Identification of Two Exosomal miRNAs in Circulating Blood of Cancer Patients by Using Integrative Transcriptome and Network Analysis.

Exosomes carry molecules of great biological and clinical interest, such as miRNAs. The contents of exosomes vary between healthy controls and cancer patients. Therefore, miRNAs and other molecules transported in exosomes are considered a potential source of diagnostic and prognostic biomarkers in cancer. Many miRNAs have been detected in recent years. Consequently, a substantial amount of miRNA-related data comparing patients and healthy individuals is available, which contributes to a better understanding of the initiation, development, malignancy, and metastasis of cancer using non-invasive sampling procedures. However, a re-analysis of available ncRNA data is rare. This study used available data about miRNAs in exosomes comparing healthy individuals and cancer patients to identify possible global changes related to the presence of cancer. A robust transcriptomic analysis identified two common miRNAs (miR-495-3p and miR-543) deregulated in five cancer datasets. They had already been implicated in different cancers but not reported in exosomes circulating in blood. The study also examined their target genes and the implications of these genes for functional processes.

Bioinformatic Tools for the Analysis and Prediction of ncRNA Interactions.

Noncoding RNAs (ncRNAs) play prominent roles in the regulation of gene expression via their interactions with other biological molecules such as proteins and nucleic acids. Although much of our knowledge about how these ncRNAs operate in different biological processes has been obtained from experimental findings, computational biology can also clearly substantially boost this knowledge by suggesting possible novel interactions of these ncRNAs with other molecules. Computational predictions are thus used as an alternative source of new insights through a process of mutual enrichment because the information obtained through experiments continuously feeds through into computational methods. The results of these predictions in turn shed light on possible interactions that are subsequently validated experimentally. This review describes the latest advances in databases, bioinformatic tools, and new in silico strategies that allow the establishment or prediction of biological interactions of ncRNAs, particularly miRNAs and lncRNAs. The ncRNA species described in this work have a special emphasis on those found in humans, but information on ncRNA of other species is also included.

Regulation of Antitumor Immune Responses by Exosomes Derived from Tumor and Immune Cells.

Exosomes are lipid membrane-enclosed vesicles released by all cell types that act at the paracrine or endocrine level to favor cell differentiation, tissue homeostasis, organ remodeling and immune regulation. Their biosynthesis begins with a cell membrane invagination which generates an early endosome that matures to a late endosome. By inward budding of the late endosome membrane, a multivesicular body (MVB) with intraluminal vesicles (ILVs) is generated. The fusion of MVBs with the plasma membrane releases ILVs into the extracellular space as exosomes, ranging in size from 30 to 100 nm in diameter. The bilipid exosome membrane is rich in cholesterol, ceramides and phosphatidylserine and can be loaded with DNA, RNA, microRNAs, proteins and lipids. It has been demonstrated that exosome secretion is a common mechanism used by the tumor to generate an immunosuppressive microenvironment that favors cancer development and progression, allowing tumor escape from immune control. Due to their ability to transport proteins, lipids and nucleic acids from the cell that gave rise to them, exosomes can be used as a source of biomarkers with great potential for clinical applications in diagnostic, prognostic or therapeutic areas. This article will review the latest research findings on exosomes and their contribution to cancer development.

TTL Proteins Scaffold Brassinosteroid Signaling Components at the Plasma Membrane to Optimize Signal Transduction in Arabidopsis.

Brassinosteroids (BRs) form a group of steroidal hormones essential for plant growth, development, and stress responses. BRs are perceived extracellularly by plasma membrane receptor-like kinases that activate an interconnected signal transduction cascade, leading to the transcriptional regulation of BR-responsive genes. TETRATRICOPEPTIDE THIOREDOXIN-LIKE (TTL) genes are specific for land plants, and their encoded proteins are defined by the presence of protein-protein interaction motives, that is, an intrinsic disordered region at the N terminus, six tetratricopeptide repeat domains, and a C terminus with homology to thioredoxins. TTL proteins thus likely mediate the assembly of multiprotein complexes. Phenotypic, molecular, and genetic analyses show that TTL proteins are positive regulators of BR signaling in Arabidopsis (Arabidopsis thaliana). TTL3 directly interacts with a constitutively active BRASSINOSTEROID INSENSITIVE1 (BRI1) receptor kinase, BRI1-SUPPRESSOR1 phosphatase, and the BRASSINAZOLE RESISTANT1 transcription factor and associates with BR-SIGNALING KINASE1, BRASSINOSTEROID INSENSITIVE2 kinases, but not with BRI1-ASSOCIATED KINASE1. A functional TTL3-green fluorescent protein (GFP) shows dual cytoplasmic plasma membrane localization. Depleting the endogenous BR content reduces plasma membrane localization of TTL3-GFP, while increasing BR content causes its plasma membrane relocalization, where it strengthens the association of BR signaling components. Our results reveal that TTL proteins promote BR responses and suggest that TTL proteins may function as scaffold proteins by bringing together cytoplasmic and plasma membrane BR signaling components.

Establishment of Two Dimensional (2D) and Three-Dimensional (3D) Melanoma Primary Cultures as a Tool for In Vitro Drug Resistance Studies.

Characteristics of melanoma cells have been deciphered by studies carried out in two dimensional cell cultures growing as adherent monolayers on the bottom of plastic flasks. Melanoma cells can be cultured with a considerable degree of success, and, depending on the further use of the cells obtained in the culture, methodologies have to be adjusted to obtain reliable results. Although there are many melanoma continuous cell lines, in vitro 2D and 3D melanoma primary cell culture may be a more useful model to investigate interactions between cancer cells and immune system, as well as the effect of cytotoxic treatments and personalized medicine in environments more similar to the physiological conditions.Here, we described a protocol which employs many strategies to obtain primary 2D and 3D melanoma cultures as a model to study cell-cell and cell-microenvironment interactions that must be considered to properly design personalized cancer treatments, as well as for testing novel anticancer drugs and drug delivery vehicles.

Self-perception of weight and physical fitness, body image perception, control weight behaviors and eating behaviors in adolescents.

INTRODUCTION: self-perception of weight and physical fitness, aesthetic reasons to diet, self-weighing as a way to feel better and body image perception have been related to a constellation of risks to develop both body image dissatisfaction and eating behavior disturbances, especially among adolescents. OBJECTIVES: to analyze weight self-perception and self-reported physical fitness, to explore the links between these variables and weight control behaviors, to explore possible relations among weight self-perception, self-reported physical fitness, dieting, self-weighing frequency and body mass index (BMI)/body image and to analyze the relation between all these variables and different eating behaviors. METHODS: a total of 336 students (mean age of 12.46 ± 2.14; 47.62% females) took part in this study. Different scales were administered (weight self-perception and self-reported physical fitness, dieting, self-weighing frequency, body image perception, eating behaviors) and height and weight were measured in order to obtain the BMI. RESULTS: mean BMI was 20.18 ± 3.58 and 41.14% of participants had overweight/obesity. Among those who perceived themselves as overweight,76.92% were girls. More than 70% of participants reported average or good physical fitness and more boys reported good or excellent physical fitness. Almost 60% of participants who planned to diet for aesthetic reasons were girls, and girls more than boys self-weighed to feel better. BMI was significantly correlated with body image dissatisfaction/restrictive eating. CONCLUSIONS: there are clear links between weight self-perception, body image, dieting, self-weighing and eating behaviors at an age which might be considered as a starting point to eating behavior disturbances.

Autocuidado de las encías y salud periodontal / Autocuidado das gengivas e saúde periodontal / Self-care of the gingiva and periodontal health

Introducción: en Cuba se prioriza la atención a la salud bucal, la que está determinada por diferentes factores, entre los que prevalece la incidencia de la enfermedad periodontal que hoy se reconoce como problema de salud, pues daña el bienestar biopsicosocial del individuo. Objetivo: brindar a los estomatólogos las bases teóricas que le permitan enriquecer su preparación respecto al tema enfermedad periodontal y de esta manera mejorar su contribución a su prevención desde el nivel de atención primaria a la salud bucal. Método: se sistematizaron los referentes relacionados con la enfermedad periodontal en la Facultad de Ciencias Médicas de Guantánamo, en el período de enero a julio de 2017. Resultados: el primer estadío de la enfermedad periodontal se conoce como gingivitis. La enfermedad periodontal incide hasta en un 20 % de la población mundial. El cuidado de las encías para la prevención de la enfermedad periodontal requiere que el individuo se apropie de los saberes esenciales que le posibiliten esta finalidad, a fin de que sean capaces de percibir el riesgo de ella y contribuir con las acciones dirigidas a la protección o restauración de la salud periodontal. Conclusiones: se ofrecen bases teóricas para la comprensión de la necesidad de desarrollar en los pacientes una cultura del cuidado de las encías por una salud periodontal. Se reitera el valor de estomatólogo, la familia, la escuela, los medios y la comunidad como agentes sociales responsables de la educación de la población en función de la promoción de salud periodontal y la prevención de las enfermedades periodontales(AU)

Introduction: in Cuba attention to oral health is prioritized, which is determined by various factors, including incidence of periodontal disease that now a day is recognized as a health problem, it damages the individual as well as biopsicosocial well-being. Objective: stomatologists provide the theoretical bases that allow them to enrich their preparation on the subject periodontal disease thus improve their contribution to prevent primary care level to oral health. Method: the references related to periodontal disease in the Faculty of Medical Sciences of Guantanamo are systematized, from January to July 2017. Results: first stage of periodontal disease is known as gingivitis. Periodontal disease affects 20% of the world population. The gingiva care to prevent periodontal disease requires the individual to appropriate the essential knowledges that will enable this purpose, so that they are able to perceive the risk of it and contribute to actions with the aim of protecting periodontal health. Conclusions: theoretical basis for understanding the need to develop in patients offer culture of gingival care by a periodontal health. The value of stomatology, family, school, community media and reiterated responsible for education as social agents of the population depending on periodontal health promotion and prevention of periodontal diseases(AU)

Introdução: Cuba atenção à saúde bucal é priorizada, que é determinada por vários fatores, incluindo a incidência de doença periodontal que prevalece é agora reconhecida como um problema de saúde, ele danifica o bem-estar biopsicossocial do indivíduo. Objetivo: fornecer aos estomatologistas as bases teóricas que lhes permitirão enriquecer seu preparo em relação à questão da doença periodontal e, assim, melhorar sua contribuição para sua prevenção, desde o nível de atenção primária até a saúde bucal. Método: os referentes à doença periodontal foram sistematizados na Faculdade de Ciências Médicas de Guantánamo, no período de janeiro a julho de 2017. Resultados: o primeiro estágio da doença periodontal é conhecido como gengivite. A doença periodontal afeta até 20% da população mundial. O cuidado das gengivas para a prevenção da doença periodontal exige que o indivíduo se aproprie dos conhecimentos essenciais que possibilitam esse propósito, para que eles sejam capazes de perceber o risco dele e contribuir com as ações voltadas à proteção ou Restauração da saúde periodontal. Conclusões: bases teóricas são oferecidas para a compreensão da necessidade de desenvolver em pacientes uma cultura de cuidado gengival para a saúde periodontal. O valor do estomatologista, da família, da escola, da mídia e da comunidade são reiterados como agentes sociais responsáveis pela educação da população em termos de promoção da saúde periodontal e prevenção de doenças periodontais(AU)

Series de Pediatría Garrahan. El niño con problemas neurológicos / Garrahan Pediatrics Series. The child with neurological problems

Las afecciones neurológicas son uno de los motivos de consulta más frecuentes en la práctica pediátrica ambulatoria y ocupan un alto índice de las camas en la internación. El papel del pediatra en este contexto es muy complejo, ya que es quien recibe a un paciente en la emergencia o en el consultorio y debe estar atento a si un determinado síntoma o signo neurológico puede ser transitorio o el indicio de una enfermedad grave. Así, son fundamentales tanto el conocimiento de las distintas entidades neurológicas y de sus aspectos epidemiológicos y patogénicos como también el examen semiológico y los primeros estudios por realizar para la orientación diagnóstica, el tratamiento inicial, las indicaciones de derivación, la prevención de riesgos y el asesoramiento a los padres. Este nuevo volumen aborda esta temática especial con énfasis en el trabajo interdisciplinario y entre sus características se destacan: El estudio de importantes temas clínicos, como las convulsiones febriles, que se presentan en el 2% al 5% de los niños; la epilepsia infantil, con una prevalencia del 1%; la cefalea, cuya incidencia ha aumentado en los últimos veinte años y es hoy el motivo de consulta más frecuente en los servicios de neurología; las crisis paroxísticas no epilépticas, que aparecen entre el 5% y el 20% de la población infantil; el desafío diagnóstico del lactante hipotónico; las encefalopatías agudas, y los trastornos de la marcha y del movimiento. La inclusión, en todos los capítulos, de casos clínicos con su evolución y desenlace, textos destacados con los principales conceptos, puntos claves para recordar, además de material complementario, como bibliografía adicional, videos y enlaces a sitios web de interés. Una obra sólida y práctica, que transmite las experiencias de los profesionales de una institución del prestigio internacional del Hospital de Pediatría Prof. Dr. Juan P. Garrahan ­a treinta años de su creación- dedicada a todos los pediatras, donde quiera que trabajen al servicio de la salud de los niños.

Series de Pediatría Garrahan. El niño con problemas respiratorios / Garrahan Pediatrics Series. The child with respiratory problems

La patología respiratoria presenta un gran desafío para las instituciones de salud, por su frecuencia, su complejidad diagnóstica y terapéutica y la carga que representa en costos económicos y vitales. Estos conceptos se extienden a todos los grupos etarios y sus características han ido cambiando a lo largo del tiempo ante los avances producidos en las inmunizaciones, los métodos diagnósticos y los tratamientos. Aún así, las infecciones respiratorias bajas son todavía la causa más frecuente de consulta, internación, morbilidad crónica, discapacidad y mortalidad en pediatría. Este nuevo volumen aborda esta temática especial y entre sus características se destacan: El estudio de las patologías más frecuentes en los diferentes ámbitos de atención pero en particular en el primer nivel, con una exposición centrada en los aspectos que facilitan el diagnóstico rápido y el tratamiento adecuado, con el menor uso de recursos y con pautas que fijan la derivación oportuna hacia el especialista o hacia una institución de mayor complejidad. El desarrollo de importantes temas, como la patología obstructiva de la vía aérea superior, su estudio diagnóstico y sus formas recurrentes; bronquiolitis; las intercurrencias respiratorias en pacientes con condiciones clínicas especiales; y la supuración pleuropulmonar. La inclusión, en todos los capítulos, de casos clínicos con su evolución y desenlace, textos destacados con los principales conceptos y puntos claves para recordar. Una obra sólida y práctica, que transmite la experiencia de los profesionales de una institución del prestigio internacional del Hospital dePediatría Prof. Dr. Juan P. Garrahan, dedicada a todos los pediatras, dondequiera que trabajen al servicio de la salud de los niños.

HLA-mediated tumor escape mechanisms that may impair immunotherapy clinical outcomes via T-cell activation.

Although the immune system provides protection from cancer by means of immunosurveillance, which serves a major function in eliminating cancer cells, it may also lead to cancer immunoediting, molding tumor immunogenicity. Cancer cells exploit several molecular mechanisms to thwart immune-mediated death by disabling cellular components of the immune system associated with tumor recognition and rejection. Human leukocyte antigen (HLA) molecules are mandatory for the immune recognition and subsequent killing of neoplastic cells by the immune system, as tumor antigens must be presented in an HLA-restricted manner to be recognized by T-cell receptors. Impaired HLA-I expression prevents the activation of cytotoxic immune mechanisms, whereas impaired HLA-II expression affects the antigen-presenting capability of antigen presenting cells. Aberrant HLA-G expression by cancer cells favors immune escape by inhibiting the activities of virtually all immune cells. The development of cancer therapies based on T-cell activation must consider these HLA-associated immune evasion mechanisms, as alterations in their expression occur early and frequently in the majority of types of cancer, and have an adverse impact on the clinical response to immunotherapy. Herein, the concept of altered HLA expression as a mechanism exploited by tumors to escape immune control and induce an immunosuppressive environment is reviewed. A number of novel clinical immunotherapeutic approaches used for cancer treatment are also reviewed, and strategies for overcoming the limitations of these immunotherapeutic interventions are proposed.

Capacitación hospitalaria de profesionales pediátricos en investigación y gestión / In-hospital capacity-building in research and management for pediatric professionals

Se describe una estrategia de capacitación en investigación y gestión para profesionales hospitalarios iniciada en 2006 en un hospital pediátrico y sus resultados a ocho años de su implementación. Gestión e Investigación en Pediatría es un curso anual de 250 horas, teórico-práctico, semipresencial con soporte en campus virtual. Proporciona herramientas de investigación (epidemiología, metodología, búsqueda bibliográfica, medicina basada en evidencias, bioestadistica) y gestión (planificación estratégica, programas de gestión, investigación en servicios de salud, calidad, economía de la salud). Se evalúa mediante ejercicios de integración, un examen final y un proyecto grupal de investigación o gestión. Los resultados obtenidos entre 2006 y 2013 fueron altamente satisfactorios. La implementación en el ámbito hospitalario de un programa de capacitación intensivo en gestión e investigación para profesionales de la salud es una estrategia útil para facilitar la incorporación y aplicación de herramientas prácticas para investigación, interpretación crítica de la bibliografía biomédica y gestión racional de servicios pediátricos.

We describe an educational strategy aimed at capacity-building of hospital health care professionals in research and management initiated at a pediatric hospital in 2006, and the results obtained eight years after its implementation. Research and Management in Pediatrics (GIP) is an annual 250-hour course combining meetings and off-site assignments delivered through the Hospital's on-line campus. It provides students with practical tools for research (epidemiology, methodology, bibliographic search, evidence-based medicine, biostatistics) and management (strategic planning, management programs, health services research, quality improvement, health economics). Assessment methods included integrative exercises, a final evaluation, and a group research or management project. Results obtained over the 2006-2013 period were highly satisfactory. An intensive training program on research and management is a useful strategy for in-hospital capacity-building of pediatric health care professionals in basic tools for research activities, critical reading of biomedical literature and rational management ofpediatric health services.

In-hospital capacity-building in research and management for pediatric professionals. / Capacitación hospitalaria de profesionales pediátricos en investigación y gestión.

We describe an educational strategy aimed at capacity-building of hospital health care professionals in research and management initiated at a pediatric hospital in 2006, and the results obtained eight years after its implementation. Research and Management in Pediatrics (GIP) is an annual 250-hour course combining meetings and off-site assignments delivered through the Hospital's on-line campus. It provides students with practical tools for research (epidemiology, methodology, bibliographic search, evidencebased medicine, biostatistics) and management (strategic planning, management programs, health services research, quality improvement, health economics). Assessment methods included integrative exercises, a final evaluation, and a group research or management project. Results obtained over the 2006-2013 period were highly satisfactory. An intensive training program on research and management is a useful strategy for in-hospital capacity-building of pediatric health care professionals in basic tools for research activities, critical reading of biomedical literature and rational management of pediatric health services.

Se describe una estrategia de capacitación en investigación y gestión para profesionales hospitalarios iniciada en 2006 en un hospital pediátrico y sus resultados a ocho años de su implementación. Gestión e Investigación en Pediatría es un curso anual de 250 horas, teórico-práctico, semipresencial con soporte en campus virtual. Proporciona herramientas de investigación (epidemiología, metodología, búsqueda bibliográfica, medicina basada en evidencias, bioestadística) y gestión (planificación estratégica, programas de gestión, investigación en servicios de salud, calidad, economía de la salud). Se evalúa mediante ejercicios de integración, un examen final y un proyecto grupal de investigación o gestión. Los resultados obtenidos entre 2006 y 2013 fueron altamente satisfactorios. La implementación en el ámbito hospitalario de un programa de capacitación intensivo en gestión e investigación para profesionales de la salud es una estrategia útil para facilitar la incorporación y aplicación de herramientas prácticas para investigación, interpretación crítica de la bibliografía biomédica y gestión racional de servicios pediátricos

Series de Pediatría Garrahan. El niño con cáncer / Garrahan Pediatrics Series. The child with cancer

La sobrevida de los niños con enfermedades oncológicas ha aumentado de manera considerable en las últimas décadas y este logro se alcanzó, entre otros factores, gracias a la detección temprana de la patología, los avances en los métodos diagnósticos, la administración de terapéuticas específicas adaptadas al riesgo y la adecuada implementación de medidas de soporte. Sin embargo, el cuidado de estos pacientes sigue representando un difícil desafío y requiere la conformación de equipos en los que el pediatra cumple un rol fundamental en la atención conjunta con el oncólogo y en la coordinación de la intervención de los demás especialistas. Este nuevo volumen aborda esta interesante temática y entre sus características destacadas se encuentran: El estudio de importantes temas, como la prevención del cáncer en pediatría en el mundo y en la Argentina, y la necesidad de construir programas de integración, educación e investigación en el cáncer pediátrico; el niño con una masa abdominal, con sus estrategias diagnósticas y las eventuales urgencias metabólicas, infectológicas y nutricionales durante el período de inducción, y cómo anticiparlas y prevenirlas; las situaciones clínicas de riesgo, como la compresión medular, el síndrome de vena cava superior y las complicaciones asociadas con la utilización de irinotecán; los aspectos ginecológicos en las niñas con cáncer, como las conductas frente al riesgo de sangrado menstrual durante el período de inducción, la actividad sexual y el embarazo durante el tratamiento, y la preservación de la fertilidad; y la leucemia linfoblástica aguda en etapa de reinducción, período especialmente significativo por la elevada morbilidad y las dificultades en el soporte clínico que requieren estos pacientes. La inclusión en todos los capítulos de casos clínicos ejemplificadores con su evolución y desenlace, textos destacados con los conceptos más importantes y puntos clave para recordar. Una obra sólida y práctica, que transmite la experiencia de los profesionales de una institución del prestigio internacional del Hospital de Pediatría Prof. Dr. Juan P. Garrahan, dedicada a todos los pediatras dondequiera que trabajen al servicio de los niños.

Successful use of infliximab and tacrolimus combination therapy in a patient with ulcerative colitis refractory to infliximab dose intensification plus azathioprine.

OBJECTIVE: To report of a case successful use of infliximab (IFX) and tacrolimus (TAC) in a patient with ulcerative colitis (UC). CASE SUMMARY: A 22-year-old woman diagnosed with UC started treatment with azathioprine 2.5 mg/kg. After 3 years of therapy, she developed a severe relapse. A colonoscopy was performed showing diffuse continuous mucosal disease and multiple erosions (< 5 mm) with no signs of spontaneous bleeding. Treatment with IFX 5 mg/kg at weeks 0, 2, and 6 was started. After IFX induction, she remained with symptoms: six stools per day, as well as presenting bloody diarrhea, tenesmus, and no abdominal pain. An IFX dose intensification of 5 mg/kg every 6 weeks was prescribed. After 6 months of azathioprine plus IFX therapy, patient's clinical condition was improved: 3 - 4 stools per day, 20% of bloody diarrhea, tenesmus, and no abdominal pain. Her Mayo endoscopic subscore was 6.3 months later, and a severe relapse of ulcerative colitis was presented. The patient refused a surgical treatment. Azathioprine 2.5 mg/kg/day was suspended and TAC 0.2 mg/kg/day (12 mg/day) as a compassionate use was added to IFX dose intensification of 10 mg/kg every 8 weeks and mesalamine 800 mg 3 times daily. After the first month of combined therapy, the patient's clinical condition improved with no bloody stools and abdominal pain. After 6 months of combination therapy, the patient was in remission, with two stools per day, no tenesmus and no abdominal pain. Due to the patient's clinical remission, IFX was suspended. Tacrolimus was continued on 10 mg/day. After 6 months of TAC monotherapy, the patient continued without symptoms (1 - 2 normal stools per day). CONCLUSIONS: Based on our case, the combination therapy of IFX and TAC could be selected as an effective approach for the patients with UC refractory to IFX dose intensification plus AZA. However, further studies need to be performed to evaluate the efficacy of this combination therapy.

Solvent-free enzymatic production of high quality cetyl esters.

A solvent-free biocatalytic process for the synthesis of high quality cetyl laurate, myristate, palmitate and stearate has been optimized. This enzymatic procedure follows the fundamental principles of the Green Chemistry and lead to sustainable products, which can be labeled as natural and conform to the principal requirements for its use in high value-added goods. The four esters selected are the main components of spermaceti, a mixture of waxes very appreciated in cosmetic and pharmacy because of its physical properties and emolliency, which was formerly extracted from the head of the sperm whales. In this paper, the influence of the amount of biocatalyst, the commercially available Novozym(®) 435, and the temperature were studied in an open-air batch reactor before carrying out the synthesis in a high performance vacuum reactor with dry nitrogen input to shift the equilibrium towards product formation. Under optimal conditions, conversion was higher than 98.5 %. The characterization of the enzymatic cetyl esters puts in evidence that these are ultra-pure compounds, which have similar properties to the ones obtained through the conventional industrial processes with the extra benefit of being environmentally friendly.

Modelo de trabajo en red para la atención de pacientes del conurbano bonaerense en el Hospital Garrahan / Networking model for the care of patients from Greater Buenos Aires at the Garrahan Hospital

Con el objetivo de recibir en el Hospital Garrahan a los pacientes provenientes de los municipios del conurbano bonaerense y atenderlos según la complejidad, se elaboró una estrategia en red respetando las modalidades de cada lugar y priorizando la fidelización a los centros locales.

Successful use of infliximab and tacrolimus in a patient with Crohn's disease.

OBJECTIVE: To report a case of successful use of infliximab (IFX) and tacrolimus (TAC) in a patient with Crohn's disease (CD). CASE SUMMARY: A 42-year-old man with no significant previous medical history was referred to our emergency department because of a 3-month history of weight loss, severe abdominal pain, and bloody diarrhea. His Harvey Bradshaw Index was 39. Ileocolonoscopic revealed severe Crohn colitis. Treatment with IFX 5 mg/kg, azathioprine 2.5 mg/kg/day and corticosteroids was started. After a second IFX infusion, he remained with symptoms with a Harvey Bradshaw Index of 17. An IFX dose intensification of 10 mg/kg every 8 weeks was prescribed. After 16 weeks, a new colonoscopic examination revealed multiple deep ulcerations in sigma and rectum. IFX was intensified to 10 mg/kg every 6 weeks. After 4 doses of IFX intensified dose, the patient's clinical condition was not improved, with a Harvey Bradshaw Index of 10. Azathioprine (AZA) 2.5 mg/kg/day was suspended. Tacrolimus 0.2 mg/kg/day as a compassionate use was added to IFX 10 mg/kg every 6 weeks. After 6 months of combination therapy, the patient was in clinical remission. His Harvey Bradshaw Index was 3. After 1 year on combination IFX and TAC therapy, the patient continued in clinical remission. CONCLUSIONS: This case documents that the combination therapy of IFX and TAC could be selected as an effective approach for patients with CD refractory to IFX dose-intensification plus AZA. However, further studies need to be performed to evaluate the efficacy of this combination therapy.

Series de Pediatría Garrahan. El niño que fue prematuro

A 27 años del nacimiento del Hospital Garrahan, sentimos la necesidad de ponernos en contacto con todos los pediatras para compartir con ellos las estrategias de atención del niño y su familia utilizadas en nuestra institución, destacar la importancia del trabajo interdisciplinario y colaboración permanente. En este volumen desarrollamos el tema del niño que fue prematuro, ya que estos pacientes presentan al pediatra desafíos específicos y novedosos. Si bien la prematurez es la principal causa de mortalidad infantil, la sobrevida de los prematuros ha aumentado significativamente en los últimos años, y por lo tanto estos niños acceden al cuidado pediátrico con creciente frecuencia y vulnerabilidad. Algunos de ellos pueden sufrir secuelas de distinto grado y en diferentes aspectos de su desarrollo, crecimiento o función respiratoria. Dado que el rol del pediatra es fundamental en el diagnóstico, la prevención y el tratamiento de posibles secuelas, el reconocimiento de sus necesidades especiales y cuidado centrado en la familia, el profesional encontrará aquí aspectos epidemiológicos, de identificación y prevención de riesgos, comunicación con la familia, oportunidades de interconsultas y abordaje de la discapacidad mediante el análisis de casos clínicos.

Series de Pediatría Garrahan. El niño con cardiopatía congénita

A 27 años del nacimiento del Hospital Garrahan, hemos sentido la necesidad de compartir con el equipo de salud las estrategias de atención del niño y su familia utilizadas en nuestro Hospital, colaborar con su actualización permanente y poner énfasis en el trabajo interdisciplinario. En este tomo desarrollamos el tema del niño con cardiopatía congénita. Se trata de la malformación congénita grave más frecuente, que se presenta en aproximadamente 5 a 8 cada mil nacidos vivos. En Argentina, nacen alrededor de 700.000 niños cada año, es decir alrededor de 4.500 con esta patología. La supervivencia actual con calidad de vida futura normal es alta para la mayoría de estos niños. A esto contribuyen las mejoras en el diagnóstico prenatal y neonatal temprano, el traslado seguro, la estabilización preoperatoria y el tratamiento por equipos cardiovasculares interdisciplinarios. El rol del pediatra es fundamental en el diagnóstico y seguimiento de estos pacientes. En este volumen, el pediatra encontrará aspectos epidemiológicos y patogénicos de algunas de las enfermedades más prevalentes, así como claves para el diagnóstico oportuno, con énfasis en la semiología y los estudios complementarios accesibles, indicaciones de derivación, prevención de riesgos y asesoramiento general para pacientes y padres.