Male Ebola Survivors: Do Not Forget to Use a Condom!

The current Ebola outbreak is the largest, longest, and most complex the world has ever seen, that is, the United Nations declared it "a threat to peace and security"1 and the World Health Organization acknowledged it to be a Public Health Emergency of International Concern. As new evidence emerges2 to enlighten the clinical characteristics and the prognosis of the acute phase of the disease, there is relatively scarce information about the convalescent phase, especially the measures to control the sexual transmission of Ebola.In order to assess the evidence that underlies the current recommendation (use of condom for 3 months in convalescent male3), we performed a systematic search of the literature (for articles indexed in Medline and Embase) using the following MESH terms (Ebolavirus; Hemorrhagic Fever, Ebola; Semen) with no further restrictions (Table 1).

El Médico para el Siglo XXI / The 21st Century Physician

La sociedad espera mucho de sus médicos. Las personas nos confían el cuidado de su sufrimiento y nos dan acceso para intervenir su cuerpo. Nos comparten información íntima sobre su vida y nos confían su custodia. ¡El médico es un actor social muy relevante! Por eso no me cabe duda, que de esa importancia se derivan las exigentes y diversas competencias que el médico debe tener para desempeñarse adecuadamente en el contexto actual. Los cambios que ha experimentado la estructura social en los últimos 20 años han modificado -y complejizado- las competencias que se le demandan hoy en día a los médicos. La población se ha envejecido; las enfermedades crónicas y mentales aparecen como las que más cargan de enfermedad a los colectivos; y la emergencia y re-emergencia de enfermedades infecciosas, que pueden convertirse en graves epidemias, ponen a prueba la capacidad de respuesta de los médicos y los sistemas de salud de forma frecuente. Adicionalmente, el médico tiene hoy a la mano una oferta de conocimientos, ¡relevantes para su práctica!, tan amplia como nunca antes, pero tiene que trabajar en contextos (como el del sistema de salud colombiano) que regulan estrictamente su actividad profesional. A todo lo anterior, debemos agregar, particularmente para nuestra realidad, todos los efectos que genera la violencia, relacionada o no con el conflicto armado.

Society expects a lot from its doctors. People entrust us with the care of their suffering and give us access to intervene in their bodies. They share intimate information about their lives with us and entrust us with their custody. The doctor is a very important social actor! I have no doubt, therefore, that from this importance derive the demanding and diverse competencies that physicians must have in order to perform adequately in today's context. The changes in the social structure over the last 20 years have modified - and made more complex - the competencies required of doctors today. The population has aged; chronic and mental illnesses appear to be the main burden of disease on the population; and the emergence and re-emergence of infectious diseases, which can become serious epidemics, frequently test the capacity of physicians and health systems to respond. In addition, doctors today have at their disposal a wider range of knowledge relevant to their practice than ever before, but they have to work in contexts (such as the Colombian health system) that strictly regulate their professional activity. To all of the above, we must add, particularly for our reality, all the effects generated by violence, whether or not related to the armed conflict.

Ciencia y conciencia: elementos trazadores de la educación médica / Science and consciousness: tracer elements of medical education

Toda acción revela una intención, por eso cada ciencia es producto de las voluntades sociales que la validan y la hacen posible. Esta especificidad social de la actividad científica le da un carácter ideológico: esto quiere decir que la dota de unos sujetos e instituciones interesados en ella. Para el caso específico hay que aclarar que nuestro actual contexto -político administrativo, local, nacional e internacional- es propicio y entusiasta para planear y ejecutar iniciativas que promuevan la producción e implementación de conocimientos científicos y prácticas basadas en dichos conocimientos. La justificación para ello podría venir dada por muchos, y diversos factores, por ejemplo, la generación y aplicación del conocimiento científico a los procesos productivos ha demostrado ser la manera más eficaz y eficiente de garantizar la disponibilidad y la calidad de bienes y servicios de alto valor social y de mercado; sin embargo, creo que hay uno que es fundamental, y además, en nuestro caso, intuyo más importante: que la ciencia -y sus aplicaciones- se constituyen como un fin y un camino para contribuir con la función social -y esencial- de los futuros médicos egresados de la Universidad Tecnológica de Pereira: ¡impactar positivamente la calidad de vida de los habitantes de la región! Como ya hay tratados más amplios, que el espacio del que dispongo en esta editorial, para justificar y fundamentar epistemológica, metodológica y pedagógicamente (1,2) la formación en investigación en el currículo de los estudiantes de medicina, me parece más pertinente y oportuno aventurarme -con toda la dificultad y superficialidad en las apreciaciones que mi corto paso por esta, y ya querida, institución conlleva- a hacer un análisis de las fortalezas a mantener y las debilidades a mitigar que considero determinarán en gran medida el desenlace de la actual apuesta, lo anterior enmarcado en una perspectiva del contexto -socio-político y jurídico- en el que está inserta la facultad.

Every action reveals an intention, which is why every science is the product of the social wills that validate it and make it possible. This social specificity of scientific activity gives it an ideological character: this means that it endows it with subjects and institutions interested in it. In this specific case, it must be made clear that our current context - political, administrative, local, national and international - is favourable and enthusiastic for planning and executing initiatives that promote the production and implementation of scientific knowledge and practices based on such knowledge. The justification for this could be given by many different factors, for example, the generation and application of scientific knowledge to productive processes has proven to be the most effective and efficient way to guarantee the availability and quality of goods and services of high social and market value; however, I believe there is one that is fundamental, and moreover, in our case, I sense more important: that science - and its applications - are constituted as an end and a way to contribute to the social - and essential - function of the future medical graduates of the Technological University of Pereira: to positively impact the quality of life of the inhabitants of the region! As there are already more extensive treatises, than the space available to me in this editorial, to justify and support epistemologically, methodologically and pedagogically (1,2) the training in research in the curriculum of medical students, it seems to me more pertinent and opportune to venture - with all the difficulty and superficiality in the appraisals that my short time at this, and already beloved institution - to make an analysis of the strengths to be maintained and the weaknesses to be mitigated, which I believe will determine to a large extent the outcome of the current venture, framed in a perspective of the context -socio-political and legal- in which the faculty is inserted.

Psiquiatría infantil: un tema en el olvido / Child psychiatry: A neglected discipline

A pesar de los esfuerzos por caracterizar los trastornos mentales en Colombia, actualmente, en el eje cafetero, no conocemos con precisión el estado de salud mental de nuestros niños y adolescentes. A la fecha no se reportan estudios que se aproximen a la situación real de este problema y tampoco se cuenta con centros de atención especializados en esta área en el departamento de Risaralda. La encuesta más reciente que se realizó en Colombia sobre enfermedad mental fue el Estudio Nacional de Salud Mental de Colombia, 2003 (1), allí se caracterizaron epidemiológicamente los trastornos mentales mas importante en adultos; la población infantil y adolescente no fue incluida, olvidando por lo tanto la importancia de estas enfermedades en este grupo.

Despite efforts to characterize mental disorders in Colombia, currently, in the coffee region, we do not know precisely the state of mental health of our children and adolescents. To date, no studies are reported that approximate the real situation of this problem and there are no specialized care centers in this area in the department of Risaralda. The most recent survey conducted in Colombia on mental illness was the National Mental Health Study of Colombia, 2003 (1), where the most important mental disorders in adults were epidemiologically characterized; the child and adolescent population was not included, thus forgetting the importance of these diseases in this group.

Proteinuria in preeclampsia from a podocyte injury perspective.

Preeclampsia is a frequent cause of maternal and fetal morbidity and mortality worldwide. The underlying causes of this hypertensive complication have remained elusive. The placenta seems to be at the origin of the disease, as its removal appears to be the only effective treatment available. Many organs can potentially be affected. Nonetheless, kidney alterations are always present: proteinuria is one of the hallmarks for a preeclampsia diagnosis. VEGF is pivotal for maintaining glomerular filtration barrier function; hence, the elevated concentrations of placental-derived VEGF inhibitors, such as sFlt-1, may largely explain the renal alterations observed. Classically, glomerular endothelial injury was considered responsible for the renal impairment present in preeclampsia. Recent findings, however, have shown that podocytes are crucial in explaining the loss of filtration capacity of the preeclamptic kidney. The aims of this manuscript are to detail the main findings that associate podocyte injury with proteinuria in preeclampsia, and discuss the eventual applications of podocyte damage biomarkers in clinical practice.

Leiomyoma of the urinary bladder: a case report.

The case of a 71-year-old woman who presented with one year history of pelvic pain and occasional dysuria is reported. Computed tomography and Magnetic Resonance Imaging revealed a well defined intramural bladder mass. The histological findings of the surgical specimen confirmed a leiomyoma of the urinary bladder. The clinical presentation,imaging findings and management of this relatively rare benign tumor are discussed.

Leiomyoma of the urinary bladder: a case report

The case of a 71-year-old woman who presented with one year history of pelvic pain and occasional dysuria is reported. Computed tomography and Magnetic Resonance Imaging revealed a well defined intramural bladder mass. The histological findings of the surgical specimen confirmed a leiomyoma of the urinary bladder. The clinical presentation, imaging findings and management of this relatively rare benign tumor are discussed.

Exogenous vascular endothelial growth factor supplementation can restore the podocyte barrier-forming capacity disrupted by sera of preeclamptic women.

AIM: To determine whether exogenous vascular endothelial growth factor (VEGF) supplementation to sera from women with preeclampsia can restore the podocyte barrier-forming capacity disrupted after stimulation with sera from these women. MATERIAL AND METHODS: Enzyme-linked immunosorbent assays (ELISAs) for sFlt-1 (soluble VEGF receptor 1) and VEGF were performed in the sera of preeclamptic and healthy pregnant women. VEGF-enriched preeclamptic serum was used to evaluate the capacity of such sera to restore the diminished podocyte barrier capacity secondary to stimulation with untreated preeclamptic sera. RESULTS: Two groups, preeclampsia (n=15) and healthy (n=15) pregnant women, were established. Median serum levels (pg/mL) of sFlt-1 and VEGF were significantly different between groups: 3987 versus 1432 and 6 versus 15.6 (P<0.001). Altered resistance values of podocytes stimulated with sera from women with preeclampsia were recovered after exogenous VEGF supplementation. CONCLUSION: The mean resistance value of cultured podocytes, an indicator of the integrity of the cytoskeleton and the capacity of these cells to form layers, is altered in women with preeclampsia. High levels of sFlt-1, an inhibitor of VEGF observed in high concentrations in the serum of these patients, could be the underlying cause of this alteration. We provide evidence that exogenous VEGF supplementation of the sera of these women could recover this indicator.

Glomerular disturbances in preeclampsia: disruption between glomerular endothelium and podocyte symbiosis.

BACKGROUND: Preeclampsia (PE) is the commonest cause of glomerular disease worldwide. Glomerular endotheliosis has been considered as the hallmark of PE, but this lesion is also found in non-proteinuric hypertensive pregnant women. Lately, podocyte alterations have been related to PE. PROPOSAL: Although it has been demonstrated that glomerular endothelium and podocyte alterations are related to PE, we could locate no formal academic discussion that integrates these two phenomena. The demonstration that alterations of the expression of vascular endothelial growth factor (VEGF) by podocytes result in a dramatic endothelial phenotype and that induced production of endothelin-1 by glomerular endothelium provokes podocyte damage could indicate that glomerular lesions in PE result from disruption of the symbiosis between these cells rather than from events occurring independently. We shall try to describe a holistic way of viewing renal disease in PE women, in which the hypertensive emergency is produced by the effects of antiangiogenic proteins on the vascular endothelium, while renal lesion and proteinuria result from the effects of these proteins on both the glomerular endothelium and the podocyte. CONCLUSIONS: VEGF deficiency within the glomerulus in women with PE leads to the disruption of podocyte and glomerular endothelium symbiosis. The evidence demonstrating that exogenous VEGF administration in a rat model of PE could alleviate hypertension and proteinuria in these animals are encouraging in view of looking for therapeutic approaches in this direction, nonetheless further evidence should be provided in humans to directly demonstrate that VEGF supplementation could mitigate the symptoms of PE.

Preeclamptic sera directly induce slit-diaphragm protein redistribution and alter podocyte barrier-forming capacity.

BACKGROUND/AIMS: Podocytes are critical in maintaining the filtration barrier of the glomerulus and are dependent on the slit diaphragm. We hypothesized that disturbances of podocyte biology contribute to proteinuria in women with preeclampsia (PE). METHODS: A human podocyte cell line was stimulated with serum from women with PE (patients) and healthy pregnant women (controls); the main changes in 3 important podocyte proteins: podocin, CD2AP and actin were established by immunofluorescence and Western blot; we also searched for changes in cell plasticity by measuring the resistance of cultured podocytes. RESULTS: Different distributions of CD2AP, podocin and actin were observed in the podocytes stimulated with patient sera compared to podocytes stimulated with control sera. We also found that the mean resistance value of podocytes cultured with serum from women with PE was significantly lower than podocytes cultured with serum from controls. There was no difference in the protein expression level of podocin and CD2AP between patients and controls. CONCLUSIONS: We present evidence that there are differences in podocytes when stimulated with sera from women with PE compared to those stimulated with healthy pregnancy sera. This is the first time that podocyte alterations have been directly related to PE; these descriptive findings could be considered as an interesting beginning for further studies relating podocytes and PE.