Diabetes materna y deficiencia de zinc: riesgos para la descendencia / Maternal diabetes and zinc deficiency, risks for the offspring

Resumen ANTECEDENTES: Cuando la mujer embarazada tiene déficit de zinc, esta carencia puede ser un factor que contribuya a la aparición de alteraciones en el feto, como las malformaciones congénitas y otros trastornos del desarrollo. OBJETIVO: Identificar los aspectos relevantes del estado actual del conocimiento de las complicaciones de la diabetes en la mujer embarazada y el déficit de zinc en el feto. Además, explicar cuál es la posible consecuencia de la deficiencia del micronutriente, entre otras causas moleculares subyacentes. METODOLOGÍA: Revisión bibliográfica efectuada en las bases de datos de Google, PubMed-Medline y SciELO de artículos publicados en inglés o español del año 2012 al 2022, con los MeSH: Maternal diabetes; Hyperglycemia; Zinc deficiency; Congenital malformations; Epigenetics; con su correspondiente traducción al español. Criterios de selección: artículos originales, estudios prospectivos, de revisión bibliográfica, metanálisis, capítulos de libro y reportes de la Asociación Americana de Diabetes (ADA) y la Asociación Latinoamericana de Diabetes (ALAD). RESULTADOS: Se localizaron 187 artículos de los que se excluyeron 126 no adecuados para el tema de la revisión, duplicados o en idioma diferente al inglés y español. CONCLUSIONES: El análisis bibliográfico evidenció que los trastornos metabólicos provocados por la hiperglucemia de la madre, el déficit de zinc, la alteración de su homeostasis y su interacción con el desequilibrio redox, la inflamación de bajo grado, la activación apoptósica y las modificaciones epigenéticas producen un ambiente intrauterino adverso que condiciona la aparición de malformaciones y otros trastornos del desarrollo en la descendencia.

Abstract BACKGROUND: When pregnant women are deficient in zinc, this deficiency may be a contributing factor to foetal disorders, such as congenital malformations and other developmental disorders. OBJECTIVE: To identify the relevant aspects of the current state of knowledge of the complications of diabetes in pregnant women and zinc deficiency in the foetus. In addition, to explain the possible consequences of micronutrient deficiency, among other underlying molecular causes. METHODOLOGY: Bibliographic review carried out in Google, PubMed-Medline and SciELO databases of articles published in English or Spanish from 2012 to 2022, with the MeSH: Maternal diabetes; Hyperglycemia; Zinc deficiency; Congenital malformations; Epigenetics; with their corresponding translation into Spanish. Selection criteria: original articles, prospective studies, literature reviews, meta-analyses, book chapters and reports of the American Diabetes Association (ADA) and the Latin American Diabetes Association (ALAD). RESULTS: 187 articles were located of which 126 unsuitable for the review topic, duplicates or in language other than English and Spanish were excluded. CONCLUSIONS: The literature review evidenced that metabolic disorders caused by maternal hyperglycemia, zinc deficiency, alteration of its homeostasis and its interaction with redox imbalance, low-grade inflammation, apoptotic activation and epigenetic modifications produce an adverse intrauterine environment that conditions the appearance of malformations and other developmental disorders in the offspring.

Validación cognitiva de un protocolo instruccional de reexperimentación emocional en adultos víctimas de violencia política en Colombia / Cognitive validation of an instructional protocol for emotional disclosure in adult victims of political violence in Colombia

Resumen La re experimentación emocional (RE) permite dar sentido a hechos traumáticos o estresantes mediante un proceso dirigido por instrucciones verbales o escritas, y por ello puede generar beneficios en el bienestar psicológico y la salud física autoinformada. El objetivo del presente estudio fue evaluar la comprensión de tres tipos de instrucciones experimentales (RE tradicional, RE con claves de aceptación y compromiso, y RE psicosocial) y una instrucción para el grupo control (RE trivial), mediante técnicas de validación cognitiva (pruebas centradas en el significado y verbalización de pensamiento) en personas expuestas a hechos de violencia política en Colombia. Para ello, se desarrolló un estudio de tipo cualitativo con corte instrumental, en el que se entrevistó a 42 colombianos víctimas de violencia política, en su mayoría mujeres, elegidos con un muestro por conveniencia. Las entrevistas fueron transcritas y codificadas mediante un análisis categorial mixto que tomó como referente procedimientos del Movimiento de Aspectos Cognitivos de la Metodología de Encuestas. Como resultado, los participantes comprendieron de manera diferencial las instrucciones dadas en cada protocolo, enfocándose en aspectos como el contexto sociopolítico en el caso del protocolo psicosocial, y en respuestas asociadas a la aceptación en el protocolo con claves de aceptación y compromiso. Se identificaron dificultades en la comprensión de algunas secciones de los protocolos, las cuales fueron ajustadas. Finalmente, se enfatiza la importancia de implementar técnicas de validación cognitiva para verificar la comprensión de instrucciones, protocolos o instrumentos, dado que el desempeño de los participantes y la calidad de las medidas de las intervenciones pueden verse afectados por la comprensión e interpretación de las instrucciones propuestas.

Abstract Emotional disclosure (ED) allows making sense of traumatic or stressful events through a process guided by verbal or written instructions, and thus may generate benefits in psychological well-being and self-reported physical health. The aim of the present study was to evaluate the understanding of three types of experimental instructions (traditional ED, ED with acceptance and commitment cues, and psychosocial ED) and one instruction for the control group (trivial ED), trough cognitive validation techniques (tests focused on meaning and verbalización of thought), in people exposed to events of political violence in Colombia. For this purpose, a qualitative study with an instrumental approach was developed, in which 42 Colombian victims of political violence, mostly women, were interviewed, chosen through convenience sampling. The interviews were transcribed and analyzed by means of a mixed categorical analysis that used as a reference procedures from the Cognitive Aspects of the Survey Methodology Movement. As a result, participants differentially understood the instructions given in each protocol, focusing on aspects such as the sociopolitical context in the case of the psychosocial protocol, and on responses associated with acceptance in the protocol with acceptance and commitment cues. Difficulties were identified in the understanding of some sections of the protocols, which were adjusted. Finally, the importance of implementing cognitive validation techniques to verify the understanding of instructions, protocols or instruments is emphasized, given that the performance of the participant and the quality of the measures of the experiments may be affected by the understanding and interpretation of the proposed instructions.

Protective effect of NeuroEPO on the reproduction of diabetic rats / Efecto protector de la NeuroEPO en la reproducción de ratas diabéticas

Introduction: Pregestational diabetes constitutes a reproductive risk which requires new treatment strategies. NeuroEPO, a variant of the recombinant human erythropoietin produced in Cuba, has neuroprotective and hypoglycemic effects which can be considered for the treatment of this entity. Objective: To evaluate the protective effect of NeuroEPO on the reproduction of diabetic rats. Material and Methods: Four groups of adult female Wistar rats with streptozotocin-induced diabetes were used. During pregnancy, one group received the vehicle and the rest of the groups received different doses of NeuroEPO (0,5 mg/kg, 0,75 mg/kg, and 1 mg/kg) subcutaneously, on alternate days, for a total of six applications. A group of non-diabetic rats was used as a control group. Glycemia and reproductive variables were evaluated. For comparisons, Analysis of Variance and Fisher's Exact Test were used. There were significant differences with p-values less than 0,05. Results: The group with vehicle presented maintained hyperglycemia, fewer implantations, and embryos, and increased gestational losses. In the group receiving 0,5 mg/kg of NeuroEPO, glycemia decreased significantly and the results of the reproductive variables were similar to the group of non-diabetic rats. With higher doses of NeuroEPO, gestational losses were increased. No congenital malformations were identified in either group. Conclusions: The repeated administration of 0,5 mg/kg of NeuroEPO has a beneficial effect on the reproduction of diabetic rats, which may be associated with the reduction of hyperglycemia. Other cytoprotective mechanisms of NeuroEPO should be evaluated in future studies(AU)

Introducción: la diabetes pre-gestacional constituye un riesgo reproductivo, lo que requiere nuevas estrategias de tratamiento. Teniendo en cuenta que la NeuroEPO, una variante de la eritropoyetina recombinante humana producida en Cuba, tiene efectos neuroprotectores e hipoglicemiantes. Objetivo: evaluar el efecto protector de la NeuroEPO en la reproducción de ratas diabéticas. Material y Métodos: se utilizaron cuatro grupos de ratas Wistar hembras adultas, con diabetes inducida por estreptozotocina. Durante la gestación, un grupo recibió el vehículo y el resto diferentes dosis de NeuroEPO (0,5 mg/kg, 0,75 mg/kg y 1 mg/kg), por vía subcutánea, en días alternos, para un total de seis aplicaciones. Se empleó un grupo de ratas no-diabéticas como control. Se evaluó la glicemia y variables reproductivas. Para las comparaciones se empleó el Análisis de Varianza y la Prueba Exacta de Fisher. Las diferencias se consideraron significativas con valores de p menores que 0,05. Resultados: el grupo con vehículo presentó hiperglicemia mantenida, menor número de implantaciones y embriones, e incremento de las pérdidas gestacionales. En el grupo que recibió 0,5 mg/kg de NeuroEPO, la glicemia disminuyó de forma significativa y los resultados de las variables reproductivas fueron similares al grupo de ratas no-diabéticas. Con las dosis superiores de NeuroEPO se incrementaron las pérdidas gestacionales. No se identificaron malformaciones congénitas en ninguno de los grupos. Conclusiones: la administración reiterada de 0,5 mg/kg de NeuroEPO tiene efecto beneficioso en la reproducción de ratas diabéticas, que puede estar asociado a la reducción de la hiperglicemia. Otros mecanismos citoprotectores de la NeuroEPO deben ser evaluados en futuros estudios(AU)

Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19

ABSTRACT Background: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. Objectives: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). Methods: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. Results: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom were discharged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176-3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A total of 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). Conclusion: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.

El desafío para el desarrollo del sistema nervioso central en la reproducción humana asociada con la diabetes / The challenge for the development of the central nervous system in human reproduction associated with diabetes

Introducción: Los hijos de madres con diabetes presentan una mayor incidencia de trastornos del neurodesarrollo como autismo, actividad cognitiva baja, déficit de atención, esquizofrenia y otras enfermedades del espectro autista. Objetivo: Explicar los mecanismos moleculares que subyacen en la aparición de los trastornos del neurodesarrollo en hijos de gestantes con diabetes. Métodos: Se llevó a cabo una revisión de la literatura que aparece en las bases de datos electrónicas Google, MEDLINE/PubMed y SciELO. Se revisaron artículos publicados entre los años 2000 y 2020. Las palabras clave utilizadas fueron: hiperglucemia, neurodesarrollo, malformaciones congénitas y epigenética. Resultados: Se pone de manifiesto el alto riesgo que representa la hiperglucemia durante el desarrollo intrauterino. El riesgo relativo que tienen los hijos de madres con diabetes pregestacional de presentar malformaciones del sistema nerviosos central es 15,5 veces mayor que en gestantes sin diabetes. El hipocampo es especialmente sensible a cambios en los niveles de glucosa. La diabetes materna puede dejar una impronta negativa para la capacidad de procesar información, adquirir habilidades y poseer un comportamiento social adecuado en la descendencia. Conclusiones: Las alteraciones en el metabolismo condicionadas por la hiperglucemia, el estrés oxidativo, la inflamación de bajo grado y las modificaciones epigenéticas crean un fatal engranaje que sustenta el desarrollo anómalo en hijos de gestantes con diabetes(AU)

Introduction: Children, whose mothers suffer from diabetes, have higher incidence of neurodevelopmental disorders such as autism, low cognitive activity, attention deficit, schizophrenia and other autism spectrum diseases. Objective: To explain the molecular mechanisms that underlie the appearance of neurodevelopmental disorders in children of pregnant women with diabetes. Methods: A review of the literature that appears in Google, MEDLINE/PubMed and SciELO electronic databases, was carried out. Articles published from 2000 to 2020 were reviewed. The keywords used were hyperglycemia, neurodevelopment, congenital malformations, and epigenetics. Results: The high risk that hyperglycemia represents during intrauterine development is highlighted. The relative risk that children of mothers with pregestational diabetes have of presenting malformations of the central nervous system is 15.5 times higher than in pregnant women without diabetes. The hippocampus is especially sensitive to changes in glucose levels. Maternal diabetes can leave negative print on the ability to process information, acquire skills and have appropriate social behavior in their children. Conclusions: Alterations in metabolism conditioned by hyperglycemia, oxidative stress, low-grade inflammation and epigenetic modifications create a fatal mechanism that supports abnormal development in children of pregnant women with diabetes(AU)

Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19.

BACKGROUND: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. OBJECTIVES: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). METHODS: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. RESULTS: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom weredischarged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176 3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A totalof 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). CONCLUSION: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.

Incidence and Prognostic Significance of High-Risk Cytogenetically Abnormalities in Multiple Myeloma Patients in Colombia.

INTRODUCTION: Multiple Myeloma (MM) is the second most common hematological cancer, several cytogenetics abnormalities such as t(4;14), del (17p), and t(14;16) were identified as a high-risk for survival, in Latin America, we have very little data on cytogenetic alterations in MM. This study describes the incidence of high-risk cytogenetically abnormalities in a Colombian population and prognostic significance. METHODS: In a retrospective cohort of new diagnostic Multiple Myeloma between 2016 and 2020, we identified a high-risk cytogenetically abnormalities t(4;14), t(14;16), and 17p deletions by FISH techniques and described incidence. We followed patients until progression or death and comparing progression free survival (PFS) and overall survival (OS), according with high- risk cytogenetically features. RESULTS: We included 135 newly diagnosed MM patients, the incidence of high-risk cytogenetically abnormalities were 30.3%, with 17.1% of 17p deletions, 14.1% of t(4;14) and 2.25% of t(14;16). According to the high risk cytogenetically abnormalities, the median PFS for the group of no abnormalities were 50.2 months 95% CI [25.2-62.4] and for the group of high-risk cytogenetic abnormalities 33.9 months 95% CI [23.6-NA] (P = .2). For OS the median were 76.9 months, 95% CI [67.5-NA] and 42.7 months 95% CI [33.3-NA], respectively (P = .009). CONCLUSION: High-risk cytogenetically abnormalities were independent risk factor for OS but not PFS in this cohort of patients, and the incidence of del (17p) was slightly higher than the literature reports.  MICROABSTRACT: Prognostic significance of high-risk cytogenetic abnormalities in Multiple Myeloma in Colombia is unknown. In a retrospective cohort study of 135 newly, diagnostic Multiple Myeloma we found incidence of high-risk cytogenetic abnormalities was 30.3%. The hazard ratio (HR) for disease progression or death compared high-risk cytogenetic group vs. control was 1.22, (95% CI, 0.73-2.05) (P = .2), and The HR for death for the group of high-risk cytogenetic abnormalities was 2.17, (95% CI, 1.19-3.97). In the group of high-risk cytogenetic abnormalities, if the patient received VRD as induction treatment the median PFS were 41.2 months 95% CI [13.3-NA] and 33.9 months 95% CI [24.9-NA] for patients with different induction treatment (P = .56).

Recommendations for the diagnosis and management of persons with suspected vaccine-induced immune thrombotic thrombocytopenia (VITT) / Recomendaciones para diagnostico y manejo de personas con trombocitopenia trombotica inmune inducida por vacunas (VITT)

Abstract In recent months, rare cases of thrombosis at unusual sites associated with thrombocytopenia, occurring within a typical risk window (i.e., 4-28 days) after receiving SARS CoV2 vaccines, have been reported. Healthcare professionals should be prepared to detect these cases on time. The Expert Panel of the Knowledge Management and Transfer Network conducted a free search of the related literature. With the available information and the clinical expertise of the working group, we formulated, reviewed, and endorsed recommendations for the timely suspicion, diagnosis (case definitions, the use of initial laboratory and imaging tests, specific tests), and management of these thrombotic conditions. This document is considered a living document that will be updated as new evidence emerges, and recommendations may change over time.

Resumen En meses recientes se han reportado casos raros de trombocitopenia y trombosis en sitios inusuales, que ocurren dentro de una ventana de riesgo típica ( por ejemplo de 4 a 28 días) luego de recibir vacunas de SARS CoV 2. Los profesionales de la salud deben estar preparados para detectar estos casos a tiempo. Un panel de expertos y una red de transferencia de conocimiento realizó una búsqueda libre de literatura seleccionada. Con la información disponible y la experticia clínica del grupo de trabajo revisamos y dimos recomendaciones para la sospecha temprana, el diagnostico (definición de caso, el uso de pruebas de laboratorio especificas y de imágenes diagnósticas) para le manejo de estas condiciones tromboticas. Este documento es considerado un documento vivo que debe ser actualizado a medida que surja nueva evidencia y las recomendaciones vayan cambiando con el tiempo

Efecto hipoglicemiante de la NeuroEPO en ratas con y sin diabetes mellitus / Hypoglycemic effect of NeuroEPO in diabetic and non-diabetic rats

RESUMEN Introducción: La NeuroEPO es una variante no-hematopoyética de la eritropoyetina recombinante humana, que pudiera tener efecto hipoglicemiante. Objetivo: Evaluar la influencia de la NeuroEPO sobre la glicemia de ratas con diabetes mellitus y ratas no-diabéticas. Material y Métodos: Se realizaron experimentos en ratas Wistar con diabetes inducida por estreptozotocina, con y sin tratamiento con insulina, y en ratas no-diabéticas con una sobrecarga de glucosa. En cada experimento, un grupo recibió una inyección subcutánea de NeuroEPO (0,5 mg/kg) y otro el vehículo, y se determinó la glicemia durante 120 minutos. Se realizaron comparaciones mediante análisis de varianza de una y dos vías, seguidas por la prueba de Bonferroni. Las diferencias se consideraron significativas con valores de p < 0,05. Resultados: En las ratas diabéticas sin tratamiento con insulina, los niveles de glicemia del grupo con NeuroEPO disminuyeron de forma significativa. En las ratas no-diabéticas que recibieron NeuroEPO y una sobrecarga de glucosa, la glicemia fue similar al grupo control. En las ratas diabéticas que recibieron NeuroEPO e insulina la reducción de la glicemia fue mayor que en el grupo que solo recibió insulina. Conclusiones: La NeuroEPO tiene un efecto hipoglicemiante en ratas diabéticas, por un mecanismo insulinotrópico que muestra sinergismo con la insulina en el tratamiento de la hiperglicemia. Sin embargo, la NeuroEPO no influye en la tolerancia a la glucosa de ratas no-diabéticas, al menos de forma inmediata. Es necesario profundizar en los mecanismos mediante los cuales la NeuroEPO puede reducir la hiperglicemia, y la influencia de esta sustancia en condiciones de normoglicemia.

ABSTRACT Introduction: NeuroEPO is a non-hematopoietic variant of human recombinant erythropoietin, which may have a hypoglycemic effect. Objectives: To evaluate the influence of NeuroEPO on glycemia in diabetic and non-diabetic rats. Material and Methods: The experiments were conducted in Wistar rats with streptozotocin-induced diabetes with and without insulin treatment, and in non-diabetic rats with glucose overload. In each experiment, one group received a subcutaneous injection of NeuroEPO (0.5 mg/kg) and the other group received a vehicle. Glycemia was determined in 120 min. Comparisons were made using one-and two-way analysis of variance, followed by the Bonferroni test. The differences were considered significant with p values < 0,05. Results: In diabetic rats without insulin treatment, glycemic levels decreased significantly in the group that received NeuroEPO. In nondiabetic rats that received NeuroEPO and a glucose overload, glycemia was similar to that in the control group. In diabetic rats that received NeuroEPO and insulin, the glycemia reduction was greater than in the group that only received insulin. Conclusions: NeuroEPO has a hypoglycemic effect in diabetic rats due to an insulinotropic mechanism that shows synergism with insulin in the treatment of hyperglycemia. However, NeuroEPO does not influence the glucose tolerance in non-diabetic rats, at least immediately. It is necessary to delve into the mechanisms by which NeuroEPO can reduce hyperglycemia and the influence of this substance under conditions of normoglycemia.

Indicadores metabólicos y de estrés oxidativo en ratas con obesidad inducida con glutamato monosódico / Metabolic and oxidative stress markers in rats with monosodium glutamate-induced obesity

Introducción: La obesidad, especialmente la visceral, constituye un factor de riesgo principal para múltiples enfermedades tales como: diabetes Mellitus tipo 2, enfermedades cardiovasculares, aterosclerosis, dislipidemias, enfermedad por hígado graso no alcohólico y cáncer. Se plantea que el estrés oxidativo podría ser el factor causal común de las comorbilidades asociadas a la obesidad. Objetivo: Evaluar el balance prooxidante/antioxidante en ratas con obesidad inducida con glutamato monosódico. Material y Métodos: Ratas Wistar hembras recibieron glutamato monosódico (4 mg/g de peso corporal) para inducir obesidad o NaCl 0,9 por ciento (Controles) subcutáneamente en período neonatal. A los 90 días, se confirmó la obesidad. Se les practicó eutanasia a los 180 días para la obtención de sangre e hígado para la determinación de marcadores bioquímicos. Resultados: Las ratas obesas presentaron niveles incrementados de TAG, AU, insulina e índices HOMA y TyG. Se constataron mayores concentraciones de nitratos y nitritos, productos avanzados de la oxidación de proteínas y productos de oxidación de la 2-desoxirribosa en el ADN en las ratas obesas. Conclusiones: Se concluye que la obesidad inducida con glutamato monosódico reproduce las principales alteraciones metabólicas asociadas a la obesidad visceral humana, dentro de las que se incluye el estrés oxidativo. Este modelo podría ser útil en la evaluación de estrategias terapéuticas para prevenir o disminuir complicaciones asociadas a la obesidad(AU)

Introduction: Obesity, especially visceral, is a major risk factor for several diseases such as Type 2 diabetes mellitus, cardiovascular diseases, atherosclerosis, dyslipidemia, non-alcoholic fatty liver disease, and cancer. Oxidative stress may be a unifying mechanism for the development of major obesity-related comorbidities. Objective: To evaluate the prooxidant-antioxidant balance in monosodium glutamate-induced obesity in Wistar rats (MSG- obese rats). Material and Methods: Female Wistar rats received subcutaneous (sc) injections of monosodium glutamate solution (4 mg/g of body weight) or vehicle (NaCl 0,9 percent; control) to induce obesity during the neonatal period. At 90 days of life, obesity was determined. At 180 days of life, rats were anesthetized and killed to obtain blood and liver samples for the determination of biochemical markers. Results: MSG obese rats presented significantly higher triglycerides, uric acid and insulin levels, as well as elevated HOMA and TyG indexes. Increased concentrations of nitrate and nitrite, 2-deoxyribose oxidation products and advanced oxidation protein products levels were observed in obese rats. Conclusions: Obesity induced by monosodium glutamate reproduces the main metabolic alterations associated with human visceral obesity, among which oxidative stress is included. This model may be useful for the evaluation of therapeutic strategies to prevent or decrease complications associated with obesity(AU)

Protocolo para la citología vaginal directa de ratas de laboratorio / Protocol for direct vaginal cytology of laboratory rats

Introducción: La citología vaginal directa es un método muy utilizado para la evaluación del ciclo estral de las ratas de laboratorio, pero la información acerca de los procedimientos e interpretación de los resultados aparece disgregada en la literatura, lo cual dificulta su empleo en los estudios de reproducción. Objetivo: Proponer un protocolo para la realización de la citología vaginal directa de ratas de laboratorio y la interpretación de los resultados. Material y métodos: Se combinó la información de la literatura y la experiencia de 10 años de estudios de reproducción, en los que se han empleado un total de 250 ratas Wistar hembras, siguiendo preceptos éticos establecidos. Se describen los procedimientos para la obtención de las muestras, mediante lavado vaginal, así como para su observación y análisis en estado húmedo, con microscopio óptico y cámara digital acoplada. Resultados: Se describen los tipos celulares principales presentes en el lavado vaginal y las características que permiten identificar cada fase o estado de transición del ciclo estral. Se discuten aspectos a considerar en la interpretación de los resultados, que incluye la relación con los cambios hormonales, los cuidados en la obtención de la muestra y la influencia de factores ambientales. Se muestran imágenes y figuras representativas para ilustrar el texto. Conclusiones: El trabajo constituye un protocolo para el estudio del ciclo estral de ratas de laboratorio, mediante la citología vaginal directa. Provee métodos no invasivos, sencillos y económicos, así como conocimientos esenciales para la interpretación de los resultados, que integran una guía de gran utilidad para los estudios experimentales de reproducción(AU)

Introduction: Direct vaginal cytology is a widely used method for the evaluation of the estrous cycle of laboratory rats, but the information about the procedures and interpretation of results is dispersed through literature, making its use difficult in investigations on reproduction. Objective: To propose a protocol for performing direct vaginal cytology of laboratory rats as well as for the interpretation of the results. Material and methods: The information obtained from literature and the experience of 10 years of investigation on reproduction in 250 female Wistar rats were combined following the established ethical principles. The procedures for obtaining samples by vaginal washing and by observation and analysis in humid state with light microscope equipped with digital camera were described. Results: The main types of cells present in the vaginal washing and the characteristics that allow us to identify each phase or transitional phases of the estrus cycle are described. Aspects to take into consideration in the interpretation of the results, which include the association between hormonal changes, the cares in the obtaining of the sample and the influence of environmental factors, are discussed. Representative images and figures are included to illustrate the text. Conclusions: The work consists of a study protocol of the estrus cycle of laboratory rats by direct vaginal cytology. It provides noninvasive, simple and cost-reducing procedures as well as essential knowledge for the interpretation of results which integrate a very useful guideline for experimental investigations on reproduction(AU)

El conocimiento de la enfermedad, un preventivo poderoso. El Heraldo Médico (1908) México / Knowledge of the disease, a powerful preventive. The Medical Herald (1908) Mexico

Es una mirada histórica, donde se reseña o muestra los esfuerzos por educar y transmitir los principios de higiene y salud. Específicamente se presenta un primer acercamiento descriptivo de la revisión de El Heraldo Médico. Guía de medicina práctica para el uso de las familias (1908, Tomo II), de la empresa editora "El Heraldo Médico", el cual menciona aspectos de higiene con potencial para la solución de los problemas cotidianos y las decisiones para mejorar la calidad de vida en el ámbito de la salud[AU]

Summary: it is a historical look, where the efforts to educate and transmit the principles of hygiene and health are reviewed or shown. Specifically, a first descriptive approach to the review of El Heraldo Médico is presented. Practical medicine guide for the use of families (1908, Volume II), by the publishing company "El Heraldo Médico", which mentions hygiene aspects with potential for solving daily problems and decisions to improve the quality of life in the field of health[AU]

é um olhar histórico, onde os esforços para educar e transmitir os princípios da higiene e saúde são revistos ou apresentados. Especificamente, é apresentada uma primeira abordagem descritiva da revisão do El Heraldo Médico. Guia prático de medicina para o uso das famílias (1908, Volume II), da editora "El Heraldo Médico", que menciona aspectos de higiene com potencial para resolver problemas cotidianos e decisões para melhorar a qualidade de vida no campo da saúde[AU]

Demographic and Pathogens of Domestic, Free-Roaming Pets and the Implications for Wild Carnivores and Human Health in the San Luis Region of Costa Rica.

Habitat loss and degradation, restricted ranges, prey exploitation, and poaching are important factors for the decline of several wild carnivore populations and additional stress from infectious agents is an increasing concern. Given the rapid growth of human populations in some regions like Costa Rica, pathogens introduced, sustained, and transmitted by domestic carnivores may be particularly important. To better understand the significance of domestic carnivore pathogens for wildlife, we determine the prevalence of infection and possible mechanisms for contact between the two groups. The demographics, role in the household, and pathogens of pet dogs and cats was studied during three annual spay/neuter clinics in San Luis, Costa Rica. Most dogs were owned primarily as pets and guard animals, but ~10% were used for hunting. Cats were owned primarily as pets and for pest control. Both roamed freely outdoors. We detected high prevalences of some pathogens (e.g., carnivore protoparvovirus 1 and Toxoplasma gondii). Some pathogens are known to persist in the environment, which increases the probability of exposure to wild carnivores. This study demonstrated that domestic pets in San Luis, home to a number of protected and endangered wildlife species, are infected with pathogens to which these wild species are potentially susceptible. Additionally, results from our questionnaire support the potential for domestic and wild animal contact, which may result in disease spillover.

Measurable Residual Disease Assessment and Allogeneic Transplantation as Consolidation Therapy in Adult Acute Lymphoblastic Leukemia in Colombia.

INTRODUCTION: Detectable minimal residual disease (MRD) after therapy for acute lymphoblastic leukemia (ALL) is the strongest predictor of hematologic relapse. The objective of the study was to assess disease-free survival (DFS) and overall survival (OS) of patients with ALL according with MRD status at the end of induction therapy in a Colombian population. PATIENTS AND METHODS: We assessed a retrospective cohort to compare DFS and OS in adults with de novo ALL according to MRD status at the end of induction chemotherapy, and the type of postinduction consolidation strategy used. RESULTS: A total of 165 adults with ALL were included in the MRD part of the study, 73 patients in the MRD-negative group and 92 in the MRD-positive group. Median DFS for the MRD-positive group was 11 months (95% confidence interval, 11.7-22.2) and was not reached for the MRD-negative group (P < .001). At 3 years, DFS was 18% and 55%, respectively (P < .001). The median OS for MRD-positive patients was 16 months (95% confidence interval, 8.8-23.15) and was not reached in the MRD-negative group. At 3 years, OS was 26% and 51% for the former and latter group, respectively. Among subjects who did not receive a transplant, median DFS was 21 months for MRD-negative patients and 9 months for MRD-positive patients (P < .001). The median DFS was not reached in either group, whereas 3-year DFS was 64% for MRD-negative and 70% for MRD-positive patients who underwent transplantation in first remission (P = .861). CONCLUSION: MRD status at the end of induction is an independent prognostic factor for DFS and OS in adult ALL. Allogeneic transplantation in first remission could overcome the adverse prognostic impact of MRD.

La prensa y la participación social frente a los desastres: desde el sismo de Oaxaca de 1787 al sismo de Tehuantepec de 2017 / A Imprensa E A Participação Social Diante Dos Desastres: Do Terremoto De Oaxaca De 1787 Ao Terremoto De Tehuantepec Em 2017 / The Press And Social Participation In The Face Of Disasters: From The Oaxaca Earthquake Of 1787 To The Tehuantepec Earthquake Of 2017

A través de su historia, México se ha caracterizado por ser un país vulnerable a la ocurrencia de diversos eventos de origen meteorológico y geofísico debido a su ubicación geográfica.

The press and social participation in the face of disasters: from the Oaxaca earthquake of 1787 to the Tehuantepec earthquake of 2017.

A imprensa e a participação social diante dos desastres: do terremoto de Oaxaca de 1787 ao terremoto de Tehuantepec em 2017.

Funciones del tutor de enfermería en la atención primaria de salud en Cuba / Functions of the nursing tutor in the primary health care in Cuba

Introducción: La Atención Primaria Salud arriba en el presente año a sus 32 años de aplicación, por lo que resulta oportuno hacer frente al siguiente problema científico ¿Cómo contribuir al desarrollo del tutor de enfermería en la atención primaria de salud en Cuba? Objetivo: Identificar las funciones del tutor de enfermería en la atención primaria de salud en Cuba. Métodos: Revisión bibliográfica sistemática realizada en junio de 2016 para desarrollar un análisis crítico reflexivo del contenido de artículos publicados en español entre 2014 y 2016 disponibles las bases de datos Medline y SciELO, (Scientific Electronic Library Online), las palabras clave utilizadas por intermedio del aperador booleano AND fueron "tutor de enfermería", "atención primaria de salud". Los criterios de inclusión para la selección de los artículos fueron: adherencia a la temática, que presentaran de manera clara la metodología o referencial teórico seleccionado. Conclusiones: Se consideran funciones del tutor de enfermería las acciones o actividades que ejecuta en la atención primaria de salud para instruir y educar de forma integral a sus estudiantes en el arte y ciencia de Enfermería, que en atención a las diferentes aristas de su accionar se clasifican en: Educativa-Orientadora, Técnico-profesional (Asistencial), Pedagógico-didáctica, Científico-Investigativa, Superación y Gerencial. Se identifica como función principal del tutor de enfermería en la atención primaria de salud en Cuba la eficiente formación de recursos humanos, calificados como profesionales de enfermería(AU)

ABSTRACT Introduction: The primary health care will celebrate its 32th anniversary of application, so it is timely to face the following scientific question: How can one contribute to the development of the nursing tutor in the primary health care in Cuba? Objective: To identify the functions of the nursing tutor in the primary health care in Cuba. Methods: Systematic literature review made in June 2016 in order to develop critical and reflective analysis on the contents of articles published in Spanish from 2014 to 2016 and available in Medline and SciELO (Scientific Electronic Library on Line). The keywords were "nursing tutor" and "primary health care" by using Boolean operator AND. The inclusion criteria for selection of articles were adherence to subject, clear presentation of methodology or of selected theoretical reference. Conclusions: It is considered that the functions of the nursing tutor cover the actions or activities that he/she carries out in the primary health care to comprehensively instruct and educate his/her students in the art and science of nursing. According to the different edges of the tutor's work, these functions may be classified into educative-guiding, technical-professional (assistance), pedagogic-didactic, scientific-research, upgrading and managerial. The main function of the nursing tutor in the primary health care in Cuba is the effective formation of human resources as skilled nursing professionals(AU)

Experiencias de mujeres frente al cuidado de hijos diagnosticados con hemofilia / Experiences of women in the care of their children diagnosed with severe and/or moderate symptomatic haemophilia

RESUMEN Objetivo: describir las experiencias de las mujeres frente al cuidado de sus hijos diagnosticados con hemofilia severa y/o moderada sintomática qué han recibido atención en el Servicio de Hematología del Hospital de San José (HSJ), Bogotá, Colombia. Metodología: estudio cualitativo de tipo fenomenológico-hermenéutico. La técnica de recolección de datos fue la entrevista a profundidad. La muestra se determinó por saturación de los datos, para la inclusión de los participantes se utilizó muestreo intencional. La información se analizó a partir de la propuesta de Strauss y Corbin quienes consideran la codificación abierta, axial y selectiva. Resultados: participaron en total nueve mujeres cuidadoras de hijos con hemofilia. La información fue reducida y analizada para establecer dos categorías: Experiencia de atención con un hijo hemofílico: desconocimiento, cambios y dificultades, y Trayectoria de la hemofilia en la vida de la mujer: implicaciones derivadas del cuidado. Conclusiones: existe un desconocimiento del sector salud y de la sociedad por ser una enfermedad huérfana dificultando el diagnostico, se evidencia situaciones que incrementan la desigualdad de género y repercuten negativamente en el desarrollo de la mujer física y socialmente.

SUMMARY Objective: To describe the experiences of women in the care of their children diagnosed with severe and/ or moderate symptomatic haemophilia who have received care at the Hematology Service of the Hospital de San José (HSJ), Bogotá, Colombia. Methods: Qualitative phenomenological-hermeneutic study. The technique of data collection was the in-depth interview. The sample was determined by saturation of the data, non-probabilistic sampling was used. The information was analyzed from the proposal of Strauss and Corbin, who considered it open, axial and selective. Results: A total of nine female caregivers of children with hemophilia participated. The information was reduced and analyzed for the category of: experience of care with hemophilia: ignorance, changes and difficulties, and Hemophilia trajectory in the life of women: implications derived from care. Conclusion: There is an ignorance of the health sector and society by the human being and the difficulty of diagnosis, it is evident that the increase of gender inequality and negatively affects the development of women physically and socially.

Análisis bibliométrico de intervenciones basadas en terapia de tercera generación para niños y adolescentes en Iberoamérica y Europa / Bibliometric analysis of interventions based on third generation therapies in children and adolescents in Iberoamerica and Europe

Resumen El presente estudio es un análisis bibliométrico de las publicaciones en intervenciones basadas en las terapias de tercera generación en niños y adolescentes durante los años 2011-2016. Para esto se realizó un estudio descriptivo dentro del cual se analizaron 60 artículos científicos de diversas bases de datos como Proquest, Redalyc, Sage, ScienceDirect y Springer Science, Dialnet, Ebsco Host. Se evidenció que entre los años 2012 y 2014 se presentó un incremento en las publicaciones de terapias de tercera generación en Iberoamérica y Europa. La revista International Journal of Behavioral Consultation & Therapy presenta la mayor cantidad de publicaciones en este ámbito. En relación con el autor que presenta más publicaciones, se referencia a Swart, J como el principal. La revisión teórica y el estudio cuasi experimental fueron la metodología más reportada y el Mindfulness la terapia más utilizada. En cuanto al país con Mayor número de investigaciones en esta temática es Estados Unidos. Este estudio permite concluir que las terapias de tercera generación han comenzado a tomar fuerza en varios de los problemas comportamentales y emocionales en niños y adolescentes. Sin embargo, es necesario ampliar las investigaciones en este ámbito dado que en la mayoría de los artículos no se cuantifica el grado de eficacia.

Abstract The present study is a bibliometric analysis of publications on interventions based on third generation therapies in children and adolescents during the years 2011-2016. For this, a descriptive study was carried out in which 60 scientific articles from diverse databases were analyzed, such as Proquest, Redalyc, Sage, ScienceDirect and Springer Science, Dialnet, Ebsco Host. It was evidenced that between the years 2012 and 2014 there was an increase in the publications of third generation therapies in Ibero-America and Europe. The International Journal of Behavioral Consultation & Therapy presents the largest number of publications in this field. In relation to the author who presents the most publications, reference is made to Swart, J as the principal. The theoretical review and the quasi-experimental study were the most reported methodology and Mindfulness the most used therapy. As for the country with the largest number of investigations in this area is the United States. This study allows us to conclude that third generation therapies have begun to gain strength in several behavioral and emotional problems in children and adolescents. However, it is necessary to expand the research in this field since in most articles the degree of efficacy is not quantified.

Effect of exposition to chlorpyrifos upon plasmatic cholinesterases, hematology and blood biochemistry values in Bothrops asper (Serpentes: Viperidae).

The terciopelo (Bothrops asper), is one of the most important venomous snakes in Costa Rica and common on agriculture where insecticides are frequently used for pest control. To assess the exposure to organophosphates on captive B. asper, an experiment using chlorpyrifos and butyrylcholinesterase (BChE), as a biomarker was conducted. In addition to BChE, hematology, aspartate aminotransferase (AST), total proteins (TP) and albumin were measured after exposure. Different concentrations of chlorpyrifos were used in Group A (0.1%) and B (1%), while the Control Group received distilled water; each group was composed of 5 snakes. Values of BChE, AST, TP, and albumin were measured before exposure, and at 6, 12, 24, 196, 360 and 528 h post-exposure. Hematology values were measured after 24 h post-exposure. As result, an important variation between subjects in all groups before exposure was obtained. Moreover, BChE activity showed 37% inhibition of Group A when compared to Control Group at 12 h post-exposure, and a higher inhibition of Group B (97%) related to Control Group, at 6 h post-exposure. Recovery of BChE occurred towards 528 h, never reaching initial values. Despite some variation in the rest of parameters used, a marked relative lymphopenia and monocytosis occurred at 24 h, assuming stress as the main cause.