Vía aérea unificada: asociación entre rinosinusitis crónica y asma bronquial / Unified airway: association between chronic rhinosinusitis and bronchial asthma

Bajo la teoría de vía aérea unificada, se ha observado que el asma y la rinosinusitis crónica (RSC) tienen una estrecha relación, con efectos importantes de una enfermedad sobre el control de la otra. El objetivo de esta revisión bibliográfica es clarificar cómo ambas enfermedades se relacionan desde su origen, epidemiología, fisiopatología y tratamiento. Sabemos que la presencia de RSC se asocia con peores resultados del asma, mayor frecuencia de exacerbaciones, hospitalizaciones y mayor uso de corticoides sistémicos. Varios mecanismos parecen tener un rol en la disfunción de la vía aérea inferior en pacientes con RSC, dentro de los cuales se plantea que la respuesta inflamatoria en común de tipo Th2 juega un papel principal. Existe amplia literatura respecto al efecto que tiene el tratamiento de la RSC en el control del asma, en esta revisión se expondrá la evidencia disponible del tratamiento médico con corticoides nasales, montelukast y macrólidos, así como también del tratamiento quirúrgico de la RSC y el uso de biológicos.

Under the unified airway theory, asthma and chronic rhinosinusitis (CRS) have a close relationship, with significant effects of one disease on the control of the other. This bibliographic review aims to clarify how both diseases relate to each other from their origin, epidemiology, pathophysiology, and treatment. CRS is associated with worse asthma outcomes, higher frequency of exacerbations, hospitalizations, and increased use of systemic corticosteroids. Several mechanisms play a role in lower airway dysfunction in patients with CRS, among which the common Th2-type inflammatory response plays a substantial role. There is extensive literature regarding the effect of the treatment of CRS in the control of asthma. We present the available evidence regarding the effect of medical treatment with nasal corticosteroids, montelukast, and macrolides, as well as the surgical treatment and use of biologics.

Base-Free Catalytic Hydrogen Production from Formic Acid Mediated by a Cubane-Type Mo3S4 Cluster Hydride.

Formic acid (FA) dehydrogenation is an attractive process in the implementation of a hydrogen economy. To make this process greener and less costly, the interest nowadays is moving toward non-noble metal catalysts and additive-free protocols. Efficient protocols using earth abundant first row transition metals, mostly iron, have been developed, but other metals, such as molybdenum, remain practically unexplored. Herein, we present the transformation of FA to form H2 and CO2 through a cluster catalysis mechanism mediated by a cuboidal [Mo3S4H3(dmpe)3]+ hydride cluster in the absence of base or any other additive. Our catalyst has proved to be more active and selective than the other molybdenum compounds reported to date for this purpose. Kinetic studies, reaction monitoring, and isolation of the [Mo3S4(OCHO)3(dmpe)3]+ formate reaction intermediate, in combination with DFT calculations, have allowed us to formulate an unambiguous mechanism of FA dehydrogenation. Kinetic studies indicate that the reaction at temperatures up to 60 °C ends at the triformate complex and occurs in a single kinetic step, which can be interpreted in terms of statistical kinetics at the three metal centers. The process starts with the formation of a dihydrogen-bonded species with Mo-H···HOOCH bonds, detected by NMR techniques, followed by hydrogen release and formate coordination. Whereas this process is favored at temperatures up to 60 °C, the subsequent ß-hydride elimination that allows for the CO2 release and closes the catalytic cycle is only completed at higher temperatures. The cycle also operates starting from the [Mo3S4(OCHO)3(dmpe)3]+ formate intermediate, again with preservation of the cluster integrity, which adds our proposal to the list of the infrequent cluster catalysis reaction mechanisms.

Impact of a Maternal Motivational Interviewing on Oral Health in the Mother-Child Dyad.

Motivational Interviewing (MI) has been included in dentistry programs. There exists a need for interventions in the mother-child dyad. The aim of this paper was to compare the effects of a MI-based educational program on oral care knowledge, attitudes, and practices (KAP) in the mother-child dyad to a Traditional Education-based program (TE). A community intervention trial was carried out. The experimental and control groups were made up of women between 18 and 45 years of age in the sixth month of gestation. Both groups were provided with TE. The experimental group additionally received a session based on the principles of the MI. Socio-demographic data, children's oral health KAP (COHKAP), that of the mother (MOHKAP), and maternal self-efficacy (MSE) in relation to children's oral health (COHMSE) were recorded. A baseline measurement was made, as well as a six-month follow up. The participants included 135 women with an average age of 24.88 ± 6.00. After intervention, the experimental group's COHKAP, MOHKAP, and COHMSE all increased (p < 0.001). When MI-based interventions are combined with TE, MSE and dental care KAP for the mother-child dyad in pregnant women can be improved.

Asma en Chile: tendencia de la mortalidad 1992-2017 / Asthma in Chile: mortality trend 1992-2017

OBJETIVOS: El asma, un problema de salud pública, tiene tasas de mortalidad global variables. En Chile, no existen estudios que informen respecto a la situación nacional. Analizamos la tendencia de mortalidad en adultos chilenos durante un período de 26 años. MÉTODOS: Utilizando datos del Departamento de Estadísticas e Información de Salud y el Instituto Nacional de Estadísticas se calcularon las tasas de mortalidad por asma 1992-2017 en personas ≥ 15 años de edad. Para evitar el impacto de los cambios por edad, las tasas de mortalidad ajustadas se calcularon mediante un método de ajuste directo utilizando la población de 2017 como referencia. Se usó Joinpoint para calcular la pendiente de las tasas ajustadas y para análisis de datos se utilizó Excel STATA versión13. RESULTADOS: Durante el período de 26 años, hubo 5.749 muertes relacionadas con el asma, con un promedio de 221 eventos / año. Las tasas de mortalidad ajustadas por edad disminuyeron significativamente de 3,26 en 1992 a 1,4 por 100.000 habitantes en 2017, con un promedio de disminución anual de -3,3%. La mayor proporción de defunciones se produjo en personas de 65 años o más, representando 79% de los casos en 1992 y 88% de los casos en 2017. CONCLUSIONES: las tendencias de las tasas de mortalidad por asma en Chile, ajustadas por edad, muestran una disminución significativa en los 26 años que abarca este estudio, disminución que es menos acentuada en los últimos 15 años.

OBJETIVES: Asthma, a public health problem, has variable global mortality rates. In Chile, there are no studies to report on the national situation. This study analyzes the mortality trend in Chilean adults over a period of 26 years. METHODS: Using data from the Department of Health Statistics and Information and the National Institute of Statistics, asthma mortality rates 1992-2017 were calculated in people ≥ 15 years-old. To avoid the impact of age changes, adjusted mortality rates were calculated using a direct adjustment method using the 2017 population as a reference. Joinpoint was used to calculate the slope of adjusted rates, and Excel STATA version13 was used for data analysis. RESULTS: Over the 26-year period, there were 5,749 asthma-related deaths, with an average of 221 events per year. Age-adjusted mortality rates decreased significantly from 3.26 in 1992 to 1.4 per 100,000 inhabitants in 2017, with an average annual decline of -3.3%. The highest proportion of deaths occurred in people 65 years of age or older, accounting for 79% of cases in 1992 and 88% of cases in 2017. CONCLUSIONS: In Chile trends in asthma mortality rates age-adjusted show a significant decrease in the 26 years covered by this study, a decrease that is less pronounced in the last 15 years.

Multiscale Modeling of Thiol Overoxidation in Peroxiredoxins by Hydrogen Peroxide.

In this work, we employ a multiscale quantum-classical mechanics (QM/MM) scheme to investigate the chemical reactivity of sulfenic acids toward hydrogen peroxide, both in aqueous solution and in the protein environment of the peroxiredoxin alkyl hydroperoxide reductase E from Mycobacterium tuberculosis (MtAhpE). The reaction of oxidation of cysteine with hydrogen peroxides, catalyzed by peroxiredoxins, is usually accelerated several orders of magnitude in comparison with the analogous reaction in solution. The resulting cysteine sulfenic acid is then reduced in other steps of the catalytic cycle, recovering the original thiol. However, under some conditions, the sulfenic acid can react with another equivalent of oxidant to form a sulfinic acid. This process is called overoxidation and has been associated with redox signaling. Herein, we employed a multiscale scheme based on density function theory calculations coupled to the classical AMBER force field, developed in our group, to establish the molecular basis of thiol overoxidation by hydrogen peroxide. Our results suggest that residues that play key catalytic roles in the oxidation of MtAhpE are not relevant in the overoxidation process. Indeed, the calculations propose that the process is unfavored by this particular enzyme microenvironment.

Awareness of obstetric warning signs in Ecuador: a cross-sectional study.

OBJECTIVE: In Ecuador, the reported maternal death rate was 45.71 per 100,000 live births in 2013. This may be partly due to a lack of maternal knowledge of obstetric warning signs during pregnancy, delivery and the post-partum period. This study sought to evaluate awareness of obstetric warning signs among pregnant women in relation to individual demographic and area-level socio-economic indicators. STUDY DESIGN: We conducted a cross-sectional analysis of data collected by Ecuador's Ministry of Health at the conclusion of a national maternal health campaign (2014-2015). A nationally representative sample of 3435 pregnant women from the nine administrative zones completed surveys regarding basic demographics and their awareness of obstetric warning signs. METHODS: We defined eight obstetrical warning signs according to the literature and Ecuadorian practice that could occur during pregnancy, delivery and the post-partum period (severe headache, strong abdominal ache, bleeding or presence of malodorous secretion, rupture of the amniotic sac, high fever, abnormal presentation of the baby, decrease in baby's movements and delayed labour). A woman was considered 'aware' if she recognised at least four of the eight warning signs and stated she would seek immediate healthcare at their presentation. For each administrative zone, four socio-economic indicators (poverty, illiteracy, unemployment and subemployment) were obtained from the National Institute of Statistics and Census. Correlates of awareness of the obstetric warning signs were evaluated using hierarchical logistic models clustered by the administrative zone. RESULTS: Nationally, 86.9% of women were 'aware' of obstetric warning signs. After adjustment for age, socio-economic indicators and clustering, indigenous participants were 59% less likely to be aware of obstetric warning signs than mestizos (odds ratio [OR] = 0.41, 95% confidence interval [CI] = 0.28-0.59). For every 1% increase in area poverty, participants had a 5% decreased likelihood of being aware of obstetric warning signs (OR = 0.95, 95% CI = 0.93-0.96), adjusting for age, ethnicity and other socio-economic indicators. The most effective source of campaign information about obstetric warning signs was personal communication with a healthcare professional, as opposed to mass media advertisements (OR = 1.90, 95% CI = 1.34-2.71). CONCLUSIONS: A majority of Ecuadorian pregnant and post-partum women are aware of obstetric warning signs. Indigenous ethnicity and area-level poverty are associated with a lack of awareness. Personal communication with a healthcare professional was the most effective source of information. These findings have implications for improvement of maternal awareness of warning signs.

Sarna sarcóptica en cerdos criados en cama profunda. Reporte de caso / Sarcoptic mange in pigs in deep beeding. Case report

RESUMEN La sarna sarcóptica en los cerdos es causada por Sarcoptes scabiei var. suis el cual se distribuye ampliamente en los cinco continentes. Los productores porcícolas en general están preocupados por las infecciones parasitarias internas e ignoran las infestaciones parasitarias externas; estas últimas, causadas por S. scabiei tienen gran importancia económica ya que causa morbilidad, mortalidad, disminución de la fertilidad y de la tasa de conversión alimenticia. Este trabajo permitió determinar la presencia de sarna sarcóptica en cerdos criados bajo sistema de producción con cama profunda de una granja en el estado Guárico (Venezuela), utilizando las técnicas parasitológicas directas de flotación-concentración y microscopía directa. Los resultados demostraron que dos de siete muestras evaluadas fueron positivas con S. scabiei var. suis. El 100% de los animales presentaron lesiones de piel compatibles con la presencia del ácaro, pero el mismo solo pudo ser detectado en el 28,6% de ellos. La técnica de flotación-concentración fue más efectiva que la de microscopía directa. En este estudio describimos la primera detección de S. scabiei var. suis en cerdos domésticos en Venezuela criados en cama profunda.

ABSTRACT Sarcoptic mange infestation in pigs is caused by Sarcoptes scabiei var. suis. It is distributed worldwide. Pig owners are generally concerned about the internal parasitic infections and ignored the external parasitic infestations. But the external parasitic infestation with S. scabiei has economic significance as it causes morbidity, mortality, decreased fertility and lower feed conversion ratio. In this study the prevalence of sarcoptic mange in a pigs farm in deep beeding in Guárico state (Venezuela) was investigated, using the direct parasitological techniques of flotation-concentration and direct microscopy. Results showed that two of the seven pigs examined were positive for Sarcoptes scabiei var. suis. Skin lesions potentially attributable to this mite were present in 100% of animals, but the parasite could be detected in only 28.6% of them. A flotation-concentration technique was more effective than direct microscopy. In this report we describe for the first time the detection of Sarcoptes scabiei var. suis mites on domestic pigs in Venezuela in deep beeding.

Infección crónica por Pseudomonas aeruginosa en pacientes con bronquiectasias no fibrosis quística / Chronic infection by Pseudomonas aeruginosa in patients with non-cystic fibrosis bronchiectasias

Resumen Introducción: La infección crónica por Pseudomonas aeruginosa (PA) es frecuente en pacientes con bronquiectasias (BQ) y representa un quiebre en la historia natural de la enfermedad, asociándose a mal pronóstico y mayor severidad. Objetivo: Caracterizar la población portadora de BQ no fibrosis quística (BQ no-FQ) del Instituto Nacional del Tórax (INT) infectados crónicamente con PA comparándolos con pacientes que mantienen cultivos de expectoración negativos para este germen. Metodología: Revisión retrospectiva de fichas clínicas de pacientes portadores de BQ del INT entre julio de 2007 y abril de 2017. Se caracterizó la población y se comparó score de FACED y otros índices de gravedad. Resultados: El promedio de edad fue de 55 ± 17,3 años, 81% de los pacientes fue de género femenino. De acuerdo a aislamiento de Pseudomonas en cultivo esputo se clasificaron como infectados crónicamente (BQ con PA; n = 61) y no infectados con PA (BQ sin PA; n = 59). No hubo diferencias entre los grupos en edad y sexo. El VEF1 fue más bajo en el grupo con PA los que tienen más hospitalizaciones. Se calculó el índice de riesgo FACED siendo mayor en los pacientes colonizados. La etiología más frecuente es la postinfecciosa, principalmente secuelas de TBC, con 30,8% de etiología no identificada. Conclusiones: Los pacientes con bronquiectasias con infección crónica por Pseudomonas aeruginosa tienen una enfermedad más severa, con VEF1 más bajo, y con mayor índice de severidad de FACED. Destaca en nuestro grupo la etiología postinfecciosa.

Introduction: Chronic airways infection with Pseudomonas aeruginosa (PA) is a common situation in patients with Bronchiectasis (BQ) and constitutes a breakdown in the natural history of the latter. Moreover, BQ is also associated with a poor prognosis and an increased severity of the disease. Objective: To describe the characteristics of the population diagnosed with non-Cystic Fibrosis Bronchiectasis (non-CFB) who are chronically infected with PA, and to perform a comparison with patients with negative sputum cultures. Methodology: We performed a retrospective analysis of the clinical files of patients diagnosed with non-CFB who were attended at the 'Instituto Nacional del Tórax' (Chile) between July 2007 and April 2017. The characteristics of the population were described and the FACED scores and other severity indexes were compared. Results: The average age of patients was 55 ± 17.3 years-old, and 81% of them were female. According to PA isolation in sputum culture, they were classified as "chronically infected" (non-CFB with PA, n = 61) and "not infected with PA" (non-CFB without PA, n = 59). There were no differences in age and gender between the two groups. On the other hand, FEV1 was lower in the non-CFB PA group. The calculated FACED score was higher in colonized patients. The most frequent etiology was post-infectious, mainly TB sequels, with a 30.8% unidentified etiology. Conclusions: Patients with bronchiectasis chronically infected with Pseudomonas aeruginosa show increases in the severity of the disease, with a lower FEV1 and a higher FACED score. The postinfectious etiology is highlighted in our group.

Antibiotic-associated diarrhea: Clinical characteristics and the presence of Clostridium difficile. / Diarrea asociada a antibióticos: características clínicas y presencia de Clostridium difficile.

INTRODUCTION AND AIMS: Evidence in Colombia and Latin America has been insufficient for establishing the clinical characteristics of patients with antibiotic-associated diarrhea (AAD). The present study attempts to describe the clinical characteristics of patients with AAD and to determine the presence of Clostridium difficile, utilizing the polymerase chain reaction (PCR) technique. MATERIALS AND METHODS: Forty-three patients with AAD, managed at the Hospital Universitario San Ignacio in Bogotá, Colombia, were evaluated. Prospective patient information was collected, with respect to demographic characteristics, profile of the antibiotic management received, clinical manifestations, risk factors, and paraclinical reports. In addition, the real time PCR test for Clostridium difficile (Cepheid Xpert®, Sunnyvale, CA, United States) was performed. RESULTS: Patient mean age was 58 years (19.31 SD). The majority of the patients received 2 or more antibiotics (62.9%) and the beta-lactams were the most frequently used. Hospital stay ranged from 2 to 104 days with a median of 10 days. The most frequent clinical manifestations were abdominal pain and bloating, followed by fever and tachycardia. At the time of diagnosis, 23 patients had noninflammatory results in the stool sample analyses and 18 had kidney failure. The mean level of albumin was 2.4mg/dl (0.7 SD). The presence of Clostridium difficile was documented through PCR in 6 patients (13.95% of the cases). CONCLUSIONS: AAD patients were characterized by a high frequency of severe comorbidities and prolonged hospital stay. The presence of Clostridium difficile in only 13.9% of the cases suggests that other causes of diarrhea in the hospitalized patient should be considered.

MAINTENANCE COST CONTROL MODEL OF CLINICAL ENGINEERING DEPARTMENTS IN COLOMBIA HEALTHCARE CENTERS / MODELO DE CONTROL DE COSTOS DE MANTENIMIENTO DE LOS DEPARTAMENTOS DE INGENIERÍA CLÍNICA EN LOS CENTROS DE SALUD EN COLOMBIA / MODELO DE CONTROLE DE CUSTOS DE MANUTENÇÃO DOS DEPARTAMENTOS DE ENGENHARIA CLÍNICA NOS CENTROS DE SAÚDE NA COLÔMBIA

This article presents a practical guidance model for clinics and hospitals of the Colombian national territory that provides technical support in the process of construction and consolidation of a schematic that shows the real cost inside their clinical engineering departments. For that purpose, an exhaustive technological vigilance has been done, relating to subject matter that compete with the managing cost in hospitable entities of diverse countries in the international arena. In addition, the study accumulates literary demonstrated in benchmarking developed by clinical - hospitable establishments of nations with out-standing standards of quality worldwide. Finally, all the information gathered is brought to the Colombian context to be applicable to the national healthcare system, and to be able to meet regulations and requirements that the Colombian Social Security System requires to clinical engineering departments.

En este artículo se presenta un modelo de orientación práctica para clínicas y hospitales del territorio nacional colombiano, que proporciona apoyo técnico en el proceso de construcción y consolidación de un esquema que muestra el costo real dentro de sus departamentos de ingeniería clínica. Para ello, se ha efectuado una exhaustiva vigilancia tecnológica, en relación con el tema que compita con el costo de gestión en entidades hospitalarias de diversos países en el ámbito internacional. Además, el estudio se compila literatura de la evaluación comparativa desarrollada por establecimientos clínicos - hospitalarios de las naciones con los mejores estándares de calidad en todo el mundo. Por último, toda la información recogida es llevada al contexto colombiano para ser aplicable al sistema nacional de salud, y para ser facilitar el cumplimiento con las normas y requisitos que el sistema de seguridad social colombiano exige a los departamentos de ingeniería clínica.

Este artigo apresenta um modelo de orientação prática para clínicas e hospitais no território colombiano, que presta apoio técnico no processo de construção e consolidação de um diagrama que mostra o custo real dentro de seus departamentos de engenharia clínica. Para este efeito, procedeu a uma vigilância tecnológica completa, em relação ao assunto que compete com o custo de gestão em entidades hospitalares de diferentes países no âmbito internacional. Além, o estudo se compila literatura da avaliação comparativa desenvolvida por estabelecimentos clínicos-Hospitalares das nações com os mais altos padrões de qualidade em todo o mundo. Finalmente, toda a informação recolhida é levada para o contexto colombiano para ser aplicável ao sistema nacional de saúde, e para facilitar o cumprimento das normas e requisitos que o sistema de segurança social colombiana exige aos departamentos de engenharia clínica.

POLITICS FOR THE INTEGRATION OF THE ACTIVITIES OF INSURANCE METROLOGICAL TO THE PROCESS OF MAINTENANCE OF BIOMEDICAL EQUIPMENTS / POLÍTICA PARA LA INTEGRACIÓN DE LAS ACTIVIDADES DE SEGUROS METROLÓGICOS AL PROCESO DE MANTENIMIENTO DE EQUIPOS BIOMÉDICOS / POLÍTICA PARA A INTEGRAÇÃO DAS ATIVIDADES DE SEGUROS METROLÓGICAS AO PROCESSO DE MANUTENÇÃO DE EQUIPAMENTOS BIOMÉDICOS

In this article, is postulated the integration of the activities for metrology and EB's maintenance (medical equipments), in order that this could be adopted for clinics and hospitals of the national territory. In a such way, which they have a theoretical support to be able to restructure the present flowcharts in his departments of clinical engineering. For such an intention, there has effected an exhaustive technological vigilance relating to subject matter that compete with the regulation, policies and functions that apply to these activities in the country and international entities; giving evidence across a comparison between these, of the diverse discrepancies and failings that are demonstrated on having developed these activities of a way independent, since also, from the opportunities of improvement that can present the institutions of health in Colombia, on having had integrated inside his engineering departments to the above mentioned areas. Finally, all the information gathered is brought to the Colombian context to be applicable to the national healthcare system. The politics of integration is outlined and the model proposes closely for mix the metrology and the maintenance of medical equipment, of a such way that are in limit with the laws that govern them in Colombia.

En este artículo se postula la integración de las actividades de metrología y mantenimiento de EBs (equipos médicos), con el fin de que estas puedan ser adoptadas para clínicas y hospitales del territorio nacional. En una forma tal, que las instituciones tengan un soporte teórico para poder reestructurar los actuales diagramas de flujo en sus departamentos de ingeniería clínica. Con ese objetivo, se ha efectuado una exhaustiva vigilancia tecnológica relacionada con los temas que competen con la regulación, las políticas y las funciones que se aplican a estas actividades en el país y por las entidades internacionales. Este proceso ha generando evidencias a través de una comparación entre estos, de las diversas discrepancias y fallas que se demuestran al haber desarrollado estas actividades de manera independiente. Esto permitirá a su vez, oportunidades de mejora que se pueden obtener y compartir en las instituciones de salud en Colombia, al haber integrado en el interior sus departamentos de ingeniería a las áreas antes mencionadas. Por último, toda la información recogida se lleva al contexto colombiano para ser aplicable al sistema nacional de salud. Las políticas de integración se esbozan. El modelo propone una estrecha mezcla para la metrología y el mantenimiento de equipos médicos, de manera tal que se encuentran en cumplimiento de las leyes que los rigen en Colombia.

Este artigo discute a integração de atividades de metrologia e de manutenção da EBs (equipamento médico), para que estes possam ser adotadas para clínicas e hospitais no território nacional. De tal forma, que tenham um relatório teórico para reestruturar os atuais diagramas de fluxo em departamentos de engenharia clínica. Com esse objetivo, se procedeu a uma exaustiva vigilância tecnologia relacionada com os tópicos relacionados com a regulamentação, as política e as funções que se aplicam a essas atividades no país e por entidades internacionais; gerando evidências através de uma comparação entre estes das várias discrepâncias e falhas que são mostradas ao ter desenvolvido essas atividades de forma independente, permitindo que a partir de oportunidades de melhoria que se podem obter nas instituições de saúde da Colômbia, para ser integrado dentro de seus departamentos de engenharia das áreas tratadas acima. Finalmente, toda a informação recolhida é levada ao contexto colombiano para ser aplicável ao sistema nacional de saúde. As políticas de integração são descritas e o modelo propõe uma estreita mistura para a metrologia e manutenção de equipamentos médicos, para que eles estejam em conformidade com as leis que regem na Colômbia.

Batch and Pulsed Fed-Batch Cultures of Aspergillus flavipes FP-500 Growing on Lemon Peel at Stirred Tank Reactor.

Aspergillus flavipes FP-500 grew up on submerged cultures using lemon peel as the only carbon source, developing several batch and pulsed fed-batch trials on a stirred tank reactor. The effect of carbon source concentration, reducing sugar presence and initial pH on exopectinase and endopectinase production, was analyzed on batch cultures. From this, we observed that the highest substrate concentration favored biomass (X max) but had not influence on the corresponding specific production (q p) of both pectinases; the most acid condition provoked higher endopectinase-specific productions but had not a significant effect on those corresponding to exopectinases; and reducing sugar concentrations higher than 1.5 g/L retarded pectinase production. On the other hand, by employing the pulsed fed-batch operation mode, we observed a prolonged growth phase, and an increase of about twofold on endopectinase production without a significant raise on biomass concentration. So, pulsed fed-batch seems to be a good alternative for obtaining higher endopectinase titers by using high lemon peel quantities without having mixing and repression problems to the system. The usefulness of unstructured kinetic models for explaining, under a theoretic level, the behavior of the fungus along the batch culture with regard to pectinase production was evident.

Enfermedad invasora por Haemophilus influenzae. A propósito de dos casos en lactantes menores / Haemophilus influenzae invasive disease: A report of two cases in young infants / Doença invasora por Haemophilus influenzae. A propósito de dois casos em lactantes menores

En la actualidad, la enfermedad invasora por Haemophilus influenzae es un evento poco común en niños, particularmente, luego de la introducción de una vacuna altamente efectiva contra este microorganismo. Se presentan los casos de dos lactantes menores, previamente sanos, a quienes se les aisló de sangre y líquido cefalorraquídeo H. influenzae, dentro del contexto clínico de una sepsis y meningitis bacteriana. En el paciente pediátrico no vacunado o con esquemas de vacunación incompletos contra H. influenzae tipo b, debe considerarse este agente dentro del diagnóstico diferencial etiológico de los casos de infección bacteriana invasora.

Today, invasive disease due to Haemophilus influenzae is an extremely rare event in children, especially after the introduction of highly effective conjugated vaccines against this microorganism. We report two cases of previously healthy infants with H. influenzae within the clinical context of sepsis and bacterial meningitis. In unvaccinated pediatric patients or patients with incomplete vaccination schedules against H. influenzae type b, this pathogen should be considered in the differential etiological diagnosis of invasive bacterial infection.

Na atualidad, a doença invasora por Haemophilus influenzae é um evento pouco comum em crianças, particularmente, após da introdução de uma vacina altamente efetiva contra este microrganismo. Se apresentam os casos de duas lactantes menores, previamente saudáveis, a quem se lhes isolou de sangre e líquido cefalorraquidiano H. influenzae, dentro do contexto clínico de uma sepse e meningite bacteriana. No paciente pediátrico não vacinado ou com esquemas de vacinação incompletos contra H. influenzae tipo b, deve considerar-se este agente dentro do diagnóstico diferencial etiológico dos casos de infecção bacteriana invasora.

Safe switching from a pdFIX (Immunine®) to a rFIX (Bax326).

The ability to switch between coagulation factors safely is of common interest to haemophilia patients and treating physicians. This is the first formal prospective comparative evaluation of safety, efficacy and incremental recovery of a plasma-derived FIX (pdFIX) and a recombinant FIX (rFIX) in the same haemophilia B patients following a switch from pdFIX Immunine® to a recently developed rFIX Bax326 product. Patients (aged <65 years) who completed a pretreatment study which prospectively documented the exposure to Immunine® and monitored FIX inhibitors while receiving prophylactic treatment were transitioned into pivotal (patients aged 12-65 years) and paediatric (patients aged <12 years) clinical studies investigating prophylaxis and treatment of bleeding episodes with Bax326. None of the 44 patients developed inhibitory or specific binding anti-FIX antibodies during the course of the studies. A total of 38 unrelated adverse events (AEs) were occurred in 20/44 (45.5%) subjects during the Immunine® study. Following a switch to Bax326, 51 AEs were reported in 25/44 (56.8%) subjects. The incidence of AEs related to Bax326 treatment (two episodes of dysgeusia in one patient) was low (2.3%); there were no serious adverse reactions. The comparison between Immunine® and Bax326 demonstrated analogous haemostatic characteristics and annualized bleeding rates. Overall, there is direct evidence indicating a safe and clinically effective transition from a pdFIX (Immunine®) to a newly developed rFIX (Bax326(1) ) for prophylaxis and treatment of bleeding in previously treated patients of all age cohorts with severe or moderately severe haemophilia B.

Zidovudina/lamivudina/efavirenz vs. zidovudina/lamivudina /lopinavir/ritonavir en el tratamiento inicial del VIH-tipo 1: Hospital Doctor Teodoro Maldonado Carbo, Guayaquil, Ecuador: período 2006 – 2009 / Zidovudine/lamivudine/efavirenz vs. zidovudine/lamivudine/lopinavir/ritonavir in the initial treatment of HIV-type 1: Doctor Teodoro Maldonado Carbo hospital, Guayaquil, Ecuador: period 2006 to 2009

Objetivo: determinar la eficacia de AZT/3TC/EFV vs AZT/3TC/LPV/RTV en el tratamiento inicial de la infección por VIH-1, tomando como variables, edad, sexo, preferencia sexual, uso de drogas, infecciones asociadas, contaje de CD4 y carga viral. Metodología: estudio longitudinal, prospectivo que se llevó a cabo en el servicio de medicina interna del hospital IESS “Dr. Teodoro Maldonado Carbo”, durante el período 2006-2009. Incluyó a 200 pacientes con VIH/SIDA que iniciaron tratamiento antirretroviral, 110 con AZT/3TC/EFV y 90 AZT/3TC/LPV/RTV, con medición de carga viral y contaje de CD4 basal y a los 3,6,12,18,24,30,36 meses. Resultados: 137 hombres (68,5); 110 (55) con esquema de 3 drogas; 107 (53,5) heterosexuales, 63 (31,5) preferían relaciones con otros hombres; 33 (17,5) eran usuarios de drogas intravenosas; 101 (50,5) con carga viral <100000; los usuarios de 3 drogas disminuyeron la carga viral desde 5,3log a 2,3log en 3 meses y 1,8log a los 6 meses; los usuarios de 4 drogas disminuyeron de un basal 5,7 a 1,5log a 3meses e imperceptible a 6 meses. Los CD4 presentaron un ascenso CD4>200 durante el período de 3 años. Conclusión: ningún esquema demostró superioridad estadística significativa en el ascenso y evolución de los linfocitos TCD4, aunque sí se pudo apreciar una disminución estadística significativa de la carga viral en los pacientes manejados con AZT+3TC+LPV+RTV.

The disruption in actin-perinuclear theca interactions are related with changes induced by cryopreservation observed on sperm chromatin nuclear decondensation of boar semen.

The perinuclear theca (PT) is a cytoskeletal structure that surrounds the mammal sperm nucleus which must be disrupted once the sperm has penetrated the oocyte to permit normal chromatin decondensation and formation of male pronucleus. F-actin is a thermo sensitive protein found in the equatorial segment which is involved in the stability of PT. It has been reported that cryopreservation induces alterations in nuclear decondensation of spermatozoa, which have been interpreted as an over condensation. The aims of the present study were identified the presence of changes in sperm sPT integrity of frozen-thawed boar spermatozoa and its effect in sperm nuclei decondensation; and whether changes in the actin cytoskeleton are involved using an in vitro model to test probably differences in a chemical decondensation (DTT/heparin) between fresh (FS) and frozen-thawed (TS) spermatozoa. Results showed an increase on sPT damage in TS (P<0.001), and significant changes in sperm chromatin nuclear decondensation (P<0.05). In same way differences on the swelling degree was found assessed by measures in equatorial region of head sperm (P<0.05). Evaluation with rodamine-labeled actin (0.2µM) showed two different patterns with differences in percentages before and after cryopreservation (P<0.001). F-actin stabilization constrained the equatorial segment of FS while this was not observed in TS. The data showed that the presence of early changes in sPT integrity and changes in the F-actin localization on TS may suggest the participation in F-actin in decondensation process and probably that the disruption of actin-PT interaction during freezing-thawing process could have far-reaching consequences for the subsequent fertility of spermatozoa.

Site specific ligand substitution in cubane-type Mo3FeS(4)(4+) clusters: kinetics and mechanism of reaction and isolation of mixed ligand Cl/SPh complexes.

The synthesis, crystal structure and solution characterization of the cubane-type [Mo(3)(FeCl)S(4)(dmpe)(3)Cl(3)] (1) (dmpe = 1,2-bis(dimethylphophane-ethane)) cluster are reported and the ligand substitution processes of chloride by thiophenolate investigated. The kinetics and the intimate mechanism of these substitutions reveal that compound 1 undergoes a number of Fe and Mo site specific ligand substitution reactions in acetonitrile solutions. In particular, PhS(-) coordination at the tetrahedral Fe site proceeds in a single resolved kinetic step whereas such substitutions at the Mo sites proceed more slowly. The effect of the presence of acids in the reaction media is also investigated and reveals that an acid excess hinders substitution reactions both at the Fe and Mo sites; however, an acid-promoted solvolysis of the Fe-Cl bonds is observed. Electrospray ionization (ESI) and tandem (ESI-MS/MS) mass spectrometry allow the identification of all the reaction intermediates proposed on the basis of stopped-flow measurements. The distinctive site specific reactivity made it possible to isolate two new clusters of the Mo(3)FeS(4)(4+) family featuring mixed chlorine/thiophenolate ligands, namely Mo(3)S(4)(FeSPh)(dmpe)(3)Cl(3) (2) and [Mo(3)S(4)(FeSPh)(dmpe)(3)(SPh)(3)] (3). A detailed computational study has also been carried out to understand the details of the mechanism of substitution at the M-Cl (M = Mo and Fe) bonds as well as the solvolysis at the Fe-Cl sites, with particular emphasis on the role of acids on the substitution process. The results of the calculations are in agreement with the experimental observations, thus justifying the non-existence of an accelerating effect of acids on the thiophenolate substitution reaction, which differs from previous proposals for the Fe(4)S(4) and MoFe(3)S(4) clusters and some related compounds.

The role of solvent on the mechanism of proton transfer to hydride complexes: the case of the [W(3)PdS(4)H(3)(dmpe)(3)(CO)](+) cubane cluster.

The kinetics of reaction of the [W(3)PdS(4)H(3)(dmpe)(3)(CO)](+) hydride cluster (1(+)) with HCl has been measured in dichloromethane, and a second-order dependence with respect to the acid is found for the initial step. In the presence of added BF(4) (-) the second-order dependence is maintained, but there is a deceleration that becomes more evident as the acid concentration increases. DFT calculations indicate that these results can be rationalized on the basis of the mechanism previously proposed for the same reaction of the closely related [W(3)S(4)H(3)(dmpe)(3)](+) cluster, which involves parallel first- and second-order pathways in which the coordinated hydride interacts with one and two acid molecules, and ion pairing to BF(4) (-) hinders formation of dihydrogen bonded adducts able to evolve to the products of proton transfer. Additional DFT calculations are reported to understand the behavior of the cluster in neat acetonitrile and acetonitrile-water mixtures. The interaction of the HCl molecule with CH(3)CN is stronger than the W-H...HCl dihydrogen bond and so the reaction pathways operating in dichloromethane become inefficient, in agreement with the lack of reaction between 1(+) and HCl in neat acetonitrile. However, the attacking species in acetonitrile-water mixtures is the solvated proton, and DFT calculations indicate that the reaction can then go through pathways involving solvent attack to the W centers, while still maintaining the coordinated hydride, which is made possible by the capability of the cluster to undergo structural changes in its core.

Unprecedented solvent-assisted reactivity of Hydrido W3CuS4 cubane clusters: the non-innocent behaviour of the cluster-core unit.

Opening the cluster core: Substitution of the chloride ligand in the novel cationic cluster [W(3)CuS(4)H(3)Cl(dmpe)(3)](+) (see figure; dmpe=1,2-bis(dimethylphosphino)ethane) by acetonitrile is promoted by water addition. Kinetic and density functional theory studies lead to a mechanistic proposal in which acetonitrile or water attack causes the opening of the cluster core with dissociation of one of the Cu--S bonds to accommodate the entering ligand.Reaction of the incomplete cuboidal cationic cluster [W(3)S(4)H(3)(dmpe)(3)](+) (dmpe=1,2-bis(dimethylphosphino)ethane) with Cu(I) compounds produces rare examples of cationic heterodimetallic hydrido clusters of formula [W(3)CuClS(4)H(3)(dmpe)(3)](+) ([1](+)) and [W(3)Cu(CH(3)CN)S(4)H(3)(dmpe)(3)](2+) ([2](2+)). An unexpected conversion of [1](+) into [2](2+), which involves substitution of chloride by CH(3)CN at the copper centre, has been observed in CH(3)CN/H(2)O mixtures. Surprisingly, formation of the acetonitrile complex does not occur in neat acetonitrile and requires the presence of water. The kinetics of this reaction has been studied and the results indicate that the process is accelerated when the water concentration increases and is retarded in the presence of added chloride. Computational studies have also been carried out and a mechanism for the substitution reaction is proposed in which attack at the copper centre by acetonitrile or water causes disruption of the cubane-type core. ESI-MS experiments support the formation of intermediates with an open-core cluster structure. This kind of process is unprecedented in the chemistry of M(3)M'Q(4) (M=Mo, W; Q=S, Se) clusters, and allows for the transient appearance of a new coordination site at the M' site which could explain some aspects of the reactivity and catalytic properties of this kind of clusters.

[Interdigital erythrasma: clinical, epidemiologic, and microbiologic findings]. / Eritrasma interdigital: datos clínicos, epidemiológicos y microbiológicos.

BACKGROUND: Erythrasma is a superficial infection caused by Corynebacterium minutissimum and affects the major skin folds and the interdigital regions of the feet. It is characterized by erythematous, brown, scaly patches and maceration, and exhibits coral-red fluorescence under Wood light. OBJECTIVE: The aim of this study was to determine the frequency of erythrasma in patients with interdigital lesions. METHODS: An open, prospective, longitudinal, observational study was performed in a hospital in Mexico City between March and December, 2006. All patients with interdigital lesions were examined with a Wood lamp and direct examination was performed with 20 % potassium hydroxide. Cultures were done in Sabouraud dextrose agar and brain heart infusion agar, and smears were analyzed. General characteristics and concomitant diseases were recorded. RESULTS: We examined 73 patients, of whom 24 (32.8 %) were diagnosed with erythrasma based on coral-red fluorescence under Wood light and identification of corynebacteria by Gram staining. The disease was more common in women (83.33 %) and the mean age of the patients was 43.5 years. The main clinical findings were scaling and maceration, and the fourth interdigital web was the most commonly affected. Corynebacterium could not be isolated in any of the cases. Mycology was positive in 15 cases (62.5 %) and the following microorganisms were isolated: Candida (16.6 %), dermatophytes (12.5 %), and Trichosporon (4.1 %). CONCLUSIONS: Interdigital erythrasma is a common condition and can be easily confused with interdigital tinea. It persists if not treated appropriately. Rapid diagnosis is easily obtained by examination with a Wood lamp, while culture is difficult and unnecessary for diagnosis. The coexistence of erythrasma with dermatophytes and Candida should be considered when the interdigital webs are affected.