Improvement of cell suspension cultures of transformed and untransformed Carica papaya cell lines, towards the development of an antiparasitic product against the gastrointestinal nematode Haemonchus contortus.

Parasitic diseases have a major impact on human and animal health worldwide. Despite the availability of effective anti-parasitic drugs, their excessive and uncontrolled use has promoted the emergence of drug resistance, severely affecting ecosystems and human health. Thus, developing environmentally friendly antiparasitic treatments is urgently needed. Carica papaya has shown promising effects against infectious diseases. C. papaya embryogenic calluses were genetically modified by our research team to insert immunogenic peptides with the goal of developing an oral anti-cysticercosis vaccine. Among these callus cell lines, one labeled as CF-23, which expresses the KETc7 immunogenic peptide, induced the highest protection levels against experimental cysticercosis. In the process of designing a natural antiparasitic product based on C. papaya that simultaneously induced immunity against cysticercosis, both transformed (SF-23) and untransformed (SF-WT) suspension cultures were produced and optimized. Our results showed a better duplication time (td) for SF-23 (6.9 days) than SF-WT (13.02 days); thus, the SF-23 line was selected for scale-up in a 2-L airlift bioreactor, reaching a td of 4.4 days. This is the first time that a transgenic line of C. papaya has been grown in an airlift bioreactor, highlighting its potential for scale-up cultivation in this type of reactor. Considering the previously reported nematocidal activity of C. papaya tissues, their activity against the nematode Haemonchus contortus of aqueous extracts of SF-WT and SF-23 was explored in this study, with promising results. The information herein reported will allow us to continue the cultivation of the transgenic cell suspension line of C. papaya under reproducible conditions, to develop a new anti-parasitic product.

Recommendations for sedation outside the operating room during the COVID-19 pandemic / Recomendaciones para sedación fuera de quirófano en la pandemia de la COVID-19

Abstract The current spread of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) and its disease COVID-19, has confronted society with a paradigm shift in all fields: political, social, religious, economic, and healthcare is no exception. This has created challenges for the adequate and safe delivery of services for patients and healthcare workers. Notwithstanding the global efforts to contain the spread of the disease, the outbreak continues to escalate. COVID-19 is currently the disease receiving the most attention worldwide; however, patients continue to present other conditions that demand the same level of care to be effectively controlled, so that they do not become another healthcare concern, as a result of potential secondary complications due to poor care. This reflection article gives recommendations to care for patients requiring diagnostic and/or therapeutic procedures under sedation, outside the operating room, keeping the current standards and biosecurity protocols in mind. Moreover, it provides a brief description of the disease, symptoms, diagnosis and transmission routes.

Resumen La actual propagación del SARS-COV-2 (Coronavirus 2 del síndrome respiratorio agudo severo) y su enfermedad, la COVID-19, ha enfrentado a la sociedad a un cambio de paradigmas en todos los aspectos: político, social, religioso, económico, y el área de la salud no es la excepción; lo que ha generado retos para la adecuada prestación de servicios dentro del marco de seguridad para los pacientes y el personal asistencial. A pesar de los esfuerzos mundiales para contener la propagación de la enfermedad, el brote sigue en aumento. La COVID-19 es en este momento la enfermedad de mayor atención en el mundo, pero los pacientes siguen presentando otras patologías que requieren igual atención para ser controladas de manera eficaz, de modo que no se conviertan en otro problema para los sistemas de salud por las posibles complicaciones secundarias a la desatención de las mismas. Este artículo de reflexión brinda recomendaciones para la atención de pacientes que requieren procedimientos diagnósticos y/o terapéuticos bajo sedación fuera de quirófanos, teniendo en cuenta la normatividad actual y los protocolos de bioseguridad vigentes; adicionalmente, proporciona una breve descripción de la enfermedad, síntomas, diagnóstico y rutas de transmisión.

Analysis of cutaneous pigmentation in a sample / Análisis de la pigmentación cutánea en una muestra.

Background: The blend of hemoglobin, carotenes, and melanin defines the skin color. Constitutive pigmentation is genetically determined, facultative color is induced when skin is exposed to environment. The objective was to quantify both pigmentations in a sample of Mexican population and to analyze its relationship with sex, age, and phototype. Methods: We evaluated 259 individuals during the winter. Skin colorimetry was obtained by diffuse reflectance spectrometry, using the International Commission of Illumination coordenates. L*a*b* parameters were measured and the individual typological angle (ITA) was estimated from forehead, thorax, neck, forearms, and buttocks areas. Results: Facultative pigmentation differed from constitutive in L*, a*, and ITA° values. In men, L* and ITA° parameters were lower. Constitutive pigmentation was similar between sexes. Phototypes III, IV, and V showed differences in L*, b*, and ITA°. Facultative values such as L*, a*, ATI°, and the constitutive a* reduce as age increases. Conclusions: The cutaneous tones of a sample of population were quantified recognizing their values for white, light brown, and dark brown skin. A reference frame for research related to cutaneous pigmentation in Mexico is presented.

Antecedentes: La mezcla de melanina, hemoglobina y carotenos definen el color cutáneo. La pigmentación constitutiva está determinada genéticamente, la facultativa se induce cuando la piel se expone al ambiente. El objetivo fue cuantificar ambas pigmentaciones en una muestra de población mexicana, y analizar su relación con el género, edad y fototipo. Métodos: Se evaluaron 259 personas durante un periodo invernal. La colorimetría cutánea se obtuvo mediante espectrometría de reflectancia difusa utilizando las coordenadas de la Comisión Internacional de Iluminación. Se registraron los valores L*a*b* y se estimó el ángulo tipológico individual (ATI°) en frente, tórax, cuello, antebrazos y glúteos. Resultados: La pigmentación facultativa difirió de la constitutiva en los parámetros L*, a*, y ATIº. En hombres, los valores facultativos de L* y ATI° fueron menores. La pigmentación constitutiva fue similar entre sexos. Los fototipos III, IV y V muestran diferencias en L*, b* y ATI°. Los valores facultativos L*, a*, ATI° y el constitutivo a* se reducen al incrementarse la edad. Conclusiones: Se cuantificaron los tonos cutáneos de una muestra de población reconociéndose los valores para la piel blanca, morena clara y morena oscura. Se presenta un marco de referencia para estudios relacionados con la pigmentación cutánea en México.

Pasado, presente y futuro de la sedación en Colombia. ¿Cuál es nuestro aporte? / Past, present and future of sedation in Colombia: What is our contribution?

Sedation is a controversial issue nationwide and, in order to gain adequate insight on this issue, it is important to review the background of this controversy in the world, and in Colombia of course.

Confort para procedimientos diagnósticos y terapéuticos bajo sedación / Comfort for diagnostic and therapeutic procedures under sedation

The evolution of medicine during the past century has shown important scientific, technological, surgical, pharmacological and anesthetic breakthroughs that have enabled various types of procedures for our patients, consistently aiming at providing the best comfort and the highest safety standards.

Insuficiencia renal aguda asociada al tratamiento con colistín en unidad de cuidados intensivos / Acute renal failure associated with colistin treatment in the intensive care unit

Introducción: La asociación de colistín e injuria renal aguda ha mostrado resultados muy diversos en diferentes estudios desde la reintroducción de esta droga en la práctica habitual. Métodos: Se realizó un estudio prospectivo y observacional de pacientes que recibieron tratamiento con colistín por al menos 48 horas en una Unidad de Cuidados Críticos (UCI). Resultados: Ingresaron al estudio 104 pacientes, de los cuales 47% (49) desarrollaron injuria renal aguda asociada a colistín (IRA-C). Estos pacientes fueron agrupados según la clasificación RIFLE en: pacientes con Riesgo (10); pacientes con Injuria (13); pacientes con Falla renal (26). Requirieron hemodiálisis 6 pacientes. El score de Charlson y la presencia de shock se asociaron al desarrollo de IRA-C. No se asociaron al desarrollo de IRA-C la edad, APACHE, creatininemia basal, ni dosis acumulada de colistín. La IRA-C se asoció a mayor mortalidad intrahospitalaria (p=0.003). Conclusión: La IRA-C es una entidad frecuente, y que se asocia a mayor mortalidad intrahospitalaria. La implementación de estrategias de nefroprotección en pacientes que reciban colistín, y el desarrollo de nuevos antibióticos con menor toxicidad, podrán mejorar la evolución de estos pacientes.

Background: The association of colistin and acute kidney injury has shown different results in several studies since the reintroduction of this drug in the common practice. Methods: A prospective and observational study of patients that received treatment with colistin for at least 48 hours in the Intensive Care Unit (ICU) was performed. Results: 104 patients participated in the study, of which 47 % (49) developed acute kidney injury associated to colistin (AKI-C). These patients were grouped according to the RIFLE classification: patients with Risk (10); patients with Injury (13); patients with kidney Failure (26). 6 patients required hemodialysis. The Charlson'™s score and the presence of shock were associated to the development of AKI-C. Neither age, APACHE, basal serum creatinine nor accumulated doses of colestin were associated to the development of AKI-C. The AKI-C was associated to a greater in-hospital mortality (p=0.003). Conclusion: The AKI-C is a frequent condition and its associated to a greater in-hospital mortality. The implementation of nephroprotection strategies in patients that receive colestin and the development of new antibiotics with less toxicity could improve the evolution of these patients.

[Prevalence of urinary tract infection in hospitalized patients with preterm labor]. / Prevalencia de infección de vías urinarias en pacientes hospitalizadas con amenaza de parto pretérmino.

OBJECTIVE: To determine the prevalence of urinary tract infection (UTI) in patients with preterm labor. METHODS: A prospective, observational, descriptive study, with a sample of 272 patients who were hospitalized in the Hospital de la Mujer at Culiacan, Sinaloa that presented symptoms of preterm labor. Age body mass index (BMI), parity, education, weeks of gestation, mode of delivery, history of preterm delivery and UTI were assessed. RESULTS: Of the 272 patients with threatened preterm delivery, 97 (35.6%) had positive urine culture and of these patients, 32 (32.9%) had preterm labor. Association between urinary tract infection and patients with a hemoglobin (Hb) less than 11 g/dL OR: 2.66 95% CI (1.55-4.55), p 0.0003. Was isolated E. coli in 72 (74.4%) patients, Proteus in 9 (9.2%) patients. It was found that 42% of E. coli strains were resistant to ampicillin and 38.4% to ciprofloxacin. CONCLUSION: The prevalence of UTI is higher than the national prevalence.

Effective protection induced by three different versions of the porcine S3Pvac anticysticercosis vaccine against rabbit experimental Taenia pisiformis cysticercosis.

In an effort to develop an effective and affordable oral vaccine against porcine Taenia solium cysticercosis, the S3Pvac anti-cysticercosis vaccine was expressed in papaya calli. Taenia pisiformis experimental rabbit cysticercosis was used as a model to compare the efficacy of the oral vaccine vs. the injectable S3Pvac-synthetic and S3Pvac-phage versions. Oral S3Pvac-papaya significantly reduced the expected number of hepatic lesions and peritoneal cysticerci to a similar extent than the injectable vaccines. This study reports for the first time an effective oral vaccine against T. pisiformis cysticercosis, possibly useful against porcine T. solium cysticercosis.

Lung function and organ dysfunctions in 178 patients requiring mechanical ventilation during the 2009 influenza A (H1N1) pandemic.

INTRODUCTION: Most cases of the 2009 influenza A (H1N1) infection are self-limited, but occasionally the disease evolves to a severe condition needing hospitalization. Here we describe the evolution of the respiratory compromise, ventilatory management and laboratory variables of patients with diffuse viral pneumonitis caused by pandemic 2009 influenza A (H1N1) admitted to the ICU. METHOD: This was a multicenter, prospective inception cohort study including adult patients with acute respiratory failure requiring mechanical ventilation (MV) admitted to 20 ICUs in Argentina between June and September of 2009 during the influenza A (H1N1) pandemic. In a standard case-report form, we collected epidemiological characteristics, results of real-time reverse-transcriptase--polymerase-chain-reaction viral diagnostic tests, oxygenation variables, acid-base status, respiratory mechanics, ventilation management and laboratory tests. Variables were recorded on ICU admission and at days 3, 7 and 10. RESULTS: During the study period 178 patients with diffuse viral pneumonitis requiring MV were admitted. They were 44 ± 15 years of age, with Acute Physiology And Chronic Health Evaluation II (APACHE II) scores of 18 ± 7, and most frequent comorbidities were obesity (26%), previous respiratory disease (24%) and immunosuppression (16%). Non-invasive ventilation (NIV) was applied in 49 (28%) patients on admission, but 94% were later intubated.Acute respiratory distress syndrome (ARDS) was present throughout the entire ICU stay in the whole group (mean PaO2/FIO2 170 ± 25). Tidal-volumes used were 7.8 to 8.1 ml/kg (ideal body weight), plateau pressures always remained < 30 cmH2O, without differences between survivors and non-survivors; and mean positive end-expiratory pressure (PEEP) levels used were between 8 to 12 cm H2O. Rescue therapies, like recruitment maneuvers (8 to 35%), prone positioning (12 to 24%) and tracheal gas insufflation (3%) were frequently applied. At all time points, pH, platelet count, lactate dehydrogenase assay (LDH) and Sequential Organ Failure Assessment (SOFA) differed significantly between survivors and non-survivors. Lack of recovery of platelet count and persistence of leukocytosis were characteristic of non-survivors. Mortality was high (46%); and length of MV was 10 (6 to 17) days. CONCLUSIONS: These patients had severe, hypoxemic respiratory failure compatible with ARDS that persisted over time, frequently requiring rescue therapies to support oxygenation. NIV use is not warranted, given its high failure rate. Death and evolution to prolonged mechanical ventilation were common outcomes. Persistence of thrombocytopenia, acidosis and leukocytosis, and high LDH levels found in non-survivors during the course of the disease might be novel prognostic findings.

Severe pandemic 2009 H1N1 influenza disease due to pathogenic immune complexes.

Pandemic influenza viruses often cause severe disease in middle-aged adults without preexisting comorbidities. The mechanism of illness associated with severe disease in this age group is not well understood. Here we find preexisting serum antibodies that cross-react with, but do not protect against, 2009 H1N1 influenza virus in middle-aged adults. Nonprotective antibody is associated with immune complex-mediated disease after infection. We detected high titers of serum antibody of low avidity for H1-2009 antigen, and low-avidity pulmonary immune complexes against the same protein, in severely ill individuals. Moreover, C4d deposition--a marker of complement activation mediated by immune complexes--was present in lung sections of fatal cases. Archived lung sections from middle-aged adults with confirmed fatal influenza 1957 H2N2 infection revealed a similar mechanism of illness. These observations provide a previously unknown biological mechanism for the unusual age distribution of severe cases during influenza pandemics.

Patrones arteriales región artebrachialis posterior / Arterial patterns of the posterior antebrachalis region

Se realizó un estudio del, patrón arterial de la región antebrachialis posterior utilizando 40 miembros superiores derechos e izquierdos provenientes de 20 fetos en diversos estadios de desarrollo. Se les inyectó acetato de vinilo al 50 por ciento por vía trans-aortica y observación con lupa estereoscópica. La arteria interósea posterior estuvo ausente en 14 casos (28.0 por ciento) y como un vaso único solamente en el 8.0 por ciento de los casos. El patrón más frecuente de la región fue la presencia de ambas interóseas (anterior y posterior) 64.0 por ciento. El segundo en importancia correspondió a la presencia de la arteria interóseas anterior y una recurrente ulnar posterior. 28.0 por ciento