Bilateral Acute Retinal Necrosis Treated With Antivirals and Corticosteroids.

We report on the case of a Hispanic male with bilateral acute retinal necrosis (BARN), whose disease was managed with intravenous acyclovir, topical prednisolone, topical atropine, intravitreal ganciclovir, oral valacyclovir, and oral prednisone. The oral corticosteroid was added to his treatment regimen eight days after his initial presentation. The 55-year-old patient presented with a two-week history of bilateral blurred vision. His medical history was pertinent for remote varicella and herpes zoster (the latter limited to the forehead). His best-corrected visual acuity (BCVA) was counting fingers in both eyes (OU). His examination was remarkable in OU for grade 3+ cells, pharmacologically dilated pupils, and grade 2+ vitreous cells. The patient's fundus was remarkable in OU for optic-nerve swelling, vitreous condensation, ghost vessels, and retinitis patches. Given the clinical and ancillary testing results, an assessment of BARN was made. The patient received acyclovir treatment initially, and systemic steroids were introduced eight days later. He ultimately experienced significant clinical improvement.

Exploring the Influence of Spacers in EDTA-ß-Cyclodextrin Dendrimers: Physicochemical Properties and In Vitro Biological Behavior.

The synthesis of a new family of ethylenediaminetetraacetic acid (EDTA) core dimers and G0 dendrimers end-capped with two and four ß-cyclodextrin (ßCD) moieties was performed by click-chemistry conjugation, varying the spacers attached to the core. The structure analyses were achieved in DMSO-d6 and the self-inclusion process was studied in D2O by 1H-NMR spectroscopy for all platforms. It was demonstrated that the interaction with adamantane carboxylic acid (AdCOOH) results in a guest-induced shift of the self-inclusion effect, demonstrating the full host ability of the ßCD units in these new platforms without any influence of the spacer. The results of the quantitative size and water solubility measurements demonstrated the equivalence between the novel EDTA-ßCD platforms and the classical PAMAM-ßCD dendrimer. Finally, we determined the toxicity for all EDTA-ßCD platforms in four different cell lines: two human breast cancer cells (MCF-7 and MDA-MB-231), human cervical adenocarcinoma cancer cells (HeLa), and human lung adenocarcinoma cells (SK-LU-1). The new EDTA-ßCD carriers did not present any cytotoxicity in the tested cell lines, which showed that these new classes of platforms are promising candidates for drug delivery.

Synthesis of ß-Cyclodextrin-Decorated Dendritic Compounds Based on EDTA Core: A New Class of PAMAM Dendrimer Analogs.

In this work, two dendritic molecules containing an ethylenediaminetetraacetic acid (EDTA) core decorated with two and four ß-cyclodextrin (ßCD) units were synthesized and fully characterized. Copper(I)-catalyzed alkyne-azide cycloaddition (CuAAC) click chemistry under microwave irradiation was used to obtain the target compounds with yields up to 99%. The classical ethylenediamine (EDA) core present in PAMAM dendrimers was replaced by an EDTA core, obtaining platforms that increase the water solubility at least 80 times compared with native ßCD. The synthetic methodology presented here represents a convenient alternative for the rapid and efficient construction of PAMAM analogs. These molecules are envisaged for future applications as drug carriers.

Adhesion pathway proteins and risk of atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis.

BACKGROUND: The cellular adhesion pathway has been suggested as playing an important role in the pathogenesis of atrial fibrillation (AF). However, prior studies that have investigated the role of adhesion pathway proteins in risk of AF have been limited in the number of proteins that were studied and in the ethnic and racial diversity of the study population. Therefore we aimed to study the associations of fifteen adhesion pathway proteins with incident AF in a large, diverse population. METHODS: Multi-Ethnic Study of Atherosclerosis participants from four races/ethnicities (n = 2504) with protein levels measured were followed for incident AF (n = 253). HGF protein was measured on Exam 1 samples (N = 6669; AF n = 851). Cox proportional hazards regression was used to assess the association of AF with 15 adhesion pathway proteins. Bonferroni correction was applied to account for multiple comparisons. RESULTS: After adjusting for potential confounding variables (age, sex, race/ethnicity, height, body mass index, systolic blood pressure, antihypertension therapy, diabetes status, current smoker, current alcohol use, and total and HDL cholesterol), and accounting for multiple testing (P < 0.05/15 = 0.0033), circulating levels of the following proteins were positively associated with a higher risk of AF: MMP-2 (HR per standard deviation increment, 1.27; 95% CI 1.11‒1.45), TIMP-2 (HR 1.28; 95% CI 1.12‒1.46), VCAM-1 (HR 1.32; 95% CI 1.16‒1.50), and SLPI (HR 1.22; 95% CI 1.07‒1.38). The association between proteins and AF did not differ by race/ethnicity. CONCLUSIONS: Circulating levels of MMP-2, TIMP-2, VCAM-1, and SLPI were positively associated with an increased risk of incident AF in a diverse population. Our findings suggest that adhesion pathway proteins may be important risk predictors of AF.

Guest-Mediated Reversal of the Tumbling Process in Phosphorus-Dendritic Compounds Containing ß-Cyclodextrin Units: An NMR Study.

The conformational study of dendritic platforms containing multiple ß-cyclodextrin (ßCD) units in the periphery is relevant to determine the availability of ßCD cavities for the formation of inclusion complexes in aqueous biological systems. In this work, we performed a detailed conformational analysis in D2O, via 1D and 2D NMR spectroscopy of a novel class of phosphorus dendritic compounds of the type P3N3-[O-C6H4-O-(CH2)n-ßCD]6 (where n = 3 or 4). We unambiguously demonstrated that a functionalized glucopyranose unit of at least one ßCD unit undergoes a 360° tumbling process, resulting in a deep inclusion of the spacer that binds the cyclodextrin to the phosphorus core inside the cavity, consequently limiting the availability of the inner cavities. In addition, we confirmed through NMR titrations that this tumbling phenomenon can be reversed for all ßCD host units using a high-affinity guest, namely 1-adamantanecarboxylic acid (AdCOOH). Our findings have demonstrated that it is possible to create a wide variety of multi-functional dendritic platforms.

First Class of Phosphorus Dendritic Compounds Containing ß-Cyclodextrin Units in the Periphery Prepared by CuAAC.

A new class of phosphorus dendritic compounds (PDCs) having a cyclotriphosphazene (P3N3) core and decorated with six ß-cyclodextrin (ßCD) units, named P3N3-[O-C6H4-O-(CH2)n-ßCD]6, where n = 3 or 4 was designed, and the synthesis was performed using copper (I) catalyzed alkyne-azide cycloaddition (CuAAC). To obtain the complete substitution of the P3N3, two linkers consisting of an aromatic ring and an aliphatic chain of two different lengths were assessed. We found that, with both linkers, the total modification of the periphery was achieved. The two new obtained dendritic compounds presented a considerably high water solubility (>1 g/mL). The compounds comprised in this new class of PDCs are potential drug carrier candidates, since the conjugation of the ßCD units to the P3N3 core through the primary face will not only serve as surface cover but, also, provide them the faculty to encapsulate various drugs inside the ßCDs cavities.

Conformational analysis by NMR and molecular dynamics of adamantane-doxorubicin prodrugs and their assemblies with ß-cyclodextrin: A focus on the design of platforms for controlled drug delivery.

Nanoscale design and construction of affinity-based drug delivery systems (ADDS) is an active research area with enormous potential for the improvement of cancer treatment. For the therapeutic load of these ADDS, a promising strategy is the design of pH-sensitive prodrugs based on the construction of conjugates between adamantane and doxorubicin (Ad-Dox), which stands out as an excellent model system to obtain novel supramolecular materials. Construction of these prodrugs involves a modification of three zones of doxorubicin which in principle does not affect the action mechanism: the carbonyl group C13 (hydrazone linker), the primary alcohol neighboring the carbonyl (ester linker) and the 3' amino group of daunosamine sugar (amide linker). These modifications are aimed to improve the efficacy and reduce the systemic toxicity of the drug chemotherapy by controlling its release in cancer cells. In this work, we performed 2D NMR experiments and molecular dynamics simulations to characterize the conformational changes of three constructed prodrugs. Our results demonstrated that ring A and the daunsamine sugar of the hydrazone and amide linkers conserve the half-chair state 9H8, while the ester linker disrupts this conformation. Our study also showed that the hydrazone-linked compound (Ad-h-Dox) does not modify the conformation of the original drug and maintains cytotoxic activity. Moreover, the inclusion complex (IC) of Ad-h-Dox with ß-cyclodextrin (ßCD) generated a highly soluble platform in water, whereas the ester-linked compound (Ad-e-Dox) causes the loss of biological activity. This study proves that Ad-h-Dox prodrug can be an optimum prodrug and act as a building block for a more complex drug transport system.

Efficient modification of PAMAM G1 dendrimer surface with ß-cyclodextrin units by CuAAC: impact on the water solubility and cytotoxicity.

The toxicity of the poly(amidoamine) dendrimers (PAMAM) caused by the peripheral amino groups has been a limitation for their use as drug carriers in clinical applications. In this work, we completely modified the periphery of PAMAM dendrimer generation 1 (PAMAM G1) with ß-cyclodextrin (ß-CD) units through the Cu(i)-catalyzed azide-alkyne cycloaddition (CuAAC) to obtain the PAMAM G1-ß-CD dendrimer with high yield. The PAMAM G1-ß-CD was characterized by 1H- and 13C-NMR and mass spectrometry studies. Moreover, the PAMAM G1-ß-CD dendrimer showed remarkably higher water solubility than native ß-CD. Finally, we studied the toxicity of PAMAM G1-ß-CD dendrimer in four different cell lines, human breast cancer cells (MCF-7 and MDA-MB-231), human cervical adenocarcinoma cancer cells (HeLa) and pig kidney epithelial cells (LLC-PK1). The PAMAM G1-ß-CD dendrimer did not present any cytotoxicity in cell lines tested which shows the potentiality of this new class of dendrimers.

Unusual Fluorescence Behavior of Pyrene-Amine Containing Dendrimers.

A new class of pyrene-based dendrimers, characterized by the presence of a 1,4,7,10-Tetraazacyclododecane (cyclen) unit as the core, was studied by SSF (steady-state fluorescence) and SPC (single-photon counting fluorescence). The photophysical behavior of these dendrimers was studied in THF, DMF and DMSO solution. The typical signals for pyrene-labeled molecules were recorded in each solvent, showing the representative fluorescence spectra: the corresponding emissions of monomer and excimer of the pyrene chromophore are observed. Unexpectedly, the typical quenching of tertiary amine on the pyrene emission was not observed in these dendrimers. Quenching studies were performed by adding up to 3 equivalents of trifluoroacetic acid (TFA). To our knowledge, this is the first report of pyrene's unquenching behavior by a tertiary amine.

A pilot project to increase health literacy among youth from seasonal farmworker families in rural eastern North Carolina: a qualitative exploration of implementation and impact.

OBJECTIVE: There are substantial health inequalities for seasonal agricultural workers and their families in the United States. One identified inequality is in health literacy. The authors explored the implementation and impact of connecting youth from seasonal farmworker families who participated in a leadership and college pipeline program with Internet access by providing a tablet with a paid cellular data plan and university library-based health literacy training. METHODS: With the support of a National Network of Libraries of Medicine Health Information Outreach Award, we conducted a qualitative, utilization-focused evaluation by conducting semi-structured interviews from December 2017 through February 2018 with middle and high school age participants in the program (n=10). After parental consent and youth assent, we recorded interviews with participants at program activity locations or in their homes. We then utilized inductive thematic analysis with 2 primary coders. RESULTS: We identified four themes: (1) having access to the Internet can be transformative, (2) access resulted in increased knowledge of and interest in one's own and others' health, (3) "Google" is the norm, and (4) participant training increased self-efficacy to determine credible sources and resources. CONCLUSION: Providing Internet access and iPads was possible to implement and resulted in increased utilization of health information. The combination of Internet access with training on information literacy was a key factor in achieving these positive outcomes. The findings suggest the importance of ensuring equitable access to the Internet in efforts to improve educational and health outcomes for seasonal farmworkers and their families.

Low Expression of IL-10 in Circulating Bregs and Inverted IL-10/TNF-α Ratio in Tears of Patients with Perennial Allergic Conjunctivitis: A Preliminary Study.

Allergic conjunctivitis (AC) is one of the most common ophthalmological disorders seen in clinical practice. Growing evidence from recent years suggests that a subset of IL-10-expressing B cells is involved in inflammatory allergic diseases. In this study, we aimed to evaluate the potential involvement of blood Bregs cells in perennial allergic conjunctivitis (PAC), and interleukins (IL)-1ß, IL-6, IL-8, IL-10, and IL-12, and tumor necrosis factor (TNF)-α, were measured in tear samples and compared with healthy controls (HC) using flow cytometry. Non-significant differences in CD19⁺IL-10⁺ cell frequency between PAC patients and healthy controls (HC) were observed. Nevertheless, when we analyzed the mean fluorescence intensity (MFI) of IL-10 on CD19⁺CD38Lo/Med/Hi-gated cells, we observed a significant decrease in MFI in all Bregs subsets in PAC patients. Additionally, tear cytokines showed 2.8 times lower levels of IL-10 than TNF-α in PAC patients when compared to HC. Our findings demonstrate an immunological dysregulation in patients with allergic conjunctivitis, characterized by the low expression of IL-10 in circulating CD19⁺CD38⁺ Bregs subsets and an inverted tear IL-10/TNF-α ratio, promoting a local pro-inflammatory microenvironment. These findings highlight the novel pathologic changes involved in ocular allergic diseases. Understanding systemic and local mechanisms will aid the design of immunomodulating therapeutics at different levels.

Messaging Lesbian, Gay, Bisexual, and Transgender Health Inequities: A Qualitative Exploration.

BACKGROUND: There are substantial health inequities for lesbian, gay, bisexual, and transgender (LGBT) people compared to their straight/cisgendered counterparts. As evidence of these inequities has become unequivocal, better strategies to address them are needed. One approach is to leverage communications and media advocacy efforts to raise awareness about inequities. However, some research suggests that highlighting health inequities can have negative consequences. This study aimed to explore how LGBT leaders view communication about health inequities. METHOD: We used an inductive qualitative approach and conducted 12 semistructured phone interviews with LGBT community leaders in North Carolina between September and October 2017. RESULTS: Four themes emerged in the data. There was support for reporting health differences between LGBT and straight/cisgendered people to raise awareness of health issues facing LGBT communities. However, participants were concerned about the stigmatizing effects of messages and worried about their effectiveness. CONCLUSION: Emphasizing health differences between LGBT and straight people can be problematic; our findings suggest that health educators (1) must be cautious, (2) must be aware of the audience, and (3) should consider focusing messages on finding a solution to the identified problem. Future work should explore how to best craft messages that address health inequities for LGBT communities.

Design of Novel Pyrene-Bodipy Dyads: Synthesis, Characterization, Optical Properties, and FRET Studies.

A new series of dendronized bodipys containing pyrene units was synthesized and characterized. Their optical and photophysical properties were determined by absorption and fluorescence spectroscopy. This series includes three different compounds. The first one has an anisole group linked to the bodipy unit, which was used as the reference compound. In the second, the bodipy core is linked to a zero generation dendron with one pyrene unit. The third compound contains a first generation Fréchet-type dendron bearing two pyrene units. In this work, the combination pyrene-bodipy was selected as the donor-acceptor pair for this fluorescence resonance energy transfer (FRET) study. Doubtless, these two chromophores exhibit high quantum yields, high extinction coefficients, and both their excitation and emission wavelengths are located in the visible region. This report presents a FRET study of a novel series of pyrene-bodipy dendritic molecules bearing flexible spacers. We demonstrated via spectroscopic studies that FRET phenomena occur in these dyads.

Synthesis of a poly(ester) dendritic ß-cyclodextrin derivative by "click" chemistry: Combining the best of two worlds for complexation enhancement.

In spite of the progress in the cyclodextrins chemistry, the synthesis of monodisperse derivatives with a defined degree of substitution is still a challenge. In this work we present a novel dendritic material produced by combining ßCD and second generation poly(ester) dendrons. The selective attachment of dendrons in the seven positions of the ßCD-primary face was performed through a CuAAC click reaction, which along with a very simple work-up, allowed obtaining the monodisperse material in very high yields. The product showed a great aqueous solubility and an in vitro non-toxic profile. The enhanced complexation potential of the product was evidenced through the formation of an inclusion complex with albendazole, which presented a Kc = 29636.17 M-1. In this system, albendazole was 45 times more water-soluble in comparison to the complex albendazole-native ßCD. All these features make the dendritic material very attractive for further applications in the formulation and drug delivery fields.

Energy Transfer in Dendritic Systems Having Pyrene Peripheral Groups as Donors and Different Acceptor Groups.

In this feature article, a specific overview of resonance energy transfer (FRET) in dendritic molecules was performed. We focused mainly on constructs bearing peripheral pyrene groups as donor moieties using different acceptor groups, such as porphyrin, fullerene C60, ruthenium-bipyridine complexes, and cyclen-core. We have studied the effect of all the different donor-acceptor pairs in the energy transfer efficiency (FRET). In all cases, high FRET efficiency values were observed.

Evaluación de la capacidad y percepción de autocuidado del adulto mayor en la comunidad / Assessment of the capability and perception of self-care of elderly in community

Medir salud en el paciente anciano resulta complejo, pues es medir la resultante de diversas variables de carácter biológico, psicológico y social, por lo que la salud del anciano debe medirse en correspondencia con su funcionabilidad. Motivado por esto se realizó un estudio descriptivo transversal en el municipio Holguín con el objetivo de evaluar la capacidad y percepción de autocuidado del Adulto Mayor en la comunidad. De un universo de 354 ancianos de 3 consultorios, se seleccionaron 195, a los cuales se les aplicó un Instrumento diseñado al efecto para medir su nivel de autocuidado. Los resultados arrojaron que el 50,5 por ciento de los hombres y el 43,3 por ciento de las mujeres no se cuida adecuadamente, existe un déficit de autocuidado cognoscitivo-perceptivo en el 46,7 por ciento, un 9,8 por ciento tienen déficit parcial y 5,6 por ciento déficit total. De los 121 pacientes cuyo nivel de autocuidado es inadecuado el 75,2 por ciento son independientes y el 63,6 por ciento perciben su estado de salud aparentemente sano, concluyéndose que no obstante la gran mayoría de los adultos mayores estudiados ser independientes para realizar las actividades de la vida diaria, estos no desarrollan adecuadamente sus capacidades de autocuidado, por lo que el grado funcional independiente es una condición necesaria pero no suficiente para un buen autocuidado, los adultos mayores que perciben algún riesgo para su salud se cuidan más que los que se perciben sanos. El instrumento aplicado define la actividad de autocuidado en las personas mayores, recomendándose su introducción en la evaluación gerontológica en la Atención Primaria de Salud(AU)

To measure health in the old patient is complex, because it is to measure the resultant of diverse variables of biological, psychological and social character, for what the health in old man should be measured in correspondence with their functional state. Motivated for this reason was carried out a traverse descriptive study in the municipality Holguin, with the objective of evaluating the capacity and perception of self-care of the old men in the community. Of an universe of 354 elderly people of 3 clinics, 195 were selected, to which were applied an Instrument designed to the effect to measure their level of self-care. The results indicated that 50,5 percent of the men and 43,3 percent of the women don't their care appropriately, a deficit of cognitive-perceptive self-care exists in 46,7 percent, 9,8 percent has partial deficit and 5,6 percent total deficit. Of the 121 patients whose level of self-care is inadequate, 75,2 percent is independent and 63,6 percent perceives its seemingly healthy state of health, being concluded that nevertheless the great majority of the studied old men to be independent to carry out the activities of the daily life, they don't develop its capacities of self-care appropriately, for what the independent functional degree is a necessary but not enough condition for a good self-care, the elderly people that perceive some risk for its health take care more than those that are perceived healthy. The applied instrument defines the activity of self-care in the study patients, being recommended its introduction in the geriatric evaluation in the Primary Attention of Health(AU)

Evaluación de la capacidad y percepción de autocuidado del adulto mayor en la comunidad / Assessment of the capability and perception of self-care of elderly in community

Medir salud en el paciente anciano resulta complejo, pues es medir la resultante de diversas variables de carácter biológico, psicológico y social, por lo que la salud del anciano debe medirse en correspondencia con su funcionabilidad. Motivado por esto se realizó un estudio descriptivo transversal en el municipio Holguín con el objetivo de evaluar la capacidad y percepción de autocuidado del Adulto Mayor en la comunidad. De un universo de 354 ancianos de 3 consultorios, se seleccionaron 195, a los cuales se les aplicó un Instrumento diseñado al efecto para medir su nivel de autocuidado. Los resultados arrojaron que el 50,5 por ciento de los hombres y el 43,3 por ciento de las mujeres no se cuida adecuadamente, existe un déficit de autocuidado cognoscitivo-perceptivo en el 46,7 por ciento, un 9,8 por ciento tienen déficit parcial y 5,6 por ciento déficit total. De los 121 pacientes cuyo nivel de autocuidado es inadecuado el 75,2 por ciento son independientes y el 63,6 por ciento perciben su estado de salud aparentemente sano, concluyéndose que no obstante la gran mayoría de los adultos mayores estudiados ser independientes para realizar las actividades de la vida diaria, estos no desarrollan adecuadamente sus capacidades de autocuidado, por lo que el grado funcional independiente es una condición necesaria pero no suficiente para un buen autocuidado, los adultos mayores que perciben algún riesgo para su salud se cuidan más que los que se perciben sanos. El instrumento aplicado define la actividad de autocuidado en las personas mayores, recomendándose su introducción en la evaluación gerontológica en la Atención Primaria de Salud(AU)

To measure health in the old patient is complex, because it is to measure the resultant of diverse variables of biological, psychological and social character, for what the health in old man should be measured in correspondence with their functional state. Motivated for this reason was carried out a traverse descriptive study in the municipality Holguin, with the objective of evaluating the capacity and perception of self-care of the old men in the community. Of an universe of 354 elderly people of 3 clinics, 195 were selected, to which were applied an Instrument designed to the effect to measure their level of self-care. The results indicated that 50,5 percent of the men and 43,3 percent of the women don't their care appropriately, a deficit of cognitive-perceptive self-care exists in 46,7 percent, 9,8 percent has partial deficit and 5,6 percent total deficit. Of the 121 patients whose level of self-care is inadequate, 75,2 percent is independent and 63,6 percent perceives its seemingly healthy state of health, being concluded that nevertheless the great majority of the studied old men to be independent to carry out the activities of the daily life, they don't develop its capacities of self-care appropriately, for what the independent functional degree is a necessary but not enough condition for a good self-care, the elderly people that perceive some risk for its health take care more than those that are perceived healthy. The applied instrument defines the activity of self-care in the study patients, being recommended its introduction in the geriatric evaluation in the Primary Attention of Health(AU)

Conformational changes accompany activation of reovirus RNA-dependent RNA transcription.

Many critical biologic processes involve dynamic interactions between proteins and nucleic acids. Such dynamic processes are often difficult to delineate by conventional static methods. For example, while a variety of nucleic acid polymerase structures have been determined at atomic resolution, the details of how some multi-protein transcriptase complexes actively produce mRNA, as well as conformational changes associated with activation of such complexes, remain poorly understood. The mammalian reovirus innermost capsid (core) manifests all enzymatic activities necessary to produce mRNA from each of the 10 encased double-stranded RNA genes. We used rapid freezing and electron cryo-microscopy to trap and visualize transcriptionally active reovirus core particles and compared them to inactive core images. Rod-like density centered within actively transcribing core spike channels was attributed to exiting nascent mRNA. Comparative radial density plots of active and inactive core particles identified several structural changes in both internal and external regions of the icosahedral core capsid. Inactive and transcriptionally active cores were partially digested with trypsin and identities of initial tryptic peptides determined by mass spectrometry. Differentially-digested peptides, which also suggest transcription-associated conformational changes, were placed within the known three-dimensional structures of major core proteins.

La capacidad y percepción de auto-cuidado, una estrategia de elección para alcanzar una longevidad satisfactoria

La salud de los ancianos dentro de las sociedades envejecidas, depende en gran medida de la capacidad de auto-cuidados. El auto-cuidado como sistema de acción incrementa la calidad de la asistencia geriátrica sectorizada en la comunidad. Su nivel de medición del estado de salud del anciano es cualitativo y cuantitativamente superior a otros instrumentos utilizados habitualmente. El desarrollo de capacidad y percepción de auto-cuidados en la persona de edad es una alternativa real y eficaz en su atención integral, que nos conduce a una longevidad satisfactoria. En el presente trabajo de revisión se analizan los aspectos fundamentales del autocuidado en el escenario de la atención primaria dirigido a la atención multidisciplinaria y exhaustiva del anciano...(AU)

The elderly health within the aged societies depends on self-care capacity. The self -care as an action system increases the quality of the diverse geriatric care assessment in the community. The measurement level related with the aged people´s health is qualitative and quantitatively superior to other instruments habitually used. The development of self-care capacity and perception in the aged persons is a real and effective alternative in their integral attention that leads us to a satisfactory longevity...(AU)

Immunoregulatory role of nitric oxide in Kilham rat virus-induced autoimmune diabetes in DR-BB rats.

Macrophages play a critical role in the pathogenesis of Kilham rat virus (KRV)-induced autoimmune diabetes in diabetes-resistant BioBreeding (DR-BB) rats. This investigation was initiated to determine the role of macrophage-derived soluble mediators, particularly NO, in the pathogenesis of KRV-induced diabetes in DR-BB rats. We found that the expression of inducible NO synthase (iNOS), an enzyme responsible for NO production, was significantly increased during the early phase of KRV infection. Inhibition of iNOS by aminoguanidine (AG) treatment resulted in the prevention of diabetes in KRV-infected animals. The expression of IL-1beta, TNF-alpha, and IL-12 was significantly decreased in the spleen of AG-treated, KRV-infected DR-BB rats compared with PBS-treated, KRV-infected control rats. Subsequent experiments revealed that AG treatment exerted its preventive effect in KRV-infected rats by maintaining the finely tuned immune balance normally disrupted by KRV, evidenced by a significant decrease in the expression of IFN-gamma, but not IL-4, and a decrease in Th1-type chemokine receptors CCR5, CXCR3, and CXCR4. We also found that iNOS inhibition by AG decreased the KRV-induced expression of MHC class II molecules and IL-2R alpha-chain, resulting in the suppression of T cell activation, evidenced by the decreased cytolytic activity of CD8(+) T cells. We conclude that NO plays a critical immunoregulatory role by up-regulating macrophage-derived proinflammatory cytokines, up-regulating the Th1 immune response, and activating T cells, leading to type 1 diabetes after KRV infection, whereas suppression of NO production by AG treatment prevents KRV-induced autoimmune diabetes in DR-BB rats.