SARS-CoV-2 Genome Variations in Viral Shedding of an Immunocompromised Patient with Non-Hodgkin's Lymphoma.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) is the most transmissible ß-coronavirus in history, affecting all population groups. Immunocompromised patients, particularly cancer patients, have been highlighted as a reservoir to promote accumulation of viral mutations throughout persistent infection. CASE PRESENTATION: We aimed to describe the clinical course and SARS-CoV-2 mutation profile for 102 days in an immunocompromised patient with non-Hodgkin's lymphoma and COVID-19. We used RT-qPCR to quantify SARS-CoV-2 viral load over time and whole-virus genome sequencing to identify viral lineage and mutation profile. The patient presented with a persistent infection through 102 days while being treated with cytotoxic chemotherapy for non-Hodgkin's lymphoma and received targeted therapy for COVID-19 with remdesivir and hyperimmune plasma. All sequenced samples belonged to the BA.1.1 lineage. We detected nine amino acid substitutions in five viral genes (Nucleocapsid, ORF1a, ORF1b, ORF13a, and ORF9b), grouped in two clusters: the first cluster with amino acid substitutions only detected on days 39 and 87 of sample collection, and the second cluster with amino acid substitutions only detected on day 95 of sample collection. The Spike gene remained unchanged in all samples. Viral load was dynamic but consistent with the disease flares. CONCLUSIONS: This report shows that the multiple mutations that occur in an immunocompromised patient with persistent COVID-19 could provide information regarding viral evolution and emergence of new SARS-CoV-2 variants.

The Evolutionary Landscape of SARS-CoV-2 Variant B.1.1.519 and Its Clinical Impact in Mexico City.

The SARS-CoV-2 pandemic is one of the most concerning health problems around the globe. We reported the emergence of SARS-CoV-2 variant B.1.1.519 in Mexico City. We reported the effective reproduction number (Rt) of B.1.1.519 and presented evidence of its geographical origin based on phylogenetic analysis. We also studied its evolution via haplotype analysis and identified the most recurrent haplotypes. Finally, we studied the clinical impact of B.1.1.519. The B.1.1.519 variant was predominant between November 2020 and May 2021, reaching 90% of all cases sequenced in February 2021. It is characterized by three amino acid changes in the spike protein: T478K, P681H, and T732A. Its Rt varies between 0.5 and 2.9. Its geographical origin remain to be investigated. Patients infected with variant B.1.1.519 showed a highly significant adjusted odds ratio (aOR) increase of 1.85 over non-B.1.1.519 patients for developing a severe/critical outcome (p = 0.000296, 1.33-2.6 95% CI) and a 2.35-fold increase for hospitalization (p = 0.005, 1.32-4.34 95% CI). The continuous monitoring of this and other variants will be required to control the ongoing pandemic as it evolves.

SARS-CoV-2 positivity rates in asymptomatic workers at a cancer referral center in Mexico City: A prospective observational study in the context of adapting hospitals back to regular practice.

BACKGROUND: Healthcare workers are at increased risk of SARS-CoV-2 infection. The positivity rates in hospitals that do not receive patients with COVID-19, such as the National Cancer Institute (INCan) in Mexico, and the associated factors are unknown. OBJECTIVE: To assess the incidence and factors associated with SARS-CoV-2 infection in health workers at INCan. METHODS: A cohort study of 531 workers who were followed for 6 months. RT-PCR analysis of saliva and nasopharyngeal swab samples were used in the baseline and to confirm cases during follow-up The incidence rate ratio was calculated according to the measured characteristics and the associated factors were calculated using logistic regression models. RESULTS: Out of 531 workers, 9.6% tested positive for SARS-CoV-2, Being male (RR: 2.07, 95% CI: 1.1-3.8, P = .02), performing administrative tasks (RR: 1.99, 95% CI: 1.0-3.9, P = .04), and having relatives also working at INCan (RR: 3.7, 95% CI: 1.4-9.5, P < .01) were associated with higher positivity rates. DISCUSSION: Incidence of positive cases in health workers were similar to that reported in non-COVID hospitals from other countries. CONCLUSIONS: Even though active surveillance helped to detect a significant number of asymptomatic infections, it is still necessary to reinforce preventive measures in non-medical staff to prevent nosocomial transmission.

Development of brushite particles synthesized in the presence of acidic monomers for dental applications.

OBJECTIVES: To synthesize and characterize brushite particles in the presence of acidic monomers (acrylic acid/AA, citric acid/CA, and methacryloyloxyethyl phosphate/MOEP) and evaluate the effect of these particles on degree of conversion (DC), flexural strength/modulus (FS/FM) and ion release of experimental composites. METHODS: Particles were synthesized by co-precipitation with monomers added to the phosphate precursor solution and characterized for monomer content, size and morphology. Composites containing 20 vol% brushite and 40 vol% reinforcing glass were tested for DC, FS and FM (after 24 h and 60 d in water), and 60-day ion release. Data were subjected to ANOVA/Tukey tests (DC) or Kruskal-Wallis/Dunn tests (FS and FM, alpha: 5%). RESULTS: The presence of acidic monomers affected particle morphology. Monomer content on the particles was low (0.1-1.4% by mass). Composites presented similar DC. For FS/24 h, only the composite containing DCPD_AA was statistically similar to the composite containing 60 vol% of reinforcing glass (without brushite, "control"). After 60 days, all brushite-containing materials showed similar FS, statistically lower than the control composite (p<0.01). Composites containing DCPD_AA, DCPD_MOEP or DCPD_U ("unmodified") showed statistically similar FM/24 h, higher than the control composite. After prolonged immersion, all composites were similar to the control composite, except DCPD_AA. Cumulative ion release ranged from 21 ppm to 28 ppm (calcium) and 9 ppm to 17 ppm (phosphate). Statistically significant reductions in ion release between 15 and 60 days were detected only for the composite containing DCPD_MOEP. SIGNIFICANCE: Acidic monomers added to the synthesis affected brushite particle morphology. After 60-day storage in water, composite strength was similar among all brushite-containing composites. Ion release was sustained for 60 days and it was not affected by particle morphology.

Expression of the ectodomain-releasing protease ADAM17 is directly regulated by the osteosarcoma and bone-related transcription factor RUNX2.

Osteoblast differentiation is controlled by transcription factor RUNX2 which temporally activates or represses several bone-related genes, including those encoding extracellular matrix proteins or factors that control cell-cell, and cell-matrix interactions. Cell-cell communication in the many skeletal pericellular micro-niches is critical for bone development and involves paracrine secretion of growth factors and morphogens. This paracrine signaling is in part regulated by "A Disintegrin And Metalloproteinase" (ADAM) proteins. These cell membrane-associated metalloproteinases support proteolytic release ("shedding") of protein ectodomains residing at the cell surface. We analyzed microarray and RNA-sequencing data for Adam genes and show that Adam17, Adam10, and Adam9 are stimulated during BMP2 mediated induction of osteogenic differentiation and are robustly expressed in human osteoblastic cells. ADAM17, which was initially identified as a tumor necrosis factor alpha (TNFα) converting enzyme also called (TACE), regulates TNFα-signaling pathway, which inhibits osteoblast differentiation. We demonstrate that Adam17 expression is suppressed by RUNX2 during osteoblast differentiation through the proximal Adam17 promoter region (-0.4 kb) containing two functional RUNX2 binding motifs. Adam17 downregulation during osteoblast differentiation is paralleled by increased RUNX2 expression, cytoplasmic-nuclear translocation and enhanced binding to the Adam17 proximal promoter. Forced expression of Adam17 reduces Runx2 and Alpl expression, indicating that Adam17 may negatively modulate osteoblast differentiation. These findings suggest a novel regulatory mechanism involving a reciprocal Runx2-Adam17 negative feedback loop to regulate progression through osteoblast differentiation. Our results suggest that RUNX2 may control paracrine signaling through regulation of ectodomain shedding at the cell surface of osteoblasts by directly suppressing Adam17 expression.

Costo-efectividad del tratamiento quirúrgico vs corticoides locales en el síndrome del túnel del carpo / Cost-effectiveness of surgical treatment vs local steroids in carpal tunnel syndrome

RESUMEN El síndrome del túnel del carpo (STC) es la neuropatía por atrapamiento más frecuente y, a su vez, la que más afecta a la población trabajadora, cuyo tratamiento implica una carga económica para el sistema de salud. El objetivo de esta investigación fue evaluar el costo-efectividad del tratamiento quirúrgico convencional y la infiltración local de corticoides, para el síndrome del túnel del carpo, en población trabajadora colombiana. Teniendo en cuenta que es una de las enfermedades de origen laboral más prevalentes en el país, se realizó un estudio de costo efectividad, desde la perspectiva del tercer pagador (Empresas Promotoras de Salud y Aseguradoras de Riesgos Laborales), en que se compararon alternativas de tratamiento quirúrgica y médica, para esta patología, para lo cual, se elaboró un árbol de decisión en el escenario clínico de un trabajador con un síndrome del túnel del carpo severo, para un horizonte temporal de un año, en el que se incluyeron los costos directos e indirectos asociados. Los resultados para el escenario y horizonte temporal propuesto en relación con esta patología es que ninguna de las alternativas resultó ser claramente dominante, dentro del plano de costo-efectividad. La razón de costo-efectividad incremental de la cirugía en comparación con la aplicación de corticoides fue de $1.974.945,68, por 0,6 casos de mejoría. En el análisis de sensibilidad de Montecarlo, la aplicación local de corticoides fue costo-efectiva en el 100% de los casos, de acuerdo con el umbral propuesto.

SUMMARY Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and in turn, the one that most affects the working population whose treatment implies an economic burden to the health system. The aim of this research was to evaluate the cost-effectiveness of conventional surgical treatment and local infiltration of corticosteroids for carpal tunnel syndrome in the Colombian working population. Considering that it is one of the most prevalent occupational diseases, in the country from the perspective of the third payer (Health Promoting Companies and Occupational Risk Insurers). A cost-effectiveness study was carried out in which alternatives of surgical and medical treatment for this pathology were compared, through a decision tree was elaborated in the clinical scenario of a worker with a severe carpal tunnel syndrome for a time horizon of one year, in which the associated direct and indirect costs were included. The results from the scenario and time horizon proposed in relation to this pathology, none of the alternatives turned out to be dominant within the plane of cost-effectiveness. The incremental costeffectiveness ratio of the surgery compared to the application of corticosteroids was 1,974,945.68 pesos for 0.6 cases of improvement. In the sensitivity analysis of Monte Carlo, the local application of corticosteroids was cost-effective in 100% of the cases according to the proposed threshold.

Mechanical characterization and ion release of bioactive dental composites containing calcium phosphate particles.

OBJECTIVE: to verify the effect of the addition of dicalcium phosphate dihydrate (DCPD) particles functionalized with di- or triethylene glycol dimethacrylate (DEGDMA or TEGDMA) on the degree of conversion (DC), post-gel shrinkage (PS), mechanical properties, and ion release of experimental composites. METHODS: Four composites were prepared containing a BisGMA/TEGDMA matrix and 60 vol% of fillers. The positive control contained only barium glass fillers, while in the other composites 15 vol% of the barium was replaced by DCPD. Besides the functionalized particles, non-functionalized DCPD was also tested. DC after 24 h (n = 3) was determined by FTIR spectroscopy. The strain gage method was used to obtain PS 5 min after photoactivation (n = 5). Flexural strength and modulus (n = 10) were calculated based on the biaxial flexural test results, after specimen storage for 24 h or 60 days in water. The same storage times were used for fracture toughness testing (FT, n = 10). Calcium and phosphate release up to 60 days was quantified by ICP-OES (n = 3). Data were analyzed by ANOVA/Tukey test (alpha: 5%). RESULTS: Composites containing functionalized DCPD presented higher DC than the control (p < 0.001). The material containing DEGDMA-functionalized particles showed higher PS than the other composites (p < 0.001). After 60 days, only the composite with DEGDMA-functionalized DCPD presented fracture strength similar to the control, while for flexural modulus only the composite with TEGDMA-functionalized particles was lower than the control (p < 0.001). FT of all composites containing DCPD was higher than the control after 60 days (p < 0.005). Calcium release was higher for the composite with non-functionalized DCPD at 15 days and no significant reductions were observed for composites with functionalized DCPD during the observation period (p < 0.001). For all the tested composites, phosphate release was higher at 15 days than in the subsequent periods, and no difference among them was recorded at 45 and 60 days (p < 0.001). CONCLUSIONS: DCPD functionalization affected all the studied variables. The composite with DEGDMA-functionalized particles was the only material with strength similar to the control after 60 days in water; however, it also presented the highest shrinkage. The presence of DCPD improved FT, regardless of functionalization. DCPD functionalization reduced ion release only during the first 15 days.

Airborne observations reveal elevational gradient in tropical forest isoprene emissions.

Isoprene dominates global non-methane volatile organic compound emissions, and impacts tropospheric chemistry by influencing oxidants and aerosols. Isoprene emission rates vary over several orders of magnitude for different plants, and characterizing this immense biological chemodiversity is a challenge for estimating isoprene emission from tropical forests. Here we present the isoprene emission estimates from aircraft eddy covariance measurements over the Amazonian forest. We report isoprene emission rates that are three times higher than satellite top-down estimates and 35% higher than model predictions. The results reveal strong correlations between observed isoprene emission rates and terrain elevations, which are confirmed by similar correlations between satellite-derived isoprene emissions and terrain elevations. We propose that the elevational gradient in the Amazonian forest isoprene emission capacity is determined by plant species distributions and can substantially explain isoprene emission variability in tropical forests, and use a model to demonstrate the resulting impacts on regional air quality.

Wnt/ß-Catenin Signaling Activates Expression of the Bone-Related Transcription Factor RUNX2 in Select Human Osteosarcoma Cell Types.

Osteosarcoma is the most common malignant bone tumor in children and adolescents. Metastasis and poor responsiveness to chemotherapy in osteosarcoma correlates with over-expression of the runt-related transcription factor RUNX2, which normally plays a key role in osteogenic lineage commitment, osteoblast differentiation, and bone formation. Furthermore, WNT/ß-catenin signaling is over-activated in osteosarcoma and promotes tumor progression. Importantly, the WNT/ß-catenin pathway normally activates RUNX2 gene expression during osteogenic lineage commitment. Therefore, we examined whether the WNT/ß-catenin pathway controls the tumor-related elevation of RUNX2 expression in osteosarcoma. We analyzed protein levels and nuclear localization of ß-catenin and RUNX2 in a panel of human osteosarcoma cell lines (SAOS, MG63, U2OS, HOS, G292, and 143B). In all six cell lines, ß-catenin and RUNX2 are expressed to different degrees and localized in the nucleus and/or cytoplasm. SAOS cells have the highest levels of RUNX2 protein that is localized in the nucleus, while MG63 cells have the lowest RUNX2 levels which is mostly localized in the cytoplasm. Levels of ß-catenin and RUNX2 protein are enhanced in HOS, G292, and 143B cells after treatment with the GSK3ß inhibitor SB216763. Furthermore, small interfering RNA (siRNA)-mediated depletion of ß-catenin inhibits RUNX2 expression in G292 cells. Thus, WNT/ß-catenin activation is required for RUNX2 expression in at least some osteosarcoma cell types, where RUNX2 is known to promote expression of metastasis related genes. J. Cell. Biochem. 118: 3662-3674, 2017. © 2017 Wiley Periodicals, Inc.

The cancer-related transcription factor Runx2 modulates cell proliferation in human osteosarcoma cell lines.

Runx2 regulates osteogenic differentiation and bone formation, but also suppresses pre-osteoblast proliferation by affecting cell cycle progression in the G(1) phase. The growth suppressive potential of Runx2 is normally inactivated in part by protein destabilization, which permits cell cycle progression beyond the G(1)/S phase transition, and Runx2 is again up-regulated after mitosis. Runx2 expression also correlates with metastasis and poor chemotherapy response in osteosarcoma. Here we show that six human osteosarcoma cell lines (SaOS, MG63, U2OS, HOS, G292, and 143B) have different growth rates, which is consistent with differences in the lengths of the cell cycle. Runx2 protein levels are cell cycle-regulated with respect to the G(1)/S phase transition in U2OS, HOS, G292, and 143B cells. In contrast, Runx2 protein levels are constitutively expressed during the cell cycle in SaOS and MG63 cells. Forced expression of Runx2 suppresses growth in all cell lines indicating that accumulation of Runx2 in excess of its pre-established levels in a given cell type triggers one or more anti-proliferative pathways in osteosarcoma cells. Thus, regulatory mechanisms controlling Runx2 expression in osteosarcoma cells must balance Runx2 protein levels to promote its putative oncogenic functions, while avoiding suppression of bone tumor growth.

Psychotic symptoms and gray matter deficits in clinical pediatric populations.

BACKGROUND: Neuroanatomic studies have not yet addressed how subtle phenotypic distinctions in psychosis alter the underlying brain changes, and whether there is evidence for psychosis as a dimensional construct. We explored the relationship of cortical GM thickness to psychotic phenotypes in children. METHODS: Cross-sectional comparison of anatomic brain imaging between patients referred as childhood-onset schizophrenia (COS) but ruled out after a drug free inpatient observation. Groups included: patients with no evidence of psychosis (n=22) after drug free observation, patients with psychosis not otherwise specified (PNOS; total n=29) further divided into those without other axis I diagnoses (n=13) and those with other axis I comorbidities (n=16), age/sex matched COS patients (n=48), and 51 matched healthy controls. GM cortical thickness was compared between the groups, and regressed on patients' SAPS, SANS and GAS scores. RESULTS: Patients with no evidence of psychosis showed no cortical GM deficits. Presence of psychosis (PNOS with or without co-morbidities) showed some areas of temporal and prefrontal deficits, more subtle compared to the extensive bilateral cortical deficits seen for COS. GAS SAPS and SANS scores showed a relationship with cortical GM thickness although it did not survive adjustment for multiple comparisons. CONCLUSIONS: These results highlight the need for careful phenotypic characterization, as subtle diagnostic distinctions appear to reflect distinct underlying patterns of brain deficits. The incremental nature of cortical deficits from no psychosis to PNOS to COS may further support dimensional model for psychosis.

Hand-washing knowledge and practices among dentists and dental specialists.

OBJECTIVE: Hand washing is the most important way to prevent the spread of infection. However, studies have shown that there is a lack of knowledge among physicians about proper hand hygiene. The purpose of this study was to determine the knowledge of general dentists and dental specialists regarding the correct agents to use and the appropriate times to wash hands. METHOD AND MATERIALS: A questionnaire asking for demographic information and the answers to questions about proper hand hygiene practices and agents was sent via email to a list of general dentists and dental specialists. A total of 480 completed surveys were received (approximately 15% response). RESULTS: None of the respondents answered all the questions correctly. Six percent answered 4 questions correctly, 23% answered 3 questions correctly, and 47% answered only 2 questions correctly. There was no correlation between the number of correct answers and whether the respondent was a general dentist or a specialist. CONCLUSION: There is a lack of knowledge among dentists regarding proper hand hygiene. For the benefit of both the patient and the doctor, this situation must be remedied.

Robotic-assisted total laparoscopic hysterectomy and staging for the treatment of endometrial cancer: a comparison with conventional laparoscopy and abdominal approaches.

The treatment of endometrial cancer using a minimally invasive approach provides benefits to the patient; however, there are currently few papers comparing robotic total laparoscopic hysterectomy with staging to conventional laparoscopic and abdominal approaches. Analyses of 102 consecutive patients undergoing robotic total hysterectomy were compared to historical cohorts of 104 patients undergoing laparoscopic total hysterectomy and 78 patients undergoing abdominal total hysterectomy (laparotomy). The majority of all patients were FIGO'88 stage IB. Patient characteristics were similar, except for lower age (P = 0.0236) and body mass index (P = 0.0134) in the laparoscopy group when compared to laparotomy. Operative time was longer for the robotic group at 108.7 min, compared to 79.4 min for laparoscopy (P = 0.0207) and 84.0 min for laparotomy (P < 0.0001). Lymph node yield was significantly higher in the robotic group (16.0 nodes) when compared to both laparoscopy (5.0 nodes, P < 0.0001) and laparotomy (11.4 nodes, P = 0.0006). The perioperative complication rates were significantly decreased in both the robotic (10.8%) and laparoscopy (6.7%) groups when compared to laparotomy at 25.6% (P = 0.0089; P = 0.0002). Hospital stay was significantly reduced in both the robotic (1.9 days, P < 0.0001) and laparoscopic (1.8 days, P < 0.0001) groups when compared to laparotomy (4.1 days). Both minimally invasive approaches reduced morbidity. Robotic assistance resulted in improved lymph node yield. Robotic surgery for endometrial cancer is at least equivalent to laparoscopic and open techniques and may be the preferred method for treatment of endometrial cancer.

Efecto de un programa de ejercicio físico controlado-supervisado sobre el perfil lipídico en mujeres postmenopáusicas en Bogotá, Colombia, 2007 / The effect of a controlled-supervised physical exercise programme on postmenopausal women's lipid profile, Bogotá, Colombia, 2007

Introducción y objetivo: en la postmenopausia se generan cambios metabólicos relacionados con alteraciones en el perfil lipídico, los cuales son un factor de riesgo de enfermedad cardiovascular en esta población. El ejercicio físico (EF) regular puede mejorar el perfil lipídico, aunque son pocos los estudios que han incluido a la mujer postmenopáusica. Esta investigación buscó evaluar el efecto de un programa de ejercicio físico aeróbico, sobre el perfil lipídico de mujeres postmenopáusicas con hiperlipidemia. Metodología: estudio cuasiexperimental de antes y después, en el cual participaron 40 mujeres postmenopáusicas, a quienes se les aplicó un programa de ejercicio aeróbico controlado supervisado, de intensidad moderada a vigorosa,4-5díasporsemana y con una duración de 16 semanas. Se valoraron las concentraciones de colesterol total, triglicéridos, lipoproteínas de alta densidad (HDL), lipoproteínas de baja densidad (LDL) y apolipoproteínas A-I y B. Resultados: se encontró una reducción significativa en las concentraciones séricas del colesterol total, triglicéridos y un incremento en el VO2 (p<0,05). Conclusiones: los resultados sugieren que el programa de ejercicio físico mejora los perfiles de triglicéridos y colesterol total, disminuyendo el riesgo de enfermedad cardiovascular en la mujer postmenopáusica, sin cambios significativos en las otras variables lipídicas.

Prescripción de medicamentos en pacientes atendidos en instituciones de mediano y alto nivel de complejidad / Drug prescription patterns in patients attended at a middle- and high-complexity level institution

Objetivo Determinar los patrones de prescripción de medicamentos ambulatorios autorizados en pacientes afiliados a una EPS y atendidos por IPS de mediano y alto nivel de complejidad. Métodos Se realizo un estudio analítico transversal donde se evaluaron las prescripciones de medicamentos en 331 IPS de segundo y tercer nivel de complejidad en 27 departamentos durante el 2006. Resultados Se analizaron 38 863 prescripciones de medicamentos de 3 663 pacientes. El 61,4 por ciento de estas provienen de IPS de tercer nivel de complejidad y principalmente de pacientes afiliados al régimen contributivo. El promedio de medicamentos por formula medica fue de 2,2 (IC 95 por ciento: 2,1 a 2,2 por ciento), la proporción de antibióticos por fórmula médica del 29,2 por ciento (IC 95 por ciento: 28,7-29,6), de medicamentos POS del 64,2 por ciento (IC 95 por ciento 63,7-64,6 por ciento) y de inyectables del 22,1 por ciento (IC 95 por ciento 21,7-25,5 por ciento). Más de la mitad de los medicamentos, 62,1 por ciento (IC 95 por ciento 61,5-62,7 por ciento), corresponden a agentes anti-infecciosos, antineoplasicos y del tracto alimentario .El consumo de medicamentos fue de 8,39 Dosis Diarias Definidas (DDD) /1 000 usuarios/día y el costo por DDD fue de $ 5 216 Conclusión Este análisis permitió identificar medicamentos cuya frecuencia de formulación no se correlaciono con el perfil epidemiológico como agentes inmunomoduladores y hormona de crecimiento. Existen diferencias en la frecuencia y cantidad de DDD de medicamentos autorizados por régimen de afiliación lo cual pude ser evidencia de barreras de acceso a los medicamentos en la población.

Objective Determining prescription patterns for outpatient medication authorised for patients affiliated to an EPS and assisted by medium- and high-level complexity IPS. Methods This was a cross-sectional study where medication prescription was evaluated in 331 second- and third-level complexity hospitals from 27 Colombian departments during 2006. Results 38 863 prescriptions for 3 663 patients’ medication were analysed. 61,4 percent came from third-level complexity hospitals, mainly for patients affiliated to contribution-based regimes. Average prescribed medication per person was 2,2 (2,1-2,2 95 percent CI), the percentage of antibiotics formulated by prescription was 29,2 percent (28,7-29,6 95 percent CI), essential prescribed medicines accounted for 64,2 percent (63,7-64,6 95 percent CI) and injectable medicines was 22,1 percent (21,7-25,5 percent). More than half the medications (62,1 percent; 61,5-62,7 95 percent CI) were in ATC groups such as anti-infectious agents, immunomodulating agents and medications for the alimentary and metabolic tract. DU90 percent consisted of 64 medications, medication consumption being 8,39 daily de-fined doses (DDD)/1 000 patients, costing 5 216 Colombian pesos per DDD. Conclusions This analysis led to identifying medications whose formulation frequency did not correlate with an epidemiologic profile as immunomudulator and growth-hormone (somatotropin) agents. There were differences in the frequency and quantity of DDD medications authorised by type of affiliation which could thus be providing evidence of obstacles to the population having access to drugs/medicaments.

An electrospray ionization tandem mass spectrometric study of p-tert-butylcalix[6]arene complexation with ammonium hydroxide, and ammonium and sodium ions.

The formation of complexes involving p-tert-butylcalix[6]arene with neutral and charged species has been investigated by tandem mass spectrometry combined with electrospray ionization. Complexes of p-tert-butylcalix[6]arene with NH4+ ions were observed in the ratios 1:1, 2:1, and 3:1, together with the complexes of p-tert-butylcalix[6]arene with NH4OH and Na+ ions in the ratios 1:1:1, 2:1:1, and 3:1:1. A single 1:1 complex of p-tert-butylcalix[6]arene with Na+ ions was observed. In addition, a doubly charged complex of p-tert-butylcalix[6]arene with NH4OH, Na+, and NH4+ ions in the ratio 6:1:1:1 was observed. The identity of each complex was determined by mass analysis of product ions formed by the application of a declustering potential over the range 20-220 V and by observation of product ion mass spectra wherein the collision energy was varied from 5 to 50 eV. Fragmentation of the complexes is characterized by the facile loss of the ammonia molecule, sodium and ammonium ions, loss of neutral p-tert-butylcalix[6]arene, and successive neutral losses of C4H8 from the six tert-butyl groups in each p-tert-butylcalix[6]arene molecule.

[Drug prescription patterns in patients attended at a middle- and high-complexity level institution]. / Prescripción de medicamentos en pacientes atendidos en instituciones de mediano y alto nivel de complejidad.

OBJECTIVE: Determining prescription patterns for outpatient medication authorised for patients affiliated to an EPS and assisted by medium- and high-level complexity IPS. METHODS: This was a cross-sectional study where medication prescription was evaluated in 331 second- and third-level complexity hospitals from 27 Colombian departments during 2006. RESULTS: 38 863 prescriptions for 3 663 patients' medication were analysed. 61,4 % came from third-level complexity hospitals, mainly for patients affiliated to contribution-based regimes. Average prescribed medication per person was 2,2 (2,1-2,2 95 % CI), the percentage of antibiotics formulated by prescription was 29,2 % (28,7-29,6 95 % CI), essential prescribed medicines accounted for 64,2 % (63,7-64,6 95 % CI) and injectable medicines was 22,1 % (21,7-25,5 %). More than half the medications (62,1 %; 61,5-62,7 95 % CI) were in ATC groups such as anti-infectious agents, immunomodulating agents and medications for the alimentary and metabolic tract. DU90% consisted of 64 medications, medication consumption being 8,39 daily de-fined doses (DDD)/1 000 patients, costing 5 216 Colombian pesos per DDD. CONCLUSIONS: This analysis led to identifying medications whose formulation frequency did not correlate with an epidemiologic profile as immunomudulator and growth-hormone (somatotropin) agents. There were differences in the frequency and quantity of DDD medications authorised by type of affiliation which could thus be providing evidence of obstacles to the population having access to drugs/medicaments.

Perfiles hematológicos e hidroelectrolíticos en sujetos sedentarios durante ejercicio de resistencia: efecto de la hidratación / Hematological and hydroelectrolytical profiles of sedentary subjets during endurance exercise: effect on the hydratacion

Prevenir la deshidratación durante el ejercicio, ingiriendo regularmente fluidos, es indispensable para asegurar un bienestar físico y mental en los sujetos; los estudios referentes al tema se centran en deportistas, dejando de lado la población sedentaria. El objetivo de este trabajo fue determinar los cambios en variables hematimétricas e hidroelectrolíticas en sujetos sedentarios a 2.600 metros sobre el nivel del mar, ante la ingesta de dos tipos de hidratación durante noventa minutos de ejercicio en bicicleta al 50 por ciento del consumo pico de oxígeno (VO2pico). En el estudio participaron treinta voluntarios sanos de ambos sexos, con edades entre los veinte y cuarenta años, que se distribuyeron en tres grupos; todos fueron sometidos a ejercicio en bicicleta, proporcionándoles, según protocolo de la American College of Sports Medicine (ACSM), hidratación con agua a un grupo, con bebida con contenido en carbohidratos a otro y ningún tipo de hidratación al tercero. Se les tomó muestras de sangre antes, durante y después del ejercicio, para hacer mediciones de hemoglobina, hematocrito, cambios de volumen plasmático, osmolaridad plasmática y concentración de sodio y potasio. Se pudo observar que el ejercicio físico con las características planteadas no produjo estrés orgánico suficiente como para llevar a estados de deshidratación y, que a pesar de producir descensos leves en el peso corporal, no se afectó el balance electrolítico del organismo. La hidratación con agua generó cambios leves en la concentración de sodio, hecho que no se observó con la hidratación con bebida que contiene carbohidratos más electrolitos. Se puede concluir que ejercicio físico en bicicleta realizado durante noventa minutos a una intensidad del 50 por ciento al 60 ppr cviento del VO2pico en sujetos sedentarios se tolera adecuadamente, generando descensos leves en el peso corporal y que el protocolo de hidratación recomendado por la ACSM es adecuado para sujetos sedentarios...