arrugas peribucales, aumento en apertura bucal, reducción de telangiectasias y en Rodnan modificado. También hubo disminución del péptido natriurético cerebral y mejora de pruebas de función pulmonar desde los seis meses de seguimiento, con mejoría en fibrosis pulmonar en tomografía de alta resolución y cambios en la capilaroscopia. En conclusión, el tratamiento con infusión de MSC parece efectivo y seguro en esclerosis sistémica refractaria.

Interacción social: Experiencias de mujeres positivas a COVID-19 con riesgo perinatal / Social Interaction: The experiences of COVID-19 positive women with perinatal risk

Resumen La pandemia COVID-19 provocó cambios en la dinámica de la vida de las mujeres en etapa perinatal quienes, ante la crisis sanitaria reconfiguraron prácticas de cuidado y convivencia social. El objetivo fue conocer a través de la interacción social algunas experiencias de mujeres con embarazo de alto riesgo positivas a COVID-19. El trabajo se realizó en un hospital de tercer nivel de atención perinatal. Se empleó metodología cualitativa, se aplicaron cuestionarios y entrevistas a 14 mujeres positivas a COVID-19 en etapa perinatal vía zoom. Se realizó análisis crítico-interpretativo del discurso con base al concepto interacción social y el pensamiento complejo. Para los resultados se desarrollaron tres tipos de interacción social: a) Interacción social primaria: Experiencias ante la notificación de la positividad al COVID-19; b) Interacción social aprendida: Experiencias del cuidado ante el COVID-19; y c) Interacción social resiliente: Experiencias necesarias ante el COVID-19. El vínculo de las experiencias desemboca en nuevas formas de interacciones sociales que van desde la notificación pasando por el cuidado y la resiliencia. Concluimos que las experiencias por el COVID-19 vividas por mujeres en etapa perinatal reinventaron sus modos de convivencia y cuidado dentro de lo institucional, familiar y personal.

Abstract The COVID-19 pandemic induced changes in the dynamics of the life of women in the perinatal phase who, due to the health crisis, restructured social care and coexistence practices. The scope of this paper was to assess the experiences of high-risk perinatal pregnancy risk among COVID-19 positive women through social interaction. The work was conducted in a hospital of tertiary perinatal care. Qualitative methodology was used, whereby questionnaires and interviews were conducted via zoom with 14 COVID-19 positive women in the perinatal phase. Critical-interpretative discourse analysis was applied based on the concept of social interaction and complex thinking. Three types of social interaction were developed to assess the results: a) Initial social interaction: experiences when becoming aware of being COVID-19 positive; b) Acquired social interaction: experiences of care prior to COVID-19; c) Enduring social interaction: experience required in the face of COVID-19. The result of experience leads to new forms of social interaction after notification ranging from care to resilience. The conclusion drawn is that the experience of COVID-19 of women in the perinatal period remodeled their ways of coexistence and care within the institutional, family, and personal spheres.

[Social Interaction: The experiences of COVID-19 positive women with perinatal risk]. / Interacción social: Experiencias de mujeres positivas a COVID-19 con riesgo perinatal.

The COVID-19 pandemic induced changes in the dynamics of the life of women in the perinatal phase who, due to the health crisis, restructured social care and coexistence practices. The scope of this paper was to assess the experiences of high-risk perinatal pregnancy risk among COVID-19 positive women through social interaction. The work was conducted in a hospital of tertiary perinatal care. Qualitative methodology was used, whereby questionnaires and interviews were conducted via zoom with 14 COVID-19 positive women in the perinatal phase. Critical-interpretative discourse analysis was applied based on the concept of social interaction and complex thinking. Three types of social interaction were developed to assess the results: a) Initial social interaction: experiences when becoming aware of being COVID-19 positive; b) Acquired social interaction: experiences of care prior to COVID-19; c) Enduring social interaction: experience required in the face of COVID-19. The result of experience leads to new forms of social interaction after notification ranging from care to resilience. The conclusion drawn is that the experience of COVID-19 of women in the perinatal period remodeled their ways of coexistence and care within the institutional, family, and personal spheres.

La pandemia COVID-19 provocó cambios en la dinámica de la vida de las mujeres en etapa perinatal quienes, ante la crisis sanitaria reconfiguraron prácticas de cuidado y convivencia social. El objetivo fue conocer a través de la interacción social algunas experiencias de mujeres con embarazo de alto riesgo positivas a COVID-19. El trabajo se realizó en un hospital de tercer nivel de atención perinatal. Se empleó metodología cualitativa, se aplicaron cuestionarios y entrevistas a 14 mujeres positivas a COVID-19 en etapa perinatal vía zoom. Se realizó análisis crítico-interpretativo del discurso con base al concepto interacción social y el pensamiento complejo. Para los resultados se desarrollaron tres tipos de interacción social: a) Interacción social primaria: Experiencias ante la notificación de la positividad al COVID-19; b) Interacción social aprendida: Experiencias del cuidado ante el COVID-19; y c) Interacción social resiliente: Experiencias necesarias ante el COVID-19. El vínculo de las experiencias desemboca en nuevas formas de interacciones sociales que van desde la notificación pasando por el cuidado y la resiliencia. Concluimos que las experiencias por el COVID-19 vividas por mujeres en etapa perinatal reinventaron sus modos de convivencia y cuidado dentro de lo institucional, familiar y personal.

The burden of the most common rheumatic disease in Colombia.

BACKGROUND: Estimating the burden of rheumatic diseases (RDs) requires proper evaluation of its lethal and nonlethal consequences. In Colombia, it is possible to find local data and Global Burden of Disease (GBD) reports that collect information from varied contexts and apply complex statistical models, but no on-site estimations are available. METHODS: This was a descriptive study on the burden of RD based on occurrence and mortality data in the general population during 2015, including information and prevalence estimations from the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) study. Disability-adjusted life years (DALYs) were estimated by combining measures of years of life lost (YLL) and years lived with disability (YLDs). For disability weight estimations among cases, different COPCORD responses were mapped using flowcharts to show the severity distribution according to GBD. All model parameters and results were validated through an expert consensus panel. RESULTS: Low back pain (LBP) was the RD with the greatest burden of disease, costing 606.05 (95% CI 502.76-716.58) DALYs per 100,000 inhabitants, followed by osteoarthritis (292.11; 95% CI 205.76-386.85) and rheumatoid arthritis (192.46, 95% CI 109.7-239.69). CONCLUSIONS: The burden of RD is as high in Colombia as in other countries of the region. The results offer an interesting tool for optimizing healthcare system design as well as for planning the distribution of human and economic resources to achieve early diagnosis and adequate care of these diseases.

Não é somente sobre Kevin que precisamos falar / No es solo Kevin de quien tenemos que hablar / It's not just Kevin that we need to talk about / Il n'y a pas que Kevin dont nous devons parler

O objetivo deste estudo consiste em apresentar uma análise do filme Precisamos falar sobre Kevin, partindo das reflexões teóricas de Jean Laplanche sobre a teoria da sedução generalizada. O artigo apresenta as contribuições teóricas do autor e de seus seguidores, principalmente no que diz respeito às mensagens enigmáticas e à construção de um modelo tópico e unificado do aparelho psíquico. A análise do filme permitiu chamar a atenção para os efeitos das vicissitudes da sedução, explorando as especificidades presentes na comunicação entre o adulto e a criança que repercutem sobre as possibilidades de tradução das mensagens enigmáticas e seus efeitos na constituição do psiquismo. Verifica-se a fecundidade do aporte teórico na compreensão do trauma psíquico infantil, uma vez que as consequências deste encontro assimétrico podem ser devastadoras e desorganizadoras, conforme elucidado pela história de Kevin

El objetivo de este estudio es presentar un análisis de la película Necesitamos hablar de Kevin, a partir de las reflexiones teóricas de Jean Laplanche sobre la teoría de la seducción generalizada. El artículo presenta los aportes teóricos del autor y sus seguidores, principalmente en lo que se refiere a los mensajes enigmáticos y la construcción de un modelo tópico y unificado del aparato psíquico. El análisis de la película permitió llamar la atención sobre los efectos de las vicisitudes de la seducción, explorando las especificidades presentes en la comunicación entre el adulto y el niño que inciden en las possibilidades de traducción de los mensajes enigmáticos y sus efectos en la constitución de la psique. Se verifica la fecundidad del aporte teórico en la comprensión del trauma psíquico infantil, ya que las consecuencias de este encuentro asimétrico pueden ser devastadoras y desorganizadoras, conforme esclarecido por la historia de Kevin

The aim of this study is to present an analysis of the film We need to talk about Kevin, based on the Jean Laplanche's theoretical reflections on the theory of generalized seduction. The article presents the theoretical contributions of the author and his followers, mainly with regard to the enigmatic messages and in the construction of a topical and unified model of the psychic apparatus. The film's analysis allowed to draw attention to the vicissitudes's effects of seduction, exploring the specificities present in the communication between the adult and child that reflect on the translation's possibilities of the enigmatic messages and their effects on the constitution of the psyche. It is verified the fecundity of the theoretical contribution to the understanding of the childhood psychic trauma, since the consequences of this asymmetrical encounter can be devastating and disorganizing, as elucidated by Kevin's story

Le but de cette étude est de présenter une analyse du film Nous devons parler de Kevin, à partir des réflexions théoriques de Jean Laplanche sur la théorie de la séduction généralisée. L'article présente les contributions théoriques de l'auteur et de ses adeptes, principalement en ce qui concerne les messages énigmatiques et dans la construction d'un modèle d'actualité et unifié de l'appareil psychique. L'analyse du film permis d'attirer l'attention sur les effets des vicissitudes de la séduction, explorant les spécificités présentes dans la communication entre l'adulte et l'enfant qui réfléchissent sur les possibilités de traduction des messages énigmatiques et leurs effets sur la constitution de la psyché. La fécondité de l'apport théorique à la compréhension du traumatisme psychique infantile est vérifiée, puisque les conséquencesde cette rencontre asymétrique peuvent être dévastatrices et désorganisantes, comme l'elucide par l'histoire de Kevin

Actos cotidianos de resistencia en el embarazo para prevenir la morbimortalidad materna / Everyday acts of resistance in pregnancy to prevent maternal morbidity and mortality

Resumen Objetivo: Analizar acciones de mujeres indígenas respecto a su cuidado durante el embarazo a través de prácticas cotidianas, nombradas como actos cotidianos de resistencia. Material y métodos: Se realizó un estudio cualitativo etnometodológico en Cuetzalan, Sierra Norte de Puebla, México; se aplicaron 93 cuestionarios a mujeres indígenas embarazadas; a 67 de ellas se les aplicaron entrevistas semiestructuradas. Se realizó análisis crítico del discurso. Resultados: Se identificaron tres actos cotidianos de resistencia para el cuidado del embarazo: 1) Convivencia comunitaria; 2) Movilidad para la atención prenatal, y 3) Saberes del cuidado del embarazo. En conjunto, los actos describen acciones preventivas de morbilidad partiendo de la percepción cultural de riesgo en mujeres embarazadas de un contexto sociocultural y económicamente vulnerable. Conclusiones: El conjunto de prácticas cotidianas para el cuidado del embarazo por las mujeres debe ser reconocido como acciones inmediatas de prevención en pro de la salud materna.

Abstract Objective: To analyze actions of indigenous women regarding their care during pregnancy through daily practices that we name as everyday acts of resistance. Materials and methods: A qualitative ethnomethodological study was carried out in Cuetzalan, Sierra Norte de Puebla, México; 93 questionnaires were applied to pregnant indigenous women, 67 of them were semi-structured interviews. Also, a critical discourse analysis was performed. Results: Three everyday acts of resistance were identified for pregnancy care: 1) Community coexistence; 2) Mobility for prenatal care, and 3) Beliefs in pregnancy care. Altogether the acts describe preventive morbidity actions based on the cultural perception of risk in pregnant women within a context sociocultural and economically vulnerability. Conclusions: The set of daily practices in prenatal care by women, must be recognized as immediate preventive actions in favor of maternal health.

Actos cotidianos de resistencia en el embarazo para prevenir la morbimortalidad materna.

Objetivo. Analizar acciones de mujeres indígenas respecto a su cuidado durante el embarazo a través de prácticas cotidianas, nombradas como actos cotidianos de resistencia. Material y métodos. Se realizó un estudio cualitativo etnometodológico en Cuetzalan, Sierra Norte de Puebla, México; se aplicaron 93 cuestionarios a mujeres indígenas embarazadas; a 67 de ellas se les aplicaron entrevistas semiestructuradas. Se realizó análisis crítico del discurso. Resultados. Se identificaron tres actos cotidianos de resistencia para el cuidado del embarazo: 1) Convivencia comunitaria; 2) Movilidad para la atención prenatal, y 3) Saberes del cuidado del embarazo. En conjunto, los actos describen acciones preventivas de morbilidad partiendo de la percepción cultural de riesgo en mujeres embarazadas de un contexto sociocultural y económicamente vulnerable. Conclusiones. El conjunto de prácticas cotidianas para el cuidado del embarazo por las mujeres debe ser reconocido como acciones inmediatas de prevención en pro de la salud materna.

Vitamin D Status and Its Determinants in Mexican Pregnant Women from a Rural and an Urban Area: A Comparative Study.

BACKGROUND: During pregnancy, vitamin D requirements are higher due to fetal growth and development. Vitamin D production occurs mainly through sunlight exposure, which is affected by geographic location and lifestyle factors. METHODS: This was a case-control study nested within two cohorts of adult pregnant women (n = 298): urban (Mexico City) and rural (Cuetzalan). To reduce confounding, pairs were selected by age, pregestational body mass index, and pregnancy trimester. Generalized linear models were used to assess the two groups according to their vitamin D status. RESULTS: A total of 298 adult women were studied: 149 from a rural area and 149 from an urban area. Vitamin D deficiency and insufficiency were observed in 28% and 38.2% of women, respectively. A trend for higher 25(OH)D concentrations was observed in women from the rural area (27.5 ng/mL vs. 25.8 ng/mL), probably related to the type of job, where women with partial jobs showing less probability of having vitamin D deficiency (OR = 0.26; CI = 0.06-1.16; p = 0.08) and vitamin D insufficiency (OR = 0.24; CI = 0.06-0.99; p = 0.05). Women whose Last Menstrual Period occurred in spring showed lower vitamin D concentration compared to those whose LMP occurred in winter (p < 0.01). CONCLUSIONS: A high prevalence of vitamin D deficiency was observed in both rural and urban areas. Women living in rural areas tended to have higher 25(OH)D concentrations, probably related to more sunlight exposure associated with their type of job.

Removal of nickel(II) from wastewater using a zeolite-packed anaerobic bioreactor: Bacterial diversity and community structure shifts.

In recent years, overexploited industrialization and urbanization activities have led to significant amounts of heavy metals released into the environment. Metal ion contamination of water, especially with toxic metals such as nickel(II) [Ni(II)], which is extensively applied in the electroplating industry, has been a serious problem. The aim of the present study was to evaluate the Ni(II) removal from real industrial wastewater using a 2 L, lab-scale, up-flow, anaerobic, zeolite-packed bioreactor inoculated with a heterotrophic consortium as the bioadsorbent. High-throughput sequencing of 16S rRNA genes revealed significant shifts in their bacterial diversity and structural composition along the bioreactor treatment location, where the bacterial genus was dominated by Kosmotogae followed by Firmicutes as Ruminococcus and Clostridium. However, Fervidobacterium and the Geobacter genus were absent at the end of the bioreactor treatment, suggesting that they play a key role in the beginning of Ni(II) removal anaerobic treatment. The physico-chemical results revealed that the Ni(II) removal rate was 99% for 250-500 ppm metal tested, with an efficient alkalinity rate and high production of biogas, which confirmed that anaerobic digestion of microorganisms was successfully performed through the process. Finally, this anaerobic bioreactor configuration offers an accessible and ecofriendly high-rate metal removal strategy from mining and electroplating effluents.

Mesenchymal stromal cells represent a therapeutic option for systemic sclerosis patients / Células estromales mesenquimales representan una opción terapéutica en pacientes con esclerosis sistémica

ABSTRACT The mesenchymal stromal cells (MSCs) are hematopoietic stem cells with high capacity of differentiation to other cellular lineages, depending on the microenvironment in which they live as well as on the interaction and signaling pathways they establish with the extracellular matrix. Several properties have been described in these cells: proangiogenic, antifibrotic and immunomodulatory. These properties are being studied as a therapeutic approach for autoimmune diseases such as cutaneous systemic sclerosis (SSc). SSc is a systemic chronic disease, with an approximate prevalence of 35.6 cases per 100,000 inhabitants in North America and of 0.02% in Colombia in 2018. There are two different clinical variants, diffuse and localized. In both variants an important skin involvement and a rapidly deterioration of organs is present, which can overshadow the clinical prognosis and increase the mortality. Options for the treatment of advanced diffuse SSc are scarce mainly targeting symptomatic control with little impact on the progression and mortality. Therefore, there is an increasing interest in new therapies like advanced cellular therapy with hematopoietic stem cells and stromal mesenchymal cells. This article reviews the information related to the use of stromal mesenchymal cells in patients with this disease.

RESUMEN Las células mesenquimales estromales son células madre no hematopoyéticas pluripotenciales con alta capacidad de derivación a diferentes linajes celulares, dependiendo tanto del microambiente en el que se encuentren, como de la interacción y señalización que establezcan con la matriz extracelular del entorno, esto ha permitido describir un potencial proangiogénico, antifibrótico e inmunomodulador, que ha sido blanco de investigación en enfermedades autoinmunes como la esclerosis sistêmica cutánea. Considerando que la esclerosis sistêmica cutánea es una enfermedad inflamatoria crónica, con una prevalencia estimada de 35,6 casos por cada 100.000 habitantes en Norte América y de 0,02% en nuestro país para el 2018, se caracteriza por presentar dos variables clínicas principalmente; una variante limitada y una variante difusa, presentando en ambas un compromiso extenso de piel y órganos que puede ser rápidamente progresivo y deteriorar el pronóstico de los pacientes que la padecen aumentando su mortalidad. Debido a que las opciones terapéuticas en esta entidad son limitadas y buscan únicamente el control de síntomas, pero con poco impacto en progresión y mortalidad, terapias celulares avanzadas han surgido como nuevas opciones terapéuticas incluyendo el trasplante de células madre hematopoyéticas y las células mesenquimales estromales. A continuación, se revisará acerca de la utilidad y evidencia de células mesenquimales estromales en pacientes con esta enfermedad.

Trauma e testemunho em Ferenczi: uma análise de Vozes de Tchernóbil de Svetlana Aleksiévith / Trauma and testimony in Ferenczi: an analysis of Voices from Tchernóbil by Svetlana Aleksiévith / Trauma et témoin chez Ferenczi: une lecture du livre La Supplication de Svetlana Aleksiévitch / Trauma y testimonio en Ferenczi: una lectura de Voces de Chernóbil de Svetlana Aleksiévitch

O artigo aborda as noções de trauma e testemunho elaborados por Sándor Ferenczi e os articula com o livro Svetlana Aleksiévitch acerca do desastre nuclear de Tchernóbil. Nosso objetivo foi demonstrar a validade das observações de Ferenczi em relação a um trauma coletivo, organizado em torno de três eixos: a dissimetria relacional, o processo de desmentido e o narcisismo ferido. Através da leitura do livro pode-se compreender como a escritora teve seu papel aproximado daquele designado por Ferenczi.

This article approaches the concepts of trauma and testimony as elaborated by Sándor Ferenczi and associates them to Svetlana Aleksiévitch's book about the nuclear disaster of Chernobyl. It aims to show the value of Ferenczi's observations on collective trauma by highlighting three topics: relational dissymmetry, process of denial and wounded narcissism. Aleksiévitch's book allowed us to understand in what ways the author's role resembles the one described by Ferenczi.

Cet article discute les notions de traumatisme et de témoignage tels que développés par Sándor Ferenczi et les compare avec le livre de Svetlana Aleksiévitch sur la catastrophe nucléaire de Tchernobyl. Notre but est de montrer la valeur des observations de Ferenczi sur le traumatisme collectif, organisé autour de trois points : la dissymétrie relationnelle, le processus de déni et le narcissisme blessé. La lecture du livre d'Aleksiévitch permet de comprendre la façon dont le rôle de l'auteur se rapproche de celui désigné par Ferenczi.

Este artículo analiza las nociones de trauma y testimonio, elaborados por Sándor Ferenczi, y se articula con el libro de Svetlana Aleksiévitch sobre el desastre nuclear de Chernóbil. Nuestro objetivo fue demostrar la vigencia de las observaciones de Ferenczi con relación a un trauma colectivo, organizándose alrededor de tres ejes: la asimetría relacional, el proceso de negación y el narcisismo herido. A través de la lectura del libro se puede entender que el papel de la escritora se acercaba al designado por Ferenczi.

Association of ERAP2 polymorphisms in Colombian HLA-B27+ or HLA-B15+ patients with SpA and its relationship with clinical presentation: axial or peripheral predominance.

OBJECTIVE: To determine the association between endoplasmic reticulum aminopeptidase (ERAP)1 and ERAP2 single-nucleotide polymorphisms (SNPs) and human leukocyte antigens (HLA)-B27+ or HLA-B15+ patients with spondyloarthritis (SpA). METHODS: 104 patients with SpA according to Assessment of Spondyloarthritis International Society criteria were included in the study. HLA typing was performed by PCR. The polymorphisms were determined by real-time PCR on genomic DNA using customised probes for SNPs rs27044, rs17482078, rs10050860 and rs30187 in ERAP1, and rs2910686, rs2248374 and rs2549782 in ERAP2. RESULTS: 70 of the104 patients with SpA were HLA-B27+ and 34 were HLA-B15+. The distribution of ERAP1 and ERAP2 SNPs between the HLA-B15+ and HLA-B27+ patients with SpA did not reveal differences. Likewise, no differences in the frequencies of ERAP1 SNP haplotypes and alleles HLA-B15 or HLA-B27 were found. Interestingly, however, the frequencies of three particular haplotypes formed by ERAP2 SNPs rs2549782/rs2248374/rs2910686 varied between HLA-B15+ and HLA-B27+ patients: the ERAP2 SNPs haplotype TGT was more common in HLA-B15+ patients with SpA (OR 2.943, 95% CI 1.264 to 6.585; P=0.009), whereas the ERAP2 SNP haplotypes TGC and CAT were more associated with HLA-B27+ patients with SpA: (OR 4.483, 95% CI 1.524 to 13.187; p=0.003) and (OR 9.014, 95% CI 1.181 to 68.807; p=0.009), respectively. CONCLUSION: An association was found between HLA-B15+ patients with SpA and haplotype TGT of ERAP2 SNPs. On the other hand, HLA-B27+ patients with SpA were associated with ERAP2 haplotypes TGC and CAT. These associations could be related to the clinical presentation of the disease, specifically with a peripheral or axial predominance, respectively.

Carcinoma de pulmón como disparador de una respuesta autoinmune: un desafío médico / Lung cancer acting as a trigger of autoimmunity: a medical challenge

RESUMEN Existe una relación compleja, dinámica y bidireccional entre la autoinmunidad y el cáncer. Si bien los mecanismos carcinogénicos y fisiopatológicos de las enfermedades autoinmunes no están claramente dilucidados, existe una base inmunológica común relacionada con la expresión de autoantígenos por parte de las células tumorales que desencadenan una respuesta antitumoral, facilitando el desarrollo de síndromes paraneoplásicos reumáticos y enfermedades autoinmunes reumáticas en población genéticamente susceptible. Se presenta un caso de un hombre que debutó con un síndrome pulmón riñón y se diagnosticó cáncer de pulmón y lupus eritematoso sistémico de forma simultánea.

A B S T R A C T There is a complex, dynamic, and bidirectional connection between autoimmunity and cancer. The underlying mechanisms of carcinogenesis and physiopathological aspects of autoimmune diseases are not fully understood. However, there is a common immunological base related to expression of autoantigens by tumour cells that cause an anti-cancer immune response, thereby, triggering the development of paraneoplastic rheumatic syndromes and autoimmune rheumatic diseases in a genetically predisposed population. The case is reported of a 57 year-old man presenting with pulmonary renal syndrome, and who was diagnosed lung cancer and systemic lupus erythematosus at the same time.

Pharmacogenetic aspects of methotrexate in a cohort of Colombian patients with rheumatoid arthritis.

Methotrexate (MTX) is the most commonly used disease-modifying antirheumatic drug for the treatment of rheumatoid arthritis (RA). However, over time, ~40% of patients may experience therapeutic failure or drug toxicity. The genetic variability of the enzymes involved in the MTX metabolic pathway seem to serve an important role in the eventual therapeutic failure or drug toxicity. Depending on the enzymes affected, the toxicity or the therapeutic response may change. The present study reports some of the polymorphisms identified in enzymes in the MTX metabolic pathway that are present in a group of Colombian patients with RA, and assesses the associations of these polymorphisms with toxicity or therapeutic response to the medication. A total of 400 patients with RA were evaluated, of which 76% were women. the average age was 60.7±13.9 years and the duration of the disease was 13.2±10.9 years. The disease activity scoring method, DAS28-CRP, was used to evaluate the therapeutic response. Toxicity was determined based on reports of adverse events during the evaluation of the patients. The single nucleotide polymorphisms (SNPs) assessed using reverse transcription-PCR in the present study were MTHFR C677T, A1298C, ATIC C347G, RFC-1-G80A, FPGS-AG and DHFR-CT. The SNPs of MTHFR C677T (P=0.05) and A1298C (P=0.048) were significantly associated with the efficacy of MTX, and DHFR-CT (P=0.01) and ATIC C347 (P=0.005) were significantly associated with documented toxicity. Haematological, hepatic or renal toxicity was not associated with any of the SNPs. The results obtained in Colombian patients with RA receiving MTX are similar to those reported in other populations; however, the SNPs associated with a lack of response previously reported in the literature were not observed in our data. The SNPs identified in the present study may be used as biomarkers to predict response to MTX in terms of efficacy and toxicity in Colombian patients with RA.

Demographic and clinical characteristics of chikungunya patients from six Colombian cities, 2014-2015.

In 2014, the chikungunya virus reached Colombia for the first time, resulting in a nationwide epidemic. The objective of this study was to describe the demographics and clinical characteristics of suspected chikungunya cases. Chikungunya infection was confirmed by enzyme-linked immunosorbent assay and 548 patients where included in the study. Of these patients, 295 were positive for antibodies against chikungunya (53.8%), and 27.6% (151/295) were symptomatic for chikungunya infection, with a symptomatic:asymptomatic ratio of 1.04:1. Factors associated with infection included low income and low socio-economic strata (odds ratio [OR]: 1.8; 95% confidence interval [CI]: 1.0-3.2, p = 0.003 and OR: 2.1; CI: 1.3-3.4, p = 0.002, respectively). Confirmed symptomatic cases were associated with symmetric arthritis (OR: 11.7; CI: 6.0-23.0, p < 0.001) of ankles (OR: 8.5; CI: 3.5-20.9, p < 0.001), hands (OR: 8.5; CI: 3.5-20.9, p < 0.001), feet (OR: 6.5; CI: 2.8-15.3, p < 0.001), and wrists (OR: 17.3; CI: 2.3-130.5, p < 0.001). Our study showed that poverty is associated with chikungunya infection. Public health strategies to prevent and control chikungunya should focus on poorer communities that are more vulnerable to infection. The rate of asymptomatic infections among confirmed cases was 48.8%. However, those with symptoms displayed a characteristic rheumatic clinical picture, which could help differentiate chikungunya infection from other endemic viral diseases.