Knowledge and attitudes of health professionals in Chile towards people living with human immunodeficiency virus: A cross-national survey.

Introduction: People living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) often experience discrimination from both other individuals and the health personnel who care for them. Chile has experienced a marked increase in the number of new HIV cases.Methods: Prospective cross-sectional study. The HIV/AIDS questionnaire for providers and health personnel was obtained from the International Planned Parenthood Federation, initially carrying out a pilot test and evaluating its validity.Results: A total of 784 health professionals answered the questionnaire correctly. Among them, 68.4% (n = 536) were women, and 36.2% (n = 284) were physicians. The study revealed that more than 90% of respondents had a positive attitude towards caring for people living with HIV, and more than 75% did not mind buying food from them or sharing services with them. Furthermore, more than 99% rejected the religiously endorsed labeling of people living with HIV/AIDS as immoral. Additionally, 95.5% (n = 749) mentioned that they did not feel anxious about knowing whether the next patient on their care list was living with HIV, and 76.9% (n = 603) of the respondents felt safe taking blood samples.Conclusions: Chilean health professionals have good knowledge about HIV infection and its mode transmission. Their attitudes towards people living with HIV are also generally positive.

Mass Spectrometric Detection of Formaldehyde-Crosslinked PBMC Proteins in Cell-Free DNA Blood Collection Tubes.

Streck tubes are commonly used to collect blood samples to preserve cell-free circulating DNA. They contain imidazolidinyl urea as a formaldehyde-releasing agent to stabilize cells. We investigated whether the released formaldehyde leads to crosslinking of intracellular proteins. Therefore, we employed a shotgun proteomics experiment on human peripheral blood mononuclear cells (PBMCs) that were isolated from blood collected in Streck tubes, EDTA tubes, EDTA tubes containing formaldehyde, or EDTA tubes containing allantoin. The identified crosslinks were validated in parallel reaction monitoring LC/MS experiments. In total, we identified and validated 45 formaldehyde crosslinks in PBMCs from Streck tubes, which were also found in PBMCs from formaldehyde-treated blood, but not in EDTA- or allantoin-treated samples. Most were derived from cytoskeletal proteins and histones, indicating the ability of Streck tubes to fix cells. In addition, we confirm a previous observation that formaldehyde crosslinking of proteins induces a +24 Da mass shift more frequently than a +12 Da shift. The crosslinking capacity of Streck tubes needs to be considered when selecting blood-collection tubes for mass-spectrometry-based proteomics or metabolomic experiments.

Relationship between Duffy Genotype/Phenotype and Prevalence of Plasmodium vivax Infection: A Systematic Review.

The Duffy protein, a transmembrane molecule, functions as a receptor for various chemokines and facilitates attachment between the reticulocyte and the Plasmodium Duffy antigen-binding protein. Duffy expression correlates with the Duffy receptor gene for the chemokine, located on chromosome 1, and exhibits geographical variability worldwide. Traditionally, researchers have described the Duffy negative genotype as a protective factor against Plasmodium vivax infection. However, recent studies suggest that this microorganism's evolution could potentially diminish this protective effect. Nevertheless, there is currently insufficient global data to demonstrate this phenomenon. This study aimed to evaluate the relationship between the Duffy genotype/phenotype and the prevalence of P. vivax infection. The protocol for the systematic review was registered in PROSPERO as CRD42022353427 and involved reviewing published studies from 2012 to 2022. The Medline/PubMed, Web of Science, Scopus, and SciELO databases were consulted. Assessments of study quality were conducted using the STROBE and GRADE tools. A total of 34 studies were included, with Africa accounting for the majority of recorded studies. The results varied significantly regarding the relationship between the Duffy genotype/phenotype and P. vivax invasion. Some studies predominantly featured the negative Duffy genotype yet reported no malaria cases. Other studies identified minor percentages of infections. Conversely, certain studies observed a higher prevalence (99%) of Duffy-negative individuals infected with P. vivax. In conclusion, this systematic review found that the homozygous Duffy genotype positive for the A allele (FY*A/*A) is associated with a higher incidence of P. vivax infection. Furthermore, the negative Duffy genotype does not confer protection against vivax malaria.

Knowledge, attitudes and experience of physicians working in Chile toward the prescription of pre-exposure prophylaxis (PrEP): A cross-national survey.

BACKGROUND: Pre-exposure prophylaxis (PrEP) involves administering antiretroviral drugs to prevent human immunodeficiency virus (HIV) infection in at-risk subjects. Chile is considered one of the countries with the highest number of new cases per year of HIV infections. METHODS: A nationwide cross-sectional study was carried out in Chile. A questionnaire of physicians' attitudes toward the prescription of PrEP was used. RESULTS: 632 doctors responded correctly the survey. 58.5% (n = 370) were women, and median age was 34 years (IQR 25-43). 55.4% (n = 350) responded that they have never prescribed antiretrovirals for HIV-negative individuals to prevent HIV infection, and only 10.1% have prescribed PrEP. 60.8% (n = 384) mentioned having informed about the possibility of using antiretroviral post-exposure prophylaxis in case of risky sexual activity. 76.3% (n = 482) believed each institution should formulate internal protocols for administering these drugs, and 98.4% (n = 622) stated that with the currently available evidence, PrEP should be suggested to cope with the HIV pandemic. CONCLUSION: It was concluded that knowledge, attitudes and experience toward PrEP prescribing are variable and related to patient care. However, Chile has a marked tendency in favor of this therapy, which is similar to that reported in studies worldwide.

The Black Box of Cellular and Molecular Events of Plasmodium vivax Merozoite Invasion into Reticulocytes.

Plasmodium vivax is the most widely distributed malaria parasite affecting humans worldwide, causing ~5 million cases yearly. Despite the disease's extensive burden, there are gaps in the knowledge of the pathophysiological mechanisms by which P. vivax invades reticulocytes. In contrast, this crucial step is better understood for P. falciparum, the less widely distributed but more often fatal malaria parasite. This discrepancy is due to the difficulty of studying P. vivax's exclusive invasion of reticulocytes, which represent 1-2% of circulating cells. Its accurate targeting mechanism has not yet been clarified, hindering the establishment of long-term continuous in vitro culture systems. So far, only three reticulocyte invasion pathways have been characterised based on parasite interactions with DARC, TfR1 and CD98 host proteins. However, exposing the parasite's alternative invasion mechanisms is currently being considered, opening up a large field for exploring the entry receptors used by P. vivax for invading host cells. New methods must be developed to ensure better understanding of the parasite to control malarial transmission and to eradicate the disease. Here, we review the current state of knowledge on cellular and molecular mechanisms of P. vivax's merozoite invasion to contribute to a better understanding of the parasite's biology, pathogenesis and epidemiology.

Validación Cuestionario FSI-10 y grado de satisfacción con dispositivos de inhaloterapia / Validation of the FSI-10 questionnaire and satisfaction assessment with inhaler devices

Introducción. El tratamiento farmacológico de la EPOC se realiza progresiva y escalonadamente de acuerdo a la gravedad y puede ser modificado en función de la respuesta al mismo, por lo cual se han desarrollado instrumentos con el fin de evaluar la satisfacción del paciente con los distintos sistemas de inhalación; sin embargo, estos instrumentos han sido diseñados en su mayoría para pacientes con Asma. Objetivo. Validar el instrumento FSI-10 y determinar el nivel de satisfacción de los dispositivos de inhaloterapia en pacientes con EPOC. Materiales y métodos. Estudio transversal prospectivo y de validación de contenido, muestreo probabilístico estratificado con afijación proporcional; población de 337 pacientes con diagnóstico EPOC de la provincia Centro del departamento de Boyacá, Colombia. Se evaluó el cuestionario FSI-10 mediante la prueba de esfericidad de Bartlett, Kaiser-Meyer-Olkin y alfa de Cronbach. Resultados. La prueba de esfericidad resultó estadísticamente significativa, sugiriendo la existencia de correlaciones dentro de la matriz de diez preguntas. La variación total explicable de las diez preguntas que corresponden a la versión del FSI 10 dio cuenta del 81 % de variabilidad. Los pacientes evaluados reportaron un nivel de satisfacción entre bastante a algo con los dispositivos de inhaloterapia. Conclusiones. Las propiedades psicométricas permiten su utilización en la satisfacción del paciente con dispositivos de medicación inhalada, sin presentar diferencias en la comprensión y teniendo resultado fiables. La satisfacción con los dispositivos de inhaloterapia no es muy alta en la mayoría de la población evaluada.

Introduction: COPD pharmacological treatment is progressively staggered according to severity, which can be modified based on its response. Therefore, instruments have been developed to assess patient satisfaction with different inhaler devices. However, these instruments have been designed mostly for patients with asthma. Objective: To validate the FSI-10 instrument and assess the degree of satisfaction with inhaler devices in COPD patients. Materials and Methods: A prospective cross-sectional study for content validation and stratified probability sampling with proportional allocation was conducted with 337 COPD patients in the Central province of the department of Boyacá, Colombia. The FSI-10 questionnaire was assessed using Bartlett's test of sphericity, Kaiser-Meyer-Olkin test and Cronbach's alpha. Results: The test of sphericity was statistically significant, suggesting the presence of a correlation within the ten-question test. Total explained variation of the FSI-10 questions accounted for 81% of the variation. Assessed patients reported a degree of satisfaction between fair to good with the use of inhaler devices. Conclusions: FSI-10 psychometric properties enable its use in assessing patient satisfaction with inhaler devices with no difference in understanding and reliability results. Satisfaction with inhaler devices is not very high among the majority of the population assessed.

Introdução. O tratamento farmacológico da DPOC é progressivo e escalonado de acordo com a gravidade e pode ser modificado de acordo com a resposta ao tratamento, por isso, foram desenvolvidos instrumentos para avaliar a satisfação do paciente com diferentes sistemas de inalação; no enta nto, esses instrumentos foram elaborados principalmente para pacientes com asma. Objetivo. Validar o instrumento FSI-10 e determinar o nível de satisfação com os dispositivos de inaloterapia em pacientes com DPOC. Materiais e métodos. Estudo transversal prospectivo e de validação de conteúdo, amostragem probabilística estratificada com alocação proporcional; população de 337 pacientes diagnosticados com DPOC na província central do departamento de Boyacá, Colômbia. O questionário FSI-10 foi avaliado usando o teste de esfericidade de Bartlett, Kaiser-Meyer-Olkin e o alfa de Cronbach. Resultados. O teste de esfericidade foi estatisticamente significativo, sugerindo a existência de correlações dentro da matriz de dez perguntas. A variação total explicável das dez perguntas correspondentes à versão FSI 10 foi responsável por 81 % da variabilidade. Os pacientes avaliados relataram um nível de satisfação entre bastante e moderada com os dispositivos de inaloterapia. Conclusões. As propriedades psicométricas permitem seu uso na satisfação do paciente com dispositivos de medicamentos inalados, sem diferenças na compreensão e resultados confiáveis. A satisfação com os dispositivos de inaloterapia não é muito alta na maioria da população avaliada.

The Cellular and Molecular Interaction Between Erythrocytes and Plasmodium falciparum Merozoites.

Plasmodium falciparum is the most lethal human malaria parasite, partly due to its genetic variability and ability to use multiple invasion routes via its binding to host cell surface receptors. The parasite extensively modifies infected red blood cell architecture to promote its survival which leads to increased cell membrane rigidity, adhesiveness and permeability. Merozoites are initially released from infected hepatocytes and efficiently enter red blood cells in a well-orchestrated process that involves specific interactions between parasite ligands and erythrocyte receptors; symptoms of the disease occur during the life-cycle's blood stage due to capillary blockage and massive erythrocyte lysis. Several studies have focused on elucidating molecular merozoite/erythrocyte interactions and host cell modifications; however, further in-depth analysis is required for understanding the parasite's biology and thus provide the fundamental tools for developing prophylactic or therapeutic alternatives to mitigate or eliminate Plasmodium falciparum-related malaria. This review focuses on the cellular and molecular events during Plasmodium falciparum merozoite invasion of red blood cells and the alterations that occur in an erythrocyte once it has become infected.

Unusual presentation Achenbach syndrome.

Achenbach syndrome is a condition of unknown etiology, characterized by changes in the coloration of the skin of the fingers and associated with acute pain. There are few epidemiological data, but it is estimated that it is a rare condition, which exceptionally appears under 40 years of age. We present the case of a young woman who has been diagnosed with Achenbach syndrome thanks to her history and after ruling out rheumatic, vascular, and metabolic pathology. We finalize by discussing data on the pathology and the differences found with the case we describe here.

El síndrome de Achenbach es una condición de etiología desconocida, caracterizado por cambios en la coloración de la piel de los dedos y asociado a dolor agudo. Existen pocos datos epidemiológicos, pero se estima que es una condición rara, que excepcionalmente aparece por debajo de los 40 años de edad. Presentamos el caso de una mujer joven a quien se dio el diagnóstico de síndrome de Achenbach por sus antecedentes y después de descartar patología reumática, vascular y metabólica. Comentamos datos sobre la patología y las diferencias que se encuentran con el caso que describimos.

A novel platform for peptide-mediated affinity capture and LC-MS/MS identification of host receptors involved in Plasmodium invasion.

Successful Plasmodium falciparum invasion of red blood cells includes the orderly execution of highly specific receptor-ligand molecular interactions between the parasite's proteins and the red blood cell membrane proteins. There is a growing need for elucidating receptor-ligand pairings, which will help in understanding the parasite's biology and provide the fundamental basis for developing prophylactic or therapeutic alternatives leading to mitigating or eliminating this type of malaria. We have thus used Plasmodium falciparum RH5 - derived peptides and ghost red blood cell proteins in synthetic peptide affinity capture assays to identify important host receptors used by Plasmodium spp. in the invasion of red blood cells. LC-MS/MS analysis confirmed the extensively described interaction between PfRH5 and the basigin receptor on the red blood cell membrane. As shown here, tagged synthetic peptides displaying high binding ability to erythrocytes can be used to identify receptors present in protein extracts from ghost red blood cells via affinity capture and LC-MS/MS. SIGNIFICANCE: The article describes a novel approach for identifying red blood cell receptors based on the ability of synthetic peptides having high red blood cell binding capacity to capture Plasmodium spp. receptors on proteins extracted from ghost red blood cells. Specifically, novel methods to identify Plasmodium falciparum reticulocyte binding protein homolog 5 PfRH5 and basigin interaction using a combination of affinity capture and LC-MS/MS assays is described. Identification of these host RBC receptors interacting with malarial parasite proteins is of utmost importance in studying the disease's pathogenesis and will provide crucial information in understanding the parasite's biology. In addition, data from these studies can be used to identify potential therapeutic target(s) to mitigate or eliminate this debilitating disease.

Primary undifferentiated sarcoma of left atrium.

El objetivo es ilustrar al lector sobre un tumor infrecuente en la literatura médica y resumir los conocimientos actuales que se tienen sobre esta patología. Caso clínico: Reportamos el caso de un varón en la quinta década de la vida, a quien se realizó ecocardiograma transtorácico por deterioro de la clase funcional. La ultrasonografía evidenció un tumor que ocupaba el 95% de la aurícula izquierda, con compromiso hemodinámico e hipertensión pulmonar grave. Luego de estudios de extensión, fue llevado a cirugía para extracción de la masa por esternotomía media. La patología reveló sarcoma de alto grado indiferenciado sin compromiso linfovascular.This text aimed to illustrate the reader about one of the most infrequent tumors in the medical literature and discuss based on current literature what is known to date of this pathology. Case report: We report the case of a male in the fifth decade of life, who underwent transthoracic echocardiography due to impairment of the functional class. Ultrasound showed tumor lesion that occupied 95% of the left atrium, with hemodynamic compromise and severe pulmonary hypertension. After extension studies, he was taken to surgery with total mass extraction by middle stereotomy. The pathology revealed undifferentiated high-grade sarcoma without lymphovascular involvement.

Hotspots in Plasmodium and RBC Receptor-Ligand Interactions: Key Pieces for Inhibiting Malarial Parasite Invasion.

Protein-protein interactions (IPP) play an essential role in practically all biological processes, including those related to microorganism invasion of their host cells. It has been found that a broad repertoire of receptor-ligand interactions takes place in the binding interphase with host cells in malaria, these being vital interactions for successful parasite invasion. Several trials have been conducted for elucidating the molecular interface of interactions between some Plasmodium falciparum and Plasmodium vivax antigens with receptors on erythrocytes and/or reticulocytes. Structural information concerning these complexes is available; however, deeper analysis is required for correlating structural, functional (binding, invasion, and inhibition), and polymorphism data for elucidating new interaction hotspots to which malaria control methods can be directed. This review describes and discusses recent structural and functional details regarding three relevant interactions during erythrocyte invasion: Duffy-binding protein 1 (DBP1)-Duffy antigen receptor for chemokines (DARC); reticulocyte-binding protein homolog 5 (PfRh5)-basigin, and erythrocyte binding antigen 175 (EBA175)-glycophorin A (GPA).

Determinación de la función pulmonar mediante espirometría en pacientes con diagnóstico clínico de enfermedad pulmonar obstructiva crónica (epoc) de la provincia centro de boyacá

Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es una patología frecuente, prevenible y tratable, que se caracteriza por síntomas respiratorios y una limitación al flujo aéreo persistente, el cual se debe a anomalías de las vías respiratorias o alveolares causadas generalmente por una exposición a partículas o gases nocivos; su abordaje debe ser integral y la exploración de la función pulmonar se realiza a través de la espirometría forzada. El resultado de la relación VEF1/CVF posbroncodilatador <0,70 confirma la limitación al flujo aéreo, lo cual permite establecer el diagnóstico de la enfermedad. Objetivo: Determinar mediante espirometría la función pulmonar de pacientes con diagnóstico clínico de EPOC de la Provincia Centro de Boyacá. Metodología: Estudio de tipo transversal con diseño descriptivo. El tamaño de la muestra fue de 337 pacientes con diagnóstico clínico de EPOC de los 15 municipios que integran la Provincia Centro del departamento de Boyacá. Los datos fueron suministrados por las empresas sociales del Estado de cada municipio. Se realizó análisis univariado a través de medidas de tendencia central, promedios, desviación estándar, porcentajes e intervalos de confianza. Resultados: La población estudiada estuvo conformada por pacientes con diagnóstico clínico de EPOC caracterizada por ser en su mayoría mujeres, con edad, talla y peso promedio de 72 años, 1,54 m y 62 kg, respectivamente; un porcentaje del 46% de pacientes reportó patrón espirométrico normal, seguido del 33 % que reportaron patrón obstructivo. Del total de pacientes con alteración espirométrica obstructiva, el 16 % presentaron obstrucción leve, seguido del 9 % con obstrucción moderada y severa. Respectivamente. Finalmente, el 33,2 % tienen diagnóstico de EPOC confirmado a través de la espirometría forzada. Conclusión: La población estudiada contaba con diagnóstico clínico de EPOC; sin embargo, de los 280 pacientes quienes realizaron pruebas de espirometrías pre y posbroncodilatador adecuadas, es decir, que tuvieron calidad (A, B o C), solo el 33 % obtuvo patrón obstructivo leve en mayor proporción, seguido de moderado y grave, lo que significa que solo en ese porcentaje de pacientes se confirmó el diagnóstico de EPOC; los demás reportaron patrones espirométricos normales o restrictivos que están relacionados con otra patología. Lo anterior permite concluir que existe un subregistro en el diagnóstico, puesto que no todos los pacientes con sintomatología relacionada con EPOC tienen la enfermedad.

Introduction: Chronic obstructive pulmonary disease (COPD) is a frequent disease, preventable and treatable, characterized by long-term breathing problems and poor airflow, and caused by anomalies in the respiratory conducts, or alveolars, after continuous exposure to particles or harmful gases. Its approach must be integral. The pulmonary function exploration is made by reinforced spirometry and the results from post-bronchodilator FEV1/FVC < 0.70 confirm the airflow limitation and the diagnoses. Objective: To determine, by spirometry, the pulmonary function of COPD's patience in Boyaca's central province. Methodology: Transversal study with a descriptive design. The sample's size was 337 COPD patients from 15 Boyaca's municipalities from the central province. Data were given by State Social Enterprises. A univariate analysis was carried out through measures of central tendency, averages, standard deviation, percentages, and confidence intervals. Results: Studied population was made of COPD patients, mostly women, with 72 years, 1,54 m, and 62 kg on average. 46% of patients reported a spirometry normal pattern and 33% an obstructive pattern of which 16% present a mild obstruction and 9% moderate and severe obstruction. Finally, 32% are COPDS diagnosed with reinforced spirometry. Conclusion: Studied population was COPD's diagnosed, but, from 280 patients who had spirometry, pre- and post-bronchodilator, (A, B, or C), only 33% had a mild obstructive pattern, followed by moderated and severe. That means, only that percentage confirmed COPD's diagnose, others had normal or restrictive obstruction patterns related to other pathologies. So, it can be confirmed the existence of a sub-register, because not all patients with COPD's symptoms already have the disease.

Malaria: Paving the way to developing peptide-based vaccines against invasion in infectious diseases.

Malaria remains a large-scale public health problem, killing more than 400,000 people and infecting up to 230 million worldwide, every year. Unfortunately, despite numerous efforts and research concerning vaccine development, results to date have been low and/or strain-specific. This work describes a strategy involving Plasmodium falciparum Duffy binding-like (DBL) and reticulocyte-binding protein homologue (RH) family-derived minimum functional peptides, netMHCIIpan3.2 parental and modified peptides' in silico binding prediction and modeling some Aotus major histocompatibility class II (MHCII) molecules based on known human molecules' structure to understand their differences. These are used to explain peptides' immunological behaviour when used as vaccine components in the Aotus model. Despite the great similarity between human and Aotus immune system molecules, around 50% of Aotus allele molecules lack a counterpart in the human immune system which could lead to an Aotus-specific vaccine. It was also confirmed that functional Plasmodium falciparum' conserved proteins are immunologically silent (in both the animal model and in-silico prediction); they must therefore be modified to elicit an appropriate immune response. Some peptides studied here had the desired behaviour and can thus be considered components of a fully-protective antimalarial vaccine.

Plasmodium falciparum pre-erythrocytic stage vaccine development.

Worldwide strategies between 2010 and 2017 aimed at controlling malarial parasites (mainly Plasmodium falciparum) led to a reduction of just 18% regarding disease incidence rates. Many biologically-derived anti-malarial vaccine candidates have been developed to date; this has involved using many experimental animals, an immense amount of work and the investment of millions of dollars. This review provides an overview of the current state and the main results of clinical trials for sporozoite-targeting vaccines (i.e. the parasite stage infecting the liver) carried out by research groups in areas having variable malaria transmission rates. However, none has led to promising results regarding the effective control of the disease, thereby making it necessary to complement such efforts at finding/introducing new vaccine candidates by adopting a multi-epitope, multi-stage approach, based on minimal subunits of the main sporozoite proteins involved in the invasion of the liver.

Control central de la temperatura corporal y sus alteraciones: fiebre, hipertermia e hipotermia / Central control of body temperature and its alterations: fever, hyperthermia and hypothermia / Controle central da temperatura corporal e suas alterações: febre, hipertermia e hipotermia

Introducción. En mamíferos, el control de la temperatura corporal es vital. El estado de consciencia y control motor en humanos, ocurren a una temperatura de 37°C y las desviaciones pueden alterar las propiedades celulares, generando disfunciones fisiológicas. En especies como los roedores (su relación área de superficie/volumen facilita la pérdida de calor) mantienen temperaturas basales cercanas a los 30°C. Distinto es con animales como los paquidermos, cuya temperatura es menor comparada con los humanos. El objetivo es identificar los aspectos fisiológicos de la termorregulación. Descripción de temas tratados. Revisión descriptiva de la literatura de artículos publicados en diferentes bases de datos. La termorregulación es la capacidad del cuerpo para establecer y mantener su temperatura, regulando producción y pérdida de calor para optimizar la eficiencia de procesos metabólicos. El protagonismo lo tiene el sistema nervioso central y su control neurohormonal en múltiples niveles. El centro regulador térmico está en el hipotálamo anterior. Este recibe información de los receptores de grandes vasos, vísceras abdominales, médula espinal y de la sangre que perfunde el hipotálamo. Cuando aumenta la temperatura central, el termorregulador activa fibras eferentes del sistema nervioso autónomo, provocando pérdida de calor por convección y evaporación. Ante el descenso de temperatura, la respuesta es disminuir la pérdida de calor (vasoconstricción y menor sudoración); además, incrementar la producción de calor, intensificando la actividad muscular. Conclusión. La termorregulación es liderada por el hipotálamo, quien regula aumento y disminución de la temperatura respondiendo a las necesidades del organismo para llegar a la homeostasis y compensación, enfrentando las alteraciones de la temperatura ambiental. Cómo citar: Picón-Jaimes YA, Orozco-Chinome JE, Molina-Franky J, Franky-Rojas MP. Control central de la temperatura corporal y sus alteraciones: fiebre, hipertermia e hipotermia. MedUNAB. 2020;23(1):118-130. doi:10.29375/01237047.3714

Introduction. In mammals, controlling body temperature is vital. Consciousness and motor control in humans occur at a temperature of 37°C and any deviation can alter the cellular properties, generating physiological dysfunctions. In species such as rodents (their surface area/volume ratio facilitates heat loss) they maintain basal temperatures close to 30°C. This is different with animals such as pachyderms, whose temperature is lower compared to humans. This article aims to Identify the physiological aspects of thermoregulation. Topics. Descriptive literature review of articles published in different databases. Thermoregulation is the body's ability to establish and maintain its temperature, regulating heat production and loss to optimize the efficiency of metabolic processes. The main actor in this process is the central nervous system and its neuro-hormonal control on multiple levels. The thermal regulating center is located in the anterior hypothalamus. It receives information from the receptors of large vessels, abdominal viscera, spinal cord and the blood that perfuses the hypothalamus. When the core temperature increases, the thermoregulator activates efferent fibers of the autonomic nervous system, causing heat loss by convection and evaporation. When the temperature drops, the response is to decrease heat loss (vasoconstriction and less sweating); in addition, increase heat production by intensifying muscle activity. Conclusion. Thermoregulation is led by the hypothalamus, which regulates temperature increase and decrease by responding to the organism's need to reach homeostasis and compensation, facing the alterations of the ambient temperature. Cómo citar: Picón-Jaimes YA, Orozco-Chinome JE, Molina-Franky J, Franky-Rojas MP. Control central de la temperatura corporal y sus alteraciones: fiebre, hipertermia e hipotermia. MedUNAB. 2020;23(1):118-130. doi:10.29375/01237047.3714

Introdução. Nos mamíferos, o controle da temperatura corporal é vital. O estado de consciencia e controle motor em humanos ocorre a uma temperatura de 37 °C e os desvios podem alterar as propriedades celulares, gerando disfunções fisiológicas. Espécies como os roedores (a sua relação superfície/volume, facilita a perda de calor), mantêm a temperatura basal próxima de 30 °C. É diferente em animais como paquidermes, cuja temperatura é mais baixa em comparação aos humanos. Objetivo. Identificar os aspectos fisiológicos da termorregulação. Desenvolvimento. Revisão descritiva da literatura de artigos publicados em diferentes bases de dados. A termorregulação é a capacidade do corpo de estabelecer e manter sua temperatura, regulando a produção e a perda de calor para otimizar a eficiência dos processos metabólicos. O sistema nervoso central tem o papel principal, assim como seu controle neuro-hormonal em múltiplos níveis. O centro de regulação térmica está no hipotálamo anterior, que recebe informações dos receptores de grandes vasos, vísceras abdominais, medula espinhal e do sangue distribuído pelo hipotálamo. Quando a temperatura central aumenta, o termorregulador ativa fibras eferentes do sistema nervoso autônomo, causando perda de calor por convecção e evaporação. Dada a diminuição da temperatura, a resposta é reduzir a perda de calor (vasoconstrição e menos transpiração), além de aumentar a produção de calor, intensificando a atividade muscular. Conclusão. A termorregulação é liderada pelo hipotálamo, que regula o aumento e a diminuição da temperatura, respondendo às necessidades do organismo de atingir a homeostase e a compensação, enfrentando mudanças na temperatura ambiente. Cómo citar: Picón-Jaimes YA, Orozco-Chinome JE, Molina-Franky J, Franky-Rojas MP. Control central de la temperatura corporal y sus alteraciones: fiebre, hipertermia e hipotermia. MedUNAB. 2020;23(1):118-130. doi:10.29375/01237047.3714

Proteínas homólogas de unión a reticulocitos de Plasmodium falciparum involucradas en el proceso de invasión al eritrocito: revisión de la literatura / Plasmodium falciparum reticulocyte-binding homologous proteins involved in the process of erythrocyte invasion: literature review / Proteínas de ligação a reticulócitos de Plasmodium falciparum homólogas envolvidas no pro-cesso de invasão de eritrócitos: revisão da literatura

Introducción: la malaria es uno de los mayores retos de la salud pública mundial. Es causada principalmente por los parásitos Plasmodium falciparum y Plasmodium vivax. Durante el proceso de invasión, se encuentran involucra-das las proteínas homólogas de unión a reticulocitos de P.falciparumPfRH1, PfRH2a, PfRH2b, PfRH4 y PfRH5, que tras su unión a receptores específicos de membrana permiten la invasión del merozoíto al eritrocito. Objetivo: compilar y resumir las características moleculares y estructurales de las interacciones entre las proteínas pertenecientes a la familia de proteínas homólogas de unión a reticulocitos de P.falciparum y los receptores expre-sados en la célula del hospedero. Método: revisión descriptiva sobre las proteínas homólogas de unión a reticulocitos de P. falciparum involucradas en el proceso de invasión al eritrocito. Esta revisiónincluye literatura publicada hasta el año 2020 en bases de datos electrónicas especializadas en investigación biomédica. Se encontraron 105 documentos, de los cuales se se-leccionaron 70 y se excluyeron 11, por no presentar los criterios de inclusión, analizando un total de 59 referencias. Conclusión: la invasión del merozoíto es mediada por interacciones específicas de los ligandos de las familias EBL y PfRH. La unión de las proteínas PfRH1 y PfRH2b a sus receptores en el eritrocito da lugar a la liberación de la proteína EBL-175 que, junto con PfRH4, median la formación de una unión estrecha entre el parásito y los glóbulos rojos. Ello permite la unión de la proteína PfRH5 a la basigina y la entrada del parásito a la célula del hospedero

Introduction: Malaria is one of the world's greatest public health challenges, caused mainly by Plas-modium falciparum and Plasmodium vivax. During the invasion process, the P. falciparum reticulo-cyte-binding homologous proteins PfRH1, PfRH2a, PfRH2b, PfRH4 and PfRH5 are involved, which after binding to specific membrane receptors allow the invasion of the merozoite into the erythrocyte. Objective: To compile and summarize the molecular and structural characteristics of the interactions between proteins belonging to the P. falciparum family of reticulocyte-binding homologous proteins and the receptors expressed in the host cell. Method: Descriptive review of the P. falciparum reticulocyte-binding homologous proteins involved in the process of erythrocyte invasion. This review includes literature published until 2020 in electronic databases specialized in biomedical research. We found 105 papers, of which 70 were selected and 11 were excluded for not presenting the inclusion criteria, analyzing a total of 59 references. Conclusion: The invasion of merozoite is mediated by specific interactions of the ligands of the LBS and PfRH families. The binding of the PfRH1 and PfRH2b proteins to their receptors in the erythrocyte results in the release of the EBL-175 protein, which together with PfRH4 mediates the formation of a close bond between the parasite and the red blood cells, thus allowing the binding of the PfRH5 protein to basigin and the entry of the parasite into the host cell.

Introdução: a malária é um dos maiores desafios globais de saúde pública. É causada principalmente pelos parasitas Plasmodium falciparum e Plasmodium vivax. Durante o processo de invasão, proteínas homólogas de ligação a reticulócitos de P. falciparum PfRH1, PfRH2a, PfRH2b, PfRH4 e PfRH5 estão envolvidas, que após a ligação a receptores de membrana específicos permitem a invasão do mero-zoíta ao andritro. Objetivo: compilar e resumir as características moleculares e estruturais das interações entre as pro-teínas pertencentes à família das proteínas reticulocitárias homólogas de P. falciparum e os receptores expressos na célula hospedeira. Método: revisão descritiva das proteínas ho-mólogas de ligação a reticulócitos de P. falciparum envol-vidas no processo de invasão eritrocitária. Esta revisão inclui literatura publicada até 2020 em bases de dados eletrônicas especializadas em pesquisa biomédica. Foram encontrados 105 documentos, dos quais 70 foram selecionados e 11 excluídos por não apresentarem os critérios de inclusão, anali-sando um total de 59 referências. Conclusão: a invasão de merozoítos é mediada por interações específicas dos ligantes das famílias EBL e PfRH. A ligação das proteínas PfRH1 e PfRH2b aos seus receptores no eritrócito resulta na libe-ração da prote-ína EBL-175 que, junto com PfRH4, a mediação da formação de uma junção compacta entre o parasita e as hemácias. Isso permite a ligação da proteína PfRH5 à basigina e a entrada do parasita na célula hospedeira.

Avances en el desarrollo de una vacuna efectiva contra Cryptosporidium parvum: una revisión de la literatura / Advances in the development of an effective vaccine against Cryptosporidium parvum: An review of the literature / Avanços no desenvolvimento de uma vacina eficaz contra Cryptosporidium parvum: uma revisão da literatura

Introducción. Cryptosporidium parvum es un parásito zoonótico altamente prevalente, asociado a enfermedad diarreica en población inmunocomprometida, niños y terneros menores de 30 días. Esta infección puede ocasionar deshidratación, alteración del estado de conciencia, retraso en el desarrollo global y, en algunos casos, la muerte del paciente. A pesar de la alta prevalencia de C. parvum, no existen medicamentos completamente efectivos ni una vacuna aprobada para prevenir dicha enfermedad. Objetivo. Realizar una revisión de la literatura sobre candidatos vacunales contra C. parvum. Método. Revisión documental mediante la búsqueda de la literatura de los últimos 20 años, disponible en las bases de datos PubMed central, WEB OF SCIENCE, Embase, REDALYC y LILACS. Resultados. Las vacunas atenuadas, recombinantes, basadas en ADN, expresadas en vectores bacterianos y sintéticas han mostrado resultados prometedores en la inducción de inmunogenicidad contra los antígenos de C. parvum, siendo el antígeno de superficie de 15 kilodaltons de Cryptosporidium parvum (cp15), el antígeno inductor de una mejor respuesta inmune celular y humoral en el modelo murino estudiado. Conclusión. Se espera que la incorporación de nuevas técnicas para la selección de antígenos promisorios y la ejecución de una gran cantidad de ensayos in vivo, favorezcan el desarrollo de una vacuna totalmente efectiva contra C. parvum. Aunque el camino para lograr este objetivo será largo y difícil, se convierte en la mejor alternativa para controlar una de las enfermedades de interés en salud pública, con mayor impacto en la población inmunocomprometida.

Introduction. Cryptosporidium parvum is a highly prevalent zoonotic parasite, associated with diarrheal disease in immunocompromised population, children and calves under 30 days. This infection is associa- ted to dehydration, delayed global development and, in some cases, the death of the patient. Despite the high prevalence of C. parvum, there are no fully effective medications and an approved vaccine to prevent such disease. Objective. To conduct a thorough review of the literature on vaccine candidates against C. parvum. Method Documentary review by searching the literature of the last 20 years, available in the central PubMed, WEB OF SCIENCE, Embase, REDALYC and LILACS databases. Results. Attenuated, recombinant, DNA-based, expressed in bacterial vectors and synthetic vaccines have shown promising results in inducing immunogenicity against C. parvum, being the Cryptospori- dium parvum 15 kiloDalton surface antigen (cp15), the antigen inducer of a better cellular and humoral immune response in the murine model studied. Conclusion. It is expected that the incorporation of new techniques for the selection of promising antigens and the execution of a large number of in vivo assays will favor the development of a fully effective vaccine against C. parvum. Although the way to achieve this goal will be long and difficult, it will become the best alternative to control one of the diseases with the greatest impact on the immu- nocompromised population.

Introdução. O Cryptosporidium parvum é um parasita zoonótico de alta prevalência associado à doença diarreica em populações imunocomprometidas, crianças e bezerros com menos de 30 dias. Essa infecção pode causar desidratação, alteração do estado de consciência, atraso no desenvolvi- mento global e, em alguns casos, a morte do paciente. Apesar da alta prevalência de C. parvum, não existem medicamentos totalmente eficazes e uma vacina aprovada para prevenir a doença. Objetivo. Realizar uma revisão literária dos candidatos à vacina contra C. parvum. Método. Revisão documental, mediante pesquisa da literatura dos últimos 20 anos, disponível nas bases de dados PubMed central, WEB OF SCIENCE, Embase, REDALYC e LILACS. Resultados. Vacinas atenuadas, recombinantes e baseadas em DNA, expressas em vetores bacteria- nos e sintéticos, mostraram resultados promissores na indução de imunogenicidade contra antígenos de C. parvum, sendo o antígeno de superfície de 15 kilodaltons de Cryptosporidium parvum (cp15) o antígeno indutor de uma melhor resposta imune celular e humoral no modelo murino estudado. Conclusão. Se espera que a incorporação de novas técnicas para a seleção de antígenos promissores e a execução de um grande número de ensaios in vivo favoreçam o desenvolvimento de uma vacina totalmente eficaz contra C. parvum. Embora o caminho para alcançar este objetivo seja longo e difícil, torna-se a melhor alternativa para controlar uma das doenças de interesse na saúde pública com maior impacto na população imunocomprometida.

Avances en el desarrollo de una vacuna contra la malaria por Plasmodium falciparum: una revisión de literatura / Advances in the development of vaccine against malaria by Plasmodium falciparum: a literature review / Avanços no desenvolvimento de uma vacina contra a Malária por Plasmodium falciparum: Uma revisão da literatura

Introducción. La malaria por Plasmodium falciparum es una enfermedad causante de altas tasas de morbimortalidad a nivel mundial. Diferentes candidatos a vacuna se han evaluado experimentalmente en humanos; sin embargo, no se dispone de ninguna vacuna que reduzca o elimine esta devastadora enfermedad. Objetivo. Describir en términos de diseño, respuesta inmune, eficacia protectiva y perspectivas, los principales candidatos vigentes a vacuna contra la malaria por Plasmodium falciparum, dirigidos a las fases pre-eritrocítica y eritrocítica. Metodología. Se realizó una revisión descriptiva de trabajos publicados en bases de datos PubMed, Science Direct, Embase y MedLine. Los criterios de inclusión fueron: trabajos publicados en una ventana de tiempo entre 2000 y 2019, candidatos a vacuna contra Plasmodium falciparum en estadíos pre y eritrocíticos y vigencia según la Organización Mundial de la Salud. En total, se revisaron 90 artículos originales, encontrando que 63 cumplieron con todos los criterios establecidos, mientras que 27, no cumplieron por lo menos con un criterio. Resultados. Los candidatos a vacunas vigentes incluyen diseños basados en parásitos atenuados, proteínas recombinantes, vectores virales y síntesis química. Las formulaciones contienen un número mínimo de antígenos con secuencias de aminoácidos altamente polimórficas, que inducen un aceptable perfil de inmunogenicidad, aunque una limitada eficacia protectora contra la malaria, debido a que tales regiones polimórficas son inmunodominantes, confiriendo únicamente inmunidad específica de cepa. Conclusiones. El desarrollo de una vacuna efectiva contra la malaria por Plasmodium falciparum posiblemente requiera incluir múltiples epítopes funcionalmente relevantes, del estadío pre y eritrocítico, que contengan regiones conservadas entre cepas, para lograr inducir respuestas inmunes duraderas que bloqueen la invasión del parásito a células hepáticas y eritrocitos.

Introduction. Plasmodium falciparum malaria is a disease that causes high rates of morbidity and mortality worldwide. Different vaccine candidates have been evaluated experimentally in humans; however, there is no vaccine available that reduces or eliminates this devastating disease. Objective. Describe in terms of design, immune response, protective efficacy and perspectives, the main current candidates for Plasmodium falciparum malaria vaccine aimed at the pre-erythrocytic and erythrocyte phases. Methodology. A descriptive review of works published in PubMed, Science Direct, Embase and MedLine databases was carried out. The inclusion criteria were: papers published in a time window between 2000 and 2019, candidates for vaccine against Plasmodium falciparum in pre and erythrocyte stages and validity according to the World Health Organization. In total, 90 original articles were reviewed, finding that 63 met all the established criteria, while Introduction. Plasmodium falciparum malaria is a disease that causes high rates of morbidity and mortality worldwide. Different vaccine candidates have been evaluated experimentally in humans; however, there is no vaccine available that reduces or eliminates this devastating disease. Objective. Describe in terms of design, immune response, protective efficacy and perspectives, the main current candidates for Plasmodium falciparum malaria vaccine aimed at the pre-erythrocytic and erythrocyte phases. Methodology. A descriptive review of works published in PubMed, Science Direct, Embase and MedLine databases was carried out. The inclusion criteria were: papers published in a time window between 2000 and 2019, candidates for vaccine against Plasmodium falciparum in pre and erythrocyte stages and validity according to the World Health Organization. In total, 90 original articles were reviewed, finding that 63 met all the established criteria, while 27 did not meet at least one criterion. Results. Applicants for current vaccines include designs based on attenuated parasites, recombinant proteins, viral vectors and chemical synthesis. The formulations include a minimum number of an- tigens with highly polymorphic amino acid sequences, which induce an acceptable immunogenicity profile, although a limited protective efficacy against malaria. Conclusion. The development of an effective vaccine against malaria by Plasmodium falciparum may require the inclusion of multiple functionally relevant epitopes, from the pre and erythrocyte stage, which do not contain polymorphic regions, in order to induce lasting immune responses that block the invasion of the parasite to hepatic and erythrocyte target cells.27 did not meet at least one criterion. Results. Applicants for current vaccines include designs based on attenuated parasites, recombinant proteins, viral vectors and chemical synthesis. The formulations include a minimum number of an- tigens with highly polymorphic amino acid sequences, which induce an acceptable immunogenicity profile, although a limited protective efficacy against malaria. Conclusion. The development of an effective vaccine against malaria by Plasmodium falciparum may require the inclusion of multiple functionally relevant epitopes, from the pre and erythrocyte stage, which do not contain polymorphic regions, in order to induce lasting immune responses that block the invasion of the parasite to hepatic and erythrocyte target cells.

Introdução. A malária por Plasmodium falciparum é uma doença que causa altas taxas de morbimortalidade em todo o mundo. Diferentes candidatos à vacina foram avaliados experimentalmente em humanos; no entanto, nenhuma vacina está disponível para reduzir ou eliminar esta doença devastadora. Objetivo. Descrever em termos de projeção, resposta imune, eficácia protetora e perspectivas, os principais candidatos atuais à vacina contra a malária por Plasmodium falciparum, visando às fases pré-eritrocítica e eritrocítica. Metodologia. Foi realizada uma revisão descritiva dos trabalhos publicados nas bases de dados PubMed, Science Direct, Embase e MedLine. Os critérios de inclusão foram: trabalhos publicados em uma janela temporal entre 2000 e 2019, candidatos à vacina contra Plasmodium falciparum nos estágios pré e eritrocitários e validade de acordo com a Organização Mundial da Saúde. No total, foram revisados 90 artigos originais, constatando que 63 atendiam a todos os critérios estabelecidos, enquanto 27 não atendiam pelo menos um critério. Resultados. Os candidatos atuais à vacina incluem projeções baseadas em parasitas atenuados, pro- teínas recombinantes, vetores virais e síntese química. As formulações contêm um número mínimo de antígenos com sequências de aminoácidos altamente polimórficas, que induzem um perfil de imu- nogenicidade aceitável, embora com eficácia protetora limitada contra a malária, uma vez que essas regiões polimórficas são imunodominantes, conferindo apenas imunidade específica à cepa. Conclusão. O desenvolvimento de uma vacina eficaz contra a malária por Plasmodium falciparum pode exigir a inclusão de vários epítopos funcionalmente relevantes, do estágio pré e eritrocítico, contendo regiões conservadas entre as cepas, a fim de induzir respostas imunes duradouras que permitam bloquear a invasão do parasita nas células hepáticas e eritrócitos.

[Spontaneous digital hematoma, Achenbach Sindrome.] / Hematoma digital espontaneo, síndrome de Achenbach.

INTRODUCTION: The Achenbach syndrome was described in the '50s by the German physician Walter Achenbach and corresponds to an entity characterized by the appearance of ecchymosis or purpura and even bruises on the fingers and sometimes on the feet. It courses benignly and is self-limited. METHODS: We present the case of a 60-year-old woman who was diagnosed with this syndrome after performing laboratory tests, antibodies and images without finding alterations in them, with improvement after receiving analgesia and physical means. RESULTS: The Achenbach syndrome continues to be an unknown entity, with few reports in the literature. Up to the year 2 016, 12 case reports had been identified worldwide, concluding that it is a pathology that mainly affects women between the fifth and sixth decade of life. CONCLUSION: Although this nosological entity is benign and its pathophysiology is not entirely clear, it is important that during the initial approach it is consulted for similar episodes in the past and if it is an acute event, look for other alterations such as delay in capillary refill, coldness distal, absence of pulses and thus discarding acute ischemic pathology with diagnostic exams.

Introducción: El síndrome de Achenbach fue descrito en los años 50' por el médico alemán Walter Achenbach y corresponde a una entidad caracterizada por la aparición de equimosis o purpuras e incluso hematomas en los dedos de las manos y en algunas ocasiones de los pies. Cursa de forma benigna y es autolimitada. Métodos: Presentamos el caso de una mujer de 60 años a quien se diagnosticó este síndrome luego de realizar exámenes de laboratorio, anticuerpos e imágenes sin encontrar alteraciones en ellos, con mejoría luego de recibir analgesia y medios físicos. Resultados: El síndrome de Achenbach continúa siendo una entidad desconocida, con pocos reportes en la literatura. Hasta el año 2 016 se habían identificado 12 reportes de caso a nivel mundial concluyendo que es una patología que afecta principalmente a mujeres entre la quinta y sexta década de vida. . Conclusión: Aunque esta entidad nosológica es benigna y su fisiopatología no está del todo clara, es importante que durante el abordaje inicial se consulte por episodios similares en el pasado y en caso de ser un evento agudo, buscar otras alteraciones como retardo en el llenado capilar, frialdad distal, ausencia de pulsos y de ese modo se descarte patología isquémica aguda con ayudas diagnosticas

Plasmodium falciparum Blood Stage Antimalarial Vaccines: An Analysis of Ongoing Clinical Trials and New Perspectives Related to Synthetic Vaccines.

Plasmodium falciparum malaria is a disease causing high morbidity and mortality rates worldwide, mainly in sub-Saharan Africa. Candidates have been identified for vaccines targeting the parasite's blood stage; this stage is important in the development of symptoms and clinical complications. However, no vaccine that can directly affect morbidity and mortality rates is currently available. This review analyzes the formulation, methodological design, and results of active clinical trials for merozoite-stage vaccines, regarding their safety profile, immunological response (phase Ia/Ib), and protective efficacy levels (phase II). Most vaccine candidates are in phase I trials and have had an acceptable safety profile. GMZ2 has made the greatest progress in clinical trials; its efficacy has been 14% in children aged less than 5 years in a phase IIb trial. Most of the available candidates that have shown strong immunogenicity and that have been tested for their protective efficacy have provided good results when challenged with a homologous parasite strain; however, their efficacy has dropped when they have been exposed to a heterologous strain. In view of these vaccines' unpromising results, an alternative approach for selecting new candidates is needed; such line of work should be focused on how to increase an immune response induced against the highly conserved (i.e., common to all strains), functionally relevant, protein regions that the parasite uses to invade target cells. Despite binding regions tending to be conserved, they are usually poorly antigenic and/or immunogenic, being frequently discarded as vaccine candidates when the conventional immunological approach is followed. The Fundación Instituto de Inmunología de Colombia (FIDIC) has developed a logical and rational methodology based on including conserved high-activity binding peptides (cHABPs) from the main P. falciparum biologically functional proteins involved in red blood cell (RBC) invasion. Once appropriately modified (mHABPs), these minimal, subunit-based, chemically synthesized peptides can be used in a system covering the human immune system's main genetic variables (the human leukocyte antigen HLA-DR isotype) inducing a suitable, immunogenic, and protective immune response in most of the world's populations.