Chemical Composition, Antioxidant, and Cytotoxic Effects of Senna rugosa Leaf and Root Extracts on Human Leukemia Cell Lines.

Senna rugosa is a species found in the Cerrado and used in folk medicine as a vermifuge and in the treatment of poisonous snakebites accidents. In this work, we identified the main secondary metabolites present in ethanolic extracts of the leaves (ELSR) and roots (ERSR) of S. rugosa and evaluated the potential cytoprotective effect against cellular macromolecular damage, as well as the cytotoxic properties of the extracts on the K562 and Jurkat leukemic cell lines. The identification of metabolites was carried out by liquid chromatography coupled with mass spectrometry. The antioxidant activities were investigated by direct ABTS•+ and DPPH• radical scavenging methods, protection against oxidative damage in proteins, and DNA. Cytotoxic properties were investigated against healthy cells, isolated from human peripheral blood (PBMC) and leukemic cell lines. The leaf extracts contained catechin, rutin, epigallocatechin derivatives, kaempferol glycosides, luteolin, and dimeric and trimeric procyanidins, while the root extract profile showed obtusichromoneside derivatives, 2-methoxystypandrone, stilbene derivatives, naphthopyranones, and flavanone derivatives. The extracts showed antioxidant activity, with an IC50 of 4.86 ± 0.51 µg/mL and 8.33 ± 0.90 µg/mL in the ABTS assay for ELSR and ERSR, respectively. Furthermore, in the DPPH• assay, the IC50 was 19.98 ± 1.96 µg/mL for ELSR and 13.37 ± 1.05 µg/mL for ERSR. The extracts protected macromolecules against oxidative damage at concentrations of 5 µg/mL. The cytotoxicity test against leukemic strains was observed after 24 and 48 h of treatment. After 48 h, results against the K562 cell line demonstrate an IC50 of 242.54 ± 2.38 µg/mL and 223.00 ± 2.34 µg/mL for ELSR and ERSR, respectively. While against the Jurkat cell line, these extracts showed an IC50 of 171.45 ± 2.25 µg/mL and 189.30 ± 2.27 µg/mL, respectively. The results pertaining to PBMC viability demonstrated that the extracts showed selectivity for the leukemic cell lines. Together, our results reveal that the leaves and roots of S. rugosa have completely distinct and complex chemical compositions and expand their significant pharmacological potential in oxidative stress and leukemia conditions.

Structural Characterization and Anticancer Activity of a New Anthraquinone from Senna velutina (Fabaceae).

In this study, a novel compound was isolated, identified, and its chemical structure was determined from the extract of the roots of Senna velutina. In addition, we sought to evaluate the anticancer potential of this molecule against melanoma and leukemic cell lines and identify the pathways of cell death involved. To this end, a novel anthraquinone was isolated from the barks of the roots of S. velutina, analyzed by HPLC-DAD, and its molecular structure was determined by nuclear magnetic resonance (NMR). Subsequently, their cytotoxic activity was evaluated by the (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) method against non-cancerous, melanoma, and leukemic cells. The migration of melanoma cells was evaluated by the scratch assay. The apoptosis process, caspase-3 activation, analysis of mitochondrial membrane potential, and measurement of ROS were evaluated by flow cytometry technique. In addition, the pharmacological cell death inhibitors NEC-1, RIP-1, BAPTA, Z-VAD, and Z-DEVD were used to confirm the related cell death mechanisms. With the results, it was possible to elucidate the novel compound characterized as 2'-OH-Torosaol I. In normal cells, the compound showed no cytotoxicity in PBMC but reduced the cell viability of all melanoma and leukemic cell lines evaluated. 2'-OH-Torosaol I inhibited chemotaxis of B16F10-Nex2, SK-Mel-19, SK-Mel-28 and SK-Mel-103. The cytotoxicity of the compound was induced by apoptosis via the intrinsic pathway with reduced mitochondrial membrane potential, increased levels of reactive oxygen species, and activation of caspase-3. In addition, the inhibitors demonstrated the involvement of necroptosis and Ca2+ in the death process and confirmed caspase-dependent apoptosis death as one of the main programmed cell death pathways induced by 2'-OH-Torosaol I. Taken together, the data characterize the novel anthraquinone 2'-OH-Torosaol I, demonstrating its anticancer activity and potential application in cancer therapy.

Soil Microbiome Influences on Seedling Establishment and Growth of Prosopis chilensis and Prosopis tamarugo from Northern Chile.

Prosopis chilensis and Prosopis tamarugo, two woody legumes adapted to the arid regions of Chile, have a declining distribution due to the lack of new seedling establishment. This study investigated the potential of both species to establish in soil collected from four locations in Chile, within and outside the species distribution, and to assess the role of the root-colonizing microbiome in seedling establishment and growth. Seedling survival, height, and water potential were measured to assess establishment success and growth. 16S and ITS2 amplicon sequencing was used to characterize the composition of microbial communities from the different soils and to assess the ability of both Prosopis species to recruit bacteria and fungi from the different soils. Both species were established on three of the four soils. P. tamarugo seedlings showed significantly higher survival in foreign soils and maintained significantly higher water potential in Mediterranean soils. Amplicon sequencing showed that the four soils harbored distinct microbial communities. Root-associated microbial composition indicated that P. chilensis preferentially recruited mycorrhizal fungal partners while P. tamarugo recruited abundant bacteria with known salt-protective functions. Our results suggest that a combination of edaphic properties and microbial soil legacy are potential factors mediating the Prosopis establishment success in different soils.

Characterization of the Sensory Nerve Action Potential of the Sural Nerve in Patients Over 60 Years of Age without Peripheral Neuropathy.

Demonstration of the possibility to obtain the sensory nerve action potential (SNAP) of sural nerve in patients over 60 years old, without peripheral neuropathy. Prospective study on 101 patients older than 60 years of age. Stimulation was applied 12 cm proximal to the recording point. Two hundred and two SNAPs of the sural nerve were collected with an average peak latency of 3.2 ms, onset latency of 2.6 ms, peak-to-peak amplitude of 15.2 µV and velocity of 45.7 m/s. It was possible to obtain the sural nerve SNAP in all tested patients older than 60, without peripheral neuropathy. The values obtained in this study prove to be useful as a reference in the evaluation of patients older than 60 years of age.

Bilateral Martin-Gruber and Marinacci Anastomosis Associated with Carpal Tunnel and Guyon's Canal Syndrome: Case Report.

Anastomoses between the median and ulnar nerves are commonly found on electrodiagnostic studies. These anastomoses are usually asymptomatic and are not discovered until nerve injuries occur that lead to unusual motor or sensory deficits. Their presence can cause difficulties in the interpretation of electrophysiological findings for the diagnosis of neuropathies and suppose a risk of iatrogenic damage during surgical procedures. We describe a rare case of bilateral Martin Gruber and Marinacci anastomosis, associated with median and ulnar nerve injuries in the carpal tunnel and Guyon's canal, respectively. The detailed anatomical knowledge of these anastomosis allows the electromyographist to identify them correctly, facilitating the interpretation of the findings and, incidentally, preventing iatrogenic injuries.

Design of a mobile application for home monitoring of babies with complex congenital heart disease / Diseño de una aplicación móvil para la monitorización domiciliaria de bebés con cardiopatías congénitas complejas / Projeto de um aplicativo móvel para monitoramento domiciliar de bebês com cardiopatias congênitas complexas

Introduction: Congenital heart diseases are related to heart defects that develop during pregnancy and are present at birth. Children must regularly attend specialized clinical centers for treatment, which includes medical check-ups, hemodynamic procedures, and surgery. Nevertheless, the success of interventions largely depends on the education of parents and caregivers about the symptoms and warning signs that babies with complex congenital heart disease may present during the period between stages. Likewise, it is necessary for caregivers to have tools to face the barriers of the health system, such as, obstacles or delays in obtaining healthcare services. This facilitates timely health care for patients and avoids fatal outcomes or deterioration in quality of life. Materials and Methods: This document presents a system that provides support to patients with complex congenital heart disease in follow-up by a home monitoring program. The system consists of a mobile application that allows parents/caregivers to monitor physiological variables of the patients (weight, intake, and oximetry). The information registered in the application is sent for real-time evaluation by the medical team. Results:The application provides an effective means for sending data and communicating with the medical control center, in addition to offering educational and informative material. In this way, parents/caregivers get constant help and feedback about their baby's condition. Conclusions: The mobile application could help mitigate the costs of medical care and overcome the limitations of follow-up at home, giving doctors the possibility to see the patient's evolution and give timely recommendations.

Introducción: Las cardiopatías congénitas están relacionadas con defectos cardíacos que se desarrollan durante el embarazo y están presentes al nacer. El éxito de las intervenciones depende en gran medida de la educación de los padres/cuidadores sobre los signos y síntomas de alerta. Los cuidadores necesitan tener herramientas para hacer frente a las barreras del sistema de salud. Objetivo: crear un sistema como herramienta de seguimiento para los bebés con cardiopatías congénitas complejas que ayude a los padres/cuidadores y a los profesionales médicos a observar las variables fisiológicas del paciente y a brindar una retroalimentación oportuna y profesional a los padres/cuidadores desde la atención domiciliaria. Materiales y métodos:se presenta un sistema que proporciona apoyo a los pacientes que necesitan seguimiento de cardiopatías congénitas complejas mediante un programa de monitoreo en casa. El sistema consiste en una aplicación móvil que permite a los padres/cuidadores controlar las variables fisiológicas del paciente (peso, ingesta de alimento y oximetría). La información registrada en la aplicación se envía para ser evaluada en tiempo real por el equipo médico. Resultados: la aplicación proporciona un medio eficaz para enviar datos y comunicarse con el centro de control médico, además de ofrecer material educativo e informativo. De este modo, los padres/cuidadores reciben constantemente ayuda e información acerca del estado de su bebé. Conclusiones: la aplicación móvil podría ayudar a minimizar los costos de la atención médica y superar las limitaciones del seguimiento domiciliario, dando a los médicos la posibilidad de ver la evolución del paciente y dar recomendaciones oportunas.

Introdução: as doenças cardíacas congênitas estão relacionadas a defeitos cardíacos que se desenvolvem durante a gravidez e estão presentes no nascimento. O sucesso das intervenções depende em grande parte da educação dos pais/responsáveis sobre os sinais e sintomas de alerta. Os cuidadores precisam ter ferramentas para lidar com as barreiras do sistema de saúde. Objetivo: Criar uma ferramenta de sistema de monitoramento para bebês com doenças cardíacas congênitas complexas, que ajude pais/cuidadores e profissionais médicos a observar as variáveis fisiológicas do paciente e manter um feedback profissional e oportuno para os pais/cuidadores dos cuidados domiciliares. Materiais e Métodos: é apresentado um sistema que fornece suporte aos pacientes com cardiopatias congênitas complexas em acompanhamento através de um programa de monitoramento domiciliar. O sistema consiste em uma aplicação móvel que permite aos pais/responsáveis pelo acompanhamento das variáveis fisiológicas do paciente (peso, ingestão e oximetria). As informações registradas no aplicativo são enviadas para serem avaliadas em tempo real pela equipe médica. Resultados: a aplicação fornece um meio eficiente para enviar dados e se comunicar com o centro de controle médico, além de oferecer material educativo e informativo. Desta forma, os pais/responsáveis recebem ajuda constante e feedback sobre a condição de seu bebê. Conclusões: a aplicação móvel pode ajudar a minimizar os custos do atendimento médico e superar as limitações do acompanhamento domiciliar, dando aos médicos a possibilidade de ver a evolução do paciente e dar recomendações oportunas.

Estudio de los músculos estabilizadores y las lesiones más frecuentes en practicantes de béisbol 5

El béisbol, también llamado pelota, es un deporte de conjunto jugado entre dos equipos de nueve jugadores cada uno. Es considerado uno de los deportes más populares en Australia, Canadá, Colombia, Corea del Sur, Cuba, Estados Unidos, Holanda, Italia, Japón, México, Nicaragua, Panamá, Puerto Rico, República Dominicana, Sudáfrica, Taiwán y Venezuela. Los países considerados potencias de este deporte se encuentran concentrados en América (Norte, Central, Caribe) y en Asia, siendo los continentes europeos y africano los más rezagados. El estudio permitió evaluar la resistencia a la fuerza de los músculos estabilizadores en 11 practicantes de beisbol 5 de la Universidad de Ciencias de la Cultura Física y el Deporte "Manuel Fajardo". Se realizó un levantamiento de las lesiones más frecuentes en ese deporte. La investigación se llevó a cabo con un diseño no experimental de control mínimo con pretest-postest para un solo grupo. Los métodos empleados fueron analítico-sintético, la encuesta y la medición. El coefi ciente de alfa de Cronbach permitió obtener la confiabilidad o fiabilidad test-retest de la consistencia interna del instrumento EVAL-MEB5. El instrumento se aplicó a la muestra en dos mediciones con intervalos de tiempo de una semana. Los principales resultados revelan que las lesiones más frecuentes arrojadas en el diagnóstico fueron: codo del lanzador, hombro del lanzador, codo del beisbolista joven, degeneración del menisco, tendinitis y bulsitis. El instrumento arrojó una fiabilidad test-retest 91 %, y, por ende, presenta una buena fiabilidad. La capacidad de resistencia a la fuerza de los músculos estabilizadores en Puente de cubito supino, Cuclillas isométricas a 90o en la pared e Isométrico de tronco se encontró deficiente.

O beisebol, também chamado de pelota, é um esporte coletivo jogado entre duas equipes de nove jogadores cada. É considerado um dos esportes mais populares na Austrália, Canadá, Colômbia, Cuba, República Dominicana, Holanda, Itália, Japão, México, Nicarágua, Panamá, Porto Rico, Coréia do Sul, África do Sul, Taiwan, EUA e Venezuela. Os países considerados potências neste esporte estão concentrados na América (Norte, Central, Caribe) e Ásia, sendo os continentes europeu e africano os mais atrasados. O estudo permitiu avaliar a resistência à força dos músculos estabilizadores em 11 jogadores de beisebol 5 da Universidade de Cultura Física e Ciências do Esporte "Manuel Fajardo". Foi realizado um levantamento das lesões mais freqüentes neste esporte. A pesquisa foi realizada com um projeto não-experimental de controle mínimo com pré-teste-pós-teste para um único grupo. Os métodos utilizados foram analítico-sintético, levantamento e medição. O coeficiente alfa do Cronbach foi usado para obter a confiabilidade de teste-reteste da consistência interna do instrumento EVAL-MEB5. O instrumento foi administrado à amostra em duas medidas com intervalos de tempo de uma semana. Os principais resultados revelam que as lesões diagnósticas mais freqüentes foram: cotovelo do lançador, ombro do lançador, cotovelo do jogador de beisebol jovem, degeneração meniscal, tendinite e bulsite. O instrumento tinha uma confiabilidade de teste de 91% e, portanto, tem uma boa confiabilidade. A capacidade de resistência dos músculos estabilizadores na ponte de côvados supinos, 90o isométrica de agachamento da parede e isométrica do tronco foi considerada pobre.

Baseball, also called pelota (Spanish voice), is a team sport played between two teams of nine players each. It is considered one of the most popular sports in Australia, Canada, Colombia, Cuba, Dominican Republic, Holland, Italy, Japan, Mexico, Nicaragua, Panama, Puerto Rico, South Korea, South Africa, Taiwan, United States, and Venezuela. The countries considered the powers of this sport are concentrated in America (North, Central and Caribbean) and Asia, with the European and African continents lagging behind. The study allowed evaluating the strength resistance of the stabilizing muscles in 11 baseball 5 players of the "Manuel Fajardo" University of Physical Culture and Sport Sciences. A survey of the most frequent injuries in this sport was carried out. The research was carried out with a non-experimental design of minimal control with pretest-posttest for a single group. The methods used were analytical-synthetic, survey and measurement. The Cron's alpha Cronbach's alpha coefficient was used to obtain the test-retest reliability of the internal consistency of the EVAL-MEB5 instrument. The instrument was applied to the sample in 2 measurements with time intervals of one week. The main results reveal that the most frequent injuries reported in the diagnosis were: pitcher's elbow, pitcher's shoulder, young baseball player's elbow, meniscus degeneration, tendinitis and bursitis. The instrument showed a test-retest reliability of 91 % and therefore presents a good reliability. The strength endurance capacity of the stabilizing muscles in the Supine Ulnar Bridge, Isometric Squat 900 to the wall and Trunk isometric was found to be deficient.

Consensus on hemophilia in Mexico.

Hemophilia is a hemorrhagic disorder with a sex-linked inherited pattern, characterized by an inability to amplify coagulation due to a deficiency in coagulation factor VIII (hemophilia A or classic) or factor IX (hemophilia B). Sequencing of the genes involved in hemophilia has provided a description and record of the main mutations, as well as a correlation with the various degrees of severity. Hemorrhagic manifestations are related to levels of circulating factor, mainly affecting the musculoskeletal system and specifically the large joints (knees, ankles, and elbows). This document is a review and consensus of the main genetic aspects of hemophilia, from the inheritance pattern to the concept of women carriers, physiopathology and classification of the disorder, the basic and confirmation studies when hemophilia is suspected, the various treatment regimens based on infusion of the deficient coagulation factor as well as innovative factor-free therapies and recommendations for the management of complications associated with treatment (development of inhibitors and/or transfusion-transmitted infections), or secondary to articular hemorrhagic events (hemophilic arthropathy). Finally, relevant reviews of clinical and treatment aspects of hemorrhagic pathology characterized by acquired deficiency of FVIII secondary to neutralized antibodies named acquired hemophilia.

La hemofilia es un trastorno hemorrágico con patrón de herencia ligado al sexo, caracterizado por una incapacidad en la amplificación de la coagulación ocasionada por la deficiencia del factor VIII (hemofilia A o clásica) o del factor IX (hemofilia B). La secuenciación de los genes involucrados en la hemofilia ha permitido la descripción y registro de las principales mutaciones, así como la correlación con los diversos grados de severidad. Las manifestaciones hemorrágicas se relacionan con los niveles de factor deficiente circulante, afectando principalmente al sistema musculoesquelético y en particular a las grandes articulaciones (rodillas, tobillos y codos). El presente documento hace una revisión y consenso de los principales aspectos genéticos de la hemofilia, desde el patrón de herencia y el concepto de mujeres portadoras, la fisiopatología y clasificación de la enfermedad, los estudios básicos y de confirmación ante la sospecha de hemofilia, y de los diversos esquemas de tratamiento basados en la infusión del factor de coagulación deficiente hasta las terapias innovadoras libres de factor, así como de las recomendaciones para el manejo de las complicaciones asociadas al tratamiento (desarrollo de inhibidores y/o infecciones transmitidas por transfusión) o secundarias a los eventos hemorrágicos a nivel articular (artropatía hemofílica). La parte final del documento revisa los aspectos clínicos y de tratamiento relevantes de una patología hemorragica caracterizada por la deficiencia adquirida del FVIII mediada por anticuerpos neutralizantes denominada hemofilia adquirida.

Chemical Modification of Agro-Industrial Waste-Based Bioadsorbents for Enhanced Removal of Zn(II) Ions from Aqueous Solutions.

Contamination of water by heavy metals is a major environmental concern due to the potential ecological impact on human health and aquatic ecosystems. In this work, we studied the chemical modification of various fruit peels such as banana (BP), granadilla (GP), and orange ones (OP) in order to obtain novel bio-adsorbents to improve the removal of Zn(II) ions from 50 mg·L-1 synthetic aqueous solutions. For this purpose, sodium hydroxide and calcium acetate were employed to modify the fruit peels. The moisture, extractives, lignin, hemicellulose, and cellulose contents of the raw materials were determined according to ASTM standards. The obtained bio-adsorbents were characterized by scanning electron microscopy (SEM), Fourier Transform Infrared Spectroscopy (FTIR) and thermogravimetric analysis (TGA). The results showed the OP bio-adsorbents performed better, especially when the concentration of the modifier solutions increased, e.g., the OP particles modified using 0.8 M NaOH and Ca(CH3COO)2 solutions resulted in 97% removal of Zn(II) contaminating ions and reached a maximum adsorption capacity of 27.5 mg Zn per gram of bio-adsorbent. The adsorption processes were found to follow a pseudo-second order model. The error function sum of square error indicated the Freundlich isotherm (non-linear regression) as best fit model. The obtained results are particularly interesting for material selection in wastewater treatment technologies based on contaminant adsorption.

Application of the metabolomics approach to the discovery of active compounds from Brazilian trees against resistant human melanoma cells.

INTRODUCTION: The chemical diversity of plants plays an essential role in the development of new drugs. However, new bioactive compound identification and isolation are challenging due to the complexity and time-consuming nature of the traditional process. Recently, alternative strategies have become popular, such as the statistical approach to correlate compounds with biological activities, overcoming bottlenecks in bioactive natural product research. OBJECTIVE: We aimed to determine bioactive compounds against resistant human melanoma cells from leaves of Aspidosperma subincanum, Copaifera langsdorffii, Coussarea hydrangeifolia, Guarea guidonea and Tapirira guianensis, using a metabolomics approach. MATERIAL AND METHODS: The extracts and fractions were obtained by accelerated solvent extraction (ASE) and tested against resistant melanoma cells SK-MEL-28 and SK-MEL-103. Chemical analysis was performed by high-performance diode array detector tandem mass spectrometry (HPLC-DAD-MS/MS). Chemical and biological data were analysed through univariate and multivariate analysis. RESULTS: The species present high chemical diversity, including indole alkaloids, glycosylated flavonoids, galloylquinic acid derivatives, cinnamic acid derivatives, and terpenes. The ASE fractionation separated the compounds according to the physicochemical properties; only C. langsdorffii and T. guianensis extracts were active. Both results from the chemical profile and the biological assay were treated using a metabolomics approach to identify the contribution of different classes of secondary metabolites in the viability of human melanoma cells. The analyses showed the metabolites from C. langsdorffii and T. guianensis, such as polyphenols and terpenes, were the main compounds correlated with the biological response. CONCLUSION: These findings afford alternative pathways that are trustworthy and less time-consuming to identify new bioactive compounds against multidrug-resistant human melanoma cells.

Lower Frequency of Call Shifts Leads to Higher Attendance, Higher Academic Performance, and Less Burnout Syndrome in Surgical Clerkships.

OBJECTIVE: Clinical clerkships are a fundamental component of medical education where students' learning is aided by exposure to real patients in diverse practical settings. Countless programs use overnight call shifts as an essential part of their clerkships. There has been concerns about the negative effects these shifts have on students. The study aims to determine relations between call schedule, lecture attendance, and academic and clinical performance. METHODS: One hundred and eight medical students were followed during their surgery clerkship. Students on a Q3 schedule had an on-call shift once every 3 nights, while students on a Q4 schedule once every 4 nights. Their academic performance was evaluated using their exams grades, while their clinical performance was evaluated by their attending physicians. Burnout syndrome was measured using Maslach Inventory. RESULTS: A total of 108 medical students attended their surgical clerkship. Sixty-nine students were under the Q3 call schedule while 39 students in the Q4 call schedule. Mean lecture attendance for students in Q3 was 82.7% (17.3%) compared to 90% (11.2%) (p = 0.020). Final exam grades were different between groups, with Q3 scoring a mean 71.55 (9.3) compared to Q4 85.07 (9.8) (p = 0.001). Clinical performance score means were similar between groups (p = 0.777). Q4 had 74% and Q3 had 49.3% of the students with >90% of attendance (p = 0.008). Q4 had 2.6% students with <70% attendance compared to Q3 with 23.2% (p = 0.008). Students with >90% attendance regardless of call schedule, scored higher in both midterms and final exams (p = 0.002; p = 0.001). Burnout prevalence was higher in students on the Q3 schedule with 28.6% compared to 4.7% of those on the Q4 schedule (p = 0.003). CONCLUSIONS: Students with less call frequency were associated with an improvement in lecture attendance and academic performance, and a lower burnout syndrome rate, without impacting clinical performance. Students with higher attendance regardless of call schedules performed higher academically. Further studies should evaluate the impact on clinical performance and exposure more thoroughly.

Image-Guided Surgery for Common Bile Duct Stones After Roux-en-Y Gastric Bypass.

Background: The relationship between obesity with common bile duct stone (CBDS) is close and increases after a Roux-en-Y gastric bypass (RYGB). Due to the anatomical modification, direct endoscopic access is not always possible. For this reason, image-guided surgery (IGS) by percutaneous transhepatic biliary drainage (PTBD) of the common bile duct (CBD) could be a first-line approach for the treatment of post-RYGB choledocholithiasis. The aim of this study was to analyze the feasibility and safety of CBDS treatment after RYGB with IGS. Materials and Methods: We present a descriptive retrospective observational multicentric study on the treatment of choledocholithiasis in patients operated on for RYGB using IGS through a minimally invasive approach by PTBD. The diagnosis of CBDS was made according to the symptoms of the patients, supported by blood tests, and medical images. Treatment was planned in two stages: in the first step, a PTBD was performed, and in the second step the choledocholithiasis was removed. Results: Of a total of 1403 post-RYGB patients, 21 presented choledocholithiasis. Of these, n = 18 were included. Symptoms were reported in n = 15 (8 cholestatic jaundice, 7 cholangitis), whereas n = 3 were asymptomatic. Percutaneous treatment was performed in all these patients, treated with a balloon and stone basket. A hyperamylasemia without pancreatitis was observed in 3 patients. No complications or deaths associated with the procedure were reported. The average hospital stay was 8.6 days. Conclusion: IGS is an interesting option for the treatment CBDS after RYGB. For these patients, PTBD is feasible and safe.

Consenso de hemofilia en México / Mexican Consensus in Haemophilia

resumen está disponible en el texto completo

Abstract Hemophilia is a hemorrhagic disorder with a sex-linked inherited pattern, characterized by an inability to amplify coagulation due to a deficiency in coagulation factor VIII (hemophilia A or classic) or factor IX (hemophilia B). Sequencing of the genes involved in hemophilia has provided a description and record of the main mutations, as well as a correlation with the various degrees of severity. Hemorrhagic manifestations are related to levels of circulating factor, mainly affecting the musculoskeletal system and specifically the large joints (knees, ankles and elbows). This document is a review and consensus of the main genetic aspects of hemophilia, from the inheritance pattern to the concept of women carriers, physiopathology and classification of the disorder, the basic and confirmation studies when hemophilia is suspected, the various treatment regimens based on infusion of the deficient coagulation factor as well as innovative factor-free therapies and recommendations for the management of complications associated with treatment (development of inhibitors and/or transfusion transmitted infections) or secondary to articular hemorrhagic events (hemophilic arthropathy). Finally, relevant reviews of clinical and treatment aspects of hemorrhagic pathology charachterized by acquired deficiency of FVIII secondary to neutralized antibodies named acquired hemophilia.

La angustia que no engaña y la que engaña / The anguish that does not deceive and the one that does

El presente texto tiene como propósito interrogar la afirmación lacaniana de la angustia como afecto que no engaña. Para tal propósito, iniciaremos revisando las últimas elaboraciones freudianas sobre la angustia localizables en el texto "Inhibición, síntoma y angustia", para luego ubicar en el seminario La angustia ciertas coordenadas allí desarrolladas por Lacan, como es la de la angustia como señal de lo real, su relación al objeto a, al falo y al fantasma; así como la propuesta de fin de análisis más allá de la angustia de castración. Posteriormente, propondremos que en Lacan podemos ubicar dos modos de presentarse la angustia: una, que engaña, en su articulación al fantasma y a la angustia de castración; otra, que no engaña, en consonancia con el significante de la falta en el Otro en términos de desamparo. Finalmente, ubicamos algunas consecuencias para la práctica analítica, al denotar la articulación del deseo del analista con la angustia vía el acto, y señalando que no distinguir en el análisis las dos manifestaciones de la angustia previamente denotadas, resulta engañoso para el analista al confundir la detención del análisis con su finalización

The purpose of this text is to interrogate the Lacanian affirmation of anguish as an affect that does not deceive. For this purpose, we will begin by reviewing the latest Freudian elaborations on anguish that can be found in the text "Inhibition, Symptom and Anguish", and then locate in the Seminar The anguish certain coordinates developed there by Lacan, such as that of anguish as a sign of what it is real, its relation to object a, phallus and phantasy; as well as the proposal for the end of the analysis beyond castration's anguish. Later, we will propose that in Lacan we can locate two ways of presenting anguish: first one, which deceives in its articulation the phantasy and the anguish of castration; another one, which does not deceive in relation with the signifier of the lack in the Other in terms of helplessness. Finally, we locate some consequences for analytical practice by denoting the articulation of the analyst´s desire with anguish by the means of the act, and pointing out that not distinguishing in the analysis the two previously denoted manifestations of anguish, is misleading for the analyst by confusing the stop of the analysis with its completion

Proposal for the management of COVID-19-associated coagulopathy in children.

SARS-CoV-2 infection (COVID-19) has become a pandemic with a high case fatality rate that mainly affects adults. Most severely ill adult patients develop a coagulopathy that was not described until recently, and which is currently considered a main cause of death. Everything indicates that a similar phenomenon also occurs in children with COVID-19. Anticoagulant treatment has become one of the therapeutic foundations for this infection; however, its implementation in children can be difficult since, until recently, it was not considered in the pediatric population. Evidence regarding the use of anticoagulants in COVID-19 is rapidly generated, changes constantly, it is often difficult to interpret, and can be contradictory. After an extensive review of the published literature, a proposal was generated that offers suggestions for anticoagulant treatment, considering available resources in Mexico.

La infección por SARS-CoV-2 (COVID-19) se ha constituido en una pandemia con alto índice de letalidad que afecta principalmente a los adultos. La mayor parte de los pacientes adultos graves desarrolla una coagulopatía que no estaba descrita, la cual actualmente se considera la principal causa de muerte. Todo indica que un fenómeno parecido ocurre también en el niño con COVID-19. El tratamiento anticoagulante se ha convertido en uno de los fundamentos terapéuticos de esta infección; sin embargo, su establecimiento en el niño puede ser difícil ya que, hasta hace poco, no estaba considerado en la población pediátrica. La evidencia respecto al uso de anticoagulantes en COVID-19 se genera con rapidez, cambia constantemente, con frecuencia es difícil de interpretar y puede ser contradictoria. Después de una extensa revisión de la literatura publicada, se generó una propuesta que ofrece sugerencias para el tratamiento anticoagulante en la que se consideran los recursos disponibles en México.

Proposal for the management of COVID-19-associated coagulopathy in children / Propuesta para el manejo de la coagulopatía asociada a COVID-19 en niños

Abstract SARS-CoV-2 infection (COVID-19) has become a pandemic with a high case fatality rate that mainly affects adults. Most severely ill adult patients develop a coagulopathy that was not described until recently, and which is currently considered a main cause of death. Everything indicates that a similar phenomenon also occurs in children with COVID-19. Anticoagulant treatment has become one of the therapeutic foundations for this infection; however, its implementation in children can be difficult since, until recently, it was not considered in the pediatric population. Evidence regarding the use of anticoagulants in COVID-19 is rapidly generated, changes constantly, it is often difficult to interpret, and can be contradictory. After an extensive review of the published literature, a proposal was generated that offers suggestions for anticoagulant treatment, considering available resources in Mexico.

Resumen La infección por SARS-CoV-2 (COVID-19) se ha constituido en una pandemia con alto índice de letalidad que afecta principalmente a los adultos. La mayor parte de los pacientes adultos graves desarrolla una coagulopatía que no estaba descrita, la cual actualmente se considera la principal causa de muerte. Todo indica que un fenómeno parecido ocurre también en el niño con COVID-19. El tratamiento anticoagulante se ha convertido en uno de los fundamentos terapéuticos de esta infección; sin embargo, su establecimiento en el niño puede ser difícil ya que, hasta hace poco, no estaba considerado en la población pediátrica. La evidencia respecto al uso de anticoagulantes en COVID-19 se genera con rapidez, cambia constantemente, con frecuencia es difícil de interpretar y puede ser contradictoria. Después de una extensa revisión de la literatura publicada, se generó una propuesta que ofrece sugerencias para el tratamiento anticoagulante en la que se consideran los recursos disponibles en México.

The immunoregulatory function of polyphenols: implications in cancer immunity.

Polyphenols have demonstrated several potential biological activities, notably antitumoral activity dependent on immune function. In the present review, we describe studies that investigated antitumor immune responses influenced by polyphenols and the mechanisms by which polyphenols improve the immune response. We also discuss the limitations in related areas, especially unexplored areas of research, and next steps required to develop a therapeutic approach utilizing polyphenols in oncology.

Transhepatic Percutaneous Sustained Dilation with Multiple Catheters for the Management of Hepaticojejunostomy Benign Stricture.

Background: Benign biliary strictures (BBS) befall in ∼7%-23% after hepaticojejunostomy and in 0.3%-0.6% after cholecystectomies. Their treatment options include surgical, endoscopic, and percutaneous management. The percutaneous approach is an excellent mini-invasive option including balloon dilation, biodegradable stents, and sustained dilation, a procedure born endoscopically. However, when the endoscopic approach fails or it is not available, it is possible to perform it percutaneously. Aim: To estimate the technical and clinical success of sustained percutaneous dilation with multiple catheters (SPDMC) in hepaticojejunostomy strictures and the percentage of complications and recurrence. Materials and Methods: We conducted a retrospective study, from a prospective database from January 2010 to March 2019, of 17 patients with postoperative BBS who failed to percutaneous pneumatic balloon dilation and underwent SPDMC with a mean follow-up of 2 years. Results: Seventeen patients between 28 and 71 years of age underwent SPMDC with technical success of 100%; the average number of catheters used was 5.59 (95% confidence interval [CI] 5.12-6.06) achieving a dilatation diameter of 16.15 mm (95% CI 14.71-17.60), and the therapeutic success rate was 71%, with recurrences of stricture and complications of 29% and 18%, respectively. The mean time with SPMDC was 7.06 months (95% CI 5.56-8.56). The median follow-up after dilation was 16 months, with an average of 27.75 months (95% CI 14.15-41.34). Conclusion: SPMDC is a feasible technique with a high technical success rate, therapeutic success rate, and low morbidity and mortality.