Effect of acute altitude exposure on physiological parameters and glucose metabolism in healthy lowland Peruvians.

BACKGROUND: High altitude exposure triggers a series of physiological changes to maintain homeostasis. Although longer-term (days to years) acclimatization processes are well studied, less is known about the physiological changes upon rapid ascent. We took advantage of Peru's geography to measure the first physiological changes following rapid transport from a low to a high-altitude environment among lowlanders. METHODS: Blood glucose, insulin, C-peptide, and salivary cortisol among healthy lowland Peruvians were measured before and after glucose ingestion at 40 m and upon arrival at 3470 m. Resting heart rate, blood oxygen saturation, and blood pressure were also monitored. RESULTS: At high altitude, we find a significant ( p<0.05) increase in heart rate and a decrease in blood oxygen saturation and salivary cortisol. Additionally, baseline levels of blood glucose, plasma C-peptide, and cortisol were reduced ( p<0.05). Blood glucose, plasma insulin, and plasma C-peptide returned to baseline or below faster at high altitude after glucose ingestion. CONCLUSIONS: Although many overlapping environmental and physiological factors are present in the high-altitude environment, the first steps of acclimatization in this population appear to be caused by increased energy expenditure and glucose metabolism to maintain oxygen homeostasis until the longer-term acclimatization mechanisms become more significant.

Selenium Injection in Dam Rabbits During Gestation Has Important Effects on Progeny Productive Performance.

Micromineral elements have a fundamental participation in the processes of organogenesis and fetal development. The objective of this study was to assess the effect of selenium (Se) injection in pregnant female rabbits, during organogenesis or rapid fetal growth, on the productive performance of their progeny. An experiment was carried out with 30 New Zealand female rabbits, with an average age of 6 months. At the end of mating (day 0), using a randomized complete design, the female rabbits were distributed into three experimental groups, which were assigned to the following treatments: Control, female rabbits were injected intramuscularly (IM) with 0.5 ml of saline on days 13 and 23 of gestation; Early administration, female rabbits that were injected IM with Se (0.10 mg/kg BW) on day 13 of gestation (organogenesis) and 0.5 ml of saline on day 23 of gestation; and Late administration, female rabbits that were injected IM with 0.5 ml of saline on day 13 of gestation and Se (0.10 mg/kg BW) on day 23 of gestation (rapid fetal growth). No differences were found on kindling performance of dams and pre-weaning growth of rabbit offspring. However, an injection of Se to pregnant rabbits affected the growth and development of their progeny, with the treatment leading to changes in the yield of some carcass traits (forelimb weight and forelimb muscle weight) and weights of some organs (liver, lungs, and spleen). The Se treatment (both early and late) also resulted in lower concentrations of glucose, triglycerides, and cholesterol when compared to the control group. These effects were different when Se injection was performed during organogenesis or rapid fetal development. The results from this study suggest that there are beneficial effects of gestational Se injection of rabbit dams on important productive traits of their progeny.

Social and ethnic-racial inequities of physical accessibility to street markets in Porto Alegre/RS, Brazil

Street markets in Brazil are important spaces for the commercialization of fruits and vegetables (FV), which access by the urban population is considered one of the key aspects for the socalled "healthy cities". This study adopts an ecological approach with geographic-spatial emphasis to describe accessibility to street markets in Porto Alegre, Brazil, by four different modes of transport (walking, bicycle, bus and car). The distribution of markets across the city is more balanced than other food establishments, although physical accessibility is highly uneven across modes of transport: the ability to reach a market on foot in 10 minutes or less is restricted to no more than 25 % of the population, while almost 90% can do it by driving a car. More importantly, the study found a direct and positive association between levels of accessibility to street markets and income: wealthier areas can reach fairs in less time using any mode of transport than poorer ones (p<0.001). In addition, regions with a majority of white inhabitants have significantly better accessibility to the fairs on foot, by bicycle and by bus (p<0.01) than regions with a majority of Black, Indigenous or yellow populations. Our study highlights the importance of addressing inequalities in access to healthy foods.

As feiras livres no Brasil são espaços importantes para a venda de frutas, verduras e legumes (FLV), considerados um dos aspectos-chave para "cidades saudáveis". Este estudo adota uma abordagem ecológica com ênfase geográfico-espacial para descrever a acessibilidade às feiras livres em Porto Alegre, Brasil, por quatro modos de transporte (a pé, bicicleta, ônibus e carro). A distribuição das feiras pela cidade é mais equilibrada do que outros estabelecimentos de alimentos, embora a acessibilidade física seja altamente desigual entre os diferentes modos de transporte: a capacidade de alcançar uma feira a pé em 10 minutos ou menos é restrita a menos de 25% da população, enquanto quase 90% podem fazê-lo dirigindo um carro. Mais importante, o estudo encontrou uma associação direta e positiva entre os níveis de acessibilidade às feiras e a renda: as localidades mais ricas podem chegar às feiras em menos tempo usando qualquer modo de transporte do que as mais pobres (p<0,001). Além disso, regiões com maioria de habitantes brancos têm acessibilidade significativamente melhor às feiras a pé, de bicicleta e de ônibus (p<0,01) do que regiões com maioria de população negra, indígena ou amarela. Nosso estudo destaca a importância de abordar as desigualdades no acesso aos alimentos saudáveis.

First report of Phyllosticta capitalensis causing brown spot disease on guava fruits (Psidium guajava) in Mexico.

The guava (Psidium guajava L.) is a plant native to the tropical region of America. In Mexico, the area established with guava cultivation is 20,525 ha (SIAP 2021). Guava is commonly consumed as fresh fruit, being rich in nutrients such as vitamins and minerals (Murthy et al. 2020). During October 2020, in the municipality of Cocula (18.207835N, 99.670322W, 595 m above sea level), Guerrero, Mexico, severely infected immature guava fruits were observed. The incidence of disease in 150 sampled fruits was 12%. Were collected fifteen symptomatic fruits. The symptoms were circular to irregular dark brown spots that varied in size (0.5 to 2.5 cm). From symptomatic fruits, tissues were cut approximately 3 x 3 mm and disinfested with 1% NaOCl, washed three times with sterile distilled water, and transferred to PDA medium amended with streptomycin and tetracycline, and incubated at 28°C. Developing colonies were retransferred to new culture PDA medium, and purified by hyphal tip technique. Two representative isolates (PHYGUA7 and PHYGUA3) were selected for morphological and molecular characterization. After 15 days in PDA at 28°C in an incubator, colonies were flat, irregular, granular and greenish gray, pycnidia were black, granular, and grouped. The conidia were hyaline and ellipsoid, unicellular and smooth-walled, 7-11×5-6.5 µm (n=50), these characteristics were consistent with those described for the fungus Phyllosticta capitalensis (Wikee et al. 2013). Molecular identification was performed by partially sequencing the internal transcribed spacer gene (ITS), the actin gene (ACT), and the translation elongation factor 1-alpha (EF-1α) gene, using primers ITS1 and ITS4, ACT-512F/ ACT-783R, and EF1-728F/EF1-986R, respectively (White et al. 1990; Carbone and Kohn 1999). The resulting sequences were deposited in GenBank (PHYGUA7: OP810947, PHYGUA3: OP810948 for ITS, PHYGUA7: OP819845, PHYGUA3: OP819846 for ACT, and PHYGUA7: OP819847, PHYGUA3: OP819848 for EF-1α). Phylogenetic analysis using maximum likelihood concatenated sequences ITS, ACT and EF-1α with MEGA X, indicated that PHYGUA7 and PHYGUA3 isolated grouped with P. capitalensis (CPC 18848 type strain). For pathogenicity test of P. capitalensis, 15 healthy immature fruits in a field experiment in the fruits on the trees, and 15 healthy mature guava fruits (detached fruits) were superficially disinfected with 70% ethanol, wounded with a sterile toothpick, and inoculated at two equidistant points by inserting PHYGUA7 isolate mycelium. As a control treatment, 10 healthy immature fruits and 10 healthy mature fruits were only injured with a sterile toothpick. After 3 days symptoms were observed in mature fruits and numerous dark pycnidia developed, and seven days later symptoms were observed in immature fruits in all the points inoculated with the PHYGUA7 isolate, similar to the symptoms observed in the field. The control fruits remained asymptomatic. The fungus P. capitalensis was re-isolated from inoculated fruits, thus confirming Koch's postulates. In Mexico P. capitalensis has been reported in Mangifera indica, Epidendrum sp., and Schomburgkia tibicinis (Farr and Rossman, 2022). In Egypt and China P. capitalensis causes black spot on guava fruits (Arafat 2016; Liao et al. 2020). To our knowledge, this is the first report of P. capitalensis as the cause of brown spot on immature guava fruit in Mexico. This research provides relevant information to the design of disease management strategies.

Evaluation of a Model (RUMINANT) for Prediction of DMI and CH4 from Tropical Beef Cattle.

Simulation models represent a low-cost approach to evaluating agricultural systems. In the current study, the precision and accuracy of the RUMINANT model to predict dry matter intake (DMI) and methane emissions from beef cattle fed tropical diets (characteristic of Colombia) was assessed. Feed intake (DMI) and methane emissions were measured in Brahman steers housed in polytunnels and fed six forage diets. In addition, DMI and methane emissions were predicted by the RUMINANT model. The model's predictive capability was measured on the basis of precision: coefficients of variation (CV%) and determination (R2, percentage of variance accounted for by the model), and model efficiency (ME) and accuracy: the simulated/observed ratio (S/O ratio) and slope and mean bias (MB%). In addition, combined measurements of accuracy and precision were carried out by means of mean square prediction error (MSPE) and correlation correspondence coefficient (CCC) and their components. The predictive capability of the RUMINANT model to simulate DMI resulted as valuable for mean S/O ratio (1.07), MB% (2.23%), CV% (17%), R2 (0.886), ME (0.809), CCC (0.869). However, for methane emission simulations, the model substantially underestimated methane emissions (mean S/O ratio = 0.697, MB% = -30.5%), and ME and CCC were -0.431 and 0.485, respectively. In addition, a subset of data corresponding to diets with Leucaena was not observed to have a linear relationship between the observed and simulated values. It is suggested that this may be related to anti-methanogenic factors characteristic of Leucaena, which were not accounted for by the model. This study contributes to improving national inventories of greenhouse gases from the livestock of tropical countries.

Tratamiento con rituximab en 2 pacientes con lupus eritematoso sistémico pediátrico

Introducción . El LES pediátrico (LESp) representa el 15% de todos los pacientes con LES. La afectación renal y neuropsiquiátrica es más agresivo en el LESp, siendo la afectación de un solo órgano la forma clínica de aparición más común. Formas de presentación como infarto cerebral y serositis son manifestaciones poco frecuentes en el LESp. El tratamiento de un LESp no difiere al de las formas adultas y el arsenal terapéutico es el mismo. El rituximab (RTX) es un agente biológico utilizado a nivel mundial en LES con excelentes resultados, sin embargo, aún no existe consenso sobre su eficacia real en LESp. Objetivos . Presentación de 2 casos de LESp con infarto cerebral y serositis como forma de presentación, que no respondieron a la terapia convencional pero sí a RTX. Métodos . Reporte de caso, con descripción del cuadro clínico, método diagnóstico y forma de tratamiento. Resultados. Primer caso: mujer de 16 años que consulta por cefalea progresiva con crisis tónico-clónica. La tomografía cerebral mostró un infarto cerebral frontoparietal izquierdo. En el examen físico se encontró livedo reticularis en miembros inferiores, dolor articular, caída del cabello y úlceras orales. Las pruebas revelaron anemia normocítica, trombocitopenia, disminución del complemento, 1/320 ANA con patrón homogéneo, 3.200 mg de proteína en muestra de orina de 24 horas y anticuerpos antifosfolipídicos negativos. Se realizó diagnóstico de LESp con compromiso renal, neurológico y hematológico, decidiendo uso de metilprednisolona 1 g EV diario durante 3 días, para luego pasar a ciclofosfamida 1 g EV mensual por 6 meses. Después de 3 meses persisten proteinuria, fatiga y artralgias. Por este motivo, se decidió utilizar rituximab a una dosis de 375 mg / m2 en días 1 y 15 cada 6 meses. Tras 4 infusiones, la proteinuria desapareció, así como las artralgias y malestar general. Actualmente mantiene scores SLEDAI-2K en remisión, con dosis bajas de prednisona. Segundo caso: niño de 10 años, presentó dolor abdominal difuso con distensión asociada de inicio más o menos abrupto. Se agregó cansancio, dificultad para respirar y palpitaciones. Una radiografía simple de abdomen no mostró niveles hidroaéreos, pero la placa torácica demostró derrame pleural bilateral con agrandamiento de la silueta cardíaca. Un ecocardiograma y una ecografía abdominal reveló derrame pericárdico y ascitis respectivamente. Al examen físico se observó palidez general, edema translúcido de miembros inferiores, roce pericárdico y disminución del soplo vesicular en ambas bases pulmonares. Las pruebas de laboratorio mostraron leucopenia, linfopenia, anemia normocítica, reactantes de fase aguda elevados, ANA 1/560, anti-ADN 280 U / mL, complemento disminuido, transaminasas elevadas, urea y creatinina normales. Se diagnosticó LESp y se pulsó con metilprednisolona 30 mg / kg / dosis durante 4 días, para luego pasar a micofenolato 600 mg / m2 diarios. Inicialmente hubo mejoría, pero después de 2 meses reapareció la serositis inicial. Se decidió usar rituximab 375 mg / m2. Después de la segunda infusión la serositis desapareció, normalizándose valores de hemograma, complemento y transaminasas. Actualmente se encuentra en remisión, con dosis bajas de prednisona. Conclusión . Los casos presentados debutaron con infarto cerebral y serositis, mostraron ANA elevados títulos y disminución del complemento. Ambos casos mejoraron con rituximab tras el fracaso a ciclofosfamida y micofenolato. Se obtuvo el consentimiento informado de los padres y los pacientes.

Introduction . Pediatric systemic lupus erythematosus (pSLE) represents 15% of all SLE patients. Renal and neuropsychiatric involvement are more aggressive in pSLE, and single organ involvement is the most commonly found clinical form. Conditions such as cerebral infarction and serositis are unusual manifestation of pSLE. Therapy for pSLE is not different from that for the adult forms, and the therapy armamentarium is the same. Rituximab (RTX) is a worldwide used biological for SLE, with excellent results; however, there is still no consensus with respect to is real efficacy in pSLE. Objectives . Presentation of two pSLE cases with cerebral infarction and serositis as main characteristics, who did not respond to conventional therapy, but who did respond to RTX. Methods . Case report, describing the clinical presentation, diagnostic methods, and therapy approach used. Results . First case: This is a sixteen-year-old girl who was brought because of progressing headache and a tonic-clonic crisis. The brain CT scan showed a left frontoparietal cerebral infarction. Physical examination revealed livedo reticularis in both legs, joint pain, hair loss, and mouth ulcers. Laboratory tests revealed normocytic anemia, thrombocytopenia, reduced complement, 1/320 ANA with a homogeneous pattern, 3.200 mg 24-hour proteinuria, and negative anti-phospholipidic antibodies. A pSLE diagnosis was made, with renal, neurologic, and hematologic involvement, so it was decided to use methylprednisolone, 1 gram IV per day for three days, and then switch to cyclophosphamide 1 g IV per month for 6 months. After three months, proteinuria, fatigue, and arthralgia persisted. For this reason, it was decided to administer rituximab, 375 mg/m2 in days 1 and 15, every six months. After four infusions, proteinuria, joint pain and malaise all disappeared. Nowadays this patient maintains SLEDAI-K scores in remission, and she is also receiving low-dose prednisone. Second case: This is a ten-year-old boy, who presented with abrupt diffuse abdominal pain associated with (abdominal) distention. Other manifestations were tiredness, shortness of breath, and palpitations. A plain abdomen X-ray film did not show hydro-aerial levels, but the chest X-ray film showed bilateral pleural effusion, and enlarged cardiac silhouette. Cardiac ultrasonography and abdominal ultrasonography revealed pericardial effusion and ascites, respectively. Findings in physical examination showed pallor translucid edema of the legs, pericardial throbbing, and reduced respiratory sounds in both pulmonary bases. Laboratory tests revealed leukopenia, lymphopenia, normocytic anemia, elevated acute phase reactants, ANA 1/560, anti-DNA 280 U/mL, reduced complement, elevated transaminases, and normal urea and creatinine. pSLE was diagnosed, and therapy instituted was methylprednisolone 30 mg/Kg/dose for 4 days, then it was switched to mycophenolate 600 mg/m2 per day. There was improvement initially, but after two months, serositis reappeared. Then it was decided to start rituximab 375 mg/m2. After the second infusion, serositis disappeared, and CBC, complement, and transaminase values returned to normal. Nowadays the patient is in remission, and he is receiving low-dose prednisone. Conclusión . Both presented cases featured cerebral infarction and serositis. They also showed high ANA titers and reduced complement. Both patients improved their condition with rituximab after failure with cyclophosphamide and mycophenolate. Informed consent from both parents and patients was obtained.

Management of Peripheral Arthritis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations.

OBJECTIVE: We aimed to compile evidence for the efficacy and safety of therapeutic options for the peripheral arthritis domain of psoriatic arthritis (PsA) for the revised 2021 Group in Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations. METHODS: A working group consisting of clinicians and patient research partners was convened. We reviewed the evidence from new randomized controlled trials (RCTs) for PsA treatment from February 19, 2013, to August 28, 2020. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-informed approach to derive evidence for the classes of therapeutic options for 3 patient groups: (1) naïve to treatment, (2) inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and (3) inadequate response to biologic DMARDs (bDMARDs). Recommendations were derived through consensus meetings. RESULTS: The evidence review included 69 RCTs. We derived GRADE evidence for each class of therapeutic options and achieved consensus for the recommendations. For patients naïve to treatment, the working group strongly recommends csDMARDs (methotrexate, sulfasalazine, leflunomide) and phosphodiesterase 4 inhibitors, and emphasizes regular assessment and early escalation to achieve treatment target. bDMARDs (tumor necrosis factor inhibitors [TNFi], interleukin 17 inhibitors [IL-17i], IL-12/23i, IL-23i) and Janus kinase inhibitors (JAKi) are also strongly recommended. For patients with inadequate response to csDMARDs, we strongly recommend TNFi, IL-17i, IL-12/23i, IL-23i, and JAKi. For those who had prior experience with bDMARDs, we strongly recommend a second TNFi, IL-17i, IL-23i, and JAKi. The evidence supporting nonpharmacological interventions was very low. An expert panel conditionally recommends adequate physical activity, smoking cessation, and diet to control weight gain. CONCLUSION: Evidence supporting optimal therapy for the peripheral arthritis domain of PsA was compiled for the revised 2021 GRAPPA treatment recommendations.

Chemical Composition and In Vitro and In Silico Antileishmanial Evaluation of the Essential Oil from Croton linearis Jacq. Stems.

Croton linearis Jacq. is an aromatic shrub that has been utilized in traditional medicine in the Bahamas, Jamaica, and Cuba. Recent studies have revealed the antiprotozoal potential of its leaves. The present work is aimed to identify the volatile constituents of essential oil from the stems of C. linearis (CLS-EO) and evaluate its in vitro antileishmanial activity. In addition, an in silico study of the molecular interactions was performed using molecular docking. A gas chromatographic-mass spectrometric analysis of CLS-EO identified 1,8-cineole (27.8%), α-pinene (11.1%), cis-sabinene (8.1%), p-cymene (5.7%), α-terpineol (4.4%), epi-γ-eudesmol (4.2%), linalool (3.9%), and terpinen-4-ol (2.6%) as major constituents. The evaluation of antileishmanial activity showed that CLS-EO has good activity on both parasite forms (IC50Promastigote = 21.4 ± 0.1 µg/mL; IC50Amastigote = 18.9 ± 0.3 µg/mL), with a CC50 of 49.0 ± 5.0 µg/mL on peritoneal macrophages from BALB/c mice (selectivity index = 2 and 3 using the promastigote and amastigote results). Molecular docking showed good binding of epi-γ-eudesmol with different target enzymes of Leishmania. This study is the first report of the chemical composition and anti-Leishmania evaluation of CLS-EO. These findings provide support for further studies of the antileishmanial effect of this product.

Entheseal Involvement in Spondyloarthritis (SpA) and Gout: An Ultrasound Comparative Study.

Objective: To compare the assessment of entheses in subjects with spondyloarthritis (SpA) with patients with gout by the Madrid Sonographic Enthesis Index (MASEI). Method: This cross-sectional study includes videos of entheses evaluated by ultrasound (US) of 30 patients with SpA diagnosed according to the ASAS criteria and 30 patients with gout established by the presence of monosodium urate crystals. Entheses were evaluated for MASEI in 2 Institutes located in two different countries. Demographic and clinical data were registered. Total MASEI score, MASEI-inflammatory, and MASEI-chronic damage were analyzed. Comparisons between groups were obtained by chi-square test and Student's t-test. An inter-reading US reliability was realized. Results: Patients with gout were older and had significantly more comorbidities than those with SpA. The total MASEI score was not significantly different among diseases (p = 0.07). MASEI-inflammatory was significantly more prevalent at the Achilles tendon in SpA, while the proximal patellar tendon was in gout. Power Doppler was higher in SpA compared to gout (p = 0.005). MASEI-chronic damage related to calcification/enthesophytes predominated in gout (p = 0.043), while calcaneal erosions did in SpA (p = 0.008). The inter-reader concordance was excellent (0.93, CI 95% 0.87-0.96, p = 0.001). Conclusions: SpA and gout similarly involve entheses according to MASE, however, some inflammatory and chronic lesions differ significantly depending on the underlying disease and tendon scanned.

Acute toxicity of aqueous extract of Ambrosia arborescens Mill. on biochemical and histopathological parameters in rats.

Medicinal plants play an important role in the management of various diseases, so their use has become widespread. However, in some cases the population uses plant species regardless of the toxicity they may possess. The objective of this study was to evaluate the acute toxicity of aqueous extract from the leaves of Ambrosia arborescens Mill. on the biochemical and histopathological parameters of albino Holtzman rats. To do this, the leaves of A. arborescens were collected in the province of Julcan, La Libertad Region-Peru. OECD (Organisation for Economic Cooperation and Development) guideline 423 was conducted, forming experimental groups of 10 animals each one (5 males and 5 females): Group I (Control), which received 2 mL physiological saline solution (SSF 0.9%), Groups II and III (A. arborescens-300 and A. arborescens-2000), which were given the aqueous extract leaves of A. arborescens in a single dose of 300 and 2000 mg/kg/day, respectively. On the 14th day of exposure, biochemical (creatinine, ALT and AST) and histopathological parameters were measured. The results show that the aqueous extract of A. arborescens at the dose of 2000 mg/kg produces an increase in biochemical parameters which is related to histopathological analysis of liver and renal tissue with mild congestion. The study concludes that the aqueous extract leaves of A. arborescens has a LD50 greater than 2000 mg/kg and produces mild congestion in kidneys and liver, but showed no significant toxicological changes in the other albino Holtzman rats organs.

Wound healing activity of Tropaeolum tuberosum-based topical formulations in mice.

Background and Aim: Tropaeolum tuberosum Ruiz and Pavón, a tuber native to South America, is characterized by its antioxidant, antimicrobial, and anti-inflammatory properties that contribute to wound healing. This study aimed to evaluate the healing effect of the topical T. tuberosum formulations (gel and cream) on induced wounds in mice. Materials and Methods: Here, an acidic ethanolic extract (1.5 N hydrochloric acid and 96% ethanol at the ratio of 15:85, v/v) was prepared with the tubers of T. tuberosum ecotype black and incorporated into topical cream and gel formulations at 1%. Thirty-twoBalb/c mice were divided into four experimental groups receiving daily topical treatments for 14 days: Group I (control; no treatment), Group II (a commercial ointment of neomycin, polymyxin B, and bacitracin), Group III (1% T. tuberosum gel), and Group IV (1% T. tuberosum cream). The wound closure in the mice was determined during the treatment; then, they were euthanized to obtain skin samples for histopathological analysis. Results: Groups III and IV showed a higher percentage of wound closure from the 6th day of the treatment. From the 8th day, the effect was greater in Group III. The healing effect was confirmed by the histopathological changes. Conclusion: This study concludes that the topical formulations of T. tuberosum demonstrate wound-healing activity in mice, and the most effective treatment is the 1% gel formulation.

Tuberculosis miliar y meningitis multidrogorresistente (MDR) en paciente pediátrico: Reporte de un caso / Complicated multidrug-resistant tuberculosis (MDR) in a pediatric patient: Case report

Objetivo: Presentar el caso de un paciente pediátrico con cuadro inicial de tuberculosis (TB) ganglionar con abandono de tratamiento en 2 ocasiones que evolucionó a la forma miliar y meningitis tuberculosa multidrogorresistente. Reporte del caso: Varón de 4 años con diagnóstico inicial de tuberculosis ganglionar, que abandonó el esquema sensible de tratamiento en dos ocasiones. Tres meses después, se evidenció compromiso bilateral sugestivo de TB miliar y durante la hospitalización desarrolló tuberculosis meníngea e hidrocefalia. Por el antecedente de abandono de tratamiento, se solicitó un estudio de sensibilidad en aspirado gástrico, identificándose como multidrogorresistente; pasando al esquema EZLfxKmEtoCs y manejo de complicaciones, consiguiendo mejoría. Conclusiones: El abandono de tratamiento es una de las principales causas de resistencia a fármacos antituberculosos y de complicaciones. Es necesario reforzar la detección temprana y tratamiento efectivo de esta infección en niños, poniéndose énfasis el seguimiento de casos para evitar abandonos de tratamiento y las complicaciones consecuentes.

Objetive:To describe a pediatric case with initial diagnosis of lymph node tuberculosis (TB) that became multidrug resistant miliar and meningeal tuberculosis (TB-MDR) due to treatment dropout twice. Case report: a 4-year-old boy with initial diagnosis of lymphnode tuberculosis who had two episodes of dropout from the sensitive scheme treatment. Three months later, there was evidence of bilateral involvement suggestive of miliary TB. During hospitalization, he developed meningeal tuberculosis and hydrocephalus. Due to the history of treatment dropout, a sensitivity of gastric aspirate study was requested, identifying it as multidrug-resistant TB. He started the EZLfxKmEtoCs treatment scheme and complications management, achieving improvement. Conclusions: Treatment dropout is one of the main causes of drug resistance in tuberculosis and its complications. It is necessary to reinforce the early detection and effective treatment of this infection in children, focusing on the follow-up of cases to avoid treatment dropout and the consequent complications.

Qualitative validation of audiovisual educational material for use on rheumatoid arthritis patients.

Medication compliance is critical to achieve therapeutic efficacy in patients with rheumatoid arthritis; however, among other factors, low patient-health literacy plays a negative role. Therefore, the development and validation of audiovisual educational material with the participation of health specialists and patients could lead to an improved level of compliance with treatment, while favoring its acceptance. To design and validate audiovisual educational material generated by a multidisciplinary and participative group of patients and health specialists. This study was carried out using a sequential methodology, including qualitative and quantitative techniques: (1) a non-participative observational study with patients and a non-systematic literature search were performed to identify conceptual topics. (2) Pilot videos were qualitatively assessed by patients and health specialists (focus groups and expert committees). (3) Improved versions of seven videos were quantitatively evaluated by patients and specialists following qualitative criteria of attraction, understanding, involvement, acceptance and induction of action. 74 patients with RA, 10 rheumatologists, 4 pharmacists and 2 medical anthropologists participated in the different phases of validation. A total of seven videos lasting 3 min each were generated, incorporating the most relevant suggestions by patients and healthcare professionals. The final version of the videos led to a mean compliance of 96.04 ± 5.2%, according to a representative group of patients and a mean 89.6 ± 9.4%, according to health professionals. With the participation of both patients and health specialists, seven audiovisual educational video recordings were developed and validated, reaching high levels of compliance in accordance with international criteria.

PTML modeling for peptide discovery: in silico design of non-hemolytic peptides with antihypertensive activity.

Hypertension is a medical condition that affects millions of people worldwide. Despite the high efficacy of the current antihypertensive drugs, they are associated with serious side effects. Peptides constitute attractive options for chemical therapy against hypertension, and computational models can accelerate the design of antihypertensive peptides. Yet, to the best of our knowledge, all the in silico models predict only the antihypertensive activity of peptides while neglecting their inherent toxic potential to red blood cells. In this work, we report the first sequence-based model that combines perturbation theory and machine learning through multilayer perceptron networks (SB-PTML-MLP) to enable the simultaneous screening of antihypertensive activity and hemotoxicity of peptides. We have interpreted the molecular descriptors present in the model from a physicochemical and structural point of view. By strictly following such interpretations as guidelines, we performed two tasks. First, we selected amino acids with favorable contributions to both the increase of the antihypertensive activity and the diminution of hemotoxicity. Then, we assembled those suitable amino acids, virtually designing peptides that were predicted by the SB-PTML-MLP model as antihypertensive agents exhibiting low hemotoxicity. The potentiality of the SB-PTML-MLP model as a tool for designing potent and safe antihypertensive peptides was confirmed by predictions performed by online computational tools reported in the scientific literature. The methodology presented here can be extended to other pharmacological applications of peptides.

Wound healing by topical application of Momordica charantia L. formulations on mice.

BACKGROUND AND AIM: Momordica charantia is mainly characterized by its antimicrobial and antioxidant properties. The current study aimed to evaluate the healing activity of gel and cream formulations based on M. charantia on induced wounds in mice. MATERIALS AND METHODS: Acetonic extract of M. charantia was prepared and incorporated into gel and cream formulations. Mus musculus Balb/c (n=30) with induced injury were distributed into five groups: Group I (control - day 7), Group II (control - day 14), Group III (1% gel - day 7), and Group IV (1% gel - day 14) to which 1% M. charantia gel was dermally applied daily for 7 and 14 days, respectively, Group V (1% cream - day 7) and Group VI (1% cream - day 14) to which of M. charantia 1% cream were dermally applied daily for 7 and 14 days, respectively. Time of wound closure was determined during the experimentation; rats were euthanized with sodium pentobarbital 60 mg/kg/pc v.ip. for obtaining skin samples for histopathological analysis. RESULTS: Groups IV and VI showed a higher percentage of wound closure on day 14, and in histopathological analysis, effect was greater in Group VI with the presence of fibroblasts and abundant collagen and elastic fibers. CONCLUSION: M. charantia gel and cream showed wound healing activity on induced wounded mice; the most effective treatment was M. charantia 1% cream formulation.

Preliminary tests of an Inertial Measurement Units based System for Spine mobility assessment in patients with Ankylosing Spondylitis.

This paper presents the preliminary tests of a novel system prototype for the physical assessment of mobility in patients with Ankylosing Spondylitis (AS). The system combines multi-inertial sensors arrays with Kalman Filters-based pose estimation for monitoring spine mobility in patients with AS. This system allows detecting movements with more reliable information than the manual clinical evaluation.

Recomendaciones del Colegio Mexicano de Reumatología para el manejo de la artritis psoriásica / Recommendations of the Mexican College of Rheumatology for the management of psoriatic arthritis

La artritis psoriásica (APs) es una enfermedad inflamatoria sistémica crónica que afecta a la piel, las estructuras musculoesqueléticas y otros órganos y sistemas, comprometiendo la funcionalidad, la calidad de vida y reduciendo la expectativa de vida de los pacientes. Es una enfermedad compleja que requiere atención y manejo especializado y oportuno. Las alternativas para el tratamiento de las manifestaciones de la APs se han incrementado y, adicionalmente, el efecto de los distintos agentes sobre manifestaciones específicas ha sido aclarado en estudios recientes, por lo tanto, es conveniente incorporar la evidencia disponible para construir una estrategia en el tratamiento de estos pacientes. El Colegio Mexicano de Reumatología seleccionó una comisión para evaluar estas distintas alternativas y generar recomendaciones. Métodos: El grupo de estudio incluyó a 16 reumatólogos y tres dermatólogos certificados, que fueron seleccionados de diferentes instituciones de salud y regiones del país. Se conformó un comité ejecutivo que coordinó las reuniones y un comité de expertos que seleccionó los criterios de búsqueda en la literatura, elaboró las preguntas de investigación, calificó la calidad de la evidencia y generó las recomendaciones en los distintos dominios de la enfermedad con base en la metodología GRADE. Resultados: Se generaron 24 recomendaciones actualizadas para el tratamiento de pacientes con APs. Las recomendaciones establecen el papel de los medicamentos disponibles actualmente en nuestro país. Se enfatiza la importancia del control adecuado de la enfermedad, individualizando el perfil de involucramiento de cada paciente en cada uno de los seis dominios potencialmente afectados por la enfermedad. Además, se establece la secuencia en la elección de los tratamientos disponibles para cada dominio, basada en su eficacia, perfil de seguridad y accesibilidad.(AU)

Psoriatic arthritis is a chronic systemic inflammatory disease that affects the skin, musculoskeletal structures and other organs and systems compromising functionality, quality of life and reducing the life expectancy of patients. It is a complex disease that requires specialist and timely care and management. The alternatives for treating the manifestations of psoriatic arthritis have increased and the effect of the different agents on specific manifestations has been clarified in recent studies. Therefore, we should incorporate the available evidence to build a strategy for the treatment of these patients. The Mexican College of Rheumatology selected a committee to evaluate these different alternatives and make recommendations. Methods: The study group included 16 rheumatologists and 3 certified dermatologists, selected from different health institutions and regions of the country. An executive committee was formed to coordinate the meetings and a committee of experts selected the literature search criteria, prepared the research questions, rated the quality of the evidence, and produced the recommendations in the different disease domains based on the GRADE methodology. Results: 24 updated recommendations were generated for the treatment of patients with psoriatic arthritis. The recommendations establish the role of the drugs currently available in our country. The importance of adequate disease control is emphasized, individualizing the level of involvement of each patient in each of the six domains potentially affected by the disease. In addition, the sequence in the choice of treatments available for each domain is established, based on their efficacy, safety profile and accessibility. Conclusions: With this consensus document, it will be possible to improve the care of patients with psoriatic arthritis. The recommendations were generated based on the best available information and in consideration of the Mexican health system.(AU)

Effects of a multimodal rehabilitation program in COVID-19 patients admitted to the Intensive Care Unit: A quasi-experimental study / Efectos de un programa de rehabilitación multimodal en pacientes con COVID-19 ingresados en la Unidad de Cuidados Intensivos: Un estudio cuasi-experimental

Background: Patients with severe COVID-19 evolve to acute respiratory distress syndrome (ARDS) and require management in Intensive Care Units (ICU) where they are exposed to immobilization, immunosuppression, malnutrition, nosocomial infections; may develop ICU Acquired Weakness (ICUAW), which increases with the stay and use of mechanical ventilation (MV).There is evidence of the use of different modalities in rehabilitation to mitigate these effects. Goal: To determine the efficacy of a Multimodal Rehabilitation Program (MRP) in reducing the number of days of mechanical ventilation and stay in patients hospitalized for COVID-19 in ICU, as well as to describe its clinical and hospital characteristics. Material and Methods: An quasi-experimental study was designed, with sequential sampling and without blinding. Acontrol and intervention group was formed, with 32 participants each. AMultimodal Rehabilitation Program (MRP) based on four therapeutic modalities was applied and the intervention was quantified through the use of proposed indicators. Results: The variation in days of ICU stay and days of MV were similar in both groups. The Multimodal Rehabilitation Index (iMR) ranged from 0.1 to 2.7 (mean = 1.2, SD = 0.7) and had significance for cut-off points ≤ 0.81 and ≤ 0.94 in mortality (p = 0.02) and Ventilator-free days at 28 days (VFDs-28) (p = 0.01). Conclusions: No statistically significant difference was found in favor of the intervention in terms of days of stay in the ICU and days of MV. Explanatorily, it was reported that iMR was related to (VFDs-28) and mortality in patients with severe COVID-19.

Introducción: Los pacientes con COVID-19 severo, evolucionan a síndrome de distrés respiratorio agudo (SDRA)y requieren manejo en Unidades de Cuidados Intensivos (UCI) donde están expuestos a inmovilización, inmunosupresión, desnutrición, infecciones nosocomiales; pueden desarrollar Debilidad Adquirida (DAUCI o ICUAW), que se incrementa con la estancia y uso de ventilación mecánica (VM). También se incrementa la mortalidad. Objetivo: Determinar la eficacia de un Programa de Rehabilitación Multimodal (PRM) en la disminución de días de ventilación mecánica y estancia en los pacientes hospitalizados por COVID-19 en UCI, así como describir sus características clínicas y hospitalarias. Material y Métodos: Se diseñó un estudio experimental, de muestreo secuencial y sin cegamiento. Se conformó un grupo control e intervención, con 32 participantes cada uno. Se aplicó un Programa de Rehabilitación Multimodal (PRM) basado en cuatro modalidadesterapéuticas y se cuantificó la intervención a través del uso de indicadores propuestos. Resultados: La variación en días de estancia UCI y días de VM fueron similar en ambos grupos. El Índice de Rehabilitación Multimodal (iRM) varió desde 0.11 a 2.71 (media= 1.23, DS=0.7) y tuvo significancia para los puntos de corte ≤ 0.81 y ≤ 0.94 en mortalidad (p=0.02) y días libres de ventilación mecánica al día 28 (DLVM-28) (p=0.01). Conclusiones: No se halló diferencia estadísticamente significativa a favor de la intervención en cuando a días de estancia en UCI y días de VM. Exploratoriamente se reportó que el iRM tuvo relación con los DLVM-28 y de la mortalidad en pacientes con COVID-19 severo.

Características maternas y resultados perinatales en mujeres peruanas infectadas con COVID-19: Un estudio observacional y transversal / Maternal characteristic and perinatal outcomes among peruvian women infected with COVID-19. An observational and cross-sectional study

Objetivo: Determinar las características maternas de mujeres infectadas con COVID-19 y de sus neonatos nacidos en el Hospital de atención referencia Covid-19 (HRDT) entre abril y setiembre del 2020. Material y Métodos: Estudio observacional y transversal realizado en el HRDT que incluyó 703 pacientes obstétricas con COVID-19. Resultados: La edad promedio fue de 27 años. El 35.7 % fueron nulíparas y el 95% fueron asintomáticas para COVID-19. Tuvieron COVID-19 leve, moderado y severo el 3%,1% y 1%; respectivamente. Los síntomas más frecuentes fueron tos (84,85%) y anosmia (39,39%). Los signos más comunes fueron Taquipnea (60.61%) y dificultad respiratoria (51,52 %). La gasometría, dímero-D y ferritina sérica estuvieron alterados en el 71%, 54% y 30%; respectivamente. Las complicaciones médicas más frecuentes fueron: sepsis (2,28%), neumonía (2,13%), insuficiencia respiratoria (2,13%) y shock séptico (1,14%). Las complicaciones obstétricas más frecuentes fueron Rotura prematura de membranas (6,69%), preeclampsia severa (5,41%), síndrome abortivo (3.27%) y trabajo de parto pretérmino (2,56%). El 73,9% de partos fue por Cesárea. El 0,99 % de pacientes requirió unidad de cuidados intensivos y la letalidad materna fue del 0,2%. El 85,7% de neonatos fueron a término y el 97,2 % tuvo APGAR a los 5 minutos ≥7. Hubo 4 muertes neonatales (0,64%) y 16 óbitos (2,58%). Hubo 8 RT-PCR positivas en neonatos (1,3%). Conclusión: La mayoría de pacientes fueron nulíparas, menores de 35 años y asintomáticas para COVID-19. La mayoría de neonatos nacieron por cesárea y evolucionaron favorablemente. Hubo dos muertes maternas, 16 óbitos fetales y 4 muertes neonatales.

Objetive: To determine the maternal characteristics of women infected with COVID-19 and their neonates born in the COVID-19 referral hospital (HRDT) between April and September 2020.Material and Methods: Observational and cross-sectional study carried out in the HRDT that included 703 obstetric patients with COVID-19. Results: The average age was 27 years. 35.7% were nulliparous and 95% were asymptomatic for COVID-19. 3%, 1% and 1% had mild, moderate and severe COVID-19; respectively. The most frequent symptoms were cough (84.85%) and anosmia (39.39%). The most common signs were tachypnea (60.61%) and respiratory distress (51.52%). Blood gas, D-dimer, and ferritin were altered in 71%, 54%, and 30%; respectively. The most frequent medical complications were: sepsis (2.28%), pneumonia (2.13%), respiratory failure (2.13%) and septic shock (1.14%). The most frequent obstetric complications were premature rupture of membranes (6.69%), severe preeclampsia (5.41%), abortive syndrome (3.27%) and preterm labor (2.56%). 73.9% of deliveries were by Caesarean section. 0.99% of patients required intensive care unit and maternal mortality was 0. 2%. 85.7% of neonates were at term and 97.2% had APGAR ≥7 at 5 minutes. There were 4 neonatal deaths (0.64%) and 16 deaths (2,58%). There were 8 positive RT-PCR in neonates (1.3%). Conclusion: The majority of patients were nulliparous, under 35 years of age and asymptomatic for COVID-19. Most of the newborns were born by cesarean section and evolved favorably. There were two maternal deaths, 16 stillbirths, and 4 neonatal deaths.