Clinical standards for the diagnosis and management of asthma in low- and middle-income countries.

BACKGROUND: The aim of these clinical standards is to aid the diagnosis and management of asthma in low-resource settings in low- and middle-income countries (LMICs).METHODS: A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards.RESULTS: Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and post-bronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94-98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3-5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding dry-powder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0-3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6-11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12-18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS.The following standards (14-18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual's lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available.CONCLUSION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings.

Terapias para la comunicación en personas con esclerosis múltiple / Therapies for communication in people with multiple sclerosis

People with Multiple Sclerosis (MS) can present a variety of communication disorders that affect their roles and social participation, affecting their quality of life and that of their environment. An early approach to these people and their communication difficulties could improve/compensate/facilitate communication, minimizing the effects on their daily life. Purpose: To contribute with recommendations for communication therapy in people with MS. Method: narrative literature review related to the topic. Results: There are few investigations focused on the intervention of communication in people with MS, those found are works in small populations, with evaluations at the beginning and at the end of therapy. The most promising studies are those that show specific effects on speech, through the LSVT LOUD, which not only improves communicative effectiveness, but has also shown improvements in dysphagia (eating disorder). significant to consider interventions with the environment and aimed at the quality of life of the affected individuals and families. Conclusions: The different presentations that MS has and its individual characteristics in each person, makes it difficult to have specific evidence on the most effective types of therapy. Despite this, it is possible to use therapies focused on different communication symptoms and adapt them under certain considerations to address communication in people with MS. (AU)

Isolation and characterization of high affinity and highly stable anti-Chikungunya virus antibodies using ALTHEA Gold Libraries™.

BACKGROUND: More than 3 million infections were attributed to Chikungunya virus (CHIKV) in the 2014-2016 outbreak in Mexico, Central and South America, with over 500 deaths directly or indirectly related to this viral disease. CHIKV outbreaks are recurrent and no vaccine nor approved therapeutics exist to prevent or treat CHIKV infection. Reliable and robust diagnostic methods are thus critical to control future CHIKV outbreaks. Direct CHIKV detection in serum samples via highly specific and high affinity anti-CHIKV antibodies has shown to be an early and effective clinical diagnosis. METHODS: To isolate highly specific and high affinity anti-CHIKV, Chikungunya virions were isolated from serum of a patient in Veracruz, México. After purification and characterization via electron microscopy, SDS-PAGE and binding to well-characterized anti-CHIKV antibodies, UV-inactivated particles were utilized as selector in a solid-phase panning in combination with ALTHEA Gold Libraries™, as source of antibodies. The screening was based on ELISA and Next-Generation Sequencing. RESULTS: The CHIKV isolate showed the typical morphology of the virus. Protein bands in the SDS-PAGE were consistent with the size of CHIKV capsid proteins. UV-inactivated CHIKV particles bound tightly the control antibodies. The lead antibodies here obtained, on the other hand, showed high expression yield, > 95% monomeric content after a single-step Protein A purification, and importantly, had a thermal stability above 75 °C. Most of the antibodies recognized linear epitopes on E2, including the highest affinity antibody called C7. A sandwich ELISA implemented with C7 and a potent neutralizing antibody isolated elsewhere, also specific for E2 but recognizing a discontinuous epitope, showed a dynamic range of 0.2-40.0 mg/mL of UV-inactivated CHIKV purified preparation. The number of CHIKV particles estimated based on the concentration of E2 in the extract suggested that the assay could detect clinically meaningful amounts of CHIKV in serum. CONCLUSIONS: The newly discovered antibodies offer valuable tools for characterization of CHIKV isolates. Therefore, the strategy here followed using whole viral particles and ALTHEA Gold Libraries™ could expedite the discovery and development of antibodies for detection and control of emergent and quickly spreading viral outbreaks.

Trastornos de la comunicación en personas con esclerosis múltiple e instrumentos de evaluación / Communication disorders in people with multiple sclerosis and evaluations instruments

Communication is an essential part of our social participation and the need to know how to evaluate and deal with its alterations is essential when working with people with neurological pathologies such as Multiple Sclerosis (MS). Purpose: to carry out a bibliographic review and group information related to communication problems, describing useful instruments for timely evaluation in the different areas involved. Material and method: bibliographic review related to the subject. Results: People with MS can face differents communication problems (aphasia, dysarthria or cognitive communicative disorder), it is important to have the characterization of these disorders and with tools that specifically carry out a pertinent evaluation with common language among experts. Conclusions: considering the importance of communication, its disorders as a consequence of MS and the forms of evaluation are a priority when intervening with this population. (AU)

A peptide derived from phage-display limits psoriasis-like lesions in mice.

BACKGROUND: Psoriasis is a pro-inflammatory disease with unknown etiology, that is characterized by skin inflammation and keratinocytes hyperproliferation. Specific inhibition of inflammation has shown positive effects avoiding the progression of the psoriatic lesions in different animal models of the disease, turning this strategy as a remarkable therapeutic alternative. OBJECTIVE: To screen the effectiveness of a novel IFN-α/ß signalling inhibitor in the development reduction of skin lesions in IMQ and TPA mice models of psoriasis. METHODS: We used a Phage-peptide library for the screening of a peptide with inhibitory effects on the development of psoriasis-like lesions in mice. To evaluate the in vivo effect of the phage-peptides (Phpep3D) and the derived peptide (Pep3D), we administered Phpep3D or Pep3D intradermally in mice with imiquimod (IMQ)-induced psoriasis and 12-O-tetradecanoyl phorbol-13-acetate (TPA)-induced psoriasis. We scored the lesions, and we determined the number of neutrophils and the production of some pro-inflammatory cytokines in the lesions. RESULTS: In this work, we describe how the Ph3pepD and Pep3D reduced skin thickness, redness, and acanthosis despite the presence of the psoriasis inducers, IMQ or TPA. We also found that Pep3D reduced the number of GR1+ infiltrated cells and decreased the production of IL-17A and TNFα in the psoriatic skin of mice. In-silico, docking analysis showed that Pep3D may interact with the interferon-alpha receptor, but further analyses should be performed to uncover the mechanism of action of this peptide. CONCLUSION: Our results suggest that Pep3D could be used as a new treatment for psoriasis.

Agrupación nutricional de las frutas y hortalizas en Venezuela / Nutritional grouping of fruits and vegetables in Venezuela

La falta de una clasificación única para las frutas y hortalizas (FyH) representa un reto al establecer recomendaciones o realizar evaluaciones de su consumo. Por ello, este estudio tiene como objetivo examinar la agrupación de las FyH en Venezuela, considerando únicamente su composición nutricional, en pro de ofrecer criterios científicos que puedan ayudar a establecer posteriormente una clasificación apropiada. Se trata de una investigación descriptiva y transversal que utilizó como fuente secundaria a los valores nutricionales presentados en la Tabla de Composición de Alimentos venezolana. Se compararon los aportes nutricionales de 73 frutas y 47 hortalizas, contra otros 27 alimentos de 8 grupos considerados como suplementarios. Se realizó una comparación entre los grupos de alimentos con la prueba ANOVA, una comparación entre las FyH a través de un análisis de componentes principales y se establecieron grupos de FyH a través del análisis por conglomerados. Se encontró que las FyH se distinguen significativamente de los otros grupos de alimentos, por su alto contenido de agua >80% y ácido ascórbico >35%, con un bajo aporte de proteínas <2% y grasas <1% (p<0,05). Se establecieron 5 grupos de FyH, de los cuales 2 distaron significativamente del promedio por su alto contenido de grasa, sodio o carbohidratos. Los hallazgos sugieren que el aporte nutricional pareciera no ser un factor concluyente para diferenciar entre las frutas y las hortalizas. En conclusión, establecer una clasificación definitiva de FyH considerando únicamente su aporte nutricional, sería limitado, ya que podrían ser muchos otros los factores intervinientes(AU)

The lack of a single classification for fruits and vegetables (F&V) represents a challenge when is necessary establishing recommendations or evaluating their consumption. This study aims to examine the grouping of F&V in Venezuela, considering only their nutritional composition, in order to offer scientific criteria that can help to establish an appropriate classification later. It is a descriptive and cross-sectional investigation that used as a secondary source the nutritional values presented in the Venezuelan Food Composition Table. The nutritional contributions of 73 fruits and 47 vegetables were compared against another 27 foods of 8 groups considered as supplementary. A comparison was made between the food groups with the ANOVA test, a comparison between the F&V through a principal component analysis and F&V groups were established through the cluster analysis. It was found that F&V are major distinguished from other food groups, due to their high-water content >80% and ascorbic acid >35%, with a low protein content <2% and fat <1% (p <0, 05). 5 F&V groups were established, of which 2 were significantly different from the average due to their high content of fat, sodium or carbohydrates. The findings suggest that the nutritional contribution appears not to be a conclusive factor to differentiate between fruits and vegetables. In conclusion, establishing a definitive classification of FyH considering only its nutritional contribution would be limited, since there could be many other factors involved(AU)

Utilization of naproxen by Amycolatopsis sp. Poz 14 and detection of the enzymes involved in the degradation metabolic pathway.

The pollution of aquatic environments by drugs is a problem for which scarce research has been conducted in regards of their removal. Amycolatopsis sp. Poz 14 presents the ability to biotransformation naphthalene at high efficiency, therefore, in this work this bacterium was proposed as an assimilator of naproxen and carbamazepine. Growth curves at different concentrations of naproxen and carbamazepine showed that Amycolatopsis sp. Poz 14 is able to utilize these drugs at a concentration of 50 mg L-1 as a source of carbon and energy. At higher concentrations, the bacterial growth was inhibited. The transformation kinetics of naproxen showed the total elimination of the compound in 18 days, but carbamazepine was only eliminated in 19.9%. The supplementation with cometabolites such as yeast extract and naphthalene (structure similar to naproxen) at 50 mg L-1, showed that the yeast extract shortened the naproxen elimination to 6 days and reached a higher global consumption rate compared to the naphthalene cometabolite. The biotransformation of carbamazepine was not improved by the addition of cometabolites. The partial sequencing of the genome of Amycolatopsis sp. Poz 14 detected genes encoding putative enzymes for the degradation of cyclic aromatic compounds and the activities of aromatic monooxygenase, catechol 1,2-dioxygenase and gentisate 1,2-dioxygenase exhibited their involving in the naproxen biodegradation. The HPLC-MS analysis detected the 5-methoxysalicylic acid at the end of the biotransformation kinetics. This work demonstrates that Amycolatopsis sp. Poz 14 utilizes naproxen and transforms it to 5-methoxysalicylic acid which is the initial compound for the catechol and gentisic acid metabolic pathway.

Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico.

BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.

The yin/yang of inflammatory status: Blood-brain barrier regulation during sleep.

Sleep loss induces a low-grade inflammatory status characterized by a subtle but sustained increase of pro-inflammatory mediators, which are key regulators of blood-brain barrier function. To investigate the influence of inflammatory status on blood-brain barrier dysfunction induced by sleep restriction we performed an experiment using two strains of mice with different immunological backgrounds, C57BL/6 mice that have a predominant pro-inflammatory response and BALB/c mice that have a predominant anti-inflammatory response. Mice were sleep-restricted during 10 days using the flowerpot technique during 20 h per day with 4 h of daily sleep opportunity. The systemic inflammatory status, blood-brain barrier permeability, and the hippocampal expression of neuroinflammatory markers were characterized at the 10th day. Serum levels of TNF and IFN-γ increased in sleep-restricted C57BL/6 but not in BALB/c mice; no changes in other cytokines were found. Sleep restriction increased blood-brain barrier permeability in C57BL/6 strain but not in BALB/c. The hippocampus of sleep-restricted C57BL/6 mice exhibited an increase in the expression of the neuroinflammatory markers Iba-1, A2A adenosine receptor, and MMP-9; meanwhile in sleep-restricted BALB/c mice the expression of this markers was lesser than the control group. These data suggest that cytokines may be playing a key role in modulating blood-brain barrier function during sleep restriction, and probably the effects are related to Iba-1, MMP-9 and A2A adenosine receptor overexpression.

Cervical cancer cells suppress effector functions of cytotoxic T cells through the adenosinergic pathway.

BACKGROUND: The expression of CD73 in tumor cells plays a significant role in the production of adenosine (Ado) that suppresses antitumor effector cells. METHODS: In this study we analyzed the capability of HPV-positive (HPV+) cervical cancer (CeCa) cell lines CaSki, SiHa, HeLa, and RoVa; and HPV-negative (HPV-) cell lines C33A and ViBo to produce Ado and inhibit effector functions of CD8+ T cells. RESULTS: HPV+ CeCa cells expressed significantly higher levels of CD73 in the membrane (p<0.01) than HPV- CeCa cells and this expression was associated with the production of larger amounts of Ado (>400µM) compared to HPV-CeCa cells (<200µM) in the presence of AMP, as well asa stronger inhibition of (>50%) proliferation, activation, and cytotoxic activity of CD8+ T cells via interaction with A2A adenosine receptor. We also provide evidence that silenced E6/E7 expression in CeCa cells, strongly reduced its CD73 expression level and its capability to generate Ado. CONCLUSION: This results suggest that HPV infection, which is associated with more than 99% of CeCa cases, may present an increased constitutive expression of CD73 in cervical neoplasia to contribute to the suppression of the immune response mediated by the production of large amounts of Ado.

Extensive preclinical evaluation of an infliximab biosimilar candidate.

Infliximab is therapeutic monoclonal antibody (mAb) against TNF-α employed in the treatment of immunoinflammatory diseases. The development of biosimilar mAbs is a global strategy to increase drug accessibility and reduce therapy-associated costs. Herein we compared key physicochemical characteristics and biological activities produced by infliximab and infliximab-Probiomed in order to identify functionally relevant differences between the mAbs. Binding of infliximab-Probiomed to TNF-α was specific and had kinetics comparable to that of the reference product. Both mAbs had highly similar neutralizing efficacy in HUVEC cell cultures stimulated with TNF-α. In vitro induction of CDC and ADCC were also similar between the evaluated products. In vivo comparability was assessed using a transgenic mouse model of arthritis that expresses human TNF-α in a 13-week multiple-administration study. Infliximab and infliximab-Probiomed showed comparable efficacy, safety, and pharmacokinetic profiles. Our results indicate that infliximab-Probiomed has highly similar activities to infliximab in preclinical models, warranting a clinical evaluation of its biosimilarity.

Caracterización de fonoaudiólogos/as insertos/as en centros comunitarios de rehabilitación / Characterization of speech therapists inserts in communitarian rehabilitation centers

El quehacer fonoaudiológico actualmente se encuentra influenciado por perspectivas de atención en salud que promueven una atención basada en el modelo biopsicosocial, el cual propende a la inclusión social de personas en situación de discapacidad. En este contexto, la presente investigación pretende caracterizar el quehacer profesional de fonoaudiólogos/as insertos en Centros Comunitarios de Rehabilitación (CCR) que utilizan una estrategia comunitaria (Rehabilitación Basada en la Comunidad, RBC) para llevar a cabo sus procesos de evaluación, diagnóstico y rehabilitación. Este estudio cualitativo se enmarca en un enfoque microsociológico relacionado con la exploración de las prácticas profesionales en contextos de salud. La recolección de datos se realizó mediante la técnica de entrevistas en profundidad y observación no participante de las prácticas de dos fonoaudiólogos que fueron registradas en bitácoras. La información obtenida fue procesada mediante análisis de contenido. Los profesionales fonoaudiólogos definieron su rol por medio de diferentes acciones que promueven su incorporación a un equipo multidisciplinario de atención y la participación activa, tanto del usuario como de la familia, en el proceso de rehabilitación. Se discute la suficiencia de las acciones fonoaudiológicas para explicar aspectos específicos del rol y diferencias en las formas de llevar a cabo las prácticas basadas en esta estrategia comunitaria de rehabilitación. Finalmente, la expresión de esta estrategia es parcial y constituye aún un desafío para el/la fonoaudiólogo/a basar la totalidad de su práctica diaria en dicha estrategia.

The speech therapists task is currently influenced by prospects of health care based on biopsychosocial model; which tends to social inclusion of people with disabilities. In this text, this article aims to characterize professional work of speech therapists inserts in Communitarian Rehabilitation Centers (CRC) using community strategy (Community based rehabilitation, RBC) to carry out assessment, diagnosis and rehabilitation processes. This qualitative research is part of a micro sociological approach which explores professional practices in health contexts. Data collection was performed using in-depth interview and nonparticipating technique in observation of two speech therapists practice that were recorded in logbooks. The information obtained was analyzed through content analysis. Speech therapists defined their role through actions that promoted their incorporation to a multidisciplinary health team, and the active participation of both the user/patient and the family in the rehabilitation process. The adequacy of actions to explain role specific aspects and carry out ways differences of speech therapists practice based on this communitarian rehabilitation strategy. Finally, expression of this strategy is partial and is still a challenge for speech therapists to base their daily practice on this strategy.

Manejo de la sialorrea en personas con enfermedad de Parkinson mediante terapia conductivo conductual y estimulación termo-táctil / Management of sialorrhea in people with Parkinson's disease through behavioral therapy and thermotactile stimulation

This study proposes a Speech Therapy treatment for individuals with sialorrhea (saliva production perceived by patient as excessive) as a consequence of Parkinson Disease (PD). Method: A prospective study in 18 individuals with PD diagnosis was taken and divided into two groups: A) received only Cognitive Behavioral Therapy (CBT) (swallowing process awareness), while B) received CBT plus Thermal Tactile Stimulation (TTS) (cold sensory stimulation to the pharyngeal anterior pillars and oral cavity). The intervention lasted 5 weeks. The purpose of this research was to prove the effectiveness of Speech Therapy in dealing with sialorrhea and to assess a significant difference between CBT and CBT plus TTS. A t-student parameter test and the Mann-Withney test were used. Resulted: The assessment by the Clinical Scale for Parkinson Sialorrhea (SCS-PD) prior to therapy was CBT group was 2.6 and 11.5 ± 9.4 ± 4.2 group difference was not statistically significant. After therapy was 3.5 ± 2.8 and 4.6 ± 3.5 both showed a statistically significant difference compared to baseline (p < 0.001), not having statistically significant difference between them. Conclusion: These tests showed that both treatments are effective to decrease sialorrhea perception in individuals with PD. Nevertheless, no statistical significant differences were noted between both treatments.

Introducción: Este estudio propone un tratamiento Fonoaudiológico para trabajar con personas que presentan sialorrea (producción de saliva que el paciente percibe como excesiva) producto de la Enfermedad de Parkinson (EP). Método: Dieciocho personas con diagnóstico de EP y sialorrea, las cuales se dividieron en dos grupos; A: recibió sólo Terapia Cognitivo Conductual (TCC) (concientización del proceso deglutorio), mientras el B: recibió TCC más Estimulación Termo Táctil (ETT) (se realiza estimulación sensorial con frío a los pilares faríngeos anteriores y cavidad oral), la intervención se realizó por 5 semanas. El objetivo de la presente investigación es evidenciar la efectividad de la terapia Fonoaudiológica en el abordaje de la sialorrea y evaluar si existe una diferencia significativa entre la TCC y la TCC más ETT. Se utilizó la prueba paramétrica t-student, y Test de Mann-Withney, se consideró significativo un p < 0,05. Resultados: La valoración mediante la Escala Clínica de la Sialorrea para Parkinson (SCS-PD) previo a la terapia en grupo con TCC 11,5 ± 2,6 y el grupo 9,4 ± 4,2 diferencia que no es estadísticamente significativa. Posterior a la terapia fue 3,5 ± 2,8 y 4,6 ± 3,5 ambos presentaron una diferencia estadísticamente significativa respecto a la basal (p < 0,001), no habiendo diferencia estadísticamente significativa entre ellas. Conclusión: Estas pruebas demostraron que ambos tratamientos son efectivos para disminuir la percepción de sialorrea en las personas con EP. Sin embargo, no se evidencian diferencias estadísticamente significativas entre ambos tratamientos.

A French collaborative survey of 272 fetuses with 22q11.2 deletion: ultrasound findings, fetal autopsies and pregnancy outcomes.

OBJECTIVE: The 22q11.2 deletion (del22q11.2) is one of the most common microdeletions. We performed a collaborative, retrospective analysis in France of prenatal diagnoses and outcomes of fetuses carrying the del22q11.2. METHODS: A total of 272 fetuses were included. Data on prenatal diagnosis, ultrasound findings, pathological features, outcomes and inheritance were analyzed. RESULTS: The mean time of prenatal diagnosis was 25.6 ± 6 weeks of gestation. Most of the diagnoses (86.8%) were prompted by abnormal ultrasound findings [heart defects (HDs), in 83.8% of cases]. On fetal autopsy, HDs were again the most common disease feature, but thymus, kidney abnormalities and facial dysmorphism were also described. The deletion was inherited in 27% of cases. Termination of pregnancy (TOP) occurred in 68.9% of cases and did not appear to depend on the inheritance status. However, early diagnosis was associated with a higher TOP rate. CONCLUSION: This is the largest cohort of prenatal del22q11.2 diagnoses. As in postnatally diagnosed cases, HDs were the most frequently observed abnormalities. However, thymus and kidney abnormalities and polyhydramnios should also be screened for in the prenatal diagnosis of del22q11.2. Only the time of diagnosis appeared to be strongly associated with the pregnancy outcome: the earlier the diagnosis, the higher the TOP rate.

Endometriosis tracto urinario: revisión de la literatura / Urinary tract endometriosis: review of the literature

Se define como endometriosis a la presencia de tejido endometrial fuera de la cavidad uterina. La endometriosis del tracto urinario (ETU) se refiere a la presencia de tejido endometrial en o alrededor de la vejiga, uréteres, uretra o riñones, lo que ocurre en alrededor de 1por ciento de los casos. El objetivo de esta revisión es realizar una puesta al día en los conceptos relativos a esta rara enfermedad. Se analiza clínica, fisiopatología y tratamiento.

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. Urinary tract endometriosis (ETU) refers to the presence of endometrial tissue in or around the bladder, ureters, urethra or kidneys, which occurs in about 1percent of cases. The objective of this review is to update the concepts concerning this rare disease. Clinic, pathophysiology and treatment are discussed.

An imbalance between frequency of CD4+CD25+FOXP3+ regulatory T cells and CCR4+ and CCR9+ circulating helper T cells is associated with active perennial allergic conjunctivitis.

Allergic conjunctivitis (AC) is one of the most common eye disorders in ophthalmology. In mice models, it has been suggested that control of allergic conjunctivitis is a delicate balance between Tregs and inflammatory migrating effector cells. Our aim was to evaluate the frequency of Tregs and the frequency of homing receptors expressing cells in peripheral blood mononuclear cells (PBMC) from patients with perennial allergic conjunctivitis (PAC). The analyses of phenotypic markers on CD4+ T cells and both soluble or intracellular cytokines were performed by flow cytometry. CD4+CD25+ cells were 15 times more frequent in PBMC from patients than HC; the vast majority of these CD4+CD25+ cells were FOXP3-, and most of CD4+ T cells were CCR4+ and CCR9+ cells. Upon allergen-stimulation, no significant changes were observed in frequency of Treg; however, an increased frequency of CD4+CCR4+CCR9+ cells, CD4+CD103+ cells and CD4+CD108+ cells with increased IL-5, IL-6, and IL-8 production was observed. These findings suggest an immune dysregulation in PAC, characterized by diminished frequency of Tregs and increased frequency of circulating activated CD4+ T cells; upon allergen-stimulation, these cells were expressing cell-surface molecules related to mucosa homing and were able to trigger an inflammatory microenvironment.

Aplicabilidad de simuladores de mediana complejidad en el proceso de formación de residentes de ginecología y obstetricia / Use of simulators in the process of residency training in obstetric and gynecology

Antecedentes: El entrenamiento de técnicas quirúrgicas durante la formación de gineco-obstetras encuentra dificultades por razones de seguridad de la paciente y del recién nacido. Una de las estrategias utilizadas es el uso de simuladores para facilitar la adquisición de las habilidades necesarias para resolver situaciones críticas frecuentes en la práctica médica, salvaguardando la ética en la enseñanza y mejorando su calidad. Objetivos: Evaluar el uso de simuladores de parto interactivo de mediana complejidad (Noelle® Gaumard Scientific, Miami, FL) como método de educación médica para adquirir las destrezas necesarias en la atención de un parto operatorio con Espátulas de Thierry. Método: Diseño: estudio piloto prospectivo controlado. Sujetos: seis médicos en formación de la especialidad de la Universidad de los Andes. Se definieron aleatoriamente 2 grupos estratificados por año de formación. A todos se les instruyó en sesión teórica sobre el uso de las espátulas. La mitad tuvo una sesión práctica. Se utilizó un simulador y pautas estandarizadas para evaluar la adquisición de habilidades. Resultados: Se expresó según el porcentaje del puntaje máximo logrado para cada prueba. El grupo experimental tuvo un resultado en la evaluación práctica de 90/25/90 por ciento. El grupo control 35/70/65 por ciento. Se observó menos diferencias inter grupos en la prueba teórica. Conclusión: Las habilidades asociadas al uso de las espátulas de Thierry se adquirieron más completamente en el grupo expuesto a un taller con simuladores de mediana complejidad.

Background: The training on surgical techniques during the instruction of obstetrician-gynecologists finds some difficulties because of patient and newborn's safety concern. One of the strategies is to use simulators that facilitate the acquisition of the skills required to solve critical situations, common in medical practice. Objective: To evaluate the use of simulators (NoelleÕ Gaumard Scientific, Miami, FL) in medical education as a mean to acquire the skills needed for an instrumental delivery using Thierry's spatulas. Methods: Design: prospective controlled pilot study. Participants: six medical residents of obstetrics and gynecology from Los Andes University. They were randomized on two groups stratified by years of resideney. All of them received a lecture on Thierry's spatulas. Half of them also had a workshop. A simulator and standardized guidelines were used to evaluate the skills acquisition. Results: They were stated by the percentage of maximum score achieved to each test. The experimental group had a practical score of 90/25/90 percent. The control group got 35/70/65 percent. There were few differences in the written test between groups. Conclusion: The experimental group showed a better performance in the use of Thierry's spatulas.

Niveles de ácidos grasos poliinsaturados omega-3 en membranas de eritrocitos de mujeres con depresión / Omega-3 polyunsaturated fatty acids in red blood cell membranes from depressed female patients

There is a hypothesis that lack ofn-3 polyunsaturated fatty acids (n-3 PUFA) is of etiological importance in depression. Docosahexaenoic acid (DHA), a member of the n-3 PUFA family, is a crucial component of synaptic cell membranes. Objective: The aim of this study was to measure red blood cell (RBC) membrane n-3 fatty acids in a group of depressed female patients relative to a matched healthy control group. Methods: We measured the fatty acid composition of membranes from RBC of 9 female depressive patients and 6 healthy controls subjects. Results: There was a significant depletion of RBC membrane n-3 PUFAs in the depressed subjects. This result agrees with the international evidence and opens a new line of investigation on etiology of the depression.

Actualmente existe una hipótesis que vincula la disminución de ácidos grasos poliinsaturados omega-3 (AGPI n-3), en diversos tejidos, con la depresión. El ácido docosahexaenoico (DITA), uno de los miembros más importantes de los AGPI n-3, cumple importantes funciones en las membranas sinápticas. Objetivo: evaluar si pacientes con depresión presentan niveles disminuidos de ácidos grasos omega-3. Sujetos y métodos: se seleccionaron 9 pacientes mujeres en tratamiento por depresión de un consultorio de Puente Alto y 6 controles pareados por edad y sexo, a quienes se midió el perfil de ácidos grasos en membrana de eritrocitos. Resultados y conclusiones: Se demostró una disminución significativa de los niveles de AGPI n-3 en las membranas de eritrocitos de las depresivas. Este resultado concuerda con la evidencia expuesta en la literatura internacional y fomenta la investigación en este nuevo campo sobre una posible etiología de la depresión.

Leontiasis ossea: a paleopathologic case report.

We describe the archeological and imaging findings of a unique specimen (skull and mandible) with leontiasis ossea (LO) that is on display in the National Museum of Anthropology and History in Mexico City. The specimen shows diffuse and irregular periosteal bone proliferation, which produces a grossly nodular appearance involving the neurocranium and the facial skeleton. Plain radiography and helical computed tomography revealed generalized hyperostosis obliterating the maxillary and sphenoidal sinuses and 2 exuberant bony masses arising from the maxilla with encroachment of the anterior nasal aperture.Currently, LO is a purely descriptive term applied to a variety of osseous conditions that have in common hyperostosis of craniofacial bones leading to a leonine appearance. Clinicians who see such lionlike facies should consider the main causes of LO, which include renal osteodystrophy, Paget disease and, as most likely in this specimen, fibrous dysplasia.