In vitro anti-Acanthamoeba activity of flavonoid glycosides isolated from Delphinium gracile, D. staphisagria, Consolida oliveriana and Aconitum napellus.

Acanthamoeba spp. are widely distributed in the environment and cause serious infections in humans. Treatment of Acanthamoeba infections is very challenging and not always effective which requires the development of more efficient drugs against Acanthamoeba spp. The purpose of the present study was to test medicinal plants that may be useful in the treatment of Acanthamoeba spp. Here we evaluated the trophozoital and cysticidal activity of 13 flavonoid glycosides isolated from Delphinium gracile, D. staphisagria, Consolida oliveriana and from Aconitum napellus subsp. Lusitanicum against the amoeba Acanthamoeba castellanii. AlamarBlue Assay Reagent® was used to determine the activity against trophozoites of A. castellanii, and cytotoxic using Vero cells. Cysticidal activity was assessed on treated cysts by light microscopy using a Neubauer chamber to quantify cysts and trophozoites. Flavonoids 1, 2, 3 and 4 showed higher trophozoital activity and selectivity indexes than the reference drug chlorhexidine digluconate. In addition, flavonoid 2 showed 100% cysticidal activity at a concentration of 50 µm, lower than those of the reference drug and flavonoid 3 (100 µm). These results suggest that flavonoids 2 and 3 might be used for the development of novel therapeutic approaches against Acanthamoeba infections after satisfactory in vivo evaluations.

Nurses Training and Capacitation for Palliative Care in Emergency Units: A Systematic Review.

Palliative care (PC) prevents and alleviates patients´ suffering to improve their quality of life in their last days. In recent years, there has been an increase in visits to the emergency services (ES) by patients who may need this type of care. The aims were to describe the training and capacitation of nurses from ES in PC. Accordingly, a systematic review was performed. Medline, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were used. The search equation was "Palliative care and nursing care and emergency room". A total of 12 studies were selected. The studies agree on the need for training professionals in PC to provide a higher quality care, better identification of patient needs and to avoid unnecessary invasive processes. Similarly, the implementation of a collaborative model between ES and PC, the existence of a PC specialized team in the ES or proper palliative care at home correspond to a decrease in emergency visits, a lower number of hospitalizations or days admitted, and a decrease in hospital deaths. The development of PC in the different areas of patient care is necessary. Better palliative care leads to a lower frequency of ES by terminal patients, which has a positive impact on their quality of life. Access to PC from the emergency unit should be one of the priority health objectives due to increment in the aged population susceptible to this type of care.

Discriminatory ability of anthropometric measurements of central fat distribution for prediction of post-prandial hyperglycaemia in patients with normal fasting glucose: the DICAMANO Study.

BACKGROUND AND AIMS: Obesity is associated with impaired glucose tolerance which is a risk factor for cardiovascular risk. However, the oral glucose tolerance test (OGTT) is not usually performed in patients with normal fasting glycaemia, thus offering false reassurance to patients with overweight or obesity who may have post-prandial hyperglycaemia. As an alternative to resource demanding OGTTs, we aimed to examine the predictive value of anthropometric measures of total and central fat distribution for post-prandial hyperglycaemia in patients with overweight and obesity with normal fasting glycaemia enrolled in the DICAMANO study. METHODS: We studied 447 subjects with overweight/obesity with a fasting glucose value ≤ 5.5 mmol l-1 (99 mg dl-1) and BMI ≥ 25 kg/m2 who underwent a 75-g OGTT. Post-prandial hyperglycaemia was defined as a glucose level ≥ 7.8 mmol l-1 (140 mg dl-1) 2-h after the OGTT. The anthropometric measurements included body mass index, body adiposity index, waist circumference, neck circumference, waist-to-hip ratio and waist-to-height ratio. RESULTS: The prevalence of post-prandial hyperglycaemia was 26%. Mean 1-h OGTT glucose levels, insulin resistance and beta cell dysfunction was higher in those subjects in the highest tertile for each anthropometric measurement, irrespective of fasting glucose level. Central fat depot anthropometric measurements were strongly and independently associated with an increased risk of post-prandial hyperglycaemia. After multivariable-adjustment for fasting plasma glucose level, smoking, and physical activity level, the odds ratio (95% confidence intervals) for the presence of post-prandial hyperglycaemia for neck circumference, waist circumference and waist-to-height ratio were 3.3 (1.4, 7.7), 2.4 (1.4, 4.4) and 2.5 (1.4, 4.5), respectively. CONCLUSIONS: In this large and comprehensively phenotyped cohort, one in four subjects had post-prandial hyperglycaemia despite normal fasting glycaemia. Anthropometric indices of central fat distribution were strongly and independently associated with an increased risk of post-prandial hyperglycaemia. These results support the association between central adiposity and glucose derangements and demonstrate the clinical usefulness of anthropometric measurements as screening tools for the selection of patients who are most likely to benefit from an OGTT. Trial registration ClinicalTrials.gov Identifier: NCT03506581. Registered 24 April 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03506581.

High Body Adiposity Drives Glucose Intolerance and Increases Cardiovascular Risk in Normoglycemic Subjects.

OBJECTIVE: The objective of this study was to assess the utility of the 2-hour oral glucose tolerance test (OGTT) value to discriminate between different cardiometabolic profiles and examine the role of body composition in predicting the associated increased risk for glucose impairment, beta-cell dysfunction, and cardiovascular disease (CVD). METHODS: Subjects with normal fasting glucose completed a 2-hour OGTT and were categorized to the carbohydrate metabolism alterations (CMAs) or the control group based on a 2-hour glucose threshold of 7.8 mmol/L. Body composition, visceral adipose tissue, OGTT-based parameters, and cardiovascular risk factors (CVRFs) such as hypertension, dyslipidemia, obstructive sleep apnea, nonalcoholic fatty liver disease, and smoking status were measured. RESULTS: Subjects with CMAs exhibited a significantly higher 1-hour postload glucose level and a greater decline in beta-cell function and CVRF profiles. After multivariate adjustment, an excess of total body and visceral fat was associated with an increased risk of CMAs, beta-cell dysfunction, CVRFs, and lower whole-body insulin sensitivity. CONCLUSIONS: These data support the etiopathogenic role of body and visceral fat in the development of glucose derangements and CVRFs early on in the metabolic dysregulation process. Thus, body composition analysis and OGTT assessment performed in individuals with normal fasting glucose enable a better identification of patients at risk of developing type 2 diabetes and CVD.

Nivel de satisfacción de los pacientes postoperados de traumatismo facial: un estudio de cohorte de un Hospital Nacional en Perú / Satisfaction level of post-operated facial trauma patients: a cohort study of a National Hospital in Peru

Resumen Objetivo Determinar el nivel de satisfacción de los pacientes postoperados de traumatismo facial en el Hospital Nacional Dos de Mayo (HNDM). Material y Método Estudio cuantitativo, cohorte longitudinal, analítica. La población estuvo constituida por 36 pacientes con diagnóstico de traumatismo facial que se sometieron a cirugía en el servicio de cabeza y cuello del HNDM durante el periodo julio de 2014-febrero de 2015. Se utilizó un cuestionario sobre satisfacción global cuya confiabilidad es r = 0,95, que evalúa cinco dimensiones: Limitación funcional, apariencia facial, apariencia sexual y corporal, autoconcepto negativo y apariencia social. Los puntajes promedio obtenidos en la escala de Likert fueron comparados con la prueba T de student pareada. Se consideró un valor p < 0,05 como estadísticamente significativo. Resultados La satisfacción global de los pacientes postcirugía fue alta en comparación con lo alcanzado en la precirugía (p = 0,01). En las dimensiones limitación funcional, apariencia facial, autoconcepto negativo y apariencia social el 100% alcanzó un nivel de satisfacción alto en la postcirugía. En la dimensión de apariencia sexual y corporal, el 100% tuvo en el periodo postcirugía un nivel de satisfacción medio, respecto al nivel bajo obtenido en la precirugía. Conclusión Los pacientes postoperados de traumatismo facial en el Hospital Nacional Dos de Mayo presentan un alto nivel de satisfacción a nivel funcional, de apariencia facial, en autoconcepto y de apariencia social.

Objective To determine the level of satisfaction of patients who underwent surgery for facial trauma in the Dos de Mayo National Hospital (HNDM). Materials and Methods Quantitative, cross-sectional analytical study. The population consisted of 36 patients diagnosed with facial trauma who underwent surgery in the Head and Neck service of the HNDM during the period July 2014-February 2015. A Global satisfaction questionnaire, previously validated for this research, was used whose reliability is r = 0.95 and evaluates aspects of Limitation functional, facial appearance, sexual and physical appearance, negative self- concept and social appearance. The average scores on the Likert scale were compared with the paired Student t test. A p-value < 0.05 was considered statistically significant. Results Regarding the overall satisfaction of patients, the number of patients who reported having a high level of satisfaction was significantly higher in the post surgery compared to what was achieved in the pre surgery (p = 0.01). In respect of functional limitations, facial appearance, negative self-concept and social appearance 100% achieved a high level of satisfaction in the post surgery. In the dimension of sexual and physical appearance, 100% was in the post surgery a medium level of satisfaction, from the low level obtained in the pre surgery. Conclusions The patients operated after facial trauma in the Dos de Mayo National Hospital have a high level of satisfaction on a functional level, facial appearance, negative self-concept and social appearance.

Prevalencia de infección tuberculosa latente en trabajadores de salud de establecimientos del primer nivel de atención. Lima, Perú / Prevalence of latent tuberculosis infection in health workers from primary health care centers in Lima, Peru

RESUMEN Con el propósito de disponer de información sobre los riesgos para infección por tuberculosis, la Dirección General de Epidemiología del Ministerio de Salud, desarrolló una vigilancia centinela en establecimientos de salud de la Provincia constitucional del Callao, dicha vigilancia incluyó el diagnóstico de infección tuberculosa latente (ITL) mediante la aplicación del método IGRA. El objetivo del presente estudio fue estimar la prevalencia de ITL en trabajadores de salud de un área con alta carga de enfermedad de tuberculosis. La prevalencia de ITL en trabajadores de salud fue 56%. En trabajadores con más de 10 años de servicio la prevalencia se incrementó a 63% y en trabajadores con más de 35 años de servicio se encontraron prevalencias entre 58 y 60%. Existe una alta prevalencia de ITL en trabajadores de salud de establecimientos del primer nivel de atención, identificándose al mayor tiempo de servicio, como uno de los principales factores de riesgo.

ABSTRACT To evaluate the risk of tuberculosis (TB) infection, the General Directorate of Epidemiology of the Ministry of Health developed a sentinel surveillance system in health centers located in the Constitutional Province of Callao. This surveillance system included the diagnosis of latent tuberculosis infection (LTI) using interferon gamma release assays. The objective of the present study was to estimate the prevalence of LTI in health workers in a region with a high burden of TB. The prevalence of LTI in health workers was 56%. The prevalence of LTI was 63% in workers with more than 10 years of service and 58-60% in workers with more than 35 years of service. The prevalence of LTI in health workers from primary health care centers was high, and longer service time was one of the main risk factors.

Altered Concentrations in Dyslipidemia Evidence a Role for ANGPTL8/Betatrophin in Lipid Metabolism in Humans.

CONTEXT: Angiopoietin-like protein 8 (ANGPTL8)/betatrophin is a secreted protein initially involved in ß-cell replication. Recent data in humans and mice models suggest that ANGPTL8/betatrophin is more related to lipid metabolism. OBJECTIVE: The aim of the present study was to compare the circulating concentrations of ANGPTL8/betatrophin in individuals with dyslipidemia defined as having high or low levels of high-density lipoprotein (HDL)-cholesterol or triglycerides, respectively. DESIGN, SETTING, AND PARTICIPANTS: Serum concentrations of ANGPTL8/betatrophin were measured by an ELISA in 177 subjects. We studied two different selected case-control dyslipidemic cohorts including individuals with high (n = 43) or low (n = 46) circulating concentrations of HDL-cholesterol or with low (n = 48) or high (n = 40) levels of triglycerides. RESULTS: Circulating concentrations of ANGPTL8/betatrophin were significantly lower in individuals with dyslipidemia (P < .001) in both males (controls 27.8 ± 15.2 vs dyslipidemic 17.0 ± 11.2 ng/mL) and females (controls 50.0 ± 22.2 vs dyslipidemic 27.0 ± 16.5 ng/mL). The magnitude of the differences was higher in dyslipidemic patients with low HDL-cholesterol than in those with high triglyceride concentrations. ANGPTL8/betatrophin levels were lower in subjects with type 2 diabetes (P < .001), but the impact of type 2 diabetes vanished (P = .257) when the effect of dyslipidemia was included in the analysis. CONCLUSIONS: We conclude that serum ANGPTL8/betatrophin concentrations are altered in human dyslipidemia. ANGPTL8/betatrophin emerges as a potential player in dyslipidemia with a strong association with HDL-cholesterol and a potential therapeutic tool for the treatment of dyslipidemia.

Validation of the Cognitive Structure of an Arithmetic Test with the Least Squares Distance Model (LSDM) / Validación de la estructura cognitiva de una prueba aritmética con el Modelo de Distancia Mínima de Cuadrados (LSDM)

The aim of the present paper is to collect evidence about validity of the cognitive structure proposed to solve the items of an arithmetic test using an cognitive diagnosis model (based on the Item Response Theory) called Least Squares Distance Model (LSDM). The test was applied to a sample of 382 students of 7th grade from five public high schools in Bogotá-Colombia. With this data the objective was addressed in three ways: first, the analysis of two statistical validity indices; second by a cross -validation of the LSDM results on attribute difficulties using other cognitive model (LLTM), and third, by comparing the LSDM results with the observed scores on individual attributes. The logical behavior of the probability curves for the five attributes under study provides important evidence for their overall validity. Additional specific evidences of validity are also presented in the results.

El objetivo del presente trabajo ha sido reunir evidencias sobre la validez de la estructura cognitiva propuesta para resolver los ítems de un test de aritmética, mediante la aplicación de un modelo de diagnóstico cognitivo basado en la Teoría de Respuesta al Item llamado Modelo de las Distancias Mínimo Cuadráticas (LSDM, por sus siglas en inglés). El test se aplicó a una muestra de 382 estudiantes de séptimo grado en cinco colegios públicos en Bogotá-Colombia. Usando estos datos el objetivo se abordó de tres maneras: en primer lugar se analizaron dos índices estadísticos de validez, en segundo lugar, se realizó una validación cruzada de los resultados del LSDM sobre las dificultades de atributos utilizando otro modelo cognitivo (LLTM) y en tercer lugar, se compararon los resultados del modelo con las puntuaciones observadas en atributos individuales. El comportamiento lógico de las curvas de probabilidad para los cinco atributos estudiados proporciona importante evidencia para su validez general. En los resultados se presentan también otras evidencias concretas de validez de la estructura propuesta.

Osteomalacia induced by adefovir in patient with hepatitis B.

Osteomalacia is defined as a defect in mineralization of the bone matrix. We describe the case of a patient with chronic hepatitis B infection in whom treatment with adefovir induced renal phosphate loss with intense and sustained hypophosphatemia which derived in symptomatic osteomalacia.

Validación del instrumento comunitario para el analisis de situacion de salud: SIS-01/ficha familiar. estado Trujillo, Venezuela. año, 2009 / Valiation of thee comunity instrument for the analysis of the healtth situation: sis-tab 01 family trujillo state, Venezuela. year, 2009

Con el propósito de estandarizar un instrumento del Sistema de Información en Salud, identificado como SIS-01/ Ficha Familiar, para su utilización en el Análisis de la Situación de Salud Comunitaria y facilitar la incorporación de información diaria generada por el personal de salud como Médicos Generales, Integrales, Cooperantes y Auxiliares de Medicina Simplificada, como parte de sus actividades extramuros; se realizo un estudio de validación que consistió en la realización de visitas y entrevistas, por parte de este equipo de salud, para el llenado del instrumento, a familias cercanas a los establecimientos de salud seleccionados en forma intencional en los Municipios Valera y Bocono del Estado Trujillo, ubicado geográficamente al occidente del país. Los resultados obtenidos fueron analizados según áreas urbana y rural, reportando el tiempo de llenado entre 38 y 39 min; que 67 y 69% del personal considera que la información solicitada es muy completa; 67 y 77% opinó que la información solicitada se entiende pero se puede mejorar y que entre 46 y 56% de las familias entrevistadas fueron receptivas para ofrecer sus respuestas. Se concluye que el instrumento validado puede ser aplicado tanto en áreas rurales como urbanas por el personal que realiza actividades a nivel comunitario para el cual fue diseñado; permitirá caracterizar las familias y comunidades según indicadores Demográficos, Socioeconómicos, Higiénico ambientales, Biológicos y de Servicios de Atención Médica y que constituye una herramienta para el ASIS Comunitario, donde podrán ser identificadas las necesidades reales y sentidas permitiendo direccionar planes de salud en base a prioridades.

In order to standardize an instrument of information system in health, identified as SIS-01/tab family, for use in the analysis of the situation of community health and facilitate the incorporation of daily information generated by health personnel such as general practitioners, integrals, cooperators and Assistant of medicine simplified, as part of its activities outside the walls; a validation study that consisted in the realization of visits and interviews from this team of health, for filling the instrument families close to health establishments selected intentionally in the municipalities Valera and Boconó of the Trujillo State, geographically located to the West of the country was conducted. The results obtained were analyzed according to urban and rural areas, reporting areas the time of filling between 38 and 39 min; 67 and 69% of staff considers that the requested information is very comprehensive; 67 and 77% believed that the requested information is understood but can be improved and that between 46 and 56% of the households surveyed were receptive to give their answers. It is concluded that the validated instrument can be applied both in rural and urban areas by personnel performing activities at the community level for which it was designed; It will characterize families and communities according to demographic, socioeconomic, environmental hygiene, biological indicators and health care services and that provides a tool for community ASIS, where needs real and heartfelt allowing addressing plans of health based on priorities may be identified.

Evidence for the presence of lipofibroblasts in human lung.

The lipid-containing alveolar interstitial fibroblast (lipofibroblast) is known to be critically involved in rodent lung development, homeostasis, and injury/repair. However, there is lack of information on their presence and function in the human lung. Based on a number of morphological (lipid staining), molecular (presence of characteristic lipogenic and absence of myogenic markers), and functional (triglyceride uptake) characteristics that are the hallmarks of the rodent lung lipofibroblast, using human lung fibroblasts of embryonic (WI-38) and adult origin and lung tissue from human autopsy specimens, the authors for the first time clearly demonstrate the presence of lipofibroblasts in the human lung.

Mechanism of nicotine-induced pulmonary fibroblast transdifferentiation.

We tested the hypothesis that in vitro nicotine exposure disrupts specific epithelial-mesenchymal paracrine signaling pathways and results in pulmonary interstitial lipofibroblast (LIF)-to-myofibroblast (MYF) transdifferentiation, resulting in altered pulmonary development and function. Studies were done to determine whether nicotine induces LIF-to-MYF transdifferentiation and to elucidate underlying molecular mechanism(s) involved and to determine whether nicotine-induced LIF-to-MYF transdifferentiation could be prevented by stimulating specific alveolar interstitial fibroblast lipogenic pathway. WI38 cells, a human embryonic pulmonary fibroblast cell line, were treated with nicotine with or without specific agonists of alveolar fibroblast lipogenic pathway, PTHrP, DBcAMP, or the potent PPARgamma stimulant rosiglitazone (RGZ) for 7 days. Expression of key lipogenic and myogenic markers was examined by RT-PCR, Western hybridization, and immunohistochemistry. The effect of nicotine on triglyceride uptake by WI38 cells and PTHrP binding to its receptor was also determined. Finally, the effect of transfecting WI38 cells with a PPARgamma expression vector on nicotine-induced LIF-to-MYF transdifferentiation was determined. Nicotine treatment resulted in significantly decreased expression of lipogenic and increased expression of myogenic markers in a dose-dependent manner, indicating nicotine-induced LIF-to-MYF transdifferentiation. This was accompanied by decreased PTHrP receptor binding to its receptor. The nicotine-induced LIF-to-MYF transdifferentiation was completely prevented by concomitant treatment with PTHrP, DBcAMP, RGZ, and by transiently overexpressing PPARgamma. Our data suggest nicotine induces alveolar LIF-to-MYF transdifferentiation through a mechanism involving downregulation of lipogenic PTHrP-mediated, cAMP-dependent PKA signaling pathway, which can be prevented using specific molecular targets. Potential therapeutic implications of these observations against in utero nicotine-induced lung injury remain to be tested.

Especies de Aeromonas en vegetales frescos que se expenden en un mercado popular de Maracaibo / Aeromonas species in fresh vegetables that are expended in a popular market of Maracaibo

Las especies de Aeromonas son patógenos emergentes que se pueden recuperar de una gran variedad de alimentos. El objetivo de esta investigación fue determinar la frecuencia de Aeromonas spp. en vegetales frescos que se expenden en Maracaibo. Se analizaron 150 muestras: 50 lechuga, 50 cilantro y 50 perejil. Para el aislamiento se utilizó agua peptonada alcalina (medio de enriquecimiento), agar almidón ampicilina y DNasa-azul de toluidina-ampilcilina agar (medios selectivos). La identificación se realizó empleando pruebas bio-químicas. La frecuencia de Aeromonas spp. fue de 37 (24,67 por ciento), siendo las muestras de cilantro las que presentaron el mayor número de aislamiento 24 (52,00 por ciento). A. caviae fue la especie mas recuperada 27 (72,97 por ciento), seguida de A. hydrophila 10 (27,03 por ciento). Estos resultados evidencian que los vegetales analizados presentan elevados niveles de contaminación por Aeromonas, lo cual indica que se deben tomar medidas para minimizar los riesgos microbiológicos que representan estos alimentos para los consumidores.