High TGM1 Allelic Heterogeneity causing Lamellar ichthyosis in a small geographic area in South Mexico: Another Example of the "Réunion Paradox".

Lamellar ichthyosis (LI) is an autosomal recessive congenital ichthyosis characterized by generalized dry skin and severe scaling. It is caused by biallelic mutations in the TGM1 gene, however molecular data from non-Caucasian populations are limited. Results of genetic-molecular analysis of a group of LI pedigrees originating from two close small populations from south Mexico are presented. LI affected individuals belonging to 9 apparently unrelated families were studied. Exome sequencing or Sanger sequencing in probands from each family was carried out. Furthermore, DNA from 294 unaffected subjects from one of the communities were Sanger sequenced to determine the carrier frequency of the c.427C > T TGM1 variant. Five different TGM1 pathogenic variants, either in homozygous or in compound heterozygous state, were demonstrated in affected subjects. The two most common variants were c.427C > T (p.Arg143Cys) and c.1159+1G > T. A novel c.1645+1G > T TGM1 pathogenic allele was recognized. Carrier frequency analysis identified a total of 23 individuals heterozygous for the c.427C > T variant, predicting a prevalence of 78 carriers per 1000 inhabitants in the community. A high TGM1 allelic heterogeneity with 5 different LI-causing alleles in a limited geographic area was demonstrated. While the occurrence of homozygosity for a founder mutation is expected in small populations with high frequency of a particular autosomal recessive disorder, the occurrence of multiple pathogenic alleles has been previously described, a situation known as the Reúnion paradox. Our results expand the current knowledge of the mutational spectrum of TGM1-linked LI.

Future care for long-term cancer survivors: towards a new model.

PURPOSE: The increase in the prevalence "long-term cancer survivor" (LCS) patients is expected to increase the cost of LCS care. The aim of this study was to obtain information that would allow to optimise the current model of health management in Spain to adapt it to one of efficient LCS patient care. METHODS: This qualitative study was carried out using Delphi methodology. An advisory committee defined the criteria for participation, select the panel of experts, prepare the questionnaire, interpret the results and draft the final report. RESULTS: 232 people took part in the study (48 oncologists). Absolute consensus was reached in three of the proposed sections: oncological epidemiology, training of health professionals and ICT functions. CONCLUSION: The role of primary care in the clinical management of LCS patients needs to be upgraded, coordination with the oncologist and hospital care is essential. The funding model needs to be adapted to determine the funding conditions for new drugs and technologies.

The electronic nose as a rule-out test for tuberculosis in an indigenous population.

INTRODUCTION: To end the tuberculosis (TB) epidemic, efficient diagnostic tools are needed. In a previous calibration study, a portable 'point of care' electronic nose device (AeonoseTM ) proved to be a promising tool in a hospital setting. We evaluated this technology to detect TB in an indigenous population in Paraguay. METHODS: A total of 131 participants were enrolled. eNose results were compared with anamnesis, physical examinations, chest radiography and mycobacterial cultures in individuals with signs and symptoms compatible with TB. The eNose analysis was performed in two stages: first, the training with a combination of a previous study population plus 47 participants from the new cohort (total n = 153), and second, the 'blind prediction' of 84 participants. RESULTS: 21% of all participants (n = 131) showed symptoms and/or chest radiography abnormalities suspicious of TB. No sputum samples resulted culture positive for Mycobacterium tuberculosis complex. Only one patient had a positive smell print analysis. In the training model, the specificity was 92% (95% confidence interval (CI): 85%-96%) and the negative predictive value (NPV) was 95%. In the blind prediction model, the specificity and the NPV were 99% (95% CI: 93%-99%) and 100%, respectively. Although the sensitivity and positive predictive value of the eNose could not be assessed in this cohort due to the small sample size, no active TB cases were found during a one year of follow-up period. CONCLUSION: The eNose showed promising specificity and negative predictive value and might therefore be developed as a rule-out test for TB in vulnerable populations.

Vivencias del ejercicio libre de la profesión en enfermeras que emplean terapias complementarias / Experiences of the free exercise of the profession in nurses who use complementary therapies

INTRODUCCIÓN: Actualmente enfermeras con posgrados y estudios en terapias complementarias, incursionan en el ejercicio libre de la profesión, al interior de consultorios propios, con la experiencia de varios años en funciones clínicas y utilización de terapias como: Acupuntura, Homeopatía, Masajes, entre otras, permiten resultados exitosos en usuarios que presentan procesos de enfermedades comunes, así como acciones sinérgicas cuando se combinan con terapias farmacológicas y quirúrgicas convencionales. METODOLOGÍA: Estudio de investigación cualitativo, descriptivo con enfoque fenomenológico, las informantes fueron 4 enfermeras residentes de la Ciudad de México y Estado de Hidalgo que utilizan terapias complementarias en ejercicio libre de la profesión, en consultorio privado, con un tiempo de trabajo mayor de tres años. Se estableció el consentimiento informado para obtener los permisos de grabar las entrevistas a profundidad. Con el método de análisis de datos de Sousa Minayo. RESULTADOS: Se describen 3 categorías con sus respectivas subcategorías las cuales representan: 1. Intencionalidad de sanar mediante terapias complementarias 2. Percepción del ejercicio libre de Enfermería 3. Inicios para la apertura del consultorio. CONCLUSIONES: Las licenciadas en Enfermería están asumiendo roles de liderazgo al llevar acabo el ejercicio libre de la profesión ya que se requiere capacitación y preparación para cumplir con la responsabilidad de tomar decisiones, esta autonomía implica un juicio crítico basado en conocimientos previos y la posibilidad de aplicar conocimientos generados a través de la investigación en la práctica para lograr un cambio en el cuidado a los usuarios, familias y comunidad por medio de la utilización de terapias complementarias.

INTRODUCTION: Currently nurses with postgraduate degrees and studies in complementary therapies, enter into the free exercise of the profession, inside their own offices, with the experience of several years in clinical functions and the use of therapies such as: Acupuncture, Homeopathy, Massages, Neural Therapy among others, they allow successful results in users who present common disease processes, as well as synergistic actions when combined with conventional pharmacological and surgical therapies. METHODOLOGY: Qualitative, descriptive research study with a phenomenological approach, the informants were 4 resident nurses from Mexico City and the State of Hidalgo who used complementary therapies in free practice of the profession, in their private office, with a working time of more than three years. Informed consent was established to obtain permission to record the interviews in depth. With the Sousa Minayo data analysis method. RESULTS: 3 categories are described with their respective subcategories which represent: 1. Intentionality to heal through complementary therapies 2. Perception of free exercise by Nursing 3. Beginnings for opening the office. CONCLUSIONS: Nursing graduates are assuming leadership roles by carrying out the free exercise of the profession since training and preparation are required to fulfill the responsibility of making decisions, this autonomy implies a critical judgment based on previous knowledge and the possibility of apply knowledge generated through research in practice to achieve a change in care for users, families and the community through the use of complementary therapies.

Epidemiology and natural history of cutaneous squamous cell carcinoma in recessive dystrophic epidermolysis bullosa patients: 20 years' experience of a reference centre in Spain.

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is the leading cause of death in patients with recessive dystrophic epidermolysis bullosa (RDEB). We provide the management and prognosis of cSCC in RDEB patients at a Spanish reference center. MATERIALS AND METHODS: We retrospectively included patients with RDEB attended in La Paz University Hospital from November 1988 to October 2018. RESULTS: Fourteen patients developed at least one cSCC. Tumors were predominantly well differentiated. Nearly half of the tumors have recurred. Median time to first recurrence was 23.4 months (95% CI: 17.2-29.5). Five patients have developed distant metastases. Median overall survival (mOS) was 136.5 months since the diagnosis of the first cSCC (95% CI: 30.6-242.3). When distant metastases occurred, mOS was 6.78 months (95% CI: 1.94-11.61). CONCLUSIONS: cSCC is a life-threatening complication of RDEB patients. Although tumors are usually well differentiated, they tend to relapse. This is the first Spanish report of cSCC arising in RDEB patients.

Detection of border disease virus in Mexican cattle.

The genus Pestivirus within Flaviviridae is comprised of four recognized species, namely, bovine viral diarrhoea virus 1 (BVDV-1), bovine viral diarrhoea virus 2 (BVDV-2), border disease virus (BDV) and classical swine fever virus (CSFV). BDV, while primarily infecting sheep and goats, has also been reported in cattle and wild animals. Infections of sheep and goats result in economic loss due to abortions and the birth of persistently infected animals that have poor production and reduced life expectancy. In this study, we report the detection of BDV in cattle serum collected as part of pestivirus surveillance programme from six regions of Mexico, where a 67.1% of BVDV seroprevalence was calculated previously. Phylogenetic analyses based on comparison of the 5'UTR region typed the Mexican strains as BDV-1. Border disease (BD) is listed as an exotic disease in Mexico, and the origin of BDV found in these cattle is unclear. This is the first identification of BDV in Mexican cattle.

Serum level of scorpion toxins, electrolytes and electrocardiogram alterations in Mexican children envenomed by scorpion sting.

The scorpion Centruroides limpidus limpidus (C.l.l.) is endemic in México, producing hundreds of accidents in humans; children being one of the most susceptible targets. Few studies reported that severe envenoming by scorpion venom induces cardiac damage and electrolytes abnormalities in children, but the relationship of envenoming severity and toxic blood levels is unknown. The aim of this study was to determine the relationship among clinical status of envenoming, serum electrolyte, electrocardiographic abnormalities, and serum toxin levels in 44 children stung by scorpion over a period of 6 months in the State of Morelos, Mexico. The patients were said to be asymptomatic, when they presented just local symptoms, and were said to be symptomatic when showing local symptoms and at least one systemic symptom. The clinical status was evaluated at the admission at the emergency room of the Hospital, and 30 min after the administration of polyspecific F(ab')2 anti-scorpion therapy to symptomatic children. Forty-one percent of the children were asymptomatic and 59% symptomatic. Potassium and sodium imbalance and an elongation of the QT interval were detected; the rate of hypokalemia was higher in symptomatic than on asymptomatic children (50% and 6%, respectively). Hypokalemia persisted in 19% in symptomatic patients, whereas sodium reached normal levels 30 min after anti-venom therapy. The hypokalemia statistically correlated with elongation of the QT interval. The concentration of the toxic components of C.l.l in serum was significantly higher in symptomatic than asymptomatic children, and the serum levels of the toxic component significantly decreased to undetectable levels after the application of anti-venom therapy. Despite the small size of the sample, this study establishes that severity of envenoming was statistically related to potassium imbalance in serum, QT interval and the concentration of toxic components in serum, which decreased at undetectable levels after specific treatment with the anti-scorpion venom, correlating with clinical disappearance or greatly reduction of symptoms of envenomation.

Plasma mepivacaine concentrations in patients undergoing third molar surgery.

BACKGROUND: Local anaesthetic-related systemic toxicity mainly results from elevated plasma concentrations of these drugs. We hypothesized that intraoral injection of submaximal doses of mepivacaine does not lead to toxic levels of this drug in blood. This study evaluated the plasma levels of mepivacaine in third molars surgeries. METHODS: Twenty-one patients were randomly assigned into two groups: group I (two unilateral third molars; submaximal dose of mepivacaine 108 mg with epinephrine 54 µg) and group II (four third molars; submaximal dose of mepivacaine 216 mg with epinephrine 108 µg). Blood samples were collected before anaesthesia, and 5, 10, 15, 20, 30, 40, 60, 90 and 120 min after anaesthesia. RESULTS: Individual peak plasma concentrations ranged 0.77-8.31 µg/mL (group I) and from 2.36-7.72 µg/mL (group II). An increase in the average dose of mepivacaine from 1.88 ± 0.12 mg/kg (group I) to 3.35 ± 0.17 mg/kg (group II) increased the mean mepivacaine peak plasma levels from 2.33 ± 0.58 to 4.01 ± 0.69 µg/mL, respectively. Four patients obtained plasma levels of mepivacaine above the threshold for toxicity (5 µg/mL). CONCLUSIONS: Toxic levels of mepivacaine are possible, even when a submaximal dose is used. A twofold increase in the dose of mepivacaine caused the mean peak plasma concentration to increase proportionally, indicating that they may be predicted based on the relation of dose per bodyweight.

Avaliação da qualidade de amostras comerciais de leite de janaguba (Himatanthus drasticus (Mart. ) Plumel) em Fortaleza – Ceará / Quality assessment of commercial samples of janaguba’s milk (Himatanthus drasticus (Mart. ) Plumel) in Fortaleza – Ceará.

RESUMO Os fitoterápicos à base de leite de janaguba (Himatanthus drasticus (Mart.) Plumel), usados para o tratamento de câncer, úlcera gástrica e outras doenças, são muito vendidos em mercados públicos de Fortaleza (CE). No entanto, registros mencionam que é comum a troca deste leite por látex de mangabeira (Hancornia speciosa Gomes). O trabalho objetivou avaliar a qualidade físico-química, química e microbiológica de amostras comerciais do leite de janaguba. Dez amostras comerciais foram adquiridas de um mercado de Fortaleza; quatro amostras autênticas de látex de janaguba foram obtidas da chapada do Araripe e uma amostra de látex de mangabeira foi obtida em Paracuru (CE). Foram determinados o aspecto geral, densidade, pH, resíduo seco, volume de sedimentação, perfil cromatográfico e qualidade microbiológica das amostras. Os resultados mostraram elevada contaminação microbiológica nas preparações comerciais e adulteração em seis destas amostras, o que aponta a urgente implantação de uma efetiva farmacovigilância dos fitoterápicos a fim de tornar seu consumo mais seguro e racional.

ABSTRACT The herbal medicines made from janaguba milk (Himatanthus drasticus (Mart.) Plumel), used to treat gastric ulcer, cancer and other diseases, and arewidely sold in the public markets of Fortaleza (CE). However, records mention that it is common to make fake copies of the milk by using mango tree latex (Hanconia speciosa Gomes). This study aimed to evaluate the chemical, physical-chemical and microbiological quality of commercial samples of janaguba milk. Ten commercial samples were purchased from a Fortaleza market; four authentic samples of janaguba latex were obtained from the Araripe plateau, and one mango tree latex sample was obtained in Paracuru (CE). We determined the general appearance, density, pH, dry residue, sedimentation volume, chromatographic profile and microbiological qualities. Results showed high microbiological contamination in the commercial preparations and evidence of tampering in six of these samples, which indicates the need for an urgent implementation of an effective pharmacovigilance strategy for herbal medicines in order to make its consumption more secure and rational.

Estudo etnofarmacológico e etnobotânico de Himatanthus drasticus (Mart. ) Plumel (janaguba) / Ethnopharmacological and ethnobotanical study of Himatanthus drasticus (Mart. ) Plumel (janaguba).

RESUMO Himatanthus drasticus (Mart.) Plumel, janaguba, produz um látex em seu caule que é usado para o tratamento de alguns tipos de câncer, vermes intestinais, febre, menstruações irregulares, infertilidade feminina e úlceras gástricas. Estudos fitoquímicos revelaram a presença de acetato de lupeol e proteínas; e estudos farmacológicos, os efeitos antiúlcera, antitumoral, imunomodulador, analgésico e anti-inflamatório. O presente trabalho objetivou realizar levantamento etnobotânico e etnofarmacológico sobre H. drasticus como contribuição ao conhecimento científico da referida espécie. Foi elaborado um questionário, que foi aplicado em entrevista a 21 raizeiros nos mercados das cidades de Crato, Fortaleza e Pacajus do estado do Ceará (CE). Observou-se que 38,1% dos raizeiros têm mais de 10 anos de serviço e 47,6%, estão na faixa etária de 40 a 59 anos, o que representa um fator positivo quanto à experiência com plantas medicinais. Aproximadamente 85,7% dos raizeiros relataram o uso do látex da H. drasticus para tratamento de úlcera; 66,7% para inflamação; 66,7% para câncer. Verificou-se que as principais indicações terapêuticas relatadas pelos raizeiros sobre esta espécie estão de acordo com as informações científicas. Os levantamentos etnobotânicos e etnofarmacológicos exercem um papel primordial no resgate do conhecimento tradicional, nos meios rurais e urbanos, tanto por seu valor histórico-cultural, como também pela necessidade de confirmação das indicações de uso.

ABSTRACT The Himatanthus drasticus (Mart.) Plumel, janaguba, produces a latex whose stem is used to treat some types of cancer, intestinal worms, fever, irregular menses, female infertility and gastric ulcers. Phytochemical studies revealed the presence of lupeol acetate and proteins in the latex; and pharmacological studies indicated antiulcer, anti-tumor, immunomodulating, analgesic and anti-inflammatory effects. This study aimed to conduct surveys on ethnopharmacological and ethnobotanical species H. drasticus as a contribution to the scientific knowledge about the species. A questionnaire and interviews were made with 21 healers in the markets of the cities of Crato, Fortaleza and Pacajús, in state of Ceara (CE). It was observed that 38.1% of the healers have more than 10 years of service, and 47.6% are between 40-59 years old, which is a positive factor about the experience with medicinal plants. Approximately 85.7% of the healers reported to apply latex H. drasticus for the treatment of ulcers, 66.7% for inflammation, and 66.7% for cancer. It was found that the main therapeutic indications mentioned by the healers about this species are consistent with the scientific information available. The ethnobotanical and ethnopharmacological surveys play an essential role on keeping the traditional knowledge in rural and urban areas, both for its historical and cultural value, but also for the need of confirmation of the intended use.

Hipotiroidismo subclínico en mujeres infértiles / Subclinical Hypothyroidism in Infertile Women

Objetivo: Comparar la frecuencia de hipotiroidismo subclínico (HSC) entre mujeres con infertilidad primaria (IP) y secundaria (IS) asistidas en la consulta de ginecología de la Maternidad “Dr. Armando Castillo Plaza”, en Maracaibo, estado Zulia. Métodos: Investigación comparativa y aplicada, con diseño de tipo no experimental, contemporáneo transeccional y de campo en la cual se incluyeron 100 mujeres con infertilidad, separadas en dos grupos pareados en relación con el tipo de infertilidad, a las cuales se les determinó el perfil hormonal tiroideo: hormona estimuladora del tiroides (TSH), tiroxina libre (FT4) y triiodotiroxina libre (FT3). Resultados: No se evidenciaron diferencias estadísticas significativas entre las mujeres con IP o IS, en cuanto a edad, menarquía, sexarquía, número de parejas y tiempo de convivencia. En las mujeres con IP prevaleció el factor ovulatorio (50 %) seguido del tubo-peritoneal (34 %), mientras que entre las pacientes con IS el factor principal fue el tubo-peritoneal (38 %) seguido del ovulatorio (28 %); mostrando solamente el factor ovulatorio una diferencia significativa (p< 0,05). Se determinó que las pacientes con IP presentaron significativamente concentraciones más elevadas tanto de la TSH (3,14 ± 2,08 vs. 2,33 ± 1,59; p< 0,05) como de FT4 (1,19 ± 0,37 vs. 1,04 ± 0,25; p< 0,05); determinándose una prevalencia de HSC en mujeres infértiles del 17 %; siendo más frecuente y significativo en el grupo de mujeres con IP que en las pacientes con IS (26 % vs. 8 %; OR [IC95%]= 4,04 [1,26 -13,43]; p < 0,05), en tanto que según la severidad del HSC todos los casos detectados en ambos grupos se encontraban dentro del grado I. Conclusión: Existe una mayor prevalencia de HSC entre las mujeres con IP que en las pacientes con IS.

Objective: To compare the frequency of subclinical hypothyroidism (SCH) among women with primary (PI) and secondary infertility (SI) who presented for gynecology consultation at Maternity "Dr. Armando Castillo Plaza" in Maracaibo, Zulia state. Methods: Comparative and applied research with non-experimental, contemporary transactional and field design, including 100 women with infertility, separated into two groups matched for the type of infertility. Thyroid hormone profile: thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyroxine (FT3) were measured in these women. Results: There were no statistically significant differences between women with PI or secondary SI, in terms of age, menarche, sexarche, number of partners and length of cohabitation. In women with PI the ovulatory factor prevailed (50 %) followed by the tube-peritoneal (34 %), while among patients with SI the main factor was the tube-peritoneal (38 %) followed by the ovulatory (28 %); only the ovulatory factor showed a significant difference (p < 0.05). PI patients had significantly higher concentrations of both TSH (3.14 ± 2.08 vs. 2.33 ± 1.59, p <0.05) and FT4 (1.19 ± 0, 37 vs. 1.04 ± 0.25, p < 0.05); the prevalence of SCH was determined at 17% in infertile women, being more frequent and significant in the PI group of women than in SI patients (26 % vs. 8 %, OR [95 % CI] = 4.04 [1.26-13.43], p < 0.05), while according to the severity of SCH all cases detected in both groups were within grade I. Conclusion: There is a higher prevalence of SCH in women with PI than in patients with SI.

Hipotiroidismo subclínico en mujeres infértiles / Subclinical Hypothyroidism in Infertile Women

Objetivo: Comparar la frecuencia de hipotiroidismo subclínico (HSC) entre mujeres con infertilidad primaria (IP) y secundaria (IS) asistidas en la consulta de ginecología de la Maternidad “Dr. Armando Castillo Plaza”, en Maracaibo, estado Zulia. Métodos: Investigación comparativa y aplicada, con diseño de tipo no experimental, contemporáneo transeccional y de campo en la cual se incluyeron 100 mujeres con infertilidad, separadas en dos grupos pareados en relación con el tipo de infertilidad, a las cuales se les determinó el perfil hormonal tiroideo: hormona estimuladora del tiroides (TSH), tiroxina libre (FT4) y triiodotiroxina libre (FT3). Resultados: No se evidenciaron diferencias estadísticas significativas entre las mujeres con IP o IS, en cuanto a edad, menarquía, sexarquía, número de parejas y tiempo de convivencia. En las mujeres con IP prevaleció el factor ovulatorio (50 %) seguido del tubo-peritoneal (34 %), mientras que entre las pacientes con IS el factor principal fue el tubo-peritoneal (38 %) seguido del ovulatorio (28 %); mostrando solamente el factor ovulatorio una diferencia significativa (p< 0,05). Se determinó que las pacientes con IP presentaron significativamente concentraciones más elevadas tanto de la TSH (3,14 ± 2,08 vs. 2,33 ± 1,59; p< 0,05) como de FT4 (1,19 ± 0,37 vs. 1,04 ± 0,25; p< 0,05); determinándose una prevalencia de HSC en mujeres infértiles del 17 %; siendo más frecuente y significativo en el grupo de mujeres con IP que en las pacientes con IS (26 % vs. 8 %; OR [IC95%]= 4,04 [1,26 -13,43]; p < 0,05), en tanto que según la severidad del HSC todos los casos detectados en ambos grupos se encontraban dentro del grado I. Conclusión: Existe una mayor prevalencia de HSC entre las mujeres con IP que en las pacientes con IS.(AU)

Objective: To compare the frequency of subclinical hypothyroidism (SCH) among women with primary (PI) and secondary infertility (SI) who presented for gynecology consultation at Maternity "Dr. Armando Castillo Plaza" in Maracaibo, Zulia state. Methods: Comparative and applied research with non-experimental, contemporary transactional and field design, including 100 women with infertility, separated into two groups matched for the type of infertility. Thyroid hormone profile: thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyroxine (FT3) were measured in these women. Results: There were no statistically significant differences between women with PI or secondary SI, in terms of age, menarche, sexarche, number of partners and length of cohabitation. In women with PI the ovulatory factor prevailed (50 %) followed by the tube-peritoneal (34 %), while among patients with SI the main factor was the tube-peritoneal (38 %) followed by the ovulatory (28 %); only the ovulatory factor showed a significant difference (p < 0.05). PI patients had significantly higher concentrations of both TSH (3.14 ± 2.08 vs. 2.33 ± 1.59, p <0.05) and FT4 (1.19 ± 0, 37 vs. 1.04 ± 0.25, p < 0.05); the prevalence of SCH was determined at 17% in infertile women, being more frequent and significant in the PI group of women than in SI patients (26 % vs. 8 %, OR [95 % CI] = 4.04 [1.26-13.43], p < 0.05), while according to the severity of SCH all cases detected in both groups were within grade I. Conclusion: There is a higher prevalence of SCH in women with PI than in patients with SI.(AU)

Teste PCR em tempo real para diagnóstico antemortem em humanos e triagem de high throughtput do vírus da raiva / Real time PCR for antemortem diagnosis in humans and high throughput rabies virus screening

a raiva é uma das mais antigas e devastadoras doenças, tipicamente com um índice de mortalidade de 100% dos casos. O diagnóstico da raiva antemortem em humanos é importante para definir os procedimentos de controle da infecção e evitar maior exposição das equipes de saúde e de outras pessoas que podem ter tido contato com a saliva do paciente; para determinar epidemiologicamente seoutros indivíduos foram expostos à mesma fonte; para monitorar a progressão da doença, medianteintervenções terapêuticas experimentares; para evitar a infecção cruzada durante transplantes de órgãos e, caso negativa, para examinar outros diagnósticos diferenciais. A obtenção de quatro amostras é o recomendadopara testes antemortem de raiva em humanos (por meio da saliva, do soro, de biópsia de pele da nuca e do fluido cerebroespinhal), nos quais os anticorpos, os antígenos virais e os ácidos nucleicos são detectados empregando métodos de neutralização, imunofluorescência direta e indireta e transcrição reversa de PCR. O momento chave para obtenção de resultados conclusivos, nas quatro amostras analisadas por todas as técnicas, é aproximadamente de 24 a 48 horas. A PCR em tempo real parece ser umatécnica promissora para acelerar os resultados da detecção no ácido nucleico e quantificar, com maior precisão, as cargas virais nas amostras dos pacientes. Não existe, porém, primer ou probe universal que possa detectar a ampla diversidade dos lissavirus descrita até o momento, o que reduz drasticamente a sensibilidade do teste. O objetivo deste estudo foi traçar o desenho de um ensaio sensível e específico de PCR em tempo real capaz de detectar e quantificar uma ampla variedade dos vírus de raiva em amostras antemortem e postmortem em tecidos e fluidos corporais de humanos e animais. MÉTODOS: Mais de2.500 sequências completas de nucleoproteínas de RABV representativas de um espectro global devariantes obtidas das bases de dados do GenBank e do CDC foram analisadas para ...

Cierre percutáneo del ductus arterioso con coils: diagnóstico y seguimiento ecocardiográfico a largo plazo / Percutaneous closure of arterious ductus with coils: echocardiographic diagnosis and follow up

Objectives: We report about the percutaneous closure with coils of small and medium sized ductus arteriosus, and their long term follow up in a single center. Patients and Method: This is a retrospective study, including 291 patients in an intention to treat basis, between 1998 and 2006. Results: The median age and weight at time of procedure was 45 months and 16,7 Kg respectively. The immediate rate of occlusion was 82 percent and 91,3 percent at 1 year follow up. Up to 98 percent of cases needed just 1 coil to close the defect. The result was considered sub optimal in 33 cases (11,6 percent) almost half of this group was evaluated as having mild residual shunt at one year, all of them closed with additional coils percutaneously. Only the size of ductus was related to this type of result (>3 mm). Conclusions: The percutaneous closure with coils, is a highly eficacious alternative, for treatment of ductus arteriosus up to 2,5-3 mm, as minor diameter, with a very convenient cost/benefit rate. Beyond these limits the advantages disappear, and alternative devices become the treatment of choice.

Objetivos: Se reporta sobre el cierre percutáneo de ductus pequeños y medianos con coils en un solo centro, su diagnóstico y seguimiento ecocardiográfico a largo plazo. Pacientes y método: Se realizó un estudio retrospectivo sobre 291 pacientes portadores de ductus arterioso diagnosticado ecocardiográficamente en quienes se intentó el cierre percutáneo entre 1998y 2006. Resultados: La mediana de edad y peso de los pacientes al momento del procedimiento fue de 45 meses y 16,7 kg. La tasa de oclusión inmediata fue de 82 por ciento y de 91,3 por ciento a un año. En el 98 por ciento de los casos se utilizó un solo coil para cerrar el defecto. El resultado fue sub óptimo en 33 casos (11,6 por ciento) siendo casi la mitad de estos casos correspondientes a shunt residual leve a un año, todos cerrados con coil en procedimiento percutáneo adicional. Sólo el tamaño del ductus estuvo relacionado con este resultado (>3mm). Conclusiones: El cierre con coils sigue siendo un tratamiento altamente eficaz para ductus de hasta 2,5-3 mm de diámetro menor, con una relación costo/beneficio muy favorable al compararse con dispositivos alternativos. Más allá de estos límites las ventajas mencionadas tienden a disminuir en forma considerable y se hace discutible su uso.

Serum electrolyte changes in pediatric patients stung by scorpions

Scorpion sting is a health problem in some places of Mexico. The clinical manifestations of scorpion envenomation are variable and include metabolic alterations. Hyperkalemia is the most frequently reported metabolic alteration. We conducted a prospective, observational, descriptive and transversal study in an emergency room at Hospital del Niño Morelense, Mexico. Eighty-two patients were included and classified as mild (17 percent) moderate (33 percent) and severe (46 percent). The mean serum level of sodium was 146.4meq/l, standard deviation (SD) 5.58; potassium 3.86meq/l, SD 0.53, and calcium 9.55mg/dl, SD 0.76. We found 30.4 percent hypernatremia, 12 percent hypokalemia, 10.9 percent abdominal distension, and 14.6 percent visual alterations.

Serum electrolyte changes in pediatric patients stung by scorpions

Scorpion sting is a health problem in some places of Mexico. The clinical manifestations of scorpion envenomation are variable and include metabolic alterations. Hyperkalemia is the most frequently reported metabolic alteration. We conducted a prospective, observational, descriptive and transversal study in an emergency room at Hospital del Niño Morelense, Mexico. Eighty-two patients were included and classified as mild (17%) moderate (33%) and severe (46%). The mean serum level of sodium was 146.4meq/l, standard deviation (SD) 5.58; potassium 3.86meq/l, SD 0.53, and calcium 9.55mg/dl, SD 0.76. We found 30.4% hypernatremia, 12% hypokalemia, 10.9% abdominal distension, and 14.6% visual alterations.

[Thiamine retention as a function of thermal processing conditions: canned salmon]. / Retención de tiamina como función de las condiciones de proceso térmico en salmón en conserva.

The present work studied the effect of different treatments at high temperatures on the nutritional properties of thiamine retention and color measurement experimentally. Canned salmon (Salmo salar) was processed under different temperatures and time conditions (110 degrees C for 135 minutes; 114 degrees C for 89 minutes; 118 degrees C for 69 minutes and 121 degrees C for 62 minutes). Thiamine was determined by HPLC before and after the process. Color changes, due to processing conditions, were also measured utilizing a Hunter colorimeter. The canning was prepared in 300 x 407 cans and sterilized until Fo value reached 6 min. The nutritional value or index represented by the B1 vitamin or thiamine was affected by high temperature and time exposition. The lowest loss of thiamine of 19.2% was obtained in the canned salmon sterilized at 114 degrees C for 89 minutes. The color in canned salmon was different from the raw material, with a severe loss of red color and a greater clarity of the meat.

Retención de Tiamina como función de las condiciones de proceso térmico en Salmón en conserva / Thiamine retention as a function of thermal processing conditions: canned salmon

Se estudió el efecto de distintos tratamientos de esterilización sobre la calidad nutricional expresada como retención de tiamina y sobre la pérdida de color en conservas de salmón (Salmo salar). En la materia prima y en las conservas se determinó el contenido de tiamina mediante HPLC y la variación de color mediante colorímetro triestímulo Hunter. Las conservas se elaboraron en envase salmonero y se esterilizaron hasta alcanzar el valor Fo = 6 min. El valor nutricional representado por la tiamina se vio afectado por las altas temperaturas y por el tiempo de exposición al calor. La mayor retención de tiamina fue de 19,2% y se obtuvo en las conservas que se procesaron a 114°C por 89 min. El color de las conservas de salmón varió significativamente respecto a la materia prima, se produjo pérdida de coloración roja y mayor claridad de la carne.

The present work studied the effect of different treatments at high temperatures on the nutritional properties of thiamine retention and color measurement experimentally. Canned salmon (Salmo salar) was processed under different temperatures and time conditions (110°C for 135 minutes; 114°C for 89 minutes; 118°C for 69 minutes and 121°C for 62 minutes). Thiamine was determined by HPLC before and after the process. Color changes, due to processing conditions, were also measured utilizing a Hunter colorimeter. The canning was prepared in 300 x 407 cans and sterilized until Fo value reached 6 min. The nutritional value or index represented by the B1 vitamin or thiamine was affected by high temperature and time exposition. The lowest loss of thiamine of 19.2% was obtained in the canned salmon sterilized at 114°C for 89 minutes. The color in canned salmon was different from the raw material, with a severe loss of red color and a greater clarity of the meat.

Manaca, batata y ñame: posibles sustitutos del trigo en alimentos para dos etnias del Amazonas venezolano / Manaca, sweet potato and yam: possible substitutes of wheat in foods for two ethnic population in Venezuelan Amazon

En este estudio se obtuvieron harinas a partir de la manaca o acai (Euterpe oleracea Mart), de la batata (Ipomea batatas), y del ñame (Dioscorea spp.), especies vegetales cultivadas en el Amazonas venezolano. A dichas harinas se les determinó su composición proximal, actividad de agua (aw), contenido de Fe, Ca, Zn, Mg, Cu, Na y K y se usaron como ingredientes de productos destinados a dos etnias del Amazonas Venezolano (Piaroa y Hiwi). Se formularon dos tipos de productos que tradicionalmente contienen harina de trigo en su formulación (ingrediente que ellos conocen por la transculturización), a los fines de sustituirla total o parcialmente por las harinas de manaca, batata y/o ñame. Para seleccionar los productos a formular se consideraron los gustos y hábitos alimentarios de las dos etnias, la facilidad y sencillez de las preparaciones. Los productos que se formularon fueron galletas y "torticas". Para decidir la(s) formulación(es) definitiva(s) se realizaron evaluaciones sensoriales a nivel de laboratorio y en las comunidades indígenas Piaroa y Hiwi. Destaca el alto contenido de grasa (16%), fibra dietética (59,7%) y hierro (73,7mg/100g) de la harina de manaca. Dos tipos de galletas y dos de "torticas" fueron igualmente aceptadas por las comunidades indígenas Las galletas aportan un alta cantidad de hierro (aproximadamente 24mg/100g). Se demostró la factibilidad de sustituir la harina de trigo por harina de manaca, batata y ñame en productos aceptados por dos etnias del amazonas venezolano.

In this study, flours from manaca or acai (Euterpe oleracea Mart), sweet potato (Ipomea batatas), and yam (Dioscorea spp.), species grown in the Venezuelan Amazon, were obtained. The proximal composition, water activity (aw), Fe, Ca, Zn, Mg, Cu, Na and K content were determined for the flours of manaca, sweet potato and yam. These flours were used as ingredients of products for the inhabitants of the indigenous populations of the Venezuelan Amazon (Piaroa and Hiwi). Two types of products that traditionally contain wheat flour in their formulation (ingredient they know by transculturation) were formulated; an attempt to substitute it totally or partially by the manaca, sweet potato and/or yam flours was made. For the selection of the products to be formulated, the preferences and eating habits of the indigenous communities and ease and simplicity of the preparations to be developed, were considered. The two products formulated were cookies and "small cakes". To decide on the formulation(s) of the final product(s), sensorial evaluations were made in the laboratory and in the indigenous communities Piaroa and Hiwi. High fat content (16%), dietetic fiber (59.7 %) and iron (25mg/100g) in manaca or acai flour were remarkable. Two types of cookies and two of "small cakes" were equally accepted by the indigenous communities. Cookies supply a high iron amount (about 24%). The feasibility of substituting the wheat flour by manaca, sweet potato and yam flour in products accepted by two ethnic populations of the Venezuelan Amazon was demonstrated.

Conocimiento sobre polifarmacia en un grupo de personas de 65 años o más residentes en una egida del área metropolitana en Puerto Rico / Knowledge on polypharmacy in a group of 65-year-old people or older living in a sector of the metropolitan area of Puerto Rico

Addressing the high utilization of medications among the elderly, this study explored the degree of knowledge of polypharmacy and its consequences, as well as the pattern of utilization by a group of elders 65 years of age and over in the San Juan metropolitan area of Puerto Rico. A dual technique was utilized: focus groups and a survey. Two focus groups were performed in order to explore issues pertaining the following domains: quality of life, doctor-patient and pharmacist-patient relationships, degree of knowledge of polypharmacy, and need of information. A questionnaire was administered to obtain information regarding their pattern of drug utilization. Results of focus groups indicated that the elderly have learned how to cope with their chronic conditions and be able to continue with quality of life. Additionally, results suggested a need form the elderly to develop more assertiveness and closeness with their health care providers, both doctor and pharmacist; as well as a lack of sufficient knowledge of the serious implications that polypharmacy brings. Results from the survey revealed and confirmed their inappropriate utilization of medications, and suggest that this segment consults multiple physicians, all of which may bring potential problems of adverse drug interactions. Further investigation is needed to examine fully the issue of polypharmacy, as well as the need of education that results in empowerment of patients, families and communities.