Latin-American guidelines of recommendations at discharge from an acute coronary syndrome.

The diagnostic criteria, treatments at the time of admission, and drugs used in patients with acute coronary syndrome are well defined in countless guidelines. However, there is uncertainty about the measures to recommend during patient discharge planning. This document brings together the most recent evidence and the standardized and optimal treatment for patients at the time of discharge from hospitalization for an acute coronary syndrome, for comprehensive and safe care in the patient's transition between care from the acute event to the outpatient care, with the aim of optimizing the recovery of viable myocardium, guaranteeing the most appropriate secondary prevention, reducing the risk of a new coronary event and mortality, as well as the adequate reintegration of patients into daily life.

Los criterios diagnósticos, los tratamientos en el momento de la admisión y los fármacos utilizados en pacientes con síndrome coronario agudo están bien definidos en innumerables guías. Sin embargo, existe incertidumbre acerca de las medidas para recomendar durante la planificación del egreso de los pacientes. Este documento reúne las evidencias más recientes y el tratamiento estandarizado y óptimo para los pacientes al momento del egreso de una hospitalización por un síndrome coronario agudo, para un cuidado integral y seguro en la transición del paciente entre la atención del evento agudo y el cuidado ambulatorio, con el objetivo de optimizar la recuperación de miocardio viable, garantizar la prevención secundaria más adecuada, reducir el riesgo de un nuevo evento coronario y la mortalidad, así como la adecuada reinserción de los pacientes en la vida cotidiana.

Documento de posición para la mejora en la reperfusión del infarto agudo de miocardio con elevación del ST en Latinoamérica / Position statement for improvement in reperfusion of ST-elevation myocardial infarction in Latin America

Resumen El tratamiento del infarto agudo de miocardio con elevación del segmento ST tiene barreras dependiendo de la región geográfica. La angioplastia coronaria primaria es el tratamiento de elección, siempre y cuando sea realizada dentro de tiempo y por operadores experimentados. Sin embargo, cuando no está disponible, la administración de fibrinólisis y el envío para angioplastia de rescate, en caso de reperfusión negativa, es la mejor estrategia. De la misma manera, la angioplastia coronaria, como parte de una estrategia farmacoinvasiva, es la mejor alternativa cuando hay reperfusión positiva. El desarrollo de redes de tratamiento del infarto aumenta el número de pacientes reperfundidos dentro de los tiempos recomendados y mejora los desenlaces. En América Latina, los programas nacionales para el tratamiento del infarto deben centrarse en mejorar los resultados y el éxito a largo plazo depende de trabajar hacia objetivos definidos y obtener métricas de rendimiento, por lo tanto, estos deben desarrollar métricas para cuantificar su desempeño. El siguiente documento discute todas estas alternativas y sugiere oportunidades de mejora.

Abstract The treatment of ST-segment elevation myocardial infarction has barriers depending on the geographic region. Primary coronary angioplasty is the treatment of choice, if it is performed on time and by experienced operators. However, when it is not available, the administration of fibrinolysis and referral for rescue angioplasty, in case of negative reperfusion, is the best strategy. In the same way, coronary angioplasty, as part of a pharmacoinvasive strategy, is the best alternative when there is positive reperfusion. The development of infarct treatment networks increases the number of patients reperfused within the recommended times and improves outcomes. In Latin America, national myocardial infarction treatment programs should focus on improving outcomes, and long-term success depends on working toward defined goals and enhancing functionality, therefore programs should develop capacity to measure their performance. The following document discusses all of these alternatives and suggests opportunities for improvement.

[Position statement for improvement in reperfusion of ST-elevation myocardial infarction in Latin America]. / Documento de posición para la mejora en la reperfusión del infarto agudo de miocardio con elevación del ST en Latinoamérica.

The treatment of ST-segment elevation myocardial infarction has barriers depending on the geographic region. Primary coronary angioplasty is the treatment of choice, if it is performed on time and by experienced operators. However, when it is not available, the administration of fibrinolysis and referral for rescue angioplasty, in case of negative reperfusion, is the best strategy. In the same way, coronary angioplasty, as part of a pharmacoinvasive strategy, is the best alternative when there is positive reperfusion. The development of infarct treatment networks increases the number of patients reperfused within the recommended times and improves outcomes. In Latin America, national myocardial infarction treatment programs should focus on improving outcomes, and long-term success depends on working toward defined goals and enhancing functionality, therefore programs should develop capacity to measure their performance. The following document discusses all of these alternatives and suggests opportunities for improvement.

El tratamiento del infarto agudo de miocardio con elevación del segmento ST tiene barreras dependiendo de la región geográfica. La angioplastia coronaria primaria es el tratamiento de elección, siempre y cuando sea realizada dentro de tiempo y por operadores experimentados. Sin embargo, cuando no está disponible, la administración de fibrinólisis y el envío para angioplastia de rescate, en caso de reperfusión negativa, es la mejor estrategia. De la misma manera, la angioplastia coronaria, como parte de una estrategia farmacoinvasiva, es la mejor alternativa cuando hay reperfusión positiva. El desarrollo de redes de tratamiento del infarto aumenta el número de pacientes reperfundidos dentro de los tiempos recomendados y mejora los desenlaces. En América Latina, los programas nacionales para el tratamiento del infarto deben centrarse en mejorar los resultados y el éxito a largo plazo depende de trabajar hacia objetivos definidos y obtener métricas de rendimiento, por lo tanto, estos deben desarrollar métricas para cuantificar su desempeño. El siguiente documento discute todas estas alternativas y sugiere oportunidades de mejora.

Síndrome de Stevens-Johnson en edad pediátrica / Stevens Johnson Syndrome of a Pediatric Age Case

El síndrome de Stevens-Johnson (SSJ) es una enfermedad inflamatoria aguda, originada por una reacción de hipersensibilidad, secundaria a ingesta de medicamentos o infecciones, que afecta a la piel y las membranas mucosas produciendo lesiones características del síndrome, causadas por apoptosis y posterior necrosis de los queratinocitos; su forma más severa es la necrolisis epidérmica tóxica, que constituye junto al SSJ un espectro de la misma enfermedad, compartiendo aspectos etiológicos, patogenéticos, histológicos y terapéuticos que ponen en peligro la vida del paciente. La afección se caracteriza por una súbita erupción morfológicamente variable, acompañada de estomatitis y oftalmia.En el presente trabajo se presenta el caso de un niño de 8 años de edad,con diagnóstico clínico de síndrome de Stevens-Johnson, con manifestaciones cutáneas, oculares y de la mucosa oral, que iniciaron posterior a ingesta de ibuprofeno, se mantuvo con un protocolo de cuidados que incluyeron soporte de oxígeno, antibioticoterapia, analgesia, corticoides, nebulizaciones, limpieza de lesiones con solución salina, sin debridación y lubricante oftálmico; tras 8 días dehospitalización el paciente evoluciona satisfactoriamente sin complicaciones durante su estancia hospitalaria.

The Stevens-Johnson syndrome (SJS) is an acute inflammatory disease caused by a hypersensitivity reaction, secondary to medication intake or infections, that affects skin and mucous membranes producing characteristic wounds of the syndrome, caused by apoptosis and subsequent necrosis of keratinocytes; the major form of this disease, is toxic epidermal necrolysis, wich together with SJS is a spectrum of the same disease, sharing etiological pathogenetic, histological and therapeutic aspects, that endanger the patient's life. The affection is characterized by a sudden morphologically varying rash, accompanied bystomatitis and ophthalmic injure. In this work we show an 8 year old patient with a clinical diagnosis of Stevens-Johnson syndrome, involving skin, eye and oral mucosa manifestations, which began after the intake of ibuprofen , it was mantained with a protocol care based on oxygen support, antibiotic therapy, analgesia, corticosteroids, sprays, cleansing wounds with saline solution without debridement and ophthalmic lubricant, after 8 days of hospitalization, our patient has a satisfactory evolution without acute complications during their time at the hospital.

Retrospective cohort of pancreatic and Vater ampullary adenocarcinoma from a reference center in Mexico.

INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) and ampulla of Vater adenocarcinomas (AVAC) are periampullary tumors. These tumors have overlapping symptoms and a common treatment, but present differences in their survival and biology. No recent studies in Mexico have been published that describe the clinicopathological characteristics of these tumors. Therefore, the aim of this study was to describe the clinicopathological characteristics of PDAC and AVAC in patients at a reference center in Mexico. METHODS: A retrospective cohort of patients with PDAC or AVAC was analyzed at our institution (July 2007 to June 2016). Inferential analysis of the clinical data was performed with Student's t-test or a χ2 test with odds ratios (OR) and confidence intervals (CI), depending on the variables. Overall survival was compared using Kaplan-Meier curves with log-rank p values. RESULTS: Forty patients with PDAC and 76 with AVAC were analyzed, including 77 females and 39 males with a mean age of 60.6 years and a mean evolution time of 5.7 months. PDAC patients had more abdominal pain, a larger tumor size and more advanced stages than AVAC patients. In contrast, AVAC patients had more jaundice, a higher percentage of complete resections and higher overall survival. Up to 70% of patients were overweight. PDAC cohort included a higher proportion of smokers. CONCLUSIONS: Our cohort was slightly younger, had a larger percentage of females, and a greater percentage of obese patients than those in many international reports. A high proportion of PDAC patients are diagnosed in advanced stages and have a low likelihood of resectability.

Resources and Costs Associated with the Treatment of Advanced and Metastatic Gastric Cancer in the Mexican Public Sector: A Patient Chart Review.

BACKGROUND: Little evidence is available on the management and cost of treating patients with advanced or metastatic gastric cancer (GC). This study evaluates patient characteristics, treatment patterns, and resource utilization for these patients in Mexico. METHODS: Data were collected from three centers of investigation (tertiary level). Patients were ≥18 years of age, diagnosed between 1 January 2009 and 1 January 2015, had advanced or metastatic GC, received first-line fluoropyrimidine/platinum, and had ≥3 months follow-up after discontinuing first-line treatment. Data were summarized using descriptive statistics. RESULTS: The study sample totaled 180. Patients' mean age was 57.2 years (±12.4) and 57.0% were male; 151 (83.9%) patients received second-line chemotherapy. A total of 16 and 19 regimens were identified in first- and second-line therapy. Of the sample, 51 (28.3%) received third-line therapy, and <10% received more than three lines of active chemotherapy. Supportive care received in first- and second-line chemotherapy, included pain interventions (12.2 and 7.9%), nutritional support (3.3 and 1.3%), radiotherapy (6.1 and 16.6%), and transfusions (13.3 and 10.6%), respectively. Using Mexican Institute of Social Security (IMSS) tariffs, the average total cost per patient-month in first- and second-line therapy was US$1230 [95% confidence interval (CI) 1034-1425] and US$1192 (95% CI 913-1471), respectively. Administration and acquisition of chemotherapy comprised the majority of costs. CONCLUSIONS: This study shows considerable variation in first- and second-line chemotherapy regimens of patients with advanced or metastatic GC. Understanding GC treatment patterns in Mexico will help address unmet needs.

Direct detection of Leishmania from clinical samples.

The ability to rapidly and accurately diagnose leishmaniasis is a military priority. Testing was conducted to evaluate diagnostic sensitivity and specificity of field-expedient Leishmania genus and visceral Leishmania specific dual-fluorogenic, hydrolysis probe (TaqMan), polymerase chain reaction assays previously established for use in vector surveillance. Blood samples of patients with confirmed visceral leishmaniasis and controls without the disease from Baringo District, Kenya, were tested. Leishmania genus assay sensitivity was 100% (14/14) and specificity was 84% (16/19). Visceral Leishmania assay sensitivity was 93% (13/14) and specificity 80% (4/5). Cutaneous leishmaniasis (CL) skin scrapes of patients from Honduras were also evaluated. Leishmania genus assay sensitivity was 100% (10/10). Visceral Leishmania assay specificity was 100% (10/10) from cutaneous leishmaniasis samples; no fluorescence above background was reported. These results show promise in a rapid, sensitive, and specific method for Leishmania direct detection from clinical samples.

Mindfulness, personalidad y sugestionalibilidad: estudio correlacional exploratorio / Mindfulness, personality and suggestibility: a correlational study

No disponible

The present paper aims to explore the relationship between mindfulness (measured by the Spanish version of the Five Facet Mindfulness Questionnaire -FFMQ), personality 'Big Five' (measured by the Spanish version of the NEO Five Factor Inventory) and suggestibility (measured by the Inventory of Suggestibility) in normal university population (N= 80). Main results revealed negative and significant correlations between Neuroticism and all FFMQ facets, except for the 'observe' subscale. Very low and mainly non-significant correlations were obtained regarding Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. Regarding suggestibility, there were positive and significant correlations between the Absorption subscale and the FFMQ total score, 'describe' and 'act with awareness' facets; and negative and significant correlations between the Influencing by others subscale and the FFMQ total score, 'act with awareness' and 'nonjudgment' facets. Taking into account FFMQ y IS total scores, mindfulness and suggestibility constructs appear to be relatively independent. Results are discussed regarding previous literature (AU)

Consumo de plantas medicinales en usuarios del 'Centro Integral del Adulto Mayor' de la Punta-Callao (Perú) / Consumo de plantas medicinais pelos utentes do 'Centro Integral del Adulto Mayor' de La Punta-Callao (Perú) / Medicinal plant consumption by users of 'Centro Integral del Adulto Mayor' of La Punta-Callao (Peru)

El uso de plantas medicinales ha aumentado durante los últimos años, siendo la población de adultos mayores un importante sector que ha incrementado su consumo. Nuestro objetivo fue conocer el consumo de plantas medicinales en una población de adultos mayores del distrito de la Punta-Callao (Perú). Se realizó una encuesta ad—hoc, semiestructurada y validada en 70 individuos voluntarios. Los resultados reflejan que el 92,9% de los encuestados consumió plantas medicinales. Fueron reportados 50 tipos de plantas medicinales, entre ellos: anís verde (16,6%), manzanilla (16,3%), maíz morado (15%), sábila (6,1%), maca (5,6%), llantén (5%), menta (3,6%), eucalipto (3,6%), linaza (2,8%) y yacón (2,2%). Se obtuvieron datos en relación a la forma de consumo, lugar de compra, frecuencia de uso durante la semana y motivo de uso por cada planta medicinal reportada. Además se observé que un 32,9% de los adultos mayores consume más de 3 fármacos y un 35,9 tiene múltiples patologías (AU)

O consumo de plantas medicinais aumentou durante os últimos anos, sendo a populaçáo idosa um dos sectores em que tal aumento é visível. O objectivo deste trabalho foi o de caracterizar o consumo de plantas medicinais numa populaçáo de idosos do distrito de Punta-Callao (Perú). Realizou-se um inquérito ad hoc, semi-estruturado e validado em 70 individuos voluntários. Os resultados mostram que 92,9% dos entrevistados utilizaram plantas medicinais. Foram identificados 50 tipos de plantas medicinais: anis (16,6%), camomila (16,3%), milho púrpura (15%), aloe (6,1%), maca (5,6%), tanchagem (5%), hortelá-pimenta (3,6%), eucalipto (3,6%), linhaga (2,8%) e yacón (2,2%). Também se obtiveram dados relativos a forma de consumo, lugar de compra, frequóncia de uso durante a semana e motivo de uso por cada planta medicinal relatada. De salientar, ainda, que 32,9% dos idosos consomem mais de 3 fármacos e 35,9 tem múltiplas patologías (AU)

The consumption of medicinal herbs have increase during the last years, being the elderly population an important group who have also increase the consumption. The objective was known the consumption of medicinal herbs of an elderly population from the Punta district, Callao (Peru). An ad-hoc, semi-structured and validated survey was conducted in 70 elderly volunteers. The results reflect that 92.9% of the sample consumed medicinal plants. Fifty types of medicinal plants were reported as: aniseed (16.6%), chamomile (16.3%), purple maize (15%), aloe (61%), maca (56%), llanten (5%), peppermint (36%), eucalyptus (36%), linseed (28%) and yacon (22%). We obtained data on the form of consumption, place of purchase, frequency of use per week and reason for use, for each medicinal herb reported. In addition, 32.9% of the elderly consume more than 3 drugs and 35.9 have multiple pathologies (AU)

Treatment of non-resectable and metastatic gastrointestinal stromal tumors: experience with the use of tyrosine kinase inhibitors in a third level hospital in Mexico.

BACKGROUND: Stromal tumors of the digestive tract are uncommon malignant diseases, are subclassified as leiomyosarcomas and Gastrointestinal Stromal Tumors (GIST) depending on the molecular expression of tyrosine kinase receptor KIT (CD117). GISTs represent 1% of malignant tumors affecting this anatomical site. Localized tumours diseases are reasonably well controlled by surgical resection and several criteria define the need for adjuvant therapy. In the case of metastatic disease a poor prognosis has been reported with systemic treatment based on chemotherapy. Recently, significant advances have been shown since tyrosine kinase inhibitors (TKIs) were introduced, with median overall survival close to 5 years. Unfortunately in Mexico, even though the therapy has been long used there are no published data of the experience in the treatment of these tumors. METHODS: We used an electronic data base to obtain clinical, radiological and histological data of patients diagnosed with GIST and treated in the oncological center of the Mexican Institute of Social Security, patients were subclassified by stage, symptoms at diagnosis as well as the initial and subsequent systemic treatment. Finally we made an analysis for progression free survival and overall survival identifying prognostic factors. RESULTS: We obtained information of 71 patients with metastatic, non-resectable or recurrent GIST, treated with a TKI, we observed a predominant relation for women (60.4%) with median age of 58 years. Stage at diagnosis was predominantly metastatic (46.5%), most frequently affected sites were lung, liver and retroperitoneum. Median progression free survival was 30.6 months and overall survival was 81.3 months. All patients were initially treated with imatinib at a dose of 400 mg per day. Treatment was well-tolerated in most cases. CONCLUSIONS: Metastatic GIST evaluated in our center shows a different affection in gender and age, and our population shows a different response to TKIs, compared to those reported in other series with superior overall survival. Poor prognosis is associated with lung affection. Biological studies will be started for the molecular evaluation of these tumors.

Systemic treatment with capecitabine as maintenance therapy in patients with recurring or metastatic breast cancer: experience in the Oncology Hospital, National Medical Center Siglo XXI, Mexican Social Security Institute.

Metastatic breast cancer as initial onset represents between 20 and 30 % of cases and is considered an incurable disease. The goal of its treatment is palliative, looking for increasing the survival while reducing the symptoms. Maintenance chemotherapy studies for metastatic breast cancer have demonstrated to prolong the progression-free survival, with unclear results in terms of overall survival. The main objectives of our study were the progression-free survival and overall survival in patients with recurring or metastatic breast cancer treated with capecitabine in the maintenance chemotherapy setting compared with patients not receiving maintenance chemotherapy. As secondary objectives, the frequency of dose-limiting toxicities and response rate were determined. A non-probabilistic sampling was used, through expert selection of patients from the recurring/metastatic breast cancer survey cared within the period from January 1, 2007, to December 21, 2012. A total of 77 patients were included. Clinical data of advanced/recurrent breast cancer patients that were treated with capecitabine were recorded. The study achieved its primary objective, since the progression-free survival was prolonged for the maintenance therapy group: 6.6 versus 18.1 months, p < 0.001. The absolute benefit was 11.5 months. Likewise, there was a benefit in the overall survival of 21.03 versus 29 months, p = 0.015, with an absolute benefit of 7.97 months. The toxicity profile was favorable in the maintenance group. The maintenance chemotherapy with capecitabine in patients treated at the National Medical Center Siglo XXI Oncology Hospital extends the overall survival and progression-free survival with a good toxicity profile.

The prognostic impact of diastolic dysfunction in patients with chronic heart failure and post-acute myocardial infarction: Can age-stratified E/A ratio alone predict survival?

OBJECTIVE: To determine the prognostic implications of diastolic filling grades and identify whether age-stratified E/A ratio alone can identify patients at high risk of death post-AMI and HF. We hypothesized that in response to ageing and pathology, a normal E/A (>1) could be considered abnormal in patients post-AMI older than 65years, and that in patients with symptomatic HF, a normal E/A always represents advanced diastolic dysfunction. METHODS AND RESULTS: This is a sub-analysis of the Meta-analysis Research Group in Echocardiography (MeRGE) which combined individual patient data from 30 prospective studies and demonstrated that restrictive filling was an important and independent predictor of all-cause mortality. This sub-analysis is restricted to those studies in which continuous E/A data were available (20 studies) and includes a total of 3082 AMI and 2321 HF patients. Patients were classified at the time of echocardiography into four filling patterns: normal, abnormal relaxation, pseudonormal, and restrictive filling. Post-AMI patients were divided into four groups on the basis of age and E/A, while patients with HF were classified into three groups, based on only E/A. Mortality across groups was compared using Kaplan-Meier survival analysis and Cox proportional hazards. In multivariable analyses in the AMI patients, age-stratified E/A was an independent predictor of outcome (HR 1.43 (95% CI: 1.31-1.56)), and in the HF cohort, E/A was confirmed as an independent predictor of mortality (HR 1.12 (95% CI 1.09-1.16)) alongside age and ejection fraction. CONCLUSIONS: Age-stratified E/A is an independent predictor of mortality after AMI and in HF patients, regardless of left ventricular ejection fraction, age and gender. E/A ratio could be a first step echocardiographic risk stratification, which could precede and indicate the need for more advanced diagnostic and prognostic considerations in high-risk AMI and HF patients.

Large scale spatial risk and comparative prevalence of Borrelia miyamotoi and Borrelia burgdorferi sensu lato in Ixodes pacificus.

Borrelia miyamotoi is a newly described emerging pathogen transmitted to people by Ixodes species ticks and found in temperate regions of North America, Europe, and Asia. There is limited understanding of large scale entomological risk patterns of B. miyamotoi and of Borreila burgdorferi sensu stricto (ss), the agent of Lyme disease, in western North America. In this study, B. miyamotoi, a relapsing fever spirochete, was detected in adult (n=70) and nymphal (n=36) Ixodes pacificus ticks collected from 24 of 48 California counties that were surveyed over a 13 year period. Statewide prevalence of B. burgdorferi sensu lato (sl), which includes B. burgdorferi ss, and B. miyamotoi were similar in adult I. pacificus (0.6% and 0.8%, respectively). In contrast, the prevalence of B. burgdorferi sl was almost 2.5 times higher than B. miyamotoi in nymphal I. pacificus (3.2% versus 1.4%). These results suggest similar risk of exposure to B. burgdorferi sl and B. miyamotoi from adult I. pacificus tick bites in California, but a higher risk of contracting B. burgdorferi sl than B. miyamotoi from nymphal tick bites. While regional risk of exposure to these two spirochetes varies, the highest risk for both species is found in north and central coastal California and the Sierra Nevada foothill region, and the lowest risk is in southern California; nevertheless, tick-bite avoidance measures should be implemented in all regions of California. This is the first study to comprehensively evaluate entomologic risk for B. miyamotoi and B. burgdorferi for both adult and nymphal I. pacificus, an important human biting tick in western North America.

Producción científica estudiantil en Latinoamérica: un análisis de las revistas médicas de habla hispana indizadas en SciELO, 2011 / Student scientific production in Latin America: an analysis of the Spanish-language medical journals indexed in SciELO, 2011

Objetivo: Describir la producción científica de los estudiantes de medicina en las revistas médicas de habla hispana indizadas en SciELO correspondiente al año 2011. Materiales y métodos: Estudio bibliométrico. Se analizaron los artículos originales de las revistas médicas indizadas en SciELO y pertenecientes a países de Latinoamérica de habla hispana correspondiente al año 2011 para determinar la participación estudiantil. Resultados: Se revisaron un total de 99 revistas indizadas en SciELO, correspondientes a 11 países latinoamericanos de habla hispana. El país con mayor número de revistas médicas indizadas en esta base de datos fue Cuba, seguido de Colombia y Chile. Se contabilizaron 2.476 artículos originales correspondientes al año 2011, de los cuales 88 (3,6%) tuvieron entre sus autores a algún estudiante de medicina. Los países que tuvieron más revistas con publicaciones estudiantiles fueron Colombia, Chile y Perú. La facultad con mayor producción científica estudiantil fue la Pontificia Universidad Católica de Chile. En cuatro publicaciones se observó participación de estudiantes de dos o más facultades distintas. No se encontraron artículos con participación de estudiantes de diferentes países. Conclusión: Se halló una escasa participación estudiantil y un bajo nivel de colaboración entre estudiantes de distintas escuelas de medicina. Se recomienda tomar medidas a distintos niveles para incrementar estas cifras, y evaluar periódicamente su evolución

Aim: To describe the scientific production of medical students in Spanish-speaking medical journals indexed in SciELO belonging to 2011. Materials and methods: Bibliometric study. We analyzed original articles from medical journals indexed in SciELO and which belonged to Spanish-speaking Latin-American countries belonging to 2011 to determine the student contribution. Results: A total of 99 journals indexed in SciELO were reviewed, all belonging to 11 Latin-American Spanish-speaking countries. The country with the most medical journals indexed in this database was Cuba, followed by Colombia and Chile. We counted 2,476 original articles belonging to 2011, from which 88 (3.6%) had a medical student as an author. The countries which had more journals with student publications were Colombia, Chile and Peru. The faculty with the most scientific student production was the Pontificia Universidad Católica de Chile. In four publications it was observed the participation of students from two or more different faculties. Articles with the participation of students from different countries were not found. Conclusion: A poor student participation was found, and a low level of collaboration between students from different schools of medicine. It is recommended to take measures in different levels to increase these figures, and to periodically evaluate its development

Increased erythrocytes by-products of arginine catabolism are associated with hyperglycemia and could be involved in the pathogenesis of type 2 diabetes mellitus.

Diabetes mellitus (DM) is a worldwide disease characterized by metabolic disturbances, frequently associated with high risk of atherosclerosis and renal and nervous system damage. Here, we assessed whether metabolites reflecting oxidative redox state, arginine and nitric oxide metabolism, are differentially distributed between serum and red blood cells (RBC), and whether significant metabolism of arginine exists in RBC. In 90 patients with type 2 DM without regular treatment for diabetes and 90 healthy controls, paired by age and gender, we measured serum and RBC levels of malondialdehyde (MDA), nitrites, ornithine, citrulline, and urea. In isolated RBC, metabolism of L-[(14)C]-arginine was also determined. In both groups, nitrites were equally distributed in serum and RBC; citrulline predominated in serum, whereas urea, arginine, and ornithine were found mainly in RBC. DM patients showed hyperglycemia and increased blood HbA1C, and increased levels of these metabolites, except for arginine, significantly correlating with blood glucose levels. RBC were observed to be capable of catabolizing arginine to ornithine, citrulline and urea, which was increased in RBC from DM patients, and correlated with an increased affinity for arginine in the activities of putative RBC arginase (Km = 0.23±0.06 vs. 0.50±0.13 mM, in controls) and nitric oxide synthase (Km = 0.28±0.06 vs. 0.43±0.09 mM, in controls). In conclusion, our results suggest that DM alters metabolite distribution between serum and RBC, demonstrating that RBC regulate serum levels of metabolites which affect nitrogen metabolism, not only by transporting them but also by metabolizing amino acids such as arginine. Moreover, we confirmed that urea can be produced also by human RBC besides hepatocytes, being much more evident in RBC from patients with type 2 DM. These events are probably involved in the specific physiopathology of this disease, i.e., endothelial damage and dysfunction.

Contributions of the Global Emerging Infections Surveillance and Response System Network to global health security in 2011.

In its 15th year, the Global Emerging Infections Surveillance and Response System (GEIS) continued to make significant contributions to global public health and emerging infectious disease surveillance worldwide. As a division of the US Department of Defense's Armed Forces Health Surveillance Center since 2008, GEIS coordinated a network of surveillance and response activities through collaborations with 33 partners in 76 countries. The GEIS was involved in 73 outbreak responses in fiscal year 2011. Significant laboratory capacity-building initiatives were undertaken with 53 foreign health, agriculture and/or defense ministries, as well as with other US government entities and international institutions, including support for numerous national influenza centers. Equally important, a variety of epidemiologic training endeavors reached over 4,500 individuals in 96 countries. Collectively, these activities enhanced the ability of partner countries and the US military to make decisions about biological threats and design programs to protect global public health as well as global health security.

Mindfulness training online for stress reduction, a global measure.

According to the World Health Organization (WHO), stress-related chronic diseases are the main source of death in developed countries. During the last decade, e-mental health, telepsychology or telepsychiatry interventions are showing its growing potential due to the gradual global adoption of the internet and mobile phone technologies. A significant number of studies have concluded that mindfulness helps to reduce physical and psychological symptoms of stress related to various health concerns and that it is a psychological skill that can be trained. The purpose of this online research study is to gather the participants' socio-demographics as well as stress and mindfulness data during an online mindfulness training program. Sustained attention and the state of mindfulness experienced in single meditation sessions are also tracked and stored. Correlational analysis yielded to a statistically significant relationship between high scores in stress and low scores in mindfulness facets (p < .001) and between state and trait aspects of mindfulness (p < .01).

Leishmania detection in sand flies using a field-deployable real-time analytic system.

We describe here the development and evaluation of advanced vector surveillance analytic technologies for real-time leishmaniasis risk assessment. Leishmania genus and visceral leishmaniasis causative agent--specific dual fluorogenic-probe hydrolysis (TaqMan), thermally stable (freeze-dried) polymerase chain reaction assays were developed using field-durable analytic instrumentation. In laboratory testing with a panel of diverse Leishmania species from culture and infected sand flies, the sensitivity and specificity of both assays were 100% concordant with DNA sequencing. In specificity testing with Leishmania genetic near neighbors, clinically significant organisms, and human genomic DNA, no detectable fluorescence above background was observed. Field evaluation was conducted in southern Iraq using wild sand flies. In field testing, Leishmania genus assay was 100% sensitive and 96% specific with a single false-positive result. The visceral leishmaniasis genotype assay was 100% sensitive and 100% specific compared to DNA sequencing. Thermally stable polymerase chain reaction assays vastly simplified transportation and storage. Assay preparation and analysis required less than 2 hours.

Capacity-building efforts by the AFHSC-GEIS program.

Capacity-building initiatives related to public health are defined as developing laboratory infrastructure, strengthening host-country disease surveillance initiatives, transferring technical expertise and training personnel. These initiatives represented a major piece of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) contributions to worldwide emerging infectious disease (EID) surveillance and response. Capacity-building initiatives were undertaken with over 80 local and regional Ministries of Health, Agriculture and Defense, as well as other government entities and institutions worldwide. The efforts supported at least 52 national influenza centers and other country-specific influenza, regional and U.S.-based EID reference laboratories (44 civilian, eight military) in 46 countries worldwide. Equally important, reference testing, laboratory infrastructure and equipment support was provided to over 500 field sites in 74 countries worldwide from October 2008 to September 2009. These activities allowed countries to better meet the milestones of implementation of the 2005 International Health Regulations and complemented many initiatives undertaken by other U.S. government agencies, such as the U.S. Department of Health and Human Services, the U.S. Agency for International Development and the U.S. Department of State.