Sulfato de magnesio y aminofilina en el tratamiento de niños, niñas y adolescentes hospitalizados. Perfil de uso y respuesta terapéutica

Introducción: Sulfato de magnesio (MgSO4) y aminofilina son broncodilatadores intravenosos utilizados en el tratamiento de niños con broncoobstrucción (BO). La evidencia disponible para recomendar su uso es escasa. Objetivo: Caracterizar el perfil de uso y la respuesta terapéutica al MgSO4 y aminofilina en el tratamiento de la BO en niños hospitalizados en un centro de referencia de Uruguay. Materiales y métodos: Estudio descriptivo de corte transversal mediante revisión de historias y entrevistas. Se incluyeron a todos los menores de 15 años que utilizaron estos fármacos. Se evaluó la respuesta terapéutica a la administración de ambos fármacos en forma exclusiva y concomitante y la presencia de efectos adversos. Resultados: Se incluyeron 102 niños, mediana de edad 4 años, ≤5 años 62%. Los principales diagnósticos fueron: crisis asmática 56% y neumonía viral 31%. Recibieron ambos fármacos 48%, únicamente aminofilina 28% y exclusiva de MgSO4 24%. Se observó buena respuesta terapéutica a la administración: exclusiva de MgSO4 67%, consecutiva de MgSO4 y aminofilina 45% y exclusiva de aminofilina en 34%. En 38,2% se registró al menos un efecto adverso, 64% eran menores de 5 años, riesgo aumentado en 1,5 veces. Conclusiones: Se registraron variadas indicaciones, la mayoría en niños asmáticos y en un porcentaje menor indicaciones fuera de prospecto. Menos de la mitad presentaron buena respuesta luego de la administración de MgSO4 y/o aminofilina. En un porcentaje no despreciable se registraron efectos adversos, predominaron en menores de 5 años. Son necesarios nuevos estudios para continuar caracterizando el perfil de uso y seguridad de estos fármacos.

Introduction: Magnesium sulfate (MgSO4) and aminophylline are intravenous bronchodilators used in the treatment of children with bronchoobstruction (BO). The evidence available to recommend their use is scarce. Objective: To characterize the use profile and therapeutic response to MgSO4 and aminophylline in the treatment of BO in children hospitalized in a reference center in Uruguay. Materials and methods: This was a descriptive cross-sectional study through review of clinical histories and interviews. All children under 15 years of age who used these drugs were included. The therapeutic response to the administration of both drugs exclusively and concomitantly and the presence of adverse effects were evaluated. Results: 102 children were included, median age was 4 years, 62% were ≤5 years. The main diagnoses were: asthmatic crisis, 56% and viral pneumonia, 31%. 48% received both drugs, 28% only aminophylline and 24% exclusively MgSO4. Good therapeutic response was observed to the administration: MgSO4 exclusively, 67%, MgSO4 followed by aminophylline, 45% and aminophylline exclusively in 34%. At least one adverse effect was recorded in 38.2%, of these, 64% were under 5 years of age, risk increased by 1.5 times. Conclusions: Various indications were recorded, the majority in asthmatic children and a smaller percentage off-label indications. Less than half had a good response after the administration of MgSO4 and/or aminophylline. Adverse effects were recorded in a non-negligible percentage, predominating in children under 5 years of age. New studies are necessary to continue characterizing the use and safety profile of these drugs.

Unraveling Multicopper [Cu3] and [Cu6] Clusters with Rare µ3-Sulfato and Linear µ2-Oxido-Bridges as Potent Antibiofilm Agents against Multidrug-Resistant Staphylococcus aureus.

In this research article, two multicopper [Cu3] and [Cu6] clusters, [Cu3(cpdp)(µ3-SO4)(Cl)(H2O)2]·3H2O (1) and [Cu6(cpdp)2(µ2-O)(Cl)2(H2O)4]·2Cl (2) (H3cpdp = N,N'-bis[2-carboxybenzomethyl]-N,N'-bis[2-pyridylmethyl]-1,3-diaminopropan-2-ol), have been explored as potent antibacterial and antibiofilm agents. Their molecular structures have been determined by a single-crystal X-ray diffraction study, and the compositions have been established by thermal and elemental analyses, including electrospray ionization mass spectrometry. Structural analysis shows that the metallic core of 1 is composed of a trinuclear [Cu3] assembly encapsulating a µ3-SO42- group, whereas the structure of 2 represents a hexanuclear [Cu6] assembly in which two trinuclear [Cu3] motifs are exclusively bridged by a linear µ2-O2- group. The most striking feature of the structure of 2 is the occurrence of an unusual linear oxido-bridge, with the Cu3-O6-Cu3' bridging angle being 180.00°. Whereas 1 can be viewed as an example of a copper(II)-based compound displaying a rare µ3:η1:η1:η1 bridging mode of the SO42- group, 2 is the first example of any copper(II)-based compound showing an unsupported linear Cu-O-Cu oxido-bridge. Employing variable-temperature SQUID magnetometry, the magnetic susceptibility data were measured and analyzed exemplarily for 1 in the temperature range of 2-300 K, revealing the occurrence of antiferromagnetic interactions among the paramagnetic copper centers. Both 1 and 2 exhibited potent antibacterial and antibiofilm activities against methicillin-resistant Staphylococcus aureus (MRSA BAA1717) and the clinically isolated culture of methicillin-resistant S. aureus (MRSA CI1). The mechanism of antibacterial and antibiofilm activities of these multicopper clusters was investigated by analyzing and determining the intracellular reactive oxygen species (ROS) generation, lipid peroxidation, microscopic observation of cell membrane disruption, membrane potential, and leakage of cellular components. Additionally, 1 and 2 showed a synergistic effect with commercially available antibiotics such as vancomycin with enhanced antibacterial activity. However, 1 possesses higher antibacterial, antibiofilm, and antivirulence actions, making it a potent therapeutic agent against both MRSA BAA1717 and MRSA CI1 strains.

Uterotonics, magnesium sulphate and antibiotics during childbirth and peripartum: Important obstetric drugs for the anaesthesiologist.

The main causes of maternal mortality are comorbidities, hypertensive pregnancy syndrome, obstetric haemorrhage, and maternal sepsis. For this reason, uterotonics, magnesium sulphate, and antibiotics are essential tools in the management of obstetric patients during labour and in the peripartum period. These drugs are widely used by anaesthesiologists in all departments, and play a crucial role in treatment and patient safety. For the purpose of this narrative review, we performed a detailed search of medical databases and selected studies describing the use of these drugs in patients during pregnancy, delivery and the pospartum period. Uterotonics, above all oxytocin, play an important role in the prevention and treatment of pospartum haemorrhage, and various studies have shown that in obstetric procedures, such as scheduled and emergency caesarean section, they are effective at lower doses than those hitherto accepted. We also discuss the use of carbetocin as an effective alternative that has a therapeutic advantage in certain clinical circumstances. Magnesium sulphate is the gold standard in the prevention and treatment of eclampsia, and also plays a neuroprotective role in preterm infants. We describe the precautions to be taken during magnesium administration. Finally, we discuss the importance of understanding microbiology and the pharmacology of antibiotics in the management of obstetric infection and endometritis, and draw attention to the latest trends in antibiotic regimens in labour and caesarean section.

Historia natural de la mucopolisacaridosis III en una serie de pacientes colombianos / Natural history of mucopolysaccharidosis type III in a series of Colombian patients

Introducción: La mucopolisacaridosis de tipo III (MPS III), o síndrome de Sanfilippo, es un trastorno de almacenamiento lisosómico con características neurodegenerativas progresivas, predominante del sistema nervioso central. Su diagnóstico se basa en el cuadro clínico, y priman alteraciones en el neurodesarrollo y neuropsiquiátricas, incluso antes de la presencia de alteraciones fenotípicas. El análisis bioquímico para identificar el tipo de glucosaminoglucanos presente, la determinación enzimática y el estudio de genética molecular confirman la enfermedad. Casos clínicos: Se realiza la descripción clínica de ocho pacientes con diagnóstico de MPS III en Colombia, con síntomas iniciales en relación con retraso del desarrollo y trastornos comportamentales evidenciados entre los 3 y 8 años, asociado a facies toscas, cejas pobladas, hepatomegalia y pérdida auditiva progresiva en todos los casos. Uno de los pacientes presentó anomalías cardíacas; dos de ellos, epilepsia focal; y en uno se evidenció atrofia óptica. Todos presentaron alteraciones en las neuroimágenes con evidencia de pérdida del volumen parenquimatoso, atrofia del cuerpo calloso y adelgazamiento cortical; el diagnostico se realizó a través de estudios bioquímicos de cromatografía de glucosaminoglucanos y todos cuentan con un estudio genético confirmatorio. Conclusiones: La MPS III es un desafío diagnóstico, particularmente en pacientes con un curso atenuado de la enfermedad, debido al curso variable, síntomas neuropsiquiátricos tempranos inespecíficos y falta de características somáticas evidentes en comparación con otros tipos de MPS. Cuando se tiene el diagnóstico definitivo, es fundamental brindar atención interdisciplinaria para el paciente y la familia, y apoyar el tratamiento de los síntomas físicos, garantizando ofrecer el mejor cuidado posible y la mejor calidad de vida para el paciente y su familia, al tratarse de una condición neurodegenerativa.(AU)

Introduction: Mucopolysaccharidosis type III (MPS III), also known as Sanfilippo syndrome, is a lysosomal storage disease with progressive neurodegenerative features, predominantly affecting the central nervous system. Diagnosis is based on clinical features, with neurodevelopmental and neuropsychiatric alterations taking precedence, including over phenotype alterations. The disease is confirmed by biochemical analysis to identify the type of glycosaminoglycans present, enzyme assay and molecular genetic studies. Case reports: A clinical description was performed for eight patients diagnosed with MPS III in Colombia. Their initial symptoms were related to developmental delay and behavioural disorders presenting between 3 and 8 years of age, associated in all cases with coarse facial features, thick eyebrows, hepatomegaly and progressive hearing loss. One of the patients presented cardiac anomalies; two presented focal epilepsy; and one presented optic atrophy. They all presented neuroimaging alterations, with evidence of parenchymal volume loss, corpus callosum atrophy and cortical thinning; the diagnosis was performed by biochemical glycosaminoglycan chromatography studies, and all patients have a confirmatory genetic study. Conclusions: MPS III is a challenge for diagnosis, particularly in its early stages and in patients in which the course of the disease is attenuated. This is due to its variable course, non-specific early neuropsychiatric symptoms, and the absence of obvious somatic features compared to other types of MPS. After a definitive diagnosis has been made, interdisciplinary care must be provided for the patient and their family, and support given for the treatment of physical symptoms, ensuring the best possible care and quality of life for the patient and their family, as the condition is neurodegenerative.(AU)

Anemia ferropénica en el embarazo: esquema de sulfato ferroso intermitente en comparación con el continuo / Iron deficiency anaemia in pregnancy: comparison of intermittent versus continuous ferrous sulphate regimen

Resumen OBJETIVO: Comparar las concentraciones de hemoglobina en embarazadas con anemia por deficiencia de hierro que recibieron un tratamiento intermitente en comparación con el continuo de 200 mg de sulfato ferroso por vía oral. Además, comparar la frecuencia de efectos secundarios del tratamiento intermitente con el continuo. MATERIALES Y MÉTODOS: Ensayo clínico, aleatorizado, no cegado, efectuado en la Unidad Médica de Alta Especialidad Hospital de Ginecoobstetricia 4 Luis Castelazo Ayala, IMSS, en pacientes de 18 a 35 años atendidas entre los meses de enero a marzo del 2023 con 30 o más semanas de embarazo, diagnóstico de anemia ferropénica (definida operativamente solo con una biometría hemática inferior a 11 g/dL, con hipocromía y microcitosis), sin antecedentes de enfermedad crónico-degenerativa. El análisis estadístico se procesó en el programa SPSS v21, la distribución y características de la muestra con análisis univariado, seguido de un análisis bivariado con t de Student y diferencia de medias. Se consideró con significación estadística el valor de p < 0.05. RESULTADOS: Se estudiaron 32 pacientes: 16 con esquema continuo y 16 con el intermitente. Ambos grupos con incremento de 1 g/dL entre la hemoglobina inicial y final (p < 0.01), con una diferencia de medias entre el aumento de los grupos con p = 0.4. Con disminución significativa de la epigastralgia y la náusea. CONCLUSIONES: El tratamiento intermitente con sulfato ferroso incrementa las concentraciones de hemoglobina igual que un esquema continuo, pero con menos efectos adversos.

Abstract OBJECTIVE: To compare hemoglobin concentrations in pregnant women with iron deficiency anemia who received intermittent versus continuous treatment with 200 mg oral ferrous sulfate. In addition, to compare the incidence of side effects of intermittent versus continuous treatment. MATERIALS AND METHODS: Randomized, non-blinded, clinical trial conducted at the Unidad Médica de Alta Especialidad Hospital de Ginecoobstetricia 4 Luis Castelazo Ayala, IMSS, in patients aged 18 to 35 years attended between January and March 2023 with 30 or more weeks of pregnancy, diagnosis of iron deficiency anemia (operationally defined only with a blood biometry lower than 11 g/dL, with hypochromia and microcytosis), without a history of chronic degenerative disease. Statistical analysis was performed in SPSS v21 program, distribution and characteristics of the sample with univariate analysis, followed by bivariate analysis with Student's t and mean difference. A value of p < 0.05 was considered statistically significant. RESULTS: Thirty-two patients were studied: 16 with continuous and 16 with intermittent regimen. Both groups with increase of 1 g/dL between initial and final hemoglobin (p < 0.01), with a mean difference between groups increase with p = 0.4. With significant reduction in epigastralgia and nausea. CONCLUSIONS: Intermittent treatment with ferrous sulfate increases hemoglobin concentrations.

Nivel de conocimiento y adhesión al tratamiento de pacientes con anemia gestacional / Level of knowledge and adherence to treatment in patients with gestational anemia

Resumen OBJETIVO: Determinar la relación entre el nivel de conocimiento y la adhesión al régimen prescrito de sulfato ferroso y ácido fólico para prevenir o tratar la anemia gestacional en pacientes atendidas en un hospital público del Perú. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, de serie de casos, transversal y prospectivo llevado a cabo entre febrero y abril de 2022 en pacientes en el puerperio inmediato con diagnóstico de anemia gestacional establecido dos meses antes del término del embarazo. Se evaluaron los conocimientos mediante un cuestionario y la adhesión mediante la prueba de Morisky-Green-Levine, ambos instrumentos validados y fiables. El análisis estadístico se procesó en el programa STATA; se utilizaron χ2 de Pearson y el modelo lineal generalizado de la familia de Poisson con varianza robusta y nivel de confianza del 95%. RESULTADOS: Se estudiaron 217 pacientes; 2 de cada 10 tenían diagnóstico de anemia gestacional y cumplían el tratamiento. En conjunto, el 71.89% de las participantes tenía un conocimiento adecuado de la importancia del tratamiento con sulfato ferroso y ácido fólico, y el 23.96% alcanzó un nivel intermedio. La relación entre el nivel de conocimientos y el apego se aproximó a la significación estadística (p = 0.05 RPa:1.63; IC95%: 0.99-2.71), establecida mediante análisis ajustado. El conocimiento de la importancia del tratamiento antianémico para la madre multiplicó por tres la prevalencia de la adherencia (p = 0.04; RPa: 3.17; IC95%: 1.04-9.72). CONCLUSIÓN: El conocimiento por parte de las madres de la importancia del tratamiento antianémico aumentó significativamente la adherencia.

Abstract OBJECTIVE: To determine the relationship between the level of knowledge and adherence to the prescribed regimen of ferrous sulfate and folic acid to prevent or treat gestational anemia in patients attended in a public hospital in Peru. MATERIALS AND METHODS: Observational, descriptive, case series, cross-sectional and prospective study carried out between February and April 2022 in patients in the immediate postpartum period with a diagnosis of gestational anemia established two months before the end of pregnancy. Knowledge was assessed by means of a questionnaire and adherence by means of the Morisky-Green-Levine test, both validated and reliable instruments. Statistical analysis was performed with the STATA program; Pearson's χ2 and the generalized linear model of the Poisson family with robust variance and 95% confidence level were used. RESULTS: A total of 217 patients were studied; 2 out of 10 had a diagnosis of gestational anemia and were compliant with treatment. Overall, 71.89% of the participants had adequate knowledge of the importance of treatment with ferrous sulfate and folic acid, and 23.96% reached an intermediate level. The relationship between the level of knowledge and adherence was close to statistical significance (p = 0.05 RPa:1.63; 95%CI: 0.99-2.71), established by adjusted analysis. Understanding the importance of antianemic treatment for the mother increased the prevalence of adherence threefold (p = 0.04; RPa: 3.17; 95%CI: 1.04-9.72). CONCLUSION: Mothers' knowledge of the importance of antianemic treatment significantly increased adherence.

Descripción de los factores contribuyentes a las muertes secundarias a trastornos hipertensivos asociados al embarazo en Antioquia, Colombia (2012-2020) / Description of the contributing factors to deaths secondary to hypertensive disorders associated with pregnancy in Antioquia, Colombia (2012-2020)

Resumen OBJETIVO: Describir las características de la población afectada y los retrasos que contribuyeron a la mortalidad materna, secundaria a los trastornos hipertensivos del embarazo. MATERIALES Y MÉTODOS: Estudio descriptivo y retrospectivo efectuado con base en la vigilancia epidemiológica de casos centinela de muertes maternas tempranas de mujeres residentes en Antioquia, Colombia, durante el embarazo, el parto y los 42 días siguientes a éste ocurridas en el periodo 2012-2020. Se creó una base de datos en Microsoft Access 2007 (Microsoft, Redmond, WA, USA) y los datos se analizaron en Microsoft Excel y SPSS versión 22. RESULTADOS: Se registraron 266 muertes maternas, de las que 38 fueron secundarias a trastornos hipertensivos del embarazo. La eclampsia fue causa de 15 fallecimientos; 12 por síndrome HELLP, 9 por hemorragia intracerebral y 2 por desprendimiento prematuro de placenta y coagulación intravascular diseminada. En 13 de los 38 casos no hubo una pauta adecuada del sulfato de magnesio, 19 no recibieron tratamiento antihipertensivo, que estaba indicado y 17 no tuvieron un control antihipertensivo adecuado. CONCLUSIÓN: La atención prenatal es una oportunidad decisiva para la detección, prevención y estratificación del riesgo. Todos los centros de atención obstétrica deben estar preparados para gestionar urgencias asociadas con los trastornos hipertensivos del embarazo. Los desenlaces mejoran con la aplicación de protocolos de emergencia estandarizados, organizados y la participación de equipos multidisciplinarios que garanticen una atención de calidad y un efecto positivo en la morbilidad y mortalidad materna susceptible de prevención.

Abstract OBJECTIVE: To describe the characteristics of the affected population and the delays that contributed to maternal mortality secondary to hypertensive disorders of pregnancy. MATERIALS AND METHODS: Descriptive and retrospective study based on the epidemiologic surveillance of sentinel cases of early maternal deaths of women residing in Antioquia, Colombia, during pregnancy, delivery and the 42 days after delivery occurring in the period 2012-2020. A database was created in Microsoft Access 2007 (Microsoft, Redmond, WA, USA), and data were analyzed in Microsoft Excel and SPSS version 22. RESULTS: There were 266 maternal deaths, of which 38 were secondary to hypertensive disorders of pregnancy. Eclampsia was the cause of 15 deaths; 12 due to HELLP syndrome, 9 due to intracerebral hemorrhage, and 2 due to placental abruption and disseminated intravascular coagulation. In 13 of the 38 cases, there was no adequate magnesium sulfate regimen, 19 did not receive indicated antihypertensive treatment, and 17 did not have adequate antihypertensive control. CONCLUSION: Antenatal care is a critical opportunity for detection, prevention, and risk stratification. All obstetric care centers should be prepared to manage emergencies associated with hypertensive disorders of pregnancy. Outcomes improve with the use of standardized, organized emergency protocols and the participation of multidisciplinary teams that ensure quality care and a positive impact on preventable maternal morbidity and mortality.

Drinking water quality of various sources in Peshawar, Mardan, Kohat and Swat districts of Khyber Pakhtunkhwa province, Pakistan

Abstract The present study involves the chemical and bacteriological analysis of water from different sources i.e., bore, wells, bottle, and tap, from Peshawar, Mardan, Swat and Kohat districts of Khyber Pakhtunkhwa (KP) province, Pakistan. From each district, 50 water samples (10 samples from each source), regardless of urban and rural status, were collected from these sources and analysed for sulphates, nitrates, nitrites, chlorides, total soluble solids and coliforms (E. coli). Results indicated that majority of the water sources had unacceptable E. coli count i.e.> 34 CFU/100mL. E. coli positive samples were high in Mardan District, followed by Kohat, Swat and Peshawar district. Besides this, the some water sources were also chemically contaminated by different inorganic fertilizers (nitrates/nitrites of sodium, potassium) but under safe levels whereas agricultural and industrial wastes (chloride and sulphate compounds) were in unsafe range. Among all districts, the water quality was found comparatively more deteriorated in Kohat and Mardan districts than Peshawar and Swat districts. Such chemically and bacteriologically unfit water sources for drinking and can cause human health problems.

Resumo O presente estudo envolve a análise química e bacteriológica de água de diferentes fontes, ou seja, furo, poços, garrafa e torneira, dos distritos de Peshawar, Mardan, Swat e Kohat da província de Khyber Pakhtunkhwa (KP), Paquistão. De cada distrito, 50 amostras de água (10 amostras de cada fonte), independentemente do status urbano e rural, foram coletadas dessas fontes e analisadas para sulfatos, nitratos, nitritos, cloretos, sólidos solúveis totais e coliformes (E. coli). Os resultados indicaram que a maioria das fontes de água tinha uma contagem inaceitável de E. coli, ou seja, > 34 UFC / 100 mL. As amostras positivas para E. coli foram elevadas no distrito de Mardan, seguido por Kohat, Swat e distrito de Peshawar. Além disso, algumas fontes de água também foram contaminadas quimicamente por diferentes fertilizantes inorgânicos (nitratos/nitritos de sódio, potássio), mas em níveis seguros, enquanto os resíduos agrícolas e industriais (compostos de cloreto e sulfato) estavam em níveis inseguros. Entre todos os distritos, a qualidade da água foi considerada comparativamente mais deteriorada nos distritos de Kohat e Mardan do que nos distritos de Peshawar e Swat. Essas fontes de água química e bacteriologicamente impróprias para beber podem causar problemas à saúde humana.

Drinking water quality of various sources in Peshawar, Mardan, Kohat and Swat districts of Khyber Pakhtunkhwa province, Pakistan / Qualidade de água potável de váris fontes dos distritos de Peshawar, Mardan, Kohat e Swat da província de Khyber Pakhtunkhwa, Paquistão

Abstract The present study involves the chemical and bacteriological analysis of water from different sources i.e., bore, wells, bottle, and tap, from Peshawar, Mardan, Swat and Kohat districts of Khyber Pakhtunkhwa (KP) province, Pakistan. From each district, 50 water samples (10 samples from each source), regardless of urban and rural status, were collected from these sources and analysed for sulphates, nitrates, nitrites, chlorides, total soluble solids and coliforms (E. coli). Results indicated that majority of the water sources had unacceptable E. coli count i.e.> 34 CFU/100mL. E. coli positive samples were high in Mardan District, followed by Kohat, Swat and Peshawar district. Besides this, the some water sources were also chemically contaminated by different inorganic fertilizers (nitrates/nitrites of sodium, potassium) but under safe levels whereas agricultural and industrial wastes (chloride and sulphate compounds) were in unsafe range. Among all districts, the water quality was found comparatively more deteriorated in Kohat and Mardan districts than Peshawar and Swat districts. Such chemically and bacteriologically unfit water sources for drinking and can cause human health problems.

Resumo O presente estudo envolve a análise química e bacteriológica de água de diferentes fontes, ou seja, furo, poços, garrafa e torneira, dos distritos de Peshawar, Mardan, Swat e Kohat da província de Khyber Pakhtunkhwa (KP), Paquistão. De cada distrito, 50 amostras de água (10 amostras de cada fonte), independentemente do status urbano e rural, foram coletadas dessas fontes e analisadas para sulfatos, nitratos, nitritos, cloretos, sólidos solúveis totais e coliformes (E. coli). Os resultados indicaram que a maioria das fontes de água tinha uma contagem inaceitável de E. coli, ou seja, > 34 UFC / 100 mL. As amostras positivas para E. coli foram elevadas no distrito de Mardan, seguido por Kohat, Swat e distrito de Peshawar. Além disso, algumas fontes de água também foram contaminadas quimicamente por diferentes fertilizantes inorgânicos (nitratos/nitritos de sódio, potássio), mas em níveis seguros, enquanto os resíduos agrícolas e industriais (compostos de cloreto e sulfato) estavam em níveis inseguros. Entre todos os distritos, a qualidade da água foi considerada comparativamente mais deteriorada nos distritos de Kohat e Mardan do que nos distritos de Peshawar e Swat. Essas fontes de água química e bacteriologicamente impróprias para beber podem causar problemas à saúde humana.

Eficácia da ivermectina e atazanavir no tempo de recuperação dos sintomas de covid-19: uma coorte prospectiva / Effectiveness of ivermectin and atazanavir on time to resolution from covid-19 symptoms: a prospective cohort / Eficacia de ivermectina y atazanavir en el tiempo hasta lá resolución de los síntomas de covid-19: una cohorte prospectiva

Objetivo: avaliar a eficácia da Ivermectina e do Atazanavir em comparação com placebo no tempo de resolução dos sintomas e no tempo de duração da doença por COVID-19. Método: estudo observacional, de coorte prospectivo, longitudinal, descritivo e analítico com pacientes sintomáticos ambulatoriais, acompanhados por 06 meses em duas Unidades Básicas de Saúde para atendimento de COVID-19 em Teresina- Piauí, Brasil, no período de novembro a abril de 2021 identificados por amostragem aleatória 1:1:1. Foram realizados exames Reverse transcription polymerase chain reaction (RT-PCR) para confirmação laboratorial da suspeita de infecção pelo novo coronavírus e avaliação sociodemográfica e clínica. Resultados: dos 87 pacientes randomizados, 62,1% (n=54) eram do sexo masculino, com média de idade de 35,1 anos, possuíam companheira (53,9%), baixa renda (50,6%), eutróficos (40,7%) e sem comorbidades de saúde (78,2%). Não houve diferença entre o tempo médio para resolução dos sintomas, que foi de 21 dias (IQR, 8-30) no grupo atazanavir, 30 dias (IQR, 5-90) no grupo ivermectina em comparação com 14 dias (IQR, 9-21) no grupo controle. No dia 180, houve resolução dos sintomas em 100% no grupo placebo, 93,9% no grupo atazanavir e 95% no grupo ivermectina. A duração mediana da doença foi de 08 dias em todos os braços do estudo. Conclusão: o tratamento com atazanavir (6 dias) e ivermectina (3 dias) não reduziu o tempo de resolução dos sintomas e nem o tempo de duração da doença entre os pacientes ambulatoriais com COVID-19 leve em comparação com o grupo placebo. Os resultados não suportam o uso de ivermectina e atazanavir para tratamento de COVID-19 leve a moderado.

Objective: to evaluate the effectiveness of Ivermectin and Atazanavir compared to placebo in the time to resolution of symptoms and duration of illness due to COVID-19. Method: observational, prospective, longitudinal, descriptive and analytical cohort study with symptomatic outpatients, followed for 06 months in two Basic Health Units for COVID-19 care in Teresina-Piauí, Brazil, from November to April 2021 identified by 1:1:1 random sampling. Reverse transcription polymerase chain reaction (RT-PCR) tests were performed for laboratory confirmation of suspected infection with the new coronavirus and sociodemographic and clinical evaluation. Results: of the 87 randomized patients, 62.1% (n=54) were male, with a mean age of 35.1 years, had a partner (53.9%), low income (50.6%), eutrophic (40.7%) and without health comorbidities (78.2%). There was no difference between the median time to resolution of symptoms, which was 21 days (IQR, 8-30) in the atazanavir group, 30 days (IQR, 5- 90) in the ivermectin group compared with 14 days (IQR, 9- 21) in the control group. At day 180, there was resolution of symptoms in 100% in the placebo group, 93.9% in the atazanavir group, and 95% in the ivermectin group. The median duration of illness was 8 days in all study arms. Conclusion: Treatment with atazanavir (6 days) and ivermectin (3 days) did not reduce the time to symptom resolution or the duration of illness among outpatients with mild COVID-19 compared to the placebo group. The results do not support the use of ivermectin and atazanavir for the treatment of mild to moderate COVID-19.

Objetivo: evaluar la efectividad de Ivermectina y Atazanavir en comparación con placebo en el tiempo de resolución de los síntomas y duración de la enfermedad por COVID-19. Método: estudio de cohorte observacional, prospectivo, longitudinal, descriptivo y analítico con pacientes ambulatorios sintomáticos, seguidos durante 06 meses en dos Unidades Básicas de Salud para atención de COVID-19 en Teresina-Piauí, Brasil, de noviembre a abril de 2021 identificados por 1:1:1 muestreo aleatorio. Se realizaron pruebas de reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) para confirmación de laboratorio de sospecha de infección por el nuevo coronavirus y evaluación sociodemográfica y clínica. Resultados: de los 87 pacientes aleatorizados, 62,1% (n=54) eran del sexo masculino, con una edad media de 35,1 años, tenían pareja (53,9%), bajos ingresos (50,6%), eutróficos (40,7%) y sin comorbilidades de salud (78,2%). No hubo diferencia entre la mediana de tiempo hasta la resolución de los síntomas, que fue de 21 días (RIC, 8-30) en el grupo de atazanavir, 30 días (RIC, 5- 90) en el grupo de ivermectina en comparación con 14 días (RIC, 9 - 21) en el grupo control. En el día 180, hubo una resolución de los síntomas del 100 % en el grupo de placebo, del 93,9 % en el grupo de atazanavir y del 95 % en el grupo de ivermectina. La mediana de duración de la enfermedad fue de 8 días en todos los brazos del estudio. Conclusión: El tratamiento con atazanavir (6 días) e ivermectina (3 días) no redujo el tiempo de resolución de los síntomas ni la duración de la enfermedad entre los pacientes ambulatorios con COVID-19 leve en comparación con el grupo placebo. Los resultados no respaldan el uso de ivermectina y atazanavir para el tratamiento de la COVID-19 de leve a moderada.

Low-protein diet supplemented with inulin lowers protein-bound toxin levels in patients with stage 3b-5 chronic kidney disease: a randomized controlled study / La dieta baja en proteínas suplementada con inulina reduce los niveles de toxinas unidas a proteínas en pacientes con enfermedad renal crónica en estadio 3b-5: un estudio controlado aleatorio

Objective: this study aimed to evaluate whether low-salt low-protein diet (LPD) supplemented with 10 g of inulin could lower serum toxin levels in patients with chronic kidney disease (CKD), thereby providing evidence for adjusting dietary prescriptions of inhospital patients and outpatient nutrition consultants. Methods: we randomized 54 patients with CKD into two groups. Dietary protein intake compliance was evaluated using a 3-day dietary diary and 24-h urine nitrogen levels. The primary outcomes were indoxyl sulfate (IS) and p-cresyl sulfate (PCS), and secondary outcomes included inflammation marker levels, nutritional status, and renal function. We assessed 89 patients for eligibility, and a total of 45 patients completed the study, including 23 and 22 in the inulin-added and control groups, respectively. Results: PCS values decreased in both groups after intervention: inulin-added group, ∆PCS -1.33 (-4.88, -0.63) μg/mL vs. LPD group, -4.7 (-3.78, 3.69) μg/mL (p = 0.058). PCS values reduced from 7.52 to 4.02 μg/mL (p < 0.001) in the inulin-added group (p < 0.001). Moreover, IS decreased from 3.42 (2.53, 6.01) μg/mL to 2.83 (1.67, 4.74) μg/mL after adding inulin; ∆IS was -0.64 (-1.48, 0.00) μg/mL, and a significant difference was observed compared with the control group (p = 0.004). The inflammation index decreased after intervention. Conclusion: dietary fiber supplementation may reduce serum IS and PCS levels and modulate their inflammatory status in predialysis CKD patients.(AU)

Objetivo: este ensayo aleatorizado doble ciego comparó el efecto de una dieta baja en proteínas (LPD) con o sin suplementos orales de 10 gde inulina en los niveles de PBUT en pacientes con ERC en prediálisis durante 12 semanas.Métodos: clasificamos aleatoriamente a 54 pacientes con ERC en dos grupos. El cumplimiento de la ingesta dietética de proteínas se evaluóutilizando un diario dietético de 3 días y nitrógeno en orina de 24 horas. Los resultados primarios fueron IS y PCS y los resultados secundariosincluyeron niveles de marcadores de inflamación, estado nutricional y función renal. Evaluamos la elegibilidad de 89 pacientes y 45 completaronla intervención, incluidos 23 y 22 en los grupos de inulina añadida y de control, respectivamente.Resultados: el sodio urinario promedio de 24 horas fue de 86 mmol/día y la ingesta promedio de proteínas fue de ~0,7 g/kg/día. Los valores dePCS exhibieron una tendencia decreciente en ambos grupos después de la intervención: grupo con inulina añadida, ∆PCS -1.33 (-4.88, -0.63)μg/mL vs. grupo LPD, -4.7 (-3.78, 3.69) μg/mL) (p =0,058). Los valores de PCS se redujeron de 7,52 a 4,02 μg/mL (p < 0,001) con inulina(p < 0,001). Además, IS disminuyó de 3,42 (2,53, 6,01) μg/mL a 2,83 (1,67, 4,74) μg/mL después de agregar inulina; El ∆IS fue -0,64 (-1,48;0,00) μg/mL y se observó una diferencia significativa en comparación con el grupo control (p =0,004).Conclusión: la suplementación con fibra dietética puede reducir las toxinas de unión a proteínas séricas en pacientes con ERC en prediálisisy modular su estado inflamatorio.(AU)

Low-protein diet supplemented with inulin lowers protein-bound toxin levels in patients with stage 3b-5 chronic kidney disease: a randomized controlled study.

Introduction: Objective: this study aimed to evaluate whether low-salt low-protein diet (LPD) supplemented with 10 g of inulin could lower serum toxin levels in patients with chronic kidney disease (CKD), thereby providing evidence for adjusting dietary prescriptions of inhospital patients and outpatient nutrition consultants. Methods: we randomized 54 patients with CKD into two groups. Dietary protein intake compliance was evaluated using a 3-day dietary diary and 24-h urine nitrogen levels. The primary outcomes were indoxyl sulfate (IS) and p-cresyl sulfate (PCS), and secondary outcomes included inflammation marker levels, nutritional status, and renal function. We assessed 89 patients for eligibility, and a total of 45 patients completed the study, including 23 and 22 in the inulin-added and control groups, respectively. Results: PCS values decreased in both groups after intervention: inulin-added group, ∆PCS -1.33 (-4.88, -0.63) µg/mL vs. LPD group, -4.7 (-3.78, 3.69) µg/mL (p = 0.058). PCS values reduced from 7.52 to 4.02 µg/mL (p < 0.001) in the inulin-added group (p < 0.001). Moreover, IS decreased from 3.42 (2.53, 6.01) µg/mL to 2.83 (1.67, 4.74) µg/mL after adding inulin; ∆IS was -0.64 (-1.48, 0.00) µg/mL, and a significant difference was observed compared with the control group (p = 0.004). The inflammation index decreased after intervention. Conclusion: dietary fiber supplementation may reduce serum IS and PCS levels and modulate their inflammatory status in predialysis CKD patients.

Introducción: Objetivo: este ensayo aleatorizado doble ciego comparó el efecto de una dieta baja en proteínas (LPD) con o sin suplementos orales de 10 g de inulina en los niveles de PBUT en pacientes con ERC en prediálisis durante 12 semanas. Métodos: clasificamos aleatoriamente a 54 pacientes con ERC en dos grupos. El cumplimiento de la ingesta dietética de proteínas se evaluó utilizando un diario dietético de 3 días y nitrógeno en orina de 24 horas. Los resultados primarios fueron IS y PCS y los resultados secundarios incluyeron niveles de marcadores de inflamación, estado nutricional y función renal. Evaluamos la elegibilidad de 89 pacientes y 45 completaron la intervención, incluidos 23 y 22 en los grupos de inulina añadida y de control, respectivamente. Resultados: el sodio urinario promedio de 24 horas fue de 86 mmol/día y la ingesta promedio de proteínas fue de ~0,7 g/kg/día. Los valores de PCS exhibieron una tendencia decreciente en ambos grupos después de la intervención: grupo con inulina añadida, ∆PCS -1.33 (-4.88, -0.63) µg/mL vs. grupo LPD, -4.7 (-3.78, 3.69) µg/mL) (p =0,058). Los valores de PCS se redujeron de 7,52 a 4,02 µg/mL (p < 0,001) con inulina (p < 0,001). Además, IS disminuyó de 3,42 (2,53, 6,01) µg/mL a 2,83 (1,67, 4,74) µg/mL después de agregar inulina; El ∆IS fue -0,64 (-1,48; 0,00) µg/mL y se observó una diferencia significativa en comparación con el grupo control (p =0,004). Conclusión: la suplementación con fibra dietética puede reducir las toxinas de unión a proteínas séricas en pacientes con ERC en prediálisis y modular su estado inflamatorio.

Uso de Ivermectina e Atazanavir no tratamento da Covid-19: uma revisão de escopo / Use of Ivermectin and Atazanavir in the treatment of Covid-19: a scoping review / Uso de Ivermectina y Atazanavir en el tratamiento de Covid-19: una revisión de alcance

Objetivo: Examinar e mapear as evidências científicas sobre a eficácia do uso de ivermectina e atazanavir no tratamento de COVID-19. Metodologia: Scoping Review, baseado nos procedimentos recomendados pelo Instituto Joanna Briggs. Estabeleceu-se a pergunta norteadora: "Quais são as evidências científicas sobre o uso de ivermectina e atazanavir no tratamento de pacientes com sintomas leves de COVID-19?". Foram realizadas buscas em seis bases de dados nacionais e internacionais, sobre trabalhos publicados até dezembro de 2022. Dos 357 estudos encontrados, 22 foram selecionados para leitura na íntegra, resultando em uma amostra final de 11 estudos analisados. Resultados: As 11 publicações analisadas foram publicadas de 2020 a 2022 durante período pandêmico, de âmbito nacional e internacional com delineamento de estudos experimentais, do tipo ensaio clínico com randomização. Apenas 03 estudos (25%) testaram o atazanavir como intervenção conjugada a outras drogas, não evidenciando melhorias significativas em relação ao seu uso. Já no tratamento com Ivermectina, dos oito (75%) estudos que a testaram, apenas três (37,5%) recomendaram seu uso e cinco (62,5%) não suportam seu uso para tratamento de COVID-19 leve. O tempo de resolução dos sintomas variou de 8 a 10 dias nos braços tratados com ivermectina e em média 07 dias no tratamento com atazanavir. Não se detectou eventos adversos graves relacionados ao uso das duas drogas. Conclusão: As evidências que recomendavam o uso de ivermectina datam do início do período pandêmico, 2020, mas posteriormente, com a realização de ensaios clínicos robustos e controlados, novas evidências não suportam o uso de ivermectina e atazanavir no tratamento de COVID-19 leve mostrando que não houve diferença no tempo de resolução dos sintomas, na taxa de mortalidade, taxa de internação na UTI e tempo de hospitalização.

Objective: To examine and map the scientific evidence on the effectiveness of using ivermectin and atazanavir in the treatment of COVID-19. Methodology: Scoping Review, based on the procedures recommended by the Joanna Briggs Institute. The guiding question was established, "What is the scientific evidence on the use of ivermectin and atazanavir in the treatment of patients with mild symptoms of COVID-19?" Searches were conducted in six national and international databases on papers published until December 2022. Of the 357 studies found, 22 were selected for reading in full, resulting in a final sample of 11 studies analyzed. Results: The 11 publications analyzed were published from 2020 to 2022 during pandemic period, of national and international scope with experimental study design, of clinical trial type with randomization. Only 03 studies (25%) tested atazanavir as a combined intervention with other drugs, showing no significant improvements in relation to its use. As for the treatment with Ivermectin, of the eight (75%) studies that tested it, only three (37.5%) recommended its use and five (62.5%) did not support its use for treating mild COVID-19. The time to symptom resolution ranged from 8 to 10 days in the ivermectin-treated arms and on average 07 days in the atazanavir treatment. No serious adverse events related to the use of the two drugs were detected. Conclusion: evidence recommending the use of ivermectin dates back to the beginning of the pandemic period, 2020, but subsequently, with robust controlled clinical trials, new evidence does not support the use of ivermectin and atazanavir in the treatment of mild COVID-19 showing that there was no difference in time to symptom resolution, mortality rate, ICU admission rate, and length of hospital stay.

Objetivo: Examinar y mapear la evidencia científica sobre la eficacia del uso de ivermectina y atazanavir en el tratamiento de COVID-19. Metodología: Scoping Review, basada en los procedimientos recomendados por el Instituto Joanna Briggs. La pregunta guía era: "¿Cuál es la evidencia científica sobre el uso de ivermectina y atazanavir en el tratamiento de pacientes con síntomas leves de COVID-19? Se realizaron búsquedas en seis bases de datos nacionales e internacionales, en artículos publicados hasta diciembre de 2022. De los 357 estudios encontrados, se seleccionaron 22 para su lectura completa, lo que dio lugar a una muestra final de 11 estudios analizados. Resultados: Las 11 publicaciones analizadas fueron publicadas entre 2020 y 2022 durante el periodo pandémico, de ámbito nacional e internacional con diseño de estudio experimental, de tipo ensayo clínico con aleatorización. Apenas 03 estudios (25%) probaron el atazanavir como intervención combinada con otras drogas, sin evidenciar mejoras significativas en relación con su uso. En cuanto al tratamiento con Ivermectina, de los ocho (75%) estudios que la probaron, sólo tres (37,5%) recomendaron su uso y cinco (62,5%) no apoyaron su uso para tratar la COVID-19 leve. El tiempo transcurrido hasta la resolución de los síntomas osciló entre 8 y 10 días en los brazos tratados con ivermectina y una media de 07 días en el tratamiento con atazanavir. No se detectaron acontecimientos adversos graves relacionados con el uso de los dos fármacos. Conclusión: las pruebas que recomiendan el uso de ivermectina se remontan al inicio del periodo pandémico, 2020, pero posteriormente, con ensayos clínicos controlados sólidos, las nuevas pruebas no apoyan el uso de ivermectina y atazanavir en el tratamiento de la COVID-19 leve, lo que demuestra que no hubo diferencias en el tiempo hasta la resolución de los síntomas, la tasa de mortalidad, la tasa de ingreso en la UCI y la duración de la estancia hospitalaria.

Efficiency of exogenous zinc sulfate application reduced fruit drop and improved antioxidant activity of 'Kinnow' mandarin fruit / A eficiência da aplicação de sulfato de zinco exógeno reduziu a queda da fruta e melhorou a atividade antioxidante da tangerina 'Kinnow'

'Kinnow' mandarin (Citrus nobilis L.× Citrus deliciosa T.) is an important marketable fruit of the world. It is mainstay of citrus industry in Pakistan, having great export potential. But out of total production of the country only 10% of the produce meets the international quality standard for export. Pre-harvest fruit drop and poor fruit quality could be associated with various issues including the plant nutrition. Most of the farmers do not pay attention to the supply of micro nutrients which are already deficient in the soil. Furthermore, their mobility within plants is also a question. Zinc (Zn) is amongst those micronutrients which affect the quality and postharvest life of the fruit and its deficiency in Pakistani soils is already reported by many researchers. Therefore, this study was carried out to evaluate the influence of pre-harvest applications of zinc sulfate (ZnSO4; 0, 0.4%, 0.6% or 0.8%) on pre-harvest fruit drop, yield and fruit quality of ‘Kinnow’ mandarin at harvest. The treatments were applied during the month of October i.e. 4 months prior to harvest. The applied Zn sprays had significant effect on yield and quality of the "Kinnow" fruit. Amongst different foliar applications of ZnSO4applied four months before harvest, 0.6% ZnSO4 significantly reduced pre-harvest fruit drop (10.08%) as compared to untreated control trees (46.45%). Similarly, the maximum number of fruits harvested per tree (627), fruit weight (192.9 g), juice percentage (42.2%), total soluble solids (9.5 °Brix), ascorbic acid content (35.5 mg 100 g-¹) and sugar contents (17.4) were also found significantly higher with 0.6% ZnSO4 treatment as compared to rest of treatments and control. Foliar application of 0.6% ZnSO4 also significantly improved total antioxidants (TAO) and total phenolic contents (TPC) in fruit. In conclusion, foliar [...].

A tangerina 'Kinnow' (Citrus nobilis L. × Citrus deliciosa T.) é uma importante fruta comercializável do mundo. É o esteio da indústria cítrica no Paquistão, com grande potencial de exportação. Mas, da produção total do país, apenas 10% da produção atendem o padrão internacional de qualidade para exportação. A queda da fruta antes da colheita e a baixa qualidade da fruta podem estar associadas a vários problemas, incluindo a nutrição da planta. A maioria dos agricultores não se preocupa com o fornecimento de micronutrientes que já são deficientes no solo. Além disso, sua mobilidade dentro das plantas também é uma questão. O zinco (Zn) está entre os micronutrientes que afetam a qualidade e a vida pós-colheita da fruta, e sua deficiência em solos paquistaneses já é relatada por diversos pesquisadores. Portanto, este estudo foi realizado para avaliar a influência da aplicação pré-colheita de sulfato de zinco (ZnSO4; 0, 0,4%, 0,6% ou 0,8%) na queda dos frutos na pré-colheita, produtividade e qualidade dos frutos da tangerina 'Kinnow' em colheita. Os tratamentos foram aplicados durante o mês de outubro, ou seja, 4 meses antes da colheita. As pulverizações de Zn aplicadas tiveram efeito significativo no rendimento e na qualidade da fruta 'Kinnow'. Entre as diferentes aplicações foliares de ZnSO4 efetuadas quatro meses antes da colheita, 0,6% de ZnSO4 reduziu significativamente a queda de frutos antes da colheita (10,08%) em comparação com as árvores de controle não tratadas (46,45%). Da mesma forma, número máximo de frutos colhidos por árvore (627), peso do fruto (192,9 g), porcentagem de suco (42,2%), sólidos solúveis totais (9,5 ° Brix), teor de ácido ascórbico (35,5 mg / 100 g-¹) e os teores de açúcar (17,4) também foram significativamente maiores com o tratamento com 0,6% de ZnSO4 em comparação com o restante dos tratamentos e o controle. A aplicação foliar de 0,6% de ZnSO4 também melhorou significativamente os [...].

Efficiency of exogenous zinc sulfate application reduced fruit drop and improved antioxidant activity of Kinnow mandarin fruit

Abstract Kinnow mandarin (Citrus nobilis L.× Citrus deliciosa T.) is an important marketable fruit of the world. It is mainstay of citrus industry in Pakistan, having great export potential. But out of total production of the country only 10% of the produce meets the international quality standard for export. Pre-harvest fruit drop and poor fruit quality could be associated with various issues including the plant nutrition. Most of the farmers do not pay attention to the supply of micro nutrients which are already deficient in the soil. Furthermore, their mobility within plants is also a question. Zinc (Zn) is amongst those micronutrients which affect the quality and postharvest life of the fruit and its deficiency in Pakistani soils is already reported by many researchers. Therefore, this study was carried out to evaluate the influence of pre-harvest applications of zinc sulfate (ZnSO4; 0, 0.4%, 0.6% or 0.8%) on pre-harvest fruit drop, yield and fruit quality of Kinnow mandarin at harvest. The treatments were applied during the month of October i.e. 4 months prior to harvest. The applied Zn sprays had significant effect on yield and quality of the Kinnow fruit. Amongst different foliar applications of ZnSO4applied four months before harvest, 0.6% ZnSO4 significantly reduced pre-harvest fruit drop (10.08%) as compared to untreated control trees (46.45%). Similarly, the maximum number of fruits harvested per tree (627), fruit weight (192.9 g), juice percentage (42.2%), total soluble solids (9.5 °Brix), ascorbic acid content (35.5 mg 100 g-1) and sugar contents (17.4) were also found significantly higher with 0.6% ZnSO4 treatment as compared to rest of treatments and control. Foliar application of 0.6% ZnSO4 also significantly improved total antioxidants (TAO) and total phenolic contents (TPC) in fruit. In conclusion, foliar spray of ZnSO4 (0.6%) four months prior to harvest reduced pre-harvest fruit drop, increase yield with improved quality of Kinnow mandarin fruit.

Resumo A tangerina Kinnow (Citrus nobilis L. × Citrus deliciosa T.) é uma importante fruta comercializável do mundo. É o esteio da indústria cítrica no Paquistão, com grande potencial de exportação. Mas, da produção total do país, apenas 10% da produção atendem o padrão internacional de qualidade para exportação. A queda da fruta antes da colheita e a baixa qualidade da fruta podem estar associadas a vários problemas, incluindo a nutrição da planta. A maioria dos agricultores não se preocupa com o fornecimento de micronutrientes que já são deficientes no solo. Além disso, sua mobilidade dentro das plantas também é uma questão. O zinco (Zn) está entre os micronutrientes que afetam a qualidade e a vida pós-colheita da fruta, e sua deficiência em solos paquistaneses já é relatada por diversos pesquisadores. Portanto, este estudo foi realizado para avaliar a influência da aplicação pré-colheita de sulfato de zinco (ZnSO4; 0, 0,4%, 0,6% ou 0,8%) na queda dos frutos na pré-colheita, produtividade e qualidade dos frutos da tangerina Kinnow em colheita. Os tratamentos foram aplicados durante o mês de outubro, ou seja, 4 meses antes da colheita. As pulverizações de Zn aplicadas tiveram efeito significativo no rendimento e na qualidade da fruta Kinnow. Entre as diferentes aplicações foliares de ZnSO4 efetuadas quatro meses antes da colheita, 0,6% de ZnSO4 reduziu significativamente a queda de frutos antes da colheita (10,08%) em comparação com as árvores de controle não tratadas (46,45%). Da mesma forma, número máximo de frutos colhidos por árvore (627), peso do fruto (192,9 g), porcentagem de suco (42,2%), sólidos solúveis totais (9,5 ° Brix), teor de ácido ascórbico (35,5 mg / 100 g-1) e os teores de açúcar (17,4) também foram significativamente maiores com o tratamento com 0,6% de ZnSO4 em comparação com o restante dos tratamentos e o controle. A aplicação foliar de 0,6% de ZnSO4 também melhorou significativamente os antioxidantes totais (TAO) e os teores fenólicos totais (TPC) nas frutas. Em conclusão, a pulverização foliar de ZnSO4 (0,6%) quatro meses antes da colheita reduziu a queda de frutos antes da colheita e aumentou o rendimento com a melhoria da qualidade da fruta tangerina Kinnow.

Actividades ligninolíticas y producción de basidiomas de Ganoderma lucidum en cultivo sólido suplementado con manganeso / Ligninolytic activities and production of Ganoderma lucidum basidiomes in solid culture supplemented with manganese

RESUMEN Ganoderma lucidum es un basidiomiceto de pudrición blanca estudiado especialmente por sus atributos medicinales. No obstante, la información sobre la suplementación de los medios de cultivo con metales como Zn, Li, Mn, Cu es escasa aun conociendo que la presencia de metales en los sustratos mejora las características de los basidiomas obtenidos e incrementa su productividad. El objetivo fue evaluar las actividades enzimáticas lacasa (Lc) y manganeso peroxidasa (MnP), la fructificación y eficiencia biológica (EB) de G. lucidum en cultivos sólidos formulados con residuos agroindustriales (aserrín de roble, cascarilla de café, salvado de maíz) suplementados con dos niveles de sal de manganeso II (0,05 % y 0,1 % p/p) y una formulación sin adición de la sal de manganeso. Las actividades enzimáticas se determinaron durante 98 días del ciclo productivo, con toma de muestras semanales. El tratamiento uno (0,05 % p/p de MnSO4H2O) suministró la mayor EB del cultivo con 25,90 ± 2,12 % y los mayores títulos de actividades ligninolíticas en el tiempo con 0,7299 UE/g s.s. de MnP a los 35 días de fermentación y 4,1 760 UE/g s.s para la actividad de Lc a los 42 días de proceso con relación a los tratamientos dos y control. Asimismo, hubo una disminución del ciclo de cultivo del hongo para los tratamientos uno (83 días) y dos (95 días) en comparación con el tratamiento control (117 días). Los resultados de este trabajo son promisorios para cultivadores industriales de G. lucidum, ya que la suplementación de los sustratos con Mn incrementa la productividad de los cultivos.

ABSTRACT Ganoderma lucidum is a white rot basidiomycete specially studied for its medicinal attributes. However, the information on the supplementation of the substrate with metals such as Zn, Li, Mn, Cu and others is scarce. Even knowing that the presence of metals in the substrates improves the characteristics of the basidiomes produced and increases their productivity. The objective was to evaluate the enzymatic activities laccase (Lc) and manganese peroxidase (MnP). The fructification and biological efficiency (BE) of G. lucidum in solid culture formulated with agroindustrial residues, (oak sawdust, coffee husk, bran corn) supplemented with two levels of manganese II salt, (0.05 % and 0.1 % w/ w) and a formulation without addition of manganese II salt. Enzymatic activities were determined during 98 days of the production cycle, with weekly sampling. Treatment one (0.05 % w/w MnSO4.H2O) provided the highest BE of the culture with 25.90 ± 0.54% and the highest titers of ligninolytic activities, in the time with 0.7299 EU/g d.s for MnP at 35 days of fermentation and 4.1760 EU/g d.s for Lc activity at 42 days of process, in relation to treatments two and control. Likewise, there was a decrease in the fungus culture cycle for treatments one (83 days) and two (95 days) compared to the control treatment (117 days). The results of this work are promising for industrial growers of G. lucidum, since the supplementation of the substrates with Mn increase the productivity of the cultures.

Sulfato de magnesio antenatal y eliminación tardía de meconio: Estudio multicéntrico / Antenatal magnesium sulphate and delayed passage of meconium: A multicentre study

Introducción: La relación entre sulfato de magnesio (MgSO4) y el retraso en la evacuación de meconio presenta resultados controvertidos en la literatura. Objetivos: Determinar si existe relación entre la administración de MgSO4 a la madre y la eliminación tardía de meconio (ETM) en el neonato y conocer los niveles de magnesio en sangre en estos, con respecto a la dosis acumulada de MgSO4 administrada a la madre. Población y métodos: Estudio descriptivo-analítico, en pacientes ≤ 32 semanas de edad gestacional, con diseño retrospectivo-prospectivo, llevado a cabo en dos hospitales de tercer nivel asistencial. Se definió la ETM como retraso en la evacuación meconial ≥ 48 horas y/o necesidad de estimulación rectal en ≥ 2 ocasiones para realizar deposición y/o retraso ≥ 48 horas entre la primera y segunda deposición. Resultados: Se reclutaron 283 pacientes (204 retrospectiva y 79 prospectivamente), de los cuales 152 (53,7%) presentó ETM. No se encontró relación entre la administración de MgSO4 a la madre, ni la dosis acumulada de MgSO4 en esta, ni los niveles de magnesio en sangre del neonato con la presencia de ETM. La mayor edad gestacional (OR 0,8, IC 0,69-0,93, p = 0,003) resultó factor protector independiente de la ETM y la necesidad de reanimación avanzada (OR 2,24, IC 1,04-4,86, p = 0,04) factor de riesgo. Conclusiones: Los niveles alcanzados de magnesio en sangre del neonato con las dosis de MgSO4 administradas a las madres, no se relacionan con la ETM. La menor edad gestacional y la necesidad de reanimación avanzada predicen mayor riesgo de ETM. (AU)

Introduction: The published evidence on the association between magnesium sulphate (MgSO4) and delayed passage of meconium (DPM) is contradictory. Objectives: To determine whether there is an association between the administration of MgSO4 to the mother and DPM in the neonate, and to analyse serum magnesium levels in neonates in relation to the cumulative dose of MgSO4 administered to the mother. Population and methods: Retrospective and prospective descriptive and analytical study conducted in patients delivered at or before 32 weeks of gestation in 2 tertiary care hospitals. Delayed passage of meconium was defined as failure to pass meconium within 48 hours of birth and/or need for rectal stimulation on 2 or more occasions to pass stool and/or interval of at least 48 hours between the first and second bowel movements. Results: The study included 283 patients (204 retrospectively and 79 prospectively), of who 152 (53.7%) experienced DPM. Delayed passage of meconium was not associated with antenatal MgSO4 administration, the cumulative maternal MgSO4 dose or neonatal serum magnesium levels. Older gestational age (OR, 0.8; confidence interval [CI], 0.69–0.93; P = .003) was an independent protective factor against DPM, while the need for advanced resuscitation (OR, 2.24; CI 1.04–4.86; P = .04) was a risk factor for DPM. Conclusion: The neonatal serum levels of magnesium reached with the doses of MgSO4 administered to mothers were not associated with DPM. Lower gestational age and the need for advanced resuscitation were predictors associated with an increased risk of DPM. (AU)

Antenatal magnesium sulphate and delayed passage of meconium: A multicentre study.

INTRODUCTION: The published evidence on the association between magnesium sulphate (MgSO4) and delayed passage of meconium (DPM) is contradictory. OBJECTIVES: To determine whether there is an association between the administration of MgSO4 to the mother and DPM in the neonate, and to analyse serum magnesium levels in neonates in relation to the cumulative dose of MgSO4 administered to the mother. POPULATION AND METHODS: Retrospective and prospective descriptive and analytical study conducted in patients delivered at or before 32 weeks of gestation in 2 tertiary care hospitals. Delayed passage of meconium was defined as failure to pass meconium within 48 h of birth and/or need for rectal stimulation on 2 or more occasions to pass stool and/or interval of at least 48 h between the first and second bowel movements. RESULTS: The study included 283 patients (204 retrospectively and 79 prospectively), of who 152 (53.7%) experienced DPM. Delayed passage of meconium was not associated with antenatal MgSO4 administration, the cumulative maternal MgSO4 dose or neonatal serum magnesium levels. Older gestational age (OR, 0.8; confidence interval [CI], 0.69-0.93; P = 0.003) was an independent protective factor against DPM, while the need for advanced resuscitation (OR, 2.24; CI 1.04-4.86; P = 0.04) was a risk factor for DPM. CONCLUSION: The neonatal serum levels of magnesium reached with the doses of MgSO4 administered to mothers were not associated with DPM. Lower gestational age and the need for advanced resuscitation were predictors associated with an increased risk of DPM.

Mucopolisacaridosis III. Revisión bibliográfica / Mucopolysaccharidosis III. Bibliographic review

Mucopolisacaridosis de tipo III es una enfermedad rara, con una incidencia de 1 en 70 000 nacidos vivos, es la más frecuente dentro del grupo de Mucopolisacaridosis y se produce por un defecto en la vía del metabolismo del heparan sulfato. Se caracteriza por afectar a mayor profundidad el sistema nervioso central, el paciente tiene un desarrollo normal hasta aproximadamente los 1 a 3 años de edad y posteriormente empieza con deterioro progresivo, cursa con retraso del desarrollo, alteración del comportamiento y trastorno del sueño agregándose déficit motor y cuadros infecciosos, culminando en un estado de postración. La esperanza de vida oscila entre los 20 a 30 años, aunque depende del fenotipo y la principal causa de muerte fue la neumonía. El diagnóstico definitivo se consigue mediante pruebas genómicas y ensayo enzimático. No cuenta con tratamiento curativo, únicamente con paliación y soporte ante las complicaciones que va desarrollando

Mucopolysaccharidosis III is a rare disease, with an incidence of 1 in 70 000 live births, it is the most frequent within the group of Mucopolysaccharidosis and is caused by a defect in the heparan sulfate metabolism pathway. It is characterized by affecting the central nervous system in greater depth, the patient has a normal development until approximately 1 to 3 years of age and later begins with progressive deterioration, courses with developmental delay, behavioral alteration and sleep disorder, adding motor deficits and infectious pictures, culminating in a state of prostration. Life expectancy ranges from 20 to 30 years, although it depends on the phenotype, and the main cause of death is pneumonia. Definitive diagnosis is achieved by genomic tests and enzymatic assay. It does not have curative treatment, only palliation and support in the face of the complications that it develops.

La unión de Candida albicans y Malassezia spp. a células de piel promueve cambios de expresión en los genes responsables de la síntesis de las cadenas de heparán y condroitín sulfato / Adherence of Candida albicans and Malassezia Species to Skin Cells Induces Changes in the Expression of Genes Responsible for Heparan and Chondroitin Sulfate Chain Synthesis

Las micosis superficiales son patologías prevalentes en dermatología, causadas frecuentemente por hongos oportunistas de los géneros Candida y Malassezia. El objetivo de este trabajo es analizar, mediante qRT-PCR, la existencia de alteraciones en la expresión génica de las enzimas biosintéticas de las cadenas de glicosaminoglicanos (GAGs) tras la adhesión de dichas levaduras a líneas celulares de piel. La interacción de C.albicans y Malassezia spp. produjo las siguientes modificaciones en genes implicados en la biosíntesis del heparán y condroitín sulfato: la subexpresión de CHPF en los queratinocitos y 4 subexpresiones (EXT1, EXT2, CHSY3 y CHPF) en los fibroblastos. Las enzimas implicadas en la modificación de las cadenas de dichos GAG se ven más alteradas en los fibroblastos, produciendo 13 subexpresiones y 2 sobreexpresiones (CHST15 y CHST7). Como consecuencia, la afinidad de las cadenas de GAGs por sus ligandos puede verse afectada, pudiendo alterar su papel como receptores de microorganismos, paso clave para el inicio de su proceso infeccioso (AU)

Superficial fungal infections are common in dermatology and are often caused by opportunistic species in the Candida and Malassezia genera. The aim of this study was to analyze changes in the expression of genes coding for enzymes involved in the biosynthesis of glycosaminoglycans (GAGs) chains following the adherence of Candida and Malassezia yeasts to skin cell lines. Gene expression was analyzed using reverse transcriptase–quantitative polymerase chain reaction assays. Interactions between the yeasts and the skin cells induced the following changes in genes involved in the biosynthesis of heparan sulfate and chondroitin sulfate: downregulation of CHPF in keratinocytes and downregulation of EXT1, EXT2, CHSY3, and CHPF in fibroblasts. Adherence to fibroblasts had an even greater effect on GAG biosynthetic enzymes, inducing the downregulation of 13 genes and the upregulation of two (CHST15 and CHST7). Interactions between yeasts and skin cells might affect the binding affinity of GAG chains, possibly changing their ability to function as receptors for pathogens and interfering with a key stage at the start of infection (AU)