Long-term outcomes of percutaneous versus surgical revascularization in patients with diabetes and left main coronary artery disease: A meta-analysis of randomized controlled trials.

BACKGROUND: The efficacy and safety of percutaneous coronary interventions (PCI) relative to coronary artery bypass grafting (CABG) in patients with diabetes and unprotected left main coronary artery disease (LMCAD) are not well established. OBJECTIVES: To perform a meta-analysis evaluating the long-term outcomes after PCI with drug-eluting stents (DES), as compared with CABG, in patients with diabetes and unprotected LMCAD. METHODS: MEDLINE, Cochrane, and Embase were searched for randomized controlled trials (RCTs) that reported outcomes after PCI with DES versus CABG in unprotected LMCAD among patients with diabetes. To evaluate the long-term effects of these interventions, we restricted this analysis to studies with a minimum follow-up period of 3 years. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Quality assessment and risk of bias were performed according to Cochrane recommendations. RESULTS: Four RCTs with a total of 1080 patients were included, 553 (51.2%) of whom underwent PCI. There was no difference for individual outcomes of all-cause mortality (RR: 1.21; 95% CI: 0.86-1.71; p = .27; I2 = 28%), cardiovascular death (RR 1.29; 95% CI: 0.76-2.18; p = .34; I2 = 0%), or myocardial infarction (MI) (RR: 0.94; 95% CI: 0.61-1.45; p = .79; I2 = 0%). However, the risk of stroke was reduced with PCI relative to CABG (RR: 0.41; 95% CI: 0.18-0.94; p = .04; I2 = 0%), whereas the risk of any repeat revascularization was higher in the PCI group (RR: 1.99; 95% CI: 1.44-2.75; p < .001; I2 = 0%). The risk of the composite outcome of all-cause mortality, MI, stroke, or repeat revascularization was higher after PCI compared with CABG (RR: 1.30; 95% CI: 1.09-1.56; p = .004; I2 = 0%). CONCLUSION: In this meta-analysis with more than 1000 patients with diabetes and unprotected LMCAD followed for a minimum of 3 years, the incidence of repeat revascularization was higher among those treated with PCI, whereas the risk of stroke was higher in patients treated with CABG.

Diversity, seasonal and diel distribution of snappers (Lutjanidae: Perciformes) in a tropical coastal inlet in the southwestern Gulf of Mexico

Snappers are marine fishes, but juveniles of many species migrate to estuaries, using these systems as nursery areas. The purpose of this study was to know the environmental factors mainly related to the migration patterns of lutjanids in La Mancha lagoon inlet. During 19 months, 24-hour cycles were performed monthly, taking samples every two hours (442 samples). Environmental variables recorded in situ and with regional records such as rainfall, atmospheric temperature and day length were considered. Genetic barcoding (COI) was used to validate species identity. Significant differences were evaluated by PERMANOVA and a Canonical Correspondence Analysis was used to determine the importance of environmental variables. Six species were recorded and the most abundant showed significant differences among months, with migration patterns during the warm-rainy season. Day length, salinity and rainfall (two of them with regional incidence) were the variables significantly associated with the distribution of the species. The abundance of Lutjanus analis, L. jocu, and L. cyanopterus was inversely associated with the length of daylight and directly related to rainfall, while L. synagris and L. griseus showed segregation along a salinity gradient. Thus, migration patterns were mainly correlated with factors of regional coverage and greater seasonal influence.(AU)

Los pargos son peces marinos, pero los juveniles de muchas especies migran a los estuarios, utilizándolos como áreas de crianza. El propósito del estudio fue conocer los factores ambientales principalmente relacionados con los patrones de migración de lutjánidos en la boca de la laguna La Mancha. Durante 19 meses se realizaron ciclos de 24 horas, tomando muestras cada dos horas (442 muestras). Se consideraron variables ambientales registradas in situ y con registros regionales tales como lluvias, temperatura atmosférica y duración del día. Se utilizó código de barras genético (COI) para validar la identidad de las especies. Diferencias significativas fueron evaluadas por PERMANOVA y un Análisis de Correspondencia Canónica permitió determinar la importancia de las variables ambientales. Se registraron seis especies y las más abundantes mostraron diferencias significativas entre meses, con patrones de migración durante la época cálida-lluviosa. La duración del día, la salinidad y la precipitación (dos con incidencia regional) fueron las variables asociadas significativamente a la distribución de las especies. La abundancia de Lutjanus analis, L. jocu y L. cyanopterus estuvo inversamente asociada con la duración del día y directamente con las lluvias, mientras que L. synagris y L. griseus mostraron segregación a lo largo de un gradiente de salinidad. Así, los patrones de migración se correlacionaron principalmente con factores de cobertura regional y de mayor influencia estacional.(AU)

COVID-19 fulminant myocarditis: a case report.

BACKGROUND: Fulminant myocarditis is a catastrophic disease with high mortality and complications. A viral aetiology is frequent and the implication of SARS-CoV-2 is not yet known. CASE SUMMARY: A 38-year-old woman who recently arrived from Spain presented with palpitations that started suddenly 3 days prior to presentation and were associated with haemodynamic instability, without dyspnoea or chest pain. We found features of myopericarditis on the electrocardiogram and severe systolic dysfunction on the echocardiogram. The chest tomography showed findings which suggested COVID-19 infection, and PCR for SARS-CoV-2 was positive. The cardiac magnetic resonance image showed Lake Louise criteria for myocarditis. The patient was treated with immunomodulatory, steroid, and immunoglobulin therapy, with a favourable clinical response. DISCUSSION: The importance of this case lies in highlighting the severe cardiac involvement in a young patient, without previous risk factors, positive for COVID-19, and the favourable response to the medical treatment given.

Neuroanatomy of two species of genus Myliobatis (Chondrichthyes: Myliobatoidea) / Neuroanatomía de dos especies del género Myliobatis (Chondrichthyes: Myliobatoidea)

Several studies on the elasmobranchs neuroanatomy have shown that their brain is more complex than previously thought, and had significant intra and interspecific variations. The objective of this work was conducting a comparative encephalic neuroanatomy study of two species of genus Myliobatis. In total, 16 organisms of genera Myliobatis californica and Myliobatis longirostris, collected in the coasts of Kino Bay, Sonora, Mexico, were used. In Myliobatis, the brain has a long telencephalon and the posterior central nucleus is poorly developed. Their cerebellum is asymmetric, has several sulci, most of which are transversally oriented, with four lobes (anterior, medium and two posterior), a condition which has not been reported for any other species. It was observed that, despite the morphology of M. californica and M. longirostris is similar, there are some significant differences. Both species have moderate foliation, but M. californica has more sulci. In the diencephalon of M. californica, it was observed that the lobes of the infundibulum are oval-shaped and separated, while in M. longirostris, such lobes are rounded and near the medium line. It has to be highlighted that Myliobatis belongs to the most derived batoid group; nevertheless, its brain is considerably less complex, as compared to what has been reported for the most derived milyobatoids species.

Diversos estudios sobre la neuroanatomía de los elasmobranquios han demostrado que el cerebro es más complejo de lo que se pensaba y presenta considerables variaciones tanto intra como interespecíficas. El objetivo de este trabajo fue realizar un estudio de neuroanatomía comparada del encéfalo de dos especies del género Myliobatis. Se utilizaron un total de 16 organismos de Myliobatis californica y Myliobatis longirostris, los cuales fueron colectados en las costas de Bahía Kino, Son., México. El cerebro de Myliobatis tiene un telencéfalo largo, el núcleo central posterior está poco desarrollado; el cerebelo es asimétrico, presenta surcos que en su mayoría están orientados transversalmente, con cuatro lóbulos (anterior, medio y dos posteriores), condición que no ha sido reportada para otra especie. Se observó que, aunque M. californica y M. longirostris presentan una morfología similar existen ciertas diferencias. En ambas especies presentan una foliación moderada; sin embargo, en M. californica se observan más surcos. En el diencéfalo de M. californica se observa que los lóbulos del infundíbulo son ovalados y están separados, mientras que en M. longirostris son redondeados y se encuentran próximos a la línea media. Es importante señalar que, pese a que Myliobatis pertenece al grupo de batoideos más derivado, su cerebro es considerablemente menos complejo de lo que se ha reportado para las especies de miliobatoideos más derivadas.

Computed tomography is a feasible method for quantifying bone density in Macaca mulatta.

Osteopathologies are a result of advanced age and decreased bone density and represent a global health problem. It is therefore important to generate models for longitudinal studies of the pathophysiology in order to improve early diagnosis and develop preventive therapies. For this kind of research, the use of computed tomography (CT) to evaluate bone health offers advantages over other techniques since it provides more complete information. The aim of this prospective, pilot study was to obtain measurements of the left femur from a population in captivity of 32 rhesus monkeys (Macaca mulatta) in order to standardize the model for future research. Healthy subjects from 5 to 28 years old were chosen. Three groups with different ages were formed as follows: (1) 5-9 years, (2) 10-19 years, and (3) 20-28 years. Semi-automatic segmentation by threshold defined the regions of interest, which were subdivided in the range of 300-700 Hounsfield units (HU) for trabecular bone and >700 HU for cortical bone. Then, the proportional ratios of the volumes of trabecular bone and cortical bone were obtained. Significant differences (analysis of variance test) in the averages of Hounsfield units, cortical, and trabecular bone proportions from each age group proved that a decrease in bone density begins at approximately 20 years of age. The values presented here, as well as the method to obtain them from CT scans, can be used as a baseline in a primate model for long-term research in bone pathology diagnosis and treatment.

Cambios morfológicos en la ontogenia temprana de Chirostoma riojai / Morphological changes in the early ontogeny of Chirostoma riojai

El charal de Toluca Chirostoma riojai es un pez de alto valor cultural e ictiológico. Los trabajos sobre esta especie se enfocan en el tipo de alimentación o forman parte de revisiones taxonómicas y son pocos los estudios sobre los cambios morfológicos durante su ontogenia. Se evaluó la figura de C. riojai mediante morfometría geométrica desde su eclosión hasta los 90 días de vida. Los ejemplares se cultivaron en condiciones controladas y fueron fijados 171 organismos pertenecientes a 11 intervalos de edad incluidos en cinco fases: embrión libre, apterolarva, pterolarva, juvenil y adulto. Se usaron seis puntos anatómicamente homólogos en una primera configuración de marcas y en una segunda se delinearon dos contornos (dorsal y ventralmente) de la región anterior. Un análisis de componentes principales mostró una fuerte diferenciación en su figura durante la transición larva-juvenil, en tanto un análisis de variables canónicas señaló diferencias significativas (ps<0.001) entre los 11 grupos de edad. La regresión lineal entre el logaritmo del tamaño centroide y las distancias procustes muestran que los organismos mantienen un cambio de figura constante hasta el término del periodo larvario, punto en el que el periodo juvenil comienza y las modificaciones en su figura disminuyen. La descripción del desarrollo temprano de C. riojai sin considerar el desarrollo de las aletas, muestra que la característica con el mayor cambio es el desplazamiento del poro anal, seguido por el alargamiento de la región cefálica. El tamaño y la figura de C. riojai durante su vida temprana pueden servir para diferenciar faces de desarrollo y ser utilizada en otras especies hermanas para evaluar si su figura es específica en cada fase. Los cambios morfológicos de C. riojai durante su vida temprana se pueden describir de forma gradual hasta el periodo larval y saltatoria en el cambio a juvenil.

Toluca silverside Chirostoma riojai is a fish with high cultural and ictiological values. Studies on this species have focused on the type of diet or as part of taxonomic reviews, while few reports are known on the morphological changes during its ontogeny. In this study the shape of C. riojai was evaluated by means of geometric morphometrics from hatchings up to 90 days-old individuals. Specimens of C. riojai were cultivated in controlled conditions, and 171 organisms there fixed, belonging to 11 age intervals included within five phases: free embryo, apterolarva, pterolarva, juvenile, and adult. There were used six landmarks in an initial configuration, and in a second configuration there were outlined two contours (dorsal and ventral) on the anterior region. A principal component analysis showed a strong differentiation in the shape during the transition larva-juvenile, for both an analysis of canonical variables found significant differences (ps<0.001) between the 11 age groups. The linear regression between the logarithm of the size centroid and procustes distances, showed that the individuals maintain a constant change in shape up to the end of the larval phase, at which time the youth stage begins and the changes in its shape decreases. The description of the early development of C. riojai without considering the development of the fins, shows that feature with greatest change is the movement of the anal pore, followed by the lengthening of the cephalic region. The size and shape of C. riojai during its early life could serve to differentiate developmental phases and could be used with other sister species to assess whether their shape is specific in each phase. The morphological changes of C. riojai during his early life could be described in a gradual form up to the the larval period, while saltatory in the change to juvenile.

Ectopic ACTH secretion (EAS) associated to a well-differentiated peritoneal mesothelioma: case report.

BACKGROUND: The association between mesotheliomas and ectopic ACTH secretion has been rarely reported; we present the first case of ectopic ACTH secretion (EAS) associated with a well-differentiated peritoneal mesothelioma in whom the high dose dexamethasone suppression test (HDDST) results and plasmatic ACTH levels were similar to those found in Cushing's disease (CD). CASE PRESENTATION: A 43-year-old hispanic woman with a 20 year history of treatment resistant diabetes mellitus and arterial hypertension. She had a full moon face, a buffalo hump, increased volume in both supraclavicular regions, purple striae in her arms and abdomen, truncal obesity, polymenorrhea and umbilical hernia. A cortisol suppression test with low dose dexamethasone (LDDST) with a result of 16.6 µg/dL and ACTH plasma levels were measured at 32.6 pg/mL. The high dose dexamethasone test suppression percentage was 84.8% and magnetic resonance imaging (MRI) showed no evidence of pituitary alterations, computed tomography (CT) showed images suggestive of uterine fibroid and an intra-abdominal tumor that correlated with an umbilical hernia, which reinforcement after contrast. Surgery was performed, finding uterine fibroids and paracolic tumor implants as well as on the omentum, bladder, bowel, ovaries and appendix. Pathology reported a well-differentiated peritoneal mesothelioma with positive immunohistochemistry for ACTH. CONCLUSIONS: Although most cases of ectopic secretion of ACTH derive from rapidly-developing lung tumors, with very high plasma ACTH levels and cortisol suppression percentages with high doses of dexamethasone under 60%, there is a small percentage of slow-developing, chronic tumors that are biochemically undistinguishable from Cushing's disease. Following the expert recommendations regarding imaging techniques it is possible to identify the associated tumor in most cases.

Caracterización y resultados de la pleurodesis con talco en derrame pleural neoplásico / Characterization and result of talc pleurodesis for malignant pleural effusion

INTRODUCCIÓN: El derrame pleural neoplásico o maligno (DPN) es una complicación frecuente de las neoplasias metastásicas. La pleurodesis con talco es un tratamiento paliativo local efectivo, que tiene por objetivo mejorar la calidad de vida del paciente. OBJETIVOS: Describir características de pacientes con DPN y los resultados inmediatos y alejados del tratamiento quirúrgico con pleurodesis con talco. MATERIALES Y MÉTODO: Estudio descriptivo transversal, se describieron características clínicas, morbimortalidad, resultados inmediatos y alejados de pacientes con DPN tratados con pleurodesis con talco, desde enero del 2011 hasta noviembre del 2015, en Hospital Clínico de Concepción. Datos extraídos de protocolos quirúrgicos, fichas clínicas y registro de anatomía patológica, previa aprobación por el comité ético-científico. RESULTADOS: Total 70 pacientes; 47 (67,1%) mujeres, edad promedio 60,5±14,3 años (Rango 15- 85). Síntomas: disnea 67 (95,7%), dolor torácico 50 (71,4%); 43 (61,4%) correspondieron al lado derecho; 55 (78,6%) se clasificaron como derrames pleurales masivos. Tipo de cáncer: cáncer de mama 20 (28,6%), cáncer broncogénico 12 (17,1%). Procedimiento quirúrgico: videotoracoscopía 53 (75,7%), pleurotomía 14 (20,0%). Se realizó biopsia pleural en 52 (74,3%). Complicaciones post-operatorias en 7 (10,0%) pacientes. Presentaron reexpansión radiológica al alta 62 (88,6%) pacientes. Necesitaron nuevo procedimiento de evacuación pleural 6 (8,6%) pacientes. Supervivencia promedio 8,3 + 9,5 meses (Rango 1-46), con un 55,7% de sobrevida a los 3 meses de seguimiento. DISCUSIÓN: La pleurodesis con talco es un tratamiento paliativo efectivo del DPN, con adecuada reexpansión pulmonar al alta, baja morbimortalidad y baja necesidad de un nuevo procedimiento de evaluación pleural, similar a lo observado en la literatura

Oral HPV infection in a clinic-based sample of Hispanic men.

BACKGROUND: Human papillomavirus (HPV) is associated to the pathogenesis of various cancers, such as oropharyngeal squamous cell carcinoma, which has a high incidence in Puerto Rican men. Despite the burden of oral cancer in Puerto Rico, little is known about the epidemiology of oral HPV infection, particularly in high-risk men. Therefore, this study is aimed at determining the prevalence of oral HPV infection, the genotype distribution and correlates associated with oral HPV infection in men of at least 16 years of age attending a sexually transmitted infection (STI) clinic in Puerto Rico. METHODS: A cross-sectional study consisting of 205 men was conducted. Participants provided a 30-second oral rinse and gargle with mouthwash. Following DNA extraction, HPV genotyping was performed in all samples using Innogenetics Line Price Assay (INNO-LiPA). A questionnaire was administered, which included a demographic, behavioral and a clinical assessment. Descriptive statistics and bivariate analysis were used to characterize the study sample. Variables that achieved statistical significance in the bivariate analysis (p < 0.05) were assessed in multivariate logistic regression models. RESULTS: The mean age of the study sample was 38.5 ± 14.2 years. Oral HPV prevalence among men was 20.0% (95.0%CI = 14.8%-26.1%) and of HPV type 16 was 2.4% (95.0%CI = 0.8%-5.6%). Oral HPV prevalence significantly increased over increasing age categories (p-trend = 0.001). Multivariate analysis showed that oral HPV was independently associated with number of sexual partners (adjusted OR = 1.02; 95%CI = 1.01-1.03) and lifetime use of cigarettes (adjusted OR = 3.00; 95%CI = 0.98-9.16). CONCLUSIONS: Oral HPV among the sampled men in the STI clinic was high, regardless of the HIV status or sexual behavior. Interventions in STI clinics should include screening for HPV in the oral cavity for the early detection and reduction of long-term consequences of oral HPV infection, such as oropharyngeal cancer.

[National guidelines of diagnosis and treatment of the non-Hodgkin lymphoma]. / Guías nacionales de diagnóstico y tratamiento de linfoma no Hodgkin.

Non-Hodgkin lymphoma comprises a heterogeneous group of haematological malignancies, classified according to their clinic, anatomic-pathological features and, lately, to their molecular biomarkers. Despite the therapeutic advances, nearly half of the patients will die because of this disease. The new diagnostic tools have been the cornerstone to design recent therapy targets, which must be included in the current treatment guidelines of this sort of neoplasms by means of clinical trials and evidence-based medicine. In the face of poor diagnoses devices in most of the Mexican hospitals, we recommend the present diagnose stratification, and treatment guidelines for non-Hodgkin lymphoma, based on evidence. They include the latest and most innovative therapeutic approaches, as well as specific recommendations for hospitals with limited framework and therapy resources.

Valor diagnóstico del ultrasonido en las afecciones testiculares en el Hospital Provincial Docente Dr Antonio Luaces Iraola / Diagnostic value of ultrasound in the testicular affections at Dr Antonio Luaces Iraola Provincial General Teaching Hospital

Se realizó un estudio observacional descriptivo en el servicio de Imagenología del Hospital General Provincial Docente Dr Antonio Luaces Iraola de Ciego de Ávila en el período comprendido entre marzo del año 2009 a febrero de 2011, con el objetivo determinar el valor diagnóstico del ultrasonido en las afecciones testiculares y estructuras afines. Predominaron los pacientes con color de la piel negra y el grupo de edad de 30-39 años, los signos flogísticos fueron las manifestaciones clínicas más frecuentes. Entre los hallazgos ecográficos las lesiones homogéneas, únicas, ecolúcidas, pequeñas, extratesticulares, no calcificadas, de contornos regulares y con testículo de tamaño normal fueron las más frecuentes. Las afecciones benignas fueron las predominantes y entre ellas las más frecuentes fueron el hidrocele, el varicocele y los quistes del epidídimo. Existió correspondencia entre las manifestaciones clínicas y los hallazgos ecográficos. Se obtuvo un elevado índice de confiabilidad, con elevada sensibilidad y especificidad, con bajo porcentaje de falso positivo.

An observational and descriptive study was carried out in theradiology unitat Dr Antonio Luaces Iraola Provincial General Teaching Hospital, in Ciego de Avila, in the period between March 2009 to February 2011, with the aim of determining the value compatible diagnosis of the ultrasound in the testicular affections and structures. Patients with black skin color and the age group of 30-39 predominated, the weak signs were the most frequent clinic manifestation. Among the ultrasound findings the homogenous injury, unique, echolucent, small, extratesticular, not calcified, of regular contours and with normal size testicle were the most frequent. The benign affections were the predominant ones and the most frequent among them were hydrocele, varicocele and the epididymis cysts. There was correspondence between the clinical manifestations and the ultrasound findings. A high index of trustworthiness was obtained, with the high sensitivity and specificity, with low percentage of false positive.

Identification of a disulfide bridge essential for structure and function of the voltage-gated Ca(2+) channel α(2)δ-1 auxiliary subunit.

Voltage-gated calcium (Ca(V)) channels are transmembrane proteins that form Ca(2+)-selective pores gated by depolarization and are essential regulators of the intracellular Ca(2+) concentration. By providing a pathway for rapid Ca(2+) influx, Ca(V) channels couple membrane depolarization to a wide array of cellular responses including neurotransmission, muscle contraction and gene expression. Ca(V) channels fall into two major classes, low voltage-activated (LVA) and high voltage-activated (HVA). The ion-conducting pathway of HVA channels is the α(1) subunit, which typically contains associated ß and α(2)δ ancillary subunits that regulate the properties of the channel. Although it is widely acknowledged that α(2)δ-1 is post-translationally cleaved into an extracellular α(2) polypeptide and a membrane-anchored δ protein that remain covalently linked by disulfide bonds, to date the contribution of different cysteine (Cys) residues to the formation of disulfide bridges between these proteins has not been investigated. In the present report, by predicting disulfide connectivity with bioinformatics, molecular modeling and protein biochemistry experiments we have identified two Cys residues involved in the formation of an intermolecular disulfide bond of critical importance for the structure and function of the α(2)δ-1 subunit. Site directed-mutagenesis of Cys404 (located in the von Willebrand factor-A region of α(2)) and Cys1047 (in the extracellular domain of δ) prevented the association of the α(2) and δ peptides upon proteolysis, suggesting that the mature protein is linked by a single intermolecular disulfide bridge. Furthermore, co-expression of mutant forms of α(2)δ-1 Cys404Ser and Cys1047Ser with recombinant neuronal N-type (Ca(V)2.2α(1)/ß(3)) channels, showed decreased whole-cell patch-clamp currents indicating that the disulfide bond between these residues is required for α(2)δ-1 function.

Niflumic acid blocks native and recombinant T-type channels.

Voltage-dependent calcium channels are widely distributed in animal cells, including spermatozoa. Calcium is fundamental in many sperm functions such as: motility, capacitation, and the acrosome reaction (AR), all essential for fertilization. Pharmacological evidence has suggested T-type calcium channels participate in the AR. Niflumic acid (NA), a non-steroidal anti-inflammatory drug commonly used as chloride channel blocker, blocks T-currents in mouse spermatogenic cells and Cl(-) channels in testicular sperm. Here we examine the mechanism of NA blockade and explore if it can be used to separate the contribution of different Ca(V)3 members previously detected in these cells. Electrophysiological patch-clamp recordings were performed in isolated mouse spermatogenic cells and in HEK cells heterologously expressing Ca(V)3 channels. NA blocks mouse spermatogenic cell T-type currents with an IC(50) of 73.5 µM, without major voltage-dependent effects. The NA blockade is more potent in the open and in the inactivated state than in the closed state of the T-type channels. Interestingly, we found that heterologously expressed Ca(V)3.1 and Ca(V)3.3 channels were more sensitive to NA than Ca(V)3.2 channels, and this drug substantially slowed the recovery from inactivation of the three isoforms. Molecular docking modeling of drug-channel binding predicts that NA binds preferentially to the extracellular face of Ca(V)3.1 channels. The biophysical characteristics of mouse spermatogenic cell T-type currents more closely resemble those from heterologously expressed Ca(V)3.1 channels, including their sensitivity to NA. As Ca(V)3.1 null mice maintain their spermatogenic cell T-currents, it is likely that a novel Ca(V)3.2 isoform is responsible for them.

Reducción hidrostática de invaginación intestinal: a propósito de un caso / Hydrostatic reduction of intussusception: a case report

Se presenta el caso de un lactante masculino de 6 meses de edad, que acude a consulta de cuerpo de guardia, en el Hospital Provincial Docente Dr Antonio Luaces Iraola de Ciego de Ávila, con vómitos y diarreas con estrías de sangre. Se realizaron estudios ecográficos pertinentes y se arribó al diagnóstico de invaginación intestinal. Se realizó evaluación conjunta con el servicio de cirugía pediátrica y se aplicó el proceder de reducción hidrostática con solución salina y control ecográfico, con lo que se logró la reducción total del segmento intestinal afectado y se evitó la intervención quirúrgica.

A case of a male infant of 6 months of age is presented, that goes to consultation of emergency service, in the Provincial Teaching Hospital in Ciego de Avila with vomiting and diarrhea streaked of blood. Relevant ultrasonography studies were carried out and it arrived to diagnosis of intussusception. Joint assessment was conducted with the pediatric surgery department, and hydrostatic reduction applies with saline solution and ultrasonographic guidance, achieving a total reduction of the affected bowel segment, thus avoiding surgery.

Outcomes of multidrug-resistant tuberculosis among binational cases in El Paso, Texas.

In the United States, multidrug-resistant tuberculosis (MDR-TB) is more commonly seen among foreign-born patients. We report outcomes for 46 patients with MDR-TB who were born in Mexico and treated along the United States-Mexico border. According to our definition, 30 were cured, 3 showed treatment failure, 3 died, and 10 abandoned treatment. Multidrug-resistant tuberculosis can be successfully treated on an ambulatory basis.

Diagnostico de la condición de salud bucal de la población que asiste a las clínicas de la Facultad de Odontología de la Universidad de El Salvador en el año 2009 / Diagnosis of the oral health condition of the population that attends the clinics of the Faculty of Dentistry of the University of El Salvador in 2009

Esta investigación fue realizada con el objetivo de diagnosticar la condición de salud bucal de la población que asistió a consulta odontológica a las clínicas de la facultad de odontología de la Universidad de El Salvador en el año 2009; El estudio se basa en una investigación de tipo descriptiva donde se clasifico la población por rangos de edad y sexo; así mismo fue necesario mencionar aspectos socioeconómicos, donde se incluyen los aspectos relacionados con el nivel de estudio, ingresos económicos y lugar de residencia actual y de los primeros años de vida; de igual manera se realizó la aplicación de diversos índices epidemiológicos, con la finalidad de descubrir los diferentes tipos de problemas bucales por los que la población consulta. La población del estudio se obtuvo de los pacientes que acudieron a la facultad de odontología de la Universidad de El Salvador durante los meses de febrero y marzo del año 2009 donde el total fue de 412 personas, del cual se obtuvo una muestra de 86 pacientes para la investigación. Se obtuvieron datos generales del paciente por medio de una cédula de la entrevista, y se evaluó la condición bucal por medio de una guía de observación. Los resultados obtenidos muestran que el principal motivo de consulta es el dolor dental, seguido de la presencia de caries, por rehabilitación dental, por prevención, por malposición dental y por problemas periodontales; las principales lesiones encontradas fueron las exostosis, el índice de placa bacteriana LOE y SILNESS fue clasificado en buen estado, en cuanto al índice gingival LOE Y SILNESS (IG),se obtuvo que el mayor porcentaje de la población posee una condición gingival en buen estado; el índice periodontal comunitario fue de buen estado; para el índice de estética dental DAI se obtuvo que predominó la oclusión normal y maloclusión mínima y en niños menores de 12 años existe una maloclusión definida y severa; con respecto al índice CPO/D-ceo/d se obtuvo un índice alto; Se concluyó que los problemas de origen dental son el principal problema que afecta a la población.

This research was carried out with the objective of diagnosing the oral health condition of the population that attended dental consultations at the clinics of the Faculty of Dentistry of the University of El Salvador in 2009; The study is based on a descriptive research where the population was classified by age and sex ranges; Likewise, it was necessary to mention socioeconomic aspects, which include aspects related to the level of study, economic income and current place of residence and the first years of life; In the same way, the application of various epidemiological indices was carried out, in order to discover the different types of oral problems for which the population consults. The study population was obtained from the patients who attended the dental school of the University of El Salvador during the months of February and March 2009, where the total was 412 people, from which a sample of 86 patients was obtained for the investigation. General patient data were obtained by means of an interview card, and the oral condition was evaluated by means of an observation guide. The results obtained show that the main reason for consultation is dental pain, followed by the presence of caries, dental rehabilitation, prevention, dental malposition and periodontal problems; the main lesions found were exostoses, the bacterial plaque index LOE and SILNESS were classified in good condition, as for the gingival index LOE and SILNESS (IG), it was obtained that the highest percentage of the population has a gingival condition in good condition ; the community periodontal index was in good condition; For the DAI dental aesthetics index, it was obtained that normal occlusion and minimal malocclusion predominated and in children under 12 years of age there is a defined and severe malocclusion; Regarding the CPO / D-ceo / d index, a high index was obtained; It was concluded that problems of dental origin are the main problem affecting the population.

Adequacy of outpatient care among hospitalized adult asthmatics in a southwest US border city.

Over 3 years we studied the baseline degree of asthma severity and the adequacy of the usual medical management among asthmatics admitted to a large US-Mexican border county hospital. The study design consisted of 2 years of retrospective chart review and 1 year of prospective semistructured interview collection. Patients were at least 18 years of age and required acute care and hospital admission for asthma exacerbations. The 127 patients studied accounted for 166 hospital admissions for asthma related primary diagnoses. Most were Hispanic and medically indigent, and only 39% of patients whose asthma severity indicated the use of inhaled corticosteroid medications reported taking them. Most of the hospitalized asthmatic patients studied were on inadequate outpatient medical regimens for the baseline severity of their asthma. Underuse of inhaled corticosteroids was the predominant medication deficiency. Other shortcomings identified in their routine management included a lack of pulmonary function testing, basic asthma education, and treatment by a practitioner qualified in the care of chronic asthma.

Selected mutations in Bacillus subtilis levansucrase semi-conserved regions affecting its biochemical properties.

Levansucrases (LS) are fructosyltransferases (FTFs) belonging to family 68 of glycoside hydrolases (GH68) using sucrose as substrate to synthesize levan, a fructose polymer. From a multiple sequence analysis of GH68 family proteins, nine residues were selected and their role in acceptor and product specificity, as well as in biochemical Bacillus subtilis LS properties, was investigated. A product specificity modification was obtained with mutants Y429N and R433A that no longer produce levan but exclusively oligosaccharides. An effect of the mutation S164A was observed on enzyme stability and kinetic behavior; this mutation also induces a levan activation effect that enhances the reaction rate. We report the crystallographic structure of this mutant and found that S164 is an important residue to maintain the nucleophile position in the active site. We also found evidence of the important role of Y429 in acceptor specificity: this is a key residue coordinating the sucrose position in the catalytic domain-binding pocket. Some of these mutations resulted in LS with a broad range of specificities and new biochemical properties.

Activity of the renal Na+-K+-2Cl- cotransporter is reduced by mutagenesis of N-glycosylation sites: role for protein surface charge in Cl- transport.

The renal-specific Na(+)-K(+)-2Cl(-) cotransporter NKCC2 belongs to the SLC12 gene family; it is the target for loop diuretics and the cause of type I Bartter's syndrome. Because the NKCC2 sequence contains two putative N-linked glycosylation sites, one of which is conserved with the renal Na(+)-Cl(-) cotransporter in which glycosylation affects thiazide affinity, we assessed the role of glycosylation on NKCC2 functional properties. One (N442Q or N452Q) or both (N442,452Q) N-glycosylation sites were eliminated by site-directed mutagenesis. Wild-type NKCC2 and mutant clones were expressed in Xenopus laevis oocytes and analyzed by (86)Rb(+) influx, Western blotting, and confocal microscopy. Inhibition of glycosylation with tunicamycin in wild-type NKCC2-injected oocytes resulted in an 80% reduction of NKCC2 activity. Immunoblot of injected oocytes revealed that glycosylation of NKCC2 was completely prevented in N442,452Q-injected oocytes. Functional activity was reduced by 50% in N442Q- and N452Q-injected oocytes and by 80% in oocytes injected with N442,452Q, whereas confocal microscopy of oocytes injected with wild-type or mutant enhanced green fluorescent protein-tagged NKCC2 clones revealed that surface fluorescence intensity was reduced approximately 20% in single mutants and 50% in the double mutant. Ion transport kinetic analyses revealed no changes in cation affinity and a small increase in Cl(-) affinity by N442Q and N442,452Q. However, a slight decrease in bumetanide affinity was observed. Our data demonstrate that NKCC2 is glycosylated and suggest that prevention of glycosylation reduces its functional expression by affecting insertion into the plasma membrane and the intrinsic activity of the cotransporter.

Respuesta refleximétrica al uso de placa de mordida modelo Michigan / Refleximetric response to the use of Michigan bite plate

El registro de reflejo inhibitorio del masetero (reflexigrama, RFXG) ha mostrado ser una herramienta útil en la valoración funcional de los mecanismos generadores y reguladores de la masticación. El propósito del presente trabajo fue determinar qué cambios se presentan en el RFXG en sujetos después del uso de placas de mordida modelo Michigan y discutir cuáles podrían ser las implicaciones fisiológicas de los mismos. El registro inicial mostró el estado neuromuscular de los sujetos antes de colocar las placas de mordida, los registros subsecuentes mostraron los cambios que se presentaron al usar las placas de mordida, tendiendo éstos hacia lo que ha sido descrito como normal. Al estudiar el RFXG pudimos determinar el área de inhibición faltante, la relación que existe entre el área de potenciación con respecto al área de inhibición, y comparamos la simetría entre el lado derecho e izquierdo. Se pudo valorar el reflejo inhibitorio del músculo masetero y determinar la presencia de alguna alteración en este reflejo, así como los cambios que sucedieron después del uso de la placa de mordida, verificando la evolución de dicho reflejo. Se registraron los músculos maseteros derecho e izquierdo de sujetos mediante la técnica de RFXG ampliamente descrita en trabajos previos, antes y después del uso de placas de mordida. Los valores promedio se sometieron a la prueba estadística rutinaria de sesgo y curtosis. Como los valores de las variables de los registros reflexométricos no se distribuyeron de acuerdo a la curva normal, para evaluar correlaciones se realizaron las pruebas no paramétricas de Spearman y de Wilcoxon, para valorar las relaciones y diferencias de los mismos. Los resultados indican que los mecanismos neurofuncionales de control en los sujetos estudiados presentan diferencias con respecto a lo normal antes del uso de las placas de mordida, que tienden a revertirse con la colocación de dichas placas y que esto puede evaluarse mediante el RFXG.