Advanced Breast Cancer Guidelines in Latin America: Assessment, Adaptation, and Implementation of Fifth Advanced Breast Cancer Consensus Guidelines.

PURPOSE: As the fifth international consensus on advanced breast cancer (ABC5) established guidelines for the management of this disease, the aim of this article was to present the applicability of the consensus recommendations and to generate knowledge to improve access. METHODS: Sixty-one recommendation statements were selected and discussed by 15 breast cancer experts from Latin America (LA). After the discussion, the level of consensus was determined through a vote. In addition to this, the level of access to each of the recommendations presented, according to the country and health system, was exposed. RESULTS: Latin American experts had a high level of agreement with the ABC5 consensus recommendations (range, 83%-100%). Twelve of 61 statements are not available for all patients in LA. Among the limitations to access, the following ones are described: limited access to certain technologies (stereotactic body radiotherapy, positron emission tomography-computed tomography), the high costs of drugs that limits access to treatment with CDK4/6 inhibitors, pertuzumab, or poly(ADP-ribose) polymerase inhibitors, and the lack of molecular tests for access to therapeutic targets, as well as the difficult geography and cultural diversity of our continent. CONCLUSION: Despite the great relevance of the recommendations of the ABC5 consensus guidelines, we highlight that we still need to improve access for all patients, regardless of the country or health system they are in, for which we call to action to policy makers and patient groups to improve clinical outcomes of patients with advanced breast cancer in our region.

Neonatal outcomes according to different degrees of maternal morbidity: cross-sectional evidence from the Perinatal Information System (SIP) of the CLAP network.

BACKGROUND: The burden of maternal morbidity in neonatal outcomes can vary with the adequacy of healthcare provision and tool implementation to improve monitoring. Such information is lacking in Latin American countries, where the decrease in severe maternal morbidity and maternal death remains challenging. OBJECTIVES: To determine neonatal outcomes according to maternal characteristics, including different degrees of maternal morbidity in Latin American health facilities. METHODS: This is a secondary cross-sectional analysis of the Perinatal Information System (SIP) database from eight health facilities in five Latin American and Caribbean countries. Participants were all women delivering from August 2018 to June 2021, excluding cases of abortion, multiple pregnancies and missing information on perinatal outcomes. As primary and secondary outcome measures, neonatal near miss and neonatal death were measured according to maternal/pregnancy characteristics and degrees of maternal morbidity. Estimated adjusted prevalence ratios (PRadj) with their respective 95% CIs were reported. RESULTS: In total 85,863 live births were included, with 1,250 neonatal near miss (NNM) cases and 695 identified neonatal deaths. NNM and neonatal mortality ratios were 14.6 and 8.1 per 1,000 live births, respectively. Conditions independently associated with a NNM or neonatal death were the need for neonatal resuscitation (PRadj 16.73, 95% CI [13.29-21.05]), being single (PRadj 1.45, 95% CI [1.32-1.59]), maternal near miss or death (PRadj 1.64, 95% CI [1.14-2.37]), preeclampsia (PRadj 3.02, 95% CI [1.70-5.35]), eclampsia/HELPP (PRadj 1.50, 95% CI [1.16-1.94]), maternal age (years) (PRadj 1.01, 95% CI [<1.01-1.02]), major congenital anomalies (PRadj 3.21, 95% CI [1.43-7.23]), diabetes (PRadj 1.49, 95% CI [1.11-1.98]) and cardiac disease (PRadj 1.65, 95% CI [1.14-2.37]). CONCLUSION: Maternal morbidity leads to worse neonatal outcomes, especially in women suffering maternal near miss or death. Based on SIP/PAHO database all these indicators may be helpful for routine situation monitoring in Latin America with the purpose of policy changes and improvement of maternal and neonatal health.

Metasearchers in the biomedical field An update / Metabuscadores en el área biomédica Una actualización

Abstract The biomedical field has benefited greatly from the influx of information and communication technologies. Over the last few years, enormous strides have been made in organizing, structuring and seeking information, facilitating this task, as evidenced by the various databases and search engines. In this context, metasearchers are a powerful tool for optimizing the effectiveness of searches for scientific evidence and, therefore, represent an added value both in clinical practice as well as in the research setting. This article is aimed at healthcare workers. The purpose is to update the basic concepts about metasearchers, their generalities and the main characteristics of the most outstanding ones in the biomedical field. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2587).

Resumen El área biomédica ha recibido grandes beneficios con el influjo de las tecnologías de la información y la comunicación. En los últimos años, en lo que respecta a organizar, estructurar y buscar información, se han visto enormes avances que facilitan esta labor y las diversas bases de datos y los motores de búsqueda dan cuenta de ello. En este contexto, los metabuscadores constituyen una herramienta poderosa para optimizar la eficacia de las búsquedas de evidencia científica y, por ende, representan un valor agregado tanto en la práctica clínica como en el escenario de la investigación. Este artículo está dirigido al personal de la salud. El propósito es actualizar conceptos básicos en cuanto a los metabuscadores, sus generalidades y las principales características de los más destacados en el área biomédica. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2587).

Qualitative public health research published in Colombian biomedical journals between 2011 and 2021 / Investigaciones cualitativas en salud pública publicadas en revistas biomédicas colombianas entre el 2011 y el 2021

Introduction: Qualitative research seeks to understand the meaning and perspective of individuals and investigates considering the context. This paradigm allows the interpretation and study of phenomena from their own complexity. In public health, qualitative research has gained ground, as it allows the study of subjective aspects of the health-disease process. Objective: To describe and analyze qualitative research on health issues published in Colombian journals between 2011 and 2021. Materials and methods: A descriptive study on qualitative health research published in Colombian journals between 2011 and 2021 was carried out. Results: Eighty-one articles were included. The journal with the highest number of publications was the Revista de Salud Pública (44.4%). The year with the highest production corresponded to 2019 and the main design was the fundamental theory (17.3%). In 79% of the articles, women were the main author and nursing was the most frequent profession of undergraduate training. The most frequent topic was HIV/AIDS (12.3%), followed by cancer (11.1%). In 24.6% of the studies, a software was used for the analysis. Conclusions: Qualitative research in public health has had a variable dynamic in scientific production between 2011 and 2021. Despite its benefits, the adoption of computer programs for qualitative analysis is rare. Nursing stands out as the area that concentrates the largest number of qualitative studies in public health with contributions on topics such as COVID-19 and HIV/AIDS.

Introducción. La investigación cualitativa busca comprender el sentido y la perspectiva de los individuos e indaga teniendo en cuenta el contexto. Este paradigma permite la interpretación y el estudio de los fenómenos desde su propia complejidad. En salud pública, la investigación cualitativa ha ganado terreno, pues permite estudiar aspectos subjetivos del proceso salud-enfermedad. Objetivo. Describir y analizar las investigaciones cualitativas en temas de salud pública publicadas en revistas colombianas entre el 2011 y el 2021. Materiales y métodos. Se llevó a cabo un estudio descriptivo sobre las investigaciones cualitativas en salud pública publicadas en revistas colombianas entre el 2011 y el 2021. Resultados. Se incluyeron 81 artículos. La revista con mayor cantidad de publicaciones fue la Revista de Salud Pública (44,4 %). El año con mayor producción correspondió al 2019 y el principal diseño fue la teoría fundamentada (17,3 %). En el 79 % de los artículos, las mujeres fueron el autor principal y la enfermería constituyó la profesión más frecuente de formación de pregrado. El tema más frecuente fue el VIH/sida (12,3 %), seguido por el cáncer (11,1%). En el 24,6 % de los estudios, se utilizó un software para el análisis. Conclusiones. Las investigaciones cualitativas en salud pública han tenido una dinámica variable en la producción científica entre el 2011 y el 2021. Pese a sus bondades, la adopción de programas informáticos para el análisis cualitativo es escasa. La enfermería se destaca como el área que concentra la mayor cantidad de estudios cualitativos en salud pública con aportes en temáticas como COVID-19 y VIH/sida.

Experiencia de estudiantes de medicina en un programa universitario de salud familiar y comunitaria de Bogotá (Colombia) / Experience of Medical Students in Family and Community Health Program at Bogotá University / Experience of Medical Students in Family and Community Health Program at Bogotá University

Introducción: el estudio se desarrolló en el contexto de un programa de salud familiar y comunitaria de una universidad de Bogotá (Colombia), del cual participan los estudiantes de Medicina. El objetivo fue comprender los significados y sentidos que los estudiantes otorgan a la práctica de salud familiar y comunitaria en el barrio El Codito, ubicado en la localidad de Usaquén al nororiente de Bogotá. Materiales y métodos: la investigación es un estudio cualitativo de tipo fenomenológico. Se realizaron entrevistas semiestructuradas a ocho estudiantes de medicina pertenecientes a un programa universitario de salud familiar y comunitaria en Bogotá. Resultados: del proceso de análisis emergieron cuatro categorías: a) realidad y territorio; b) institucionalidad y salud familiar y comunitaria; c) agencia y proyección profesional, y d) comunicación, escucha y reconocimiento del otro. Se evidenciaron narrativas embebidas de experiencias significativas, dificulta- des y retos. Se destaca el rol participativo del estudiante en la interacción y comunicación con la familia. Conclusiones: la experiencia da cuenta de un proceso dinámico de donde emergen vivencias que confrontan a los estudiantes. Esta experiencia refleja aprendizajes y desafíos de carácter multidimensional, en especial por la vulnerabilidad del sector. De dicho proceso surge el reconocimiento de otras realidades, el autorreconocimiento y la proyección del estudiante como agente social y futuro profesional en medicina.

Introduction: This study was developed in accordance to the family and community health program at Bogotá University. The objective of this study was to understand the experiences of students in family and community health practice in the El Codito neighborhood of northeast Bogotá (Colombia) in the town of Usaquen. Materials and methods: Medical students of the university participated in this qualitative phenomenological study. Eight semi-structured interviews were conducted with the students who participated in the family and community health program at Bogotá University (Colombia). Results: Four categories emerged from the analysis process: reality and territory, institutionality and family and community health, agency and professional projection, and communication; listening; and recognition of other. Embedded narratives of significant experiences, difficulties, and multidimensional challenges were evident. The student's role in the interaction and communication with families was highlighted. Self-recognition, recognition of other realities, and the student's projection as a future professional emerged from this process. Conclusions: The participation of students was a dynamic process from which experiences that confront students emerged. This experience reflected multidimensional learning and challenges due to the vulnerability of this sector. This process resulted in the recognition of other realities, self-recognition, and the student's projection as a social agent and future professional in medicine.

Introdução: este estudo foi desenvolvido no contexto de um programa de saúde familiar e comunitária de uma universidade de Bogotá, do qual participam estudantes de medicina. O objetivo do estudo foi compreender os significados e sentidos que os alunos atribuem à prática de saúde familiar e comunitária no bairro El Codito, localizado no nordeste de Bogotá (Colômbia). Materiais e métodos: para a pesquisa, foi realizado um estudo qualitativo de tipo fenomenológico. Foram realizadas oito entrevistas semiestruturadas com estudantes de medicina pertencentes a um programa universitário de saúde familiar e comunitária em Bogotá (Colômbia). Resultados: do processo de análise emergiram quatro categorias: realidade e território; institucionalidade e saúde familiar e comunitária; agenciamento e projeção profissional; comunicação, escuta e reconhecimento do outro. Evidenciaramse narrativas embutidas de experiências significativas, dificuldades e desafios. Destaca-se o papel participativo do aluno na interação e comunicação com a família. Conclusões: a experiência dá conta de um processo dinâmico do qual emergem experiências que confrontam os alunos. Essa experiência reflete aprendizados e desafios de natureza multidimensional, especialmente devido à vulnerabilidade do setor. Deste processo decorre o reconhecimento de outras realidades, o autorreconhecimento e a projeção do aluno como agente social e futuro profissional da medicina.

DNA methylation analysis identifies key transcription factors involved in mesenchymal stem cell osteogenic differentiation.

BACKGROUND: Knowledge about regulating transcription factors (TFs) for osteoblastogenesis from mesenchymal stem cells (MSCs) is limited. Therefore, we investigated the relationship between genomic regions subject to DNA-methylation changes during osteoblastogenesis and the TFs known to directly interact with these regulatory regions. RESULTS: The genome-wide DNA-methylation signature of MSCs differentiated to osteoblasts and adipocytes was determined using the Illumina HumanMethylation450 BeadChip array. During adipogenesis no CpGs passed our test for significant methylation changes. Oppositely, during osteoblastogenesis we identified 2462 differently significantly methylated CpGs (adj. p < 0.05). These resided outside of CpGs islands and were significantly enriched in enhancer regions. We confirmed the correlation between DNA-methylation and gene expression. Accordingly, we developed a bioinformatic tool to analyse differentially methylated regions and the TFs interacting with them. By overlaying our osteoblastogenesis differentially methylated regions with ENCODE TF ChIP-seq data we obtained a set of candidate TFs associated to DNA-methylation changes. Among them, ZEB1 TF was highly related with DNA-methylation. Using RNA interference, we confirmed that ZEB1, and ZEB2, played a key role in adipogenesis and osteoblastogenesis processes. For clinical relevance, ZEB1 mRNA expression in human bone samples was evaluated. This expression positively correlated with weight, body mass index, and PPARγ expression. CONCLUSIONS: In this work we describe an osteoblastogenesis-associated DNA-methylation profile and, using these data, validate a novel computational tool to identify key TFs associated to age-related disease processes. By means of this tool we identified and confirmed ZEB TFs as mediators involved in the MSCs differentiation to osteoblasts and adipocytes, and obesity-related bone adiposity.

Investigaciones cualitativas en salud pública publicadas en revistas biomédicas colombianas entre el 2011 y el 2021 / Qualitative public health research published in Colombian biomedical journals between 2011 and 2021

Introducción. La investigación cualitativa busca comprender el sentido y la perspectiva de los individuos e indaga teniendo en cuenta el contexto. Este paradigma permite la interpretación y el estudio de los fenómenos desde su propia complejidad. En salud pública, la investigación cualitativa ha ganado terreno, pues permite estudiar aspectos subjetivos del proceso salud-enfermedad. Objetivo. Describir y analizar las investigaciones cualitativas en temas de salud pública publicadas en revistas colombianas entre el 2011 y el 2021. Materiales y métodos. Se llevó a cabo un estudio descriptivo sobre las investigaciones cualitativas en salud pública publicadas en revistas colombianas entre el 2011 y el 2021. Resultados. Se incluyeron 81 artículos. La revista con mayor cantidad de publicaciones fue la Revista de Salud Pública (44,4 %). El año con mayor producción correspondió al 2019 y el principal diseño fue la teoría fundamentada (17,3 %). En el 79 % de los artículos, las mujeres fueron el autor principal y la enfermería constituyó la profesión más frecuente de formación de pregrado. El tema más frecuente fue el VIH/sida (12,3 %), seguido por el cáncer (11,1%). En el 24,6 % de los estudios, se utilizó un software para el análisis. Conclusiones. Las investigaciones cualitativas en salud pública han tenido una dinámica variable en la producción científica entre el 2011 y el 2021. Pese a sus bondades, la adopción de programas informáticos para el análisis cualitativo es escasa. La enfermería se destaca como el área que concentra la mayor cantidad de estudios cualitativos en salud pública con aportes en temáticas como COVID-19 y VIH/sida.

Introduction: Qualitative research seeks to understand the meaning and perspective of individuals and investigates considering the context. This paradigm allows the interpretation and study of phenomena from their own complexity. In public health, qualitative research has gained ground, as it allows the study of subjective aspects of the health-disease process. Objective: To describe and analyze qualitative research on health issues published in Colombian journals between 2011 and 2021. Materials and methods: A descriptive study on qualitative health research published in Colombian journals between 2011 and 2021 was carried out. Results: Eighty-one articles were included. The journal with the highest number of publications was the Revista de Salud Pública (44.4%). The year with the highest production corresponded to 2019 and the main design was the fundamental theory (17.3%). In 79% of the articles, women were the main author and nursing was the most frequent profession of undergraduate training. The most frequent topic was HIV/AIDS (12.3%), followed by cancer (11.1%). In 24.6% of the studies, a software was used for the analysis. Conclusions: Qualitative research in public health has had a variable dynamic in scientific production between 2011 and 2021. Despite its benefits, the adoption of computer programs for qualitative analysis is rare. Nursing stands out as the area that concentrates the largest number of qualitative studies in public health with contributions on topics such as COVID-19 and HIV/AIDS.

DNA methylation analysis identifies key transcription factors involved in mesenchymal stem cell osteogenic differentiation

BACKGROUND: Knowledge about regulating transcription factors (TFs) for osteoblastogenesis from mesenchymal stem cells (MSCs) is limited. Therefore, we investigated the relationship between genomic regions subject to DNA-methylation changes during osteoblastogenesis and the TFs known to directly interact with these regulatory regions. RESULTS: The genome-wide DNA-methylation signature of MSCs differentiated to osteoblasts and adipocytes was determined using the Illumina HumanMethylation450 BeadChip array. During adipogenesis no CpGs passed our test for significant methylation changes. Oppositely, during osteoblastogenesis we identified 2462 differently significantly methylated CpGs (adj. p < 0.05). These resided outside of CpGs islands and were significantly enriched in enhancer regions. We confirmed the correlation between DNA-methylation and gene expression. Accordingly, we developed a bioinformatic tool to analyse differentially methylated regions and the TFs interacting with them. By overlaying our osteoblastogenesis differentially methylated regions with ENCODE TF ChIP-seq data we obtained a set of candidate TFs associated to DNA-methylation changes. Among them, ZEB1 TF was highly related with DNA-methylation. Using RNA interference, we confirmed that ZEB1, and ZEB2, played a key role in adipogenesis and osteoblastogenesis processes. For clinical relevance, ZEB1 mRNA expression in human bone samples was evaluated. This expression positively correlated with weight, body mass index, and PPARγ expression. CONCLUSIONS: In this work we describe an osteoblastogenesis-associated DNA-methylation profile and, using these data, validate a novel computational tool to identify key TFs associated to age-related disease processes. By means of this tool we identified and confirmed ZEB TFs as mediators involved in the MSCs differentiation to osteoblasts and adipocytes, and obesity-related bone adiposity.

Antifungal Activity of Avocado Seed Recombinant GASA/Snakin PaSn.

The avocado fruit (Persea americana) has become a significant fruit in the human diet for its nutritional properties. However, the seed is a source of bioactive molecules and has been poorly utilized. Previously, we reported that the PaSn gene is expressed in the avocado seeds, a cysteine-rich antimicrobial peptide (GASA/Snakin), and demonstrated its antibacterial activity. In this work, we report the recombinant production of PaSn in the Escherichia coli system and evaluate its antifungal activity against plant and human pathogen fungi. The recombinant peptide showed antifungal activity at 200 µg/mL against phytopathogens Colletotrichum gloeosporioides and Fusarium oxysporum and human pathogens Candida albicans and C. glabrata. Our results demonstrate the usefulness of a prokaryotic expression system for avocado antimicrobial peptide production. In conclusion, the snakin PaSn could be helpful in the control of postharvest avocado and other fruits' fungal diseases and human fungal pathogens.

La ilustración anatómica: comunión entre arte y medicina / The anatomical illustration: communion between art and medicine

El artículo describe de forma sucinta hechos claves en el discurrir histórico de la ilustración anatómica desde el siglo xv. Se realiza un breve repaso de la conexión entre el arte y la medicina en el Renacimiento, donde es clara la comunión entre médicos y artistas en torno a las disecciones anatómicas. Se resaltan algunos elementos históricos tras el origen de la profesión de ilustrador médico y se destaca, principalmente en el siglo xx, el protagonismo de algunos médicos ilustradores, aquellos que no solo han dado libertad a sus habilidades artísticas con el dibujo, sino que también han dedicado su vida al arte de la medicina.

Summary The article succinctly describes key events in the historical course of anatomical illustration since the 15th century. A brief review of the connection between art and medicine in the Renaissance period is made, where the communion of doctors and artists around anatomical dissections is clear. Some historical elements behind the origin of the profession of medical illustrator are highlighted and, mainly, the prominence in the 20th century of some medical illustrators, who have not only given freedom to their artistic skills with drawing, but also, have dedicated their lives to the art of medicine.

Internet de las cosas, salud pública y pandemias

Internet de las cosas está transformando el mundo a pasos acelerados. Esta nueva dimensión digital permite conectar millones de objetos a Internet, lo cual representa oportunidades para recopilar todo tipo de información. Entre los nuevos aliados de la salud pública están las mascarillas inteligentes y los drones conectados a Internet para apoyar el monitoreo de casos y la vigilancia epidemiológica. También se cuenta con Internet of Drones, la robó-tica y los wearables, los cuales se incorporan a ropa y accesorios gracias a la miniaturización de sensores. Así, la nueva salud pública podrá contar con datos masivos en pro de una salud pública menos reactiva y más predictiva. El propósito de este artículo es reflexionar sobre el papel de Internet de las cosas como aliado de la salud pública en la respuesta y el control de las pandemias.

The Internet of Things is transforming the world at a rapid pace. This new digital dimension allows millions of objects to be connected to the Internet, which represents opportunities to collect all kinds of information. Among the new allies of public health are smart masks and drones connected to the internet to support case monitoring and epidemiological surveillance. There is also Internet of Drones, robotics, and wearables, which are incorporated into clothing and accessories thanks to the miniaturization of sensors. Thus, the new public health will be able to count on massive data for a less reactive and more predictive public health. The purpose of this article is to reflect on the role of the Internet of Tings as an ally of public health in the response and control of pandemics.

Conductas de intimidación como forma de violencia en tiempos de pandemia y repercusión en la salud mental

RESUMEN Introducción: Muchas son las formas de violencia entre adolescentes, fenómeno que actualmente va en aumento. El desarrollo de las nuevas tecnologías y su uso indebido está causando una serie de desajustes emocionales y otros problemas mentales. El desastre sanitario que actualmente se vive ha puesto al descubierto tales situaciones. Objetivo: Describir los aspectos relacionados con conductas de intimidación o ciberbullying durante la pandemia, las causas que lo provocan, características de los afectados y las manifestaciones psicopatológicas que aparecen en quienes lo sufren. Métodos: Se realizó una revisión bibliográfica narrativa a través de una búsqueda en bases de datos bibliográficas como PubMed, Lilacs, Google académico, Cumed. Se utilizaron descriptores en inglés y español. Análisis e integración de la información: Se exponen argumentos relacionados con la intimidación como forma de violencia a través del uso de la tecnología y los desajustes a la salud mental que estos pueden ocasionar. Conclusiones: Los tiempos de crisis generan estrés. La pandemia que azota al mundo hace un poco más de un año no solo ha traído cifras elevadas de infectados y pérdidas de vidas humanas, también ha generado trastornos emocionales en las poblaciones más vulnerables Los niños y adolescentes se han visto afectados por la intimidación a través de la tecnología, que se ha reforzado por el apego excesivo a estos medios.

ABSTRACT Introduction: There are many forms of violence among adolescents, a phenomenon that is currently increasing. The development of new technologies and their misuse is causing a number of emotional misalignments and other mental problems. The current health disaster has exposed such situations. Objective: Describe the aspects related to bullying behaviors or cyberbullying during the pandemic, the causes that cause it, characteristics of those affected and the psychopathological manifestations that appear in those who suffer it. Methods: A narrative literature review was carried out through a search in bibliographic databases such as PubMed, Lilacs, Google scholar, Cumed. Descriptors were used in English and Spanish. Analysis and integration of information: Arguments related to intimidation as a form of violence through the use of technology and the mental health imbalances that these can cause are presented. Conclusions: Times of crisis generate stress. The pandemic that hit the world around a year ago has not only brought high numbers of infected and loss of human lives, it has also generated emotional disorders in the most vulnerable populations. Children and adolescents have been affected by bullying through technology, which has been reinforced by excessive attachment to these means.

Sinopsis de estudios primarios Herramienta de la medicina basada en la evidencia / Synopses of primary studies An evidence-based medicine tool

Resumen El crecimiento exponencial de la información biomédica en los últimos años, ha hecho que la tarea de mantenerse actualizado sea compleja debido a la masiva información a la que se puede acceder a través de la web. Hoy en día, conocer los fundamentos de las denominadas sinopsis de estudios primarios y su utilidad en el contexto de la práctica clínica y la medicina basada en la evidencia es de gran relevancia para la práctica diaria de estudiantes y médicos en ejercicio. El presente artículo pretende ser una herramienta tanto para quienes se inician en el mundo de la medicina basada en la evidencia como para quienes desean extender su conocimiento en torno a las sinopsis de estudios dentro del modelo piramidal de recursos de información. Los orígenes del modelo piramidal 6s se describen de forma puntual, se explica lo concerniente a las sinopsis de estudios y se aporta información sobre los principales sitios online para acceder a estos recursos. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2184).

Abstract The exponential growth of biomedical information in recent years has made the task of keeping up to date complex, due to the massive amount of information available on the web. Today, understanding the basics of the so-called synopses of primary studies and their usefulness in the context of clinical practice and evidence-based medicine, is highly relevant for the daily work of students and practicing physicians. This article aims to be a tool for both newcomers to the world of evidence-based medicine as well as those who want to broaden their knowledge of the synopses of studies within the Pyramid Model of data resources. The origin of the Pyramid Model is specifically described, the matter of study synopses is explained, and information is provided on the main online sites for accessing these resources. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2184).

PaDef (Persea americana var. drymifolia), a Plant Antimicrobial Peptide, Triggers Apoptosis, and Induces Global Epigenetic Modifications on Histone 3 in an Acute Lymphoid Leukemia Cell Line.

In recent years, it has been recognized that epigenetic alterations play an important role in the development and maintenance of cancer, including leukemias. Furthermore, it is known that these alterations are involved in the emergence of resistance to conventional chemotherapeutics. Consequently, molecules with an anticancer activity whose activity is ruled by epigenetic modifications are attractive to search for new therapies against cancer. The plant antimicrobial peptides have been widely evaluated as molecules with anticancer activity; however, the analysis of the epigenetic regulation induced by these molecules associated with this activity is scarce and still is an unexplored field. In this work, we show that the PaDef defensin, a plant antimicrobial peptide from Mexican avocado fruit (Persea americana var. drymifolia) is cytotoxic for Jurkat cell line from acute lymphoid leukemia cells, through an apoptotic process. PaDef inhibited cell viability in a concentration-dependent manner, with an IC50 = 47.3 µM. Treatment of Jurkat cells with PaDef (IC50) induced cell death by apoptosis dependent on caspases 8 and 9; besides, it was related to an increase in the production of reactive oxygen species and the loss of mitochondrial membrane potential. Interestingly, the inhibition of caspase activation by inhibitors of caspases 8 and 9 does not revert the reduction in viability, suggesting that other mechanisms, in addition to caspase activity, could be participating in the PaDef cytotoxic effect. Also, the modifications in the histone 3 tails induced by PaDef in Jurkat cells were evaluated, specifically acetylation and methylation. PaDef increased global histone 3 acetylation and lysine 9 specific marks (2-fold and up to 4-fold, respectively). These effects correlated with the reduction of the Histone Deacetylase activity (HDAC, ∼50%). Based on methylation marks, PaDef treatment increased lysine 9 di- and tri-methylation tags (2-fold in both cases). The epigenetic modulation induced by PaDef on Jurkat cells could be related to the chromatin compaction-decompaction promoting gene expression or repression; however, further studies are necessary to correlate these marks with the transcription of specific genes. Therefore, the study of new molecules that may have anticancer activity through epigenetic modulation is interesting.

Ausencia paterna en la infancia: vivencias en personas con enfermedad mental / Paternal absence in childhood: experiences of people with mental illnesses / Ausência paterna na infância: viver em pessoas com doença mental

Resumen (analítico) El objetivo del estudio consistió en comprender los fenómenos que emergen de la experiencia de la ausencia paterna durante la infancia del adulto con diagnóstico de enfermedad mental. La investigación se desarrolló mediante el análisis cualitativo de las narrativas recogidas en ocho entrevistas semiestructuradas; estas se realizaron a cuatro mujeres y cuatro hombres. Se expusieron los resultados según las seis categorías que emergieron del análisis: universo de la ausencia, miedo e incertidumbre, representación e idealización del padre, tristeza y soledad, estigma y diferencia e ícono del sustituto. Según los hallazgos, la ausencia del padre en la infancia de personas con enfermedad mental origina sentimientos y cogniciones de depresión, estigmatización, soledad y desprotección; estas se asocian a vivencias dolorosas e invitan a profundizar en su comprensión y abordaje terapéutico.

Abstract (analytical) The objective of the research was to understand the phenomena that emerged from the experiences of paternal absence during childhood in adults with mental illnesses. This qualitative research was conducted through semi-structured interviews conducted with men and women. The results are grouped into six categories that emerged from the analysis: the universe of absence, fear and uncertainty, representation and idealization of the father, sadness and loneliness, stigma and difference and the icon that is the substitute. Based on the results of the study, the absence of the father in childhood for people with mental illness contributes to feelings of depression, stigmatization, loneliness and lack of protection and are associated with painful experiences that require improved comprehension and a therapeutic approach.

Resumo (analítico) O objetivo do estudo foi compreender os fenômenos que emergem da vivência da ausência paterna na infância do adulto com diagnóstico de doença mental. A pesquisa foi desenvolvida por meio da análise qualitativa das narrativas coletadas em oito entrevistas semiestruturadas, realizadas em quatro mulheres e quatro homens. Os resultados são apresentados de acordo com as seis categorias que emergiram da análise: universo da ausência, medo e incerteza, representação e idealização do pai, tristeza e solidão, estigma e diferença e ícone do substituto. Baseado em descobertas, a ausência do pai na infância de pessoas com transtorno mental provoca sentimentos e cognições de depressão, estigmatização, solidão e falta de proteção, os quais estão associados a experiências dolorosas e convidam a aprofundar sua compreensão e abordagem terapêutica.

Bioactive Molecules From Native Mexican Avocado Fruit (Persea americana var. drymifolia): A Review.

Avocado (Persea americana Mill.) is a tree native from central and eastern México that belongs to the Lauraceae family. Avocado has three botanical varieties known as Mexican (P. americana var. drymifolia), West Indian (P. americana var. americana), and Guatemalan (P. americana var. guatemalensis). It is an oil-rich fruit appreciated worldwide because of its nutritional value and the content of bioactive molecules. Several avocado molecules show attractive activities of interest in medicine. Avocado fatty acids have beneficial effects on cardiovascular disease risk factors. Besides, this fruit possesses a high content of carotenoids and phenolic compounds with possible antifungal, anti-cancer and antioxidant activities. Moreover, several metabolites have been reported with anti-inflammatory effects. Also, an unsaponifiable fraction of avocado in combination with soybean oil is used for the treatment of osteoarthritis. The Mexican variety is native from México and is characterized by the anise aroma in leaves and by small thin-skinned fruits of rich flavor and excellent quality. However, the study of the bioactive molecules of the fruit has not been addressed in detail. In this work, we achieved a literature review on the inflammatory, immunomodulatory and cytotoxic properties of long-chain fatty acids and derivatives from Mexican avocado seed. Also, the antioxidant and anti-inflammatory properties of the oil extracted from the avocado seed are referred. Finally, the antimicrobial, immunomodulatory, and cytotoxic activities of some antimicrobial peptides expressed in the fruit are reviewed.

Evaluation of Virola oleifera activity in musculoskeletal pathologies: Inhibition of human multiple myeloma cells proliferation and combination therapy with dexamethasone or bortezomib.

ETHNOPHARMACOLOGICAL RELEVANCE: Virola oleifera (Schott) A.C. Smith, Myristicaceae, has been widely used in traditional medicine in Brazil to treat rheumatic pain, joint tumours, skin diseases, halitosis, bronchial asthma, haemorrhoids, and intestinal worms. Recently, research data showed the antioxidant properties in several oxidative stress-related models. However, there is no experimental evidence supporting its potential use in managing rheumatic diseases and bone malignancies. AIMS OF THE STUDY: To evaluate the therapeutic potential of the resin from Virola oleifera in joint and bone diseases, namely arthritis, osteosarcoma, chondrosarcoma, and multiple myeloma. MATERIALS AND METHODS: To determine Virola oleifera resin (VO) effects on arthritis-associated inflammation and cartilage degradation, the LPS-induced NO production, and mRNA and protein expression of ADAMTS5, MMP13, COL2, and ACAN, were evaluated in chondrocytes (ATDC5 and TC28 cell lines). The cytotoxic effects of VO (0.05-50 µg/ml) on multiple myeloma (ARH-77), osteosarcoma (SAOS-2), and chondrosarcoma (SW-1353) cell lines were analysed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. The VO effects, combined with dexamethasone or bortezomib, were evaluated in a multiple myeloma cell line. The mechanisms of VO, alone or in combination with bortezomib, were determined by cell cycle analysis through flow cytometry, while expression levels of p-Akt/Akt, p-ERK/ERK, p-p38/p38 MAPK, Bax, Bcl-2, and cleaved-caspase-3/caspase-3 proteins by Western blot. RESULTS: VO had no significant effect on LPS-induced NO production in chondrocytes at non-cytotoxic concentrations. VO treatment diminished the mRNA levels of metalloproteinases and ECM components; however, any significant effect was observed on the protein expression levels. The cell viability of a multiple myeloma cell line was strongly reduced by VO treatment in a dose- and time-dependent manner, while osteosarcoma and chondrosarcoma cell lines viability was significantly affected only by the highest dose assessed. In multiple myeloma cells, VO leads to G2/M cell cycle arrest. Furthermore, it synergizes with dexamethasone by increasing cell toxicity. Finally, VO reverts bortezomib activity by counteracting ERK1/2, Bax, and caspase-3 activation. CONCLUSIONS: The current work supports the ethnopharmacological use of Virola oleifera (Schott) A.C. Smith in bone and joint diseases, but there is no evidence for the amelioration of arthritis-associated inflammatory or catabolic processes. Our data also supports the potential use of Virola oleifera as adjuvant therapy to optimize the pharmacologic effects of current chemotherapeutic drugs. However, possible herb-drug interactions should be considered before clinical application.

Two Oleosins Expressed in the Mesocarp of Native Mexican Avocado, Key Genes in the Oil Content.

Intracellular lipid droplets (LD) provide the oil storage mechanism of plants. They are found within seeds as individual structures, even under conditions of cold stress and dehydration, due to the protein that covers them. This protein, called oleosin, is found exclusively in plants and has been widely studied in seeds. Avocado fruits (Persea americana Mill.) are rich in oil, which is stored in the mesocarp, not in the seeds. The presence of oleosin in the mesocarp tissue of avocadoes has been reported, but its physiological role is still unknown. In this study, we identify two genes that code for oleosin in the mesocarp of the native Mexican avocado. These sequences are very different from those of seed oleosins. Both genes are expressed during fruit ripening, while one, PaOle1, has the highest expression in the green fruit stage. The protein of PaOle1 is stable during the fruit ripening process and covers all the mesocarp LDs. The expression of PaOle1 gene and protein is organ specific to avocado mesocarp. Among avocadoes varieties oleosin abundance is directly related to oil content.

Tétanos generalizado en adulto. Reporte de caso / Adult generalized tetanus. Case report

RESUMEN Fundamento: El tétanos es una enfermedad infecciosa causada por las esporas de la bacteria Clostridium tetani que afecta el sistema nervioso. La inmunización contra esta enfermedad ha permitido reducir la morbilidad y la mortalidad en Cuba por esa causa. Los pocos casos reportados son pacientes sin previa vacunación contra el tétanos, por lo que constituye de interés para la comunidad científica el reporte de aquellos que desarrollan esa enfermedad después de haber sido vacunados. Objetivo: Describir el caso de un paciente con diagnóstico de tétanos generalizado a pesar de que ya había sido vacunado contra esa enfermedad. Presentación del caso: Paciente de 33 años, con el antecedente de haber sido vacunado contra el tétanos, al cual le diagnosticaron tétanos generalizado, por lo se decidió su ingresó en la unidad de cuidados intensivos. Clínicamente se manifestó por contracciones musculares generalizadas y rigidez, los síntomas y signos neurológicos tuvieron una duración de 4 semanas. A pesar de las complicaciones el paciente egresó con adecuada calidad de vida. Conclusiones: La presentación de este caso busca concientizar en la comunidad científica la importancia de considerar el diagnóstico de tétanos en pacientes ya vacunados, lo cual es poco frecuente y obliga a actuar con prontitud.

ABSTRACT Background: Tetanus is an infectious disease caused by the bacterium Clostridium tetani spores which affects the nervous system. In Cuba, immunization against this disease has made it possible to reduce morbidity and mortality from this cause. The few cases reported are patients without prior vaccination against tetanus, so is the interest to the scientific community the reporting of those who develop this disease after having been vaccinated. Objective: To describe a patient´s case with a generalized tetanus diagnosis despite has already been vaccinated against this disease. Case report: A 33-year-old patient, with a history of has been vaccinated against tetanus, and diagnosed with generalized tetanus, so it was decided he to be admitted to the intensive care unit. Clinically manifested by generalized muscle contractions and stiffness, the neurological symptoms and signs lasted 4 weeks. Despite the complications, the patient discharged from hospital with an adequate life quality. Conclusions: This case presentation searches for raising awareness in the scientific community about the importance of considering the diagnosis of tetanus in previous vaccinated patients, which is rare and requires quickness of action.

Internet de las cosas: Futuro y desafío para la epidemiología y la salud pública / Internet of things: The future and challenges for epidemiology and public health

Resumen Introducción: Internet vive una de las más grandes revoluciones de la historia denominada Internet de las cosas. En ella, tanto la epidemiología como la salud pública tienen gran potencial, ya que el nuevo mundo hiperconectado representará espacios de reinvención e innovación nunca antes imaginados en diversos aspectos del campo de la salud. Objetivo: Reflexionar sobre las posibilidades para la epidemiología y la salud pública ante el escenario de Internet de las cosas. Materiales y métodos: Revisión documental que incluyó textos físicos y bases de datos electrónicas. Resultados: Internet de las cosas representa para la epidemiología y la salud pública, una dimensión llena de oportunidades debido a las fuentes de datos masivos y a las tecnologías de la cuarta revolución industrial, aunque también nuevos desafíos, principalmente en cuanto a seguridad y privacidad de la información. Conclusiones: Ante la era de Internet de las cosas, para la salud en general y particularmente para la epidemiología y la salud pública, se abre la posibilidad múltiples fuentes de datos, muchas en tiempo real. Esto permitirá optimizar la perspectiva y la comprensión de numerosos eventos en salud, y con ello, lograr una atención en salud más proactiva y predictiva.

Abstract Introduction: Internet is living one of the greatest revolutions in history called Internet of things. Both epidemiology and public health have great potential in it since the new hyperconnected world will represent spaces for the reinvention and innovation never before imagined in various aspects of the health field. Objective: To reflect on the possibilities for epidemiology and public health in the scenario of the Internet of things. Materials and methods: Documentary review that included physical texts and electronic databases. Results: Internet of things represents for epidemiology and public health, a dimension full of opportunities due to the massive data sources and technologies of the fourth industrial revolution, but also new challenges, mainly in terms of security and privacy of information. Conclusions: The age of Internet of things has opened up the possibility of multiple data sources, many in real time, for epidemiology and public health. This will facilitate the optimization of the perspective and understanding of multiple health events and the achievement of more proactive and predictive health care.