Daño hepático inducido por uso de anticonceptivos orales en una paciente con ictericia prolongada y transaminasas elevadas: reporte de caso / Drug-induced liver injury secondary to the use of oral contraceptives in a patient with prolonged jaundice and elevated transaminases: Case report

La hepatotoxicidad inducida por medicamentos es un diagnóstico de descarte. Típicamente, se presenta en pacientes que desarrollan cambios clínicos y bioquímicos compatibles con hepatitis, pero relacionados con el inicio reciente de agentes farmacológicos, y que se resuelven tras el retiro de la noxa. Su desarrollo se ha descrito con el uso de algunos antibióticos, antituberculosos, estatinas, herbolarios y antiinflamatorios no esteroideos; sin embargo, hay pocos reportes de casos con el uso de anticonceptivos orales, en los cuales el surgimiento de mecanismos idiosincráticos puede llevar a la presentación de características clínicas como ictericia y anormalidades en los exámenes de laboratorio, como la elevación de las transaminasas. Esto requiere de estudios extensos para descartar otras patologías que pueden presentarse de esta forma, lo que representa un reto clínico. En este artículo se muestra el reporte de un caso de una paciente con antecedente de uso crónico de anticonceptivos implantables y que, tras el ajuste de la terapia con el inicio de anticonceptivos orales, desarrolla un episodio de elevación marcada de transaminasas e ictericia.

Drug-induced liver injury is a rule-out diagnosis. Typically, it occurs in patients who develop clinical and biochemical changes compatible with hepatitis, but related to a history of recent onset of pharmacological agents, and resolves after withdrawal of the noxious substances. Its development has been described with the use of some antibiotics, antituberculosis agents, statins, herbal and nonsteroidal anti inflammatory drugs; however, there are few reports of cases with the use of oral contraceptives, in which the appearance of idiosyncratic mechanisms can lead to the presentation of clinical features such as jaundice and laboratory tests abnormalities, like transaminase elevation, requiring extensive studies to rule out other pathologies that may have this clinical presentation, wich represents a clinical challenge. We present a case report of a patient who had chronic use of implantable contraceptives and who, after adjustment of therapy with the start of oral contraceptives, developed an episode of marked elevation of transaminases and jaundice.

Alteraciones genéticas asociadas a la enfermedad de Parkinson y Alzheimer: evolución y respuesta al tratamiento / Genetic Alterations Associated with Parkinson's and Alzheimer's Disease: Evolution and Response to Treatment

La enfermedad de Parkinson y Alzheimer son las enfermedades neurodegenerativas más frecuentes a nivel mundial. Tienen etiología multifactorial, entre ellas, la genética; y son motivo de interés en la investigación científica actual. Se realizó una revisión narrativa con el objetivo de determinar las alteraciones genéticas asociadas a estas patologías, además su influencia en la evolución y respuesta al tratamiento de ellas. Se consultaron artículos originales, revisiones bibliográficas, sistemáticas, metaanálisis en inglés y español, con fecha de publicación entre el 1 enero de 2018 y el 20 de mayo de 2023, en bases como PubMed y Medline. Se utilizaron los términos MeSH «Alzheimer Disease¼, «Parkinson Disease¼, «Drug Therapy¼ y «Mutations¼. El riesgo hereditario para la enfermedad de Parkinson suele ser poligenético, sin embargo, existen genes relacionados con mutaciones monogénicas. Se identifican alteraciones en genes de α-sinucleína, glucocerebrosidasa y quinasa 2 rica en leucina que se relacionan con mayor riesgo de desarrollar Parkinson, además de variaciones en el cuadro clínico y edad de inicio de síntomas. En cuanto a la enfermedad de Alzheimer, las alteraciones en los genes de la proteína precursora amiloide, presenilina 1 y 2 se relacionan con la forma familiar de la enfermedad; por otra parte, las de apolipoproteína E4 se han identificado en la forma esporádica, por lo que se consideran como el factor de riesgo genético más importante para su desarrollo

Parkinson's and Alzheimer's are the most frequent neurodegenerative diseases worldwide. They have a multifactorial etiology, including genetics, and are of interest in current scientific research. A narrative review was carried out with the aim of determining the genetic alterations associated with these pathologies, as well as their influence on their evolution and response to treatment. Original articles, literature reviews, systematic reviews, meta-analyses in English and Spanish, with publication date between January 1, 2018 and May 20, 2023, were consulted in databases such as PubMed and Medline. MeSH terms "Alzheimer Disease", "Parkinson Disease", "Drug Therapy" and "Mutation" were used. Hereditary risk for Parkinson's disease is usually polygenetic, however, there are genes related to monogenic mutations. Alterations in α-synuclein, glucocerebrosidase and leucine-rich kinase 2 genes have been identified that are related to an increased risk of developing Parkinson's disease, in addition to variations in the clinical picture and age of symptom onset. As for Alzheimer's disease, alterations in the genes of the amyloid precursor protein, presenilin 1 and 2 are related to the familial form of the disease; on the other hand, those of apolipoprotein E4 have been identified in the sporadic form, and are therefore considered to be the most important genetic risk factor for its development

Uso y abuso de dispositivos móviles y su rol en el desarrollo de trastornos del sueño en adolescentes / Use and abuse of mobile devices and their role in the development of sleep disorders in adolescents

Las tecnologías de información y comunicación suponen un avance para la sociedad. Hoy en día, los dispositivos móviles proveen servicios convenientes para la cotidianidad, facilitando la comunicación, el ocio y las relaciones interpersonales, sin embargo, se describe que su uso excesivo influye en la aparición de síntomas como ansiedad, comportamientos adictivos y alteraciones del sueño. De todos los usuarios de estas tecnologías, los adolescentes son un grupo especialmente afectado, debido al fácil acceso a estas desde edades muy tempranas y la consecuente integración a su vida diaria. Por lo que se pretende determinar el papel del uso de dispositivos móviles en el desarrollo de trastornos del sueño en adolescentes. Pese a sus efectos deletéreos, se ha observado que el uso de estas tecnologías puede ocasionar sensación de bienestar y apoyo social en algunos usuarios, particularmente cuando promueve la interacción con sus pares. El uso excesivo de las tecnologías, en especial horas antes de dormir, se relaciona con un patrón de sueño anómalo, se ha identificado que los trastornos del sueño más prevalentes en los usuarios son el insomnio y la somnolencia diurna excesiva

Information and communication technologies represent an advance for society. Nowadays, mobile devices provide convenient services for everyday life, facilitating communication, leisure and interpersonal relationships, however, it is described that their excessive use influences the appearance of symptoms such as anxiety, addictive behaviors and sleep disturbances. Of all the users of these technologies, adolescents are a particularly affected group, due to the easy access to them from a very early age and the consequent integration into their daily lives. Therefore, it is intended to determine the role of the use of mobile devices in the development of sleep disorders in adolescents. Despite their deleterious effects, it has been observed that the use of these technologies can cause a feeling of well-being and social support in some users, particularly when it promotes interaction with their peers. The excessive use of technologies, especially hours before bed, is related to an abnormal sleep pattern, it has been identified that the most prevalent sleep disorders in users are insomnia and excessive daytime sleepiness

Urban versus Rural Prevalence of Intestinal Parasites Using Multi-Parallel qPCR in Colombia.

Stool samples from 122 children living in an urban slum (n = 72) and rural (n = 50) areas were analyzed using multi-parallel real-time quantitative PCR to determine intestinal prevalence parasites from two communities in Colombia. Findings indicated a prevalence of 86.1% Blastocystis spp., 62.5% Giardia intestinalis, 19.4% Cryptosporidium spp., 19.4% Ascaris lumbricoides, and 5.6% Trichuris trichiura in an urban slum; and 76% Blastocystis spp., 68% G. intestinalis, 20% Entamoeba histolytica, 50% A. lumbricoides, 46% T. trichiura, and 2% Strongyloides stercoralis in rural areas. Polyparasitism was higher in rural (58%) than urban (25%) areas (P = 0.001). Trichuris trichiura burden was higher in the rural area (P = 0.002). Over 40% of helminthic infections in rural areas had a heavy parasite burden by WHO classification. Over half of urban and rural children were infected with G. intestinalis and Blastocystis spp. Our data provide accurate epidemiologic surveillance for public health interventions.

High Frequency of Illegal Drug Use Influences Condom Use Among Female Transgender Sex Workers in Argentina: Impact on HIV and Syphilis Infections.

The high prevalence of HIV and syphilis found among female transgender sex workers (FTSWs) in Argentina calls for the study of factors leading to negative health consequences. Given the particular characteristics observed in this population (high marginalization, school dropout, and low adherence to healthcare services), we explored the association of several socio-demographic characteristics with syphilis and HIV infections, and the determinants of condom use. This study revealed that FTSWs from Argentina were exposed to several risk factors decreasing thus their ability to negotiate condom use and leading to increased risk for transmission of HIV and other sexually transmitted infections (STIs). Strategies to reduce HIV and syphilis in this population should consider interventions aimed at decreasing violence and substance use which appear to be the most important determinants. Results of this study will contribute to the global information among FTSWs.

First report on sexually transmitted infections among trans (male to female transvestites, transsexuals, or transgender) and male sex workers in Argentina: high HIV, HPV, HBV, and syphilis prevalence.

OBJECTIVES: Due to the scarce data on the prevalence of sexually transmitted infections (STIs) among male-to-female trans-sex workers (TSW) and male sex workers (MSW) in Argentina, the present study aimed to estimate the incidence of human immunodeficiency virus (HIV), and the prevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and Treponema pallidum. Human papillomavirus (HPV) and Chlamydia trachomatis infections were tested among TSW. METHODS: Two hundred and seventy-three TSW and 114 MSW were recruited by nongovernmental organizations. HIV incidence was estimated by STARHS (serologic testing algorithm for recent HIV seroconversion). HPV and C. trachomatis infections were tested in anal cells from TSW. RESULTS: TSW showed significantly higher prevalences of HIV (34.1 vs. 11.4%), HBV (40.2 vs. 22.0%), and T. pallidum (50.4 vs. 20.4%) than MSW. TSW tested positive for HPV in 111/114 cases and for C. trachomatis in 4/80 cases. Investigation of HBV, HCV, HIV, and T. pallidum co-infections showed that 72% of TSW and 39% of MSW had at least one STI. T. pallidum was the most frequent mono-infection. The estimated HIV incidence was 10.7 per 100 person-years (95% confidence interval (CI) 3.8-17.7) for TSW and 2.3 per 100 person-years (95% CI 0-6.7) for MSW. CONCLUSIONS: The high prevalence of STIs and the high incidence of HIV demonstrate the great vulnerability of these high-risk populations and indicate the urgent need for preventive strategies on intervention and facilitation of access to healthcare programs.

Riesgo de suicidio en jóvenes universitarios de Bucaramanga en el año 2011 / Suicide risk in college students from Bucaramanga in the year 2011

Introducción: el suicidio es un fenómeno social con una alta tasa de mortalidad entre los jóvenes que pasan por varias etapas de cambios físicos y emocionales, con los intentos o pensamientos de suicidio común sentir miedo de lo que podría suceder en una situación difícil por la que están pasando. Santander en Colombia y las mayores tasas de suicidio son los jóvenes y la tendencia a aumentar. Todavía no sabemos la magnitud del problema en este grupo de alto riesgo, sin llegar a un suicidio total. Por lo tanto, esta investigación busca comprender este problema de una manera real de los que están vivos y en riesgo de suicidio y no esperar hasta que se trate y/o morir por esta causa Materiales y Métodos: Estudio descriptivo, observacional de corte transversal, en una muestra de 343 estudiantes de la Facultad de Ingenierías de la Universidad de Santander de Bucaramanga; mediante una encuesta utilizando la Escala de Riesgo suicida Plutchik y otras variables socio demografías conformada por 27 preguntas. Se validan en dos bases de datos del programa EPIDATA, posteriormente se exportan al programa STATA 10, para el análisis estadístico. Resultados: El 64.1% de los participantes fueron hombres, 35.9% son mujeres; prevaleciendo las edades 18 (15.7%) y 20 (14.6%); el 11.7% tenían antecedentes personales de suicidio; la ingeniería con mayor riesgo suicida fueron Civil 13%, Electrónica 6.2%, Ambiental 4.9%, Industrial 3.6%; evidenciando en los factores socio demográficos que solo el 83.4% gozan de una buena funcionalidad familiar; 51.3% consume alcohol y el 2.3% depende de éste. Discusión y Conclusiones: Los jóvenes son más vulnerables a tener riesgo suicidio debido a los múltiples factores socio demográficos: disfunción familiar, antecedentes de suicidio y consumo de alcohol, cigarrillo, sustancias psicoactivas.

Introduction: suicide is a social phenomenon with a high mortality rate among young people who go through multiple stages of physical and emotional changes, with attempts or suicidal thoughts common to feel fear of what might happen in a difficult situation by that are happening. Santander in Colombia and the highest rates of suicide are young people and the tendency to increase. Still do not know the magnitude of the problem in this high risk group, without reaching a complete suicide. Therefore, this research seeks to understand this problem in a real way of those who are alive and at risk of suicide and not wait until they try it and / or die for this cause. Materials and Methods: A descriptive, observational cross-sectional in a sample of 343 students of the Faculty of Engineering at the University of Santander in Bucaramanga, a survey using the Plutchik Suicide Risk Scale and other socio demographics consists of 27 questions . Validated in two databases EPIDATA then exported to STATA 10 for statistical analysis. Results: 64.1% of participants were men, 35.9% are women ages 18 to prevail (15.7%) and 20 (14.6%), 11.7% had a history of suicide, the more suicidality Facultad of Engineering Civil were 13% Electronics 6.2% Environmental 4.9% 3.6% Industrial, evidenced in the socio-demographic factors that only 83.4% have a good family functioning, 51.3% consumed alcohol and 2.3% dependent on this. Discussion and Conclusions: Young people are more vulnerable to having suicidal risk because of multiple socio demographic factors, family dysfunction, history of suicide and alcohol consumption, smoking, psychoactive substances.

Gliopathic pain: when satellite glial cells go bad.

Neurons in sensory ganglia are surrounded by satellite glial cells (SGCs) that perform similar functions to the glia found in the CNS. When primary sensory neurons are injured, the surrounding SGCs undergo characteristic changes. There is good evidence that the SGCs are not just bystanders to the injury but play an active role in the initiation and maintenance of neuronal changes that underlie neuropathic pain. In this article the authors review the literature on the relationship between SGCs and nociception and present evidence that changes in SGC potassium ion buffering capacity and glutamate recycling can lead to neuropathic pain-like behavior in animal models. The role that SGCs play in the immune responses to injury is also considered. We propose the term gliopathic pain to describe those conditions in which central or peripheral glia are thought to be the principal generators of principal pain generators.

Infecciones de transmisión sexual en personas transgénero y otras identidades sexuales / Sexually transmitted infections among transgender individuals and other sexual identities

Existen pocos datos disponibles acerca del comportamiento de riesgo y la prevalencia de infecciones de transmisión sexual (ITS), incluyendo HIV-1, en personas transgénero. El objetivo del estudio fue comparar las características demográficas, factores de riesgo, prevalencia de HIV-1 e ITS en personas transgénero versus personas no transgénero que consultan al Centro de Prevención, Asesoramiento y Diagnóstico del Hospital General de Agudos J.M. Ramos Mejía. Se utilizó el diseño de estudio de corte transversal y se incluyeron pacientes asistidos en nuestro centro que firmaron consentimiento informado entre noviembre de 2002 y abril de 2006. Se obtuvieron datos sociodemográficos, uso de drogas, utilización de preservativos, nivel de educación alcanzado, diagnóstico de ITS y estado actual de la pareja. Se utilizó estadística descriptiva y chi² para comparar proporciones. En la población estudiada (n: 4118) se identificaron a 105 personas transgénero. La prevalencia de infección por HIV-1 fue del 27.6% (29/105), mientras que en personas no transgénero (n: 4013) fue de 6.2% (247/4013); p:0.0000. El bajo nivel educativo, el consumo de alcohol, el abuso de drogas, los antecedentes de ITS y el trabajo sexual (100% en transgénero y 2.3% en no transgénero) fueron más frecuentes en personas transgénero. La prevalencia de sífilis fue del 42% en personas transgénero y del 18% en personas no transgénero. Estos datos demuestran que las personas transgénero que consultan en nuestro centro tienen alta prevalencia de infección por HIV-1 e ITS. Esta información podría contribuir al diseño de estrategias de prevención necesarias en esta población.

Few data are available regarding the prevalence of sexually transmitted infections (STI), including HIV-1 infection, and risk behaviors of transgender individuals. Previous reports indicate that this community has a high prevalence of HIV and STIs. Our objective was to compare the prevalence of HIV-1 infection, STI and risk behaviors of transgender people versus non transgender people. We used a cross sectional design study. Patients who received services at our testing site between November 2002 and April 2006, and provided written informed consent, were included in the analysis. Socio-demographic data, sexual behaviour, recreational drug use, condom use, concurrent or previous STI and HIV-1 infection diagnosis and partner serologic status, were collected. We used descriptive statistics and chi² for comparisons of proportions. In the period of the study, 105 transgender individuals were identified in a population of 4118 patients tested. The prevalence of HIV infection in the transgender group was 27.6% (29/105), while in the non transgender group was 6.2% (247/4013) p:0.0000. Low level of formal instruction, alcohol consumption, drug abuse, previous history of STI and sex work (100% transgenders and 2.3% of non-transgenders) were significantly more frequent in the transgender. The referred correct use of condom was similar in both groups. The prevalence of syphilis was 42.3% in transgender group and 18.1% in non-transgender individuals. These data show that this population has a very high prevalence of HIV-1 and STI. This information could be instrumental to design targets for intensive HIV prevention strategies in this particular high risk population.

Infección del sitio operatorio de apendicectomías en un hospital de la orinoquia colombiana / Surgical site infection following appendectomy at a hospital in the Colombian Orinoco river basin (Colombian Orinoquia)

Objetivos. Determinar las características de los pacientes operados por apendicitis aguda en nuestra institución y los factores de riesgo para la infección del sitio operatorio.Materiales y métodos. Estudio retrospectivo de casos y controles en un hospital de mediana complejidad. Se estudiaron las características de 30 pacientes que presentaron infección de la herida quirúrgica luego de apendicectomía de urgencia por apendicitis aguda y se compararon con las de 250 controles de la misma cohorte expuesta. Se seleccionó la muestra por método no probabilístico no apareado a fin de analizar todas las variables.Resultados. Se incluyeron 280 pacientes operados por apendicitis aguda. Se observó un tiempo de evolución prolongado antes de la consulta en urgencia (41,3 ± 43,4 horas) y, aunque el diagnóstico fue acertado inicialmente en la mayoría de los casos (80,4%), el tiempo para ser llevados a cirugía en promedio fue de 14,4 ± 15,4 horas. También se encontró falta de uniformidad en la profilaxis antimicrobiana preoperatoria y un mayor costo en los pacientes que recibieron antibióticos por tiempo prolongado en forma injustificada (porcentaje del costo de antibiótico en la cuenta total de 12,6% (DE=6,7) vs. 16,0 (DE=10,3) con un valor de p<0,001 y el total de lo facturado $1’892.132 (DE=$649.034) vs. $2’172.777 (DE=$828.273). Sólo se presentó una muerte. nclusiones. La infección del sitio operatorio en apendicitis aguda en esta institución está dentro de los valores esperados, a pesar de las dificultades en el acceso, la demora en la atención y la gran frecuencia de presentación complicada (51,8%). os principales factores asociados a la infección del sitio operatorio fueron la presentación complicada y, paradójicamente, los pacientes que recibieron antibióticos en forma más regular. Por ello, se hace necesario el establecimiento de estrategias para agilizar la consulta temprana y el manejo quirúrgico definitivo. El uso inadecuado de antibióticos es un factor de riesgo para la infección del sitio operatorio, aumenta los costos en la atención y, probablemente, tenga efectos deletéreos en la ecología microbiológica de las instituciones. Se requiere la implementación y la observación de guías de manejo para la profilaxis antimicrobiana preoperatoria y la vigilancia del impacto en la resistencia bacteriana.

Rapid and potent induction of cell death and loss of NK cell cytotoxicity against oral tumors by F(ab')2 fragment of anti-CD16 antibody.

Freshly isolated untreated NK cells undergo rapid apoptosis and lose their cytotoxic function upon the addition of F(ab')2 fragment of anti-CD16 antibodies. Loss of NK cell cytotoxic function after treatment with F(ab')2 fragment of anti-CD16 antibody can be seen against K562 and UCLA-2 oral tumor cells when either added immediately in the co-cultures of NK cells with the tumor cells or after pre-treatment of NK cells with the antibody before their addition to the tumor cells. Addition of Interleukin-2 (IL-2) in combination with anti-CD16 antibody to NK cells delayed the induction of DNA fragmentation in NK cells, and even though decreased cytotoxicity could still be observed against K562 and UCLA-2 oral tumors when compared to IL-2 alone treated NK cells, the cytotoxicity levels remained relatively higher and approached those obtained by untreated NK cells in the absence of antibody treatment. No increases in IFN-gamma, Granzymes A and B, Perforin and TRAIL genes could be seen in NK cells treated with anti-CD16 antibody. Neither secretion of IFN-gamma nor increased expression of CD69 activation antigen could be observed after the treatment of NK cells with anti-CD16 antibody. Furthermore, IL-2 mediated increase in CD69 surface antigens was down-modulated by anti-CD16 antibody. Finally, the addition of anti-CD16 antibody to co-cultures of NK cells with tumor target cells was not inhibitory for the secretion of VEGF by oral tumor cells, unlike those co-cultured with untreated or IL-2 treated NK cells. Thus, binding and triggering of CD16 receptor on NK cells may enhance oral tumor survival and growth by decreased ability of NK cells to suppress VEGF secretion or induce tumor cell death during the interaction of NK cells with oral tumor cells.

Potential contribution of naïve immune effectors to oral tumor resistance: role in synergistic induction of VEGF, IL-6, and IL-8 secretion.

The aim of this study is to identify the phenotype of resistant oral tumors, and to delineate the contribution of immune effectors to resistance of oral tumors. UCLA-1 oral tumors which were resistant to NK cell mediated cytotoxicity secreted increased amounts of IL-6, IL-1beta, GM-CSF, and IL-8 when cultured with or without immune effectors. In addition, the levels of vascular endothelial growth factor (VEGF) secretion in the co-cultures of naïve immune effectors with UCLA-1 rose significantly when compared to tumor cells alone. IL-2 activated NK cells decreased VEGF secretion in all tumor cells. However, NK cells which were induced to undergo cell death with anti-CD16 antibody were not only unable to decrease VEGF secretion, but they also contributed further to the increase in VEGF secretion by oral tumors. Overall, we show in this paper that naïve as well as non-viable immune effectors may contribute to the growth and resistance of oral tumors by triggering the secretion of key tumor cell growth factors.

Inhibition of nuclear factor kappa B (NFkappaB) activity in oral tumor cells prevents depletion of NK cells and increases their functional activation.

The aim of this study is to identify candidate factors which may be responsible for the functional inactivation and depletion of NK cells by tumor cells. Inhibition of NFkappaB activity by an IkappaB super-repressor in HEp2 cells, a cell line commonly used as an oral tumor model, blocked tumor-induced NK cell death, and increased the function of NK cells significantly. Increased expression of CD69 early activation antigen on NK cells as well as augmented proliferation and secretion of IFN-gamma by NK cells were observed when these cells were co-incubated with IkappaB super-repressor transfected HEp2 cells (HEp2-IkappaB((S32AS36A))). More importantly, the secretion of IL-6 was significantly inhibited when NK cells were co-cultured with HEp2-IkappaB((S32AS36A)) cells. In addition, the survival and function of cytotoxic effector cells remained significantly elevated in the presence of IFN-gamma-treated HEp2-IkappaB((S32AS36A)) cells when compared to either untreated or IFN-gamma-treated vector-alone transfected HEp2 cells. Similar findings to those obtained using purified peripheral blood NK cells were also observed when non-fractionated peripheral blood mononuclear cells were used in the co-cultures of immune effectors with HEp2 cell transfectants. Addition of recombinant human IL-6 to the co-cultures of immune effectors with the NFkappaB knockdown HEp2 tumor cells substantially decreased the levels of secreted IFN-gamma. Thus, the results presented in this paper suggest that the inhibition of NFkappaB function in oral tumors may serve to activate and expand the function and numbers of NK cells. Moreover, NFkappaB-mediated increase in IL-6 secretion by oral tumors may in part be responsible for the observed inactivation and death of the immune effectors.