Education About Specialty Palliative Care Among Nonhealthcare Workers: A Systematic Review.

CONTEXT: Despite the expansion of palliative care (PC) services, the public has little knowledge and holds misperceptions about PC, creating barriers to accessing timely specialty PC. OBJECTIVES: To systematically review the evidence regarding the efficacy of educational interventions to improve knowledge and attitudes about PC among nonhealthcare workers. METHODS: We searched five databases (PubMed/MEDLINE, Embase, CIANHL, Web of Science, and Scopus) for studies investigating educational interventions about specialty PC in adults who identified as patients, caregivers, or members of the public. We included studies that were available in English and had a comparator group. We excluded studies that only sampled health professionals or children. We used the Mixed Methods Appraisal Tool to assess quality and risk of bias. RESULTS: Of 12,420 records identified, we screened 5948 abstracts and assessed 526 full texts for eligibility. Twenty-one articles were extracted for analysis, representing 20 unique educational interventions. Common methodologies included quasi-experimental (9, 45%), randomized controlled trial (4, 20%), and nonrandomized trial (2, 10%). Common components of the educational interventions included video presentations (9, 45%), written materials (8, 40%), and lectures (4, 20%). Content included definition (14, 70%) and philosophy (14, 70%) of PC, distinctions between PC and hospice (11, 55%), and eligibility for PC (11, 55%). Fourteen (70%) interventions showed statistically significant positive differences in either knowledge or attitudes about PC. CONCLUSIONS: While educational interventions can positively impact knowledge and attitudes about PC among nonhealthcare workers, more research is needed to inform the design, delivery, and evaluation of interventions to increase knowledge and attitudes about PC.

Blood donor notification rate in a blood bank in Veracruz, Mexico.

Blood banks are primarily responsible for providing safe blood, but they also indirectly act to prevent the spread of infectious diseases by notifying blood donors of positive screening results. The notification process differs between countries and notifications rates are generally low. This study sought to analyze the notification rate of healthy and infection-positive donors who donated blood at CETS-Veracruz. A total of 41790 donors were analyzed, 1585 (3.79%) were positive for one or more of the screened infection markers. Only 4163 (9.96% of the total) were notified about their serology results. Of the positive donors, 157 were contacted by phone call; of them, 91 (57%) returned to the blood bank for their results. The average notification rate for positive donors was only 17.48%. The highest notification rate was for anti-HBc (26.63%), while the lowest was for HBsAg (4.17%). Age significantly influenced the return of donors: Those aged 18-24 and 25-39 years were 4.71 and 1.64 times less likely, respectively, to return for their results compared to the rate for all ages. The advice received in the pre-donation stage about the risks of transfusion-transmitted infections and the relevance of returning for results did not appear to impact donors, since the rate of notification was lower than those reported internationally. These data indicate that CETS-Veracruz should improve donor data registration and communication mechanisms to increase the notification rate, and that donor notification studies should be carried out in other Mexican blood banks to analyze the return rate at the national level.

Use of Investigator 24plex GO! To analyse allele frequencies of 21 autosomal STRs in the population of Veracruz state, Mexico.

BACKGROUND: Mexican population databases for autosomal STRs are scarce, and no previous studies have been performed with the Qiagen Investigator 24plex GO! AIM: To analyse the frequency of 21 autosomal short tandem repeat (STR) loci and forensic parameters in individuals from Veracruz state, Mexico. SUBJECTS AND METHODS: A total of 234 unrelated individuals were analysed with the Investigator 24plex GO! Kit, which includes the following autosomal STRs: TH01, D3S1358, vWA, D21S11, TPOX, D1S1656, D12S391, SE33, D10S1248, D22S1045, D19S433, D8S133879, D2S1338, D2S441, D18S51, FGA, D16S539, CSF1PO, D13S317, D5S818, and D7S820. Allele frequencies, forensic parameters, and relationships with neighbouring Mexican populations were estimated. RESULTS: The STRs analysed were in Hardy-Weinberg Equilibrium (HWE). The combined matching probability and combined PE were 1.5266 E-24 and 0.999999988711, respectively. The D18S51 and SE33 loci presented the highest Ho (0.8974 and 0.8932) and PE (0.7902 and 0.7815), respectively. The highest PIC (0.9337) and PD (0.9894) values corresponded to SE33. Conversely, D22S1045 had the lowest PIC and PE (0.5533 and 0.3546, respectively). A population cluster among southern Mexican populations, which included non-differentiation between Guerrero and Veracruz states was detected. CONCLUSION: The forensic efficacy of the 21 STRs analysed by the Investigator 24plex GO! Kit was evaluated in the Veracruz state. Moreover, new population clusters that have not yet been described and are related to geographic regions were identified, and these are in agreement with previously reported ancestral differences.

Efficacy of a Nasal Spray Containing Iota-Carrageenan in the Postexposure Prophylaxis of COVID-19 in Hospital Personnel Dedicated to Patients Care with COVID-19 Disease.

BACKGROUND: Iota-Carrageenan (I-C) is a sulfate polysaccharide synthesized by red algae, with demonstrated antiviral activity and clinical efficacy as nasal spray in the treatment of common cold. In vitro, I-C inhibits SARS-CoV-2 infection in cell culture. RESEARCH QUESTION: Can a nasal spray with Iota-Carrageenan be useful in the prophylaxis of COVID-19 in health care workers managing patients with COVID-19 disease? STUDY DESIGN AND METHODS: This is a pilot pragmatic multicenter, randomized, double-blind, placebo-controlled study assessing the use of a nasal spray containing I-C in the prophylaxis of COVID-19 in hospital personnel dedicated to care of COVID-19 patients. Clinically healthy physicians, nurses, kinesiologists and other health care providers managing patients hospitalized for COVID-19 were assigned in a 1:1 ratio to receive four daily doses of I-C spray or placebo for 21 days. The primary end point was clinical COVID-19, as confirmed by reverse transcriptase polymerase chain reaction testing, over a period of 21 days. The trial is registered at ClinicalTrials.gov (NCT04521322). RESULTS: A total of 394 individuals were randomly assigned to receive I-C or placebo. Both treatment groups had similar baseline characteristics. The incidence of COVID-19 differs significantly between subjects receiving the nasal spray with I-C (2 of 196 [1.0%]) and those receiving placebo (10 of 198 [5.0%]). Relative risk reduction: 79.8% (95% CI 5.3 to 95.4; p=0.03). Absolute risk reduction: 4% (95% CI 0.6 to 7.4). INTERPRETATION: In this pilot study a nasal spray with I-C showed significant efficacy in preventing COVID-19 in health care workers managing patients with COVID-19 disease. CLINICAL TRIALS REGISTRATION: NCT04521322.

Characterization of the IL-17 and CD4+ Th17 Cells in the Clinical Course of Dengue Virus Infections.

The aims of this study were to determine the involvement of interleukin 17 (IL-17) and IL-17-producing cells in dengue pathogenesis. Blood samples from dengue virus (DENV)-infected patients were collected on different days after the onset of symptoms. Patients were classified according to 1997 World Health Organization guidelines. Our study examined 152 blood samples from dengue fever (DF, n = 109) and dengue hemorrhagic fever (DHF, n = 43) patients and 90 blood samples from healthy controls (HC). High serum concentrations of IL-17A and IL-22 were also associated with DHF (IL-17A [DHF vs. DF, p < 0.01; DHF vs. HC, p < 0.0001]; IL-22 [DHF vs. DF, p < 0.05; DHF vs. HC, p < 0.0001]). Moreover, there was a positive correlation between serum levels of IL-17A and IL-23, a key cytokine that promotes IL-17-based immune responses (r = 0.4089, p < 0.0001). Consistent with the IL-17-biased immune response in DHF patients, we performed ex vivo activation of peripheral blood mononuclear cells (PBMCs) from DHF patients and flow cytometry analysis showed a robust IL-17-biased immune response, characterized by a high frequency of CD4+IL-17+ producing cells. Our results suggests IL-17-producing cells and their related cytokines can play a prominent role in this viral disease.

Occult hepatitis B infections and anti-HBc prevalence at a resource-limited blood bank in Mexico.

OBJECTIVES: To identify blood donors with occult hepatitis B infections (OBIs), determine the prevalence of antibody to hepatitis B core antigen (anti-HBc) positivity and estimate the impact of anti-HBc screening on donor deferral at CETS-Veracruz (Mexico). BACKGROUND: Hepatitis B virus infection is a major concern in transfusion medicine. Mexican regulations only mandate screening for hepatitis B surface antigen (HBsAg), and there are no requirements regarding testing for anti-HBc or use of a nucleic acid test (NAT). There is, therefore, limited information about the prevalence of anti-HBc positivity and occult hepatitis B among blood donors in Mexico. METHODS: This retrospective study examined individuals who donated blood to CETS-Veracruz from June 2014 to June 2017. All donors were serologically examined according to Mexican health regulations, and the prevalence of anti-HBc positivity was determined. A NAT was used to identify individuals with OBIs. RESULTS: We analysed the data of 28 016 blood donors. Over 4 years, the average prevalence of anti-HBc positivity was 1.05%. The risk factors for anti-HBc positivity were low education and age over 50 years. There were nine donors with OBIs. CONCLUSION: The presence of donors with OBIs in CETS-Veracruz and other Mexican blood banks highlights the need to mandate the implementation of anti-HBc screening in Mexico.

Impacto clínico y epidemiológico de las infecciones por varicela en niños previo a la introducción de la vacuna al Calendario Nacional de Argentina / Clinical and epidemiological impact of varicella infection in children prior to the introduction of the varicella vaccine in the national immunization schedule of Argentina

Introducción. En Argentina, se estiman 400 000 casos anuales de varicela. Dado el subregistro de casos existentes, la carga de enfermedad real se desconoce. Objetivo. Evaluar la carga de enfermedad por varicela antes de la introducción de la vacuna al Calendario Nacional. Materiales y métodos. Estudio retrospectivo, analítico, observacional, realizado en tres centros asistenciales del país. Revisión de los registros de consultas ambulatorias a los Servicios de Urgencias y de las historias clínicas de las internaciones por varicela en pacientes < 18 años. Período: 1/2011-12/2013. Resultados. Fueron asistidas un total de 382782 consultas ambulatorias; 3367 (0,88 %) correspondieron a consultas por varicela; el 57,6 %, < 4 años. Requirieron internación 164 (4,9 %) con una tasa de hospitalización global de 65,3/10000 hospitalizados/año (IC 95 %: 55,4-76,5); tasa de hospitalización en niños sanos: 57,2/10 000 (IC 95 %: 67,7-48,0); mediana de edad: 31,5 meses. Las causas de internación más frecuentes fueron infecciones de piel y/o partes blandas (61,1 %) y respiratorias (10,1 %). El 54,3 % recibió tratamiento con aciclovir, y el 73,1 %, con antibióticos. Presentaron bacteriemia 5/67 (7,5 %), todas por cocos Gram(+) y en inmunocompetentes. De los 19 pacientes inmunocomprometidos, el 36,8 % tuvo complicaciones (5 infecciones de piel y/o partes blandas y 2 neumonías). La mediana de días de internación fue 4, significativamente más prolongada en pacientes inmunocomprometidos. Un paciente requirió cuidados intensivos. No hubo fallecidos. Conclusión. La carga de enfermedad registrada fue significativa, con impacto considerable en pacientes sin patología de base.

Introduction. In Argentina, an estimated 400 000 varicella cases occur annually. Given the under-recording of existing cases, the actual burden of disease is unknown. Objective. To assess the burden of varicella before the introduction of the varicella vaccine in the national immunization schedule. Materials and methods. Retrospective, analytical, observational study carried out in three hospitals of Argentina. Review of medical records from outpatient visits to the Emergency Department and from patients younger than 18 years hospitalized for varicella. Period: 1/2011-12/2013. Results. A total of 382 782 outpatients were seen; 3367(0.88%) corresponded to visits due to varicella; 57.6 % were < 4 years old. A total of 164 (4.9 %) patients required hospitalization, with an overall hospitalization rate of 65.3/10 000 hospitalized patients/year (95 % confidence interval -#91;CI-#93;: 55.4-76.5); hospitalization rate in healthy children: 57.2/10 000 (95 % CI: 67.7-48.0); median age: 31.5 months. The most common causes of hospitalization were skin and/or soft tissue infections (61.1 %) and respiratory infections (10.1 %). Also, 54.3 % were treated with acyclovir and 73.1 %, with antibiotics. Bacteremia developed in 5/67 patients (7.5 %), all cases were caused by Gram-positive cocci and occurred in immunocompetent patients. Out of 19 immunocompromised patients, 36.8 % had complications (5 skin and/or soft tissue infection and 2 pneumonia cases). The median length of stay was 4 days, which is significantly more prolonged in immunocompromised patients. One patient required intensive care. No patient died. Conclusion. The burden of disease was significant, with a considerable impact in patients without an underlying disease.

Clinical and epidemiological impact of varicella infection in children prior to the introduction of the varicella vaccine in the national immunization schedule of Argentina. / Impacto clínico y epidemiológico de las infecciones por varicela en niños previo a la introducción de la vacuna al Calendario Nacional de Argentina.

INTRODUCTION: In Argentina, an estimated 400 000 varicella cases occur annually. Given the under-recording of existing cases, the actual burden of disease is unknown. OBJECTIVE: To assess the burden of varicella before the introduction of the varicella vaccine in the national immunization schedule. MATERIALS AND METHODS: Retrospective, analytical, observational study carried out in three hospitals of Argentina. Review of medical records from outpatient visits to the Emergency Department and from patients younger than 18 years hospitalized for varicella. Period: 1/2011-12/2013. RESULTS: A total of 382 782 outpatients were seen; 3367(0.88%) corresponded to visits due to varicella; 57.6 % were < 4 years old. A total of 164 (4.9 %) patients required hospitalization, with an overall hospitalization rate of 65.3/10 000 hospitalized patients/year (95 % confidence interval |#91;CI|#93;: 55.4-76.5); hospitalization rate in healthy children: 57.2/10 000 (95 % CI: 67.7-48.0); median age: 31.5 months. The most common causes of hospitalization were skin and/or soft tissue infections (61.1 %) and respiratory infections (10.1 %). Also, 54.3 % were treated with acyclovir and 73.1 %, with antibiotics. Bacteremia developed in 5/67 patients (7.5 %), all cases were caused by Gram-positive cocci and occurred in immunocompetent patients. Out of 19 immunocompromised patients, 36.8 % had complications (5 skin and/or soft tissue infection and 2 pneumonia cases). The median length of stay was 4 days, which is significantly more prolonged in immunocompromised patients. One patient required intensive care. No patient died. CONCLUSION: The burden of disease was significant, with a considerable impact in patients without an underlying disease.

Introducción. En Argentina, se estiman 400 000 casos anuales de varicela. Dado el subregistro de casos existentes, la carga de enfermedad real se desconoce. Objetivo. Evaluar la carga de enfermedad por varicela antes de la introducción de la vacuna al Calendario Nacional. Materiales y métodos. Estudio retrospectivo, analítico, observacional, realizado en tres centros asistenciales del país. Revisión de los registros de consultas ambulatorias a los Servicios de Urgencias y de las historias clínicas de las internaciones por varicela en pacientes < 18 años. Período: 1/2011-12/2013. Resultados. Fueron asistidas un total de 382782 consultas ambulatorias; 3367 (0,88 %) correspondieron a consultas por varicela; el 57,6 %, < 4 años. Requirieron internación 164 (4,9 %) con una tasa de hospitalización global de 65,3/10000 hospitalizados/año (IC 95 %: 55,4-76,5); tasa de hospitalización en niños sanos: 57,2/10 000 (IC 95 %: 67,7-48,0); mediana de edad: 31,5 meses. Las causas de internación más frecuentes fueron infecciones de piel y/o partes blandas (61,1 %) y respiratorias (10,1 %). El 54,3 % recibió tratamiento con aciclovir, y el 73,1 %, con antibióticos. Presentaron bacteriemia 5/67 (7,5 %), todas por cocos Gram(+) y en inmunocompetentes. De los 19 pacientes inmunocomprometidos, el 36,8 % tuvo complicaciones (5 infecciones de piel y/o partes blandas y 2 neumonías). La mediana de días de internación fue 4, significativamente más prolongada en pacientes inmunocomprometidos. Un paciente requirió cuidados intensivos. No hubo fallecidos. Conclusión. La carga de enfermedad registrada fue significativa, con impacto considerable en pacientes sin patología de base.

Trends in prevalence of HIV and syphilis in a central blood bank of Veracruz, Mexico.

Syphilis and HIV infections continue to threaten the safety of blood banks in countries where altruistic donations are rare. The aim of this study of blood donors to the Centro Estatal de la Transfusion Sanguínea de Veracruz (Mexico) was to determine changes in the prevalence of syphilis and HIV, and to identify factors associated with these infections. A total of 109,054 blood donors were retrospectively analyzed from 2007 to 2014. Serological screening of blood units was performed, and demographic data were collected from clinical records to identify risk factors. The prevalence of Treponema pallidum was 1.4% and that of confirmed HIV was 0.11%. The main risk factors for HIV positivity were age of 18 to 24 years-old, being unmarried, and being an employee or student. The main risk factors for syphilis positivity were being a widow or divorced, being over 35 years-old, having a low level of education, and being a driver, fisherman, or trade worker. There were high prevalences for both infections in southeast Veracruz, where females and males had equal probabilities of each infection. Strengthening of education programs on sexually transmitted diseases for young people may help to prevent new and congenital infections.

Agrandamiento gingival por ciclosporina: reporte de un caso / Gingival enlargement due to cyclosporine: a case report

El agrandamiento gingival (AG) es el aumento de volumen anormal de la encía que genera cambios estéticos y síntomas clínicos como sangrado gingival espontáneo o inducido, trastornos periodontales y migración patológica dentaria, entre otros. Este proceso patológico puede ser un efecto secundario a ciertos fármacos como anticonvulsivantes, bloqueadores de canales de calcio e inmunosupresores. Se presenta el caso de un paciente sexo masculino de 74 años de edad con antecedentes de trasplante renal, en tratamiento con ciclosporina, que acude por aumento del volumen intraoral, clínicamente compatible con agrandamiento gingival. Se realiza tratamiento basado en exodoncias, biopsia y control de placa. A los 2 meses se pudo observar una regresión de la lesión, y se confirma el diagnóstico con el estudio histopatológico. El manejo actual del tratamiento de esta enfermedad se basa en el control de la placa. Se sugiere dar un enfoque multidisciplinario y crear protocolos para derivar oportunamente antes de la expresión más agresiva de la enfermedad.

Gingival enlargement is an abnormal increased volume of the gum that induces cosmetic changes and clinical symptoms, such as gingival bleeding, periodontal disorders, pathological tooth migration, among others. This condition can be a side effect of certain drugs such as anticonvulsants, calcium channel blockers, and immunosuppressants. A 74 year-old male patient with a medical record of kidney transplant secondary to chronic renal failure receiving cyclosporine for the past 14 years is referred to our Hospital with the chief complaint of gingival enlargement. The treatment is based on tooth extractions, biopsy and periodontal treatment. A complete regression of the lesion was observed after two months. The current approach to treat this disease is focused on plaque control. A multidisciplinary approach should be used and clinical protocols prepared that allow early treatment and avoidance of more aggressive disease expression.

[Gastric band erosion: Alternative management]. / Banda gástrica penetrada. Una alternativa de tratamiento.

BACKGROUND: Obesity is a public health problem, for which the prevalence has increased worldwide at an alarming rate, affecting 1.7 billion people in the world. OBJECTIVE: To describe the technique employed in incomplete penetration of gastric band where endoscopic management and/or primary closure is not feasible. MATERIAL AND METHODS: Laparoscopic removal of gastric band was performed in five patients with incomplete penetrance using Foley catheterization in the perforation site that could lead to the development of a gastro-cutaneous fistula. CLINICAL CASES: The cases presented include a leak that required surgical lavage with satisfactory outcome, and one patient developed stenosis 3 years after surgical management, which was resolved endoscopically. In all cases, the penetration site closed spontaneously. DISCUSSION: Gastric band erosion has been reported in 3.4% of cases. The reason for inserting a catheter is to create a controlled gastro-cutaneous fistula, allowing spontaneous closure. CONCLUSIONS: Various techniques have been described: the totally endoscopic, hybrid techniques (endoscopic/laparoscopic) and completely laparoscopic. A technique is described here that is useful and successful in cases where the above-described treatments are not viable.

Seroprevalence of hepatitis viruses and risk factors in blood donors of Veracruz, Mexico.

INTRODUCTION: Hepatitis B and C are among the most important transfusion-transmitted infections and sources of liver diseases worldwide. In Veracruz, Mexico, liver diseases are important causes of mortality, and the prevalence reports of these viruses are scarce. This study sought to determine the prevalence of these infections in blood donors, in order to increase the safety of blood products in this region. METHODOLOGY: A retrospective study was performed on blood donors who attended the Veracruz State Blood Transfusion Center from 2006 to 2010. All samples were screened for transfusion-transmitted infections. The prevalence rates of hepatitis B virus (HBV) and hepatitis C virus (HCV) were determined, and demographic data obtained from clinical records were used to evaluate risk factors. RESULTS: A total of 56,377 donors were serologically screened; of them, 403 were seropositive for HCV (357 men and 46 women), and 61 were positive for HBsAg (52 men and 9 women). The overall prevalence rates were 0.72% (0.63%-0.76%) for HCV and 0.11% (0.08%-0.14%) for HBsAg. The risk factors for HBsAg positivity were being a cattleman and living in the Huasteca Baja region, whereas those for HCV were being a fisherman, living in the Papaloapan region, and having an elementary-level or lower education. CONCLUSIONS: This is the first study to show that being a fisherman is a risk factor for HCV. The implementation of nucleic acid test technology will help to identify the real risks for transfusion-transmitted hepatitis C in Veracruz.

Prevalence of Trypanosoma cruzi antibodies in blood donors from Veracruz State, Mexico.

BACKGROUND: Trypanosoma cruzi is the causal agent of Chagas disease. Of the Mexican states, Veracruz is among the most affected by this sickness. However, the actual epidemiologic situation of this disease is not well understood. This study sought to determine the prevalence and risk factors for Chagas disease among Veracruzan blood donors. STUDY DESIGN AND METHODS: Blood donors from Centro Estatal de la Transfusion Sanguinea de Veracruz were included. Blood units were serologically scrutinized for T. cruzi antibodies using enzyme-linked immunosorbent assays. To identify risk factors, demographic data were collected from the medical records of positive donors and a representative sample of healthy donors. RESULTS: A total of 87,232 donations were analyzed, and the mean prevalence of T. cruzi was found to be 0.5%. The identified risk factors were living as a couple and in a rural area, having a low level of education, being a farmer, dwelling in a house with earthen or wooden walls and a tile or thatch roof, living with domestic animals, recognition of or exposure to triatomine bugs, and residing in the Huasteca region. An increase of rural-living donors infected with T. cruzi was observed in the past 3 years of the study period. CONCLUSION: The prevalence to Chagas disease has not decreased in the past decade and the disease appears to be spreading in rural areas of Veracruz. This increases the risk of T. cruzi transfusion-transmitted infection, not only in Veracruz and Mexico, but also in other nonendemic countries that receive immigrants from Veracruz State.

[Simplified laparoscopic gastric bypass. Initial experience]. / Bypass gástrico laparoscópico simplificado. Experiencia inicial.

BACKGROUND: Obesity surgery includes various gastrointestinal procedures. Roux-en-Y gastric bypass is the prototype of mixed procedures being the most practiced worldwide. A similar and novel technique has been adopted by Dr. Almino Cardoso Ramos and Dr. Manoel Galvao called "simplified bypass," which has been accepted due to the greater ease and very similar results to the conventional technique. The aim of this study is to describe the results of the simplified gastric bypass for treatment of morbid obesity in our institution. METHODS: We performed a descriptive, retrospective study of all patients undergoing simplified gastric bypass from January 2008 to July 2012 in the obesity clinic of a private hospital in Mexico City. RESULTS: A total of 90 patients diagnosed with morbid obesity underwent simplified gastric bypass. Complications occurred in 10% of patients; these were more frequent bleeding and internal hernia. Mortality in the study period was 0%. The average weight loss at 12 months was 72.7%. CONCLUSION: Simplified gastric bypass surgery is safe with good mid-term results and a loss of adequate weight in 71% of cases.

Antecedentes: la cirugía de la obesidad comprende diversos procedimientos gastrointestinales. El bypass gástrico en Y de Roux es el prototipo de los procedimientos mixtos y el más practicado en el mundo en sus diversas variedades. Una técnica similar y novedosa es la adoptada por Cardoso-Ramos y Galvao denominada "bypass simplificado" que rápidamente se aceptó por la mayor facilidad y resultados muy parecidos a la técnica convencional. Objetivo: describir los resultados a un año del bypass gástrico simplificado para el tratamiento de la obesidad mórbida. Material y métodos: estudio retrospectivo y descriptivo de todos los pacientes a quienes se realizó bypass gástrico de enero de 2008 a julio de 2012, en la clínica de obesidad de un hospital privado de la Ciudad de México. Resultados: se estudiaron 90 pacientes con diagnóstico de obesidad mórbida, con límites de edad de 18 y 65 años, operados para bypass gástrico simplificado. En 10% de los pacientes hubo complicaciones, las más frecuentes fueron: hemorragia y hernia interna. Durante el periodo de estudio la mortalidad fue de 0%. La pérdida de peso promedio a los 12 meses fue de 72.7%. Conclusión: el bypass gástrico simplificado laparoscópico es una cirugía segura, con buenos resultados a mediano plazo, y con una pérdida del exceso de peso adecuada en 71% de los casos.

Acetylenic inhibitors of ADAM10 and ADAM17: in silico analysis of potency and selectivity.

The matrix metalloproteinase family has been a pharmaceutical target for most of the last three decades, but success has been hampered by unwanted side effects caused by lack of selectivity, poor oral bioavailability and decreased potency in vivo. The surface-expressed metalloproteinases ADAM10 and ADAM17, the latter also referred to as TACE, play important roles in various physiological processes, especially involving tissue repair and development. Because of its role in the release of the cytokine TNF-α TACE has been a key target for pharmaceutical intervention in the treatment of rheumatoid arthritis. An extensive body of structural activity data has been developed for a series of small molecule inhibitors of TACE based on a sulfonamide scaffold containing key acetylenic substituents. We have undertaken an extensive molecular modeling study of select members of this ligand group to better understand the structural nuances involved in the development of ever more potent TACE inhibitors, and identify those elements of structure-based design that would enhance the selectivity of such inhibitors for TACE over ADAM10. Results include the identification of a flexible loop, comparable to that found in other MMPs that plays a subtle, yet significant, role in determining inhibitor potency.

Identification and characterization of a surface-associated, subtilisin-like serine protease in Trichomonas vaginalis.

SUMMARY: Trichomonas vaginalis is a protozoan parasite causing trichomonosis, a sexually transmitted infection in humans. This parasite has numerous proteases, most of which are cysteine proteases that appear to be involved in adherence and cytotoxicity of host cells. In this report we identify and characterize a putative subtilisin-like serine protease (SUB1). The sub1 gene encodes a 101-kDa protein. In silico analyses predict signal and pro-peptides at the N-terminus, and a transmembrane helix at the carboxy-terminal region. The sub1 gene was found as single copy by Southern analysis, albeit additional serine protease related genes are annotated in the T. vaginalis genome. The expression of sub1 could only be detected by RT-PCR and Ribonuclease Protection Assays, suggesting a low abundant mRNA. The sub1 gene transcription start site was correctly assigned by RPA. The transcript abundance was found to be modulated by the availability of iron in the growth medium. Antibodies raised to a specific SUB1 peptide recognized a single protein band (approximately 82 kDa) in Western blots, possibly representing the mature form of the protein. Immunofluorescence showed SUB1 on the trichomonad surface, and in dispersed vesicles throughout the cytoplasm. A bioinformatic analysis of genes annotated as serine proteases in the T. vaginalis genome is also presented. To our knowledge this is the first putative serine protease experimentally described for T. vaginalis.