KRAS Exon 2 Mutations in Patients with Sporadic Colorectal Cancer: Prevalence Variations in Mexican and Latin American Populations.

We searched for the prevalence of actionable somatic mutations in exon 2 of the KRAS gene in western Mexican patients with CRC. Tumor tissue DNA samples from 150 patients with sporadic CRC recruited at the Civil Hospital of Guadalajara were analyzed. Mutations in exon 2 of the KRAS gene were identified using Sanger sequencing, and the data were analyzed considering clinical-pathological characteristics. Variants in codon 12 (rs121913529 G>A, G>C, and G>T) and codon 13 (rs112445441 G>A) were detected in 26 patients (with a prevalence of 17%). No significant associations were found between these variants and clinical-pathological characteristics (p > 0.05). Furthermore, a comprehensive search was carried out in PubMed/NCBI and Google for the prevalence of KRAS exon 2 mutations in Latin American populations. The 17 studies included 12,604 CRC patients, with an overall prevalence of 30% (95% CI = 0.26-0.35), although the prevalence ranged from 13 to 43% across the different data sources. Determining the variation and frequency of KRAS alleles in CRC patients will enhance their potential to receive targeted treatments and contribute to the understanding of the genomic profile of CRC.

Linking Anthropogenic Landscape Perturbation to Herbivory and Pathogen Leaf Damage in Tropical Tree Communities.

Anthropogenic disturbance of tropical humid forests leads to habitat loss, biodiversity decline, landscape fragmentation, altered nutrient cycling and carbon sequestration, soil erosion, pest/pathogen outbreaks, among others. Nevertheless, the impact of these alterations in multitrophic interactions, including host-pathogen and vector-pathogen dynamics, is still not well understood in wild plants. This study aimed to provide insights into the main drivers for the incidence of herbivory and plant pathogen damage, specifically, into how vegetation traits at the local and landscape scale modulate such interactions. For this purpose, in the tropical forest of Calakmul (Campeche, Mexico), we characterised the foliar damage caused by herbivores and pathogens in woody vegetation of 13 sampling sites representing a gradient of forest disturbance and fragmentation in an anthropogenic landscape from well preserved to highly disturbed and fragmented areas. We also evaluated how the incidence of such damage was modulated by the vegetation and landscape attributes. We found that the incidence of damage caused by larger, mobile, generalist herbivores, was more sensitive to changes in landscape configuration, while the incidence of damage caused by small and specialised herbivores with low dispersal capacity was more influenced by vegetation and landscape composition. In relation to pathogen symptoms, the herbivore-induced foliar damage seems to be the main factor related to their incidence, indicating the enormous importance of herbivorous insects in the modulation of disease dynamics across tropical vegetation, as they could be acting as vectors and/or facilitating the entry of pathogens by breaking the foliar tissue and the plant defensive barriers. The incidence of pathogen damage also responded to vegetation structure and landscape configuration; the incidence of anthracnose, black spot, and chlorosis, for example, were favoured in sites surrounded by smaller patches and a higher edge density, as well as those with a greater aggregation of semi-evergreen forest patches. Fungal pathogens were shown to be an important cause of foliar damage for many woody species. Our results indicate that an increasing transformation and fragmentation of the tropical forest of southern Mexico could reduce the degree of specialisation in plant-herbivore interactions and enhance the proliferation of generalist herbivores (chewers and scrapers) and of mobile leaf suckers, and consequently, the proliferation of some symptoms associated with fungal pathogens such as fungus black spots and anthracnose. The symptoms associated with viral and bacterial diseases and to nutrient deficiency, such as chlorosis, could also increase in the vegetation in fragmented landscapes with important consequences in the health and productivity of wild and cultivated plant species. This is a pioneering study evaluating the effect of disturbances on multitrophic interactions, offering key insights on the main drivers of the changes in herbivory interactions and incidence of plant pathogens in tropical forests.

Potential Involvement of Oxidative Stress, Apoptosis and Proinflammation in Ipconazole-Induced Cytotoxicity in Human Endothelial-like Cells.

Triazole fungicides are widely used in the world, mainly in agriculture, but their abuse and possible toxic effects are being reported in some in vivo and in vitro studies that have demonstrated their danger to human health. This in vitro study evaluated the cytotoxicity, oxidative stress and proinflammation of EA.hy926 endothelial cells in response to ipconazole exposure. Using the MTT assay, ipconazole was found to produce a dose-dependent reduction (*** p < 0.001; concentrations of 20, 50 and 100 µM) of cell viability in EA.hy926 with an IC50 of 29 µM. Also, ipconazole induced a significant increase in ROS generation (** p < 0.01), caspase 3/7 (** p < 0.01), cell death (BAX, APAF1, BNIP3, CASP3 and AKT1) and proinflammatory (NLRP3, CASP1, IL1ß, NFκB, IL6 and TNFα) biomarkers, as well as a reduction in antioxidant (NRF2 and GPx) biomarkers. These results demonstrated that oxidative stress, proinflammatory activity and cell death could be responsible for the cytotoxic effect produced by the fungicide ipconazole, such that this triazole compound should be considered as a possible risk factor in the development of alterations in cellular homeostasis.

Computer-Supported Collaborative Design of Standardized Clinical Cases: Algorithm Development and Validation.

Background: The creation of computer-supported collaborative clinical cases is an area of educational research that has been widely studied. However, the reuse of cases and their sharing with other platforms is a problem, as it encapsulates knowledge in isolated platforms without interoperability. This paper proposed a workflow ecosystem for the collaborative design and distribution of clinical cases through web-based computing platforms that (1) allow medical students to create clinical cases collaboratively in a dedicated environment; (2) make it possible to export these clinical cases in terms of the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) interoperability standard; (3) provide support to transform imported cases into learning object repositories; and (4) use e-learning standards (eg, Instructional Management Systems Content Packaging [IMS-CP] or Sharable Content Object Reference Model [SCORM]) to incorporate this content into widely-used learning management systems (LMSs), letting medical students democratize a valuable knowledge that would otherwise be confined within proprietary platforms. Objective: This study aimed to demonstrate the feasibility of developing a workflow ecosystem based on IT platforms to enable the collaborative creation, export, and deployment of clinical cases. Methods: The ecosystem infrastructure for computer-supported collaborative design of standardized clinical cases consists of three platforms: (1) Mosaico, a platform used in the design of clinical cases; (2) Clavy, a tool for the flexible management of learning object repositories, which is used to orchestrate the transformation and processing of these clinical cases; and (3) Moodle, an LMS that is geared toward publishing the processed clinical cases and delivering their course deployment stages in IMS-CP or SCORM format. The generation of cases in Mosaico is exported in the HL7 FHIR interoperability standard to Clavy, which is then responsible for creating and deploying a learning object in Moodle. Results: The main result was an interoperable ecosystem that demonstrates the feasibility of automating the stages of collaborative clinical case creation, export through HL7 FHIR standards, and deployment in an LMS. This ecosystem enables the generation of IMS-CPs associated with the original Mosaico clinical cases that can be deployed in conventional third-party LMSs, thus allowing the democratization and sharing of clinical cases to different platforms in standard and interoperable formats. Conclusions: In this paper, we proposed, implemented, and demonstrated the feasibility of developing a standards-based workflow that interoperates multiple platforms with heterogeneous technologies to create, transform, and deploy clinical cases on the web. This achieves the objective of transforming the created cases into a platform for web-based deployment in an LMS.

Ipconazole Induces Oxidative Stress, Cell Death, and Proinflammation in SH-SY5Y Cells.

Ipconazole is an antifungal agrochemical widely used in agriculture against seed diseases of rice, vegetables, and other crops; due to its easy accumulation in the environment, it poses a hazard to human, animal, and environmental health. Therefore, we investigated the cytotoxic effect of ipconazole on SH-SY5Y neuroblastoma cells using cell viability tests (MTT), ROS production, caspase3/7 activity, and molecular assays of the biomarkers of cell death (Bax, Casp3, APAF1, BNIP3, and Bcl2); inflammasome (NLRP3, Casp1, and IL1ß); inflammation (NFκB, TNFα, and IL6); and antioxidants (NRF2, SOD, and GPx). SH-SY5Y cells were exposed to ipconazole (1, 5, 10, 20, 50, and 100 µM) for 24 h. The ipconazole, in a dose-dependent manner, reduced cell viability and produced an IC50 of 32.3 µM; it also produced an increase in ROS production and caspase3/7 enzyme activity in SH-SY5Y cells. In addition, ipconazole at 50 µM induced an overexpression of Bax, Casp3, APAF1, and BNIP3 (cell death genes); NLRP3, Casp1, and IL1B (inflammasome complex genes); and NFκB, TNFα, and IL6 (inflammation genes); it also reduced the expression of NRF2, SOD, and GPx (antioxidant genes). Our results show that ipconazole produces cytotoxic effects by reducing cell viability, generating oxidative stress, and inducing cell death in SH-SY5Y cells, so ipconazole exposure should be considered as a factor in the presentation of neurotoxicity or neurodegeneration.

The occurrence of Sarcocystis spp. in the myocardium of alpacas (Vicugna pacos) with associated risk factors in the Peruvian Andes.

Sarcocystis masoni n. sp. (known as "S. lamacanis") infects alpacas affecting their productivity and can cause a food poisoning syndrome in humans by consuming contaminated, undercooked cardiac muscle. There are few studies estimating the prevalence of this parasite in alpacas, although this information is crucial for the control and prevention of sarcocystosis. This study aimed to determine the frequency and density of Sarcocystis masoni n. sp. in the heart of alpacas in Huancavelica, a province of the Andean region of Peru. Heart samples were taken for histopathology from 104 alpacas slaughtered at the municipal slaughterhouse of Huancavelica, the official abattoir in the Huancavelica district. No macroscopic sarcocysts were observed. All alpacas (100%) had microscopic sarcocysts of Sarcocystis masoni n. sp., with no inflammatory reactions. The alpacas showed an average sarcocyst density of 60.8 ± 23.3/mm2. Sarcocysts density was significantly higher (p < 0.05) as the age of the animals increased. In addition, sarcocysts density was significantly higher (p < 0.05) in male animals aged 4 and 5 years compared to females of the same age. These results confirmed that heart sarcocystosis is highly endemic in Peruvian alpacas. Therefore, it is recommended that alpaca hearts be well-cooked at the time of consumption. The present study showed current data and contributes to the knowledge of this parasitosis. Studies of this nature are necessary because they are the basis for developing animal health programs.

Chemical Characterization, Antioxidant Capacity and Anti-Oxidative Stress Potential of South American Fabaceae Desmodium tortuosum.

It has been proposed that oxidative stress is a pathogenic mechanism to induce cytotoxicity and to cause cardiovascular and neuronal diseases. At present, natural compounds such as plant extracts have been used to reduce the cytotoxic effects produced by agents that induce oxidative stress. Our study aimed to evaluate the antioxidant and cytoprotective capacity of Desmodium tortuosum (D. tortuosum) extract in the co- and pre-treatment in EA.hy926 and SH-SY5Y cell lines subjected to oxidative stress induced by tert-butylhydroperoxide (t-BOOH). Cell viability, reactive oxygen species (ROS), nitric oxide (NO), caspase 3/7 activity, reduced glutathione (GSH), glutathione peroxidase (GPx), glutathione reductase (GR), and molecular expression of oxidative stress biomarkers (SOD2, NRF2 and NFκB1) and cell death (APAF1, BAX, Caspase3) were all evaluated. It was observed that the D. tortuosum extract, in a dose-dependent manner, was able to reduce the oxidative and cytotoxicity effects induced by t-BOOH, even normalized to a dose of 200 µg/mL, which would be due to the high content of phenolic compounds mainly phenolic acids, flavonoids, carotenoids and other antioxidant compounds. Finally, these results are indicators that the extract of D. tortuosum could be a natural alternative against the cytotoxic exposure to stressful and cytotoxic chemical agents.

Experiencia en patología cervical alta en el Hospital Guillermo Almenara Irigoyen 2016 - 2021

Introducción : El complejo C0-C1-C2 es responsable de la transición de la carga axial, con función biomecánica única, siendo afectada por múltiples patologías, que por lo general la literatura no las considera como un solo ítem, sino que lo desarrolla según su etiología, pero en nuestro estudio se ha considerado en 5 grupos: traumática, congénita, inflamatoria reumática, neoplásica y degenerativa. Objetivo : Determinar las características epidemiológicas, clínicas y del tratamiento en la patología cervical alta. Materiales y métodos : Se incluyeron a todos los pacientes con diagnóstico clínico radiológico de alguna patología cervical alta que hayan sido sometidos a tratamiento quirúrgico entre 2016 y 2021 en el Hospital Almenara. Se usó el test "t" de student y de chi cuadrado. Se dividió a los pacientes en alguno de los 5 grupos antes mencionados. Resultados : Se consideraron 31 pacientes, con una edad media de 51.16 años. La patología cervical alta más frecuente fue la traumática con el 35.48%. El déficit motor se presentó en el 51.61% y el déficit sensitivo se presentó en el 54.84%. La cirugía más frecuente fue la fijación cervical alta con el 43.89%. La tasa de complicaciones fue del 16.13% con una mortalidad del 0%. Conclusiones : La patología cervical alta es rara, siendo la del tipo traumática la más frecuente, pero un manejo oportuno y adecuado permite un mejor pronóstico funcional del paciente.

Introduction : The C0-C1-C2 complex is responsible of axial load transition, and its biomechanical function is unique, it is affected by multiple pathological conditions; and generally speaking, the literature does not consider these conditions as a single item, it describes them according to etiology. For our study we considered five groups: trauma-related, congenital, rheumatic-inflammatory, neoplastic, and degenerative. Objective : To determine epidemiological, clinical, and therapy-related characteristics in upper cervical pathological conditions. Materials and methods : All patients with a clinical-radiological diagnosis of any upper cervical pathological condition that had undergone surgery between 2016 and 2021 in Guillermo Almenara Hospital were included. Student's t test and chi square methods were used. patients were divided into one of the five aforementioned groups. Results : Thirty-one patients were included in the study; their mean age was 51.16 years. The most frequent upper cervical pathological condition was trauma-related, with 35.48%. Motor deficit occurred in 51.61% of all patients, and sensitive deficit occurred in 54.84%. The most frequently surgical procedure performed was upper cervical fixation, in 43.89% of all patients. Complication rate was 16.13%, and mortality was 0%. Conclusions : Upper cervical pathological conditions are rare, trauma-related conditions are most frequent, but timely and adequate management allow us to achieve better functional prognosis for these patients.

Left oblique corridor for pre-psoas approach: image study / Corredor obliquo esquerdo para a abordagem pré-psoas: estudo de imagem / Corredor oblicuo izquierdo para el abordaje pre-psoas: estudio de imagen

ABSTRACT Introduction: This study describes the imaging characteristics and accessibility of the L4 / L5 left oblique corridor used in the OLIF spinal fusion approach and the dimensions of the left oblique corridor at L2/L3 and L3/L4. Methods: Observational, retrospective, and descriptive study, in which MRI is described for 330 patients. The length of the left OC L2/L3, L3/L4, and L4/L5 were measured and classified into four grades: 0 (not measurable), 1 (≤10 mm), 2 (10-20 mm), and 3 (≥20 mm). The psoas was measured at the level of the L4 / L5, and the modified Moro classification was used for the height of the psoas, considering high psoas from AII to AIV. The data was processed in the SPSS 26.0 system. Results: The mean age was 62.1 ± 13.5 years, the OC length in L2/L3, L3/L4 y L4/L5 were 16.1 ± 5.9, 16.2 ± 6.7 and 14.7 ± 8.8 mm, respectively. 14.8% had high psoas. OC grade 0 (2.1%) was obtained in 7 patients, 87 with grade 1 (26.4%), 129 with grade 2 (39.1%), and 107 with grade 3 (32.4%). The length of the OC in males was 2.4 mm (MD, 95% CI: 0.4-4.5, p: 0.02), more than in females. Conclusion: It was shown that 85.2% had an accessible psoas muscle for the left OLIF L4 / L5 approach, 71.5% had an accessible oblique corridor, and only 14.8% had high psoas. These parameters combined, 61.5% of MRI, were appropriate for this approach. Level of evidence III; Retrospective study.

Resumo: Introducción: Este estudio describe las características imagenológicas y la accesibilidad del corredor oblicuo izquierdo L4/L5 utilizado para la fusión intersomática oblicua, así como las dimensiones del corredor oblicuo izquierdo en L2/L3 y L3/L4. Métodos: Estudio observacional, retrospectivo y descriptivo, que se describe la RM de 330 pacientes. Se midió la longitud del CO izquierdo L2/L3, L3/L4 y L4/L5 y se clasificó en cuatro grados: 0 (no medible), 1 (≤10 mm), 2 (10-20 mm) y 3 (≥20 mm). El psoas se midió a nivel de L4/L5, para la altura del psoas se utilizó la clasificación de Moro modificada; considerando psoas alto de AII a AIV. Los datos fueron procesados en el sistema SPSS 26.0. Resultados: La edad media fue de 62.1 ± 13.5 años, la longitud de CO en L2/L3, L3/L4 y L4/L5 fue de 16.1 ± 5.9, 16.2 ± 6.7 y 14.7 ± 8.8 mm, respectivamente. El 14.8% tenía psoas alto. En 7 pacientes, se obtuvo CO grado 0 (2.1%), 87 con grado 1 (26.4%), 129 con grado 2 (39.1%) y 107 con grado 3 (32.4%). La longitud de la CO en hombres fue 2.4 mm (DM, IC 95%: 0.4-4.5, p: 0.02) más que en las mujeres. Conclusão: Se demostró que el 85.2% tenía un psoas accesible para el abordaje OLIF L4/L5 izquierdo, el 71.5% tenía corredor oblicuo accesible y solo el 14.8% tenía psoas alto. Combinados estos parámetros, el 61.5% de las RM fueron apropiadas para este abordaje. Nivel de evidencia III; estudio retrospectivo.

Resumen: Introdução: Este estudo descreve as características de imagem e acessibilidade do corredor oblíquo esquerdo L4/L5 usado para a fusão intersomática oblíqua, bem como as dimensões do corredor oblíquo esquerdo em L2/L3 e L3/L4. Métodos: Estudo observacional e descritivo, no qual é descrita a RM de 330 pacientes. O comprimento do OC esquerdo L2/L3, L3/L4 e L4/L5 foi medido e classificado em quatro graus: 0 (não mensurável), 1 (≤10 mm), 2 (10-20 mm) e 3 (≥20 mm). O psoas foi medido no nível de L4/L5 sendo utilizada a classificação de Moro modificada; considerando um psoas alto de AII a AIV. Os dados foram processados no sistema SPSS 26.0. Resultados: A média de idade foi de 62.1 ± 13.5 anos, o comprimento do CO em L2/L3, L3/L4 e L4/L5 foi de 16.1 ± 5.9, 16.2 ± 6.7 e 14.7 ± 8.8 mm, respectivamente. 14.8% tinham psoas alto. Em 7 pacientes obteve-se CO grau 0 (2.1%), 87 com grau 1 (26.4%), 129 com grau 2 (39.1%) e 107 com grau 3 (32.4%). O comprimento do CO nos homens foi 2.4 mm (MD, IC 95%: 0.4-4.5, p: 0.02) a mais do que nas mulheres. Conclusión: Evidenciou-se que 85.2% tinham psoas acessível para a abordagem OLIF L4/L5 esquerda, 71.5% tinham corredor oblíquo acessível e apenas 14.8% tinham psoas alto. Combinados esses parâmetros, 61.5% das RMs foram adequadas para essa abordagem. Nível de evidência III; Estudo retrospectivo.

Neurotoxicity associated with oxidative stress and inflammasome gene expression induced by allethrin in SH-SY5Y cells.

Pyrethroids, including allethrin, have largely been used as commercial insecticides. The toxicity of allethrin is little known, but it is assumed that, as occurs with other pyrethroids, it could cause alterations of the nervous system and pose both occupational and non-occupational health hazards. To evaluate the neurotoxicity of allethrin we used the MTT assay of SH-SY5Y neuroblastoma cells to determine cell viability. Dose-dependent reductions of cell viability served to compare the vehicle-group and the IC50 for allethrin, which was 49.19 µM. ROS production increased significantly at concentrations of 10-200 µM of allethrin, and NO levels were significantly increased by the effect of allethrin at a minimum concentration of 50 µM. Lipid peroxidation increased by the effect of allethrin at concentrations of 25, 50, 100, and 200 µM. Caspase 3/7 activity was induced by allethrin concentrations of 50, 100, and 200 µM. Here, we suggest that allethrin might affect the inflammasome complex (Caspase-1, NLRP3, and PYDC1) and apoptosis (Bax and Bcl-2) gene expression by mRNA fold change expression levels shown in Caspase-1 (2.46-fold), NLRP3 (1.57-fold), PYDC1 (1.48-fold), and Bax (2.1-fold). These results demonstrated that allethrin induced neurotoxicity effects on SH-SY5Y cells through activation of inflammasome pathways, cell death, and oxidative stress.

Molecular Profiling of Tumor Tissue in Mexican Patients with Colorectal Cancer.

Colorectal cancer is a heterogeneous disease with multiple genomic changes that influence the clinical management of patients; thus, the search for new molecular targets remains necessary. The aim of this study was to identify genetic variants in tumor tissues from Mexican patients with colorectal cancer, using massive parallel sequencing. A total of 4813 genes were analyzed in tumoral DNA from colorectal cancer patients, using the TruSight One Sequencing panel. From these, 192 variants with clinical associations were found distributed in 168 different genes, of which 46 variants had not been previous reported in the literature or databases, although genes harboring those variants had already been described in colorectal cancer. Enrichment analysis of the affected genes was performed using Reactome software; pathway over-representation showed significance for disease, signal transduction, and immune system subsets in all patients, while exclusive subsets such as DNA repair, autophagy, and RNA metabolism were also found. Those characteristics, whether individual or shared, could give tumors specific capabilities for survival, aggressiveness, or response to treatment. Our results can be useful for future investigations targeting specific characteristics of tumors in colorectal cancer patients. The identification of exclusive or common pathways in colorectal cancer patients could be important for better diagnosis and personalized cancer treatment.

A Brief Review on Gender Differences in Mexican-Mestizo Patients with Pulmonary Arterial Hypertension (PAH) at a Tertiary-Level Hospital.

Pulmonary hypertension (PH) is a hemodynamic condition with different etiological groups but common pathophysiology. Gender differences have been studied in group 1 of the PH classification, the pulmonary arterial hypertension (PAH) group. PAH has an etiopathogenic basis in sex hormones and directly affects the pulmonary vasculature and the heart. Gender differences are observed before and after the age of 45 when women lose the cardioprotective effect of estrogen. A retrospective cohort study in adult patients ≤45 years and >45 years. We compared hemodynamic, echocardiographic, and imaging variables that demonstrated gender differences in adult patients with PAH below and above 45 years. Gender differences in adults ≤45 years were significant for the pronounced pulmonic component of the second heart sound (P2) and the right atrium pressure, on the other hand, more significant sex differences were observed in patients over 45 years of age including the pronounced pulmonic component of P2 (greater in women), the brain natriuretic peptide had a higher median in men, the same happened in the echocardiographic data referring to the area of the right atrium and tricuspid annular plane systolic excursion, abnormal values predominate in men. Although PAH has greater incidence and prevalence in women, the lesions corresponding to cardiac remodeling that subsequently led to right ventricular failure are more remarkable in men, raising their mortality. These findings help recognize its clinical usefulness and propose new research studies aimed at mortality and new pharmacological therapies that might unveil the pathophysiological mechanisms to treat PAH.

In Vitro Neurotoxicity of Flumethrin Pyrethroid on SH-SY5Y Neuroblastoma Cells: Apoptosis Associated with Oxidative Stress.

Pyrethroids are neurotoxicants for animals, showing a pattern of toxic action on the nervous system. Flumethrin, a synthetic pyrethroid, is used against ectoparasites in domestic animals, plants, and for public health. This compound has been shown to be highly toxic to bees, while its effects on other animals have been less investigated. However, in vitro studies to evaluate cytotoxicity are scarce, and the mechanisms associated with this effect at the molecular level are still unknown. This study aimed to investigate the oxidative stress and cell death induction in SH-SY5Y neuroblastoma cells in response to flumethrin exposure (1-1000 µM). Flumethrin induced a significant cytotoxic effect, as evaluated by MTT and LDH leakage assays, and produced an increase in the biomarkers of oxidative stress as reactive oxygen species and nitric oxide (ROS and NO) generation, malondialdehyde (MDA) concentration, and caspase-3 activity. In addition, flumethrin significantly increased apoptosis-related gene expressions (Bax, Casp-3, BNIP3, APAF1, and AKT1) and oxidative stress and antioxidative (NFκB and SOD2) mediators. The results demonstrated, by biochemical and gene expression assays, that flumethrin induces oxidative stress and apoptosis, which could cause DNA damage. Detailed knowledge obtained about these molecular changes could provide the basis for elucidating the molecular mechanisms of flumethrin-induced neurotoxicity.

Tuberculosis espinal: diagnóstico y manejo / Spinal tuberculosis: diagnosis and treatment

RESUMEN La tuberculosis espinal representa el 50 % de los casos de tuberculosis osteoarticular y, sin un tratamiento oportuno, puede ocasionar discapacidad (por complicaciones neurológicas) y deformidad. Se sospecha de esta enfermedad con base en los antecedentes del paciente, la clínica y los hallazgos radiológicos. El diagnóstico se establece con la identificación de Mycobacterium tuberculosis, las características histopatológicas y/o hallazgo de bacilos ácido-alcohol resistentes (BAAR) en el frotis. El diagnóstico diferencial más importante de la tuberculosis espinal es la espondilodiscitis piógena. La resonancia magnética es la prueba de imagen indicada para la valoración del compromiso neurológico y el estudio diagnóstico diferencial. El tratamiento principal es la quimioterapia antituberculosa, y la cirugía puede ser coadyuvante en los casos de tuberculosis espinal complicada, luego de evaluar el déficit neurológico y la deformidad resultante. Está contraindicado realizar solamente una laminectomía, y los implantes para la artrodesis se pueden utilizar en la infección activa. El 8 % de los pacientes con déficit neurológico no logra recuperarse, aun con el tratamiento.

ABSTRACT Spinal tuberculosis accounts for 50 % of all cases of osteoarticular tuberculosis, causing disability (due to neurological complications) and deformity if left untreated. This disease is suspected based on the patient's medical history, clinical manifestations and radiological findings. It is diagnosed by positive cultures for Mycobacterium tuberculosis, the histopathological characteristics of the condition and/or acid-fast bacilli (AFB)-positive smear tests. The main differential diagnosis of spinal tuberculosis is pyogenic spondylodiscitis. Magnetic resonance imaging is the appropriate imaging test to assess the neurological involvement and study the differential diagnosis of the disease. The main treatment is antituberculous chemotherapy, but surgery can be adjunctive in cases of complicated spinal tuberculosis. The decision of which treatment to implement depends on the neurological deficit and the resulting deformity. Laminectomy alone is contraindicated and arthrodesis implants can be used during the active infection. Despite treatment, 8 % of the patients with neurological deficit do not recover.

Familial hypertriglyceridemia: an entity with distinguishable features from other causes of hypertriglyceridemia.

BACKGROUND: Familial hypertriglyceridemia (FHTG) is a partially characterized primary dyslipidemia which is frequently confused with other forms hypertriglyceridemia. The aim of this work is to search for specific features that can help physicians recognize this disease. METHODS: This study included 84 FHTG cases, 728 subjects with common mild-to-moderate hypertriglyceridemia (CHTG) and 609 normotriglyceridemic controls. All subjects underwent genetic, clinical and biochemical assessments. A set of 53 single nucleotide polymorphisms (SNPs) previously associated with triglycerides levels, as well as 37 rare variants within the five main genes associated with hypertriglyceridemia (i.e. LPL, APOC2, APOA5, LMF1 and GPIHBP1) were analyzed. A panel of endocrine regulatory proteins associated with triglycerides homeostasis were compared between the FHTG and CHTG groups. RESULTS: Apolipoprotein B, fibroblast growth factor 21(FGF-21), angiopoietin-like proteins 3 (ANGPTL3) and apolipoprotein A-II concentrations, were independent components of a model to detect FHTG compared with CHTG (AUC 0.948, 95%CI 0.901-0.970, 98.5% sensitivity, 92.2% specificity, P < 0.001). The polygenic set of SNPs, accounted for 1.78% of the variance in triglyceride levels in FHTG and 6.73% in CHTG. CONCLUSIONS: The clinical and genetic differences observed between FHTG and CHTG supports the notion that FHTG is a unique entity, distinguishable from other causes of hypertriglyceridemia by the higher concentrations of insulin, FGF-21, ANGPTL3, apo A-II and lower levels of apo B. We propose the inclusion of these parameters as useful markers for differentiating FHTG from other causes of hypertriglyceridemia.

Toracostomía cerrada bajo sedación en el servicio de urgencias / Thoracostomy under sedation in the emergency service

El trauma es uno de los principales retos en cuanto a salud pública mundial se trata. Según la OMS, causa alrededor de cinco millones de muertes al año, siendo el trauma de tórax uno de los más frecuentes, reportándose hasta 90-96% de lesiones penetrantes con una mortalidad cercana al 30%. La toracotomía es un procedimiento frecuentemente realizado en el servicio de urgencias, pero es una técnica dolorosa e incómoda que puede generar dificultades a la hora de su realización. Se requiere encontrar la información disponible acerca de la seguridad en la intervención bajo sedación y determinar su utilidad en el servicio de urgencias, así como conocer los niveles de sedación para poder realizar las diferentes técnicas y evaluar según el procedimiento a realizar a qué nivel se debe llevar el paciente. La utilización de fármacos para analgesia y sedación en este servicio tiene por objetivo el control efectivo y seguro del dolor, control de la ansiedad, para evitar movimientos del paciente, buscando disminuir las posibles complicaciones. En esta revisión se estudian medicamentos como ketamina, propofol, morfina, hidromorfona, fentanilo, etomidato y midazolam, así como sus posibles combinaciones para implementarlos en el proceso de sedación en la toracostomía de urgencia. No hay una estrategia terapéutica aplicable a todos los pacientes por lo que cada una de ellas debe individualizarse..Au

Trauma constitutes one of the main challenges in terms of public health in the world. According to the WHO, it causes about five million deaths per year, chest trauma is one of the most frequently occurring injuries, reporting up to 90-96% of penetrating injuries with mortality close to 30%. Thoracostomy is a procedure frequently performed in the emergency department, however, it is a painful and uncomfortable procedure, and there could be difficulties while it is done. It is required to find the available information about how safe a thoracostomy is under sedation is and determine its usefulness in the emergency department; learning the levels of sedation, and depending of the procedure the patient needs, determine the level of sedation the patient has to induced into. The use of medications for analgesia and sedation in the emergency room is aimed to the effective and safe control of pain and anxiety as well as to avoid movements of the patient to reduce complications. This review considers medications such as ketamine, propofol, morphine, hydromorphone, fentanyl, etomidate, midazolam and the best combinations of these medications to carry out sedation for emergency thoracostomy. However, there is not a therapeutic strategy applicable to all patients, therefore each patient has to be analyzed individually..Au

Vaginohisteroscopia, diagnóstico y tratamiento de las patologías endometriales en consultorio / Vaginohysteroscopy, diagnosis and treatment of endometrial pathologies in office / Vaginohysteroscopy, diagnosis and treatment of endometrial pathologies in office

RESUMEN En los últimos años se han visto avances tecnológicos importantes, muchos aplicados al ámbito médico, permitiendo la evolución de numerosos procedimientos. Un ejemplo es la histeroscopia, donde la miniaturización de su instrumental y la mejora en la resolución de las imágenes han permitido su evolución de un procedimiento exclusivo de sala de operaciones al uso en consultorio. La vaginohisteroscopia permite diagnosticar y tratar la mayoría de las patologías endometriales sin anestesia, espéculo, pinzamiento ni dilatación del cuello uterino. Presenta una serie de ventajas como buena tolerancia por parte de la paciente, disminución de los costos, menos tiempo de espera para resolver las patologías y reposo laboral más corto, haciendo a este procedimiento el estándar para el diagnóstico y tratamiento de las patologías endometriales y endocervicales.

ABSTRACT In recent years there have been important technological advances, many applied to the medical field, allowing the evolution of numerous procedures. An example is hysteroscopy, where the miniaturization of its instruments and the improvement in the resolution of the images have allowed its evolution from an exclusive procedure in the operating room to use in the office. Vaginohysteroscopy allows the diagnosis of most endometrial pathologies without anesthesia, speculum, clamping or dilation of the cervix. It presents a series of advantages such as good tolerance by the patient, lower costs, less waiting time to resolve the pathologies and shorter work rest, making this procedure the standard for the diagnosis and treatment of endometrial and endocervical pathologies.

La necesidad de una posición crítica en la investigación psicológica. Apuntes sobre teoría y experiencia / The Need for a Critical Position in Psychological Research. Notes on Theory and Experience

Resumen En el presente artículo argumentamos una tesis doble. La primera premisa sugiere que las distintas formas de investigación en psicología deben tomarse en serio el ejercicio de la crítica. La segunda premisa realiza una crítica racional del lugar que tienen teoría y experiencia en las prácticas investigativas. Algunos investigadores en psicología se encuentran en un doble riesgo: o bien parten de una concepción implícita de la experiencia según la cual ella no es útil para criticar las propias asunciones teóricas sino sólo para ilustrarlas; o bien, y en consecuencia, consideran también implícitamente que las teorías son dogmas cerrados que no se dejan someter a la crítica racional. Por esta razón, ponemos en duda escisiones entre investigadores, a propósito de la distinción entre investigación cualitativa y cuantitativa, teórica y empírica, entre otras. Argumentamos que, a pesar de sus esfuerzos por diferenciarse, los investigadores se parecen más de lo que estarían dispuestos a reconocer.

Abstract In the article we argue a double thesis. The first premise suggests that the different forms of research in psychology should take the exercise of criticism seriously. The second premise makes a rational criticism when theory and experience take place in research practices. Some researchers are in a double risk: either part of an implicit conception of experience according to which it is not useful to criticize the theoretical assumptions but only to illustrate them, or it is also implicitly considered that theories are closed dogmas that cannot be rationally criticized. For this reason, we question divisions among researchers, for example, the distinction between qualitative and quantitative, theoretical and empirical research, etc. We argue that, despite their efforts to differentiate, researchers are more alike than they would be willing to acknowledge.