A bipolar disorder-associated missense variant alters adenylyl cyclase 2 activity and promotes mania-like behavior.

The single nucleotide polymorphism rs13166360, causing a substitution of valine (Val) 147 to leucine (Leu) in the adenylyl cyclase 2 (ADCY2), has previously been associated with bipolar disorder (BD). Here we show that the disease-associated ADCY2 missense mutation diminishes the enzyme´s capacity to generate the second messenger 3',5'-cylic adenosine monophosphate (cAMP) by altering its subcellular localization. We established mice specifically carrying the Val to Leu substitution using CRISPR/Cas9-based gene editing. Mice homozygous for the Leu variant display symptoms of a mania-like state accompanied by cognitive impairments. Mutant animals show additional characteristic signs of rodent mania models, i.e., they are hypersensitive to amphetamine, the observed mania-like behaviors are responsive to lithium treatment and the Val to Leu substitution results in a shifted excitatory/inhibitory synaptic balance towards more excitation. Exposure to chronic social defeat stress switches homozygous Leu variant carriers from a mania- to a depressive-like state, a transition which is reminiscent of the alternations characterizing the symptomatology in BD patients. Single-cell RNA-seq (scRNA-seq) revealed widespread Adcy2 mRNA expression in numerous hippocampal cell types. Differentially expressed genes particularly identified from glutamatergic CA1 neurons point towards ADCY2 variant-dependent alterations in multiple biological processes including cAMP-related signaling pathways. These results validate ADCY2 as a BD risk gene, provide insights into underlying disease mechanisms, and potentially open novel avenues for therapeutic intervention strategies.

Needle Therapy: A Minimally Invasive Therapeutic Concept as Part of Temporomandibular Single-Portal Arthroscopy.

The transition from a single portal to a double portal can be complex, necessitating time and training to minimize complications that rely on the operator's skill. Needle therapy is a simple method for treating symptoms that has several benefits. Consequently, this innovative strategy aims to introduce an intermediate technique that enables surgeons to perform therapeutic procedures during single-port arthroscopy.

Could titanium screws be an appropriate disc stabilization technique in temporomandibular joint arthroscopy?

Multiple techniques for disc fixation through temporomandibular joint arthroscopy have been described. They can be classified as non-rigid, semi-rigid, and rigid. They all offer different advantages and disadvantages, and some have greater difficulties than others. Currently, multiple modifications to the basic techniques have been described in order to facilitate the technique since disc fixation corresponds to one of the procedures that most require skill. However, each technique requires extensive evaluation and monitoring in order to avoid complications and find the benefits of each technique. For this reason, the objective of this letter to the editor is to discuss two situations observed in the previously described fixation technique with osteosynthesis screws. The first issue is the fixation mechanism, and the second is the fixation time. This is in order to continue searching for the truth among all to achieve the best results and the benefit of patients.

Comparison of the TMJ arthroscopy discopexy techniques: A systematic review and meta-analysis.

This article aims to analyze which of the main arthroscopic discopexy techniques has the best results and if there are differences between the techniques for both pain and maxillary intercuspid opening. A systematic review and meta-analysis was performed according to the PRISMA statement. An electronic search was performed with no publication date restriction in PubMed, Ovid and Embase. The PICO criteria: (P) Patients: With temporomandibular internal disorders with discopexy indication. (I) Intervention: Temporomandibular joint arthroscopic discopexy. (C) Comparison: Arthroscopic discopexy among different techniques classified as non-rigid, semi-rigid and rigid. (O) Outcomes: Impact in clinical conditions such as pain and maximum mouth opening. The inclusion criteria were Patients with temporomandibular internal disorders with discopexy indication performed with different techniques classified as non-rigid, semi-rigid and rigid. The outcomes evaluated were pain and maximum mouth opening. Case series, cohort studies, quasi-experimental studies, and randomized clinical trials with at least 3 months of follow-up were included. The exclusion criteria considered were patients with related concomitant surgeries, patients with associated neoplastic disease or connective tissue disease. A total of 1515 joints where 1400 discopexies were performed including 849 females and 204 males. The most common diagnostic was Wilkes stage III in 257 joints. For pain and oral opening, the semi-rigid technique shows the best results median (MD) 4.84 (CI 2.52-7.16; p = 0.001, I2:100%), MD -2.78 (CI -4.34, -1.21; p = 0.001, I2:99%), respectively. The rigid technique has the greatest probability for complications MD 0.14 CI 95% (0.00, -0.28). Although the semi-rigid technique showed better results, there is no statistically significant difference. However, due to the heterogeneity of the studies, the results should be interpreted with caution.

Comparison of the Clinical Effectiveness of Intra-Articular Injection with Different Substances After TMJ Arthroscopy: A Systematic Review and Meta-Analysis.

Objective: This systematic review aims to describe the clinical outcomes after TMJ arthroscopy followed by intra articular infiltration with different substances. Materials and Methods: A literature search was carried out, the variables were Arthroscopy with different substances, pain and maximal mouth opening. The inclusion criteria were articles that reported infiltration of different substances after arthroscopy. Case series, observational studies, and randomized clinical trials were included. Exclusion criteria were studies that included arthrocentesis, animal studies, connective tissue disease, patients with previous surgeries. Results: Of the 5 studies finally included, the population studied were 346 subjects, of which 315 were female. The mean age was 34.7 (16-77). Regarding diagnoses, Wilkes III and Wilkes IV were taken into account. The most commonly used substance was sodium hyaluronate/hyaluronic acid in 4 of the 5 studies. Conclusion: Multiple substances have been infiltrated within the temporomandibular joint, with sodium hyaluronate/hyaluronic acid being the most studied. However, the benefit of substances like ATM artroscopia adyuvantes has not been clearly established. It is recommended in future studies that the substances and results be evaluated in the same way to obtain more homogeneous studies.

Recurrence of Glandular Odontogenic Cysts: A Systematic Review.

BACKGROUND: The glandular odontogenic cyst (GOC) is a benign developmental cyst of the jaws that is characterized by a high recurrence rate. METHODS: A systematic review is presented of reported cases, case series, and retrospective studies of recurrent cases of glandular odontogenic cysts, to determine the overall and detailed demographic features with documentation of the specific histologic features of the initial presentation of each cyst. Searches of detailed databases were carried out to identify articles published in the English language from 1988 to 2023. The variables were demographics, patient symptoms, cyst location, radiographic features, histopathological findings, type of treatment, and minimum eight months of follow-up. RESULTS: Eighteen cases were identified: with an equal gender presentation of 50% females and 50% males. The average age was 44.7. The mean size was 3.5 cm. The most common location was in the anterior mandible in 50% (n = 9) of cases, followed by the posterior mandible 27.8% (n = 5). Most patients were asymptomatic 55.6% (n = 10). The most common histologic features at first diagnosis were mucous cells in 88.9% (n = 16), variable thickness with 83.3% (n = 15), eosinophilic cuboidal cells 88.9% (n = 16), microcysts 83.3% (n = 15), and clear cells 77.8% (n = 14) cases. CONCLUSION: GOC has an aggressive behavior. Evidence was not conclusive to link any single or combination of histologic features to recurrence, and the strongest correlation for recurrence was the type of treatment. Since this is an uncommon cyst, more cases are needed. Follow-up should continue for at least five years, because recurrences were higher between years 3 and 5.

Late-Presenting Eosinophilic Granulomatosis with Polyangiitis as Cause of Pulmonary Fibrosis: A Case-Based Review.

Introduction: Eosinophilic granulomatosis with polyangiitis (eGPA) is a necrotising vasculitis of small and medium calibre vessels, which affects mostly patients in their fourth to sixth decade of life, and it is a very uncommon aetiology for pulmonary fibrosis. Clinical case: A Hispanic 72-year-old female patient presents with a history of lower extremities pain, paraesthesia, oedema, and occasional macroscopic haematuria. During her hospitalisation, the patient presents, and images showed findings compatible with pulmonary fibrosis and alveolar haemorrhage, which require a biopsy, establishing the diagnosis of an eGPA. Discussion: eGPA is a low-incidence autoimmune vasculitis, with a high number of phenotypes which explain the broad clinical spectrum, but recent advances has helped to understand the physiopathology and its link with other conditions like pulmonary fibrosis. Conclusion: Early diagnosis and management of this condition is mandatory because it is the only factor that change the outcome of the patients.

Understanding the Causes of Frailty Using a Life-Course Perspective: A Systematic Review.

(1) Background: Few studies have examined risk factors of frailty during early life and mid-adulthood, which may be critical to prevent frailty and/or postpone it. The aim was to identify early life and adulthood risk factors associated with frailty. (2) Methods: A systematic review of cohort studies (of at least 10 years of follow-up), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). A risk of confounding score was created by the authors for risk of bias assessment. Three databases were searched from inception until 1 January 2023 (Web of Science, Embase, PubMed). Inclusion criteria were any cohort study that evaluated associations between any risk factor and frailty. (3) Results: Overall, a total of 5765 articles were identified, with 33 meeting the inclusion criteria. Of the included studies, only 16 were categorized as having a low risk of confounding due to pre-existing diseases. The long-term risk of frailty was lower among individuals who were normal weight, physically active, consumed fruits and vegetables regularly, and refrained from tobacco smoking, excessive alcohol intake, and regular consumption of sugar or artificially sweetened drinks. (4) Conclusions: Frailty in older adults might be prevented or postponed with behaviors related to ideal cardiovascular health.

Consenso colombiano de la enfermedad inflamatoria intestinal pediátrica

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Introduction: Pediatric ulcerative colitis (CUP), pediatric Crohn's disease (PCD), and pediatric inflammatory bowel disease not classifiable (PIDNCID) have clinical and psychosocial particularities that differentiate them from those of adults and may condition different therapeutic approaches due to possible nutritional, growth and developmental repercussions, representing a challenge for the pediatrician and gastroenterologist. Objective: Develop expert consensus evidence-based recommendations for the timely and safe diagnosis and treatment of Pediatric Inflammatory Bowel Disease (PID) in children under 18 years of age for professionals caring for these patients and healthcare payers. Methodology: Through a panel of experts from the Colombian College of Pediatric Gastroenterology, Hepatology and Nutrition (COLGAHNP) and a multidisciplinary group, 35 questions were asked regarding the clinical picture, diagnosis, and treatment of PID. Through a critical review and analysis of the literature with particular emphasis on the main clinical practice guidelines (CPGs), randomized clinical trials (RCTs), and meta-analyses of the last ten years, from which the experts made 77 recommendations that responded to each of the research questions with their respective practical points. Subsequently, each of the statements was voted on within the developer group, including the statements that achieved > 80%. Results: All statements scored > 80%. PID has greater extension, severity, and evolution towards stenosis, perianal disease, extraintestinal manifestations, and growth retardation compared to adult patients, so its management should be performed by multidisciplinary groups led by pediatric gastroenterologists and prepare them for a transition to adulthood. Porto's criteria allow a practical classification of PID. In CPE, we should use the Paris classification and perform ileocolonoscopy and esophagogastroduodenoscopy, since 50% have upper involvement, using the SES-CD (UCEIS/Mayo in CUP) and taking multiple biopsies. Initial labs should include inflammatory markers and fecal calprotectin and rule out intestinal infections. Treatment, induction, and maintenance of PID should be individualized and decided according to risk stratification. Follow-up should use PCDAI and PUCAI for the last 48 hours. Immunologists and geneticists should evaluate patients with early and infantile PID. Conclusion: A consensus guideline is provided with evidence-based recommendations on timely and safe diagnosis and treatments in patients with ILD.

Análisis in silico de la inmunogenicidad e interacción molecular de péptidos de plantas aromáticas con SARS-CoV-2 / In silico analysis of immunogenicity and molecular interaction of aromatic plant peptides with SARS-CoV-2

SARS-CoV-2 es un coronavirus de ARN que causa infecciones respiratorias como la actual pandemia de COVID-19. Los sistemas de salud combaten esta infección con cuidados paliativos; sin embargo, existen pocos tratamientos específicos para este patógeno. Este contexto representa la posibilidad de buscar tratamientos alternativos, como el uso de moléculas naturales. El objetivo de este estudio fue determinar in silico la interacción de péptidos de plantas aromáticas con proteínas específicas de SARS-CoV-2 que no comprometan la respuesta inmune. Se procesaron quinientos ochenta y tres péptidos con menos de 30 aminoácidos de Thymus vulgaris L., Cymbopogon citratus, Salvia officinalis, Ocimum basilicum L y Zingiber officinale. La metodología aplicó filtros de acuerdo a los más altos puntajes de docking molecular para encontrar 20 péptidos por cada planta. Los péptidos registraron interacción molecular fuerte de los sitios activos de las proteínas Spike RBD, S2 y Nsp4, empleando una energía de menos de ­150 kcal/mol. La proteína Nsp4 mostró la mayor interacción con todas las especies. El 35% y el 65% de estos péptidos se registraron con baja activación de la respuesta inmune a través de la antigenicidad, puntuación inferior a 0,5 y ausencia de alergenicidad. Estos resultados indican el uso de moléculas de origen vegetal que pueden implementarse en el consumo para combatir la replicación viral del SARS-CoV-2.

SARS-CoV-2 is an RNA coronavirus that causes respiratory infections as the current COVID-19 pandemic. The health systems combat this infection with palliative care; however, there are few specific treatments for this pathogen. This context represents the possibility of searching for alternative treatments, such as using molecules from natural products. Our main objective was the in silico study of aromatic plant peptides and their interaction with specific proteins of SARS-CoV-2 that do not compromise the immune response. Five hundred eighty-three peptides with less than 30 amino acids from Thymus vulgaris L., Cymbopogon citratus, Salvia officinalis, Ocimum basilicum L, and Zingiber officinale were processed. The methodology applied filters according to the highest molecular docking scores to find 20 peptides for each plant species. The peptides show solid molecular interaction of the Spike RBD, S2, and Nsp4 proteins' active sites, using less than ­150 kcal/mol energy. Nsp4 protein exposes the most interaction with all species. 35 and 65% of these peptides were recorded with low activation of the immune response through antigenicity, score below 0.5, and absence of allergenicity. These results indicate the use of plant-derived molecules that can be implemented in consumption to combat the viral replication of SARS-CoV-2.

Análisis in silico de un candidato a vacuna multi-epítopo contra viruela del mono usando vaculonogía reversa / In silico analysis of a multi-epitope vaccine candidate against monkey pox using reverse vaccinology

Introducción. La viruela del mono es una infección zoonótica con una tasa de transmisión global aumentada durante 2022. Actualmente, la enfermedad no tiene tratamientos específicos disponibles; por lo tanto, se puede lograr un enfoque preventivo a través de la inmunización. Objetivo. Diseño in sílico de una vacuna aplicando técnicas computacionales avanzadas utilizando una construcción de múltiples epítopos del M. virus. Materiales y métodos. Los antígenos se seleccionaron en base a informes sobre proteínas que provocan la activación de linfocitos T y B citotóxicos. Los ensayos inmunoinformáticos fueron antigenicidad, alergenicidad, toxicidad, afinidad de unión al complejo mayor de histocompatibilidad (CMH) y estimulación de IFN-γ. Resultados y discusión. Ocho epítopos de las proteínas M1R, ADN polimerasa, B6R y A35R de M. virus mostraron una respuesta significativa para las células inmunitarias. Se eligieron once epítopos con antigenicidad >0,3, no alergénicos y no tóxicos, de los cuales 4 presentaron alta afinidad por los linfocitos T, 4 generaron alta activación de linfocitos B y 3 se asociaron con resultados de activación de IFN-γ. La construcción in sílico del candidato vacunal de 509 aminoácidos con alta similitud topológica registró principalmente carga negativa, además de ser soluble con índice alifático >80%, estable y particular con activación CMH y alta afinidad molecular con TLR-3, y además presentó multiantigenicidad, similar a las vacunas generadas por esta metodología con M. tuberculosis e Influenza. La simulación de inyección de una dosis de la construcción molecular mostró la activación de las células plasmáticas auxiliares T durante aproximadamente 15 a 25 días y una alta expresión de IFN-γ e IL-2 durante ocho días. Conclusión. Estos resultados indican un excelente proceso de inmunización que podría potenciarse con dosis múltiples.

Introduction. Monkey pox is a zoonotic infection with an increased global transmission rate during 2022, denoted epidemiological trouble in public health. Currently, the disease has no specific treatments available; thus, a preventive approach can be achieved through immunization. Objective. was to design in silico a vaccine applying advanced computational techniques using a multi-epitope construct of the Monkeypox virus. Materials and methods. Antigens were selected based on reports about proteins that cause the activation of cytotoxic T and B lymphocytes. The immunoinformatics assays were antigenicity, allergenicity, toxicity, MHC binding affinity, and IFN-γ stimulation. Results and discussion. Eight epitopes of the M1R, DNA polymerase, B6R, and A35R proteins of the M. virus showed a significant response for immune cells. Eleven epitopes with antigenicity >0.3, non-allergenic and non-toxic were chosen, of which 4 presented high affinity to T lymphocytes, 4 generated high activation of B lymphocytes, and 3 were associated with IFN-γ activation results. The in silico construction of the 509-amino acid vaccine candidate with high topological similarity registered mainly a negative charge, in addition to being soluble with an aliphatic index >80%, stable and particular with MHC activation and high molecular affinity with TLR-3, and also presented multi-antigenicity, similar to vaccines generated by this methodology with M. tuberculosis and Influenza. One-dose injection simulation of the molecular construct showed activation of T helper plasma cells for about 15 to 25 days and high expression of IFN-γ and IL-2 for eight days. Conclusion. These results indicate an excellent immunization process that could be potentiated with multi-dosing.

Caloric energy, biomass and structure of aquatic macroinvertebrates in the Reservoir La Nitrera, Concordia, Antioquia, Colombia / Energía calórica, biomasa y estructura de los macroinvertebrados acuáticos en la reserva la nitrera, concordia, antioquia, colombia

RESUMEN El embalse La Nitrera se encuentra localizado a 2140 m.s.n.m. en el municipio de Concordia, departamento de Antioquia (Colombia) y es la única fuente de abastecimiento de agua del municipio. La operación de un embalse sobre un sistema lótico afecta la estructura y ensamblaje de sus ecosistemas acuáticos. Esta investigación tuvo como propósito analizar la distribución de la biomasa de los macroinvertebrados acuáticos antes y después del embalse, con el fin de determinar el impacto de este sobre las comunidades hidrobiológicas. Para tal fin, se analizaron las variables hidrobiológicas en época seca, de lluvia y en diferentes periodos de transición entre el año 2016 y 2017. Se investigaron cuatro estaciones de monitoreo, realizando la determinación, conteo y definiendo el rol trófico de los macroinvertebrados acuáticos, además de un análisis termogravimétrico (TGA) de la biomasa. Con la información obtenida, se construyó un modelo trófico y se calculó la pérdida de energía calórica disponible de la biomasa (TGA). Los resultados evidenciaron que las comunidades de macroinvertebrados acuáticos presentan una modularidad similar entre ellas en las estaciones antes del embalse, y una modularidad diferente en la estación después del embalse. A través del índice de modularidad (modelo Ghepi) y el análisis TGA, se logró establecer que el embalse altera la cadena trófica de las comunidades de macroinvertebrados acuáticos.

ABSTRACT The reservoir La Nitrera is located at 2140 m.a.s.l. in Concordia's town, in the Antioquia's department (Colombia) and is the only source of water supply in the municipality. The operation of a reservoir on a lotic system generates affectations in the structure and assembly of aquatic ecosystems. The purpose of this research was to analyze the distribution of biomass of aquatic macroinvertebrates before and after of the reservoir to determine the impact of it on the hydrobiological communities. For this purpose, the hydrobiological variables were analyzed in dry season, rain season and in different periods of transition between 2016 and 2017 in four monitoring stations, making the determination, counting and defining the trophic role of aquatic macroinvertebrates, in addition to a thermogravimetric analysis (TGA) of the biomass. With the obtained information, a trophic model and an analysis of the loss of the available caloric energy of the biomass (TGA) was made. The results showed that the communities of aquatic macroinvertebrates had a similar modularity between them in the stations before the reservoir and different modularity in the station after the reservoir. Through the modularity index (Ghepi model) and the TGA analysis, it could be established that the reservoir generates an alteration in the trophic chain of aquatic macroinvertebrate communities.

Time before surgery vs recovery of lumbar herniation. chilean reality in the public health system / Tempo prévio cirurgia v/s recuperação em hérnia lombar. a realidade chilena na atenção pública / Tiempo antes de la cirugía versus recuperación de hernia lumbar. realidad chilena en atención pública

ABSTRACT Objective: To evaluate the influence between the time elapsed since the onset of symptoms and the surgery of lumbar HNP in the final functional recovery of the comprehensive treatment of patients. Methods: Retrospective descriptive study of cases of HNP treated by lumbar discectomy between 2009 and 2015 by the spine team of the Hospital San José, using SPSS (version 22 of IBM) for the statistical analysis. Results: Of 110 patients subject to surgery, 54 were recruited (22 women and 32 men), between 18 and 75 years old, with an average age of 43 years. Eighty percent of patients are active workers, 76% without comorbidities. The predominant level affected was L4/L5 with 52% of the cases. The mean progression time of the symptoms before the first consultation was 27 months, the waiting time between the consultation and the surgery was 5.6 months. Conclusions: Eighty-six percent of the patients -presented good results in VAS. The Oswestry questionnaire reached a positive result in 90%, a minimum disability in 40%, moderate in 50% and maximum in 10%. No statistical relationship was achieved between any of the evaluated variables and the outcome of the surgery. Level of Evidence IV; Therapeutic Study - Investigation of Treatment Results.

RESUMO Objetivo: Avaliar a influência entre o tempo de início dos sintomas e a resolução cirúrgica da hérnia lombar na recuperação funcional no tratamento dos pacientes. Métodos: Estudo descritivo retrospectivo de casos de hérnia lombar com discectomia entre 2009 e 2015 no "Hospital San José", usando análise estatística SPSS (versão 22 da IBM). Resultados: De 110 pacientes operados, se recrutaram 54 pacientes para o estudo, dos quais 22 são mulheres e 32 homens, entre 18 e 75 anos com uma média de idade de 43 anos. 80% dos pacientes são trabalhadores ativos, 76% não apresentam co-morbidades. O nível mais frequentemente afetado foi L4/L5 com 52% dos casos. O tempo médio de evolução da sintomatologia antes da primeira consulta foi de 27 meses, o tempo de espera entre consulta e resolução cirúrgica, foi de cinco,seis meses. Conclusões: 86% dos pacientes mostraram bons resultados em EVA. Segundo o questionário OSWESTRY, se obtiveram bons resultados num 90% dos casos; uma deficiência mínima em um 40%; moderada em 50% e máxima em 10% dos pacientes. Se observou ainda falta de relacão estadística entre as variáveis avaliadas e o resultado da cirugía. Nível de Evidência IV; Os Resultados do Tratamento de Estudo Terapêutico - Pesquisa.

RESUMEN Objetivos: Evaluar la influencia entre el tiempo transcurrido desde el inicio de los síntomas y la resolución quirúrgica de la HNP lumbar en la recuperación funcional final en el tratamiento integral de pacientes. Métodos: Estudio descriptivo retrospectivo de casos operados de HNP con discectomía lumbar entre 2009 y 2015 por el equipo de columna del Hospital San José, utilizando SPSS (versión 22 de IBM) para el análisis estadístico. Resultados: De 110 pacientes operados, se reclutaron 54, 22 mujeres y 32 hombres, entre los 18 y 75 años, promedio de edad de 43 años. Ochenta por ciento de los pacientes son laboralmente activos, un 76% no presentan comorbilidades. El nivel predominante afectado fue L4/L5 con 52% de los casos. El tiempo de evolución promedio de la sintomatología antes de la primera consulta fue 27 meses, el tiempo de espera entre la consulta y la resolución quirúrgica, fue 5,6 meses. Conclusiones: Ochenta y seis por ciento de los pacientes presentaron resultados positivos en EVA. El cuestionario Oswestry obtuvo un resultado positivo en 90%, discapacidad mínima en 40%, moderada en 50% y máxima en 10%. No se logró establecer relación estadística entre ninguna de las variables evaluadas y el resultado final de la cirugía. Nivel de Evidencia IV; Estudio terapéutico - Investigación de los resultados de tratamiento.

Why precision medicine is not the best route to a healthier world

ABSTRACT Precision medicine has been announced as a new health revolution. The term precision implies more accuracy in healthcare and prevention of diseases, which could yield substantial cost savings. However, scientific debate about precision medicine is needed to avoid wasting economic resources and hype. In this commentary, we express the reasons why precision medicine cannot be a health revolution for population health. Advocates of precision medicine neglect the limitations of individual-centred, high-risk strategies (reduced population health impact) and the current crisis of evidence-based medicine. Overrated "precision medicine" promises may be serving vested interests, by dictating priorities in the research agenda and justifying the exorbitant healthcare expenditure in our finance-based medicine. If societies aspire to address strong risk factors for non-communicable diseases (such as air pollution, smoking, poor diets, or physical inactivity), they need less medicine and more investment in population prevention strategies.

Late puerperal sepsis, case report and literature review / Caso clínico y revisión de la literatura sepsis puerperal tardía

A case of extremely rare puerperal sepsis is presented in this paper. Postpartum infection is an entity given in between 0.1% and 10% of postpartum patients and has a mortality rate ranging from 2% to 11%. In this case report, a primigravida patient, age 19, presented hypogastric pain, emesis and fever five days after delivery. Postpartum endometritis and retained products of conception were diagnosed; uterine curettage was performed and antibiotic treatment was formulated with satisfactory outcome. The patient was discharged on the fourth day. The patient was readmitted 27 days after delivery with hypogastric persistent pain and fever, vomiting, hypotension and pulmonary dysfunction; gynecological examination showed findings consistent with salpingitis and a laparotomy was performed to confirm the diagnosis, finding salpingitis along with pelvic peritonitis. An intravenous antibiotic treatment, laparotomy and peritoneal washings were provided with satisfactory evolution. The literature on puerperal sepsis, myometritis and postpartum salpingitis is reviewed because, in order to improve morbidity and mortality, timely diagnosis and treatment are determining.

Se presenta un caso de sepsis puerperal de evolución poco frecuente. La infección pos-parto es una entidad que se da entre el 0.1% y 10% de las pacientes en posparto y tie-ne una mortalidad que varía del 2% al 11%. En este reporte de caso, se presenta una paciente primigestante de 19 años, quién a los cinco días posparto presenta cuadro de dolor en hipogastrio, emesis y fiebre. Se diagnostica endometritis posparto y reten-ción de restos, se realiza legrado uterino y se le formula tratamiento antibiótico con evolu-ción satisfactoria y salida al cuarto día. La paciente reingresó a los 27 días pos-parto con dolor en hipogastrio y fiebre, persis-tencia del dolor, vómito, hipotensión y disfun-ción pulmonar; el examen ginecológico arrojó hallazgos compatibles con salpingitis, por lo que fue llevada a laparotomía confirmándose el diagnóstico de salpingitis con pelvi-perito-nitis. Se comenzó tratamiento antibiótico intra-venoso, laparostomía y lavados peritoneales con evolución satisfactoria. Para mejorar la morbimortalidad, es im-portante un diagnóstico y tratamiento oportu-no, por lo cual se revisa la literatura de sepsis puerperal, miometritis y salpingitis posparto.

Marcadores moleculares como herramientas en la identificación y análisis genético de especies vectores de interés en salud pública, género Lutzomyia (Grupo Verrucarum Theodor, 1965) / Molecular markers as tools in the identification and genetic analysis of vector species of interest in public health, type Lutzomyia (Verrucarum Theodor group, 1965)

Introducción: Los insectos flebotomíneos del grupo Verrucarum, son vectores de interés en salud pública dada su participación en la transmisión de las enfermedades tropicales: leishmaniasis y bartonelosis. El empleo de marcadores moleculares como herramienta de identificación y análisis genético de especies que se comportan como vectores potenciales y confirmados, muestran un uso ampliamente difundido, que genera un conjunto de información que se actualiza constantemente, más aun cuando la identificación de estas especies, es prioritaria en los países donde estas enfermedades ocurren de forma recurrente. Objetivo: Se presenta una revisión sistemática con el objetivo de recopilar y presentar una actualización sobre el uso de marcadores moleculares empleados en especies del grupo Verrucarum. Materiales y métodos: Esta búsqueda se efectuó en un rango de literatura relevante publicada en un periodo de 24 años que incluyó 23 artículos en la temática de genética y biología molecular de flebótomos y 39 artículos de otras áreas como sistemática, ecología de flebótomos y microbiología de agentes patógenos asociados. Resultados: Los resultados muestran el empleo de los genes que codifica para el ARN ribosomal 18S y para el citocromo oxidasa subunidad I como los más efectivos para observar las relaciones filogenéticas entre especies del grupo Verrucarum; el uso del gen citocromo b como carácter taxonómico alternativo para identificar correctamente los flebótomos y, el uso de secuencias espaciadoras de la transcripción interna del ARN ribosomal y el gen citocromo b para determinar la variación genética intra e interespecífica de las poblaciones. Conclusión: Esta revisión contribuirá a estudios filogenéticos de vectores de importancia en salud pública.

Introduction: The phlebotomine flies of the Verrucarum group are vectors of interest in public health because of their participation in the transmission of the tropical diseases: leishmaniasis and bartonellosis. The use of molecular markers, as a tool for the identification and genetic analysis of species that behave as potential and confirmed vectors, show a widely disseminated use that generates a set of information that is constantly updated, even more when the identification of these species is a priority in the countries where these diseases occur on a recurring basis. Objective: The paper presents a systematic review that aims at compiling and presenting an update on the use of molecular markers employed in species of the Verrucarum group. Materials and methods: This search was conducted in a range of relevant literature published in a period of 24 years which included 23 articles on the subject of genetics and molecular biology of sand flies, and 39 articles from other areas such as systematic, ecology of sand flies and microbiology of related pathogenic agents. Results: The results show the use of genes coding for ribosomal 18S RNA and cytochrome oxidase subunit I as the most effective to observe the phylogenetic relationships among species of the Verrucarum group; the use of the cytochrome b gene as alternative taxonomic character to correctly identify the sand flies, and the use of spacer sequences of the internal transcript of the ribosomal RNA and the Cytochrome b gene to determine the genetic variation of intra- and inter-specific populations. Conclusions: This review will contribute to phylogenetic studies of vectors of public health importance.

Pancreatitis Aguda como consecuencia del uso de Orlistat / Acute Pancreatitis as consequence of the use of Orlistat

La pancreatitis aguda es un proceso inflamatorio del páncreas desencadenada por la auto digestión ante la activación de sus pro fermentos, tiene un manejo urgente ya que pone en peligro la vida del paciente. El reciente ingreso de Orlistat, un fármaco inhibidor de la lipasa gástrica y pancreática para tratar la obesidad, a través de su venta creciente sin receta se ha estado traduciendo en una mayor frecuencia de eventos adversos sobre todo gastrointestinales (diarrea grasa, esteatorrea, incontinencia, pero con insignificantes efectos sistémicos) con complicaciones por un mal uso, entre éstos la pancreatitis cuyo mecanismo causal no está aún determinado en su totalidad. Hasta la fecha se han reportado a la Administración de Alimentos y Medicamentos de Estados Unidos (FDA) 99 casos de pancreatitis aguda relacionadas con el uso de Orlistat, no habiéndose encontrado reportes de casos similares en América Latina. En el caso clínico una adolescente de 15 años de edad, desencadenó un cuadro típico de severa pancreatitis aguda con necrosis de más del 50% asociada a colección peripancrática clasificada como Baltazar D- E, Ranson de 5 a 6, secundaria al consumo de Orlistat para su obesidad grado III, apoyando esto con los criterios de probabilidad de Naranjo.

Acute pancreatitis is an inflammatory process of the pancreas, triggered by self digestión before activation of their pro ferments, it has a urgent management because it endangers the life of the patient.The recent accession of Orlistat, an inhibitor drug of lipase gastric and pancreatic to treat obesity, through its growing sale without a prescription has been translated in a greater frequency of especially gastrointestinal adverse events (fatty diarrhea, steatorrhea, incontinence, but with negligible systemic effects) with complications from misuse, among these pancreatitis whose causal mechanism is not yet determined in its entirety.To date, the U S Food and Drug Administration (FDA) have been reported 99 cases of acute pancreatitis associated with the use of Orlistat, not having found reports of similar cases in Latin America. In the clinical case a 15-year-old teenager, triggered a typical pattern of severe acute pancreatitis with more than 50% necrosis associated with peripancreática collection classified as Baltazar D-E, Ranson of 5-6, secondary to the use of Orlistat for his obesity grade III, supporting this with the criteria of probability of Naranjo.