Asclepain cI, a proteolytic enzyme from Asclepias curassavica L., a south American plant, against Helicobacter pylori.

Helicobacter pylori is a Gram negative bacterium most frequently associated with human gastrointestinal infections worldwide. The increasing occurrence of antibiotic-resistant isolates of H. pylori constitutes a challenge. The eradication of the microorganism is currently being considered a "high priority" by the World Health Organization (WHO). In this context, bioactive compounds found in natural products seem to be an effective therapeutic option to develop new antibiotics against the pathogen. In this study, we investigated the effect of asclepain cI, the main purified proteolytic enzyme of the latex of petioles and stems from Asclepia curassavica L. (Asclepiadaceae), a South American native plant, against H. pylori; in order to obtain a natural therapeutic adjuvant and a safe nutraceutical product. Asclepain cI showed antibacterial activity against reference strains and drug-resistant clinical isolates of H. pylori in vitro. A range of minimal inhibitory concentration (MIC) from 1 to 2 µg/ml and minimal bactericidal concentration (MBC) from 2 to 4 µg/ml was obtained, respectively. The action of asclepain cI on the transcription of omp18, ureA, flaA genes showed a significantly decreased expression of the selected pathogenic factors. Furthermore, asclepain cI did not induce toxic effects at the concentrations assayed. Asclepain cI could be considered a highly feasible option to be used as a natural therapeutic adjuvant and a safe nutraceutical product against H. pylori.

Non-ionic surfactant formulation sequentially enhances the enzymatic hydrolysis of cellulignin from sugarcane bagasse and the production of Monascus ruber biopigments.

The effect of a non-ionic surfactant optimized formulation (SOF) obtained from an experimental design was evaluated for different influencing variables in the processing of sugarcane bagasse cellulignin to produce biopigments. The major findings in the saccharification stage using the SOF point that: at same enzyme loading, the highest glucan hydrolysis yield was 63 % (2-fold higher compared to control); the enzyme loading of 2.5 FPU/g resulted in similar yield compared to 10 FPU/g (control); 15 % (m/v) of total solids loading maintained the yield in fed-batch configuration; the hydrolysis yield is maintained at high shear force stress (800 rpm of stirring rate) and temperatures (50-70 °C). Besides, under separate and semi-simultaneous hydrolysis and fermentation, the maximum biopigments production were of 10 AU510nm/mL and 17.84 AU510nm/mL, respectively. The SOF used in this study was found to be a promising additive either in a single or sequential steps to produce biopigments in biorefineries.

Recent Advances and Potential Applications of Atmospheric Pressure Cold Plasma Technology for Sustainable Food Processing.

In a circular economy, products, waste, and resources are kept in the system as long as possible. This review aims to highlight the importance of cold plasma technology as an alternative solution to some challenges in the food chain, such as the extensive energy demand and the hazardous chemicals used. Atmospheric cold plasma can provide a rich source of reactive gas species such as radicals, excited neutrals, ions, free electrons, and UV light that can be efficiently used for sterilization and decontamination, degrading toxins, and pesticides. Atmospheric cold plasma can also improve the utilization of materials in agriculture and food processing, as well as convert waste into resources. The use of atmospheric cold plasma technology is not without challenges. The wide range of reactive gas species leads to many questions about their safety, active life, and environmental impact. Additionally, the associated regulatory approval process requires significant data demonstrating its efficacy. Cold plasma generation requires a specific reliable system, process control monitoring, scalability, and worker safety protections.

Consensus in acute myeloid leukemia in Mexico.

Acute myeloid leukemia (AML) comprises a heterogeneous group of hematopoietic cell neoplasms of myeloid lineage that arise from the clonal expansion of their precursors in the bone marrow, interfering with cell differentiation, leading to a syndrome of bone marrow failure. AML is a consequence of genetic and epigenetic changes (point mutations, gene rearrangements, deletions, amplifications, and arrangements in epigenetic changes that influence gene expression) in hematopoietic precursor cells, which create a clone of abnormal cells that are capable of proliferating but cannot differentiate into mature hematopoietic cells or undergo programmed cell death. The diagnosis requires more than 20% myeloid blasts in the bone marrow and certain cytogenic abnormalities. Treatment will depend on age, comorbidities, and cytogenetic risk among the most frequent.

La leucemia mieloide aguda (LMA) comprende un grupo heterogéneo de neoplasias de células hematopoyéticas de linaje mieloide que surgen de la expansión clonal de sus precursores en la médula ósea, interfiriendo con la diferenciación celular, lo que conlleva a un síndrome de falla medular. La LMA es una consecuencia de cambios genéticos y epigenéticos (mutaciones puntuales, rearreglos de genes, deleciones, amplificaciones y arreglos en cambios epigenéticos que influyen en la expression del gen) en las células hematopoyéticas precursoras, la cual crea una clona de células anormales que son capaces de proliferar, pero no se pueden diferenciar en células hematopoyéticas maduras ni sufrir una muerte celular programada. El diagnostic requiere más del 20% de blastos mieloides en médula ósea y ciertas anormalidades citogénicas. El tratamiento dependerá de la edad, comorbilidades, riesgo citogenético entre las más frecuentes.

Consenso de leucemia mieloide aguda en México / Mexican consensus in acute myeloid leukemia in Mexico

resumen está disponible en el texto completo

Abstract Acute myeloid leukemia (AML) comprises a heterogeneous group of hematopoietic cell neoplasms of myeloid lineage that arise from the clonal expansion of their precursors in the bone marrow, interfering with cell differentiation, leading to a syndrome of bone marrow failure. AML is a consequence of genetic and epigenetic changes (point mutations, gene rearrangements, deletions, amplifications, and arrangements in epigenetic changes that influence gene expression) in hematopoietic precursor cells, which create a clone of abnormal cells that are capable of proliferating but cannot differentiate into mature hematopoietic cells or undergo programmed cell death. The diagnosis requires more than 20% myeloid blasts in the bone marrow and certain cytogenic abnormalities. Treatment will depend on age, comorbidities, and cytogenetic risk among the most frequent.

Intestinal obstruction secundary to gallstone ileus: case report.

Gallstone ileus is an intestinal obstruction that is secondary to the presence of gallstones in the small intestine. It is a rare complication of cholelithiasis, which represents 1-3% of the causes of intestinal obstruction. The diagnosis is difficult given that the symptoms are nonspecific with intermittent intestinal obstruction, Rigler's triad (pneumobilia, stone and abdominal distention) is pathognomonic. Among the diagnostic aids are abdominal radiography, ultrasound and abdominal tomography. Treatment should be individualized depending on the patient's conditions, with laparotomy with enterotomy being the treatment of choice.

El íleo biliar es una obstrucción intestinal secundaria a la presencia de cálculos biliares en el intestino delgado. Es una complicación rara de la colelitiasis y representa el 1-3% de las causas de obstrucción intestinal. El diagnóstico es difícil dado que la clínica es inespecífica, con un cuadro de oclusión intestinal intermitente; la tríada de Rigler (neumobilia, lito y distensión abdominal) es patognomónica. Dentro de los auxiliares diagnósticos se encuentran la radiografía de abdomen, el ultrasonido y la tomografía computarizada abdominal. El tratamiento debe individualizarse dependiendo de las condiciones del paciente, siendo de elección la laparotomía con enterotomía.

Frustración, temperamento y vulnerabilidad social en bebés: estudio comparativo / Frustration, temperament and social vulnerability in babies: a comparative study

Resumen Antecedentes: la frustración se define como las respuestas del organismo que se desencadenan cuando existe una discrepancia negativa entre un incentivo esperado con el que realmente se recibe. Estas situaciones provocan respuestas conductuales, emocionales y neurofisiológicas análogas a las que ocurren con la presentación de estímulos aversivos o su anticipación. Existen investigaciones en bebés, pero pocos sobre sus asociaciones con diferencias individuales y ambientales y ninguno en población argentina. Objetivos: asociar la frustración, el temperamento y la vulnerabilidad social en una muestra de infantes. Metodología: se realizó un estudio asociativo-comparativo con una situación observacional estructurada donde se evaluaron a 22 bebés de 10 a 14 meses durante una tarea de frustración y su relación con el temperamento a través del Cuestionario de Conducta Infantil (IBQ-VSF) pertenecientes a dos extractos sociales evaluados con una ficha sociodemográfica. Resultados: se halló que a mayor extroversión, menor manipulación del objeto; y a mayor esfuerzo de control, menor fue la respuesta de morder, y viceversa. No se encontraron diferencias significativas en función del nivel socioeconómico. Conclusiones: se discutieron los resultados en función de la teoría de la frustración y las limitaciones del estudio, incluyendo recomendaciones para futuras investigaciones.

Abstract Background: Frustration is defined as the body's responses that are triggered when there is a negative discrepancy between an expected incentive and the one actually received. These situations elicit behavioral, emotional and neurophysiological responses analogous to those that occur with aversive stimuli or their anticipation. There is research on babies, but few on the associations with individual and environmental differences and none on the Argentine population. Objectives: To associate frustration, temperament and social vulnerability in a sample of infants. Method: A comparative associative study was carried out using a structured observation technique where frustration and its relationship with temperament were evaluated in 22 babies aged 10 to 14 months through the infant behavior questionnaire-revised very short form (IBQ-R VSF). The study population belonged to two social strata according to a sociodemographic record. Results: An inverse correlation was found between extroversion and manipulation of objects, and between effortful control and biting response. No significant differences were identified based on the socioeconomic level. Conclusions: The results were discussed taking into account the frustration theory, the study limitations and the recommendations for future research.

Antimicrobial Effect of a Proteolytic Enzyme From the Fruits of Solanum granuloso-leprosum (Dunal) Against Helicobacter pylori.

Helicobacter pylori is a gram-negative, helix-shaped, and microaerophilic bacteria that colonizes the human gastric mucosa, causing chronic infections, gastritis, peptic ulcer, lymphomas associated with lymphoid mucosa tissue, and gastric cancer. H. pylori is considered a Type 1 human carcinogen by WHO. The prevalence of the infection is estimated in more than half of the world population. Treatment of H. pylori infection includes antibiotics and proton pump inhibitors, but the increasing antibiotic resistance promotes the research of novel, more effective, and natural antibacterial compounds. The aim of this work was to study the effect of the partially purified proteolytic extract (RAP) of the fruits from Solanum granuloso-leprosum (Dunal), a South American native plant, and a purified fraction named granulosain I, against H. pylori, to obtain natural food additives for the production of anti-H. pylori functional foods. Furthermore, granulosain I and RAP could be used as natural adjuncts to conventional therapies. Granulosain I and RAP antibacterial activity was evaluated as minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against H. pylori NCTC 11638 (reference strain) and twelve H. pylori wild strains, using a microdilution plating technique (Clinical and Laboratory Standards Institute). All the strains tested were susceptible to granulosain I with MIC from 156.25 to 312.5 µg/mL and MBC from 312.5 to 625 µg/mL, respectively. Besides, all the strains tested were susceptible to the RAP with MIC from 312.5 to 625 µg/mL and MBC from 625 to 1,250 µg/mL, respectively. The effect of granulosain I and RAP on the transcription of H. pylori genes encoding pathogenic factors, omp18, ureA, and flaA, with respect to a housekeeping gene (16S rRNA), was evaluated by RT-PCR technique. The band intensity between pathogenic factors and control gene was correlated under treated or untreated conditions, using the ImageJ program. Granulosain I and RAP significantly decreased the expression of pathogenic factors: omp18, ureA, and flaA. The combined inhibitory effect of granulosain I or RAP and an antibiotic such as, amoxicillin (AML, 10 µg), clarithromycin (CLA, 15 µg), levofloxacin (LEV, 5 µg), and metronidazole (MTZ, 5 µg) was evaluated, using the agar diffusion technique. Granulosain I and RAP showed significant synergistic effect on AML, CLA, and LEV, but no significant effect on MTZ was observed. Besides, granulosain I and RAP did not show toxicological effects at the concentrations studied. Finally, granulosain I and RAP could be used as safe natural food additives and as adjuvants for conventional therapies against H. pylori.

Situation, challenges, and SEOM recommendations for the future of undergraduate education in Oncology in Spain.

PURPOSE: The Spanish Society of Medical Oncology (SEOM, for its Spanish acronym) would like to attest to the relevance of training in Oncology as part of the undergraduate education in Medicine program and issue recommendations to improve said training, with the aim of responding better to the challenges that cancer poses to our society. MATERIALS AND METHODS: The curricula of 42 schools of medicine were reviewed with interviews with at least one teaching medical oncologist from each faculty. The qualitative and opinion analysis was completed by means of an online questionnaire targeting lecturers, resident tutors, and residents in Medical Oncology (MO), enabling the detection of needs and areas for improvement at an organizational level and in terms of skill acquisition. RESULTS: While the number of medical schools with a specific, mandatory program in MO has grown by up to 90%, it has not been accompanied by an increase in independent programs. Instead, they largely consist of programs shared with other specialties (61% of the medical faculties). In most of the undergraduate education programs, Oncology contents are fragmented and approached from the perspective of each organ system. CONCLUSIONS: Despite the positive evolution in recent years, the heterogeneity in Oncology contents during undergraduate education training continues to be remarkable. Cross-sectional programs with an integral vision, taught in the final years of undergraduate medical education would be desirable. Among the recommendations for improvement of training in Medical Oncology, the SEOM proposes that updated, theoretical content be incorporated and clinical practice in Medical Oncology departments be promoted.

Emociones y frustración en bebés: el temperamento y la vulnerabilidad social como factores moduladores / Emotions and frustration in babies: temperament and social vulnerability as modulating factors

Las emociones son consideradas como mecanismos que se configuran a largo del tiempo para adaptarse a las demandas del medio ambiente, procurando de esta forma la supervivencia. Una de ellas es la frustración que se define como las respuestas del organismo que se desencadenan cuando existe una discrepancia negativa entre un incentivo esperado con el que realmente recibe. Estas situaciones provocan respuestas conductuales, emocionales y neurofisiológicas análogas a las que ocurren con la presentación de estímulos aversivos o su anticipación, tales como la ansiedad, el miedo, el estrés y el dolor nocioceptivo. El objetivo del presente artículo es: a) presentar los principales modelos teóricos de la emoción y frustración, su desarrollo y sus relaciones con factores individuales (temperamento) y ambientales (pobreza), y b) hacer un relevamiento de la bibliografía existente sobre los efectos de la frustración en bebés de hasta un año. Se encontró que el temperamento contribuye a los niveles de emoción y frustración expresados por los infantes. Son necesarios más trabajos para evaluar la influencia del ambiente y en un segundo momento, realizar intervenciones que puedan aumentar la tolerancias a la frustración(AU)

Emotions are considered as mechanisms that are configured over time for conflicts to the demands of the environment, thus seeking survival. Frustration is defined as an organism response that is triggered when there is a negative discrepancy between an expected incentive and the one that actually receives. These situations provoke behavioral, emotional and neurophysiological responses analogous to those that occur with the presentation of aversive stimuli or their anticipation, stories such as anxiety, fear, stress and nocioceptive pain. The objective of this article is: a) to present the main theoretical models of emotion and frustration, their development and their relationships with individual (temperament) and environmental (poverty) factors, and b) to survey the existing bibliography on the effects of frustration in babies up to one year old. Temperament and vulnerability were found to have the levels of emotion and frustration expressed by infants. However, it will be necessary to carry out more studies to decrease the contradictory results and generate, in a second moment, those that can increase the levels of this ability(AU)

Regulation During the Second Year: Executive Function and Emotion Regulation Links to Joint Attention, Temperament, and Social Vulnerability in a Latin American Sample.

Although a growing body of work has established developing regulatory abilities during the second year of life, more work is needed to better understand factors that influence this emerging control. The purpose of the present study was to examine regulation capacities in executive functions (i.e., EF or cognitive control) and emotion regulation (i.e., ER or control focused on modulating negative and sustaining positive emotions) in a Latin American sample, with a focus on how joint attention, social vulnerability, and temperament contribute to performance. Sixty Latin American dyads of mothers and children aged 18 to 24 months completed several EF tasks, a Still-Face Paradigm (SFP) to examine ER (Weinberg et al., 2008), and the Early Social Communication Scale to measure joint attention (Mundy et al., 2003). Parents completed the Early Childhood Behavior Questionnaire Very Short Form to measure temperament (ECBQ-VS, Putnam et al., 2010) and the Social Economic Level Scale (SES) from INDEC (2000). Results revealed the typical responses expected for toddlers of this age in these EF tasks and in the SFP. Also, we found associations between EF and ER and between non-verbal communication related to monitoring infants' attention to objects (i.e., responding to joint attention) and initiation of pointing (e.g., pointing and showing of an object while the child alternates his gaze to an adult) with EF. Regarding social factors, family differences and type of housing contribute to regulation. For temperament, effortful control was associated with both regulatory capacities. Finally, only age predicted EF. These results suggest that many patterns regarding the development of these abilities are duplicated in the first months of life in a Latin American sample while further highlighting the importance of considering how the environment and the individual characteristics of infants may associate to these regulatory abilities, which is particularly relevant to developing public policies to promote their optimal development.

Intolerancia a la frustración y estrategias cognitivas de regulación emocional en la predicción de la agresividad / Frustration intolerance and cognitive strategies of emotional regulation in the prediction of aggressiveness

Resumen La conducta agresiva constituye un problema que afecta a los individuos y a la so ciedad. El Modelo de Agresión General integra un conjunto de variables que influyen en la pro babilidad de exhibir una conducta agresiva entre las cuales está la regulación emocional y la frustración. Esta investigación evalúa las relaciones entre la regulación emocional cognitiva y la intolerancia a la frustración. A 419 sujetos adultos se les administraron la Escala de Intoleran cia a la Frustración, la Escala de Regulación Emocional Cognitiva y el Cuestionario de Agresión. Se hallaron relaciones positivas en la mayoría de las estrategias desadaptativas cognitivas de regulación emocional y relaciones negativas entre la mayoría de las estrategias cognitivas adap tativas de regulación emocional con la conducta agresiva, y relaciones positivas entre todas las dimensiones de la intolerancia a la frustración y la conducta agresiva. El Análisis de Regresión Múltiple muestra que las variables que producen un cambio significativo en la agresividad son la catastrofización y culpar a otros, así como la intolerancia a la frustración referida a derechos. Mediante path análisis se verificó que estas tres variables mencionadas permiten explicar un 41% de la variabilidad en la agresividad.

Abstract Aggressive behavior is a problem that affects individuals and society. The General Aggression Model integrates a set of variables that influence the probability of exhibiting aggressive behavior, among which is emotional regulation and frustration. This research assesses the relationships between cognitive emotional regulation and frustration intolerance. A total of 419 adult subjects were administered the Frustration Intolerance Scale, the Cognitive Emotional Regulation Scale and the Aggression Questionnaire. Positive relationships were found in most of the maladaptive cognitive emotional regulation strategies and negative re lationships between most of the adaptive cognitive emotional regulation strategies with the aggressive behavior, and positive relationships between all the dimensions of the frustration intolerance and the aggressive behavior. The Multiple Regression Analysis shows that the vari ables that produce a significant change in aggressiveness are catastrophization and blaming others, as well as the frustration intolerance referring to rights. By means of path analysis, it was verified that these three variables can explain 41% of the variability in aggressiveness.

Optimization of oral chemotherapy in outpatient clinics in Spain: results from a survey of the Spanish Society of Medical Oncology (SEOM).

PURPOSE: To determine the current management of oral and intravenous chemotherapy (OC and IVC) in outpatient clinics of Oncology Departments in Spain to detect opportunities for improvement. MATERIALS AND METHODS: The Spanish Society of Medical Oncology designed a questionnaire specifically for Heads of Oncology Department: 142 were invited and 52 responded. RESULTS: In most centers, the waiting time (69.7%) and time at the outpatient clinic (84.8%) was shorter for patients receiving OC compared to those receiving IVC. The time spent at the outpatient clinic by the patients having OC was approximately 30 min (88.5%). In addition, the time expended by the oncologist with each patient was shorter when they were treated with OC in 21.2% of cases. CONCLUSIONS: Patients' waiting times and individual dedication of oncologists might be reduced by administering OC, and general management might be improved. This should be considered when planning therapies if OC is an option.

Somatic Embryogenesis in Common BeanPhaseolus vulgaris L.

Common bean Phaseolus vulgaris L. has been shown to be a recalcitrant plant to induce somatic embryogenesis (SE) under in vitro conditions. An alternative strategy to yield SE is based upon the use of a cytokinin (benzyladenine) coupled with osmotic stress adaptation instead of the auxin-inducing SE in common bean. Here we described the induction of proembryogenic masses (PEM) derived from the apical meristem and cotyledonary zone of zygotic embryos, from which secondary SE indirect embryogenesis emerged. Maturation of SE was achieved by using osmotic stress medium and converted to plants. Long-term recurrent SE was demonstrated by propagation of PEM at early stages of SE. This protocol is currently being applied for stable genetic transformation by means of Agrobacterium tumefaciens and biobalistics as well as basic biochemical and molecular biology research.

Prognostic role for the derived neutrophil-to-lymphocyte ratio in early breast cancer: a GEICAM/9906 substudy.

PURPOSE: Elevated markers of host inflammation, a hallmark of cancer, have been associated with worse outcomes in several solid tumors. Here, we explore the prognostic role of the derived neutrophil-to-lymphocyte ratio (dNLR), across different tumor subtypes, in patients with early breast cancer. PATIENTS AND METHODS: This was a retrospective analysis of 1246 patients with lymph node-positive, operable early breast cancer enrolled in the GEICAM/9906 trial, a multicenter randomized phase 3 study evaluating adjuvant chemotherapy. dNLR was calculated as the ratio of neutrophils and the difference between total leukocytes and neutrophils in peripheral blood before chemotherapy. Disease-free survival (DFS) and overall survival were explored using a Cox proportional hazard analysis. RESULTS: The analysis comprised 1243 (99.8%) patients with dNLR data, with a median follow-up of 10 years. Data on intrinsic subtypes were available from 818 (66%) patients (luminal A 34%, luminal B 32%, HER2-enriched 21% and basal-like 9%). Median dNLR was 1.35 [interquartile range (IQR) 1.08-1.71]. In the whole population, dNLR was not prognostic after adjustment for clinico-pathological factors. However, dNLR ≥ 1.35 was independently associated with worse DFS in the hormone receptor-negative/HER2+ population (HR 2.86; p = 0.038) and in patients with one to three lymph node metastases (HR 1.32, p = 0.032). There was a non-significant association with worse DFS in non-luminal and in HER2-enriched tumors (HR 1.40, p = 0.085 and HR 1.53, p = 0.067). No significant interaction was observed between the treatment arm and dNLR. CONCLUSION: Elevated dNLR appears to be an adverse prognostic factor in hormone receptor-negative early breast cancer. TRIAL REGISTRATION: EudraCT: 2005-003108-12 (retrospectively registered 28/06/2005). ClinicalTrials.gov Identifier: NCT00129922 (retrospectively registered 10/08/2005). Results of this study were presented in part at the 2016 ESMO conference October 7-11, 2016, Copenhagen, Denmark (oral presentation).

Bevacizumab for recurrent, persistent or advanced cervical cancer: reproducibility of GOG 240 study results in "real world" patients.

PURPOSE: Bevacizumab is the only therapeutic target approved for patients with persistent, recurrent or advanced cervical cancer from a phase III study that combined with chemotherapy; it proves a significant increase in overall survival. To retrospectively assess the efficacy and safety of bevacizumab as the first-line treatment in patients from usual clinical practice with recurrent/persistent or advanced cervical cancer. PATIENTS AND METHODS: Treatment consisted of cisplatin 50 mg/m2 or carboplatin AUC 5 plus paclitaxel 175 mg/m2 for 6-8 cycles and bevacizumab 15 mg/kg every 3 weeks up to progression or unacceptable toxicity. The endpoints were progression-free survival (PFS), overall survival (OS), response rates (RR) and toxicity. RESULTS: Twenty-seven patients were included from January 2014 to June 2017, with a median follow-up 10, 1 months. Eleven percent had recurrent/persistent disease and 89% had metastatic disease at diagnosis. The prior exposition to platinum was 70%. The median PFS and OS were 9, 6 and 21, 5 months, respectively. There was an increase of fistula formation (22%). All of them had pelvic and peritoneal disease at the beginning of treatment and previous treatment with chemoradiotherapy; non-incidence differences were found according to the type of platinum agent used. There were two treatment-related deaths, one from intestinal perforation and another from severe sepsis. CONCLUSION: Finally, although our study does have certain limitations, we believe that it can provide useful information and encouraging evidence that the routine use of bevacizumab as part of first-line treatment of patients with advanced cervical cancer may be associated with outcomes comparable with those obtained in GOG240 study.

Tromboembolismo pulmonar en el embarazo y puerperio: una patología mortal / Pulmonary embolism in pregnancy: a deadly pathology

La enfermedad tromboembólica venosa (TEV) en el embarazo y puerperio continúa siendo una de la primeras causas de muerte materna en los países desarrollados; su incidencia es 5 a 10 veces mayor en comparación con mujeres no embarazadas, debido a las modificaciones que el propio embarazo produce tanto en el sistema de la coagulación, como en el sistema venoso por el útero gestante. El riesgo se distribuye a lo largo de todo el embarazo, siendo el periodo de mayor riesgo las primeras 6 semanas post parto donde se incrementa 20 veces (el 80% de los eventos sucede en las primeras 3 semanas); se suman factores de riesgo como edad, multiparidad, enfermedades del colágeno, trombofilias o TEV previo, se facilita aún más la presencia de ésta. La prevención, diagnóstico y manejo terapéutico del embolismo pulmonar (TEP) en las embarazadas se ve complicado por pocos abordajes validados en esta población particular. Sin embargo, la sospecha clínica y el examen físico son de vital importancia. El valor predictivo negativo del dímero D, la angiotomografía pulmonar helicoidal con su alta sensibilidad y especificidad y el estándar de oro, la arteriografía pulmonar, son útiles para el diagnóstico definitivo. El tratamiento oportuno con heparina no fraccionada así como las de bajo peso molecular, son los medicamentos de elección sobre los antagonistas de la vitamina K, debido a sus bajos efectos adversos,vida media corta y la no circulación a la barrera feto placentaria(AU)

Venous thromboembolic disease (VTD) in pregnancy continues to be one of the leading causes of maternal death in developed countries; it's incidence is 5 to 10 times compared to non-pregnant women; this is due to the modifications that pregnancy itself produces in both the coagulation system, as well as the changes produced in the venous system by the pregnant uterus. The risk is distributed throughout the pregnancy, being the period of greatest risk the first 6 weeks postpartum where it increases 20 times (80% of events occur in the first 3 weeks) and if aditional factors such as age, multiparity, collagen diseases, thrombophilia or prior VTD, even more complicates the presence of this entity. The prevention, diagnosis and therapeutic management of pulmonary embolism (PE) in pregnant women are complicated by the scarcity of validated approaches in this particular population. However clinical suspicion, physical examination is of vital importance. The negative predictive value of D dimer, helical pulmonary angiotomography with its high sensitivity and specificity, and the gold standard pulmonary: arteriography are useful for definitive diagnosis. Timely treatment with unfractionated heparin as well as low-molecular-weight heparin are the drugs of choice for vitamin K antagonists because of their low adverse effects, short half-life, and no circulation to the fetal-placental barrier(AU)

Effectiveness of music therapy as an aid to neurorestoration of children with severe neurological disorders.

This study was a two-armed parallel group design aimed at testing real world effectiveness of a music therapy (MT) intervention for children with severe neurological disorders. The control group received only the standard neurorestoration program and the experimental group received an additional MT "Auditory Attention plus Communication protocol" just before the usual occupational and speech therapy. Multivariate Item Response Theory (MIRT) identified a neuropsychological status-latent variable manifested in all children and which exhibited highly significant changes only in the experimental group. Changes in brain plasticity also occurred in the experimental group, as evidenced using a Mismatch Event Related paradigm which revealed significant post intervention positive responses in the latency range between 308 and 400 ms in frontal regions. LORETA EEG source analysis identified prefrontal and midcingulate regions as differentially activated by the MT in the experimental group. Taken together, our results showing improved attention and communication as well as changes in brain plasticity in children with severe neurological impairments, confirm the importance of MT for the rehabilitation of patients across a wide range of dysfunctions.

Utilización de escalas en el laboratorio de evaluación integral sicomotriz del Centro Internacional de Restauración Neurológica a pacientes que padecen de esclerosis múltiple / Utilization of scales laboratory psychomotor comprehensive assessment of the International Center for Neurological Restoration patients suffering from Multiple Sclerosis

La evaluación y diagnóstico de las funciones motrices se erige en un aspecto importante y vital para los especialistas y oacientes que acuden a nuestra nstitución a fin de valorar sus posibilidades neurorrestaurativas para cumplimentar un plan de rehabilitación, encaminado a recuperar parcial o totalmente estas funciones, teniendo en cuenta sus potencialidades; de ahí que la evaluación antes y después del tratamiento neurorrestaurativo cobre vital importancia en pacientes con patologías neurológicas como la Esclerosis Múltiple; por ello el objetivo de nuestro trabajo fue valorar la sensilibidad de los test que se aplican para dicha patología en el Laboratorio de Evaluación Integral Sicomotriz (LEIS), del Centro Internacional de Restauración Neurológica (CIREN), a través de la compacación de los resultados obtenidos en las evaluaciones (inicial y final al tratamiento neurorrestaurativo) para el conocimiento del estado real de los pacientes. La muestra estuvo conformada por 25 pacientes atendidos en la Clínica de Lesiones Raquimedulares y Enfermedades Neuromusculares, a los que se les aplicaron los test evaluativos antes y después del tratamiento neurorrestaurativo, comparándose ambos resultados, para ello también se utilizó la prueba de Significación Estadística: Wilcoxon matched pairs test, evidenciándose que los test aplicados en el LEIS permitieron definir los puntos de partida para el tratamiento de rehabilitación física y se cuantificaron de manera objetiva los cambios en la capacidad física ocurridos en los pacientes en el desarrollo de su rehabilitación.