A 50-Year-Old Man With a History of Recurrent Exudative Right-Sided Pleural Effusion.

In this case report, we describe a 50-year-old man who presented to our facility for a second opinion after a year-long history of recurrent and now persistent right-sided exudative pleural effusion. On review of previous records, negative findings were seen in microbiological studies, including acid-fast bacilli, cytology, flow cytometry, and pleural biopsy using video-assisted thoracoscopy. On transthoracic echocardiography performed during our evaluation, the expected respiratory variations across the mitral and tricuspid valves were not appreciated. This necessitated subsequent cardiac workup via magnetic resonance imaging, which showed a small pericardial fluid, thickened pericardium, and a septal bounce. The patient was surgically treated using a phrenic-to-phrenic pericardiectomy, following which his symptoms resolved completely. Pleural effusions occur in approximately 40-60% of patients with constrictive pericarditis, and despite the known association of pleural effusions with constrictive pericarditis, the diagnosis of constrictive pericarditis is not readily entertained in patients with undiagnosed pleural effusions.

Epstein-Barr virus peptides derived from latent cycle proteins alter NKG2A + NK cell effector function.

Natural killer (NK) cells control viral infection through the interaction between inhibitory receptors and human leukocyte antigen (HLA) ligands and bound peptide. NK cells expressing the inhibitory receptor NKG2A/CD94 recognize and respond to autologous B cells latently infected with Epstein-Barr virus (EBV). The mechanism is not yet understood, thus we investigated peptides derived from seven latent proteins of EBV in the interaction of NKG2A and its ligand HLA-E. Functional analysis demonstrated that EBV peptides can bind to HLA-E and block inhibition of NK cell effector function. Moreover, analysis of DNA from 79 subjects showed sequence variations in the latent protein, LMP1, which alters NK responses to EBV. We provide evidence that peptides derived from EBV latent cycle proteins can impair the recognition of NKG2A despite being presented by HLA-E, resulting in NK cell activation.

Early life metal dysregulation in amyotrophic lateral sclerosis.

OBJECTIVE: Deficiencies and excess of essential elements and toxic metals are implicated in amyotrophic lateral sclerosis (ALS), but the age when metal dysregulation appears remains unknown. This study aims to determine whether metal uptake is dysregulated during childhood in individuals eventually diagnosed with ALS. METHODS: Laser ablation-inductively coupled plasma-mass spectrometry was used to obtain time series data of metal uptake using biomarkers in teeth from autopsies or dental extractions of ALS (n = 36) and control (n = 31) participants. Covariate data included sex, smoking, occupational exposures, and ALS family history. Case-control differences were identified in temporal profiles of metal uptake for individual metals using distributed lag models. Weighted quantile sum (WQS) regression was used for metals mixture analyses. Similar analyses were performed on an ALS mouse model to further verify the relevance of dysregulation of metals in ALS. RESULTS: Metal levels were higher in cases than in controls: 1.49 times for chromium (1.11-1.82; at 15 years), 1.82 times for manganese (1.34-2.46; at birth), 1.65 times for nickel (1.22-2.01; at 8 years), 2.46 times for tin (1.65-3.30; at 2 years), and 2.46 times for zinc (1.49-3.67; at 6 years). Co-exposure to 11 elements indicated that childhood metal dysregulation was associated with ALS. The mixture contribution of metals to disease outcome was likewise apparent in tooth biomarkers of an ALS mouse model, and differences in metal distribution were evident in ALS mouse brains compared to brains from littermate controls. INTERPRETATION: Overall, our study reveals direct evidence that altered metal uptake during specific early life time windows is associated with adult-onset ALS.

Promoción del cuidado sensible en contextos de riesgo: un estudio de caso en una cuidadora de Ibagué (Colombia) / Promoting Sensitive Caregiving in Risk Settings: A Case Study in a caregiver in Ibagué (Colombia)

Se tuvo como propósito promover la calidad del cuidado de niños/as en situación de riesgo a través de los cambios en la sensibilidad de una cuidadora que vive en condiciones de vulnerabilidad de la ciudad de Ibagué (Tolima). Este estudio se fundamentó en perspectivas teóricas sobre el desarrollo infantil basadas en la teoría del apego (Bowlby, 1958; Carbonell, 2013; Pianta, 1999) y el modelo bioecológico propuesto por Urie Bronfenbrenner (1987, 2005). Se adoptó un método mixto con alcance descriptivo a partir de un estudio de caso único. Los resultados indican que la cuidadora se encontraba expuesta a diferentes factores externos asociados con la exclusión social, lo que posiblemente se relaciona con su alta percepción subjetiva de vulnerabilidad. El nivel de sensibilidad previo a la intervención se encuentra en el extremo negativo (-0.42). Posterior a la intervención, se identificó un aumento (0.60), usando la técnica del videofeedback. Se concluye que la técnica de intervención utilizada muestra resultados favorables con cuidadores expuestos a situaciones de riesgo, por lo que resulta fundamental dirigir futuros estudios e intervenciones hacia adultos cuidadores como principal estrategia para contrarrestar las afectaciones producto de situaciones de adversidad social y emocional, que puedan incidir el desarrollo integral de la infancia.

The aim was to promote the quality of caregiving for children at risk through changes in the sensitivity of adult caregivers. This study was based on theoretical perspectives on child development based on the Attachment Theory (Bowlby, 1958; Carbonell, 2013; Pianta, 1999 and Salinas & Posada, 2014) and the bioecological model proposed by Urie Bronfenbrenner (1987). The study adopted a quantitative method with a descriptive scope of a quasi-experimental type without a control group and a qualitative phase with a descriptive scope based on a case study. The results indicate that the caregiver who participated in the study is exposed to different external factors associated with social exclusion, which possibly is related to its high subjective perception of vulnerability. The level of sensitivity before the intervention is at the negative end (-0.42). After the intervention with the video feedback technique, an increase was identified (0.60). In conclusion, the intervention technique used shows favourable results with caregivers exposed to risk situations, so it is essential to direct the interventions towards adult caregivers as the primary prevention strategy in child mental health.

Genome-wide DNA methylation profiling of human diabetic peripheral neuropathy in subjects with type 2 diabetes mellitus.

DNA methylation is an epigenetic mechanism important for the regulation of gene expression, which plays a vital role in the interaction between genetic and environmental factors. Aberrant epigenetic changes are implicated in the pathogenesis of diabetes and diabetic complications, but the role of DNA methylation in diabetic peripheral neuropathy (DPN) is not well understood. Therefore, our aim in this study was to explore the role of DNA methylation in the progression of DPN in type 2 diabetes. We compared genome-wide DNA methylation profiles of human sural nerve biopsies from subjects with stable or improving nerve fibre counts to biopsies from subjects with progressive loss of nerve fibres. Nerve fibre counts were determined by comparing myelinated nerve fibre densities between an initial and repeat biopsy separated by 52 weeks. Subjects with significant nerve regeneration (regenerators) and subjects with significant nerve degeneration (degenerators) represent the two extreme DPN phenotypes. Using reduced representation bisulfite sequencing, we identified 3,460 differentially methylated CpG dinucleotides between the two groups. The genes associated with differentially methylated CpGs were highly enriched in biological processes that have previously been implicated in DPN such as nervous system development, neuron development, and axon guidance, as well as glycerophospholipid metabolism and mitogen-activated protein kinase (MAPK) signalling. These findings are the first to provide a comprehensive analysis of DNA methylation profiling in human sural nerves of subjects with DPN and suggest that epigenetic regulation has an important role in the progression of this prevalent diabetic complication.

The forgotten urinalysis: an integral part of unmasking thrombophilia.

A 43-year-old female presented with flank pain of two days duration. She had been admitted previously for bilateral lower extremity edema which had not improved with diuresis. Abdominal Imaging showed left ovarian vein thrombosis and left renal vein thrombosis extending into the IVC. Chest imaging revealed right lower lobe segmental pulmonary emboli. Careful review of serial urinalysis during previous admissions revealed significant proteinuria. Confirmatory urine tests followed by a renal biopsy led to a diagnosis of membranous nephropathy. We report a case of acute diffuse thromboembolism due to membranous nephropathy, unmasked by serial abnormal urinalysis.

Cutting Edge: Transcriptional Profiling Reveals Multifunctional and Cytotoxic Antiviral Responses of Zika Virus-Specific CD8+ T Cells.

Zika virus (ZIKV) constitutes an increasing public health problem. Previous studies have shown that CD8+ T cells play an important role in ZIKV-specific protective immunity. We have previously defined antigenic targets of the ZIKV-specific CD8+ T cell response in humans. In this study, we characterized the quality and phenotypes of these responses by a combined use of flow cytometry and transcriptomic methods, using PBMCs from donors deriving from different geographical locations collected in the convalescent phase of infection. We show that ZIKV-specific CD8+ T cells are characterized by a polyfunctional IFN-γ signature with upregulation of TNF-α, TNF receptors, and related activation markers, such as CD69, as well as a cytotoxic signature characterized by strong upregulation of GZMB and CRTAM. The signature is stable and not influenced by previous dengue virus exposure, geographical location, or time of sample collection postinfection. To our knowledge, this work elucidates the first in-depth characterization of human CD8+ T cells responding to ZIKV infection.

Discusión sobre la necesidad de delimitación de una nueva nosografía psiquiátrica y psicológica. síndrome del accidentado por rayo eléctrico / Discussion on the delimitation of a nosography new psychiatric and psychological need. syndrome of the accident by electric ray

La observación y análisis de las variadas manifestaciones clínicas y secuelas que presentan las víctimas sobrevivientes de accidente por rayo, nos proporciona la posibilidad de cambiar el punto de vista desde el cual consideramos y estudiamos las mismas. Debemos evaluar la conveniencia de considerar tales manifestaciones meramente como un conjunto de signos y síntomas inespecíficos o pertenecientes a múltiples síndromes ya tipificados; o bien, abrir una nueva y profunda discusión en torno a la posibilidad de su agrupación y delimitación de una nueva categoría nosográfica psiquiátrica y psicológica. La metodología de la presente investigación se basa en el análisis de gran parte de la casuística extranjera de estos pacientes y la investigación bibliográfica exhaustiva sobre las escasas publicaciones científicas existentes. Asimismo, se revisan distintos procedimientos habituales en el ingreso de estos pacientes a los centros de salud que dificultan el estudio epidemiológico y sanitario de los mismos.

The observation and analysis of the varied clinical manifestations and sequels surviving accident victims presented by ray, gives us the possibility to change the point of view from which we consider and study them. We must assess the appropriateness of considering such manifestations merely as a set of signs and symptoms nonspecific, or belonging to multiple syndromes already described; Alternatively, open a new and profound discussion about the possibility of their grouping and delimitation of a new category of psychiatric and psychological nosographic. The methodology of this research is based on the analysis of much of the world Casuistry of these patients and the comprehensive bibliographic research on the scarce existing scientific publications. Also reviewed various common procedures in income of these patients to health centers, hindering the health and epidemiological study of them.

Tipo de violencia ejercida por la pareja, a mujeres con trastorno dependiente de la personalidad, evidenciadas en Hospital Policlínico Arce ISSS, agosto/2013 a enero/2015 / Type of violence exerted by the partner, to women with dependent personality disorder, evidenced in Arce Polyclinic Hospital of the ISSS, August / 2013 to January / 2015

Los rasgos de personalidad, identifican la manera en que una persona puede comportarse, tolerar, enfrentar o aceptar diferentes situaciones, por otro lado la violencia intrafamiliar es un problema sociocultural, que es adoptado en algunas familias y aceptado como parte de la vida, aunque muchas veces tenga resultados fatales. La mujer se encuentra en una desventaja social y cultural, y esto le puede dar el rol de víctima dentro de la familia. Por lo tanto, el presente estudio estableció el tipo de violencia más frecuentemente ejercida por la pareja, en mujeres con trastorno dependiente de personalidad, evidenciados en Hospital Policlínico Arce ISSS, durante el periodo de agosto 2013 a enero del 2015, definió el perfil socio demográfico y detalla otros tipos de violencia y trastornos de personalidad encontrados en las mujeres consultantes del Hospital Policlínico Arce, como un problema social con elevada incidencia, consecuencias negativas para las víctimas, familiares y la gravedad de los hechos que entraña e impiden a la víctima ejercer respuestas racionales y adecuadas para enfrentar su situación y posiblemente exacerban su patología psiquiátrica de base. Por lo tanto este estudio constituye una herramienta para evaluar las intervenciones terapéuticas y ajustar las necesidades de los pacientes a los recursos asistenciales presentes y futuros. El tipo de investigación es con alcance descriptivo, retrospectivo, durante enero 2013 agosto 2015, la población estudiadas son pacientes femeninas víctimas de violencia y diagnosticadas con trastorno dependiente de la personalidad, se utilizó como fuente primaria la entrevista al paciente y secundaria la revisión de expediente clínicos, para posteriormente ser analizados y procesados en una base digital previamente diseñada. Los resultados describen que el tipo de violencia más representativo encontrado en pacientes con diagnósticos dependiente de la personalidad es el físico y clasificado como nivel leve, se encontraron así mismo otras características de personalidad en esta población estudiada como lo es, anancástica y mixta, así como otro tipo violencia emocional y el perfil socio demográfico de las mujeres víctimas de violencia por su pareja mujeres educación básica, procedentes del interior del país, de diversas religiones, de estado civil acompañadas y clase social pobre. Una de las conclusiones es que a pesar de que se obtuvo un tamaño muestral pequeño, se pudo identificar características sociodemográficas claves en las mujeres consultantes del Hospital Policlínico Arce, datos significativos que acercan a la realidad de las pacientes que consultan en psiquiatría del ISSS

Factores asociados al nivel de conocimiento en diagnóstico y tratamiento del dengue en médicos del Primer Nivel de Atención de la Región Lambayeque / Associated factors with the level of knowledge in diagnosis and treatment of dengue in physicians of the First Attention level of the Lambayeque Region

Objetivo: Determinar la asociación de factores académicos y laborales con el nivel de conocimiento en diagnóstico y tratamiento de Dengue en médicos del primer nivel de atención de la región Lambayeque. Material y Método: El presente estudio es de tipo Transversal analítico, en el cual se utilizó como instrumento un cuestionario de 16 preguntas previamente validado a una muestra de 126 médicos del primer nivel de atención del Ministerio de Salud de la Región Lambayeque. Para el análisis estadístico utilizamos frecuencias absolutas y relativas, Chi-cuadrado y razón de prevalencia. Resultados: Tener estudios de post grado es un factor protector para obtener un nivel de conocimiento bajo en Dengue con una RP= 0,36 (IC 95%=0,15 ­ 0,86). Se obtuvo una asociación entre la existencia de estudios en Post Grado y el nivel de conocimiento obtenido por los médicos encuestados. (p=0,03). Se obtuvo un nivel de conocimiento alto en el 67% de los médicos que participaron en nuestro trabajo de investigación. Conclusión: El factor académico: estudio de post grado es factor protector para obtener un nivel de conocimiento bajo en Dengue. Existe una asociación entre la capacitación en Post grado con el nivel de conocimiento en Dengue en médicos de atención primaria de la región Lambayeque.

Objetive: Determine the association of academic and work factors with the level of knowledge in diagnosis and treatment of Dengue fever in the physicians of the first level care in Lambayeque region. Material and Methods: This study is analytical transversal type, which was used an instrument a questionnaire of 16 questions previously validated in a sample of 126 physicians of primary care the Ministry of Health of the Lambayeque region. For statistical analysis we used absolute and relative frequencies, Chi- square and prevalence reason.Results:The post-graduate training is a protector factor for have low knowledge in dengue. Was found a statistically significant association between post-graduate training and level of knowledge in Dengue gained by physicians surveyed (p= 0.03). Ahigher level of knowledge was obtained in 67 % of physicians who participated in this research. Conclusion: The academic factor: post-graduate training is a protector factor for a low level of knowledge in Dengue. There is an association between post-graduate training and level of knowledge in Dengue fever in physicians of primary care in the Lambayeque region.

Insulin Resistance Prevents AMPK-induced Tau Dephosphorylation through Akt-mediated Increase in AMPKSer-485 Phosphorylation.

Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors including obesity, diabetes, and dyslipidemia, and insulin resistance (IR) is the central feature of MetS. Recent studies suggest that MetS is a risk factor for Alzheimer disease (AD). AMP-activated kinase (AMPK) is an evolutionarily conserved fuel-sensing enzyme and a key player in regulating energy metabolism. In this report, we examined the role of IR on the regulation of AMPK phosphorylation and AMPK-mediated Tau phosphorylation. We found that AMPK(Ser-485), but not AMPK(Thr-172), phosphorylation is increased in the cortex of db/db and high fat diet-fed obese mice, two mouse models of IR. In vitro, treatment of human cortical stem cell line (HK-5320) and primary mouse embryonic cortical neurons with the AMPK activator, 5-aminoimidazole-4-carboxamide 1-ß-D-ribofuranoside (AICAR), induced AMPK phosphorylation at both Thr-172 and Ser-485. AMPK activation also triggered Tau dephosphorylation. When IR was mimicked in vitro by chronically treating the cells with insulin, AICAR specifically induced AMPK(Ser-485), but not AMPK(Thr-172), hyperphosphorylation whereas AICAR-induced Tau dephosphorylation was inhibited. IR also resulted in the overactivation of Akt by AICAR treatment; however, preventing Akt overactivation during IR prevented AMPK(Ser-485) hyperphosphorylation and restored AMPK-mediated Tau dephosphorylation. Transfection of AMPK(S485A) mutant caused similar results. Therefore, our results suggest the following mechanism for the adverse effect of IR on AD pathology: IR → chronic overactivation of Akt → AMPK(Ser-485) hyperphosphorylation → inhibition of AMPK-mediated Tau dephosphorylation. Together, our results show for the first time a possible contribution of IR-induced AMPK(Ser-485) phosphorylation to the increased risk of AD in obesity and diabetes.

Ecto-nucleotidases activities in the contents of ovarian endometriomas: potential biomarkers of endometriosis.

Endometriosis, defined as the growth of endometrial tissue outside the uterus, is a common gynecologic condition affecting millions of women worldwide. It is an inflammatory, estrogen-dependent complex disorder, with broad symptomatic variability, pelvic pain, and infertility being the main characteristics. Ovarian endometriomas are frequently developed in women with endometriosis. Late diagnosis is one of the main problems of endometriosis; thus, it is important to identify biomarkers for early diagnosis. The aim of the present work is to evaluate the ecto-nucleotidases activities in the contents of endometriomas. These enzymes, through the regulation of extracellular ATP and adenosine levels, are key enzymes in inflammatory processes, and their expression has been previously characterized in human endometrium. To achieve our objective, the echo-guided aspirated fluids of endometriomas were analyzed by evaluating the ecto-nucleotidases activities and compared with simple cysts. Our results show that enzyme activities are quantifiable in the ovarian cysts aspirates and that endometriomas show significantly higher ecto-nucleotidases activities than simple cysts (5.5-fold increase for ATPase and 20-fold for ADPase), thus being possible candidates for new endometriosis biomarkers. Moreover, we demonstrate the presence of ecto-nucleotidases bearing exosomes in these fluids. These results add up to the knowledge of the physiopathologic mechanisms underlying endometriosis and, open up a promising new field of study.

Costos de hospitalización de los accidentes por mordedura de canes en un hospital de niños en Lima-Perú, periodo 2006-2010 / Cost of hospitalization for dogs bite accidents in a children's hospital in Lima, Peru, 2006-2010 period

Objetivos: Determinar los costos de los pacientes hospitalizados por mordedura de canes atendidos en el Instituto Nacional de Salud del Niño Lima- Perú (INSN), periodo 2006-2010. Material y Métodos: Se revisó las historias clínicas de 72 pacientes con diagnóstico de mordedura canina de las cuales se obtuvo información tal como sexo, procedencia, edad, estancia hospitalaria, medicamentos usados, exámenes auxiliares y procedimientos médicos. Los costos fueron proporcionados por el Servicio de Farmacia y el Servicio de Cirugía Plástica del INSN. Resultados: Del total de hospitalizados, 68% pertenecieron al sexo masculino y 32% al femenino. El 79% de pacientes asumieron los costos hospitalarios mediante financiamiento propio, mientras, que en el 21% de los pacientes el costo fue subvencionado por el INSN. El 78% de los casos pertenecieron a Lima y Callao y el 22% a regiones del interior del país. El rango de edad de los pacientes afectados fue de 1 a 4 años (53%) y el promedio de estancia hospitalaria fue de 7 días, con un rango de 1 a 32 días. Se obtuvo que el costo total fue de 15 181,5 US dólares y el costo promedio por día fue de 30,6 US dólares. El rubro en el que se produjo el mayor costo es el de farmacia en el que se encuentra incluido principalmente materiales quirúrgicos y productos de fluidoterapia. Conclusiones: Los accidentes por mordedura canina producen costos de hospitalización elevados, por lo que se debe establecer programas de control a fin de disminuir su incidencia.

Objectives: Dog bites are an important problem in public health which involves physical and physiological injuries, zoonotics diseases and mean a high cost in the community. For this reason the objective of this research was to define the costs of hospitalization for patients at Instituto Nacional de Salud del Niño Lima-Perú (INSN), during the 2006-2010 period. Material and methods: Medical history of 72 patients diagnosed with dog bites were reviewed in which we obtained information about sex, place of origin, age, hospital staying, drugs used, tests, and surgical procedures. Cost information was provided by the Pharmacy Service and Plastic Surgery Service of INSN. Results: From all the hospitalized, 68% were male and 32% were female. 79% of patients assumed the cost of hospitalization through their own funding and for 21% of the patients the cost was subsidized by the INSN. 78% of the cases belonged to Lima and Callao and 22% to the countryÆs interior regions. The age range of affected patients was from 1 to 4 years (53%). The average hospital staying was 7 days, with a range from 1 to 32 days. The total cost was 15 181,5. US dollars and the average cost per day was 30,6 US dollars. The item which produces the major cost is the pharmacy (involving surgical and fluid products). Conclusions: Dog bites accidents produce high hospital cost, so it must be established control programs to reduce its incidence.

Validación y desarrollo del instrumento: Nivel de conocimientos en diagnóstico y tratamiento sobre dengue en médicos de la región Lambayeque / Validation and development of an instrument: Level of knowledge for the diagnosis and treatment of dengue fever in Lambayeque region

Objetivos: Validar un instrumento y determinar el nivel de conocimientos sobre diagnóstico y tratamiento a aplicar en casos de dengue por parte de los médicos generales. Material y Método: Estudio descriptivo, transversal. Se realizó un estudio piloto con 30 médicos para validación del instrumento. El cuestionario final constó de 16 preguntas. El tamaño de muestra fue de 115 médicos de establecimientos del primer nivel de atención y servicios de Emergencia en hospitales de la región. Para el análisis estadístico utilizamos frecuencia absoluta y relativa, chi y ANOVA. Resultados: En la validación del instrumento se encontró un Alfa de Cronbach de 0,804 (>0,8) además las correlaciones en los 16 ítems fueron 0,438 y 0,852. En Validez de Contenido, los expertos asignaron puntaje en pertinencia y claridad de 3,5/5. Validez del constructo, el test de adecuación de la muestra de Kaiser- Meyer-Olkin fue 0,082 y el test de esfericidad de Bartlett fue 0,023. Se encontró que el 50,4 % de los médicos encuestados tienen un nivel de conocimiento bajo, el 48,7 % un nivel de conocimiento medio y únicamente un 0,9 % obtuvo nivel alto en conocimiento sobre diagnóstico y tratamiento de Dengue, estando asociado con capacitación previa y número de años de egresado del médico (p <0,05). Conclusiones: Existe un bajo nivel de conocimiento sobre diagnóstico y tratamiento de dengue y asociación entre nivel de conocimientos con los antecedentes de capacitación previa y número de años de egresado del médico de la región Lambayeque.

Objectives: To validate an instrument for determining the knowledge status with respect to the diagnosis and treatment to be used by general practitioners when facing cases of dengue fever. Material and Method: This is a descriptive and cross-sectional study. We performed a pilot study with 30 physicians for validating the instrument. The final questionnaire had 16 questions. The sample included 115 primary health care facilities and emergency services in hospitals in Lambayeque region. The statistical analysis was performed using absolute and relative rates, chi-square, and ANOVA. Results: When validating the instrument, a Cronbach 0,804 alpha value (>0,8) was found; and the 16-item correlations were 0,438 and 0,852. With respect to the validity of contents, experts assigned 3,5/5 values for pertinence and clarity scores. In construct validity, the Kaiser-MeyerOlkin score for sample adequacy was 0,082, and the Bartlett's sphericity test value was 0,023. We found that 50,4 % of interviewed physicians had a low level of knowledge with respect to diagnosis and management of dengue fever cases; 48,7 % had a midline knowledge level, and only 0,9% had a good level with respect to diagnosing and managing cases of dengue fever. These findings were associated with prior training and years being in practice (p <0,05). Conclusions: There is a low level of knowledge in Lambayeque region physicians with respect to the diagnosis and treatment of dengue fever cases, and there is an association between this and the prior training history and years being in practice.

Prevención de hepatitis A mediante vacunación en Uruguay (2005-2010) / Preventing hepatitis A through immunization in Uruguay

Introducción: la hepatitis A es un problema sanitario en países en vías de desarrollo. Objetivos: describir estrategias para controlar hepatitis A mediante vacunación. Describir evolución de número de casos, tasas y brotes entre 2005-2010. Material y método: estudio descriptivo retrospectivo 2005-2010. Se analizan:-Estrategias utilizadas por Ministerio de Salud Pública (MSP) para controlar hepatitis A mediante vacunación: bloqueo de brotes; población de riesgo e inclusión universal de vacuna. Descripción: número de casos de hepatitis A en Uruguay y Artigas; número de brotes en ciudades, barrios, familia y otros; número de casos/edad.Resultados: se registraron 21 brotes. Se aplicaron 16.715 primeras dosis y 11.354 segundas dosis. Entre el 10 de setiembre de 2007 y el 26 de noviembre de 2007, el MSP y el Ministerio de Desarrollo Social realizaron una campaña de vacunacióndirigida a niños de entre 1 y 5 años del subsector público. Docentes y estudiantes de Medicina de la Universidad de la República apoyaron y difundieron la campaña. Se aplicaron44.716 primeras dosis y 25.095 segundas dosis. En 2008 se incluye la vacuna en dos dosis en el esquema de vacunación, obligatoria y gratuita. La tasa país disminuyó de 69,6 a 2,7 entre 2005 y 2010 (p<0,05); en el Departamento de Artigas de 780,57/100.000 en 2005 a 0,66 en 2010 (p<0,05). Durante 2005-2008 ocurrieron 22 brotes en ciudades; en 2010 se registraron escasos brotes intrafamiliares y en escuelas. El descenso de número de casos de 2005 a 2010 fue significativo en todas las edades. Comentario: del 2005 al 2010 se produjo una disminución significativay sostenida del número de brotes y tasas de hepatitis A en Uruguay.

Introduction: Hepatitis A is a health problem in developing countries.Objectives: To describe strategies to control Hepatitis A through immunization. To describe the evolutionof the number of cases, rates and outbreaks from 2005 through 2010.Method: Retrospective descriptive study covering the 2005-2010 period of time. The following was analysed:- Strategies used by the Ministry of Public Health to control Hepatitis A through immunization: blocking ofoutbreaks; population at risk; universal immunization. - Description: Number of cases of Hepatitis A in Uruguay, and in the department of Artigas; number ofoutbreaks in cities, neighborhoods, families and other; number of cases/age.Results: 21 outbreaks were recorded. 16.715 first doses and 11.354 second doses were applied. From 10 September, 2007 through 26 November, 2007 the Ministry of Public Health and the Ministry of Social Developmentconducted an immunization campaign aimed at children in the public sub-sector who were between 1 and 5 years old. Professors at the School of Medicine of the University of the Republic and medical students supported and contributed to the dissemination of the campaign. 44.716 first doses and 25.095 second doses were applied. In 2008 the two dose vaccine is included in the mandatory and free immunization plan. The national rate dropped from 69.6 to 2.7 from 2005 through 2010 (p<0,05); and in the department ofArtigas from 780.57/100.000 in 2005 to 0.66 in 2010 (p<0,05). Between 2005 and 2008 there were 22 outbreaks in cities, in 2010 few intra-family outbreaks and in schools were registered. The decrease in the number of cases from 2005 through 2010 was significant for all ages. Comment: A significant and sustained decrease ofHepatitis A outbreaks and rates was evidenced in Uruguay from 2005 through 2010.

Introdução: a hepatite A é um problema sanitário nos países em vias de desenvolvimento. Objetivos: Descrever estratégias para controlar hepatiteAporvacinação. Descrever a evolução do número de casos, taxas e surtos entre 2005-2010. Material e método: estudo descritivo retrospectivo 2005-2010. Foram analisadas: - Estratégias utilizadas pelo Ministério de Salud Pública (MSP) para controlar a hepatite A por vacinação: bloqueio de surtos; população de risco; inclusão universal da vacina. - Descrição: número de casos de hepatite A no Uruguai e especificamente no departamento de Artigas; número de surtos en cidades, bairros, famílias e outros; número de casos/idade. Resultados: foram registrados 21 surtos. Foram aplicadas16.715 primeiras doses e 11.354 segundas doses. Entre o dia 10 de setembro de 2007 e o dia 26 de novembro de 2007, o MSP e o Ministério de Desenvolvimento Social realizaram una campanha de vacinação dirigida acrianças entre 1 e 5 anos do setor público. Docentes e estudantesde Medicina da Universidad de la República apoiaram e difundiram a campanha. Foram aplicadas 44.716 primeiras doses e 25.095 segundas doses. Em 2008 a vacina em duas doses foi incluída ao esquema de vacinação, obrigatória e gratuita. La taxa país diminuiu de 69,6 a 2,7 entre 2005 y 2010 (p<0,05); no departamento de Artigas passou de 780,57/100.000 em 2005 a 0,66 em 2010 (p<0,05). Durante 2005-2008 foram registrados 22 surtos em cidades; em 2010, foram registrados poucos surtos intrafamiliarese em escolas. A redução do número de casos de 2005 a 2010 foi significativa em todas as idades. Comentário: de 2005 a 2010 observou-se uma diminuição significativa e mantida do número de surtos e das taxas de hepatite A no Uruguai.

Características de los pacientes con nefrocalcinosis atendidos en el Instituto Nacional de Salud del Niño, 2007-2011 / Characteristics of the patients with nefrocalcinosis attended in the National Institute of Health of the Child, 2007-2011

Objetivo: caracterizar a los pacientes con nefrocalcinosis que acudieron al Instituto Nacional de Salud del Niño (INSN) durante el periodo 2007-2011. Métodos: Se realizó un estudio observacional y descriptivo. Se revisaron las historias clínicas de todos los pacientes con diagnóstico de nefrocalcinosis, y se obtuvieron las siguientes variables: Sexo, edad, procedencia, antecedentes patológicos (familiares y personales), síntomas, hallazgos ecográficos, cristales en la orina, y hallazgos laboratoriales. Resultados: El 60,4 por ciento de los pacientes fueron varones, la mediana de la edad fueron 5 años, y el 76,3 por ciento provino de Lima. Los antecedentes familiares y personales han no están descritos correctamente en todas las historias. Los síntomas más comunes fueron el dolor a la micción y SAT...

Objective: to characterize patients with nephrocalcinosis who were attending at Nacional Institute of Child Health (INSN, Instituto Nacional de Salud del Niño) during the period 2007 - 2011. Métodos: an observational and descriptive. We reviewed the medical records of all patients who met the inclusion criteria and extracted the following variables: sex, age, origin medical history (family and personal), symptoms, ultrasound findings and laboratory findings. Resultados: 60, 4 per cent of patients were male, median age was 5 years, and 76.3 per cent of all patients came from Lima. The family and personal history have not described correctly in all medical records. The most common symptoms were pain/dysuria and SAT...

Cellular infiltration and cytokine expression correlate with fistulizing state in Crohn's disease.

The purpose of this study was to determine the degree of infiltration of different cell subpopulations (tissue dendritic macrophages, T-helper cells, cytotoxic T lymphocytes, monocytes, neutrophils, and B cells) and the expression of the cytokines interleukin-12 (IL-12) and tumor necrosis factor alpha (TNF-α) in inflamed and noninflamed resected tissues from Crohn's disease (CD) and non-CD patients. Twenty-one resected full-thickness intestinal tissue specimens representing 13 subjects (8 CD and 5 non-CD patients) were included in this study. Sections of 20 µm in thickness were cut and then stained using immunohistochemistry. The sections were analyzed using confocal laser scanning microscopy (CLSM). Patterns of staining for inflamed CD and noninflamed CD tissues versus non-CD tissues demonstrated significant differences in the macrophage and T-helper subpopulations. Surprisingly, the T-helper subset was decreased significantly in the inflamed CD sections compared to the noninflamed CD and non-CD sections. The staining patterns also suggested differences in the expression of both IL-12 and TNF-α between the groups, with cytokine overexpression directly relating to the fistulizing state in CD patients. Cytokine expression is upregulated in chronic CD patients; therefore, the degree of inflammation and tissue damage in CD is dependent on the expression of specific cytokines within the tissue. Differentiation of cell subpopulations may be important for establishing a direct relationship with each state of CD (inflammatory, stricturing, and fistulizing states).

Accidentes en la infancia: prevalencia, características y morbilidad determinada por los accidentes en una población de Uruguay / Childhood accidents: prevalence, characteristics and morbidity determined by accidents in the Uruguayan population

Introducción: en el ámbito mundial los accidentes constituyen un importante problema de salud. En Uruguay, ocupan la primera causa de muerte en niños de 1 a 14 años. Objetivos: conocer la prevalencia de consultas por accidentes, principales características y morbilidad de los mismos en la etapa aguda, en niños asistidos en centros de atención públicos y privados de Montevideo, Salto y Paysandú. Material y método: se realizó un estudio observacional entre el 1° y el 30 de setiembre de 2008. Se incluyó a todos los niños de 0 a 14 años que consultaron por accidentes en servicios de emergencia determinados. Se registró: edad, sexo, lugar donde ocurrió (intradomicilio o extradomicilio), tipo, topografía de la lesión, tratamiento requerido, sector de internación, alta a domicilio o fallecimiento. Resultados: se registraron 29.216 consultas pediátricas, la prevalencia de accidentes fue 7,8 por ciento. La mediana de edad fue 6 años (rango: 22 días a 14 años), 60 por ciento varones. El mecanismo accidental más frecuente fueron las caídas, seguido por: heridas punzantes o cortantes, o ambas, traumatismo de mecanismo desconocido, quemaduras, trauma del deporte, mordeduras, accidente de tránsito e intoxicaciones. Los accidentes de tránsito y las intoxicaciones provocaron las lesiones más graves. El 3,6 por ciento requirió internación en sala. Cuatro niños ingresaron a unidades de cuidados intensivos y dos a cuidados intermedios. No hubo pacientes fallecidos. Conclusiones: es necesario el involucramiento comprometido y sostenido de muchos sectores para evitar lesiones y muertes de niños por accidentes.

Introduction: accidents constitute an important health problem within the global context. In Uruguay, they represent the first cause of death in children between 1 and 14 years old. Objetives: to learn about the prevalence of consultations for accidents, main characteristics and morbidity in the acute stage, in children assisted in private and public health centers in Montevideo, Salto and Paysandú. Method: we conducted an observational study from September 1 through 30, 2008. Children between 0 and 14 years old who consulted for accidents in certain emergency services were included in the study. We recorded: age, sex, place where it occurred (intradomicile or extradomicile), type, lesion topography, treatment required, hospitalization sector, dismissal from hospital or death. Results: 29.216 pediatrics consultations took place, accident prevalence was 7.8 percent. Median age was 6 years old (varying from 22 days to 14 years old), 60 percent were boys. The most frequent kind of accident was falls, followed by: cuts and puncture wounds, or both, trauma or unknownmechanism of injury, burns, sports trauma, bites, car accidents and poisoning. Car accidents and poisoning caused the most serious lesions. 3.6 percent required hospitalization. Four children were admitted to the intensive care unit, and two to the intermediate care unit. No patients died. Conclusions: we need to encourage and sustained involvement from many sectors to avoid children lesions and death caused by accidents.

Introdução: em todo o mundo os acidentes são um problema importante de saúde. No Uruguai é a primeira causa de morte em crianças com idade entre um e 14 anos. Objetivos: conhecer a prevalência de consultas por acidentes, principais características e morbidade na etapa aguda, em crianças atendidas em centros públicos e privados em Montevidéu, Salto e Paysandu. Material e método: no período entre 1 e 30 de setembro de 2008 realizou-se um estudo observacional. Foram incluídas todas as crianças consultadas por acidentes em pronto-socorros determinados. Foram registrados idade, sexo, lugar onde ocorreu (intradomiciliar ou extradomiciliar), tipo, topografia da lesão, tratamento requerido, setor de internação, alta adomicilio ou óbito. Resultados: foram registradas 29.216 consultas pediátricas; a prevalência de acidentes foi de 7,8 por cento. A mediana de idade foi 6 anos (intervalo: 22 dias a 14 anos), 60 por cento do sexo masculino. O mecanismo acidental mais freqüente foram as quedas, seguido por: ferimentos perfurantes ou cortantes, ou ambos, traumatismo de mecanismo desconhecido, queimaduras, trauma esportivo, mordeduras, acidente de trânsito e intoxicações. Os acidentes de trânsito e as intoxicações provocaram as lesões mais graves. 3,6 por cento foram internados; quatro crianças foram internadas em unidades de tratamento intensivo e dois em cuidados intermediários. Não foram registrados óbitos. Conclusões: é necessário o compromisso permanente de vários setores para evitar as lesões e mortes de crianças por acidentes.

Análisis inmunofenotípico de muestras normales de médula ósea: aplicaciones en el control de calidad en los laboratorios de citometría / Immunophenotypic analysis of normal cell samples from bone marrow: applications in quality control of cytometry laboratories / Análise imunofenotípica de amostras de medula óssea normal: aplicações no controle de qualidade em laboratórios de citometria

Objetivo. Describir un protocolo estandarizado mediante citometría de flujo para cuantificar en términos absolutos y relativos distintas subpoblaciones celulares de médula ósea normal y analizar la expresión de diferentes marcadores celulares específicos de linaje cuya reactividad está asociada a la diferenciación celular para ser usado como parte del control de calidad de rutina en los laboratorios de citometría. Materiales y métodos. El análisis inmunofenotípico de distintas subpoblaciones celulares se realizó en muestras de MO normal empleando un panel de anticuerpos monoclonales y policlonales útiles para la caracterización fenotípica de leucemias agudas en 4 fluorescencias distintas, con un protocolo que combina marcaje celular de antígenos de membrana y de citoplasma. El análisis de expresión se realizó en términos de intensidad media de fluorescencia. Para el cálculo de recuentos absolutos se adicionaron esferas fluorescentes de concentración conocida. Resultados. El panel de anticuerpos utilizado permitió la identificación y cuantificación de las distintas subpoblaciones leucocitarias normales de origen linfoide y mieloide incluyendo células precursoras CD34+, y poblaciones celulares más diferenciadas incluidas en las líneas granulocítica, monocítica y eritroide. Se establecieron los valores de referencia de las poblaciones celulares y los rangos de expresión de los diferentes marcadores celulares importantes como parte del control de calidad de rutina en los laboratorios de citometría. Conclusión. Los patrones inmunofenotípicos identificados y la determinación de los valores absolutos y relativos de referencia de las distintas poblaciones leucocitarias normales en MO podrán ser utilizados por los laboratorios de citometría como modelo para establecer parámetros de referencia en el análisis fenotípico de neoplasias hematológicas.

Objective. To describe a standardized flow cytometry protocol for the relative and absolute quantification of hematopoietic cell subpopulations from normal bone marrow, and to evaluate the expression of different lineage-specific cell markers with a reactivity associated to cell differentiation to be used as part of the routine quality control in cytometry laboratories. Materials and methods. The immunophenotypical analysis of different cell subpopulations was done with samples from normal bone marrow using a panel of monoclonal and polyclonal antibodies useful in the characterization of acute leukemias with four different fluorescences, by means of a protocol that combines cell labeling of membrane and cytoplasm antigens. Expression analysis was done in terms of mean fluorescence intensity (MFI). Fluorescent beads at a known concentration were added for calculating the absolute count of cells. Results. The antibody panel used allowed the identification and quantification of different normal leukocyte subpopulations of lymphatic and myeloid origin, including CD34+ stem cells and more differentiated cell populations in the granulocytic, monocytic, and erythroid cell lines. We established reference values for cell populations and cell marker expression ranges as part of routine quality control of cytometry laboratories. Conclusion. Immunophenotypic patterns identified as well as absolute and relative reference values for the different normal leukocyte populations from bone marrow can be used by cytometry laboratories as a basis for establishing reference parameters in phenotypic analyses of hematologic neoplasia.

Objetivo. Descrever um protocolo padronizado por citometria de fluxo para quantificar em termos absolutos e relativos diferentes subpopulações de células de medula óssea normal e analisar a expressão de diferentes marcadores celulares de linhagem específica, cuja reatividade é associada com a diferenciação celular para ser usado como parte do controle de qualidade de rotina nos laboratórios de citometria de fluxo. Materiais e métodos. A análise imunofenotípica das subpopulações de células foi realizada em amostras de MO normais utilizando um painel de anticorpos monoclonais e policlonais úteis para a caracterização fenotípica de leucemia aguda em quatro fluorescências, com um protocolo que combina rotulagem celular de antígeno de membrana celular e de citoplasma. A análise de expressão foi realizada em termos de intensidade média de fluorescência. Para calcular a recontagem absoluta foram adicionadas esferas fluorescentes de concentração conhecida. Resultados. O painel de anticorpos utilizado permitiu a identificação e quantificação das subpopulações de leucócitos normais de origem linfóide e mielóide incluindo as células precursoras CD34+, e populações de células mais diferenciadas incluídas nas linhas granulocítica, monocítica e eritróide. Foram estabelecidos os valores de referência das populações celulares e os intervalos de expressão dos diferentes marcadores celulares importantes como parte da rotina de controle de qualidade em laboratórios de citometria. Conclusão. Os padrões imunofenotípicos identificados e a determinação dos valores absolutos e relativos de referência das diferentes populações de leucócitos normais em MOM podem ser utilizados pelos laboratórios de citometria como um modelo para estabelecer parâmetros de referencia na análise fenotípica de neoplasias hematológicas.

Evaluation of a rapid water-surface sweeping method to accurately estimate numbers of Aedes aegypti (Diptera: Culicidae) late larval stages in large water-storage containers: comparison with pupal estimates / Evaluación de un método de barrido rápido sobre la superficie para estimar el número total de estados larvarios tardíos de Aedes aegypti (Diptera: Culicidae) en depósitos de agua de grandes capacidades: comparación con estimativos de pupas

Introduction. Since the methodologies used to calculate Stegomyia indices have been shown to be inadequate for assessing the risk of dengue virus transmission and targeting Aedes aegypti control strategies, new surveillance methods are needed. Objective. To evaluate the water-surface sweeping method in combination with calibration factors to estimate the total number of Ae. aegypti late larval stages (L3/L4) in large water-storage containers at different temperatures at which transmission of dengue virus occurs. Materials and methods. Calibration factors were derived based on the proportion of L3/L4 recovered from a predetermined number of larvae using a net of specific dimensions and water-storage containers of different capacities and water levels in semi-field conditions and at four different altitudes (14, 358, 998 and 1,630 meters above sea level). The calibration factors obtained at 14 masl were then fully validated in a field study site at this altitude. Results. Four calibration factors were derived at 14 masl (28-30°C) that were used to estimate the total L3/L4 numbers in large water storage containers greater than 20 L (n=478) at 1/3, 2/3 and full water-levels. This methodology was accurate and robust within and between the 10 pairs of field workers who applied it. Different calibration factors were, however, derived to accurately estimate the total L3/L4 numbers at each of the study sites located at 358, 998 and 1,630 masl, where average temperatures were 19°C, 24°C, and 26°C respectively. Conclusions. The accurate estimates of L3/L4 numbers calculated using the water surface sweeping method can be useful for evaluating intervention strategies directed against the larval stages.

Introducción. Las metodologías usadas para calcular los índices de Stegomyia son inadecuadas para evaluar el riesgo de transmisión del virus del dengue y, tampoco, permiten enfocar estrategias de control de Aedes aegypti, por lo cual se requiere desarrollar nuevos métodos para la vigilancia. Objetivo. Evaluar el método de barrido del agua superficial combinado con factores de calibración para estimar el número total estadios larvarios tardíos (L3/L4) de Ae. aegypti en depósitos de grandes capacidades a diferentes temperaturas de transmisión del virus del dengue. Materiales y métodos. Los factores de calibración se derivaron de la proporción de L3/L4 recolectadas con una malla de dimensiones específicas y a partir de un número conocido de larvas, en depósitos de diferentes capacidades y niveles de agua, en condiciones de campo simuladas y a cuatro altitudes diferentes (14, 358, 998 y 1.630 metros sobre el nivel del mar). Los factores de calibración obtenidos a 14 msnm fueron plenamente validados en el campo a esa altitud. Resultados. Se derivaron cuatro factores de calibración a 14 msnm (28°C-30°C) los cuales se emplearon para estimar el número total de L3/L4 en depósitos con capacidades mayores a 20 L (n=478) y a niveles de agua de un tercio, dos tercios y lleno. Esta metodología fue precisa y sólida en los 10 pares de trabajadores que aplicaron el método y entre ellos. Sin embargo, diferentes factores de calibración fueron derivados para estimar con precisión los números totales de L3/L4 en cada uno de los sitios de estudio localizados a 358, 998 y 1.630 msnm, donde las temperaturas promedio fueron de 19°C, 24°C y 26°C, respectivamente. Conclusión. La estimación precisa del número total de L3/L4 usando el barrido descrito permite proponer el uso de este método para evaluar estrategias de control dirigido a contra estados larvarios.