Parkinson's disease: a short story of 200 years.

After Alzheimer's disease, Parkinson's disease (PD) is the second most prevalent and incidental neurodegenerative disorder, affecting more than 2% of the population older than 65 years old. Since it was first described 200 years ago by Dr James Parkinson, great steps have been made in the understanding of the pathology. However, the cause(s) that initiates and perpetuates the neurodegenerative process is (are) still not clear. Thus, early diagnosis is not available, nor are there efficient therapies that can stop neurodegeneration. PD clinical features are defined by motor (like bradykinesia, resting tremor, gait impairment) and non-motor symptoms (like constipation, apathy, fathigue, olfactory dysfunction, depression and cognitive decline) that get more severe as the disease advances. Neuropathological hallmarks comprise selective loss of dopaminergic neurons in the Substantia Nigra pars compacta (SNpc) and Lewy bodies (LB) in different nuclei of the nervous system. Numerous studies have shown that these pathological features are aggravated by the confluence of other contributing factors, such as a genetic component, exposure to environmental toxins, mitochondrial dysfunction, increase of oxidative stress, calcium imbalance and chronic neuroinflammation, among others. Here, we provide a summary of the actual state of PD's pathology, the most studied molecular mechanisms, classic and novel therapeutic strategies and diagnosis methods, especially highlighting recent advances in these 200 years.

Electrical stimulation or MK-801 in the inferior colliculus improve motor deficits in MPTP-treated mice.

The inferior colliculus (IC) is an important midbrain relay station for the integration of descending and ascending auditory information. Additionally, the IC has been implicated in processing sensorimotor responses. Glutamatergic and GABAergic manipulations in the IC can improve motor deficits as demonstrated by the animal model of haloperidol-induced catalepsy. However, how the IC influences motor function remains unclear. We investigated the effects of either intracollicular deep brain stimulation (DBS) or microinjection of the glutamatergic antagonist MK-801 or the agonist NMDA in C57BL/6J mice chronically treated with saline or 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). After DBS or microinjections, the mice were submitted to rotarod and open field tests, respectively. DBS in the IC was effective to increase the time spent on the rotarod in MPTP-treated mice. After unilateral microinjection of MK-801, but not NMDA, MPTP-treated mice increased the distance travelled in the open field (p < 0.05). In conclusion, intracollicular DBS or MK-801 microinjection can improve motor performance in parkinsonian mice suggesting the IC as a new and non-conventional therapeutic target in motor impairment.

La bioética como eje transversal en el pensum de estudio de la Facultad de Odontología de la Universidad del Zulia Venezuela / Bioethics mainstreaming in the curriculum of study at the Faculty of Dentistry at the University of Zulia Venezuela

Se realizó una investigación descriptiva con el propósito de constatar la inserción de la bioética desde la perspectiva de la transversalidad curricular en las unidades curriculares de la carrera Odontología de la Universidad del Zulia, durante el periodo académico anual 2010, a través de la presencia de contenidos y objetivos bioéticos y relacionando los objetivos generales de la carrera con los terminales de las unidades curriculares. Se trata de un diseño de investigación de fuente documental, transeccional, contemporáneo y univariable; la población de estudio estuvo conformada por las unidades curriculares del primero al quinto año de la carrera; la muestra fue de tipo censal. Se emplearon técnicas de revisión documental. Para el procesamiento de los datos se utilizó el programa estadístico SPSS, versión 14. Al analizar los resultados se observó que el 80% de los programas de las asignaturas no presentan contenidos bioéticos, sólo el 20% lo expresa como propósito de la unidad curricular, el 27,5% como objetivo general de la asignatura, el 30% como objetivos terminales, el 10% de las materias presentan objetivos específicos actitudinales, el 12,5% lo presentan cognitivos y el 10% de naturaleza procedimental. En conclusión, la Facultad de Odontología de la Universidad del Zulia presenta la bioética como eje transversal, sin embargo, aun no se observa la inserción plena de la misma en todas las unidades curriculares del Pensum de Estudio

Descriptive research was conducted in order to verify the inclusion of bioethics from the perspective of the transversal axis in the curricular units of the Dentistry School of the University of Zulia, during the academic year 2010, through of contents and bioethical objectives, relating the generals and teminals objectives of the curricular units. The design of research was created from a mixed-source (field and documentary), transactional univariate contemporary, the study population consisted of curriculum units from first to fifth year of the carrer of dentistry, the sample was of census type, were used techniques of document review and interview. For data processing we used the statistical program SPSS, version 14. The analysis of the results showed that 80% of programs have no bioethical contents, only 20% expresses them as the purpose of the curricular unit, 27,5% expresses them as general objectives, 30% as terminal objectives, 10% of the subjects as attitudinal specific objectives, 12,5% has cognitive objectives and 10% procedural. In conclusion, Dentistry School of the University of Zulia presents the bioethics as a transversal axis, however, still is not observed the full insertion of the same in all curricular units of study Pensum

Nivel de conocimiento de madres sobre higiene bucal en niños de 0 a 3 años. Hospital materno infantil san pablo. Paraguay, 2010 / Level of knowledge of mothers about moist hygiene in children from 0 to 3 years old. Hospital materno infantil san pablo. Paraguay, 2010

Introducción: El futuro de la salud bucal de un niño, aún antes de que nazca, puede estar determinado por la madre, y los cuidados que le provean en los primeros meses de vida garantizan una dentadura saludable en la infancia y la adolescencia. Objetivo: Describir el nivel de conocimiento de las madres sobre higiene bucal en niños de 0 a 3 años que asisten al Hospital Materno Infantil San Pablo en el año 2010. Material y método: Se realizó un estudio descriptivo observacional de corte transversal. La población consta de 102 madres de bebés de 0 a 3 años que acudieron al Hospital Materno Infantil de San Pablo. Resultados: La mayoria de las madres encuestadas (87-85%) denotaron niveles no aceptables en cuanto al conocimiento sobre salud bucal en los bebés. El nivel de conocimiento bueno (1-1%) es muy bajo. Se observa que las madres mayores de 25 años presentan mejores niveles de conocimiento, al igual que las que trabajan fuera de casa, en ellas la frecuencia de nivel no aceptable es menor. Conclusión: El conocimiento de las madres sobre los cuidados buco dentales de sus niños es bajo, por lo que se hace necesario impartir educación acerca de los mismos, tanto a las madres como a los profesionales de salud. Palabras clave: Nivel de conocimiento - Salud bucodental ­ Niños de 0 a 3 años

Introduction: The future of oral health of a child can be determined by their mothers, even before his birth, and the care that it's provide them at the first months of their life would ensure healthy teeth in childhood and adolescence. Objective: Describe the level of knowledge of mothers on oral hygiene in children aged between 0 to 3 years attending the St. Paul's Maternal and Child Hospital in 2010. Material and Methods: It was conducted a descriptive cross-sectional observational study. The population consists of 102 mothers of infants of 0 to 3 years who attended the St. Paul's Maternal and Child Hospital. Results: The majority of mothers surveyed (87-85%) shown unacceptable levels in knowledge about oral health in infants. Good knowledge level (1-1%) is very low. It is observed that mothers over 25 years old have higher levels of knowledge, as well as those who work outside the home, to whom, the frequency of unacceptable level is low. Conclusion: the knowledge of mothers on dental oral care of they children is low, so it is necessary to provide education about it, to both mothers and health professionals. Keywords: Level of knowledge - Oral Health - Children from 0 to 3 years

Efficacy and tolerability of human fibrinogen concentrate administration to patients with acquired fibrinogen deficiency and active or in high-risk severe bleeding.

BACKGROUND AND OBJECTIVES: Fibrinogen deficiency is a cause for massive haemorrhage whose management in emergency situations is the subject of debate. Plasma-derived fibrinogen concentrates are indicated for reversing the haemorrhagic diathesis found in congenital and acquired deficiencies. MATERIALS AND METHODS: We report on the results of an observational study that evaluated the effects of fibrinogen concentrates in patients suffering from various forms of acquired severe hypofibrinogenaemia with life-threatening consumptive thrombo-haemorrhagic disorders (surgery, trauma and digestive haemorrhage), or underlying disease states that limit fibrinogen synthesis (hepatic dysfunction, haematological malignancies). RESULTS: Sixty-nine patients were identified and included, in whom most of the processes (62%) corresponded to consumptive hypofibrinogenaemia. After a median dose of 4 g, a mean absolute increase of 1.09 g/l in plasma fibrinogen was measured and coagulation parameters were significantly improved (P < 0.001). Mortality rates of 32.3% and 44.2% were reported after 24 h and 72 h, respectively. CONCLUSION: We conclude that the administration of fibrinogen concentrates in unresponsive, life-threatening haemorrhage with acquired hypofibrinogenaemia improves laboratory measures of coagulation, and may also be life saving. Although observational in nature, our data indicate a direct relationship between plasma fibrinogen levels and survival in acquired fibrinogen deficiency. Further studies are warranted to ascertain a clear relationship between fibrinogen levels and survival.

[Education and women's health: reflections from a gender perspective]. / Educación y salud de la mujer: reflexiones desde una perspectiva de género.

Using a gender perspective, this paper presents a critical bibliographic review of several projects and experiences focused on education and women's health. It aims to analyze some assumptions related to women's health on which different works and practices are based and reproduced in society. Several examples are given which, by illustrating women's living conditions and their experiences, make it possible to visualize some links between women's oppressed conditions of living and their health conditions. This paper concludes by emphasizing the need to constantly analyze social reality from a critical viewpoint; this would enable us to question and reformulate the logic underlying social organizations and health care, which emphasizes the women's maternal role and overlooks their health and well-being as a whole.

[Quality of the physician-patient pedagogic relationship in external consultation: the case of Oaxaca, Mexico ]. / Calidad de la relación pedagógica médico-paciente en consulta externa: el caso de Oaxaca, México.

This research seeks to explore the quality of the pedagogical relationship physician-patient in primary care, in several health centers (A, B, C) depending from the Health Ministry (SSA) in the state of Oaxaca, Mexico. It is assumed that the out-patient clinic constitutes a setting for the educative transmission, and that the physician-patient encounter must result in an increase of the knowledge that the patient has on his body and his health, with the help of the former. It is assumed also that the physician not only seeks to elaborate a diagnosis and to solve the health problems, but also to contribute to the education of the patient on this matter. This research seeks to contribute to the reflection in this direction, from a perspective that explores the quality and the nature of the educative processes that there take place. In order to reach this goal, two levels of analysis have been established: the first one, a theoretic approach, which refers to the main aspects of the historic evolution of the medicine -key element that permits to understand the type of physician-patient relationship that it is established in out-patient clinic. The second one, an empirical approach, which seeks to characterize -by using indicators previously determined and through the implementation of the technic "shadow study" (direct observation)- the six tasks (identification, clinic history, exploration, diagnosis, medical treatment, and following) that give structure to the physician-patient relationship in out-patient clinic. This elements, indeed, are useful for defining the nature of the pedagogical relationship that is established between these two actors. This investigation was conducted with a sample of 168 patients and 17 physicians, distributed all of them in 9 localities. The results allow us to conclude that, in the majority of the cases, it does not exist a physician-patient relationship, but that it is possible to talk just of a physician-problem relationship. Due to this fact, it is not possible to find the health education of the individuals, as a basic input for the training of the population as co- responsible of his/her health-illness process.

Acute poststreptococcal glomerulonephritis. A review of recent developments.

This revision is concerned with controversial aspects of the etiopathogenesis of acute poststreptococcal glomerulonephritis (APSGN) and with recently published clinical, serologic, immunohistologic and prognostic data. The putative nephritogenic antigens in group A streptococcus are discussed and the pathogenetic alternatives of exogenous (streptococcal) versus autologous (streptococcal-induced) immune complex (IC) disease are analyzed. The possible role of antiglobulins is reviewed in the light of the work that shows high titers of rheumatoid factor activity in the serum, as early as the first day of clinical APSGN, and glomerular-fixed anti-IgG in the biopsies of these patients. Circulating IC have been documented to be more frequent in the first week of the disease (2/3 of patients) that at a later date. Cryoglobulins are present in most cases tested in the first week, and elevation of serum IgG and IgM levels is found in over 90% of the patients. From the immunohistologic viewpoint, emphasis is made in recent work indicating IgG localization in the dermal papillae of uninvolved skin, which may be of potential diagnostic significance. Review of the published data on the prognosis of APSGN suggest that this issue is far from settled. Attention is called to the fact that the conflicting opinions may reflect different interpretations of possibly not too different data.

Immunopathology of the skin in acute poststreptococcal glomerulonephritis.

The immunohistologic features of the skin were studied in 26 cases of poststreptococcal glomerulonephritis. Twenty-two patients had vascular and extravascular dermal deposition of IgG. Positive stains for C3 (eight patients). IgM (two patients), and fibrinogen (five patients) were confined to vessel walls. Staining with anti-IgA serum was uniformly negative. Circulating antiskin antibodies could not be detected. Extravascular accumulation of IgG has a widespread distribution in the dermal papillary layer that is highly characteristic. It was absent in 7 patients with chronic glomerulonephritis and in 11 patients with various other renal diseases. The described findings appear to occur consistently in acute poststreptococcal glomerulonephritis. The distinctive extravascular demonstration of IgG may prove to be valuable in the diagnosis of this entity.

Epidemic glomerulonephritis in Maracaibo. Evidence for progression to chronicity.

In 1968 an outbreak of 348 cases of acute poststreptococcal glomerulonephritis (AGN) was observed in Maracaibo, Venezuela. During the year, the epidemic had three peaks of incidence. Districts with better sanitation showed a lower incidence of disease than those with less adequate facilities. Endemic cases occur every year. Lowering of serum complement activity was observed in 96% and hypertension in 90% of the patients. The mortality rate in the acute phase during the epidemic was 1.31%. A history of antecedent infection was found in 39% of the cases. 70% of these infections were in the upper respiratory tract. During 1973-74, 120 of the patients (19 adults and 101 children) were reexamined. All but one had been completely asymptomatic. Sixteen patients (13.3%) had one or more of the following abnormalities (group A): low CCr, microscopic hematuria, proteinuria of 1 g/day or more and hypertension. One hundred and four patients (86.7%) were normal by all clinical and laboratory parameters tested (group B). The incidence of persisting disease, as judged by biochemical findings, was significantly higher (P less than .01) in adults (36.7%) than in children (8.9%). Percutaneous renal biopsies from 7 patients of group A, and 8 patients from group B, were studied by light microscopy and immune histology. All biopsies from group A patients had evidence of advanced glomerular disease by light microscopy and by immune histology. Seven biopsies from group B patients were also abnormal showing mild changes with corresponding immunologic findings. Only in one patient was the biopsy completely normal. Our studies indicate that significant numbers of patients progress towards chronicity after epidemic, poststreptococcal AGN. Such progression is more common in adults than in children.