Prevalence and transmission of the most relevant zoonotic and vector-borne pathogens in the Yucatan peninsula: A review.

BACKGROUND: Habitat modification and land use changes impact ecological interactions and alter the relationships between humans and nature. Mexico has experienced significant landscape modifications at the local and regional scales, with negative effects on forest cover and biological biodiversity, especially in the Yucatan peninsula in southeastern Mexico. Given the close relationship between landscape modification and the transmission of zoonotic and vector-borne diseases, it is essential to develop criteria for identifying priority zoonoses in the south of the country. METHODOLOGY/PRINCIPAL FINDINGS: We reviewed 165 published studies on zoonotic and vector-borne diseases in the region (2015-2024). We identified the most frequent vectors, reservoirs, and hosts, the most prevalent infections, and the factors associated with transmission risk and the anthropogenic landscape modification in urban, rural, ecotone, and sylvatic habitats. The most relevant pathogens of zoonotic risk included Trypanosoma cruzi, arboviruses, Leishmania, Rickettsia, Leptospira, and Toxoplasma gondii. Trypanosoma cruzi was the vector-borne agent with the largest number of infected vertebrate species across habitats, while Leishmania and arboviruses were the ones that affected the greatest number of people. Dogs, cats, backyard animals, and their hematophagous ectoparasites are the most likely species maintaining the transmission cycles in human settlements, while rodents, opossums, bats, and other synanthropic animals facilitate connection and transmission cycles between forested habitats with human-modified landscapes. Pathogens displayed different prevalences between the landscapes, T. cruzi, arbovirus, and Leptospira infections were the most prevalent in urban and rural settlements, whereas Leishmania and Rickettsia had similar prevalence across habitats, likely due to the diversity and abundance of the infected vectors involved. The prevalence of T. gondii and Leptospira spp. may reflect poor hygiene conditions. Additionally, results suggest that prevalence of zoonotic and vector-borne diseases is higher in deforested areas and agricultural aggregates, and in sites with precarious health and infrastructure services. CONCLUSIONS: Some hosts, vectors, and transmission trends of zoonotic and vector-borne diseases in the YP are well known but others remain poorly recognized. It is imperative to reinforce practices aimed at increasing the knowledge, monitoring, prevention, and control of these diseases at the regional level. We also emphasize the need to perform studies on a larger spatio-temporal scale under the socio-ecosystem perspective, to better elucidate the interactions between pathogens, hosts, vectors, environment, and sociocultural and economic aspects in this and many other tropical regions.

The role of the osteoprotegerin/RANKL/RANK axis and osteopontin in acute coronary syndrome.

Objectives: The primary objective of this study is to ascertain the levels of osteoprotegerin (OPG) and osteopontin (OPN), alongside osteoprotegerin/RANKL ratio (ORR), and assess their association with the SYNTAX score and ascertain the potential of these molecules as predictive markers for risk, aiding in risk stratification. Eventually, they could potentially be employed even before angiography to gauge the severity of coronary lesions. Methods: Prospective study with 147 participants, 101 (69%) were men, with an average age of 60. We included three groups - (1) patients with acute coronary syndrome undergoing percutaneous coronary intervention (ACS-PCI), (2) patients without ACS who underwent coronary angiography for an indication other than ischemia and did not undergo PCI (non-ACS without), and (3) one asymptomatic subject. OPG and OPN were measured. ORR and SYNTAX scores were calculated. The association between OPG and OPN levels and important clinical variables was investigated. Results: OPG levels in Group 1 were lower compared to Groups 2 and 3 (controls), Group 1 (490 pg/mL) versus Group 2 (829 pg/mL) versus Group 3 (845 pg/mL) (p = 0.001). OPG had lower levels in patients with coronary artery stenosis versus without stenosis. A decrease in ORR was shown in all groups and no association with the SYNTAX score. Conclusion: OPG and OPN (and ORR) levels are decreased in patients with ACS and show no correlation with the SYNTAX score. As an exploratory study, our work suggest that increased OPG and OPN levels in non-ACS patients may have, in fact, a protective effect. This study is one of the few with an appropriate control in ACS and reproducibility is necessary mainly with multicenter studies.

Objetivo: El objetivo principal de este estudio es conocer los niveles de OPG y OPN, junto con la ORR, y evaluar su asociación con la puntuación SYNTAX y conocer el potencial de estas moléculas como marcadores predictivos de riesgo, ayudando en la estratificación del riesgo. Con el tiempo, podrían emplearse incluso antes de la angiografía para medir la gravedad de las lesiones coronarias. Métodos: Estudio prospectivo con 147 participantes, 101 (69%) eran hombres, con una edad promedio de 60 años. Se incluyeron tres grupos (1) pacientes con SCA sometidos a ICP (SCA-ICP), (2); pacientes sin SCA sometidos a angiografía coronaria por una indicación distinta a la isquemia y no sometidos a ICP (sin SCA sin) (3) un sujeto asintomático. Se midieron OPG, OPN. Se calcularon las puntuaciones ORR y SYNTAX. Se investigó la asociación entre los niveles de OPG y OPN y variables clínicas importantes. Resultados: Los niveles de OPG en el Grupo 1 fueron más bajos en comparación con los Grupos 2 y 3 (controles). Grupo 1 (490 pg/mL) versus Grupo 2 (829 pg/mL) versus Grupo 3 (845 pg/mL) [p = 0.001]). La OPG tuvo niveles más bajos en pacientes con estenosis de la arteria coronaria versus sin estenosis. Se mostró una disminución en la ORR en todos los grupos y no hubo asociación con la puntuación SYNTAX. Conclusione: Los niveles de OPG OPN (y ORR) están disminuidos en pacientes con SCA y no muestran correlación con la puntuación SYNTAX. Como estudio exploratorio, nuestro trabajo sugiere que los niveles elevados de OPG y OPN en pacientes sin SCA pueden tener, de hecho, un efecto protector. Este estudio es uno de los pocos con un control adecuado en SCA y la reproducibilidad es necesaria principalmente con estudios multicéntricos.

Evidence of Validity and Reliability of the Lasher and Faulkender Anxiety about Aging Scale in Mexican Older Adults.

Anxiety about aging is an important mediating factor in attitudes and behavior toward elderly individuals as well as a mediating factor in the adjustment to one's own aging processes. The aim of this study was to analyze the factor structure, internal consistency and factorial invariance by sex of the Lasher and Faulkender Anxiety about Aging Scale. The sample consisted of 601 Mexican older adults, 394 women and 207 men, with a mean age of 70.69 ± 8.10 years. The factor structure of the questionnaire was analyzed using confirmatory factor analysis. Analyses show that a four-factor structure is feasible and adequate. The four-factor structure (fear of the elderly, psychological concerns, physical appearance and fear of loss), according to statistical and substantive criteria, showed adequate reliability and validity indicators. However, the obtained model does not fully coincide with that proposed by the questionnaire authors, although it continues to support the multi-factor component of anxiety about aging. On the other hand, the factor structure, the factor loadings and the intercepts are considered invariant in the two populations (men and women); however, there are differences between populations on the means of the physical appearance and fear of loss factors.

Assessing the Diversity of Benthic Sulfate-Reducing Microorganisms in Northwestern Gulf of Mexico by Illumina Sequencing of dsrB Gene.

This study investigates the community composition, structure, and abundance of sulfate-reducing microorganisms (SRM) in surficial sediments of the Northwestern Gulf of Mexico (NWGoM) along a bathymetric gradient. For these purposes, Illumina sequencing and quantitative PCR (qPCR) of the dissimilatory sulfite reductase gene beta subunit (dsrB gene) were performed. Bioinformatic analyses indicated that SRM community was predominantly composed by members of Proteobacteria and Firmicutes across all the samples. However, Actinobacteria, Thermodesulfobacteria, and Chlorobi were also detected. Phylogenetic analysis indicated that unassigned dsrB sequences were related to Deltaproteobacteria and Nitrospirota superclusters, Euryarchaeota, and to environmental clusters. PCoA ordination revealed that samples clustered in three different groups. PERMANOVA indicated that water depth, temperature, redox, and nickel and cadmium content were the main environmental drivers for the SRM communities in the studied sites. Alpha diversity and abundance of SRM were lower for deeper sites, suggesting decreasing sulfate reduction activity with respect to water depth. This study contributes with the understanding of distribution and composition of dsrAB-containing microorganisms involved in sulfur transformations that may contribute to the resilience and stability of the benthic microbial communities facing metal and hydrocarbon pollution in the NWGoM, a region of recent development for oil and gas drilling.

A propósito de 3 casos con retinopatía posterior a fase aguda de fiebre por chikungunya / About 3 cases of post-acute retinopathy of chikungunya fever

Este es un estudio descriptivo de serie de casos de 3 pacientes con diagnóstico por serología IgM e IgG de chikungunya y en quienes se descartaron otras enfermedades metabólicas autoinmunes e infecciosas que presentaron manifestaciones oculares con alteraciones vasculares y características inflamatorias. Fueron atendidos en las clínicas de Retinovascular y Retina y Vitreo del Hospital «Dr. Rodolfo Robles Valverde», del Benemérito Comité Pro-Ciegos y Sordos de la ciudad de Guatemala en el transcurso del año 2019. Guatemala es un país con una alta prevalencia de enfermedades transmitidas por vectores, dentro de las cuales se encuentra la chikungunya1,2, la cual presenta aumento en la incidencia los últimos años. Dentro de las complicaciones oculares se han reportado casos de neuritis óptica, iridociclitis, epiescleritis, retinitis y uveítis; además de discrasias sanguíneas que pueden afectar la retina3. Es importante considerarlos como un diagnóstico diferencial importante de alteraciones vasculares oculares

A descriptive study is presented on a case series of 3 patients, with IgM an IgG serology diagnosis of Chikungunya in whom other metabolic, autoimmune and infectious diseases were ruled out. They presented with other ocular manifestations with vascular changes and inflammatory characteristics. They were treated at the Retinovascular and Retinal and Vitreous clinics at the "Dr. Rodolfo Robles Valverde Hospital" and "Benemérito Comité Pro-ciegos y Sordos" in Guatemala City during 2019. Guatemala is a country with a high prevalence of vector-borne diseases, including chikungunya. In recent years cases of this disease has increased in recent years, and complications are currently seen more frequently. Within these complications, there have been reports of cases of optic neuritis, iridocyclitis, episcleritis, retinitis, uveitis, and blood dyscrasia that can affect the retina. It is important to consider these as an important differential diagnosis of ocular vascular alterations

Association between the transporters ABCA1/G1 and the expression of miR-33a/144 and the carotid intima media thickness in patients with arterial hypertension.

ATP-binding cassette membrane transporters (ABC), functions as an outflow facilitator of phospholipids and cellular cholesterol, playing an important role in the development of atherosclerosis and arterial hypertension. ABC's transporters could post-transcriptionally regulated by miRs. Evaluate the association in the transporters ABCA1 and ABCG1 with the expression of miR-33a and miR-144 and the carotid intima media thickness (cIMT) in patients with essential arterial hypertension. The miR-33a-5p, miR-144-3p and mRNA ABCA1 and ABCG1 expression in monocytes from Mexican hypertensive patients were examined by RT-PCR. The miR-33a and miR-144 expression in monocytes and mRNA ABCA1 and ABCG1 from Mexican hypertensive patients were examined by RT-PCR. This study involved 84 subjects (42 normotensive subjects and 42 patients with essential hypertension). Our study revealed that miR-33a expression (p = 0.001) and miR-144 (p = 0.985) were up-regulated, meanwhile, ABCA1 and ABCG1 transporters were down-regulated (p = 0.007 and p = 0.550 respectively) in hypertensive patients compared with the control group. The trend remains for miR33a/ABCA1 in presence of cIMT. Moreover, an inverse correlation was found with the expression levels of ABCA1 and ABCG1 as well as in HDL-C with miR-33a and miR-144. Our results showed an increase in the expression of miR-33a and miR-144 and an inverse correlation in their target ABCA1 and ABCG1; it may be associated with essential arterial hypertension in patients with cIMT and as consequence for atheromatous plaque.

Effect of Resistance Exercise Plus Cholecalciferol on Nutritional Status Indicators in Adults With Stage 4 Chronic Kidney Disease.

OBJECTIVE: Decreased serum concentrations of 25-hydroxyvitamin D (25(OH)D) affect people with chronic kidney disease (CKD); lower concentrations of 25(OH)D have been associated with decrease in nutritional status indicators. On the other hand, muscle resistance exercise has improved the nutritional status of patients with CKD.The aim of this study was to evaluate the effect of resistance exercise and dietary supplementation with cholecalciferol on nutritional status indicators in adults with stage 4 CKD. METHODS: Patients with an estimated glomerular filtration rate between 15 and 29 mL/min/1.73 m2 in an open-label clinical trial were followed for 12 weeks. The intervention group received exercise resistance training sessions three times per week with oral cholecalciferol supplementation each day. The control group only received standard medical care. The outcomes were anthropometric measurements, handgrip strength, and bioelectrical impedance analysis. RESULTS: Thirty-nine patients of a median age of 48 (36-52) years had an estimated glomerular filtration rate of 21.8 ± 6.5 mL/min/1.73 m2. A total of 57.5% of the patients were women. In 41% of the patients, the etiology of CKD was diabetes. After 12 weeks, in the intervention group, the adherence to the resistance training was 77%, and the adherence to the supplementation with cholecalciferol was 96.2%. Significant improvements in 25(OH)D serum concentrations and in handgrip strength were detected in the intervention group (P < .05). In the control group, a decrease in 25(OH)D serum concentrations and a loss in handgrip strength were observed, although the difference was not statistically significant. Anthropometrics and biochemical and dietary indicators, but not bioelectrical impedance data, exhibited changes. CONCLUSION: Supplementation with cholecalciferol improves serum concentrations of 25(OH)D and, when combined with resistance exercise, improved muscle function as measured by handgrip strength in a study of patients with CKD not on dialysis.

25 hydroxyvitamin D and nutritional parameters correlation in adults with stage 4 chronic kidney disease.

BACKGROUND AND AIMS: Serum concentrations of 25-hydroxyvitamin D (abbreviated "25(OH)D") and parameters of nutritional status both decline as chronic kidney disease (CKD) progresses. The objective of this study was to measure and correlate 25(OH)D concentrations with alterations in the nutritional status of adult patients with stage 4 CKD. METHODS: The study was cross-sectional, included patients with stage 4 CKD (CKD-Epi between 15 and 30 ml/min/1.73 m2), between the ages of 18 and 65, who sought services at the Department of Nephrology between April 2016 and April 2017. RESULTS: seventy participants were evaluated; the median age was 47 years old (interquartile range [IQR] of 33-53 years), and 54% of the participants were women. All of the participants presented 25(OH)D serum concentrations below 30 ng/ml. According to a Subjective Global Assessment, 32.6% of the study population was malnourished and 14% presented protein energy wasting. An inverse and proportional correlation was found between levels of 25(OH)D and urea (r = -0.342), cholesterol (r = -0.383), triglycerides (r = -0.316), and extracellular water (r = -0.399). In contrast, levels of 25(OH)D were directly proportional with serum albumin (r = 0.388), serum hemoglobin (r = 0.331), phase angle (r = 0.355), resistance (r = 0.518), and reactance (r = 0.580) in a statistically significant manner (p < 0.05). CONCLUSIONS: All the participants in this study presented levels of 25(OH)D considered to be deficient. Levels of 25(OH)D were shown to be significantly correlated with alterations in nutritional status. It is necessary to implement effective interventions to help correct these deficiencies in patients with CKD.

Increased expression of miR-33a in monocytes from Mexican hypertensive patients in elevated carotid intima-media thickness.

miR-33a has been described as a key regulator in the initiation and progression of atherosclerosis. However, its role in arterial hypertension (HTA) has not been elucidated. Therefore, the aim of this study was to determine the association between the expression of miR-33a (5p and 3p) and the carotid intima-media thickness (cIMT) in samples of monocytes and serum from hypertensive patients. The miR-33a-5p and miR-33a-3p expression in monocytes and serum from Mexican hypertensive patients were examined by RT-PCR. This study involved 84 subjects (42 normotensive subjects and 42 patients with essential hypertension). Our study revealed that miR-33a-5p expression was significantly upregulated in the monocytes of hypertensive patients compared with the control group (p = 0.001), while miR-33a-3p was significantly downregulated (p = 0.013). miR-33a-5p upregulation [OR: 5.53, 95% CI: 2.01-15.20; p = 0.001], as well as miR-33a-3p downregulation [OR: 3.32, 95% CI: 1.45-7.60; p = 0.004] in monocytes, was associated with an increased risk of developing hypertension. In addition, miR-33a-5p upregulation in hypertensive patients was associated with an increased risk of presenting cIMT [OR: 5.99, 95% CI: 1.10-32.85; p = 0.039]. Moreover, we found no significant differences in the expression of both strands of miR-33a in serum of our patients. Our results showed an upregulation of miR-33a-5p and downregulation of miR-33a-3p in monocytes, these data are associated with cIMT, which could be a risk factor for the development of hypertension. In addition, upregulation of miR-33a-5p in monocytes from Mexican hypertensive patients could be involved in the development of atherosclerosis.

Mortality in Patients With Chronic Renal Disease Without Health Insurance in Mexico: Opportunities for a National Renal Health Policy.

INTRODUCTION: Despite a systematic increase in the coverage of patients with end-stage renal disease (ESRD) who have received dialytic therapies and transplantation over the past 2 decades, the Mexican health system currently still does not have a program to provide full coverage of ESRD. Our aim was to analyze mortality in patients with ESRD without health insurance. METHODS: This was a prospective cohort study of 850 patients with advanced chronic kidney disease (CKD). Risk factors associated with death were calculated using a Cox's proportional hazards model. We used the statistical package SPSS version 22.0 for data analysis. RESULTS: The mean age of patients was 44.8 ± 17.2 years old. At the time of hospital admission, 87.6% of the population did not have a social security program to cover the cost of renal replacement treatment, and 91.3% of families had an income below US$300 per month. During the 3 years of the study, 28.8% of the cohort patients were enrolled in 1 of Mexico's social security programs. The 3-year mortality rate was of 56.7% among patients without access to health insurance, in contrast to 38.2% of patients who had access to a social security program that provided access to renal replacement therapy (P < 0.001). Risk factor analysis revealed that not having health insurance increased mortality (risk ratio: 2.64, 95% confidence intervals: 1.84-3.79; P = 0.001). CONCLUSION: Mexico needs a coordinated National Kidney Health and Treatment Program. A program of this nature should provide the basis for an appropriate educational and intervention strategy for early detection, prevention, and treatment of patients with advanced chronic kidney disease.

Serie de casos de afección ocular por dengue. Primeros casos publicados en Guatemala / Case series of ocular involvement due to dengue. First reported cases in Guatemala

OBJETIVO: Describir los hallazgos oculares en una serie de casos de 8 pacientes con diagnóstico de dengue. MATERIALES Y MÉTODOS: Revisión de expedientes clínicos y entrevistas con pacientes durante visitas en consulta externa con consentimiento informado y siguiendo las normas éticas de la declaración de Helsinki, con diagnóstico de dengue por serología IgM/IgG en los que se identificó afección ocular, durante el periodo de enero a octubre del 2017 en la clínica de retinovascular del Hospital Dr. Rodolfo Robles Valverde, Guatemala. RESULTADOS: Ocho pacientes originarios del interior del país (área rural) fueron diagnosticados con dengue (por serología IgM/IgG) asociado a afección ocular. Todos con una media de edad de 32,3 años de edad, siendo el mayor de 45 años y el menor de 20 años; de los cuales 5 son hombres y 3 son mujeres. Las manifestaciones oculares fueron 4 neurorretinitis, 3 obstrucciones venosas, 3 maculopatías, 2 desprendimientos serosos, una epiescleritis y una vasculitis. Dos pacientes desarrollaron atrofia óptica después de resolver la neurorretinitis y un paciente desarrolló cicatrización perifoveal después de la maculopatía. Todos resolvieron el cuadro clínico ocular después del tratamiento, presentando una mejoría en agudeza visual, pero en algunos casos se produjo daño al campo visual por la neurorretinitis. CONCLUSIÓN: Es necesario tener en cuenta el dengue como un importante diagnóstico principal en un país endémico como lo es Guatemala, considerando la amplia cantidad de manifestaciones oculares que puede presentar tanto por afección directa como por la reacción del sistema inmunitario, y así evitar clasificar como idiopático el cuadro clínico presentado o que sea atribuido a otra entidad

OBJECTIVE: Describe the ocular findings of a case series of 8 patients with a diagnosis of dengue. MATERIALS AND METHODS: Review of clinical records and interviews with patients during outpatient visits, after informed consent was obtained and following the ethical standards of the Helsinki declaration. The patients were diagnosed with diagnosis by IgM / IgG dengue serology in whom ocular involvement was identified, between January and October 2017 in Retinal-vascular clinic of the "Dr. Rodolfo Robles Valverde Hospital", Guatemala. RESULTS: The 8 patients, 5 men and 3 women from rural areas in Guatemala, were diagnosed with dengue by IgM / IgG serology with associated ocular involvement. The mean age was 32.3 years, with the oldest being 45 years old and the youngest being 20 years old. The ocular manifestations identified were, 4 neuroretinitis, 3 venous obstructions, 3 maculopathies, 2 serous detachments, 1 episcleritis, and 1 vasculitis. Two patients developed optic atrophy after resolving the neuroretinitis, and 1 developed peri-foveal scarring after the maculopathy. The ocular involvement was resolved in all patients after treatment, with an improvement in visual acuity, although in some cases damage to the visual field developed as a sequela of neuroretinitis. CONCLUSION: It is necessary to consider dengue as an important differential diagnosis in an endemic country such as Guatemala. There are a large number of ocular manifestations due to direct involvement, as well as by an immune system reaction, and thus avoid considering the different ocular manifestations as idiopathic, or due to a different condition

Efectividad de la terapia combinada de compresión isquémica con estiramiento poscontracción isométrica para la recuperación del rango de movimiento cervical en el tratamiento de puntos gatillo / Effectiveness of combined therapy of ischemic compression with post isometric contraction stretch, for recovery of cervical range of motion in the trigger point treatment

Objetivo: Identificar el efecto que tiene la terapia combinada de compresión isquémica con estiramiento poscontracción isométrica aplicada en puntos gatillo ubicados en el músculo trapecio superior, en la recuperación del rango de movimiento cervical. Material y método: Estudio de tipo cuantitativo, cuasi experimental. La muestra la componen 26 trabajadoras de oficina previamente diagnosticadas con puntos gatillo en el músculo trapecio superior y que no presentaran alguna patología cervical previa. Primero se les midió el rango de movimiento cervical, luego se aplicó técnica placebo o experimental al azar y, posteriormente, se volvió a medir el rango de movimiento. Luego de 7 días se aplicó la técnica no realizada en la primera intervención, midiendo nuevamente el rango de movimiento antes y después de aplicada la técnica. En el análisis estadístico se compararon los resultados del antes y después intertécnica e intratécnica, considerando una p < 0,05 y un intervalo de confianza del 95%. Resultados: La técnica experimental mostró tener un aumento significativo, al igual que la técnica placebo, ambos para una p de 0,05, pero al comparar la técnica placebo con la técnica experimental esta última mostró ser significativamente mayor a la placebo para una p de 0,05. Conclusiones: La técnica experimental aplicada sobre puntos gatillo ubicados en el músculo trapecio superior tiene mayor efectividad en la recuperación del rango de movimiento cervical de inclinación lateral frente a la técnica realizada en el grupo placebo

Objective: To identify the effect of ischemic compression therapy combined with post isometric contraction stretching applied to trigger points located in the upper trapezius muscle in recovery of cervical range of motion. Material and methods: A quantitative, quasi-experimental study. The sample consisted of 26 office workers previously diagnosed with trigger points in the upper trapezius muscle and who had no previous cervical pathology. First, cervical range of motion was measured, after which a technique was applied using placebo or randomly combined technique. Following this, range of motion was remeasured. Seven days later, the technique that was not applied in the first operation was performed, re-measuring the range of motion before and after application of the technique. In the statistical analysis, results were compared before and after the inter-and intra- technique, considering p<.05 and a confidence interval of 95%. Result: The experimental technique as well as the placebo technique showed a significant increase for a P of .05. However, when the placebo technique was compared with the experimental one, the latter was shown to be significantly greater than the placebo for a P of .05. Conclusions: The experimental technique applied to trigger points located in the upper trapezius muscle is more effective in the recovery of range of motion of cervical lateral tilt versus the technique performed in the placebo group

Effect of Resistance Exercises on the Indicators of Muscle Reserves and Handgrip Strength in Adult Patients on Hemodialysis.

OBJECTIVE: Although resistance exercise has been associated with improvement in the muscle reserves, muscle strength and quality of life in end-stage renal disease patients, the objective of this paper is to evaluate the effect of resistance exercise performed during hemodialysis sessions on the anthropometric indicators of muscle reserve and handgrip strength in sedentary malnourished patients with end-stage renal disease. METHODS: Patients were randomized to perform resistance exercise during hemodialysis sessions with ankle weights and resistance bands. The exercises were performed twice a week over the course of 12 weeks. The control group underwent a hemodialysis session alone. The outcomes measures were the following anthropometric measurements: arm muscle circumference and arm muscle area. Dynamometry was used to measure the handgrip strength. RESULTS: Sixty-one sedentary patients with a median age of 29 years (interquartile range [IQR] 21-39 years), and 83% presenting with some grade of malnutrition were equally randomized to either the intervention or control group. In the resistance exercise group, there was an increase in the arm muscle circumference from 233.6 (IQR 202-254) mm to 241.4 (IQR 203-264) mm (P= .001), arm muscle area from 35.9 (26-41) cm(2) to 36.6 (IQR 26-46) cm(2) (P= .002), and handgrip strength from 19.6 (IQR 11-28) kg to 21.2 (IQR 13-32) kg between the basal and final measurements (P < .05). The tolerance to exercise was adequate, and no adverse events were reported during the practical exercise. CONCLUSIONS: Resistance exercise at least twice a week is safe and represents an opportunity for improving the muscle mass and strength in adult patients who are on hemodialysis, including in those with malnutrition.

Evaluación de hábitos tóxicos en una población de estudiantes universitarios / Evaluation of toxic habits in a population of university students

Introducción: Una de las epidemias sociales de mayor y más rápida extensión de nuestro siglo, es el problema mundial que se presenta con el uso indebido de drogas. Esto tiene tal trascendencia, fundamentalmente en los jóvenes, que no solo trae consigo el deterioro personal, familiar y de comunidades completas, sino que al mismo se asocian factores tales como: el tráfico ilícito, problemas delictivos, que obstaculizan hasta el desarrollo adecuado de la economía de una nación.Objetivo: Determinar el grado de conocimiento y de utilización de drogas, tales como: cocaína, marihuana, cigarros, y bebidas alcohólicas.Diseño metodológico: Se aplicó una encuesta en forma de cuestionario a una población de 60 universitarios entre becados y externos.Resultados: Se detectó que la mayor parte de la muestra estudiada no consume drogas ni legales ni ilegales, además conocían dicha clasificación, sin embargo, no pudieron identificar los efectos de las drogas sobre las funciones psíquicas del organismo, ni a los psicofármacos, así como los daños que ocasionan las drogas en la salud humana. Encontramos una respuesta contradictoria en cuanto a la ocurrencia de problemas sociales por consumo de alcohol en la residencia estudiantil y la prohibición de este consumo en dichos lugares.Conclusiones: Existe bajo conocimiento sobre aspectos básicos concernientes a las drogas y por tanto, fue necesario la realización de actividades educativas para incrementar el nivel de conocimiento sobre este tema y evitar que adquieran estilos de vida inadecuados. Estos programas educativos, tuvieron una muy buena aceptación entre nuestros estudiantes universitarios(AU)

Introduction: One of the social epidemics of greater and more rapid expansion of our century, is the global problem that occurs with drug abuse. This has such importance, primarily young people, who not only brings personal, family and entire communities decline, but at the same associated factors such as: trafficking, crime problems that hinder to the proper development of the economy of a nation.Objective: To determine the degree of knowledge and use of drugs, such as cocaine, marijuana, cigarettes and alcohol.Methodological design: a survey questionnaire form was applied to a population of 60 college between recipients and external.Results: It was found that most of the sample does not consume neither legal nor illegal drugs also knew that classification, however, could not identify the effects of drugs on mental functions of the body, or psychotropic drugs and damage caused by drugs on human health. We found a contradictory answer as to the occurrence of social problems by drinking in the dorm and the prohibition of consumption in those places.Conclusions: The low knowledge concerning drugs basics and therefore it was necessary to the implementation of educational activities to increase the level of knowledge on this issue and prevent them from acquiring inappropriate lifestyles. These educational programs, had a very good acceptance among our college students(AU)

Estenosis aórtica pura y resonancia magnética en el adulto / Pure aortic stenosis and magnetic resonance in adult patients

OBJECTIVE: To evaluate the utility of the cardiovascular magnetic resonance imaging (cMRI) for quantify the aortic area in adult patients with pure aortic stenosis (AS). METHOD: Comparative cross-sectional study, blinded, in patients with AS, without another valvular pathology associated. A transthoracic echocardiogram (TTE) and cMRI were performed, in all of them. Results were analyzed by Student t test and ji-square, considering significant values p < 0.05. Bayesian analysis and ROC curve, for the determination of the disease severity. RESULTS: No were significant differences with respect to quantification of the speed of transvalvular flow between both methods (TTE 4.593 +/- 0.9114 m/s vs. cMRI 4.233 +/- 0.6894 m/s, p = 0.080), nor the ejection fraction (TTE 54.27 +/-16.451 vs. cMRI 48.40 +/-17.332, p = 0.760). The cMRI seems to underestimate the maximum and medium gradients compared with the TTE, in 12.53 mm Hg and 10.07 mm Hg respectively. The sensitivity for the diagnosis of severe aortic stenosis is 90% with specificity 80%. CONCLUSIONS: The cMRI is a useful diagnostic method for the evaluation of patients with pure aortic valve stenosis, as good as TTE. cMRI can to be a diagnostic alternative in cases with limitations to TTE.

Antibiotic prophylaxis in pediatric odontology. An update.

Most orofacial infections are of odontogenic origin, and are of a self-limiting nature, characterized by spontaneous drainage. The causal bacteria are generally saprophytes. On the other hand, invasive dental interventions give rise to transient bacteremia. When an oral lesion is contaminated by extrinsic bacteria, the required antibiotic treatment should be provided as soon as possible. In the case of pulpitis, such treatment is usually not indicated if the infection only reaches the pulp tissue or the immediately adjacent tissues. In the event of dental avulsion, local antibiotic application is advised, in addition to the provision of systemic antibiotics. The dental professional must know the severity of the infection and the general condition of the child in order to decide referral to a medical center. Prophylaxis is required in all immunocompromised patients, as well as in individuals with cardiac problems associated with endocarditis, vascular catheters or prostheses. Penicillin V associated to clavulanic acid and administered via the oral route is known to be effective against odontogenic infections. In the case of allergies to penicillin, an alternative drug is clindamycin. Most acute infections are resolved within 3-7 days. In recent years, the tendency is to reduce general antibiotic use for preventive or therapeutic purposes.

Apósitos hidrocoloides liberadores de plata hidroactiva / Hydro-colloidal dressings which release hydro-active silver

Se presenta un estudio multicéntrico, prospectivo, abierto y comparativo cuyo objetivo fue evaluar el rendimiento de un apósito antibacteriano de plata hidroactiva formulado sobre una base de hidrocoloide, en la activación del proceso de cicatrización en heridas con elevada carga bacteriana, signos clínicos de infección y mal olor. Por otro lado, una vez preparado el lecho ulceral, se comparó en términos de eficacia el tratamiento prolongado con plata frente al tratamiento con plata seguido de tratamiento con apósitos específicos para la fase de granulación. Se han incluido 43 pacientes con úlceras crónicas distribuidos en dos grupos paralelos de tratamiento: Comfeel® Plata (Coloplast A/S), hasta la completa cicatrización o durante un máximo de 10-12 semanas desde el inicio del tratamiento o este mismo apósito, hasta que la úlcera estuviera limpia y mostrara signos de evolución positiva hacia la cicatrización, seguido de tratamiento con apósitos sin plata específicos para la fase de granulación [Alione®, Comfeel® o Biatain® (Coloplast A/S)], hasta la completa cicatrización o durante un máximo de 10-12 semanas. Los resultados recogidos en los varios parámetros de evaluación indican que la utilización del apósito estudiado en heridas infectadas o colonizadas prepara el lecho ulceral para una cicatrización más rápida, disminuyendo tanto el olor como el dolor de forma efectiva. Los resultados indican que una vez preparado el lecho ulceral el proceso de cicatrización se ve favorecido por la utilización de un apósito sin plata específico para la fase de granulación

The study presented is a multicentric, prospective, open and comparative study designed with the objective of evaluating the performance of an antibacterial hydrocolloid dressing with hydroactivated silver (Comfeel® Plata), when used to activate the healing process in wounds with high bacterial load, clinical signs of infection or malodour. Additionally, once the wound bed was appropriately prepared, a comparison in terms of efficacy was made between, on the one hand, continued treatment with the antibacterial hydrocolloid dressing, and, on the other hand, continued treatment with other dressings specifically designed for the proliferative phase of healing. Included into this study were 43 patients with chronic ulcers who were divided into two parallel treatment groups: In one group, Comfeel® Plata (Coloplast A/S) was used until complete wound healing or for a maximum of 10-12 weeks, and in the second group Comfeel® Plata (Coloplast A/S) was used until a clean wound bed was obtained and until the wound showed signs of positive evolution, at which moment the treatment was continued until complete healing or for a maximum of 10-12 weeks with dressings without silver designed especially for the proliferative phase of healing [Alione®, Comfeel® or Biatain® (Coloplast A/S)]. The results obtained from the various study parameters indicate that the use of Comfeel® Plata in the treatment of infected or colonized wounds prepares the wound bed and facilitates more rapid healing, and that the use of Comfeel® Plata effectively reduces pain and malodour. The results indicate that once a clean wound bed is obtained, the use of a dressing without silver specifically for the proliferative phase will facilitate healing

Serotonin modulation of CHH secretion by isolated cells of the crayfish retina and optic lobe.

The authors used the reverse hemolytic plaque assay to investigate whether single retinal and optic lobe cells of juvenile and adult crayfish secrete crustacean hyperglycemic hormone (CHH) and whether the secretion rate depends on extracellular serotonin (5-HT) concentration. Nearly 25% of individual retinal and optic lobe cells of juvenile and adult organisms secrete CHH in response to KCl depolarization. In this condition, CHH secretion increased as a function of 5-HT concentration. In both cases, the dose-response curve indicates two different populations of CHH-secreting cells. Juveniles showed a higher CHH secretion index than did adult organisms, demonstrating a developmental interstage variation of CHH secretion. The authors conclude that (1) retinal CHH-secreting cells correspond to a population of retinal tapetal cells and (2) optic lobe CHH-secreting cells correspond to two subpopulations of CHH of medulla terminalis-X organ.