DHEA Induces Sex-Associated Differential Patterns in Cytokine and Antibody Levels in Mice Infected with Plasmodium berghei ANKA.

Malaria is the most lethal parasitic disease worldwide; the severity of symptoms and mortality are higher in men than in women, exhibiting an evident sexual dimorphism in the immune response; therefore, the contribution of 17ß-estradiol and testosterone to this phenomenon has been studied. Both hormones differentially affect several aspects of innate and adaptive immunity. Dehydroepiandrosterone (DHEA) is the precursor of both hormones and is the sexual steroid in higher concentrations in humans, with immunomodulatory properties in different parasitic diseases; however, the involvement of DHEA in this sexual dimorphism has not been studied. In the case of malaria, the only information is that higher levels of DHEA are associated with reduced Plasmodium falciparum parasitemia. Therefore, this work aims to analyze the DHEA contribution to the sexual dimorphism of the immune response in malaria. We assessed the effect of modifying the concentration of DHEA on parasitemia, the number of immune cells in the spleen, cytokines, and antibody levels in plasma of CBA/Ca mice infected with Plasmodium berghei ANKA (P. berghei ANKA). DHEA differentially affected the immune response in males and females: it decreased IFN-γ, IL-2 and IL-4 concentrations only in females, whereas in gonadectomized males, it increased IgG2a and IgG3 antibodies. The results presented here show that DHEA modulates the immune response against Plasmodium differently in each sex, which helps to explain the sexual dimorphism present in malaria.

Immunomodulatory effects of testosterone and letrozole during Plasmodium berghei ANKA infection.

Introduction: Malaria is one of the leading health problems globally. Plasmodium infection causes pronounced sexual dimorphism, and the lethality and severity are more remarkable in males than in females. To study the role of testosterone in the susceptibility and mortality of males in malaria, it is common to increase its concentration. However, this strategy does not consider the enzyme CYP19A1 aromatase, which can transform it into oestrogens. Methods: To avoid the interference of oestrogens, we inhibited in vivo CYP19A1 aromatase with letrozole and increased the testosterone level by exogen administration before infection with Plasmodium berghei ANKA. We measured the impact on free testosterone, 17ß-oestradiol and dehydroepiandrosterone levels in plasma; additionally, we evaluated parasitaemia, body temperature, body mass, glucose levels and haemoglobin concentration. Furthermore, we evaluated the effects of testosterone on the immune response; we quantified the CD3+/CD4+, CD3+/CD8+, CD19+, Mac-3+ and NK cells in the spleen and the plasma concentrations of the cytokines IL-2, IL-4, IL-6, IFN-, IL-10, TNF-α and IL-17A. Finally, we quantified the levels of antibodies. Results: We found that mice treated with the combination of letrozole and testosterone and infected with Plasmodium berghei ANKA had increased concentrations of free testosterone and DHEA but decreased levels of 17ß-oestradiol. As a result, parasitaemia increased, leading to severe anaemia. Interestingly, testosterone increased temperature and decreased glucose concentration as a possible testosterone-mediated regulatory mechanism. The severity of symptomatology was related to critical immunomodulatory effects generated by free testosterone; it selectively increased CD3+CD8+ T and CD19+ cells but decreased Mac-3+. Remarkably, it reduced IL-17A concentration and increased IL-4 and TNF-α. Finally, it increased IgG1 levels and the IgG1/IgG2a ratio. In conclusion, free testosterone plays an essential role in pathogenesis in male mice by increasing CD8+ and decreasing Mac3+ cells and mainly reducing IL-17A levels, which is critical in the development of anaemia. Our results are important for understanding the mechanisms that regulate the exacerbated inflammatory response in infectious diseases and would be useful for the future development of alternative therapies to reduce the mortality generated by inflammatory processes.

Testosterone induces sexual dimorphism during infection with Plasmodium berghei ANKA.

Malaria is the most lethal parasitic disease worldwide; men exhibit higher mortality and more severe symptomatology than women; however, in most studies of immune response in malaria, sex is not considered a variable. Sex hormones 17ß-oestradiol and testosterone are responsible for the main physiological differences between sexes. When interacting with their receptors on different immune cells, they modify the expression of genes that modulate cell proliferation, differentiation, and synthesis of cytokines. The immunosuppressive activity of testosterone is well accepted; however, its participation in the sexual dimorphism of the immune response to malaria has not been studied. In this work, we analysed whether altering the concentration of testosterone, through increasing the concentration of this hormone for exogenous administration for three weeks, or gonadectomy before infection with Plasmodium berghei ANKA affects different cells of the immune response necessary for parasite clearance. We also assessed the concentration of pro-and anti-inflammatory cytokines in male and female CBA/Ca mice infected or not with the parasite. Our results show that testosterone changes affect females more than males, resulting in sex-associated patterns. Testosterone administration increased parasitaemia in intact males while reducing it in intact females leading to a dimorphic pattern. In addition, gonadectomy increased parasitaemia in both sexes. Moreover, testosterone administration prevented both weight loss caused by the infection in females and hypothermia in gonadectomized mice of both sexes. Boosting testosterone concentration increased CD3+ and CD8+ populations but decreased the B220+ cells exclusively in females. Additionally, testosterone reduced IFN-γ concentration and increased IL-6 levels only in females, while in males, testosterone increased the number of NK cells. Finally, gonadectomy decreased TNF-α concentration in both sexes. Our results demonstrate that testosterone induces different patterns depending on sex and testosterone concentration. The results of this work contribute to understanding the impact of modifying testosterone concentration on the immune response specific against Plasmodium and the participation of this hormone in sexual dimorphism in malaria.

Transcriptome analysis reveals involvement of oxidative stress response in a copper-tolerant Fusarium oxysporum strain.

High amount of copper is toxic to most organisms, but endophytic fungi can develop survival strategies to tolerate and respond to environmental stressors such as heavy metal contaminants. While high copper induces oxidative stress, it is still unclear which genes are associated with copper tolerance. Here, we performed a metatranscriptome analysis of endophytic fungi isolated from a black nightshade plant Solanum nigrum L. growing on mine tailings of a gold processing area. Initial screening revealed the presence of a copper-tolerant strain of Fusarium oxysporum, designated as IB-SN1W, which tolerated up to 1000 ppm and 300 ppm copper in solid and liquid media, respectively. Differential gene expression analysis by RNA sequencing showed that 23% of contigs are uniquely expressed in the copper-treated fungus. These genes are involved in copper ion import, polyamine transport, oxidoreductase activity, and oxidative stress response. Catalase transcripts were also highly upregulated in IB-SN1W compared to a non-tolerant F. oxysporum strain. Catalase inhibition decreased copper-tolerance in IB-SN1W, while the addition of antioxidants prevented the copper-dependent growth inhibition in the non-tolerant strain. Overall, these results suggest that oxidative stress response contributes to copper tolerance in F. oxysporum.

17ß-Estradiol Is Involved in the Sexual Dimorphism of the Immune Response to Malaria.

Malaria is the leading cause of parasitic infection-related death globally. Additionally, malaria-associated mortality is higher in men than in women, and this sexual dimorphism reflects differences in innate and adaptive immune responses that are influenced by sex hormones. Normally, females develop more robust immune responses against parasites than males. However, most clinical and laboratory studies related to the immune response to malaria do not consider sex as a variable, and relatively few studies have compared the sex-dependent role of 17ß-estradiol in this process. In this study, we decreased in vivo the levels of 17ß-estradiol by gonadectomy or administered 17ß-estradiol to intact or gonadectomized male and female CBA/Ca mice infected with Plasmodium berghei ANKA. Subsequently, we assessed the effects of 17ß-estradiol on parasite load; the percentages of different immune cells in the spleen; the plasma levels of antibodies and pro- and anti-inflammatory cytokines; and the mRNA expression levels of cytokine-encoding genes in the brain. The results showed that the administration of 17ß-estradiol increased parasitemia and decreased body weight in intact female mice. Moreover, intact females exhibited higher levels of CD8+ T cells and lower levels of NK1.1+ cells than their male counterparts under the same condition. Gonadectomy increased IFN-γ and decreased TNF-α concentrations only in intact female mice. Additionally, IL-10 levels were higher in intact females than in their male counterparts. Finally, the mRNA expression levels of cytokines coding genes in the brain showed a dimorphic pattern, i.e., gonadectomy upregulated Tnf, Il1b, and Il10 expression in males but not in females. Our findings explain the sexual dimorphism in the immune response to malaria, at least in part, and suggest potential sex-dependent implications for the efficacy of vaccines or drugs targeting malaria.

Estratificación epidemiológica de la mortalidad por suicidio en Cuba, 2011-2016 / Epidemiological stratification of mortality by suicide in Cuba, 2011-2016

Introducción: La estratificación epidemiológica de riesgo es un proceso que categoriza áreas geoecológicas y grupos poblacionales, de acuerdo con factores de riesgo de un determinado problema de salud. El suicidio en Cuba es la décima causa de muerte y la tercera en el grupo de 10 a 19 años. Objetivo: Estratificar epidemiológicamente la mortalidad por suicidio en Cuba, en el periodo comprendido entre 2011- 2016. Material y Métodos: Se realizó un estudio descriptivo, retrospectivo. El universo fueron los registros de fallecimiento por suicidio de la Dirección de Registros Médicos y Estadísticas de Cuba, desde 2011- 2016. Las variables estudiadas: sexo, edad, lugar de fallecimiento, color de la piel, y provincias de residencia. Se calcularon las tasas acumuladas, brutas, ajustadas y específicas por 100,000 habitantes. Se calculó el porcentaje según variables y el cambio relativo de la serie. Se estratificó la mortalidad por provincias de residencia, en adolescentes y para todos los grupos de edades, utilizando como punto de cortes los percentiles. Resultados: El 79,9% de los fallecidos fueron hombres. El grupo de ( 60 años tuvo la más alta tasa promedio (26,8 por 100,000 habitantes). Predominó según lugar de fallecimiento, el domicilio (57,1 por ciento). La estratificación provincial en adolescentes mostró; Muy Alto Riesgo: Mayabeque (tasa 4,9); Cienfuegos (4,0); Granma (3,8); Las Tunas (3,0) por 100,000 habitantes. En todas las edades; Muy Alto riesgo: Villa Clara (tasa 17,9); Las Tunas (17,6); Holguín (17,1); Mayabeque (16,7) por 100,000 habitantes. Conclusiones: Las tasas de suicidio son más bajas entre las mujeres. Existen diferencias en la estratificación de riesgo provincial. Los resultados contribuyen a la actualización epidemiológica del suicidio en Cuba(AU)

Introduction: Epidemiological risk stratification is a process that categorizes geo-ecological areas and population groups according to risks factors in a particular health problem. Suicide in Cuba is the tenth cause of death and the third one in the age group of 10 - 19 years. Objective: To present the epidemiological stratification of mortality by suicide in Cuba during the period between 2011 and 2016. Material and Methods: A descriptive retrospective study was carried out. The universe consisted of the records of death by suicide from the Dirección de Registros Médicos y Estadísticas de Cuba from 2011 to 2016. The variables studied were: sex, age, place of death, skin color, and provinces of residence. Cumulative, gross, adjusted and specific rates per 100,000 inhabitants were calculated. The percentage was calculated according to variables and the relative change of the series. Mortality was stratified by provinces of residence, in adolescents and for all age groups, using percentiles as a cut-off point. Results: It was identified that 79.9 percent of the deceased were men. The ( 60 year- old-group had the highest average rate (26.8 per 100,000 inhabitants). Regarding place of death, residence predominated (57.1 percent). Provincial stratification in adolescents showed Very High Risk in Mayabeque (rate: 4.9), Cienfuegos (4.0), Granma (3.8) and Las Tunas (3.0) per 100,000 inhabitants; whereas in all ages, Very High Risk was present in: Villa Clara (rate: 17.9), Las Tunas (17.6), Holguín (17.1) and Mayabeque (16.7) per 100,000 inhabitants. Conclusions: Suicide rates are lower among women. There are differences in the provincial risk stratification. The results contribute to the epidemiological update of suicide in Cuba(AU)

Assessment of Alternanthera sessilis and Aster philippinensis as excluders in a small-scale Cu-Au processing site at Kias, Benguet, Philippines.

In unregulated mining and processing for Cu and Au, large amounts of heavy metals and metalloids are generated as tails. These wasted by-products could actually pose serious environmental problems. The objective of this study was to assess the potential ability of Alternanthera sessilis and Aster philippinensis thriving abundantly in a small-scale mine processing site at Kias, Benguet, for possible Cu, Pb, Zn, and As uptake. It also aimed to determine the cellular localization of the contaminants within the plant biomass. Alternanthera sessilis and Aster philippinensis exhibited low bioaccumulation factor (BF) and translocation factor (TF) values for Cu, Pb, Zn, and As. The BF and TF values could suggest possible exclusion mechanisms of the plants in avoiding phytotoxicity. SEM-EDX analysis of the Alternanthera sessilis roots indicated higher weight % of Cu, Pb, and As in the epidermis, and Zn in the cortex. On the other hand, Aster philippinensis roots showed high weight % of Zn and As in the epidermis and Cu and Pb in the cortex. The localization of the contaminants in the root epidermal and cortical cells signifies restriction of their mobility to the xylem, preventing migration to the shoot system. The findings of this study suggest that Alternanthera sessilis and Aster philippinensis are considered potential phytostabilizers capable of immobilizing contaminant toxicity in the soil and in the rhizosphere.

Localization of nickel in the hyperaccumulator plant Breynia cernua (Poir.) Mull.Arg. discovered in the nickeliferous laterites of Zambales, the Philippines.

A newly discovered nickel (Ni) hyperaccumulator plant, Breynia cernua (Phyllanthaceae) from the nickeliferous laterites of Acoje, Zambales, has elevated Ni concentrations. Its computed bioaccumulation factor is 1.7 and the translocation factor is 4.6. Leaf tissues which contain the highest Ni concentrations were analyzed using optical microscopy and Scanning Electron Microscopy with Energy-Dispersive X-ray (SEM/EDX). The results indicated that most of the Ni are stored in the epidermal cells of the leaves, followed by the mesophyll cells then the vascular bundles. The accumulation of Ni found in the subcellular locations, probably in the vacuoles, may prevent phytotoxicity that could affect the normal function of other cellular structures. A possible resistance mechanism through strain avoidance towards Ni accumulation makes B. cernua capable of tolerating elevated Ni concentrations in its tissues. The tolerance of B. cernua to Ni phytotoxicity suggests possible applications of this hyperaccumulator plant in phytoextraction technology.

Dimorphic effect of 17ß-oestradiol on pathology and oxidative stress in experimental malaria.

Malaria is the parasitic disease with the highest mortality worldwide; males exhibit higher mortality and more severe symptomatology than females, suggesting the participation of sexual hormones in protection and pathology. We have documented that gonadectomy modifies oxidative stress in Plasmodium berghei ANKA-infected mice in a dimorphic manner. However, gonadectomy decreases all sexual steroids levels, making it difficult to determine the contribution of each hormone to the results. This study aimed to explore the participation of 17ß-oestradiol (E2) in oxidative stress in the blood, spleen, liver and brain of P. berghei-infected female and male mice. E2 was administered to intact or gonadectomized (GX) male and female mice to assess their effects on parasitaemia, body weight loss and hypothermia. We also measured the effect of E2 on the specific activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) and on malondialdehyde (MDA) levels in the blood, spleen, liver and brain of CBA/Ca male and female mice infected with P. berghei ANKA. We detected the effects of E2 and sexual dimorphism on all tissues and variables analysed. Administration of E2 increased parasitaemia in intact mice. However, reconstitution of GX female mice with E2 decreased parasitaemia. E2 decreased body weight and differentially modulated oxidative stress depending on the sex, infection and tissue analysed. Low antioxidant activity was detected in the brain, suggesting additional protective antioxidant mechanisms in the brain independent of antioxidant enzymes. Our results explained, at least in part, the sexual dimorphism in this experimental model of malaria.

Pteris melanocaulon Fée is an As hyperaccumulator.

Pteris melanocaulon is noted to thrive very well in selected Cu-Au mines in the Philippines such as the Carmen Cu mine in Cebu and the Manila Mining Cu-Au mine in Surigao. Soil and plant samples were collected from field surveys as well as potted experiments. The computed bioaccumulation factor (BF) and translocation factor (TF) values from the analyses of As contents of the soil and the belowground and above ground components of the plant, apparently were comparable to known As hyperaccumulators Pteris vittata and Pityrogramma calomelanos. It is inferred with probability that the factors that influence the bioavailability of As as well as the uptake mechanisms for P. melanocaulon would be similar to the 2 known As hyperaccumulators. Previous works have noted P. melanocaulon as a very good Cu accumulator with very high Cu values in the belowground components and this study further identified it to be an excellent As hyperaccumulator with high As values in the aboveground components.

Towards integrated management of a shallow tropical lake: assessment of water quality, sediment geochemistry, and phytoplankton diversity in Lake Palakpakin, Philippines.

The limited carrying capacities of shallow tropical lakes render them more vulnerable to ecological problems like eutrophication. Unregulated human activities such as unsustainable aquaculture and urbanization can alter ecosystem dynamics rapidly, and this warrants more comprehensive researches than what has been previously conducted. Here, we presented an integrated assessment of the nutrient dynamics, phytoplankton diversity, and sediment geochemistry in Lake Palakpakin, a shallow tropical lake of volcanic origin, to understand its deteriorating ecological state. Water, phytoplankton, and sediment samples were collected, and in situ water quality measurements were done during wet and dry seasons in four critical areas in the lake, namely, the inlet, center, sanctuary, and outlet. Results revealed that high light extinction coefficient (1.13 m-1), high turbidity (28 NTU), high phosphate concentration (> 2.0.5 mg/L), and the abundance of Microcystis aeruginosa, Anabaena helicoidea, and Lyngbya sp. indicate that from a relatively healthy lake in 2008, Lake Palakpakin has become a eutrophic to hypereutrophic freshwater body. High concentrations of available nutrients such as N and P were detected in the center and sanctuary sediments, which drive the internal nutrient loading in the lake. We recommend that management efforts be directed towards a whole-ecosystem approach in addressing the problem of eutrophication, especially in shallow tropical lakes.

The identification of indigenous Cu and As metallophytes in the Lepanto Cu-Au Mine, Luzon, Philippines.

The mining activities in the Lepanto Cu-Au Mine which is situated within the Mankayan Mineral District in the Philippines have exposed the arsenic (As)-rich copper (Cu)-gold (Au) and polymetallic ores to surface conditions. Cu and As dispersal into nearby soils and waters could pose health hazards to the natural ecosystems and human settlements. The study focused on the identification of indigenous metallophytes thriving in the area as well as the bioavailability of Cu and As in soils and its implication to the growth of the indigenous plants. Particular interests were on plant species that are capable of Cu and As absorption and have potential applications to mine rehabilitation. The samples were analyzed for total Cu and As contents. The soil samples were also subjected to different physicochemical analyses such as pH, organic matter, and nutrient content. Fern species had relatively high Cu and As contents in their biomass than other plant species found in the study area. The Cu and As concentrations in the plants might have been strongly influenced by the bioavailability of the metal and metalloid which were dependent on the physicochemical properties of the soil such as pH, organic matter, and nutrient contents. These identified metallophytes namely Dicranopteris linearis, Histiopteris incisa, Pityrogramma calomelanos, Pteris vittata, Nephrolepis hirsutula, Pteris sp., Pinus sp., Thysanolaena latifolia, and Melastoma malabathricum have tolerated the different Cu and As concentrations in the soil thus could be useful and effective for ecological restoration as an option to post-mining rehabilitation.

Homicidio y disfuncionalidad familiar / Homicide and family dysfunction

Introducción: La familia es la instancia de intermediación entre el individuo y la sociedad. Es en ella donde la persona adquiere sus primeras experiencias, valores y concepción del mundo. Constituye el espacio por excelencia para el desarrollo de la identidad y es el primer grupo de socialización del individuo. Una familia con un funcionamiento apropiado, o familia funcional, origina el desarrollo integral de sus miembros y logra la subsistencia de estados de salud favorables en estas. Por otra parte, una familia disfuncional o con un funcionamiento inadecuado, debe ser considerada como factor de riesgo, al favorecer la aparición de enfermedades en sus miembros y la ocurrencia de hechos violentos, como el homicidio. Objetivo: Explorar la relación que existe entre la disfuncionalidad familiar y el delito de homicidio. Métodos: Se realizó una investigación retrospectiva e indirecta de todos los homicidios acaecidos en el contexto familiar en La Habana durante el año 2013, utilizando para la misma el método de autopsia psicológica. Conclusiones: En el homicidio, como máxima expresión de la violencia, existe un estrecho vínculo entre los protagonistas del homicidio y la disfuncionalidad familiar, dado por el hacinamiento, la promiscuidad y la actividad ilícita como medio de sustentación familiar, unido a esto el consumo de alcohol y otras drogas(AU)

Introduction: Family is the instance of intermediation between the individual and society. In the family, the person acquires his/her first experiences, values ​​and conception of the world. It constitutes the space par excellence for the development of identity and is the first group of socialization of the individual. A family with an appropriate functioning, or a functional family, originates the integral development of its members and achieves the subsistence of favorable health states in these. On the other hand, a dysfunctional family or one with an inadequate functioning, should be considered as a risk factor, favoring the onset of diseases in its members and the occurrence of violent acts, such as homicide. Objective: To explore the relationship between family dysfunctionality and the crime of homicide. Methods: A retrospective and indirect research was carried out of all homicides occurred in the family context in Havana during 2013, using the method of psychological autopsy. Conclusions: In homicide, as the maximum expression of violence, there is a close link between the homicide protagonists and family dysfunction, given by overcrowding, promiscuity and illegal activity as a means of family support, together with the consumption of alcohol and other drugs(AU)

Trace organic chemical pollutants from the lake waters of San Pablo City, Philippines by targeted and non-targeted analysis.

More than half of the freshwater lakes in the Philippines are small with surface areas of <2 km2. The dynamics in these lakes are different from those in the bigger lakes. This study was conducted to determine the organic pollutants and their sources in three of the seven lakes of San Pablo City in Laguna, Philippines: lakes Palakpakin, Sampaloc, and Pandin. Gas Chromatography-Mass Spectrometry (GC-MS) and Liquid Chromatography - Tandem Mass Spectrometry (LC-MS/MS) were used in the targeted and non-targeted analysis of the lake water samples. The three lakes are all volcanic crater lakes but are exposed to different anthropogenic activities, which includes domestic activities, livelihood (farming and aquaculture) and eco-tourism. Due to the presence of rice fields and fruit plantations, chlorpyrifos was detected in the three lakes while other pesticides like cypermethrin, picolinafen and quinoxyfen were additionally found in Lake Sampaloc, which is the biggest of the three lakes and located within the urbanized section of the city. Traces of different surfactants (linear alkylbenzene sulfonates, secondary alkyl sulfonates, alkyl sulfates, alkyl ether sulfates), biocide benzalkonium chloride, insect repellent diethyltoluamide, antibiotics (sulfadiazine and sulfamethoxazole), hypertension drug telmisartan, phosphate-based fire retardants, and artificial sweeteners (acesulfame, cyclamate, saccharin and sucralose) were detected in lakes Sampaloc and Palakpakin. The same surfactants, artificial sweeteners, insect repellant and phosphate-based fire retardants were also found in Lake Pandin, which is mainly used for eco-tourism activities like swimming and boating. The results of this study suggest that the organic pollutants present in the small lakes can be linked to the various human activities in the immediate lake environment. Because small lakes are more prone to environmental stresses, human activities in the said lakes must be regulated to ensure sustainable development.

Trastornos mentales y homicidio / Mental disorders and homicide

Introducción: El delito de homicidio es uno de los más graves y perjudiciales a la sociedad; es la forma más extrema de expresión y resolución de los conflictos sociales entre las personas y los colectivos. En la historia del ser humano, la existencia de trastornos mentales en los protagonistas de la violencia social, en especial del homicidio, ha sido una realidad constante, en algunos casos magnificada, aunque determinadas entidades, como el Trastorno de la Personalidad Antisocial, han demostrado tener una significación estadística en aquellos homicidios que se apegan más a patrones de violencia instrumental o predatoria. Objetivo: Caracterizar psicopatológicamente a los autores de homicidios acaecidos en La Habana que fueron peritados en el período 2011- 2013. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo de todos los expedientes de los acusados autores del delito de homicidio peritados por el Departamento de Peritación Mental del Instituto de Medicina Legal durante el período 2011- 2013. Conclusiones: Existen características psicopatológicas de los homicidas que los clasifican como personalidades patológicas de tipo antisocial y orgánica, al igual que consumidores perjudiciales de alcohol, lo cual justifica el patrón de violencia instrumental, las incitaciones interpersonales unido a un patrón de violencia reactiva, y a comportamientos no planificados, que salen de su control, por las dificultades que presentan para contener sus impulsos. En pocos casos son portadores de verdaderas enfermedades psiquiátricas(AU)

Introduction: The crime of homicide is one of the most serious and harmful to any society. It is the most extreme form of expression and resolution of social conflicts between people and groups. In the history of the human beings, the existence of mental disorders in the protagonists of social violence, especially murdering, has been a constant reality, in some cases magnified, although certain entities, such as the antisocial personality disorder, have been shown to have a statistical significance in those homicides that are more attached to patterns of instrumental or predatory violence. Objective: To characterize psycho-pathologically the authors of homicides that occurred in Havana and were reported in the period 2011-2013. Methods: A descriptive, cross-sectional and retrospective study was conducted with all the files of the perpetrators prosecuted for the crime of homicide reported by the Department of Mental Perception of the Institute of Legal Medicine during the period 2011-2013. Conclusions: There are psycho-pathological characteristics of homicides that classify them as with pathological personalities of antisocial and organic type, as well as harmful consumers of alcohol, which justifies the pattern of instrumental violence, interpersonal incitements together with a pattern of reactive violence, and behaviors unplanned, out of control, by the difficulties they present to restrain their impulses. In a few cases, they are carriers of true psychiatric illnesses(AU)

El envejecimiento, la vejez y la calidad de vida: ¿éxito o dificultad? / Aging, Elderly and Quality of Life: Success or Difficulty?

En el presente siglo se vive, lo que muchos han llamado como, "momento único", porque por primera vez en la historia de la humanidad conviven varias generaciones. Esa dinámica demográfica en el mundo y en Cuba en lo particular, es un logro y a la vez un desafío. Reconocer que este fenómeno involucra a la salud, y a otros sectores de la sociedad, y que además necesita de recursos incluyentes y creativos en las políticas públicas, para que esa prolongación de la vida sea de calidad, es indispensable para la sostenibilidad. Las nuevas concepciones en el campo gerontológico nos conducen a la necesidad de integrarnos de forma multidisciplinar y multisectorial, no solo para enfrentar este fenómeno del envejecimiento poblacional desde el punto de vista social, sino también, en el orden individual, para aprender a envejecer con calidad. El objetivo del trabajo es exponer algunos de los retos que implica enfrentar el envejecimiento poblacional, para que los adultos mayores puedan envejecer con mayor calidad de vida.

In this century, life is something that many have called a "unique moment" because for the first time in history various generations coexist. This demographic dynamics in the world and in Cuba in particular, is an achievement and at the same time a challenge. Identifying that this phenomena involves the health area and other sectors of the society and in addition it requires inclusive and creative resources in public policies so this is life extension with quality, is indispensable for sustainability. The new conceptions in gerontologic field lead us to a need of multidiscipline and multisectorial integration, not only to face the population aging from the social point of view but also, from the individual perspective, to learn aging with quality. The objective of this work is present some of the challenges it implies to facing the population aging so that older adults may age with a higher quality if life.

Trastornos mentales y homicidio / Mental disorders and homicide

Introducción: El delito de homicidio es uno de los más graves y perjudiciales a la sociedad; es la forma más extrema de expresión y resolución de los conflictos sociales entre las personas y los colectivos. En la historia del ser humano, la existencia de trastornos mentales en los protagonistas de la violencia social, en especial del homicidio, ha sido una realidad constante, en algunos casos magnificada, aunque determinadas entidades, como el Trastorno de la Personalidad Antisocial, han demostrado tener una significación estadística en aquellos homicidios que se apegan más a patrones de violencia instrumental o predatoria. Objetivo: Caracterizar psicopatológicamente a los autores de homicidios acaecidos en La Habana que fueron peritados en el período 2011- 2013. Métodos: Se realizó un estudio descriptivo, transversal y retrospectivo de todos los expedientes de los acusados autores del delito de homicidio peritados por el Departamento de Peritación Mental del Instituto de Medicina Legal durante el período 2011- 2013. Conclusiones: Existen características psicopatológicas de los homicidas que los clasifican como personalidades patológicas de tipo antisocial y orgánica, al igual que consumidores perjudiciales de alcohol, lo cual justifica el patrón de violencia instrumental, las incitaciones interpersonales unido a un patrón de violencia reactiva, y a comportamientos no planificados, que salen de su control, por las dificultades que presentan para contener sus impulsos. En pocos casos son portadores de verdaderas enfermedades psiquiátricas(AU)

Introduction: The crime of homicide is one of the most serious and harmful to any society. It is the most extreme form of expression and resolution of social conflicts between people and groups. In the history of the human beings, the existence of mental disorders in the protagonists of social violence, especially murdering, has been a constant reality, in some cases magnified, although certain entities, such as the antisocial personality disorder, have been shown to have a statistical significance in those homicides that are more attached to patterns of instrumental or predatory violence. Objective: To characterize psycho-pathologically the authors of homicides that occurred in Havana and were reported in the period 2011-2013. Methods: A descriptive, cross-sectional and retrospective study was conducted with all the files of the perpetrators prosecuted for the crime of homicide reported by the Department of Mental Perception of the Institute of Legal Medicine during the period 2011-2013. Conclusions: There are psycho-pathological characteristics of homicides that classify them as with pathological personalities of antisocial and organic type, as well as harmful consumers of alcohol, which justifies the pattern of instrumental violence, interpersonal incitements together with a pattern of reactive violence, and behaviors unplanned, out of control, by the difficulties they present to restrain their impulses. In a few cases, they are carriers of true psychiatric illnesses(AU)

Códigos éticos y deontológicos en Psiquiatría / Ethical and professional codes in Psychiatry

Se realiza una revisión bibliográfica con el objetivo de analizar los diferentes códigos éticos y deontológicos internacionales, regionales y nacionales de los que se nutre la especialidad de psiquiatría. Se concluye que el comportamiento ético se basa en el sentido de la responsabilidad individual de cada psiquiatra hacia cada paciente y en la capacidad de ambos para determinar cuál es la conducta correcta y más apropiada. Las normas externas y las directrices, tales como los códigos de conducta profesional, las aportaciones de la ética y de las normas legales, no garantizan por sí solas la práctica ética de la medicina, pero constituyen un importante marco referencial(AU)

A literature review was performed with the objective of analyzing the various international, regional and national ethical and deontological codes that the psychiatry specialty feeds on. It is concluded that ethical behavior is based on the sense of individual responsibility of each psychiatrist to each patient and the ability of both to determine what the correct and appropriate behavior is. External standards and guidelines, such as professional codes of conduct, the study of ethics and legal standards alone do not guarantee the ethical practice of medicine but are an important framework(AU)

Códigos éticos y deontológicos en Psiquiatría / Ethical and Professional Codes in Psychiatry

Se realiza una revisión bibliográfica con el objetivo de analizar los diferentes códigos éticos y deontológicos internacionales, regionales y nacionales de los que se nutre la especialidad de psiquiatría. Se concluye que el comportamiento ético se basa en el sentido de la responsabilidad individual de cada psiquiatra hacia cada paciente y en la capacidad de ambos para determinar cuál es la conducta correcta y más apropiada. Las normas externas y las directrices, tales como los códigos de conducta profesional, las aportaciones de la ética y de las normas legales, no garantizan por sí solas la práctica ética de la medicina, pero constituyen un importante marco referencial.

A literature review was performed with the objective of analyzing the various international, regional and national ethical and deontological codes that the psychiatry specialty feeds on. It is concluded that ethical behavior is based on the sense of individual responsibility of each psychiatrist to each patient and the ability of both to determine what the correct and appropriate behavior is. External standards and guidelines, such as professional codes of conduct, the study of ethics and legal standards alone do not guarantee the ethical practice of medicine but are an important framework.

Epidemiología de la candidemia en el Hospital México / Candidemia and it's Epidemiology at Hospital México

Justificación y objetivos:las infecciones invasivas por Candida son frecuentes y de alta mortalidad en la práctica clínica. Existe poca información publicada al respecto en el país. Estudio retrospectivo y observacional que pretende aportar conocimiento novedoso sobre la epidemiología local de la candidemia.Métodos:se incluyó 136 pacientes mayores de 17 años en su primer episodio de candidemia, internados en el Hospital México, entre 2007 y 2010. Se realizó un análisis descriptivo y temporal, se evaluaron los factores asociados con C. parapsilosis y con la sobrevida a 30 días.Resultados:se detectó en promedio 34 episodios por año (rango 27 a 51), la incidencia acumulada fue de 1,1 casos/1000 admisiones. Las especies de Candida no albicans constituyeron el 62% de las levaduras aisladas. Exceptuando 2009, C. parapsilosis fue la especie predominante en 3 de 4 años estudiados (41%), seguida por C. albicans (38%). Se demostró una fuerte asociación entre la candidemia por C. parapsilosis, la presencia de catéter venoso central (OR=19,6, IC95%: 2,6 a 403,8, p<0,001) y el uso de nutrición parenteral (p=0,014). La mortalidad a 30 días fue del 46%. C. albicans mostró la mortalidad más alta y C. parapsilosis, la más baja. Los pacientes que no recibieron tratamiento antifúngico presentaron una probabilidad significativamente mayor de morir.Conclusiones:la elevada incidencia de candidemia por C. parapsilosisestá directamente relacionada con los catéteres venosos centrales y el uso de nutrición parenteral; su marcada reducción en la frecuencia durante 2009, merece ser investigada para dilucidar los factores que provocaron este cambio.

Background:Invasive Candida infections are frequent and exhibit high mortality in clinical practice. There are few published data in our country. This retrospective observational study intends to provide new knowledge about the local epidemiology of candidemia.Methods:136 patients older than 17 years were included when they had their first episode of candidemia during hospitalization at the Hospital Mexico, in the time period between 2007 and 2010. Descriptive and temporal analysis was performed and the risk factors associated with C. parapsilosis and survival were evaluated.Results:An average of 34 episodes of candidemia were recorded per year (range 27-51) and the cumulative incidence was 1.1 cases/1,000 admissions. The non-albicans Candida species accounted for 62% of the isolated yeasts, C. parapsilosis (41%) was the predominant yeast isolated in 3 out of the 4 years analized, except for 2009, followed by C. albicans (38%). Strong association between C. parapsilosis bloodstream infection, the presence of a central venous catheter (2.6 to 403.8, p <0.001 OR = 19.6, 95% CI) and use of parenteral nutrition (p=0.014) was established. The 30-day mortality was 46%, with C. albicans displaying the highest and C. parapsilosis the lowest. Patients who did not receive antifungal treatment had significantly higher mortality.Conclusions:the unusually high incidence of candidemia due to C. parapsilosis is directly related to the use of central venous catheters and parenteral nutrition; the marked reduction observed in 2009 needs further investigation to find out the causes of this change.