Fungal and bat diversities along a landscape gradient in central Mexico.

Species interactions between bats and fungi are poorly known. We documented the association between fungal and bat diversities along a landscape gradient. Ten, eight, and seven bat species were captured in conserved, semi-conserved, and urban sites, respectively. Eptesicus fuscus, Myotis ciliolabrum and Corynorhinus townsendii were the most abundant in conserved and semi-conserved sites. E. fuscus, Myotis velifer, and Lasiurus cinereus were abundant in urban sites. C. townsendii was the least abundant bat. A total of 15 cultivated fungi genera included the fungal diversity in bats, of which nine fungi genera were shared along the landscape gradient. Penicillium and Aspergillus were the most abundant genera, and Aureobasidium, Bispora, Stachybotrys, and Verticillium were only documented in the conserved sites. We observed a higher fungal diversity associated with bat species along this landscape gradient. The individual site-based accumulation curves of fungal diversity showed significant decreasing values along the conserved, semi-conserved, and urban sites, respectively. In conserved and urban sites, M. californicus and M. velifer showed the highest fungal diversity, respectively. E. fuscus was associated to the fungi genera Scopulariopsis, Alternaria, Penicillium and Beauveria; L. cinereus to Cladosporium and Aspergillus, and M. velifer to Alternaria sp1, Bispora and Trichoderma. Conserved sites showed both high bat and fungal diversities [species richness and abundance] compared to semi-conserved and urban sites. More studies associating bat and fungal diversities in other ecosystems are needed to corroborate this pattern.

Consensus Pharmacophore Strategy For Identifying Novel SARS-Cov-2 Mpro Inhibitors from Large Chemical Libraries.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) main Protease (Mpro) is an enzyme that cleaves viral polyproteins translated from the viral genome and is critical for viral replication. Mpro is a target for anti-SARS-CoV-2 drug development, and multiple Mpro crystals complexed with competitive inhibitors have been reported. In this study, we aimed to develop an Mpro consensus pharmacophore as a tool to expand the search for inhibitors. We generated a consensus model by aligning and summarizing pharmacophoric points from 152 bioactive conformers of SARS-CoV-2 Mpro inhibitors. Validation against a library of conformers from a subset of ligands showed that our model retrieved poses that reproduced the crystal-binding mode in 77% of the cases. Using models derived from a consensus pharmacophore, we screened >340 million compounds. Pharmacophore-matching and chemoinformatics analyses identified new potential Mpro inhibitors. The candidate compounds were chemically dissimilar to the reference set, and among them, demonstrating the relevance of our model. We evaluated the effect of 16 candidates on Mpro enzymatic activity finding that seven have inhibitory activity. Three compounds (1, 4, and 5) had IC50 values in the midmicromolar range. The Mpro consensus pharmacophore reported herein can be used to identify compounds with improved activity and novel chemical scaffolds against Mpro. The method developed for its generation is provided as an open-access code (https://github.com/AngelRuizMoreno/ConcensusPharmacophore) and can be applied to other pharmacological targets.

[Mixed adenoneuroendocrine carcinoma: case report]. / Carcinoma adenoneuroendocrino mixto: reporte de caso.

Introducción: Mixed adenoneuroendocrine carcinoma is a rare tumor of the gastrointestinal tract with double differentiation into adenomatous and neuroendocrine carcinoma, each component with at least 30%. Case report: A 60-year-old female with acute abdominal pain. Surgical treatment was decided, finding a tumor at the level of the cecum and ascending colon, a right hemicolectomy and ileostomy were performed. Discussion: Mixed adenoneuroendocrine carcinoma can appear in various organs. They are highly malignant tumors, with a high risk of metastasis. Conclusions: These tumors do not present symptoms or specific radiological or laboratory findings; diagnosis depends on postoperative histopathological and immunohistochemical studies.

Introducción: El carcinoma adenoneuroendocrino mixto es un tumor raro del tracto gastrointestinal con doble diferenciación en carcinoma adenomatoso y neuroendocrino, cada componente con al menos el 30%. Caso clínico: Mujer de 60 años con cuadro de dolor abdominal agudo. Se decide tratamiento quirúrgico, encontrando un tumor a nivel de ciego y colon ascendente, y se realizan hemicolectomía derecha e ileostomía. Discusión: El carcinoma adenoneuroendocrino mixto puede aparecer en diversos órganos. Son tumores muy malignos, con alto riesgo de metástasis. Conclusiones: Estos tumores no presentan síntomas ni hallazgos radiológicos o de laboratorio específicos; el diagnóstico depende de estudios histopatológicos e inmunohistoquímicos posoperatorios.

Intervención integral de salud para mejorar el control de la diabetes mellitus tipo II

Introducción: La diabetes mellitus es una enfermedad caracterizada por un aumento sostenido de las cifras de glucemia. Las manifestaciones clínicas y complicaciones de la enfermedad generan discapacidad funcional y afectación de la percepción calidad de vida. El control de la glucemia es fundamental para mejorar el estado de salud de los pacientes. Objetivo: Implementar una intervención de salud integral en pacientes con diagnóstico de DM tipo II residentes en el cantón Riobamba. Métodos: Se realizó una investigación aplicada, con diseño cuasiexperimental, descriptivo y longitudinal. El universo estuvo constituido por 256 pacientes con diagnóstico de diabetes mellitus tipo II, de los cuales 155 formaron parte de la muestra del estudio. Se analizaron, al inicio y final de la intervención, el control glucémico, estado nutricional, circunferencia de la cintura y nivel de conocimiento; así como las características generales al inicio del estudio. Se utilizó la prueba de rangos con signos de Wilcoxon para identificar si la intervención generó cambios en las variables de estudio comparando los resultados antes y después de la intervención. Resultados: Promedio de edad de 63,28 años, predominio de pacientes femeninas (69,68 %) y sin comorbilidades asociadas (66,45 %). Al inicio del estudio predominó el nivel de conocimiento bajo (60,00 %), control glucémico admisible (34,19 %) y circunferencia de la cintura con riesgo elevado en hombres (37,96 %) y mujeres (38,30 %). Después de terminado el estudio predominó el nivel medio de conocimiento (38,71%), los pacientes con normopeso (57,4 2%), control glucémico adecuado (34,84 %). Conclusiones: la intervención aplicada generó cambios positivos en las variables estudiadas.

Introduction: Diabetes mellitus is a disease characterized by a sustained increase in blood glucose levels. The clinical manifestations and complications of the disease generate functional disability and affect the perception of quality of life. Glycemic control is essential to improve the health status of patients. Objective: To implement a comprehensive health intervention in patients diagnosed with type II DM residing in the Riobamba canton. Methods: Applied research was carried out, with a quasi-experimental, descriptive and longitudinal design. The universe consisted of 256 patients diagnosed with type II diabetes mellitus, of which 155 were part of the study sample. Glycemic control, nutritional status, waist circumference and level of knowledge were analyzed at the beginning and end of the intervention; as well as the general characteristics at the beginning of the study. The Wilcoxon signed rank test was used to identify whether the intervention generated changes in the study variables by comparing the results before and after the intervention. Results: Average age of 63.28 years, predominance of female patients (69.68 %) and no associated comorbidities (66.45 %). At the beginning of the study, the low level of knowledge (60.00 %), admissible glycemic control (34.19%) and waist circumference with high risk prevailed in men (37.96 %) and women (38.30 %). . After completing the study, the average level of knowledge (38.71 %), patients with normal weight (57.42 %), adequate glycemic control (34.84 %) predominated. Conclusions: the applied intervention generated positive changes in the variables studied.

Determination of TTT Diagrams of Ni-Al Binary Using Neural Networks.

The heat treatment of a metal is a set of heating and cooling cycles that a metal undergoes to change its microstructure and, therefore, its properties. Temperature-time-transformation (TTT) diagrams are an essential tool for interpreting the resulting microstructures after heat treatments. The present work describes a novel proposal to predict TTT diagrams of the γ' phase for the Ni-Al alloy using artificial neural networks (ANNs). The proposed methodology is composed of five stages: (1) database creation, (2) experimental design, (3) ANNs training, (4) ANNs validation, and (5) proposed models analysis. Two approaches were addressed, the first to predict only the nose point of the TTT diagrams and the second to predict the complete curve. Finally, the best models for each approach were merged to compose a more accurate hybrid model. The results show that the multilayer perceptron architecture is the most efficient and accurate compared to the simulated TTT diagrams. The prediction of the nose point and the complete curve showed an accuracy of 98.07% and 86.41%, respectively. The proposed final hybrid model achieves an accuracy of 96.59%.

Occurrence and spatial distribution of triatomines (Hemiptera: Reduviidae) in the urban area of the municipality of Montes Claros, Northern Minas Gerais, Brazil.

The north of the Brazilian state of Minas Gerais is classified as an area of high risk of vectorial transmission of Chagas disease (CD) or of reestablishing transmission in the home, but the Chagas disease control programme is disjointed. The study evaluated the occurrence, natural infection and the spatial distribution of species of triatomines associated with climatic variations in the urban area of Montes Claros, a municipality endemic to CD in the north of Minas Gerais, Brazil. Triatomine data were obtained from passive entomological surveillance actions of the Chagas Disease Control Program (Programa de Controle de Doença de Chagas-PCDCh), registered by the Zoonosis Control Center (Centro de Controle de Zoonoses-CCZ) from 2009 to 2019. A total of 277 triatomines belonging to eight species were collected, and of these, 203 insects were examined. It was found that 46.2% of triatomines were captured inside the home and 8.3% around the home. The natural infection rate was 6.9%; 14 specimens showed natural infection by Trypanosoma cruzi (12 females and 2 males), and of these, 13 were found in the home and one in an uninformed location. The number of triatomine records collected was significantly higher in the month of September (p = .01), and there was an inverse correlation between the number of triatomines and the relative humidity of the air (p < .001). It was verified that the highest triatomine densities are located in transition areas between urban infrastructure (32.12%) and pasture (25.72%). The diversity of species of triatomines infected with T. cruzi in residential units in urban areas in the municipality of Montes Claros is worrying, as it suggests a potential risk of transmission of the parasite to domestic animals and humans.

Hemobilia como causa infrecuente y grave de hemorragia digestiva alta / Hemobilia as a rare and serious cause of upper gastrointestinal bleeding

Introducción: La hemobilia es por definición una causa de hemorragia digestiva alta, donde existe una comunicación de la vía biliar en cualquiera de sus segmentos con vasos sanguíneos que desembocan a través de la ampolla de Vater. Su presentación es infrecuente y no sospechada en la práctica clínica diaria de gastroenterólogos, cirujanos, hepatólogos, clínicos e intensivistas, con un difícil manejo diagnóstico-terapéutico y una elevada morbi-mortalidad. Objetivo: Describir tres casos de pacientes con diagnóstico de hemobilia. Desarrollo: Se presentan tres casos con hemobilia que tuvieron una elevada mortalidad y con diferente etiología; en el primer caso por trombosis de la arteria hepática postrasplante hepático, el segundo secundario a un colangiocarcinoma de la unión hepatocística y el tercero con diagnóstico de un aneurisma de la arteria hepática derecha confirmado y parcialmente tratado por angiotomografía, posteriormente intervenido quirúrgicamente y único sobreviviente. Conclusiones: Resultaron tres casos con hemobilia de diferentes causas, con una elevada mortalidad por la intensidad de la hemorragia digestiva alta y las comorbilidades asociadas, además de señalar que ninguno de ellos presentó la tríada clásica reportada por Quincke(AU)

Introduction: Hemobilia is, by definition, a cause of upper gastrointestinal bleeding, where there is a communication of the bile duct in any of its segments with blood vessels that flow through the ampulla of Vater. It is rare and it is not suspected in the daily clinical practice of gastroenterologists, surgeons, hepatologists, clinicians and intensivists, hence the diagnostic-therapeutic management is difficult and it has high morbidity and mortality. Objective: To report three cases of patients with a diagnosis of hemobilia. Case report: We report three cases of hemobilia of high mortality and different etiology. The first case had post-liver transplantation hepatic artery thrombosis, the second had asecondary cholangiocarcinoma of the hepatocystic junction and the third had diagnosis of confirmed right hepatic artery aneurysm partially treated by CT angiography, subsequently operated on and the only survivor. Conclusions: These three hemobilia cases had different causes, and high mortality due to the intensity of the upper gastrointestinal bleeding and the associated comorbidities, in addition to noting that none of them exhibited the classic triad reported by Quincke(AU)

In Silico Design and Selection of New Tetrahydroisoquinoline-Based CD44 Antagonist Candidates.

CD44 promotes metastasis, chemoresistance, and stemness in different types of cancer and is a target for the development of new anti-cancer therapies. All CD44 isoforms share a common N-terminal domain that binds to hyaluronic acid (HA). Herein, we used a computational approach to design new potential CD44 antagonists and evaluate their target-binding ability. By analyzing 30 crystal structures of the HA-binding domain (CD44HAbd), we characterized a subdomain that binds to 1,2,3,4-tetrahydroisoquinoline (THQ)-containing compounds and is adjacent to residues essential for HA interaction. By computational combinatorial chemistry (CCC), we designed 168,190 molecules and compared their conformers to a pharmacophore containing the key features of the crystallographic THQ binding mode. Approximately 0.01% of the compounds matched the pharmacophore and were analyzed by computational docking and molecular dynamics (MD). We identified two compounds, Can125 and Can159, that bound to human CD44HAbd (hCD44HAbd) in explicit-solvent MD simulations and therefore may elicit CD44 blockage. These compounds can be easily synthesized by multicomponent reactions for activity testing and their binding mode, reported here, could be helpful in the design of more potent CD44 antagonists.

Repositioning of Etravirine as a Potential CK1ε Inhibitor by Virtual Screening.

CK1ε is a key regulator of WNT/ß-catenin and other pathways that are linked to tumor progression; thus, CK1ε is considered a target for the development of antineoplastic therapies. In this study, we performed a virtual screening to search for potential CK1ε inhibitors. First, we characterized the dynamic noncovalent interactions profiles for a set of reported CK1ε inhibitors to generate a pharmacophore model, which was used to identify new potential inhibitors among FDA-approved drugs. We found that etravirine and abacavir, two drugs that are approved for HIV infections, can be repurposed as CK1ε inhibitors. The interaction of these drugs with CK1ε was further examined by molecular docking and molecular dynamics. Etravirine and abacavir formed stable complexes with the target, emulating the binding behavior of known inhibitors. However, only etravirine showed high theoretical binding affinity to CK1ε. Our findings provide a new pharmacophore for targeting CK1ε and implicate etravirine as a CK1ε inhibitor and antineoplastic agent.

Reverse Docking for the Identification of Molecular Targets of Anticancer Compounds.

Molecular docking is a useful and powerful computational method for the identification of potential interactions between small molecules and pharmacological targets. In reverse docking, the ability of one or a few compounds to bind a large dataset of proteins is evaluated in silico. This strategy is useful for identifying molecular targets of orphan bioactive compounds, proposing new molecular mechanisms, finding alternative indications of drugs, or predicting drug toxicity. Herein, we describe a detailed reverse docking protocol for the identification of potential targets for 4-hydroxycoumarin (4-HC). Our results showed that RAC1 is a target of 4-HC, which partially explains the biological activities of 4-HC on cancer cells. The strategy reported here can be easily applied to other compounds and protein datasets.

Molecular Detection of Leptospira interrogans and Borrelia burgdorferi in Wild Rodents from Mexico.

Leptospirosis and Lyme borreliosis are zoonotic emerging diseases of global importance and wide distribution. The aim of this study was to detect by molecular testing to Leptospira interrogans and Borrelia burgdorferi sensu lato in wild rodents from Nuevo Leon, Quintana Roo, and Campeche, Mexico. This study is the first in report to Chaetodipus nelsoni, Dipodomys merriami, and Peromyscus eremicus infected with L. interrogans in Mexico. Besides, Chaetodipus hispidus, Heteromys gaumeri, Heteromys irroratus, Neotoma micropus, Peromyscus leucopus, Peromyscus maniculatus, and Sigmodon hispidus infected with B. burgdorferi s.l. in Mexico. Also, is the first report in identify coinfection of L. interrogans and B. burgdorferi s.l. in wild rodents such as H. irroratus and S. hispidus in Nuevo Leon, and H. gaumeri in Quintana Roo, Mexico. These wild rodent species infected represent a risk factor for the exposed population in these sylvatic and rural areas of Mexico.

Pranlukast Antagonizes CD49f and Reduces Stemness in Triple-Negative Breast Cancer Cells.

INTRODUCTION: Cancer stem cells (CSCs) drive the initiation, maintenance, and therapy response of breast tumors. CD49f is expressed in breast CSCs and functions in the maintenance of stemness. Thus, blockade of CD49f is a potential therapeutic approach for targeting breast CSCs. In the present study, we aimed to repurpose drugs as CD49f antagonists. MATERIALS AND METHODS: We performed consensus molecular docking using a subdomain of CD49f that is critical for heterodimerization and a collection of pharmochemicals clinically tested. Molecular dynamics simulations were employed to further characterize drug-target binding. Using MDA-MB-231 cells, we evaluated the effects of potential CD49f antagonists on 1) cell adhesion to laminin; 2) mammosphere formation; and 3) cell viability. We analyzed the effects of the drug with better CSC-selectivity on the activation of CD49f-downstream signaling by Western blot (WB) and co-immunoprecipitation. Expressions of the stem cell markers CD44 and SOX2 were analyzed by flow cytometry and WB, respectively. Transactivation of SOX2 promoter was evaluated by luciferase reporter assays. Changes in the number of CSCs were assessed by limiting-dilution xenotransplantation. RESULTS: Pranlukast, a drug used to treat asthma, bound to CD49f in silico and inhibited the adhesion of CD49f+ MDA-MB-231 cells to laminin, indicating that it antagonizes CD49f-containing integrins. Molecular dynamics analysis showed that pranlukast binding induces conformational changes in CD49f that affect its interaction with ß1-integrin subunit and constrained the conformational dynamics of the heterodimer. Pranlukast decreased the clonogenicity of breast cancer cells on mammosphere formation assay but had no impact on the viability of bulk tumor cells. Brief exposure of MDA-MB-231 cells to pranlukast altered CD49f-dependent signaling, reducing focal adhesion kinase (FAK) and phosphatidylinositol 3-kinase (PI3K) activation. Further, pranlukast-treated cells showed decreased CD44 and SOX2 expression, SOX2 promoter transactivation, and in vivo tumorigenicity, supporting that this drug reduces the frequency of CSC. CONCLUSION: Our results support the function of pranlukast as a CD49f antagonist that reduces the CSC population in triple-negative breast cancer cells. The pharmacokinetics and toxicology of this drug have already been established, rendering a potential adjuvant therapy for breast cancer patients.

Arteritis de Takayasu / Takayasu arteritis

Introducción: La arteritis de Takayasu es una vasculitis sistémica considerada como una enfermedad rara. Su mecanismo etiopatogénico se basa en un proceso inflamatorio que afecta la arteria aorta y sus grandes ramas. La ausencia de pulso, la angiodinia, los trastornos hipertensivos y la presencia de nódulos en miembros inferiores se describen como sus principales manifestaciones clínicas. Objetivo: Dar a conocer las principales manifestaciones clínicas que permiten la sospecha diagnóstica de la arteritis de Takayasu en la atención primaria de salud. Caso clínico: Se presenta el caso de una paciente de 36 años de edad, la cual acude con manifestaciones clínicas que hace que se sospeche y finalmente se realice el diagnóstico de arteritis de Takayasu. Conclusiones: La sospecha clínica de la enfermedad se basa en una adecuada historia clínica, epidemiológica y hallazgos de laboratorio, los cuales son perfectamente detectables en la atención primaria de salud(AU)

Introduction: Takayasu arteritis is a systemic vasculitis considered a rare disease. Its etiopathogenic mechanism is based on an inflammatory process that affects the aorta and its large branches. The absence of pulse, the angiodynia, the hypertensive disorders and the presence of nodules in the lower limbs are described as their main clinical manifestations. Objective: To present the main clinical manifestations that allows the diagnostic suspicion of Takayasu arteritis in primary health care. Clinical case: 36-year-old female patient, which presents clinical manifestations that allow the diagnosis of Takayasu arteritis. Conclusions: The clinical suspicion of the disease is based on adequate clinical, epidemiological and laboratory findings, which are perfectly detectable in primary health care(AU)

Diagnóstico de Arteritis de Takayasu, un caso infrecuente / Diagnosis of Takayasu's Arteritis, an infrequent case

Introducción: la arteritis de Takayasu es considerada como una rara enfermedad que afecta fundamentalmente a mujeres jóvenes donde produce alteraciones en la aorta y sus principales ramas. Esta vasculitis tiene su sustento epidemiológico en la inflamación de las paredes de los vasos sanguíneos lo que determina la intensidad y severidad de las manifestaciones clínicas de la enfermedad. Objetivo: socializar las principales manifestaciones clínicas, elementos epidemiológicos y exámenes complementarios que permiten realizar el diagnóstico de la arteritis de Takayasu. Caso clínico: se presenta el caso de una paciente de 46 años de edad la cual es referida desde la atención primaria de salud, con manifestaciones clínicas y de laboratorio que permiten confirmar el diagnóstico de la arteritis de Takayasu. Conclusiones: Las manifestaciones generales, oftalmológicas y cardiovasculares fueron las más representativas en este caso. La identificación de la misma, unidos a los elementos epidemiológicos y los resultados de los exámenes complementarios constituyeron los pilares diagnósticos de la enfermedad. Los esteroides e inmunosupresores son los grupos farmacéuticos más utilizados en el tratamiento de la AT. Un elevado por ciento de pacientes requieren tratamiento quirúrgico(AU)

Introduction: Takayasu arteritis is considered a rare disease that affects mainly young women where it produces alterations in the aorta and its main branches. This vasculitis has its epidemiological sustenance in the inflammation of the walls of the blood vessels which determines the intensity and severity of the clinical manifestations of the disease. Objective: to socialize the main clinical manifestations, epidemiological elements and complementary tests that allow the diagnosis of Takayasu arteritis. Clinical case: the case of 46-year-old patient is presented, which is referred from primary health care, with clinical and laboratory manifestations that confirm the diagnosis of Takayasu's arteritis. Conclusions: The general, ophthalmological and cardiovascular manifestations were the most representative in this case. The identification of the same, together with the epidemiological elements and the results of the complementary tests constituted the diagnostic pillars of the disease. Steroids and immunosuppressants are the pharmaceutical groups most used in the treatment of TA. A high percentage of patients require surgical treatment(AU)

Comportamiento del síndrome poliglandular autoinmune tipo III en una cohorte de ocho casos / Behavior of autoimmune polyglandular syndrome type III in a cohort of eight cases

Introducción: el síndrome poliglandular autoinmune es una afección que se caracteriza por la presencia de varias afecciones entre las que destaca la presencia de diabetes insulinodependiente, enfermedad tiroidea y enfermedad autoinmune no tiroidea fundamentalmente. Pueden presentarse otras afecciones específicas como es el caso del vitiligo, la psoriasis, alopecia y anemia perniciosa entre otras. Objetivo: conocer el comportamiento clínico y epidemiológico del síndrome poliglandular autoinmune tipo III en pacientes con enfermedades reumáticas. Método: estudio de tipo descriptivo y retrospectivo, de una serie de 8 casos con presencia de enfermedades que permiten el diagnóstico de síndrome autoinmune tipo III. Se procedió a realizar una revisión exhaustiva de las historias clínicas que posibilitó la recogida de la información mediante un cuestionario creado específicamente para la investigación. La información recogida permitió describir las variables sociodemográficas, clínicas y de laboratorio planteadas para la investigación. Resultados: el promedio de edad fue de 47.34 ± 5 años. El 87.5 por ciento correspondió al sexo femenino y el 75 por ciento de los casos refirió algún hábito nocivo, de los cuales el de mayor representatividad (83,3 por ciento) fue el sedentarismo. El hipotiroidismo (87,5 por ciento) y el síndrome de Sjögren (37,5 por ciento) fueron las enfermedades que con mayor frecuencia se presentaron. Conclusiones: el síndrome poliglandular autoinmune es una afección múltiple que incluye diversas afecciones generando polifarmacia que pude incidir negativamente en la adherencia terapéutica de estos pacientes. La presencia de hábitos nocivos puede ser considerada como un posible agente desencadenante de muchas de las afecciones que componen el síndrome. Existe una tendencia a minimizar la importancia de las afecciones dermatológicas lo que genera un subregistro de las mismas(AU)

Introduction: autoimmune polyglandular syndrome is a condition that is characterized by the presence of several conditions among which the presence of insulin-dependent diabetes, thyroid disease and non-thyroid autoimmune disease is fundamental. There may be other specific conditions such as vitiligo, psoriasis, alopecia and pernicious anemia among others. Objective: to know the clinical and epidemiological behavior of type III autoimmune polyglandular syndrome in patients with rheumatic diseases. Methodo: estudio de tipo descriptivo y retrospectivo, de una serie de 8 casos con presencia de enfermedades que permiten el diagnóstico de síndrome autoinmune tipo III. Se procedió a realizar una revisión exhaustiva de las historias clínicas que posibilitó la recogida de la información mediante un cuestionario creado específicamente para la investigación. La información recogida permitió describir las variables sociodemográficas, clínicas y de laboratorio planteadas para la investigación. Results: the average age was 47.34 ± 5 years. 87.5 percent corresponded to the female sex and 75 percent of the cases reported some harmful habit, of which the one with the highest representation (83.3 percent) was a sedentary lifestyle. Hypothyroidism (87.5 percent) and Sjögren's syndrome (37.5 percent) were the diseases that most frequently occurred. Conclusions: autoimmune polyglandular syndrome is a multiple condition that includes various conditions generating polypharmacy that could negatively affect the therapeutic adherence of these patients. The presence of harmful habits can be considered as a possible triggering agent of many of the conditions that make up the syndrome. There is a tendency to minimize the importance of dermatological conditions, which causes underreporting(AU)

Diagnóstico de artritis idiopática juvenil en el primer nivel de atención: a propósito de un caso / Diagnosis of juvenile idiopathic arthritis in the first level of care: in relation to a case

Introducción: la artritis idiopática juvenil es una afección inflamatoria y sistémica que afecta a pacientes menores de 18 años. Engloba una serie de manifestaciones clínicas que en edad adulta tiene nombre común como enfermedades ya establecida; sin embargo, todas ellas se engloban bajo este término en niños y adolescentes. Todas sus formas clínicas tienen como elemento común la presencia de un cuadro inflamatorio que genera artritis; según la característica de la toma articular y la presencia de otras manifestaciones, es que se definen las formas clínicas de la enfermedad. Objetivo: dar a conocer los elementos clínicos y de laboratorio que permiten llegar al diagnóstico de la artritis idiopática juvenil en la atención primaria de salud. Caso clínico: se presenta el caso de una paciente de 9 años de edad que presenta manifestaciones clínicas y de laboratorio que permiten realizar el diagnóstico de artritis idiopática juvenil. Conclusiones: las enfermedades reumáticas afectan generalmente a pacientes adultos, con predominio de edades avanzadas, sin embargo, resulta importante conocer los elementos diagnósticos de cada uno de ellos para poder detectar su aparición en edades tempranas de la vida(AU)

Introduction: juvenile idiopathic arthritis is an inflammatory and systemic condition that affects patients under 18 years of age. It encompasses a series of clinical manifestations that in adult age has a common name as established diseases; however, all of them are included under this term in children and adolescents. All its clinical forms have as a common element the presence of an inflammatory condition that generates arthritis; According to the characteristic of the joint taking and the presence of other manifestations, it is that the clinical forms of the disease are defined. Objective: to present the clinical and laboratory elements that allow to reach the diagnosis of juvenile idiopathic arthritis in primary health care. Clinical case: the case of a 9-year-old patient with clinical and laboratory manifestations that allow the diagnosis of juvenile idiopathic arthritis is presented. Conclusions: rheumatic diseases generally affect adult patients, with a predominance of advanced ages; however, it is important to know the diagnostic elements of each of them in order to detect their appearance at early ages of life(AU)

Pseudoquiste Pancreático como complicación de una paciente con lupus eritematoso sistémico / Pancreatic pseudocyst as a complication of a patient with systemic lupus erythematosus

Introducción: el pseudoquiste pancreático es una complicación que puede obedecer a factores traumáticos, infecciosos o inflamatorios; aunque puede aparecer a cualquier edad, frecuentemente se presenta en pacientes mayores de 40 años: Sus principales manifestaciones incluyen el dolor abdominal y la presencia de una masa tumoral abdominal. Objetivo: dar a conocer los elementos etiopatogénicos, manifestaciones clínicas y exámenes complementarios que permiten diagnosticar el pseudoquiste pancreático. Caso clínico: paciente femenina, 22 años de edad, con antecedentes de Lupus Eritematoso y que acude con manifestaciones compatibles con el diagnóstico de un pseudoquiste pancreático. Conclusiones: el pseudoquiste pancreático es considerada una complicación poco frecuente pero preocupante que puede poner en peligro la vida de los pacientes. Todos los casos a los cuales se le diagnostique alguna afección pancreática, transitoria o permanente debe tener un seguimiento estricto para advertir la presencia precoz de esta complicación y de esta forma minimizar sus posibles consecuencias para la salud humana(AU)

Introduction: the pancreatic pseudocyst is a complication that may be due to traumatic, infectious or inflammatory factors; Although it can appear at any age, it frequently occurs in patients older than 40 years: Its main manifestations include abdominal pain and the presence of an abdominal tumor mass. Objective: to present the etiopathogenic elements, clinical manifestations and complementary tests that allow to diagnose the pancreatic pseudocyst. Clinical case: female patient, 22 years old, with a history of Lupus erythematosus and who presents with manifestations compatible with the diagnosis of a pancreatic pseudocyst. Conclusions: tha pancreatic pseudocyst is considered an uncommon but worrisome complication that can endanger the life of patients. All cases in which a pancreatic, transient or permanent condition is diagnosed must have a strict follow-up to warn of the early presence of this complication and in this way minimize its possible consequences for human health(AU)

Artritis reumatoide y embarazo, a propósito de un caso / Rheumatoid arthritis and pregnancy, about a case

Introducción: La artritis reumatoide es una enfermedad inflamatoria sistémica y crónica que, aunque suele tener su pico de incidencia en edades superiores, también puede presentar en edades más tempranas de la vida. La gestación es estas pacientes es considerada una situación de elevado riesgo debido a la misma actividad de la enfermedad y al posible efecto teratogénico que pueden devenirse del uso de muchos de los fármacos que generalmente se utilizan en estos casos. Sin embargo, una correcta planificación, un adecuado seguimiento ginecobstétrico y reumatológico y la valoración sistemática de la actividad de la enfermedad, constituyen los elementos básicos de la atención médica durante este periodo. Objetivo: dar a conocer los elementos fundamentales del seguimiento de la gestación en pacientes con artritis reumatoide. Caso clínico: se presenta el caso de una paciente de 23 años de edad con diagnóstico de artritis reumatoide de 5 años de evolución que concibe una gestación que con todos los cuidados médicos se logra llegar a un feliz término. Conclusiones: al ser la artritis reumatoide una enfermedad de compleja evolución las pacientes jóvenes tienen cierto temor a la gestación, sin embargo, durante el embarazo se produce cierta mejoría clínica de la artritis. Es imprescindible garantizar la menor actividad posible para que no afecte el pronóstico y la salud materna y fetal(AU)

Introduction: Rheumatoid arthritis is a systemic and chronic inflammatory disease that, although it usually has its peak of incidence in older ages, can also present at younger ages of life. The pregnancy is these patients is considered a situation of high risk due to the same activity of the disease and the possible teratogenic effect that can be derived from the use of many of the drugs that are generally used in these cases. However, proper planning, adequate gynecobysteometric and rheumatological follow-up, and systematic assessment of disease activity are the basic elements of medical care during this period. Objective: to present the fundamental elements of the pregnancy follow-up in patients with rheumatoid arthritis. Clinical case: We present the case of a 23-year-old patient with a diagnosis of rheumatoid arthritis of 5 years of evolution who conceives a pregnancy that with all medical care is achieved a happy term. Conclusions: as rheumatoid arthritis is a disease of complex evolution young patients have some fear of pregnancy, however, during pregnancy there is some clinical improvement of arthritis. It is essential to guarantee as little activity as possible so that it does not affect prognosis and maternal and fetal health(AU)

Pancreatitis y apendicitis aguda como complicación en una paciente con enfermedad mixta del tejido conectivo / Pancreatitis and acute appendicitis as a complication in a patient with mixed connective tissue disease

Introducción: la enfermedad mixta del tejido conectivo es una afección que incluye manifestaciones clínicas de diversas enfermedades reumáticas. Se caracteriza sobre todo por la presencia de afectación en todos los órganos y sistemas de órganos del cuerpo humano. Las complicaciones relacionadas con el aparato digestivo han sido señaladas como una de las que con mayor frecuencia se presentan. La pancreatitis y la apendicitis suelen presentarse de forma aislada, pero al presentarse al unísono complican más aún la evolución del paciente. Objetivo: dar a conocer los elementos clínicos, de laboratorio e imagenológicos que posibilitan llegar al diagnóstico de apendicitis y pancreatitis en una paciente con enfermedad mixta del tejido conectivo. Caso clínico: se presenta el caso de una paciente de 29 años de edad con diagnóstico de enfermedad mixta del tejido conectivo de 3 años de evolución que es remita al servicio de emergencia con elementos clínicos, de laboratorio e imagenológicos que permiten llegar al diagnóstico de una apendicitis y pancreatitis de presentación conjunta. Conclusiones: la enfermedad mixta del tejido conectivo es una enfermedad sistémica que cursa con una amplia variedad de manifestaciones clínicas y complicaciones. Los procesos agudos como la apendicitis y la pancreatitis suponen un peligro sobreañadido y un factor desencadenante de la actividad de la enfermedad(AU)

Introduction: mixed connective tissue disease is a condition that includes clinical manifestations of various rheumatic diseases. It is characterized above all by the presence of affectation in all organs and organ systems of the human body. Complications related to the digestive system have been identified as one of the most frequent. Pancreatitis and appendicitis usually occur in isolation, but when presented in unison, they complicate the evolution of the patient even more. Objective: to present the clinical, laboratory and imaging elements that make it possible to reach the diagnosis of appendicitis and pancreatitis in a patient with mixed connective tissue disease. Clinical case: the case of a 29-year-old patient with a diagnosis of mixed connective tissue disease of 3 years of evolution is presented, which is referred to the emergency service with clinical, laboratory and imaging elements that allow to reach the diagnosis of a appendicitis and pancreatitis of joint presentation. Conclusions: Mixed connective tissue disease is a systemic disease that presents with a wide variety of clinical manifestations and complications. Acute processes such as appendicitis and pancreatitis pose an added danger and a triggering factor in the activity of the disease(AU)