Laboratory surveillance of invasive Haemophilus influenzae disease in Argentina, 2011-2019.

The incorporation of Haemophilus influenzae type b (Hib) vaccine into the Argentine National Immunization Program in 1998 resulted in a dramatic decrease in the incidence of invasive disease due to this serotype. We assessed 1405 H. influenzae (Hi) isolates causing invasive infections referred to the National Reference Laboratory between 2011 and 2019. Non-encapsulated Hi were the most common strains (44.5%), followed by types b (41.1%) and a (10.0%). Significant increase in the proportion of type b was observed, from 31.2% in 2011, to 50% in 2015, correlating with the peak incidence rate, later decreasing to 33.6% by 2019. We compared the genetic relationship between clones circulating during the period of increased Hib incidence (2011-2015) and those of the prevaccination-transition period (1997-1998). Four pulsotypes predominated in both periods, G, M, P and K, G being the most common. Multi-locus sequence typing revealed that the 4 pulsotypes belonged to ST6, or one of its simple or double locus variants. Isolates from fully vaccinated individuals did not differ from those of the rest of the population studied. After ruling out aspects associated with emergence of specific clones, we concluded that factors such as low booster coverage rates, delayed vaccination schedules and use of different vaccines may have contributed to the reemergence of Hib infections.

Anthropogenic threats to evolutionary heritage of angiosperms in the Netherlands through an increase in high-competition environments.

Present biodiversity comprises the evolutionary heritage of Earth's epochs. Lineages from particular epochs are often found in particular habitats, but whether current habitat decline threatens the heritage from particular epochs is unknown. We hypothesized that within a given region, humans threaten specifically habitats that harbor lineages from a particular geological epoch. We expect so because humans threaten environments that dominated and lineages that diversified during these epochs. We devised a new approach to quantify, per habitat type, diversification of lineages from different epochs. For Netherlands, one of the floristically and ecologically best-studied regions, we quantified the decline of habitat types and species in the past century. We defined habitat types based on vegetation classification and used existing ranking of decline of vegetation classes and species. Currently, most declining habitat types and the group of red-listed species are characterized by increased diversification of lineages dating back to Paleogene, specifically to Paleocene-Eocene and Oligocene. Among vulnerable habitat types with large representation of lineages from these epochs were sublittoral and eulittoral zones of temperate seas and 2 types of nutrient-poor, open habitats. These losses of evolutionary heritage would go unnoticed with classical measures of evolutionary diversity. Loss of heritage from Paleocene-Eocene became unrelated to decline once low competition, shade tolerance, and low proportion of non-Apiaceae were accounted for, suggesting that these variables explain the loss of heritage from Paleocene-Eocene. Losses of heritage from Oligocene were partly explained by decline of habitat types occupied by weak competitors and shade-tolerant species. Our results suggest a so-far unappreciated human threat to evolutionary heritage: habitat decline threatens descendants from particular epochs. If the trends persist into the future uncontrolled, there may be no habitats within the region for many descendants of evolutionary ancient epochs, such as Paleogene.

Amenazas Antropogénicas para la Herencia Evolutiva de las Angiospermas en los Países Bajos a partir del Incremento en los Ambientes de Competencia Elevada Resumen La biodiversidad actual abarca la herencia evolutiva de las épocas de la Tierra. Los linajes de épocas particulares se encuentran con frecuencia en hábitats particulares pero desconocemos si la declinación contemporánea de los hábitats amenaza a la herencia de una época en particular. Nuestra hipótesis supone que dentro de una región determinada, los humanos son una amenaza específica para los hábitats que albergan linajes de una época geológica particular. Suponemos esto pues los humanos amenazan a los ambientes y a los linajes que se diversificaron durante estas épocas. Diseñamos una nueva estrategia para cuantificar, por tipo de hábitat, la diversificación de los linajes de épocas distintas. Cuantificamos para los Países Bajos, una de las regiones mejor estudiada florística y ecológicamente, la declinación de los tipos de hábitat y de especies durante el siglo pasado. Definimos los tipos de hábitat con base en la clasificación de la vegetación y usamos las jerarquías existentes de la declinación de clases y especies de vegetación. Hoy en día, la mayoría de los tipos de hábitat en declinación y el grupo de especies en lista roja se caracterizan por la diversificación incrementada de los linajes que datan del Paleógeno, específicamente el Paleoceno-Eoceno y el Oligoceno. Entre los tipos de hábitat vulnerables con una gran representación de los linajes de estas épocas encontramos a la zona sublitoral e intermareal de los mares templados y dos tipos de hábitats abiertos con deficiencia de nutrientes. Estas pérdidas de linaje evolutivo pasarían desapercibidas con las medidas clásicas de la diversidad evolutiva. La pérdida de la herencia del Paleoceno-Eoceno dejó de estar relacionada con la declinación una vez que contabilizamos la baja competencia, la tolerancia a la sombra y la baja proporción de especies no pertenecientes a la familia Apiaceae, lo que sugiere que estas variables explican la pérdida de herencia del Paleoceno-Eoceno. La pérdida de herencia del Oligoceno estuvo explicada en parte por la declinación de los tipos de hábitat ocupados por competidores débiles y especies tolerantes a la sombra. Nuestros resultados sugieren una amenaza humana para la herencia evolutiva que todavía no ha sido apreciada: la declinación del hábitat amenaza a los descendientes de épocas particulares. Si en el futuro las tendencias siguen sin ser controladas, puede que no haya hábitats en la región para muchos de los descendientes evolutivos de épocas antiguas, como el Paleógeno.

Predominance of SCCmec types IV and V among biofilm producing device-associated Staphylococcus aureus strains isolated from tertiary care hospitals in Mysuru, India.

INTRODUCTION: Device associated infections caused by Staphylococcus aureus in hospitalised patients is a serious healthcare problem. The present study was designed to determine the prevalence of biofilm-producing MRSA in device-associated infections. METHODS: Device-associated S. aureus strains (n=200) obtained from two tertiary care hospitals in Mysuru city, India were screened for biofilm production, antibiotic resistance, Panton-Valentine Leucocidin genes, SCCmec-types, spa-types, and intercellular adhesion (icaAD) dependent and independent genes. The efficacy of antibiotics (linezolid, vancomycin and rifampicin) on biofilms was studied using MTT assay, and the results were correlated with the occurrence of ica-dependent and independent factors. RESULTS: Multidrug resistance was observed in 155 strains (77.5%), and 124 strains (62%) were identified as biofilm producers. Methicillin resistance was identified in 145 strains (72.5%), and SCCmec typing of these isolates revealed high prevalence of type IV and type V. They also showed increased prevalence of pvl gene. icaAD was identified in 65 isolates, with 37 isolates showing both icaAD and ica-independent genes. spa types t852 and t657 were predominantly observed in MRSA isolates. Those isolates that had both ica-dependent and ica-independent genes showed more resistance to the screened antibiotics than the ica-dependent alone. CONCLUSION: This study reports a high prevalence of SCCmec type IV and V in biofilm producing S. aureus strains isolated from device-associated infections. Increased prevalence of pvl in SCCmec types IV and V strains suggests the role of community associated S. aureus in device-associated infections. The simultaneous presence of ica-dependent and independent genes increased the antibiotic resistance in established biofilms. Thus, S. aureus on medical devices is a potential risk for patients.

Predicting extinction risk of Brazilian Atlantic forest angiosperms.

Understanding how plant life history affects species vulnerability to anthropogenic disturbances and environmental change is a major ecological challenge. We examined how vegetation type, growth form, and geographic range size relate to extinction risk throughout the Brazilian Atlantic Forest domain. We used a database containing species-level information of 6,929 angiosperms within 112 families and a molecular-based working phylogeny. We used decision trees, standard regression, and phylogenetic regression to explore the relationships between species attributes and extinction risk. We found a significant phylogenetic signal in extinction risk. Vegetation type, growth form, and geographic range size were related to species extinction risk, but the effect of growth form was not evident after phylogeny was controlled for. Species restricted to either rocky outcrops or scrub vegetation on sandy coastal plains exhibited the highest extinction risk among vegetation types, a finding that supports the hypothesis that species adapted to resource-limited environments are more vulnerable to extinction. Among growth forms, epiphytes were associated with the highest extinction risk in non-phylogenetic regression models, followed by trees, whereas shrubs and climbers were associated with lower extinction risk. However, the higher extinction risk of epiphytes was not significant after correcting for phylogenetic relatedness. Our findings provide new indicators of extinction risk and insights into the mechanisms governing plant vulnerability to extinction in a highly diverse flora where human disturbances are both frequent and widespread.

Autophagy, a relevant process for metabolic health and type-2 diabetes.

Introduction: Autophagy is a very active process that plays an important role in cell and organ differentiation and remodelling, being a crucial system to guarantee health. This physiological process is activated in starvation and inhibited in the presence of nutrients. This short review comments on the three types of autophagy: macroautophagy, microautophagy, and chaperone-mediated autophagy, as well as different aspects that control autophagy and its relationship with health and degenerative diseases. As autophagy is highly dependent on functional autophagy (ATG) proteins integrating the phagophore, the role of some key ATG genes and epigenes are briefly commented on. The manuscript deepens discussing some central aspects of type-2 diabetes mellitus and their relationship with the cell cleaning process and mitochondria homeostasis maintenance, as well as the mechanisms through which antidiabetic drugs affect autophagy. Well-designed studies are needed to elucidate whether autophagy plays a casual or causal role in T2DM.

Introducción: La autofagia es un proceso muy activo que juega un papel importante en la diferenciación y remodelación de células y órganos, siendo un sistema crucial para garantizar la salud. Este proceso fisiológico se activa en la inanición y se inhibe en presencia de nutrientes. En esta breve revisión se definen los tres tipos de autofagia: macroautofagia, microautofagia y autofagia mediada por chaperonas, y los diferentes aspectos que controlan la autofagia y su relación con la salud y las enfermedades degenerativas. Como la autofagia depende en gran medida de las proteínas de autofagia funcional (ATG) que integran el fagóforo, se comenta brevemente el papel clave de algunos genes y epigenes de las ATG. El manuscrito profundiza discutiendo algunos aspectos centrales de la diabetes mellitus de tipo 2 (DMT2) y su relación con el proceso de limpieza celular y el mantenimiento de la homeostasis mitocondrial, así como los mecanismos a través de cuales los fármacos antidiabéticos afectan a la autofagia. Se necesitan estudios bien diseñados para dilucidar si la autofagia juega un papel de casualidad o causalidad en el desarrollo de la DMT2.

Urinary stone diagnosis. Morphologic and composition analysis. / Diagnóstico de la litiasis renal a través del cálculo. Estudio morfocomposicional.

Analysis of urinary stones is an essential step in establishing the diagnosis and treatment of the stone patient. In fact, the need for an exhaustive study of the stones increases as the relationships between the type of stone and the etiological factors that predispose to this disease become evident. The enumeration (qualitative or quantitative) of the major components that make up the kidney stone (calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, calcium phosphates, cystine), which is obtained by the most commonly used analytical method, infrared spectroscopy (IR), is no longer enough to guide the urologist on the etiology of the disease. Only a detailed structural analysis and macro and micro components can provide key information on the etiology of the stone, and therefore, on the possible causes that have led to its formation. This study should conclude with a report that is provided to the Urologist. Obtaining this report involves a detailed study, sample by sample, which involves the systematic handling of stereoscopic microscopy, IR spectroscopy and scanning electron microscopy (SEM) with energy dispersive X-raymicroanalysis (EDAX).

El análisis de los cálculos urinarios es un paso esencial para establecer el diagnóstico y tratamiento del paciente litiásico. De hecho, la necesidad de un estudio exhaustivo de los cálculos aumenta a medida que se evidencian las relaciones entre la tipologíadel cálculo y los factores etiológicos que predisponen a esta enfermedad. La relación de los componentes mayoritario sque componen el cálculo renal (oxalato cálcico monohidrato, oxalato cálcico dihidrato, ácido úrico, fosfatos cálcicos, cistina), que se obtiene por el método analítico generalmente más utilizado, la espectroscopía infrarroja (IR), ya no es suficiente para orientar al urólogo sobre la etiología de la enfermedad. Únicamente un detallado análisis estructural y de macro y micro componentes permite aportar información clave sobre el origen del cálculo, y por tanto, de las posibles causas que han inducido a su formación. Este estudio debe concluir con un informe que se suministra al Urólogo. La obtención de este informe supone un estudio en detalle, muestra a muestra, que implica el manejo sistemático de microscopía estereoscópica, espectroscopía IR y microscopía electrónica de barrido (SEM) con microanálisis por energía dispersiva de rayos X (EDAX).

The current situation and the cultural background of psychological type theory in China.

As analytical psychology in China develops, especially with the China Society for Analytical Psychology approved for membership in the International Association for Analytical Psychology (IAAP), many Chinese, who are already familiar with MBTI®-based personality testing in corporations, are interested in learning more about Jungian theory and practice with regard to psychological types. The author, a Chinese psychologist, emphasizes current problems standing in the way of this development, such as the common opinion that MBTI is equal to psychological types. He reports his recent research that highlights the present understanding of psychological types within China. Noting that Jung combined two attitudes with four functions to form eight function-attitudes of consciousness, the author explores the possible connection between Jung's eightfold system and the eight trigrams that organize the wisdom that the I Ching brings to emergent situations requiring exceptionally conscious decision-making. He compares I Ching translator Richard Wilhelm's naming and description of these eight Gua with Jungian analyst John Beebe's descriptions of the eight function-attitudes and finds striking parallels. This amplification sheds light on the archetypal nature of psychological consciousness as well upon the typology of it that Jung advanced.

Maintenant que la psychologie analytique se développe en Chine, particulièrement avec la Société Chinoise des Analystes Jungiens, reconnue par l'Association Internationale de Psychologie Analytique (AIPA), beaucoup de Chinois - étant déjà familiarisés avec l'évaluation de la personnalité dans les entreprises par le test MBTI - cherchent à en savoir plus sur les types psychologiques en théorie et en pratique. L'auteur, un psychologue chinois, évoque les problèmes actuels qui rendent ce développement difficile, par exemple l'opinion répandue que le MBTI est équivalent aux types psychologiques de Jung. L'auteur rend compte de ses recherches récentes en Chine sur la compréhension actuelle des types psychologiques. Soulignant que Jung a combiné deux attitudes avec quatre fonctions formant huit fonction-attitudes de la conscience, il explore le lien possible entre le système à huit parties de Jung et les huit trigrammes qui ordonnent la sagesse que le Yi King apporte à des situations naissantes et qui requièrent un processus de décision particulièrement conscient. Il compare la manière dont le traducteur du Yi King Richard Wilhelm nomme et décrit les huit Gua avec les descriptions par l'analyste Jungien John Beebe des huit fonction-attitudes et il trouve des parallèles frappants. Cette amplification éclaire la nature archétypale de la conscience psychologique et de sa typologie telle que Jung l'a conçue.

A medida que la psicología analítica se ha desarrollado en China, especialmente con la Sociedad China de Analistas Junguianos aprobada por la Asociación Internacional de Psicología Analítica (IAAP), muchas personas de China, quienes ya estaban familiarizadas con el test de personalidad MBTI® aplicado en corporaciones, se interesaron en aprender más sobre la teoría y práctica Junguiana con relación a los tipos psicológicos. El autor, psicólogo chino, enfatiza los problemas actuales que se interponen en este desarrollo, como la opinión común que sostiene que MBTI es lo mismo que los tipos psicológicos. El autor presenta su investigación reciente, la cual destaca la comprensión actual sobre tipos psicológicos en China. Observando que Jung combinó dos actitudes con cuatro funciones para formar ocho funciones-actitudes de la consciencia, el autor explora la posible conexión entre el sistema óctuple de Jung y los ocho trigramas que organizan la sabiduría que el I Ching brinda a las situaciones emergentes que requieren excepcionalmente una toma de decisión consciente. El autor compara las denominaciones y descripciones de los ocho Gua de Richard Wilhelm, traductor del I Ching, con las descripciones de las ocho funciones-actitudes descriptas por John Beebe, y encuentra notables paralelismos. Esta amplificación ilumina la naturaleza arquetipal de la consciencia psicológica, así como la de su tipología, que Jung desarrolló.

Experiencing whole type: living into the archetypal Self.

Expanding on Jung's use of the role of the superior and inferior functions, Angelo Spoto advances a new typological model based on 'whole type' that utilizes a typological perspective on the archetypal Self. In this new model four cognitive modes taking superior positions are developed in the first half of life and four cognitive modes taking inferior positions are encountered in the second half of life. This model indicates that type development and type dynamics take place through the holding of the tension of opposites between superior and inferior functions, helped by the transcendent function operating differently in the first and second halves of life. Specifically, in the first half of life, the transcendent function produces a tertium that moves typological development along to consolidate an ego-pattern. In the second half of life, the transcendent function takes the individual into encounters having to do with an appreciation of sacrifice, transformation, and symbol-making, as the personality advances towards a greater awareness of wholeness, by way of the inferiors.

Elargissant l'utilisation que fait Jung du rôle des fonctions supérieures et inférieures, Angelo Spoto propose un nouveau modèle typologique basé sur la totalité du type, qui utilise une perspective typologique du Soi archétypal. Dans ce nouveau modèle quatre modes cognitifs prenant des positions supérieures sont développés dans la première moitié de la vie et quatre modes cognitifs prenant des positions inférieures sont rencontrés dans la deuxième moitié de la vie. Ce modèle montre que le développement et les dynamiques de la typologie se font en soutenant la tension des opposés entre les fonctions supérieures et inférieures. Ceci est aidé par la fonction transcendante qui fonctionne différemment dans la première moitié de la vie et dans la seconde. Précisément, dans la première moitié de la vie, la fonction transcendante produit un tertium qui fait avancer le développement typologique afin de consolider un schéma de l'égo. Dans la seconde moitié de la vie, la fonction transcendante amène l'individu à des confrontions en rapport avec la valeur du sacrifice, la transformation, et l'élaboration de symboles, tandis que la personnalité chemine vers une conscience plus grande de la totalité, par le soutien des inférieures.

Expandiendo sobre la base del uso de la función superior e inferior propuesta por Jung, Angelo Spoto ofrece un nuevo modelo tipológico basado en el 'tipo de la totalidad' utilizando una perspectiva tipológica en el Self arquetipal. En este nuevo modelo, cuatro modalidades cognitivas que adquieren una posición superior se desarrollan en la primera mitad de la vida, y cuatro modalidades cognitivas que adquieren posiciones inferiores son encontradas en la segunda mitad de la vida. Este modelo indica que el desarrollo y las dinámicas tipológicas tienen lugar a través del sostener la tensión entre opuestos entre las funciones superiores e inferiores, con la ayuda de la función trascendente operando de manera diferente en la primera y segunda mitad de la vida. Específicamente, en la primera mitad, la función trascendente produce un tertium que moviliza el desarrollo tipológico hacia la consolidación de un patrón egoico. En la segunda mitad de la vida, la función trascendente, conduce al individuo al encuentro con la apreciación del sacrificio, la transformación y la creación de símbolos, a medida que la personalidad se acerca a una percepción mayor de la totalidad, por medio de las funciones inferiores.

Trichorhinophalangeal syndrome. / Síndrome tricorinofalángico.

Trichorhinophalangeal syndrome I (TPRSI) has an autosomal dominant inheritance; the proportion of «de novo¼ cases is unknown1. It is characterized by unique facial features, bulbous nose, flat and elongated nasolabial furrow, thin hair and slow growth. Skeletal abnormalities that include short phalanges and metacarpals -brachydactyly-, cone-shaped epiphyses, hip dysplasia and short stature1-3.

[Our clinical experience and follow-up results in hydatid cyst cases: a review of 393 patients from a single center]. / Nossa experiência clínica e resultados no acompanhamento de casos de cisto hidático.

BACKGROUND AND OBJECTIVES: Hydatid cyst is a zoonotic disease caused by Echinococcus granulosus. The aim of our study is to present the clinical features of the patients who were treated for hydatid cyst, determine the interventional techniques and anesthesia methods used and review the occurred complications in detail. METHODS: This study included 393 patients who were followed up and/or treated with the diagnosis of hydatid cyst between January 2013 and November 2018. The patients' data was evaluated retrospectively. RESULTS: The mean age of the patients was 31.0±17.2 years. Of the patients, 111 (28.4%) had more than one cyst and 36 (9.2%) patients had multi-organ involvement. Six of the patients refused the intervention or was transferred to another hospital. Among the remaining 387 patients, 335 (85.2%) received general anesthesia and intubation, 9 patients (2.3%) received general anesthesia and laryngeal mask airway, 39 patients (9.9%) received sedoanalgesia and 4 patients (1%) received regional anesthesia. Perioperative mortality was developed in one patient. The most common periopertaive complication was allergic reaction (1.5%), whereas the most common post-operative complications were atelectasis (3.3%) and biliary fistula (3%). The mean Intensive Care Unit stay (ICU) was 1.9±1.1 days in patients requiring ICU. Recurrence during the 40±17 months follow-up occurred in 8.4% patients. CONCLUSIONS: Anesthesiologists have an important role in the management of hydatid cyst patients. Patients should be evaluated exhaustively in terms of multi-organ involvement and the presence of more than one cyst in the same organ. The type of treatment procedure and the localization of the cysts determine the anesthetic management.

[Social considerations affecting acceptance of HPV vaccination in Colombia. A systematic review].

OBJECTIVE: To identify social factors influencing the acceptance of human papilloma virus (HPV) vaccination in the Colombian population before and after the unexpected and poorly defined event of unknown etiology which occurred in 2014. METHODS: A systematic review of the literature was conducted in the following databases: Scopus, Web of Science, Medline via PubMed, Embase, Online Health Library (Biblioteca Virtual en Salud) and Ovid, and also in Google Scholar, academic repositories and in Colombian health institutions, using the terms "recombinant tetravalent vaccine against Human Papilloma Virus types 6, 11, 16, 18", "Colombia", "Papilloma" in order to primarily identify systematic reviews, quantitative and qualitative studies, narrative reviews, focusing on social aspects such as education, access, relationship with healthcare staff and role of the media which may have acted as barriers or facilitators for the acceptance of HPV vaccination in Colombia between 2006-2018. A narrative synthesis of the data was made. RESULTS: Twenty-four documents were included. The importance attached by parents, adolescents, providers and the media to having greater knowledge about HPV and its association with cervical cancer was identified. The relevance of good communication among healthcare professions and the community to enable adequate sharing of information regarding the risks and benefits of the vaccines was recognized. The inclusion of the vaccine in health insurance plans made access easier. The media must be involved as facilitators in vaccination programs. CONCLUSIONS: Education regarding HPV, patient-centered healthcare and adequate media coverage influence the acceptance of HPV vaccination in the Colombian population. Close follow-up of any vaccine-related adverse events is required.

TITULO: ASPECTOS SOCIALES QUE HAN AFECTADO LA ACEPTACIÓN DE LA VACUNACIÓN CONTRA EL VIRUS DEL PAPILOMA HUMANO EN COLOMBIA. UNA REVISIÓN SISTEMÁTICA. OBJETIVO: Establecer los aspectos sociales que afectaron la aceptación de la vacuna del virus del papi- loma humano (VPH) en la población colombiana antes y después del evento mal definido e inusitado de etiología desconocida sucedido en 2014. METODOS: Se realizó una búsqueda sistemática de literatura en las bases de datos: Scopus, Web of Science, Medline vía PubMed, Embase, Biblioteca Virtual en Salud y Ovid; además, en Google Académico y en repositorios de universidades y en instituciones de salud en Colombia, con los términos: "Vacuna Tetravalente Recombinante contra el Virus del Papiloma Humano Tipos 6, 11, 16, 18", "Colombia", "Papiloma" y sus correspondientes términos en inglés, para identificar principalmente revisiones sistemáticas, estudios cuantitativos y cualitativos, y revisiones narrativas que se enfocaran en aspectos sociales como: educación, acceso, relación con el personal de salud, papel de los medios de comunicación, que pudieran haber actuado como barreras o facilitadores para la aceptación de vacunación para VPH en Colombia en el periodo 2006-2018. Se hace una síntesis narrativa de la información. RESULTADOS: Se incluyeron 24 documentos. Se identificó la importancia, para los padres, adolescentes, proveedores y los medios, de tener un mejor conocimiento del VPH y su relación con el cáncer de cuello uterino (CCU). Se reconoce la relevancia de una buena comunicación entre las profesiones de la salud y la comunidad para informar adecuadamente tanto los beneficios como los riesgos de la vacuna. La inclusión en los planes de aseguramiento facilitó el acceso a esta por parte de la población. Los medios de comunicación deben ser considerados para que actúen como facilitadores de los programas de vacunación. CONCLUSIONES: Educar en el conocimiento del VPH, una atención en salud centrada en el paciente y una adecuada cobertura de los medios de comunicación influencian la aceptación del programa de vacuna- ción contra VPH en la población colombiana. Se requiere seguir haciendo seguimiento estricto de los efectos adversos asociados a la vacuna.

Biopsia en carcinoma escamoso de orofaringe

La biopsia en carcinoma escamoso de orofaringe es un paso fundamental para su diagnóstico, por lo que es relevante conocer los diferentes tipos de ésta. Actualmente, se reconocen 4 tipos de biopsia en este tipo de carcinoma, cada uno de las cuales presentan indicaciones específicas: Biopsia incisional, excisional, punción con aguja fina (PAF) y biopsia liquida. La más frecuente y recomendada es la biopsia incisional por su rapidez y poca morbilidad asociada. Tanto la biopsia excisional como la PAF se reservan para casos de metástasis cervical de primario desconocido dependiendo de la etapa del análisis del paciente en particular. Finalmente, existe un fuerte desarrollo de la biopsia liquida, especialmente mediante el estudio del biomarcador ctHPV-DNA, el cual al ser un marcador sensible y específico para este tipo de carcinoma puede cambiar el paradigma del diagnóstico en un futuro cercano.

Oropharyngeal squamous cell carcinoma biopsy is a fundamental step in the diagnosis; therefore, it is relevant to know its different types. Currently, four types of biopsy are recognized for this type of carcinoma, each of which has specific indications: incisional biopsy, excisional biopsy, fine needle aspiration (FNA), and liquid biopsy. The most frequent and recommended procedure is incisional biopsy, because of its speed and low associated morbidity. Both excisional biopsy and FNA are reserved for cases of cervical metastasis of unknown primary depending on the stage of analysis of the particular patient. Finally, there is a strong development in liquid biopsy, especially through the study of the ctHPV-DNA biomarker, which is a sensitive and specific marker for this type of carcinoma, and may change the diagnostic paradigm in the near future.

The Impact of Various Factors on the Difficulties in Learning and Teaching Strategies for Histology / El Impacto de Diversos Factores en las Dificultades en el Aprendizaje y las Estrategias de Enseñanza de Histología

SUMMARY: Histology is considered one of the most important but challenging topics in health sciences. Deficiencies in teaching and general histology directly affect the student's understanding, performance and promote dynamism and integration while covering the primary curriculum. The goal of the current study was to assess and provide a better experience of difficulties in learning histology, examine some standard teaching strategies, and determine how to implement suitable changes to improve the curriculum from students' perspectives. The study comprised of a self-administered questionnaire that included descriptive questions. Data was collected based on the survey conducted via 100 students studying histology. Data was analyzed further qualitatively and quantitatively to elaborate on the difficulties in this area. Many of them strongly agreed that the lack of essential comprehension regarding using light and electron microscopes resulted in challenges with comprehending and identifying tissue samples for image identification due to inadequate anatomical knowledge. Moreover, according to students, some difficulties understood the topic, perception of new terminologies, and insufficient teaching strategies to grasp students' interests. They also agreed that improvement was needed in terms of the modes of teaching employed by histology teachers; they felt that modern education techniques based on practical tasks should be incorporated to stimulate student interest and make understanding histological concepts easier. The Institution should modify the teaching system to allocate more time to relevant subjects to make this subject matter more interesting. This survey-based study evaluated that students faced some challenges while studying the current curriculum of histology. From the student's perspective, it is identified that some changes are needed to improve the course curriculum and way of teaching to make it more understandable.

La histología se considera uno de los temas más importantes pero desafiantes de las ciencias de la salud. Las deficiencias en la enseñanza y en la histología general afectan directamente la comprensión, el desempeño del estudiante y promueven el dinamismo y la integración al abarcar el currículo primario. El objetivo del estudio actual fue evaluar y proporcionar una mejor experiencia de las dificultades en el aprendizaje de histología, examinar algunas estrategias de enseñanza estándar y determinar cómo implementar cambios adecuados para mejorar el plan de estudios desde la perspectiva de los estudiantes. El estudio constaba de un cuestionario auto administrado que incluía preguntas descriptivas. Los datos se recopilaron a partir de una encuesta realizada a 100 estudiantes de histología. Los datos se analizaron más a fondo de forma cualitativa y cuantitativa para profundizar en las dificultades en esta área. Muchos de ellos estuvieron totalmente de acuerdo en que la falta de comprensión esencial sobre el uso de microscopios ópticos y electrónicos resultó en desafíos para comprender e identificar muestras de tejido para la identificación de imágenes debido a un conocimiento anatómico inadecuado. Además, según los estudiantes, algunas dificultades en la comprensión del tema, percepción de nuevas terminologías y estrategias de enseñanza insuficientes para captar los intereses de los estudiantes. También coincidieron en que era necesario mejorar los métodos de enseñanza empleados por los profesores de histología; sintieron que deberían incorporarse técnicas educativas modernas basadas en tareas prácticas para estimular el interés de los estudiantes y facilitar la comprensión de los conceptos histológicos. La Institución debería modificar el sistema de enseñanza para asignar más tiempo a materias relevantes para hacer esta materia más interesante. Este estudio basado en encuestas evaluó que los estudiantes enfrentaron algunos desafíos mientras estudiaban el plan de estudios actual de histología. Desde la perspectiva del estudiante, se identifica que se necesitan algunos cambios para mejorar el plan de estudios del curso y la forma de enseñar para hacerlo más comprensible.

Angioedema hereditário com deficiência do Inibidor de C1 ­ Armadilhas no diagnóstico, tratamento e compreensão / Hereditary angioedema with C1 inhibitor deficiency: traps in the diagnosis, treatment, and understanding

Angioedema hereditário (AEH) é uma condição rara, subdiagnosticada e de elevada morbimortalidade, devido ao caráter de suas manifestações clínicas. O AEH se diferencia do angioedema histaminérgico por não responder aos anti-histamínicos, corticosteroides ou epinefrina. Por esse motivo, é extremamente importante o diagnóstico dessa situação, a fim de instituir a terapia adequada. Tal afecção deve ser suspeitada a partir da história clínica de episódios imprevisíveis e recorrentes de edema que quando se manifesta sob a forma de edema laríngeo, pode levar a óbito por asfixia, se não for adequadamente tratado. Relatamos o caso de uma paciente de 18 anos que, apesar de previamente diagnosticada com AEH tipo 1, ao procurar um serviço de emergência devido a crise de angioedema, não dispunha de medicação específica nem apresentou plano de ação com as opções possíveis para crises. Este caso reforça a necessidade de maior divulgação da doença, além da conscientização de pacientes e familiares sobre a doença e eventuais crises, assim como o acesso as medicações.

Hereditary angioedema (HAE) is a rare, underdiagnosed condition with high morbidity and mortality due to the characteristics of its clinical presentation. HAE differs from histaminergic angioedema by not responding to antihistamines, corticosteroids, or epinephrine. Therefore, early diagnose is crucial to initiate adequate therapy. HAE is suspected in patients with a clinical history of unpredictable and recurrent episodes of edema. When laryngeal edema occurs, it can lead to death from asphyxiation if not treated properly. We report the case of an 18-year-old patient previously diagnosed with HAE type 1 who sought emergency care during an angioedema attack. However, the patient was not taking any specific medication and did not have an action plan to manage attacks. This case highlights the importance of increasing awareness about the disease, educating patients and their families about the disease and potential attacks, and ensuring access to medications.

Avaliação das características morfofuncionais do pé e do hábito de andar descalço de indivíduos com alterações nos pés / Evaluation of the morpho-functional characteristics of the foot and the habit of walking barefoot in individuals with foot alterations

O objetivo deste estudo foi avaliar o perfil funcional, características do pé, o hábito de andar descalço de indivíduos com alterações musculoesqueléticas nos pés e comparar com indivíduos controle. Os participantes foram avaliados por meio de questionário eletrônico. Dados antropométricos, funcionalidade dos pés, hábito de andar descalço, tipo de calçado, tipo de pé e pisada e qual comprometimento do pé foram coletados. A amostra total foi composta por 160 indivíduos divididos em grupo controle (GC) (n=82) e grupo problemas no pé (GPE) (n=78). O hálux valgo foi o principal tipo de problema no grupo GPE (24,4%), com uma maior porcentagem de participantes com doença crônica (35,9%), tipos de pés cavos (pé esquerdo (PE) 16,7% e pé direito (PD) 19,2%) ou planos (PE 21,8% e PD 21,8%) e com o Índice de função do pé comprometido em 7% (P =0,001). Ambos os grupos consideram o hábito de andar descalço saudável (72% GC e 66,7% GPE), porém não são adeptos deste hábito (93,9% GC e 91% GPE). O sapato foi o modelo menos utilizado pelo GPE (10,3%). Concluímos que indivíduos do grupo GPE apresentaram maior associação de alterações morfofuncionais com a presença de distúrbios nos pés e que o hábito de andar descalço apesar de ser considerado um aspecto positivo para a saúde dos pés de ambos os grupos, nenhum destes o praticam.

This study aimed to evaluate the functional profile, foot characteristics, and barefoot walking habits of individuals with musculoskeletal foot alterations and compare them with control individuals. Participants were assessed through an electronic questionnaire. Anthropometric data, foot functionality, barefoot walking habits, footwear type, foot type, foot arch, stride type, and foot impairments were collected. The total sample consisted of 160 individuals divided into a control group (CG) (n=82) and a foot problems group (FPG) (n=78). Hallux valgus was the main foot problem in the FPG (24.4%), with a higher percentage of participants having chronic conditions (35.9%), cavus foot types (left foot (LF) 16.7% and right foot (RF) 19.2%), or flat foot types (LF 21.8% and RF 21.8%), and with a compromised Foot Function Index in 7% (P=0.001). Both groups considered barefoot walking healthy (72% CG and 66.7% FPG), but they are not practitioners of this habit (93.9% CG and 91% FPG). Shoes were the least utilized type of footwear in the FPG (10.3%). In conclusion, individuals in the FPG showed a stronger association between morpho-functional alterations and foot disorders. Although barefoot walking is considered beneficial for foot health in both groups, neither group practices this habit.

Análisis del cáncer de pulmón en un hospital de referencia de la ciudad de Santa Fe en 21 años de seguimiento / Analysis of Lung Cancer in a Reference Hospital in the City of Santa Fe with a Follow-Up of 21 Years

El cáncer de pulmón es una neoplasia de mal pronóstico. Es la tercera causa de muerte por cáncer y el de mayor mortalidad a nivel mundial. El objetivo del estudio es describir las características clínicas de los pacientes con diagnóstico de cáncer de pulmón, evaluados a lo largo de 21 años por el Comité multi­disciplinario de un hospital de la ciudad de Santa Fe, Argentina y el análisis comparativo entre el primer período del 2001 al 2011 (P1) y el segundo (P2) entre 2012 y 2022. Es un estudio descriptivo, observacional y retrospectivo. Se analizó un total de 416 pacientes adultos, de ambos sexos con diagnóstico de cáncer de pulmón compren­didos entre junio 2001 a julio 2022, en la primera década 211 pacientes y 205, en la segunda. Se excluyeron del análisis 65 pacientes con diagnóstico clínico radiológico de cáncer de pulmón. Del total de pacientes 294 (70,7%) eran varones, con edad media de 60 años. Se observó que 249 pacientes (80,72%) padecía una o más comorbilidades y las pato­logías más frecuentes fueron 146 casos de enfermedad pulmonar obstructiva crónica (58,9%, p = 0,05), 19 casos de diabetes (7,7%), 11 pacientes con hepatopatía crónica (5%), 23 casos con patología cardíaca (9.32%) y 10 pacientes con enfermedad renal crónica (4,3%). El tabaquismo se registró en 320 pacientes (81,3%) incluye a los exfumadores (66,7% de las mujeres y 87,1% de los hombres) con una media de 50 paquetes/año (3 a 169 p/a). El tabaquismo en general disminuyó a expensas de los hombres, pero se evidenció un incremento del hábito tabáquico en las mujeres. La histología más frecuente fue el adenocarcinoma, con 149 casos (35,6%, p = 0,04), seguidos del carcinoma escamoso o epidermoide, con 128 casos (30,8%, p = 0,04), 44 casos de carcinoma neuroendocrino de pequeñas células u oat cell (10,6%, p = 0,06), 65 indiferenciados (15,6%, p = 0,05), 10 carcinomas de células grandes (2,4% p = 0,12), 7 tumores carcinoides (1,7%, p = 0,15) y otras histologías registradas fueron 6 casos de mesotelioma (1,44%) y 7 (1,7%) tumores extrapulmonares. Se observó que en el segundo período el adenocarcinoma aumentó significativamente del 32,7% al 39,02%, mientras que, para epidermoide, los casos descendieron de 40,7% a 32,8%. También se estableció para los casos indiferenciados un incremento del 9,45% al 21,46% y en los tipos histológicos oat cell no se percibieron cambios (10,9% al 10,2%). Los métodos diagnósticos más utilizados fueron la broncofibroscopia y la punción bajo tomografía computarizada. Se realizaron 172 endoscopias (41,7%) que fueron de mayor rendimiento en el cáncer epidermoide y se realizaron 110 punciones guiadas por tomo­grafía computarizada (26,7%), de mayor rendimiento diagnóstico en el adenocarcinoma. Para la estadificación se utilizó la edición TNM al momento del diagnóstico, ambos sexos se encontraban en estadios avanzados en las principales estirpes de neoplasias no células pequeñas. Recibieron tratamiento quirúrgico con intención curativa 92 pacientes (22%), tratamiento oncológico a base de quimioterapia o radioterapia 292 pacientes (70%), y 33 pacientes (8%) recibieron tratamiento paliativo único(AU)

Lung cancer (LC) is a neoplasm with a poor prognosis, it is the third leading cause of cancer death and the highest mortality worldwide. The objective of the study is to describe the clinical characteristics of patients diagnosed with lung cancer, evaluated over 21 years by the multidisciplinary Committee of a hos­pital in the city of Santa Fe, Argentina (MCLC) and the comparative analysis between the first period from 2001 to 2011 (p1) and the second (p2) between 2012 and 2022. It is a descriptive, observational and retrospective study. A total of 416 adult patients of both sexes with a diagnosis of lung cancer between June 2001 and July 2022 were studied, 211 patients in the first decade and 205 in the second. 65 patients with clinical radiological diagnosis of lung cancer were excluded from the analysis. The results showed that 294 (70.7%) were male, with a mean age of 60 years. It was observed that 249 patients (80.72%) suffered from one or more comorbidities and the most frequent pathologies were 146 cases of COPD (58.9%, p: 0.05), 19 cases of dia­betes (7.7%), 11 patients with chronic liver disease (5%), 23 cases with cardiac disease (9.32%) and 10 patients with chronic kidney disease (4.3%). Smoking was recorded in 320 patients (81.3%) includes ex-smokers (66.7% of women and 87.1% of men) with a mean of 50 pack-years (3 to 169 p/y). Smoking in general decreased at the expense of men, but there was an increase in smoking in women. The most frequent histology was adenocarcinoma with 149 cases (35.6%, p: 0.04), followed by squamous or squamous cell carcinoma with 128 cases (30.8%, p: 0.04), 44 cases of small cell neuroendocrine carcinoma or oat cell (10.6%, p: 0.06), 65 undif­ferentiated (15.6%, p 0.05), 10 large cell carcinoma (2.4% p. 0.12), 7 carcinoid tumors (1.7%, p: 0.15) and other recorded histologies there were 6 cases of mesothelioma (1.44%) and 7 (1.7%) extra tumors pulmonary. It is observed that in the second period adenocarcinoma increased significantly from 32.7% to 39.02%, while for epidermoid the cases decreased from 40.7% to 32.8%. An increase from 9.45% to 21.46% was also established for undifferentiated cases and in oat cell histological types no changes were seen (10.9 to 10.2%). The most used diagnostic methods were bronchoscopy and puncture under CT. A total of 172 endoscopies (41.7%) were performed, which had the highest performance in the 91 ca epidermoid and 110 °CT-guided punctures (26.7%) were performed, with the highest diagnostic yield in adenocarcinoma. For staging, the TNM edition was used at the time of diagnosis, both sexes were in advanced stages in the main strains of non- small cell neoplasms. Ninety-two patients (22%) received surgical treatment with curative intent, 292 patients (70%) received cancer treatment based on chemotherapy and/or radiotherapy, and 33 patients (8%) received only palliative treatment(AU)

Genital Human Papillomavirus Infection in women from Florianópolis - Santa Catarina, Brazil / Infecção genital pelo Papilomavírus Humano em mulheres de Florianópolis - Santa Catarina, Brasil

Introduction: Human Papillomavirus (HPV) infection is the most common sexually transmitted infection in women. About 80% of sexually active women will have contact with this virus at some age in their lives. Most infections will be transient, but when the infection becomes persistent, associated with high oncogenic risk HPV, there may be progression to cancer, especially cervical cancer. The best way to prevent HPV infection is through the use of vaccines. Objective: To assess which are the most prevalent types of HPV in the city of Florianópolis, Brazil and if the majority of the diagnosed types are contained in the HPV vaccines currently available on the market and in the public health sector. Methods: More than 14,727 HPV tests were evaluated for the diagnosis of genital HPV infection in women from Florianópolis. The prevalence of infection was evaluated according to age of the women. HPV detection was performed using molecular biology tests, such as hybrid capture (for diagnosis of the HPV group, high or low oncogenic risk) and PCR (viral genotyping) techniques. Results: The diagnosis of HPV infection was made for women between one and 102 years of age. The highest positivity of the exams was observed in women aged 20­25 years (51% of the exams). The most prevalent age group was 31­35 years old (23.5%), and the lowest was for women aged 70 and above (0.6%). High oncogenic risk HPV was detected in 94.1% of positive samples and was the most frequent in all age groups. Mixed infection (high- and low-risk HPV) was more prevalent in the 66­70 age group (25.6%). The most frequent genotypes were non-16/18 high oncogenic risk HPV (77% of positive cases). HPV 16 was found in 17.1% of positive cases, and HPV 18 in 6.5%. Conclusion: The most prevalent types of HPV in Florianópolis in the last 6 years are non-16/18 high oncogenic risk HPV types, viral types not covered by the current HPV vaccine available in the public health sector in Brazil.

Introdução: A infecção pelo Papilomavírus Humano (HPV)é a infecção sexualmente transmissível mais frequente na mulher. Cerca de 80% das mulheres sexualmente ativas irão entrar em contato com este vírus em algum momento da sua vida. A maioria das infecções será transitória, mas quando a infecção se torna persistente, associada aos HPV de alto risco oncogênico, poderá haver a progressão para o câncer, principalmente o câncer de colo de útero. A melhor forma de prevenção da contaminação pelo HPV é através da utilização das vacinas. Objetivo: Avaliar quais são os tipos de HPV mais prevalentes na cidade de Florianópolis, Brasil, e se a maioria dos tipos diagnosticados estão contidos nas vacinas contra o HPV atualmente disponíveis no mercado e no setor público de saúde. Métodos: Foram avaliados 14.727 exames para diagnóstico da infecção genital pelo HPV em mulheres de Florianópolis, de acordo com a idade das mulheres. A detecção do HPV foi realizada através dos exames de biologia molecular pelas técnicas de captura híbrida (para diagnóstico do grupo de HPV, alto ou baixo risco oncogênico) e PCR (genotipagem viral). Resultados: Foram avaliados exames para diagnóstico da infecção de mulheres entre um e 102 anos de idade. A maior positividade dos exames foi observada em mulheres dos 20­25 anos (51% dos exames). A faixa etária de maior prevalência foi dos 31­35 anos (23,5%), e a menor, após os 70 anos (0,6%). O HPV de alto risco oncogênico foi detectado em 94,1% dos casos positivos e foi o mais frequente em todas as faixas etárias. A infecção mista (HPV de alto e baixo risco) foi mais prevalente na faixa etária dos 66­70 anos (25,6%). Os genótipos mais frequentes foram os HPV de alto risco oncogênico não 16/18 (77% dos casos positivos). O HPV 16 foi encontrado em 17,1% dos casos positivos, e o HPV 18 em 6,5%. Conclusão: Os tipos de HPV mais prevalentes em Florianópolis nos últimos 6 anos são os HPV de alto risco oncogênico não 16/18, tipos virais não cobertos pela atual vacina contra o HPV disponível no setor público de saúde do Brasil.Palavras-chave: HPV. Tipos de HPV. Câncer de colo de útero. Cobertura vacinal.

Clinical Adaptation According to Anatomical Types of Nasal Septum / Adaptación Clínica Según Tipos Anatómicos de Tabique Nasal

SUMMARY: The purpose of this study was to inform the anatomical types of the nasal septum of which including variations by dissection and to provide guidelines for clinical adaptation. For this purpose dissections were performed on 70 nasal septums of formalin fixed Korean adult cadavers (20 males, 11 females, and 39 of unknown sex) with an age at death of 13-105 years. The septal deviation was checked before midsagittal section the nasal cavity with the aid of a laryngoscope. The mucosa on the nasal septum was then removed to observe the morphology of the nasal septum. The shape of each component of the nasal septum was identified, and photographs were taken from a midsagittal plane. This study has discovered various anatomical types of the nasal septum and its variations. The correlations between septal types according to their proportions were also analyzed. The results reported herein provide detailed anatomical knowledge that can be used as a valuable reference for rhinoplasty procedures.

El propósito de este estudio fue informar los tipos anatómicos del tabique nasal incluyendo las variaciones por disección y brindar pautas para la adaptación clínica. Para este propósito, se realizaron disecciones en 70 tabiques nasales de cadáveres adultos coreanos fijados con formalina (20 hombres, 11 mujeres y 39 de sexo desconocido) con una edad de muerte de 13 a 105 años. La desviación septal se comprobó antes de la sección medio sagital de la cavidad nasal con la ayuda de un laringoscopio. A continuación, se retiró la mucosa del tabique nasal para observar la morfología del tabique nasal. Se identificó la forma de cada componente del tabique nasal y se tomaron fotografías desde un plano mediano sagital. En el estudio se descubrieron varios tipos anatómicos del tabique nasal y sus variaciones. También se analizaron las correlaciones entre los tipos septales según sus proporciones. Los resultados informados en este documento proporcionan un conocimiento anatómico detallado que se puede utilizar como una referencia valiosa para los procedimientos de rinoplastía.

Manejo de urgencias odontológicas en pacientes afiliados al Seguro Social Campesino El Porvenir, El Carmen, Ecuador

Introducción: las urgencias dentales que se presentan a diario en el campo odontológico son de suma importancia, de ahí que sea necesario saber manejarlas y así evitar consecuencias posteriores que pueden poner en riesgo la vida. Objetivo: diagnosticar cómo se manejan las urgencias odontológicas en el Instituto Ecuatoriano de Seguridad Social Campesino. Materiales y métodos: estudio descriptivo, cuantitativo y transversal, con una muestra de 60 usuarios. Se tomaron, además, criterios de inclusión y de exclusión. Se utilizaron como técnicas de recolección de datos encuestas estructuradas -basadas en los protocolos de odontología del Ministerio de Salud Pública (2014) y el protocolo de urgencias odontológica COVID (2020)-, las que indicaron el manejo de las urgencias en el área mencionada. Se evaluó el servicio mediante los porcentajes que se reflejaron en la encuesta sobre el manejo de urgencias y los tipos de patologías de mayor frecuencia. Resultados: el 82 % de los encuestados manifestó que recibió una atención inmediata a su urgencia dental. Un 95 % refirió que les dieron una atención adecuada según su urgencia de calidad. Además, se evaluaron los tipos de urgencias más frecuentes, destacando infección dental (50 %), caries profunda (20 %), extracción (15 %), fractura (8 %) y tercer molar impactado (2 %). Conclusiones: se concluye que en el Seguro Social Campesino El Porvenir destacó el buen manejo en las urgencias odontológicas. Esto se ve reflejado en la utilización de maniobras y protocolos que están determinados en el área de la odontología.

Introduction: dental urgencies that daily present in the odontological field are of great importance, so it is necessary to know how to manage them and that way to avoid posterior consequences that could put life at risk. Objective: to diagnose how to manage odontological urgencies in the Ecuadorian Institute of Rural Social Security Materials and methods: descriptive, quantitative, cross-sectional study, with a sample of 60 users. Inclusion and exclusion criteria were also taken in to account. Structured inquiries were used as data collection techniques-based on the odontological protocols of the Ministry of Public Health (2014) and the COVID odontological emergency protocol (2020)-, which indicate emergencies management in the mentioned field. The service was evaluated through the percentages reflected in the emergency management enquiry and the most frequent types of pathologies. Results: 82% of those surveyed stated that they received an immediate attention to their dental emergency. 95% said that they were given an adequate attention according to their quality emergency. Besides that, the most frequent emergency types were evaluated, highlighting dental infection (50%), deep caries (20%), extraction (15%), fracture (8%) and impacted third molar (2%). Conclusion: It is concluded that in the Rural Social Security El Porvenir, the good management of odontological urgencies stood out. This is reflected in the use of maneuvers and protocols that are determined in the area of dentistry.

Autophagy, a relevant process for metabolic health and type-2 diabetes / Autofagia, un proceso relevante para la salud y la diabetes tipo 2

Autophagy is a very active process that plays an important role in cell and organ differentiation and remodelling, being a crucial system to guarantee health. This physiological process is activated in starvation and inhibited in the presence of nutrients. This short review comments on the three types of autophagy: macroautophagy, microautophagy, and chaperone-mediated autophagy, as well as different aspects that control autophagy and its relationship with health and degenerative diseases. As autophagy is highly dependent on functional autophagy (ATG) proteins integrating the phagophore, the role of some key ATG genes and epigenes are briefly commented on. The manuscript deepens discussing some central aspects of type-2 diabetes mellitus and their relationship with the cell cleaning process and mitochondria homeostasis maintenance, as well as the mechanisms through which antidiabetic drugs affect autophagy. Well-designed studies are needed to elucidate whether autophagy plays a casual or causal role in T2DM. (AU)

La autofagia es un proceso muy activo que juega un papel importante en la diferenciación y remodelación de células y órganos, siendo un sistema crucial para garantizar la salud. Este proceso fisiológico se activa en la inanición y se inhibe en presencia de nutrientes. En esta breve revisión se definen los tres tipos de autofagia: macroautofagia, microautofagia y autofagia mediada por chaperonas, y los diferentes aspectos que controlan la autofagia y su relación con la salud y las enfermedades degenerativas. Como la autofagia depende en gran medida de las proteínas funcionales de autofagia (ATG) que integran el fagóforo, se comenta brevemente el papel clave de algunos genes y epigenes de las ATG. El manuscrito profundiza discutiendo algunos aspectos centrales de la diabetes mellitus tipo 2 (DMT2) y su relación con el proceso de limpieza celular y el mantenimiento de la homeostasis mitocondrial, así como los mecanismos a través de cuales los fármacos antidiabéticos afectan a la autofagia. Se necesitan estudios bien diseñados para dilucidar si la autofagia juega un papel de casualidad o causalidad en el desarrollo de la DMT2. (AU)