Comparison between the KARVI scale and the Child Development Evaluation test (EDI) as a screening tool for suspected neurodevelopmental delay / Comparación entre la escala KARVI y la prueba de Evaluación del Desarrollo Infantil (EDI) como tamizaje para la sospecha de retraso en el neurodesarrollo

Abstract Background: Early detection of suspected neurodevelopmental delay allows for timely diagnosis and appropriate intervention, for which numerous screening tests have been developed. However, most are complex and impractical for health-care workers at the community level. This study aimed to validate the KARVI scale in the neurodevelopment assessment of children under 1 year of age. Methods: We conducted an observational, longitudinal, comparative, inferential, and prospective study. Healthy children without risk factors for developing neurodevelopmental delay from 0 to 12 months of age were evaluated remotely using the Zoom® application. The Child Development Evaluation Test and the KARVI scale were applied once a month for four consecutive months. Results: Fifty individuals were analyzed, with a predominance of males in 52%. Adequate percentages for a screening test were obtained in the first evaluation with a sensitivity of 70% (confidence interval [CI] 95% 34.75-93.33) and a specificity of 75% (CI 95% 58.8-87.31), and in the fourth evaluation with a sensitivity of 100% (CI 95% 29.4-100) and a specificity of 78.72% (CI 95% 64.34-89.3), being significant in both evaluations (p = 0.007 and p = 0.001, respectively). Conclusions: The KARVI scale has the elements to be an effective screening test for suspected neurodevelopmental delay, but more extensive studies are needed to obtain more reliable results.

Resumen Introducción: La identificación temprana de retraso en el neurodesarrollo permite un diagnóstico oportuno y una intervención apropiada. Para ello, se han creado diversas pruebas de tamizaje; sin embargo, la mayoría son complejas y poco prácticas para el personal de la salud a nivel comunitario. El objetivo del estudio fue realizar la validación de la escala KARVI en la valoración del neurodesarrollo en niños menores de un año. Métodos: Se realizó un estudio observacional, longitudinal, comparativo inferencial y prospectivo, en el cual se evaluaron, vía remota mediante la aplicación Zoom®, niños sanos de 0 a 12 meses de edad sin factores de riesgo para desarrollar retraso en el neurodesarrollo. Se aplicaron la prueba EDI (Evaluación del Desarrollo Infantil) y la escala KARVI una vez al mes por cuatro meses consecutivos. Resultados: Se analizaron 50 individuos, con predominio del sexo masculino en el 52%. Se obtuvieron porcentajes adecuados para una prueba de tamizaje tanto en la primera evaluación, con sensibilidad de 70% (IC 95% 34.75-93.33) y especificidad de 75% (IC 95% 58.8-87.31), como en la cuarta, con sensibilidad de 100% (IC 95% 29.4-100) y especificidad de 78.72% (IC 95% 64.34-89.3), con significación estadística en ambas evaluaciones (p = 0.007 y p = 0.001, respectivamente). Conclusiones: Se considera que la escala KARVI cuenta con los elementos para considerarla como una prueba de tamizaje efectiva para detectar retraso del neurodesarrollo, sin embargo. Sin requieren estudios más extensos para obtener resultados más confiables.

Síndrome inflamatorio multisistémico post-COVID en niños: reporte de casos en Montevideo, Uruguay, 2020-2021 / Multsystemic inflammatory syndrome in post-Covid children: clinical case studies in Montevideo, Uruguay, 2020-2021 / Sindrome inflamatório multisistêmico pós-COVID em crianças: relato de casos em Montevdéu, Uruguai, 2020-2021

El síndrome inflamatorio multisistémico asociado a COVID-19 es una presentación postinfecciosa, que puede ser particularmente grave, pudiendo producir una severa disfunción multiorgánica. Se presenta una serie de 6 casos clínicos, asistidos en Servicio Médico Integral, Montevideo-Uruguay, con el fin de exponer las características clínicas y paraclínicas de este nuevo síndrome, y la evolución clínica de los mismos. Se realiza un estudio observacional descriptivo. La edad media fue de 6 años, con predominio en sexo femenino. Estos pacientes tuvieron una presentación clínica leve a moderada, con buena evolución Las manifestaciones clínicas principales fueron: fiebre, compromiso gastrointestinal, mucocutáneo y afectación ocular; dos de estos pacientes presentaron compromiso cardiovascular. Todos tuvieron alteraciones en la paraclínica, destacándose reactantes de fase aguda elevados. Todos los pacientes recibieron inmunoglobulina intravenosa y corticoides, tres de ellos recibieron heparina de bajo peso molecular por valor de D-dímeros 5 veces por encima del valor de referencia. No descartamos el impacto del diagnóstico y tratamiento precoz en la buena evolución de estos niños.

The Multisystem Inflammatory Syndrome associated with COVID-19 is a postinfectious presentation, which can be particularly serious, and can produce severe multiorgan dysfunction. A report of 6 clinical cases, assisted in the Comprehensive Medical Service, Montevideo-Uruguay, is presented in order to expose the clinical and paraclinical characteristics of this new syndrome, and their clinical evolution. A descriptive observational study was carried out. The mean age was 6 years, with a predominance of females. These patients had a mild to moderate clinical presentation, with good evolution. The main clinical manifestations were: fever, gastrointestinal and mucocutaneous involvement, and ocular involvement; two of these patients had cardiovascular compromise. All had alterations in the paraclinical, standing out elevated acute phase reactants. All patients received intravenous immunoglobulin and corticosteroids, three of them received low molecular weight heparin with a value of D-dimers 5 times higher than the reference value. We do not rule out the impact of early diagnosis and treatment on the positive evolution of these children.

A Síndrome Inflamatória Multissistêmica associada à COVID-19 é uma apresentação pósinfecciosa, que pode ser particularmente grave e produzir disfunção grave de múltiplos órgãos. Apresentamos um relato de 6 casos clínicos, atendidos no Serviço Médico Integral, Montevidéu-Uruguai, com o objetivo de expor as características clínicas e para clínicas desta nova síndrome, e sua evolução clínica. Tratase de um estudo observacional descritivo. A média de idade foi de 6 anos, com predomínio do sexo feminino. Esses pacientes tinham apresentação clínica leve a moderada, com boa evolução. As principais manifestações clínicas foram: febre, envolvimento gastrointestinal, muco cutâneo e ocular; dois desses pacientes apresentaram comprometimento cardiovascular. Todos apresentavam alterações para clínicas, destacandose elevados reagentes na fase aguda. Todos os pacientes receberam imunoglobulina e corticosteroides endovenosos, três deles receberam heparina de baixo peso molecular com valor do dímero D 5 vezes acima do valor de referência. Não descartamos o impacto do diagnóstico e tratamento precoces na evolução positiva dessas crianças.

Formulation Process Analysis of a Virus-based Biopesticide to Control the Tomato leafminer Tuta absoluta

Abstract: Virus-based biopesticides are effective biocontrol agents of crop insect pests. Development of suitable formulations and production processes are necessary to obtain high-quality products easily adopted by farmers. A detailed unit operation study was carried out for the production process of a Phthorimaea operculella granulovirus-based biopesticide to control the tomato leafminer, Tuta absoluta, one of the most important pests affecting this crop. Physicochemical, microbiological, and insecticidal parameters were implemented in the process and applied to the finished product, and a scaling strategy was developed. A Quantitative Polymerase Chain Reaction (Q-PCR) technique was implemented to quantify viral concentrations in the active ingredient (5.34 ± 1.44 x109 Occlusion Bodies mL-1) and in the finished product (>1.6x109 OB mL-1), without contaminant interferences. The Q-PCR methodology was also useful to select the appropriate solid mixing time following Lacey´s mixing index (8 min). Factors and similarity principles influencing the liquid mixing process were identified in the scaling evaluation. Furthermore, the drying kinetics analysis enabled identifying a drying temperature of 35 °C, with an efficacy under controlled conditions higher than 97%. Contaminant concentration was lower than 1%, indicating controlled and aseptic formulation process conditions. A simple statistical method was used to estimate the reproducibility and repeatability of the parameters assessed in the finished product. These results enable to establish and extrapolate important parameters in the standardization, scale-up, and quality control for the granulovirus-based biopesticide.

Abundance and richness of Arctiinae moths throughout the night in a Cerrado area / Abundância e riqueza de mariposas Arctiinae ao longo da noite em uma área de Cerrado

Abstract: The main goal of this work was to investigate how the abundance and richness of Arctiinae moths varies over time, during the night. Specifically, we analyzed the following questions: (1) Is there a relationship between Arctiinae abundance and richness with the temperature and relative humidity? (2) What are the hours of activity of each species of moth? (3) Does the species composition differ over night? (4) Is it necessary to sample this group of moths throughout the night to have a representative sample of the species? We sampled the moths in Emas National Park (17°49'-18°28'S and 52°39'-53°10'W), Brazil. We selected seven sampling points in an area of savanna. At each sampling point, we collected the Arctiinae moths with a light trap (with a 15-W black light fluorescent light bulb), reflected in a white cloth (2 x 3 m) extended vertically. We sampled the moths in seven consecutive nights (one night in each sampling point, from December 13 to December 19, 2012, from 7 p.m. until 7 a.m.). We divided the samplings in twelve periods over the night, with an hour each. At each period of time, we measured the temperature and the relative humidity with a digital termohygrometer. We sampled 149 individuals belonging to 17 species of Arctiinae moths. Most species (70.5%) were active only for one or two hours at night. The species differed in terms of time activity. The higher abundance occurred at 8 p. m. (44 individuals), followed by 38 individuals at 9 p. m. and 23 at 10 p. m. The species richness was also higher in the early hours of the night. The temperature was the only variable that showed a positive and significative relationship with the Arctiinae moth abundance. The species richness was not influenced neither by the temperature nor by the relative air humidity. The possible causes of the peak of abundance and species richness in specific hours of the night are discussed.

Resumo: Este trabalho teve como objetivo principal investigar como a abundância e a riqueza de mariposas Arctiinae variam temporalmente, ao longo do período noturno. Especificamente, analisamos as seguintes questões: (1) existe relação entre a abundância e a riqueza de Arctiinae e a umidade relativa do ar e a temperatura? (2) qual é o horário de atividade de cada espécie de mariposa? (3) a composição de espécies difere ao longo da noite? (4) é necessário amostrar esse grupo de mariposas ao longo de toda a noite para ter uma amostra representativa das espécies? Realizamos as amostragens no Parque Nacional das Emas (17°49'-18°28'S e 52°39'-53°10'W), Brasil. Selecionamos sete pontos amostrais em uma área de campo cerrado. Em cada ponto, coletamos as mariposas Arctiinae utilizando uma fonte luminosa (lâmpada UV de 15 W) refletida em um pano branco (2 x 3 m) estendido na vertical. Coletamos as mariposas durante sete noites consecutivas (uma noite por ponto, entre os dias 13 e 19 de dezembro de 2012, das 19:00 até as 07:00). Dividimos o período noturno em doze faixas de uma hora. Medimos a temperatura e a umidade relativa do ar com auxílio de um termohigrômetro digital. Amostramos 149 indivíduos pertencentes a 17 espécies de mariposas Arctiinae. A maioria das espécies (70,5%) esteve ativa apenas por uma ou duas horas durante a noite. As espécies diferiram em termos de horário de atividade. O horário das 20 h apresentou uma maior abundância (44 indivíduos), seguido do horário das 21 (38) e das 22 h (23). A riqueza também foi maior nas primeiras horas da noite. Somente a temperatura foi positivamente correlacionada com a abundância de mariposas. A riqueza de mariposas não foi influenciada nem pela temperatura nem pela umidade relativa do ar. As possíveis causas das diferenças em termos de horários de atividade são discutidas..

Clinical decision making in older adults with COVID-19 in developing countries: looking beyond chronological age

ABSTRACT Background: The coronavirus disease 2019 (COVID-19) has been declared a global pandemic. Older adults have been found as a vulnerable group for developing severe forms of disease and increased mortality. Objective: The objective of the study was to propose a pathway to assist the decision-making process for hospital resource allocation for older adults with COVID-19 using simple geriatric assessment-based tools. Methods: We reviewed the available literature at this point of the COVID-19 outbreak, focusing in older adult care to extract key recommendations for those health-care professionals who will be treating older adults in the hospital emergency ward (HEW) in developing countries during the COVID-19 pandemic. Results: We listed a series of easy recommendations for non-geriatrician doctors in the HEW and suggested simple tools for hospital resource allocation during critical care evaluation of older adults with COVID-19 in low- and middle-income countries. Conclusions: Age must not be used as the sole criterion for resource allocation among older adults with COVID-19. Simple and efficient tools are available to identify components of the comprehensive geriatric assessment, which could be useful to predict outcomes and provide high-quality care that would fit the particular needs of older adults in resource-limited settings amidst this global pandemic.

Importância da biópsia hepática no diagnóstico da deficiência de lipase ácida lisossomal: relato de caso / Importance of liver biopsy in the diagnosis of lysosomal acid lipase deficiency: a case report

RESUMO Objetivo: Descrever a doença de depósito de ésteres de colesterol (DDEC) e a importância da biópsia hepática na realização do diagnóstico. Descrição do caso: Paciente feminina, dois anos e dez meses de idade, com queixa de aumento do volume abdominal secundário à hepatomegalia há quatro meses. Ultrassonografia abdominal demonstrou hepatomegalia e esteatose hepática. Exames laboratoriais mostraram aumento de enzimas hepáticas e dislipidemia. A biópsia hepática foi compatível com DDEC. Comentários: Embora a medida da atividade enzimática seja o padrão-ouro para o diagnóstico de DDEC, a biópsia hepática é muito útil na investigação de casos suspeitos, particularmente quando há outros diagnósticos diferenciais a serem considerados.

ABSTRACT Objective: To describe a case of cholesteryl ester storage disease (CESD) and discuss the importance of liver biopsy for diagnosis. Case description: A female patient, aged two years and ten months, presented with an increased abdominal volume following hepatomegaly for four months. Abdominal ultrasound demonstrated hepatomegaly and hepatic steatosis. Laboratory tests showed elevated liver serum enzymes and dyslipidemia. Liver biopsy was consistent with CESD. Comments: Although measuring enzyme activity is the gold standard for CESD diagnosis, liver biopsy is very helpful when investigating suspected cases of CESD, particularly upon other differential diagnoses to be considered.

Diagnosis and Management of Classica Homocystinuria in Brazil: A Summary of 72 Late-Diagnosed Patients

Abstract This study described a broad clinical characterization of classical homocystinuria (HCU) in Brazil. This was a cross-sectional, observational study including clinical and biochemical data from 72 patients (60 families) from Brazil (South, n = 13; Southeast, n = 37; Northeast, n = 8; North, n = 1; and Midwest, n = 1). Parental consanguinity was reported in 42% of families. Ocular manifestations were the earliest detected symptom (53% of cases), the main reason for diagnostic suspicion (63% of cases), and the most prevalent manifestation at diagnosis (67% of cases). Pyridoxine responsiveness was observed in 14% of patients. Only 22% of nonresponsive patients on treatment had total homocysteine levels <100 mmol/L. Most commonly used treatment strategies were pyridoxine (93% of patients), folic acid (90%), betaine (74%), vitamin B12 (27%), and low-methionine diet + metabolic formula (17%). Most patients diagnosed with HCU in Brazil are late diagnosed, express a severe phenotype, and poor metabolic control. Milder forms of HCU are likely underrepresented due to underdiagnosis.

Diagnóstico diferencial de lesiones cutáneas infecciosas en paciente VIH: reporte de un caso / Differential diagnosis of infectious skin lesions in an HIV-positive patient: a case report

La infección por VIH confiere al portador la susceptibilidad para desarrollar un conjunto de infecciones que normalmente no serían encontradas en un paciente inmunocompetente. En Colombia, en el año 2015, se reportaron 11.606 casos de infección por VIH. En este escrito documentamos el caso de un paciente con diagnóstico de infección por VIH, el cual desarrolló lesiones típicas de infección por el virus Varicela Zoster, y se documentó la evolución de las lesiones vesiculares hacia flictenas con necrosis local. Dada la presentación del caso, el diagnóstico de lesiones en piel en pacientes inmunocomprometidos o con infección por VIH se convierte en un reto para el profesional de la salud a la hora de establecer un diagnóstico etiológico, a fin de establecer un adecuado tratamiento de acuerdo a este.

HIV infection makes HIV carriers susceptible to develop a group of infections that would not normally be found in an immunocompetent patient. In Colombia, a total of 11,606 cases of HIV infection were reported in 2015. This paper documents the case of a patient diagnosed with HIV infection, who developed lesions typically caused by the varicellazoster virus. These vesicular lesions evolved into phlyctenas with local necrosis. Given the case presentation, the diagnosis of skin lesions in immunocompromised or HIV-infected patients becomes a challenge for health professionals when determining an etiological diagnosis, in order to establish an appropriate treatment.

Analysis of the combined effects of resveratrol and radiation on lung cancer cells

Mucoepidermoid lung carcinoma is frequently manifested by obstructive trachea symptoms. It is necessary to develop effective curative or palliative therapeutic strategies for treating mucoepidermoid lung carcinoma through administration of compounds that improve ionizing radiation treatment, thereby increasing the effects of the treatment on tumor cells while minimizing the effects on normal tissues surrounding the tumor cells. Resveratrol is a polyphenolic phytoalexin present in wines and several plants and has a broad spectrum of biological activities, including antioxidant and anticarcinogenic effects. The biological effects of ionizing radiation plus resveratrol have been examined in different types of cell in many studies. Here, we aimed to verify the effects of resveratrol on mucoepidermoid lung carcinoma cells NCI-H292 exposed to ionizing radiation. In vitro studies in NCI-H292 cell culture using neutral red uptake assays showed that the cytotoxicity index (IC50) of resveratrol was 401.5 µM, and the lethal dose 50 % (LD50) of ionizing radiation in the absence of resveratrol was 693 Gy. In vitro micronucleus...(AU)

Identifying fear-evoking pictures from the International Affective Picture System (IAPS) in a Chilean sample / Identificando un conjunto de imágenes provocadoras de miedo del International Affective Picture System (IAPS) en una muestra chilena

the goal of this study was to identify a valid set of fear-evoking pictures from IAPS images (Lang, Bradley, & Cuthbert, 2008) in a Chilean Sample. To do so, categorical and dimensional ratings of pictures made by our participants were analyzed, considering potential sex differences. We also evaluated potential transcultural differences by comparing our results with the results of Barke, Stahl, & Kröner-Herwig (2012), whose methodology was followed in the present study, but incorporating new statistical criteria for the valid identification of pictures that evoke fear. Sixty Chilean volunteers (30 women) with a mean age of 22.3 years rated 146 pictures of the LAPS regarding to the choice of discrete emotions and the ratings of valence, arousal and dominance. Six pictures were identified that evoked fear significantly more than any other emotion. Compared to the German sample, the Chilean group evaluated images with more arousal and valence.

El objetivo del presente estudio fue identificar, en una muestra chilena, un conjunto válido de imágenes provocadoras de miedo a partir de un conjunto de imágenes del IAPS (Lang, Bradley, & Cuthbert, 2008). Para ello, se analizaron las calificaciones categoriales y dimensionales de las imágenes observadas por 60 participantes, evaluando la existencia de diferencias en función del sexo del examinado. Asimismo, se estudiaron posibles diferencias transculturales, comparando los resultados obtenidos con los hallazgos de Barke, Stahl y Kröner-Herwig (2012), cuya metodología fue similar a la utilizada en este trabajo. Así, 60 voluntarios chilenos (30 mujeres) con una media de 22,3 años, puntuaron 146 imágenes del IAPS respecto a la elección de las emociones y las calificaciones de valencia, excitación y dominio. Se identificaron seis imágenes que provocaron más miedo que cualquier otra emoción. En comparación con la muestra alemana, el grupo chileno evaluó las imágenes con mayor excitación y valencia.

Eritrodisestesia o síndrome mano pie. Presentación de dos casos y revisión de la literatura / Erythrodysesthesia or foot hand syndrome Presentation of two cases and review of the literature

La eritrodisestesia, o síndrome mano pie, es una reacción adversa relacionada con algunos agentes quimioterápicos. Se caracteriza por comenzar con un pródromo de disestesia palmo-plantar y, entre 2 a 4 días, la sensación progresa a un dolor quemante con edema y eritema en placas bien delimitadas y simétricas. Los quimioterápicos que se asocian con más frecuencia son la doxorrubicina, 5-fluorouracilo, capecitabina, citarabina y docetaxel. Es más frecuente y severo en mujeres, pacientes de edad avanzada o con compromiso vascular periférico. Se presentan dos pacientes de sexo femenino. La primera con cáncer de ovario en tratamiento con doxorrubicina liposomal que presentó eritrodisestesia luego del quinto ciclo de quimioterapia. La segunda paciente con diagnóstico de cáncer de mama que recibió tratamiento con capecitabina presentando síntomas luego del segundo ciclo de quimioterapia. El interés de la presentación es la consulta a dermatología por un síndrome que constituye un efecto adverso que potencialmente limita el uso de determinados antineoplásicos. Sin embargo, educando al paciente, con intervenciones farmacológicas y ajuste de dosis, es posible aliviar los síntomas continuando una terapéutica efectiva (AU)

Erythrodysesthesia, or hand foot syndrome, is a side effect related to some chemotherapeutic agents. It is characterized by a prodrome of palmoplantar dysesthesia followed by burning pain with edema and erythema on well-defined and symmetrical plaques, 2-4 days later. Doxorubicin, 5-fluorouracil, capecitabine, cytarabine and docetaxel are the most frequently associated chemotherapy drugs. Women, elderly or peripheral vascular compromise patients are more frequent and severe affected. Two female patients are reported. The first patient with ovarian cancer in treatement with liposomal doxorrubicin developed erythrodysesthesia after the fifth cycle of chemotherapy. Meanwhile the second patient diagnosed with breast cancer in treatment with capecitabine developed it after the second cycle of chemotherapy. The interest of this report is the dermatological consultation about a side effect syndrome which potentially limits the prescription of certain antineoplastic drugs. However, patients can continue specific treatment by indicating dose adjustment and prescribing medicine to relieve the symptoms (AU)

Arctiinae moths (Lepidoptera, Erebidae) of the Emas National Park, Goiás, Brazil / Mariposas Arctiinae (Lepidoptera, Erebidae) do Parque Nacional das Emas, Goiás, Brasil

Arctiinae are a species-rich subfamily of moth, with approximately 1,400 species in Brazil and 723 recorded in the Cerrado biome. A list of species of these moths was compiled during three years of sampling in four vegetation types within the Emas National Park. A total of 5,644 individuals belonging to 149 species were collected. About 67% of these species are new records for the Emas National Park, 31% for the State of Goiás and 9% for the Cerrado biome. Cerrado sensu stricto and semideciduous forests have higher species richness, followed by campo cerrado and campo sujo. The vegetation type with the highest number of exclusive species was the semideciduous forest, followed by cerrado sensu stricto, campo cerrado and campo sujo. The high species richness and the high proportion of new species records for Goiás and Cerrado reinforce the importance of the Emas National Park region as a center of diversity for this group of moths. The conservation of areas not yet cleared around the Park, including the creation of new protected areas, and the establishment of ecological corridors between these areas and the Park would be strategies to preserve the fauna of these moths.

Arctiinae é uma das subfamílias de mariposas mais ricas em espécies. Já foram registradas cerca de 1400 espécies no Brasil e 723 no bioma Cerrado. Uma lista de espécies destas mariposas foi compilada de três anos de amostragens realizadas em quatro fitofisionomias do Parque Nacional das Emas. Um total de 5.644 indivíduos, pertencentes a 149 espécies foram coletados. Cerca de 67% das espécies representam novos registros para o Parque Nacional das Emas, 31% para o Estado de Goiás e 9% para o bioma Cerrado. Cerrado sensu stricto e mata estacional semidecídua apresentaram maior riqueza de espécies, seguidas por campo cerrado e campo sujo. A fitofisionomia que apresentou maior número de espécies exclusivas foi a mata estacional semidecídua, seguida por cerrado sensu stricto, campo cerrado e campo sujo. A grande riqueza de espécies e a alta proporção de novos registros de espécies para Goiás e para o Cerrado reforçam a importância da região do Parque Nacional das Emas como um centro de diversidade para esse grupo de mariposas. A conservação das áreas ainda não desmatadas no entorno do Parque, incluindo a criação de novas unidades de conservação, e o estabelecimento de corredores ecológicos entre essas áreas e o Parque seriam estratégias para preservar a fauna dessas mariposas.

Factores asociados a la aceptación de donar órganos entre la población de Querétaro / Factors associated with organ donation acceptance by the population in Queretaro / Fatores associados à aceitação da população à doação de órgãos em Querétaro

La presente investigación busca determinar los factores asociados a la aceptación de donar órganos entre la población de Queré\r\n-\r\ntaro. Se realizó un estudio transversal comparativo en población ubicada en iglesias, parques recreativos, lugares de trabajo, zona \r\ncomercial y agrupaciones sociales de la ciudad de Querétaro, México. Se integraron dos grupos: con y sin aceptación de donar \r\nórganos, conformados por personas de 18 años o mayores, previo consentimiento informado. El tamaño de la muestra (n=117 \r\npersonas por grupo) se calculó mediante la fórmula de porcentajes para dos poblaciones con un nivel de confianza del 95%; se \r\nseleccionó a la población con la técnica muestral no aleatoria por cuota. Para analizar el fenómeno, se establecieron las siguientes \r\nvariables: características sociodemográficas, y factores económicos, sociales, culturales y psicológicos. El análisis estadístico incluyó \r\npromedios, desviación estándar, porcentajes, prueba de chi cuadrado, razón de momios, IC 95%, modelo y proyección. De acuerdo \r\ncon los resultados, los factores psicológicos asociados a la aceptación de donar de órganos fueron servir a una persona (RM=13,94; IC 95%; 1,86-104,19), satisfacción de ayudar (RM=7,39; IC 95%; 2,95-18,55) y alegría de que otra persona viva con algo mío (RM=4,61; \r\nIC 95%; 1,36-15,62). Se concluye que los factores psicosociales se asocian a la aceptación de donar órganos. El miedo en general y \r\nel miedo a una muerte prematura se asocian a la no aceptación de donar órganos.

Objective: to determine the factors associated with organ \r\ndonor status in the population of Queretaro. Method: a \r\ncross-sectional study was conducted in the general popu\r\n-\r\nlation found in churches, recreational parks, workplaces, \r\nshopping centers, and social gatherings in the city of Quere\r\n-\r\ntaro, Mexico. Two groups were created: organ donors, and \r\nnon-organ donors, both made up of people over 18 years old, \r\nwith informed consent. Data sample size (n = 117 people per \r\ngroup) was calculated using the percent formula for two popu\r\n-\r\nlations with a confidence level of 95%, and the population was \r\nselected with the nonrandom sampling technique by quota. \r\nTo analyze the phenomenon, the following variables were \r\nestablished: socio-demographic characteristics; economic, \r\nsocial, cultural and psychological factors. The statistical analysis \r\nincluded mean, standard deviation, percentages, chi square \r\ntest, odds ratio, 95% confidence interval, and projection model. \r\nResults: psychological factors associated with organ donor \r\nstatus are: helping a person (OR = 13.94; 95% CI 1.86 to 104.19), \r\nthe satisfaction of helping a person (OR = 7.39; 95% CI 2.95 to \r\n18.55) and the joy of another person living due to my organ \r\ndonation (OR = 4.61 person; 95% CI 1.36 to 15.62). Conclusions: \r\npsychosocial factors are associated with organ donor status. \r\nFears in general, and fear of premature death, are associated \r\nwith non-organ donors.

Objetivo: determinar fatores associados à aceitação da popu\r\n-\r\nlação à doação de órgãos em Querétaro. Método: um estudo \r\ntransversal comparativo foi realizado em população localizada \r\nem igrejas, parques recreativos, locais de trabalho, lojas e grupos \r\nsociais na cidade de Querétaro, México. Foram formados dois \r\ngrupos: com e sem a aceitação à doação de órgãos feita por \r\npessoas acima de 18, com consentimento prévio informado. O \r\ntamanho da amostra (n=117 pessoas por grupo) foi calculada \r\nutilizando a fórmula de percentagens para duas populações \r\ncom um nível de confiança de 95%, a população foi selecio\r\n-\r\nnada com a técnica de amostragem não aleatória por quota. \r\nPara analisar o fenômeno, estabeleceram-se as seguintes \r\nvariáveis: características sociodemográficas; factor econômico, \r\nsocial, cultural e psicológico. A análise estatística incluiu média, \r\ndesvio padrão, percentagens, teste do qui quadrado, razão \r\nde possibilidades, IC de 95%, modelo e projeção. Resultados: \r\nos fatores psicológicos associados com a aceitação à doação \r\nde órgãos são: servir uma pessoa (OR = 13,94; IC de 95%; 1,86-\r\n104,19), satisfação de ajudar (OR = 7,39; IC de 95%; 2,95-18,55) e \r\nalegria de que outra pessoa viva com algo meu (OR = 4,61; IC \r\nde 95%; 1,36-15,62). Conclusões: os fatores psicossociais asso\r\n-\r\nciados com a aceitação da doação de órgãos. O medo em \r\ngeral e o medo de uma morte prematura se associam à não \r\naceitação de doação de órgãos.

Descripción del perfil neuropsicológico de cuatro casos con intoxicación por mercurio elemental / Description of the neuropsychological profile of four cases with elemental mercury poisoning

El mercurio elemental, es un metal tóxico líquido a temperatura ambiente; sus vapores son absorbidos por el organismo humano y atraviesa fácilmente la barrera hematonencefálica. Su exposición crónica genera una intoxicación que lleva al cuadro clínico llamado eretismo mercurial, caracterizado por cambios comportamentales, cognitivos y motores. Los efectos a largo plazo de la intoxicación por mercurio elemental no ha sido ampliamente documentada, razón por la cual el objetivo del presente estudio es describir el perfil neuropsicológico secundario a un cuadro de intoxicación por mercurio elemental, en un grupo familiar después de un tiempo de evolución de 20 años. Se realizó una evaluación neuropsicológica a cuatro sujetos intoxicados por mercurio elemental encontrando alteraciones en la atención ejecutiva, memoria operativa, memoria verbal a corto plazo, memoria visual, procesamiento viso construccional, fluidez semántica y fonológica, velocidad de procesamiento, altas implicaciones en las funciones ejecutivas, conductas comportamentales de predominio frontal y depresión. Se concluye que generalmente las alteraciones son permanentes en el tiempo de evolución de la patología y que no existe diferenciación en las funciones cognitivas afectadas, independientemente del ciclo vital por el cual atraviese la persona al momento de padecer la intoxicación...

Elemental mercury is a toxic metal liquid at room temperature. Whose vapours are absorbed by the human organism and readily crosses the blood-brain barrier. Its chronic exposition leads to erethismmercurialis, a neurological disorder characterized by behavioural, cognitive and motor changes. Long-term effects of mercurial poisoning are not widely documented; the aim of the present study is to describe the neuropsychological profile of a family, poisoned by elemental mercury 20 years ago. Cognitive deficits in executive attention, working memory, short-term verbal memory, visual memory, visuo constructional processing, semantic fluency, processing speed, elicited deficits in executive functions, frontal behavioural conducts and depression where found. It is concluded, that generally in chronic poisoning the deficits are permanent in time and that there are not differences on the cognitive deficits, independently of the cycle of life in which the person is at the moment when the poisoning occurs...

Acute liver failure in a term neonate after repeated paracetamol administration / Falencia hepatica aguda en neonato a termino despues de la ingestion de dosis repetidas de paracetamol / Falencia hepatica aguda em neonato de termo apos ingestao de doses repetidas de paracetamol

Objective: Severe hepatotoxicity caused by paracetamol is rare in neonates. We report a case of paracetamol-induced acute liver failure in a term neonate. Case description: A 26-day-old boy was admitted with intestinal bleeding, shock signs, slight liver enlargement, coagulopathy, metabolic acidosis (pH=7.21; bicarbonate: 7.1mEq/L), hypoglycemia (18mg/dL), increased serum aminotransferase activity (AST=4,039IU/L; ALT=1,087IU/L) and hyperbilirubinemia (total: 9.57mg/dL; direct: 6.18mg/dL) after receiving oral paracetamol (10mg/kg/dose every 4 hours) for three consecutive days (total dose around 180mg/kg; serum concentration 36-48 hours after the last dose of 77µg/ mL). Apart from supportive measures, the patient was successfully treated with intravenous N-acetylcysteine infusion during 11 consecutive days, and was discharged on day 34. The follow-up revealed full recovery of clinical and of laboratory findings of hepatic function. Comments: The paracetamol pharmacokinetics and pharmacodynamics in neonates and infants differ substantially from those in older children and adults. Despite the reduced rates of metabolism by the P-450 CYP2E1 enzyme system and the increased ability to synthesize glutathione - which provides greater resistance after overdoses -, it is possible to produce hepatotoxic metabolites (N-acetyl-p-benzoquinone) that cause hepatocellular damage, if glutathione sources are depleted. Paracetamol clearance is reduced and the half-life of elimination is prolonged. Therefore, a particular dosing regimen should be followed due to the toxicity risk of cumulative doses. This report highlights the risk for severe hepatotoxicity in neonates after paracetamol multiple doses for more than two to three days. .

Objetivo: La hepatotoxicidad grave inducida por el paracetamol es muy rara en neonatos. Se relata el caso de un neonato a término que desarrolló falencia hepática aguda después del uso de paracetamol. Descripción del caso: Niño, 26 días, admitido con sangrado intestinal, señales de choque, discreta hepatomegalia, coagulopatía, acidosis metabólica (pH=7,21; bicarbonato: 7,1mEq/L), hipoglucemia (18mg/dL), aumento de las aminotransferasas séricas (AST=4.039UI/L; ALT=1.087UI/L) e hiperbilirrubinemia (total: 9,75mg/dL; directa: 6,18mg/dL), después del uso de paracetamol por vía oral (10mg/kg/dosis a cada cuatro horas) durante tres días consecutivos (dosis alrededor de 180mg/kg; nivel sérico de 36-48 horas después de la última dosis de 77µg/mL). Además de las medidas de soporte, el paciente fue tratado con N-acetilcisteína (infusión intravenosa continua por 11 días consecutivos), recibiendo alta después de 34 días de internación. El seguimiento mostró recuperación clínica y de los parámetros laboratoriales de la función hepática. Comentarios : La farmacocinética y la farmacodinámica del paracetamol en neonatos y lactantes jóvenes (menores de un año) difieren substancialmente de niños más grandes y adultos. A pesar de que las tasas de metabolismo del sistema enzimático P-450 CYP2E1 están reducidas y la capacidad de generar glutatión, aumentada - confiriendo más protección después de superdosis -, existe la posibilidad de producción de metabólitos hepatotóxicos (N-acetil-pbenzoquinoneimina) que determinan lisis celular, caso se agoten las reservas de glutatión. La depuración es reducida y la media vida de la eliminación, alargada, recomendándose posología distinta por el riesgo de toxicidad ...

Objetivo: A hepatoxicidade grave induzida pelo paracetamol é muito rara em neonatos. Relata-se o caso de um neonato de termo que desenvolveu falência hepática aguda após o uso de paracetamol. Descrição do caso: Menino, 26 dias, admitido com sangramento intestinal, sinais de choque, discreta hepatomegalia, coagulopatia, acidose metabólica (pH=7,21; bicarbonato: 7,1mEq/L), hipoglicemia (18mg/dL), aumento das aminotransferases séricas (AST=4.039UI/L; ALT=1.087UI/L) e hiperbilirrubinemia (total: 9,57mg/dL; direta: 6,18mg/dL), após uso de paracetamol via oral (10mg/kg/dose a cada quatro horas) por três dias consecutivos (dose total ao redor de 180mg/kg; nível sérico de 36-48 horas após a última dose de 77µg/mL). Além das medidas de suporte, o paciente foi tratado com N-acetilcisteína (infusão intravenosa contínua por 11 dias consecutivos), recebendo alta após 34 dias de internação. O seguimento mostrou recuperação clínica e dos parâmetros laboratoriais da função hepática. Comentários: A farmacocinética e a farmacodinâmica do paracetamol em neonatos e lactentes jovens (menores de um ano) diferem substancialmente de crianças maiores e adultos. Apesar de as taxas de metabolismo do sistema enzimático P-450 CYP2E1 estarem diminuídas e a capacidade de gerar glutationa, aumentadas - conferindo maior proteção após superdosagens -, existe a possibilidade de produção de metabólitos hepatotóxicos (N-acetil-p-benzoquinoneimina) que determinam lise celular, caso se esgotem as reservas de glutationa. A depuração é diminuída e a meia-vida de eliminação é prolongada, recomendando-se posologia distinta pelo risco de toxicidade de doses cumulativas. O presente relato destaca o risco de hepatotoxicidade grave ...

Estudo da etiopatogenia da hidropisia fetal não-imune a partir de uma série de casos utilizando um protocolo de investigação ampliado / Study of etiopathogenesis of non-immune hydrops fetalis from a series of cases using an expanded investigation protocol

A hidropisia fetal não-imune (HFNI) é causada por um grupo heterogêneo de condições e atualmente corresponde à maior parte dos casos de hidropisia fetal. Em função da ampla diversidade etiopatogênica, a investigação dos casos de HFNI constitui um desafio diagnóstico. Esse estudo teve como objetivo a avaliação prospectiva e sistemática de uma série de casos de HFNI a partir de um protocolo de investigação ampliado, que incluiu a pesquisa de doenças metabólicas. O presente estudo também incluiu a revisão dos casos de HFNI registrados previamente pelo Programa de Genética Perinatal na maternidade da Unicamp. Durante aproximadamente dois anos (2010-2012), foram identificados 53 casos de HFNI. Nesse período, ocorreram 6.129 nascimentos na maternidade local, com registro de HFNI em 37 recém-nascidos, conferindo uma prevalência de 60 por 10.000 nascimentos, valor maior do que o observado no período anterior ao estudo (1987 a 2009). Para o restante da análise, quatro casos foram excluídos devido à impossibilidade de estudá-los adequadamente. A maioria dos hidrópicos nasceu pré-termo (43 - 73,5%). Houve registro de 23 nativivos (47%), 10 óbitos no período neonatal e 26 óbitos durante a gestação (53%), resultado em uma mortalidade geral (pré-natal e neonatal) de 73,4%. A hidropisia foi identificada no pré-natal na maioria dos casos (44 - 89,8%) e, apesar da condição ser comumente associada a mau prognóstico, em três pacientes (6,1%) houve resolução completa e espontânea da hidropisia durante a gestação. Os principais grupos diagnósticos encontrados foram: anomalias cromossômicas (17 casos - 34,7%), quadros sindrômicos (16,4% - oito casos), cardiopatias e infecções congênitas (8,2% - quatro casos cada). Os erros inatos do metabolismo (EIM) corresponderam a 6,1% da amostra (três casos de doenças de depósito lisossômico). Três casos (6,1%) foram classificados como idiopáticos.

Non-immune hydrops fetalis (NIHF) is caused by a hetereogenous group of conditions, currently accounting for the most cases of hydrops fetalis. Because of the wide etiopathogenic diversity, the investigation of NIHF cases constitutes a real diagnostic challenge. This study aimed to evaluate prospectively and systematically a series of NIHF cases from an expanded research protocol including the investigation of metabolic diseases. The present study also aimed to revise the NIHF cases previously recorded by Perinatal Genetics Program (PGP) in the maternity hospital of Unicamp. During approximately two years (2010-2012), 53 cases were identified. In this period, among 6,129 births that occurred in our hospital, NIHF was identified in 37 newborns, given a birth prevalence of 60 per 10,000, higher than that was observed in the previous period - 23:10,000 (1987-2009). For purpose of all other analysis, four of the 53 cases evaluated had to be excluded due to inability to assess them correctly. Most hydropic individuals were born preterm (43 - 73.5%). Twenty-three patients (47%) were live births, 10 of them died before hospital discharge; and 26 (53%) died in the prenatal period, given an overall mortality of 73.4%. The hydrops were identified in prenatal period in most cases (44 - 89.8%), and despite being commonly associated with poor prognosis, three cases (6.1%) had complete and spontaneous resolution of hydrops during pregnancy. The main diagnostic groups were chromosomal abnormalities (17 - 34.7%), syndromic (8 - 16.4%), isolated heart defects (4 - 8.2%), and congenital infections (4 - 8.2%). Inborn errors of metabolism (IEM) occurred in three cases (6.1%), all represented by lysosomal storage diseases. Three cases (6.1%) were classified as idiopathic.

Exitoso cultivo in vitro de gametocitos de Plasmodium falciparum / Successful in vitro culture of Plasmodium falciparum gametocytes

Introducción. Los estadios sexuales de Plasmodium falciparum han sido menos estudiados que los estadios asexuales. Al parecer, esto se debe a la carencia de cultivos estandarizados in vitro y a la dificultad de reconocer sus estadios de desarrollo. Estos hechos no permiten el estudio de aspectos biológicos, aspectos metabólicos, expresión de genes y síntesis de proteínas durante los estadios sexuales, temas de interés en la investigación de nuevos medicamentos antipalúdicos, principalmente los aislados de plantas, y la identificación de un potencial blanco contra Plasmodium. Objetivos. Establecer un cultivo in vitro de gametocitos, con la identificación de sus cinco estadios de desarrollo, y asegurar su continua producción. Materiales y métodos. El cultivo in vitro de gametocitos se realizó a partir de la cepa NF54 de P. falciparum en medio RPMI, con determinación de la parasitemia asexual y sexual, adición de glóbulos rojos A-Rh+ sólo el primer día de cultivo y cambio diario del medio con adición de mezcla de gases (90 por ciento N2, 5 por ciento O2; 5 por ciento CO2), asegurándose que el cultivo se mantuviera a 37 °C. Cuando la parasitemia asexual estuvo entre 3 por ciento y 5 por ciento , se comenzó a agregar el doble de volumen de medio. Resultados. Se obtuvieron gametocitos en estadios I, II y III a partir del día 11 de cultivo y estadios IV y V a partir del día 14 de cultivo. Conclusiones. Se estandarizó un cultivo in vitro para estadios sexuales de P. falciparum que puede usarse para futuros estudios de evaluación de compuestos, naturales o sintéticos, que actúen sobre los gametocitos, lo cual podría permitir el desarrollo de nuevas estrategias de control contra el paludismo.