In silico and in vitro analysis of cation-activated potassium channels in human corneal endothelial cells.

The corneal endothelium is the inner cell monolayer involved in the maintenance of corneal transparence by the generation of homeostatic dehydration. The glycosaminoglycans of the corneal stroma develop a continuous swelling pressure that should be counteracted by the corneal endothelial cells through active transport mechanisms to move the water to the anterior chamber. Protein transporters for sodium (Na+), potassium (K+), chloride (Cl-) and bicarbonate (HCO3-) are involved in this endothelial "pump function", however despite its physiological importance, the efflux mechanism is not completely understood. There is experimental evidence describing transendothelial diffusion of water in the absence of osmotic gradients. Therefore, it is important to get a deeper understanding of alternative models that drive the fluid transport across the endothelium such as the electrochemical gradients. Three transcriptomic datasets of the corneal endothelium were used in this study to analyze the expression of genes that encode proteins that participate in the transport and the reestablishment of the membrane potential across the semipermeable endothelium. Subsequently, the expression of the identified channels was validated in vitro both at mRNA and protein levels. The results of this study provide the first evidence of the expression of KCNN2, KCNN3 and KCNT2 genes in the corneal endothelium. Differences among the level of expression of KCNN2, KCNT2 and KCNN4 genes were found in a differentially expressed gene analysis of the dataset. Taken together these results underscore the potential importance of the ionic channels in the pathophysiology of corneal diseases. Moreover, we elucidate novel mechanisms that might be involved in the pivotal dehydrating function of the endothelium and in others physiologic functions of these cells using in silico pathways analysis.

T2 formula in a highly myopic population, comparison with other methods and description of an improved approach for estimating corneal height.

BACKGROUND: To determine the accuracy of the T2 formula as applied to highly myopic eyes, to compare the T2 formula to the SRK/T and Holladay 1 formulas, and to describe possible ways to improve the estimation of corneal height and prediction error in two settings, the Hadassah Hospital, Ophthalmology Department, Jerusalem, Israel and Clínica Barraquer, Bogotá, Colombia. METHODS: In this retrospective case series, optical biometer measurements were taken for 63 highly myopic patients (> 25 mm) undergoing uneventful crystalline lens phacoemulsification and insertion of an acrylic intraocular lens. Prediction errors were obtained, with estimations of ±0.50 D, ± 1.00 D, and greater than ±2.00 D. A method to improve the corneal height calculation is described. RESULTS: The SRK/T formula (mean absolute error [MAE] = 0.418; median absolute error [MedAE] = 0.352) was the most accurate, followed by the T2 (MAE = 0.435; MedAE = 0.381) and Holladay 1 (MAE = 0.455; MedAE = 0.389) formulas. Both the SRK/T and T2 formulas overestimated corneal height, but values were higher with the T2 formula. Corneal height was more precisely estimated using an alternative method that, when combined with axial length optimization, resulted in lower MAE (0.425) and MedAE (0.365) values than when applying the T2 formula alone. CONCLUSIONS: The T2 formula seems to be less accurate than the SRK/T formula in highly myopic eyes. An improved corneal height estimation method is described for the the T2 formula.

Risk factors for COVID-19 hospitalisations and deaths in Mexican children and adolescents: retrospective cross-sectional study.

OBJECTIVE: To describe the epidemiology and risk factors for hospitalisation and death in Mexican children under 18 years of age with COVID-19. DESIGN: Retrospective, cross-sectional and analytical study. SETTING: Mexican Ministry of Health open databases with COVID-19 cases occurred from 7 March 2020 to 30 September 2021. PARTICIPANTS: Mexican children under 18 years of age with COVID-19. MAIN OUTCOME MEASURES: COVID-19 hospitalisations and deaths were characterised by age group, sex, presence of pneumonia and comorbidities, intubation and intensive care unit admission, and institution that provided medical care. Cumulative incidence, mortality, case fatality rates and ORs for hospitalisation and death were estimated by age group. RESULTS: 5.5% (204 641) of national COVID-19 cases were children under 18 years of age: 2.9% under 1 year, 12.5% from 1 to 5 years, 15% from 6 to 9 years and 69.4% from 10 to 17 years. 4.6% of all cases were hospitalised, from which 54.6% were male, 35.3% were children under 1 year old, 39.6% were adolescents and 34% had pneumonia. Pneumonia developed in 2.3% of cases, from which 50% were adolescents. Case fatality rate was higher in children less than 1 year old (4.2%). Risk analyses showed that male sex (OR 1.16-1.28), history of pneumonia (OR 29.7-65.4), immunosuppression (OR 5.3-42.9), cardiovascular disease (OR 4.4-14.6) and other comorbidities (OR 5.4-19.1), as well as age less than 1 year (OR 20.1, 95% CI 18.8 to 21.4), confer a greater risk of hospitalisation; in addition to comorbidities, age less than 1 year (OR 16.6, 95% CI 14.1 to 19.6), history of pneumonia (OR 14.1-135.1) and being an adolescent from an indigenous community (OR 2.6, 95% CI 1.23 to 5.54, p=0.012) increase the risk of death. CONCLUSIONS: In Mexico, children less than 1 year old with COVID-19 have higher risk of hospitalisation and death than older children. Adolescents with COVID-19 in association with comorbidities develop adverse outcomes more frequently.

[Our teenagers: still a pending subject]. / Nuestros adolescentes: una asignatura aún pendiente.

Background: Adolescents (ages 10-19) represent approximately 16% of the population in Mexico. This article identifies their main morbidity and mortality conditions, as well as current strategies and interventions to reduce preventable causes. Objective: Identify the main causes of morbidity, mortality, and disease burden in adolescents from 10 to 19 years of age, and current interventions to reduce mortality and improve adolescent health in the Mexican and international context. Method: A descriptive-exploratory statistical analysis of primary sources was performed to identify the main causes of adolescent morbidity and mortality in Mexico. Through a structured literature search, current policies, and interventions to improve adolescent health were identified. Results: Accidents are the second leading cause of death in adolescents aged 10 to 14 years and in the group of 15 to 19 years. Intentional injuries have increased in recent years, occupying the third cause of death in adolescents between 10 and 14 years old and the first cause of death among youngsters between 15 and 19 years old. Conclusions: The current health system urgently needs restructuring and reengineering, in which adolescent health and wellbeing intervention needs are considered.

Introducción: Los adolescentes (edades entre 10 y 19 años) representan aproximadamente el 16% de la población en México. En este artículo se identifica su principal de morbimortalidad, así como las estrategias e intervenciones actuales para reducir las causas prevenibles. Objetivo: Identificar las principales causas de morbilidad, mortalidad y carga de enfermedad en adolescentes, así como las intervenciones de salud pública actuales para reducir la mortalidad y mejorar la salud de los adolescentes en el contexto mexicano e internacional. Método: Se realizó un análisis estadístico, descriptivo-exploratorio, de fuentes primarias, para determinar las principales causas de morbilidad y mortalidad en adolescentes de México. Mediante búsqueda estructurada de la literatura se identificaron las políticas e intervenciones actuales para mejorar la salud de los adolescentes. Resultados: Los accidentes son la segunda causa de muerte en los adolescentes de 10 a 14 años y en el grupo de 15 a 19 años. Las lesiones intencionales se han incrementado en los últimos años, ocupando la tercera causa de muerte en adolescentes de entre 10 y 14 años y la primera entre los de 15 a 19 años Conclusiones: El actual sistema de salud necesita urgentemente una reestructura y una reingeniería que contemplen las necesidades de intervención en lo que respecta a la salud y el bienestar de nuestros adolescentes.

High Prevalence of Abnormal Ocular Surface Tests in a Healthy Pediatric Population.

PURPOSE: To describe ocular surface characteristics and tests' results in a healthy pediatric population. METHODS: We performed a cross-sectional study with 60 healthy children, obtaining consent, OSDI and screen use survey and conducting ocular surface tests. Statistical univariate analysis for categorical and quantitative variables was made. To describe the correlation of the results in both eyes, we used a model of random effects. To characterize the possible profiles of device use, we applied the mixed-cluster methodology. RESULTS: Sixty healthy children between 7 and 17 years old were evaluated. Girl's proportion was 41.6%. Mean Ocular Surface Disease Index Score was 9.98±8.49 points. Daily screen time was 5.59±2.77 hours and the most popular screen was the smartphone. Mean results (with standard deviations or confidence intervals) of ocular surface tests were blink frequency while reading on paper, 6.8±5.68 times per minute; blink frequency while reading on screen, 8.7±7.14 times per minute; tear meniscus height, 0.19[0.18-0.2] mm; non-invasive tear break-up time, 12.44[10.99-13.9] seconds; nasal conjunctival redness, 0.86[0.77-0.94]; temporal conjunctival redness, 0.96[0.87-1.04]; tear osmolarity, 299.3[295.14-303.45] mmol; and Schirmer test, 23.73[21.28-26.18] mm. Lid margin was irregular in three eyes; 44.7% had thin lipid layer; lissamine green staining was positive in 70.8%; fluorescein staining was positive in 47.4%; 36.64% exhibited partial meibomian gland loss. CONCLUSION: Considering the scarcity of specific pediatric values of ocular surface tests, we performed a clinical investigation involving the complete pool of ocular surface tests in children. Although healthy children were included in this study, we found that all the participants had at least one abnormal result and 33.33% had dry eye disease diagnosis, according to the TFOS DEWS II. It would be relevant to carry out further multicentric studies to compare our ocular surface tests' results with other groups of children.

[Shared Psychotic Disorder between Two Sisters]. / Trastorno psicótico compartido: a propósito de un caso entre dos hermanas.

INTRODUCTION: The Shared Psychotic Disorder, also known as "folie à deux", is a mental disorder characterized by the development of psychiatric symptoms (psychotic symptoms) in an individual within the context of a close interpersonal relationship with another individual who has an established mental illness, usually with the presence of delusions. It is not considered a common disorder, its diagnosis is rare and it is a condition in which psychosocial factors are vital for its development. OBJECTIVE: To present the case of two sisters, the social consequences and difficulties in the intervention as well as ethical issues related to involuntary hospitalization. To perform a brief review of the topic so as to have a framework for the case. METHOD: Case report. CONCLUSIONS: This case makes evident the difficulty to achieve an adequate pharmacological and psychotherapeutic intervention because delusion symptoms can affect not only one but several family members. Furthermore, this case accounts both for individual risks inherent to the disease and for social risks involving third parties.

Trastorno psicótico compartido a propósito de un caso entre dos hermanas / Shared psychotic disorder between two sisters

Introducción: El trastorno psicótico compartido, también conocido como folie à deux, es un trastorno mental caracterizado por el desarrollo de síntomas psiquiátricos (síntomas psicóticos) en un individuo que tiene una relación interpersonal cercana con otro individuo que tiene una enfermedad mental establecida (usualmente con presencia de delirios). No se considera un cuadro común, es un diagnóstico poco frecuente y una condición en la que los factores psicosociales son fundamentales para su desarrollo. Objetivo: Presentar el caso de dos hermanas con trastorno psiquiátrico compartido, ahondando en sus consecuencias sociales y en las dificultades en la intervención, al igual que en los aspectos éticos relacionados con la internación involuntaria. Realizar una breve revisión del tema para tener un marco de referencia frente al caso. etodología: Reporte de caso. Conclusiones: Se pone en evidencia la dificultad para realizar una adecuada intervención tanto farmacológica como psicoterapéutica, debido a que el delirio puede afectar no solo a uno, sino a varios miembros de la familia. Así mismo, este caso da cuenta de los riesgos individuales e inherentes a la enfermedad y de los riesgos sociales en los que se ven involucrados terceros…

Introduction: The Shared Psychotic Disorder, also known as “folie à deux”, is a mental disorder characterized by the development of psychiatric symptoms (psychotic symptoms) in an individual within the context of a close interpersonal relationship with another individual who has an established mental illness, usually with the presence of delusions. It is not considered a common disorder, its diagnosis is rare and it is a condition in which psychosocial factors are vital for its development. Objective: To present the case of two sisters, the social consequences and difficulties in the intervention as well as ethical issues related to involuntary hospitalization. To perform a brief review of the topic so as to have a framework for the case. Method: Case report. Conclusions:This case makes evident the difficulty to achieve an adequate pharmacological and psychotherapeutic intervention because delusion symptoms can affect not only one but several family members. Furthermore, this case accounts both for individual risks inherent to the disease and for social risks involving third parties…

Seguridad en el tratamiento de la migraña aguda durante el embarazo: una revisión sistemática / Safety in the acute management of migraine during pregnancy: a systematic review

Background. Migraine is three times more frequent in females than males and is modulated by changes in ovarian hormones throughout different stages of a female’s life; migraine thus begins with the onset of menstruation, improves during the second and third trimester of pregnancy and a remission may sometimes be brought about during menopause.Objetive.Evaluating the safety of acute management of migraine during pregnancy.Materials and methods. A systematic review was made of the literature concerning observational analytical studies. A systematic search and selection was made of all analytical studies (cohort studies and cases and controls studies) regarding the acute management of migraine during pregnancy published between January 1966 and September 2007. The search covered the COCHRANE, MEDLINE, EMBASE and LILACS databases. Data were extracted using the PECOT strategy bearing in mind the intervention strategy, methodological quality and presence of greater or lesser congenital malformations related to the different medicaments used for the acute management of migraine.Results. A total of 389 references were obtained of which 7 articles were selected by title and summary. Four articles complied with the inclusion criteria. No articles were found describing the risk of congenital malformations before being exposed to acetaminophen, anti-inflammatory agents non-steroidal, ergot alkaloids and/or opioids; just articles related to tryptans (specifically sumatryptan) were found.Conclusions. Only data concerning the risk of congenital malformations arising from sumatryptan use was found regarding all the medicaments used for acute migraine attack, this being insufficient as the information was really poor and the studies had limitations, thereby making it difficult to make statements concerning their safety during pregnancy.

Uso del activador de plasminógeno tisular recombinante (rt-PA) en el ataque cerebrovascular isquémico (ACVi) en Colombia: un estudio de costo-efectividad / Tissue plasminogen activador (rt-PA) for acute ischemic stroke in Colombia: a cost-effectiveness study

INTRODUCIÓN: en Colombia el ataque cerebrovascular (ACV) es un enorme problema de salud pública, es la tercera causa de muerte y la segunda de años de vida potenciales perdidos (AVPP). El rt-PA ha demostrado su costo-efectividad en el tratamiento del ACV. MATERIAL Y MÉTODOS: para estimar el costo-efectividad de la terapia trmbolítica se comparo la terpia usual contra la aplicación de terapia usual mas rt-PA, se calculo el costo del tratamiento y se calcularon los costo tanto de la complicación hemorrágica como de la discapacidad aguda y crónica en pesos colombianos con base en un tarifario de uso corriente en el sistema de salud nacional y se calculo la expectativa d evid apara un paciente típico de ACV. Dado que en Colombia no hay estudios de trombólisis se extrajeron los datos de ensayos con rt-PA, controlados con placebo; también se analizaron los meta-análisis sobre este tema. RESULTADOS: aunque el costo de la terapia usual es menor que el de la terpia combinada con rt-PA ésta es más efectiva y brinda una mejor costo efectivida (diferencia de 1,07 años de vida ajustados por QALYS), es decir que por cada año asi ajustado se deben invertir $1.138.373 pesos, como se demostró en el análisis de sensibilidad realizado para estos hallazgos. CONCLUSIÓN: la trombólisis con rt-PA es costo-efectiva en Colombia con las tarifas actuales del sistema y en los diversos escenarios contemplados en el análisis de sensibildad.

INTRODUCTION: stroke is a major public health problem in Colombia, is the third leading cause of death and second of potential life years lost. rt-PA has proven its cost-effectiveness in the treatment of ischaemic stroke. PATIENTS AND METHODS: to estimate the cost-effectiveness of thrombolytic therapy, usual therapy was compared against the application of usual therapy and rt-PA, cost treatments was calculate. The cost of both: hemorrhagic complications, acute and chronic disability was done in Colombian pesos based on a current price in national health system, life expectancy was calculated too for a typical stroke patient. Given that in Colombia there are no studies of thrombolytic theraphy we extracted data from trials with rt-PA and placebo-controlled, and also analyzed some meta-analysis on this subject. RESULTS: although the cost of usual therapy is less than the combined therapy, this one is more effective and it provides a better cost-efectiveness (difference of 1.07 years of life QALYS adjusted), meaning that for each year of life, the national healt system must invest $ 1,138,373 pesos, as demonstrated in the sensitivity analysis performed for these findings. CONCLUSION: thrombolysis with rt-PA is cost-effective in Colombia, with current prices of health system in differents sensitivity analysis.

Uso de anticonvulsionantes durante el embarazo y riesgo de malformaciones en el reciénc nacido, metaanálisis / Anticonvulsants use during the pregnancy and risk of malformations in the newly born, a meta-analysis

Objetivos: establecer si el riesgo de desarrollar malformaciones mayores (MM) es mayor en hijos de embarazadas con epilepsia, al compararlo con hijos de mujeres tomadas de la población general. Material y métodos: se emplearon las bases de datos MEDLINE, EMBASE, SCISEARCH y programas como ProQuest, HINARI y Ovid para acceder a la literatura médica de estudios en humanos. Se incluyeron los estudios de observación analíticos: casos y controles y estudios de cohorte que buscaran la presencia de MM en los productos de madres con epilepsia en tratamiento anticonvulsionante durante la correspondiente gestación. La MM se definió utilizando los criterios de Holmes. Se obtuvo la información sobre el número de neonatos expuestos y no expuestos que se diagnosticaban con MM, para crear las tablas de 2x2. Para cada estudio se calcularon los riesgos relativos, las razones de disparidad (odds ratio-OR-) y los intervalos de confianza (IC) del 95 por ciento. Resultados: se incluyeron 10 estudios de cohorte y cuatro estudios de casos y controles. Se incluyeron un total de 2.509 casos y 433.890 controles. Se encontraron MM en el 9,8 por ciento de los expuestos y en el 7,4 por ciento de los no expuestos (OR:2,7; IC 95 por ciento:2,062-3,641; p <0,000). No se pudo establecer asociación entre un anticonvulsionante y una malformación mayor específica. Conclusiones: los datos epidemiológicos disponibles permiten confirmar la hipótesis de un incremento del riesgo de desarrollar malformaciones mayores de dos a tres veces entre aquéllos expuestos a anticonvulsionantes durante el período de gestación

Los médicos y la industria farmacéutica: una relación de vulnerabilidad vista desde la bioética / The doctors and the pharmaceutical industry: a vulnerability relationship seen from the Bioethics

La prescripción farmacológica en la práctica clínica de nuestro quehacer diario exige que nos enfrentemos a una serie de influencias y responsabilidades, ya que cada decisión recae sobre un ser humano, el paciente, quien recibirá el medicamento y en lo posible sus beneficios. Hoy en día hay un gran número de presiones comerciales para formular uno u otro producto que generan un conflicto de intereses cuando el juicio profesional en relación con su interés primario se ve influenciado indebidamente por un interés secundario como puede ser un beneficio económico o un afán de notoriedad. Presentamos a continuación una aproximación al dilema ético que esta situación conlleva

A cirurgia refrativa na América latina: análise atualizada / Overview of refractive surgery in Latin America

Objetivo: avaliar o estágio atual da cirurgia refrativa na América Latina. Material e método: questionário analisando aspectos demográficos de cada país, técnicas realizadas, custo de equipamentos e preços cobrados por serviços säo estudados. Também säo analisadas as sugestöes e críticas ao estado atual da cirurgia refrativa em diferentes regiöes. Os questionários foram respondidos pelos representantes da International Society of Refractive Surgery. A data de término da pesquisa foi de 30/03/97. Resultados: Duas centenas de Excimer Lasers funcionam na América Latina. Os preços dos serviços variam de 200 a 2200 USD com variaçöes regionais. Queixas como comportamento antiético, alto preço dos equipamentos e baixo preço dos serviços se constituem nos ..

Reabsorción radicular asociada a injertos de tejido conectivo subepitelial en perros / Response of the root surface after the placement of a subepithelial connective tissue graft in dogs

El propósito de la siguiente investigación fué observar la respuesta de la superficie radicular posterior a la colocación de injerto de tejido conectivo subepitelial en perros. Se tomaron 4 perros adultos a los cuales se les crearon dehiscencias quirúrgicas en los cuatro incisivos anteriores superiores, tomando en cada perro dos control y dosis experimental; se tomó un injerto de conectivo del paladar, previa elevación de un colgajo parcial. Estos fueron colocados en dientes experimentales mientras que en los dientes control se posicionaron los colgajos. Los animales fueron sacrificados a los seis meses. El análisis histológico mostró que en ningún caso hubo reabsorción radicular, observándose migración epical del epitelio oral a lo largo de la superficie radicular; igualmente se observó una disposición paralela de las fibras de tejido conectivo. Un hallazgo interesante fué la evidencia de hipercementosis