Increased Brucella abortus asRNA_0067 expression under intraphagocytic stressors is associated with enhanced virB2 transcription.

Intracellular pathogens like Brucella face challenges during the intraphagocytic adaptation phase, where the modulation of gene expression plays an essential role in taking advantage of stressors to persist inside the host cell. This study aims to explore the expression of antisense virB2 RNA strand and related genes under intracellular simulation media. Sense and antisense virB2 RNA strands increased expression when nutrient deprivation and acidification were higher, being starvation more determinative. Meanwhile, bspB, one of the T4SS effector genes, exhibited the highest expression during the exposition to pH 4.5 and nutrient abundance. Based on RNA-seq analysis and RACE data, we constructed a regional map depicting the 5' and 3' ends of virB2 and the cis-encoded asRNA_0067. Without affecting the CDS or a possible autonomous RBS, we generate the deletion mutant ΔasRNA_0067, significantly reducing virB2 mRNA expression and survival rate. These results suggest that the antisense asRNA_0067 expression is promoted under exposure to the intraphagocytic adaptation phase stressors, and its deletion is associated with a lower transcription of the virB2 gene. Our findings illuminate the significance of these RNA strands in modulating the survival strategy of Brucella within the host and emphasize the role of nutrient deprivation in gene expression.

Clinical and Surgical Outcomes of Endoscopic Endonasal Approach for Giant Pituitary Adenomas: Analysis of Predictive Factors.

BACKGROUND: Giant pituitary adenomas (GPAs) are defined as tumors with ≥40 mm in any maximum diameter, and these tend to invade multiple intracranial compartments. Hence, treatment remains a surgical challenge. OBJECTIVE: To describe the clinical and surgical outcomes of the endoscopic endonasal approach (EEA) for GPA in a pituitary referral center in Latin America and to analyze associated predictive factors. METHODS: 37 patients with histologically-confirmed GPA treated solely through the EEA between a 2-year period were included. Preoperative and postoperative clinical and neuroimaging findings; surgical morbidity and mortality; and binary logistic regression analysis to assess predictive factors were analyzed. RESULTS: Preoperative visual impairment prevalence was 97.3%. Mean tumor volume was 32 cc and gross total resection rate was 40.5%. Favorable visual acuity and visual fields outcome rate was 75% and 82.9%, respectively. In the multivariate analysis, bilateral cavernous sinus invasion (P = 0.018) and postoperative cerebrospinal fluid (CSF) leak (P = 0.036) were associated with an unfavorable visual acuity outcome, while radiation therapy (P = 0.035) was for visual fields. Similarly, intraoperative CSF leak was a predictive factor for postoperative CSF leak (10.8%) (P = 0.042) and vascular injury (13.5%) (P = 0.048). CONCLUSIONS: In this first Mexican clinical series, we demonstrated that the EEA is a safe and effective technique for GPA, although early diagnosis and prompt intervention may promote further visual function preservation without significant endocrine morbidity.

Genomic-wide analysis approach revealed genomic similarity for environmental Mexican S. Oranienburg genomes.

As the human population grows, an increase in food trade is needed. This elevates the risk of epidemiological outbreaks. One of the prevalent pathogens associated with food production in Mexico has been Salmonella Oranienburg. Effective surveillance systems require microbial genetic knowledge. The objective of this work is to describe the genetic composition of Mexican S. Oranienburg genomes. For that, 53 strains from different environmental sources were isolated and sequenced. Additionally, 109 S. Oranienburg genomes were downloaded. Bioinformatic analyses were used to explore the clonal complex and genomic relatedness. A major clonal group formed by ST23 was identified comprising four STs. 202 SNPs were found the maximum difference among isolates. Virulence genes for host invasion and colonization as rpoS, fimbria type 1, and, T3SS were found common for all isolates. This study suggests that Mexican S. Oranienburg strains are potential pathogens circulating continuously in the region between host and non-host environments.

Declaración de Cuernavaca.

Los Institutos Nacionales de Salud (INS) miembros de la Red Regional Latinoamericana de la Asociación Internacional de Institutos Nacionales de Salud Pública, reunidos en forma presencial en la sede del Instituto Nacional de Salud Pública de México, en la Ciudad de Cuernavaca, los días 5 al 7 de octubre de 2022, contando con la participación de los directores o representantes de los INS de (...).

La carga de enfermedades cardiovasculares en México, 1990-2021. Un resumen del estudio Global Burden of Disease 2021 / The burden of cardiovascular disease in Mexico 1990-2021. Summary of the Global Burden of Disease 2021 study

Resumen Antecedentes: La enfermedad cardiovascular (ECV) es una causa importante de mortalidad, con implicaciones económicas para el sistema de salud. Objetivo: Caracterizar la carga de ECV en México de 1990 a 2021 con base en el estudio Global Burden of Disease (GBD), para abordar la carga de salud y enfermedad, sus implicaciones en la salud pública y el desarrollo del sistema de atención médica. Material y métodos: Se describe la mortalidad de las ECV en México y se examina en qué medida el crecimiento y el envejecimiento de la población explican las tendencias, las diferencias por sexo y los patrones geográficos. Resultados: Las ECV representan la primera causa de mortalidad, principalmente por cardiopatía hipertensiva, hemorragia intracerebral, hemorragia subaracnoidea, cardiopatía isquémica y accidente cerebrovascular isquémico. Se observó un cambio de tendencia en hombres y mujeres, mayor mortalidad en mayores de 80 años y en estados del norte del país. Conclusiones: México debe invertir en programas de salud pública para abordar los riesgos modificables, promover el envejecimiento saludable y reducir la muerte prematura por ECV.

Abstract Background: Cardiovascular disease (CVD) is a major cause of mortality, with economic implications for the health system. Objective: To characterize the burden of CVD in Mexico from 1990 to 2021 based on the Global Burden of Disease (GBD) study, to address the burden of health and disease, its implications for public health and for the development of the health care system. Material and methods: CVD mortality in Mexico is described, and the extent to which population growth and aging explain the observed trends, sex differences, and geographic patterns is examined. Results: CVD is the leading cause of mortality, mainly due to hypertensive heart disease, intracerebral hemorrhage, subarachnoid hemorrhage, ischemic heart disease and ischemic stroke. A change of trend was observed in men and women, with higher mortality in people older than 80 years and in the northern states of the country. Conclusions: Mexico must invest in public health programs to address modifiable risks, promote healthy aging, and reduce premature death due to CVD.

Endemismo urbano por COVID-19 en Petrópolis: Detección de un foco endémico mediante análisis espacial / Urban COVID-19 endemism in Petrópolis: detection of an endemic focus by spatial analysis

RESUMEN Se realizó un estudio con el objetivo de identificar un ecosistema de endemismo urbano que explique la persistencia del SARS-CoV-2 durante los primeros 18 meses de la pandemia en el municipio de Petrópolis, Río de Janeiro, Brasil. Se analizaron los registros oficiales de casos mensuales de COVID-19, georreferenciados según el domicilio de residencia de cada caso confirmado y se elaboraron mapas de calor mensuales que identifican puntos con diferentes densidades espaciales de la enfermedad mediante la aplicación de la metodología de kernel. Se identificaron puntos de calor con cinco niveles de intensidad para la densidad espacial de casos. Los puntos de mayor intensidad, conocidos como «hotspots¼, se mantuvieron constantes durante todo el período en un polígono de aproximadamente 4 km2 ubicado en el centro de la ciudad de Petrópolis. En conclusión, se encontró que la mayor concentración de casos se mantuvo en la misma ubicación a lo largo del tiempo, a pesar de la dispersión esporádica de los casos en el territorio municipal.

ABSTRACT This study aimed to identify an ecosystem of urban endemism that explains the persistence of SARS-CoV-2 during the first 18 months of the pandemic in the municipality of Petrópolis, Rio de Janeiro, Brazil. We analyzed official records of monthly COVID-19 cases, georeferenced according to the residence address of each confirmed case. Monthly heat maps identifying points with different spatial densities of the disease were constructed by applying the kernel methodology. Heat spots with five intensity levels were identified for the spatial density of cases. The points of highest intensity, known as hotspots, remained constant throughout the period in a polygon of approximately 4 km2 located in the center of the city of Petrópolis. In conclusion, we found that the highest concentration of cases remained in the same location over time, despite the sporadic dispersion of cases within the municipal territory.

The microbiome of the ice-capped Cayambe Volcanic Complex in Ecuador.

A major challenge in microbial ecology is to understand the principles and processes by which microbes associate and interact in community assemblages. Microbial communities in mountain glaciers are unique as first colonizers and nutrient enrichment drivers for downstream ecosystems. However, mountain glaciers have been distinctively sensitive to climate perturbations and have suffered a severe retreat over the past 40 years, compelling us to understand glacier ecosystems before their disappearance. This is the first study in an Andean glacier in Ecuador offering insights into the relationship of physicochemical variables and altitude on the diversity and structure of bacterial communities. Our study covered extreme Andean altitudes at the Cayambe Volcanic Complex, from 4,783 to 5,583 masl. Glacier soil and ice samples were used as the source for 16S rRNA gene amplicon libraries. We found (1) effects of altitude on diversity and community structure, (2) the presence of few significantly correlated nutrients to community structure, (3) sharp differences between glacier soil and glacier ice in diversity and community structure, where, as quantified by the Shannon γ-diversity distribution, the meta-community in glacier soil showed more diversity than in glacier ice; this pattern was related to the higher variability of the physicochemical distribution of variables in the former substrate, and (4) significantly abundant genera associated with either high or low altitudes that could serve as biomarkers for studies on climate change. Our results provide the first assessment of these unexplored communities, before their potential disappearance due to glacier retreat and climate change.

Urban COVID-19 endemism in Petrópolis: detection of an endemic focus by spatial analysis. / Endemismo urbano por COVID-19 en Petrópolis: Detección de un foco endémico mediante análisis espacial.

OBJECTIVES.: Motivation for the study. During the COVID-19 pandemic, spatial analysis methodologies were used to identify the territorial determinants of its distribution and social inequalities in access to medical care. Main findings. We found a concentration of cases in a specific location of the municipality, which remained constant throughout the study period, with sporadic outbreaks in other areas. Implications. It is necessary to pay attention to possible endemic foci of viral diseases in urban settings and to take measures to eliminate them as well as to prevent their spread within and outside the area.

[Late onset Pompe disease: an analysis of 19 patients from Mexico]. / Enfermedad de Pompe de inicio tardío: análisis de una casuística de 19 pacientes mexicanos.

INTRODUCTION: Pompe disease (PD) is a rare metabolic myopathy with an ample and heterogeneous clinical spectrum, particularly late onset PD (LOPD), which is characterized by appearance at older age and slower disease progression, leading to diagnostic confirmation difficulty and delay. AIM: To describe the genotype and clinical characteristics of Mexican patients with LOPD. MATERIAL AND METHODS: Clinical information from 19 Mexican patients with LOPD confirmed with enzyme activity and GAA gene analysis was reviewed. Genetic information of our population was crossed with international genetic databases. RESULTS: Median age between onset of symptoms and diagnosis was 19 years (range 2-43) and diagnostic confirmation 36 years (range 9-52). Most frequently referred symptoms were proximal axial weakness (n = 17; 89.5%), waddling gait (n = 17; 89.5%) and hyperlordosis (n = 7; 36.8%). Sixteen patients (84.2%) were evaluated with electromyography; a myopathic pattern was reported in 11 (57.8%), but only in 5 patients (26%) paraspinal muscle evaluation was included. The most pathogenic mutations in our group were c.-32-13T>G, c.1799G>A and c.1082C>T. CONCLUSIONS: Similar to other international publications, LOPD in Mexico is clinically heterogeneous; patients may delay years before diagnosis is established. Axial and proximal weakness is the most frequent clinical feature; thus, electromyography with paraspinal muscle evaluation is essential. Except for one, the mutations found in our patients have been previously reported in PD genetic databases.

TITLE: Enfermedad de Pompe de inicio tardío: análisis de una casuística de 19 pacientes mexicanos.Introducción. La enfermedad de Pompe es una miopatía metabólica rara con espectro clínico heterogéneo, especialmente la de inicio tardío, cuya sintomatología es de progresión más lenta y representa un gran reto diagnóstico. Objetivo. Describir el genotipo y las características clínicas de pacientes mexicanos con Pompe de inicio tardío (LOPD). Material y métodos. Se incluyó a 19 pacientes mexicanos con LOPD confirmada mediante actividad enzimática y estudio molecular del gen GAA. Se evaluaron datos clínicos y se revisaron las mutaciones en bases de datos genómicas. Resultados. La mediana de edad de inicio de los síntomas fue de 19 años (rango: 2-43 años), y la edad de diagnóstico, de 36 años (rango: 9-52 años). Los síntomas más frecuentes fueron debilidad axial y proximal (n = 17; 89,5%), marcha basculante (n = 17; 89,5%) e hiperlordosis (n = 7; 36,8%). A 16 pacientes (84,2%) se les realizó electromiografía; 11 (57,8%) describieron patrón miopático y sólo en cinco pacientes (26%) se incluyó la valoración de los músculos paraespinales. Las variantes patogénicas más frecuentes en nuestra casuística fueron c.-32-13T>G, c.1799G>A y c.1082C>T. Conclusiones. Parecido a lo comunicado en publicaciones internacionales, la LOPD en México es clínicamente heterogénea; los pacientes pueden tardar años en llegar al diagnóstico. La debilidad muscular axial y proximal es el dato clínico más frecuente, por lo que la electromiografía debe incluir valoración de los músculos paraespinales. A excepción de una, las mutaciones encontradas en nuestra serie de casos se encuentran previamente descritas en las bases de datos de enfermedad de Pompe.

Endoscopic endonasal surgery for massive subarachnoid neurocysticercosis: illustrative case / Cirugía endoscópica endonasal para neurocisticercosis subaracnoidea masiva: caso ilustrativo

BACKGROUND. Subarachnoid neurocysticercosis (NCC) is associated with high morbidity and mortality rates. Conventional transcranial approaches and transventricular endoscopy have been previously reported for extraparenchymal NCC and ventricular NCC, respectively. By October 2019, endonasal endoscopic approaches had not been used for the treatment of NCC. OBSERVATIONS. A 54-year-old-woman with NCC was admitted with acute neurological deterioration due to severe intracranial hypertension caused by massive subarachnoid NCC cysts, as evidenced on magnetic resonance imaging (MRI) with great brainstem compression. The case was discussed, and an endoscopic endonasal resection of the NCC cysts was scheduled. The diagnosis was confirmed by pathological anatomy. There were no complications in the surgery, with marked neurological improvement. Control MRIs demonstrated a significant reduction of NCC cysts. LESSONS. Minimally invasive approaches are an excellent alternative for skull-base tumoral and infectious pathology. Prior knowledge of the pathophysiology and the authors' experience in the management of patients with NCC allowed them to propose this approach, with optimal results.

FONDO. La neurocisticercosis subaracnoidea (NCC) se asocia a altas tasas de morbilidad y mortalidad. Se han descrito anteriormente abordajes transcraneales convencionales y endoscopia transventricular para la NCC extraparenquimatosa y la NCC ventricular, respectivamente. Hasta octubre de 2019, no se habían utilizado abordajes endoscópicos endonasales para el tratamiento de la NCC. OBSERVACIONES. Una mujer de 54 años con carcinoma de células no pequeñas fue ingresada con deterioro neurológico agudo debido a hipertensión intracraneal grave causada por quistes de carcinoma de células no pequeñas subaracnoideos masivos, evidenciados en la resonancia magnética (RM) con gran compresión del tronco encefálico. Se discutió el caso y se programó una resección endoscópica endonasal de los quistes de carcinoma de células no pequeñas. El diagnóstico se confirmó mediante anatomía patológica. No hubo complicaciones en la cirugía, con una marcada mejoría neurológica. Las RM de control demostraron una reducción significativa de los quistes de carcinoma de células no pequeñas. LeECCIONES. Los abordajes mínimamente invasivos son una excelente alternativa para la patología tumoral e infecciosa de la base del cráneo. El conocimiento previo de la fisiopatología y la experiencia de los autores en el manejo de pacientes con NCC les permitió proponer este abordaje, con óptimos resultados.

Innate lymphoid cells in peripheral blood of patients with American Cutaneous Leishmaniasis.

Innate lymphoid cells (ILCs) are classified by the expression of specific transcription factors: ILC1 depending on T-bet for IFN-γ production; ILC2 depending on GATA3 for IL-5 and IL-13; and ILC3 depending on ROR-γτ and AHR for IL-17 and IL-22. This study aimed to determine circulating ILCs in 23 patients with localized (LCL) = 7, mucocutaneous (MCL) = 10, intermediate (ICL) = 3 and diffuse (DCL) = 3 cutaneous leishmaniasis and 17 healthy controls from endemic area (EC) = 9 and non-endemic area (HC) = 8. Results evidenced a higher proportion of ILC1 in LCL than controls and MCL. ILC2 was higher in DCL compared with controls. ILC3 s were abundant in MCL and DCL concerning controls. A prevalence ratio was calculated to approach cell plasticity: in LCL, the ratio showed a prevalence of ILC1/ILC3 (plasticity 1), in contrast to DCL, and controls, where ILC2/ILC3 (plasticity 3) is prevalent. Also, MCL and ICL showed higher ILC1/ILC2 (plasticity 2). These results suggest that ILC1 and ILC3 in LCL are associated with disease control and regulation of inflammation, while MCL and ICL are related to immunopathology and uncontrolled inflammation. In DCL, ILC2 is associated with the tolerogenic state of these patients.

Effect of exercise training on cardiovascular autonomic and muscular function in subclinical Chagas cardiomyopathy: a randomized controlled trial.

PURPOSE: Patients with chronic chagasic cardiomyopathy with preserved ventricular function present with autonomic imbalance. This study evaluated the effects of exercise training (ET) in restoring peripheral and cardiac autonomic control and skeletal muscle phenotype in patients with subclinical chronic chagasic cardiomyopathy. METHODS: This controlled trial (NCT02295215) included 24 chronic chagasic cardiomyopathy patients who were randomized www.random.org/lists/ into two groups: those who underwent exercise training (n = 12) and those who continued their usual activities (n = 12). Eight patients completed the exercise training protocol, and 10 patients were clinically followed up for 4 months. Muscular sympathetic nerve activity was measured by microneurography and muscle blood flow (MBF) using venous occlusion plethysmography. The low-frequency component of heart rate variability in normalized units (LFnuHR) reflects sympathetic activity in the heart, and the low-frequency component of systolic blood pressure variability in normalized units reflects sympathetic activity in the vessels. The infusion of vasoactive drugs (phenylephrine and sodium nitroprusside) was used to evaluate cardiac baroreflex sensitivity, and a vastus lateralis muscle biopsy was performed to evaluate atrogin-1 and MuRF-1 gene expression. RESULTS: The baroreflex sensitivity for increases (p = 0.002) and decreases (p = 0.02) in systolic blood pressure increased in the ET group. Muscle blood flow also increased only in the ET group (p = 0.004). Only the ET group had reduced resting muscular sympathetic nerve activity levels (p = 0.008) and sympathetic activity in the heart (LFnu; p = 0.004) and vessels (p = 0.04) after 4 months. Regarding skeletal muscle, after 4 months, participants in the exercise training group presented with lower atrogin-1 gene expression than participants who continued their activities as usual (p = 0.001). The reduction in muscular sympathetic nerve activity was positively associated with reduced atrogin-1 (r = 0.86; p = 0.02) and MuRF-1 gene expression (r = 0.64; p = 0.06); it was negatively associated with improved baroreflex sensitivity both for increases (r = -0.72; p = 0.020) and decreases (r = -0.82; p = 0.001) in blood pressure. CONCLUSIONS: ET improved cardiac and peripheral autonomic function in patients with subclinical chagasic cardiomyopathy. ET reduced MSNA and sympathetic activity in the heart and vessels and increased cardiac parasympathetic tone and baroreflex sensitivity. Regarding peripheral muscle, after 4 months, patients who underwent exercise training had an increased cross-sectional area of type I fibers and oxidative metabolism of muscle fibers, and decreased atrogin-1 gene expression, compared to participants who continued their activities as usual. In addition, the reduction in MSNA was associated with improved cardiac baroreflex sensitivity, reduced sympathetic cardiovascular tone, and reduced atrogin-1 and MuRF-1 gene expression. TRIAL REGISTRATION: ID: NCT02295215. Registered in June 2013.

Atención primaria en salud y gestión urbana en comunidades sujetas a elevada fragilidad socioeconómica y ambiental.

Based on the knowledge of the social determination of health, the challenge and the strategy of action to promote integrated public policies are posed, focusing on the concept of expanded health in territories where populations with high social exclusion prevail. For this purpose, the dialectic relationship between social classes, territories and health is considered. Based on the founding objectives of primary health care, the family health teams in the municipality of Petrópolis, state of Rio de Janeiro, Brazil, were trained to carry out a participatory rapid assessment related to the goals of the sustainable development objectives, in their areas of operation. This diagnosis guided the action plan for health promotion in eight pilot areas, within which conglomerates of greater social exclusion are defined through participatory mapping. Following criteria for the social control of the health system, established in the country's legislation, the creation of community forums is encouraged, which will elect legitimate community representatives to serve on local health councils, whose main mission is to discuss health and welfare problems on the basis of an intersectoral and expanded vision. The community forums, in conjunction with other local society organizations, discuss the main problems and propose alternative solutions that will collectively transform the reality of the territories. As an initial alternative, agro-ecological urban agriculture projects are established to promote sovereign and resilient transformations.

Con base en los conocimientos sobre la determinación social de la salud, se plantea el desafío y la estrategia de actuación para fomentar políticas públicas integradas, con foco en el concepto de salud ampliada en los territorios donde prevalecen poblaciones de elevada exclusión social. Para ello, se considera la relación dialéctica existente entre las clases sociales, los territorios y la salud. Partiendo de los objetivos fundadores de la atención primaria de la salud, los equipos de salud de la familia en la municipalidad de Petrópolis, estado de Río de Janeiro, Brasil, fueron capacitados para realizar un diagnóstico rápido participativo relacionado con las metas de los objetivos de desarrollo sostenible, en sus áreas de actuación. Dicho diagnóstico orientó el plan de acción para la promoción de salud en ocho áreas piloto, dentro de las cuales se delimitan conglomerados de mayor exclusión social mediante la cartografía participativa. Siguiendo criterios del control social del sistema de salud, establecidos en la legislación del país, se fomenta la creación de foros comunitarios que elegirán representantes legítimos de la comunidad para integrar los consejos locales de salud, cuya principal misión es discutir los problemas de salud y bienestar a partir de una visión intersectorial y ampliada. Los foros comunitarios, en conjunto con otras organizaciones de la sociedad local, debaten los principales problemas y proponen soluciones alternativas que permitan transformar colectivamente la realidad de los territorios. Como alternativa inicial se establecen proyectos de agricultura urbana de carácter agroecológico para promover transformaciones soberanas y resilientes.

Atención primaria en salud y gestión urbana en comunidades sujetas a elevada fragilidad socioeconómica y ambiental

RESUMEN Con base en los conocimientos sobre la determinación social de la salud, se plantea el desafío y la estrategia de actuación para fomentar políticas públicas integradas, con foco en el concepto de salud ampliada en los territorios donde prevalecen poblaciones de elevada exclusión social. Para ello, se considera la relación dialéctica existente entre las clases sociales, los territorios y la salud. Partiendo de los objetivos fundadores de la atención primaria de la salud, los equipos de salud de la familia en la municipalidad de Petrópolis, estado de Río de Janeiro, Brasil, fueron capacitados para realizar un diagnóstico rápido participativo relacionado con las metas de los objetivos de desarrollo sostenible, en sus áreas de actuación. Dicho diagnóstico orientó el plan de acción para la promoción de salud en ocho áreas piloto, dentro de las cuales se delimitan conglomerados de mayor exclusión social mediante la cartografía participativa. Siguiendo criterios del control social del sistema de salud, establecidos en la legislación del país, se fomenta la creación de foros comunitarios que elegirán representantes legítimos de la comunidad para integrar los consejos locales de salud, cuya principal misión es discutir los problemas de salud y bienestar a partir de una visión intersectorial y ampliada. Los foros comunitarios, en conjunto con otras organizaciones de la sociedad local, debaten los principales problemas y proponen soluciones alternativas que permitan transformar colectivamente la realidad de los territorios. Como alternativa inicial se establecen proyectos de agricultura urbana de carácter agroecológico para promover transformaciones soberanas y resilientes.

ABSTRACT Based on the knowledge of the social determination of health, the challenge and the strategy of action to promote integrated public policies are posed, focusing on the concept of expanded health in territories where populations with high social exclusion prevail. For this purpose, the dialectic relationship between social classes, territories and health is considered. Based on the founding objectives of primary health care, the family health teams in the municipality of Petrópolis, state of Rio de Janeiro, Brazil, were trained to carry out a participatory rapid assessment related to the goals of the sustainable development objectives, in their areas of operation. This diagnosis guided the action plan for health promotion in eight pilot areas, within which conglomerates of greater social exclusion are defined through participatory mapping. Following criteria for the social control of the health system, established in the country's legislation, the creation of community forums is encouraged, which will elect legitimate community representatives to serve on local health councils, whose main mission is to discuss health and welfare problems on the basis of an intersectoral and expanded vision. The community forums, in conjunction with other local society organizations, discuss the main problems and propose alternative solutions that will collectively transform the reality of the territories. As an initial alternative, agro-ecological urban agriculture projects are established to promote sovereign and resilient transformations.

Association of human beta-defensin 1 gene polymorphisms with nonsegmental vitiligo.

BACKGROUND: Vitiligo is a pigmentation disorder of autoimmune aetiology. Polymorphisms in beta-defensin genes have been linked to a predisposition to some autoimmune disorders. AIM: To evaluate the role of polymorphisms in DEFB1, the gene encoding for human beta-defensin (HBD)-1 and its 5' untranslated region in nonsegmental vitiligo. METHODS: In total, 354 participants [171 patients with non-segmental vitiligo and 183 age and sex-matched healthy controls (HCs)], were genotyped by the PCR-restriction fragment length polymorphism (RFLP) method. For 80 of these individuals (40 patients and -40 HCs) serum HBD-1 was also measured by ELISA. RESULTS: The -44 G allele, CG genotype and GGG haplotype increased the risk for vitiligo (P < 0.02 in all cases), whereas the -20 AA genotype seems to be protective (P = 0.04). Serum HBD-1 levels were lower in patients with vitiligo than in HCs (P < 0.01), as well as in patients with active vitiligo compared with those with stable vitiligo and with HCs (P < 0.05 in both cases), CONCLUSION: Our results suggest that HBD-1 and its gene polymorphisms may modulate vitiligo susceptibility and/or disease activity. This is the first report, to our knowledge, of the association of serum HBD-1 levels and DEFB1 gene polymorphisms with vitiligo.