From Cosmetic Surgery to Critical Care: Clinical Mimicry of Acute Respiratory Distress Syndrome Following Gluteal Augmentation Surgery.

Gluteal augmentation surgery, commonly known as the Brazilian Butt Lift (BBL), has become increasingly popular and is offered at numerous surgical centers. Typically performed on an outpatient basis, the procedure takes less than four hours, making it an appealing option for many patients. However, BBL is associated with multiple complications, some of which can be severe, resulting in high mortality rates. Most such post-operative adverse events necessitate urgent transfer to hospitals for optimal care, with post-operative respiratory distress being one such critical sign. Fat embolism syndrome (FES) is a notable complication of BBL. The diagnosis of FES is primarily clinical, supported by imaging studies such as chest X-rays and CT scans. FES often goes underdiagnosed due to the lack of definitive diagnostic criteria and its clinical and radiological similarities to other conditions. Despite its underdiagnosis, FES is reported in approximately 0.06% of patients undergoing BBL. Failure to diagnose it early can lead to complications from empiric treatment of other suspected conditions, potentially worsening the prognosis. Our patient developed respiratory failure within an hour after undergoing BBL. The time to symptom onset and the patient's agitation before the respiratory episode broadened the differential for her condition. This case report highlights the importance of recognizing FES and exploring potential preventive measures, including advancements in surgical techniques and prophylactic strategies.

Determinación de tiempos quirúrgicos estándar de los procedimientos más comunes de cirugía general y su probabilidad de extensión para eficientizar la programación de cirugías / Estimation of the standard surgical times of the most common general surgery procedures and the probability of extending them to make surgery scheduling more efficient

RESUMEN Objetivo: Determinar los tiempos quirúrgicos estándar de los cuatro procedimientos más comunes en cirugía general (hernioplastia inguinal unilateral, hernioplastia inguinal bilateral, hernioplastia umbilical y colecistectomía) de un hospital de segundo nivel y calcular la probabilidad de extensión de cada uno de los procedimientos. La eficiencia es un fenómeno ampliamente estudiado en el ámbito económico, pues hace referencia a la necesidad de menor cantidad de factores para la producción de un determinado nivel de bienes y servicios, por ello, es de vital importancia incluirlo en el ámbito quirúrgico. Materiales y métodos: Estudio observacional, descriptivo y retrospectivo. Se utilizaron los registros de quirófano de un hospital de segundo nivel del año 2017 al 2019 del servicio de Cirugía General. A partir de esta información, se estandarizó el tiempo necesario para cada procedimiento mediante la media de cada uno (hernioplastia umbilical, hernioplastia inguinal unilateral o bilateral y colecistectomía). Se calculó la probabilidad de extensión de las cirugías tomando en consideración los datos obtenidos y el intervalo de confianza. Resultados: Para el procedimiento de hernioplastia inguinal unilateral se obtuvo una media de 76 min (IC 95,00 %: 72-80 min, DE 23); en hernioplastia inguinal bilateral, una media de 104,38 min (IC 95,00 %: 91-116 min, DE 41,7); en hernioplastia umbilical, una media de 59,31 min (IC 95,00 %: 54-63 min, DE 29,9), y en colecistectomía, una media de 85,735 min (IC 95,00 %: 83-88 min). La probabilidad de que se programen tres cirugías y todas estén a tiempo (límite superior del IC) es de 92,69 %, la probabilidad de que se programen tres cirugías y todas se prolonguen es de 0,0016 % (límite inferior del IC). Conclusiones: Es posible realizar la planeación de las cirugías programadas mediante el uso de tiempos quirúrgicos estandarizados. Se requiere contar con estadística actualizada de los procedimientos quirúrgicos (promedios del tiempo de realización de cada procedimiento), ya que es posible detectar y supervisar de manera más precisa la dinámica de quirófano mediante la detección de las áreas de oportunidad, de esta manera, se eficientizará el tiempo de quirófano para beneficio de los sistemas de salud y los pacientes.

ABSTRACT Objective: To determine the standard surgical times of the four most common general surgery procedures (unilateral inguinal hernioplasty, bilateral inguinal hernioplasty, umbilical hernioplasty and cholecystectomy) in a second-level hospital and to estimate the probability of extending the time of each of the procedures. Efficiency is a widely studied subject in economics. It involves the need for fewer elements in the production of a certain level of goods and services. Therefore, it is extremely important to consider it in the field of surgery. Materials and methods: An observational, descriptive and retrospective study. It used the operating room records from 2017 to 2019 of the General Surgery service in a second-level hospital. Based on this information, the time required for each procedure was standardized using the mean for each one (umbilical hernioplasty, unilateral or bilateral inguinal hernioplasty and cholecystectomy). The probability of extending surgical times was estimated based on the obtained data and confidence interval. Results: The mean for unilateral inguinal hernioplasty was 76 min (95.00 % CI: 72-80 min, SD 23), for bilateral inguinal hernioplasty 104.38 min (95.00 % CI: 91-116 min, SD 41.7), for umbilical hernioplasty 59.31 min (95.00 % CI: 54-63 min, SD 29.99) and for cholecystectomy 85.735 min (95.00 % CI: 83-88 min). The probability of scheduling three surgical interventions and completing all of them on time (upper limit of the CI) is 92.69 %, and the probability of scheduling three surgical interventions and extending the time of all of them is 0.0016 % (lower limit of the CI). Conclusions: Planning scheduled operations using standardized surgical times is feasible. Updated statistics on surgical procedures (average time for each procedure) are required since it is possible to more accurately detect and supervise operating room dynamics by identifying opportunity areas. This will make operating room time more efficient for the benefit of health care systems and patients.

Detección de hemoglobinopatías en gestantes cubanas del programa: Anemias por Hematíes Falciformes en Cuba

Fundamento: La detección prenatal de hemoglobinopatías en Cuba se realiza a todas las gestantes en la atención Primaria de Salud, a través de la electroforesis de hemoglobina para identificar parejas de alto riesgo. El programa brinda asesoramiento genético, diagnóstico prenatal molecular e interrupciones selectivas de fetos afectados, a solicitud de las parejas. Objetivo: Determinar el tipo y frecuencia de hemoglobinopatías en gestantes cubanas. Método: Se realizó un estudio descriptivo, retrospectivo y de corte transversal para determinar el tipo de hemoglobinopatías en 1 342 917 gestantes captadas en un periodo de diez años. El método de pesquisa fue la electroforesis de hemoglobina en geles de agarosa a pH alcalino. La confirmación por electroforesis de hemoglobina en gel de agarosa a pH ácido, ambos métodos mediante el equipo Hydrasys 2. Resultados: La frecuencia global de gestantes con hemoglobinopatías fue de 3,5 %. Se detectó hemoglobinopatías en 47 465 mujeres; 38 698 con variante S heterocigoto, 8 706 variantes de hemoglobina C y 158 de otras variantes. Se detectaron 44 283 esposos con hemoglobinopatías, 3 099 parejas de alto riesgo y se realizaron 2 689 diagnósticos prenatales moleculares. Se confirmaron 522 fetos afectados y 382 parejas solicitaron la interrupción del embarazo. El programa alcanzó 99,24 % de cobertura en el país. Conclusiones: La detección de las hemoglobinopatías en gestantes residentes en Cuba, permitió conocer el tipo de hemoglobinopatía y la frecuencia de hemoglobinas anormales y nuevas variantes, de ahí el interés de continuar el programa de pesquisa para prevenir la aparición de formas graves de la enfermedad.

Foundation: Prenatal detection of hemoglobinopathies in Cuba is performed on all pregnant women in Primary Health Care, through hemoglobin electrophoresis to identify high-risk couples. The program provides genetic counseling, molecular prenatal diagnosis and selective interruptions of affected fetuses, at the request of couples. Objective: Determine the type and frequency of hemoglobinopathies in Cuban pregnant women. Method: A descriptive, retrospective and cross-sectional study was carried out to determine the type of hemoglobinopathies in 1,342,917 pregnant women recruited over a period of ten years. The research method was hemoglobin electrophoresis in agarose gels at alkaline pH. Confirmation by electrophoresis of hemoglobin in agarose gel at acidic pH, both methods using the Hydrasys 2 equipment. Results: The overall frequency of pregnant women with hemoglobinopathies was 3.5%. Hemoglobinopathies were detected in 47,465 women; 38,698 with heterozygous S variant, 8,706 hemoglobin C variants and 158 other variants. 44,283 husbands with hemoglobinopathies were detected, 3,099 high-risk couples were detected, and 2,689 molecular prenatal diagnoses were performed. 522 affected fetuses were confirmed and 382 couples requested termination of pregnancy. The program reached 99.24% coverage in the country. Conclusions: The detection of hemoglobinopathies in pregnant women residing in Cuba allowed us to know the type of hemoglobinopathy and the frequency of abnormal hemoglobins and new variants, hence the interest in continuing the research program to prevent the appearance of severe forms of the disease.

Youth Mental Health Screening and Linkage to Care.

One Mind, in partnership with Meadows Mental Health Policy Institute, convened several virtual meetings of mental health researchers, clinicians, and other stakeholders in 2020 to identify first steps toward creating an initiative for early screening and linkage to care for youths (individuals in early adolescence through early adulthood, ages 10-24 years) with mental health difficulties, including serious mental illness, in the United States. This article synthesizes and builds on discussions from those meetings by outlining and recommending potential steps and considerations for the development and integration of a novel measurement-based screening process in youth-facing school and medical settings to increase early identification of mental health needs and linkage to evidence-based care. Meeting attendees agreed on an initiative incorporating a staged assessment process that includes a first-stage brief screener for several domains of psychopathology. Individuals who meet threshold criteria on the first-stage screener would then complete an interview, a second-stage in-depth screening, or both. Screening must be followed by recommendations and linkage to an appropriate level of evidence-based care based on acuity of symptoms endorsed during the staged assessment. Meeting attendees proposed steps and discussed additional considerations for creating the first nationwide initiative for screening and linkage to care, an initiative that could transform access of youths to mental health screening and care.

Hematological Alterations in Patients Recovered from SARS-CoV-2 Infection in Havana, Cuba.

INTRODUCTION: COVID-19 sequelae, or the short-, medium-, and long-term manifestations of the disease are under continuous study. There are currently few reports on the evolution of hematological variables following a demonstrated absence of SARS-CoV-2 after infection. OBJECTIVE: Identify hematological alterations in Cuban adults recovered from SARS-CoV-2 infection, and their relation with disease severity. METHODS: We selected 348 persons recovered from COVID-19 residing in Havana, Cuba with an RT-PCR study negative for SARS-CoV-2 performed two weeks after hospital discharge; a structured survey was administered to obtain clinical-epidemiological data. Three groups were established according to COVID-19 clinical criteria: asymptomatic, mild/moderately symptomatic, and severely symptomatic, which, in turn, were divided according to hospital discharge date and blood sample collection date. We performed hemograms with differential leukocyte counts and compared results among groups. We then measured the associations between hematological variables, personal medical history, and relevant lifestyle habits (smoking). RESULTS: All hematological variables were within normal reference limits, although men from the group of severely ill patients had increased total leukocytes, neutrophils and lymphocytes, and decreased hemoglobin and eosinophils, which was also evident in those with a recovery time of 31-90 days. CONCLUSIONS: The relation between hematological variables and degree of clinical severity offers evidence as to persistence of systemic alterations (possibly inflammatory) associated with viral infection. Their identification and characterization can facilitate personalized patient followup and rehabilitation.

Biomass-derived isosorbide-based thermoresponsive hydrogel for drug delivery.

Herein, we describe the design and synthesis of a new variety of bio-based hydrogel films using a Cu(I)-catalyzed photo-click reaction. These films exhibited thermal-triggered swelling-deswelling and were constructed by crosslinking a triazide derivative of glycerol ethoxylate and dialkyne structures derived from isosorbide, a well-known plant-based platform molecule. The success of the click reaction was corroborated through infrared spectroscopy (FTIR) and the smooth surface of the obtained films was confirmed by scanning electron microscopy (SEM). The thermal characterization was carried out in terms of thermogravimetry (TGA) and differential scanning calorimetry (DSC), from which the decomposition onset and glass transition temperatures were determined, respectively. Additionally, mechanical properties of the samples were estimated by stress-strain experiments. Then, their swelling and deswelling properties were systematically examined in PBS buffer, revealing a thermoresponsive behavior that was successfully tested in the release of the anticancer drug doxorubicin. We also confirmed the non-cytotoxicity of these materials, which is a fundamental aspect for their potential use as drug carriers or tissue engineering matrices.

Niveles glutatión reducido y estado redox celular en pacientes pediátricos con inmunodeficiencias / Reduced glutathione levels and cellular redox status in pediatric patients with immunodeficiencies

Introducción: Las alteraciones en el estado redox celular se han descrito como factores causales en diversas enfermedades. La depleción del glutatión reducido se ha asociado fundamentalmente a enfermedades neurodegenerativas, pulmonares, hepáticas, cardiovasculares e inmunológicas. Objetivo: Determinar las concentraciones de glutatión reducido y el estado redox celular en pacientes pediátricos con inmunodeficiencias. Métodos: Se estudiaron 21 pacientes con inmunodeficiencias procedentes de la consulta de Inmunogenética, en edades comprendidas entre 1 y 8 años, de ambos sexos, y 8 niños en el mismo rango de edad de los pacientes, como grupo control, con estudios de inmunidad humoral y celular normales. Los pacientes con diagnóstico de inmunodeficiencia se dividieron para su estudio en 2 grupos según el componente afectado de la respuesta inmune: humoral y celular. Fueron determinadas las concentraciones intraeritrocitarias de glutatión reducido y oxidado, mediante un método de HPLC-UV. Para evaluar el estado redox celular se calculó la relación entre las formas reducidas y oxidadas del glutatión (GSH/GSSG). Resultados: Las concentraciones de glutatión reducido y el estado redox celular se encontraron disminuidos en ambos grupos de pacientes en relación con los niños sin inmunodeficiencia (p=0,031 y p=0,03; respectivamente). El glutatión oxidado no mostró diferencias entre los grupos. Conclusiones: En los pacientes con inmunodeficiencia se evidenció la afectación del estado redox celular como consecuencia de la disminución del glutatión reducido. Este primer acercamiento ofreció las potencialidades del empleo de estos biomarcadores en la evaluación integral de pacientes con inmunodeficiencia(AU)

Introduction: Alterations in the cellular redox state have been described as causal factors in various diseases. Reduced glutathione depletion has been fundamentally associated with neurodegenerative, pulmonary, liver, cardiovascular and immunological diseases. Objective: To determine the concentrations of reduced glutathione and the cellular redox status in pediatric patients with immunodeficiencies. Methods: We studied 21 patients with immunodeficiencies from the immunogenetic service, aged between 1 and 8 years and as a control group, 8 children in the same age range as the patients, with normal humoral and cellular immunity studies. Patients diagnosed with immunodeficiency were divided into two groups according to the affected component of the immune response: humoral and cellular. The intraerythrocyte concentrations of oxidized and reduced glutathione were determined by means of an HPLC-UV method. To evaluate the cellular redox state, the relationship between the reduced and oxidized forms of glutathione (GSH/GSSG) was calculated. Results: Reduced glutathione concentrations and cellular redox status were found to be decreased in both groups of patients in relation to children without immunodeficiency (p=0,031 and p=0,03; respectively). Oxidized glutathione showed no difference between the groups. Conclusions: In patients with immunodeficiency, the cellular redox state is affected as a consequence of the decrease in reduced glutathione. This first approach offers the potential for the use of these biomarkers in the comprehensive evaluation of patients with immunodeficiency(AU)

Relación entre el estado redox celular y marcadores sistémicos de inflamación / Relationship between Cellular Redox Status and Systemic Inflammation Markers

RESUMEN Fundamento: la relación entre la forma reducida y oxidada del glutatión, GSH/GSSG, es frecuentemente utilizada como indicador del estado redox celular. En las condiciones donde se generan altos niveles de especies oxidantes, se pueden aumentar los requerimientos de glutatión reducido, y por tanto, afectarse el estado redox celular. Objetivo: determinar la relación entre el estado redox celular y marcadores sistémicos de inflamación. Métodos: se realizó un estudio descriptivo en una serie de 56 casos remitidos de la consulta de inmunogenética, en edades comprendidas entre 1 y 76 años, de ambos sexos. Se determinaron la velocidad de eritrosedimentación y los niveles séricos de proteína C-reactiva como marcadores sistémicos de inflamación. La relación GSH/GSSG se calculó a partir de las concentraciones intraeritrocitarias de glutatión reducido y su forma oxidada, las que fueron determinadas mediante un método de HPLC-UV. Resultados: la relación GSH/GSSG promedio fue de 7,9 (IC 95 %:6,4-9,4) y la edad no influyó en esta proporción. En los casos que tenían valores alterados de los marcadores de inflamación, mostraban una disminución en la relación GSH/GSSG. El estado redox celular se correlacionó negativamente con los valores de la eritrosedimentación (r=-0,41; p=0,017). Sin embargo, esta asociación no aparece cuando se analizan los niveles de proteína C-reactiva. Conclusiones: los pacientes que presentan alteraciones en los marcadores de inflamación muestran cambios en el estado redox celular. El estudio combinado de estos biomarcadores permite realizar un análisis integral del estado de salud del paciente con enfermedades inflamatorias.

ABSTRACT Background: the relationship between the reduced and oxidized form of glutathione, GSH/ GSSG, is frequently used as an indicator of the cellular redox state. Under conditions where high levels of oxidizing species are generated, reduced glutathione requirements can be increased, and therefore, the cellular redox state can be affected. Objective: to determine the relationship between the cellular redox state and systemic markers of inflammation. Methods: a descriptive study was carried out in a series of 56 cases referred from the immunogenetics clinic, aged between 1 and 76 years old, of both sexes. Erythrocyte sedimentation rate and serum levels of C-reactive protein were determined as systemic markers of inflammation. The GSH/GSSG ratio was calculated from the intraerythrocyte concentrations of reduced glutathione and its oxidized form, which were determined by an HPLC-UV method. Results: the average GSH/GSSG ratio was 7.9 (95 % CI: 6.4-9.4) and age did not influence this proportion. In the cases that had altered values of the inflammation markers, they showed a decrease in the GSH/GSSG ratio. Cellular redox status was negatively correlated with erythrocyte sedimentation values (r=0.41; p=0.017). However, this association does not appear when C-reactive protein levels are analyzed. Conclusions: the patients who present alterations in the inflammation markers show changes in the cellular redox state. The combined study of these biomarkers allows a more comprehensive analysis of the health status of patients with inflammatory diseases.

Sistema de acciones educativas para desarrollar habilidades psicosociales en el Equipo Básico de Salud para la prevención del cáncer / System of educational actions to develop psychosocial skills in the Basic Health Team for cancer prevention

RESUMEN La investigación tiene como objetivo fundamentar, desde el punto de vista teórico, un sistema de acciones educativas para el desarrollo de habilidades psicosociales del Equipo Básico de Salud para la prevención del cáncer en el Consejo Popular San Juan de Dios. El estudio se llevó a cabo de febrero a julio del 2018 y extiende sus acciones hasta el 2022 pues forma parte de la carpeta de proyectos del Centro para el Desarrollo de las Ciencias Sociales y Humanísticas en Salud. Se realizó un diagnóstico en el cual se utilizaron instrumentos como la entrevista y la encuesta, aplicados a miembros del equipo de salud, a los pacientes oncológicos, sus familiares y población en general, así como a profesionales de la salud de los 13 consultorios del Consejo Popular, aunque fue escogido el número 29 para el estudio piloto. Los resultados obtenidos evidenciaron que existe un insuficiente abordaje psicosocial de la enfermedad por parte del Equipo Básico de Salud.

ABSTRACT The research aims at establishing, from the theoretical point of view, a system of educational actions for the development of psychosocial skills of the Basic Health Team for the prevention of cancer in the San Juan de Dios Popular Council. The study was carried out from February to July 2018 and extends its actions until 2022 as it is part of the project portfolio of the Center for the Development of Social and Humanistic Sciences in Health. A diagnosis was made in which instruments such as the interview and the survey were used, applied to members of the health team, cancer patients, their relatives and the general population, as well as health professionals from the 13 medical offices of the Popular Council. Number 29 was chosen for the pilot study. The results obtained showed that there is insufficient psychosocial approach to the disease bythe Basic Health Team.

Frecuencia de hemoglobinopatías en mujeres embarazadas del programa de anemias por hematíes falciformes en Cuba / Frequency of hemoglobinopathies among pregnant women from the sickle cell anemia program in Cuba

Introducción: Las hemoglobinopatías se consideran errores monogénicos hereditarios y están caracterizados por defectos en la molécula de hemoglobina. En Cuba, la detección prenatal de hemoglobinopatías se realiza a través de la electroforesis de hemoglobina para identificar parejas de alto riesgo. El programa brinda: asesoramiento genético, diagnóstico prenatal molecular e interrupciones selectivas de fetos afectados, a solicitud de las parejas. Objetivo: Determinar la frecuencia de hemoglobinopatías en mujeres embarazadas residentes en Cuba. Métodos: Se realizó un estudio descriptivo, retrospectivo y de corte transversal para determinar la frecuencia de hemoglobinopatías en 1 342 917 mujeres embarazadas captadas en el periodo 2009-2019. El método diagnóstico de la pesquisa fue la electroforesis de hemoglobina en geles de agarosa a pH alcalino. La confirmación se realizó por electroforesis de hemoglobina en gel de agarosa a pH ácido; ambos métodos mediante la tecnología HYDRASYS. Resultados: La frecuencia global de embarazadas con hemoglobinopatías fue de 3,5 por ciento. Se detectó hemoglobinopatías en 47 465 mujeres; 38 698 con variante S heterocigoto, 8 706 variantes de hemoglobina C y 158 de otras variantes. Se detectaron 44 283 esposos con hemoglobinopatías, 3 099 parejas de alto riesgo y se realizaron 2 689 diagnósticos prenatales moleculares. Se confirmaron 522 fetos afectados y 382 parejas solicitaron la interrupción del embarazo. El subprograma alcanzó 99,24 por ciento de cobertura en el país. Conclusión: La alta frecuencia de hemoglobinopatías en Cuba justifica la importancia de continuar el subprograma de detección de portadores para prevenir la aparición de las formas graves de la enfermedad(AU)

Introduction: Hemoglobinopathies are hereditary monogenic errors characterized by defects in the hemoglobin molecule. In Cuba, prenatal detection of hemoglobinopathies is performed by hemoglobin electrophoresis to identify high-risk couples. The program offers genetic counseling, prenatal molecular diagnosis and selective pregnancy termination in case of affected fetuses at the request of couples. Objective: Determine the frequency of hemoglobinopathies among pregnant women living in Cuba. Methods: A descriptive cross-sectional retrospective study was conducted to determine the frequency of hemoglobinopathies in 1 342 917 pregnant women recruited in the period 2009-2019. Screening was based on the diagnostic method of hemoglobin electrophoresis in alkaline pH agarose gels. Confirmation was performed with hemoglobin electrophoresis in acid pH agarose gel. Both methods used HYDRASYS technology. Results: Overall frequency of pregnant women with hemoglobinopathies was 3.5 percent. Hemoglobinopathies were detected in 47 465 women: 38 698 with variant S heterozygote, 8 706 with variants of hemoglobin C y 158 with other variants. 44 283 husbands with hemoglobinopathies and 3 099 high-risk couples were detected, and 2 689 prenatal molecular diagnostic tests were conducted. A total 522 affected fetuses were confirmed, and 382 couples requested pregnancy termination. The subprogram achieved 99.24 percent coverage in the country. Conclusion: The high frequency of hemoglobinopathies in Cuba justifies the importance of continuing the carrier detection subprogram to prevent the emergence of severe forms of the disease(AU)

Psychosis screening in schools: Considerations and implementation strategies.

AIM: Duration of untreated psychosis, or the time between onset of psychosis symptoms and accurate diagnosis and treatment, is a significant predictor of both initial treatment response and long-term outcomes. As such, efforts to improve rapid identification are key. Because early signs of psychosis commonly emerge in adolescence, schools have the potential to play an important role in the identification of psychosis-spectrum disorders. METHODS: To illustrate the potential role of schools in this effort, the current paper describes implementation of a psychosis screening tool as part of a larger study focused on reducing the duration of untreated psychosis in Sacramento, CA. RESULTS: Clinical considerations related to screening for psychosis in schools, including ethical concerns, logistics, screening population and stigma are addressed. Implementation strategies to address these concerns are suggested. CONCLUSIONS: Early psychosis screening in the school system could improve early identification, reduce stigma and may represent an important further step towards an integrative system of mental health.

Evaluation of the anti-Acanthamoeba activity of two commercial eye drops commonly used to lower eye pressure.

Efficient treatments against Acanthamoeba Keratitis (AK), remains until the moment, as an issue to be solved due to the existence of a cyst stage which is highly resistant to most chemical and physical agents. In this study, two antiglaucoma eye drops were tested for their activity against Acanthamoeba. Moreover, this study was based on previous data which gave us evidence of a possible link between the absences of Acanthamoeba at the ocular surface in patients treated with beta blockers for high eye pressure both containing timolol as active principle. The amoebicidal activity of the tested eye drops was evaluated against four strains of Acanthamoeba using Alamar blue method. For the most active drug the cysticidal activity against A. castellanii Neff cysts and further experiments studying changes in chromatin condensation levels, in the permeability of the plasmatic membrane, the mitochondrial membrane potential and the ATP levels in the treated amoebic strains were done. Even though both eye drops were active against the different tested strains of Acanthamoeba, statistical analysis revealed that one of them (Timolol Sandoz) was the most effective one against all the tested strains presenting IC50s ranging from 0.529% ± 0.206 for the CLC 16 strain to 3.962% ± 0.150 for the type strain Acanthamoeba castellanii Neff. Timolol Sandoz 0.50% seems to induce amoebic cell death by damaging the amoebae at the mitochondrial level. Considering its effect, Timolol Sandoz 0.50% could be used in the case of contact lens wearers and patients with glaucoma.

The rs61764370 Functional Variant in the KRAS Oncogene is Associated with Chronic Myeloid Leukemia Risk in Women.

BACKGROUND: Chronic myeloid leukemia (CML) is one of the most frequent hematopoietic malignancies in the elderly population; however, knowledge is limited regarding the genetic factors associated with increased risk for CML. Polymorphisms affecting microRNA (miRNA) biogenesis or mRNA:miRNA interactions are important risk factors in the development of different types of cancer. Thus, we carried out a case-control study to test the association with CML susceptibility of gene variants located in the miRNA machinery genes AGO1 (rs636832) and GEMIN4 (rs2740348), as well as in the miRNA binding sites of the genes BRCA1 (rs799917) and KRAS (rs61764370). MATERIALS AND METHODS: We determined the genotype of 781 Mexican-Mestizo individuals (469 healthy subjects and 312 CML cases) for the four polymorphisms using TaqMan probes to test the association with CML susceptibility. RESULTS: We found a borderline association of the minor homozygote genotype of the KRAS_rs61764370 polymorphism with an increased risk for CML susceptibility (P = 0.06). After gender stratification, this association was significant only for women (odds ratio [OR] = 13.41, P = 0.04). The distribution of the allelic and genotypic frequencies of the four studied SNPs was neither associated with advanced phases of CML nor treatment response. CONCLUSIONS: To the best of our knowledge, this study is the first to show a significant association of the KRAS_rs61764370 SNP with CML. To further determine such an association of with CML susceptibility, our results must be replicated in different ethnic groups.

Mercurius solubilis en el tratamiento de pacientes con estomatitis aftosa recurrente / Mercurius solubilis in the treatment of patients with recurrent aphthous estomatitis

Se realizó ensayo clinicoterapéutico controlado, de fase II B, de 112 pacientes con estomatitis aftosa recurrente, atendidos en la Clínica Estomatológica "José Luis Tassende" de Santiago de Cuba, desde enero hasta diciembre de 2013, para evaluar la eficacia del Mercurius solubilis en el tratamiento de estos. La muestra fue distribuida de forma aleatoria, mediante orden de llegada, en 2 grupos (uno de estudio y uno control), con 56 integrantes cada uno. Los primeros fueron tratados con Mercurius solubilis y los segundos con los remedios homeopáticos habituales. Para la validación estadística de la información obtenida se emplearon el porcentaje, el test de Ji al cuadrado, con 95 % de confiabilidad, y la probabilidad exacta de Fisher. Entre los grupos estudiados no existieron diferencias significativas en relación con la remisión de la intensidad del dolor, la recuperación de la integridad epitelial y la curación al tercer, quinto y séptimo días de tratamiento. Se demostró que esta terapia alternativa fue tan eficaz como el bórax.

A controlled clinical and therapeutical trial, of phase II B, was carried out on 112 patients with recurrent aphthous stomatitis, assisted in "José Luis Tassende" Stomatological Clinic in Santiago de Cuba from January to December, 2013, to evaluate the effectiveness of the Mercurius solubilis in their treatment. The sample was randomly distributed, through arrival order, in 2 groups (a study group and a control group), with 56 members each. The first ones were treated with Mercurius solubilis and the seconds with the habitual homeopathic remedies. For the statistical validation of the obtained information, the percentage, the chi square test, with 95% of confidence, and the exact probability of Fisher were used. There were no significant differences among the studied groups in relation to the remission of the pain intensity, the recovery of the epithelial integrity and the cure at the third, fifth and seventh days of treatment. It was demonstrated that this alternative therapy was as effective as borax.

Enfermedad periodontal y climaterio / Periodontal disease and climaterium

Se realizó un estudio descriptivo y transversal de 282 pacientes que se encontraban en la etapa del climaterio, que acudieron a la consulta de Endocrinología del Policlínico de Especialidades del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, durante el 2012, con vistas a caracterizar el estado de la enfermedad periodontal en este grupo según variables de interés clínico, periodontal y epidemiológico. Se obtuvo que la severidad de la enfermedad gingival y periodontal estuvo directamente relacionada con los grados de higiene bucal regular y malo, con predominio de la gingivitis (90,4 %), de la gingivitis severa (81,7 %), así como de la periodontitis establecida con higiene bucal regular (79,1 %) y de la periodontitis terminal con higiene bucal mala (76,0%); asimismo, la gingivitis resultó ser la afección más común en ambas etapas del período climatérico (67,9 y 35,3 % en las premenopáusicas y posmenopáusicas, respectivamente). Se demostró que a medida que pasan los años sin efecto estrogénico, la riesgo de la afección se incrementa, sin existir relación entre esta y la edad en que ocurrió la menopausia o la gravedad del síndrome climatérico. Se recomienda continuar las investigaciones para conocer el estado de la enfermedad periodontal en pacientes climatéricas a escala nacional y elaborar programas destinados a la prevención.

A descriptive and cross-sectional study of 282 patients who were in the climacteric stage and were assisted in the Endocrinology Department of the Specialties Polyclinic from "Saturnino Lora Torres" Clinical Surgical Teaching Provincial Hospital in Santiago de Cuba was carried out during the 2012, with the aim of characterizing the periodontal disease in this group according to variables of clinical, periodontal and epidemiological interest. It was obtained that the severity of the gingival and periodontal disease was directly related to the degrees of mean and poor oral hygiene, with prevalence of the gingivitis (90.4%), of the severe gingivitis (81.7%), as well as of the established periodontitis with mean oral hygiene (79.1%) and of the terminal periodontitis with poor oral hygiene (76.0%); also, gingivitis turned out to be the most common disorder in both stages of the climacteric period (67.9 and 35.3% in the premenopausic and posmenopausic women, respectively). It was demonstrated that, as the years pass without estrogenic effect, the risk for the disease increases, without existing relationship between it and the age in which menopause or the severity of the climacteric syndrome took place. It is recommended to continue the investigations to know the periodontal disease in climacteric patients at a national scale and to implement programs aimed at its prevention.

Cooking, healthy eating, fitness and fun (CHEFFs): qualitative evaluation of a nutrition education program for children living at urban family homeless shelters.

OBJECTIVES: We assessed the feasibility of a 15-week nutrition education, physical activity, and media literacy program for children living in urban family homeless shelters. METHODS: We developed a qualitative monitoring tool to evaluate program process and impact at 2 shelter sites in the Bronx, New York, from 2009 to 2012. Facilitators recorded indications of participants' understanding of intended messages and demonstrations of changes in attitudes and behaviors. Comments, insights, and actions were recorded as they occurred. Facilitators also documented barriers to delivery of content and activities as intended. We used content analysis to examine data for patterns and identify themes. RESULTS: A total of 162 children participated at the 2 shelter sites. Analysis of qualitative data yielded 3 themes: (1) children's knowledge and understanding of content, (2) children's shift in attitudes or intentions, and (3) interpretations through children's life experience. Food insecurity as well as shelter food service and policies were important influences on children's choices, hunger, and sense of well-being. CONCLUSIONS: Children's experiences highlighted the need to advocate for shelter policies that adequately provide for children's nutritional and physical activity requirements and foster academic development.

Usp16 contributes to somatic stem-cell defects in Down's syndrome.

Down's syndrome results from full or partial trisomy of chromosome 21. However, the consequences of the underlying gene-dosage imbalance on adult tissues remain poorly understood. Here we show that in Ts65Dn mice, which are trisomic for 132 genes homologous to genes on human chromosome 21, triplication of Usp16 reduces the self-renewal of haematopoietic stem cells and the expansion of mammary epithelial cells, neural progenitors and fibroblasts. In addition, Usp16 is associated with decreased ubiquitination of Cdkn2a and accelerated senescence in Ts65Dn fibroblasts. Usp16 can remove ubiquitin from histone H2A on lysine 119, a critical mark for the maintenance of multiple somatic tissues. Downregulation of Usp16, either by mutation of a single normal Usp16 allele or by short interfering RNAs, largely rescues all of these defects. Furthermore, in human tissues overexpression of USP16 reduces the expansion of normal fibroblasts and postnatal neural progenitors, whereas downregulation of USP16 partially rescues the proliferation defects of Down's syndrome fibroblasts. Taken together, these results suggest that USP16 has an important role in antagonizing the self-renewal and/or senescence pathways in Down's syndrome and could serve as an attractive target to ameliorate some of the associated pathologies.

Exome sequencing and functional validation in zebrafish identify GTDC2 mutations as a cause of Walker-Warburg syndrome.

Whole-exome sequencing (WES), which analyzes the coding sequence of most annotated genes in the human genome, is an ideal approach to studying fully penetrant autosomal-recessive diseases, and it has been very powerful in identifying disease-causing mutations even when enrollment of affected individuals is limited by reduced survival. In this study, we combined WES with homozygosity analysis of consanguineous pedigrees, which are informative even when a single affected individual is available, to identify genetic mutations responsible for Walker-Warburg syndrome (WWS), a genetically heterogeneous autosomal-recessive disorder that severely affects the development of the brain, eyes, and muscle. Mutations in seven genes are known to cause WWS and explain 50%-60% of cases, but multiple additional genes are expected to be mutated because unexplained cases show suggestive linkage to diverse loci. Using WES in consanguineous WWS-affected families, we found multiple deleterious mutations in GTDC2 (also known as AGO61). GTDC2's predicted role as an uncharacterized glycosyltransferase is consistent with the function of other genes that are known to be mutated in WWS and that are involved in the glycosylation of the transmembrane receptor dystroglycan. Therefore, to explore the role of GTDC2 loss of function during development, we used morpholino-mediated knockdown of its zebrafish ortholog, gtdc2. We found that gtdc2 knockdown in zebrafish replicates all WWS features (hydrocephalus, ocular defects, and muscular dystrophy), strongly suggesting that GTDC2 mutations cause WWS.

Evolución al tratamiento de las ulceras corneales en pacientes hospitalizados en el Centro Nacional de Oftalmología. Octubre 2001-Octubre 2002 / Evolution to the treatment of the you ulcerate horns them in patient hospitalized in the National Ophthalmology Center. October 2001 - October 2002

Se realizó un estudió de tipo descriptivo y corte transversat en 108 pacientes hospitalizados con diagnóstico de úlcera corneal en el servicio de Hospitalizados del CENAO entre octubre 2001 a octubre 2002. Entre los resultados se destacan que la mayoría de los pacientes tenían entre l5 y.55 años, mascuinos obreros, con escolaridad primaria y de procedencia urbana. En el 69.5 porciento de los casos hubo antecedentes de condición previo al desarrollo de la úlcera corneal. El tiempo transcucrrido entre el inicio de los síntomas y hospitalización fue de 13.5 días. El 74.1 porciento había sido tratado previamente de diferentes formas y los medicamentos tópicos más frecuentemente usados y fueron antibióticos en el 50 porciento y corticoides en 32.5 porciento de los casos. 20 pacientes ingresaron sin visión y un 65.9 porciento presentaban agudeza visual desde 20/200 hasta PL. El 75.9 porciento de las úlceras corneales eran centrales, ulverativas, con un promedio de afectación corneal del 36.6 porciento; únicas (90 porciento); profundas (75.9 porciento) y con hipopion el 49 porciento. El diagnóstico de ingreso en el 38 porciento de los casos fue úlcera conrneal+absceso estromal+hipopion; seguido de úlcera corneal en un 26.9 porciento. En el 51 porciento de los pacientes no se aisló el agente cuasal específico; solamente 44 casos fueron positivos y las bacterias más frecuentemente aisladas fueron E.epidermidis (45.5 porciento), en segundo lugar se encontró Klebsiella spp (22.7 porciento), seguido de Pseudomonas (15.9 porciento). En el 37 porciento el tratamiento fue exclusivamente médico, en 68 de los casos se recurrió al quirúrgico, realizándose un total de 48 recubrimientos conjuntivales+tarsorrafía, 33 evisceraciones, 1 enucleación y 1 tarsorrafía. El 81.5 porciento de los casos fueron úlceras corneales complicadas; en 34 casos hubo pérdida del globo ocular, un 38 porciento quedaron con mala visión y solamente el 30.5 porciento conservó una agudeza visual adecuada...

Manejo del trauma de recto extraperitoneal en el Hospital General de Oeste experiencia en los últimos 6 años / Trauma of rectus handling besides in addition to peritoneal experience to be nean its 6 year

Veintitrés pacientes con diagnóstico de trauma de recto extraperitoneal fueron tratados en el Hospital General del Oeste "Dr. José Gregorio Hernández" durante el período de 1990 a 1995. Los principales mecanismos de lesión fueron heridas por arma de fuego (78,3 por ciento) y empalamiento rectal (21,7 por ciento).el diagnóstico fue fundamentalmente clínico, a través de tacto rectal (73,9 por ciento) necesitando la ayuda de la rectosigmoidoscopia en dos casos. La terapéutica estuvo orientada en el principio de la derivación fecal proximal, confeccionando para tal fin : colostomía en asa en 21 pacientes (91,3 por ciento), colostomía terminal con cierre del muñon distal en uno (4,34 por ciento) y colostomía con fístula mucosa en otro (4,34 por ciento). Se realizó rafia de la lesión rectal en solo 5 pacientes (21,7 por ciento), lavado del cabo distal en 3 (13,04 por ciento) y el drenaje presacro no fue utilizado. Se empleó el cierre del cabo distal de la colostomía en asa en 15 pacientes (65,2 por ciento) dándole carácter totalmente desfuncionante, sin obtener complicaciones. Concluimos que la colostomía en asa con la variante técnica del cierre del cabo distal constituye la mejor alternativa para tratar este tipo de lesión, además, la utilización de: drenaje presacro, lavado del cabo distal y rafi de la lesión rectal, no alteran la morbimortalidad en estos pacientes "