Medicinal plants from Mexico used in the treatment of scorpion sting.

Scorpion sting envenomation is a major public health in Mexico. Rural communities rarely have antivenoms in the health centers, therefore, the people commonly resort to using medicinal plants to treat the symptoms of envenoming caused by scorpion venom, but this knowledge has not yet been reported in detail. In this review, we carry out a review of the medicinal plants used in Mexico against scorpion stings. PubMed, Google, Science Direct, and the Digital Library of Mexican Traditional Medicine (DLMTM) were used to collect data. The results showed the use of at least 48 medicinal plants distributed in 26 families, where Fabaceae (14.6%), Lamiaceae (10.4%), and Asteraceae (10.4%) have the maximum representation. The application of leaves (32%) was preferred followed by roots (20%), stem (17.3%), flowers (16%), and bark (8%). In addition, the most common method of use to treat scorpion stings is decoction (32.5%). The oral and topical routes of administration have similar percentages of use. In vitro and in vivo studies of Aristolochia elegans, Bouvardia ternifolia, and Mimosa tenuiflora were found, which showed an antagonistic effect on the contraction of the ileum caused by the venom of C. limpidus, likewise, they increased the LD50 of said venom and even B. ternofila showed reduced albumin extravasation. The results of these studies demonstrate the promising use of medicinal plants for future pharmacological applications; nevertheless, validation, bioactive compound isolation and toxicity studies are necessary to support and improve therapeutics.

Cardiovascular disease and survival in non-small cell lung cancer: a multicenter prospective assessment.

PURPOSE: Chronic inflammation contributes to cancer development via multiple mechanisms. We hypothesized that cardiovascular diseases (CVD) are also an independent risk factor for survival in non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Prospective multicenter data from 345 consecutive NSCLC patients treated from January 2013 to January 2017 were assessed. Median follow-up for all patients was 13 months (range 3-60 months). There were 109 patients with baseline heart disease (HD 32%), 149 with arterial hypertension (43%), 85 with diabetes mellitus (25%), 129 with hyperlipidemia (37%) and 45 with venous thromboembolism events (VTE 13%). A total of 289 patients (84%) were treated with platinum-based chemotherapy (CT), 300 patients (87%) received thoracic radiation therapy (RT; median radiation dose: 60 Gy [range 12-70]); and 50 (15%) patients underwent surgery. RESULTS: Our cohort consisted of 305 men (88%) and 40 (12%) women, with a median age of 67 years (range 31-88 years). Seventy percent had a Karnofsky performance status (KPS) ≥ 80. Multivariate analyses showed a lower OS and higher risk of distant metastasis in patients with advanced stages (p = 0.05 and p < 0.001, respectively) and HD (HR 1.43, p = 0.019; and HR 1.49, p = 0.025, respectively). Additionally, patients with VTE had lower local control (HR 1.84, p = 0.025), disease-free survival (HR 1.64, p = 0.020) and distant metastasis-free survival (HR 1.73, p = 0.025). CONCLUSIONS: HD and VTE are associated with a higher risk of mortality and distant metastasis in NSCLC patients. Chronic inflammation associated with CVDs could be an additional pathophysiologic factor in the development of distant metastasis.

ALBA Screening Instrument (ASI): A brief screening tool for Lewy Body Dementia.

BACKGROUND: Early detection of neurodegenerative diseases is essential for treatment and proper care of these patients. Screening tools available today are effective for several types of dementia. However, there is no one specific for Lewy Body Dementia (LBD). OBJECTIVES: The aim of this paper is to present a tool for early detection of LBD, accessible even for non-medical staff. METHODS: We stratified subjects (MMSE>20) into four groups: health controls (HC), Mild Cognitive Impairment (MCI), LBD and other dementias (Alzheimer and vascular). All subjects (age range 50-90) were examined with a comprehensive neuropsychological and neuropsychiatric evaluation, as well as neuroimaging to differentiate diagnosis between groups, fulfilling corresponding criteria. Both neurologists and neuropsychologists were blind to the performance on clinical evaluations and ASI, respectively. The sensitivity and specificity of the instrument were determined to differentiate LBD from other groups. RESULTS: We evaluated 427 subjects, 91 HC, 140 with MCI and 196 with dementia. In the dementia group, 75 were diagnosed with LBD and 121 with other dementias. ASI total score was 12.7±0.4 for LBD, 2.9±0.2 for HC, 5±0.7 for MCI, and 5.4±2.6 for other causes of dementia. ROC curve analysis showed a sensitivity of 90.7% and a specificity of 93.6% stands, with 9 as the cutoff with better test performance compared against other groups. CONCLUSION: ASI is a brief screening tool for LBD with high sensitivity and specificity and useful even for non-medical staff.

Programa integral para el cáncer en Cuba: Pautas para la gestión de implementación / Comprehensive program for cancer in Cuba: Guidelines for implementation management

Esta nueva edición sirve de orientación en la planificación y aplicación de intervenciones dirigidas a integrar el control del cáncer a las acciones del sistema nacional de salud, basa su actualización en el programa del médico y enfermera de la familia, y se estructura en paquetes tecnológicos como innovación para incorporar entre otros, los productos de la biotecnología. En ese sentido, organiza la gestión direccionada por el conocimiento, la socialización de las nuevas formas de organización establecidas para el control de la enfermedad.

[How does sleep deprivation during 24 hours on call duty affect the cognitive performance orthopaedic residents?]. / ¿Cómo afecta la privación de sueño durante una guardia de 24 horas las funciones cognitivas de los residentes de ortopedia y traumatología?

INTRODUCTION: Sleep deprivation is usually present in residents during their training program. The purpose of our study was to analyze the cognitive performance of a group of orthopaedic residents before and after 24 hours on call duty. METHODS: We include orthopaedic residents and their cognitive functions were evaluated by the following tests: Continuous Performance Test (CPT 2), Digit Spam (Versión 5), 1 letter Fonologic Fluence y Pasat Test. All the tests were done after a sleeping period at home of at least 6 hours and after being on call (sleeping less than 3 hours). RESULTS: Nineteen residents were included in the study. The median age was 27 ± 1.89 and 15 were male. The mean hours of sleeping at home was 6.5 (range 6-8) and after on call duty was 1.5 (range 0.5-3). Statistical difference were found in CPT 2 test en terms of correct answers (p=0.007), omissions (p=0.004) and perseverations (p=0.036). No significant differences were found in the other tests. CONCLUSION: Sleep deprivation after 24 hours on call duty affects cognitive performance of orthopaedic residents, increasing the number of errors and omissions.

Proceso de eliminación del mercurio en un hospital público de alta complejidad / Process of mercury elimination from a public tertiary-care hospital

El mercurio (Hg) es un tóxico metálico, ubícuo, con alto impacto en la salud humana y en los ecosistemas. Los efectos adversos sobre la población infantil dependen de la vulnerabilidad de este grupo etario. La toxicidad se manifiesta principalmente por sus conocidos efectos sobre el neurodesarrollo a partir del momento de la concepción hasta la adolescencia. El sector de la salud es una de las principales fuentes de emisión de Hg a nivel mundial. El Hg está presente en gran cantidad de insumos y dispositivos de uso médico en los establecimientos de salud. La rotura y el descarte de estos insumos producen pequeños derrames ocasionando así que este sector contribuya no sólo a alterar la calidad del ambiente laboral sino también, la carga global del tóxico. Un grupo multidisciplinario de profesionales de diferentes áreas comprometido en el cuidado del medio ambiente y la salud infantil trabajó para reemplazar el uso del mercurio en el Hospital Garrahan. Se describe el desarrollo de este proceso en cinco etapas: 1) Diagnóstico; 2) Concientización del personal; 3) Segregación del HG; 4) Reemplazo de insumos; 5) Monitoreo continuo.

Proceso de eliminación del mercurio en un hospital público de alta complejidad / Process of mercury elimination from a public tertiary-care hospital

El mercurio (Hg) es un tóxico metálico, ubícuo, con alto impacto en la salud humana y en los ecosistemas. Los efectos adversos sobre la población infantil dependen de la vulnerabilidad de este grupo etario. La toxicidad se manifiesta principalmente por sus conocidos efectos sobre el neurodesarrollo a partir del momento de la concepción hasta la adolescencia. El sector de la salud es una de las principales fuentes de emisión de Hg a nivel mundial. El Hg está presente en gran cantidad de insumos y dispositivos de uso médico en los establecimientos de salud. La rotura y el descarte de estos insumos producen pequeños derrames ocasionando así que este sector contribuya no sólo a alterar la calidad del ambiente laboral sino también, la carga global del tóxico. Un grupo multidisciplinario de profesionales de diferentes áreas comprometido en el cuidado del medio ambiente y la salud infantil trabajó para reemplazar el uso del mercurio en el Hospital Garrahan. Se describe el desarrollo de este proceso en cinco etapas: 1) Diagnóstico; 2) Concientización del personal; 3) Segregación del HG; 4) Reemplazo de insumos; 5) Monitoreo continuo

Monitoring cyclosporine microemulsion at two hours post dosing in pediatric maintenance liver transplant recipients.

Cyclosporine absorption has been key to obtaining adequate results in immunosuppressive regimens. Since 2005, we have used a different monitoring program for Cyclosporine among pediatric liver transplant recipients namely, two hours post dosing concentrations (O(2)). This study of 128 patients included 50.8% males and 64.8% recipients of cadaveric livers. Their main reasons for transplantation were as follows: 43.8% acute liver failure and 37.5% biliary atresia. Mean age at time of transplantation was 5.4 +/- 4.5 years for boys and 3.4 +/- 3.3 years for girls. Mean age at the beginning of C(2) monitoring was 8.9 +/- 4.8 years and time elapsed since transplantation was 53.6 +/- 36.4 months. The initial Cyclosporine dose of 5.5 +/- 5 mg/kg/d had been reduced by month 24 to 4.5 +/- 1.5 mg/kg/d. Estimation of glomerular filtration rate (eGFR) was performed using the Schwartz formula. Baseline creatinine and eGFR were 0.73 +/- 0.49 mg/dL and 111.99 +/- 28.27 mL/min.m(2) versus 24-month creatinine and eGFR of 0.69 +/- 0.20 mg/dL and 122.26 +/- 24.47 mL/min.m(2), respectively (P < .05). Eight patients experienced acute rejection episodes, 4 had chronic rejection, 3 posttransplantation proliferative diseases (PTLD) were reported, and 2 patients died. Cyclosporine C2 monitoring allowed a trend toward long-term dose reduction. Consequently we observed significant improvement in renal function. Acute/chronic rejection rates were low, which suggested that C(2) monitoring was effective to control immunosuppressive therapy.The low incidence of PTLD and patient mortality showed that there was an adequate balance between safety and efficacy profiles.

Reduction of parasite levels in blood improves pregnancy outcome during experimental Trypanosoma cruzi infection.

Infection with a myotropic Trypanosoma cruzi clone induces maternal fertility failure. In the current work, we evaluated whether reduction of maternal parasitaemia before mating has beneficial effects on pregnancy outcome. Female mice were subjected to benznidazole (Bz) treatment after infection. On day 30 of therapy, mating was assessed and pregnancy outcome was determined on day 14 of gestation. Fetal resorptions diminished in T. cruzi-infected Bz-treated mice compared with T. cruzi-infected untreated mice. This was in agreement with the reduction in the blood/solid tissue parasite load and with the percentage of necrotic foci in placental samples from T. cruzi-infected Bz-treated females. To study eventual changes in the immune homeostasis of T. cruzi-infected Bz-treated mice, activation of the immune system was evaluated at the end of Bz therapy and before mating. We found specific IgG1 reduction resulting in a predominance of specific IgG2a, reduced numbers of CD69+ CD4+ cells and diminished frequency and numbers of CD44+ T cells. Concanavalin A-stimulated splenocytes from T. cruzi-infected Bz-treated mice produced higher amounts of IFN-gamma than T. cruzi-infected untreated mice. These results indicate that reduction of maternal parasite load improves pregnancy outcome. These findings correlate with a favourable modulation of the immune response.

Aeromonas hydrophila and its relation with drinking water indicators of microbiological quality in Argentine.

In Argentine, water municipal supplies disinfection is carried out by chlorine. We have isolated Aeromonas hydrophila from a chlorinated water supply in Buenos Aires that fulfilled Argentinean microbiological quality standards. It is an aquatic organism that could produce cytotoxins and enterotoxins associated with acute gastroenteritis and wound infections in human and hemorrhagic septicaemia of fish, reptiles and amphibians. The isolated strain produced protein bands at isoelectric point in the range of 4.6-5.3 lightly labile at 56 degrees C and heat labile at 100 degrees C non cholera antitoxin reactive in electrofocusing assay (IEF) and showed hemolytic activity thermolabile at 56 degrees C and 100 degrees C in 5% rabbit erythrocytes in phosphate buffered saline. A cytotoxic effect thermolabile at 56 degrees C and 100 degrees C and a cytotonic activity were demonstrated in Vero cell cultures. Survival assay of A. hydrophila and indicator organisms would show no correlation between their contamination sources. Biofilms production could explain the persistence of this gram negative pathogen organism in chlorinated tap water. A water system supply maintenance program and pasteurisation may be performed in spite of water chlorination.

Relative weight of glucose, insulin and parathyroid hormone in the urinary loss of phosphate by chronically diabetic rats.

This report deals with the relationships between glucose (G) and insulin on the tubular transport of phosphate (P) in chronically diabetic rats with high plasma levels of parathyroid hormone (PTH). Alloxan-induced diabetes leads to phosphorus depletion of the soft tissues. This phenomenon appears associated with weight loss and negative P balances caused by the increased urinary P excretion. Administration of 2 IU of insulin/100 g body weight (bw) to diabetic rats normalized their P balance and body weight. The effect of parathyroid function on the P metabolism of diabetic rats was investigated with balance experiments. Diabetic rats, intact or thyroparathyroidectomized (TPTX), have a greater urinary excretion of P than their controls. However, in control rats, the ratio intact:TPTX for urinary P is 1.0:0.76, showing the antiphosphaturic effect of parathyroid ablation. For diabetic animals, on the other hand, the ratio is 1.0:1.44. The simultaneous deficit of insulin and PTH thus quadruples the urinary P loss, instead of compensating for each other. The contribution of insulin deficit and hyperglycemia to the defect in tubular reabsorption (TRP) was investigated with clearance experiments (done on anesthetized, perfused rats). Five experimental groups were used: Controls (C), diabetics (D), controls + glucose (C + G), diabetics + insulin (D + I) and diabetics + insulin + glucose (D + I + G). All experimental groups showed a linear relationship between the TRP of P and G. The regression equation for C is significantly different (F = 40.1, P < 0.001) from that of D animals. The slope value measure the number of mumoles of P per mumol of G reabsorbed. For C and D rats, the ratio P:G approximates 1:4 and 1:20, respectively. The increase in P:G ratios represents the competition between both substrates for tubular resorption. Glycemias up to 11 mM (C and D + I) exist concurrent with the P:G ratio 1:4 Glycemias above 25 mM (D, C + G and D + I + G) produce a P:G ratio of 1:20. Fractional excretion of P (FEP) increased significantly in untreated, chronically diabetic rats (0.47 +/- 0.12 vs controls = 0.05 +/- 0.01, P < 0.001). After a single intramuscular injection of insulin, the FEP decreased as a function of insulin levels. To normalize the FEP of diabetic rats in short-term experiments, insulin had to be administered in doses that produce plasma insulin levels 25 times greater than normal. The general information afforded by the present experiments shows that in untreated, chronically diabetic rats, insulin deficit plays an indirect role. The absence of PTH enhances the effect of hyperglycemia. The latter and the concurrent tubular overload of glucose are the cause of hyperphosphaturia in these animals.

Time course of hexachlorobenzene-induced alterations of lipid metabolism and their relation to porphyria.

A great deal of information concerning the effects of hexachlorobenzene on the haem metabolic pathway has been obtained but little is known about the effects of the drug on lipid metabolism. Consequently, the time course of phospholipid metabolism alteration caused by this xenobiotic was evaluated as related to changes in porphyrin metabolism with the aim to understand better the interregulation of both metabolisms. Female Wistar rats were treated with HCB (1 g/kg) over a 1-8 week period. Individual phospholipid content, [32P] incorporation, total lipid content, lipid peroxidation, uroporphyrinogen decarboxylase activity, its inhibitor generation and porphyrin content, were the parameters measured in the liver of treated rats. Phospholipid metabolism-with the exception of sphingomyelin-presents a biphasic behaviour, in both the endogenous contents and de novo synthesis. The turning point between both phases is the time at which levels of porphyrin and conjugated dienes increase, the latter compounds being involved in oxidative processes. On the other hand, sphingomyelin decreases continuously during the 8 weeks of treatment. It was also found that the malondialdehyde content increased during the early stages. The time sequence for haem metabolism parameters showed that the accumulation of porphyrins occurs after the decrease in uroporphyrinogen decarboxylase activity and the enzyme inhibitor formation, which are early events (first and second weeks). Porphyrins could not by themselves exacerbate uroporphyrinogen decarboxylase impairment or inhibitor generation. This study shows that hexachlorobenzene alters simultaneously phospholipid and porphyrin metabolisms from the early stages, and generates an oxidative environment that favours porphyrinogens and lipid oxidation at later stages. So, this oxidative environment links the alterations on both metabolisms.

Snakes and snakebite in Central America.

This review treats the general biology, taxonomy, distribution and venom apparatus of the venomous snakes of Central America. Consideration has been given to the chemistry, pharmacology and immunology of the venom, and particular attention is dispensed to the clinical problem, including the treatment, of envenomations by these reptiles.

Accelerated recovery from toxic acute renal failure with thyroxin: stimulation of renal phospholipid biosynthesis.

Thyroxine (T4) seems to accelerate recovery from various forms of acute renal failure. The mechanisms of this effect are still debated. We decided to evaluate if thyroxine enhances the recovery of HgCl2 renal failure through an increment in the mitotic activity or through an increase in membrane phospholipid biosynthesis of the regenerating tubular cells. Male Wistar rats were allocated to four groups: one group received 0.4 mg/100 g BW HgCl2 SC and saline IP (HgCl2 group); the second received the toxin and 24 and 48 h after it, T4 15 micrograms/100 g BW IP (HgCl2 + T4 group); a third group received saline SC and T4 IP (T4 group), and the last group received saline SC and IP (control group). On the third day GFR was evaluated by 24-h creatinine clearance and afterward rats were sacrificed and the kidneys removed. Some of them were studied histologically, evaluating the severity of the tubular lesion using a semiquantitative score (0-4) and the mitotic index (N mitotic figures per 10 high-power fields). In the other kidneys we studied phospholipid synthesis through the incorporation of 32 P into the different renal phospholipids of the several kidney regions. The T4-treated group had a better recovery of GFR after the toxin (HgCl2 + T4: 0.44 +/- .09 vs. HgCl2: 0.23 +/- .06, p < .05). Both HgCl2-treated groups had similar lesional scores and mitotic indexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Growth and development of bone mass in untreated alloxan diabetic rats. Effects of collagen glycosylation and parathyroid activity on bone turnover.

Body and skeletal growth and development were studied in alloxan-treated and age-matched control rats, between 3 and 23 weeks of age. For both groups the growth of the skeletal and body weights were in phase, with a maximum at 7 weeks of age. The growth data was assessed according to Parks' theory of feeding and growth. Alloxan-treated rats showed an important reduction in body and bone mass, with a greater impact on soft tissues. As expected, the asymptotic body and skeletal weights were reduced respect to controls. The time needed to attain 63% of mature food intake (Brody's 'time constant') was also reduced, indicating that maturation occurred at an earlier age than controls. The diabetic state is characterized by a reduced food conversion efficiency. Despite hyperfagia, alloxan-treated rats showed circa one-half the body and skeletal weights of age-matched controls. The following adverse effects of alloxan diabetes on bone tissue were observed: (a) a decrease in trabecular bone volume (femoral metaphyses) and cortical width (femoral diaphyses), (b) increased bone collagen glycosylation as a function of extracellular glucose concentration, (c) increased resistance of bone collagen to collagenase hydrolysis, (d) decreased rate of bone resorption except under strongly stimulated parathyroid function, (d) significantly lower ashes/bone matrix ratio in diabetic rats with more than 10 weeks of diabetes, and (e) no histological evidence of osteomalacia.