[Anorectal melanoma: Clinical case]. / Melanoma anorrectal: un caso clínico.

Background: Anorectal melanoma (AM) is a rare and aggressive type of tumor, with varied and inconclusive scientific information. Its preoperative diagnosis is challenging due to its rarity and similarity to other anorectal conditions. It represents only 1.3% of melanomas and affects more women than men. Approximately 20-30% of AM cases are amelanotic, complicating endoscopic detection and leading to misdiagnoses. AM is often confused with hemorrhoids, polyps, and rectal cancer in two thirds of patients due to similar symptoms. The causes and risk factors of AM are not well understood, but they are suspected to differ from cutaneous and ocular melanomas. Diagnosis is performed through biopsy and immunohistochemical staining. Colonoscopy helps to characterize the lesions, and histological examination is crucial for definitive diagnosis. Clinical case: 50-year-old woman with rectal bleeding and proctalgia. AM was diagnosed through colonoscopy, and transanal resection with hemorrhoidectomy was performed. Conclusions: Management of AM is complicated by the lack of randomized trials. Resection surgery is the standard treatment, but there is no established protocol. Wide local excision may be an option for limited cases. Further research is needed to improve the management and treatment of AM. Early detection and complete surgical removal are crucial for enhancing survival in these patients.

Introducción: el melanoma anorrectal (MA) es un tipo raro y agresivo de tumor, cuya información científica es variada y poco concluyente. Su diagnóstico preoperatorio es un desafío debido a su rareza y a su similitud con otras afecciones anorrectales. Representa solo el 1.3% de los melanomas y afecta más a mujeres que a hombres. Aproximadamente el 20-30% de los casos de MA son amelanóticos, lo que complica su detección endoscópica y conduce a diagnósticos erróneos. El MA se confunde con hemorroides, pólipos y cáncer de recto en dos tercios de los pacientes debido a síntomas similares. Las causas y factores de riesgo del MA aún no se conocen bien, pero se sospecha que son diferentes de los melanomas cutáneos y oculares. El diagnóstico se realiza mediante biopsia y tinción inmunohistoquímica. La colonoscopía permite caracterizar las lesiones y el examen histológico es crucial para el diagnóstico definitivo. Caso clínico: mujer de 50 años con rectorragia y proctalgia. Se diagnosticó MA mediante colonoscopía y se realizó una resección transanal con hemorroidectomía. Conclusiones: el manejo del MA es complicado por la falta de ensayos aleatorizados. La cirugía de resección es el tratamiento habitual, pero no hay un protocolo establecido. La escisión local amplia puede ser una opción para casos limitados. Se necesita más investigación para mejorar el manejo y tratamiento del MA. La detección temprana y la extirpación quirúrgica completa son cruciales para mejorar la supervivencia en estos pacientes.

Molecular characterization of antibiotic resistant Salmonella enterica across the poultry production chain in Costa Rica: A cross-sectional study.

Antibiotic resistant Salmonella enterica are on the increase, worldwide. Given the scarcity of data, this study aimed to investigate its occurrence, virulence, and antibiotic resistance in Costa Rica's food chain. In total, 65 chicken meat- and 171 chicken caecal samples were collected and examined for Salmonella. High frequencies of Salmonella were found in chicken meat (58.5 %, n/N = 38/65) and poultry farms (38.0 %, n/N = 65/171). The majority of Salmonella from chicken meat (89.5 %, n/N = 34/38) and caecum samples (93.6 %, n/N = 59/63) exhibited multidrug resistance (MDR). Serovar Infantis was the most prevalent (94 %, n/N = 67/71), followed by serovars Anatum and Kentucky (3 %, n/N = 2/71). A pESI-like plasmid (92 %, n/N = 65/71) containing virulence and resistance markers was found in S. Infantis. Given the high prevalence of MDR Salmonella, this study emphasizes the need to enhance surveillance systems for foodborne pathogens and antimicrobial resistance in Costa Rica's food production chain.

A strategy for the investigation of toxic mechanisms and protection by efflux pumps using Schizosaccharomyces pombe strains: Application to rotenone.

Effects not related with the inhibition of complex I of the mitochondrial electron transport chain are studied in S. pombe, which lacks it. This study aims: First, the use of a strategy with S. pombe strains to investigate the toxicity, mechanisms of action, interactions and detoxication by efflux pumps. Second, to investigate the mechanisms of toxic action of rotenone. In the dose-response assessment, the yeast presented a good correlation with the toxicity in Daphnia magna for 15 chemicals. In the mechanistic study, the mph1Δ strain presented marked specificity to the interaction with microtubules by carbendazim. DNA damage caused by hydroxyurea, an inhibitor of deoxynucleotide synthesis, was identified with marked specificity with the rad3Δ strain. The sty1Δ strain was very sensitive to the oxidative and osmotic stress induced by hydrogen peroxide and potassium chloride, respectively, being more sensitive to oxidative stress than the pap1Δ strain. The protection by exclusion pumps was also evaluated. Rotenone presented low toxicity in S. pombe due to the lack of its main target, and the marked protection by the exclusion transporters Bfr1, Pmd1, Caf5 and Mfs1. Marked cellular stress was detected. Finally, the toxicity of rotenone could be potentiated by the fungicide carbendazim and the antimetabolite hydroxyurea. In conclusion, the use of S. pombe strains is a valid strategy to: a) assess global toxicity; b) investigate the main mechanisms of toxic action, particularly spindle and DNA interferences, and osmotic and oxidative stress not related to complex I inhibition; c) explore the detoxication by efflux pumps; and d) evaluate possible chemical interactions. Therefore, it should be useful for the investigation of adverse outcome pathways.

Cuidados del adulto mayor que reside en zonas montañosas: importancia del conocimiento del profesional de enfermería

El cuidado en enfermería debe abordarse desde una perspectiva holística que permita cubrir las necesidades reales de los pacientes en su entorno. El enfermero tiene entre sus funciones la de ayudar al anciano enfermo o sano a realizar las actividades que contribuyen a su salud, a la recuperación o una muerte tranquila en la comunidad. Este artículo tiene como objetivo reflexionar sobre el papel que juegan los enfermeros en la atención al adulto mayor que reside en zonas montañosas y la importancia que recobra el elevar los conocimientos de esos profesionales en este sentido.

Nursing care must be approached from a holistic perspective that allows covering the patients' real needs in their environment. One of the functions of the nurse is to help the sick or healthy elderly person to carry out the activities that contribute to their health, recovery or a peaceful death in the community. This article aims to reflect on the role that nurses play in caring for the elderly who live in mountainous areas and the importance of increasing these professionals' knowledge of in this regard.

Sorption/Desorption and Kinetics of Atrazine, Chlorfenvinphos, Endosulfan Sulfate and Trifluralin on Agro-Industrial and Composted Organic Wastes.

The use of pesticides presents a risk to terrestrial and aquatic ecosystems. For this reason, the development of strategies to prevent and restore pollution is of the greatest interest, including the adsorption to organic matter. The aim of the present study was to investigate the sorption/desorption and kinetics of atrazine, chlorfenvinphos, endosulfan sulfate, and trifluralin onto several raw organic wastes by batch experiments. Three kinetic models were used to fit the obtained sorption kinetics data and two to fit the obtained adsorption isotherm data; both the Freundlich and pseudo-second-order kinetic models described the sorption isotherms well. The desorption study revealed hysteresis in all cases, showing strong, and not completely reversible, adsorption in most cases, with the exception of atrazine-sawdust and chlorfenvinphos-sawdust and chicken manure combinations, for which responses were weak and irreversible. The best kinetic, adsorption and desorption constants were achieved for the hydrophobic pesticides. With respect to sorption-desorption rates, orujillo was found to be the best adsorbent for atrazine, while composted urban solid waste was more suitable for trifluralin and endosulfan sulfate. Sorption constants and simple correlations indicated that, not only the organic matter content, but also the nature of the organic matter itself, and the pesticide and adsorbent properties, determine pesticide sorption-desorption. The use of wastes as efficient and cheap adsorbents for reducing the risk of pesticide pollution is proposed.

Integration of fish cell cultures in the toxicological assessment of effluents.

The pollution by industrial and municipal effluents are major sources of concerns. Fish cell cultures were applied in different strategies of the evaluation of effluents, particularly whole toxicity, toxicity identification evaluation and mode of action studies based in adverse outcome pathways. Whole effluent toxicity was evaluated using a battery of five model systems from four trophic levels: Daphnia magna was the most sensitive system, followed by the hepatoma fish cell line PLHC-1, the bacterium Allivibrio fischeri, the fibroblastic fish cell line RTG-2 and the algae Chlorella vulgaris, detecting a risk of eutrofization. The uptake of neutral red was more sensitive than the content of protein assay. The main morphological alterations observed were cell loss, hydropic degeneration, and a general loss of lysosomes and of their perinuclear distribution. The toxicity was characterized in PLHC-1 cells through toxicity identification evaluation, in which a partial reduction with graduation at pH 11, filtration, aeration and addition of thiosulfate or EDTA was shown; on the other hand, a low sorption in solid phase extraction suggested that the main responsible were not organic compounds. Consequently, it was not necessary to apply an effect directed analysis HPLC fractionation. In the chemical identification phase, Zn, Cd, As, Cu and Pb were quantified in decreasing concentrations. In the toxicity confirmation phase, a reconstituted sample and individual solutions, presented decreasing toxicity: Zn > Pb > As+5 > Cd > Cu > As+3, the global toxicity being explained by response addition. In the last step, the mode of action was investigated using five specific biomarkers. While metallothionein and succinate dehydrogenase activity were increased, no changes occurred for lysosomal function, acetylcholinesterase and EROD activities, the responsibility of the toxicity for the elements found being confirmed.

Metilación de genes supresores tumorales en pacientes venezolanos con cáncer colorrectal: relación con estadio clínico de la enfermedad / Relationship of Methylation of Tumor Suppressor Genes with Clinical Stage of Colorectal Cancer in Venezuelan Patients

Resumen El cáncer colorrectal es una enfermedad heterogénea, en cuya aparición se involucran factores hereditarios y ambientales. En las formas heredadas existen genes responsables de incrementar el desarrollo tumoral en los portadores, y se consideran a los factores medioambientales como responsables de gran parte de las formas esporádicas. El objetivo de este estudio fue analizar el estado de metilación de 5 genes implicados en la carcinogénesis colorrectal y su relación con los distintos estadios clínicos de estos tumores. Por una parte, nuestro análisis reveló que el estado de metilación de los promotores de los genes HMLH1 (human mut homologue 1), APC (adenomatous poliposis coli), P15, P16 y CDH1, considerados como unas de las alteraciones más tempranas en este proceso; fluctuaron entre 13,3 % para hMLH1 y 56,6 % para APC. También reveló que la inactivación epigenética de los genes APC y P16 podrían ser responsables de la aparición y de la progresión de los tumores ya que se encontraron en pacientes con estadio II. Por otra parte, los genes APC y p15 resultaron estar mutados en todas las etapas de la carcinogénesis, por lo que se involucrarían en todos los procesos tanto de inicio como de invasión y metástasis. Por último, nuestros resultados apoyan la utilización de la identificación de la metilación de los genes supresores ya que se están identificando dianas epigenéticas para el desarrollo de nuevos tratamientos de quimioterapia y está emergiendo como una estrategia con gran potencial dado que, en principio, las alteraciones epigenéticas son potencialmente reversibles.

Abstract Colorectal cancer is a heterogeneous disease which involves hereditary and environmental factors. The inherited forms have genes which are responsible for increasing the tumor development in carriers. Environmental factors are considered responsible for many sporadic forms. The objective of this study was to analyze the methylation status of five genes involved in colorectal carcinogenesis and their relationships with the various clinical stages of these tumors. Our analysis revealed that the methylation status of the promoters of genes HMLH1, APC, P15, P16 and CDH1, considered to be among the earliest alterations in this process, ranged from 13.3% for HMLH1 to 56.6% for APC. In addition, epigenetic inactivation of APC and P16 genes could be responsible for the appearance and progression of tumors since inactivation was found in stage II patients. On the other hand, the APC and p15 gene were mutated in all stages of carcinogenesis, so they could be involved throughout the processes of initiation, invasion and metastasis. Finally, our results support using identification of methylation of suppressor genes since they identify epigenetic targets for development of new chemotherapy treatments. This is emerging as a strategy with great potential since epigenetic alterations are, in principle, potentially reversible.

Metilación de genes supresores de tumores en pacientes venezolanos con leucemia linfoide aguda / Methylation of tumor suppressor genes in Venezuelan patients with acute lymphoid leukemia

La leucemia linfoide aguda (LLA) es la neoplasia maligna hematológica más común en niños. Se ha podido demostrar un perfil específico de metilación de islas CpG en las regiones promotoras de genes supresores de tumor, que desempeña un papel crítico en el silenciamiento transcripcional y puede ofrecer nuevas opciones de tratamiento. Con el objetivo de determinar este perfil, se analizó el estado de metilación de las islas CpG de la región promotora de cuatros genes supresores de tumor asociados a diferentes etapas del proceso de carcinogénesis, dos p15 y p73 asociados a la regulación del ciclo celular y a la apoptosis y dos E-cadherin y RARβ2, involucrados en la migración y metástasis tumoral. Se analizaron 30 muestras de sangre periférica mediante modificación del ADN con bisulfito sódico y reacción en cadena de la polimerasa específica para metilación y se obtuvo en todos los pacientes, al menos la metilación de un gen (100%) y frecuencias específicas de metilación de 76,67% para el gen p73 (23 pacientes); 56,67% para el p15 (7 pacientes); 16,67% para el E-cadherin (5 pacientes) y 20,0% para el RARβ2 (6 pacientes). La frecuencia de metilación observada en los genes p15 y p73, sugiere el papel importante de esos genes en la patogenia de la LLA y su probable utilidad en el asesoramiento de riesgo y en la selección del tratamiento más adecuado.

Acute lymphocytic leukemia (ALL) is the most common hematologic malignancy in children. A specific methylation profile of CpG islands in the promoter regions of tumor suppressor genes has been demonstrated, which plays a critical role in transcriptional silencing and may offer new treatment options. In order to determine this profile, the methylation status of CpG islands was analyzed in the promoter region of four tumor suppressor genes associated with different stages of carcinogenesis: two associated with the regulation of cell cycle and apoptosis: p15 and p73; and two involved in migration and tumor metastasis: E-cadherin and RARβ2. Thirty peripheral blood samples were analyzed by modification of DNA with sodium bisulfite and chain reaction polymerase specific for methylation. In all patients, the methylation of at least one gene was observed (100%) and additionally, there were specific methylation frequencies of 76.67% for the p73 gene (23 patients); 56.67% for p15 (seven patients); 16.67% for E-cadherin (five patients) and 20.0% for the RARβ2 (six patients). The frequency of methylation observed in p15 and p73 genes suggests the important role of these genes in the pathogenesis of ALL and its usefulness in risk assessment and the selection of the most appropriate treatment.

Characterization of sorption processes for the development of low-cost pesticide decontamination techniques.

The adsorption/desorption behavior of four pesticides (atrazine, alachlor, endosulfan sulfate and trifluralin) in aqueous solutions onto four adsorbents (sunflower seed shells, rice husk, composted sewage sludge and soil) was investigated. Pesticide determination was carried out using stir bar sorptive extraction and gas chromatography coupled with mass spectroscopy. Maximum removal efficiency (73.9%) was reached using 1 g of rice husk and 50 mL of pesticide solution (200 µg L(-1)). The pseudo adsorption equilibrium was reached with 0.6 g organic residue, which was used in subsequent experiments. The pseudo-first-order, pseudo-second-order kinetics and the intra-particle diffusion models were used to describe the kinetic data and rate constants were evaluated. The first model was more suitable for the sorption of atrazine and alachlor while the pseudo-second-order best described endosulfan sulfate and trifluralin adsorption, which showed the fastest sorption rates. 4h was considered as the equilibrium time for determining adsorption isotherms. Experimental data were modeled by Langmuir and Freundlich models. In most of the studied cases both models can describe the adsorption process, although the Freundlich model was applicable in all cases. The sorption capacity increased with the hydrophobic character of the pesticides and decreased with their water solubility. Rice husk was revealed as the best adsorbent for three of the four studied pesticides (atrazine, alachlor and endosulfan sulfate), while better results were obtained with composted sewage sludge and sunflower seed shell for the removal of trifluralin. Although desorption percentages were not high (with the exception of alachlor, which reached a desorption rate of 57%), the Kfd values were lower than the Kf values for adsorption and all H values were below 100, indicating that the adsorption was weak.

Enhancing soil sorption capacity of an agricultural soil by addition of three different organic wastes.

This study evaluated the ability of three unmodified organic residues (composted sewage sludge, RO1; chicken manure, RO2; and a residue from olive oil production called 'orujillo', RO3) and a soil to sorb six pesticides (atrazine, lindane, alachlor, chlorpyrifos, chlorfenvinphos and endosulfan sulfate) and thereby explored the potential environmental value of these organic residues for mitigating pesticide pollution in agricultural production and removing contaminants from wastewater. Pesticide determination was carried out using gas chromatography coupled with mass spectrometry. Adsorption data were analyzed by the Langmuir and Freundlich adsorption approaches. Experimental results showed that the Freundlich isotherm model best described the adsorption process and that Kf values increased with an increase in organic matter (OM) content of the amended soil. The order of adsorption of pesticides on soils was: chlorpyrifos≥endosulfan sulfate>chlorfenvinphos≥lindane>alachlor≥atrazine. The sorption was greater for the most hydrophobic compounds and lower for the most polar ones, as corroborated by a negative correlation between Kf values and solubility. Sorption increased with an increase in organic matter. Sorption capacity was positively correlated with the organic carbon (OC) content. The organic amendment showing the maximum sorption capacity was RO3 in all cases, except for chlorfenvinphos, in which it was RO2. The order of adsorption capacity of the amendments depended on the pesticide and the organic dosage. In the case of the 10% amendment the order was RO3>RO2>RO1>soil, except for chlorfenvinphos, in which it was RO2>RO3>RO1>soil, and atrazine, where RO2 and RO3 amendments had the same effect on the soil sorption capacity (RO2≥RO3>RO1>soil).

Fractionation of metals and As in sediments from a biosphere reserve (Odiel salt marshes) affected by acidic mine drainage.

The Odiel salt marshes (Marismas del Odiel) are an important nature area declared a Biosphere Reserve, but they are greatly affected by pollution from the Odiel River. Surface sediments from this area were analysed using the latest version of the BCR sequential extraction procedure to determine the fractionation of As, Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn among four geochemical phases (acid-soluble, reducible, oxidisable and residual). The total content of each of the metals and As was also determined. The results showed high concentrations of As, Cd, Cu, Pb and Zn, with maximums of 791 mg kg(-1) of As, 8.5 mg kg(-1) of Cd, 2,740 mg kg(-1) of Cu, 1,580 mg kg(-1) of Pb and 3,920 mg kg(-1) of Zn. The concentrations of Cr, Mn and Ni were low since there are no sources of pollution by them in the area. A comparison of the metal and As levels with the sediment quality guidelines showed that the pollution is sufficient to produce noxious effects in aquatic organisms in most of the Odiel salt marshes. Based on the chemical distribution of the elements, it was found that Cd and Zn were the most mobile (i.e., elements that can pass easily into the water under changing environmental conditions). However, Cr, Fe, Ni and As were present in the greatest percentages in the residual fraction, which implies that these elements are strongly linked to the sediments.