Risk factors for severe disease in pediatric respiratory syncytial virus infections.

OBJECTIVES: To assess factors associated with the risk of severe disease in children aged 5 years or younger with laboratory-confirmed respiratory syncytial virus (RSV) infection. STUDY DESIGN: We conducted a nationwide retrospective cohort study in Mexico. METHODS: Eligible participants included children aged 5 years or younger with laboratory-confirmed RSV infection January 1, 2023, and May 15, 2024. We collected relevant clinical and epidemiological data. Risk ratios (RR) and 95% confidence intervals (CI) were employed to identify factors associated with the risk of severe disease, characterized by clinical and radiographic evidence of bronchiolitis or pneumonia requiring hospital admission. RESULTS: Data from 2022 children were analyzed and the overall risk of severe disease was 21.0% (n = 424/2022). In multiple generalized linear regression analysis, a personal history of immunosuppression (due to any cause) showed a protective effect (RR = 0.14, 95% CI 0.05-0.42, P = 0.001) against severe RSV disease, while an increased risk was documented for each additional day elapsed between the date of symptom onset and the date of seeking healthcare RR = 1.06, 95% CI 1.02-1.10, P = 0.004). CONCLUSION: These findings provide insights into risk stratification and suggest specific directions for future research. This information informs the development of targeted intervention strategies to mitigate the impact of RSV infections in this vulnerable population.

La historia olvidada del alzhéimer: recordando a Oskar Fischer

Introducción: La Enfermedad de Alzheimer (EA), es una patología neurodegenerativa progresiva que afecta la memoria y otras funciones cognitivas. Hasta ahora no existen tratamientos curativos ni modificadores de la enfermedad, por lo que el manejo está centrado en la prevención y en el tratamiento de factores que puedan contribuir a su evolución; las herramientas farmacológicas son escasas y tienen efectos modestos en la ralentización de la enfermedad. Se propone realizar una breve biografía de Oskar Fischer, describir el conflicto con Alois Alzheimer que se identifica en documentos científicos y mencionar los principales elementos de la teoría de Oskar Fischer. Método: Se realizó una revisión narrativa en las bases de datos Scielo, PubMed y Lilacs, con los términos "Oskar Fischer" y se encontró quince artículos publicados entre 1906 a 2023, los cuales fueron resumidos por los autores GS y NR. El artículo fue posteriormente revisado por los demás autores. Resultados: Se organizaron en secciones, partiendo con una breve biografía del autor, su interacción con Alois Alzheimer y un resumen de su teoría; lo descrito por Oskar Fischer en términos de las estructuras de placas y ovillos se considera como una de las principales teorías fisiopatológicas de la EA. Conclusiones: Oskar Fisher hizo un aporte invaluable y planteó conceptos clásicos con respecto a la EA, que, si bien no le valieron para ser reconocido en la posteridad, han permitido que en las investigaciones posteriores sea de gran importancia repensar estos conceptos e incluir otras posibilidades e hipótesis, para continuar en la profundización del conocimiento de la enfermedad.

Introduction: Alzheimer's disease (AD) is a progressive neurodegenerative pathology that affects memory and other cognitive functions. Until now, there are no curative or disease-modifying treatments, so management is focused on prevention and treatment of factors that may contribute to its evolution; pharmacological tools are scarce and have modest effects in slowing the disease. It is proposed to make a brief biography of Oskar Fischer, describe the conflict with Alois Alzheimer that is identified in scientific documents and mention the main elements of Oskar Fischer's theory. Method: A narrative review was carried out in the Scielo, PubMed and Lilacs databases, with the terms "Oskar Fischer" and fifteen articles published between 1906 and 2023 were found, which were summarized by the authors GS and NR. The article was subsequently reviewed by the other authors. Results: They were organized in sections, starting with a brief biography of the author, his interaction with Alois Alzheimer and a summary of his theory; what was described by Oskar Fischer in terms of the structures of plaques and tangles is considered one of the main pathophysiological theories of AD. Conclusions: Oskar Fisher made an invaluable contribution and raised classic concepts regarding AD, which, although they did not earn him recognition in posterity, have allowed subsequent research to be of great importance to rethink these concepts and include other possibilities and hypotheses, to continue deepening the knowledge of the disease.

Entre la incertidumbre de la liberación y otras formas de uso de la fauna silvestre / Between the uncertainty of release and other forms of wildlife use

RESUMEN Con el proyecto que fundamenta este artículo se desarrolló un análisis detallado del destino final de animales silvestres por parte la autoridad ambiental, con enfoque en los procesos de liberación en los departamentos amazónicos del Amazonas, Caquetá y Putumayo, entre 2019 y 2021, para proponer alternativas efectivas de abordaje y manejo de la situación. Los datos fueron directamente requeridos a la Corporación para el Desarrollo Sostenible del Sur de la Amazonía (Corpoamazonía), y a partir de estos se desarrolló manejo estadístico para posteriormente interpretar los resultados obtenidos a la luz de la literatura académica publicada sobre el tema y la normatividad vigente relacionada. Como producto de la investigación, se identifica que la principal proveniencia de especímenes se establece en la entrega voluntaria (65,59%), seguido del rescate o traslado (27,87%), y decomiso, incautación, aprehensión o medida preventiva (3,96%). Como su principal destino final se identificó la liberación (45,21%). Del total de liberaciones entre 2019 y 2021, solo en 50 (4,09% de los casos), se consignó algún tipo de indicación del lugar o la ubicación específica donde se llevó a cabo, sin mención del procedimiento de caracterización del hábitat o genética del espécimen, o seguimiento posliberación, por lo que resulta necesario potenciar otras formas de uso de la fauna silvestre que permitan reducir el margen de incertidumbre.

ABSTRACT Alongside the project that supports this article, we developed a detailed analysis of the final destination of wild animals by the environmental authority, with a focus on the release processes in the Amazonian departments of Amazonas, Caquetá, and Putumayo, between 2019 to 2021, in order to propose effective alternatives for approaching and managing the situation. The data was directly requested from the Corporation for the Sustainable Development of the South of the Amazon (Corpoamazonía), and they were handled with statistical management to interpret the results obtained according to the academic literature published on the subject and current related regulations. As a result of the investigation, the primary origin of the specimens was identified as voluntary surrender, in 65.59% of the cases; followed by rescue or transfer, in 27.87%; and confiscation, seizure, apprehension, or preventive measure in 3.96%. As their main final destination, release was identified in 45,21% of the cases. Of the total number of releases between 2019 and 2021, only 50 (4.09% of the cases) included some type of indication of the place or specific location where the release took place, with no mention of the habitat or genetic characterization procedure of the specimen, or postrelease follow-up, it is, therefore, necessary to promote other forms of wildlife use that reduce the margin of uncertainty.

Study of the oxidation process of bismuth nanoparticles using NaClO.

Bismuth nanoparticles (NPs) colloids synthesized in deionized water by laser ablation of solids in liquids technique (LASL) were oxidized using NaClO solutions at different concentrations. Oxidized nanomaterials were characterized using several techniques. The crystalline phases of the bismuth compound were determined using Raman microspectroscopy, and the crystallographic structure was identified by x-ray diffraction (XRD). The size and morphology of the obtained nanomaterials were studied by transmission electron microscopy (TEM). The chemical states were determined using x-ray photoelectron spectroscopy (XPS), and the optical properties of the colloids were characterized by UV-vis spectroscopy. The absorption spectra were analyzed using the Tauc method to determine the band gaps of the obtained nanomaterials. Our results showed morphological changes, starting from small nanoparticles to nanosheets and a mixture of nanosheets with hollow nanoparticles. Two kinds of nanomaterials were found depending on the NaClO solution concentration: Bi2O2CO3single phase and a mixture ofδ-Bi2O3and Bi2O2CO3. Some samples were tested as photocatalysts and showed good performance in the degradation of methylene blue in solution. To the best of our knowledge, this is the first study on the oxidation process of bismuth colloidal nanoparticles at room temperature.

[Femoral revision surgery with fully coated stems. Long-term results of 78 cases]. / Cirugía de revisión femoral con vástagos monobloque de recubrimiento completo. Resultados a largo plazo de 78 casos.

INTRODUCTION: Loss of bone stock and anatomical alteration of the proximal femur make femoral revision surgery a complex procedure in which the choice of implant will be critical. Our goal is to assess the clinical and radiological results of complete coating Monoblock stems. MATERIAL AND METHODS: Retrospective study of 78 consecutive cases of femoral review surgery intervened by our unit. RESULTS: The average follow-up was 122 months. The average score on the Harris Hip Score was 81.2 ± 11.4 points. An age of less than 65 years, a minor femoral defect according to Paprosky classification (I, II and IIIA), the existence of a single previous surgery and the non-occurrence of intra or postoperative complications, was associated with better clinical and functional outcomes (p < 0.05).Cumulative survival was 96.7% at age 10 if we consider as failure the removal of the stem by aseptic loosening and 92% if we consider withdrawal for any cause to fail. CONCLUSION: Despite the current tendency to use modularity in femoral review surgery and given the results presented, we consider that complete coating monoblock stems provide a firm and stable fixation. However, the worst results in patients with major defects have led to other options being considered.

INTRODUCCIÓN: La pérdida de stock óseo y la alteración anatómica del fémur proximal hacen de la cirugía de revisión femoral un procedimiento complejo en la que la elección del implante será fundamental. Nuestro objetivo es valorar los resultados clínicos y radiológicos de los vástagos monobloque de recubrimiento completo. MATERIAL Y MÉTODOS: Estudio retrospectivo de 78 casos consecutivos de cirugía de revisión femoral intervenidos por nuestra unidad. RESULTADOS: El seguimiento medio fue de 122 meses. La puntuación media en la escala de Harris Hip Score fue de 81.2 ± 11.4 puntos. Una edad menor de 65 años, un defecto femoral menor según la clasificación de Paprosky (I, II y IIIA), la existencia de una única cirugía previa y la no aparición de complicaciones intraoperatorias o postoperatorias se asoció con mejores resultados clínicos y funcionales (p < 0.05). La supervivencia acumulada fue de 96.7% a los 10 años si consideramos como fracaso la retirada del vástago por aflojamiento aséptico y de 92% si consideramos como fracaso la retirada por cualquier causa. CONCLUSIÓN: Pese a la tendencia actual al uso de la modularidad en cirugía de revisión femoral y dados los resultados presentados, consideramos que los vástagos monobloque de recubrimiento completo proporcionan una fijación firme y estable. Sin embargo, los peores resultados obtenidos en pacientes con defectos óseos mayores han provocado que se valore otro tipo de opciones.

Tratamiento de Oxigenación Hiperbárica en Heridas Complejas / Hyperbaric Oxygen Therapy for Complex Wounds

RESUMEN El tratamiento de oxigenación hiperbárica (TOHB) a presiones de tratamiento mayores a 2 ATA (respirando concentraciones cercanas al 100% O2) se encuentra ampliamente descripto para el tratamiento de heridas. Se presentan 6 casos de heridas no cicatrizantes tratadas con TOHB a 1,45 ATA como tratamiento coadyuvante. Estudios observacionales y ensayos clínicos aleatorizados son necesarios para confirmar la eficacia e instaurar esta modalidad de oxigenación hiperbárica en las diferentes heridas crónicas.

ABSTRACT Hyperbaric Oxygen Therapy (HBOT) at pressures above 2 ATA (breathing near 100% O2) is widely described for wounds treatment. We present 6 cases of non-healing wounds treated with HBOT at 1.45 ATA, treatment as coadjutant treatment. Observational studies and randomized clinical trials are necessary to confirm the efficacy and establish this hyperbaric oxygenation modality in chronic wounds treatment.

Detección de anticuerpos anti-Mycobacterium avium subsp. paratuberculosis (MAP) en venados silvestres en Colombia / Detection of anti-Mycobacterium aviumsubsp. paratuberculosis antibodies in wild deer in Colombia

RESUMEN Objetivo. Determinar la presencia de anticuerpos anti-Mycobacterium avium subsp. paratuberculosis (MAP) en venados de cola blanca (Odocoileus virginianus) y venados de páramo (Mazama rufína), capturados en las regiones de la Orinoquía y el Caribe en Colombia. Materiales y métodos. Un total de 44 muestras de suero sanguíneo de venados de las especies M. rufína y O. virginianus fueron colectadas en condiciones de campo entre 2014 y 2016. Se utilizó un kit comercial de ELISA para la detección de anticuerpos anti-MAP. Un animal se consideró positivo a ELISA cuando la relación muestra-positivo (S/P%) fue > 0.4, según lo recomendado por el fabricante. Resultados. El 50% (22/44) de los animales muestreados resultaron positivos, lo que corresponde a 10 hembras y 12 machos. Un 81.8% (18/22) y un 77.3% (17/22) de estos animales seropositivos fueron capturados en la región de la Orinoquía y fueron reportados como adultos, respectivamente. Conclusiones. No se sabe cómo o cuándo se introdujo MAP en la población de ciervos colombianos en las regiones de estudio. La hipótesis más plausible para explicar la presencia de anticuerpos anti-MAP en estas poblaciones silvestres es la transmisión por contacto con el ganado bovino infectado, ya que en ambas regiones estas especies comparten pasturas. Este es el primer estudio en explorar la infección por MAP en animales silvestres en Colombia. Estos hallazgos respaldan la necesidad de realizar más estudios utilizando técnicas de diagnóstico directo, y aproximaciones investigativas que permitan la definición de vínculos en la dinámica de la infección entre mamíferos silvestres y domésticos en Colombia.

ABSTRACT Objective. To determine the presence of anti-Mycobacterium avium subsp. paratuberculosis (MAP) antibodies in white-tailed deer (Odocoileus virginianus) and red brocket deer (Mazama rufína), captured in the Orinoquía and Caribbean regions in Colombia. Materials and methods. A total of 44 blood serum samples from deer of species M. rufina and O. virginianus were collected under field conditions between 2014 and 2016. An ELISA commercial kit was used to detect anti-MAP antibodies. An animal was considered ELISA-positive at a sample-to-positive ratio (S/P%) of > 0.4, as recommended by the manufacturer. Results. The 50% (22/44) of the animals were positive, corresponding to 10 females and 12 males. An 81.8% (18/22) and 77.3% (17/22) of these seropositive animals were captured in the Orinoquía region and were reported as adults, respectively. Conclusions. It is not known how or when MAP was introduced in the Colombian deer population in the study regions. The most plausible hypothesis to explain the presence of antibodies against MAP in these wild populations is transmission by contact with infected bovine cattle since, in both regions, these species share pastures. This is the first study to explore MAP infection in wild animals in Colombia. These findings support the need for further studies using different direct diagnostic techniques and research approaches that allow the definition of links in the infection dynamics between wild and domestic mammals in Colombia.

Morbidity Trends and Risk of Tuberculosis: Mexico 2007-2017.

Background: To know the current status of the epidemiological and geographic distribution of tuberculosis and its complication meningeal tuberculosis in Mexico, this work analyzes national surveillance data (ten years) issued by the General Directorate of Epidemiology (GDE). Methods: An observational and retrospective analysis of monthly and annual reports of pulmonary and meningeal tuberculosis cases from January 2007 to December 2017 was performed on the annual reports issued by the GDE in Mexico. The number of cases and incidence were classified by year, state, age group, gender, and seasons. Results: A national case distribution map of pulmonary and meningeal tuberculosis incidence was generated. During this period, a total of 184,003 and 3,388 cases were reported with a median of 16,727.5 and 308 cases per year for pulmonary and meningeal tuberculosis diseases, respectively. The number of cases and incidence of pulmonary and meningeal tuberculosis per year showed that male gender presented a continuous increase in both parameters. The geographic analysis of the distribution of cases of tuberculosis showed that states like Guerrero, Tabasco, and Veracruz presented higher means of tuberculosis cases during this period. Northern states had the highest number of cases in the country compared to other states. In Mexico, pulmonary tuberculosis and meningeal tuberculosis are seasonal. Interestingly, cases of meningeal tuberculosis show an increase during October and November (autumn). Conclusions: In Mexico, during the years 2007-2017, there has been an increase in the proportion of male TB patients. It remains necessary to implement strategies to detect TB in the adult population, especially among men, because tuberculosis could be difficult to recognize in an early stage in the population, and the appearance of resistant strains can cause an increase in the incidence of the disease.

Differential detoxifying responses to crude oil water-accommodated fraction in Hyallela curvispina individuals from unpolluted and contaminated sites.

Sublethal effects of water-accommodated fraction (WAF) from crude oil of Neuquén basin, Northern Patagonia-Argentina, were examined on both antioxidant and detoxification system of Hyalella curvispina adults collected in Los Barreales (LB) lake and in an oil-polluted stream (DS). The effects of WAF exposure during 6, 24 and 48 h were evaluated in the glutathione content (GSH) and glutathione S-transferase (GST), catalase (CAT) and cytochrome P450 (CYP450) activities. Populations from DS and LB showed not only different basal GSH content and enzyme activities but also different behavior to WAF exposure. LB population exposed to WAF showed a significant increase in GSH content, CAT and CYP450 activities, compared to control group. DS population presented high basal levels in CAT and CYP activity compared with LB population, but their response to WAF exposure was minor. Amphipods from DS, chronically exposed to hydrocarbons, were adapted to their environment.

Population structure of Pseudomonas aeruginosa through a MLST approach and antibiotic resistance profiling of a Mexican clinical collection.

Pseudomonas aeruginosa is one of the most important pathogens worldwide. Population genetics studies have shown that the P. aeruginosa population has an epidemic structure with highly conserved clonal complexes. Nonetheless, epidemiological studies of P. aeruginosa have been historically absent or infrequent in developing countries, in which different medical treatments, conditions and infrastructure may have an impact in population dynamics and evolutionary outcomes, including antibiotic resistance profiles. In this study we contribute to fill this gap by analyzing 158 P. aeruginosa isolates from the most extensive nosocomial collection in Mexico City. We investigated the population genetic structure through a MLST approach together with a classical microbiology antibiotic resistance profiling, one of the associated concerns in the evolution of this pathogen. On the one hand, our results are in accordance with previous studies on the epidemic structure of P. aeruginosa, as well as the existence of three main phylogroups, that are not related to environmental parameters. On the other hand, antibiotic resistance profiles indicate higher prevalence in our sample of multi drug resistant (75.15%), extremely drug resistant (17.72%) and pan-drug resistant (9.49%) than resistance reported in developed countries. It is important to reflect on the causes that make less developed countries hotspots of antibiotic resistance, considering the multifactorial aspects of the socio-political context of such countries that include, but are not restricted to, public policy implementation and enforcement regarding access to antibiotics, as well as health care personnel education and other obstacles related to poverty and unequal access to health services and information.

Los predictores en el retiro de la ventilación mecánica ¿resultan suficientes para el paciente neurocrítico? / Predictors in the retirement of mechanical ventilation: are they enough to neurocritical patient?

Resumen La ventilación mecánica prolongada incrementa el riesgo de complicaciones; asimismo, el retiro temprano de la misma expone al paciente a los riesgos que tenía antes de iniciarla. Cuando hablamos de ventilación mecánica prolongada y retiro temprano, el equilibrio sigue siendo controvertido, además de ser un tema no resuelto, más aun al referirnos al paciente neurológico. La protección de la vía aérea y evitar mayor afectación de la distensibilidad cerebral son los propósitos de la ventilación mecánica invasiva en el paciente con deterioro neurológico, además de acoplar al paciente con el ventilador, en particular ante patrones respiratorios anormales. De los pacientes que requieren ventilación mecánica en la unidad de cuidados intensivos, alrededor de 20% corresponde a padecimientos neurológicos. El momento apropiado para la extubación puede estar basado en una decisión clínica, que puede considerarse subjetiva; por esta razón, se han propuesto parámetros objetivos para tomar esta decisión, éstos permitirán identificar a los pacientes aptos para realizar prueba de ventilación espontánea con gran posibilidad de éxito. La búsqueda de un parámetro que evalúe el éxito o fracaso de la extubación en el paciente neurológico es un problema no resuelto hasta el momento, por lo que deberá ser tema de más estudios; hasta el día de hoy la Escala de Coma de Glasgow (EC) es la variable asociada con buenos o malos resultados.

Abstract Long mechanical ventilation (MV) increases the risk of complications; moreover, early retirement of it exposes the patient to the risks presented before starting. The balance in speaking of prolonged mechanical ventilation and early retirement remains controversial, besides being an unresolved issue, even more so when speaking of neurological patients. Protection of the airway and prevention of further compromised brain compliance are the purposes of initiating invasive mechanical ventilation in patients with neurological impairment in addition to engaging the patient with particular fan under the presence of abnormal breathing patterns. Of patients requiring mechanical ventilation in the Intensive Care Unit (ICU), about 20% are due to neurological diseases. The appropriate time for extubation may be based on a clinical decision, which may be considered subjective, for this reason objective parameters have been proposed to make such a decision, they will identify candidates to perform test of spontaneous ventilation with great chance of success. The search for a parameter to evaluate the success or failure of extubation in neurological patient is a problem not solved so far, so it should be the subject of further studies, until today the Glasgow Coma Scale (SCG) is the variable associated with good or bad results.

Prevalence of bacterial contamination in platelet concentrates at the National Center of Blood Transfusion (Mexico).

OBJECTIVES: Most common bacterial sepsis associated with transfusion is caused by contaminated Platelet Concentrates (PC). The screening of PC to detect bacterial contamination is obligatory in Mexico, and it is carried out in quality control programs. In Mexico, the identification and molecular characterization of bacterial contaminants to detect contamination sources have not been implemented due to high costs; however, it is an actual current need. MATERIAL AND METHODS: One hundred PC were randomly selected and microbiologically analyzed. This sample size corresponds to 1% of the PC obtained by the National Center of Blood Transfusion (NCBT) in Mexico City according to the Official Mexican Standard NOM-253-SSA1-2012. Additionally, molecular biology tests were implemented in order to identify the possible contamination sources. RESULTS: Nine of the 100 PC analyzed (9%) showed bacterial contamination; analysis of the nucleotide sequences revealed the presence of characteristic microbiota from donor skin and soil. Diverse clonal relationship between the strains was identified in Staphylococcus epidermidis. CONCLUSION: Detection of contaminants associated with environmental and skin flora, shows the need to implement measures in the process of disinfecting skin at the site of phlebotomy and cleaning each of the areas involved in blood collection.

[Bilateral amputation in diabetic patient with blindness, the use of inadequate prosthesis. Case report]. / Amputación bilateral en paciente diabética con ceguera, el uso de prótesis inadecuadas. Reporte de caso.

The most frequent diabetes-related complications are diabetic foot and glaucoma, which lead to amputation and loss of vision, respectively. Current scientific and technologic developments have permitted the design and implementation of prosthetic systems that are optimal for these patients, as the latter adapt themselves to them and can resume activities of daily living. The lack of economic resources compromises the quality of the prostheses patients can afford, as they resort to «artisanal¼ or «rustic¼ systems that hamper their adaptation process. We present herein the case of a 47 year-old female patient, housewife, with bilateral paresthesias and phantom limb sensation associated with amputation neuromas resulting from type II diabetes mellitus that had affected the patient for eight years. This patient of a low socioeconomic stratum underwent a post-amputation assessment and was diagnosed as being heavily dependent when performing activities of daily living and required assisted wheelchair for ambulation. This is a frequent variant resulting from bilateral loss of lower limbs together with complete loss of vision. We describe the rehabilitation therapy during the pre- and post-prosthetic stages, together with the results of the assessments to show the effectiveness of the treatment process, without forgetting the participation of the caregiver as a fundamental co-therapeutic element in this process.

Las complicaciones más frecuentes asociadas con la diabetes incluyen al pie diabético y al glaucoma, que suelen llevar a la amputación y a la pérdida de la visión, respectivamente. El desarrollo científico y tecnológico actual ha permitido el diseño e implementación de sistemas protésicos óptimos para estos pacientes, asegurando una reincorporación a las actividades de la vida diaria, así como una correcta adaptación al uso de las mismas. La falta de recursos económicos compromete la adquisición de las prótesis ideales, recurriendo al uso de sistemas «artesanales¼ o «rústicos¼ que afectan la adaptación. Se presenta el caso de un paciente femenino de 47 años de edad, ama de casa, quien presenta parestesias bilaterales y sensación de miembro fantasma asociado a neuromas de amputación por diabetes mellitus tipo II de ocho años de evolución. La paciente, con bajos recursos económicos, es evaluada postamputación con diagnóstico de dependencia grave en la ejecución de las actividades de la vida diaria, con desplazamiento en silla de ruedas asistido; esta presentación es una variante frecuente como consecuencia de la pérdida bilateral de miembros inferiores, concomitante a la ausencia total de la visión. Se presenta el tratamiento de rehabilitación en etapa preprotésica y protésica, acompañados por los resultados de las evaluaciones para mostrar la efectividad del proceso terapéutico, sin olvidar la participación del cuidador como ente coterapéutico fundamental en el proceso.

Evidencias en indicaciones de la progesterona / Evidence in progesterone prescription

Resumen ANTECEDENTES: la progesterona es una hormona esteroide con participación en la ovulación, implantación, embarazo y regulación de la función uterina durante el ciclo menstrual y de otros órganos, como la glándula mamaria. Por su mecanismo de acción, la progesterona está indicada en distintos padecimientos ginecológicos y obstétricos: síndrome premenstrual, amenaza de aborto, parto pretérmino, hemorragia uterina disfuncional y mastalgia relacionada con el ciclo menstrual. OBJETIVO: evaluar la seguridad y eficacia de la progesterona en pacientes con: síndrome premenstrual, amenaza de aborto y de parto pretérmino, hemorragia uterina disfuncional, mastalgia y terapia hormonal en la menopausia. METODOLOGÍA: revisión sistemática de la evidencia científica acerca de las distintas indicaciones de la progesterona. RESULTADOS: se encontraron 92 artículos de los que se seleccionaron 41 para revisión. CONCLUSIONES: la evidencia clínica evaluada acerca de las indicaciones de la progesterona demuestra ventajas en eficacia y seguridad en los diferentes esquemas.

Abstract BACKGROUND: Progesterone is a steroid hormone involved in ovulation, implantation, pregnancy and regulation of uterine function during the menstrual cycle and other organs such as the mammary gland. Because of its mechanism of action, progesterone is indicated in different gynecological and obstetric conditions: premenstrual syndrome, threatened abortion, preterm birth, dysfunctional uterine bleeding and mastalgia related to the menstrual cycle. OBJECTIVE: To evaluate the safety and efficacy of progesterone in patients with: premenstrual syndrome, threatened abortion, preterm birth, dysfunctional uterine bleeding, mastalgia and hormone therapy in menopause. MATERIAL AND METHODS: Systematic review of scientific evidence about different indications of progesterone. RESULTS: We found 92 articles from wich 41 were selected for review. CONCLUSIONS: The clinical evidence evaluated on different indications of progesterone demonstrates advantages in efficacy and safety in different regimens.

Anti-inflammatory effect of dialysable leucocyte extract in a rat model of osteoarthritis: histopathological and molecular characterization.

OBJECTIVES: To evaluate the effect of dialysable leucocyte extract (DLE) on pro- and anti-inflammatory profiles in a rat model of osteoarthritis (OA). METHOD: Forty-eight male Wistar rats were divided into three groups: normal rats without treatment, OA rats treated with placebo, and OA rats treated with DLE. After treatment, the animals were killed to obtain cartilage for histological analysis and to determine the expression of pro- and anti-inflammatory cytokines by reverse transcription multiplex polymerase chain reaction (RT-MPCR) and immunohistofluorescence analyses. RESULTS: Histological analysis revealed that OA cartilage from rats treated with DLE displayed similar characteristics to non-OA cartilage from the control group. The OA cartilage treated with placebo showed alterations in the cellular architecture and in chondrocyte cluster formation. Analysis of cytokine expression by RT-MPCR showed that OA cartilage from DLE-treated rats expressed platelet-derived growth factor (PDGF), interferon (IFN)-γ, and fibroblast growth factor (FGF)-2, similar to non-OA cartilage from the control group. However, OA cartilage from rats treated with placebo expressed interleukin (IL)-1, PDGF, and I kappa B (IκB). Confocal immunodetection of FGF-2, PDGF, and non-phosphorylated IκB showed that they were distributed in the cytoplasm of most chondrocytes in OA cartilage from DLE-treated rats whereas no nuclear factor kappa B (NF-κB) expression was observed in the nuclei. Instead, in OA cartilage from the placebo group, only weak FGF-2 staining was observed, PDGF and IκB were not detected, and NF-κB was strongly observed in both cytoplasm and nuclei. CONCLUSIONS: Our findings suggest that DLE treatment modifies the OA process, promoting the expression of anti-inflammatory cytokines and diminishing the inflammatory effects, avoiding the nuclear translocation of NF-κB in chondrocytes.

Caryospora neofalconis and other enteroparasites in raptors from Mexico.

A coprological survey of enteroparasites in raptors (60 Falconiformes) from Central Mexico is reported. Three samples contained coccidian unsporulated oocysts, one contained Eimeria sp., one contained trematode eggs and one contained capillarid and trematode eggs and Eimeria sp. After sporulation at the laboratory, oocysts from a Falco peregrinus were identified as Caryospora neofalconis. The phylogenetic analysis of the C. neofalconis (GenBank accession number KT037081) showed a close relationship to the Australian strain RY 2014 isolate 16710 (GenBank accession number KJ634019) of Caryospora daceloe, with 99.2% similarity. As far as we are aware, this is the first report of C. neofalconis in raptors from Mexico and the Americas.

Reemplazo femoral total, reporte de tres casos con revisión de la literatura / Total femoral replacement. Three case reports and literature review

Introducción: En la actualidad, la cirugía de recambio articular de cadera y rodilla es un procedimiento común en centros ortopédicos. Sin embargo, sabemos que este tipo de cirugía tiene vigencia y requiere procedimientos de revisión. Estos últimos generalmente conllevan complicaciones importantes como la pérdida de hueso que puede llegar a comprometer la estabilidad de los implantes. Métodos: Se realizaron tres revisiones de artroplastía tanto de cadera como de rodilla que han requerido el reemplazo total del fémur y de las articulaciones involucradas en el período comprendido del 2006 al 2011. El objetivo del presente trabajo es presentar la experiencia con estos implantes en cirugía de revisión de artroplastía. Resultados: El protocolo de manejo del postoperatorio fue estandarizado para todos y cada uno de los pacientes, requirieron manejo mediante desbridamientos y antibioticoterapia específica. Evidenciaron mejora significativa en el puntaje de la escala visual análoga del dolor (8-2.3 puntos p < 0.05) y funcional con la escala de valoración de WOMAC (21.6 preoperatorio a 55 puntos p < 0.05). Conclusiones: El reemplazo femoral total es un procedimiento quirúrgico de salvamento poco frecuente, demandante y complejo, que representa una alternativa ante la desarticulación de la extremidad pélvica en la etapa final de la enfermedad protésica. Se trata de una opción factible de realizar para mejorar la funcionalidad del paciente y disminuir la discapacidad residual para la realización de actividades de manera independiente.

Introduction: Currently hip and knee joint replacement were performed frequently at orthopedic centers. However, these surgeries do not last forever and thus revision procedures are required. The latter usually involve complications like bone loss that may compromise implant stability. Methods: Three hip and knee arthroplasty revisions were performed from 2006 to 2011, which warranted the total replacement of the femur and the joints involved. The purpose of this paper is to describe our experience with these implants used in arthroplasty revision surgery. Results: A standardized postoperative management protocol was used in all patients. They required debridement and specific antibiotic therapy. They had a significant improvement in the pain visual analog scale (VAS) (the score went from 8 to 2.3, p < 0.05) and in function, measured with the WOMAC score (from a preoperative score of 21.6 to 55, p < 0.05). Conclusions: Total femoral replacement is an infrequent, demanding and complex salvage surgery that represents an alternative to the disarticulation of the pelvic limb at the end stage of prosthetic disease. This is a feasible option used to improve patient functionality and decrease residual capacity for performing activities independently.

[Total femoral replacement. Three case reports and literature review]. / Reemplazo femoral total, reporte de tres casos con revisión de la literatura.

INTRODUCTION: Currently hip and knee joint replacement were performed frequently at orthopedic centers. However, these surgeries do not last forever and thus revision procedures are required. The latter usually involve complications like bone loss that may compromise implant stability. METHODS: Three hip and knee arthroplasty revisions were performed from 2006 to 2011, which warranted the total replacement of the femur and the joints involved. The purpose of this paper is to describe our experience with these implants used in arthroplasty revision surgery. RESULTS: A standardized postoperative management protocol was used in all patients. They required debridement and specific antibiotic therapy. They had a significant improvement in the pain visual analog scale (VAS) (the score went from 8 to 2.3, p < 0.05) and in function, measured with the WOMAC score (from a preoperative score of 21.6 to 55, p < 0.05). CONCLUSIONS: Total femoral replacement is an infrequent, demanding and complex salvage surgery that represents an alternative to the disarticulation of the pelvic limb at the end stage of prosthetic disease. This is a feasible option used to improve patient functionality and decrease residual capacity for performing activities independently.

INTRODUCCIÓN: En la actualidad, la cirugía de recambio articular de cadera y rodilla es un procedimiento común en centros ortopédicos. Sin embargo, sabemos que este tipo de cirugía tiene vigencia y requiere procedimientos de revisión. Estos últimos generalmente conllevan complicaciones importantes como la pérdida de hueso que puede llegar a comprometer la estabilidad de los implantes. MÉTODOS: Se realizaron tres revisiones de artroplastía tanto de cadera como de rodilla que han requerido el reemplazo total del fémur y de las articulaciones involucradas en el período comprendido del 2006 al 2011. El objetivo del presente trabajo es presentar la experiencia con estos implantes en cirugía de revisión de artroplastía. RESULTADOS: El protocolo de manejo del postoperatorio fue estandarizado para todos y cada uno de los pacientes, requirieron manejo mediante desbridamientos y antibioticoterapia específica. Evidenciaron mejora significativa en el puntaje de la escala visual análoga del dolor (8-2.3 puntos p < 0.05) y funcional con la escala de valoración de WOMAC (21.6 preoperatorio a 55 puntos p < 0.05). CONCLUSIONES: El reemplazo femoral total es un procedimiento quirúrgico de salvamento poco frecuente, demandante y complejo, que representa una alternativa ante la desarticulación de la extremidad pélvica en la etapa final de la enfermedad protésica. Se trata de una opción factible de realizar para mejorar la funcionalidad del paciente y disminuir la discapacidad residual para la realización de actividades de manera independiente.

Using a participatory evaluation design to create an online data collection and monitoring system for New Mexico's Community Health Councils.

We present the collaborative development of a web-based data collection and monitoring plan for thirty-two county councils within New Mexico's health council system. The monitoring plan, a key component in our multiyear participatory statewide evaluation process, was co-developed with the end users: representatives of the health councils. Guided by the Institute of Medicine's Community, Health Improvement Process framework, we first developed a logic model that delineated processes and intermediate systems-level outcomes in council development, planning, and community action. Through the online system, health councils reported data on intermediate outcomes, including policy changes and funds leveraged. The system captured data that were common across the health council system, yet was also flexible so that councils could report their unique accomplishments at the county level. A main benefit of the online system was that it provided the ability to assess intermediate, outcomes across the health council system. Developing the system was not without challenges, including creating processes to ensure participation across a large rural state; creating shared understanding of intermediate outcomes and indicators; and overcoming technological issues. Even through the challenges, however, the benefits of committing to using participatory processes far outweighed the challenges.