Evaluación de parámetros inflamatorios, trombóticos y variantes genéticas en pacientes con ataque cerebrovascular isquémico que se asisten en un hospital de Uruguay

Introducción: El ataque cerebrovascular es la segunda causa de muerte en adultos en el mundo occidental y una de las principales causas de discapacidad permanente, aumentando su frecuencia con la edad, el 85 % es de tipo isquémico. Objetivos: Analizar parámetros trombofílicos, hipofibrinolíticos y genéticos en pacientes con ataque cerebrovascular isquémico y evaluar la posible asociación de estos con factores de riesgo cardiovascular. Metodología: Se utilizó un cuestionario para evaluar la presencia de factores de riesgo cardiovascular en 114 pacientes incluidos en el estudio con diagnóstico de ataque cerebrovascular isquémico. Proteína C y antitrombina fueron determinados mediante métodos cromogénicos, resistencia a la proteína C activada e inhibidor lúpico mediante métodos coagulométricos y proteína S libre, inhibidor del activador del plasminógeno-1, homocisteína y lipoproteína (a) por métodos inmunoquímicos. Fibrinógeno fue determinado por coagulometría y proteína C reactiva por inmunoturbidimetría, ambos contra un grupo control. Las variantes genéticas factor V Leiden, protrombina G20210A, rs1205 (gen PCR), rs1800779 (gen NOS3) y rs2257073 (gen ASB10) fueron analizadas mediante real-time PCR, comparando los últimos tres con una población de referencia. La alteración de las frecuencias de las variables fue determinada por análisis estadístico chi-cuadrado. Resultados: Tres de los cuatro pacientes jóvenes estudiados presentaron indicadores de trombofilia. El resto de los parámetros alterados fueron homocisteína 30.1% (22.4-39.1), lipoproteína (a) 32.1% (24.1-41.4), inhibidor del activador del plasminógeno-1 36.0% (27.8-45.1), fibrinógeno 12.3% (7.5-19.6) y proteína C reactiva 78.1% (69.6-84.7). Se encontró asociación (p < 0.05) entre ciertos factores de riesgo cardiovascular y los parámetros evaluados como hipertensión/proteína C reactiva, dislipemia/lipoproteína (a), arritmia/lipoproteína (a) y arritmia/fibrinógeno. Para pacientes con ataque cerebrovascular isquémico solo la variante rs1205 mostró una frecuencia más alta del alelo T. Conclusiones: Este estudio revela la importancia de analizar la trombofilia en pacientes jóvenes, especialmente en aquellos sin factores de riesgo cardiovascular, así como el rol de la hipofibrinolisis, inflamación y algunas variantes genéticas en el desarrollo de ataque cerebro vascular isquémico.

Introduction: Stroke is the second cause of death in adults in the Western world and one of the main causes of permanent disability, increasing in frequency with age; 85% are ischemic. Objectives: To analyze thrombophilic, hypofibrinolytic, inflammatory, and genetic parameters in patients with ischemic stroke and evaluate possible associations with vascular risk factors. Methodology: Questionnaires were used to evaluate vascular risk factors in 114 patients included in the study with ischemic stroke diagnosis. Protein C and Antithrombin were determined by chromogenic assays, Activated Protein C Resistance and Lupus Anticoagulant were determined with by coagulometry and Free Protein S, Plasminogen activator inhibitor-1, Homocysteine and Lipoprotein (a) by immunochemistry. Fibrinogen was assayed by coagulometry and C-reactive protein by immunoturbidimetry, both against a control group. Factor V Leiden, Prothrombin G20210A, rs1205 (CRP gene), rs1800779 (NOS3 gene) and rs2257073 (ASB10 gene) genetic variants were analyzed by Real-Time PCR, comparing the last three with a reference population. Alteration frequencies of the variables were determined by chi-square statistical analysis. Results: Three out of four of the young patients studied presented indicators of thrombophilia. The rest of the altered parameters were Homocysteine 30.1% (22.4-39.1), Lipoprotein (a) 32.1% (24.1-41.4), Plasminogen activator inhibitor-1 36.0% (27.8-45.1), Fibrinogen 12.3% (7.5-19.6) and C-reactive protein 78.1% (69.6-84.7). Associations were found (p<0.05) between certain vascular risk factors and parameters evaluated, namely hypertension/C-reactive protein, dyslipidemia/lipoprotein (a), arrhythmia/lipoprotein (a) and arrhythmia/fibrinogen. For ischemic stroke patients only the genetic variant rs1205 showed higher frequency of the T allele. Conclusions: This study reveals the importance of analyzing thrombophilia in young patients, especially those without vascular risk factors, as well as the role of hypofibrinolysis, inflammation and some genetic variants in the development of ischemic stroke.

Introdução: O AVC é a segunda causa de morte em adultos no mundo ocidental e uma das principais causas de incapacidade permanente, aumentando de frequência com a idade; 85% são isquémicos. Metas: Analisar os parâmetros trombofílicos, hipofibrinolíticos e genéticos em pacientes com acidente vascular cerebral isquêmico e avaliar a possível associação com fatores de risco cardiovascular. Metodologia: Um questionário foi utilizado para avaliar a presença de fatores de risco cardiovascular em 114 pacientes incluídos no estudo com diagnóstico de acidente vascular cerebral isquêmico. Proteína C e antitrombina foram determinadas por métodos cromogênicos, resistência à proteína C ativada e inibidor de lúpus por métodos coagulométricos e proteína S livre, inibidor do ativador do plasminogênio-1, homocisteína e lipoproteína (a) por métodos imunoquímicos. O fibrinogênio foi determinado por coagulometria e a proteína C-reativa por imunoturbidimetria, ambos contra um grupo controle. As variantes genéticas fator V Leiden, protrombina G20210A, rs1205 (gene PCR), rs1800779 (gene NOS3) e rs2257073 (gene ASB10) foram analisadas por PCR em tempo real, comparando as três últimas com uma população de referência. As frequências de alteração das variáveis ​​foram determinadas pela análise estatística qui-quadrado. Resultados: Três dos quatro pacientes jovens estudados apresentaram indicadores de trombofilia. O resto dos parâmetros alterados foram homocisteína 30,1% (22,4-39,1), lipoproteína (a) 32,1% (24,1-41,4), inibidor do ativador de plasminogênio-1 36,0% (27,8-45,1), fibrinogênio 12,3% (7,5-19,6) e proteína C reativa 78,1% (69,6-84,7). Foi encontrada associação (p<0,05) entre alguns fatores de risco cardiovascular e os parâmetros avaliados como hipertensão/proteína C reativa, dislipidemia/lipoproteína (a), arritmia/lipoproteína (a) e arritmia/fibrinogênio. Para pacientes com acidente vascular cerebral isquêmico apenas a variante rs1205 apresentou maior frequência do alelo T. Conclusões: Este estudo revela a importância de analisar a trombofilia em pacientes jovens, especialmente aqueles sem fatores de risco cardiovascular, bem como o papel da hipofibrinólise, inflamação e algumas variantes genéticas no desenvolvimento do acidente vascular cerebral isquêmico.

Sífilis: las sombras en el diagnóstico. A propósito de un caso clínico

La sífilis es una infección de transmisión sexual, potencialmente grave. La presentación clínica es muy variada, desde manifestaciones cutáneo-mucosas hasta neurológicas. Para el diagnóstico se emplean estudios de laboratorio, treponémicos y no treponémicos, con los que se realizan diferentes algoritmos para disminuir las limitaciones de cada prueba por separado. Se discute el caso de un joven que se presenta con fiebre y lesiones en piel sugestivas de sífilis secundaria, con un test VDRL falso negativo por efecto prozona. Este fenómeno, infrecuente, se debe a la concentración desproporcionadamente alta de anticuerpos. Conocer las herramientas diagnósticas y trabajar en conjunto con el equipo de laboratorio, puede facilitar el acercamiento a la enfermedad y a un tratamiento oportuno disminuyendo así la morbimortalidad de los pacientes.

Syphilis is a potentially serious sexually transmitted infection. The clinical presentation is very varied, from cutaneous-mucosal to neurological manifestations. For the diagnosis, treponemal and non-treponemal laboratory studies are used, with which different algorithms are performed to reduce the limitations of each test separately. We discuss the case of a young man who presented with fever and skin lesions suggestive of secondary syphilis, with a false negative VDRL test due to prozone effect. This rare phenomenon is due to a disproportionately high concentration of antibodies. Knowing the diagnostic tools and working together with the laboratory team can facilitate the approach to the disease and timely treatment, thus reducing the mor bidity and mortality of patients.

A sífilis é uma infecção sexualmente transmissível potencialmente grave. A apresentação clínica é muito variada, desde manifestações cutâneo-mucosas a neurológicas. Para o diagnóstico, são utilizados estudos laboratoriais, treponêmicos e não treponêmicos, com os quais são realizados diferentes algoritmos para reduzir as limitações de cada teste separadamente. Discutimos o caso de um jovem que apresentou febre e lesões cutâneas sugestivas de sífilis secundária, com teste VDRL falso negativo devido ao efeito prozona. Esse fenômeno raro se deve à concentração desproporcionalmente alta de anticorpos. Conhecer as ferramentas diagnósticas e trabalhar em conjunto com a equipe do laboratório pode facilitar a abordagem da doença e o tratamento oportuno, reduzindo assim a morbimortalidade dos pacientes.

Characterizing the impact of verbal communication and health literacy in the patient-surgeon encounter.

BACKGROUND: Patients with limited health literacy (HL) have difficulty understanding written/verbal information. The quality of verbal communication is not well understood. Therefore, our aim was to characterize patient-surgeon conversations and identify opportunities for improvement. METHODS: New colorectal patient-surgeon encounters were audio-recorded and transcribed. HL was measured. Primary outcomes were rates-of-speech, understandability of words, patient-reported understanding, and usage of medical jargon/statistics. Secondary outcomes included length-of-visit (LOV), conversation possession time, patient-surgeon exchanges, and speech interruptions. RESULTS: Significant variations existed between surgeons in rates-of-speech and understandability of words (p < 0.05). Faster rates-of-speech were associated with significantly less understandable words (p < 0.05). Patient-reported understanding varied by HL and by surgeon. Conversation possession time and usage of medical jargon/statistics varied significantly by surgeon (p < 0.05) in addition to patient-surgeon exchanges and interruptions. Patients with limited HL had shorter LOV. CONCLUSIONS: Significant variations exist in how surgeons talk to patients. Opportunities to improve verbal communication include slowing speech and using more understandable words.

Stem Cell Therapy in the Treatment of Patients With Autism Spectrum Disorder: a Systematic Review and Meta-analysis.

OBJECTIVE: Assess the safety and efficacy of upcoming stem cell treatments and analyze their effects on the cognitive and behavioral impairments in patients diagnosed with autism. METHODS: We included controlled and noncontrolled, randomized and non-randomized trials evaluating stem cell therapy as a treatment in patients with autism spectrum disorder compared to placebo or without comparator. DATA SOURCES: Scopus, Web of Science, MEDLINE and EMBASE. Risk of bias was assessed using Cochrane's Risk of Bias tool and the NIH's Quality Assessment Tool for Studies With No Control Group. RESULTS: Eleven trials including 461 patients proved eligible. ABC scale meta-analysis showed a mean raw of -11.97 in the intervention groups (95 % CI -91.45 to 67.52, p < 0.01). CARS scale reported a mean raw of -9.08 (95 % CI -15.43 to -2.73, p < 0.01). VABS scale was reported by their domains: communication domain reported a mean raw of 2.69 (95 % CI 1.30 to 4.08, p = 0.92); daily living domain, 1.99 (95 % CI 0.83 to 3.15, p = 0.51); motor domain, 1.06 (95 % CI -0.37 to 2.48, p = 0.20); socialization domain, 3.09 (95 % CI 1.71 to 4.48, p = 0.61); adaptive behavior domain, 2.10 (95 % CI 1.04 to 3.16, p = 0.36). Furthermore, the most common side effects reported included fever, hyperactivity, vomit, headache, and aggressiveness; no serious adverse events were reported. CONCLUSIONS: The body of evidence suggests that stem cell therapy significantly improves scales in patients with autism spectrum disorder, hence, future studies should help us have more confidence in the results. We found no serious adverse events related to the stem cell therapy.

The association of health literacy and postoperative complications after colorectal surgery: A cohort study.

BACKGROUND: Health literacy is a determinant of health. Few studies characterize its association with surgical outcomes. METHODS: Retrospective cohort study of patients undergoing elective colorectal surgery 2015-2020. Health literacy assessed using Brief Health Literacy Screening Tool. Outcomes were postoperative complications, LOS, readmissions, mortality. RESULTS: Of 552 patients, 46 (8.3%) had limited health literacy, 506 (91.7%) non-limited. Median age 57.7 years, 305 (55.1%) patients were female, 148 (26.8%) were Black. Limited patients had higher rates of overall complications (43.5% vs. 24.3%, p = 0.004), especially surgical site infections (21.7% vs. 11.3%, p = 0.04). Limited patients had longer LOS (5 vs 3.5 days, p = 0.006). Readmissions and mortality did not differ. On multivariable analysis, limited health literacy was independently associated with increased risk of complications (OR 2.03, p = 0.046), not LOS (IRR 1.05, p = 0.67). CONCLUSION: Limited health literacy is associated with increased likelihood of complications after colorectal surgery. Opportunities exist for health literate surgical care to improve outcomes for limited health literacy patients.

Impact of the Gut Microbiota Balance on the Health-Disease Relationship: The Importance of Consuming Probiotics and Prebiotics.

Gut microbiota is a group of microorganisms that are deposited throughout the entire gastrointestinal tract. Currently, thanks to genomic tools, studies of gut microbiota have pointed towards the understanding of the metabolism of important bacteria that are not cultivable and their relationship with human homeostasis. Alterations in the composition of gut microbiota could explain, at least in part, some epidemics, such as diabetes and obesity. Likewise, dysbiosis has been associated with gastrointestinal disorders, neurodegenerative diseases, and even cancer. That is why several studies have recently been focused on the direct relationship that these types of conditions have with the specific composition of gut microbiota, as in the case of the microbiota-intestine-brain axis. In the same way, the control of microbiota is related to the diet. Therefore, this review highlights the importance of gut microbiota, from its composition to its relationship with the human health-disease condition, as well as emphasizes the effect of probiotic and prebiotic consumption on the balance of its composition.

Comparative Evaluation of Four Extraction Methods of Antioxidant Compounds from Decatropis bicolor in Aqueous Medium Applying Response Surface Design.

The objective of this paper is to compare conventional, ultrasound, microwave, and French press methods for the extraction of antioxidant compounds from Decatropis bicolor in an aqueous medium. This plant is widely used in Mexican traditional medicine for breast cancer treatment. Despite that, there are few studies on D. bicolor. Two response surface designs were applied to establish the best conditions of the liberation of antioxidants from D. bicolor, which were determined by DPPH• and Ferric Reducing Antioxidant Power (FRAP) techniques. The total phenolic content was evaluated by the Folin-Ciocalteu method. The results showed that D. bicolor is a source of antioxidants (669-2128 mg ET/100 g and 553-1920 mg EFe2+/100 g, respectively) and phenolic compounds (2232-9929 mg EGA/100 g). Among the physical factors that were analyzed, the temperature was the determinant factor to liberate the compounds of interest by using low concentrations of the sample and short times of extraction. The French press was the most efficient method, obtaining values of antioxidant activity and phenolic compounds even higher than those reported by using extraction methods with solvents such as methanol.

Lactobacillus pentosus ABHEAU-05: An in vitro digestión resistant lactic acid bacterium isolated from a traditional fermented Mexican beverage / Lactobacillus pentosus ABHEAU-05: una bacteria ácido láctica resistente a la digestión in vitro aislada de una bebida fermentada tradicional mexicana

Abstract The health benefits attributed to probiotics generate interest in the search of competent strains adapted to several ecological niches, especially those related to traditional beverages and foods of each country. Pineapple tepache, a traditional Mexican fermented beverage, was used for the isolation of lactic acid bacteria with probiotic potential, one of which withstood the in vitro tests. The isolated strain AB-05, which exhibited the tested probiotic functional properties, was designated as Lactobacillus pentosus ABHEAU-05. The sequence was registered in GenBank under access code MK587617. This study is the first report of a lactic acid bacterium with in vitro digestion resistance isolated from pineapple tepache. The survival of L. pentosus ABHEAU-05 in a symbiotic medium was proven using fermented milk enriched with inulin. The in vitro digestion-resistant probiotic activity of lactobacilli was measured through analysis of pH and proteolysis. Results showed that L. pentosus grew properly in fermented milk; therefore, this microorganism could be used in the manufacture of this kind of products. The concentration of L. pentosus reached up to 8.5 logCFU/ml after 40 h of fermentation. In addition, the production of peptides and the decrease in pH indicated the vigorous and active metabolic state of the lactic acid bacterium tested. The activity and the concentration of this microorganism were maintained during refrigeration. The results of this research conclude that L. plantarum ABHEAU-05 is an in vitro digestion-resistant microorganism that can be used as a starter culture for the production of functional foods of dairy origin.

Resumen Los beneficios a la salud atribuidos a los probióticos generan interés en la búsqueda de cepas competentes adaptadas a varios nichos ecológicos, especialmente los relacionados con bebidas y alimentos tradicionales de cada país. En este estudio, se aisló del tepache de pina, una bebida fermentada tradicional mexicana, una bacteria láctica resistente a la digestión in vitro. Entre 5 bacterias aisladas, una de ellas soportó las pruebas simuladas de digestión gastrointestinal. Se analizó la resistencia a sales biliares, a condiciones ácidas y al ataque enz-imático con pepsina. La bacteria aislada, que exhibió las propiedades funcionales probióticas referidas, fue identificada como Lactobacillus pentosus y designada como L. pentosus ABHEAU-05. La secuencia fue depositada en GenBank (acceso MK587617). Se comprobó la supervivencia de L. pentosus ABHEAU-05 en una leche fermentada adicionada con inulina y su resistencia a la digestión in vitro mediante el análisis del pH y la proteólisis. Los resultados muestran que la leche fermentada es una matriz adecuada, donde L. pentosus ABHEAU-05 se desarrolla sin inconvenientes, alcanzando un título de 8,5 logufc/ml después de 40 h de fermentación. Además, la producción de péptidos y el descenso del pH indicaron el estado metabólico vigoroso y activo del microorganismo probiótico. Se concluye que L. pentosus ABHEAU-05 es un microorganismo resistente a la digestión in vitro, que puede servir como cultivo iniciador para la producción de alimentos de origen lácteo. Este es el primer informe acerca del aislamiento de una bacteria ácido láctica resistente a la digestión in vitro a partir del tepache de piña.

Mexican Concensus of Multiple Myeloma.

To identify this increasingly common pathology, known as multiple myeloma (MM), it is necessary to refer to the specific factors that characterize it; to this end, the classic criteria known as CRAB (hyperkalemia, renal failure, anemia, and lytic lesions) are available, in which renal failure is one of the most frequent complications. Recently, three indisputable biomarkers have been described for the diagnostic support for MM, which are: more than 10% of clonal plasma cells in bone marrow or, a biopsy that corroborates the presence of a plasmacytoma, light chain ratio ≥ 100 mg/dL and more than one focal lesion on magnetic resonance imaging. A differential diagnosis for plasma cell leukemia, solitary bone plasmacytoma, and extramedullary plasmacytoma should always be considered. Being this an incurable disease, a lot of research has been done regarding its therapeutic management, whose main objective is the disappearance of plasma cells and the patient clinical improvement. Melphalan was the first drug that showed a benefit in 1958 and afterward, with the addition of a steroid as a second drug, it was possible to improve response rates. Subsequently, different molecules were studied, forming multiple combinations, and achieving better rates of overall survival and progression-free survival. Years later, with the arrival of proteasome inhibitors such as bortezomib, and immunomodulators such as thalidomide and lenalidomide, an important turnaround in the disease has been seen, as deeper responses, more prolonged remissions, and improvement in the quality of life of patients have been achieved. This consensus has the purpose of integrating a group of Mexican specialists and promoting the updating of this pathology.

Para identificar una patología cada vez más común, conocida como mieloma múltiple, es necesario hacer alusión de los factores específicos que la caracterizan. Para ello existen los clásicos criterios conocidos como CRAB (hipercalcemia, insuficiencia renal, anemia y lesiones líticas), siendo la insuficiencia renal una de sus complicaciones más frecuentes. Recientemente se han descrito tres biomarcadores indiscutibles para el apoyo diagnóstico del mieloma múltiple, que son: más del 10% de células plasmáticas clonales en medula ósea o biopsia que corrobora la presencia de un plasmocitoma, relación de cadenas ligeras ≥ 100 mg/dl y más de una lesión focal en resonancia magnética. Se debe tomar siempre en cuenta el diagnóstico diferencial con leucemia de células plasmáticas, plasmocitoma óseo solitario y plasmocitoma extramedular. Al ser una enfermedad incurable, se ha investigado mucho en cuanto al manejo terapéutico, el cual tiene como objetivo principal la desaparición de las células plasmáticas y la mejoría clínica del paciente. El primer fármaco que demostró algún beneficio fue el melfalán en el año 1958 y posteriormente al adicionar un esteroide como segundo fármaco se logró mejorar las tasas de respuesta. Después se fueron estudiando diferentes moléculas, con las que se han realizado múltiples combinaciones, alcanzando mejores tasas de supervivencia global y supervivencia libre de progresión. Años más tarde, con la llegada de los inhibidores de proteosoma como el bortezomib, así como de los agentes inmunomoduladores como la talidomida y la lenalidomida, se presenta un giro importante en la enfermedad, ya que se logran respuestas más profundas, periodo de remisiones más prolongadas y mejoría en la calidad de vida de los pacientes. Este consenso tiene la finalidad de integrar a un grupo de especialistas mexicanos y promover la actualización de esta patología.

Valores de referencia de analitos en orina en la edad pediatrica / Reference values of analytes in urine in the pediatric age / Valores de referência de analitos na urina na idade pediátrica

La deteccion de trastornos metabolicos minerales puede explicar diversas anomalias fisiologicas que exigen para su interpretacion la comparacion con valores de referencia validados. El objetivo de este trabajo fue la determinacion de valores de referencia en la poblacion infantil uruguaya, de los analitos sodio, potasio, calcio, magnesio, fosforo y urato relacionados con la creatinina en muestras de la segunda miccion de la manana en 470 escolares (240 ninas y 230 ninos) con edades comprendidas entre 7 y 12 anos. Las medianas obtenidas fueron: Na/Crea: 139 mmol/g, K/Crea: 78 mmol/g, Ca/Crea: 77 mg/g, Mg/Crea: 71 mg/g, P/Crea: 500 mg/g, Ur/Crea: 554 mg/g, Crea: 117 mg/dL. A excepcion de los cocientes Na/Crea y K/Crea se encontro una disminucion de la excrecion de estos analitos con la edad, independientemente del sexo. Los valores obtenidos resultaron ser analogos a los de otras poblaciones con tipo de alimentacion similar.

The detection of mineral metabolic disorders can explain several pathologies which require the comparison with reference values for their interpretation. The aim of this study was to determine the reference values of 470 Uruguayan school children with ages between 7 and 12 for sodium, potassium, calcium, magnesium, phosporous and urate and their relationship with creatinine in urine samples of the second urination of the morning. The median obtained were: Na/Crea: 139 mmol/g, K/Crea: 78 mmol/g, Ca/Crea: 77 mg/g, Mg/Crea: 71 mg/g, P/Crea: 500 mg/g, Ur/Crea: 554 mg/g, Crea: 117 mg/dL. A diminishment of excretion with the age was found, regardless the sex, except for Na/Crea and K/Crea. The values obtained were similar to those of others populations with a similar diet.

A detecção de distúrbios metabólicos minerais pode explicar várias anomalias fisiológicas, que exigem a comparação com valores de referência validados para serem interpretados. O objetivo deste estudo foi determinar valores de referência na população infantil uruguaia, dos analitos sódio, potássio, cálcio, magnésio, fósforo e urato relacionados com a creatinina em amostras da segunda micção da manhã em 470 alunos (240 meninas e 230 meninos) com idades entre 7 e 12 anos. As medianas obtidas foram: Na/Crea: 139 mmol/g, K/Crea: 78 mmol/g, Ca/Crea: 77 mg/g, Mg/Crea: 71 mg/g, P/Crea: 500 mg/g, Ur/Crea: 554 mg/g, Crea: 117 mg/dL. Com exceção dos quocientes Na/Crea e K/Crea, foi encontrada uma diminuição na excreção destes analitos com a idade independentemente do sexo. Os valores obtidos foram análogos aos de outras populações com um tipo similar de dieta.

Uso de Totaltrack®, nuevo dispositivo para vía aérea en México / Use of Totaltrack®, new device for airway in Mexico

Resumen: Introducción: Las complicaciones relacionadas con el manejo de la vía aérea representan de 1 a 18%. Totaltrack® es un aparato video-máscara laríngea con un orificio que permite intubar y ventilar al paciente con visión indirecta a través de una cámara, además de un puerto para introducir una sonda de aspiración esófago-gástrica. Material y métodos: Se evaluó el dispositivo en 57 pacientes, ASA I-III de 18 a 65 años de edad sometidos a anestesia general balanceada, con y sin predictores de vía aérea difícil, sin bloqueo neuromuscular. Se realizó la medición del índice predictor de intubación difícil antes de cada procedimiento. Durante la laringoscopía directa por extubación incidental se realizó la valoración Cormack-Lehane. Una vez obtenidos los resultados se realizó el análisis del uso de Totaltrack® en las presiones de sellado de la máscara laríngea y el éxito de la intubación traqueal a través del dispositivo. Resultados: Del total de pacientes analizados, la inserción y ventilación fueron exitosas en todos los casos, la fuga estática y las presiones máximas de inflado del componente de la máscara laríngea fueron a 30 cm de aire, respectivamente. La intubación traqueal a través del dispositivo tuvo éxito en el total de los pacientes, con un tiempo medio de intubación de 4.5 ± 0.58 segundos. No se observó insuflación gástrica. La variabilidad hemodinámica no fue clínicamente significativa. No se reportaron efectos secundarios significativos, el Cormack-Lehane de los dos pacientes extubados incidentalmente fue de III en ambos casos. Conclusiones: Sí se encontró útil el uso de Totaltrack® en todos los casos. El uso de Totaltrack® permite una visualización óptima de la vía aérea, la intubación no se complica y se puede realizar con secuencia rápida, independientemente del índice predictor de intubación difícil y el Cormack-Lehane.

Abstract. Introduction: Complications related to airway management represent from 1 to 18%. Totaltrack® is a laryngeal video-mask device with, that allows intubate and ventilate patients with indirect vision through a camera, also have a port to introduce an esophagogastric aspiration probe. Material and methods: The device was evaluated in 57 ASA I-III patients from 18 to 65 years of age undergoing balanced general anesthesia, with and without predictors of difficult airway, without neuromuscular block, it has been made the difficult intubation predictor index before each procedure. During the direct laryngoscopy due to incidental extubation, the Cormack-Lehane assessment was performed. Once the results were obtained, an analysis was made of the use of Totaltrack® in the sealing pressures of the laryngeal mask and the success of tracheal intubation through the device. Results: Of the total number of patients analyzed. The insertion and ventilation were successful in all cases, the static leak and the maximum inflation pressures of the laryngeal mask component were 30 cm of air respectively. The tracheal intubation through the device was successful in all cases, with a mean intubation time of 4.5 ± 0.58 seconds. Gastric insufflation was not observed. The hemodynamic variability was not clinically significant. No significant side effects were reported, the Cormack-Lehane of the two patients incidentally extubated was III in both cases. Conclusions: Yes, the use of Totaltrack® was found useful in all cases. The use of Totaltrack® allows an optimal visualization of the airway, the intubation is not complicated and can be performed with rapid sequence, independently of the difficult intubation predictor index and the Cormack Lehane.

Propiedades psicométricas del Inventario de Hábitos de Estudio CASM-85: un estudio multicéntrico con estudiantes de secundaria peruanos / Psychometric properties of the Inventory of Study Habits CASM-85: a multicenter study with Peruvian high school students

Objetivo: evaluar la estructura interna, invarianza de medida, validez de criterio y confiabilidad del CASM-85 en estudiantes de secundaria peruanos. Materiales y Métodos: se evaluaron 2075 estudiantes de ambos sexos, entre 11 y 18 años, provenientes de colegios nacionales y particulares de Arequipa, Chimbote, Lima y Pucallpa. Se realizó un análisis de la correlación ítem-ítem e ítemresto para cada dimensión del CASM-85, un análisis factorial confirmatorio y modelos MIMIC (Multiple Indicator, Multiple Cause) para evaluar la invarianza de medida a través de grupos según sexo, edad, colegio y ciudad. La confiabilidad fue estimada mediante los coeficientes Alpha y Omega. La validez de criterio entre el CASM-85 y el rendimiento académico se revisó a través de la r de Pearson y modelos de regresión. Resultados: se eliminaron ítems heterogéneos y se obtuvo una forma reducida de 45 ítems a compararse con su original de 53 ítems. Para la forma original el CFI y TLI fue < .9 en todas las ciudades, mientras que para la forma reducida fue < . 9 solo en Chimbote. Los SRMR y RMSEA fueron ≤ .10 y ≤ .09 para las formas original y reducida respectivamente. Los modelos MIMIC confirmaron invarianza para todas las variables excepto para la variable ciudad con la forma original (│ΔCFI│ = .09, │ΔTLI│ = .08). La confiabilidad fue moderada tanto para la forma original (Ω ≥ .68; α ≥ .81) como para la reducida (Ω ≥ .77; α ≥ .84). La r de Pearson mostró una relación positiva y de fuerza débil para la forma original (r = .17) y reducida (r = .18). Conclusión: la forma reducida del CASM-85 (45 ítems) ha mostrado mejores propiedades psicométricas que su forma original.

Objective: To assess the internal structure, measurement invariance, criterion validity and reliability of the CASM-85 in Peruvian high school students. Materials and methods: Two thousand seventy-five (2075) students of both sexes, aged 11 to 18 years, from public and private high schools of Arequipa, Chimbote, Lima and Pucallpa were evaluated. An item-item and item-rest correlation analysis for each dimension of the CASM- 85, a confirmatory factorial analysis and MIMIC (Multiple Indicator, Multiple Cause) models were used to evaluate the measurement invariance across the groups according to their sex, age, school and city. Reliability was estimated using alpha and omega coefficients. The criterion validity between the CASM-85 and academic performance was determined using Pearson’s r and regression models. Results: The heterogeneous items were removed, obtaining a 45-item short form compared to the original 53-item form. In the original form, CFI and TLI were < .9 in all the cities, whereas in the short form, CFI and TLI were < .9 only in Chimbote. SRMR and RMSEA were ≤ .10 and ≤ .09 in the original and short forms, respectively. The MIMIC models confirmed the measurement invariance in all variables, with the exception of the original form between cities (│ΔCFI│ = .09, │ΔTLI│= .08). Reliability was moderate for both the original (Ω ≥ .68; α ≥ .81) and short forms (Ω ≥ .77; α ≥ .84). Pearson’s r showed a positive and weak correlation in the original (r = .17, p < .001) and short (r = .18, p < .001) forms. Conclusion: The CASM-85 short form (45 items) has shown better psychometric properties than its original full form.

Associations of Parental Marijuana Use With Offspring Marijuana, Tobacco, and Alcohol Use and Opioid Misuse.

Importance: Marijuana use is increasing among adults and often co-occurs with other substance use; therefore, it is important to examine whether parental marijuana use is associated with elevated risk of substance use among offspring living in the same household. Objective: To examine associations of parental marijuana use with offspring marijuana, tobacco, and alcohol use and opioid misuse. Design, Setting, and Participants: This cross-sectional study used survey data from the 2015 through 2018 National Surveys on Drug Use and Health (NSDUH), which provide nationally representative data on adolescents or young adults living with a parent (the mother or the father). Annual average percentages were based on survey sampling weights. Final analyses were conducted September 21 through 23, 2019. Exposures: Parental marijuana use status. Main Outcomes and Measures: Offspring self-reported use of marijuana, tobacco, or alcohol or misuse of opioids. Results: Survey respondents included 24 900 father-offspring or mother-offspring dyads sampled from the same household. Among mothers living with adolescent offspring, 8.2% (95% CI, 7.3%-9.2%) had past-year marijuana use, while 7.6% (95% CI, 6.2%-9.2%) of mothers living with young adult offspring had past-year marijuana use. Among fathers living with adolescent offspring, 9.6% (95% CI, 8.5%-10.8%) had past-year marijuana use, and 9.0% (95% CI, 7.4%-10.9%) of fathers living with young adult offspring had past-year marijuana use. Compared with adolescents whose mothers never used marijuana, adjusted relative risk (ARR) of past-year marijuana use was higher among those whose mothers had lifetime (without past-year) marijuana use (ARR, 1.3; 95% CI, 1.1-1.6; P = .007), less than 52 days of past-year marijuana use (ARR, 1.7; 95% CI, 1.1-2.7; P = .02), or 52 days or more of past-year marijuana use (ARR, 1.5; 95% CI, 1.1-2.2; P = .02). Compared with young adults whose mothers never used marijuana, adjusted risk of past-year marijuana use was higher among those whose mothers had lifetime (without past-year) marijuana use (ARR, 1.4; 95% CI, 1.1-1.7; P = .001), less than 52 days of past-year marijuana use (ARR, 1.5; 95% CI, 1.0-2.3; P = .049), or 52 days or more of past-year marijuana use (ARR, 1.8; 95% CI, 1.3-2.5; P = .002). Compared with adolescents whose fathers never used marijuana, adolescents whose fathers had less than 52 days of past-year marijuana use were more likely to use marijuana (ARR, 1.8; 95% CI, 1.2-2.7; P = .006). Compared with young adults whose fathers never used marijuana, young adults whose fathers had 52 days or more of past-year marijuana use were more likely to use marijuana (ARR, 2.1; 95% CI, 1.6-2.9; P < .001). Compared with their peers whose parents never used marijuana and after adjusting for covariates, the adjusted risk of past-year tobacco use was higher among adolescents whose mothers had lifetime marijuana use (ARR, 1.3; 95% CI, 1.0-1.6; P = .03), less than 52 days of past-year marijuana use (ARR, 1.5; 95% CI, 1.0-2.1; P = .04), or 52 days or more of past-year marijuana use (ARR, 1.6; 95% CI, 1.1-2.3; P = .03); adolescents whose fathers had lifetime marijuana use (ARR, 1.5; 95% CI, 1.1-1.9; P = .004) or 52 days or more of past-year marijuana use (ARR, 1.8; 95% CI, 1.2-2.7; P = .006); young adults whose mothers had lifetime marijuana use (ARR, 1.2; 95% CI, 1.0-1.4; P = .04); and young adults whose fathers had 52 days or more of past-year marijuana use (ARR, 1.4; 95% CI, 1.0-1.9; P = .046). Compared with their peers whose parents had no past marijuana use and after adjusting for covariates, risk of past-year alcohol use was higher among adolescents whose mothers had lifetime marijuana use (ARR, 1.2; 95% CI, 1.1-1.4; P = .004), less than 52 days of past-year marijuana use (ARR, 1.5; 95% CI, 1.2-1.9; P = .002), or 52 days or more of past-year marijuana use (ARR, 1.3; 95% CI, 1.0-1.7; P = .04). After adjusting for covariates, parental marijuana use was not associated with opioid misuse by offspring. Conclusions and Relevance: In this cross-sectional study, parental marijuana use was associated with increased risk of substance use among adolescent and young adult offspring living in the same household. Screening household members for substance use and counseling parents on risks posed by current and past marijuana use are warranted.

Experimental and theoretical study of the role of CH/π interactions in the aminolysis reaction of acetyl galactoside.

Molecular recognition of saccharides is a growing field, which has many implications in cancer therapy, drug discovery, and cellular communication among others. The participation of CH/π interactions in this event is well known. Nevertheless, the intrinsic role of CH/π for modulating chemical reactions is still far from being applicable. In this experimental and computational work we have evaluated the participation of CH/π interactions in the aminolysis reaction of acetyl galactoside promoted with different 6-substituted 2(1H)-pyridones. Two features have been incorporated to the promoter molecular structure, on one end the promoting pyridone group and on the other end the recognition moiety, joined together by an alkyne spacer. The small increment in the observed pseudo-first-order rate constant values (kobs) was related to the stability of the transition state provided by noncovalent interactions, including CH/π interactions. A longer alkyne spacer was necessary to improve the molecular recognition of the galactoside substrate. The trend of the calculated activation energy values (ΔERTS) was in good accordance with the experimental rate constant values.

Health determinants in adults in Chimbote, Peru: A descriptive study. / Determinantes de la salud en adultos de la ciudad de Chimbote, Perú: estudio descriptivo.

OBJETIVE: To describe health determinants in adults from the jurisdictions of the North and South Pacific Health Networks in the city of Chimbote. METHODS: A non-controlled descriptive study was carried out. Health determinants were classified in the following categories: bio-socioeconomic characteristics, lifestyle, and social and community support. For the descriptive analysis of categorical variables, relative and absolute frequencies were used. RESULTS: A total of 1 496 adults were included in the study. In the bio-socioeconomic determinants category, 62.2% were women and 53.3% were older adults. In the lifestyle determinants category, 52.4% did not smoke and had not ever smoked regularly, 50.5% did not consume alcoholic bever-ages, and 66.9% had 6 to 8 hours of sleep. In the social/community support determinants category, 53% had been treated at a health facility in the previous 12 months, 47.5% considered the distance between the health facility where they were treated and their home to be average, and 64.6% had public health insurance (SIS) from Perus Ministry of Health (MINSA). CONCLUSION: Most participants completed high school but this level of education did not result in access to higher-scale salaries. In addition, most partici-pants owned their own homes as well as access to basic services but lived in overcrowded conditions. A sedentary lifestyle and high-carbohydrate diet were predominant in this sample, highlighting the need for education to improve health.

OBJETIVO: Describir los determinantes de la salud en adultos de la jurisdicción de la Red de Salud Pacifico Norte y Sur de la ciudad de Chimbote. MÉTODOS: Se realizó un estudio descriptivo no controlado. Los determinantes de la salud fueron descritos mediante las dimensiones: del entorno biosocioeconómico, de los estilos de vida y de las redes sociales y comunitarias. Para el análisis descriptivo de variables categóricas se utilizaron frecuencias relativas y absolutas. RESULTADOS: Se incluyeron 1496 adultos. En los determinantes del entorno biosocioeconómico, el 62,2% son mujeres y 53,3% adultos mayores. En determinantes de estilos de vida, el 52,4% no fuma, ni ha fumado nunca de manera habitual, 50,5% no consumen bebidas alcohólicas y 66,9% duerme de seis a ocho horas. En determinantes de apoyo comunitario, el 53% se atendió en estos 12 últimos meses en un puesto de salud, 47,5% considera que el lugar donde se atendió se encuentra a regular distancia desde su vivienda y 64,6% tiene Seguro Integral de Salud del Ministerio de Salud peruano, SIS–MINSA. CONCLUSIÓN: La mayoría de las personas estudiadas culminó estudios secundarios y no accedió a mejores escalas salariales. La mayoría cuenta con vivienda propia y servicios básicos, pero viven en hacinamiento. Predomina el sedentarismo y alimentación elevada en carbohidratos.

Sequence Identification of Bioactive Peptides from Amaranth Seed Proteins (Amaranthus hypochondriacus spp.).

Amaranthus hypochondriacus spp. is a commonly grown cereal in Latin America, known for its high protein content. The objective of this study was to separate and identify bioactive peptides found in amaranth seeds through enzymatically-assisted hydrolysis using alcalase and flavourzyme. Hydrolysis was carried out for each enzyme separately and compared to two-step continuous process where both enzymes were combined. The biological activity of the resulting three hydrolysates was analyzed, finding, in general, higher bioactive potential of the hydrolysate obtained in a continuous process (combined enzymes). Its fractions were separated by RP-HPLC, and their bioactivity was analyzed. In particular, two fractions showed the highest biological activity as ACE inhibitors with IC50 at 0.158 and 0.134, thrombin inhibitors with IC50 of 167 and 155, and antioxidants in ABTS assay with SC50 at 1.375 and 0.992 mg/L, respectively. Further sequence analysis of the bioactive peptides was carried out using MALDI-TOF, which identified amino acid chains that have not been reported as bioactive so far. Bibliographic survey allowed identification of similarities between peptides reported in amaranth and other proteins. In conclusion, amaranth proteins are a potential source of peptides with multifunctional activity.

Bioactive compounds in aqueous extracts of lemon balm (Melissa officinalis) cultivated in Mexico

Lemon balm (Melissa officinalis) is a plant in the family of Lamiaceae. In Mexican traditional medicine it is used to alleviate gastrointestinal and hepatic problems. Studies carried out mainly in ethanolic and methanolic extracts, have revealed the presence of diverse compounds to which those medicinal properties are attributed. The objective of this research work was to extract in aqueous solution the antioxidants present in lemon balm and identify them through HPLC-MS. A Box-Behnken design was applied to determine the physical conditions of antioxidant extraction, where the analyzed variables were time, temperature and sample quantity. The antioxidant activity was determined through methodologies of DPPH*, FRAP and total phenolics. The aqueous solution with the highest antioxidant activity was analyzed through HPLC-MS. The results showed that the interaction temperature-time has a positive influence on the liberation of antioxidants. The best condition for a conventional extraction of antioxidants was 90°C, 15 min and 2 g of sample. Higher correlations were observed at r2>0.6 between determined antioxidant activity by DPPH* (or FRAP) vs Total phenolics; this would indicate that such activity could be attributed to phenolic compounds whose presence was confirmed through an analysis by HPLC-MS(AU)

El toronjil (Melissa officinalis) es una planta de la familia Lamiaceae. En la medicina tradicional mexicana es utilizado para aliviar problemas gastrointestinales y hepáticos. Algunos estudios realizados con extractos etanólicos y metanólicos de dicha planta, han revelado la presencia de diversos compuestos a los que se les atribuye sus propiedades medicinales. El objetivo de esta investigación fue extraer en solución acuosa los antioxidantes presentes en el toronjil e identificarlos a través de HPLC-MS. Para ello, se aplicó un diseño de experimentos Box-Behnken a fin de determinar las condiciones físicas de extracción de antioxidantes; las variables analizadas fueron tiempo, temperatura y cantidad de muestra. La actividad antioxidante fue determinada a través de las metodologías de DPPH*, FRAP y fenoles totales. El extracto acuoso con la mayor actividad antioxidante fue analizado mediante HPLCMS. Los resultados mostraron que la interacción tiempotemperatura tuvo una influencia positiva en la liberación de antioxidantes. La mejor condición para la extracción de antioxidantes presentes en el toronjil fue 90°C, 15 min y 2 g de muestra. Correlaciones superiores a r2>0.6 fueron determinadas entre la actividad antioxidante medida por DPPH* (o FRAP) vs Fenoles totales; esto podría indicar que la actividad antioxidante encontrada podría atribuirse a compuestos de tipo fenólico cuya presencia fue confirmada por el análisis en HPLC-MS(AU)

Calidad de vida relacionada con la salud: percepción de los adolescentes obesos, no obesos y sus padres / Quality of life related to health: perception of obese, non-obese adolescents and their parents

Resumen

Introducción: la obesidad y el sobrepeso son factores de riesgo para desencadenar enfermedades crónicas. Los adolescentes obesos son más susceptibles que los no obesos a presentar síntomas de ansiedad, disminución del rendimiento escolar, aislamiento social, baja autoestima y depresión.

Objetivo: comparar la percepción de calidad de vida relacionada con la salud (CVRS) en adolescentes obesos, en no obesos y en los padres de ambos.

Metodología: estudio descriptivo y transversal, en una muestra de 98 adolescentes (de 13 a 18 años), 57 de ellos con obesidad y 41 sin obesidad, además de sus respectivos padres. Se midió peso, talla e índice de masa corporal (IMC) y se utilizó el cuestionario The Pediatric Quality of Life Inventory (PedsQL" 4.0). Se hizo el análisis estadístico con U de Mann-Whitney y r de Pearson para IMC y CVRS.

Resultados: en la dimensión física y psicosocial los adolescentes no obesos y sus padres tuvieron una mejor percepción que los adolescentes obesos y sus padres. En el grupo de adolescentes obesos existió correlación significativa entre el IMC y la función escolar (r = 0.310 y p = 0.049).

Conclusión: en términos de percepción global de la CVRS, hubo diferencias en la percepción entre los grupos. La mejor percepción se presentó en el grupo de adolescentes no obesos y sus padres.

Abstract

Introduction: Obesity and overweight are risk factors that may lead to the development of chronic diseases; obese adolescents are more susceptible than non-obese to present symptoms of anxiety, decreased school performance, social isolation, low self-esteem and depression.

Objective: To compare the perception of quality of life related to health (HRQOL) in obese and non-obese adolescents and their parents.

Methods: Descriptive and cross-sectional study, in a sample of 98 adolescents (13-18 years of age), 57 of them with obesity and 41 without obesity, as well as their parents. Weight, height and body mass index (BMI) were measured and the Pediatric Quality of Life Inventory questionnaire (PedsQL" 4.0) was used. The analysis was made with Mann-Whitney U and Pearson's r tests for BMI and HRQoL.

Results: in the physical and psychosocial dimension non-obese adolescents and their parents had better perception than obese adolescents and their parents. In the group of obese adolescents there was a significant correlation between the BMI and the school function (r = 0.310 and p = 0.049).

Conclusion: In terms of global perception of HRQoL, there were differences in perception between the groups. The group of non-obese adolescents and their parents had the best perception.