In vitro antifungal activity of polymeric nanoparticles loaded with Euphorbia tirucalli extract.

The therapeutic potential of medicinal plants is known as an alternative in treatment of human affections; in effect, the conventional application of these medicinal sources has several limitations like low bioavailability, solubility and stability, which affect its pharmacological efficacy. In recent decades, extraordinary advances have been made in new drug delivery systems using nanocarriers. This work consisted in determining the in vitro antifungal activity of the methanolic extract of Euphorbia tirucalli formulated in polymeric nanoparticles. The antifungal activity was determined by the microdilution method in 96-well microplates, applying nanoparticles loaded with plant extract (NP-Ext) obtained by nanoprecipitation on clinical isolates of Trichophyton rubrum and T. interdigitalis. Regarding the nanoparticles, the lots used did not present significant differences in their physicochemical characteristics, with a size of 91.885 ± 1.621nm, polydispersity index of 0.152 ± 0.025 and Z-potential of -6.047 ± 0.987. The quantification of the extract in the polymeric matrix was determined by infrared spectroscopy (FTIR), where an efficiency and encapsulation percentage of 22.15 ± 0.82 and 2.95 ± 0.11, respectively, were obtained. The in vitro antifungal activity of the crude and formulated extract was obtained calculating the Minimum Inhibitory Concentration (MIC) of each one; a MIC of 125 µg/mL was obtained against T. rubrum and T. interdigitalis with the crude extract, while a MIC value of 55.55 and 0.1 µg/mL was obtained with NP-Ext, respectively, against these same. Conclusions: biological activity is closely linked to the phytochemical profile of the extract; while the improvement of said potential with the NP-Ext with the dosage form was directly related to the physicochemical characteristics of the nanocarrier.

Association of tyrosine hydroxylase 01 (TH01) microsatellite and insulin gene (INS) variable number of tandem repeat (VNTR) with type 2 diabetes and fasting insulin secretion in Mexican population.

PURPOSE: A variable number of tandem repeats (VNTR) in the insulin gene (INS) control region may be involved in type 2 diabetes (T2D). The TH01 microsatellite is near INS and may regulate it. We investigated whether the TH01 microsatellite and INS VNTR, assessed via the surrogate marker single nucleotide polymorphism rs689, are associated with T2D and serum insulin levels in a Mexican population. METHODS: We analyzed a main case-control study (n = 1986) that used univariate and multivariate logistic regression models to calculate the risk conferred by TH01 and rs689 loci for T2D development; rs689 results were replicated in other case-control (n = 1188) and cross-sectional (n = 1914) studies. RESULTS: TH01 alleles 6, 8, 9, and 9.3 and allele A of rs689 were independently associated with T2D, with differences between sex and age at diagnosis. TH01 alleles with ≥ 8 repeats conferred an increased risk for T2D in males compared with ≤ 7 repeats (odds ratio, ≥ 1.46; 95% confidence interval, 1.1-1.95). In females, larger alleles conferred a 1.5-fold higher risk for T2D when diagnosed ≥ 46 years but conferred protection when diagnosed ≤ 45 years. Similarly, rs689 allele A was associated with T2D in these groups. In males, larger TH01 alleles and the rs689 A allele were associated with a significant decrease in median fasting plasma insulin concentration with age in T2D cases; the reverse occurred in controls. CONCLUSION: Larger TH01 alleles and rs689 A allele may potentiate insulin synthesis in males without T2D, a process disabled in those with T2D.

Evolution of physico-chemical parameters, microorganism diversity and volatile organic compound of apple pomace exposed to ambient conditions.

In apple processing, waste material known as apple pomace amounts to 45% of production volumes. When this residue is stored in open-air for its stabilization and potential uses, Volatile Organic Compounds (VOCs) are produced, resulting in environmental and odor pollution, and must be managed to avoid their impact. This work aims to study the emission of VOCs utilizing TD-GC/MS and its relationship with changes in physico-chemical (moisture, pH, proteins, among others) and biological (bacteria and fungi using Illumina MiSeq) parameters under three environmental conditions: open-air (outdoors), under-roof (indoors) and oxygen-free. The 8-month study results showed a gradual increase in odorous VOCs and microbial diversity, a product of chemical and biological transformation processes in the samples. A 30% increase in odorant compounds responsible for the unpleasant smell was observed, especially esters, aldehydes and hydrocarbons in samples stored in oxygen-free and Open-air conditions. Increases in VOCs over time were associated with changes in physico-chemical and biological parameters, as well as fluctuations in environmental variables (temperature, relative humidity, and precipitation). The results of this research allow establishing a relationship between storage conditions and the production of VOCs. In addition, recommendations for waste storage time are provided for the most common uses of apple pomace based on the physico-chemical parameters observed, in order to avoid the generation of odorous compounds. Of all storage methods analyzed, under-roof is the most adequate in practice. This study's findings are pertinent for managing agribusiness waste and its potential environmental pollution.

Extraction methods of algae oils for the production of third generation biofuels - A review.

Microalgae are the main source of third-generation biofuels because they have a lipid content of 20-70%, can be abundantly produced and do not compete in the food market besides other benefits. Biofuel production from microalgae is a promising option to contribute for the resolution of the eminent crisis of fossil energy and environmental pollution specially in the transporting sector. The choice of lipid extraction method is of relevance and associated to the algae morphology (i.e., rigid cells). Therefore, it is essential to develop suitable extraction technologies for economically viable and environment-friendly lipid recovery processes with the aim of achieving a commercial production of biofuels from this biomass. This review presents an exhaustive analysis and discussion of different methods and processes of lipid extraction from microalgae for the subsequent conversion to biodiesel. Physical methods based on the use of supercritical fluids, ultrasound and microwaves were reviewed. Chemical methods using solvents with different polarities, aside from mechanical techniques such as mechanical pressure and enzymatic methods, were also analyzed. The advantages, drawbacks, challenges and future prospects of lipid extraction methods from microalgae have been summarized to provide a wide panorama of this relevant topic for the production of economic and sustainable energy worldwide.

The rs1800795 single nucleotide polymorphism in the IL6 gene is not associated with primary open angle glaucoma in Mexican population.

PURPOSE: Interleukin-6 (IL-6) is a proinflammatory cytokine with pleiotropic effects which has been related to primary open angle glaucoma (POAG) due to its particular effect of protecting the retinal ganglion cells (RGc) from the apoptosis. Different single nucleotide polymorphisms (SNP) have been associated with POAG. The aim of this study was to determine whether an association between IL-6 rs1800795 (-174 G>C) SNP and a higher risk for POAG is present in western Mexican population. METHODS: One hundred and sixty-five unrelated Mexican mestizo patients with POAG and 108 control subjects were included. Genomic DNA was extracted from leukocytes and purified, followed by genotyping and amplification by polymerase chain reaction (PCR) with Taqman Biosystem probes. Allelic and genotypic diversity was evaluated between cases and control subjects. RESULTS: There was no statistically significant association between allele and genotype frequencies, neither with dominant nor recessive genetic association models (p > 0.05). CONCLUSION: Even though there is a role of IL6 in the pathophysiology of POAG, our results ruled out the association between IL-6 and the rs1800795 SNP showing not to be an index of higher risk for POAG in Mexican population.

Dosimetric impact of rectum and bladder anatomy and intrafractional prostate motion on hypofractionated prostate radiation therapy.

OBJECTIVE: The objective of this study was to evaluate the dosimetric impact on hypofractionated prostate radiation therapy of two geometric uncertainty sources: rectum and bladder filling and intrafractional prostate motion. MATERIALS AND METHODS: This prospective study included 544 images (375 pre-treatment cone-beam CT [CBCT] and 169 post-treatment CBCT) from 15 prostate adenocarcinoma patients. We recalculated the dose on each pre-treatment CBCT once the positioning errors were corrected. We also recalculated two dose distributions on each post-treatment CBCT, either using or not intrafractional motion correction. A correlation analysis was performed between CBCT-based dose and rectum and bladder filling as well as intrafraction prostate displacements. RESULTS: No significant differences were found between administered and planned rectal doses. However, we observed an increase in bladder dose due to a lower bladder filling in 66% of treatment fractions. These differences were reduced at the end of the fraction since the lower bladder volume was compensated by the filling during the treatment session. A statistically significant reduction in target volume coverage was observed in 27% of treatment sessions and was correlated with intrafractional prostate motion in sagittal plane > 4 mm. CONCLUSIONS: A better control of bladder filling is recommended to minimize the number of fractions in which the bladder volume is lower than planned. Fiducial mark tracking with a displacement threshold of 5 mm in any direction is recommended to ensure that the prescribed dose criteria are met.

Identification of regulatory T cell molecules associated with severity of multiple sclerosis.

BACKGROUND: Regulatory CD4+ T cells (Tregs) exhibit functional alterations in patients with multiple sclerosis (MS). Transforming growth factor (TGF)-ß is a key regulator of Treg development and function. OBJECTIVE: The objective of this study is to determine whether the expression of functionally relevant TGF-ß-regulated molecules is altered in Tregs from patients with MS. METHODS: Expression of nine Treg markers was analyzed by multi-color flow cytometry in CD4+ T cells and Treg subpopulations of 31 untreated MS patients and age- and sex-matched healthy donors (HDs). Correlations between Treg marker expression and clinical variables were sought. RESULTS: Expression of the transcription factor Helios, which defines thymic-derived Tregs, was decreased in this Treg subpopulation. The frequency of peripherally generated Tregs was increased in patients with MS, particularly in patients with progressive MS. Low frequencies of thymic-derived Tregs were associated with magnetic resonance imaging (MRI) lesion-burden and a high relapse rate. Four surface markers associated with TGF-ß signaling (ABCA1, BTLA, DNAM-1, and GARP) were differentially expressed on Tregs from patients with MS and HDs. Expression levels of CD73, CD103, ABCA1, and PAR2 showed strong correlations with disease severity. CONCLUSION: We have identified novel markers abnormally expressed on Tregs from patients with MS that could detect patients with severe disease.

Variation of δ18O in otoliths of Stellifer lanceolatus and Eucinostomus gula environmental change indicator in Terminos Lagoon, Mexico.

Environmental changes have been associated with natural climatic variability or human activity. Water resources management is, perhaps, the most drastic change observed in the coastal environment. However, external forcings such as the El Niño event have important implications in the global and regional hydrological balance. These environmental changes have an impact on the density and biomass of the ichthyofauna in the Terminos Lagoon (TL) for the past 30 years, presumably, associated with variations in the temperature and surface salinity of the sea. Therefore, in the present study, δ18O was quantified in otoliths of two important species due to their dominance: Stellifer lanceolatus and Eucinostomus gula, and to understand the environmental changes reflected in both species. The δ18O was analyzed in otoliths of these two species captured in 1998/1997, 2006/2007 and 2016/2017 and were compared with in situ temperature and salinity data. Sea surface temperature and salinity increased by 2 °C and 9, respectively, between 1997 and 2017. Stellifer lanceolatus δ18O values was in isotopic equilibrium with seawater calcite; while, E. gula is not in isotopic equilibrium. The δ18O of S. lanceolatus and E. gula varied significantly with the increase in salinity (R2 = 0.8987 and R2 = -0.2964) and not with the sea surface temperature. S. lanceolatus is an excellent bioindicator of changes in sea surface salinity in this region of the Gulf of Mexico.

Spectro-electrochemical characterization and quantification of Rutin in aqueous media.

From UV-Vis spectrophotometric measurements the acidity constants of Rutin in aqueous media, at 25 °C and 0.1 M ionic strength, were determined as: pK1 = 4.392 ±â€¯0.167, pK2 = 7.130 ±â€¯0.050, pK3 = 8.661 ±â€¯0.042 and pK4 = 12.354 ±â€¯0.020 and the molar absorptivity coefficients of all the Rutin pH-dependent species were reported as a function of wavelength. Furthermore, the electrochemical behavior of Rutin at neutral pH was investigated using a bare carbon paste electrode, CPE. It was found that both: Rutin electrochemical oxidation and reduction are reversible, adsorption-controlled processes, involving 2 electron transfers. Moreover, the bare CPE was used for the electrochemical quantification of Rutin in neutral aqueous media, displaying the following features: (1.078 ±â€¯0.440) µM, (3.594 ±â€¯0.400) µM and (0.308 ±â€¯0.014) µA µM-1 for the detection and quantification limits and sensitivity, respectively, within the 1-11 µM linear range. Meanwhile the spectrophotometric method displayed the following analytical features: (3.385 ±â€¯1.318) µM, (11.283 ±â€¯3.114) µM and (0.0120 ±â€¯0.0001) AU µM-1 for the detection and quantification limits and sensitivity, respectively within the 11-110 µM linear range. In like manner, the bare CPE is also shown as a robust electrochemical sensor that allows Rutin quantification even in the presence of ascorbic acid, commonly found in Rutin samples.

Contribución a la restauración y el mantenimiento de obras de importancia histórica, cultural y social de la ciudad de La Habana / Contribution to the restoration and maintenance of works of historical, cultural and social importance of the city of Havana

RESUMEN Entre las aplicaciones de la Ciencia e Ingeniería de Materiales que realiza el Centro de Aplicaciones Tecnológicas y Desarrollo Nuclear CEADEN está el apoyo mediante varias técnicas físicas a la restauración y el mantenimiento de estructuras y objetos de la ciudad de La Habana que poseen interés histórico, cultural y social . En el presente trabajo es abordado el campo de la Defectoscopía, en lo cual los Ensayos no destructivos aplicados tributaron a la restauración del patrimonio cultural, a la mejora de instalaciones deportivas de la capital y, en mayor medida, a la seguridad de instalaciones de interés social como son los parques de diversión. En ese sentido se presentan la inspección de estructuras en el marco de la restauración de la Sala Cabildo del Museo de la Ciudad de La Habana en el Palacio de los Capitanes Generales en La Habana Vieja; el diagnóstico de uniones soldadas durante la restauración de la iluminación y la instalación de la pantalla gigante del Estadio Latinoamericano del Cerro y la Inspección realizada sistemáticamente en mantenimiento a elementos críticos de equipos de los parques de diversión.

ABSTRACT Among the applications of Materials Science and Engineering carried out by the Center for Technological Applications and Nuclear Development (CEADEN) / Centro de Aplicaciones Tecnológicas y Desarrollo Nuclear CEADEN is the use of various physical techniques to support the restoration and maintenance of buildings and other work objects of historical, cultural and social interest in Havana city. The field of Defectoscopy is addressed in this paper, where the applied Nondestructive testings also contributed to restore the cultural heritage, to upgrade the structural conditions at an important sport facility in Havana, and in a greater extent, to the safety of facilities of social significance, such as amusement parks. In this regard, three examples are presented: the inspection of structures during the restoration of the City Hall in the Museum of the Havana City at the Palace of Captains General; the welded joints testing during the restoration of the lighting system and the installation of the digital screen at the Latin American Stadium in Cerro municipality; and finally, the inspection systematically performed at maintenance works to critical elements and related devices at amusement parks.

Data extracted from olive oil mill waste exposed to ambient conditions.

Recent studies show that the process of extraction of olive oil results in a large amount of waste. Around 20% the oil is obtained in the process and the remaining 80% corresponds to mainly two types of waste, known as orujo and alperujo. These residues were stored in pools for 6 months in an uncontrolled environment. The reservoirs are open and generate Odorous Volatile Organic Compounds (VOCs) as products of waste decomposition. The data in this article corresponds of physical-chemical compounds of olive oil mill waste exposed to ambient conditions. The data was obtained from two different oil mills, namely, Almazara del Pacífico located in the Alto Pangue area, Talca, Chile; and Agricola y Forestal Don Rafael oil mill, Molina, Chile. Samples were extracted directly from the oil mills to fill 200 L plastic containers that simulated the waste storage in oil mill reservoirs. Each sample was identified and standardized to a mass of 150 kg and moved and stored under uncontrolled ambient conditions at the Universidad de Talca, Curicó, Chile.

Bcl-2 expression in a diabetic embryopathy model in presence of polyamines.

The frequency of congenital malformations is 3-5 times higher in mothers with pregestational diabetes mellitus than in general population. Apparently, this problem is due to change in the expression of apoptotic and antiapoptotic genes induced by the oxidative stress derived from the diabetes/hyperglycemia. One of these genes is Bcl-2, which is associated with the control and inhibition of apoptosis. The purpose of the present work was to study the effect of polyamine addition over expression of Bcl-2 gene in a model of diabetic embryopathy. For this, gestational day 10.5 (GD10.5) rat embryos were incubated at 37°C for 24 h in control medium, medium with high glucose, or medium with high glucose and supplemented with spermidine or spermine. Post-cultured embryos were harvested and observed to obtain morphological scores; some of them were subjected to molecular biology studies: DNA isolation plus conventional PCR or RNA isolation plus RT-PCR; other embryos were fixed with paraformaldehyde and used for immunohistochemical detection of Bcl-2 protein. Although Bcl-2 mRNA was similarly expressed in all rat embryo treatments, Bcl-2 protein was found only in control-incubated embryos. In conclusion, it seems that the inhibition of Bcl-2 gene expression induced by glucose was not reversed by polyamines.

Metacercariae of Heterodiplostomum lanceolatum (Trematoda: Proterodiplostomidae) found in Leptodactylus podicipinus (Anura: Leptodactylidae) from Brazil: a morphological, molecular and ecological study.

The trematodes from South American reptiles are poorly known, with only one life cycle completely characterized. We used molecular and morphological methods to characterize diplostomoid metacercariae found in 29 of 86 pointedbelly frogs, Leptodactylus podicipinus (Cope, 1862) collected in a marsh pond in Selvíria, in the central-west region of Brazil. The metacercariae were identified as Heterodiplostomum lanceolatum Dubois, 1936 (Proterodiplostomidae), a rarely reported species that matures in snakes. In phylogenetic analysis of partial sequences from 28S rDNA, H. lanceolatum fell within a polytomy with the proterodiplostomid Crocodilicola pseudostoma (molecular divergence of 4.1%) and other members of the superfamily Diplostomoidea. Our collections provide insights into the ecology of this parasite, in that infected frogs were smaller than uninfected frogs, and metacercariae were more numerous in the abdominal cavity and hindlimb muscles than in abdominal muscles, which suggests directions for future research on the transmission and pathology of this proterodiplostomid.

Impact of rectum and bladder anatomy in intrafractional prostate motion during hypofractionated radiation therapy.

BACKGROUND: The objective was to determine the magnitude of the prostate intrafractional motion relative to bony pelvis anatomy, and to evaluate the relationship between this displacement and some clinical and anatomical variables. MATERIALS AND METHODS: The prospective study consisted of 544 images (375 pre-treatment CBCT and 169 post-treatment CBCT) from 15 prostate adenocarcinoma patients that were used for intrafractional prostate motion determination. In addition, two radiation oncologists re-contoured the bladder and rectum on each CBCT according to the patient's anatomy of the day. ANOVA and correlation analysis followed by linear regression analysis were performed to identify clinical or anatomical variables that predict large prostate intrafractional motion. RESULTS: Prostate shift increased in patients with hormone therapy (p ≤ 0.02). The regression analysis showed that patients with large bladder intrafractional filling (p < 0.01) and a large bladder volume difference from planning CT were more likely to experience bigger longitudinal prostate motion (> 3 mm). Recommended bladder size values: anterior-posterior size ≤ 10 cm and anterior-posterior/cranio-caudal ratio ≤ 1.7, both parameters measured in the midsagittal prostate plane, were defined. CONCLUSIONS: The treatment margin should not be reduced for those patients who were treated with hormone therapy and/or whose rectum or bladder was far from complying the preparation protocol conditions.

Temperature Measurement of Fluid Flows by Using a Focusing Schlieren Method.

A method for measuring planar temperature fields of fluid flows is proposed. The focusing schlieren technique together with a calibration procedure to fulfill such a purpose is used. The focusing schlieren technique uses an off-axis circular illumination to reduce the depth of focus of the optical system. The calibration procedure is based on the relation of the intensity level of each pixel of a focused schlieren image to the corresponding cutoff grid position measured at the exit focal plane of the schlieren lens. The method is applied to measure planar temperature fields of the hot air issuing from a 10 mm diameter nozzle of a commercial Hot Air Gun Soldering Station Welding. Our tests are carried out at different temperature values and different planes along the radial position of the nozzle of the hot air. The experimental values of temperature measurements are in agree with those measured using a thermocouple.

Participation of voltage-gated sodium and calcium channels in the acute cardiac effects of toluene.

Inhaling solvents can lead to occurrence of cardiac arrhythmias and sudden sniffing death. Mechanisms related to this phenomenon are not fully understood. The purpose of this study was to investigate the effect of acute toluene exposure on heart reactivity to epinephrine and the participation of voltage-gated sodium and calcium channels. We found that acute toluene exposure increased perfusion pressure, left ventricular developed pressure, and heart rate. These actions were inhibited by lidocaine and nifedipine. Our results suggest that acute toluene exposure modify voltage-gated sodium and calcium channel function and expression likely due to a cardiac adrenergic mechanism and these effects could be participating, at least in part, in the presence of cardiac arrhythmias. To our best knowledge, this is the first report to establish a direct participation of voltage-gated Na+ and Ca2+ channels, toluene and epinephrine on cardiac function in rats.

High frequency of Taenia pisiformis metacestodes and high sex-associated susceptibility to cysticercosis in naturally infected wild rabbits.

Sexual dimorphism is a well-documented phenomenon observed at all levels of the animal kingdom, with the inclusion of both sexes in clinical trials and basic research becoming mandatory. Regarding parasitosis, in several animal species, the signs and virulence of the disease may change depending on the sex of the affected animal. In the cestodiasis caused by Taenia solium and Taenia crassiceps, females are more susceptible to experimental infection than males. Cysticercosis by Taenia pisiformis in rabbits has acquired relevance due to its economic impact, namely affecting welfare and production. In America, specifically in Mexico, there are no formal reports on the infection with T. pisiformis metacestodes in populations of wild rabbits, despite being the country with more endemic species (about 15 species), among them, the volcanoes rabbits or the endangered teporingo (Romerolagus diazi). In this study, 31 wild rabbits were obtained by hunters of some regions of Morelos state during several hunting seasons, and sex, physiological stage, and number of metacestodes were recorded. A high frequency of infection by T. pisiformis metacestodes (67.7%) was found. Also, a higher susceptibility to this infection was observed in does (80% infected) compared to bucks (40%), finding 84.2% of metacestodes (235 metacestodes) in does and 15.8% of metacestodes (44 metacestodes) in bucks. The percentage of infection was higher in lactating compared with pregnant and non-pregnant does, with metacestodes lodging mainly in the uterus. Increasing our knowledge regarding parasitic infections can help us better understand transmission circles as well as the parasite-host interaction of these increasingly at risk rabbit species.

Safety and efficacy of small bowel polypectomy using a balloon-assisted enteroscope in pediatric patients with Peutz-Jeghers syndrome. / Seguridad y eficacia de la polipectomía en intestino delgado utilizando enteroscopio asistido por balones en pacientes pediátricos con síndrome de Peutz-Jeghers.

INTRODUCTION AND AIMS: Peutz-Jeghers syndrome is an autosomal dominant inherited pathology characterized by gastrointestinal hamartomatous polyps, predominantly in the small bowel, and pigmented mucocutaneous lesions. Guidelines suggest polypectomy with a balloon-assisted enteroscope when polyps are larger than 10mm. Complications in adults can be as high as 6.8%, but there is little information on pediatric populations. Our aim was to describe the safety and efficacy of polypectomy in a group of pediatric patients with Peutz-Jeghers syndrome using balloon-assisted enteroscopy. MATERIALS AND METHODS: A retrospective study was conducted at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI on pediatric patients with Peutz-Jeghers syndrome that required balloon-assisted enteroscopy and polypectomy within the time frame of January 2010 and December 2015. Patients that underwent polypectomy with a push enteroscope were excluded from the study. RESULTS: A total of 35 polypectomies were performed on 4 patients (female/male: 3/1). The mean age of the patients was 13.7 years (range:11-16). Twelve enteroscopies were carried out, 8 of which were anterograde. A single-balloon enteroscope was used in 7 procedures and a double-balloon enteroscope in 5. The mean size of the polyps was 1.6cm (range: 1-4cm). A major complication (acute pancreatitis) presented in only one case (8.3%). No other major complications associated with the procedures were observed. CONCLUSION: Balloon-assisted enteroscopy with polypectomy in children is a safe and effective procedure, with complications similar to those reported in adults.

Present and past perspectives on Clostridium difficile infection. / Perspectivas históricas y vigentes sobre la infección por Clostridium difficile.

Clostridium difficile is a Gram-positive bacillus that has become one of the main hospital-acquired human gastrointestinal infections in recent years. Its incidence is on the rise, involving more virulent strains, affecting new and previously uncontemplated groups of patients, and producing changes in clinical presentation and treatment response that influence disease outcome. Early diagnosis and disease stratification based on the severity of C.difficile infection are essential for therapeutic management and the implementation of containment measures. However, the speed at which new strains with greater pathogenicity are developing is surpassing that of the development of new drugs, making it necessary to validate other therapeutic options. The present article is a review of the epidemiologic, pathophysiologic, diagnostic, and therapeutic aspects of C.difficile infection, from its first isolation to the present date, that aims to contribute to the preparation of general physicians and specialists, so that patients with this infection receive opportune and quality medical attention.

Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico.

BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.