Toxicity profiles and protective effects of antifreeze proteins from insect in mammalian models.

Antifreeze proteins (AFPs), found in many cold-adapted organisms, can protect them from cold and freezing damages and have thus been considered as additional protectants in current cold tissue preservation solutions that generally include electrolytes, osmotic agents, colloids and antioxidants, to reduce the loss of tissue viability associated with cold-preservation. Due to the lack of toxicity profile studies on AFPs, their inclusion in cold preservation solutions has been a trial-and-error process limiting the development of AFPs' application in cold preservation. To assess the feasibility of translating the technology of AFPs for mammalian cell cold or cryopreservation, we determined the toxicity profile of two highly active beetle AFPs, DAFP1 and TmAFP, from Dendroides canadensis and Tenebrio molitor in this study. Toxicity was examined on a panel of representative mammalian cell lines including testicular spermatogonial stem cells and Leydig cells, macrophages, and hepatocytes. Treatments with DAFP1 and TmAFP at up to 500 µg/mL for 48 and 72 h were safe in three of the cell lines, except for a 20% decrease in spermatogonia treated with TmAFP. However, both AFPs at 500 µg/mL or below reduced hepatocyte viability by 20-40% at 48 and 72 h. At 1000 µg/mL, DAFP1 and TmAFP reduced viability in most cell lines. While spermatogonia and Leydig cell functions were not affected by 1000 µg/mL DAFP1, this treatment induced inflammatory responses in macrophages. Adding 1000 µg/mL DAFP1 to rat kidneys stored at 4 °C for 48 h protected the tissues from cold-related damage, based on tissue morphology and gene and protein expression of two markers of kidney function. However, DAFP1 and TmAFP did not prevent the adverse effects of cold on kidneys over 72 h. Overall, DAFP1 is less toxic at high dose than TmAFP, and has potential for use in tissue preservation at doses up to 500 µg/mL. However, careful consideration must be taken due to the proinflammatory potential of DAFP1 on macrophages at higher doses and the heighten susceptibility of hepatocytes to both AFPs.

Association of bilateral oophorectomy and menopause hormone therapy with mild cognitive impairment: the REDLINC X study.

BACKGROUND: Dementia is a major public health problem. Estrogen is a regulator of the central nervous system and its deficit could be involved in cognitive decline in older women. OBJECTIVE: This study aimed to evaluate the association of bilateral oophorectomy, menopause hormone therapy (MHT) and other factors on mild cognitive impairment (MCI). METHOD: The case-control study included 941 otherwise healthy postmenopausal women aged 60 years and over from six Latin American countries. Personal and family data were recorded and MCI was assessed using the Montreal Cognitive Assessment test (MoCA). RESULTS: Average age, years of education and body mass index were 66.1 ± 5.8 years, 12.4 ± 5.0 years and 26.0 ± 4.3 kg/m2, respectively. A total of 30.2% had undergone bilateral oophorectomy and 40.3% had used MHT. A total of 232 women (24.7%) had MCI. The prevalence of MCI was higher in women with intact ovaries and non-MHT users as compared to MHT users (29.3% vs. 11.7% [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.20-0.51]). Among oophorectomized women, MCI prevalence was higher among non-MHT users as compared to MHT users (45.2% vs. 12.8% [OR 0.18; 95% CI 0.10-0.32]). Logistic regression analysis determined that the variables associated with MCI were age >65 years (OR 1.69; 95% CI 1.20-2.38), parity (having >2 children; OR 1.69; 95% CI 1.21-2.37), bilateral oophorectomy (OR 1.56; 95% CI 1.09-2.24), hypertension (OR 1.41; 95% CI 1.01-1.96), being sexually active (OR 0.56; 95% CI 0.40-0.79), education >12 years (OR 0.46; 95% CI 0.32-0.65) and MHT use (OR 0.31; 95% CI 0.21-0.46). CONCLUSION: Age, parity, bilateral oophorectomy and hypertension are independent factors associated with MCI; contrary to this, higher educational level, maintaining sexual activity and using MHT are protective factors.

Polineuropatía desmielinizante inflamatoria crónica: revisión a propósito de un caso / Chronic inflammatory demyelinating polyneuropathy: review, case and report

Resumen La polineuropatía desmielinizante inflamatoria crónica (CIDP por sus siglas en inglés) corresponde a un espectro de diferentes fenotipos clínicos caracterizados por lesiones de naturaleza autoinmune, inflamatoria y desmielinizante, que afectan primariamente nervios periféricos y raíces nerviosas. Generalmente, los pacientes con CIDP presentan un curso crónico de discapacidad neurológica, pero hasta un tercio de los casos puede exhibir un curso remitente-recidivante. El fenotipo clásico involucra compromiso simétrico de la fuerza muscular y la sensibilidad proximal y distal, asociado a arreflexia generalizada. El diagnóstico requiere la demostración de la desmielinización de nervios mediante electromiografía o biopsia de nervios. Debido a la afectación de personas relativamente jóvenes, laboralmente activos, y a la gran discapacidad neurológica que puede generar, el tratamiento debiera ser iniciado precozmente. Los pilares de la terapia en su fase inicial son los corticoides intravenosos en altas dosis, inmunoglobulina intravenosa y la plasmaféresis, mientras que la terapia de mantención se basa, principalmente, en el uso de corticoides orales a bajas dosis. Este artículo presenta el caso de un paciente evaluado en nuestro hospital y diagnosticado con CIDP, y expone una revisión bibliográfica actualizada de la enfermedad.

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) can be defined as a spectrum of different clinical phenotypes which are characterized by autoimmune, inflammatory and demyelinating injuries, primarily affecting the peripheral nerves and nerve roots. Most patients with CIDP have a chronic course of neurological disability, but about a third of cases exhibit a relapsing-remitting course. Classic phenotype of CIDP involves symmetric compromise of proximal and distal muscle strength and sensitivity, associated with generalized areflexia. For an accurate diagnosis, demonstration of nerve demyelination by electromyography or nerve biopsy is required. Due to the affectation of relatively young, labor-active people and the high risk for neurological disability by the disease, treatment should be initiated early. The predominant lines of therapy, in its initial phase, are high-dose intravenous corticosteroids, intravenous immunoglobulin and plasmapheresis, while the maintenance therapy is mainly based on low-dose oral corticosteroids. This article presents a case report of a patient evaluated in our hospital and diagnosed with CIDP and exposes an updated literature review about this disease.

Epistemologías ocultas en el discurso de la salud pública. Una mirada para su resignificación transcompleja desde las disciplinas colaborativas y emergentes / Hidden epistemologies in the public health discourse. a look for its transcomplex resignification from collaborative and emerging disciplines

Los problemas fundamentales de la Salud Pública, han querido atribuírseles al proceso historiográfico de la modernidad y se han extrapolado a las prácticas universitarias, como si se tratara de situaciones de orden academicista, cuando sus explicaciones están dadas en un largo devenir diacrónico-histórico que ha arrastrado consigo la lógica heredada de la visión androeurocéntrica que se instaló en América Latina y Venezuela en todos los ámbitos del conocimiento de los cuales la Salud Pública forma parte importante. Por ello, urge plantear, lo oculto en el discurso de los distintos problemas de la Salud Pública, en los saberes colaborativos y emergentes como el histórico, epistemológico, la salud ocupacional, el saber médico, epidemiológico, bioanalítico y la violencia delincuencial juvenil. Develaremos lo que se ha ocultado en la matriz epistemológica de la modernidad por cada saber de lo humano, invisibilizando los derechos sociales de las mujeres y hombres poco abordados, lo relacionado a la participación social de las mujeres en sus derechos a la salud, lo oculto de la mortalidad materna, de la salud y medio ambiente laboral de los trabajadores y trabajadoras y de los procesos de violencia juvenil delincuencial. Mencionaremos, el origen sociohistórico que reivindica la epistemosemiología de la diversidad en la Salud Pública a partir de una ética de las diferencias y el avance para vencer la parálisis paradigmática, se disertará acerca de la militancia desde la perspectiva epistemológica del enfoque integrador transcomplejo como opción para resignificar la Salud Pública y develar la epistemología y la ética de lo oculto.

Fundamental public health problems, have wanted to attribute them to the historiography of the modernity process and have extrapolated the University practices and out of them, as if they were situations academicism, when in essence, their explanations are given in a long diachronic history-evolution that has been dragging with it the logic inherited vision androeurocentrism who settled in Latin America and Venezuela in all areas of the knowledge of which health Public an important part. Therefore, it urges us today consider in this article, what is hidden in the speech of the various problems of public health, in the collaborative and emerging knowledge as the historical, epistemological, occupational health, medical, epidemiological knowledge, bioanalytical and knowledge of youth criminal violence. We will discover all what has been hidden in the matrix of epistemological modern for each knowing human, be osbcuring rights social voices of women and men little discussed, related to the social participation of women in their rights to health, what is hidden from the maternal mortality related to the health and environment of workers and concerning the processes of delinquent youth violence. It will mention, origin socio-historical claimed the epistemosemiology of diversity in public health from an ethic of the differences and advance to beat the paradigmatic paralysis and shall be some lectures about militancy from the epistemological perspective of approach transcomplex integrator as an option to give a new meaning to public health and reveal the epistemology and ethics of the unseen.

Aspectos clínicos en el espectro de neuromielitis óptica: revisión de la literatura / Clinical aspects in neuromyelitis optica spectrum disorders: literature review

Neuromyelitis optica (NMO) is currently recognized as a broad spectrum of autoimmune disorders of the Central Nervous System (CNS), causing demyelinating and inflammatory injuries, primarily in the spinal cord and optic nerves, but also in other regions such as brainstem, diencephalon or specific brain areas. These disorders are grouped under the unifying term "NMO spectrum disorders" (NMOSD). For many years this pathological entity was thought like a variant of the Multiple Sclerosis (MS). However, current evidence shows that there are distinctive features of clinical presentation, pathophysiology, laboratory, neuroimaging and therapy response that distinguish NMOSD from the latter. Most patients with NMOSD are seropositive for autoantibodies (AQP4-IgG) againstAQP4, the major water channel ofastrocytes. New advances in research have allowed recognize that AQP4-IgG is pathogenic in NMOSD, probably by a mechanism involving complement dependent cellular cytotoxicity. Due to the severity of attacks in NMOSD and the high risk for neurological disability, treatment should be initiated as soon as the diagnosis is confirmed. Acute attacks ofoptic neuritis or myelitis are treated with high-dose intravenous corticosteroid and plasmapheresis. Maintenance therapy to avoid further relapses is based on low-dose oral corticosteroid and non-specific immunosuppressant drugs; nevertheless, to date there are no controlled randomized trials to confirm the safety and efficacy for the drugs currently used.

La Neuromielitis óptica (NMO) es reconocida hoy como un espectro amplio de trastornos autoinmunes del Sistema Nervioso Central (SNC), que causan lesiones desmielinizantes e inflamatorias, primariamente, en la médula espinal y nervios ópticos, pero también en otras regiones encefálicas como tronco cerebral, diencéfalo o áreas cerebrales específicas. Estos trastornos se agrupan bajo el término unificador "trastornos del espectro NMO". Por muchos años se pensó que esta entidad patológica era una variante de la Esclerosis Múltiple (EM). Sin embargo, la evidencia actual muestra que existen características de presentación clínica, fisiopatología, laboratorio, neuroimágenes, y respuesta a tratamiento, que diferencian NMOSD de esta última. La mayoría de los pacientes con NMOSD son seropositivos para un autoanticuerpo dirigido contra AQP4 (AQP4-IgG), el principal canal de agua expresado en los astrocitos. Nuevos avances en investigación han permitido reconocer que AQP4-IgG es patogénico en NMOSD, probablemente por un mecanismo de citotoxicidad celular dependiente de complemento. Debido a la severidad de los ataques en NMOSD, y al alto riesgo de generar discapacidad neurológica, el tratamiento debería ser iniciado en cuanto se confirma el diagnóstico. Los ataques agudos de neuritis óptica o mielitis son tratados con altas dosis de corticosteroides intravenosos y plasmaféresis. La terapia de mantención, para evitar futuras recaídas, está basada en la administración de corticosteroides orales a bajas dosis y en drogas inmunosupresoras, aunque a la fecha se carece de ensayos clínicos controlados que confirmen la seguridad y eficacia de las drogas usadas actualmente.

Immediate Sequential Bilateral Pediatric Vitreoretinal Surgery: An International Multicenter Study.

PURPOSE: To determine the feasibility and safety of bilateral simultaneous vitreoretinal surgery in pediatric patients. DESIGN: International, multicenter, interventional, retrospective case series. PARTICIPANTS: Patients 17 years of age or younger from 24 centers worldwide who underwent immediate sequential bilateral vitreoretinal surgery (ISBVS)-defined as vitrectomy, scleral buckle, or lensectomy using the vitreous cutter-performed in both eyes sequentially during the same anesthesia session. METHODS: Clinical history, surgical details and indications, time under anesthesia, and intraoperative and postoperative ophthalmic and systemic adverse events were reviewed. MAIN OUTCOME MEASURES: Ocular and systemic adverse events. RESULTS: A total of 344 surgeries from 172 ISBVS procedures in 167 patients were included in the study. The mean age of the cohort was 1.3±2.6 years. Nonexclusive indications for ISBVS were rapidly progressive disease (74.6%), systemic morbidity placing the child at high anesthesia risk (76.0%), and residence remote from surgery location (30.2%). The most common diagnoses were retinopathy of prematurity (ROP; 72.7% [P < 0.01]; stage 3, 4.8%; stage 4A, 44.4%; stage 4B, 22.4%; stage 5, 26.4%), familial exudative vitreoretinopathy (7.0%), abusive head trauma (4.1%), persistent fetal vasculature (3.5%), congenital cataract (1.7%), posterior capsular opacification (1.7%), rhegmatogenous retinal detachment (1.7%), congenital X-linked retinoschisis (1.2%), Norrie disease (2.3%), and viral retinitis (1.2%). Mean surgical time was 143±59 minutes for both eyes. Higher ROP stage correlated with longer surgical time (P = 0.02). There were no reported intraoperative ocular complications. During the immediate postoperative period, 2 eyes from different patients demonstrated unilateral vitreous hemorrhage (0.6%). No cases of endophthalmitis, choroidal hemorrhage, or hypotony occurred. Mean total anesthesia time was 203±87 minutes. There were no cases of anesthesia-related death, malignant hyperthermia, anaphylaxis, or cardiac event. There was 1 case of reintubation (0.6%) and 1 case of prolonged oxygen desaturation (0.6%). Mean follow-up after surgery was 103 weeks, and anatomic success and globe salvage rates were 89.8% and 98.0%, respectively. CONCLUSIONS: This study found ISBVS to be a feasible and safe treatment paradigm for pediatric patients with bilateral vitreoretinal pathologic features when repeated general anesthesia is undesirable or impractical.

Síndrome de sommer asociado con amioplasia exclusiva de miembros superiores: A propósito de un caso / Sommer syndrome associated with upper limb exclusive amyoplasia: Apropos of a case

Introducción: El Síndrome cráneofacial sordera mano (deafness-hand .CDHS) también conocido como síndrome de Sommer, es una condición patológica poco frecuente caracterizada por una mutación en el gen PAX3 (Asn 47 lys).Se presenta un caso de un lactante mayor de 13 meses de edad con alteraciones craneofaciales, hipoacusia neurosensorial y anormalidades en las manos, que presenta además amioplasia simétrica de los miembros superiores con limitación funcional de la cintura escapular. Discusión: Con apoyo de la base de datos de la Universidad de Oxford se discute el diagnóstico de síndrome de Sommer y se realiza correlación clínica-fenotípica con el síndrome de Waanderburg (tipo I,y III),Artrogriposis distal tipo IV, Amioplasia Congénita, síndrome de CODAS; síndrome sordera, cataratas, microstomía, alteraciones craneofaciales y retardo mental; Síndrome de Braegger, Síndrome de Saethre Chotzen y Síndrome de Lambotte. Conclusión: Se presenta la asociación de Síndrome de Sommer y amioplasia simétrica exclusiva de miembros superiores, con compromiso codo- hombro, condición no reportada hasta ahora.

Introduction: The Cranialfacial Deafness-Hand Syndrome (CDHS) also known as Sommer syndrome, is a rare pathological condition characterized by a mutation in PAX3 (Asn 47 lys) gene. A case of one infant older than 13 months with cranialfacial disorders, neurosensory hearing loss, abnormalities in the hands, and symmetrical amyoplasia of the upper limbs with functional limitation of the scapular waist is here presented. Discussion: Standing on the University of Oxford database, the diagnosis of a Sommer syndrome is discussed and a clinical-phenotypical correlation with Waanderburg syndrome (type I and III), distal Arthrogryposis syndrome type IV, Amyoplasia congenita, CODAS syndrome; syndrome deafness, cataracts, microstomia, cranialfacial abnormalities and mental retardation; Braegger syndrome, Saethre chotzen syndrome and Lambotte syndrome is performed. Conclusion: The Association with the syndrome of Sommer is confirmed with a unique symmetrical amyoplasia of the upper limbs, compromising the elbow-shoulder: a condition that has not been reported so far in the literature.

Neumopatías en el nivel primario de atención / Neumopathies in primary care level

Se analiza la cantidad de consultas por neumopatías (neumonias, bronconeumonias, neumonitis y un grupo que se registra como neumopatía) de menores de 15 años ocurridas entre 1989 y 1991 en un consultorio del área Norte de Santiago. Se encontró que de las 65.574 consultas otorgadas, un 2,4% correspondieron a neumopatías. Casi dos tercios son bronconeumonias, 17,2% neumonía y 6,5% neumonitis, el resto no tenía diagnóstico específico. La incidencia para los tres años es de 31,3 por mil. No se observó diferencia por sexo aunque sí por edad. Es un problema frecuente entre los lactantes de 6 a 11 meses (26,5%) y de 12 a 23 meses (16,8%) el que disminuye con la edad. El riesgo es de 105,2% en menores de 2 años, 35,1% en los niños de edad preescolar y sólo 9,5% en los de edad escolar. Es una patología con variación estacional. Aumenta entre Mayo y Agosto y alcanza su máxima frecuencia en el mes de Julio (23,0%), disminuyendo a medida que se acerca el verano. En relación al total de consultas mensuales, las neumopatías varían entre 1,77% y 0,95% en el período de Diciembre a Junio, alcanza el máximo de 6,1% en Julio. Entre Agosto y Noviembre la proporción varía alrededor de 3%. El comportamiento de estas neumopatías sugiere especial preocupación por los menores de dos años, y un reforzamiento de atención de Mayo a Agosto

[Systematic examination of the uterine cavity after parturition]. / Revisión sistematizada de cavidad uterina post alumbramiento.

The revision of uterine cavity afterbirth should be a process preventing complications immediate or late during puerperium, due to the retention of ovular remains that are not diagnosed in opportunely, avoiding so the risk that implies for the patients who show bleeding that leads them to complications of hemorrhaging in the interest of puerperal infection, with consequences so serious such as mutilation or death, otherwise undergoing surgery under poor conditions, in addition to the extra administrative costs, that imply surgery and those costs, derived from hospitalization; 1,205 patients were studied. On 1,155 the revision of the uterine cavity was performed; only one of them developed complications irrelevant to the process, consisting in fever, uterine subinvolution, more than normal hemorrhaging. On fifty patients the uterine cavity afterbirth was not found, fourteen patients experienced greater than normal hemorrhaging and hypothermia two to five days after being released, caused by the presence of ovarian remains, requiring posterior hospitalization. One patient experienced inflammation of the peritoneo due to the presence of placental remains.