[Lifestyle modification and risk factor control in the prevention and treatment of atrial fibrillation]. / Modificaciones en el estilo de vida y control de los factores de riesgo en la prevención y el tratamiento de la fibrilación auricular.

Atrial fibrillation (AF) is the most prevalent arrhythmia and is related with significant morbidity, mortality and costs. In spite of relevant advances in the prevention of embolic events and rhythm control, little has been done to reduce its prevalence, progression and impact, since it increases with ageing as well as with common risk factors such as alcohol intake, tobacco use and stress as well as with arterial hypertension, diabetes mellitus, heart failure, sleep apnea, kidney failure, chronic pulmonary obstructive disease, ischemic heart disease and stroke, among other important comorbidities. Fortunately, new evidence suggests that lifestyle modifications and adequate risk factors and comorbidities control could be effective in primary and secondary AF prevention, especially in its paroxysmal presentations. This is why a multidisciplinary approach integrating lifestyle modifications, risk factors and comorbidities control, is necessary in conjunction with rhythm or rate control and anticoagulation. Unfortunately, that holistic approach strategy is not considered, is scarcely studied or is subtilized in general clinical practice. The present statement's objectives are to: 1) review the relationship between habits, risk factors and illnesses with AF, 2) review the individual and common physiopathology mechanisms of each one of those conditions that may lead to AF, 3) review the effect of control of habits, risk factors and co-morbidities on the control and impact of AF, and 4) supply guidelines and recommendations to start multidisciplinary and integrative AF treatment.

La fibrilación auricular (FA) es la arritmia más frecuente y se asocia con importante morbilidad, mortalidad y costos. A pesar de los grandes avances en la prevención de eventos embólicos y en el control del ritmo, poco se ha realizado para reducir su prevalencia, progresión e impacto, debido a que incrementa con la edad y con la presencia de múltiples factores de riesgo muy comunes en la población, como obesidad, sedentarismo, alcoholismo, tabaquismo y estrés, así como con hipertensión arterial sistémica, diabetes mellitus, insuficiencia cardiaca, apnea del sueño, enfermedad renal crónica, enfermedad pulmonar obstructiva crónica, cardiopatía isquémica y enfermedad vascular cerebral, entre otra comorbilidad importante. Afortunadamente, nuevas evidencias demuestran que las modificaciones en el estilo de vida y el control adecuado de los factores de riesgo y de la comorbilidad pueden ser efectivos en la prevención primaria y secundaria de la FA, en especial en sus formas paroxísticas; para ello, es necesario un manejo multidisciplinario que integre las modificaciones en el estilo de vida, el manejo de los factores de riesgo y el control de la comorbilidad en el tratamiento de la FA en conjunto con el control del ritmo o de la frecuencia y la anticoagulación. Por desgracia, en la práctica clínica estas estrategias a menudo no se tienen en cuenta, son infrautilizadas y poco estudiadas. Los objetivos del presente posicionamiento son: 1) revisar la relación de los factores de riesgo y la comorbilidad con la FA, 2) revisar los mecanismos fisiopatológicos de cada una de estas condiciones, 3) revisar el impacto del control de los factores de riesgo y de la comorbilidad en el control y en el impacto de la FA, y 4) proporcionar guías y recomendaciones para la puesta en práctica de programas de tratamiento multidisciplinario e integral en pacientes con FA.

Fibrilación auricular en población mexicana: Diferencias en presentación, comorbilidades y factores de riesgo entre hombres y mujeres / Atrial fibrillation in Mexican population: Differences in presentation, comorbidities and risk factors between men and women

Resumen Objetivo: Conocer el comportamiento epidemiológico y asociaciones de la FA en población mexicana. Material y métodos: Analizamos 8,686 pacientes de 38 cardiólogos inscritos en REMECAR, divididos por edad y sexo. Comorbilidades estudiadas: obesidad, ERC, HTA, DM, dislipidemia, EVC, EPOC, hipotiroidismo, IC y CI. Programa: IBM SPSS. Resultados: FA en 498 pacientes (5.7%), mayor prevalencia en hombres (6.1 vs. 5.3%), mayor edad en mujeres (74.3 ± 12.1 vs. 70.5 ± 12.3 años, p < 0.0001). En mujeres menores de 60 años la FA se asoció con IC (p = 0.041), en hombres con ERC (p = 0.43), DM (p = 0.009), EVC (p = 0.001), hipotiroidismo (p = 0.001) e IC (p = 0.001). En mujeres mayores de 60 años se asoció con ERC (p = 0.001), dislipidemia (p = 0.001), EVC (p = 0.001), EPOC (p = 0.001) e IC (p = 0.001), en hombres con ERC (p = 0.002), EVC (p = 0.001), EPOC (p = 0.002), hipotiroidismo (p = 0.002), IC (p = 0.001) y CI (p = 0.033). En mujeres la FA se asoció con 1.13 veces mayor probabilidad de obesidad, 1.13 de HTA, 2.8 de ERC, 2.9 de EPOC, 4.3 de EVC y 6.5 de IC, en hombres la FA se asoció con 1.05 veces mas probabilidad de HTA, 1.4 de DM, 2.1 de ERC, 2.4 de EPOC, 3 de hipotiroidismo, 4.7 de EVC y 6 de IC. Conclusiones: La FA es una arritmia muy frecuente, con mayor prevalencia en pacientes que acuden a consulta de cardiología, en hombres y mayor edad de presentación en las mujeres. A mayor edad, mayor prevalencia de FA y de comorbilidades, la IC es la condición más frecuente con la que se asoció la FA.

Abstract Objective: To know the epidemiological behavior and associations of AF in Mexican population. Material and methods: 8,686 patients from 38 cardiologists participating in REMECAR were analyzed. They were divided by gender and age, the comorbidities studied were obesity, chronic kidney disease (CKD), high blood pressure (HBP), diabetes mellitus (DM), dyslipidemia, stroke, chronic obstructive pulmonary disease (COPD), hypothyroidism, heart failure (HF) and ischemic heart disease (IHD). Program used: IBM SPSS Statistic. Results: AF was diagnosed in 498 patients (5.7%), with higher prevalence in men (6.1% vs. 5.3%) and older age in women (74.3 ± 12.1 vs. 70.5 + -12.3 years, p<0.0001). In those under 60 years, AF was associated in women with HF, in men with CKD, DM, stroke, hypothyroidism and HF. In women older than 60 years, AF was associated with CKD, dyslipidemia, stroke, chronic COPD and HF, in men with CKD, stroke, COPD, hypothyroidism, HF and IHD. AF in women increase the probability 1.13 for obesity, 1.13 for HBP, 2.8 for CKD, 2.9 for COPD, 4.3 for stroke and 6.5 for HF, in men increase the probability 1.05 for HBP, 1.4 for DM, 2.1 for CKD, 2.4 for COPD, 3.0 for hypothyroidism, 4.7 for stroke and 6.0 for HF. Conclusions: AF is a very common arrhythmia, with a higher prevalence in patients attending the cardiology consultation, in men and with an older age of presentation in women. The older the age, the higher the prevalence of AF and comorbidities, HF is the most frequent condition associated with AF.

Trastornos psiquiátricos posteriores al diagnóstico oncológico de primera vez: Revisión sistemática / Psychiatric disorders after first-time cancer diagno-sis: A systematic review

Introducción: Los pacientes oncológicos tienen un mayor riesgo de desarrollar signos, síntomas y trastornos psiquiátricos y suicidio. El objetivo de la presente revisión sistemática fue recopilar evidencia respecto de los trastornos psiquiátricos posteriores al primer diagnóstico oncológico, para obtener información de calidad sobre su frecuencia, impacto en el paciente y tratamiento en el mundo. Metodología: Revisión sistemática de la literatura publicada desde enero de 2016 hasta marzo de 2021. Las fuentes de información fueron artículos de revistas indexadas en bases de datos, como Pubmed, Wiley Online Library, y Google académico. Se incluyeron artículos científicos sobre trastornos psiquiátricos después del diagnóstico oncológico; desde 2016 hasta marzo de 2021; en idioma castellano o inglés, originales, con diseño observacional, analítico, prospectivo, retrospectivo, transversal, de series de casos, revisiones sistemáticas y metaanálisis, con un nivel de calidad de la evidencia según el sistema GRADE "Alto y Moderado" y un grado de cumplimento de CONSORT, PRISMA-p, o STROBE ≥ 75 %. Resultados: Se incluyeron 19 artículos; con una población total de 6 377 483 pacientes adultos. Dentro de los trastornos mentales más frecuentes se encontraron ansiedad (1.8 %-78.8 %); depresión (4.2 %- 61.1 %) y estrés (1.9 %-56.1 %). La aparición de estos trastornos se relacionó con mayor sintomatología y peor pronóstico, aumentando las visitas al hospital y con esto mayor mortalidad (P < 0.05). El abordaje psicoterapéutico debe ser personalizado, enfocado en fortalecer la resiliencia, autoestima, afrontamiento y resolución de crisis. Conclusión: Los trastornos psiquiátricos después del primer diagnóstico oncológico son frecuentes, tienen un impacto negativo en el pronóstico y calidad de vida de los pacientes, por lo que es necesario un diagnóstico y tratamiento oportuno, mediante un esquema psicoterapéutico personalizado a cada paciente.

Introduction: Cancer patients are at increased risk of developing signs, symptoms, psychiatric disorders, and suicide. The objective of this systematic review was to collect evidence regarding psychiatric disorders after the first oncological diagnosis and obtain quality information on their frequency, impact on the patient, and treatment in the world. Methodology: Systematic review of the literature published from January 2016 to March 2021. The sources of information were articles from journals indexed in databases, such as PubMed, Wiley Online Library, and Google Scholar. Scientific papers on psychiatric disorders after cancer diagnosis were included; from 2016 to March 2021; in Spanish or English, original, with an observational, analytical, prospective, retrospective, cross-sectional, case series, systematic review, and meta-analysis de-sign, with a level of quality of evidence according to the GRADE system "High and Moderate" and a grade of compliance with CONSORT, PRISMA-p, or STROBE ≥ 75%. Results: Nineteen articles were included, with a total population of 6,377,483 adult patients. Among the most frequent mental disorders were anxiety (1.8%-78.8%), depression (4.2%-61.1%), and stress (1.9%-56.1%). The appearance of these disorders was related to more significant symptoms and worse prognosis, increased hospital visits, and higher mortality (P < 0.05). The psychotherapeutic approach must be personalized and strengthen resilience, self-esteem, coping, and crisis resolution. Conclusion: Psychiatric disorders after the first oncological diagnosis are frequent; they hurt patients' prognosis and quality of life. Timely diagnosis and treatment are necessary through a personalized psychotherapeutic scheme for each patient.

Atrial fibrillation in Mexican population: Differences in presentation, comorbidities and risk factors between men and women / Fibrilación auricular en población mexicana: Diferencias en presentación, comorbilidades y factores de riesgo entre hombres y mujeres

OBJECTIVE: To know the epidemiological behavior and associations of AF in Mexican population. MATERIAL AND METHODS: 8,686 patients from 38 cardiologists participating in REMECAR were analyzed. They were divided by gender and age, the comorbidities studied were obesity, chronic kidney disease (CKD), high blood pressure (HBP), diabetes mellitus (DM), dyslipidemia,stroke, chronic obstructive pulmonary disease (COPD), hypothyroidism, heart failure (HF) and ischemicheart disease (IHD). Program used: IBM SPSS Statistic. RESULTS: AF was diagnosed in 498 patients (5.7%), with higher prevalence in men (6.1% vs. 5.3%) and older age in women (74.3 ± 12.1 vs. 70.5 + -12.3 years, p<0.0001). In those under 60 years, AF was associated in women with HF, in men with CKD, DM, stroke, hypothyroidism and HF. In women older than 60 years, AF was associated with CKD, dyslipidemia, stroke, chronic COPD and HF, in men with CKD, stroke, COPD, hypothyroidism, HF and IHD. AF in women increase the probability 1.13 for obesity, 1.13 for HBP, 2.8 for CKD, 2.9 for COPD, 4.3 for stroke and 6.5 for HF, in men increase the probability 1.05 for HBP, 1.4 for DM, 2.1 for CKD, 2.4 for COPD, 3.0 for hypothyroidism, 4.7 for stroke and 6.0 for HF. CONCLUSIONS: AF is a very common arrhythmia, with a higher prevalence in patients attending the cardiology consultation, in men and with an older age of presentation in women. The older the age, the higher the prevalence of AF and comorbidities, HF is the most frequent condition associated with AF.

OBJETIVO: Conocer el comportamiento epidemiológico y asociaciones de la FA en población mexicana. MATERIAL Y MÉTODOS: Analizamos 8,686 pacientes de 38 cardiólogos inscritos en REMECAR, divididos por edad y sexo. Comorbilidades estudiadas: obesidad, ERC, HTA, DM, dislipidemia, EVC, EPOC, hipotiroidismo, IC y CI. Programa: IBM SPSS. RESULTADOS: FA en 498 pacientes (5.7%), mayor prevalencia en hombres (6.1 vs. 5.3%), mayor edad en mujeres (74.3 ± 12.1 vs. 70.5 ± 12.3 años,p < 0.0001). En mujeres menores de 60 años la FA se asoció con IC (p = 0.041), en hombres con ERC (p = 0.43), DM(p = 0.009), EVC (p = 0.001), hipotiroidismo (p = 0.001) e IC (p = 0.001). En mujeres mayores de 60 años se asoció conERC (p = 0.001), dislipidemia (p = 0.001), EVC (p = 0.001), EPOC (p = 0.001) e IC (p = 0.001), en hombres con ERC(p = 0.002), EVC (p = 0.001), EPOC (p = 0.002), hipotiroidismo (p = 0.002), IC (p = 0.001) y CI (p = 0.033). En mujeres la FA se asoció con 1.13 veces mayor probabilidad de obesidad, 1.13 de HTA, 2.8 de ERC, 2.9 de EPOC, 4.3de EVC y 6.5de IC, en hombres la FA se asoció con 1.05 veces mas probabilidad de HTA, 1.4 de DM, 2.1 de ERC, 2.4 de EPOC, 3 dehipotiroidismo, 4.7 de EVC y 6 de IC. CONCLUSIONES: La FA es una arritmia muy frecuente, con mayor prevalencia en pacientes que acuden a consulta de cardiología, en hombres y mayor edad de presentación en las mujeres. A mayor edad, mayor prevalencia de FA y de comorbilidades, la IC es la condición más frecuente con la que se asoció la FA.

Salud mental de equipos que trabajan en contextos de violencia hacia niñas, niños y jóvenes: una aproximación desde Terapia Ocupacional / Mental health of teams that work in contexts of violence towards children and young people: an approach from Occupational Therapy / Saúde mental de equipes que trabalham em contextos de violência contra meninas, meninos e jovens: uma abordagem a partir da Terapia Ocupacional

Las y los integrantes de equipos que abordan profesionalmente situaciones de violencia hacia niños, niñas y jóvenes en Chile pueden sufrir consecuencias para su salud mental, tanto por los problemas que abordan como por sus condiciones laborales, que pueden llegar a ser alienantes. Por esto, han comenzado a tener relevancia las acciones de cuidado de equipos. Este artículo desarrolla una aproximación reflexiva al cuidado de equipos desde la Terapia Ocupacional, considerando la actividad laboral como una ocupación colectiva que facilita el conocimiento mutuo, la confianza y el trabajo hacia un bien común. A modo de conclusión, la Terapia Ocupacional puede aportar, desde la perspectiva de ocupaciones co- lectivas, promoviendo la generación de políticas institucionales de cuidado de los equipos, así como el desarrollo de prácticas colaborativas que garanticen los derechos individuales y colectivos.

Members of teams that professionally address cases of violence towards children and teenagers in Chile may suffer mental health consequences do to the situations presented and their working conditions, which can be alienating. For this reason, measures to ensure team care have become more relevant. This article develops a reflective approach to team care from Occupational Therapy, considering the work-life as a collective occupation that facilitates mutual knowledge, trust, and work towards a common benefit. In conclusion, occupational therapy can contribute from the perspective of collective occupations, pro- moting the generation of institutional policies for the care of teams and the development of collaborative practices that guarantee individual and collective rights.

Os integrantes das equipes que atendem profissionalmente situações de violência contra crianças e jovens no Chile podem sofrer consequências em sua saúde mental, tanto pelos problemas que abordam quanto por suas condições de trabalho, que podem se tornar alienantes. Por este motivo, as ações de cuidado das equipes passam a ter relevância. Este artigo desenvolve uma abordagem reflexiva do cuidado em equipe a partir da Terapia Ocupacional, considerando a atividade laboral como uma ocupação coletiva que facilita o conhecimento mútuo, a confiança e o trabalho em prol de um bem comum. A modo de conclusão, a Terapia Ocupacional pode contribuir, na perspectiva das ocupações coletivas, promovendo a criação de políticas institucionais para o cuidado das equipes, bem como o desenvolvimento de práticas colaborativas que garantam os direitos individuais e coletivos.

Right Ventricular Longitudinal Strain Predicts Low-Cardiac- Output Syndrome After Surgical Aortic Valve Replacement in Patients With Preserved and Mid-range Ejection Fraction.

OBJECTIVES: The aim of this study was to analyze whether right ventricular free wall longitudinal strain (RVFWSL) could be a predictor of low-cardiac-output syndrome (LCOS) after surgical aortic valve replacement (SAVR) in patients with left ventricular ejection fraction ≥40%. DESIGN: Prospective, observational study. SETTING: The study was conducted at a third level university hospital. PARTICIPANTS: The study comprised 75 patients with severe aortic stenosis and LVEF ≥40% who underwent SAVR. The primary outcome was the occurrence of LCOS, and secondary outcomes were in-hospital mortality, hospital stay, or vasoplegic syndrome. INTERVENTIONS: Patients were divided into two groups (LCOS and no LCOS), and RVFWSL was analyzed to determine whether it is a predictor for LCOS. In addition, a receiver operating characteristic curve also was constructed, and the best cutoff value to predict LCOS was found. Furthermore, the reproducibility of RVFWSL measurements was evaluated. MEASUREMENT AND MAIN RESULTS: The incidence of LCOS was 20% in the present study's cohort. After multivariate analysis, cross-clamp time (odds ratio 1.06, 95% confidence interval 1.02-1.11; p = 0.002) and RVFWSL (odds ratio 1.41, 95% confidence interval 1.07-1.87; p = 0.015) were the only predictors of LCOS. However, RVFWSL did not show association with secondary outcomes (p > 0.05 for all). The area under the curve of RVFWSL to predict LCOS was 0.75, and the best cutoff value was -17.3%, with a sensitivity of 86.7% and specificity of 61.7%. CONCLUSIONS: RVFWSL seems to be a predictor of LCOS in patients with severe aortic stenosis and LVEF ≥40% undergoing SAVR. RVFWSL less than -17.3% may identify patients at increased risk for LCOS.

Anachronic Fruit Traits and Natural History Suggest Extinct Megafauna Herbivores as the Dispersers of an Endangered Tree.

Megafaunal seed dispersal syndrome refers to a group of traits attributed to the evolution of plants in the presence of large mammals. Present-day plants that bear these traits in areas where megafauna are absent are presumed to represent anachronic dispersal systems. Gomortega keule is an endangered tree species from a monotypic family (Gomortegaceae), endemic to Chile. Its fruit traits suggest adaptation to seed dispersal by large vertebrates; however, none are present today along its area of distribution. Here, we conducted a detailed revision on the fruit morphology of G. keule to examine whether its fruit traits fit a megafaunal dispersal syndrome. Additionally, we examined the fruit processing behavior of large domestic and captive wild animals fed with G. keule fruits, and its effect on germination. G. keule fruits had traits consistent with those of a Type 1 megafaunal fruit. Compared to intact, whole stones, seed germination probabilities decreased when fruits were handled by animals, suggesting that the seed was damaged during mastication and/or ingestion. Moreover, results from our feeding trials with elephants may also imply low efficiency of extinct gomphotheres as seed dispersers of this species. Our results also suggest that although domestic animals may disperse G. keule, it is unlikely that at present they can substitute the services of its original dispersers. Further investigation on seedling survival, local livestock management and forest management practices may help reinstate sexual regeneration in G. keule. Finally, integrating observations on fruit ecology and local people's knowledge with experimental data enriches our species-centered approach and may help to address regeneration problems in other endangered plants.

Integrating the STOP-BANG Score and Clinical Data to Predict Cardiovascular Events After Infarction: A Machine Learning Study.

BACKGROUND: OSA conveys worse clinical outcomes in patients with coronary artery disease. The STOP-BANG score is a simple tool that evaluates the risk of OSA and can be added to the large number of clinical variables and scores that are obtained during the management of patients with myocardial infarction (MI). Currently, machine learning (ML) is able to select and integrate numerous variables to optimize prediction tasks. RESEARCH QUESTION: Can the integration of STOP-BANG score with clinical data and scores through ML better identify patients who experienced an in-hospital cardiovascular event after acute MI? STUDY DESIGN AND METHODS: This is a prospective observational cohort study of 124 patients with acute MI of whom the STOP-BANG score classified 34 as low (27.4%), 30 as intermediate (24.2%), and 60 as high (48.4%) OSA-risk patients who were followed during hospitalization. ML implemented feature selection and integration across 47 variables (including STOP-BANG score, Killip class, GRACE score, and left ventricular ejection fraction) to identify those patients who experienced an in-hospital cardiovascular event (ie, death, ventricular arrhythmias, atrial fibrillation, recurrent angina, reinfarction, stroke, worsening heart failure, or cardiogenic shock) after definitive MI treatment. Receiver operating characteristic curves were used to compare ML performance against STOP-BANG score, Killip class, GRACE score, and left ventricular ejection fraction, independently. RESULTS: There were an increasing proportion of cardiovascular events across the low, intermediate, and high OSA risk groups (P = .005). ML selected 7 accessible variables (ie, Killip class, leukocytes, GRACE score, c reactive protein, oxygen saturation, STOP-BANG score, and N-terminal prohormone of B-type natriuretic peptide); their integration outperformed all comparators (area under the curve, 0.83 [95% CI, 0.74-0.90]; P < .01). INTERPRETATION: The integration of the STOP-BANG score into clinical evaluation (considering Killip class, GRACE score, and simple laboratory values) of subjects who were admitted for an acute MI because of ML can significantly optimize the identification of patients who will experience an in-hospital cardiovascular event.

Trombosis en paciente pediátrico con osteosarcoma / (Thrombosis in pediatric patient with osteosarcoma)

ResumenPaciente masculino de 12 años, con cuadro de 2 meses de evolución de dolor en cadera derecha y claudicación, con circulación colateral abdominal y edema de miembro inferior derecho al examen físico, con radiografías de pelvis que muestran masa en cresta iliaca derecha; ultrasonido de abdomen y miembro inferior derecho (con doppler ) con masa en cresta iliaca derecha asociada a trombo oclusivo total de vena iliaca común derecha, hasta vena cava inferior en su desembocadura en aurícula derecha; además, tomografía de tórax con múltiples vasos de circulación colateral con extenso trombo en la vena cava inferior, que se extiende a la aurícula derecha, cruzando la válvula tricúspide e insinuándose en el ventrículo derecho, con múltiples nódulos pulmonares bilaterales, que por sus características, son altamente sugestivos de lesiones metastásicas, y tomografía de pelvis que muestra extensa lesión infiltrante del hueso iliaco derecho, la cual compromete la totalidad del hueso hasta la altura del techo acetabular. Además, se documenta masa de tejido blando que desplaza músculos adyacentes, estructuras vasculares y vísceras de la pelvis hacia la izquierda, con patrón blástico, con áreas líticas que comprometen el aspecto lateral derecho de S3 y S4, encontrándose también infiltradas por la neoplasia.Debido al patrón de destrucción ósea y aspecto morfológico del trombo, se desaconseja trombectomía, y se realiza biopsia tumoral, con reporte de osteosarcoma; se inicia quimioterapia.

AbstractA 12-year-old male patient, with a 2-month history of pain in the right hip and claudication, with collateral abdominal circulation and lower right limb edema on physical examination, with pelvic radiographs showing a right iliac crest mass; ultrasound of abdomen and lower right limb (with Doppler) with right iliac crest mass associated with total occlusive thrombus of right common iliac vein, to inferior vena cava at its right atrial outlet; also chest tomography with multiple collateral circulation vessels with extensive thrombus in the inferior vena cava, extending to the right atrium, crossing the tricuspid valve and insinuating itself in the right ventricle, with multiple bilateral pulmonary nodules that, because of their characteristics are highly suggestive of metastatic lesions, and pelvic tomography which shows extensive infiltrating lesion of the right iliac bone, which compromises the entire bone to the height of the acetabular roof; in addition, a mass of soft tissue is documented that displaces adjacent muscles, vascular structures and viscera of the pelvis to the left, with blastic pattern, with lithic areas that compromise the right lateral aspect of S3 and S4, being also infiltrated by the neoplasia.Due to the bone destruction pattern and the morphological aspect of the thrombus, thrombectomy is advised against and tumor biopsy is performed with osteosarcoma report and chemotherapy is initiated.

La Interrupción Terapéutica del Embarazo como Derecho Humano a la Salud. Un análisis desde el Bioderecho / The Therapeutic Interruption of Pregnancy as a Human Right to Health. An analysis from the Bioderecho / O aborto terapêutico como um Direito Humano à Saúde. Uma análise do Biodireito

Actualmente en Latinoamérica lo referente al Aborto abre el debate ético-jurídico en torno a la legalización del proceso. Si bien el debate sobre el Aborto está aún lejos de agotarse. Se pretende con esa revisión circunscribir la discusión específicamente a la Interrupción Terapéutica del Embarazo, entendiendo esta como un derecho a la salud de las mujeres, que ha sido plasmado en la jurisprudencia constitucional, y ha sido reconocido en la mayoría de las legislaciones tanto en América como en Europa. El bioderecho nos otorga una nueva perspectiva de análisis de la Interrupción Terapéutica del Embarazo al abordar el problema desde tres corrientes, biológica, ética y jurídica. Además, nos permitimos mediante ejercicios de derecho comparado y análisis de los razonamientos jurisprudenciales, aproximarnos a conclusiones con respecto de un problema de salud que afrontan miles de mujeres.

At present, in Latin America, abortion refers to the ethical-legal debate around the legalization of the process. While the debate on abortion is still far from exhausted. The purpose of this review is to circumscribe the discussion specifically to the Therapeutic Interruption of Pregnancy, understanding this as a right to women's health, which has been reflected in constitutional jurisprudence, and has been recognized in most of the legislations both in America As in Europe. The Bioderecho gives us a new perspective of analysis of the Therapeutic Interruption of Pregnancy in addressing the problem from three streams, biological, ethical and legal; We also allow comparative law exercises and analysis of jurisprudential reasoning to approximate conclusions regarding a health problem faced by thousands of women

Atualmente na América Latina abre-se o debate para a relação do aborto com os temas ético e jurídico em torno do processo de sua legalização. Mas o debate sobre o aborto ainda está longe de se esgotar. Pretende-se com esta revisão circunscrever a discussão especificamente ao aborto terapêutico, entendido como o direito à saúde das mulheres, que foi incorporada na jurisprudência constitucional, e tem sido reconhecida na maioria das leis na América e na Europa. O Biodireito nos dá uma nova perspectiva de análise do aborto terapêutico na abordagem do problema a partir de três eixos: biológicos, éticos e legais. Além disso, permite que o direito comparado através de exercícios e análise da abordagem de raciocínio jurisprudencial conclusa sobre problema de saúde enfrentado por milhares de mulheres.

Profile of Class I Histone Deacetylases (HDAC) by Human Dendritic Cells after Alcohol Consumption and In Vitro Alcohol Treatment and Their Implication in Oxidative Stress: Role of HDAC Inhibitors Trichostatin A and Mocetinostat.

Epigenetic mechanisms have been shown to play a role in alcohol use disorders (AUDs) and may prove to be valuable therapeutic targets. However, the involvement of histone deacetylases (HDACs) on alcohol-induced oxidative stress of human primary monocyte-derived dendritic cells (MDDCs) has not been elucidated. In the current study, we took a novel approach combining ex vivo, in vitro and in silico analyses to elucidate the mechanisms of alcohol-induced oxidative stress and role of HDACs in the periphery. ex vivo and in vitro analyses of alcohol-modulation of class I HDACs and activity by MDDCs from self-reported alcohol users and non-alcohol users was performed. Additionally, MDDCs treated with alcohol were assessed using qRT-PCR, western blot, and fluorometric assay. The functional effects of alcohol-induce oxidative stress were measured in vitro using PCR array and in silico using gene expression network analysis. Our findings show, for the first time, that MDDCs from self-reported alcohol users have higher levels of class I HDACs compare to controls and alcohol treatment in vitro differentially modulates HDACs expression. Further, HDAC inhibitors (HDACi) blocked alcohol-induction of class I HDACs and modulated alcohol-induced oxidative stress related genes expressed by MDDCs. In silico analysis revealed new target genes and pathways on the mode of action of alcohol and HDACi. Findings elucidating the ability of alcohol to modulate class I HDACs may be useful for the treatment of alcohol-induced oxidative damage and may delineate new potential immune-modulatory mechanisms.

Alcohol Versus Cannabinoids: A Review of Their Opposite Neuro-Immunomodulatory Effects and Future Therapeutic Potentials.

Due to the legalization of marijuana and the increased demand for cannabis and alcohol consumption, research efforts highlighting the biomedical consequences of the use of alcohol and cannabinoids are not only relevant to the substance abuse scientific field, but are also of public health interest. Moreover, an overview of the recent literature about alcohol and cannabinoids neuro-immunomodulatory effects highlighting their future therapeutic potentials will provide a significant contribution to science and medicine. Therefore, in the current review, we will first discuss briefly the prevalence of alcohol and marijuana abuse, followed by a discussion on the individual effects of alcohol and cannabinoids on the immune system; then, we will focus on the role of endocannabinoids on the alcohol-induced inflammatory effects. In addition, the review also incorporates cytokine array data obtained from human monocyte-derived dendritic cells, providing a different perspective on the alcohol and cannabinoid abuse divergent effects on cytokine production. The final section will highlight the therapeutic potential of cannabinoid receptors and the novel strategies to treat alcohol dependence as determined by in vitro, in vivo and clinical studies.

Alcohol and Cannabinoids Differentially Affect HIV Infection and Function of Human Monocyte-Derived Dendritic Cells (MDDC).

During human immunodeficiency virus (HIV) infection, alcohol has been known to induce inflammation while cannabinoids have been shown to have an anti-inflammatory role. For instance cannabinoids have been shown to reduce susceptibility to HIV-1 infection and attenuate HIV replication in macrophages. Recently, we demonstrated that alcohol induces cannabinoid receptors and regulates cytokine production by monocyte-derived dendritic cells (MDDC). However, the ability of alcohol and cannabinoids to alter MDDC function during HIV infection has not been clearly elucidated yet. In order to study the potential impact of alcohol and cannabinoids on differentiated MDDC infected with HIV, monocytes were cultured for 7 days with GM-CSF and IL-4, differentiated MDDC were infected with HIV-1Ba-L and treated with EtOH (0.1 and 0.2%), THC (5 and 10 µM), or JWH-015 (5 and 10 µM) for 4-7 days. HIV infection of MDDC was confirmed by p24 and Long Terminal Repeats (LTR) estimation. MDDC endocytosis assay and cytokine array profiles were measured to investigate the effects of HIV and substances of abuse on MDDC function. Our results show the HIV + EtOH treated MDDC had the highest levels of p24 production and expression when compared with the HIV positive controls and the cannabinoid treated cells. Although both cannabinoids, THC and JWH-015 had lower levels of p24 production and expression, the HIV + JWH-015 treated MDDC had the lowest levels of p24 when compared to the HIV + THC treated cells. In addition, MDDC endocytic function and cytokine production were also differentially altered after alcohol and cannabinoid treatments. Our results show a differential effect of alcohol and cannabinoids, which may provide insights into the divergent inflammatory role of alcohol and cannabinoids to modulate MDDC function in the context of HIV infection.

NESTING ECOLOGY OF THE OLIVE RIDLEY SEA TURTLE (Lepidochelys olivacea) (CHELONIIDAE) AT EL VALLE BEACH, NORTHERN PACIFIC, COLOMBIA / Ecología de anidación de la tortuga golfina (Lepidochelys olivacea) (Cheloniidae) en la Playa El Valle, Pacífico Norte, Colombia

The olive ridley (Lepidochelys olivacea) is the most common sea turtle to nest in Colombia. El Valle beach is considered the most important nesting beach for this species in South America. Intensive direct capture of nesting females and egg poaching for consumption and local commercial purposes has been a common practice for years. We conducted an analysis of the nesting ecology of the olive ridley on El Valle beach in the northern Pacific of Colombia in 2008. A total of 164 clutches were transferred to an artificial hatchery for protection. The peak of nesting occurred from the second half of August until the end of September, accounting for 64.6 % of all nests. Along the beach, the section most frequently used was Section 3, with 26 % of the nests. The nests were laid mainly in zone 3.69 %. We encountered 55 nesting females and marked 46 of them. Mean CCL was 64.9 ± 2.4 cm and mean CCW was 68.6 ± 2.6 cm. Females laid on average of 87.3 ± 14.2 eggs per clutch. We recorded two nesting events per female, with a mean inter-nesting period of 18.8 ± 4.2 days. The reproductive output for the season was 181.5 ± 34.8 eggs / female. Mean hatching success was 81.1 ± 12.1 % and mean emergence success was 77.6 ± 12.7 %. The incubation period was 65 ± 4.7 days. Our study is a valuable contribution to knowledge of the reproductive ecology of the olive ridley population regionally and globally.

En Colombia, la tortuga golfina (Lepidochelys olivacea) es la más común de las tortugas anidantes. La playa El Valle es considerada la más importante para anidación en Suramérica. La intensa captura de hembras y saqueo de huevos para consumo y comercio local ha sido una práctica común por años. Realizamos un análisis de la ecología de anidación de la tortuga golfina en la Playa El Valle, Pacifico Norte, durante la temporada de 2008. Un total de 164 nidadas fueron transferidas a viveros de protección. El pico de anidación ocurrió durante la segunda quincena de agosto y septiembre con un 64,63 % de las posturas. A lo largo de la playa, el sector 3 presento la mayor frecuencia de anidación con 26 %. Los nidos fueron desovados principalmente en la zona 3, con 69 %. Encontramos 55 hembras y 46 fueron marcadas. El LCC fue (promedio± DE: 64,9 ± 2,4 cm) y ACC fue (promedio ± DE: 68,6 ± 2,6 cm). Las hembras desovaron 87,3 ± 14,2 huevos por nidada. Registramos dos eventos de anidación por hembra, con un intervalo de (promedio ± DE: 18,8 ± 4,2 días). El producto reproductivo fue (promedio ± DE: 181,5 ± 34,8 huevos por hembra). El promedio en éxito de eclosión fue 81,1 ±12,1 % y de emergencia 77,6 ± 12,7 %. El período de incubación fue (promedio ± DE: 65 ± 4,7 días). Nuestros datos son una valiosa contribución al conocimiento de la ecología reproductiva de la población de tortugas golfina regional y globalmente.

Abnormal myocardial perfusion and risk of heart failure in patients with type 2 diabetes mellitus.

BACKGROUND: Diabetes is a major risk factor for heart failure (HF), although the pathophysiological processes have not been clarified. OBJECTIVE: To determine the prevalence of HF and of abnormal myocardial perfusion in diabetic patients evaluated using technetium (99m) sestamibi single-photon emission computed tomography. METHODS: An observational cross-sectional study was conducted that included patients with type 2 diabetes mellitus who underwent echocardiography to diagnose HF and a pharmacological stress test with intravenous dipyridamole to examine cardiac scintigraphic perfusion abnormalities. Clinical and biochemical data were also collected. RESULTS: Of the 160 diabetic patients included, 92 (57.6%) were in HF and 68 (42.5%) were not. When patients were stratified according to the presence of abnormal myocardial perfusion, those with abnormal perfusion had a higher prevalence of HF (93%) than those with normal perfusion (44.4%) (P<0.0001). Patients with HF weighed more (P=0.03), used insulin less frequently (P=0.01), had lower total cholesterol (P=0.05) and high-density lipoprotein cholesterol concentrations (P=0.002), and a greater number of their myocardial segments showed abnormal perfusion (P≤0.001). More HF patients had a history of myocardial infarction (P<0.001) compared with those without HF. In a logistic regression analysis, the number of segments exhibiting abnormal myocardial perfusion was an independent risk factor for HF. CONCLUSIONS: The prevalence of HF in diabetic patients was high and HF predominantly occured in association with myocardial ischemia.

Effect of ivabradine on endothelial function in diastolic and right heart failure patients.

Background. Ivabradine is an If ion current inhibitor that has proved to reduce mortality in patients with systolic heart failure by slowing heart rate without decreasing myocardial contractility. Photoplethysmography is a simple, low-cost optical technique that can evaluate vascular function and detect changes in blood flow, pulse, and swelling of tissular microvascular space. Objective. To evaluate the effect of ivabradine on endothelial function by photoplethysmography in diastolic and right heart failure patients. Methodology. 15 patients were included (mean age of 78.1 ± 9.2 years) with optimally treated diastolic and right heart failure. They underwent photoplethysmography before and after induced ischemia to evaluate the wave blood flow on the finger, using the maximum amplitude time/total time (MAT/TT) index. Two measurements were made before and after oral Ivabradine (mean 12.5 mg a day during 6 months of followup). Results. In the study group, the MAT/TT index was 29.1 ± 2.2 versus 24.3 ± 3.2 (P = 0.05) in basal recording and 30.4 ± 2.1 versus 23.3 ± 2.9 (P = 0.002), before versus after ischemia and before versus after Ivabradine intervention, respectively. Conclusions. Ivabradine administration improves endothelial function (shear stress) in diastolic and right heart failure patients.

Differential expression and functional role of cannabinoid genes in alcohol users.

BACKGROUND: Genetic factors account for about fifty percent of the risk for alcoholism and alcohol dependence (AD) has been reported to be influenced by cannabinoid receptors (CBRs) and the endocannabinoid system (ECS). Previous studies have focused on cannabinoids and alcohol-related effects in the CNS; however, the role CBRs play on alcohol effects in the immune system has not been elucidated yet. Since alcohol can affect immune responses and have detrimental effects on immune cells such as dendritic cells (DCs), we hypothesize that alcohol can exert its effects on DCs by modulating changes in CBRs, which in turn can regulate important DC functions such as cytokine production. METHODS: Therefore, we studied the expression of CNR1 and CNR2, and the novel cannabinoid G protein-coupled receptor (GPCR) 55 (GPR55) in human monocyte-derived dendritic cells (MDDCs) from alcohol users. CNR1, CNR2, and GPR55 genes were measured by qRT-PCR and protein by flow cytometry. MDDCs from alcohol users show significantly higher levels of CNR2 and GPR55 compared to MDDCs from non-users. These findings were further confirmed using MDDCs treated with alcohol. Inflammatory cytokines were measured in EtOH-treated and non-treated cells by antibody array. RESULTS: Functional effects of CBRs on MDDCs were shown by CB2 and GPR55 siRNA transfection. Transfected EtOH-treated cells showed significantly higher levels of proinflammatory cytokine production as measured by IL-1ß expression. Our results provide insights into alcohol mechanisms of DC regulation and show, for the first time, that alcohol is inducing CNR2 and GPR55 in human DCs.

Improvement of ventricular function in systolic heart failure patients with oral L-citrulline supplementation.

BACKGROUND: The utility of L-arginine and L-citrulline in treatment of arterial hypertension by increasing vascular oxide nitric availability has been demonstrated. Photoplethysmography, a simple and low-cost optical technique, makes it possible to assess vascular function and to detect changes in blood flow, pulse and swelling of the microvascular tissular space. The aim of the study was to evaluate the effect of L-citrulline supplementation on functional class, ejection fraction and peripheral blood flow in patients with systolic heart failure. METHODS: Thirty-five stable outpatients attending the Heart Failure Clinic at the INCMNSZ underwent clinical evaluation, radioisotopic ventriculography and photoplethysmography before and at the end of 4 months. They were randomized into two groups: experimental group, with oral L-citrulline supplementation (3 g/day, n = 20) and control group, without supplementation (n = 15). RESULTS: In the experimental group the left ventricular ejection fraction (LVEF) increased 20.3% at rest and 12.7% with stress, as well as the right ventricular ejection fraction at rest of 15.10% and 14.88% with stress. In addition, functional class improved in 35%, and the maximum amplitude time/total time (MAT/TT) index decreased 23.1%. These changes were statistically significant compared with the control group. CONCLUSIONS: Citrulline supplementation significantly improved the LVEF, the endothelial function (MAT/TT index) and functional class. Citrulline can be an important co-adjuvant in the treatment of stable and stable systolic heart failure patients.

La influenza en Costa Rica 2003-2006, un tema fundamental para la vigilancia epidemiológica actual / Influenza in Costa Rica 2003-2006, a fundamental issue for the current epidemiological surveillance

Anualmente la influenza causa aproximadamente 3.5 millones de casos severos en el mundo. Objetivo: Describir y analizar la situación epidemiológica de la influenza y apoyar el fortalecimiento de su sistema de vigilancia. Métodos: Estudio descriptivo retrospectivo. Se calculó incidencia, riesgo relativo, RR, intervalo de confianza al 95 por ciento, IC 95 por ciento, y número de egresos con sus promedios móviles, tasas de egreso hospitalario de influenza y neumonía. Fuentes de datos: los registros de notificación colectiva del Ministerio de Salud, la base de datos de egresos hospitalarios del Seguro Social y los registros de la vigilancia centinela del Centro Nacional de Influenza. Resultados: La incidencia anual mostró tendencia al aumento, R2 igual 0.9, con picos en marzo a abril, junio a septiembre y agosto a diciembre. Las tasas anuales de egreso hospitalario mostraron tendencia a disminuir, R2 igual 0.9, con picos en marzo a mayo, julio a septiembre y septiembre a octubre. El pico de aislamientos del laboratorio se presentó en el segundo semestre de cada año, más frecuente en los meses de julio, agosto y septiembre. discusión: Se cotejaron los datos de la vigilancia, los egresos hospitalarios y el laboratorio, los resultados no fueron suficientes para concluir si la influenza muestra estacionalidad. Se sugiere realizar un estudio del sistema de vigilancia de influenza para mejorar la calidad y el registro de los datos ya que es fundamental conocer la estacionalidad de la influenza y sus cambios para respaldar las intervenciones correspondientes y sus modificaciones.

Objective: To describe and analyze the influenza epidemiological situation in the past four years in order to support enhancement of the influenza surveillance system in Costa Rica.Methods: A descriptive, retrospective study was conducted. Incidence and hospital discharge rates were calculated. Sources of data were: collective notification forms of the Ministry of Health, the hospital discharge data base of the Costa Rican Social Security system as well as the influenza surveillance forms of the National Influenza Center. Results: Since 2005 collective information has been gathered monthly, by province, by age-groups and sex. From 2005 through 2006, the highest rates were found in the months of March and May. Regarding hospital discharges, mobile averages showed that a peak was reached between June and September. Laboratory diagnoses were highest during the months of July through September. Discussion: Collective notification is higher in the first semester; nevertheless, hospital discharge rates are higher between June and September which match the peak reached by laboratory diagnoses for influenza virus; this may suggest seasonality but there is a lack of robust data to confirm this; therefore, we suggest conducting further seasonality studies. This study supports the development of guidelines for the influenza surveillance process in Costa Rica.

T-cell distribution and adhesion receptor expression in metastatic melanoma.

PURPOSE: Metastatic malignant melanoma is a devastating disease with a poor prognosis. Recent therapeutic trials have focused on immunotherapy to induce development of endogenous antitumor immune responses. To date, such protocols have shown success in activation of tumor-specific CTL but no overall improvement in survival. To kill tumor, antigen-specific CTL must efficiently target and enter tumor tissue. The purpose of this study was to examine the pathway of leukocyte migration to metastatic melanoma. EXPERIMENTAL DESIGN: Peripheral blood and metastatic melanoma tissues (n = 65) were evaluated for expression of adhesion molecules using immunohistochemistry of tumor sections and flow cytometry of tumor-associated and peripheral blood CTL and compared with healthy controls. CTL expressing T-cell receptors for the melanoma antigen MART-1 were identified in a subset of samples by reactivity with HLA-A2 tetramers loaded with MART-1 peptide. RESULTS: Results show that the majority of metastatic melanoma samples examined do not express the vascular adhesion receptors E-selectin (CD62E), P-selectin (CD62P), and intercellular adhesion molecule-1 (CD54) on vessels within the tumor boundaries. Strong adhesion receptor expression was noted on vessels within adjacent tissue. Tumor-associated T lymphocytes accumulate preferentially in these adjacent areas and are not enriched for skin- or lymph node-homing receptor phenotype. CONCLUSION: Expression of leukocyte homing receptors is dysregulated on the vasculature of metastatic melanoma. This results in a block to recruitment of activated tumor-specific CTL to melanoma metastases and is a likely factor limiting the effectiveness of current immunotherapy protocols.