miRNome profiling of extracellular vesicles in severe COVID-19 patients and identification of predictors of mortality.

BACKGROUND: Extracellular vesicles (EVs), containing microRNAs (miRNAs) and other molecules, play a central role in intercellular communication, especially in viral infections caused by SARS-CoV-2. This study explores the miRNA profiles in plasma-derived EVs from severe COVID-19 patients referred to controls, identifying potential mortality miRNA predictors. METHODS: A prospective study was carried out, including 36 severe COVID-19 patients and 33 non-COVID-19 controls. EVs-derived miRNAs were sequenced, and bioinformatics and differential expression analysis between groups were performed. The plasma miRNA profile of an additional cohort of severe COVID-19 patients (n=32) and non-COVID-19 controls (n=12) was used to compare with our data. Survival analysis was used to identify potential mortality predictors among the SDE miRNAs in EVs. RESULTS: Severe COVID-19 patients showed 50 significantly differentially expressed (SDE) miRNAs in plasma-derived EVs. These miRNAs were associated with pathways related to inflammation and cell adhesion. Fifteen of these plasma-derived EVs miRNAs were also SDE in the plasma of severe patients vs controls. Two miRNAs, hsa-miR-1469 and hsa-miR-6124, were identified as strong mortality predictors with an área under the ROC Curve (AUC) of 0.938. CONCLUSION: : This research provides insights into the role of miRNAs found within EVs in severe COVID-19 and their potential as clinical biomarkers for mortality.

Low-level HIV-1 viremia affects T-cell activation and senescence in long-term treated adults in the INSTI era.

BACKGROUND: Around 10% of people with HIV (PWH) exhibit a low-level viremia (LLV) under antiretroviral therapy (ART). However, its origin and clinical significance are largely unknown, particularly at viremias between 50 and 200 copies/mL and under modern ART based on integrase strand transfer inhibitors (INSTIs). Our aim was to characterize their poor immune response against HIV in comparison to individuals with suppressed viremia (SV) and non-HIV controls (NHC). METHODS: Transversal observational study in 81 matched participants: 27 PWH with LLV, 27 PWH with SV, and 27 NHC. Activation (CD25, HLA-DR, and CD38) and senescence [CD57, PD1, and HAVCR2 (TIM3)] were characterized in peripheral T-cell subsets by spectral flow cytometry. 45 soluble biomarkers of systemic inflammation were evaluated by immunoassays. Differences in cell frequencies and plasma biomarkers among groups were evaluated by a generalized additive model for location, scale, and shape (GAMLSS) and generalized linear model (GLM) respectively, adjusted by age, sex at birth, and ART regimen. RESULTS: The median age was 53 years and 77.8% were male. Compared to NHC, PWH showed a lower CD4+/CD8+ ratio and increased activation, senescence, and inflammation, highlighting IL-13 in LLV. In addition, LLV showed a downtrend in the frequency of CD8+ naive and effector memory (EM) type 1 compared to SV, along with higher activation and senescence in CD4+ and CD8+ EM and terminally differentiated effector memory RA+ (TEMRA) subpopulations. No significant differences in systemic inflammation were observed between PWH groups. CONCLUSION: LLV between 50 and 200 copies/mL leads to reduced cytotoxic activity and T-cell dysfunction that could affect cytokine production, being unable to control and eliminate infected cells. The increase in senescence markers suggests a progressive loss of immunological memory and a reduction in the proliferative capacity of immune cells. This accelerated immune aging could lead to an increased risk of developing future comorbidities. These findings strongly advocate for heightened surveillance of these PWH to promptly identify potential future complications.

Incidence of pleural effusion with dasatinib and the effect of switching therapy to a different TKI in patients with chronic phase CML.

Dasatinib is one of the second generation tyrosine kinase inhibitors (TKI) which is approved for the treatment of patients with chronic phase CML (CP-CML) both in the front line and in the second line setting. Pleural effusion (PE) is a unique toxicity associated with dasatinib use. Our aim was to study the incidence of pleural effusion in our cohort of patients who were treated with dasatinib for CP-CML and the safety upon TKI switch. A total of 390 patients were treated with dasatinib during their course of treatment for CP-CML. A total of 69 patients (17.6%) developed any grade of PE. About 33 (48%) patients developed CTCAE grade 2 PE, 34 (49%) grade 3 and only 1 patient developed grade 4 PE. Recurrence of PE was observed in 34 (49%) patients. While only 12 patients (17.3%) continued using dasatinib after development of PE, dasatinib was discontinued in the other 57 patients. Therapy was switched to bosutinib in 13 patients out of which 6 (46%) patients re-developed PE. While only 12.5% patients developed re-accumulation of pleural fluid in patients switched to imatinib, none of the patients switched to nilotinib re-developed PE. A change in TKI to bosutinib was associated with a 46% risk of recurrence of PE in patients who develop PE on dasatinib for the treatment of CP-CML. The incidence of recurrent PE was markedly lower in patient switched to imatinib or nilotinib.

Longer ICU stay and invasive mechanical ventilation accelerate telomere shortening in COVID-19 patients 1 year after recovery.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes virus-induced-senescence. There is an association between shorter telomere length (TL) in coronavirus disease 2019 (COVID-19) patients and hospitalization, severity, or even death. However, it remains unknown whether virus-induced-senescence is reversible. We aim to evaluate the dynamics of TL in COVID-19 patients 1 year after recovery from intensive care units (ICU). Longitudinal study enrolling 49 patients admitted to ICU due to COVID-19 (August 2020 to April 2021). Relative telomere length (RTL) quantification was carried out in whole blood by monochromatic multiplex real-time quantitative PCR (MMqPCR) assay at hospitalization (baseline) and 1 year after discharge (1-year visit). The association between RTL and ICU length of stay (LOS), invasive mechanical ventilation (IMV), prone position, and pulmonary fibrosis development at 1-year visit was evaluated. The median age was 60 years, 71.4% were males, median ICU-LOS was 12 days, 73.5% required IMV, and 38.8% required a prone position. Patients with longer ICU-LOS or who required IMV showed greater RTL shortening during follow-up. Patients who required pronation had a greater RTL shortening during follow-up. IMV patients who developed pulmonary fibrosis showed greater RTL reduction and shorter RTL at the 1-year visit. Patients with longer ICU-LOS and those who required IMV had a shorter RTL in peripheral blood, as observed 1 year after hospital discharge. Additionally, patients who required IMV and developed pulmonary fibrosis had greater telomere shortening, showing shorter telomeres at the 1-year visit. These patients may be more prone to develop cellular senescence and lung-related complications; therefore, closer monitoring may be needed.

The use of digital technologies in peri-implant soft tissue augmentation - A narrative review on planning, measurements, monitoring and aesthetics.

OBJECTIVE: To identify the different uses and modalities of digital technologies to diagnose, plan and monitor peri-implant soft tissue conditions and aesthetics. METHODS: A comprehensive narrative review of pertinent literature was conducted, critically appraising key digital technologies that may assist peri-implant soft tissue augmentation and assessment. An electronic search on four databases including studies published prior to 1st July 2023 was performed and supplemented by a manual search. RESULTS: Predominantly, tools such as cone beam computed tomography (CBCT), intraoral scanning (iOS), intraoral ultrasonography and digital spectrophotometry were commonly to assess and monitor peri-implant soft tissues. The main clinical and research applications included: (i) initial assessment of mucosal thickness, supra-crestal tissue height and keratinized mucosa width, (ii) evaluation of peri-implant soft tissue health and inflammation, (iii) monitoring profilometric changes and midfacial mucosal margin stability over time and (iv) aesthetic evaluation through colour assessment. While evidence for some digital tools may be limited, the integration of digital technologies into peri-implant soft tissue management holds great promise. These technologies offer improved precision, comfort and speed in assessment, benefiting both patients and clinicians. CONCLUSION: As digital technologies progress, their full potential in peri-implant soft tissue augmentation and their value will become more evident with ongoing research. Embracing these innovations and their potential benefits is recommended to ensure that during progress in implant dentistry, patient care is not hindered.

Complications Associated With Inferior Vena Cava Filter Retrieval: A Systematic Review.

Inferior vena cava (IVC) filters have been used successfully in high-risk patients to prevent thromboembolism. The filters are widely created as retrievable devices, but complication rates progressively increase during IVC filter retrieval. This study aims to analyze IVC filter retrieval cases and associated complications during and following the procedures regarding dwell times, specific filter types, filter positioning, and advanced retrieval techniques. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to select and analyze relevant articles. A literature search for articles was performed on September 23, 2023, through three research databases: PubMed, ProQuest, and ScienceDirect. The keywords used to identify relevant publications were "IVC Filter retrieval AND complications" and "IVC filter removal AND complications". The articles before 2012 were excluded. Relevant articles were selected based on the inclusion and exclusion criteria. In total, 20,435 articles were found: 812 from PubMed, 15,635 from ProQuest, and 3,988 from Science Direct. Among the exclusions were 18,462 articles, which were excluded in the automatic screening process, leaving 1,973 for manual screening. The manual screening of articles was conducted based on title, abstract, article type, duplicates, and case reports, where 1,918 articles were excluded. Ultimately, 55 articles were included in this review. This study demonstrates that IVC filter retrievals have significant complication rates. Many complications have a common theme: prolonged dwell time and lost follow-up appointments. Therefore, importance should be placed on patient education and implementing strict protocols regarding the timelines of IVC filter removals.

A systematic review of oral wound healing indices.

Wound healing monitoring for abnormality identification and intervention is crucial to securing a successful surgical outcome. Indices have been used to summarize the degree of healing. Given the increasing frequency of regenerative procedures which preserve dentition and implant stability, and the higher esthetic demands, an appraisal of the available indices is needed to identify the current knowledge gap. This study aimed to systematically review published oral wound healing indices and scores. MATERIALS AND METHODS: A complete literature electronic search in 5 databases was conducted by two reviewers. A combination of keywords related to oral wound healing was used. RESULTS: A total of 11 articles were included in the evaluation of various procedures (conventional periodontal procedures, guided tissue regeneration, soft tissue reconstruction procedures, and tooth extractions), at different time points (1 day to 12 weeks), with a focus on diverse clinical signs and symptoms. Frequently evaluated parameters included wound dehiscence/epithelialization (91%), tissue color (redness) (73%), suppuration (55%), swelling/edema (55%), and hemostasis (55%). Other less commonly used parameters include esthetics-related and patient-centered outcomes. CONCLUSION: The available indices evaluate a diverse group of subjective clinical signs and symptoms to estimate the underlying biological healing events and assess the degree of clinical success. The majority of the included indices are not validated. Quantitative and objective subclinical parameters including blood perfusion, biomaterial stability, and completeness of epithelialization, are needed for customized wound healing care and better outcome prediction.

Ultrasound-based jawbone surface quality evaluation after alveolar ridge preservation.

BACKGROUND: Bone readiness for implant placement is typically evaluated by bone quality/density on 2-dimensional radiographs and cone beam computed tomography at an arbitrary time between 3 and 6 months after tooth extraction and alveolar ridge preservation (ARP). The aim of this study is to investigate if high-frequency ultrasound (US) can classify bone readiness in humans, using micro-CT as a reference standard to obtain bone mineral density (BMD) and bone volume fraction (BVTV) of healed sockets receiving ARP in humans. METHODS: A total of 27 bone cores were harvested during the implant surgery from 24 patients who received prior extraction with ARP. US images were taken immediately before the implant surgery at a site co-registered with the tissue biopsy collection location, made possible with a specially designed guide, and then classified into 3 tiers using B-mode image criteria (1) favorable, (2) questionable, and (3) unfavorable. Bone mineral density (hydroxyapatite) and BVTV were obtained from micro-CT as the gold standard. RESULTS: Hydroxyapatite and BVTV were evaluated within the projected US slice plane and thresholded to favorable (>2200 mg/cm3; >0.45 mm3/mm3), questionable (1500-2200 mg/cm3; 0.4-0.45 mm3/mm3), and unfavorable (<1500 mg/cm3; <0.4 mm3/mm3). The present US B-mode classification inversely scales with BMD. Regression analysis showed a significant relation between US classification and BMD as well as BVTV. T-test analysis demonstrated a significant correlation between US reader scores and the gold standard. When comparing Tier 1 with the combination of Tier 2 and 3, US achieved a significant group differentiation relative to mean BMD (p = 0.004, true positive 66.7%, false positive 0%, true negative 100%, false negative 33.3%, specificity 100%, sensitivity 66.7%, receiver operating characteristics area under the curve 0.86). Similar results were found between US-derived tiers and BVTV. CONCLUSION: Preliminary data suggest US could classify jawbone surface quality that correlates with BMD/BVTV and serve as the basis for future development of US-based socket healing evaluation after ARP.

Plasma metabolomic profile is near-normal in people with HIV on long-term suppressive antiretroviral therapy.

Background: Combination antiretroviral therapy (ART) has transformed human immunodeficiency virus (HIV) infection in people with HIV (PWH). However, a chronic state of immune activation and inflammation is maintained despite achieving HIV suppression and satisfactory immunological recovery. We aimed to determine whether the plasma metabolomic profile of PWH on long-term suppressive ART and immunologically recovered approximates the normality by comparison with healthy controls with similar age and gender. Methods: We carried out a cross-sectional study in 17 PWH on long-term ART (HIV-RNA <50 copies/mL, CD4+ ≥500 cells/mm3, and CD4+/CD8+ ≥1) and 19 healthy controls with similar age and gender. Metabolomics analysis was performed by gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS). The statistical association analysis was performed by principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and Generalized Linear Models (GLM) with a gamma distribution (log-link). Significance levels (p-value) were corrected for multiple testing (q-value). Results: PCA and PLS-DA analyses found no relevant differences between groups. Adjusted GLM showed 14 significant features (q-value<0.20), of which only three could be identified: lysophosphatidylcholine (LysoPC) (22:6) (q-value=0.148), lysophosphatidylethanolamine (LysoPE) (22:6) (q-value=0.050) and hydroperoxy-octadecatrienoic acid (HpOTrE)/dihydroperoxy-octadecatrienoic acid (DiHOTrE)/epoxy-octadecadienoic acid (EpODE) (q-value=0.136). These significant identified metabolites were directly correlated to plasma inflammatory biomarkers in PWH and negatively correlated in healthy controls. Conclusion: PWH on long-term ART have a metabolomic profile that is almost normal compared to healthy controls. Nevertheless, residual metabolic alterations linked to inflammatory biomarkers persist, which could favor the development of age-related comorbidities among this population.

"I'm Like A Chameleon": An Exploration of the Experiences of Mexican American Women Who Are Group Psychotherapists-in-Training.

The purpose of this study was to explore the tasks, challenges, and perspectives of group-therapy leadership among Mexican American women who are psychotherapists-in-training. The literature regarding counselor and psychotherapist development suggests that culture and gender interact and shape group leadership, along with the group leader's effectiveness, behavior, and style. This study sought to answer the following research questions: (1) What are the experiences of group leadership of Mexican American women who are psychotherapists-in-training (PITs)? (2) What tasks and challenges do Mexican American women PITs encounter as group psychotherapy leaders? Results suggest that Mexican American women group PITs encounter obstacles to group leadership associated with their cultural and professional identities. However, consistent with Anzaldúa's borderlands theory, the Mexican American women group PITs in this study straddle two cultures and competing demands while also turning obstacles into sources of empowerment and strength. Implications for training and supervision of Mexican American women group PITs are discussed.

Análisis de las variables del espermograma en pacientes de la consulta de infertilidad del municipio de Cienfuegos / Spermogram variables analysis in the infertility consultation patients of the Cienfuegos municipality

RESUMEN Fundamento El análisis de la calidad del semen es considerado un elemento básico en la evaluación de la fertilidad masculina. Objetivo analizar los valores del espermograma de pacientes atendidos en la consulta municipal de Infertilidad de Cienfuegos. Métodos estudio descriptivo, que incluyó 128 muestras resultantes de espermogramas realizados a pacientes atendidos en la consulta municipal de Infertilidad de Cienfuegos, entre los años 2019 y 2020. Los espermogramas registran las variables: edad, volumen, concentración, movilidad, morfología y vitalidad. Estas variables fueron comparadas con los valores de referencia propuestos por la OMS. Resultados en cuanto a la concentración, resaltó que los valores oscilaron en un rango amplio, desde 0 hasta 350 mmol/L-1, con una media de 89,1; mientras que la movilidad de los espermatozoides mostró valores muy bajos, incluso algunos con 0 %. La movilidad total (movilidad rápida más movilidad lenta) fue de un 57,7 %. El porcentaje de espermatozoides con una morfología adecuada fue de 46,3, mientras que la vitalidad fue de 71,8 %. Conclusión La mayoría de las muestras analizadas mostraron valores normales en todos los parámetros. Resultó significativo el número de pacientes con leucospermia, parámetro que probablemente tenga relación directa con la infertilidad en estos sujetos.

Background: Semen quality analysis is considered a basic element in the evaluation of male fertility. Objective to analyze the spermogram values in patients treated at the Cienfuegos Municipal Infertility Clinic. Methods descriptive study, which included 128 samples resulting from spermograms performed on patients treated at the Cienfuegos municipal infertility clinic, between 2019 and 2020. Spermograms record the variables: age, volume, concentration, mobility, morphology, and vitality. These variables were compared with the reference values proposed by the WHO. Results regarding the concentration, it highlighted that the values oscillated in a wide range, from 0 to 350 mmol / L-1, with a mean of 89.1; while the mobility of the spermatozoa showed very low values, even some with 0%. Total mobility (fast mobility plus slow mobility) was 57.7%. The percentage of sperm with an adequate morphology was 46.3, while the vitality was 71.8%. Conclusion Most of the analyzed samples showed normal values in all parameters. The number of patients with leukospermia was significant, a parameter that is probably directly related to infertility in these subjects.

Un análisis semanal de los casos confirmados a la COVID-19 en Cuba: primeros 70 días / A weekly analysis of cases confirmed to COVID-19 in Cuba: first 70 days

RESUMEN Fundamento: la COVID-19, causada por el SARS-CoV2, ha evolucionado como una pandemia que contabiliza más de 1 millón de contagios y ha causado la muerte, hasta ahora, a más de 300 000 personas. Objetivo: describir el comportamiento semanal de casos confirmados de la enfermedad en el país, haciendo una valoración de la incidencia. Métodos: análisis descriptivo y de tendencia de las 10 semanas completadas de lunes a domingo de los casos confirmados de la COVID19 en Cuba desde el día 11 de marzo al 17 de mayo de 2020. El análisis se realizó con el lenguaje estadístico R. Resultados: se constató que las semanas 5, 6 y 7, fueron las de mayor media de casos confirmados. Además, se observó que las semanas 2, 3, 8 y 10 son las de mayor variabilidad. El valor más alejado de la media se presentó en la semana 8 con 74 casos el viernes y los valores más altos se presentan entre los días miércoles y sábado en 8 de las semanas estudiadas. Conclusión: en Cuba se ha logrado un aplanamiento de la curva de número de casos que nos mantiene en un escenario favorable y donde las variaciones dadas por brotes esporádicos y con un control rápido no deforman significativamente dicha curva, lo que justifica el bajo grado de variación por semanas, con una tendencia sostenida de decrecimiento del número de casos.

ABSTRACT Foundation: COVID-19, caused by SARS-CoV2, has evolved as a pandemic that accounts for more than 1 million infections and has killed, up to now, more than 300,000 people. Objective: to describe the weekly behavior of confirmed cases of the disease in the country, making an assessment of its incidence. Methods: descriptive and trend analysis of the 10 weeks completed from Monday to Sunday of confirmed cases of COVID-19 in Cuba from March 11 to May 17, 2020. The analysis was performed with the statistical language R. Results: it was found that weeks 5, 6 and 7 had the highest mean of confirmed cases. In addition, it was observed that weeks 2, 3, 8 and 10 are those of greater variability. The value furthest from the mean was presented in week 8 with 74 cases on Friday and the highest values were presented between Wednesday and Saturday in 8 of the weeks studied. Conclusion: in Cuba a flattening of the line has been achieved, which shows in a favorable scenario and where the variations given by sporadic outbreaks and with rapid control do not significantly deform this line. This justifies few variations by weeks, with a sustained trend of decreasing number of cases.

Prevalencia de tabaquismo en pacientes con enfermedad pulmonar obstructiva crónica. Cienfuegos, 2017- 2018 / Prevalence of tabaccoism in patients with obstructive chronic pulmonary disease, 2017- 2018

Fundamento: el tabaquismo se considera una epidemia de carácter universal y una grave carga para el individuo, la familia y la sociedad. Objetivo: determinar la prevalencia de tabaquismo en pacientes con enfermedad pulmonar obstructiva crónica. Métodos: se realizó un estudio de serie de casos, en el Hospital Dr. Gustavo Aldereguía Lima, de la provincia de Cienfuegos, en las salas de Medicina Interna, en el período de septiembre de 2017 a enero de 2018. Las variables de estudio fueron: edad, sexo, escolaridad, ocupación, procedencia, tabaquismo, cantidad de cigarros fumados diariamente, cantidad de años fumando, enfermedad pulmonar obstructiva crónica, hipertensión arterial, diabetes mellitus, insuficiencia renal crónica, cardiopatías isquémica, accidente vascular encefálico y cáncer. Se utilizó como instrumento de recogida de información el cuestionario utilizado por el proyecto CARMEN (Conjunto de Acciones para Reducir las Enfermedades no Transmisibles). El instrumento se aplicó de forma individual y el análisis estadístico de la información se realizó en el paquete estadístico SPSS. Resultados: prevalecieron los fumadores del sexo masculino (79,5 %), con más de 12º de escolaridad (68,4 %), de procedencia rural (76,5 %). Representan el mayor por ciento los pacientes que llevan fumando más de 40 años (51,8 %) y que consumen hasta una cajetilla diaria (68,5 %). Dentro de las enfermedades crónicas que coexistieron con el tabaquismo prevaleció la hipertensión arterial (64,8 %). Conclusiones: la prevalencia de tabaquismo en los pacientes con enfermedad pulmonar obstructiva crónica es alta a pesar de las consecuencias negativas que tiene para la salud.

Foundation: tobbacoism is considered an epidemic of universally spread and a burden for the individual, the family and the society. Objective: to determine the prevalence of tobbacoism in patients with obstructive chronic pulmonary disease. Methods: A cross descriptive study was done at the University General Hospital Dr. Gustavo Aldereguía Lima. Cienfuegos, at the internal medicine wards from September 2017 to 2018. All the patients who voluntarily wished to participate, the simple was constituted with 80 patients. The variables studied were age, sex, scholarship, occupation, precedence, tobaccoism, number of cigarettes smoked daily, years smoking, obstructive chronic pulmonary disease, high blood pressure, diabetes mellitus, renal chronic failure, ischemic cardiopathies, stroke and cancer. It was used the questionnaire of the CARMEN (Group of Actions to reduce non-transmissible diseases) project instrument for collecting information. The instrument was applied individually and the statistical analysis was done by the SSPS package. Results: male smokers prevailed (79,5 %), with more than senior high school scholarship (68,4 %), of rural orygen (76,5 %). They represent the highest percentage of patients who have been smoking for more than 40 years (51,8 %) and consume up to a box of cigarettes a day (68,5 %). Among the chronic diseases which co-existed hypertension prevaled. Conclusion: the prevalence of tobaccoism in patients with obstructive pulmonary disease is high in spite of the negative consequences for health.

Calidad de vida y percepción de apoyo social en personas con HIV en Bogotá, Colombia / Quality of life and perceived social support in people with HIV in Bogotá, Colombia

Introducción. En estudios llevados a cabo en países desarrollados se ha establecido que las personas con HIV/sida refieren tener una menos calidad de vida y menor apoyo social. Objetivo. Explorar la asociación entre la percepción del apoyo social afectivo o de personas de confianza y cada dimensión de la calidad de vida relacionada con la salud en personas con HIV/sida en Bogotá. Materiales y métodos. Se hizo un estudio de corte transversal en personas con HIV/sida seleccionadas por conveniencia, en el marco de un programa de atención en una red hospitalaria de Bogotá. Se utilizaron los cuestionarios de calidad de vida relacionada con la salud SF36 y el cuestionario genérico de apoyo social funcional Duke-UNC-11. Se utilizaron modelos de regresión lineal en el análisis. Resultados. Se evidenció una relación directa entre la dimensión del bienestar emocional de la calidad de vida, el apoyo social afectivo (ß=7,36; IC95% 1,04-13,68) y el de personas de confianza (ß=11,63; IC95% 5,30-17,96), así como entre las dimensiones de la función física, el desempeño emocional y el dolor corporal y la percepción del apoyo social de tipo afectivo, y entre el apoyo social de personas de confianza y las dimensiones de la vitalidad y la función social. Se encontró una relación inversa entre los promedios de los puntajes de las dimensiones de desempeño emocional, desempeño físico y salud general y la percepción del apoyo social de tipo afectivo con la primera dimensión y el de personas de confianza con las dos últimas. Conclusiones. Los sujetos con una mejor percepción del apoyo social reportaron una mejor calidad de vida relacionada con la salud, lo cual puede servir de base para la planeación, el diseño y la implementación de planes de atención médica que incorporen variables clínicas, paraclínicas y del entorno del paciente.

Introduction: People living with HIV/AIDS in developing countries tend to have a lower quality of life and less social support compared with those in developed countries. Objective: To explore the association between affective social support or social support generating confidence and each dimension of the quality of life related to health among people with HIV/AIDS from Bogotá. Materials and methods: We conducted a cross-sectional study of people living with HIV/AIDS using convenience sampling of a care program in a hospital network in Bogotá. The quality of life questionnaire SF36 and the generic social support questionnaire Duke-UNC-11 were used, along with linear regression models for the analyses. Results: There was a direct relationship between the emotional well-being dimension of quality of life and the social support systems of affectivity (ß =7.36;95% CI: 1.04; 13.68) and those generating confidence (ß =11.63;95% CI: 5.30; 17.96). There was a correlation between the dimensions of physical function, emotional performance, pain, and perceived affective social support. Likewise, we detected relations between the perception of social support generating confidence and the dimensions of vitality and social function. Contrarily, we found an inverse relationship between the averages of the dimension of emotional performance and the perceived affective social support, as well as between the dimension of physical performance and general health with social support generating confidence. Conclusions: Subjects with higher levels of social support had higher levels of quality of life related to health. This finding offers an opportunity for the design and implementation of healthcare plans that incorporate clinical, para-clinical and environmental variables of the patient.

Eficacia de la dieta libre de gluten en el síndrome Gilles de la Tourette con enfermedad celíaca. Reporte de caso / Efficacy of the gluten-free diet in the Gilles de la Tourette syndrome with celiac disease. Case Report

RESUMEN Fundamentación: El síndrome Gilles de la Tourette es un proceso neuropsiquiátrico de causa desconocida caracterizado por múltiples tics. Los desórdenes relacionados al gluten cubren múltiples manifestaciones clínicas inmunológicas ante el consumo de gluten; incluyen la enfermedad celíaca y la sensibilidad al gluten no celíaca. Se han publicado casos de síndrome Gilles de la Tourette con sensibilidad al gluten no celíaca, pero ninguno relacionado con la enfermedad celíaca clásica. Reporte de caso: Paciente masculino de 20 años, con diagnóstico de EC desde la infancia y cuadro típico de Tourette diagnosticado recientemente. Mostró excelente respuesta y remisión clínica neurológica y conductual después de establecerse rigurosamente una dieta libre de gluten. Conclusiones: Es necesario incluir entre los grupos de riesgo de sensibilidad al gluten los niños con trastornos neuropsicológicos como los aquí referidos. La enfermedad celíaca clásica debe incluirse entre las posibles asociaciones con el síndrome Gilles de la Tourette. La dieta restrictiva también mejora en estos casos la evolución de ambas enfermedades.

ABSTRACT Background: The Gilles de la Tourette syndrome is a neuropsychiatric process of unknown cause characterized by multiple tics. Disorders related to gluten cover multiple immunological clinical manifestations when eating gluten; they include celiac disease and non-celiac gluten sensitivity. There have been cases of Gilles de la Tourette syndrome with sensitivity to non-celiac gluten, but none related to classic celiac disease. Case report: A 20-year-old male patient, with a CD diagnosis from childhood and typical GTS pattern recently diagnosed. He showed excellent response and clinical neurological and behavioral remission after rigorously establishing a gluten-free diet. Conclusions: Children with neuropsychological disorders such as those referred here need to be included among the risk groups with gluten sensitivity. Classical celiac disease should be included among the possible associations with the Gilles de la Tourette syndrome. The restrictive diet also improves the evolution of both diseases in these cases.

Actividad in vitro de la mezcla de alcaloides de Ervatamia coronaria (Jacq) Staff. Apocynaceae sobre amastigotes de Leishmania braziliensis / Atividade in vitro da mistura de alcalóides de Ervatamia coronaria (Jacq) Staff. Apocynaceae sobre amastigotas de Leishmania braziliensis / In vitro activity of the alkaloids mixture of Ervatamia coronaria (Jacq) Staff. Apocynaceae on Leishmania braziliensis amastigotes

A leishmaniose é considerada uma importante causa de morbidade e mortalidade a nível mundial, principalmente nos países tropicais. As formas cutânea e mucocutânea são causadas, entre outras espécies, por Leishmania braziliensis. Na procura de compostos leishmanicidas de origem natural, foi estudada a atividade da mistura de alcalóides de Ervatamia coronaria (Apocynaceae) contra amastigotas de L. braziliensis em 6 concentrações diferentes (1, 10, 20, 25, 50 e 100 µg/mL). Foram tratados macrófagos de ratos da linha J774, infectados com promastigotas de L. braziliensis, com a mistura de alcalóides 1 hora após-infecção e diariamente por 3 dias sem mudança de meio. As experiências de citotoxicidade foram efetuadas sobre os macrófagos com azul tripam. Todos os cultivos foram feitos de forma triplicada e os grupos de controle não foram submetidos à mistura de alcalóides. Foi obtido que o composto adicionado exerce atividade doses/dependente sobre a parasita. No entanto, as concentrações mais altas (50 e 100 µg/mL), adicionado durante 3 dias, mostraram os maiores índices de infecção, provavelmente devido a diminuição no número de macrófagos, sobre os quais não foi observado efeito tóxico do tratamento durante 24 horas DL50/24h = 233,52 µg/mL. Os resultados dessa pesquisa revelaram uma nova atividade farmacológica de alcalóides da espécie Ervatamia coronaria sobre a forma amastigota de Leishmania braziliensis, com IC50 = 2,6 e 12,4 µg/mL sem mostrar toxicidade sobre a célula hospedeira.

Leishmaniasis, caused by Leishmania sp., is one of the mean reason of considerable mortality and morbidity throughout the world, especially in the tropics. Cutaneous and mucocutaneous manifestations are caused by Leishmania braziliensis, and the cutaneous form is the most common one in Colombia. In the search for antileishmanial compounds from natural sources, we studied the alkaloids mixture from Ervatamia coronaria against L. braziliensis at six different concentrations (1.0, 10, 20, 25, 50 and 100 µg/mL). Macrophages J774 infected with L. braziliensis were treated with alkaloids one hour, and once a day for three days, after parasitic infection and preserving the same culture medium. Cytotoxicity with trypan blue was undertaken in macrophages J774 by using the same concentrations. Three different cultures samples were carried out. As a control we used medium alone. The alkaloids mix showed a dose/dependent activity on amastigote, but by increasing concentrations from 50 to 100 µg/mL for three days, we saw a high index of infection, probably caused by cellular death. We did not see any toxic effect on macrophages J774 at 100 µg/mL, LD50/24h= 233.52 µg/mL. These results revealed a novel pharmacological activity of alkaloids from E. coronaria against amastigotes of L. braziliensis IC50 = 2.6 and 12.4 µg/mL without toxicity on host cells.

¿Sutura?: Nueva técnica de medialización del cornete medio en cirugía endoscópica de mínima invasión / Suture: A new technique for medializing turbinate in minimal invasive endoscopic sinus surgery

Las técnicas de medialización del cornete medio persiguen evitar adherencias o sinequias en el meato medio, así como la recurrencia de enfermedad sinusal. Las adherencias iatrogénicas entre el septum nasal y la cara medial del cornete medio para mantener el espacio del meato medio en el posoperatorio, además de comprometer el flujo respiratorio nasal, pueden tener efectos adversos en la olfación. El objetivo del presente trabajo fue mostrar una nueva técnica de medialización del cornete medio, la cual evita la formación iatrogénica de sinequias entre el cornete medio y el septum nasal. En el presente estudio se incluyeron 75 pacientes, los cuales se sometieron a cirugía nasal endoscópica de mínima invasión. En todos se preservó el cornete medio. La porción medial del cornete medio fue adelgazada con debridador. Se colocó una sutura transfictiva entre el cornete medio de un lado hacia el cornete contranatural, abrazándolos a través del septum nasal. Todos los pacientes fueron seguidos con endoscopia de control a las 12 semanas del posoperatorio. El cornete medio se mantuvo medializado, sin formación de sinequias de éste, contra el septum nasal, logrando mantener el espacio del meato medio libre. El control visual, la limpieza del área, así como la ventilación y drenaje de las cavidades nasosinusales fueron evaluadas en el posoperatorio.

Comportamiento clínico y tratamiento del vitiligo en pacientes de primera consulta en el Centro Nacional de Dermatología Dr. Francisco José Gómez Urcuyo, del 1o de enero al 31 de diciembre del año 2002 / Clinical behavior and treatment of the vitiligo in patient of first consultation in the National Center of Dermatology Dr. Francisco José Gómez Urcuyo, of January 1o at 31 december of the year 2002

Objetivo: identificar el comportamiento clínico y la terapéutica aplicada en los pacientes con diagnóstico de vitiligo en la primera consulta. Material y método: Estudio descriptivo, restrospectivo, transversal. La recolección de la información fue obtenida de los expedientes clínicos evaluándose a través de una ficha de recolección de datos; las caractrísticas sociodemográficas, de evolución, las manifestaciones clínicas y el tratamiento indicado a estos pacientes. Resultados: Se revisaron 205 expedientes de pacientes con Vitiligo: la edad promedio fue de 24 años más o menos 18.5, el sexo más afectado fue el femenino con 61.9 por ciento (n=127) y la procedencia más frecuente fue de 75.6 por ciento (n=155) el área urbana. Al determinar la edad de inicio más frecuente oscilo entre 5-9 años con 26.8 por ciento (n= 55), 10-14 años 15.6 por ciento (n=32), 20 años a más. El tiempo de evolución de la enfermedad a la primera consulta se encontró que la mayoría tenía menos de un año 53.6 por ciento (n=110). Se consiguió este dato en el expediente clínico. La forma clínica más común fue el Vitiligo diseminado 52.6 por ciento (n=108), seguido de la forma focal 37.5 por ciento (n=77). Las terapias más utilizadas fueron el esteroides tópicos más 8-metoxipsoraleno tópico 39.5 por ciento (n=81), seguido de esteroides tópicos 15.12 por ciento (n=31)...

Protocolo de atencion de enfermeria en la prevencion primaria de la enfermedad hemolitica por incompatibilidad del factor RH en el recien nacido Hospital La Victoria de Bogota D.E / Nursing care protocol for primary prevention of haemolitic disease due to RH factor incompatibility in the newborn, Hospital La Victoria. Bogota D.E

La enfermedad hemolitica del recien nacido por incompatibilidad de Rh negativo es una de las patologias que afecta al neonato y que se ha venido estudiando desde 1939; esta incompatibilidad se refiere a la diferencia del Rh en una pareja donde la madre es Rh negativa y el padre Rh positivo. Cuando sangre Rh positiva se transfunde a una mujer Rh negativa, por error, o cuando pequenas cantidades (mas de un milimetro) de sangre fetal Rh positiva que contiene antigeno D heredado de un padre Rh positivo; entra en la circulacion materna durante el embarazo, o bien por aborto espontaneo, o inducido, o en el momento del parto, la madre no sensibilizada Rh negativa produce anticuerpos anti D. Una vez que ha ocurrido la isoinmunizacion, pequenas dosis de antigeno pueden estimular el incremento del titulo de anticuerpos, produciendo un aumento de la destruccion de los eritricitos y causando sintomatologia de enfermedad hemolitica, manifestaciones que pueden ir desde la simple evidencia de laboratorio con moderada hemolisis hasta anemia severa, acompanada de hepatoesplenomegalia como mecanismo compensador; al aumentar esta capacidad compensatorio por anemia profunda dara lugar a palidez, signos de descompensacion cardiaca, anasarca masiva y colapso cardiocirculatorio. Este cuadro clinico denominado hidropesia fetal da lugar frecuentemente a muerte intrauterina o inmediatamente despues de nacer. Generalmente al nacimiento no presenta ictericia, puesto que la placenta ha representado el papel de aclaramiento a la bilirrubina no conjugada..