Aging is defined as a progressive decline of cognitive and physiological functions over lifetime. Since the definition of the nine hallmarks of aging in 2013 by López-Otin, numerous studies have attempted to identify the main regulators and contributors in the aging process. One interesting group of proteins whose participation has been implicated in several aging hallmarks are the nuclear DBF2-related (NDR) family of serine-threonine AGC kinases. They are one of the core components of the Hippo signaling pathway and include NDR1, NDR2, LATS1 and LATS2 in mammals, along with its highly conserved metazoan orthologs; Trc in Drosophila melanogaster, SAX-1 in Caenorhabditis elegans, CBK1, DBF20 in Saccharomyces cerevisiae and orb6 in Saccharomyces pombe. These kinases have been independently linked to the regulation of widely diverse cellular processes disrupted during aging such as the cell cycle progression, transcription, intercellular communication, nutrient homeostasis, autophagy, apoptosis, and stem cell differentiation. However, a comprehensive overview of the state-of-the-art knowledge regarding the post-translational modifications of and by NDR kinases in aging has not been conducted. In this review, we summarize the current understanding of the NDR family of kinases, focusing on their relevance to various aging hallmarks, and emphasize the growing body of evidence that suggests NDR kinases are essential regulators of aging across species.
Loss of neuropeptide Y (NPY)-expressing interneurons in the hippocampus and decaying cholinergic neuromodulation are thought to contribute to impaired cognitive function during aging. However, the interaction of these two neuromodulatory systems in maintaining hippocampal synaptic plasticity during healthy aging has not been explored so far. Here we report profound sex differences in the Neuropeptide-Y (NPY) levels in the dorsal dentate gyrus (DG) with higher NPY concentrations in the male mice compared to their female counterparts and a reduction of NPY levels during aging specifically in males. This change in aged males is accompanied by a deficit in theta burst-induced long-term potentiation (LTP) in the medial perforant path-to-dorsal DG (MPP-DG) synapse, which can be rescued by enhancing cholinergic activation with the acetylcholine esterase blocker, physostigmine. Importantly, NPYergic transmission is required for this rescue of LTP. Moreover, exogenous NPY application alone is sufficient to recover LTP induction in aged male mice, even in the absence of the cholinergic stimulator. Together, our results suggest that in male mice NPYergic neurotransmission is a critical factor for maintaining dorsal DG LTP during aging.
Subcapsular renal hematomas may appear spontaneously in patients in chronic hemodialysis, though other causes as neoplasms, vasculitis, and infections should be excluded. Patients may present with abdominal pain and hemorrhagic shock; hence, early diagnosis is vital. Nephrectomy or renal artery embolization are suitable treatment options.
Introducción: El año 2015 es el marco de referencia temporal internacional para evaluar las acciones de la estrategia Fin a la tuberculosis. La eliminación de la enfermedad como problema de salud requiere de la identificación de poblaciones y territorios en mayor riesgo, y de los determinantes de su distribución geográfica. Objetivo: Determinar la influencia de factores socioeconómicos, demográficos y geoespaciales en la distribución espacial de la tuberculosis en La Habana en el año 2015. Métodos: Se realizó un estudio ecológico. Se describió la distribución espacial del total de casos de tuberculosis, la confección TB/VIH y los casos TB/reclusos a nivel de municipio; así como de variables socioeconómicas, demográficas y geoespaciales con datos disponibles de todos los municipios de la provincia. Se realizaron mapas temáticos para cada una de las variables. Posteriormente, se realizó un análisis de superposición de capas. Resultados: Se observó una mayor concentración de casos en el centro-sur de la provincia; principalmente en los municipios Centro Habana, Habana Vieja, Diez de Octubre y Boyeros, a excepción de este último, estos municipios son los más densamente poblados, los que tienen mayor ocupación del suelo y condiciones de vida más desfavorables. Conclusiones: La distribución espacial de la tuberculosis en La Habana está estrechamente relacionada al comportamiento de variables socioeconómicas, demográficas y geoespaciales en sus diferentes municipios. Estas variables deben ser tomadas en cuenta en intervenciones de salud dirigidas a la eliminación de la enfermedad en la provincia(AU)
Introduction: The year 2015 constitutes the international time frame of reference to evaluate the actions of the End tuberculosis strategy. The elimination of the disease as a health problem requires the identification of populations and territories at greatest risk, and the determinants of their geographical distribution. Objective: Determine the influence of socio-economic, demographic and geospatial factors on the spatial distribution of tuberculosis in Havana in 2015. Methods: An ecological study was conducted. The spatial distribution of total TB cases, TB/HIV and TB/inmate cases at the municipality level was described; as well as socio-economic, demographic and geospatial variables with data available from all municipalities in the province. Thematic maps were made for each of the variables. Subsequently, a layer overlap analysis was performed. Results: A higher concentration of cases was observed in the center-south of the province; mainly in the municipalities of Centro Habana, Habana Vieja, Diez de Octubre and Boyeros ; with the exception of the latter, these municipalities are the most densely populated, those with the highest land occupation and the most unfavorable living conditions. Conclusions: The spatial distribution of tuberculosis in Havana is closely related to the behavior of socio-economic, demographic and geospatial variables in its different municipalities. These variables should be taken into account in health interventions aimed at eliminating the disease in the province(AU)
Humans , Male , Female , Social Conditions , Tuberculosis/prevention & control , Geographic Information Systems , Ecological Studies
Introducción: La tuberculosis infantil posee baja incidencia en Cuba, no obstante, se considera un indicador de transmisión reciente de la enfermedad. Objetivo: Estratificar espacialmente la tuberculosis en menores de 15 años de edad en la región occidental de Cuba en el periodo 2011-2015, según las metas progresivas hacia la eliminación de la enfermedad. Métodos: Se realizó un estudio ecológico de series temporales. La estatificación espacial de la tuberculosis se realizó a partir de técnicas geoespaciales que asignan a cada territorio valores ponderados graduados con respecto a los rangos establecidos de las medias geométricas de las tasas de notificación en el periodo. Los estratos se corresponden con las metas progresivas hacia la eliminación de la tuberculosis. Resultados: Se encontraron en la categoría de ultracontrol muy avanzado las provincias La Habana [municipios Plaza de la Revolución (2,4), Centro Habana (3,7), San Miguel del Padrón (2,1), Diez de Octubre (1,6) y Marianao (1,0)], Mayabeque [Melena del Sur (3,5) y San José de las Lajas (1,4)] y Matanzas [Unión de Reyes (1,1)]. Conclusiones: La presencia de diferentes estratos geoespaciales de la tuberculosis en menores de 15 años de edad en la región occidental de Cuba constata la necesidad de diseñar estrategias que se adecuen a la realidad de los diferentes territorios. El abordaje geoespacial fortalece la estratificación epidemiológica de acuerdo a las metas progresivas hacia la eliminación de la tuberculosis(AU)
Introduction: Children tuberculosis has a low incidence in Cuba, however, it is considered an indicator of recent transmission of the disease. Objective: Spatially stratify tuberculosis in children under 15 years of age in the western region of Cuba in the period 2011-2015, according to the progressive goals towards the elimination of the disease. Methods: An ecological time series study was conducted. The spatial stratification of tuberculosis was carried out from geospatial techniques that assign to each territory weighted values graded with respect to the established ranges of the geometric means of the notification rates in the period. The strata correspond to the progressive goals towards the elimination of tuberculosis. Results: The provinces of Havana [municipalities : Plaza de la Revolución (2.4), Centro Habana (3.7), San Miguel del Padrón (2.1), Diez de Octubre (1.6) and Marianao (1.0)], Mayabeque (municipalities : Melena del Sur (3.5) and San José de las Lajas (1.4)] and Matanzas [municipalities : Unión de Reyes (1.1)] were found in the category of very advanced ultracontrol. Conclusions: The presence of different geospatial strata of tuberculosis in children under 15 years of age in the western region of Cuba confirms the need to design strategies that adapt to the reality of the different territories. The geospatial approach strengthens the epidemiological stratification according to the progressive goals towards the elimination of tuberculosis(AU)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Tuberculosis/prevention & control , Geographic Information Systems , Cuba
INTRODUCTION: SARS-CoV-2 seroprevalence studies are currently being recommended and implemented in many countries. Forming part of the COVID-19 monitoring and evaluation plan of the Catalan Government Health Department, our network aims to initiate a primary healthcare sentinel monitoring system as a surrogate of SARS-CoV-2 exposure in the Barcelona Metropolitan Area. METHODS AND ANALYSIS: The seroCAP is a serial cross-sectional study, which will be performed in the Barcelona Metropolitan Area to estimate antibodies against SARS-CoV-2. From February 2021 to March 2022, the detection of serum IgG antibodies against SARS-CoV-2 trimeric spike protein will be performed on a monthly basis in blood samples collected for diverse clinical purposes in three reference hospitals from the three Barcelona healthcare areas (BCN areas). The samples (n=2588/month) will be from patients attended by 30 primary healthcare teams at 30 basic healthcare areas (BHA). A lab software algorithm will systematically select the samples by age and sex. Seroprevalence will be estimated and monitored by age, sex, BCN area and BHA. Descriptive and cluster analysis of the characteristics and distribution of SARS-CoV-2 infections will be performed. Sociodemographic, socioeconomic and morbidity-associated factors will be determined using logistic regression. We will explore the association between seroprevalence, SARS-CoV-2 confirmed cases and the implemented measures using interrupted time series analysis. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University Institute Foundation for Primary Health Care Research Jordi Gol i Gurina ethics committee. An informed consent is not required regarding the approval of the secondary use of biological samples within the framework of the COVID-19 pandemic. A report will be generated quarterly. The final analysis, conclusions and recommendations will be shared with the stakeholders and communicated to the general public. Manuscripts resulting from the network will be submitted for publication in peer-reviewed journals.
COVID-19 , SARS-CoV-2 , Antibodies, Viral , Cross-Sectional Studies , Humans , Immunoglobulin G , Pandemics , Primary Health Care , Seroepidemiologic Studies
Antibiotics are widely applied for the treatment of bacterial infections, but their long-term use may lead to gut flora dysbiosis and detrimental effects on brain physiology, behavior as well as cognitive performance. Still, a striking lack of knowledge exists concerning electrophysiological correlates of antibiotic-induced changes in gut microbiota and behavior. Here, we investigated changes in the synaptic transmission and plasticity together with behaviorally-relevant network activities from the hippocampus of antibiotic-treated mice. Prolonged antibiotic treatment led to a reduction of myeloid cell pools in bone marrow, circulation and those surveilling the brain. Circulating Ly6Chi inflammatory monocytes adopted a proinflammatory phenotype with increased expression of CD40 and MHC II. In the central nervous system, microglia displayed a subtle activated phenotype with elevated CD40 and MHC II expression, increased IL-6 and TNF production as well as with an increased number of Iba1 + cells in the hippocampal CA3 and CA1 subregions. Concomitantly, we detected a substantial reduction in the synaptic transmission in the hippocampal CA1 after antibiotic treatment. In line, carbachol-induced cholinergic gamma oscillation were reduced upon antibiotic treatment while the incidence of hippocampal sharp waves was elevated. These alterations were associated with the global changes in the expression of neurotrophin nerve growth factor and inducible nitric oxide synthase, both of which have been shown to influence cholinergic system in the hippocampus. Overall, our study demonstrates that antibiotic-induced dysbiosis of the gut microbiome and subsequent alteration of the immune cell function are associated with reduced synaptic transmission and gamma oscillations in the hippocampus, a brain region that is critically involved in mediation of innate and cognitive behavior.
Dysbiosis , Microglia , Animals , Anti-Bacterial Agents/pharmacology , Cholinergic Agents/metabolism , Cholinergic Agents/pharmacology , Dysbiosis/chemically induced , Dysbiosis/metabolism , Hippocampus/metabolism , Mice , Microglia/metabolism
A presynaptic active zone organizer protein Bassoon orchestrates numerous important functions at the presynaptic active zone. We previously showed that the absence of Bassoon exclusively in forebrain glutamatergic presynapses (BsnEmx1cKO) in mice leads to developmental disturbances in dentate gyrus (DG) affecting synaptic excitability, morphology, neurogenesis and related behaviour during adulthood. Here, we demonstrate that hyperexcitability of the medial perforant path-to-DG (MPP-DG) pathway in BsnEmx1cKO mice emerges during adolescence and is sustained during adulthood. We further provide evidence for a potential involvement of tropomyosin-related kinase B (TrkB), the high-affinity receptor for brain-derived neurotrophic factor (BDNF), mediated signalling. We detect elevated TrkB protein levels in the dorsal DG of adult mice (~3-5 months-old) but not in adolescent (~4-5 weeks-old) mice. Electrophysiological analysis reveals increased field-excitatory-postsynaptic-potentials (fEPSPs) in the DG of the adult, but not in adolescent BsnEmx1cKO mice. In line with an increased TrkB expression during adulthood in BsnEmx1cKO, blockade of TrkB normalizes the increased synaptic excitability in the DG during adulthood, while no such effect was observed in adolescence. Accordingly, neurogenesis, which has previously been found to be increased in adult BsnEmx1cKO mice, was unaffected at adolescent age. Our results suggest that Bassoon plays a crucial role in the TrkB-dependent postnatal maturation of the hippocampus.
Hippocampus/metabolism , Membrane Glycoproteins/metabolism , Nerve Tissue Proteins/metabolism , Prosencephalon/metabolism , Protein-Tyrosine Kinases/metabolism , Signal Transduction , Synaptic Transmission , Animals , Membrane Glycoproteins/genetics , Mice , Mice, Knockout , Nerve Tissue Proteins/genetics , Protein-Tyrosine Kinases/genetics
RESUMEN Introducción: Durante enfermedades infecciosas emergentes en curso como la COVID-19, la vigilancia espacio-temporal es fundamental para identificar áreas prioritarias para intervenciones específicas, diferenciar intensidad diagnóstica y asignación de recursos. Objetivo: Modelar la evolución del riesgo relativo de presentación de casos de COVID-19 e identificar conglomerados en municipios donde la enfermedad se mantuvo en el periodo posterior al descenso de la curva epidémica en Cuba. Métodos: El periodo mencionado comprendió entre el 26/05/2020 hasta el 4/09/2020. Se realizaron corridas cíclicas del modelo prospectivo espacio-temporal de Poisson, con incrementos progresivos de 14 días, mediante la aplicación SaTScan™ 9.6. Resultados: Se identificaron 15 conglomerados significativos (p ≤ 0,0001) cuya extensión involucró desde uno hasta trece municipios, con distribución en seis provincias (Pinar del Río, Artemisa, La Habana, Mayabeque, Matanzas, Villa Clara y Ciego de Ávila). En los conglomerados todos los municipios mostraron riesgo relativo alto, entre ellos, La Palma en la provincia de Pinar del Río y Ciego de Ávila en la provincia del mismo nombre, con los valores más altos, 119,95 y 121,04, respectivamente. Conclusión: El modelo empleado pudo identificar los conglomerados en territorios con significativa probabilidad de ocurrencia de COVID-19, así como periodos de evolución del riesgo relativo. Además, reconoce los municipios que merecen prioridad para intensificar en ellos intervenciones de contención y control sanitario y evitar la reemergencia de la enfermedad con mayor dispersión espacial.
ABSTRACT Introduction: During the occurrence of ongoing emerging infectious diseases such as COVID-19, spatiotemporal surveillance is crucial to identify priority areas for specific interventions, differentiate diagnostic intensity and assign resources. Objective: To model the evolution of the relative risk of presentation of COVID-19 cases and to identify clusters in municipalities where the disease remains at the stage following the descent of the epidemic curve in Cuba. Methods: The period mentioned was from 26/05/2020 to 4/09/2020. Cyclic runs of Poisson's prospective spatiotemporal model were performed, with progressive 14-day increases, using the software SaTScan™ 9.6. Results: A total 15 significant clusters were identified (p ≤ 0.0001) extending over one to thirteen municipalities and distributed in six provinces (Pinar del Río, Artemisa, Havana, Mayabeque, Matanzas, Villa Clara and Ciego de Ávila). In the clusters, all municipalities showed a high relative risk among them, La Palma in Pinar del Rio province and Ciego de Avila in the province of the same name, with the highest values, 119.95 and 121.04, respectively. Conclusion: The model was able to identify territories with a significant likelihood of COVID-19 occurrence, as well as periods in the evolution of relative risk. It also showed that surveillance and early warning strategies may facilitate prioritization of health control and containment interventions aimed at preventing the reemergence of the disease with greater spatial coverage.
RESUMEN El síndrome de Axenfeld-Rieger es una enfermedad de origen genético de muy baja prevalencia que se hace acompañar de manifestaciones clínicas variables con afectación ocular y no ocular. Por tales razones se decidió presentar el caso de una paciente de 14 años de edad, antecedente familiar (en este caso su madre) de dicha enfermedad, con historia de retraso mental ligero, hipoacusia y mala visión en ambos ojos que se acompaña de alteraciones oculares: malformaciones a nivel del segmento anterior: deformidad de la pupila, prominencia blanquecina perilímbica que se corresponde con un embriotoxón posterior. Presenta otros signos de afectación no oculares: dismorfismo craneofacial leve, hipertelorismo, hipoplasia maxilar con aplanamiento del tercio medio facial, frente prominente, puente nasal ancho y aplastado así como anomalías dentales. Sufre complicaciones propias de la evolución de la entidad como es el glaucoma secundario, por lo que se trató con triple terapia con hipotensores oculares, en espera de la respuesta al tratamiento para, en el caso de una evolución tórpida, proceder al tratamiento quirúrgico: trabeculectomía.
ABSTRACT Axenfeld-Rieger syndrome is a very low prevalence disease of genetic origin that is accompanied by variable clinical manifestations with ocular and non-ocular involvement. For these reasons, it was decided to present the case of a 14-years-old patient with a family history (in this case her mother) of this disease, with a history of mild mental retardation, hearing loss and poor vision in both eyes that is accompanied by ocular alterations: malformations at the level of the anterior segment: pupil deformity, perilimbic whitish prominence corresponding to a posterior embryotoxon. He presents other non-ocular signs of involvement: mild craniofacial dysmorphism, hypertelorism, maxillary hypoplasia with flattening of the midface, prominent forehead, wide and flattened nasal bridge, as well as dental anomalies. He suffers from complications inherent to the evolution of the entity, such as secondary glaucoma, for which he was treated with triple therapy with ocular hypotensive agents, pending the response to treatment, and in the case of a torpid evolution, proceed to surgical treatment: trabeculectomy.
Eye Diseases, Hereditary/diagnosis , Eye Diseases, Hereditary/genetics , Maxillofacial Abnormalities/diagnosis , Genetic Diseases, Inborn/diagnosis
RESUMEN La miastenia gravis es una enfermedad crónica autoinmune, poco común, cuya prevalencia ha aumentado desde la década de los 80 debido a la mejoría en su diagnóstico y al aumento de la longevidad de la población. Este trabajo tiene como objetivo realizar una actualización acerca de los aspectos de mayor importancia sobre la entidad, conocimiento que todo personal de salud y estudiantes deben poseer. Para ello se consultó un total de 32 referencias bibliográficas resultado de búsquedas en bibliotecas virtuales: Scopus, Google Académico y Medline. Se concluyó que, a partir de la mejora en el conocimiento de la fisiopatología de la enfermedad, el diagnóstico y el tratamiento, se ha logrado reducir la mortalidad, mejorar la calidad de vida de los pacientes y su funcionalidad.
ABSTRACT Myasthenia gravis is a rare, autoimmune chronic disease whose prevalence has increased since the 1980s due to improved diagnosis and increased longevity of the population. The objective of this work is to update the most important aspects of the entity, a knowledge that all health personnel and students must have. For this, a total of 32 bibliographic references resulting from searches in virtual libraries were consulted: Scopus, Google Academic and Medline. It was concluded that, from the improvement in the knowledge of the pathophysiology of the disease, the diagnosis and the treatment, it has been possible to reduce mortality, improve the quality of life of patients and their functionality.
OBJECTIVES: Lipid mediators derived from polyunsaturated fatty acids (FA), have been related to inflammation and immune response regulation. Herein we evaluated the intake and serum levels of ω-3 and ω-6 FA among patients with primary Sjögren's syndrome (pSS), and correlated with ocular/oral sicca symptoms, disease activity and a panel of chemokines/cytokines. METHODS: We included 108 patients and 100 controls. Dietary information was obtained from a food questionnaire of one-day reminder and processed using a nutritional software. Among the SS group, we measured serum ω-3 (α-linolenic acid [α-LN], eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA]) and ω-6 (linoleic acid [LA], arachidonic acid [AA]) by gas chromatography flame ionization. We scored the ESSDAI, ESPRI, Schirmer-I test and NSWSF. In a subsample, we assessed the OSDI, ophthalmologic staining scores and measured CXCL8, CXCL10, CCL2, IL-22 and IL-21 in saliva, and CXCL8, CXCL10, CCL2 and CXCL9 in tears by Luminometry. RESULTS: ω-3 and ω-6 intake was lower in SS patients than controls, and did not correlate with serum levels. We found a negative correlation between α-LN and the OSDI and ESSDAI, as well as DHA and ESSDAI. In tears, AA positively correlated with CXCL9, whereas in saliva, α-LN, DHA and the ω3 sum negatively correlated with CCL2. We observed a negative correlation between the ω6 sum and IL-21. CONCLUSIONS: pSS patients had deficient omega intake. Lower ocular symptoms, ESSDAI scores and salivary CCL2 correlated with higher ω-3 levels, possible suggesting a role in chronic inflammation. Further studies are warranted to deepen in the knowledge of this association.
Fatty Acids, Omega-3 , Sjogren's Syndrome , Docosahexaenoic Acids , Fatty Acids, Omega-6 , Humans , Inflammation , Sjogren's Syndrome/diagnosis
Introducción: La utilización creciente de productos tóxicos a escala mundial ha generado un amplio espectro de problemas. El suicidio, entre ellos, constituye un problema de salud internacional. En Cuba ocupa el sexto lugar como causa de mortalidad general y el segundo en el grupo de 15 a 49 años. Objetivo: caracterizar algunas variables epidemiológicas relacionadas con las intoxicaciones exógenas agudas en infantes. Métodos: Estudio observacional descriptivo retrospectivo en una muestra constituida por 142 pacientes. ingresados con el diagnóstico de intoxicación exógena en la Unidad de Cuidados Intensivos Pediátricos del Hospital General Docente Comandante Pinares de San Cristóbal, Artemisa, durante el periodo comprendido desde enero de 2008 a diciembre de 2016 Resultados: El grupo de 10-14 años representó la mayoría de la muestra para 39,4 por ciento y el 71,9. por ciento de esta muestra total correspondió al sexo femenino. El mayor porcentaje de las intoxicaciones ocurrieron de forma intencional (tentativa suicida) (64,1 por ciento). Los medicamentos ocuparon el primer lugar (87,3 por ciento) de los tóxicos identificados, el consumo de psicofármacos representó el 68,3 por ciento muchas veces asociado a la ingestión de alcohol (20,4 por ciento). Predominaron los síntomas neurológicos (66,3 por ciento), El lavado gástrico se le realizó en 79,6 por ciento y fue necesario realizar gastroenterodiálisis en 65,4 por ciento. Conclusiones: Las intoxicaciones exógenas constituyen una de las causas prevenibles que aportan incremento de la morbilidad y mortalidad en infantes. Su atención debe ser multidisciplinaria e intersectorial, lo que influirá positivamente en la calidad de vida de los grupos poblacionales vulnerables(AU)
Introduction: The increasing use of toxic products on a global scale has generated a broad spectrum of problems. Suicide, among them, is an international health problem. In Cuba, it is the sixth main cause of death and the second in the group of 15 to 49 years. Objective: To characterize some epidemiological variables related to exogenous acute poisonings in infants. Methods: An observational descriptive retrospective study was conducted in a sample of 142 patients admitted with the diagnosis of exogenous poisoning in the Pediatric Intensive Care Unit of Comandante Pinares General Teaching Hospital, San Cristóbal, Artemisa province, during the period from January 2008 to December 2016. Results: The group of 10-14 years represented the majority of the sample for a 39.4 percent, and the 71.9 percent of the total sample was female sex. The largest percentage of the poisonings were intentional (suicide attempt) (64.1percent). Drugs were the first (87.3 percent) of the toxic chemicals identified; the consumption of psychotropic drugs represented the 68.3 percent often associated with alcohol ingestion (20.4 percent). There was a predominance of neurological symptoms (66.3 percent). The gastric lavage was performed in 79.6 percent and it was necessary to perform gastroentero dyalisis in 65.4 percent. Conclusions: Exogenous poisonings are one of the preventable causes that increase morbidity and mortality in infants. Their attention must be with a multidisciplinary and intersectoral approach, which positively influences the quality of life of vulnerable population groups(AU)
Humans , Male , Female , Child , Adolescent , Poisoning/epidemiology , Suicide/prevention & control , Intensive Care Units, Pediatric/standards
INTRODUCCIÓN: Para la estimación del filtrado glomerular renal (FG) en trasplantados renales se emplean las ecuaciones MDRD y CKD-EPI de 2009 que han mostrado diferencias importantes cuando se comparan con el FG medido con técnicas de referencia. OBJETIVO: Analizar el rendimiento de las ecuaciones MDRD, CKD-EPI de 2009 y de 2012 en 270 pacientes trasplantados renales de un año de evolución, comparando con el FG medido con aclaramiento plasmático de 51Cr-EDTA. RESULTADOS: El FG medido fue 43,0 ± 11,4 (18,2-79,4) mL/min/1,73 m2, con niveles de creatinina de 1,42 ± 0,46 (0,60-4,33) mg/dL y de cistatina C de 1,45 ± 0,53 (0,42-3,48) mg/L. El FG medido se correlacionó moderadamente con creatinina (r = -0,61; p < 0,001) y cistatina C (r = - 0,52; p < 0,001). Empleando técnicas de regresión lineal observamos que creatinina, cistatina C, sexo y edad solo explicaban el 52% de la varianza total del FG. Todas las ecuaciones sobrestimaron el FG, con sesgo medio de +11,1 mL/min/1,73 m2 para MDRD, +16,4 mL/min/1,73 m2 para CKD-EPI de 2009, +15 mL/min/1,73 m2 para CKD-EPI con cistatina C y +14,1 mL/min/1,73 m2 para CKD-EPI con creatinina y cistatina C de 2012. Las estimaciones con MDRD y CKD-EPI de 2009 se correlacionaron mejor con 51Cr-EDTA que CKD-EPI con creatinina y/o cistatina C. Las sobrestimaciones se correlacionaron negativamente con los niveles de creatinina y cistatina C, siendo más importantes para CKD-EPI con creatinina y/o cistatina C cuando el FG fue mayor de 60 mL/min/1,73 m2. CONCLUSIONES: Las ecuaciones CKD-EPI de 2012 con creatinina y/o cistatina C sobrestiman el FG de forma muy marcada en estadios 1 y 2 de la enfermedad renal crónica, por lo que en ellos sería recomendable emplear la ecuación MDRD. La técnica de referencia empleada para medir el FG parece tener una influencia muy importante en el sesgo de las ecuaciones
BACKGROUND: When estimating the glomerular filtration rate (GFR) in kidney transplant patients, significant differences have been found between MDRD and the 2009 CKD-EPI equations, and reference techniques. OBJECTIVE: To analyse and compare the performance of MDRD and the 2009 and 2012 CKD-EPI equations against 51Cr-EDTA plasma clearance in measuring GFR in 270 kidney transplant patients after one year. RESULTS: The mean measured GFR was 43.0 ± 11.4 (18.2-79.4) ml/min/1.73 m2, with creatinine levels of 1.42 ± 0.46 (0.60-4.33) mg/dl and cystatin C levels of 1.45 ± 0.53 (0.42-3.48) mg/l. This correlated moderately with creatinine (r = -0.61, P < .001) and cystatin C (r = -0.52, P < .001). Using linear regression techniques, it was found that creatinine, cystatin C, gender and age only explained 52% of GFR total variance. All equations overestimated GFR, with a mean bias of +11.1 ml/min/1.73 m2 for MDRD, + 16.4 ml/min/1.73 m2 for 2009-CKD-EPI, +15 ml/min/1.73m2 for CKD-EPI with cystatin C, and +14.1 ml/min/1.73 m2 for 2012-CKD-EPI with creatinine and cystatin C. eGFR by MDRD and the 2009 CKD-EPI equation correlated better with 51Cr-EDTA than CKD-EPI with creatinine and/or cystatin C. The overestimations were negatively correlated with creatinine and cystatin C levels, most significantly for CKD-EPI with creatinine and/or cystatin C when GFR was greater than 60 ml/min/1.73 m2. CONCLUSIONS: The 2012 CKD-EPI equations with creatinine and/or cystatin C significantly overestimate GFR in stage 1 and 2 chronic kidney disease. The MDRD equations is therefore recommended in these cases. The reference method used to measure GFR seems to heavily influence the bias of the equations
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Creatinine/blood , Cystatin C/blood , Glomerular Filtration Rate/physiology , Kidney Transplantation , Renal Insufficiency, Chronic/physiopathology , Age Factors , Algorithms , Diet Therapy , Linear Models , Renal Insufficiency, Chronic/blood , Retrospective Studies , Sensitivity and Specificity , Sex Factors
To assess the presence of persistent serological activity and its association with clinical outcomes in primary Sjögren's syndrome. Clinical charts of 275 patients were reviewed retrospectively. Persistent serological activity was defined as an increase IgG ≥ 1.6 mg/dL or globulins > 3.7 g/dL or diminished C3 < 52 mg/dL or C4 < 12 mg/dL at least during two consecutive visits during a year (index period). The ClinESSDAI at the index period and the cumulative ClinESSDAI and the SSDDI at the last medical appointment were scored. A total of 159 patients with complete serological data were included mostly women and median disease duration of 10.2 years. Persistent serological activity was identified in 85 patients (53.1%). Only 13 patients changed their status to serological inactivity though the follow-up. Comparison of patients with (n = 85) versus without persistent serological activity (n = 74) showed that the first group had a higher frequency of impaired non-stimulated salivary flow, anti-La/SSB antibody, and RF, as well as higher ClinESSDAI scores. The most affected domains were the constitutional, glandular, cutaneous, renal, and hematological domains. On logistic regression analysis, the RF (OR 6.4, 95% CI 1.8-22, p = 0.003), the renal (OR 12.8, 95% CI 1.7-92, p = 0.01), and the hematological involvement (OR 4.7, 95% CI 1.6-13.4, p = 0.004) remained associated. Half of the patients studied had persistent serological activity, being this status constant through the follow-up. Persistent serological activity was associated with positive RF and higher ESSDAI scores due to hematological and renal activity. Scoring serological activity is an important issue in SS patients.
Antibodies, Antinuclear/blood , Severity of Illness Index , Sjogren's Syndrome/diagnosis , Adult , Aged , Female , Humans , Logistic Models , Male , Middle Aged , Retrospective Studies , Sjogren's Syndrome/blood
BACKGROUND: When estimating the glomerular filtration rate (GFR) in kidney transplant patients, significant differences have been found between MDRD and the 2009 CKD-EPI equations, and reference techniques. OBJECTIVE: To analyse and compare the performance of MDRD and the 2009 and 2012 CKD-EPI equations against 51Cr-EDTA plasma clearance in measuring GFR in 270 kidney transplant patients after one year. RESULTS: The mean measured GFR was 43.0±11.4 (18.2-79.4)ml/min/1.73m2, with creatinine levels of 1.42±0.46 (0.60-4.33)mg/dl and cystatin C levels of 1.45±0.53 (0.42-3.48)mg/l. This correlated moderately with creatinine (r=-0.61, P<.001) and cystatin C (r=-0.52, P<.001). Using linear regression techniques, it was found that creatinine, cystatin C, gender and age only explained 52% of GFR total variance. All equations overestimated GFR, with a mean bias of +11.1ml/min/1.73m2 for MDRD, +16.4ml/min/1.73m2 for 2009-CKD-EPI, +15ml/min/1.73m2 for CKD-EPI with cystatin C, and +14.1ml/min/1.73m2 for 2012-CKD-EPI with creatinine and cystatin C. eGFR by MDRD and the 2009 CKD-EPI equation correlated better with 51Cr-EDTA than CKD-EPI with creatinine and/or cystatin C. The overestimations were negatively correlated with creatinine and cystatin C levels, most significantly for CKD-EPI with creatinine and/or cystatin C when GFR was greater than 60ml/min/1.73m2. CONCLUSIONS: The 2012 CKD-EPI equations with creatinine and/or cystatin C significantly overestimate GFR in stage 1 and 2 chronic kidney disease. The MDRD equations is therefore recommended in these cases. The reference method used to measure GFR seems to heavily influence the bias of the equations.
Creatinine/blood , Cystatin C/blood , Glomerular Filtration Rate/physiology , Kidney Transplantation , Renal Insufficiency, Chronic/physiopathology , Adolescent , Adult , Age Factors , Aged , Algorithms , Diet Therapy , Female , Humans , Linear Models , Male , Middle Aged , Renal Insufficiency, Chronic/blood , Retrospective Studies , Sensitivity and Specificity , Sex Factors , Young Adult
OBJETIVO: La tuberculosis (TB) continúa siendo un problema importante de salud pública, debido a que la mayoría de los casos se concentran en población vulnerable. El objetivo de este trabajo fue describir la tendencia de las tasas de incidencia en población autóctona y extranjera (2009-2018) en la Comunidad de Madrid (CM). MÉTODOS: Se realizó un análisis retrospectivo de casos del Registro Regional de casos de Tuberculosis de la CM en el período 2009-2018. Se calcularon tasas de incidencia anual por cada 100.000 habitantes, por país de nacimiento (España, fuera de España), sexo y grupo de edad (<15, 15-34, 35-44, 45-64, >64), utilizando las poblaciones de padrón continuo a 1 de enero de cada año. Se calculó la tendencia de las tasas de incidencia y el porcentaje anual de cambio (APC), así como el mejor ajuste del punto de inflexión utilizando la regresión de Jointpoint. RESULTADOS: Se analizaron 7.696 casos, siendo el 48,2% en personas nacidas fuera de España. La edad media en población autóctona fue de 50 años (DS: 23,96) y 35 (DS: 36,64) en inmigrante (p < 0,001). La tasa de incidencia global pasó de 17,30 por cada 100.000 habitantes en 2009 a 9 en 2018, siendo superior en hombres. La incidencia de tuberculosis pulmonar pasó de 11,90 a 6,55. En población autóctona, la incidencia de TB pasó de 10,29 a 5,24, con un APC de -7,3% (IC95%: -8,9; -5,7; p < 0,05), y no se identificó ningún punto de inflexión. En población extranjera la incidencia de tuberculosis pasó de 46,54 a 25,49, identificándose un punto de inflexión en 2013, con una disminución más acusada de la incidencia para el periodo 2009-2013 debido a un APC de -13,8% (IC95%: -17,5; -10,0). CONCLUSIONES: La tasa de incidencia global en este periodo disminuye cerca de un 7% anual; sin embargo, esta disminución de la incidencia se produce fundamentalmente en población autóctona. En población extranjera la incidencia desciende cerca de un 14% durante el periodo 2009-2013. Tras este periodo no hay cambios significativos en la incidencia
OBJECTIVE: Tuberculosis is a major public health problem and most cases are concentrated in vulnerable populations. The objective was to describe the incidence rates trend in native and foreign population (2009-2018) in Madrid Region. METHODS: Retrospective analysis of cases from the Tuberculosis Regional Registry of cases of Madrid Region 2009-2018. Annual incidence rates were calculated by country of birth (Spain, other), sex and age group (<15, 15-34, 35-44, 45-64, >64), using the annual January 1st continuous register population. The infection rate trend and the annual percentage change (APC) were calculated, along with the best jointpoint adjustment using Jointpoint regression. RESULTS: 7,696 cases were analyzed, 48.2% were foreign-born individuals. Average age in native population was 50 years old (SD: 23.96) and 35 (DS: 36.64) in foreign-born individuals (p < 0.001). The overall incidence rate decreased from 17.30 in 2009 to 9.00 per 100,000 in 2018 and was higher in men. Pulmonary tuberculosis reduced from 11.90 to 6.55. Among native population, the incidence of TB fell from 10.29 to 5.24 with an APC of -7.3% (95%IC: -8.9; -5.7) (p < 0.05), no jointpoint was identified. Among foreign-born individuals the incidence of tuberculosis declined from 46.54 to 25.49, a joint point was identified in 2013, observing an incidence decrease for the period 2009-2013 and APC of -13.8% (IC95%: -17.5; -10.0). CONCLUSIONS: The global incidence rate in this period has decreased by approximately 7% per year. However, this reduction occurred mainly in native population. In foreign-born individuals the incidence decreased by approximately 14% during the 2009-2013 period, after this period there have been no significant incidence changes
Humans , Female , Male , Adult , Middle Aged , Tuberculosis/epidemiology , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use , Spain/epidemiology , Tuberculosis/drug therapy , Mycobacterium tuberculosis/pathogenicity , Emigration and Immigration/statistics & numerical data
RESUMEN Fundamento: la incidencia de las ametropías, sobretodo de la miopía, está aumentando a nivel mundial. Son los defectos refractivos no compensados la primera causa de deficiencia visual y la segunda causa de ceguera evitable en el mundo. Objetivo: caracterizar pacientes con ametropías. Métodos: estudio descriptivo que incluyó 2891 casos tratados en la consulta de Oftalmología de la Isla de Fogo, Cabo Verde, entre los meses de noviembre del 2015 y noviembre del 2017, a los que se les aplicó una encuesta que incluyó variables como edad, sexo. A todos se les realizó examen oftalmológico para determinar si el paciente era portador de ambliopía. Se determinó agudeza visual sin corrección y con corrección, así como tipo de ametropía. Resultados: se detectaron ametropías en 59,6 %; el sexo femenino y el grupo etario entre 21 a 41 años fue el más representativo, de ellos el 4,9 % era ambliope; el mayor porciento de los pacientes presentó el rango de buena visión( de 0,7-1,0) con predominio de las ametropías con componente cilíndrico y de ellas con mayor frecuencia el astigmatismo hipermetrópico compuesto y el miópico simple y compuesto. Conclusiones: la incidencia de ametropías fue elevada, con mayor representatividad de los defectos con componente cilíndrico. Se produjo mejoría de la visión una vez corregida.
ABSTRACT Foundation: the incidence of ametropies, mainly miopía, is increasing worldwide. Non-compensated refractive defects are the first cause of visual deficiency and the second of blindness in the world. Objective: to characterize patients with ametropies. Methods: descriptive study which included 2891 cases in the Ophthalmology consultation in Fogo Island, Green Cape, between November 2015 and 2017, who were surveyed including age and sex. All of them had an ophthalmological exam to determine if amblyopia was present. Visual acuteness with or without correction was determined, so as ametropy. Results: ametropy was detected in 59.6%, the femile sex and the age group between 21 and 41 years old were the most representative. Out of them, 4.9% had amblyopia, the highest percent of the patients presented a rank of good vision, (from 0,7-1,0) predominating ametropies with cylindrical component and from them with highest frequency compound hypermetropic astigmatism and myopic simple and compound. Conclusion: the incidence of ametropies was elevated, with higher representation of defects of cylindrical component. An improvement was achieved once corrected.
Introducción: La infección por virus dengue es considerada una de las arbovirosis de mayor prevalencia en los países tropicales. La encefalomielitis diseminada aguda es un trastorno inflamatorio desmielinizante y multifocal que afecta al sistema nervioso central, de inicio agudo y curso clínico monofásico. El proceso inflamatorio se encuentra mediado por mecanismos inmunológicos y su relación con infecciones por el virus dengue aún no se establece con claridad. Objetivo: Describir un caso clínico con manifestaciones del sistema nervioso central después de una probable infección por el virus dengue. Presentación del caso: Paciente femenina de 50 años, con antecedentes de hipertensión arterial controlada. Quince días después de un cuadro de fiebre de 4 días de duración, que posiblemente fue por una infección por el virus dengue, comienza con síntomas y signos de afectación neurológica caracterizadas por ligera irritabilidad, dificultad para la concentración en una actividad específica de la vida cotidiana. Progresivamente se nota dificultad motora en el hemicuerpo izquierdo además de encontrarse agitada y distraída, motivo por el cual se decide su ingreso hospitalario. Se realiza el diagnóstico a través de los hallazgos en el examen físico, los estudios positivos de resonancia magnética nuclear y el resultado positivo de la IgM de dengue en sangre. Tanto la evolución clínica como la respuesta al tratamiento con esteroides fueron favorables. Conclusiones: El evento ocurrido en este caso sugiere que los facultativos deben tener presente el diagnóstico de encefalomielitis diseminada aguda en pacientes que han tenido infección previa o alta sospecha de esta por el virus dengue(AU)
Introduction: Dengue virus infection is one of the most prevalent arboviruses in tropical countries. Acute disseminated encephalomyelitis is an inflammatory demyelinating multifocal disorder affecting the central nervous system. Its onset is acute and its clinical course monophasic. The inflammatory process is mediated by immunological mechanisms, and its relationship to dengue virus infections is still not clear. Objective: Describe a clinical case of central nervous system manifestations after probable dengue virus infection. Case presentation: Female 50-year-old patient with a history of controlled hypertension. Fifteen days after a 4-day fever episode, possibly due to dengue virus infection, the patient starts presenting neurological signs and symptoms, such as slight irritability and difficulty to concentrate on a specific activity of daily living. The patient notices progressive motor difficulty in her left hemibody and she feels agitated and distracted. It is therefore decided for her to be hospitalized. A diagnosis is made based on physical examination findings, positive nuclear magnetic resonance studies, and the positive result of the dengue IgM blood test. Both the patient's clinical evolution and her response to treatment with steroids were favorable. Conclusions: The event herein described suggests that physicians should consider the diagnosis of acute disseminated encephalomyelitis in patients with previous infection or high suspicion of infection with dengue virus(AU)
Humans , Female , Middle Aged , Dengue/complications , Encephalomyelitis, Acute Disseminated/complications , Encephalomyelitis, Acute Disseminated/diagnosis , Clinical Evolution , Encephalomyelitis, Acute Disseminated/diagnostic imaging
