Assessing climate change and health provisions among staff in higher education institutions: A preliminary investigation.

Climate change can have direct and indirect effects on human health. Direct effects can include an increase in extreme weather events, such as heatwaves and floods, as well as an increase in the spread of vector-borne and infectious diseases, which may lead to a set of health problems and diseases. Indirect effects can include changes in air quality, water availability, and food production and distribution. These changes can lead to an increase in respiratory problems, malnutrition, and increased food insecurity. There is a perceived need to investigate the extent to which Higher Education Institutions (HEIs) are engaged in efforts to foster a greater understanding of the connections between climate change and health. In this context, this preliminary investigation offers an overview of the relationships between climate change and health. By means of a survey among teaching staff and researchers at HEIs from 42 countries across all continents working on the connection between climate change and health. The study has investigated the extent to which current provisions for education and training on the connection between climate change and health are being considered and how current needs in terms of policy development, research, and training are being met. A series of case studies illustrate how universities worldwide are actively developing strategies and implementing measures to address climate change and health. The study concludes by providing specific recommendations aimed at facilitating the handling of issues related to climate change and health in a higher education context.

Dichotomous colorectal cancer behaviour.

Colorectal cancer (CRC) is the third most common malignant tumor and one of the deadliest cancers. At molecular level, CRC is a heterogeneous disease that could be divided in four Consensus Molecular Subtypes. Given the differences in the disease due to its anatomical location (proximal and distal colon), another classification should be considered. Here, we review the current knowledge on CRC dichotomic´s behaviour based on two different entities; right and left-sided tumors, their impact on clinical trial data, microbiota spatial composition and the interaction with the nervous system. We discuss recent advances in understanding how the spatial tumor heterogeneity influences the tumor growth, progression, and responses to current therapies.

Endocrine Abnormalities and Growth Characterization in Colombian Pediatric Patients with 22q11 Deletion Syndrome

Objective: Several endocrine manifestations have been described in patients with 22q11 deletion syndrome, including growth retardation, hypoparathyroidism, and thyroid disorders. This study aimed to characterize these abnormalities in a Colombian retrospective cohort of children with this condition. Methods: A retrospective study comprising a cohort of children with 22q11 deletion syndrome in Medellín, Colombia followed up between 2011 and 2017 was conducted. Results: Thirty-seven patients with a confirmed diagnosis of 22q11 deletion syndrome were included. 37.8% had some endocrinopathy, the most frequent being hypoparathyroidism (21.6%), followed by hypothyroidism (13.5%), hyperthyroidism (2.7%) and growth hormone deficiency (2.7%). There was wide heterogeneity in the clinical presentation, with late onset of severe hypocalcemia associated with seizure or precipitated in postoperative cardiac surgery, which highlights the importance of continuous follow-up as indicated by the guidelines. Short stature was mainly related to nutritional factors. Growth monitoring is required with the use of syndrome-specific charts and careful monitoring of the growth rate. Conclusion: As previously reported, a significant proportion of patients with endocrine abnormalities were found in this cohort. This highlights that it is essential to carry out an adequate multidisciplinary follow-up, based on the specific clinical guidelines, in order to avoid serious complications such as convulsions due to hypocalcemia. It is important to track size with curves specific to the syndrome and analyze the growth rate.

Recommendations of the Spanish Society of Thoracic Surgery for the management of malignant pleural effusion.

This article summarizes the clinical guidelines for the diagnosis and treatment of malignant pleural effusion (MPE) sponsored by the Spanish Society of Thoracic Surgery (SECT). Ten clinical controversies were elaborated under the methodology of PICO (Patient, Intervention, Comparison, Outcome) questions and the quality of the evidence and grading of the strength of the recommendations was based on the GRADE system. Immunocytochemical and molecular analyses of pleural fluid may avoid further invasive diagnostic procedures. Currently, the definitive control of MPE can be achieved either by pleurodesis (talc poudrage or slurry) or the insertion of a indwelling pleural catheter (IPC). It is likely that the combination of both techniques (i.e., thoracoscopy with talc poudrage and insertion of a IPC, or instillation of talc slurry through a IPC) will have a predominant role in the future therapeutic management.

Mitral valve thrombosis in term pregnancy: A case report and review of the literature.

OBJECTIVE: With this case report would like to emphasize the complexity that involves the management of pregnant women with mechanical heart valves. In that sense, an adequate interdisciplinary management of this potentially serious pathology is required for maternal and fetal well-being. CASE REPORT: A 32-year-old primipara, with a mechanical mitral valve replacement, was admitted to our emergency department at 37+1 weeks of gestation with acute dyspnea and presyncope. The patient was diagnosed with mechanical mitral valve thrombosis and, due to the appearance of hemodynamic instability, the patient underwent an uncomplicated emergency caesarean section and subsequent prosthetic mitral valve replacement. The patient was discharged six days after surgery, without any obstetric complication and with normal valve function. CONCLUSION: This case report shows that, despite strict control and optimal anticoagulation regimen, pregnant women with mechanical heart valves still have a high risk of developing valve thrombosis.

Relationship between substance use and schizotypal traits in school-aged adolescents. / Relación entre consumo de sustancias y rasgos esquizotípicos en adolescentes escolarizados.

GOAL: The main goal of the present study was to analyze the relationship between substance use (tobacco, alcohol, cannabis) and schizotypal traits in a representative sample of school-aged adolescents from the general population. METHOD: cross-sectional, descriptive survey 1,588 students (M = 16.13 years, SD = 1.36), 739 male (46.5%), selected by random stratified cluster sampling, participated in the study. The instruments administered were the Oviedo Questionnaire for Schizotypy Assessment, the Modified Substance Use Questionnaire, the Strengths and Difficulties Questionnaire, the Penn Matrix Reasoning Test, the Family Affluence Scale-II, and the Oviedo Infrequency Scale. RESULTS: Controlling for the effects of multiple covariates (gender, age, IQ, socio-economic level, psychopathology and consumption), the results showed that compared with non-users, alcohol drinkers reported higher average scores in the Social Disorganization dimension. Cigarette smokers, differentiated by frequency, reported higher average scores in the Anhedonia and Social Disorganization dimensions than non-smokers. No statistically significant differences between users and non-users of cannabis were found in terms of schizotypal traits. CONCLUSION: controlling for the effects of multiple covariates, adolescents who use tobacco and alcohol reported higher scores - depending on frequency of use - in schizotypal traits. Future studies should continue to analyze the role of substance use in individuals at risk of psychosis and determine its role in the transition to serious mental disorders using new methodologies such as ambulatory assessment.

Objetivo: analizar la posible relación entre el consumo de sustancias psicoactivas (en concreto, tabaco, alcohol y cannabis) y los rasgos esquizotípicos en una muestra representativa de adolescentes escolarizados de la población general.  Método: diseño transversal descriptivo tipo encuesta. La muestra se compuso por 1.588 estudiantes (M = 16,13 años; DT = 1,36; 739 varones, 46,5%), seleccionados mediante muestreo aleatorio estratificado por conglomerados. Los instrumentos administrados fueron el Cuestionario Oviedo para la Evaluación de la Esquizotipia, el Cuestionario de Consumo de Sustancias Modificado, el Cuestionario de Capacidades y Dificultades, el Penn Matrix Reasoning Test, la Family Affluence Scale-II y la Escala Oviedo de Infrecuencia de Respuesta. Resultados: una vez controlado el efecto de múltiples covariables (género, edad, cociente intelectual, nivel socio-económico, psicopatología previa y consumo de sustancias), los consumidores de alcohol comparados con los no consumidores, informaron de mayores puntuaciones medias en la dimensión Desorganización Social. Los consumidores de tabaco comparados con los no consumidores, informaron de mayores puntuaciones medias en las dimensiones de esquizotipia de Anhedonia y Desorganización Social. Con respecto al consumo de cannabis, no se hallaron diferencias estadísticamente significativas entre consumidores y no consumidores en las dimensiones esquizotípicas. Conclusiones: controlando el efecto de múltiples variables de confundido, los adolescentes consumidores de tabaco y alcohol ­según su frecuencia­ informaron de mayores puntuaciones en rasgos esquizotípicos. Futuros estudios podrían continuar analizando el papel del consumo de sustancias en la aparición de trastornos mentales, como la psicosis, mediante nuevas metodologías como la evaluación ambulatoria.

Evidence and decision-making in times of pandemic / Evidencias y decisiones en tiempos de pandemia

In December 2019, an outbreak of a respiratory desease caused by a new coronavirus strain was detected in Wuhan, China. The disease spread rapidly around the world and was recognized as a pandemic by the World Health Organization in March 2020. From the very beginning of the pandemic, society was faced with a scenario fraught with uncertainty: a new disease with severe effects on some patients and no specific treatment. The medical community reacted promptly and undertook the quest for treatment options, some based on prior experiences with diseases caused by other coronavirus strains or related viruses, and other approaches based on potential pathophysiological mechanisms promising at the time but without any supporting scientific evidence.

En diciembre de 2019, se detectó en Wuhan (China) un brote de una enfermedad respiratoria causada por una nueva cepa de coronavirus. La enfermedad se extendió rápidamente por todo el mundo y fue reconocida como pandemia por la Organización Mundial de la Salud en marzo de 2020. Desde el principio de la pandemia, la sociedad se enfrentó a un escenario cargado de incertidumbre: una nueva enfermedad con graves efectos en algunos pacientes y sin tratamiento específico. La comunidad médica reaccionó rápidamente y emprendió la búsqueda de opciones de tratamiento, algunas basadas en experiencias previas con enfermedades causadas por otras cepas de coronavirus o virus relacionados, y otras aproximaciones basadas en posibles mecanismos fisiopatológicos prometedores en ese momento pero sin ninguna evidencia científica que los respaldara.

Filariasis mamaria: a propósito de un caso / Breast filariasis: case report

INTRODUCCIÓN: La filariasis con afectación mamaria es una enfermedad endémica de áreas tropicales y subtropicales de África, Asia, el Pacífico y América, que afecta a unos 120 millones de personas. Aunque es una patología rara en España, dado el aumento de pacientes procedentes de dichos países, debemos conocerla para saber diagnosticarla y tratarla adecuadamente. OBJETIVO DE REPORTAR EL CASO: Dar a conocer la filariasis con afectación mamaria, sus manifestaciones clínicas y radiológicas principales, a través de un caso clínico de nuestras consultas de ginecología. DESCRIPCIÓN DEL CASO: Paciente de 43 años, procedente de Guinea Ecuatorial que acude a la consulta de Ginecología por mastalgia bilateral y aumento del volumen de las mamas de semanas de evolución. La exploración es anodina por lo que se solicita mamografía bilateral en la que describen calcificaciones compatibles con filariasis. A pesar de que el resto de pruebas fueron negativas, dada la alta sospecha clínica y radiológica se diagnosticó de filariasis mamaria. CONCLUSIONES: A pesar de la actual campaña mundial para eliminar la filariasis, el aumento de migración global incrementa la probabilidad de padecer casos importados de filariasis mamaria. Por tanto, el conocimiento de las diferentes parasitosis es imprescindible para realizar un buen diagnóstico diferencial con otras entidades clínicamente similares, e instaurar el tratamiento más adecuado.

INTRODUCTION: Breast filariasis is an endemic disease from tropical and subtropical areas of Africa, Asia, the Pacific and America affecting about 120 million people. Although it is a rare pathology in Spain, given the increase in patients from the referred countries, we must be aware of it in order to know how to diagnose and treat it properly. OBJECTIVE OF REPORTING THE CASE: To raise awareness of filariasis with breast involvement and its main clinical and radiological manifestations, through a clinical case of our gynecology consultations. CASE REPORT: 43-year-old patient from Equatorial Guinea who comes to the Gynecology consultation for bilateral mastalgia and breast enlargement of weeks of evolution. The examination is anodyne, so bilateral mammography is requested in wich calcifications compatible with filariasis are described. Despite the rest of the tests are negative, given the high clinical and radiological suspicion, the diagnosis of breast filariasis is made. CONCLUSIONS: Despite the current worldwide campaign to eliminate filariasis, the increase in global migration enhances the probability of suffering from imported cases of breast filariasis Therefore, the knowledge of the different parasitoses is essential to make a correct differential diagnosis with other clinically similar entities, and to establish the most appropriate treatment.

Psychotic-like experiences and cannabis use in adolescents from the general population. / Experiencias psicóticas atenuadas y consumo de cannabis en adolescentes de la población general.

The purpose of this study was to analyze the relationship between psychotic-like experiences and cannabis use in a representative sample of adolescents from the general population. A total of 1,588 students (M=16.13 years, SD = 1.36), 739 men (46.5%), selected by stratified random sampling by conglomerates from 98 classes in 34 schools participated in the survey. The instruments used were the Prodromal Questionnaire-Brief, the Strengths and Difficulties Questionnaire, the Modified Substance Use Questionnaire, the Penn Matrix Reasoning Test, the Family Affluence Scale-II, and the Oviedo Infrequency Scale. Results showed that a percentage of adolescents reported psychotic-like experiences and/or cannabis use. Prior to controlling for multiple confounders (gender, age, socio-economic level, alcohol use, smoking, emotional and behavioral problems, and IQ), cannabis use was associated with psychotic-like experiences. After adjustment for confounders, psychotic-like experiences were not seen to be associated with cannabis use. Mediational analyses showed that emotional and behavioral problems mediate the relationship between cannabis use and risk of psychosis. It seems that once the effect of multiple confounding variables is controlled for, the use of cannabis increases the risk of comorbid psychopathology and this in turn increases the risk of psychosis. These results suggest that the relationships established between psychotic experiences and cannabis are complex and mediated by relevant variables. Further studies should examine this relationship in follow-up studies and gene-environmental designs.

El propósito de este estudio fue analizar la relación entre las experiencias psicóticas atenuadas y el consumo de cannabis en una muestra representativa de adolescentes de la población general. Un total de 1,588 estudiantes (M=16,13 años; DT = 1,36), 739 eran hombres (46,5%), pertenecientes a 34 escuelas y 98 aulas, seleccionados mediante muestreo aleatorio estratificado por conglomerados, fueron encuestados. Los instrumentos administrados fueron el Cuestionario de Pródromos de Psicosis-Breve, el Cuestionario de Capacidades y Dificultades, el Cuestionario de Consumo de Sustancias Modificado, el Penn Matrix Reasoning Test (PMRT), la Family Affluence Scale-II y la Escala Oviedo de Infrecuencia de Respuesta. Los resultados mostraron que un porcentaje de adolescentes informaron de experiencias psicóticas atenuadas y/o consumo de cannabis. Antes de controlar el efecto de múltiples covariables (género, edad, nivel socio-económico, consumo de tabaco, problemas emocionales y CI), los jóvenes consumidores de cannabis informaron de un mayor riesgo teórico de psicosis. Cuando se controló el efecto de las covariables, las experiencias psicóticas no se asociaron con el consumo de cannabis. El análisis mediacional indicó que los problemas en el ajuste emocional y comportamental mediaban en la relación entre consumo de cannabis y experiencias psicotiformes. Parece ser que, una vez controlado el efecto de las múltiples variables de confundido, el uso de cannabis aumenta el riesgo de psicopatología comórbida y esta a su vez el riesgo de psicosis (mayor frecuencia de experiencias psicóticas). Estos resultados sugieren que la relación que se establece entre las experiencias psicóticas y el cannabis es compleja y se encuentra mediada por variables relevantes. Futuros estudios deberán examinar las interacciones Gen x Ambiente en estudios longitudinales.

Bacteriemia con afectación inflamatoria pélvica y miositis secundaria a histeroscopia diagnóstica. Reporte de un caso / Bacteremia with pelvic inflamatory involvement and secondary myositis due to diagnostic hysteroscopy. A case report

Resumen ANTECEDENTES: Las complicaciones infecciosas secundarias a la histeroscopia diagnóstica ambulatoria son bajas (0.6%). CASO CLÍNICO: Paciente de 46 años que a los 6 días posthisteroscopia diagnóstica ambulatoria por pólipos endometriales ingresó al servicio de Ginecología debido a un cuadro de piomiositis del músculo piriforme izquierdo, secundario a bacteriemia por Streptococcus pyogenes luego de un procedimiento ginecológico. Se trató con una dosis subcutánea de 40 mg de enoxaparina al día, y 2 g de ceftriaxona intravenosa cada 24 h, 240 mg de gentamicina intravenosa una vez al día. En las siguientes 48 horas se retiró la gentamicina y se prescribió 1 g de amoxicilina cada 8 h, por vía oral más 300 mg de clindamicina cada 8 h, también por vía oral que la paciente continuó durante 7 días más. En la resonancia magnética de control tomada a los 10 días quedó de manifiesto la tromboflebitis séptica en la vena iliaca interna izquierda y la persistencia del cuadro de piomiositis, con colección pélvica intra y extramuscular. Se decidió reingresarla para tratarla con el siguiente esquema: 1 g de amoxicilina por vía intravenosa cada 8 horas y 900 mg de clindamicina con igual pauta; se suspendió a las 24 h enseguida de la valoración por el infectólogo. Se indicó nuevo tratamiento antitrombótico con 0.5 mL de fraxiparina forte cada 24 horas, por vía subcutánea. El eco-Doppler descartó la trombosis venosa profunda; los hemocultivos que resultaron negativos. La paciente fue dada de alta con prescripción de fraxiparina Forte a dosis de 0.5 mL cada 24 horas durante 6 semanas; la evolución clínica fue favorable. La resonancia magnética de control a los 30 días reportó la desaparición completa del proceso inflamatorio. Luego de un año, la paciente permanece asintomática y continúa en seguimiento médico anual. CONCLUSIONES: La histeroscopia diagnóstica ambulatoria es una técnica eficaz y segura aunque excepcionalmente pueden sobrevenir complicaciones infecciosas derivadas de la técnica. Esto se previene con profilaxis antibiótica. La valoración previa a la histeroscopia es indispensable para advertir factores de riesgo que puedan controlarse o contraindiquen la realización del procedimiento.

Abstract BACKGROUND: Infectious complications due to diagnostic hysteroscopy are uncommon, being only 0.6% of all complications. CLINICAL CASE: A 46-year-old patient who, 6 days after performing an outpatient diagnostic hysteroscopy due to endometrial polyps, was admitted to the Gynecology Department, due to pyomyositis of the left piriformis muscle secondary to Streptococcus pyogenes bacteremia after gynecological procedure. Antithrombotic treatment was initiated with Enoxaparin 40 mg, 1/24h subcutaneously and antibiotic therapy with Ceftriaxone 2g/24h intravenously (iv) and Gentamicin 240 mg/24h iv, which 48 hours later were changed to Amoxicillin 1g/8h orally (VO) and Clindamycin 300 mg/8 hours orally for another 7 days. In the 10-day control magnetic resonance imaging (MRI), septic thrombophlebitis was seen in the left internal iliac vein as well as persistence of the pyomyositis condition, with intra and extramuscular pelvic collections. Therefore, a new admission was decided to start antibiotic therapy again with Amoxicillin 1g/8h IV and Clindamycin 900 mg/8h IV, which was suspended 24 hours after assessment by the Infectious Diseases Unit; and new antithrombotic treatment with Fraxiparin Forte 0.5 mL/24h subcutaneous, by consensus with the Vascular Surgery Service. ECO-DOPPLER was performed, which ruled out Deep Venous Thrombosis (DVT); and negative blood cultures. The patient was discharged with Fraxiparina Forte 0.5 mL/24h for 6 weeks presenting good clinical evolution. A new MRI control was scheduled for the following month, finding a complete resolution of the inflammatory process. Currently, one year later, the patient is asymptomatic and continues in annual follow-up in our consultations. CONCLUSIONS: Outpatient diagnostic hysteroscopy is an effective and safe technique. Infectious complications derived from the technique are infrequent, which is why it is not necessary to perform an antibiotic prophylaxis in patients who are going to undergo this test

Efectos de una intervención de educación emocional en alumnos de un programa universitario para mayores / Effects of an Emotional Education Intervention in Students of University Programs for Older Students

RESUMEN Los programas universitarios para mayores tienen como objetivo la potenciación de las capacidades cognitivas, emocionales y sociales, así como la mejora de la calidad de vida y el bienestar personal. Las competencias emocionales, por su impacto a múltiples niveles, se deben desarrollar y fomentar a lo largo de todo el ciclo vital. No obstante, hasta el momento, en España existen escasos trabajos que implementen programas de intervención de educación emocional para mayores y que al mismo tiempo evalúen empíricamente su posible impacto. El principal objetivo de este trabajo fue examinar el efecto de un programa de educación emocional en alumnos de un programa universitario para mayores. Se utilizó un grupo experimental (n = 28) y dos grupos control (n = 23; n 2 = 15) que fueron evaluados en dos momentos temporales, a través del TMMS-24 y MSCEIT Los resultados mostraron que, tras un periodo de 4 meses de intervención, el grupo experimental no difirió de forma estadísticamente significativa del grupo control en las puntuaciones medias de inteligencia emocional entre el pretest y el postest. A pesar de los resultados obtenidos, es necesario promocionar las habilidades emocionales y sociales a lo largo del ciclo vital. Es sumamente interesante que se adquieran y potencien las habilidades emocionales en este sector de la población, con la finalidad de mejorar el ajuste personal y la calidad de vida, así como el desarrollo integral de la persona. Futuros estudios deberían utilizar muestras más representativas, así como llevar a cabo un seguimiento longitudinal.

ABSTRACT University programs for older students aim at enhancing the cognitive, emotional and social skills as well as improving the quality of life and personal well-being. The emotional competencies, due to their impact at multiple levels on individual well-being, should be developed and promoted throughout all stages across the lifespan. However, there is a paucity of studies in Spain that have conducted intervention programs and, at the same time, have empirically assessed their impact. The main goal of the present study was to examine the effects of an emotional education program on older students. An experimental (n = 28) and two control groups (nj = 23; n 2 = 15) were used and assessed at two time points using the TMMS-24 and the MSCEIT The results showed that, after a period of 4 months of intervention, the experimental group did not differ significantly from the control group mean scores of measures of emotional intelligence between the pre-test and post-test. These findings, although inconclusive, highlight the importance of promoting social and emotional skills throughout the whole lifespan. It is very interesting to enhance the emotional and social competences in this sector of the population in order to improve their personal adjustment and quality of life. Future studies should use representative sampling as well as include long term follow-up.

Screening for depressive symptoms in adolescents at school: New validity evidences on the short form of the Reynolds Depression Scale.

The main purpose of the present study was to assess the depressive symptomatology and to gather new validity evidences of the Reynolds Depression Scale-Short form (RADS-SF) in a representative sample of youths. The sample consisted of 2914 adolescents with a mean age of 15.85 years (SD = 1.68). We calculated the descriptive statistics and internal consistency of the RADS-SF scores. Also, confirmatory factor analyses (CFAs) at the item level and successive multigroup CFAs to test measurement invariance, were conducted. Latent mean differences across gender and educational level groups were estimated, and finally, we studied the sources of validity evidences with other external variables. The level of internal consistency of the RADS-SF Total score by means of Ordinal alpha was .89. Results from CFAs showed that the one-dimensional model displayed appropriate goodness of-fit indices with CFI value over .95, and RMSEA value under .08. In addition, the results support the strong measurement invariance of the RADS-SF scores across gender and age. When latent means were compared, statistically significant differences were found by gender and age. Females scored 0.347 over than males in Depression latent variable, whereas older adolescents scored 0.111 higher than the younger group. In addition, the RADS-SF score was associated with the RADS scores. The results suggest that the RADS-SF could be used as an efficient screening test to assess self-reported depressive symptoms in adolescents from the general population.

Costos de la rehidratación oral y nasogástrica comparadas con la rehidratación endovenosa en niños con diarrea en Colombia / Costs of oral and nasogastric rehydration compared to intravenous rehydration in children under 5 years of age with diarrhea in Colombia

RESUMEN Objetivo Evaluar los costos de las terapias de rehidratación oral (TRO) y de rehidratación nasogástrica (TRN) comparadas con la terapia de rehidratación endovenosa (TRE) para corregir la deshidratación por diarrea en niños. Metodología Análisis de minimización de costos desde la perspectiva del Sistema de Salud colombiano comparando TRO (seguida de TRN ante falla de la TRO), con la TRE. El horizonte temporal fue la duración de la rehidratación. La medida de efectividad se extrajo de una revisión sistemática de literatura. Para determinar costos, se construyó un caso típico y un árbol de decisiones, a partir de revisión de guías e historias clínicas, validado con expertos. Los costos unitarios se obtuvieron de bases de datos colombianas. Costos fueron calculados en pesos colombianos (COP) y dólares americanos (USD). Se realizaron análisis de sensibilidad de una y dos vías. Resultados La TRO y la TRE son similares en efectividad para prevenir hospitalización y lograr rehidratación. En el caso base, el costo de la TRO fue $91,221COP (40.5 USD) y para TRE $112,944COP (50.14USD), es decir, un ahorro de $21,723 COP (9.64 USD). En los análisis de sensibilidad por regímenes de aseguramiento y complejidad del hospital, la TRO suele ser la estrategia menos costosa. Discusión Ambas intervenciones son similares en efectividad, pero la TRO, seguida de TRN ante falla de la primera resulta menos costosa que la TRE. La TRO es recomendable como primera opción para corregir la deshidratación. Deberían continuarse esfuerzos por implementar TRO y TRN en los servicios de salud en Colombia.(AU)

ABSTRACT Objective To evaluate the costs of oral rehydration therapy (ORT) and nasogastric rehydration therapy (NRT) compared with intravenous rehydration therapy (IRT) to treat dehydration in children under 5 years of age with diarrhea. Methodology Cost-minimization analysis from the perspective of the Colombian Health System, comparing ORT, (followed by NRT when ORT fails), with IRT. The time horizon was the duration of rehydration. The effectiveness measure was obtained from a systematic review of the literature. To determine costs, a typical case was created based on current guidelines and medical records; this case was validated by experts. Unit costs were obtained from Colombian databases and were provided in Colombian pesos (COP) and US dollars (USD) for 2010. One- and two-way sensitivity analyzes were performed. Results ORT and ERT are similarly effective to prevent hospitalization and to achieve rehydration. In the base case, the expected cost of ORT was $91,221 COP (40.5 USD) and for IRT was $112,944 COP ($50.14 USD), saving $21,723 COP ($9.64 USD) per case. In the sensitivity analyzes by health insurance and hospital level, ORT is often the least costly strategy. Discussion Both interventions are similarly effective, but ORT, followed by NRT when ORT fails, is less costly than IRT. ORT is recommended as the first option to treat dehydration since it is effective and less expensive. Efforts should be continued to implement TRO and NRT in the health services of Colombia.(AU)

Olfactory Ensheathing Cell-Conditioned Medium Reverts Aß25-35-Induced Oxidative Damage in SH-SY5Y Cells by Modulating the Mitochondria-Mediated Apoptotic Pathway.

Olfactory ensheathing cells (OECs) are a type of glia from the mammalian olfactory system, with neuroprotective and regenerative properties. ß-Amyloid peptides are a major component of the senile plaques characteristic of the Alzheimer brain. The amyloid beta (Aß) precursor protein is cleaved to amyloid peptides, and Aß25-35 is regarded to be the functional domain of Aß, responsible for its neurotoxic properties. It has been reported that Aß25-35 triggers reactive oxygen species (ROS)-mediated oxidative damage, altering the structure and function of mitochondria, leading to the activation of the mitochondrial intrinsic apoptotic pathway. Our goal is to investigate the effects of OECs on the toxicity of aggregated Aß25-35, in human neuroblastoma SH-SY5Y cells. For such purpose, SH-SY5Y cells were incubated with Aß25-35 and OEC-conditioned medium (OECCM). OECCM promoted the cell viability and reduced the apoptosis, and decreased the intracellular ROS and the lipid peroxidation. In the presence of OECCM, mRNA and protein levels of antioxidant enzymes (SOD1 and SOD2) were upregulated. Concomitantly, OECCM decreased mRNA and the protein expression levels of cytochrome c, caspase-9, caspase-3, and Bax in SH-SY5Y cells, and increased mRNA and the protein expression level of Bcl-2. However, OECCM did not alter intracellular Ca2+ concentration in SH-SY5Y cells. Taken together, our data suggest that OECCM ameliorates Aß25-35-induced oxidative damage in neuroblastoma SH-SY5Y cells by inhibiting the mitochondrial intrinsic pathway. These data provide new insights into the functional actions of OECCM on oxidative stress-induced cell damage.

Early Activation of Th2/Th22 Inflammatory and Pruritogenic Pathways in Acute Canine Atopic Dermatitis Skin Lesions.

Determining inflammation and itch pathway activation in patients with atopic dermatitis (AD) is fraught with the inability to precisely assess the age of skin lesions, thus affecting the analysis of time-dependent mediators. To characterize inflammatory events occurring during early experimental acute AD lesions, biopsy samples were collected 6, 24, and 48 hours after epicutaneous application of Dermatophagoides farinae house dust mites to sensitized atopic dogs. The skin transcriptome was assessed using a dog-specific microarray and quantitative PCR. Acute canine AD skin lesions had a significant up-regulation of genes encoding T helper (Th) 2 (e.g., IL4, IL5, IL13, IL31, and IL33), Th9 (IL9), and Th22 (IL22) cytokines as well as Th2-promoting chemokines such as CCL5 and CCL17. Proinflammatory (e.g., IL6, LTB, and IL18) cytokines were also up-regulated. Other known pruritogenic pathways were also activated: there was significant up-regulation of genes encoding proteases cathepsin S (CTSS), mast cell chymase (CMA1), tryptase (TPS1) and mastin, neuromedin-B (NMB), nerve growth factor (NGF), and leukotriene-synthesis enzymes (ALOX5, ALOX5AP, and LTA4H). Experimental acute canine house dust mite-induced AD lesions exhibit an activation of innate and adaptive immune responses and pruritogenic pathways similar to those seen in humans with acute AD, thereby validating this model to test innovative therapeutics modalities for this disease.

Programas Educativos Universitarios Para Mayores: Evaluación de su Impacto en la Autopercepción del Apoyo Social y la Salud Mental / University Education Programs for Older Adults: Evaluation of Their Impact on Individual Perceptions of Social Support and Mental Health / Programas Educativos Universitários Para Idosos: Avaliação de Seu Impacto na Autopercepção do Apoio Social e da Saúde Mental

Algunos estudios indican que los programas universitarios para mayores pueden tener un impacto positivo en la autopercepción del apoyo social y la salud de los participantes. Sin embargo, dichos estudios no evalúan estas variables con instrumentos de medida estandarizados y grupos de control dentro y fuera del programa. En el presente trabajo se utilizó un grupo experimental y dos grupos control que fueron evaluados en dos momentos con instrumentos estandarizados. Los resultados no confirmaron los efectos beneficiosos esperados de los programas. Es necesario seguir profundizando en esta línea de actuación y explorar el efecto de variables socioafectivas en estudios longitudinales.

Some studies indicate that university programs for older adults can have a positive impact on the participants' perceptions of social support and health. However, those studies fail to evaluate these variables with standardized measurement instruments and control groups, both within and outside the program. This study used an experimental group and two control groups that were evaluated at two different moments, using standardized instruments. The results did not confirm the expected beneficial effects of the programs. Thus, it is necessary to continue in-depth research along these lines and explore the effect of socio-affective variables in longitudinal studies.

Alguns estudos indicam que os programas universitários para idosos podem ter um impacto positivo na autopercepção do apoio social e da saúde dos participantes. Contudo, esses estudos não avaliam essas variáveis com instrumentos de medidas padronizados e grupos de controle dentro e fora do programa. No presente trabalho, utilizaram-se um grupo experimental e dois grupos de controle que foram avaliados em dois momentos com instrumentos padronizados. Os resultados não confirmaram os efeitos benéficos esperados dos programas. É necessário continuar aprofundando nessa linha de atuação e explorar os efeitos de variáveis socioafetivas em estudos longitudinais.

Altered subcellular localization of IL-33 leads to non-resolving lethal inflammation.

Non-resolving inflammation is a major contributor to chronic disease pathogenesis, including that of cancer, chronic obstructive pulmonary disease, asthma, arthritis, inflammatory bowel disease, multiple sclerosis and obesity. Some cytokines, such as IL-1α and IL-33, may act as endogenous alarmins that contribute to non-resolving inflammation. These cytokines are constitutively expressed in the nucleus and are thought to promote inflammation only upon release during tissue damage or cell necrosis. However, the importance of their nuclear localization in immune homeostasis is not fully understood. We describe herein a novel mouse model in which the nuclear localization signal of IL-33 is abolished and demonstrate for the first time that, alone, altered subcellular localization of IL-33 dramatically affects immune homeostasis. Heterozygous IL33(tm1/+) mice display elevated serum IL-33 levels, indicating that IL-33 is constitutively released when not actively targeted to the nucleus. IL33(tm1/+) mice succumb to lethal inflammation characterized by eosinophil-dominated immune cell infiltration of multiple organs. The profound inflammatory phenotype is dependent on mediators downstream of ST2 as ST2-null mice are protected in spite of high serum IL-33 levels. Importantly, IL-33 transcript levels in this knock-in mouse model remain under endogenous control. We adopt the term "nuclear alarmin" to describe a danger signal that is primarily regulated by nuclear compartmentalization in this fashion.

Incidencia de meningitis en lactantes con crisis febriles simples. Experiencia en un hospital de 3er nivel / Incidence of meningitis in infants with simple febrile seizures. Experience in a 3th level hospital

IINTRODUCCIÓN. Se denominan convulsiones febriles (CF) simples aquellas crisis generalizadas, autolimitadas, de menos de 15 minutos de duración, sin recurrencia en las primeras 24 horas y sin alteración neurológica postictal. Las CF constituyen el cuadro convulsivo más frecuente en niños menores de 5 años y se caracterizan por ser eventos benignos y autolimitados. Aproximadamente 2-4% de los niños tienen al menos una CF en algún momento de la vida. OBJETIVO. Determinar la incidencia de meningitis en niños menores de 18 meses de edad con un primer episodio de convulsión febril simple. MATERIAL Y MÉTODOS. Revisión retrospectiva de historias clínicas de pacientes entre 3 y 18 meses que consultaron a urgencias del Hospital Universitario San Vicente Fundación (HUSVF), en Medellín, por un primer episodio de convulsión febril simple, entre 2006 y 2011. RESULTADOS. Se revisaron 286 registros de pacientes con diagnóstico de convulsión febril, 79 (27%) correspondían a CF simple. 50 niños (63%) tenían menos de 12 meses, Se realizó punción lumbar en 45 (57%), y se identificaron 6 casos con pleocitosis, uno de los cuáles fue considerado meningitis bacteriana y tres como meningitis aséptica. Dos casos adicionales se consideraron meningitis parcialmente tratada. Los niños con meningitis o meningitis parcialmente tratada tenían sígnos clínicos sospechosos, habían recibido antibióticos o tenía vacunación incompleta. CONCLUSIÓN. La meningitis en niños con CF simple es poco frecuente y los casos sospechosos pueden detectarse con los criterios de la Academia Americana de Pediatría; si se realiza punción lumbar a niños que han recibido antibióticos, con vacunas incompletas o con signos clínicos neurológicos. La punción lumbar no debe ser rutinaria en casos de CF. Debe estudiarse el perfil epidemiologico de las de las infecciones por neumococo en Colombia, luego de la inclusión de la vacuna de 10 serotipos, para determinar su efecto en el riesgo de meningitis.

INTRODUCCTION. Febrile seizures (FS) are defined as generalized, self limited crisis lasting less than 15 minutes with no recurrence in 24 hours and without neurological inpairment in the post ictal period. FS are the most common cause for convulsions in patients less than 5 years old. These type of crisis are benign and self-limited . FS Lifetime incidence has been calculated between 2-4% in pediatric population. OBJECTIVE. To determine the inicidence of meningitis in children under 18 months with first simple febrile seizure (FS). Materials and METHODS. A retrospective review of medical records of patients 3 to 18 months of age who visited the emergency room at the Hospital Universitario San Vicente Fundación (HUSVF) after first episode of simple febrile seizure (FS), between January 2005 and December 2010. RESULTS. We analized 286 clinical records of patients between 3 and 18 months of age with febrile seizures, 79 (27%) were considered a single FS. Fifty-patients were under 12 months of age (63%). Lumbar puncture was performed in 45 children (57%) and there were 6 children with pleocytosis, one of them was considered as bacterial meningitis, and three as aseptic meningitis. Two cases had diagnosis of partially treated meningitis. Children with suspected meningitis had abnormal neurological signs, had previously received antibiotics or had incomplete vaccination. CONCLUSION. Meningitis in children with simple FS is not frequent and all cases could be detected according to the criteria of the American Academy of Pediatrics to perform lumbar puncture in children who previously received antibiotics, had incomplete vaccination or have positive neurological signs. Routine lumbar puncture in children with simple CF must be discouraged. The current state of pneumococcal infections in Colombia after implementation of immunization 10 serotypes vaccine must be assessed, in order to know the effect of vaccination status on the risk of meningitis in children with FS.

Immunosupressive therapy in children with steroid-resistant nephrotic syndrome: single center experience / Tratamento com imunossupressores em crianças com síndrome nefrótica resistente a corticosteróide: experiência de um único centro

INTODUCTION: Nephrotic syndrome is one of the most frequent glomerular diseases among children, and steroid therapy remains as the treatment choice. In spite of this, 10 to 15% of the patients are steroidresistant, and the best therapy for such cases has never been defined. Mycophenolate acid (MA) is one of the treatments used in such situations. OBJECTIVE: To describe the clinical behavior of children diagnosed with steroid-resistant nephrotic syndrome (SRNS) and to assess the therapeutic response to MA. METHODS: This was a retrospective and descriptive study. RESULTS: 26 clinical records of patients with SRNS; 70% male and 30% female. All patients underwent kidney biopsies, which showed a predominance of focal segmental glomerulosclerosis (FSGS). The immunosuppresive drugs used were: Mycophenolate mofetil (MMF) 100%, Cyclosporine 69.2%, Cyclophosphamide 23.1%, and Rituximab 23%. One month after treatment initiation with MMF 61.5% achieved remission. The median of relapses per year for the patients was 3 (p25: 2.75 - p75: 4). This median became 1 (p25: 1 - p75: 3.25) after using this medication (p = 0.08). Furthermore, prior to the start of the MMF treatment, the median of the steroid dose was 1 (p25: 0.5- p75: 1.62) mg/k/day. After using MMF, this median became 0.07 (p25: 0 - p75: 0.55) mg/k/day (p < 0.001), in 8 patients prednisolone was stopped. CONCLUSION: In our experience, treatment with MMF showed positive results such as decrease in the frequency of relapses, less proteinuria, and reduction in the dose of steroids administered without deterioration of glomerular filtration rates. However, more studies are needed to assess efficacy, safety, and optimal dosage.

INTRODUÇÃO: A síndrome nefrótica é uma das mais frequentes doenças glomerulares em crianças e o tratamento com corticosteróides ainda é o tratamento de escolha. Apesar disso, 10 a 15% dos pacientes são resistentes a corticosteróides, e o melhor tratamento para tais casos ainda não foi definido. O ácido micofenólico (AM) é um dos tratamentos usados em tais situações. OBJETIVO: Descrever o comportamento clínico de crianças diagnosticadas com síndrome nefrótica resistente a corticosteróide (SNRC) e avaliar a resposta terapêutica ao AM. MÉTODOS: Esse foi um estudo retrospectivo e descritivo. RESULTADOS: 26 registros de pacientes com SNRC; 70% homens e 30% mulheres. Todos os pacientes foram submetidos a biópsias renais, o que mostrou predominância de glomeruloesclerose segmentar focal (GESF). Os medicamentos imunossupressores utilizados foram: Mofetil Micofenolato (MMF) 100%; Ciclosporina 69,2%; Ciclosfosfamida 23,1%; e Rituximabe 23%. Um mês após início do tratamento com MMF, 61,5% tiveram remissão. A mediana das recidivas por ano para os pacientes foi de 3 (p25: 2,75 - p75: 4). Essa mediana se tornou 1 (p25: 1 - p75: 3,25) após o uso da medicação (p = 0,08). Além disso, antes do início do tratamento com MMF, a mediana da dose de corticosteróide foi de 1 (p25: 0.5 - p75: 1.62) mg/k/ dia. Após a utilização do MMF, essa mediana se tornou 0,07 (p25: 0 - p75: 0,55) mg/k/dia (p < 0,001), em 8 pacientes a prednisolona foi interrompida. CONCLUSÃO: em nossa casuística, o tratamento com MMF mostrou resultados positivos, tais como a redução na frequência de recidivas, menos proteinúria, e redução da dose de corticosteróide administrada sem deterioração nas taxas de filtração glomerular. Entretanto, mais estudos são necessários para se avaliar a eficácia, segurança e otimização da dosagem.