Agave angustifolia Haw. Leaves as a Potential Source of Bioactive Compounds: Extraction Optimization and Extract Characterization.

The leaves of Agave angustifolia Haw. are the main agro-waste generated by the mezcal industry and are becoming an important source of bioactive compounds, such as phenolic compounds, that could be used in the food and pharmaceutical industries. Therefore, the extraction and identification of these phytochemicals would revalorize these leaf by-products. Herein, maceration and supercritical carbon dioxide (scCO2) extractions were optimized to maximize the phenolic and flavonoid contents and the antioxidant capacity of vegetal extracts of A. angustifolia Haw. In the maceration process, the optimal extraction condition was a water-ethanol mixture (63:37% v/v), which yielded a total phenolic and flavonoid content of 27.92 ± 0.90 mg EAG/g DL and 12.85 ± 0.53 µg QE/g DL, respectively, and an antioxidant capacity of 32.67 ± 0.91 (ABTS assay), 17.30 ± 0.36 (DPPH assay), and 13.92 ± 0.78 (FRAP assay) µM TE/g DL. Using supercritical extraction, the optimal conditions for polyphenol recovery were 60 °C, 320 bar, and 10% v/v. It was also observed that lower proportions of cosolvent decreased the polyphenol extraction more than pressure and temperature. In both optimized extracts, a total of 29 glycosylated flavonoid derivatives were identified using LC-ESI-QTof/MS. In addition, another eight novel compounds were identified in the supercritical extracts, showing the efficiency of the cosolvent for recovering new flavonoid derivatives.

Confiabilidad y validez de una escala de identidad organizacional en servicios de salud

Objetivo Validar la Escala de Identidad Organizacional (IDN) de algunas instituciones mexicanas de servicios de salud a través de análisis confirmatorio. Métodos Se utilizó una escala de identidad de quince ítems aplicados a una muestra de 214 trabajadores pertenecientes a seis clínicas de servicios de salud en el Estado de Hidalgo, México. Resultados El análisis de fiabilidad indicó que la IDN posee consistencia interna adecuada. Los análisis factorial exploratorio y confirmatorio permitieron identificar una estructura de tres factores (orgullo, pertenencia y significado). El factor orgullo muestra cargas estimadas más elevadas. Conclusión La versión final del instrumento presenta confiabilidad y validez adecuadas para la medición de la identidad organizacional.

Objective To validate the Organizational Identity Scale (IDN) for Mexican health service institutions through confirmatory analysis. Methodology We applied a fifteen-item identity scale to a sample of 214 workers from six health service clinics in Hidalgo, Mexico. Results The reliability analysis indicated that the IDN has adequate internal consistency. The exploratory and confirmatory factor analyses allowed us to identify a struc-ture of three factors (pride, belonging, and meaning). The pride factor shows higher estimated loads. Conclusion The final version of the instrument presents adequate reliability and validity for the measurement of organizational identity.

Black Bean (Phaseolus vulgaris L.) Polyphenolic Extract Exerts Antioxidant and Antiaging Potential.

Phenolic compounds present in common beans (Phaseolus vulgaris L.) have been reported to possess antimicrobial, anti-inflammatory and ultraviolet radiation (UVR) protective properties. UVR from sunlight, which consists of UV-B and UV-A radiations, induces reactive oxygen species (ROS) and free radical formation, consequently activating proteinases and enzymes such as elastase and tyrosinase, leading to premature skin aging. The objective of this work was to extract, characterize and evaluate the antioxidant and antiaging potential of polyphenols from a black bean endemic variety. The polyphenolic extract was obtained from black beans by supercritical fluid extraction (SFE) using CO2 with a mixture of water-ethanol as a cosolvent and conventional leaching with a mixture of water-ethanol as solvent. The polyphenolic extracts were purified and characterized, and antioxidant potential, tyrosinase and elastase inhibitory potentials were measured. The extract obtained using the SFE method using CO2 and H2O-Ethanol (50:50 v/v) as a cosolvent showed the highest total phenolic compounds yield, with 66.60 ± 7.41 mg GAE/g coat (p > 0.05) and 7.30 ± 0.64 mg C3GE/g coat (p < 0.05) of anthocyanins compared to conventional leaching. Nineteen tentative phenolic compounds were identified in leaching crude extract using ESI-QTOF. Quercetin-3-D-galactoside was identified in crude and purified extracts. The purified SFC extract showed IC50 0.05 ± 0.002 and IC50 0.21 ± 0.008 mg/mL for DPPH and ABTS, respectively. The lowest IC50 value of tyrosinase inhibition was 0.143 ± 0.02 mg/mL and 0.005 ± 0.003 mg/mL of elastase inhibition for leaching purified extract. Phenolic compounds presented theoretical free energy values ranging from -5.3 to -7.8 kcal/mol for tyrosinase and -2.5 to -6.8 kcal/mol for elastase in molecular docking (in silico) studies. The results suggest that the purified extracts obtained by SFE or conventional leaching extraction could act as antioxidant and antiaging ingredients for cosmeceutical applications.

Production of rhamnolipids by the Thermoanaerobacter sp. CM-CNRG TB177 strain isolated from an oil well in Mexico.

This study aimed to produce and characterize biosurfactants using the Thermoanaerobacter sp. CM-CNRG TB177 strain isolated from an oil field in Mexico, as well as assessing the influence of different carbon and nitrogen sources on the capacity of the produced surfactant to reduce the surface tension of water. The thin-layer chromatography (TLC) revealed that the obtained extract corresponds to a mono-rhamnolipid; the results of the ultra-performance-liquid chromatography/mass spectrometry (UPLC/MS) analysis revealed that the Thermoanaerobacter sp. CM-CNRG TB177 strain produces a mixture of three rhamnolipids, whose masses correspond to mono-rhamnolipid. The rhamnolipids mixture obtained using 2.5% molasses as carbon source diminished the surface tension of water to 29.67 mNm-1, indicating that the concentration of molasses influenced the capacity of the produced surfactant to reduce the surface tension of water. Also, the microorganism was not capable of growing in the absence of yeast extract as nitrogen source. To the best of our knowledge, the presented results describe for the first time the nature of the biosurfactant produced by a bacterium of the Thermoanaerobacter genus.Key points• Thermoanaerobacter sp. CM-CNRG TB177 produces biosurfactants, and its glycolipid nature is described for the first time.• The HPLC analysis revealed a mixture of three rhamnolipid congeners, and UPLC/MS analysis determined that two of the congeners are the rhamnolipids Rha-C8-C10 and Rha-C12-C10.• The lowest surface tension of 29.67 mNm-1 was obtained with molasses as source of carbon at a 2.5% concentration.

Variables clínicas, humorales e imagenológicas útiles para el diagnóstico de las peritonitis persistentes / Clinical, humoral and imaging variables useful for the diagnosis of persistent peritonitis / Variáveis clínicas, humorais e de imagem úteis para o diagnóstico de peritonite persistente

RESUMEN Introducción: las peritonitis, proceso inflamatorio general o localizado de la membrana peritoneal; traen consigo una serie de trastornos locales intraabdominales y generales que amenaza la vida del paciente de manera potencial, dejada sin tratamiento más del 90 % de los pacientes mueren. Objetivo: evaluar la utilidad de variables clínicas, humorales e imaginológicas postoperatorios, vitales para el diagnóstico precoz de la infección intraabdominal persistente. Método: se realizó un estudio observacional analítico, de cohorte, prospectivo y longitudinal en 45 pacientes mayores de 15 años intervenidos quirúrgicamente por peritonitis secundaria supurada difusa (PSSD) y que fueron reintervenidos con la impresión diagnóstica de peritonitis persistente de los cuales unos la desarrollaron y otros no, en el período comprendido de septiembre del 2014 hasta abril del 2018. Resultados: para el diagnóstico precoz de las peritonitis persistentes en pacientes operados de peritonitis supuradas; la frecuencia cardiaca prereintervención, el dolor abdominal espontáneo posoperatorio mantenido en las primeras 48 horas y el dolor posoperatorio a la descompresión del abdomen fueron los hallazgos más significativos. Conclusiones: el dolor posoperatorio a la descompresión del abdomen adquirió valor predictivo de reintervención para las primeras 48 horas de operado y su aparición incrementó en 6 veces el riesgo de presentar una peritonitis persistente.

ABSTRACT Introduction: peritonitis, general or localized inflammatory process of the peritoneal membrane; they bring with them a series of local intra-abdominal and general disorders that threatens the patient's life in a potential way, left untreated more than 90% of patients die. Objective: to evaluate the usefulness of postoperative clinical, humoral and imaginological variables, vital for the early diagnosis of persistent intra-abdominal infection. Method: An analytical, cohort, prospective and longitudinal observational study was carried out in 45 patients older than 15 years undergoing surgery for diffuse suppurative secondary peritonitis (PSSD) and who were reoperated with the diagnostic impression of persistent peritonitis of which some developed and others do not, in the period from September 2014 to April 2018. Results: For the early diagnosis of persistent peritonitis in patients operated with suppurative peritonitis, prereintervention heart rate, postoperative spontaneous abdominal pain maintained in the first 48 hours and post-operative pain after abdominal decompression were the most significant findings. Conclusions: the postoperative pain to decompression of the abdomen acquired a predictive value of reoperation for the first 48 hours of surgery and its appearance increased by 6 times the risk of presenting a persistent peritonitis.

RESUMO Introdução: peritonite, processo inflamatório geral ou localizado da membrana peritoneal; eles trazem consigo uma série de distúrbios intra-abdominais e gerais locais que ameaçam a vida do paciente de uma maneira potencial, deixando sem tratamento mais de 90% dos pacientes morrem. Objetivo: avaliar a utilidade de variáveis ​​clínicas, humorais e imaginológicas no pós-operatório, vitais para o diagnóstico precoce de infecção intra-abdominal persistente. Método: Foi realizado um estudo observacional analítico, de coorte, prospectivo e longitudinal em 45 pacientes com idade superior a 15 anos submetidos à cirurgia para peritonite difusa supurativa difusa (DSPD) e que foram reoperados com a impressão diagnóstica de peritonite persistente da qual alguns desenvolveram e outros não, no período de setembro de 2014 a abril de 2018. Resultados: para o diagnóstico precoce de peritonite persistente em pacientes operados com peritonite supurativa; Frequência cardíaca pré-intervenção, dor abdominal espontânea pós-operatória mantida nas primeiras 48 horas e dor pós-operatória após descompressão abdominal foram os achados mais significativos. Conclusões: a dor pós-operatória à descompressão do abdome adquiriu um valor preditivo de reoperação nas primeiras 48 horas de cirurgia e sua aparência aumentou 6 vezes o risco de apresentar peritonite persistente.

Distribución de la población vulnerable a la enfermedad COVID-19 en La Habana, Cuba

RESUMEN Introducción: La Habana, en su condición de capital de Cuba, muestra la mayor complejidad en el enfrentamiento a la epidemia por el virus SARS-CoV-2. Objetivo: Proporcionar un análisis de la distribución de la población vulnerable a la COVID-19 en la provincia La Habana. Métodos: Investigación estructurada en tres etapas, en las áreas de salud de los municipios de La Habana: 1. Estudio del grupo de población de 60 años y más que padece enfermedades crónicas (etapa A). 2. Análisis de factores que pudieran estar favoreciendo la transmisión del virus SARS-CoV-2 (etapa B). 3. Integración de las dos etapas anteriores y adición del análisis espacial de la enfermedad COVID-19 según la ubicación de los casos confirmados positivos entre el 12 de marzo-22 de junio de 2020 (etapa C). Resultados: Se presentan en cuatro mapas que se corresponden con las etapas del estudio. El primero aporta el grado de vulnerabilidad de la población de 60 años y más con enfermedades crónicas de mayor riesgo a la COVID-19; el segundo, ofrece el grado de vulnerabilidad a la transmisión del virus SARS CoV-2; el tercero, el grado de vulnerabilidad una vez integradas las etapas A y B y el cuarto mapa, presenta la ubicación por lugar de residencia de los pacientes confirmados con la COVID-19 en La Habana. Conclusiones: Estos resultados constituyen una herramienta eficaz para asistir a las autoridades en la toma de decisiones mediante un mejor conocimiento de la distribución de la población vulnerable a la COVID-19 en la provincia La Habana.

ABSTRACT Introduction: Being the capital city in Cuba, Havana displays the greatest complexity in the response to the SARS-CoV-2 epidemic. Objective: Provide an analysis of the distribution of the population vulnerable to COVID-19 in the province of Havana. Methods: A study was conducted of the health areas in the municipalities of Havana which was structured into three stages: 1. Study of the population group aged 60 years and over with chronic diseases (Stage A). 2. Analysis of the factors which might be facilitating transmission of the SARS-CoV-2 virus (Stage B). 3. Integration of the two previous stages and addition of a spatial analysis of COVID-19 based on the location of positive cases confirmed from 12 March to 22 June 2020 (Stage C). Results: The data collected is presented in four maps corresponding to the stages of the study. The first map presents the degree of vulnerability of the population aged 60 and over with chronic diseases of highest risk for COVID-19; the second the degree of vulnerability to SARS-CoV-2 virus transmission; the third the degree of vulnerability upon integration of Stages A and B; and the fourth the location by place of residence of the patients confirmed with COVID-19 in Havana. Conclusions: These results constitute an effective tool to assist authorities in decision making by providing broader knowledge about the distribution of the population vulnerable to COVID-19 in the province of Havana.

Intervalo de referencia de testosterona en hombres adultos jóvenes del municipio Plaza de la Revolución / Testosterone´s reference interval in young adult men from Plaza de la Revolución municipality

RESUMEN Introducción: El hipogonadismo masculino puede provocar una reducción importante de la calidad de vida. La determinación de testosterona total constituye la opción inicial para el diagnóstico bioquímico del hipogonadismo. Objetivo: Determinar el intervalo de referencia de testosterona total para la población masculina en edad reproductiva del municipio Plaza de la Revolución. Métodos: Se realizó un estudio transversal y descriptivo, en una muestra representativa (n= 143) de la población masculina entre 20 y 40 años de edad, del municipio Plaza de la Revolución. Para el reclutamiento de la muestra se utilizó un método directo. El intervalo de referencia se estableció mediante un método no paramétrico. Se realizó interrogatorio, examen físico, complementarios bioquímicos (glucemia, colesterol, triglicéridos, HDL-c, LDL-c), y hormonales (testosterona total, PRL, FSH y LH). Resultados: El promedio de edad fue de 29,7 años. El índice de masa corporal osciló entre 18,95 y 29,88 kg/m2 (valor medio 24,15). Las medias de las circunferencias de cintura y cadera fueron de 86,62 cm y 99,77 cm respectivamente. El intervalo de referencia de testosterona total calculado para la población masculina del municipio Plaza de la Revolución, fue de 7,69 a 40,52 nmol/L. La mediana para la testosterona total fue de 19,10 nmol/L. Conclusiones: El intervalo de referencia de testosterona total calculado para la población masculina adulta (20 - 40 años) del municipio Plaza de la Revolución difiere del reportado por el fabricante del kit diagnóstico y puede resultar de utilidad en la práctica clínica(AU)

ABSTRACT Introduction: Male hypogonadism may cause a significant reduction in the quality of life. The determination of total testosterone constitutes the initial option for the biochemical diagnosis of hypogonadism. Objective: To determine the reference interval of total testosterone for the male population in reproductive age of Plaza de la Revolución municipality. Methods: It was conducted a cross-sectional and descriptive study in a representative sample (n=143) of the male population from 20 to 40 years old of Plaza de la Revolución municipality. For the recruitment of the sample it was used a direct method. The reference interval was established through a non-parametric method. There were conducted interrogations, physical examination, complementary biochemical (blood glucose, cholesterol, triglycerides, HDL-c, LDL-c), and hormonal tests (total testosterone, PRL, FSH and LH). Results: The average age was 29.7 years. The body mass index ranged between 18.95 and 29.88 kg/m2 (mean value of 24.15). The means of the waist and hip circumferences were 86.62 and 99.77 cm, respectively. The reference interval of total testosterone calculated for the male population of Plaza de la Revolución municipality was of 7.69 to 40.52 nmol/L. The mean for total testosterone was 19.10 nmol/L. Conclusions: The reference interval of total testosterone calculated for the adult male population (20 - 40 years old) of Plaza de la Revolución municipality differs from that reported by the manufacturer of the diagnostic kit and it can be useful in clinical practice(AU)

Large left posterior fossa meningioma presenting with quadriplegia in a woman with history of carbidopa-levodopa resistant parkinsonism.

A 56-year-old Afro-Trinidadian woman with a history of a carbidopa-levodopa resistance Parkinsonian-like syndrome for 2 years, presented with acute onset spastic quadriplegia and decreased responsiveness. Diagnosis involved clinical and MR-imaging correlation consistent with a large left posterior fossa meningioma. Surgical removal of the tumor led to complete reversibility of the neurological manifestations associated with cerebellar tonsillar herniation beyond the foramen magnum and mass effect on the brainstem, cerebellum and midbrain regions. Pathological findings were typical of a meningioma. This case demonstrates the association of a large left posterior fossa meningioma and carbidopalevodopa resistant parkinsonism in an Afro-Trinidadian woman who presented with acute onset acute quadriplegia and decreased responsiveness. This case reminds clinicians that patients with dopa unresponsiveness and/or acute neurological deficit or deterioration should be worked up for other possible causes and adds to the literature on the association of parkinsonism and intracranial space occupying lesions.

Endoscopic ultrasound cytologic brushing vs endoscopic ultrasound - fine needle aspiration for cytological diagnosis of cystic pancreatic lesions. A multicenter, randomized open-label trial.

INTRODUCTION: the incidence of cystic pancreatic lesions (CPL) in the asymptomatic population is increasing. Achieving a preoperative diagnosis of CPL still remains a challenge. OBJECTIVES: to evaluate the diagnostic accuracy of the cytological diagnosis of CPL from samples obtained by cytology brush versus standard endoscopic ultrasound fine needle aspiration (EUS-FNA). METHODS: a multicenter, randomized, open-label trial was performed of EUS-cytology brush (EUS-EB) versus EUS-FNA for the cytological diagnosis of CPL. Patients that underwent EUS-FNA with a CPL > 15 mm were included and randomized into two groups: group I, EUS-EB; group II, EUS-FNA. The final diagnosis was based on the histological evaluation of surgical specimens and clinical parameters, imaging and a five year follow-up in non-operated patients. The main outcome was the diagnostic accuracy of both methods. Secondary outcomes were the diagnostic adequacy of specimens and the rate of adverse events. Data were compared using the Chi-squared test. An intention to treat (ITT) and per-protocol (PP) analysis were performed. RESULTS: sixty-five patients were included in the study, 31 in group I and 34 in group II. Three patients initially randomized to group I were changed to group II as it was impossible to obtain a sample using the brush. The mean size of the CPL was 28.2 mm (range 16-60 mm). The diagnostic accuracy of EUS-EB was not superior to EUS-FNA, neither in the ITT nor the PP analysis (44.8% vs 41.1%, p = 0.77 and 38.4% vs 45.9%, p = 0.55). CONCLUSIONS: EUS-EB does not improve the diagnostic accuracy of CPL in comparison with EUS-FNA.

La atención primaria de salud como fundamento de la reforma de salud salvadoreña / Primary health care as the foundation for Salvadorian health system reform / Atenção primária à saúde como pilar da reforma da saúde em El Salvador

RESUMEN Desde la Declaración de Alma-Ata, y durante sus 40 años de vigencia, la atención primaria de salud (APS) se ha convertido en uno de los fundamentos de la reforma de salud salvadoreña iniciada en el 2010. Los valores, principios y elementos de la APS han sido una pieza esencial de su diseño e implementación para alcanzar logros importantes en la salud. La gratuidad y la ampliación de la cobertura, el ordenamiento de los niveles de atención, el impulso a la promoción de la salud y la voluntad política se identifican como factores que han permitido la mejora de los indicadores sanitarios, pero no de manera aislada, sino integrados a un proceso de transformación junto a otros programas sociales, que han abonado a la reducción de la pobreza y a la disminución de las desigualdades; estos, a su vez, han contribuido a la mejora de los indicadores de salud. La reforma de salud debe superar las dificultades actuales que enfrenta, como la deslegitimización frente a la opinión pública, la concepción biologicista de la "buena medicina" y superar aspectos negativos de su gestión como el presupuesto de salud insuficiente y desigual, las condiciones laborales precarias para el personal de salud, el trato deshumanizado y la baja calidad de los servicios. El avance de la reforma estará condicionado a su capacidad de reinventarse, superar las contradicciones que ha generado e ir al encuentro de las necesidades de los trabajadores de salud y la ciudadanía.

ABSTRACT The Declaration of Alma-Ata on primary health care (PHC), issued 40 years ago, has become one of the foundations of El Salvador's health system reform, launched in 2010. The values, principles, and elements of PHC have been an essential piece in the design and implementation of the reform, aimed at achieving significant advances in health. Free services and the expansion of coverage, the organization of the levels of care, the encouragement of health promotion, and political will are identified as facilitating factors in the improvement of health indicators, a phenomenon that has not occurred in isolation but, rather, as part of a process of change involving other social programs that has helped to reduce poverty and inequality; this, in turn, has contributed to the improvement of health indicators. Health system reform must overcome its current challenges, such as its lack of legitimacy in the eyes of the public and the biologistical concept of "good medicine," as well as negative aspects of management, such as an inadequate and unequal health budget, poor working conditions for health personnel, impersonal care, and poor-quality services. The progress of the reform will be determined by its capacity for reinvention and its ability to overcome the conflicts it has generated and identify the needs of health workers and citizens alike.

RESUMO Da sua origem na Declaração de Alma-Ata e nos seus 40 anos de existência, a atenção primária à saúde (APS) se consolidou como um dos pilares da reforma da saúde de El Salvador iniciada em 2010. Os valores, os princípios e os elementos da APS são peças fundamentais do planejamento e implementação para o alcance de grandes conquistas em saúde. Gratuidade, expansão da cobertura, organização dos níveis de atenção, incentivo à promoção da saúde e vontade política são identificados como fatores que vêm possibilitando melhorar os indicadores de saúde. Não se trata de um efeito isolado, mas integrado a um processo de transformação junto com outros programas sociais que têm contribuído para reduzir a pobreza e as desigualdades. Isso, por sua vez, ajuda a melhorar os indicadores de saúde. A reforma da saúde precisa superar as atuais dificuldades como a deslegitimização perante a opinião pública e a concepção biologicista de "boa medicina" e enfrentar as deficiências administrativas e de gestão como um orçamento de saúde insuficiente e desigual, condições de trabalho precárias para os profissionais da saúde, o trato desumanizado e a baixa qualidade dos serviços. O avanço da reforma está condicionado à capacidade de reinventar-se, superar as contradições geradas e atender as necessidades dos profissionais da saúde e da sociedade.

Analysis of resilience and sexual behavior in persons with HIV infection

Abstract The main objective of this study was to evaluate ex post facto resilience in persons with HIV infection and its relationship to socio-demographic and sexual behavior variables. Participants included 159 persons with HIV infection, of both sexes, aged between 19 and 55 years. Fifty-one percent of patients were infected through homosexual means. Sixty-seven percent were in the asymptomatic phase of infection. Assessment instruments used were the following: a questionnaire on socio-demographic data and sexual behavior and the Connor-Davidson Resilience Scale. The evaluation was individual, voluntary, and anonymous. The results showed that 49.05% of patients had average resilience, 27.68% had high resilience, and 23.37% had low resilience. They found that heterosexual patients infected with HIV, diagnosed between 1985 and 1990 (23 and 28 years of diagnosis) and those who had disclosed their HIV status to more than 30 people, had greater resilience than homosexual patients, diagnosed between 1996 and 2000 (13 and 17 years of diagnosis) and those who had disclosed their HIV status to 1-5 people. Finally, resilience was not a predictor of sexual risk factor. It is suggested that health interventions take into account the resilience and psychological variables that may be beneficial to improve coping with the disease.

Molecular analyses reveal two geographic and genetic lineages for tapeworms, Taenia solium and Taenia saginata, from Ecuador using mitochondrial DNA.

Tapeworms Taenia solium and Taenia saginata are the causative agents of taeniasis/cysticercosis. These are diseases with high medical and veterinary importance due to their impact on public health and rural economy in tropical countries. The re-emergence of T. solium as a result of human migration, the economic burden affecting livestock industry, and the large variability of symptoms in several human cysticercosis, encourage studies on genetic diversity, and the identification of these parasites with molecular phylogenetic tools. Samples collected from the Ecuadorian provinces: Loja, Guayas, Manabí, Tungurahua (South), and Imbabura, Pichincha (North) from 2000 to 2012 were performed under Maximum Parsimony analyses and haplotype networks using partial sequences of mitochondrial DNA, cytochrome oxidase subunit I (COI) and NADH subunit I (NDI), from Genbank and own sequences of Taenia solium and Taenia saginata from Ecuador. Both species have shown reciprocal monophyly, which confirms its molecular taxonomic identity. The COI and NDI genes results suggest phylogenetic structure for both parasite species from south and north of Ecuador. In T. solium, both genes gene revealed greater geographic structure, whereas in T. saginata, the variability for both genes was low. In conclusion, COI haplotype networks of T. solium suggest two geographical events in the introduction of this species in Ecuador (African and Asian lineages) and occurring sympatric, probably through the most common routes of maritime trade between the XV-XIX centuries. Moreover, the evidence of two NDI geographical lineages in T. solium from the north (province of Imbabura) and the south (province of Loja) of Ecuador derivate from a common Indian ancestor open new approaches for studies on genetic populations and eco-epidemiology.

Initiating sacubitril/valsartan (LCZ696) in heart failure: results of TITRATION, a double-blind, randomized comparison of two uptitration regimens.

AIMS: To assess the tolerability of initiating/uptitrating sacubitril/valsartan (LCZ696) from 50 to 200 mg twice daily (target dose) over 3 and 6 weeks in heart failure (HF) patients (ejection fraction ≤35%). METHODS AND RESULTS: A 5-day open-label run-in (sacubitril/valsartan 50 mg twice daily) preceded an 11-week, double-blind, randomization period [100 mg twice daily for 2 weeks followed by 200 mg twice daily ('condensed' regimen) vs. 50 mg twice daily for 2 weeks, 100 mg twice daily for 3 weeks, followed by 200 mg twice daily ('conservative' regimen)]. Patients were stratified by pre-study dose of angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker (ACEI/ARB; low-dose stratum included ACEI/ARB-naïve patients). Of 540 patients entering run-in, 498 (92%) were randomized and 429 (86.1% of randomized) completed the study. Pre-defined tolerability criteria were hypotension, renal dysfunction and hyperkalaemia; and adjudicated angioedema, which occurred in ('condensed' vs. 'conservative') 9.7% vs. 8.4% (P = 0.570), 7.3% vs. 7.6% (P = 0.990), 7.7% vs. 4.4% (P = 0.114), and 0.0% vs. 0.8% of patients, respectively. Corresponding proportions for pre-defined systolic blood pressure <95 mmHg, serum potassium >5.5 mmol/L, and serum creatinine >3.0 mg/dL were 8.9% vs. 5.2% (P = 0.102), 7.3% vs. 4.0% (P = 0.097), and 0.4% vs. 0%, respectively. In total, 378 (76%) patients achieved and maintained sacubitril/valsartan 200 mg twice daily without dose interruption/down-titration over 12 weeks (77.8% vs. 84.3% for 'condensed' vs. 'conservative'; P = 0.078). Rates by ACEI/ARB pre-study dose stratification were 82.6% vs. 83.8% (P = 0.783) for high-dose/'condensed' vs. high-dose/'conservative' and 84.9% vs. 73.6% (P = 0.030) for low-dose/'conservative' vs. low-dose/'condensed'. CONCLUSIONS: Initiation/uptitration of sacubitril/valsartan from 50 to 200 mg twice daily over 3 or 6 weeks had a tolerability profile in line with other HF treatments. More gradual initiation/uptitration maximized attainment of target dose in the low-dose ACEI/ARB group.

Clinical characteristics and HPV type in recurrent respiratory papillomatosis in Colombia.

OBJECTIVE: Describe factors associated with aggressive forms of recurrent respiratory papillomatosis (RRP). MATERIALS AND METHODS: One hundred eighty-nine RRP cases diagnosed between 1985 and 2009 were identified in pathological records. HPV was detected by the SPF-10 method with broad spectrum primers, (version 1). RESULTS: 113 patients had only one surgery (less aggressive) and 76, two or more interventions (more aggressive). The likelihood of aggressive lesions decreased with increasing age at diagnosis and HPV-11 was associated with no significant increase in the risk of aggressiveness. CONCLUSIONS: The age at diagnosis was the main determinant of RRP aggressiveness.

Clinical characteristics and HPV type in recurrent respiratory papillomatosis in Colombia / Características clínicas y genotipo de VPH en papilomatosis respiratoria recurrente en Colombia

Objective. Describe factors associated with aggressive forms of recurrent respiratory papillomatosis (RRP). Materials and methods. One hundred eighty-nine RRP cases diagnosed between 1985 and 2009 were identified in pathological records. HPV was detected by the SPF-10 method with broad spectrum primers, (version 1). Results. 113 patients had only one surgery (less aggressive) and 76, two or more interventions (more aggressive). The likelihood of aggressive lesions decreased with increasing age at diagnosis and HPV-11 was associated with no significant increase in the risk of aggressiveness. Conclusions. The age at diagnosis was the main determinant of RRP aggressiveness.

Objetivo. Describir factores asociados con formas agresivas de papilomatosis respiratoria recurrente (PRR). Material y métodos. Se identificaron 189 casos de PRR diagnosticados entre 1985-2009 en registros patológicos. VPH fue detectado por el método SPF-10 con cebadores de amplio espectro, (versión 1). Resultados. 113 casos presentaron una intervención quirúrgica (menos agresivas) y 76, dos o más intervenciones (más agresivas). La probabilidad de lesiones agresivas disminuyó con el aumento de la edad al momento del diagnóstico y el VPH-11 se asoció con aumento no significativo del riesgo de agresividad. Conclusiones. La edad al momento del diagnóstico fue el principal determinante de la agresividad de PRR.