Clinical Outcomes of a Toric Enhanced Depth-of-Focus Intraocular Lens Based on the Combination of 4th- and 6th-Order Spherical Aberration.

PURPOSE: To assess the visual and refractive outcomes of patients implanted with a toric extended depth-of-focus (EDOF) intraocular lens (IOL) following cataract surgery. METHODS: A total of 44 eyes implanted with the EDOF LuxSmart toric IOL were evaluated 4 to 6 months postoperatively. The main outcomes measurements evaluated were refractive error, rotational stability, distance, intermediate, and near visual acuities, defocus curve, photopic and mesopic contrast sensitivity, wavefront aberrations, and modulation transfer function, and the Catquest-9SF-questionnaire. RESULTS: The mean postoperative spherical equivalent and cylinder were -0.02 ± 0.26 and -0.17 ± 0.29 diopters (D), respectively. A total of 90.45% and 100% of the eyes had a postoperative spherical equivalent within ±0.50 and ±1.00 D, respectively (this being 93.18% and 100% for the refractive cylinder). The mean rotational stability was 0.61 ± 1.61 degrees. The mean binocular corrected distance visual acuity (CDVA), corrected distance intermediate visual acuity (CDIVA), and corrected distance near visual acuity (CDNVA) were -0.02 ± 0.06, 0.07 ± 0.08, and 0.26 ± 0.09 logMAR, respectively. The CDVA was 20/25 or better in 95.45% of patients, CDIVA was 20/25 or better in 72.73%, and CDNVA was 20/40 or better in 72.73%. The defocus curve showed good visual acuity at distance and intermediate vergences. The contrast sensitivity and optical quality outcomes were good with mean higher order, spherical, and coma aberration values of 0.161 ± 0.155, -0.019 ± 0.048, and 0.080 ± 0.065 µm, respectively. A total of 90.9% of patients were either fairly satisfied or very satisfied with their vision after the surgery, and 77.7% of patients reported no difficulties when reading text in newspapers. CONCLUSIONS: Implantation of the toric pure refractive EDOF technology IOL provides good refractive, optical, and visual quality at different distances, with high levels of patient satisfaction being reported. [J Refract Surg. 2024;40(6):e398-e406.].

Manifestaciones digestivas en el curso de enfermedades reumáticas, estudio de 5 años / Digestive manifestations in the course of rheumatic diseases, 5-year study

RESUMEN Introducción: Las enfermedades reumáticas son un grupo de alrededor de 250 afecciones que afectan fundamentalmente el sistema osteomioarticular, aunque la mayoría tiene un carácter sistémico. En el caso del sistema digestivo el compromiso puede estar causado por el propio proceso inflamatorio de la enfermedad o secundario a la afectación que causa los distintos grupos farmacológicos usados contra las enfermedades reumáticas. Objetivo: Caracterizar el compromiso digestivo de una cohorte de paciente con enfermedades reumáticas durante un periodo de estudio de 5 años. Métodos: Investigación básica, no experimental, descriptiva y longitudinal que incluyó como población de estudio una cohorte de 109 pacientes con diagnóstico de enfermedades reumáticas según criterios del Colegio Americano de Reumatología. Se identificaron las características generales de los pacientes, de las enfermedades reumáticas incluidas en la investigación y las principales manifestaciones digestivas identificadas. Resultado: Promedio de edad de 57,83 años, predominio de pacientes femeninas (71,56 %), procedencia urbana (55,05 %) y con diagnóstico de artritis reumatoide (50,46 %). El 90,82 % de los pacientes refirió haber utilizado glucocorticoides. El 94,49 % de los pacientes presentó algún tipo de manifestación extraarticular digestiva. La gastritis (36,89 %), úlcera péptica (25,24 %), reflujo gastroesofágico (18,45 %) y sequedad bucal (15,53 %) fueron las de mayor frecuencia de presentación. Conclusiones: Las manifestaciones digestivas constituyen una expresión extraarticular frecuente en el curso de las enfermedades reumáticas. Su origen pude estar supeditado a la patogenia de la enfermedad o a los eventos adversos de los grupos farmacológicos utilizados en los esquemas terapéuticos de las enfermedades reumáticas. Los glucocorticoides fueron el grupo farmacológico más usado. Algunas manifestaciones digestivas puede llegar a poner en peligro la vida de los pacientes.

ABSTRACT Introduction: Rheumatic diseases are a group of around 250 conditions that mainly affect the osteomyoarticular system, but most of them have a systemic nature, which is why they affect different organs and organ systems. In the case of the digestive system, the compromise may be caused by the inflammatory process of the disease itself or secondary to the affectation generated by the different pharmacological groups that are used to control rheumatic diseases. Objective: To characterize the digestive compromise of a cohort of patients with rheumatic diseases during a study period of 5 years. Methods: Basic, non-experimental, descriptive, correlational and longitudinal research that included as a study population a cohort of 109 patients diagnosed with rheumatic diseases according to the criteria of the American College of Rheumatology. The general characteristics of the patients, the rheumatic diseases included in the research, the main digestive manifestations identified were identified. Result: Average age of 57.83 years, predominance of female patients (71.56%), urban origin (55.05%) and with a diagnosis of rheumatoid arthritis (50.46%). 90.82% of the patients reported having used glucocorticoids. 94.49% of the patients presented some type of extra-articular digestive manifestation. Gastritis (36.89%), peptic ulcer (25.24%), gastroesophageal reflux (18.45%) and dry mouth (15.53%) were the ones with the highest frequency of presentation. Conclusions: Digestive manifestations are a frequent extra-articular expression in the course of rheumatic diseases. Its origin may be subject to the etiopathogenic mechanisms of the disease or to the adverse events of the pharmacological groups used in the therapeutic regimens for rheumatic diseases. Glucocorticoids were the most frequently used pharmacological group in the therapeutic regimens for rheumatic diseases. The presence of some digestive manifestations endanger the lives of patients.

Acquisition Time for Swept-Source Optical Biometry Plus Corneal Power Measurement During Cataract Evaluation.

Purpose: To compare the acquisition time necessary to obtain the optical biometry plus corneal power measurement using the IOLMaster 700 with central topography with that found using the standard IOLMaster 700 in combination with two corneal topographers, when acquiring biometry measurements during cataract evaluation. Methods: This prospective, observational, controlled study included 96 eyes of 96 cataract patients. Acquisition times were registered for different conditions: time required for one complete measurement with IOLMaster 700 with central topography, time required for one complete measurement with standard IOLMaster 700 (without central topography), time required for one complete measurement with standard IOLMaster 700 plus time required for one complete measurement with Cassini, and time required for one complete measurement with standard IOLMaster 700 plus time required for one complete measurement with Pentacam HR. In addition, the agreement between keratometry (K), total keratometry (TK) and equivalent K reading (EKR) parameters using the three devices was performed. Results: The post hoc Tukey's test revealed that there were statistically significant differences for all pairwise comparisons (p < 0.001) except for the acquisition times of the IOLMaster with central topography and the standard IOLMaster 700 (p = 0.501). The acquisition time by the IOLMaster 700 with central topography takes approximately three less times than the use of a corneal topographer combined with a biometer. The agreement of K1, K2, TK1, TK2, EKR1 and EKR2 measurements between the three devices revealed statistically significant differences for all possible comparisons (p < 0.001) except for the comparison between the IOLMaster 700 and the Cassini for all parameters (p > 0.05). Conclusion: We consider that this is an efficient procedure that improves clinical flow. We also conclude that K readings obtained with the three devices cannot be used interchangeably since there are clinically relevant differences that may affect cataract surgery outcomes.

Hemoglobina glucosilada en el diagnóstico de diabetes gestacional en mujeres mexicanas durante el tercer trimestre / Glycosylated hemoglobin in the diagnosis of gestational diabetes in Mexican women during the third trimester

Resumen El objetivo del trabajo fue analizar los valores de hemoglobina glucosilada en el tercer trimestre de embarazo como predictores alternativos de la diabetes gestacional en pacientes del Noreste de México. Se trata de un estudio retrospectivo de casos y controles a partir de 121 expedientes de pacientes embarazadas, divididos en dos grupos, pacientes con diabetes gestacional (casos) y gestantes con valores glucémicos normales (controles). Se analizaron los factores de riesgo asociados a la diabetes gestacional y se obtuvo un punto de corte para la hemoglobina glucosilada. Se encontró que la obesidad materna, la edad y el antecedente del padecimiento fueron asociados significativamente con la diabetes gestacional. Valores de hemoglobina glucosilada ≥5% incrementaron el riesgo de padecer diabetes mellitus gestacional 4 veces y, aunado a un factor de riesgo, la probabilidad se incrementó 7 veces. Se concluye que los valores de hemoglobina glucosilada en el tercer trimestre de embarazo podrían emplearse como prueba diagnóstica de la diabetes gestacional en pacientes del Noreste de México. Sin embargo, aunque las diferencias encontradas fueron estadísticamente significativas, los resultados se deben interpretar con cautela y requieren su confirmación con estudios que incluyan una muestra mayor.

Abstract The objective of this study was to analise glycosylated hemoglobin values in the third trimester of pregnancy as an alternative predictor of gestational diabetes in North East Mexican cohort patients. This is a retrospective case-control study based on 121 records of pregnant patients, divided into two groups, patients with gestational diabetes (cases) and pregnant women with normal glycemic values (control). The risk factors associated with gestational diabetes were analised and a cut-off point for glycosylated hemogestaglobin was obtained. It was found that maternal obesity, age and a history of the condition were significantly associated with gestational diabetes. Values of glycosylated hemoglobin ≥5% increased the risk of suffering from gestational diabetes 4 times, and coupled with a risk factor, the risk increased 7 times. It is concluded that glycosylated hemoglobin values in the third trimester of pregnancy could be used as a diagnostic test for gestational diabetes in patients from the North East of Mexico. Although the differences found were statistically significant, our results must be interpreted with caution and require confirmation by studies with a larger sample.

Resumo O objetivo deste estudo foi analisar os valores da hemoglobina glicada no terceiro trimestre de gestação como preditores alternativos do diabetes gestacional em pacientes na região nordeste do México. Trata-se de um estudo retrospectivo de casos e controles utilizando 121 prontuários de gestantes divididas em dois grupos; pacientes com diabetes gestacional (casos) e gestantes com valores de glicemia normais (controles). Foram analisados os fatores de risco associados a diabetes gestacional obtendo-se um ponto de corte para a hemoglobina glicada. Descobriu-se que a obesidade materna, idade e antecedentes da doença foram associados significativamente ao diabetes gestacional. Valores da hemoglobina glicada ≥ 5% aumentaram o risco de padecer diabetes mellitus gestacional 4 vezes, e juntamente a um fator de risco, a probabilidade aumentou 7 vezes. Conclui-se que os valores da hemoglobina glicada no terceiro trimestre de gestação poderiam ser usados como teste diagnóstico do diabetes gestacional em pacientes da região nordeste do México. Embora as diferenças encontradas tenham sido estatisticamente significativas, os resultados devem ser interpretados com cautela e requerem confirmação através de estudos que incluam uma amostra maior.

Hacia un mundo libre de malaria: Utopía o realidad / Towards a malaria-free world: Utopia or reality

La Malaria es una enfermedad causada por un parásito que se transmite a los humanos a través de la picadura de mosquito hembra Anophele. Reportando la WHO en el 2019, 229 millones de casos y 409.000 muertes por la enfermedad en 87 paises del mundo, Existen seis especies de este párasito: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale wallickeri, Plasmodium ovale curtisi, Plasmodium malariae y Plasmodium knowlesi. Siendo la especie P. falciparum la causante de mayor morbilidad, con tasa entre 10 y 50% de mortalidad por malaria complicada. Alrededor de 108 países han declarado la malaria como enfermedad endémica, pudiendo padecer la enfermedad en cualquier época del año. Sin embargo, en el caso de América Latina hoy en día se vive un estancamiento de la enfermedad, reportándose en países menos de 100 casos autóctonos entre el 2000 y 2019, con algunas excepciones. Esta situación de vulnerabilidad de países como Brasil, Colombia, la frontera Perú-Ecuador, Venezuela, se incrementan ante la presencia activa de la pandemia producto del Covid -19 aunado a restricciones económicas, incremento de la actividad minera, o políticas públicas que ponen en riesgo la sostenibilidad del programa de control de la enfermedad. Para el 2021 la OMS corrobora que existen 87 países con malaria a nivel mundial, de los cuales 24 de ellos habían interrumpido su transmisión autóctona por 3 años. Realidad que consolidad la propuesta tras la experiencia adquirida, que cualquiera que sea la situación epidemiológica de entrada, el trabajo hacia la erradicación de la malaria debe entenderse y atenderse como un proceso continuo donde los propios Estados deben desde su realidad y estrategias propias se articulen con el Plan Estratégico Técnico Mundial Contra la Malaria 2016-2030 propuesto por la OMS(AU)

Malaria is a disease caused by a parasite that is transmitted to humans through the bite of the female Anophele mosquito. Reporting the WHO in 2019, 229 million cases and 409,000 deaths from the disease in 87 countries of the world, There are six species of this parasite: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale wallickeri, Plasmodium ovale curtisi, Plasmodium malariae and Plasmodium knowlesi. The species P. falciparum is the cause of greatest morbidity, with a rate between 10 and 50% of mortality from complicated malaria. About 108 countries have declared malaria as an endemic disease, and the disease can occur at any time of the year. However, in the case of Latin America today there is a stagnation of the disease, with fewer than 100 indigenous cases reported in countries between 2000 and 2019, with some exceptions. This situation of vulnerability of countries such as Brazil, Colombia, the Peru-Ecuador border, Venezuela, increases in the face of the active presence of the pandemic product of the Covid -19 coupled with economic restrictions, increased mining activity, or public policies that put at risk the sustainability of the disease control programme. By 2021, WHO confirms that there are 87 countries with malaria worldwide, of which 24 had interrupted their indigenous transmission for 3 years. Reality that consolidates the proposal after the experience acquired, that whatever the epidemiological situation of entry, The work towards the eradication of malaria must be understood and addressed as a continuous process where the States themselves must from their own reality and strategies articulate with the Global Technical Strategic Plan Against Malaria 2016-2030 proposed by the WHO(AU)

Punicalin and ellagic acid from pomegranate peel extract facilitate apoptotic behaviour in the Hela cell line.

Polyphenols may be an effective therapy for both the prevention and treatment of cancer. Previous studies have found that these compounds may inactive Hela cells, which may even be converted into a normal cells post-treatment. The present study extracted phenolic compounds from pomegranate peel, with the polyphenols then purified using different solvents and identified by means of high-performance liquid chromatography-tandem mass spectrometry (HPLC/MS). Once the phenolic compounds had been purified, we evaluated their cytotoxic effects on both the Hela and NIH-3T3 cell lines, on which an apoptosis assay was also carried out. Additionally, apoptosis assay was carried out on Hela and NIH-3T3. Lastly, the proteome profile was analysed via two-dimensional gel electrophoresis (2-DE) and liquid chromatography-tandem mass spectrometry (LC/MS/MS). We isolated and then purified punicalagin and ellagic acid (EA) from pomegranate peel, with both compounds likely to have a cytotoxic effect on Hela and NIH-3T3. However, this effect depends on both concentration and exposure time. Results obtained using a Cayman commercial assay kit suggests that punicalin and EA regulate the apoptosis on the Hela and NIH-3T3 cell lines. Finally, we observed that polyphenols compounds regulate the expression of proteins related to apoptosis. In conclusion, punicalin and EA have a cytotoxic effect on Hela and, furthermore, reactive the apoptotic pathway in this cell.

Morbilidad y mortalidad asociadas con protocolos de transfusión masiva en hemorragia obstétrica severa / Morbidity and mortality associated with mass transfusion protocols in severe obstetric hemorrhage

Resumen OBJETIVO: Determinar la morbilidad y mortalidad debidas a la aplicación de protocolos de transfusión masiva en pacientes con hemorragia obstétrica atendidas en cuidados intensivos. MATERIALES Y MÉTODOS: Estudio de una cohorte retrospectiva de pacientes con hemorragia obstétrica severa atendidas en la unidad de cuidados intensivos obstétricos del Hospital Materno Infantil del Instituto de Seguridad Social del Estado de México y Municipios, entre septiembre de 2014 y mayo de 2019. Se compararon tres protocolos de transfusión masiva en los que se aplicaron los derivados de la sangre en relación con la proporción de concentrado eritrocitario, de plaquetas y plasma con las siguientes proporciones: 2:1:1, 1:1:1 y liberal. Para analizar la posible asociación de las complicaciones con la elección de los diferentes protocolos de transfusión masiva, se utilizó un análisis mediante prueba ANOVA y χ2 en el programa SPSS versión 21; se consideró significativo el valor de p < 0.05. RESULTADOS: Se analizaron 75 pacientes con edad promedio de 32.8 años; 63 eran multigestas. La causa principal de la hemorragia obstétrica fue la atonía uterina. 51 de 75 de los protocolos de transfusión masiva fueron liberales, 11 de ellos con una relación 2:1:1 y 4 de 51 de 1:1:1. Las complicaciones fueron: síndrome de insuficiencia respiratoria aguda, lesión renal aguda, lesión renal aguda originada por la transfusión, infecciones y reintervención quirúrgica. Se encontró asociación positiva con: los días de estancia en cuidados intensivos (p = 0.031), reintervención quirúrgica (p = 0.006) y síndrome de insuficiencia respiratoria aguda (p = 0.044) y los protocolos de transfusión masiva liberal respecto de los protocolos con relación 1:1:1. Solo una paciente falleció y ello se asoció con el protocolo de transfusión masiva liberal. CONCLUSIONES: La aplicación de protocolos de transfusión masiva 1:1:1 y 2:1:1 en pacientes con hemorragia obstétrica severa disminuye el riesgo de complicaciones. La mortalidad materna debido a la aplicación del protocolo de transfusión masiva liberal fue de solo un caso en 51 pacientes.

Abstract OBJECTIVE: To determine the morbidity and mortality due to the application of massive transfusion protocols in patients with obstetric hemorrhage treated in intensive care. MATERIALS AND METHODS: study of a retrospective cohort of patients with severe obstetric hemorrhage treated in the obstetric intensive care unit of the maternal and child hospital of the social Security Institute of the State of Mexico and municipalities, between september 2014 and may 2019. three massive transfusion protocols were compared in which blood derivatives were applied in relation to the ratio of erythrocyte concentrate, platelets and plasma with the following ratios: 2:1:1, 1:1:1 and liberal. to analyze the possible association of complications with the choice of the different mass transfusion protocols, an anova and χ2 test was used in the spss version 21 program; the value of p < 0.05 was considered significant. RESULTS: Seventy-five patients with a mean age of 32.8 years were analyzed; 63 were multigrafted. The main cause of obstetric bleeding was uterine atony. 51 of 75 of the mass transfusion protocols were liberal, 11 of them with a 2:1:1 ratio and 4 of 51 of 1:1:1. The complications were: acute respiratory failure syndrome, acute renal injury, acute renal injury originated by transfusion, infections and surgical reintervention. Positive association was found with: days of stay in intensive care (p = 0.031), surgical reintervention (p = 0.006) and acute respiratory failure syndrome (p = 0.044) and liberal mass transfusion protocols with respect to 1:1:1 ratio protocols. Only one patient died and this was associated with the liberal mass transfusion protocols. CONCLUSIONS: The application of 1:1:1 and 2:1:1 mass transfusion protocols in patients with severe obstetric hemorrhage decreases the risk of complications. Maternal mortality due to the application of liberal mass transfusion protocols was only one case in 51 patients.

Encapsulation of Upconversion Nanoparticles in Periodic Mesoporous Organosilicas.

(1) Background: Nanomedicine has recently emerged as a promising field, particularly for cancer theranostics. In this context, nanoparticles designed for imaging and therapeutic applications are of interest. We, therefore, studied the encapsulation of upconverting nanoparticles in mesoporous organosilica nanoparticles. Indeed, mesoporous organosilica nanoparticles have been shown to be very efficient for drug delivery, and upconverting nanoparticles are interesting for near-infrared and X-ray computed tomography imaging, depending on the matrix used. (2) Methods: Two different upconverting-based nanoparticles were synthesized with Yb3+-Er3+ as the upconverting system and NaYF4 or BaLuF5 as the matrix. The encapsulation of these nanoparticles was studied through the sol-gel procedure with bis(triethoxysilyl)ethylene and bis(triethoxysilyl)ethane in the presence of CTAB. (3) Results: with bis(triethoxysilyl)ethylene, BaLuF5: Yb3+-Er3+, nanoparticles were not encapsulated, but anchored on the surface of the obtained mesoporous nanorods BaLuF5: Yb3+-Er3+@Ethylene. With bis(triethoxysilyl)ethane, BaLuF5: Yb3+-Er3+ and NaYF4: Yb3+-Er3+nanoparticles were encapsulated in the mesoporous cubic structure leading to BaLuF5: Yb3+-Er3+@Ethane and NaYF4: Yb3+-Er3+@Ethane, respectively. (4) Conclusions: upconversion nanoparticles were located on the surface of mesoporous nanorods obtained by hydrolysis polycondensation of bis(triethoxysilyl)ethylene, whereas encapsulation occurred with bis(triethoxysilyl)ethane. The later nanoparticles NaYF4: Yb3+-Er3+@Ethane or BaLuF5: Yb3+-Er3+@Ethane were promising for applications with cancer cell imaging or X-ray-computed tomography respectively.

Association of the Vascular Endothelial Growth Factor Gene Polymorphism +936 C/T with Diabetic Neuropathy in Patients with Type 2 Diabetes Mellitus.

BACKGROUND: Peripheral neuropathy is one of the most common late complications of diabetes. Vascular endothelial growth factor (VEGF) gene polymorphisms have been associated with the development of peripheral neuropathy in different populations of patients with type 2 diabetes mellitus (DM2). OBJECTIVE: To analyze the prevalence of the +936 C/T VEGF gene polymorphism among patients with DM2 with and without peripheral neuropathy. STUDY DESIGN AND METHODOLOGY: 218 unrelated DM2 patients, 90 with and 128 without peripheral neuropathy were genotyped for the +936 C/T VEGF gene polymorphism using PCR amplification followed by restriction length polymorphism analysis. RESULTS: The CC homozygous VEGF+936 C/T (rs3025039) was the predominant genotype in DM2 patients with peripheral neuropathy, whereas the predominant genotype in patients without neuropathy was the heterozygous C/T. No statistical association was found between genotype distribution and the presence of neuropathy (p = 0.063). The distribution of the genotypes according to the dominant (CC vs. CT + TT) and recessive (TT vs. CT + CC) models showed that the homozygous CC and TT genotypes, respectively, are not risk factors for neuropathy. The CT genotype conferred a protective effect as seen in the over-dominant model (CT vs. CC + TT) (OR = 0.52; 95% CI = 0.300-0.90; p = 0.019). CONCLUSION: We conclude that the VEGF+936 C/T (rs3025039) gene polymorphisms are related to peripheral neuropathy in Mexican DM2 patients, with the heterozygous genotype potentially conferring a protective effect.

Optimization of the shelf life of lamb forelegs packed in different multilayer polymeric materials and modified atmospheres.

Lamb forelegs were packed in three different gas mixtures (Treatment N2: 70% N2-30% CO2; Treatment O2: 70% O2-30% CO2; Treatment Ar: 70% Ar-30% CO2) and two types of polymeric materials (B1, a polyamide-polypropylene bag and B2, a bag made of bio-oriented polyamide, aluminium and polyethylene). Physical, chemical and microbiological parameters were determined, initially and after 7, 14 and 21 days of storage (3 ± 1 °C). Colour and oxidative stability decreased and the number of microorganisms increased significantly during the storage period. Treatment O2 increased a* and TBARs. Despite the different permeability to O2, shown by the polymeric material (< 6.0 vs . < 0.5 cm3/m2/24 h bar), the different types of packaging did not significantly affect any of the studied parameters. Regarding the atmosphere treatment or type of packaging, these factors did not significantly affect mesophile or Enterobacteriaceae counts either.

Uso de agrotóxicos de agricultores en cantón Cerro Verde, municipio de Tecapán, Departamento de Usulután, de Mayo a Agosto 2019 / Use of pesticides by farmers in cantón Cerro Verde, municipality of Tecapán, Department of Usulután, from May to August 2019

Propósito: promover un proceso de formación integral para los agricultores del Cantón Cerro Verde, municipio de Tecapán, departamento de Usulután, sobre el uso de productos agrotóxicos. Materiales y métodos: investigación de tipo descriptivo, de corte transversal. Resultados: se determinó que los agricultores utilizan los agrotóxicos sin protección, el 69% los usa más de tres veces por semana, y los guardan en frascos comunes dentro de su propia casa, exponiéndose a casi permanentemente a la contaminación. El 58% de los agricultores o sus familiares se ha intoxicado alguna vez y solo el 22% ha buscado atención médica inmediata. Los productos más utilizados son el paraquat, hedonal y dimetoato, el 78%, proporcionados por sus empleadores y el 22%, los adquieren libremente. Conclusiones: los agricultores están expuestos a los riesgos que genera el uso de los agrotóxicos casi de manera permanente, esto influye en el aparecimiento de intoxicaciones agudas que pueden traer consecuencias posteriores en su salud. Recomendaciones: utilizar el Sistema de Vigilancia Epidemiológica del Ministerio de Salud para investigar, informar y prevenir riesgos, daños y afecciones individuales o colectivas de la población actual como de las futuras generaciones, garantizando así el derecho humano a la Salud. Elaborar y ejecutar un plan educativo integral, con un enfoque de prevención en salud

Evaluación del control de infecciones poscesárea mediante la implementación de un programa preventivo / Evaluation of post-cesarean infection control through the implementation of a preventive program

Resumen OBJETIVO: Estimar la incidencia de infecciones en pacientes que finalizaron el embarazo por cesárea e identificar los factores de riesgo asociados antes y después de la implementación de un programa preventivo. MATERIALES Y MÉTODOS: Estudio cuantitativo, no experimental, de cohorte prospectiva. Se seleccionaron mujeres que finalizaron el embrazo por cesárea en el Hospital Universitario de Saltillo, entre octubre de 2015 a octubre de 2016. Se practicaron tres medidas preventivas para disminuir el riesgo de infecciones poscesárea: administración profiláctica de antibiótico, lavado vaginal preoperatorio con yodopovidona y retiro del catéter urinario al término de la cirugía. Al séptimo día del alta hospitalaria se citó a las pacientes para evaluar la posibilidad de infección de la herida quirúrgica, endometritis o sepsis. Para el análisis estadístico se utilizó el programa SPSS versión 21. Se consideró estadísticamente significativo el valor de p < 0.05. RESULTADOS: Se registraron 103 pacientes. La incidencia de infección de la herida quirúrgica, fue de 1.9% y de dehiscencia 1%; no se registraron casos de endometritis. Al comparar la incidencia de infecciones poscesárea, previo al protocolo (año 2015) y posterior a la implementación de las medidas preventivas, se demostró la disminución de infección de la herida quirúrgica (2.4 a 1.9%) y de endometritis (1.9 a 0%). CONCLUSIÓN: La implementación del programa preventivo de infecciones poscesárea, basado en la administración profiláctica de antibiótico, lavado vaginal con yodopovidona y retiro de la sonda urinaria temprana, disminuye el índice de infecciones puerperales poscesárea.

Abstract OBJECTIVE: An estimates the incidence and risk factors associated with infections in caesarean sections before and after the implementation of the preventive program. MATERIALS AND METHODS: Non-experimental quantitative study of a prospective cohort type. The study population were women they finished the pregnancy by caesarean section during the period of october 2015 to october 2016. Three preventive measures were performed to reduce the risk of postoperative infections: prophylactic antibiotic, preoperative vaginal lavage with iodopovidone and urinary catheter removal at the end of the surgery a follow-up was performed at 7 days identifying patients with infected wound, endometritis and sepsis. The results will be analyzed using the SSPS software versión 21. RESULTS: A total of 103 women were incorporated into the protocol. The incidence of postoperative infections was 1.9% for wound infections, 1.0% dehiscence and 0% endometritis. A comparative analysis was performed of incidences of surgical site infection, endometritis, sepsis and surgical wound dehiscence, prior to the preventive protocol (year 2015) and after the implementation of preventive measures, and we observed a reduction of endometritis from 1.9% to 0% and of the surgical wound infection from 2.4% to 1.9%. CONCLUSION: The preventive program integrated by the use of prophylactic antibiotic, preoperative vaginal lavage with iodopovidone and urinary catheter removal at the end of surgery, reduced the rate of post-cesarean puerperal infections.

Exosomes derived from mesenchymal stem cells enhance radiotherapy-induced cell death in tumor and metastatic tumor foci.

BACKGROUND: We have recently shown that radiotherapy may not only be a successful local and regional treatment but, when combined with MSCs, may also be a novel systemic cancer therapy. This study aimed to investigate the role of exosomes derived from irradiated MSCs in the delay of tumor growth and metastasis after treatment with MSC + radiotherapy (RT). METHODS: We have measured tumor growth and metastasis formation, of subcutaneous human melanoma A375 xenografts on NOD/SCID-gamma mice, and the response of tumors to treatment with radiotherapy (2 Gy), mesenchymal cells (MSC), mesenchymal cells plus radiotherapy, and without any treatment. Using proteomic analysis, we studied the cargo of the exosomes released by the MSC treated with 2 Gy, compared with the cargo of exosomes released by MSC without treatment. RESULTS: The tumor cell loss rates found after treatment with the combination of MSC and RT and for exclusive RT, were: 44.4% % and 12,1%, respectively. Concomitant and adjuvant use of RT and MSC, increased the mice surviving time 22,5% in this group, with regard to the group of mice treated with exclusive RT and in a 45,3% respect control group. Moreover, the number of metastatic foci found in the internal organs of the mice treated with MSC + RT was 60% less than the mice group treated with RT alone. We reasoned that the exosome secreted by the MSC, could be implicated in tumor growth delay and metastasis control after treatment. CONCLUSIONS: Our results show that exosomes derived form MSCs, combined with radiotherapy, are determinant in the enhancement of radiation effects observed in the control of metastatic spread of melanoma cells and suggest that exosome-derived factors could be involved in the bystander, and abscopal effects found after treatment of the tumors with RT plus MSC. Radiotherapy itself may not be systemic, although it might contribute to a systemic effect when used in combination with mesenchymal stem cells owing the ability of irradiated MSCs-derived exosomes to increase the control of tumor growth and metastasis.

Prognostic stratification of adult primary glioblastoma multiforme patients based on their tumor gene amplification profiles.

Several classification systems have been proposed to address genomic heterogeneity of glioblastoma multiforme, but they either showed limited prognostic value and/or are difficult to implement in routine diagnostics. Here we propose a prognostic stratification model for these primary tumors based on tumor gene amplification profiles, that might be easily implemented in routine diagnostics, and potentially improve the patients management. Gene amplification profiles were prospectively evaluated in 80 primary glioblastoma multiforme tumors using single-nucleotide polymorphism arrays and the results obtained validated in publicly available data from 267/347 cases. Gene amplification was detected in 45% of patients, and chromosome 7p11.2 including the EGFR gene, was the most frequently amplified chromosomal region - either alone (18%) or in combination with amplification of DNA sequences in other chromosomal regions (10% of cases). Other frequently amplified DNA sequences included regions in chromosomes 12q(10%), 4q12(7%) and 1q32.1(4%). Based on their gene amplification profiles, glioblastomas were subdivided into: i) tumors with no gene amplification (55%); ii) tumors with chromosome 7p/EGFR gene amplification (with or without amplification of other chromosomal regions) (38%); and iii) glioblastoma multiforme with a single (11%) or multiple (6%) amplified DNA sequences in chromosomal regions other than chromosome 7p. From the prognostic point of view, these amplification profiles showed a significant impact on overall survival of glioblastoma multiforme patients (p>0.001). Based on these gene amplification profiles, a risk-stratification scoring system was built for prognostic stratification of glioblastoma which might be easily implemented in routine diagnostics, and potentially contribute to improved patient management.

Combination of melatonin and rapamycin for head and neck cancer therapy: Suppression of AKT/mTOR pathway activation, and activation of mitophagy and apoptosis via mitochondrial function regulation.

Head and neck squamous cell carcinoma (HNSCC) clearly involves activation of the Akt mammalian target of rapamycin (mTOR) signalling pathway. However, the effectiveness of treatment with the mTOR inhibitor rapamycin is often limited by chemoresistance. Melatonin suppresses neoplastic growth via different mechanisms in a variety of tumours. In this study, we aimed to elucidate the effects of melatonin on rapamycin-induced HNSCC cell death and to identify potential cross-talk pathways. We analysed the dose-dependent effects of melatonin in rapamycin-treated HNSCC cell lines (Cal-27 and SCC-9). These cells were treated with 0.1, 0.5 or 1 mmol/L melatonin combined with 20 nM rapamycin. We further examined the potential synergistic effects of melatonin with rapamycin in Cal-27 xenograft mice. Relationships between inhibition of the mTOR pathway, reactive oxygen species (ROS), and apoptosis and mitophagy reportedly increased the cytotoxic effects of rapamycin in HNSCC. Our results demonstrated that combined treatment with rapamycin and melatonin blocked the negative feedback loop from the specific downstream effector of mTOR activation S6K1 to Akt signalling, which decreased cell viability, proliferation and clonogenic capacity. Interestingly, combined treatment with rapamycin and melatonin-induced changes in mitochondrial function, which were associated with increased ROS production, increasing apoptosis and mitophagy. This led to increase cell death and cellular differentiation. Our data further indicated that melatonin administration reduced rapamycin-associated toxicity to healthy cells. Overall, our findings suggested that melatonin could be used as an adjuvant agent with rapamycin, improving effectiveness while minimizing its side effects.

Spermatic Cord Leiomyosarcoma Rare Case.

Case description of a male patient of 64 years who presents a left groin-scrotum painless tumor, growing, from several months of evolution. Physical examination demonstrated the existence of a mass effect of the left distal spermatic cord, and was later confirmed by ultrasound and CT. Laboratory parameters were normal. The performed surgery consisted in a radical orchiectomy with high ligation of the left cord. In conclusion, preoperative diagnosis of spermatic cord leiomyosarcoma is difficult we need the combination of present illness, physical examination, exams and the gold standard histopathological and immunohistochemical studies allowed a definitive diagnosis.

Assessment of biochemical parameters and characterization of TNFα -308G/A and PTPN22 +1858C/T gene polymorphisms in the risk of obesity in adolescents.

Obesity is currently considered an inflammatory condition associated with autoimmune diseases, suggesting a common origin. Among other factors, candidate genes may explain the development of this disease. Polymorphisms in the tumor necrosis factor α (TNFα) and lymphoid protein tyrosine phosphatase (PTPN22) genes lead to an increased risk to development of immune and inflammatory diseases. The aim of the present study was to analyze the biochemical parameters and the effect of the TNFα -308G/A and PTPN22 +1858C/T polymorphisms in the susceptibility of adolescents to obesity. A group of 253 adolescent subjects were recruited and classified as obese, overweight or normal weight according to their nutritional status. Anthropometric measurements, clinical and biochemical data were analyzed. DNA was extracted from peripheral blood samples by the phenol-chloroform method, and TNFα -308G/A and PTPN22 1858C/T polymorphisms were determined by polymerase chain reaction-restriction fragment length polymorphism assays. Clinical, genetic and biochemical parameters were analyzed to determine the existence of a possible association with the development of obesity. Statistically significant differences in body mass index, insulin, triglyceride levels and homeostatic model assessment for insulin resistance (HOMA-IR) index were observed among the three groups analyzed (P≤0.05). The studied polymorphisms did not confer a risk for developing obesity in the analyzed population (P>0.05); however, significantly low levels of insulin and decreased rates of HOMA-IR were observed in the 1858 CT genotype carriers of the PTPN22 gene. In conclusion, no association between the TNFα -308G/A and PTPN22 +1858C/T polymorphisms and the risk to development of obesity in the adolescent population analyzed was observed. However, the 1858 CT genotype of the PTPN22 gene was associated with variations of certain biochemical parameters analyzed.

Human mesenchymal stem cells enhance the systemic effects of radiotherapy.

The outcome of radiotherapy treatment might be further improved by a better understanding of individual variations in tumor radiosensitivity and normal tissue reactions, including the bystander effect. For many tumors, however, a definitive cure cannot be achieved, despite the availablity of more and more effective cancer treatments. Therefore, any improvement in the efficacy of radiotherapy will undoubtedly benefit a significant number of patients. Many experimental studies measure a bystander component of tumor cell death after radiotherapy, which highlights the importance of confirming these observations in a preclinical situation. Mesenchymal stem cells (MSCs) have been investigated for use in the treatment of cancers as they are able to both preferentially home onto tumors and become incorporated into their stroma. This process increases after radiation therapy. In our study we show that in vitro MSCs, when activated with a low dose of radiation, are a source of anti-tumor cytokines that decrease the proliferative activity of tumor cells, producing a potent cytotoxic synergistic effect on tumor cells. In vivo administration of unirradiated mesenchymal cells together with radiation leads to an increased efficacy of radiotherapy, thus leading to an enhancement of short and long range bystander effects on primary-irradiated tumors and distant-non-irradiated tumors. Our experiments indicate an increased cell loss rate and the decrease in the tumor cell proliferation activity as the major mechanisms underlying the delayed tumor growth and are a strong indicator of the synergistic effect between RT and MSC when they are applied together for tumor treatment in this model.

The protein expression profile of meningioma cells is associated with distinct cytogenetic tumour subgroups.

AIMS: Limited information exists about the impact of cytogenetic alterations on the protein expression profiles of individual meningioma cells and their association with the clinicohistopathological characteristics of the disease. The aim of this study is to investigate the potential association between the immunophenotypic profile of single meningioma cells and the most relevant features of the tumour. METHODS: Multiparameter flow cytometry (MFC) was used to evaluate the immunophenotypic profile of tumour cells (n = 51 patients) and the Affymetrix U133A chip was applied for the analysis of the gene expression profile (n = 40) of meningioma samples, cytogenetically characterized by interphase fluorescence in situ hybridization. RESULTS: Overall, a close association between the pattern of protein expression and the cytogenetic profile of tumour cells was found. Thus, diploid tumours displayed higher levels of expression of the CD55 complement regulatory protein, tumours carrying isolated monosomy 22/del(22q) showed greater levels of bcl2 and PDGFRß and meningiomas carrying complex karyotypes displayed a greater proliferation index and decreased expression of the CD13 ectoenzyme, the CD9 and CD81 tetraspanins, and the Her2/neu growth factor receptor. From the clinical point of view, higher expression of CD53 and CD44 was associated with a poorer outcome. CONCLUSIONS: Here we show that the protein expression profile of individual meningioma cells is closely associated with tumour cytogenetics, which may reflect the involvement of different signalling pathways in the distinct cytogenetic subgroups of meningiomas, with specific immunophenotypic profiles also translating into a different tumour clinical behaviour.

Strengthening systems for integrated early childhood development services: a cross-national analysis of governance.

While there has been substantial growth in early childhood development (ECD) services in low- and middle-income countries (LMICs), there is considerable inequity in their distribution and quality. Evidence-based governance strategies are necessary, but currently they are insufficient for widespread, quality implementation. In particular, there is a limited understanding of the use of systems approaches for the analysis of ECD services as they go to scale. The aim of this paper is to present findings from four countries, using a cross-national case study approach to explore governance mechanisms required to strengthen national systems of ECD services. While different sets of governance strategies and challenges were identified in each country, overarching themes also emerged with implications for systems strengthening. Study results focus on local, mid-level and central governance, with recommendations for effective coordination and the integration of ECD services in LMICs.