Differential effects of 3,5-T2 and T3 on the gill regeneration and metamorphosis of the Ambystoma mexicanum (axolotl).

Thyroid hormones (THs) regulate tissue remodeling processes during early- and post-embryonic stages in vertebrates. The Mexican axolotl (Ambystoma mexicanum) is a neotenic species that has lost the ability to undergo metamorphosis; however, it can be artificially induced by exogenous administration of thyroxine (T4) and 3,3',5-triiodo-L-thyronine (T3). Another TH derivative with demonstrative biological effects in fish and mammals is 3,5-diiodo-L-thyronine (3,5-T2). Because the effects of this bioactive TH remains unexplored in other vertebrates, we hypothesized that it could be biologically active in amphibians and, therefore, could induce metamorphosis in axolotl. We performed a 3,5-T2 treatment by immersion and observed that the secondary gills were retracted, similar to the onset stage phenotype; however, tissue regeneration was observed after treatment withdrawal. In contrast, T4 and T3 immersion equimolar treatments as well as a four-fold increase in 3,5-T2 concentration triggered complete metamorphosis. To identify the possible molecular mechanisms that could explain the contrasting reversible or irreversible effects of 3,5-T2 and T3 upon gill retraction, we performed a transcriptomic analysis of differential expression genes in the gills of control, 3,5-T2-treated, and T3-treated axolotls. We found that both THs modify gene expression patterns. T3 regulates 10 times more genes than 3,5-T2, suggesting that the latter has a lower affinity for TH receptors (TRs) or that these hormones could act through different TR isoforms. However, both TH treatments regulated different gene sets known to participate in tissue development and cell cycle processes. In conclusion, 3,5-T2 is a bioactive iodothyronine that promoted partial gill retraction but induced full metamorphosis in higher concentrations. Differential effects on gill retraction after 3,5,-T2 or T3 treatment could be explained by the activation of different clusters of genes related with apoptosis, regeneration, and proliferation; in addition, these effects could be initially mediated by TRs that are expressed in gills. This study showed, for the first time, the 3,5,-T2 bioactivity in a neotenic amphibian.

The importance of thyroid hormone signaling during early development: Lessons from the zebrafish model.

The zebrafish is an optimal experimental model to study thyroid hormone (TH) involvement in vertebrate development. The use of state-of-the-art zebrafish genetic tools available for the study of the effect of gene silencing, cell fate decisions and cell lineage differentiation have contributed to a more insightful comprehension of molecular, cellular, and tissue-specific TH actions. In contrast to intrauterine development, extrauterine embryogenesis observed in zebrafish has facilitated a more detailed study of the development of the hypothalamic-pituitary-thyroid axis. This model has also enabled a more insightful analysis of TH molecular actions upon the organization and function of the brain, the retina, the heart, and the immune system. Consequently, zebrafish has become a trendy model to address paradigms of TH-related functional and biomedical importance. We here compilate the available knowledge regarding zebrafish developmental events for which specific components of TH signaling are essential.

Biological removal of hexavalent chromium: evaluation of the metabolic activity of native and Cr(VI)-acclimated activated sludge using a respirometric method.

Hexavalent chromium becomes in one of the tops internationally concern environmental issues due to its wide usage in several industrial activities. There are two stable oxidation states of chromium in the environment which differ significantly on its toxicity; Cr(III) has lower solubility, mobility and lesser biological toxicity in comparison with Cr(VI). While Cr(VI) is a well-known carcinogen, Cr(III) is an essential dietary element. For this reason, most technologies focus attention on the reduction of Cr(VI) to Cr(III). On this context, the ability of microorganisms to reduce Cr(VI) to Cr(III) has gained attention. The objectives of the present work were to analyze the effect of Cr(VI) on the activated sludge community in a continuous reactor, and to evaluate the differences on the metabolic activity of native (NAS) and Cr(VI)-acclimated activated sludge (CrAAS) using a respirometric method. Results showed that the activated sludge community had the capability to acclimate to the presence of Cr(VI). On the other hand, the increase of the initial Cr(VI) concentration from 0 to 100 mgCr/L leads to a decrease in the specific exogenous respiration rate (qEx ) values, but this reduction was more noticeably in the case of NAS in comparison with CrAAS. The respirometric curves were well described by the proposed mathematical model. It was concluded that the CrAAS tolerated a Cr(VI) concentration about one order of magnitude higher than NAS, which was positively reflected in the respiration rate first-order decay constant (kd ), the specific maximum exogenous respiration rate (qExm ), and the observed oxidation coefficient (YO/S ) values.

Bone Marrow Culture Yield for the Diagnosis of Opportunistic Diseases in Patients with AIDS and Disseminated Kaposi Sarcoma.

BACKGROUND: Disseminated Kaposi sarcoma (DKS) is present in patients with advanced HIV infection in whom co-infection with other opportunistic pathogens can occur. Bone marrow (BM) aspirate and biopsy comprise a robust diagnostic tool in patients with fever, cytopenias, and abnormal liver tests. However, the yield in patients with DKS has not been determined. OBJECTIVE: The aim of this study was to evaluate the utility of BM aspirate and biopsy in patients with DKS. METHODS: We included 40 male patients with a recent diagnosis of DKS. BM aspirate and biopsy was performed as part of the workup to rule out co-infections. RESULTS: In four patients, Mycobacterium avium complex (MAC) was recovered from culture. In other four patients, intracellular yeasts were observed in the Grocott stain, diagnosed as Histoplasma. The yield of BM was calculated in 20%. Only 12 patients (30%) had fever and 11 (27.5%) had pancytopenia. Alkaline phosphatase (ALP) above normal values and C-reactive protein (CRP) were higher in patients with positive results for BM than in those with negative results (63% vs. 21.9%, and 3.0 vs. 1.2 mg/L; p = 0.03 in both comparisons). No differences were found when complete blood-count abnormalities were compared. CONCLUSION: We recommend performing a BM aspirate for stains, culture, and biopsy in all HIV patients with DKS, as this will permit the early diagnosis of co-infections and prevent further complications in those who receive chemotherapy.

Super large cardiac hemangioma in right atrium and inferior vena cava: case report.

BACKGROUND: Cardiac hemangiomas are rare cardiac neoplasia usually diagnosed in autopsies, from being asymptomatic to debuting with sudden death. The largest hemangioma published in the literature is of 130 mm size, we present the following case of a successful cardiac hemangioma excision of 280 × 35 mm in size, diagnosed due to recurrent cardiac symptoms. CASE PRESENTATION: A 48-year-old female patient, Jehovah's Witness, with no previous diagnoses, is admitted due to recurrent syncopal episodes in the previous months. A transthoracic echocardiogram diagnosed a tumor in the right atrium and inferior vena cava producing a diastolic right ventricular, with preservation of the left ventricular ejection fraction at 55%. Given the high mortality risk, a surgical intervention was performed immediately. Successful excision was completed confirming a 280 × 35 mm mass without any complications, consistent with hemangioma on histopathology. Postoperative recovery showed no recurrence or complications. CONCLUSIONS: Cardiac hemangiomas are rare and its clinical course can be varied from patient to patient. We present excision of a large cardiac mass with a high mortality risk due to its size and the patient's spiritual beliefs.

3,5-T2 and 3,3',5-T3 Regulate Cerebellar Thyroid Hormone Signalling and Myelin Molecular Dynamics in Tilapia.

In contrast to mammalian adults, myelination in teleosts occurs throughout their lifespan and most of the progenitor cells are originated in the cerebellum. To understand the role that thyroid hormones (THs) play in juvenile cerebellar myelination in teleosts, we identified and localised the expression of genes involved in TH signalling (mct8, oatp1c1, dio2, dio3, thraa and l-thrb1) and analysed the effects of the two bioactive THs, T2 and T3, upon their regulation, as well as upon some structural components of the myelination process. Ex vivo approaches using organotypic cerebellar cultures followed by FISH and qPCR showed gene-specific localisation and regulation of TH signalling genes in the cerebellar nuclei. In vivo approaches using methimazole (MMI)-treated juvenile tilapias replaced with low doses of T3 and T2 showed by immunofluorescence that myelin fibres in the cerebellum are more abundant in the granular layer and that their visible size is reduced after MMI treatment but partially restored with TH replacement, suggesting that low doses of TH promote the re-myelination process in an altered condition. Together, our data support the idea that T2 and T3 promote myelination via different pathways and prompt T2 as a target for further analysis as a promising therapy for hypomyelination.

Interdependence between the aerobic degradation of BPA and readily biodegradable substrates by activated sludge in semi-continuous reactors.

The objective of the present work was to analyze the interrelationship between the aerobic degradation of BPA and readily biodegradable substrates by activated sludge (AS) in semi-continuous reactors (SCRs). AS were obtained from three SCRs fed with glucose, acetate or peptone. AS from these reactors were used as inocula for three SCRs that were fed with each biogenic substrate, and for three SCRs that were fed with the biogenic substrate and BPA. In all cases, dissolved organic carbon (DOC), BPA, total suspended solids (TSS) and respirometric measurements were performed. Although BPA could be removed in the presence of all the tested substrates, AS grown on acetate exhibited the longest acclimation to BPA. Reactors fed with peptone attained the lowest TSS concentration; however, these AS had the highest specific BPA degradation rate. Specific DOC removal rates and respirometric measurements demonstrated that the presence of BPA had a negligible effect on the removal of the tested substrates. A mathematical model was developed to represent the evolution of TSS and DOC in the SCRs as a function of the operation cycle. Results suggest that the main effect of BPA on AS was to increase the generation of microbial soluble products. This work helps to understand the relationship between the biodegradation of BPA and readily biodegradable substrates.

Babesia spp. no líquido peritoneal em cão com ascite - relato de caso / Babesia spp. in the peritoneal fluid in dog with ascites - case report

Babesia canis é um protozoário cosmopolita que parasita eritrócitos de cães domésticos e selvagens. O diagnóstico é realizado mediante a observação direta do microrganismo em hemácias no esfregaço de sangue periférico, métodos sorológicos e técnicas moleculares. O objetivo deste trabalho é relatar pela primeira vez a presença de merozoítos de Babesia spp. no líquido peritoneal de um cão com ascite. No Hospital Veterinário da Universidade Federal de Viçosa, foi atendido um cão, macho, sem raça definida, de sete meses de idade, com histórico de emaciação, apatia e abaulamento abdominal. No exame físico, foram evidenciadas mucosas hipocoradas, ascite, sopro sistólico grau IV/V e taquipneia. Nos exames laboratoriais, evidenciou-se anemia normocítica/normocrômica, trombocitopenia e hipoproteinemia. No esfregaço sanguíneo, foram observadas estruturas intraeritrocitárias compatíveis com Babesia spp. A avaliação do líquido ascítico foi compatível com transudato modificado e observaram-se inúmeras estruturas intra e extracelulares compatíveis com merozoítas de Babesia spp. A presença de microrganismos intra e extracelular poderia estar relacionada a uma lesão no baço com extravasamento do conteúdo para a cavidade abdominal. A coleta do líquido peritoneal pode ser uma alternativa para o diagnóstico de babesiose quando o animal com suspeita da infecção apresentar ascite.(AU)

Babesia canis is a cosmopolitan protozoan that parasites erythrocytes of domestic and wild dogs. The diagnosis is performed by direct observation of the microorganism in red blood cells in the peripheral blood smear, serological methods and molecular techniques. The aim of this work is to report for the first time the presence of merozoites of Babesia spp. in the peritoneal fluid of a dog with ascites. At the Veterinary Hospital of the Federal University of Viçosa was attended a Mixed-breed seven month old dog, male, with history of emaciation, apathy and abdominal bulging. Pale mucous membranes, ascites, grade IV/V systolic murmur and tachypnea were evidenced in the physical examination. Laboratory tests revealed normocytic/normochromic anemia, thrombocytopenia, and hypoproteinemia. Intra-erythrocyte structures compatible with Babesia spp. were observed in the blood smear. The evaluation of the ascites fluid was compatible with modified transudate where numerous intra and extracellular structures compatible with Babesia spp. merozoites were observed. The presence of intra and extracellular microorganisms could be related to an injury of the spleen with extravasation of the contents into the abdominal cavity. Collection of the peritoneal fluid may be an alternative for the diagnosis of babesiosis when the animal with suspected infection has ascites.(AU)

Babesia spp. no líquido peritoneal em cão com ascite - relato de caso / Babesia spp. in the peritoneal fluid in dog with ascites - case report

Babesia canis é um protozoário cosmopolita que parasita eritrócitos de cães domésticos e selvagens. O diagnóstico é realizado mediante a observação direta do microrganismo em hemácias no esfregaço de sangue periférico, métodos sorológicos e técnicas moleculares. O objetivo deste trabalho é relatar pela primeira vez a presença de merozoítos de Babesia spp. no líquido peritoneal de um cão com ascite. No Hospital Veterinário da Universidade Federal de Viçosa, foi atendido um cão, macho, sem raça definida, de sete meses de idade, com histórico de emaciação, apatia e abaulamento abdominal. No exame físico, foram evidenciadas mucosas hipocoradas, ascite, sopro sistólico grau IV/V e taquipneia. Nos exames laboratoriais, evidenciou-se anemia normocítica/normocrômica, trombocitopenia e hipoproteinemia. No esfregaço sanguíneo, foram observadas estruturas intraeritrocitárias compatíveis com Babesia spp. A avaliação do líquido ascítico foi compatível com transudato modificado e observaram-se inúmeras estruturas intra e extracelulares compatíveis com merozoítas de Babesia spp. A presença de microrganismos intra e extracelular poderia estar relacionada a uma lesão no baço com extravasamento do conteúdo para a cavidade abdominal. A coleta do líquido peritoneal pode ser uma alternativa para o diagnóstico de babesiose quando o animal com suspeita da infecção apresentar ascite.(AU)

Babesia canis is a cosmopolitan protozoan that parasites erythrocytes of domestic and wild dogs. The diagnosis is performed by direct observation of the microorganism in red blood cells in the peripheral blood smear, serological methods and molecular techniques. The aim of this work is to report for the first time the presence of merozoites of Babesia spp. in the peritoneal fluid of a dog with ascites. At the Veterinary Hospital of the Federal University of Viçosa was attended a Mixed-breed seven month old dog, male, with history of emaciation, apathy and abdominal bulging. Pale mucous membranes, ascites, grade IV/V systolic murmur and tachypnea were evidenced in the physical examination. Laboratory tests revealed normocytic/normochromic anemia, thrombocytopenia, and hypoproteinemia. Intra-erythrocyte structures compatible with Babesia spp. were observed in the blood smear. The evaluation of the ascites fluid was compatible with modified transudate where numerous intra and extracellular structures compatible with Babesia spp. merozoites were observed. The presence of intra and extracellular microorganisms could be related to an injury of the spleen with extravasation of the contents into the abdominal cavity. Collection of the peritoneal fluid may be an alternative for the diagnosis of babesiosis when the animal with suspected infection has ascites.(AU)

Modelo Matemático de VIH bajo la Administración de un Antirretroviral / HIV Mathematical Model considering Antiretroviral Administration

RESUMEN En este trabajo se propone un modelo matemático consistente de cuatro ecuaciones diferenciales ordinarias que describen la evolución del VIH en un individuo seropositivo y el efecto de un antirretroviral en el proceso de replicación del virus en las células T CD4+. Con el propósito de determinar la efectividad del medicamento en el largo plazo se analizan los casos con y sin el tratamiento antirretroviral para observar el efecto en la población de células T CD4+ sanas e infectadas. Con el modelo matemático propuesto se encuentra un caso en el cual el tratamiento antirretroviral permite mantener una concentración de T CD4+ no infectadas clínicamente saludable en el organismo. Mediante la aplicación del método de Conjuntos Compactos Invariantes se establecen los límites máximos para las poblaciones de células sanas e infectadas, así como la concentración del VIH libre en el organismo. Finalmente, se realizan simulaciones numéricas para ilustrar los resultados en el plano temporal, se grafican las soluciones del sistema y los límites superiores obtenidos, estos permiten observar el valor máximo que pueden llegar a alcanzar las poblaciones de células sanas, las infectadas y la concentración de VIH en el torrente sanguíneo.

ABSTRACT In this work, we present a proposal of a mathematical model of four ordinary differential equations that describe the evolution of HIV in an HIV-positive individual and the effect of an antiretroviral in the process of virus replication in CD4+ T cells. In order to determine the long-term effectiveness of the drug, the cases with and without antiretroviral treatment are analyzed to observe the effect on the population of healthy and infected CD4+ T cells. With our mathematical model, we are able to obtain a case where the antiretroviral allows a clinically healthy concentration of uninfected CD4+ T cells. Additionally, by applying the Compact Invariant Sets method we determine maximum values for the concentration of free HIV and both cells populations, healthy and infected. Finally, we perform numerical simulations in order to illustrate our results in the temporal plane, we plot the solutions of the system and their corresponding upper bounds, the latter allow us to define the maximum values of the HIV concentration in the bloodstream and the infected and healthy cells populations.

Differential transcriptome regulation by 3,5-T2 and 3',3,5-T3 in brain and liver uncovers novel roles for thyroid hormones in tilapia.

Although 3,5,3'-triiodothyronine (T3) is considered to be the primary bioactive thyroid hormone (TH) due to its high affinity for TH nuclear receptors (TRs), new data suggest that 3,5-diiodothyronine (T2) can also regulate transcriptional networks. To determine the functional relevance of these bioactive THs, RNA-seq analysis was conducted in the cerebellum, thalamus-pituitary and liver of tilapia treated with equimolar doses of T2 or T3. We identified a total of 169, 154 and 2863 genes that were TH-responsive (FDR < 0.05) in the tilapia cerebellum, thalamus-pituitary and liver, respectively. Among these, 130, 96 and 349 genes were uniquely regulated by T3, whereas 22, 40 and 929 were exclusively regulated by T2 under our experimental paradigm. The expression profiles in response to TH treatment were tissue-specific, and the diversity of regulated genes also resulted in a variety of different pathways being affected by T2 and T3. T2 regulated gene networks associated with cell signalling and transcriptional pathways, while T3 regulated pathways related to cell signalling, the immune system, and lipid metabolism. Overall, the present work highlights the relevance of T2 as a key bioactive hormone, and reveals some of the different functional strategies that underpin TH pleiotropy.

Monitoring the biodegradability of bisphenol A and its metabolic intermediates by manometric respirometry tests.

As a result of its wide usage in the production of polycarbonate plastics and epoxy resins, bisphenol A (BPA) is commonly detected in wastewaters. Recently, BPA became a major concern because its adverse effects as an endocrine disruptor. In this work, the biodegradation kinetics of BPA and its metabolic intermediates 4-hydroxyacetophenone (4HAP), 4-hydroxybenzaldehyde (4HB) and 4-hydroxybenzoic acid (4HBA) by BPA-acclimated activated sludge was studied using manometric respirometry (BOD) tests. For all the tested compounds, BOD curves exhibited two phases. In the first one, a fast increase of the oxygen consumption (OC) due to the active oxidation of the substrate was obtained. Then, when the substrate was exhausted, the endogenous respiration produced a slower increase of OC. A standard Monod-model with biomass growth was used to represent the OC profiles as a function of time. For all the tested compounds, a good agreement between the proposed model and the experimental data was obtained. According to their biodegradation rates, the tested compounds can be ordered as follows: BPA < 4HAP â‰ª 4HB < 4HBA. Because the oxidation rate of BPA by BPA-acclimated activated sludge limits the rate of the whole biodegradation pathway, the accumulation of metabolic intermediates 4HAP, 4HB, and 4HBA would be negligible. To calculate the dissolved oxygen (DO) concentration (C) during the BOD tests, the oxygen transfer coefficient (kLa) of the BOD bottles was obtained using the sulfite method. Finally, a simple procedure to calculate the minimum DO concentration (Cmin) based on BOD data was developed. Calculation results demonstrated that under the tested conditions, C values were high enough as not to be the limiting substrate for the microbial growth.

Attitudes Toward Organ Donation and Transplantation in Guanajuato, Mexico.

BACKGROUND: Chronic diseases have become a main cause of morbidity and mortality provoking function loss in organs. Quality of life is poor and expensive with replacement therapy. Transplantation offers a higher survival rate and a better life; however, the donation rate in Mexico is low, making it important to know the opinion of the population. METHODS: Six hundred forty-two people in Guanajuato, Mexico, (>15 years old) were enrolled. Demographic characteristics, education, religion, organ donation, and transplantation attitudes were evaluated. RESULTS: Donation attitudes in life or death were: very willing to donation (82.8% vs 61.5%), refuse to donate (12.7% vs 29.4%), and undecided (4.5% vs 9.1%). Reasons for donation were: altruism (63%), being useful to someone (28.6%), and empathy (7.1%). Negative causes were: personal beliefs (35.6%), fear (23.7%), and ignorance or "I don't know the recipient" (18.5%). Finally, 94.5% of the population is willing to receive a transplant if they need it. CONCLUSIONS: Guanajuato has a high tendency to donate their own organs, but less to donate from a family member. Refusal to donate has originated from lack/misinformation that people received from health professionals. Although most people are willing to donate, this is not reflected in donation rates. To be able to make this intention reality, we must create educational models for health care personnel that will allow them to transmit proper information to the population.

Generalización e inferencia: un acercamiento a su compresión desde tres enfoques / Generalization and inference: an understanding based on three approaches

Se trata de una reflexión que busca poner en discusión los diferentes significados que pueden adquirir los conceptos de generalización e inferencia, de acuerdo con el enfoque o perspectiva desde el cual se pretendan utilizar. Para este propósito, en primer lugar, se pone en consideración la importancia y el uso que se ha dado a estos conceptos en el campo de la epidemiología clásica-moderna, especialmente para definir asuntos de validez interna y externa y para la formulación de hipótesis. Seguidamente, se presentan las principales argumentaciones que al respecto defiende Clifford Geertz desde su perspectiva epistemológica de la etnografía interpretativista y de acuerdo con su concepción teórica de la cultura. Posteriormente, se presentan las ideas que sustenta Juan Samaja desde su enfoque epistemológico y metodológico para la investigación en salud, abogando principalmente por el razonamiento abductivo, y no sólo el inductivo y el deductivo que han sido privilegiados en los estudios lógicos. Por último se presenta una discusión y unas conclusiones destacando que en estas tres perspectivas la salud pública tiene una oportunidad para enriquecer sus procesos de generación de nuevo conocimiento y para comprender de mejor manera las condiciones de salud y de bienestar colectivo.

This paper is a reflection which seeks to stimulate discussion and debate concerning the different meanings that the concepts of generalization and inference can take on, based on the approach or perspective that is being employed. For this purpose the importance and usage which has been accorded to these concepts within the field of classic-modern epidemiology is taken into consideration, especially in order to define internal and external validity issues and to formulate hypotheses. Next the main arguments are presented and are defended by Clifford Geertz from his epistemological perspective of interpretive ethnography and based on his theoretical conception of culture. Subsequently the ideas maintained by Juan Samaja are presented from his epistemological and methodological approach for research into health, advocating primarily for abductive reasoning, and not simply inductive and deductive, which have until now been privileged in logic studies. Finally a discussion and conclusions are presented, highlighting that from these three perspectives public health has the opportunity to expand its new knowledge generation processes and to better understand the conditions for good collective health and wellbeing.

Justicia global: sus implicaciones para el manejo de las inequidades en salud / Global justice: implications for managing health inequities

El debate sobre la justicia global, es decir, sobre la transformación de las relaciones económicas y políticas entre las sociedades más ricas y las más pobres es de vital importancia para la salud pública por dos motivos. Primero, porque se encuentra bien documentado un aumento de las desigualdades en salud como efecto del proceso de globalización económica; y segundo, porque para el manejo de estas desigualdades en salud se han hecho visibles especialmente dos enfoques que tienen total relación con el campo de trabajo de la salud pública: el enfoque de determinantes sociales de la salud de la oms y el enfoque de la determinación social de la salud de la medicina social latinoamericana. En tal sentido, el propósito de este artículo es analizar las perspectivas de justicia global que asume cada uno de estos enfoques y las propuestas para el manejo de las inequidades en salud que en cada caso se generan. Se concluye de dicho análisis que en los textos de la Comisión de Determinantes de la Salud de la oms no se cuestiona ni se demanda un cambio en las relaciones económicas y políticas globales, mientras que, por el contrario, para la medicina social latinoamericana el propósito de avanzar en la eliminación de las desigualdades globales pasa obligatoriamente por un cuestionamiento tico y una re-estructuración de las relaciones de poder a escala global.

The discussion on global justice, namely, on the transformation of economic and political relations among the richest societies and the poorest becomes vital for public health today due to two reasons. First, because its well documented an increase in health inequities as an effect of economic globalization process; and second, because to manage these health inequalities, have become visible especially two approaches that have full regard with the public health field of work: social determinants of health approach of the WHO, and Latin American Social Medicine approach. In this sense, the purpose of this article is to analyze the prospects for global justice that assumes each of these approaches, and proposals for management of health inequities that are generated in each case. We concluded, that texts of the Committee on Health Determinants of WHO don´t question nor demand a change in the global economic and political relationships, while in contrast, Latin American Social Medicine considers that to advance in global inequalities elimination involves ethical questions and to restructure power relationship globally.

Eficacia de la premedicación anestésica en el paciente pediátrico con midazolam oral y acetaminofén. Estudio observacional / Efficacy of anesthetic premedication in pediatric patients using oral midazolam and acetaminophen. Observational study

La premedicación anestésica con midazolam, permite disminuir la ansiedad de los niños y los padres así como los requerimientos analgésicos, la aparición de eventos psicológicos negativos en el postoperatorio, y acorta los tiempos de inducción inhalatoria de la intubación orotraqueal. Se han desarrollado preparaciones magistrales utilizando ampollas de administración parenteral mezcladas con sustancias que modifican su sabor para mejorar la aceptación. Para determinar la eficacia de la premedicación con midazolam mezclado con acetaminofén se realizó un estudio observacional descriptivo prospectivo en 216 niños ASAI o II sometidos a procedimientos quirúrgicos o diagnósticos que requerían anestesia general; se aplicaron escalas de ansiedad-sedación (Yale modificada y RASS) y se valoró la tolerancia a la separación de los padres. Resultados: La escala de RASS aplicada al momento de la inducción evidenció que el 92% de los pacientes se encontraban en un grado adecuado de sedación para tolerar la máscara facial y la inducción inhalatoria, y además el 86% de los pacientes toleró de manera adecuada la separación de sus padres. El 61,6% de los pacientes se encontraban con un grado adecuado de sedación ansiólisis con la escala de Yale, previo al momento de la separación de los padres. Edad, género, escolaridad, estrato socioeconómico, tipo de valoración preanestésica o antecedente de anestesia no se correlacionaron con el grado de ansiedad-sedación. Conclusiones: La premedicación con la mezcla magistral utilizada disminuye la ansiedad en el momento en que el niño se separa de sus padres y permite una buena aceptación de la inducción anestésica inhalada.

Anesthetic premedication with midazolam helps reduce anxiety in the children and the parents, the need for analgesic use, and the development of negative psychological events during the postoperative period; it also results in shorter inhalation induction and orotracheal intubation. Compounded preparations have been developed using ampoules for parenteral administration mixed with flavor modifiers in order to improve acceptance. To determine the efficacy of premedication using a mix of midazolam plus acetaminophen, a prospective descriptive observational study was conducted in 216 children ASAI or II, scheduled for surgical or diagnostic procedures requiring general anesthesia. Anxiety-sedation scales were given (Modified Yale scale and RASS), and tolerance to separation from the parents was assessed. Results: The RASS scale applied at the time of induction showed that 92% of the patients were at an appropriate level of sedation to tolerate facemask inhalation induction, and 86% of patients tolerated well their separation from their parents. It was found that age, gender, education, socioeconomic status, pre-anesthetic check type (telephonic or in person), or a history of previous anesthesia, did not have a statistically significant correlation with the degree of anxiety-sedation. Conclusions: Premedication with a compounded preparation does reduce anxiety at the time of separating the child from its parents, and allows a good acceptance of the inhaled anesthetic induction.

Evaluación clínico-nutricional y del funcionamiento familiar en niños con alto nivel de riesgo de padecer inmunodeficiencia primaria / Family functioning, nutritional and clinical assessment of children with high risk of primary immunodeficiency

Antecedentes. Los estados de inmunodeficiencia impactan en el funcionamiento familiar. Objetivo. Comparar el funcionamiento familiar y aspectos clínico-nutricionales entre niños con alto nivel de sospecha de inmunodeficiencias primarias y aquellos con menor nivel de sospecha. Lugar de aplicación. Clínica de atención primaria. Diseño. Estudio transversal con grupos comparados. Población. 400 niños entre 1 año y 7 años 11 meses de edad, asignados a dos grupos, uno integrado por aquellos con puntaje ≥25 en la escala PRIDE (primary immunodeficiency disease evaluation), n=9 y otro integrado por aquellos que alcanzaron un puntaje ≤25 en la evaluación con la escala PRIDE, n=391. Material y métodos. Los grupos se compararon con respecto a funcionamiento familiar, estado nutricional y criterios clínicos de riesgo para inmunodeficiencias primarias. Resultados. Se encontraron asociaciones estadísticamente significativas de puntaje PRIDE con infecciones respiratorias altas >8, episodios de otitis media aguda ≥4, episodios de sinusitis aguda ≥2, infecciones de vías respiratorias bajas ≥2, no respuesta a ≥3 esquemas de antibióticos para un mismo cuadro de infección, infecciones urinarias >6, infecciones del sistema nervioso central, enfermedades alérgicas o autoinmunes concomitantes, caída del cordón umbilical > 30 días y funcionamiento familiar. Las áreas más dañadas del funcionamiento familiar fueron roles y armonía. Conclusiones. Hubo diferencias en el funcionamiento familiar y factores de riesgo relacionados con infección y predisposición a ella entre los niños con puntaje PRIDE ≥25 y aquellos con puntaje <25. (AU)

Background. Immunodeficiency states impact on family functioning. Objective. To compare family functioning, clinical and nutritional status among children with high suspicion of primary immunodeficiencies versus those in which the level of suspicion is lower. Design. Cross-sectional study with compared groups. Population. 400 children between 1 year and 7 years 11 months of age, assigned to two groups according to PRIDE (primary immunodeficiency disease evaluation) ³25 average, n=9 and the other composed of those who scored below 25 on the assessment with that scale, n = 391. Material and methods. The groups were compared regarding: family functioning, nutritional status and clinical risk criteria for primary immunodeficiencies. Results. Statistically significant associations were found among PRIDE scoring with following variables: upper respiratory infections >8, episodes of acute media otitis ³4, two o more episodes of lower respiratory infections, sinusitis ³ 2, three or more schedules of antibiotics to treat the same infection, more than six urinary tract infections in the past year, central nervous system infections, allergic or autoimmune concomitant diseases, drop of umbilical cord > 30 days and family functioning. The most damaged areas of family functioning were roles and harmony. Conclusions. There were differences in family functioning and related risk factors for both infection and predisposition to that between children receiving 25 or more points after PRIDE evaluation and those with PRIDE score below 25(AU)

Eficacia y seguridad clínica de ebastina contra loratadina en monoterapia o en combinación con fluticasona en pacientes con rinitis alérgica persistente / Efficacy and clinical safety of ebastine versus loratadine in monotherapy or in combination with fluticasone in patients with persistent allergic rhinitis

Fundamento y objetivo. Comparar la eficacia y seguridad de ebastina 20 mg, ebastina 10 mg y loratadina 10 mg en monoterapia o en terapia combinada con fluticasona en el tratamiento de la rinitis persistente. Pacientes y método. Estudio prospectivo, comparativo, al azar, abierto, con grupos paralelos, en 36 pacientes con diagnóstico de rinitis alérgica persistente que fueron asignados primero a tres grupos: ebastina 20 mg (n=12), ebastina 10 mg + pseudoefedrina 120 mg (n=12), y loratadina 10 mg + pseudoefedrina 120 mg; posteriormente se reasignaron a 6 grupos en los que se trataron con ebastina 20 mg, ebastina 10 mg o loratadina 10 mg en monoterapia o terapia combinada con fluticasona nasal. Al término de cada fase se calificaron los síntomas de rinitis, y para evaluar la seguridad se practicaron biometría hemática, pruebas de funcionamiento hepático y ELISA para IL-4, IL-5 e IL-13. Resultados. No se observaron diferencias significativas entre los diferentes grupos de estudio en las pruebas realizadas para evaluar la eficacia y la seguridad de los tratamientos. Se observó al final del estudio una disminución significativa (p=0,003) en los niveles de IL-5 en el lavado nasal de los pacientes de todos los grupos de estudio. Conclusiones. Duplicar la dosis de ebastina a 20 mg fue tan seguro y eficaz como la combinación de la mitad de la dosis de esta (10 mg, con descongestionante nasal). La co-administración con fluticasona no mejoró la eficacia del tratamiento de la rinitis alérgica con antihistamínicos y se sugiere valorar como segunda opción en pacientes con pobre respuesta. Los tratamientos con ebastina 20 mg, ebastina 10 mg y loratadina 10 mg mostraron similar perfil de seguridad y eficacia.(AU)

Efecto comparado de dosis inmunoestimulantes de fracciones ribosomales y proteoglicanos de membrana sobre la activación de subpoblaciones de células mononucleadas humanas de sangre periférica / Compared effect of immunostimulatory dose of ribosomal fractions and membrane proteoglycans on the activation of human mononuclear cell subsets from peripheral blood

Antecedentes. La población mexicana presenta una alta prevalencia de infecciones recurrentes de vías respiratorias altas. Objetivos. Comparar el efecto de dosis inmunoestimulantes de ribosomas bacterianos y proteoglicanos de membrana Ribovac® sobre células mononucleadas. Material y métodos. La expresión de IL-6 de células mononucleadas en cultivo, se midió a concentraciones y tiempos variables por la técnica de ELISA, mientras que el efecto de Ribovac® en poblaciones de células mononucleadas fue analizado por citometría de flujo. Resultados. Ribovac® tiene un efecto dependiente de dosis y tiempo de exposición sobre la expresión de IL-6 por células mononucleadas; las concentraciones de IL-6 fueron máximas a las 6 horas de tratamiento con Ribovac®. La expresión de CD3+ fue mayor cuando las células mononucleadas se trataron con 125 µg/ml por 72 horas (p=0,010) respecto a aquellas que se trataron a mitad de esa concentración en igual tiempo, a diferencia de la expresión de CD19, que fue mayor en células mononucleadas tratadas con 62,5 µg/ml por 72 horas que en aquellas tratadas con 125 µg/ml por 72 horas (p=0,021). No se encontraron disminuciones estadísticamente significativas en el número de células CD16+CD56+ ni en la coexpresión de los marcadores CD45 y CD19 cuando se compararon tanto tiempos de administración como concentraciones de Ribovac®. Conclusiones. La expansión de poblaciones linfoides y la maduración de éstas a fenotipos con mayor capacidad efectora son efectos inducibles y deseables de Ribovac®, que deben tenerse en cuenta al decidir su tiempo e intervalos de administración.(AU)

Background. The Mexican population has a high prevalence of recurrent infections of upper respiratory tract. Objective. To compare the effect of immunostimulatory dose of bacterial ribosomes and membrane proteoglycan Ribovac® on mononuclear cells. Methods. The expression of interleukin 6 from mononuclear cells in culture was measured at varying concentrations and times by ELISA, while the effect of R in populations of mononuclear cells was analyzed by flow cytometry. Results. Ribovac® has an dose-dependent and exposure time effect on the expression of IL-6 by mononuclear cells, concentrations of IL-6 were maximal at 6 hours of treatment with Ribovac®. The expression of CD3+ was higher when mononuclear cells weretreated with 125 µg/ml for 72 hours (p=0,010) than those who were treated to half that concentration in the same time, unlike the expression of CD19 which was higher in mononuclear cells treated with 62,5 µg/ml for 72 hours than those that were treated with 125 µg/ml for 72 hours (p=0,021). There were no statistically significance in the decrease in the number of CD16+CD56+ cells and in the coexpression of CD45 and CD19 markers neither; when comparing both times of administration and evaluated concentrations of Ribovac®. Conclusions. The lymphoid population expansion and their maturation to better effector phenotypes effector are inducible and desirable effects of Ribovac® and these important when deciding the time and intervals of administration.(AU)