[Palliative care for people with advanced Parkinson's disease. A systematic review]. / Cuidados paliativos para personas con enfermedad de Parkinson avanzada. Revisión sistemática.

INTRODUCTION: Palliative care refers to treatment aimed at the early and comprehensive identification of pain and other physical, psychosocial and spiritual problems that limit the quality of life of the person, their family and their caregivers. The aim of this article is to identify palliative interventions used for the assessment and control of symptoms in people with advanced Parkinson's disease (PD). MATERIALS AND METHODS: A systematic review of the literature was conducted following the steps proposed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was guided by a structured review question and included original studies of patients with advanced PD published in databases such as Medline and Google Scholar between 2010 and 2021. RESULTS: Thirty-one full-text studies were reviewed and 12 were excluded due to not meeting quality criteria. A total of 19 papers were included in this systematic review, which identified 10 clinical tools to assess palliative needs in advanced PD, four pharmacological interventions, and three non-pharmacological interventions focused on reducing motor symptoms, improving quality of life and avoiding the on/off state. One study reported the referral of patients to complementary and device-assisted therapies. CONCLUSION: As part of the palliative approach, a set of tools for identifying symptoms and assessing palliative care needs have been described. Interventions in advanced PD focus on the control of motor and non-motor symptoms so as to reduce the impact of the disease on quality of life.

TITLE: Cuidados paliativos para personas con enfermedad de Parkinson avanzada. Revisión sistemática.Introducción. Los cuidados paliativos hacen referencia al tratamiento dirigido a la identificación precoz e impecable del dolor y otros problemas físicos, psicosociales y espirituales que limitan la calidad de vida de la persona, la familia y sus cuidadores. El objetivo de este artículo es identificar las intervenciones paliativas utilizadas para la valoración y el control de síntomas en personas con enfermedad de Parkinson (EP) avanzada. Materiales y métodos. Se desarrolló una revisión sistémica de la bibliografía aplicando los pasos propuestos por Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). La búsqueda se orientó a partir de una pregunta de revisión estructurada y se incluyeron estudios originales de pacientes con EP avanzada publicados en bases de datos como Medline y Google Scholar entre 2010 a 2021. Resultados. Se revisaron 31 estudios en texto completo y se excluyeron 12 estudios por no alcanzar los criterios de calidad. En total, se incluyeron 19 trabajos en esta revisión sistemática, identificando 10 herramientas clínicas para valorar las necesidades paliativas en EP avanzada, cuatro intervenciones farmacológicas, y tres intervenciones no farmacológicas centradas en disminuir síntomas motores, mejorar la calidad de vida y evitar el estado on/off. Un estudio notificó la derivación del paciente a terapias complementarias y asistidas por dispositivos. Conclusión. Como parte del abordaje paliativo se han descrito un conjunto de herramientas para identificar síntomas y valorar necesidades de atención paliativa. Las intervenciones en la EP avanzada se enfocan en el control de los síntomas motores y no motores para disminuir el impacto de la enfermedad sobre la calidad de vida.

Primary cell wall inspired micro containers as a step towards a synthetic plant cell.

The structural integrity of living plant cells heavily relies on the plant cell wall containing a nanofibrous cellulose skeleton. Hence, if synthetic plant cells consist of such a cell wall, they would allow for manipulation into more complex synthetic plant structures. Herein, we have overcome the fundamental difficulties associated with assembling lipid vesicles with cellulosic nanofibers (CNFs). We prepare plantosomes with an outer shell of CNF and pectin, and beneath this, a thin layer of lipids (oleic acid and phospholipids) that surrounds a water core. By exploiting the phase behavior of the lipids, regulated by pH and Mg2+ ions, we form vesicle-crowded interiors that change the outer dimension of the plantosomes, mimicking the expansion in real plant cells during, e.g., growth. The internal pressure enables growth of lipid tubules through the plantosome cell wall, which paves the way to the development of hierarchical plant structures and advanced synthetic plant cell mimics.

Ovulation requires the activation on proestrus of M1 muscarinic receptors in the left ovary.

We analyzed the effects of chemically blocking type 1 muscarinic receptors (M1R) on either the left or right ovary on ovulation rate, number of ova shed and steroid hormones levels. M1R were unilaterally blocked in ovary with the M1R selective antagonist pirenzepine (PZP). PZP was delivered into the bursa ovarica of the left or right ovary of adult rats at 13:00 h on proestrus day. PZP treatment in the left but not in the right ovary blocked ovulation. PZP did not modify the number of ova shed, nor progesterone or 17ß-estradiol serum levels. The surge of luteinizing hormone levels was diminished while that of follicle-stimulating hormone did not change in animals treated with PZP in the left ovary. Interestingly, treatment with either synthetic luteinizing hormone-releasing hormone or human chorionic gonadotropin 1 h after PZP administration in the left ovary restored ovulation in both ovaries. The presence of M1R protein in the theca cells of the ovarian follicles as well as in cells of the corpus luteum was detected on proestrus day. These results suggest that M1R activation in the left ovary is required for pre-ovulatory gonadotropin-releasing hormone (GnRH) secretion and ovulation. Furthermore, these results also suggest that M1R in the left ovary might be regulating ovulation asymmetrically through a stimulatory neural signal relayed to the hypothalamus via the vagus nerve to induce the GnRH secretion which then triggers ovulation.

Manejo de artritis idiopática juvenil sistémica en pediatría con agentes biológicos: a propósito de un caso / Management of systemic idiopathic juvenile arthritis in pediatrics with biological agents: a propos of a case

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Anestesia intracervical para la realización del legrado uterino instrumental / Intracervical anesthetic infiltration for use with instrumental uterine curettage

OBJETIVO: En esta investigación se evaluó la infiltración anestésica intracervical en pacientes en situación de aborto para realizar el legrado uterino instrumental. Pacientes y métodos Se estudió una muestra de 20 pacientes en situación de aborto. El estudio fue abierto, prospectivo y exploratorio. La edad de las pacientes tuvo un rango de 17 a 49 años de edad, con una media y desviación estándar de 26,95 ± 9,2058. La edad de la gestación tuvo un rango de 5 a 14 semanas con una media y desviación estándar de 8,75 ± 2,4622. Para el análisis estadístico se usó el programa SPSS. Para la anestesia intracervical se utilizó lidocaína al 1%, 10 ml; 5 ml en cada una de las infiltraciones, la primera a las III y la segunda a las IX de las manecillas del reloj. RESULTADOS: La duración de la anestesia tuvo un rango de 30 a 70 min, con una media y desviación estándar de 48,25 ± 13,8992. CONCLUSIÓN: La duración del tiempo quirúrgico desde la infiltración anestésica y el legrado uterino tuvieron un rango de 7 a 14min, con una media y desviación estándar de 10,9 ± 2,1886. El sangrado tuvo un rango de 50 a 150ml, con una media y desviación estándar de 100 ± 44,7213. Todos los estudios fueron longitudinales

Objetive: We performed an open, prospective, exploratory and longitudinal study to evaluate the use of intracervical anesthetic infiltration with instrumental uterine curettage in 20 women undergoing pregnancy termination. PATIENTS AND METHODS: The patients' age ranged from 17 to 49 years (mean and SD:26.95±9.2058). The length of gestation ranged from 5 to 14 weeks (mean and SD:8.75±2.4622). The SPSS program was used for the statistical analysis. RESULTS: For intracervical anesthesia, 10 ml lidocaine at 1% was used; 5ml was applied at infiltration points III and IX clockwise. Anesthesia lasted 30 to 70 minutes (mean and SD: 48.25 ± 13.8992). CONCLUSIONS: Operating time (infiltration and curettage) ranged from 7 to 14 minutes (mean and SD: 10.9 ± 2.1886). Blood loss ranged from 50 to 150ml (mean and SD: 100 ± 44.7213). All studies were longitudinal

Nutrient inputs from submarine groundwater discharge on the Santiago reef flat, Bolinao, Northwestern Philippines.

Submarine groundwater discharge (SGD) on the reef flat of Bolinao, Pangasinan (Philippines) was mapped using electrical resistivity, 222Rn, and nutrient concentration measurements. Nitrate levels as high as 126 µM, or 1-2 orders of magnitude higher than ambient concentrations, were measured in some areas of the reef flat. Nutrient fluxes were higher during the wet season (May-October) than the dry season (November-April). Dissolved inorganic nitrogen (DIN=NO3+NO2+NH4) and soluble reactive phosphorus (SRP) fluxes during the wet season were 4.4 and 0.2 mmoles m(-2) d(-1), respectively. With the increase population size and anthropogenic activities in Bolinao, an enhancement of SGD-derived nitrogen levels is likely. This could lead to eutrophic conditions in the otherwise oligotrophic waters surrounding the Santiago reef flat.

Aged garlic extract delays the appearance of infarct area in a cerebral ischemia model, an effect likely conditioned by the cellular antioxidant systems.

Experimental evidence has shown that some garlic-derived products have a protective effect against ischemic brain injury. The present study was designed to investigate the effect of aged garlic extract (AGE), establish the therapeutic window, and determine its protective mechanism in a cerebral ischemia model. Animals were subjected to middle cerebral artery occlusion (MCAO) for 2h and treated with 1.2ml/kg body wt.(i.p.) of AGE 30min before, at the beginning of (0R), or 1h after reperfusion. The 0R treatment significantly reduced the size of the infarct area after 2h of reperfusion. Repeated doses subsequent to the 0R treatment (at 1, 2, or 3h after reperfusion) had no effect on the temporal window of protection. The protective 0R treatment with AGE prevented the increase in nitrotyrosine and the decrease in total superoxide dismutase, glutathione peroxidase, and extracellular superoxide dismutase activities induced by MCAO. These data indicate that AGE delays the effects of ischemia/reperfusion-induced neuronal injury. However, this treatment itself was not associated with a noticeable improvement in the neurological outcome, or with an effect on the inflammatory response. We conclude that the neuroprotective effect of AGE in the 0R treatment might be associated with control of the free-radical burst induced by reperfusion, preservation of antioxidant enzyme activity, and the delay of other pathophysiological processes.

[Immunotherapy with an oral Alternaria extract in childhood asthma. Clinical safety and efficacy and effects on in vivo and in vitro parameters]. / Inmunoterapia con un extracto oral de Alternaria en el asma infantil. Eficacia clínica, seguridad, repercusiones sobre parámetros in vivo e in vitro.

Studies of immunotherapy with oral Alternaria extracts are scarce. We decided to perform a clinical trial of the clinical safety and efficacy of this extract as well as of its effects on in vivo and in vitro parameters in 39 patients with Alternaria allergy, aged between 7 and 17 years, who are also sensitized extract was used. Allergic activity was determined through RAST inhibition and skin prick test. Quantification of the principal allerten (Alt a 1) was performed through the 2-site binding assay, with a mean content of 34.2 ng Alt a 1/micro g protein. The parameters analyzed were the symptom-medication score, skin prick using the end-point technique, specific bronchial challenge test, peak flow, total and specific IgE and IgG4. Nineteen patiens received active treatment with oral immunotherapy and another 19 received symptomatic treatment. The initial phase of immunotherapy lasted 3 months until the maximum dose was reached. This was maintained for 12 months; the mean accumulated dos was 280,000 PNU. Significant differences were found in reduction in the symptom-medication score in the treated group after 12 months of immunotherapy. No differences were found in the control group. Immunotherapy was well tolerated with 0.42 adverse reactions per 100 doses administered. All adverse reactions were mild-to-moderate. In the treated group, papule size was significantly reduced. Values for the specific bronchial challenge test, expressed through PD20, were significantly higher in the immunotherapy group. Peak flow showed no changes in either group. Values of IgG4 were significantly higher in the immunotherapy group. Total and specific IgE levels showed no significant changes in either group. In conclusion, oral immunotherapy with Alternaria extract is clinically effective in pediatric patients. In general, the therapy was well tolerated. It modified specific cutaneous and bronchial reactivity in our sample and increased levels of specific IgG4, wich are implicated in humoral response.

Inmunoterapia con un extracto oral del Alternaria en el asma infantil. Eficacia clínica, seguridad, repercusines sobre parámetros in vivo e in vitro / Immunotherapy with an oral Alternaria extract in chilhood asthma. Clinical safety and efficacy and effects on in vivo and in vitro

Ante la escasez de trabajos con inmunoterapia oral de Alternaria, planteamos la realización de un ensayo clínico en 39 pacientes, con edades comprendidas entre 7 y 17 años, alérgicos a Alternaria, y sensibilizados también a pólenes y epitelios para evaluar su eficacia clínica y seguridad, así como las repercusiones sobre parámetros in vivo e in vitro. Se empleó un extracto estandarizado, determinando la actividad alérgica mediante RAST inhibición y prick test cutáneo. La cuantificación del alergeno principal (Alt a 1) se llevó a cabo mediante la técnica de fijación en dos lugares, siendo el contenido medio de 34,2 ng Alt a 1/ g de proteína. Los parámetros analizados fueron la puntuación de síntomas-medicación, prick test cutáneo a punto final (TC), test de bronco provocación específico (TBPE), pico de flujo (PF), IgE total y específica e IgG4.Diecinueve pacientes recibieron tratamiento activo con inmunoterapia oral (ITO) y otros diecinueve recibieron tratamiento sintomático. La fase de inicio de la inmunoterapia duró 3 meses, hasta llegar a dosis máxima, que se mantuvo durante 12 meses, alcanzando una dosis acumulada media de 280.000 PNU. Se hallaron diferencias significativas en la disminución de la puntuación de síntomas-medicación en el grupo tratado, tras los 12 meses de inmunoterapia (ITO). No se encontraron diferencias en el grupo control. La inmunoterapia fue bien tolerada, presentando 0,42 reacciones adversas (RA) por 100 dosis administradas, siendo de carácter leve-moderado exclusivamente. Se encontró disminución significativa del tamaño de pápula en el grupo tratado. El TBPE expresado mediante la PD20 mostró cifras significativamente más altas en el grupo con ITO. El pico de flujo no mostró cambios en ninguno de los dos grupos. Los valores de la IgG4 fueron significativamente más altos en el grupo con inmunoterapia. Los niveles de IgE total y específica no mostraron cambios significativos en ambos grupos. En conclusión, la Inmunoterapia Oral con extracto de Alternaria ha demostrado eficacia clínica en pacientes pediátricos, siendo en general bien tolerada, modificando la reactividad específica cutánea y bronquial con incremento de los niveles de IgG4 específica implicados en la respuesta humoral (AU)

Studies of immunotherapy with oral Alternaria extracts are scarce. We decided to perform a clinical trial of the clinical safety and efficacy of this extract as well as of its effects on in vivo and in vitro parameters in 39 patients with Alternaria allergy, aged between 7 and 17 years, who are also sensitized extract was used. Allergic activity was determined through RAST inhibition and skin prick test. Quantification of the principal allerten (Alt a 1) was performed through the 2-site binding assay, with a mean content of 34.2 ng Alt a 1/μg protein. The parameters analyzed were the symptom-medication score, skin prick using the end-point technique, specific bronchial challenge test, peak flow, total and specific IgE and IgG4. Nineteen patiens received active treatment with oral immunotherapy and another 19 received symptomatic treatment. The initial phase of immunotherapy lasted 3 months until the maximum dose was reached. This was maintained for 12 months; the mean accumulated dos was 280,000 PNU. Significant differences were found in reduction in the symptom-medication score in the treated group after 12 months of immunotherapy. No differences were found in the control group. Immunotherapy was well tolerated with 0.42 adverse reactions per 100 doses administered. All adverse reactions were mild-to-moderate. In the treated group, papule size was significantly reduced. Values for the specific bronchial challenge test, expressed through PD20, were significantly higher in the immunotherapy group. Peak flow showed no changes in either group. Values of IgG4 were significantly higher in the immunotherapy group. Total and specific IgE levels showed no significant changes in either group. In conclusion, oral immunotherapy with Alternaria extract is clinically effective in pediatric patients. In general, the therapy was well tolerated. It modified specific cutaneous and bronchial reactivity in our sample and increased levels of specific IgG4, wich are implicated in humoral response (AU)

Papel del fisioterapeuta en una asociación de Parkinson / Role of physiotherapy in a Parkinson's associations

La enfermedad de Parkinson se manifiesta básicamente por la presencia de temblor, rigidez muscular, lentificación y dificultad para iniciar el movimiento.Los medios de los que dispone la Fisioterapia son muy variados, pero generalmente, y por desgracia, los enfermos de Parkinson no suelen seguir un programa de Fisioterapia controlado en una sala adaptada para este fin.Por ello hemos dirigido nuestro trabajo hacia las posibilidades que tienen los pacientes de mejorar/mantener los síntomas de su enfermedad, beneficiándose de sesiones de Fisioterapia en aquellas asociaciones que cuenten con este programa.A continuación mostramos nuestra experiencia de trabajo como fisioterapeutas en la Asociación de Parkinson de Málaga. (AU)

Determinación de beta lactamasas de espectro expandido en el laboratorio: análisis comparativo de tres métodos / Determination of expanded spectrum beta lactamases in the laboratory: comparative analysis of three methods

58 cepas (16 escherichia coli y 42 klebsiella pneumoniae) aisladas de muestras clínicas entre septiembre 1999 y julio 2000 en las secciones de bacteriología del Laboratorio Metropolitano Hospital José Gregorio Hernández y Hospital de Clínicas Caracas, con patrón sugestivo de ser productoras de ß-lactamasa de espectro expandido (BLEE) sensibles a cefoxitin y resistentes a ceftazidime, cefotaxime, ceftriaxone y aztreonam) fueron evaluadas de forma prospectiva por los métodos del doble disco (DD), Etest (AB Biodisk) y ATB BLSE (bioMérieux) para la detección de BLEE, tomando como técnica de referencia la de DD, obteniéndose en general un 100 por ciento de correlación con la prueba de Etest y un 86,2 por ciento con la de ATB BLSE, estadísticamente no significativa (p>0,05). Se recomienda el uso de ambas técnicas para la confirmación de cepas productoras de BLEE en conjunto con el despistaje inicial realizado a través del análisis de los patrones de resistencia obtenido por las metodologías usadas rutinariamente en los laboratorios para la realización del antibiograma.

Fungicidal activity of latex sap from Carica papaya and antifungal effect of D(+)-glucosamine on Candida albicans growth.

Carica papaya latex sap inhibits the growth of Candida albicans when added to a culture during the exponential growth phase. Approximately 60% was achieved. This fungistatic effect is the result of cell wall degradation due to a lack of polysaccharidic constituents in the outermost layers of the fungal cell wall and release of cell debris into the culture medium. When C. albicans was cultured on medium supplemented with D(+)-glucosamine, an inhibitor of N-acetyl-beta-D-glucosaminidase, growth was inhibited (34%) in a similar manner. Addition of D(+)-glucosamine during the exponential growth phase also had a fungistatic effect (26%). The modes of action of C. papaya latex and of D(+)-glucosamine in cell wall breakdown are discussed.

Pituitary-ovarian dysfunction in rats with induced nephrotic syndrome.

The reproductive hormonal profile was evaluated in female rats with experimental nephrotic syndrome induced with a single subcutaneous dose of puromycin aminonucleoside (PAN). Serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), progesterone (P4), testosterone and 17 beta-estradiol (E2) were determined sequentially in control and experimental groups on days 1, 3, 7 and 10 after PAN administration. Prolactin levels were also assessed on day 10. In both groups, vaginal smears were taken daily throughout the study to evaluate cyclic histological changes. At the end of the experiment the histological appearance of the ovaries was evaluated by light microscopy. Nephrotic rats had a rapid loss of the estrous cycle starting on day 4, which set them at diestrus. At the same time the hormonal evaluation indicated a gradual decrease in E2, LH and P4 concentrations, starting from days 3, 7 and 10, respectively. No significant changes were noted in FSH or testosterone values. Besides, on day 10, prolactin concentrations remained unmodified. Even though most hormonal levels were found low on day 10, all values except E2 (undetectable) corresponded to the interval reported for the diestrus phase. Likewise, histological examination of ovarian tissue from nephrotic rats showed a considerable increase in the number of atretic follicles. These findings indicate that female rats with nephrotic syndrome develop an important endocrine dysfunction that probably involves steroidogenic tissues (ovary and/or adrenal gland), and suggest the existence of a hypothalamic-hypophyseal impairment.

Structure, expression, and antisense inhibition of the systemin precursor gene.

A gene that encodes systemin, a mobile 18-amino acid polypeptide inducer of proteinase inhibitor synthesis in tomato and potato leaves, has been isolated from tomato, Lycopersicon esculentum. Induction of proteinase inhibitors in plants is a response to insect or pathogen attacks. The gene has 10 introns and 11 exons, ten of which are organized as five homologous pairs with an unrelated sequence in the eleventh, encoding systemin. Systemin is proteolytically processed from a 200-amino acid precursor protein, prosystemin. Prosystemin messenger RNA was found in all organs of the plant except the roots and was systemically wound-inducible in leaves. Tomato plants transformed with an antisense prosystemin complementary DNA exhibited greatly suppressed systemic wound induction of proteinase Inhibitor I and II synthesis in leaves.

Plant hallucinogens, shamanism and Nazca ceramics.

The ceramics of the ancient Nazca, an extinct people that lived on the south coast of Peru from 100 to 800 AD, are examined. It is suggested that plant hallucinogens and stimulants including Trichocereus pachanoi, Erythroxylon coca, Datura spp., and Anadenanthera peregrina were utilized in religious ritualism connected with shamanism, stressing personal ecstasy as a means of contact with the supernatural on the part of regional religious-political leaders. Shamanic themes linked to world-wide plant hallucinogenic ingestion are identified and summarized, and their representation in Nazca ceramic art delineated.