[Late onset Pompe disease: an analysis of 19 patients from Mexico]. / Enfermedad de Pompe de inicio tardío: análisis de una casuística de 19 pacientes mexicanos.

INTRODUCTION: Pompe disease (PD) is a rare metabolic myopathy with an ample and heterogeneous clinical spectrum, particularly late onset PD (LOPD), which is characterized by appearance at older age and slower disease progression, leading to diagnostic confirmation difficulty and delay. AIM: To describe the genotype and clinical characteristics of Mexican patients with LOPD. MATERIAL AND METHODS: Clinical information from 19 Mexican patients with LOPD confirmed with enzyme activity and GAA gene analysis was reviewed. Genetic information of our population was crossed with international genetic databases. RESULTS: Median age between onset of symptoms and diagnosis was 19 years (range 2-43) and diagnostic confirmation 36 years (range 9-52). Most frequently referred symptoms were proximal axial weakness (n = 17; 89.5%), waddling gait (n = 17; 89.5%) and hyperlordosis (n = 7; 36.8%). Sixteen patients (84.2%) were evaluated with electromyography; a myopathic pattern was reported in 11 (57.8%), but only in 5 patients (26%) paraspinal muscle evaluation was included. The most pathogenic mutations in our group were c.-32-13T>G, c.1799G>A and c.1082C>T. CONCLUSIONS: Similar to other international publications, LOPD in Mexico is clinically heterogeneous; patients may delay years before diagnosis is established. Axial and proximal weakness is the most frequent clinical feature; thus, electromyography with paraspinal muscle evaluation is essential. Except for one, the mutations found in our patients have been previously reported in PD genetic databases.

TITLE: Enfermedad de Pompe de inicio tardío: análisis de una casuística de 19 pacientes mexicanos.Introducción. La enfermedad de Pompe es una miopatía metabólica rara con espectro clínico heterogéneo, especialmente la de inicio tardío, cuya sintomatología es de progresión más lenta y representa un gran reto diagnóstico. Objetivo. Describir el genotipo y las características clínicas de pacientes mexicanos con Pompe de inicio tardío (LOPD). Material y métodos. Se incluyó a 19 pacientes mexicanos con LOPD confirmada mediante actividad enzimática y estudio molecular del gen GAA. Se evaluaron datos clínicos y se revisaron las mutaciones en bases de datos genómicas. Resultados. La mediana de edad de inicio de los síntomas fue de 19 años (rango: 2-43 años), y la edad de diagnóstico, de 36 años (rango: 9-52 años). Los síntomas más frecuentes fueron debilidad axial y proximal (n = 17; 89,5%), marcha basculante (n = 17; 89,5%) e hiperlordosis (n = 7; 36,8%). A 16 pacientes (84,2%) se les realizó electromiografía; 11 (57,8%) describieron patrón miopático y sólo en cinco pacientes (26%) se incluyó la valoración de los músculos paraespinales. Las variantes patogénicas más frecuentes en nuestra casuística fueron c.-32-13T>G, c.1799G>A y c.1082C>T. Conclusiones. Parecido a lo comunicado en publicaciones internacionales, la LOPD en México es clínicamente heterogénea; los pacientes pueden tardar años en llegar al diagnóstico. La debilidad muscular axial y proximal es el dato clínico más frecuente, por lo que la electromiografía debe incluir valoración de los músculos paraespinales. A excepción de una, las mutaciones encontradas en nuestra serie de casos se encuentran previamente descritas en las bases de datos de enfermedad de Pompe.

Phototherapy Induces an Improvement in Clinical and Biochemical Scores in Patients with Rheumatoid Arthritis

ABSTRACT Objective: Rheumatoid arthritis (RA) is a common autoimmune disease for which there is no known cure. Ultraviolet light can induce immunosuppressive effects. Our main objective was to ascertain whether a complementary treatment with phototherapy would improve changes in functional scales in patients with RA. Methods: Seven women with RA were enrolled for this study and submitted to phototherapy sessions with a 425-650 nm lamp. Results: The Karnofsky scale changed from requiring frequent medical care to being capable of normal activity with few symptoms or signs of disease (p = 0.018), the rheumatoid arthritis-specific quality of life questionnaire decreased abruptly from 29 to 0 points (p = 0.018), the Steinbrocker functional capacity rating changed from limited to little or none of the duties of usual occupation or self-care to complete ability to carry out all the usual duties without handicaps (p = 0.017). The pain was remitted after the treatment period. The acute inflammation variables showed a significant decrease after the indicated sessions, C-reactive protein (p = 0.042) and erythrocyte sedimentation rate (p = 0.018). Conclusion: The evaluated scales clearly show a benefit with the phototherapy in patients with RA. Thus, phototherapy seems to be a plausible complementary option to reduce the symptoms of RA.

Hepatocellular carcinoma in the noncirrhotic liver: Clinical features and outcomes in Veracruz, Mexico. / Carcinoma hepatocelular en hígado no cirrótico: características clínicas y resultados en Veracruz, México.

INTRODUCTION AND AIM: Hepatocellular carcinoma (HCC) is the most frequent primary tumor of the liver. HCC in the noncirrhotic liver accounts for 15-20% of all HCC. Noncirrhotic HCC is a clinically different entity because of the non-neoplastic liver parenchyma involved. Our aim was to describe the presentation, treatment, and predictive survival results of noncirrhotic HCC in Veracruz. MATERIAL AND METHOD: A retrospective study, spanning 13 years, was conducted on patients with noncirrhotic HCC. It analyzed their clinical characteristics, fibrosis/cirrhosis biologic index (NAFLD, MELD, ALBI, APRI, CDS, FIB-4, GUCI, Lok) results, disease treatment, and survival. RESULTS: From a total of 168 cases of HCC, 33 (19.6%) noncirrhotic patients were included in the study. Of those patients, the mean patient age was 67.3 years (51.5% men), 9.1% had hepatitis C virus infection, and 27.3% were alcoholics. Less than 20% of the patients had biologic indexes suggestive of fibrosis/cirrhosis. Mean tumor size was 7.7cm and 42.4% of the patients had alpha-fetoprotein levels>15ng/ml. A total of 52.5% of the tumors were classified as Okuda II and 30.3% of the patients had advanced disease (the Milan criteria). Liver resection was performed on 51.5% of the patients, radiofrequency ablation on 18.2%, and transarterial chemoembolization on 9.1%. The overall 5-year survival rate was 55.4%. Liver resection resulted in the best 5-year survival rate (72.7%). Age>67 years and elevated alpha-fetoprotein levels were associated with poorer survival (P<.05, log-rank). CONCLUSIONS: The characteristics and survival rate of HCC in the noncirrhotic liver were similar to those reported in other studies. Liver resection provided the highest survival rates. The liver fibrosis biologic indexes were not risk factors for survival.

Prevalence, associated risk factors, and antimicrobial resistance profiles of non-typhoidal Salmonella in large scale swine production in Córdoba, Argentina.

Non-typhoidal Salmonella is considered a major public health concern. The growing relevance of pigs as reservoir of Salmonella spp. has prompted several countries to set up surveillance and control programs to fight Salmonella infection in swine and reduce public health risk. In the last decade, pork production in Córdoba increased significantly to become one of the most important pig production provinces in Argentina. The aim of this study was to estimate Salmonella spp. prevalence and associated risk factors in large scale-farms in this province. Mesenteric lymph nodes (MLN) of 580 pigs from 20 finishing large-scale farms were collected between 2014 and 2015 to estimate Salmonella infection. A prevalence of 41.5% (95%CI: 37.6-45.6%) was observed. Two major risk factors were significantly associated with Salmonella infection, both related to the pre-slaughter period (distance from the farm to the slaughterhouse and lairage time), highlighting the need to pay special attention to pre-slaughter practices in the province. Shortening transport times and complying with national regulations for lairage time at slaughter may help to reduce the prevalence of infection. Sixteen different serovars were identified, being S. Anatum and S. Typhimurium the most prevalent ones. Moreover, two isolate of the monophasic variant of Salmonella Typhimurium (I 4,5,12:i:-) resistant to enrofloxacin and which also displayed multidrug resistance was isolated for first time from pigs in Córdoba. The moderate to high levels of antimicrobial resistance detected for antibiotics commonly used in the pig sector suggested the need for implementing a plan to limit their use in the province.

Trajectories of neuropsychological functioning in Mexican children with traumatic brain injury over the first year after injury.

BACKGROUND: Children with traumatic brain injury (TBI) usually displayed substantial neuropsychological impairment at short and long term after injury. OBJECTIVE: To compare the course of cognitive functioning among children with TBI and healthy controls over the first-year post-injury in Guadalajara, Mexico. METHODS: A sample of 46 children with TBI and 46 healthy controls from Guadalajara, Mexico were recruited. Both groups received a comprehensive neuropsychological evaluation at three-time (3, 6, and 12 months) with measures of memory, attention, executive function, processing speed, language, perceptual reasoning, visuo-spatial abilities, and intellectual functioning. Sixteen hierarchical linear models (HLMs) were performed to examine whether linear trajectories of cognitive functioning differed over time between groups. RESULTS: Trajectories of neuropsychological performance were significantly worse over time among children with TBI than healthy controls across every cognitive domain. HLMs suggested that cognitive performance increased over time in both groups, however, TBI group scored significantly lower at each time point compare to the control group, except in Stroop-Interference. CONCLUSIONS: Cognitive deficits are common during the first-year after pediatric TBI. Thus, it is imperative to implement early rehabilitation programs to mitigate the consequences of these problems in the social, academic, and family reintegration of these children.

Use of Institutional Social Media for Information Management and Communication in Healthcare in a National Health System.

Social media has a growing presence in the eHealth research agenda. This research aims to characterize the use of social media in the Cuban National Health System for health information management and communication in healthcare. We specifically examine the strategy developed by Infomed and its main results.

[Effect of transcraneal magnetic stimulation on the motor recovery of the thoracic limb in cerebrovascular disease -a systematic review]. / Efecto de la estimulacion magnetica transcraneal sobre la recuperacion motora del miembro toracico en la enfermedad vascular cerebral. Revision sistematica.

INTRODUCTION: There have been studies in which contralesional inhibitory and ipsilesional excitatory transcranial magnetic stimulation (TMS) has been used as coadjuvant therapy in the motor rehabilitation of the thoracic limb in patients. However, there is no consensus regarding the stimulation variables or their clinical outcomes. AIM: To describe the results of clinical trials where TMS has been applied in rehabilitation in patients with cerebrovascular disease (CVD). PATIENTS AND METHODS: A systematic review of the PubMed database was performed. The articles cataloged as originals in English, whose population had limitation of thoracic limb after CVD were selected. Pilot studies, as well as studies in which patients under pharmacological treatment included any intervention other than physical or occupational therapy were excluded. Given their heterogeneity, it was not possible to apply inferential statistics, only descriptive statistics were use. RESULTS: Seven studies were identified; 259 cases with an age of 64.3 ± 4.28 years (range: 35-89 years) were reported. The TMS protocols, for the most part, were performed by contralesional inhibitory type stimulation. There were positive results in five studies. CONCLUSION: In accordance with the results obtained, we observed that TMS could contribute to the improvement of motor control of the thoracic limb in patients with sequelae due to CVD.

TITLE: Efecto de la estimulacion magnetica transcraneal sobre la recuperacion motora del miembro toracico en la enfermedad vascular cerebral. Revision sistematica.Introduccion. Existen estudios donde se ha utilizado la estimulacion magnetica transcraneal (EMT) inhibitoria contralesional y excitatoria ipsilesional como terapia coadyuvante en la rehabilitacion motora del miembro toracico; sin embargo, no existe un consenso respecto a las variables de estimulacion ni sobre sus resultados clinicos. Objetivo. Describir los resultados de los ensayos clinicos donde se ha aplicado EMT en la rehabilitacion en pacientes con enfermedad vascular cerebral (EVC). Pacientes y metodos. Se realizo la revision sistematica de la base de datos PubMed. Fueron seleccionados los estudios catalogados como originales en idioma ingles, cuya poblacion tuvo afectacion de miembro toracico tras una EVC. Se excluyeron todos los estudios piloto, ademas de estudios que incluyeran pacientes bajo tratamiento farmacologico o alguna intervencion diferente a terapia fisica u ocupacional. Dada la heterogeneidad percibida en los estudios, no fue posible aplicar estadistica inferencial, unicamente se empleo estadistica descriptiva. Resultados. Fueron seleccionados siete estudios. Se identificaron 259 casos con una edad media de 64,3 ± 4,28 años (rango: 35-89 años). Los protocolos de EMT, en su mayoria, se realizaron mediante estimulacion de tipo inhibitoria contralesional. Hubo resultados positivos en cinco estudios. Conclusion. De acuerdo con los resultados obtenidos, existen indicios de que la EMT podria contribuir a la mejoria del control motor del miembro toracico en los pacientes con secuelas por EVC.

[Guillain-Barre syndrome in times of arbovirosis. Reply]. / Sindrome de Guillain-Barre en tiempos de arbovirosis. Replica.

TITLE: Sindrome de Guillain-Barre en tiempos de arbovirosis. Replica.

[The most frequent causative agents of Guillain-Barre syndrome in a Mexican general hospital]. / Agentes causales mas frecuentes del sindrome de Guillain-Barre en un hospital de Veracruz, Mexico.

INTRODUCTION: After Zika virus outbreak and the increase in the incidence of Guillain-Barre syndrome (GBS), the causal relationship has been studied, however a full etiological correlation has not been found. PATIENTS AND METHODS: From January 1 to December 31, 2017, patients with GBS were included. In addition to the basic serologies, enterovirus, herpes, Campylobacter, hepatitis B and C, TORCH, HIV, Brucella and Salmonella were requested. RESULTS: Cohort of seven male patients. Five patients analyzed cerebrospinal fluid reporting normal; all of them underwent brain scan, reporting normal. Neuroconduction was performed, resulting in acute inflammatory demyelinating polyneuropathy in four cases and acute motor axonal neuropathy in one case. All received intravenous immunoglobulins, five cases had a good prognosis and two deaths. No positive cases were reported to Zika virus. A positive case was reported to dengue and another to chikungunya. Five positive cases were reported to Campylobacter. One case positive to enterovirus. Dengue + Campylobacter coinfections were reported in one case and chikungunya + Campylobacter in another case. CONCLUSIONS: The present cohort shows that it was not possible to establish a causal relationship between GBS and Zika virus, but other viral and bacterial causal agents were identified, such as dengue, chikungunya and enterovirus, with the identification of Campylobacter cases even more remarkable.

TITLE: Agentes causales mas frecuentes del sindrome de Guillain-Barre en un hospital de Veracruz, Mexico.Introduccion. Con posterioridad a la oleada del virus del Zika y el incremento en la incidencia de sindrome de Guillain-Barre (SGB), se ha estudiado la relacion causal, pero no se ha encontrado una plena correlacion etiologica. Pacientes y metodos. Del 1 de enero al 31 de diciembre de 2017, se incluyeron pacientes con SGB. Ademas de las serologias basicas, se solicitaron determinaciones de enterovirus, virus del herpes, Campylobacter, hepatitis B y C, TORCH, virus de la inmunodeficiencia humana, Brucella y Salmonella. Resultados. Cohorte de siete pacientes de sexo masculino. A cinco pacientes se les analizo el liquido cefalorraquideo, que era normal. A todos se les realizo una tomografia encefalica, tambien normal, y se realizo neuroconduccion, que mostro polineuropatia inflamatoria desmielinizante aguda en cuatro casos y neuropatia motora axonal aguda en uno. Todos recibieron inmunoglobulinas intravenosas; tuvieron buen pronostico cinco casos y hubo dos defunciones. No se informo de casos positivos al virus del Zika. Hubo un caso positivo al dengue, uno al chikungunya, cinco a Campylobacter y uno a enterovirus. Se informo de coinfecciones de dengue + Campylobacter en un caso y de chikungunya + Campylobacter en otro. Conclusiones. La presente cohorte demuestra que no fue posible establecer una relacion causal entre el SGB y el virus del Zika, pero se identificaron otros agentes causales viricos y bacterianos, como dengue, chikungunya y enterovirus, y fue aun mas destacable la identificacion de los casos de Campylobacter.

Tilapia rearing with high rate algal pond effluent: ammonia surface loading rates and stocking densities effects.

In two pilot-scale experiments, fingerlings and juvenile of tilapia were reared in high rate algal pond (HRAP) effluent. The combination of three different total ammonia nitrogen (TAN) surface loading rates (SLR1 = 0.6, SLR2 = 1.2; SLR3 = 2.4 kg TAN·ha-1·d-1) and two fish stocking densities (D1 = 4 and D2 = 8 fish per tank) was evaluated during two 12-week experiments. Fingerlings total weight gain varied from 4.9 to 18.9 g, with the highest value (equivalent to 0.225 g·d-1) being recorded in SLR2-D1 treatment; however, high mortality (up to 67%) was recorded, probably due to sensitivity to ammonia and wide daily temperature variations. At lower water temperatures, juvenile tilapia showed no mortality, but very low weight gain. The fish rearing tanks worked as wastewater polishing units, adding the following approximate average removal figures on top of those achieved at the HRAP: 63% of total Kjeldahl nitrogen; 54% of ammonia nitrogen; 42% of total phosphorus; 37% of chemical oxygen demand; 1.1 log units of Escherichia coli.

Further contributions to the understanding of nitrogen removal in waste stabilization ponds.

A set of experiments were conducted in Brazil in a pilot-scale waste stabilization pond (WSP) system (a four-maturation-pond series) treating an upflow anaerobic sludge blanket (UASB) reactor effluent. Over a year and a half the pond series was monitored under two flow rate conditions, hence also different hydraulic retention times and surface loading rates. On-site and laboratory trials were carried out to assess: (i) ammonia losses by volatilization using acrylic capture chambers placed at the surface of the ponds; (ii) organic nitrogen sedimentation rates using metal buckets placed at the bottom of the ponds for collecting settled particulate matter; (iii) nitrogen removal by algal uptake based on the nitrogen content of the suspended particulate matter in samples from the ponds' water column. In addition, nitrification and denitrification rates were measured in laboratory-based experiments using pond water and sediment samples. The pond system achieved high nitrogen removal (69% total nitrogen and 92% ammonia removal). The average total nitrogen removal rates varied from 10,098 to 3,849 g N/ha·d in the first and the last ponds, respectively, with the following fractions associated with the various removal pathways: (i) 23.5-45.6% sedimentation of organic nitrogen; (ii) 13.1-27.8% algal uptake; (iii) 1.2-3.1% ammonia volatilization; and (iv) 0.15-0.34% nitrification-denitrification.

Brominated Flame Retardants in Sediments of Four Coastal Lagoons of Yucatan, Mexico.

We examined the sediments of four coastal lagoons (Ria Lagartos, Bocas de Dzilam, Laguna de Chelem and Ria Celestun) from the state of Yucatan, Mexico, for three widely used commercial polybrominated diphenyl ethers formulations (penta-, octa- and deca-BDE). The most commonly found congeners in all four lagoons were BDEs 47, 99 and 100 (all in the penta-BDE formulation) and BDE209 (deca-BDE formulation). The greatest variety and highest concentrations of brominated flame retardants were found in Ria Lagartos, which also showed the highest BDE 100 concentration (24.129 ng/g). Hexabromocyclododecane was found in all lagoons, but at lower concentrations than those of the various polybrominated diphenyl ethers. Dispersal routes of these compounds are discussed, such as a ring of sinkholes (cenotes) adjacent to the lagoons. Moreover, electronic waste is a serious problem because municipal landfills have been the primary disposal method for these wastes and therefore represent a reservoir of brominated fire retardants.

[Intraarticular lesions associated with tibial fixation during anterior cruciate ligament reconstruction]. / Lesiones intraarticulares asociadas a la fijación tibial en la reconstrucción del ligamento cruzado anterior.

Anterior cruciate ligament reconstruction is a demanding procedure; complications may arise at any of its stages. This is the report of three cases in which the tibial fixation devices (IntraFix and Bio-IntraFix) led to intraarticular lesions. The complications were detected in one of the cases while the patient was still in the operating room and in the remaining two during the follow-up. All the patients had a stable knee, but all of them sustained chondral lesions resulting from the inadequate placement of the implants used for tibial fixation. Several suggestions to avoid the complications stemming from these devices are provided.

La reconstrucción del ligamento cruzado anterior es un procedimiento exigente; las complicaciones pueden presentarse en cualquiera de sus etapas. Presentamos tres casos en los cuales los dispositivos para la fijación tibial (IntraFix y Bio-IntraFix) condicionaron lesiones intraarticulares. Las complicaciones fueron detectadas, en uno de los casos, mientras el paciente se encontraba aún en la sala de operaciones, y en los otros dos, durante el seguimiento. Todos los pacientes contaban con una rodilla estable, pero tuvieron lesiones condrales causadas por la inadecuada colocación de los implantes para la fijación tibial. Se exponen algunas sugerencias para evitar complicaciones con estos dispositivos.

(Chitosan-g-glycidyl methacrylate)-xanthan hydrogel implant in Wistar rats for spinal cord regeneration.

This work reports the results of in vivo assays of an implant composed of the hydrogel Chitosan-g-Glycidyl Methacrylate-Xanthan [(CTS-g-GMA)-X] in Wistar rats. Degradation kinetics of hydrogels was assessed by lysozyme assays. Wistar rats were subjected to laminectomy by cutting the spinal cord with a scalpel. After the surgical procedure, hydrogels were implanted in the injured zone (level T8). Somatosensory evoked potentials (SEPs) obtained by electric stimulation onto periphery nerves were registered in the corresponding central nervous system (CNS) areas. Rats implanted with the biomaterials showed a successful recovery compared with the non-implanted rats after 30days. Lysozyme, derived from egg whites, was used for in vitro assays. This study serves as the basis for testing the biodegradability of the hydrogels (CTS-g-GMA)-X that is promoted by enzymatic hydrolysis. Hydrogels' hydrolysis was studied via lysozyme kinetics at two pH values, 5 and 7, under mechanical agitation at 37°C. Results show that our materials' hydrolysis is slower than pure CTS possibly due to the steric hindrance imposed by the GMA grafting of functionalization. This hydrolysis helps degrade the biomaterial and at the same time it provides support for spinal cord recovery. Combination of these results may prove useful in the use of these hydrogels as scaffolds for cells proliferation and their application as implants in living organisms.

Lesiones intraarticulares asociadas a la fijación tibial en la reconstrucción del ligamento cruzado anterior / Intraarticular lesions associated to a tibial fixation device in anterior cruciate ligament reconstruction

Resumen: La reconstrucción del ligamento cruzado anterior es un procedimiento exigente; las complicaciones pueden presentarse en cualquiera de sus etapas. Presentamos tres casos en los cuales los dispositivos para la fijación tibial (IntraFix y Bio-IntraFix) condicionaron lesiones intraarticulares. Las complicaciones fueron detectadas, en uno de los casos, mientras el paciente se encontraba aún en la sala de operaciones, y en los otros dos, durante el seguimiento. Todos los pacientes contaban con una rodilla estable, pero tuvieron lesiones condrales causadas por la inadecuada colocación de los implantes para la fijación tibial. Se exponen algunas sugerencias para evitar complicaciones con estos dispositivos.

Abstract: Anterior cruciate ligament reconstruction is a demanding procedure; complications may arise at any of its stages. This is the report of three cases in which the tibial fixation devices (IntraFix and Bio-IntraFix) led to intraarticular lesions. The complications were detected in one of the cases while the patient was still in the operating room and in the remaining two during the follow-up. All the patients had a stable knee, but all of them sustained chondral lesions resulting from the inadequate placement of the implants used for tibial fixation. Several suggestions to avoid the complications stemming from these devices are provided.

[The challenges of the 21st century in orthopedic surgery]. / Los retos del siglo XXI en cirugía ortopédica.

No Abstract available.

Risk assessment of Soulatrolide and Mammea (A/BA+A/BB) coumarins from Calophyllum brasiliense by a toxicogenomic and toxicological approach.

Calophyllum brasiliense (Calophyllaceae) is a tropical rain forest tree distributed in Central and South America. It is an important source of tetracyclic dipyrano coumarins (Soulatrolide) and Mammea type coumarins. Soulatrolide is a potent inhibitor of HIV-1 reverse transcriptase and displays activity against Mycobacterium tuberculosis. Meanwhile, Mammea A/BA and A/BB, pure or as a mixture, are highly active against several human leukemia cell lines, Trypanosoma cruzi and Leishmania amazonensis. Nevertheless, there are few studies evaluating their safety profile. In the present work we performed toxicogenomic and toxicological analysis for both type of compounds. Soulatrolide, and the Mammea A/BA + A/BB mixture (2.1) were slightly toxic accordingly to Lorke assay classification (DL50 > 3000 mg/kg). After a short-term administration (100 mg/kg/daily, orally, 1 week) liver toxicogenomic analysis revealed 46 up and 72 downregulated genes for Mammea coumarins, and 665 up and 1077 downregulated genes for Soulatrolide. Gene enrichment analysis identified transcripts involved in drug metabolism for both compounds. In addition, network analysis through protein-protein interactions, tissue evaluation by TUNEL assay, and histological examination revealed no tissue damage on liver, kidney and spleen after treatments. Our results indicate that both type of coumarins displayed a safety profile, supporting their use in further preclinical studies to determine its therapeutic potential.

Toxicogenomic analysis of pharmacological active coumarins isolated from Calophyllum brasiliense.

Calophyllum brasiliense (Calophyllaceae) is a tropical rain forest tree, mainly distributed in South and Central America. It is an important source of bioactive natural products like, for instance soulatrolide, and mammea type coumarins. Soulatrolide is a tetracyclic dipyranocoumarins and a potent inhibitor of HIV-1 reverse transcriptase and Mycobacterium tuberculosis. Mammea A/BA and A/BB coumarins, pure or as a mixture, are highly active against several leukemia cell lines, Trypanosoma cruzi and Leishmania amazonensis. In the present work, a toxicogenomic analysis of Soulatrolide and Mammea A/BA + A/BB (3:1) mixture was performed in order to validate the toxicological potential of this type of compounds. Soulatrolide or mixture of mammea A/BA + A/BB (3:1) was administered orally to male mice (CD-1) at dose of 100 mg/kg/daily, for 1 week. After this time, mice were sacrificed, and RNA extracted from the liver of treated animals. Transcriptomic analysis was performed using Affymetrix Mouse Gene 1.0 ST Array. Robust microarray analysis (RMA) and two way ANOVA test revealed for mammea mixture treatment 46 genes upregulated and 72 downregulated genes; meanwhile, for soulatrolide 665 were upregulated and 1077 downregulated genes. Enrichment analysis for such genes revealed that in both type of treatments genetic expression were mainly involved in drug metabolism. Overall results indicate a safety profile. The microarray data complies with MIAME guidelines and are deposited in GEO under accession number GSE72755.

Reemplazo femoral total, reporte de tres casos con revisión de la literatura / Total femoral replacement. Three case reports and literature review

Introducción: En la actualidad, la cirugía de recambio articular de cadera y rodilla es un procedimiento común en centros ortopédicos. Sin embargo, sabemos que este tipo de cirugía tiene vigencia y requiere procedimientos de revisión. Estos últimos generalmente conllevan complicaciones importantes como la pérdida de hueso que puede llegar a comprometer la estabilidad de los implantes. Métodos: Se realizaron tres revisiones de artroplastía tanto de cadera como de rodilla que han requerido el reemplazo total del fémur y de las articulaciones involucradas en el período comprendido del 2006 al 2011. El objetivo del presente trabajo es presentar la experiencia con estos implantes en cirugía de revisión de artroplastía. Resultados: El protocolo de manejo del postoperatorio fue estandarizado para todos y cada uno de los pacientes, requirieron manejo mediante desbridamientos y antibioticoterapia específica. Evidenciaron mejora significativa en el puntaje de la escala visual análoga del dolor (8-2.3 puntos p < 0.05) y funcional con la escala de valoración de WOMAC (21.6 preoperatorio a 55 puntos p < 0.05). Conclusiones: El reemplazo femoral total es un procedimiento quirúrgico de salvamento poco frecuente, demandante y complejo, que representa una alternativa ante la desarticulación de la extremidad pélvica en la etapa final de la enfermedad protésica. Se trata de una opción factible de realizar para mejorar la funcionalidad del paciente y disminuir la discapacidad residual para la realización de actividades de manera independiente.

Introduction: Currently hip and knee joint replacement were performed frequently at orthopedic centers. However, these surgeries do not last forever and thus revision procedures are required. The latter usually involve complications like bone loss that may compromise implant stability. Methods: Three hip and knee arthroplasty revisions were performed from 2006 to 2011, which warranted the total replacement of the femur and the joints involved. The purpose of this paper is to describe our experience with these implants used in arthroplasty revision surgery. Results: A standardized postoperative management protocol was used in all patients. They required debridement and specific antibiotic therapy. They had a significant improvement in the pain visual analog scale (VAS) (the score went from 8 to 2.3, p < 0.05) and in function, measured with the WOMAC score (from a preoperative score of 21.6 to 55, p < 0.05). Conclusions: Total femoral replacement is an infrequent, demanding and complex salvage surgery that represents an alternative to the disarticulation of the pelvic limb at the end stage of prosthetic disease. This is a feasible option used to improve patient functionality and decrease residual capacity for performing activities independently.