Engineering a microparticle-loaded rough membrane for guided bone regeneration modulating osteoblast response without inducing inflammation.

Guided bone regeneration (GBR) is a widely used procedure that prevents the fast in-growth of soft tissues into bone defect. Among the different types of membranes, the use of collagen membranes is the gold standard. However, these membranes are implanted in tissue location where a severe acute inflammation will occur and can be negatively affected. The aim of this study was to develop a collagen-based membrane for GBR that incorporated alginate-hydroxyapatite microparticles. Membranes were manufactured using collagen type I and gelatin and alginate-hydroxyapatite microparticles. Membranes were assessed in terms of topography by scanning electron microscopy and confocal microscopy; stability by swelling after an overnight incubation in saline and enzymatic degradation against collagenase and mechanical properties by tensile tests. Furthermore, the biological response was assessed with SaOs-2 cells and THP-1 macrophages to determine alkaline phosphatase activity and inflammatory cytokine release. Our results showed that the incorporation of different percentages of these microparticles could induce changes in the surface topography. When the biological response was analyzed, either membranes were not cytotoxic to THP-1 macrophages or to SaOs-2 cells and they did not induce the release of pro-inflammatory cytokines. However, the different surface topographies did not induce changes in the macrophage morphology and the release of pro- and anti-inflammatory cytokines, suggesting that the effect of surface roughness on macrophage behavior could be dependent on other factors such as substrate stiffness and composition. Collagen-gelatin membranes with embedded alginate-hydroxyapatite microparticles increased ALP activity, suggesting a positive effect of them on bone regeneration, remaining unaffected the release of pro- and anti-inflammatory cytokines.

Unveiling Melanoma: A Deep Dive into Disparities at a Latin-American Cancer Institute.

INTRODUCTION: The worldwide incidence of melanoma has increased in the last 40 years. Our aim was to describe the clinic-pathological characteristics and outcomes of three cohorts of patients diagnosed with melanoma in a Latin-American cancer institute during the last 20 years. METHODS: We evaluated three retrospective patient cohorts diagnosed with melanoma at Instituto Nacional de Enfermedades Neoplasicas (INEN), a public hospital in Lima, Peru, for the years 2005-2006, 2010-2011, and 2017-2018. Survival rate differences were assessed using the Log-rank test. RESULTS: Overall, 584 patients were included (only trunk and extremities); 51% were male, the mean age was 61 (3-97) years, and 48% of patients resided in rural areas. The mean time to diagnosis was 22.6 months, and the mean Breslow thickness was 7.4 mm (T4). Lower extremity was the most common location (72%). A majority of the patients (55%) had metastases at the time of presentation, with 36% in stage III and 19% in stage IV. Cohorts were distributed as 2005-2006 (n = 171), 2010-2011 (n = 223), and 2017-2018 (n = 190). No immunotherapy was used. Cohort C exhibited the most significant increase in stage IV diagnoses (12.3%, 15.7%, 28.4%, respectively; p < 0.01). The median overall survival rates at the three-year follow-up demonstrated a decline over the years for stages II (97%, 98%, 57%, respectively; p < 0.05) and III (66%, 77%, 37%; p < 0.01). CONCLUSIONS: There has been a worsening in the incidence of late-stage metastatic melanoma in Peru throughout the years, coupled with a significant decline in overall survival rates. This is underscored by the fact that half of the population lives in regions devoid of oncological access.

Development of clobetasol-loaded biodegradable nanoparticles as an endodontic intracanal medicament.

AIM: The aim of current study is the development and optimization of biodegradable polymeric nanoparticles (NPs) to be used in the field of Endodontics as intracanal medication in cases of avulsed teeth with extended extra-oral time, utilizing PLGA polymers loaded with the anti-inflammatory drug clobetasol propionate (CP). METHODOLOGY: CP-loaded nanoparticles (CP-NPs) were prepared using the solvent displacement method. CP release profile from CP-NPs was assessed for 48 h against free CP. Using extracted human teeth, the degree of infiltration inside the dentinal tubules was studied for both CP-NPs and CP. The anti-inflammatory capacity of CP-NPs was evaluated in vitro measuring their response and reaction against inflammatory cells, in particular against macrophages. The enzyme-linked immunosorbent assay (ELISA) was used to examine the cytokine release of IL-1ß and TNF-α. RESULTS: Optimized CP-NPs displayed an average size below 200 nm and a monomodal population. Additionally, spherical morphology and non-aggregation of CP-NPs were confirmed by transmission electron microscopy. Interaction studies showed that CP was encapsulated inside the NPs and no covalent bonds were formed. Moreover, CP-NPs exhibited a prolonged and steady release with only 21% of the encapsulated CP released after 48 h. Using confocal laser scanning microscopy, it was observed that CP-NPs were able to display enhanced penetration into the dentinal tubules. Neither the release of TNF-α nor IL-1ß increased in CP-NPs compared to the LPS control, displaying results similar and even less than the TCP after 48 h. Moreover, IL-1ß release in LPS-stimulated cells, decreased when macrophages were treated with CP-NPs. CONCLUSIONS: In the present work, CP-NPs were prepared, optimized and characterized displaying significant increase in the degree of infiltration inside the dentinal tubules against CP and were able to significantly reduce TNF-α release. Therefore, CP-NPs constitute a promising therapy for the treatment of avulsed teeth with extended extra-oral time.

Survival according to the site of metastasis in triple-negative breast cancer patients: The Peruvian experience.

BACKGROUND: Evidence regarding differences in survival associated with the site of metastasis in triple-negative breast cancer (TNBC) remains limited. Our aim was to analyze the overall survival (OS), distant relapse free survival (DRFS), and survival since the diagnosis of the relapse (MS), according to the side of metastasis. METHODS: This was a retrospective study of TNBC patients with distant metastases at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru) from 2000 to 2014. Prognostic factors were determined by multivariate Cox regression analysis. RESULTS: In total, 309 patients were included. Regarding the type of metastasis, visceral metastasis accounted for 41% and the lung was the most frequent first site of metastasis (33.3%). With a median follow-up of 10.2 years, the 5-year DRFS and OS were 10% and 26%, respectively. N staging (N2-N3 vs. N0, HR = 1.49, 95%CI: 1.04-2.14), metastasis in visceral sites (vs. bone; HR = 1.55, 95%CI: 0.94-2.56), the central nervous system (vs. bone; HR = 1.88, 95% CI: 1.10-3.22), and multiple sites (vs. bone; HR = 2.55, 95%CI:1.53-4.25) were prognostic factors of OS whereas multiple metastasis (HR = 2.30, 95% CI: 1.42-3.72) was a predictor of MS. In terms of DRFS, there were no differences according to metastasis type or solid organ. CONCLUSION: TNBC patients with multiple metastasis and CNS metastasis have an increased risk of death compared to those with bone metastasis in terms of OS and MS.

Efectos de un Programa de Ejercicios y Educación en Dolor mediante Tele-rehabilitación en la Calidad de Vida de Mujeres Jóvenes con Dismenorrea Primaria / Effects of an Exercise and Pain Education Program via Telerehabilitation on the Quality of Life of Young Women with Primary Dysmenorrhea

Introducción. La dismenorrea primaria afecta la calidad de vida de mujeres jóvenes. Este estudio investiga los efectos de un protocolo de ejercicios y educación en dolor mediante telerehabilitación. Objetivo. Determinar los efectos de un protocolo de ejercicios y educación en dolor y su impacto en la calidad de vida mediante tele-rehabilitación en mujeres jóvenes con dismenorrea primaria. Métodos. Se realizó un estudio experimental pre y post test con un grupo control, utilizando tele-rehabilitación. Participaron 21 mujeres jóvenes con dismenorrea primaria, asignadas aleatoriamente a dos grupos: el grupo experimental (10 mujeres) y el grupo control (11 mujeres). Se utilizaron cuestionarios específicos de calidad de vida relacionada con la menstruación y dolor (cuestionario breve de McGill) para evaluar los efectos del programa de ejercicios y educación en dolor. Resultados. En el grupo control, no se observaron diferencias significativas en las puntuaciones de calidad de vida relacionada con la menstruación ni en la intensidad del dolor antes y después de la intervención (p>0,05). En contraste, el grupo experimental experimentó mejoras significativas en ambas áreas después de la intervención (todos los p<0,001). Conclusiones. Este estudio demuestra que un protocolo de ejercicios y educación en dolor realizado mediante telerehabilitación tiene un impacto positivo y significativo en la calidad de vida y la intensidad del dolor percibido en mujeres jóvenes con dismenorrea primaria. Estos resultados sugieren que la telerehabilitación puede ser una estrategia efectiva para abordar este problema de salud en esta población.

Background. Primary dysmenorrhea impacts the quality of life of young women. This study investigates the effects of an exercise and pain education protocol through telerehabilitation. Objective: To determine the effects of an exercise and pain education protocol and its impact on the quality of life through telerehabilitation in young women with primary dysmenorrhea. Methods: A pre and post-test experimental study with a control group was conducted using telerehabilitation. Twenty-one young women with primary dysmenorrhea participated, randomly assigned to two groups: the experimental group (10 women) and the control group (11 women). Specific questionnaires related to menstruation-related quality of life and pain (McGill short-form questionnaire) were used to assess the effects of the exercise and pain education program. Results: In the control group, no significant differences were observed in menstruation-related quality of life scores or pain intensity before and after the intervention (p>0.05). In contrast, the experimental group experienced significant improvements in both areas after the intervention (all p<0.001). Conclusion: This study demonstrates that an exercise and pain education protocol conducted through telerehabilitation has a positive and significant impact on the perceived quality of life and pain intensity in young women with primary dysmenorrhea. These results suggest that telerehabilitation can be an effective strategy for addressing this health issue in this population.

Unravelling Peritoneal Carcinomatosis Using Cross-Sectional Imaging Modalities.

Peritoneal carcinomatosis (PC) refers to malignant epithelial cells that spread to the peritoneum, principally from abdominal malignancies. Until recently, PC prognosis has been considered ill-fated, with palliative therapies serving as the only treatment option. New locoregional treatments are changing the outcome of PC, and imaging modalities have a critical role in early diagnosis and disease staging, determining treatment decision making strategies. The aim of this review is to provide a practical approach for detecting and characterizing peritoneal deposits in cross-sectional imaging modalities, taking into account their appearances, including the secondary complications, the anatomical characteristics of the peritoneal cavity, together with the differential diagnosis with other benign and malignant peritoneal conditions. Among the cross-sectional imaging modalities, computed tomography (CT) is widely available and fast; however, magnetic resonance (MR) performs better in terms of sensitivity (92% vs. 68%), due to its higher contrast resolution. The appearance of peritoneal deposits on CT and MR mainly depends on the primary tumour histology; in case of unknown primary tumour (3-5% of cases), their behaviour at imaging may provide insights into the tumour origin. The timepoint of tumour evolution, previous or ongoing treatments, and the peritoneal spaces in which they occur also play an important role in determining the appearance of peritoneal deposits. Thus, knowledge of peritoneal anatomy and fluid circulation is essential in the detection and characterisation of peritoneal deposits. Several benign and malignant conditions show similar imaging features that overlap those of PC, making differential diagnosis challenging. Knowledge of peritoneal anatomy and primary tumour histology is crucial, but one must also consider clinical history, laboratory findings, and previous imaging examinations to achieve a correct diagnosis. In conclusion, to correctly diagnose PC in cross-sectional imaging modalities, knowledge of peritoneal anatomy and peritoneal fluid flow characteristics are mandatory. Peritoneal deposit features reflect the primary tumour characteristics, and this specificity may be helpful in its identification when it is unknown. Moreover, several benign and malignant peritoneal conditions may mimic PC, which need to be considered even in oncologic patients.

Hepatitis C: A Rare Cause of Subacute Paralysis.

The effects of the hepatitis C virus (HCV) on the nervous system have been primarily reported with a pathology of the peripheral nervous system through the involvement of a vasculitic process via cryoglobulinemia. A review of the recent literature reinforced the likely association between chronic HCV infection and transverse myelitis (TM), but the causal relationship remains elusive. Here, we present a rare case of acute TM developing over the course of days from symptom onset and a concomitant new diagnosis of HCV infection. A 31-year-old male with a medical history of stimulant use disorder with intravenous methamphetamine use presented to the hospital for acute bilateral leg weakness. The weakness was predominantly in his thighs and later progressed to his calves over the course of days. He denied urinary or fecal incontinence; however, on hospital day two, he developed acute urinary retention requiring the insertion of a Foley catheter. An initial MRI of the spine revealed an intramedullary T2 hyperintense signal at the lower thoracic cord concerning for TM, multiple sclerosis, ischemia, or neoplasm. MRI of the brain was unremarkable. Lumbar puncture results also displayed no abnormalities. HCV screening should be considered in all patients who develop acute neurological deficits that are not otherwise explained, such as TM, given the significant morbidity associated with delayed treatment.

Diagnóstico de la vigilancia, prevención y control de la COVID-19 en el trabajo minero peruano

Introducción: En Perú, las empresas mineras debían registrar e implementar el plan para la vigilancia, prevención y control de la COVID-19 en el trabajo (requerido por el Ministerio de Salud), previo al reinicio de actividades suspendidas debido a la pandemia. Objetivo: Describir el estado situacional de los planes para la vigilancia, prevención y control de la COVID-19 en el trabajo del sector minero (1ra y 2da fase de reactivación económica, 2020). Métodos: Se realizó un estudio transversal de la base de datos del sistema SISCOVID-Empresas. Se reportaron frecuencias y proporciones de las características de los planes (región de procedencia, número de trabajadores, número de profesionales de salud, existencia de comité o supervisor de seguridad y salud en el trabajo, estado de registro y reporte de presupuesto) según el número de trabajadores de la empresa. Resultados: Se revisaron 2 236 registros de planes. El 6,2 % indica no contar con supervisor o comité de seguridad y salud en el trabajo y el 71,5 % no cuenta con profesional de la salud. El 81,2 % de las empresas con más de 500 trabajadores contaban con profesionales de medicina y enfermería. El 89,2 % de las empresas con 1 a 20 trabajadores no contaban con profesionales de la salud. Conclusiones: Tres de cada 4 empresas del sector minero incumplen lo requerido en el plan para la vigilancia, prevención y control de la COVID-19 en el trabajo.

Introduction: In Peru, mining companies had to register and implement the Plan for the surveillance, prevention, and control of COVID-19 at work (requested by the Ministry of Health), prior to restarting activities suspended due to the pandemic. Objective: To describe the situational status of the plans for the surveillance, prevention, and control of COVID-19 at work in the mining sector (1st and 2nd phases of economic reactivation, 2020). Methods: A cross-sectional study was carried out of the database from the SISCOVID- Empresas system. Frequencies and proportions of the characteristics of the plans were reported (region of origin, number of workers, number of health professionals, existence of an occupational health and safety committee or supervisor, status of registration and budget report) according to the number of company workers. Results: In total 2,236 plan records were reviewed. Of the total, 6.2% of the registered plans indicate that they do not have an occupational health and safety supervisor or committee, and 71.5% do not have a health professional. Furthermore, 81.2% of the companies with more than 500 workers had medicine and nursing professionals, and 89.2% of companies with 1 to 20 workers did not have health professionals. Conclusions: Three out of 4 companies in the mining sector fail to comply with the requirements of the plan for the surveillance, prevention, and control of COVID-19 at work.

Positivización de la autoestima específica en el docente quirúrgico. Resultados del Curso 2CeQ Docencia Quirúrgica® / Positivization of specific self-esteem in the surgical teacher. Results of the grade 2CeQ Surgical Teaching®

Resumen Objetivo: Evidenciar la mejora en la autoestima específica docente y del conocimiento integral de los dominios cognitivos de Bloom en los participantes en el curso 2CeQ®, estimados a través del incremento y análisis comparativo en la puntuación obtenida en la Escala de Autoestima de Rosenberg (EAR) y ejercicios de evaluación pre y poscurso. Diseño, metodología o aproximación: Estudio analítico comparativo transversal, de datos correspondientes a los valores de las variables (puntuación obtenida) de dos cuestionarios (Escala de Autoestima de Rosenberg [EAR] y ejercicios de evaluación pre y poscurso) contestados por los participantes en el curso. Análisis estadístico: frecuencia relativa de ocurrencia, medidas de dispersión y prueba t (p<0.05 fue estadísticamente significativo). Resultados: Se incluyeron 21 individuos. Se observó una mejora significativa en la puntuación de la autoestima específica como docente quirúrgico según la EAR (16.3±5 [7-25] vs 20.9±5.2 [13-30]; p=0.003). En el ejercicio de evaluación, hubo una diferencia estadísticamente significativa en la puntuación pre y poscurso (38.5±14.3 [10.3-70.6] vs 72.4±17 [29.4-88.2]; p=0.006). Limitaciones del estudio o implicaciones: Serie unicéntrica, con limitado número del tamaño de la muestra, lo que impide validar los resultados. Originalidad o valor: Estudio en epistemología educativa quirúrgica nacional, único en su clase. Hallazgos o conclusión: La participación en el Curso "2CeQ Docencia Quirúrgica®" aumenta la autoestima específica para el ejercicio docente y la capacidad técnica para desarrollar el proceso de enseñanza aprendizaje, por lo cual puede coadyuvar a elevar la calidad de los programas educativos.

Abstract Objetive: To show improvement in teaching-specific self-esteem and comprehensive knowledge on Bloom's cognitive domains, among participants in 2CeQ® Course, estimated through increase and comparative analysis of pre- and post-course scores obtained from Rosenberg's Self-esteem Scale (RSS) and evaluation-tests. Design, methodology and approximation: Transversal, analytic and comparative study of pre- and post-course values from data corresponding to RSS and evaluation tests scores, answered by participants. Statistics: Occurrence relative frequency, dispersion calculations, and t test (p<0.05 statistically significant). Results: 21 individuals were included. A significant improvement in surgical-teaching self-esteem from RSS (16.3±5 [7-25] vs 20.9±5.2 [13-30]; p=0.003) and a statistically significant difference between pre- and postcourse test's scores (38.5±14.3 [10.3-70.6] vs 72.4±17 [29.4-88.2]; p=0.006 were observed). Limitations and implications of study: Unicentric series and a limited sample, avoiding the validation of results. Originality or value: Study on national surgical education epistemology, one of a kind. Findings and conclusion: Participation in "2CeQ" Course increases specific self-esteem for teaching and technical ability to develop teaching and learning process, helping to optimize the quality of educational programs.

Pentraxin 3 Inhibits Complement-driven Macrophage Activation to Restrain Granuloma Formation in Sarcoidosis.

Rationale: Sarcoidosis is a multisystemic inflammatory disease characterized by the formation of granulomas in response to persistent stimuli. The long pentraxin PTX3 (pentraxin 3) has emerged as a component of humoral innate immunity with essential functions in the resolution of inflammation, but its role during granuloma formation is unknown. Objectives: To evaluate PTX3 as a modulator of pathogenic signals involved in granuloma formation and inflammation in sarcoidosis. Methods: Peripheral blood mononuclear cells obtained from patients with sarcoidosis harboring loss-of-function genetic variants and gene-deleted mice were used to assess the role of PTX3 in experimental models of granuloma formation in vitro and in vivo. The identified mechanisms of granulomatous inflammation were further evaluated in tissue and BAL samples and correlated with the disease course. Measurements and Main Results: We have identified a molecular link between PTX3 deficiency and the pathogenic amplification of complement activation to promote granuloma formation. Mechanistically, PTX3 deficiency licensed the complement component C5a-mediated activation of the metabolic checkpoint kinase mTORC1 (mammalian target of rapamycin complex 1) and the reprogramming of macrophages toward increased glycolysis to foster their proliferation and aggregation. This process sustained the further recruitment of granuloma-promoting immune cells and the associated proinflammatory microenvironment and influenced the clinical course of the disease. Conclusions: Our results identify PTX3 as a pivotal molecule that regulates complement-mediated signaling cues in macrophages to restrain granulomatous inflammation and highlight the therapeutic potential of this signaling axis in targeting granuloma formation in sarcoidosis.

Prevención y detección precoz del cáncer de mama en atención primaria / Prevention and early detection of breast cancer in primary care

El cáncer de mama es el tipo de cáncer más común, no restrictivo por edad, condición social, sexo, que afecta la condición de salud de alrededor de 2,3 millones de mujeres con resultados desfavorables. Este tipo de enfermedad afecta gravemente a la población y se estima que a nivel mundial la pérdida de la funcionalidad supera a las de otros tipos de cánceres. La información pertinente al tema se pudiera considerar como aporte en el nivel de conocimientos, estrategias válidas para la prevención y el despistaje oportuno de esta patología clínica Objetivo: Describir las estrategias de prevención y detección precoz del cáncer de mamá en atención primaria. Materiales y Métodos: Esta investigación es del tipo descriptiva, observacional y transversal. Se aplica una técnica de abordaje al tema con la extracción de datos bibliográficos y la intervención de la misma mediante el análisis sistemático, donde se emplea el método y diseño descriptivo. Resultados: El tipo de estudio busca la correlación estilo de vida saludable y no prevalencia de cáncer mediante una actuación temprana y oportuna como una conducta saludable. Conclusiones: La inspección y la técnica de palpación son de gran importancia para evaluar la aparición de un bulto y su reconocimiento por parte médica especializada. Cabe resaltar que no todo bulto en las mamas se considera cáncer, sin embargo, el diagnóstico médico oportuno y las pruebas diagnóstico especializadas para la detección son claves en la detección precoz y prevención(AU)

Breast cancer is the most common type of cancer, not restricted by age, social condition, sex, which affects the health condition of around 2.3 million women with unfavorable results. This type of disease seriously affects the population and it is estimated that worldwide the loss of functionality exceeds that of other types of cancers. The information pertinent to the topic could be considered as contribution in the level of knowledge, valid strategies for prevention and screening of this clinical pathology. Objective: To describe the strategies of prevention and Early detection of breast cancer in primary care. Materials and methods: This The research is descriptive, observational and cross-sectional. A technique is applied approach to the subject with the extraction of bibliographic data and the intervention of the same through systematic analysis, where the method and descriptive design are used. Results: The type of study seeks the correlation of healthy lifestyle and not prevalence of cancer through early and timely action as a behavior healthy. Conclusions: Inspection and palpation technique are of great importance to evaluate the appearance of a lump and its recognition by a specialized medical part. It should be noted that not every lump in the breast is considered cancer, however, the Timely medical diagnosis and specialized diagnostic tests for screening are keys to early detection and prevention(AU)

Biofabrication of Collagen Tissue-Engineered Blood Vessels with Direct Co-Axial Extrusion.

Cardiovascular diseases are considered one of the worldwide causes of death, with atherosclerosis being the most predominant. Nowadays, the gold standard treatment is blood vessel replacement by bypass surgery; however, autologous source is not always possible. Thereby, tissue-engineered blood vessels (TEBVs) are emerging as a potential alternative source. In terms of composition, collagen has been selected in many occasions to develop TEBVs as it is one of the main extracellular matrix components of arteries. However, it requires specific support or additional processing to maintain the tubular structure and appropriate mechanical properties. Here, we present a method to develop support-free collagen TEBVs with co-axial extrusion in a one-step procedure with high concentrated collagen. The highest concentration of collagen of 20 mg/mL presented a burst pressure of 619.55 ± 48.77 mmHg, being able to withstand perfusion of 10 dynes/cm2. Viability results showed a high percentage of viability (86.1 and 85.8% with 10 and 20 mg/mL, respectively) of human aortic smooth muscle cells (HASMCs) and human umbilical vein endothelial cells (HUVEC) after 24 h extrusion. Additionally, HUVEC and HASMCs were mainly localized in their respective layers, mimicking the native distribution. All in all, this approach allows the direct extrusion of collagen TEBVs in a one-step procedure with enough mechanical properties to be perfused.

Factores de riesgo y complicaciones cardiovasculares en pacientes por alteraciones de fosforo y calcio

Resumen La enfermedad renal crónica es un problema de salud pública a nivel mundial y se define como una anormalidad patológica del riñón como hematuria o proteinuria, o una reducción de la tasa de filtrado glomerular menor a 60ml-min por más de tres meses. En todos los estudios la prevalencia a esta enfermedad va aumentando debido a que sus principales causas diabetes e hipertensión se han convertido en pandemias. Objetivo. Demostrar los factores de riesgo y complicaciones cardiovasculares en pacientes por alteraciones minerales y óseas. Métodos. Se realizó un estudio descriptivo transversal en los pacientes del Instituto del riñón INRIDI San Martin de Enero a Nov del 2019, los métodos de investigación implementados fueron analítico y cualitativo- cuantitativo. El universo estuvo constituido por los 253 pacientes de la clínica de diálisis San Martin se obtuvo como muestra 70 pacientes basado en los criterios de exclusión. Resultados. Se halló que el 94.2 % de los pacientes estudiados estuvieron en el grupo de casos sin hipercalcemia, así mismo 58.55% sentaron en el grupo con hiperfosfatemia. Entre los factores de riesgo se demostró la prevalencia en el sexo masculino, la hipertensión, diabetes y la dislipidemia. Conclusiones . La frecuencia de cambios en el metabolismo mineral y óseo en pacientes con ERC es muy variable, y este estudio revela aspectos epidemiológicos que permiten reconocer los problemas actuales de la enfermedad que viabilizaran reducir el riesgo de eventos cardiovasculares y mejorar la calidad de vida de los pacientes.

Abstract Chronic kidney disease is a worldwide public health problem and is defined as a pathological abnormality of the kidney such as hematuria or proteinuria, or a reduction of the glomerular filtration rate to less than 60 ml-min for more than three months. In all studies the prevalence of this disease is increasing because its main causes diabetes and hypertension have become pandemics. Objective. To demonstrate the risk factors and cardiovascular complications in patients with mineral and bone alterations. Methods. A cross-sectional descriptive study was conducted in patients of the Instituto del riñón INRIDI San Martin from January to Nov 2019, the research methods implemented were analytical and qualitative-quantitative. The universe was constituted by the 253 patients of the San Martin dialysis clinic, 70 patients were obtained as a sample based on the exclusion criteria. Results: Results. It was found that 94.2% of the patients studied were in the group of cases without hypercalcemia, and 58.55% were in the group with hyperphosphatemia. Among the risk factors, the prevalence in the male sex, hypertension, diabetes and dyslipidemia was demonstrated. Conclusions . The frequency of changes in bone and mineral metabolism in patients with CKD is highly variable, and this study reveals epidemiological aspects that allow us to recognize the current problems of the disease that will make it feasible to reduce the risk of cardiovascular events and improve the quality of life of patients.

Resumo A doença renal crónica (CKD) é um problema de saúde pública mundial e é definida como uma anomalia patológica do rim, como a hematúria ou proteinúria, ou uma redução da taxa de filtração glomerular para menos de 60ml-min durante mais de três meses. Em todos os estudos, a prevalência desta doença está a aumentar porque as suas principais causas de diabetes e hipertensão se tornaram pandemias. Objectivo. Demonstrar os factores de risco e as complicações cardiovasculares em doentes com doenças minerais e ósseas. Métodos. Foi realizado um estudo descritivo transversal em pacientes do instituto renal San Martin INRIDI de Janeiro a Novembro de 2019, os métodos de investigação implementados foram analíticos e qualitativos-quantitativos. O universo consistia em 253 pacientes da clínica de diálise de San Martin, 70 pacientes foram obtidos como amostra com base nos critérios de exclusão. Resultados. Verificou-se que 94,2% dos doentes estudados se encontravam no grupo de casos sem hipercalcemia, e 58,55% estavam no grupo com hiperfosfatemia. Entre os factores de risco, foi demonstrada a prevalência de hipertensão, diabetes e dislipidemia no sexo masculino. Conclusões . A frequência das alterações do metabolismo ósseo e mineral em doentes com CKD é altamente variável, e este estudo revela aspectos epidemiológicos que nos permitem reconhecer os problemas actuais da doença que tornarão viável a redução do risco de eventos cardiovasculares e a melhoria da qualidade de vida dos doentes.

Evaluation of the immunomodulatory effects of cobalt, copper and magnesium ions in a pro inflammatory environment.

Biomaterials and scaffolds for Tissue Engineering are widely used for an effective healing and regeneration. However, the implantation of these scaffolds causes an innate immune response in which the macrophage polarization from M1 (pro-inflammatory) to M2 (anti-inflammatory) phenotype is crucial to avoid chronic inflammation. Recent studies have showed that the use of bioactive ions such as cobalt (Co2+), copper (Cu2+) and magnesium (Mg2+) could improve tissue regeneration, although there is limited evidence on their effect on the macrophage response. Therefore, we investigated the immunomodulatory potential of Co2+, Cu2+ and Mg2+ in macrophage polarization. Our results indicate that Mg2+ and concentrations of Cu2+ lower than 10 µM promoted the expression of M2 related genes. However, higher concentrations of Cu2+ and Co2+ (100 µM) stimulated pro-inflammatory marker expression, indicating a concentration dependent effect of these ions. Furthermore, Mg2+ were able to decrease M1 marker expression in presence of a mild pro-inflammatory stimulus, showing that Mg2+ can be used to modulate the inflammatory response, even though their application can be limited in a strong pro-inflammatory environment.

Epidemiología de los pacientes hospitalizados con COVID-19 en un hospital de tercer nivel / Epidemiology of hospitalized patients with COVID-19 in a tertiary care hospital

Resumen Introducción: COVID-19, causada por el betacoronavirus SARS-CoV-2, ha saturado los sistemas de salud del mundo. Objetivo: Describir las características epidemiológicas de los pacientes atendidos en un hospital de tercer nivel. Métodos: Se realizó una cohorte retrospectiva de pacientes con diagnóstico o sospecha de COVID-19, del 23 de marzo al 31 de julio de 2020. Resultados: En el Hospital Central Militar se hospitalizaron 4401 pacientes, 35 % derechohabientes, 26 % civiles, 28 % militares en activo y solo 11 %, militares retirados. Predominó el sexo masculino, tanto en los pacientes hospitalizados como en los que fallecieron, el grupo O+ y la ausencia de comorbilidades; entre las comorbilidades que se observaron, las principales fueron el sobrepeso y la diabetes. La mediana de edad de los pacientes hospitalizados fue de 49 años, mientras que 62 años fue la edad de quienes fallecieron; las mujeres mayores de 51 años tuvieron mayor riesgo de fallecer. La tasa de letalidad ajustada fue de 18.5 %; 50 % falleció durante los primeros seis días. Conclusiones: En este estudio se lograron identificar las características epidemiológicas y se destacaron las principales comorbilidades en pacientes mexicanos con infección por SARS-CoV-2.

Abstract Introduction: COVID-19, caused by the betacoronavirus SARS-CoV-2, has overwhelmed the world's health systems. Objective: To describe the epidemiological characteristics of patients treated in a tertiary care hospital. Methods: A retrospective cohort study of patients diagnosed with or suspected of having COVID-19 from March 23 to July 31, 2020 was conducted. Results: 4,401 patients were hospitalized at the Central Military Hospital, out of which 35 % were beneficiaries, 26 % civilians, 28 % active military, and only 11%, retired military. Male gender predominated, both in hospitalized patients and in those who died, as well as the O+ group and absence of comorbidities; among the observed comorbidities, the main ones were overweight and diabetes. Hospitalized patients' median age was 49 years, while median age of those who died was 62 years; women older than 51 years had a higher risk of dying. Adjusted case fatality rate was 18.5 %; 50 % died within the first six days. Conclusions: In this study, the epidemiological characteristics and main comorbidities in Mexican patients with SARS-CoV-2 infection were identified.