Trauma ocular pediátrico y repercusiones visuales. Revisión sistemática

Introducción: En 2016, aproximadamente 55 millones de pacientes en todo el mundo sufrieron lesiones oculares. La carga de sufrimiento tras las lesiones oculares es muy alta, sobre todo por las consecuencias de estas lesiones, que son en gran parte responsables de la ceguera monocular. Objetivo: Sistematizar los referentes teóricos sobre el trauma ocular pediátrico y su impacto en los resultados visuales. Método: Se realizó una revisión sistemática del trauma ocular pediátrico y su impacto en los resultados visuales, basada en la literatura publicada en PubMed, Trip Medical Database y British Medical Journal en el periodo 2018-2022. El nivel de evidencia se evaluó mediante la escala de Oxford y se determinó el sexo, la edad, el tipo de lesión ocular, lugar de ocurrencia del trauma ocular y secuelas postlesión reportadas. Resultados: La evidencia recolectada fue principalmente de estudios retrospectivos de corte transversal que corresponde a nivel de evidencia según escala de Oxford 2b. El trauma ocular fue más común en niños (77 %) que en niñas (23 %) y la edad promedio fue de 10,5±1,96 años. Hubo mayor incidencia de trauma ocular cerrado (56%). Los lugares fuera del domicilio fueron los más reportados (64%). En lo que refiere a las consecuencias de los traumatismos oculares en edades pediátricas se pudo observar que la mayor frecuencia reportada fue la no presencia de secuelas (52,16 %), contra el 48,47 % de los repostados con secuelas. Conclusiones: Existen consideraciones básicas que se pueden comunicar al paciente que pueden prevenir efectos graves o permanentes en la visión. El examen oftalmológico profesional permite una evaluación temprana y evita complicaciones por subestimar la lesión ocular aguda.

Introduction: In 2016, approximately 55 million patients worldwide suffered eye injuries. The burden of suffering after eye injuries is very high, especially due to the consequences of these injuries, which are largely responsible for monocular blindness. Objective: To systematize the theoretical references on pediatric ocular trauma and its impact on visual results. Method: A systematic review of pediatric ocular trauma and its impact on visual outcomes was carried out, based on the literature published in PubMed, Trip Medical Database and British Medical Journal in the period 2018-2022. The level of evidence found was evaluated using the Oxford scale and the sex, age, type of ocular injury, place of occurrence of the ocular trauma and reported post-injury sequelae were determined. Results: The evidence collected was mainly from retrospective cross-sectional studies that correspond to the level of evidence according to the Oxford 2b scale. Ocular trauma was more common in boys (77%) than in girls (23%) and the average age was 10.5±1.96 years. There was a higher incidence of blunt ocular trauma (56%). Places outside the home were the most reported (64%). Regarding the consequences of ocular trauma in pediatric ages, it could be observed that the highest frequency reported was the absence of sequelae (52.16%), compared to 48.47% of those refueled with sequelae. Conclusions: There are basic considerations that can be communicated to the patient that can prevent serious or permanent effects on vision. Professional ophthalmological examination allows early evaluation and avoids complications due to underestimation of acute eye injury.

Introdução: Em 2016, aproximadamente 55 milhões de pacientes em todo o mundo sofreram lesões oculares. A carga de sofrimento após lesões oculares é muito elevada, especialmente devido às consequências destas lesões, que são em grande parte responsáveis pela cegueira monocular. Objetivo: Sistematizar os referenciais teóricos sobre trauma ocular pediátrico e seu impacto nos resultados visuais. Método: Foi realizada uma revisão sistemática sobre trauma ocular pediátrico e seu impacto nos resultados visuais, com base na literatura publicada no PubMed, Trip Medical Database e British Medical Journal no período 2018-2022. O nível de evidência encontrado foi avaliado pela escala de Oxford e foram determinados sexo, idade, tipo de lesão ocular, local de ocorrência do trauma ocular e sequelas pós-lesão relatadas. Resultados: As evidências coletadas foram principalmente provenientes de estudos transversais retrospectivos que correspondem ao nível de evidência da escala Oxford 2b. O trauma ocular foi mais comum em meninos (77%) do que em meninas (23%) e a idade média foi de 10,5±1,96 anos. Houve maior incidência de trauma ocular contuso (56%). Os locais fora de casa foram os mais relatados (64%). Quanto às consequências do trauma ocular em idade pediátrica, pôde-se observar que a maior frequência relatada foi a ausência de sequelas (52,16%), contra 48,47% dos reabastecidos com sequelas. Conclusões: Existem considerações básicas que podem ser comunicadas ao paciente e que podem prevenir efeitos graves ou permanentes na visão. O exame oftalmológico profissional permite avaliação precoce e evita complicações por subestimação da lesão ocular aguda.

Resistencia a los azoles en cepas de Aspergilus fumigatus sensu stricto aislados de muestras clínicas respiratorias

Introducción. La aspergilosis invasiva presenta alta mortalidad en pacientes con enfermedades crónicas e inmunocomprometidos. Aspergillus fumigatus sensu stricto (AFSS) es el principal agente etiológico y su tipificación requiere de métodos moleculares. La incidencia incrementada de AI resistentes a los antifúngicos demanda un diagnóstico certero y oportuno. Métodos. Se estudiaron 20 cepas de la micoteca del Instituto de Medicina Tropical - Universidad Nacional Mayor de San Marcos, aisladas de muestras respiratorias e identificadas como Aspergillus fumigatus sensu lato mediante el estudio macroscópico y microscópico. Las cepas fueron referidas a la Universidad Nacional del Litoral para su tipificación mediante una PCR screening para AFSS basada en secuencias del gen CYP51A y el estudio de sensibilidad antifúngica para voriconazol (VOR), itraconazol (ITC), posaconazol (POS), isavuconazol (ISA), anidulafungina (ANF), caspofungina (CSF) y anfotericina B (AMB) obteniendo la concentración inhibitoria mínima (CIM) mediante el protocolo de CLSI M38M51S-Ed3. Resultados. Las 20 cepas fueron identificadas como AFSS. Ninguna de las cepas tuvo una CIM por encima del punto de corte clínico (VOR), ni epidemiológico (ITC, ISA, AMB y CSF). POS fue la droga más potente frente a la colección de cepas evaluadas (media geométrica (GM) de CIM de 0,042 µg/ml). Conclusiones. Todos los aislamientos fueron tipificados como AFSS sensibles a los azoles según los puntos de corte clínico, posaconazol tuvo la mayor actividad antifúngica. Nuestros hallazgos aportan a incrementar la escasa información sobre la etiología y sensibilidad a los antifúngicos de uso clínico de las aspergilosis invasiva en nuestro país.

Introduction. Invasive Aspergillosis (IA) poses a significant threat to patients with chronic diseases and compromised immune systems, with Aspergillus fumigatus sensu stricto (AFSS) being the primary etiological agent. Accurate and timely diagnosis is crucial, particularly given the rising incidence of IA strains resistant to antifungals, necessitating molecular methods for typing. Methods. Twenty strains from Instituto de Medicina Tropical - Universidad Nacional Mayor de San Marcos, mycological collection, previously identified as Aspergillus fumigatus sensu lato through macroscopic and microscopic analysis, were studied. These strains were forwarded to the Universidad Nacional del Litoral for AFSS typing using a PCR screening based on CYP51A gene sequences. Antifungal susceptibility testing was performed for Voriconazole (VOR), Itraconazole (ITC), Posaconazole (POS), Isavuconazole (ISA), Anidulafungin (ANF), Caspofungin (CSF), and Amphotericin B (AMB), obtaining Minimum Inhibitory Concentrations (MICs) according to CLSI M38M51S-Ed3. Results. All 20 strains were identified as AFSS. None of the strains exhibited MICs above the clinical breakpoint (VOR) or the epidemiological cutoffs (ITC, ISA, AMB, and CSF). POS demonstrated the highest potency against the strain collection, with a geometric mean MIC of 0,042 µg/ml. Conclusions. All isolates were classified as azole-sensitive Aspergillus fumigatus sensu stricto (AFSS) based on clinical cutoff points, particularly posaconazole, which exhibited superior antifungal activity. Our findings contribute to augmenting the limited information on the etiology and clinical antifungal sensitivity of IA in our country.

The Anterior Pelvic Index (API) in the Classification of the Female Pelvis and Prediction of Fetopelvic Disproportion / El Índice Pelviano Anterior (API) en la Clasificación de la Pelvis Femenina y Predicción de la Desproporción Fetopélvica

SUMMARY: Measurements of the upper strait of the pelvis can be calculated using the Anterior Pelvic Index. The objective of the study was to determine the external validity and cut-off point of the API, to classify narrow pelvises from normal ones. We selected 214 women from 15 to 55 years old, 171 had vaginal delivery and 43 by caesarean section by feto-pelvic disproportion (FPD) of maternal origin, in whom the API was calculated, of which its mean difference was established with an alpha error of <0.05. Maximum values of sensitivity and specificity, ROC curve and Youden index were determined. The student's t gave a p-value =0.000 of the mean difference between the women who had vaginal delivery and those who had cesarean section by FPD of maternal origin; the value of the area under the ROC curve was 0.758 (CI 95% 0.695 - 0.814) with a p-value=0.0001. Maximum sensitivity was 74.42 % (CI 95%: 58.8 % to 86.5 %) and maximum specificity was 73.10 % (CI 95%: 65.8 % to 79.6 %), produced a Youden index of 0.475 (CI 95% 0.283 - 0.590) which is associated with the 15.44 (CI 95% 14.19 - 15.83) of the API scale. The API is a good tool for predicting women with suspected narrow pelvis and allows its classification into three types of pelvises: an API value of more than 15.83 would indicate pelvis suitable for vaginal delivery; an API value between 14.19 and 15.83 would be suspected of pelvic narrowness; an API value less than 14.19 would confirm a narrow pelvis.

Las medidas del estrecho superior de la pelvis pueden calcularse mediante el Índice Pelviano Anterior. El objetivo del estudio fue determinar la validez externa y el punto de corte del API, para clasificar pelvis estrechas de las normales. Seleccionamos 214 mujeres de 15 a 55 años, 171 tuvieron parto vaginal y 43 mediante cesárea por DFP de origen materno, en quienes se calculó el API, del cual se estableció su diferencia de medias con un error alfa de <0,05. Se determinaron valores máximos de sensibilidad y especificidad, curva ROC e índice de Youden. La t de Student dio un p-valor=0,000 de la diferencia de medias entre las mujeres de tuvieron parto vaginal y las que fueron sometidas a cesárea por DFP de origen materno; el valor del área bajo la curva ROC fue 0,758 (IC 95% 0,695 - 0,814) con un p- valor=0,0001. La máxima sensibilidad (74,42 %. IC 95%: 58,8 % a 86,5 %) y máxima especificidad (73,10 %. IC 95%: 65,8 % a 79,6 %), produjeron un índice de Youden de 0,475 (IC 95% 0,283 - 0,590) el cual está asociado al valor 15,44 (IC 95% 14,19 - 15,83) de la escala del API. El API es una buena herramienta de predicción de mujeres con sospecha de pelvis estrecha y permite su clasificación en tres tipos de pelvis: un valor de API de mas de 15,83 indicaría pelvis aptas para un parto vaginal; un valor de API entre 14,19 y 15,83 se sospecharía de estrechez pélvica; un valor de API menor a 14,19 confirmaría una pelvis estrecha.

Determinación de transgenicidad y verificación en el etiquetado de alimentos industrializados de maíz en centros de expendio de Lima metropolitana

Introducción. El consumo de alimentos transgénicos constituye un riesgo potencial para la salud. Sin embargo, en el Perú se carece de información actualizada y confiable sobre la presencia de transgénicos en los alimentos y sobre los datos pertinentes en su etiquetado; de igual manera sobre los alimentos que consumen los animales de abasto, cuyos productos van a ser ingeridos por el humano. Objetivo. Determinar la transgenicidad, mediante la detección del promotor 35S, en productos alimenticios industrializados de maíz para consumo humano y animal, que se comercializan en Lima y verificar sí en el etiquetado se menciona si contiene o no secuencias transgénicas. Métodos. Se analizaron 30 muestras de alimentos para consumo humano y 10 para consumo de animales de abasto; y se revisó el etiquetado. Para la extracción del ADN se utilizó el kit Dneasy Mericon Food, para la detección del P35S el método Real Time-PCR empleando el kit Mericon Screen 35S y para determinar la concentración de copias el kit Mericon Quant Mon 810. Resultados. Se detectó el P35S en el 66,66% de las muestras para consumo humano, y en el 90,00% de las muestras para consumo animal. En el etiquetado del 100% de las muestras para consumo humano y animal no se menciona si contiene o no componentes transgénicos. Conclusiones. La detección de contenido transgénico en la mayoría de los alimentos industrializados de maíz para humanos y animales evidencian la necesidad de su mención en el etiquetado y de la implementación de una política exigente en bioseguridad alimentaria.

Introduction. Consumption of transgenic foods constitutes a potential health risk. However, in Peru there is a lack of updated and reliable information on the presence of transgenics in food and on the relevant data on their labeling; in the same way about the food consumed by animals for supply, whose products are going to be ingested by humans. Objetive. To determine the transgenicity, through the detection of the 35S promoter, in industrialized corn food products for human and animal consumption, which are marketed in Lima and to verify if the labeling mentions whether or not it contains transgenic sequences. Methods. 30 food samples for human consumption and 10 for consumption by animals for production were analyzed; and the labeling was revised. The Dneasy Mericon Food kit was used for DNA extraction, the Real Time-PCR method for P35S detection using the Mericon Screen 35S kit, and the Mericon Quant Mon 810 kit to determine the copy concentration. Results. P35S was detected in 66,66% of the samples for human consumption, and in 90.00% of the samples for animal consumption. The labeling of 100% of the samples for human and animal consumption does not mention whether or not it contains transgenic components. Conclusions. The detection of transgenic content in the majority of industrialized corn foods for humans and animals demonstrates the need to mention them on the label and the implementation of a demanding policy on food biosafety.

Índice ROX, oxigenoterapia a alto flujo y neumonía por COVID-19 / ROX index, high-flow oxygen therapy and COVID-19 pneumonia

Resumen Introducción: El objetivo fue evaluar el valor predic tivo del índice ROX (Ratio of Oxygen Saturation) y describir la evolución de una población de pacientes ingresados en cuidados intensivos por neumonía por COVID-19 que requirieron oxigenoterapia a alto flujo. Métodos: Estudio de cohorte retrospectivo en paci entes mayores de 18 años con hisopado nasofaríngeo positivo para SARS-CoV-2 que ingresaron a cuidados intensivos con insuficiencia respiratoria aguda y requi rieron oxigenoterapia con alto flujo por > 2 h. Resultados: De un total de 97 pacientes 42 (43.3%) respondieron satisfactoriamente al tratamiento con cánula nasal de alto flujo (CNAF) y 55 (56.7%) fracasa ron al tratamiento requiriendo intubación orotraqueal y soporte ventilatorio invasivo. De los 55 pacientes que fracasaron, 11 (20%) sobrevivieron y 44 (80%) fallecier on durante su internación en cuidados intensivos (p < 0.001). Ningún paciente que respondió satisfac toriamente al tratamiento con CNAF falleció durante su internación. El análisis ROC identificó el índice de ROX de las 12 horas como el mejor predictor de fracaso con un área bajo la curva de 0.75 (0.64-0.85) y un punto de corte de 6.23 como mejor predictor de intubación [sensibilidad 0.85 (IC 95% 0.70-0.94), especificidad 0.55 (IC 95% 0.39-0.70)]. Discusión: En pacientes con insuficiencia respiratoria aguda secundaria a neumonía por COVID-19 tratados con oxigenoterapia a alto flujo, el índice de ROX resultó un buen predictor de éxito.

Abstract Introduction: The objective was to evaluate the pre dictive value of the ROX index and describe the evolu tion of a population of patients admitted to intensive care for COVID-19 pneumonia who required high-flow oxygen therapy. Methods: Retrospective cohort study in patients older than 18 years with a positive nasopharyngeal swab for SARS-COV-2 who were admitted to intensive care unit with acute respiratory failure and required high-flow oxygen therapy for > 2 hours. Results: Of a total of 97 patients, 42 (43.3%) responded satisfactorily to treatment with high-flow nasal cannula (HFNC) and 55 (56.7%) failed treatment, requiring orotra cheal intubation and invasive ventilatory support. Of the 55 patients who failed, 11 (20%) survived and 44 (80%) died during intensive care admission (p < 0.001). No patient who responded satisfactorily to HFNC treatment died during hospitalization. The ROC analysis identified the 12-hour ROX index as the best predictor of failure with an area under the curve of 0.75 (0.64-0.85) and a cut-off point of 6.23 as the best predictor of intubation [Sensitivity 0.85 (95% CI 0.70-0.94), Specificity 0.55 (95% CI 0.39-0.70)]. Discussion: In patients with acute respiratory failure secondary to COVID-19 pneumonia treated with high-flow oxygen therapy, the ROX index was a good predictor of success.

The Impact of Digital Health on Smoking Cessation.

BACKGROUND: Smartphones have become useful tools for medicine, with the use of specific apps making it possible to bring health care closer to inaccessible areas, continuously monitor a patient's pathology at any time and place, promote healthy habits, and ultimately improve patients' quality of life and the efficiency of the health care system. Since 2020, the use of smartphones has reached unprecedented levels. There are more than 350,000 health apps, according to a 2021 IQVIA Institute report, that address, among other things, the management of patient appointments; communication among different services or professionals; the promotion of lifestyle changes related to adopting healthy habits; and the monitoring of different pathologies and chronic conditions, including smoking cessation. The number of mobile apps for quitting smoking is high. As early as 2017, a total of 177 unique smoking cessation-relevant apps were identified in the iPhone App Store, 139 were identified in Google Play, 70 were identified in the BlackBerry app store, and 55 were identified in the Windows Phone Store, but very few have adequate scientific support. It seems clear that efforts are needed to assess the quality of these apps, as well as their effectiveness in different population groups, to have tools that offer added value to standard practices. OBJECTIVE: This viewpoint aims to highlight the benefits of mobile health (mHealth) and its potential as an adjuvant tool in health care. METHODS: A review of literature and other data sources was performed in order to show the current status of mobile apps that can offer support for smoking cessation. For this purpose, the PubMed, Embase, and Cochrane databases were explored between May and November 2022. RESULTS: In terms of smoking cessation, mHealth has become a powerful coadjuvant tool that allows health workers to perform exhaustive follow-ups for the process of quitting tobacco and provide support anytime and anywhere. mHealth tools are effective for different groups of smokers (eg, pregnant women, patients with chronic obstructive pulmonary disease, patients with mental illness, and the general population) and are cost-effective, generating savings for the health system. However, there are some patient characteristics that can predict the success of using mobile apps in the smoking cessation process, such as the lower age of patients, dependence on tobacco, the number of quit attempts, and the previous use of mobile apps, among others. Therefore, it is preferable to offer these tools to patients with a higher probability of quitting tobacco. CONCLUSIONS: mHealth is a promising tool for helping smokers in the smoking cessation process. There is a need for well-designed clinical studies and economic evaluations to jointly assess the effectiveness of new interventions in different population groups, as well as their impact on health care resources.

Mucosal Leishmaniasis of the lip: Report of an Exuberant case in a Young man.

BACKGROUND: Leishmaniasis is a tropical disease caused by protozoan parasites of the genus Leishmania. Mucosal leishmaniasis has been described as secondary to the cutaneous form; however, isolated mucosal involvement can also occur. Specifically, mucosal leishmaniasis of the lip is poorly described and its diagnosis challenges clinicians. METHODS: We herein report a case of mucosal leishmaniasis affecting the lower lip without cutaneous involvement in a 20-year-old Venezuelan man. The patient had no relevant past medical history. Clinically, a mass-like lesion with ulcerations and crusts was observed. RESULTS: Microscopically, the lesion was composed of granulomatous inflammation along with macrophages containing intracytoplasmic inclusions similar to round-shaped Leishmania. The species Leishmania (Viannia) braziliensis was confirmed. Treatment with meglumine antimonate was effective. The lesion healed satisfactorily, and no side effects or recurrences were observed. CONCLUSION: Clinicians should be aware of isolated forms of mucosal leishmaniasis of the lip, even in cases where the cutaneous lesion is undetected or clinically manifests as self-limiting. Knowing the endemic areas in the scenario of the dynamics of the ecoepidemiology of leishmaniasis is also essential for surveillance and counselling of the population.

Comportamiento informativo en las bibliotecas de la Facultad de Estudios Superiores Zaragoza de la Universidad Nacional Autónoma de México, antes y durante la pandemia por SARS-CoV-2

Se estudia el comportamiento informativo de alumnos y docentes de la Facultad de Estudios Superiores Zaragoza (FESZ), de la Universidad Nacional Autónoma de México (UNAM), durante la pandemia ocasionada por el SARS-CoV-2, en la Biblioteca Digital UNAM ante el cierre total de las bibliotecas, lo que limitó la consulta presencial de libros y revistas impresas. Se llevó a cabo una investigación cuantitativa con la técnica de análisis de datos estadísticos a partir de las bitácoras de acceso a la Biblioteca Digital (BIDI UNAM) que en suma contempló 15,597 accesos, en comparación a dos periodos, antes y durante la pandemia, obteniendo como resultado un incremento en los accesos, sumado al impulso de estrategias de alfabetización informacional para el uso y aprovechamiento de los recursos de información, mismos que pueden ser integrados en los procesos de enseñanza y aprendizaje, fortaleciendo el modelo educativo de la FESZ.

The informational behavior of students and professors of the Facultad de Estudios Superiores Zaragoza (FESZ) of the Universidad Nacional Autónoma de México (UNAM) during the pandemic caused by SARS-CoV-2, is studied in the Biblioteca Digital UNAM (BIDI UNAM) before the total closure of libraries, which limited the consultation of printed books and journals. A quantitative research was carried out with the statistical data analysis technique from the access logs to the BIDI UNAM, wich in total included 15,597 accesses, compared to two periods, before and during the pandemic, obtaining as a result an increase in accesses, in addition to the promotion of information literacy strategies for the use and exploitation of information resources, which can be integrated into the teaching and learning processes, strengthening the educational model of the FESZ.

The genomic basis of the plant island syndrome in Darwin's giant daisies.

The repeated, rapid and often pronounced patterns of evolutionary divergence observed in insular plants, or the 'plant island syndrome', include changes in leaf phenotypes, growth, as well as the acquisition of a perennial lifestyle. Here, we sequence and describe the genome of the critically endangered, Galápagos-endemic species Scalesia atractyloides Arnot., obtaining a chromosome-resolved, 3.2-Gbp assembly containing 43,093 candidate gene models. Using a combination of fossil transposable elements, k-mer spectra analyses and orthologue assignment, we identify the two ancestral genomes, and date their divergence and the polyploidization event, concluding that the ancestor of all extant Scalesia species was an allotetraploid. There are a comparable number of genes and transposable elements across the two subgenomes, and while their synteny has been mostly conserved, we find multiple inversions that may have facilitated adaptation. We identify clear signatures of selection across genes associated with vascular development, growth, adaptation to salinity and flowering time, thus finding compelling evidence for a genomic basis of the island syndrome in one of Darwin's giant daisies.

Multiomic identification of factors associated with progression to cystic kidney disease in mice with nephron Ift88 disruption.

Ift88 gene mutations cause primary cilia loss and polycystic kidney disease (PKD) in mice. Nephron intraflagellar transport protein 88 (Ift88) knockout (KO) at 2 mo postnatal does not affect renal histology at 4 mo postnatal and causes PKD only in males by 11 mo postnatal. To identify factors associated with PKD development, kidneys from 4-mo-old male and female control and Ift88 KO mice underwent transcriptomic, proteomic, Western blot, metabolomic, and lipidomic analyses. mRNAs involved in extracellular matrix (ECM) synthesis and degradation were selectively upregulated in male KO mice. Proteomic analysis was insufficiently sensitive to detect most ECM components, while Western blot analysis paradoxically revealed reduced fibronectin and collagen type I in male KO mice. Only male KO mice had upregulated mRNAs encoding fibrinogen subunits and receptors for vascular endothelial growth factor and platelet-derived growth factor; period 2, period 3, and nuclear receptor subfamily 1 group D member 1 clock mRNAs were selectively decreased in male KO mice. Proteomic, metabolomic, and lipidomic analyses detected a relative (vs. the same-sex control) decrease in factors involved in fatty acid ß-oxidation in female KO mice, while increased or unchanged levels in male KO mice, including medium-chain acyl-CoA dehydrogenase, 3-hydroxybutyrate, and acylcarnitine. Three putative mRNA biomarkers of cystogenesis in male Ift88 KO mice (similar control levels between sexes and uniquely altered by KO in males) were identified, including high levels (fibrinogen α-chain and stromal cell-derived factor 2-like 1) and low levels (BTG3-associated nuclear protein) in male KO mice. These findings suggest that relative alterations in renal ECM metabolism, fatty acid ß-oxidation, and other pathways precede cystogenesis in Ift88 KO mice. In addition, potential novel biomarkers of cystogenesis in Ift88 KO mice have been identified.NEW & NOTEWORTHY Male, but not female, mice with nephron intraflagellar transport protein 88 (Ift88) gene knockout (KO) develop polycystic kidneys by ∼1 yr postnatal. We performed multiomic analysis of precystic male and female Ift88 KO and control kidneys. Precystic male Ift88 KO mice exhibited differential alterations (vs. females) in mRNA, proteins, metabolites, and/or lipids associated with renal extracellular matrix metabolism, fatty acid ß-oxidation, circadian rhythm, and other pathways. These findings suggest targets for evaluation in the pathogenesis of Ift88 KO polycystic kidneys.

Resultados en el manejo quirúrgico del cáncer colorrectal en el Hospital Santo Tomás

Introducción. El cáncer colorrectal (CCR) es la tercera causa de muerte a nivel mundial, constituyendo la cirugía la piedra angular de tratamiento. El abordaje abierto inicialmente era el más utilizado, situación que ha cambiado en los últimos años con el avance de las técnicas laparoscópicas. En nuestra población no encontramos estudios que comparen los resultados del abordaje laparoscópico versus abierto. Objetivo. Mostrar los resultados de los pacientes con CCR primario intervenidos quirúrgicamente con intención curativa según el abordaje laparoscópico versus abierto. Metodología. Se analizaron los datos recogidos de forma retrospectiva de 159 pacientes sometidos a cirugía programada por CCR en el servicio de coloproctología del Hospital Santo Tomás del 2014 al 2017. Resultados. En las variables preoperatorias, solamente el antígeno carcinoembrionario mostró diferencia significativa (p<0.001) con mediana de 2.37 en laparoscopia versus 4.9 con abordaje abierto. Las variables operatorias tiempo y sangrado quirúrgico resultaron menores por laparoscópica ambas con (p<0.001). No se encontraron diferencias en: número de ganglios resecados (p=0.366), márgenes distales (p=0.786). En el postoperatorio la estancia hospitalaria fue menor por laparoscopía (p<0.001); complicaciones (p=0.425) e intervalo libre de enfermedad (p=0.575) fueron similares en ambos grupos. Conclusiones. Este estudio muestra resultados equiparables de la técnica laparoscópica vs la técnica abierta en cuanto a estándares de calidad intraoperatorios como la cosecha ganglionar y márgenes libres, sin diferencia en el grado de complicaciones en el postoperatorio inmediato. (provisto por Infomedic International)

Levels of low-molecular-weight hyaluronan in periodontitis-treated patients and its immunostimulatory effects on CD4+ T lymphocytes.

OBJECTIVES: During periodontitis, chronic inflammation triggers soft tissue breakdown, and hyaluronan is degraded into fragments of low molecular weight (LMW-HA). This investigation aimed to elucidate whether LMW-HA fragments with immunogenic potential on T lymphocytes remain in periodontal tissues after periodontal treatment. MATERIALS AND METHODS: GCF samples were obtained from 15 periodontitis-affected patients and the LMW-HA, RANKL, and OPG levels were analyzed before and after 6 months of periodontal treatment by ELISA. Eight healthy individuals were analyzed as controls. Besides, human T lymphocytes were purified, exposed to infected dendritic cells, and pulsed with LMW-HA. Non-treated T lymphocytes were used as control. The expression levels of the transcription factors and cytokines that determine the Th1, Th17, and Th22 lymphocyte differentiation and function were analyzed by RT-qPCR. Similarly, the expression levels of RANKL and CD44 were analyzed. RESULTS: In the GCF samples of periodontitis-affected patients, higher levels of LMW-HA were detected when compared with those of healthy individuals (52.1 ± 15.4 vs. 21.4 ± 12.2, p < 0.001), and these increased levels did not decrease after periodontal therapy (52.1 ± 15.4 vs. 45.7 ± 15.9, p = 0.158). Similarly, the RANKL levels and RANKL/OPG ratios did not change after periodontal therapy. Furthermore, in human T lymphocytes, LMW-HA induced higher expression levels of the Th1, Th17, and Th22-related transcription factors and cytokines, as well as CD44 and RANKL, as compared with non-treated cells. CONCLUSIONS: In some patients, increased levels of LMW-HA persist in periodontal tissues after conventional periodontal therapy, and these remaining LMW-HA fragments with immunostimulatory potential could induce the polarization of a pathologic Th1/Th17/Th22-pattern of immune response on T lymphocytes. CLINICAL RELEVANCE: The persistence of increased levels of LMW-HA in periodontal tissues after periodontal therapy could favor the recurrence of the disease and further breakdown of periodontal supporting tissues.

Interleukin 6 as a marker of depression in women with sleep apnea.

Depression is common in women with obstructive sleep apnea (OSA), but objective markers of depression have not yet been explored in such patients. We hypothesized that inflammation and antioxidant biomarkers may be associated with depression in a cohort of OSA women. We conducted a multicentre, cross-sectional study in 247 women diagnosed with moderate-to-severe OSA. Depression was assessed by the depression subscale of the Hospital Anxiety and Depression Questionnaire (HAD-D) and defined as a score ≥11. Associations between tumour necrosis factor α (TNFα), interleukin 6 (IL-6), C-reactive protein (CRP), intercellular adhesion molecule 1 (ICAM-1), catalase (CAT), superoxide dismutase (SOD) and brain-derived neurotrophic factor (BDNF) plasma levels and depression were assessed. The women had a median (25th-75th percentiles) age of 58 (51-65) years, body mass index (BMI) of 33.5 (29.0-38.3) Kg/m2 , Epworth Sleepiness Scale (ESS) score of 10 (6-13) and apnea-hypopnea index (AHI) of 33.3 (22.8-49.3). Logistic regression analyses revealed that only IL6 levels were associated with the presence of depression (adjusted odds ratio [OR], 1.20; 95% confidence interval [CI], 1.08-1.34), whereas linear regression further confirmed that IL6 levels were significantly associated with HAD-D scores (ß = .154; 95% CI, 0.03-0.30). Multivariate regression analysis showed that IL6 (OR, 1.22; 95% CI, 1.09-1.36), ESS (OR, 1.10; 95% CI 1.02-1.19) and physical activity <30 min/day (OR, 2.51; 95% CI, 1.25-5.05) were independent predictors of depression. Thus, we conclude that in a cohort of women with moderate-to-severe OSA, IL6 levels are independently associated with the presence of depression and correlate with depression scores. Low physical activity and higher ESS scores are also independent indicators of risk of depression in this population.

Pandemia por el SARS-CoV-2: aspectos biológicos, epidemiológicos y clínicos / SARS-CoV-2 Pandemic. Biological, epidemiological, clinical aspects

El objetivo principal de este trabajo es describir los principales aspectos biológicos, epidemiológicos y clínicos,con especial énfasis en la fisiopatología, ocasionado por el SARS-CoV-2.El Coronavirus 2 del Síndrome Agudo Respiratorio Severo,es un orthocoronavirinae, del grupoI V, pertenecientes al género betacoronavirus,que causa la actual enfermedad pandémica definida por la Organización Mundial de la Salud (OMS)(2020), como COVID-19.Esta es considerada por los expertos mundiales como una infección viral emergente. Su origenes veterinario y su transmisión zoonótica, a partir de virus que tienen como reservorios a murciélagos y como hospedador intermediario al pangolín, desde el cual se infiere que pudo adaptarse al ser humano, para transmitirse de persona a persona,mediante gotitas respiratorias y secreciones nasales contaminadas con partículas altamente infecciosas. No se descarta la transmisión fecal-oral. La enfermedad posee un periodo de incubación de 2 a 14 días (promedio:5,2 días) y hasta ahora las medidas de prevención y control más eficientes son la cuarentena social obligatoria, el uso de tapabocas, lavado de manos con agua y jabón por al menos 20 segundos,o con productos en gel con alcohol al 70%, mantener una distancia mínima entre las personas de 2 metros. Lo aprendido de los otros dos betacoronavirus humanos relacionados, causantes de las epidemias previas: SARS-CoVen 2002-2003 y el MERSen 2012 ,permiten encarar de mejor forma la actual pandemia(AU)

The main objective of this work is to describe the main biological, epidemiological and clinical aspects, with special emphasis on pathophysiology, caused by SARS-CoV-2. Coronavirus 2 of Severe Acute Respiratory Syndrome is a member of group IV orthocoronavirinae, belonging to the betacoronavirus genus, which causes the current pandemic disease defined by the World Health Organization as COVID-19. This is considered by world experts as an emerging viral infection. Its origin is veterinary and its zoonotic transmission, from viruses that have bats as reservoirs to pangolin an as an intermediate host, from which it is inferred that it could have adapted to the human being, transmitted from person to person by means of respiratory droplets, and highly infectious contaminated nasal secretions Fecal-oral transmission is not ruled out. The disease has an incubation period of 2 to 14 days (5.2 days in mean), and until now the most efficient prevention and control measures are the obligatory social quarantine, the use of face masks, hand washing with soap and water for at least 20 seconds, or with products in gel with 70 alcohol, keeping a minimum distance between people of 2 meters. What has been learned from the other two related human betacoronaviruses that caused the previous epidemics: SARS-CoV in 2002-2003 and MERS in 2012, allow us to better face the current pandemic(AU)

Using adaptive genetic algorithms combined with high sensitivity single cell-based technology to detect bladder cancer in urine and provide a potential noninvasive marker for response to anti-PD1 immunotherapy.

OBJECTIVE: To use adaptive genetic algorithms (AGA) in combination with single-cell flow cytometry technology to develop a noninvasive test to detect bladder cancer. MATERIALS AND METHODS: Fifty high grade, cystoscopy confirmed, superficial bladder cancer patients, and 15 healthy donor early morning urine samples were collected in an optimized urine collection media. These samples were then used to develop an assay to distinguish healthy from cancer patients' urine using AGA in combination with single-cell flow cytometry technology. Cell recovery and test performance were verified based on cystoscopy and histology for both bladder cancer determination and PD-L1 status. RESULTS: Bladder cancer patients had a significantly higher percentage of white blood cells with substantial PD-L1 expression (P< 0.0001), significantly increased post-G1 epithelial cells (P < 0.005) and a significantly higher DNA index above 1.05 (P < 0.05). AGA allowed parameter optimization to differentiate normal from malignant cells with high accuracy. The resulting prediction model showed 98% sensitivity and 87% specificity with a high area under the ROC value (90%). CONCLUSIONS: Using single-cell technology and machine learning; we developed a new assay to distinguish bladder cancer from healthy patients. Future studies are planned to validate this assay.

Effect of continuous positive airway pressure on inflammatory, antioxidant, and depression biomarkers in women with obstructive sleep apnea: a randomized controlled trial.

STUDY OBJECTIVES: The effect of continuous positive airway pressure (CPAP) on mediators of cardiovascular disease and depression in women with obstructive sleep apnea (OSA) is unknown. We aimed to assess the effect of CPAP therapy on a variety of biomarkers of inflammation, antioxidant activity, and depression in women with OSA. METHODS: We conducted a multicenter, randomized controlled trial in 247 women diagnosed with moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥ 15). Women were randomized to CPAP (n = 120) or conservative treatment (n = 127) for 12 weeks. Changes in tumor necrosis factor α (TNFα), interleukin 6 (IL-6), C-reactive protein (CRP), intercellular adhesion molecule 1 (ICAM-1), catalase (CAT), superoxide dismutase (SOD), and brain-derived neurotrophic factor (BDNF) were assessed. Additional analyses were conducted in subgroups of clinical interest. RESULTS: Women had a median (25th-75th percentiles) age of 58 (51-65) years, body mass index 33.5 (29.0-38.3) kg/m2, and AHI 33.3 (22.8-49.3). No differences were found between groups in the baseline levels of the biomarkers. After 12 weeks of follow-up, there were no changes between groups in any of the biomarkers assessed. These results did not change when the analyses were restricted to sleepy women or to those with severe OSA. In women with CPAP use at least 5 hours per night, only TNFα levels decreased compared to the control group (-0.29 ± 1.1 vs -0.06 ± 0.53, intergroup difference -0.23 [95% CI = -0.03 to -0.50]; p = 0.043). CONCLUSIONS: Twelve weeks of CPAP therapy does not improve biomarkers of inflammation, antioxidant activity, or depression compared to conservative treatment in women with moderate-to-severe OSA. TRIAL REGISTRATION: NCT02047071.

Kaposi sarcoma of th e penis in anHIV-negative patient.

Kaposi sarcoma is an angioproliferative disorder that ranges from a single indolent skin lesion to respiratory and gastrointestinal/visceral involvement. Kaposi sarcoma is rare in non-immunosuppressed patients. Nineteen cases of penile Kaposi sarcoma in HIV-negative patients were reported in 2012. We present the case report of a 48-year-old male patient with no previous medical history, who came to our urology clinic presenting a purple-color papule on the penis glans. Lab tests revealed negative serology for HIV, but tissue PCR was positive for human herpesvirus 8. Histopathology examination after lesion excision was compatible with Kaposi sarcoma. No other cutaneous or mucosal lesions were present. Primary Kaposi sarcoma of the penis is rare, but may occur in non-immunosuppressed patients.

Prevalence of overweight and obesity in child population. A study of a cohort in Castile and Leon, Spain. / Prevalencia de sobrepeso y obesidad infantil. Estudio de una cohorte en Castilla y León, España.

INTRODUCTION: Several studies warn that overweight and obesity have become an epidemic with severe consequences in the population's health. The objetive of the present study is to estimate the prevalence of overweight and obesity in Castile and Leon in a sample of children at 6, 11 and 14 years of age, to describe its evolution and its association with life habits and antecedents. MATERIAL AND METHODS: Observational study, retrospective cohort, performed by the pediatricians of the Health Sentinel Network. The study is part of a joint Project with the National Research Center on Human Evolution (CENIEH) in Burgos to know the pattern of growth and development of the child population of Castile and Leon. In 2012, a health examination and a retrospective collection were carried out based on the clinical history of a simple of 326 children, from the cohort was born in 1998. RESULTS: Following the WHO references, at age 14 there was 25.3% of boys and 18.5% of girls with overweight. Obesity was estimated to affect the 8.2% and 4.8% of them respectively. At 11 years of age there was the maximum of overweight in girls and of obesity in boys. At the urban-non urban environment, quantity and quality of sleep and the parents' BMI have been some of the associated factors to weight level of the children. DISCUSSION: In Castile and Leon, as in other populations of our environment, there is a severe problema of overweight and obesity. For their control it is necesary to deepen understanding of lifestyles and antecedents related to the birth as well as to calculate the growth rate in the pediatric age.

Immunostimulatory activity of low-molecular-weight hyaluronan on dendritic cells stimulated with Aggregatibacter actinomycetemcomitans or Porphyromonas gingivalis.

OBJECTIVES: Periodontitis is a chronic inflammatory disease characterized by tooth-supporting tissue destruction, which is elicited by the host's immune response triggered against periodonto-pathogen bacteria. During periodontal tissue destruction, extracellular matrix components are metabolized and fragmented. Some extracellular matrix component-derived fragments, such as low-molecular-weight hyaluronan (LMW-HA), have potent immunogenic potential, playing a role as damage-associated molecular patterns (DAMPs) during activation of immune cells. Dendritic cells (DCs) play a central role in the host's immune response displayed during periodontitis; thus, this study aimed to analyze whether LMW-HA has an immunostimulatory activity on DCs when stimulated with periodonto-pathogen bacteria. MATERIALS AND METHODS: LMW-HA-treated and non-treated DCs were stimulated with Aggregatibacter actinomycetemcomitans or Porphyromonas gingivalis and the mRNA expression for cytokines tumor necrosis factor-α (TNF-alpha), interleukin-1ß (IL-1B), interleukin-6 (IL-6), and interleukin-23 (IL-23A) was quantified by RT-qPCR. In addition, transcription factors interferon regulatory factor 4 (IRF4), interferon regulatory factor 8 (IRF8), neurogenic locus notch homolog protein 2 (NOTCH2), and basic leucine zipper ATF-like transcription factor 3 (BATF3), involved in DC activation, were analyzed. RESULTS: Higher expression levels of TNF-alpha, IL-1B, IL-6, and IL-23A were detected in LMW-HA-treated DCs after bacterial infection, as compared with non-treated DCs. When LMW-HA-treated DCs were infected with A. actinomycetemcomitans, higher levels of IRF4, NOTCH2, and BATF3 were detected compared with non-treated cells; whereas against P. gingivalis infection, increased levels of IRF4 and NOTCH2 were detected. CONCLUSION: LMW-HA plays an immunostimulatory role on the immune response triggered by DCs during infection with A. actinomycetemcomitans or P. gingivalis. CLINICAL RELEVANCE: Detection of extracellular matrix component-derived fragments produced during periodontal tissue destruction, such as LMW-HA, could explain at least partly unsuccessful periodontal treatment and the chronicity of the disease.

Kaposi sarcoma of th e penis in anHIV-negative patient / Sarcoma de Kaposi de pênis em paciente HIV negativo

ABSTRACT Kaposi sarcoma is an angioproliferative disorder that ranges from a single indolent skin lesion to respiratory and gastrointestinal/visceral involvement. Kaposi sarcoma is rare in non-immunosuppressed patients. Nineteen cases of penile Kaposi sarcoma in HIV-negative patients were reported in 2012. We present the case report of a 48-year-old male patient with no previous medical history, who came to our urology clinic presenting a purple-color papule on the penis glans. Lab tests revealed negative serology for HIV, but tissue PCR was positive for human herpesvirus 8. Histopathology examination after lesion excision was compatible with Kaposi sarcoma. No other cutaneous or mucosal lesions were present. Primary Kaposi sarcoma of the penis is rare, but may occur in non-immunosuppressed patients.

RESUMO O sarcoma de Kaposi é uma doença angioproliferativa que varia de uma lesão cutânea indolente isolada ao envolvimento visceral respiratório e gastrintestinal. É raro em pacientes não imunossuprimidos. Dezenove casos de sarcoma de Kaposi de pênis em pacientes HIV negativos foram relatados em 2012. Descrevemos o caso de um paciente do sexo masculino, 48 anos, sem história pregressa, que se apresentou em nossa clínica urológica com pápula violeta na glande. Os testes de laboratório revelaram sorologia negativa para HIV, mas o PCR em tecido foi positivo para o herpesvírus humano 8. A histopatologia após a excisão da lesão foi compatível com sarcoma de Kaposi. Não existia outra lesão cutânea ou de mucosa. O sarcoma de Kaposi primário de pênis é raro, mas pode ocorrer em pacientes não imunossuprimidos.