Tuberculosis extrapulmonar: Presentación atípica de compromiso de la médula ósea / Extrapulmonary Tuberculosis: Unusual Presentation with Bone Marrow Involvement

RESUMEN La primera causa de muerte por enfermedad infecto-contagiosa a nivel mundial es atribuible a la infección por Mycobacterium tuberculosis. La tuberculosis extrapulmonar representa entre un 20 % y un 25 % de los casos de enfermedad tuberculosa. Frecuentemente, para arribar al diagnóstico de dichas localizaciones, se debe recurrir a pruebas diagnósticas invasivas Se presenta el caso de un paciente de 17 años de edad con compromiso extrapulmo nar de tuberculosis en médula ósea sin inmunocompromiso conocido, con síntomas de fiebre, astenia, pérdida de peso, tricitopenia y hepatoesplenomegalia, sin otros hallazgos clínicos significativos. Se arriba al diagnóstico por cultivo positivo para tuberculosis en material de punción/ biopsia de médula ósea. Luego de un mes de tratamiento con isoniacida, pirazinamida, etambutol y rifampicina evoluciona con registros febriles aún después de recibir antibióticos por infección urinaria por Klebsiella pneumoniae, por lo cual se inicia corticoterapia oral con buena respuesta. El paciente abandona el tratamiento luego de tres meses y medio por mala adherencia a este.

ABSTRACT The leading cause of death from a contagious infectious disease worldwide is attribut able to Mycobacterium tuberculosis infection. Extrapulmonary tuberculosis accounts for 20-25 % of cases of tuberculous disease. Frequently, in order to reach the diagnosis of these sites, invasive diagnostic tests have to be used. We present the case of a 17-year-old patient with extrapulmonary tuberculosis with bone marrow involvement. The patient wasn't immunocompromised, and had the following symptoms: fever, asthenia, weight loss, tricytopenia and hepatosplenomegaly, without other significant clinical findings. The diagnosis was reached by positive culture for tuberculosis in bone marrow puncture aspiration/biopsy material After one month of treatment with isoniazid, pyrazinamide, ethambutol and rifampicin, the patient evolved with fever episodes, even after having received antibiotics for urinary tract infection caused by Klebsiella pneumoniae. Thus, oral corticosteroid therapy was started, with good response. The patient discontinued treatment after three and a half months due to poor adherence.

Criando aberturas em regime fechado: percursos por entre o trabalho como atividade no âmbito da socioeducação / Creating openings is closed regime: pahs between work as an activity in the field os socio-education / Creando aberturas en regime cerrado: caminhos entre el trabajo como actividad en el ámbito de la socioeducación

A pesquisa a qual tratamos neste artigo visou a produção de questões clínicas do trabalho com Agentes Socioeducadores, problematizando a expansão do poder de agir em meio às tensões educar/punir/vigiar características do exercício neste campo. Amparamo-nos na Clínica da Atividade e Ergologia. Tais perspectivas afirmam que trabalhar implica em gerir a distância entre o prescrito e o real, buscando analisar como trabalhadores efetuam cotidianamente microgestões dos processos laborais mediante imprevisibilidades e os modos como experimentam o trabalho, produzindo transformações através de relações entre si e o mundo. A metodologia operou pela pesquisa-intervenção cartográfica, utilizando diários de campo, observações, análise documental, acompanhamento das situações concretas de trabalho, formação de espaços coletivos junto aos trabalhadores e Instrução ao Sósia. As análises permitiram explorar peculiaridades da dinâmica expansão-constrangimento do poder de agir no trabalho da Socioeducação, discutindo que cuidar da saúde pelo cuidado do ofício abre perspectivas para a instauração de relação éticas por entre a expansão do poder de agir no trabalho socioeducativo.(AU)

The research we covered in this article aimed at the production of clinical questions of the work with Socioeducational Agents, problematizing the expansion of the power to act amid the tensions to educate / punish / monitor characteristics of the exercise in this field. We are supported by the Clinic of Activity and Ergology. Such perspectives affirm that working implies managing the distance between what is prescribed and what is real, seeking to analyze how workers perform micro-management of work processes on a daily basis through unpredictability and the ways in which they experience work, producing transformations through relationships between themselves and the world. The methodology operated by cartographic research-intervention, using field diaries, observations, document analysis, monitoring of concrete work situations, formation of collective spaces with workers and Instruction to the Double. The analyzes allowed to explore peculiarities of the dynamic expansion-constraint of the power to act in the work of Socioeducation, arguing that taking care of health by taking care of the work opens up perspectives for the establishment of ethical relationships between the expansion of the power to act in socio-educational work.(AU)

Esta investigación que cubrimos en este artículo tuvo como objetivo la producción de preguntas clínicas del trabajo con Agentes Socioeducativos, problematizando la expansión del poder de actuar en medio de las tensiones para educar / sancionar / monitorear características del ejercicio en este campo. Nos avala la Clínica de Actividad y Ergología. Tales perspectivas afirman que trabajar implica gestionar la distancia entre lo prescrito y lo real, buscando analizar cómo los trabajadores realizan la microgestión de los procesos de trabajo en el día a día a través de la imprevisibilidad y las formas en que viven el trabajo, produciendo transformaciones a través de las relaciones entre ellos mismos y el mundo. La metodología operada por investigación-intervención cartográfica, utilizando diarios de campo, observaciones, análisis documental, seguimiento de situaciones concretas de trabajo, formación de espacios colectivos con trabajadores e Instrucción a Sósia. Los análisis permitieron explorar peculiaridades de la dinámica expansión-constreñimiento del poder de actuar en el trabajo de Socioeducación, argumentando que cuidar la salud cuidando el trabajo abre perspectivas para el establecimiento de relaciones éticas entre la expansión del poder de actuar en el trabajo socioeducativo.(AU)

[An evaluation of teacher training to promote healthy and equitable relationships: transforming or reproducing?] / Evaluación de la formación a profesorado para promover relaciones saludables y equitativas: ¿transformar o reproducir?

OBJECTIVE: To evaluate the impact of the training on teacher capacity to implement Posem el Focus, a socio-educational intervention adapted from Lights4Violence to prevent the gender-based violence during adolescence. METHOD: Evaluation study of a training using qualitative methodology in Terrassa, 2019-2021. The socio-constructionist perspective was used to understand the impact of teacher training and its translation into educational practice. A purposive sampling of teachers (n=32) was carried out. A descriptive-interpretative analysis of the discourses was carried out based on the written productions of the participants in the training and their answers to some open questions. An explanatory theoretical framework was developed. RESULTS: Teachers reported acquiring concepts, developing new skills and modifying some attitudes. Teachers stated theoretical understanding of the sex-gender system, intersectionality and explicit and implicit violence. However, they reproduced gender stereotypes, did not understand the inclusive approach and pointed out not identifying implicit violence. Teachers perceived the training as useful and felt empowered to implement the intervention. No differences were identified in discursive production with respect to gender or age. CONCLUSIONS: Teacher training ensures minimum knowledge and facilitates the acquisition of some skills, although it does not achieve in-depth changes in attitudes. It is concluded that the training enables teachers to implement Posem el Focus, although it is recommended that it be reformulated.

Canine parasitoses in north Patagonia (Argentina): comparison between different social and environmental factors.

In many countries, urban areas are commonly contaminated with canine feces that spread parasites, a situation related to the natural and social environment. Dogs having free access to public areas therefore constitutes a health risk. Because in Patagonia there are no records of city comparisons that consider the number of free-roaming dogs and the local environmental and socioeconomic characteristics, in this study we analyse and compare canine parasitoses in two cities of Rio Negro province, Argentina. Canine feces were collected from public areas of El Bolsón and Cipolletti cities and examined using enrichment methods, Kinyoun stain and immunoassay (Copro-Elisa). The total percentage of positive feces in El Bolsón was 68.95% and 16 parasite taxa being identified, whereas in Cipolletti the total positive feces was 41.1%, with 11 taxa. Both cities presented more helminth species than protozoans. The variables that explained the occurrence of all parasites were rainfall and socioeconomic stratum with the highest values being found in low-income areas.Soil moisture is conditioned by rainfall. This study highlights the presence of the zoonotic Echinococcus sp. in dogs in urban areas of the Rio Negro province. The occurrence of this parasite in Cipolletti is unexpected, given that this city is not considered an endemic zone for this disease, which is not included in local monitoring and control plans.

A new species of Notocotylus (Digenea: Notocotylidae) from the black-necked swan Cygnus melancorhyphus (Molina) of Argentina.

Notocotylus cygni n. sp. is described here, taken from the intestine of the black-necked swan Cygnus melancoryphus (Molina) of Patagonia, Argentina. This new species differs from other members of the genus Notocotylus by having the genital pore anterior to the caecal bifurcation (located slightly posterior to oral sucker) and the unequal number and arrangement of ventral papillae (2-3 in the lateral rows and 10-12 in the median row). Phylogenetic analyses of the 28S and ITS1-5.8S ribosomal DNA (rRNA) sequences of the new species and other notocotylid trematodes available in GenBank indicate that N. cygni n. sp. is a sister taxon of Notocotylus fosteri Kinsella et Tkach, 2005, a trematode of the intestine of the rice rat Oryzomys palustris of Florida, United States. The new species differs from N. fosteri in the unequal number and arrangement of ventral papillae, number of uterine loops, size of the egg, definitive hosts (birds vs. mammals), and disparate environment and geographical distribution (freshwater environment in Patagonia vs. salt marsh in North America). This is the eighth species of Notocotylus reported from birds in Argentina, and the ninth species from the family Notocotylidae recorded in black-necked swans in South America.

A regional scale study of parasites in Percichthys trucha, an endemic fish of southern South America: insights on diversity and distribution from two decades of field surveys.

The current conservation status of Percichthys trucha (Creole perch) is Least Concern, although the population trend is considered to be decreasing. We conducted an extensive survey of parasite fauna in this species over two decades in its distribution range in Argentina. Fish were collected using gill and trawl nets. Parasites were collected, identified, and counted to calculate prevalence and mean intensity. The present work reports the parasite species infecting P. trucha, using data from our own survey and from previously published records. This information enables us to evaluate infection and distribution patterns, assess the role of P. trucha as host, determine the specificity of the parasites, and evaluate the threat represented by introduced, invasive parasites. The data set consists of a total of 453 host-parasite-locality records, of which only 15 are exclusively bibliographic. We found 44 parasite taxa: 19 digeneans, 4 monogeneans, 5 cestodes, 8 nematodes, 4 acanthocephalans, 3 crustaceans, and 1 mollusk. The most represented families were Diplostomidae, Heterophyidae, and Dactylogyridae. This study increases the number of parasite species known from 25 to 44. It can be concluded that this parasite fauna is characterized by high diversity, particularly of digeneans, and most of the parasites reproduce within this host, a pattern which is related to the top position of this fish species in the trophic webs. Six parasite species (Allocreadium patagonicum, Homalometron papilliferum, Acanthostomoides apophalliformis, Duplaccessorius andinus, Pseudodelphys limnicola, and Hysterothylacium patagonense) exhibit high host specificity (only matures in Creole perches) and are widely distributed, which could now be considered as "biogeographical core helminth fauna." Some P. trucha populations are affected by the invasion of alien fishes like Cyprinus carpio and pathogenic parasites like Lernaea cyprinacea and Schizocotyle acheilognathi. Our findings emphasize the need for further research.

Relational Continuity of Chronic Patients with Primary and Secondary Care Doctors: A Study of Public Healthcare Networks of Six Latin American Countries.

Despite relational continuity (RC) with the doctor being key to care quality for chronic patients, particularly in fragmented healthcare systems, like many in Latin America (LA), little is known about RC and its attributes, particularly regarding specialists. Aim: We aim to analyse chronic patients' perceptions of RC with primary (PC) and secondary (SC) care doctors, and record changes between 2015 and 2017 in the public healthcare networks of six LA countries. An analysis of two cross-sectional studies applying the CCAENA questionnaire to chronic patients (N = 4881) was conducted in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. The dependent variables of RC with PC and SC doctors were: consistency, trust, effective communication, and synthetic indexes based on RC attributes. Descriptive and multivariate analyses were performed. Although the RC index was high in 2015, especially in PC in all countries, and at both levels in Argentina and Uruguay, low perceived consistency of PC and SC doctors in Colombia and Chile and of SC doctors in Mexico revealed important areas for improvement. In 2017 the RC index of SC doctors increased in Chile and Mexico, while SC doctors' consistency in Colombia decreased. This study reveals important gaps in achieving RC with doctors, particularly in SC, which requires further structural and organisational reforms.

The role of the different CD3γ domains in TCR expression and signaling.

The CD3 subunits of the T-cell antigen receptor (TCR) play a central role in regulation of surface TCR expression levels. Humans who lack CD3γ (γ-) show reduced surface TCR expression levels and abolished phorbol ester (PMA)-induced TCR down-regulation. The response to PMA is mediated by a double leucine motif in the intracellular (IC) domain of CD3γ. However, the molecular cause of the reduced TCR surface expression in γ- lymphocytes is still not known. We used retroviral vectors carrying wild type CD3γ or CD3δ or the following chimeras (EC-extracellular, TM-transmembrane and IC): δECγTMγIC (δγγ for short), γγδ, γδδ and γγ-. Expression of γγγ, γγδ, γδδ or γγ- in the γ- T cell line JGN, which lacks surface TCR, demonstrated that cell surface TCR levels in JGN were dependent on the EC domain of CD3γ and could not be replaced by the one of CD3δ. In JGN and primary γ- patient T cells, the tested chimeras confirmed that the response to PMA maps to the IC domain of CD3γ. Since protein homology explains these results better than domain structure, we conclude that CD3γ contributes conformational cues that improve surface TCR expression, likely at the assembly or membrane transport steps. In JGN cells all chimeric TCRs were signalling competent. However, an IC domain at CD3γ was required for TCR-induced IL-2 and TNF-α production and CD69 expression, indicating that a TCR without a CD3γ IC domain has altered signalling capabilities.

Seroprevalence of Trypanosoma cruzi in Eight Blood Banks in Mexico.

BACKGROUND: The true prevalence of Chagas disease in Mexico is unknown. However, it has been estimated that 1.1-4 million people are infected with Trypanosoma cruzi, which represents a potential risk for transmission of the disease via contaminated blood. AIM OF THE STUDY: To determine the Chagas disease seroprevalence in donors from eight blood banks in the north of Mexico City, and the northeast of the State of Mexico. STUDY DESIGN AND METHODS: Serum samples from blood donors (n = 515,038) were tested to detect the presence of anti-Trypanosoma cruzi antibodies in eight blood banks. The serologic screening test was performed in each of the blood banks. To confirm the seropositive blood donors, only two out of the eight blood banks used a test with a different principle with the aim of identifying anti-Trypanosoma cruzi antibodies. All tests were validated by the Mexican Institute for Epidemiological Diagnosis and Reference. RESULTS: One thousand two hundred and ten blood donors were seropositive for Trypanosoma cruzi, which represents a 0.23% seroprevalence (95% CI 0.22-0.25%). Of the seropositive blood donors, 97.03 % resided in the northeast area of the State of Mexico, Mexico City, and southern part of the State of Hidalgo. CONCLUSIONS: Active transmission of Chagas disease may be occurring in non-endemic regions in the northeast of the State of Mexico.

RTX-KG2: a system for building a semantically standardized knowledge graph for translational biomedicine.

BACKGROUND: Biomedical translational science is increasingly using computational reasoning on repositories of structured knowledge (such as UMLS, SemMedDB, ChEMBL, Reactome, DrugBank, and SMPDB in order to facilitate discovery of new therapeutic targets and modalities. The NCATS Biomedical Data Translator project is working to federate autonomous reasoning agents and knowledge providers within a distributed system for answering translational questions. Within that project and the broader field, there is a need for a framework that can efficiently and reproducibly build an integrated, standards-compliant, and comprehensive biomedical knowledge graph that can be downloaded in standard serialized form or queried via a public application programming interface (API). RESULTS: To create a knowledge provider system within the Translator project, we have developed RTX-KG2, an open-source software system for building-and hosting a web API for querying-a biomedical knowledge graph that uses an Extract-Transform-Load approach to integrate 70 knowledge sources (including the aforementioned core six sources) into a knowledge graph with provenance information including (where available) citations. The semantic layer and schema for RTX-KG2 follow the standard Biolink model to maximize interoperability. RTX-KG2 is currently being used by multiple Translator reasoning agents, both in its downloadable form and via its SmartAPI-registered interface. Serializations of RTX-KG2 are available for download in both the pre-canonicalized form and in canonicalized form (in which synonyms are merged). The current canonicalized version (KG2.7.3) of RTX-KG2 contains 6.4M nodes and 39.3M edges with a hierarchy of 77 relationship types from Biolink. CONCLUSION: RTX-KG2 is the first knowledge graph that integrates UMLS, SemMedDB, ChEMBL, DrugBank, Reactome, SMPDB, and 64 additional knowledge sources within a knowledge graph that conforms to the Biolink standard for its semantic layer and schema. RTX-KG2 is publicly available for querying via its API at arax.rtx.ai/api/rtxkg2/v1.2/openapi.json . The code to build RTX-KG2 is publicly available at github:RTXteam/RTX-KG2 .

Cannabidiol attenuates hypersensitivity and oxidative stress after traumatic spinal cord injury in rats.

Neuropathic pain (NP) arises as a direct consequence of traumatic spinal cord injury (SCI), which leads to devastating consequences for people suffering from this condition since no specific treatment has been defined. One relevant mechanism in generating painful stimuli involves the direct participation of reactive oxygen species (ROS) at the cellular and subcellular levels. Cannabidiol (CBD) is one of the two most crucial cannabinoid components of the cannabis plant and has been proposed as a potential treatment for NP. Its antioxidant, neuroprotective and anti-inflammatory properties have been documented. However, there is insufficient evidence regarding CBD as treatment of NP induced by SCI or the mechanisms that underlie this effect. In this study, we evaluated the antinociceptive effect of CBD as an acute treatment after the nociceptive behaviors characteristic of NP were established (hypersensitivity threshold and hypersensitivity response). Furthermore, the participation of oxidative stress was determined by lipid peroxidation (LP) and glutathione concentration (GSH) in female Wistar rats with SCI. Acute treatment with CBD (2.5-20 mg/kg, i.p.) decreased nociceptive behaviors in a dose-dependent manner, decreased LP, and increased GSH concentration in injured tissue 15 days after injury. The findings of this study suggest that the antinociceptive effect induced by CBD is regulated by reducing oxidative stress by decreasing the LP and increasing the concentration of antioxidant (GSH) defenses.

A cross-sectional study of free-roaming dogs in a Patagonian city: Their distribution and intestinal helminths in relation to socioeconomic aspects of neighborhoods.

Human and dog health are inextricably linked, and although our relationship with dogs brings numerous benefits for our well-being, it is known that they can transmit disease. Bariloche is a Patagonian tourist city with heterogeneous social composition. This cross-sectional study evaluates the population of free-roaming dogs and their intestinal parasites in relation to the socioeconomic level of the city's human population. Census areas were used as survey units, stratified in three levels according to socioeconomic status. The free-roaming dog population was estimated by walking around each census area. Eight fresh feces per census count area were collected and analyzed using coproparasitological flotation tests, and CoproELISA was used to detect Echinococcus sp. A total of 858 free-roaming dogs were registered along 40.9 km, with significant differences between socioeconomic strata: the highest numbers were found in the lowest income strata. Of the feces collected, 39.2% tested positive for parasites, those associated with a lower socioeconomic level having higher percentages of positive feces and a greater number of species. Eight species of helminths were found, some of which were zoonotic, such as Echinococcus sp., Toxocara canis, and Dibothriocephalus latus. The presence of parasites can be explained by the number of free-roaming dogs per census count area. The free-roaming dogs generally have owners, and their parasitic infection is strongly associated with the socioeconomic level of the population. The main problem is irresponsible pet care, which generates healthy conditions for both dogs and humans. Thus, both dogs and humans deserve effective ethical public policies.

Phylogenomics and Diversification of the Schistosomatidae Based on Targeted Sequence Capture of Ultra-Conserved Elements.

Schistosomatidae Stiles and Hassall 1898 is a medically significant family of digenetic trematodes (Trematoda: Digenea), members of which infect mammals or birds as definitive hosts and aquatic or amphibious gastropods as intermediate hosts. Currently, there are 17 named genera, for many of which evolutionary interrelationships remain unresolved. The lack of a resolved phylogeny has encumbered our understanding of schistosomatid evolution, specifically patterns of host-use and the role of host-switching in diversification. Here, we used targeted sequence capture of ultra-conserved elements (UCEs) from representatives of 13 of the 17 named genera and 11 undescribed lineages that are presumed to represent either novel genera or species to generate a phylogenomic dataset for the estimation of schistosomatid interrelationships. This study represents the largest phylogenetic effort within the Schistosomatidae in both the number of loci and breadth of taxon sampling. We present a near-comprehensive family-level phylogeny providing resolution to several clades of long-standing uncertainty within Schistosomatidae, including resolution for the placement of the North American mammalian schistosomes, implying a second separate capture of mammalian hosts. Additionally, we present evidence for the placement of Macrobilharzia at the base of the Schistosoma + Bivitellobilharzia radiation. Patterns of definitive and intermediate host use and a strong role for intermediate host-switching are discussed relative to schistosomatid diversification.

First report of post-cyclic transmission in trematodes: Derogenes lacustris (Digenea: Hemiuroidea) in Patagonian freshwater fishes.

The transmission of adult parasites from prey to predatory hosts has been demonstrated for some acanthocephalan and one cestode species. Derogenes lacustris (Digenea: Hemiuroidea: Derogenidae) is a generalist parasite that infects, as an adult, the stomach of native and introduced freshwater fishes in Andean Patagonia. In the present work, the post-cyclic transmission of D. lacustris from native Galaxias maculatus (Galaxiidae) to introduced Oncorhynchus mykiss (Salmonidae) was proved experimentally. The observed transmission rate for this experimental infection was 19%. The body length of D. lacustris on day 14 post-infection was significantly greater than before transmission. The number of eggs also increased significantly after transmission, showing that D. lacustris can survive, grow and continue with egg production for at least 2 weeks in predatory salmonids. This study provides the first experimental evidence of post-cyclic transmission of trematodes and the results suggest that post-cyclic parasitism enables this species to broaden its range of hosts and distribution ranges in Argentinean Patagonia.

Cortical taste processing evolves through benign taste exposures.

Experience impacts learning and perception. Familiarity with stimuli that later become the conditioned stimulus (CS) in a learning paradigm, for instance, reduces the strength of that learning-a fact well documented in studies of conditioned taste aversion (CTA; De la Casa & Lubow, 1995; Lubow, 1973; Lubow & Moore, 1959). Recently, we have demonstrated that even experience with "incidental" (i.e., non-CS) stimuli influences CTA learning: Long Evans rats pre-exposed to salty and/or sour tastes later learn unusually strong aversions to novel sucrose (Flores et al., 2016), and exhibit enhanced sucrose-responsiveness after learning in gustatory cortex (GC; Flores et al., 2018). These findings suggest that incidental taste exposure (TE) may change spiking responses that have been shown to underlie the processing of tastes in GC. Here, we test this hypothesis, evaluating whether GC neuron spiking responses change across 3 days of taste exposure. Our results demonstrate that the discriminability of GC ensemble taste responses increases with this familiarization. Analysis of single-neuron responses recorded across multiple sessions reveals that taste exposure not only enriches identity and palatability information in taste-evoked activity but also enhances the discriminability of even novel tastes. These findings demonstrate that "mere" familiarization with incidental episodes of tasting changes the neural spiking responses of taste processing and provides specific insight into how such TE may impact later learning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries.

Although fragmentation in the provision of services is considered an obstacle to effective health care, there is scant evidence on the impact of interventions to improve care coordination between primary care and secondary care in terms of continuity of care-i.e. from the patient perspective-particularly in Latin America (LA). Within the framework of the Equity-LA II project, interventions to improve coordination across care levels were implemented in five Latin American countries (Brazil, Chile, Colombia, Mexico and Uruguay) through a participatory action research (PAR) process. This paper analyses the impact of these PAR interventions on the cross-level continuity of care of chronic patients in public healthcare networks. A quasi-experimental study was performed with measurements based on two surveys of a sample of patients with chronic conditions (392 per network; 800 per country). Both the baseline (2015) and evaluation (2017) surveys were conducted using the CCAENA questionnaire. In each country, two comparable public healthcare networks were selected, one intervention and one control. Outcomes were cross-level continuity of information and clinical management continuity. Descriptive analyses were conducted, and Poisson regression models with robust variance were fitted to estimate changes. With differences between countries, the results showed improvements in cross-level continuity of clinical information (transfer of clinical information) and clinical management continuity (care coherence). These results are consistent with those of previous studies on the effectiveness of the interventions implemented in each country in improving care coordination in Brazil, Chile and Colombia. Differences between countries are probably related to particular contextual factors and events that occurred during the implementation process. This supports the notion that certain context and process factors are needed to improve continuity of care. The results provide evidence that, although the interventions were designed to enhance care coordination and aimed at health professionals, patients report improvements in continuity of care.

Porfiria hepato eritropoyética asociada a diabetes mellitus tipo 1: a propósito de un caso clínico / A clinical case of hepato-erythropoietic porphyria associated with type 1 diabetes mellitus / Relato de caso de porfiria hepato-eritropoiética associada a diabetes mellitus tipo 1

Las porfirias son un grupo complejo y heterogéneo de defectos en la vía de la síntesis del hemo. La porfiria hepato eritropoyética es un subtipo muy poco frecuente y de presentación en la infancia, con compromiso cutáneo predominante. Describimos el caso clínico de una paciente de 5 años, que se presenta con lesiones cutáneas e hipertricosis, se confirma el diagnóstico por elevación de uroporfirinas en orina y secuenciación del gen UROD.

Porphyria is a complex and heterogeneous group of heme synthesis disorder. Hepato-erythropoietic porphyria is a very rare subtype that onsets in childhood, and shows predominant skin involvement. We describe the clinical case of a 5-year-old patient who showed skin lesions and hypertrichosis and whose diagnosis was confirmed due to increased uroporphyrins in urine and UROD gene sequencing

A porfiria é um grupo complexo e heterogêneo de distúrbios da síntese do grupo heme. A porfiria hepato-eritropoiética é um subtipo muito raro que se inicia na infância e mostra envolvimento predominante da pele. Descrevemos o caso clínico de uma paciente de 5 anos que apresentou lesões cutâneas e hipertricose e cujo diagnóstico foi confirmado por aumento de uroporfirinas na urina e sequenciamento do gene UROD.

Dog care and parasitosis in a rural community of Patagonia: An integrative approach.

Human interaction with dogs can potentially lead to zoonoses. The aim of this integrative approach is to describe the relationship between dog parasites, dog care, and the human population of a rural Patagonian village. Surveys were carried out to evaluate owners' attitudes towards dogs, and coproparasitological and coproELISA analyses were performed to determine parasitic infection values. Fur samples and vegetable garden soil were also analyzed. A multivariate regression was performed to identify factors determining infection. All households owned at least one dog, of which only 54.9% had been dewormed in the past three months, and almost half of which were allowed to roam freely. Dogs with protozoan and helminth infections represented 68.8% of the total, 50% being parasitized by helminths of 7 species, including the zoonotic Toxocara canis, Uncinaria sp. Ancylostoma sp. and Echinococcus sp. All hair samples were negative, but 42.8% of vegetable gardens harbored Ancylostomatidae larvae. Statistical analyses indicated that the predictor "time since last deworming" explained infections by Cryptosporidium sp. and helminths, while the predictors "number of dogs per household", "sex", and "freedom to roam" explained the infections by helminths. This shows that the longer the time interval since the last deworming treatment, the greater the probability of a dog being infected by some type of parasite, either Cryptosporidium sp. or a helminth. On the other hand, the probability of being infected by helminths increased when there was more than one dog in the household. Furthermore, male dogs and dogs allowed to roam freely were more likely to be infected. Considering the inadequate care and sanitary status of dogs infected with zoonotic species, it is necessary to raise awareness of the need for responsible care of dogs.

The acute systemic toxicity of thallium in rats produces oxidative stress: attenuation by metallothionein and Prussian blue.

Thallium (TI) is one of the most toxic heavy metals. Human exposure to Tl occurs through contaminated drinking water and from there to food, a threat to health. Recently, environmental contamination by Tl has been reported in several countries, urging the need for studies to determine the impact of endogenous and exogenous mechanisms preventing thallium toxicity. The cytoprotective effect of metallothionein (MT), a protein with high capacity to chelate metals, at two doses (100 and 600 µg/rat), was tested. Prussian blue (PB) (50 mg/kg) was administered alone or in combination with MT. A dose of Tl (16mg/kg) was injected i.p. to Wistar rats. Antidotes were administered twice daily, starting 24h after Tl injection, for 4 days. Tl concentrations diminished in most organs (p < 0.05) by effect of PB, alone or in combination with MT, whereas MT alone decreased Tl concentrations in testis, spleen, lung and liver. Likewise, brain thallium also diminished (p < 0.05) by effect of PB and MT alone or in combination in most of the regions analyzed (p < 0.05). The greatest diminution of Tl was achieved when the antidotes were combined. Plasma markers of renal damage increased after Tl administration, while PB and MT, either alone or in combination, prevented the raise of those markers. Only MT increased the levels of reduced glutathione (GSH) in the kidney. Finally, increased Nrf2 was observed in liver and kidney, after treatment with MT alone or in combination with PB. Results showed that MT alone or in combination with PB is cytoprotective after thallium exposure.