Endometritis por Actinomyces en una adolescente: a propósito de un caso / Actinomyces endometritis in an adolescent girl: a case report

La actinomicosis pélvica es una infección poco común del tracto genital inferior y la pelvis. La especie causal más frecuente es la bacteria Actinomyces israelii, y se debe sospechar en toda paciente que presente dolor crónico pélvico y hemorragia uterina. Aunque se manifiesta excepcionalmente en mujeres sin antecedentes de portar dispositivos intrauterinos, es importante considerarla como diagnóstico. Se presenta el caso clínico de una paciente de 12 años con hemorragia uterina anormal resistente al tratamiento, que requirió intervención quirúrgica, incluyendo biopsia endometrial. El diagnóstico resultante fue actinomicosis endometrial. Este caso aporta la actualización del conocimiento sobre esta rara enfermedad y su presentación poco frecuente en adolescentes(AU)

Pelvic actinomycosis is a rare infection of the lower genital tract and pelvis. The most common causative species is the bacterium Actinomyces israelii, and it should be suspected in any patient who presents with chronic pelvic pain and uterine bleeding. Although it occurs exceptionally in women without a history of carrying intrauterine devices, it is important to consider it as a diagnosis. It is presented the clinical case of a 12-year-old patient with abnormal uterine bleeding resistant to treatment, which required surgical intervention, including endometrial biopsy. The resulting diagnosis was endometrial actinomycosis. This case contributes to updating knowledge about this rare disease and its uncommon presentation in adolescents(AU)

Lead Levels in the Most Consumed Mexican Foods: First Monitoring Effort.

Globally, there is growing concern over the presence of lead (Pb) in foods because it is a heavy metal with several toxic effects on human health. However, monitoring studies have not been conducted in Mexico. In this study, we estimated the concentrations of Pb in the most consumed foods and identified those that exceeded the maximum limits (MLs) for Pb in foods established by the International Standards. Based on the Mexican National Health and Nutrition Survey, 103 foods and beverages were selected and purchased in Mexico City retail stores and markets. Samples were analyzed twice using atomic absorption spectrophotometry. Values above the limit of quantification (0.0025 mg/kg) were considered to be detected. The percentage of detected values was 18%. The highest concentration was found in infant rice cereal (1.005 mg/kg), whole wheat bread (0.447 mg/kg), pre-cooked rice (0.276 mg/kg), black pepper (0.239 mg/kg), and turmeric (0.176 mg/kg). Among the foods with detected Pb, the levels in infant rice cereal, whole wheat bread, pre-cooked rice, and soy infant formula exceeded the MLs. The food groups with the highest percentages of exceeded MLs were baby foods (18%) and cereals (11%). Monitoring the concentration of contaminants in foods is essential for implementing food safety policies and protecting consumer health.

Share of food group expenditure in Mexican households according to the gender of the head of household and size of the locality.

OBJECTIVE: To evaluate differences in the percentage of expenditure on food groups in Mexican households according to the gender of the household head and the size of the locality. DESIGN: Analysis of secondary data from the National Household Income and Expenditure Survey (ENIGH) 2018. We estimated the percentage of expenditure on fifteen food groups according to the gender of the head of household and locality size and evaluated the differences using a two-part model approach. SETTING: Mexico, 2018. PARTICIPANTS: A nationally representative sample of 74 647 Mexican households. RESULTS: Female-headed households allocated a lower share of expenditure to the purchase of sweetened beverages and alcoholic beverages and higher percentages to milk and dairy, fruits and water. In comparison with metropolitan households, households in rural and urban localities spent more on cereals and tubers, sugar and honey, oil and fat and less on food away from home. CONCLUSIONS: Households allocate different percentages of expenditure to diverse food groups according to the gender of the head of the household and the size of the locality where they are located. Future research should focus on understanding the economic and social disparities related to differences in food expenditure, including the gender perspective.

Hiperandrogenismo por tumor ovárico de células esteroideas en paciente pediátrico / Hyperandrogenism due to ovarian steroid cell tumor in a pediatric patient

RESUMEN Los tumores de ovario son raros en pediatría. En este grupo, los tumores de células esteroideas representan el 0,1% de los casos y existen escasos reportes en la literatura. Presentamos el caso de una niña de 11 años con síntomas de engrosamiento de la voz, hirsutismo, acné y clitoromegalia. El análisis de laboratorio mostró niveles elevados de testosterona total y libre, niveles normales de 17-hidroxiprogesterona. La evaluación ecográfica reveló un agrandamiento significativo del ovario izquierdo. La paciente fue sometida a salpingooforectomía izquierda. Este hallazgo fue consistente con un tumor de células esteroideas de ovario. A esto le siguió la reducción gradual de los andrógenos y la mejoría clínica. Los tumores de células esteroideas son raros en pediatría, sin embargo, deben considerarse como diagnóstico diferencial al estudiar pacientes con síntomas de hiperandrogenismo.

ABSTRACT Ovarian tumors are rare in pediatrics. In this group, steroid cell tumors represent 0.1% of total cases and there are few reports in the literature. We present the case of an 11-year-old girl who suffered from deeper voice, hirsutism, acne and clitoromegaly. Analysis showed elevated levels of total and free testosterone, normal levels of 17-hydroxyprogesterone. Ultrasound evaluation revealed significant enlargement of the left ovary. The patient underwent left salpingo-oophorectomy. This finding is consistent with an ovarian steroid cell tumor. This is followed by gradual reduction of androgens and clinical improvement. Steroid cell tumors are rare in pediatrics, however, they should be considered as a differential diagnosis when studying patients with symptoms of hyperandrogenism.

The burden of intestinal parasitic infections in Antioquia, Colombia: Impact in childhood growth development and nutritional status.

Gastrointestinal protist (GP) and soil-transmitted helminth (STH) infections cause significant morbidity among children in poor-resource settings of tropical and sub-tropical countries including Colombia. Few prospective transversal studies investigating how GP and STH infections affect growth development and nutritional status during childhood have been conducted in this country, none of them in the Antioquia Department. This microscopy-based study estimated the prevalence of GP and helminth (including STH) infections in faecal samples from schoolchildren (n = 384) collected during April-May 2019 in three municipalities of the Antioquia Department. Demographic, epidemiological, and household data were elicited through face-to-face interviews. Parasite detection was carried out by direct microscopic examination of both fresh smears and concentrated faecal material. Children (aged 6-15 years) also had their haemoglobin (Hb) levels, height and weight data collected, and BMI estimated. Data were analysed using bivariate and multivariate logistic regression analysis. Overall, 60.7 % (233/384) of schoolchildren were infected by at least one intestinal parasitic species. Among GPs, Blastocystis sp. was the most common species found (47.7 %, 95 % CI: 42.6-52.8), followed by G. duodenalis (15.9 %, 95 % CI: 12.4-19.9). Cryptosporidium spp. and Cyclospora cayetanensis were sporadically identified (0.3 %, 95 % CI: 0.1-1.4 each). Among helminths, the most prevalent species found were Trichuris trichiura (6.0 %, 95 % CI: 3.8-8.9) and Enterobius vermicularis (1.0 %, 95 % CI: 0.3-2.6). Hookworms, Ascaris lumbricoides, and Strongyloides stercoralis were found at prevalence rates <1 %. Underweight, overweigh, or obese schoolchildren had 1.2 times greater chance of being infected with intestinal parasites than their counterparts with a healthy weight (P-value: 0.015). Variables significantly associated with an increased likelihood of being infected by intestinal parasites include living in a household with unfinished flouring, not wearing shoes, being in close proximity to rodents, and having improper waste disposal. Relatively simple interventional measures directed towards the improvement of household conditions, access to sanitary toilets, and promoting shoe wearing can significantly reduce childhood infections by GP and helminths in the Antioquia Department.

Draft genome sequences of four Morganella morganii strains isolated from Colombian colorectal cancer patient stool specimens.

We report the draft genome sequences of four Morganella morganii strains isolated from the stools of four patients diagnosed with colorectal cancer (CRC) in Medellín, Colombia. These genomes represent an important addition to the limited number of genomes of M. morganii strains originating from CRC patients currently available.

Social Robots and Brain-Computer Interface Video Games for Dealing with Attention Deficit Hyperactivity Disorder: A Systematic Review.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity that affects a large number of young people in the world. The current treatments for children living with ADHD combine different approaches, such as pharmacological, behavioral, cognitive, and psychological treatment. However, the computer science research community has been working on developing non-pharmacological treatments based on novel technologies for dealing with ADHD. For instance, social robots are physically embodied agents with some autonomy and social interaction capabilities. Nowadays, these social robots are used in therapy sessions as a mediator between therapists and children living with ADHD. Another novel technology for dealing with ADHD is serious video games based on a brain-computer interface (BCI). These BCI video games can offer cognitive and neurofeedback training to children living with ADHD. This paper presents a systematic review of the current state of the art of these two technologies. As a result of this review, we identified the maturation level of systems based on these technologies and how they have been evaluated. Additionally, we have highlighted ethical and technological challenges that must be faced to improve these recently introduced technologies in healthcare.

Contenido de yodo de la sal alimentaria en puestos de venta del Gran San Salvador de Jujuy, Argentina (Mayo 2022) / Iodine content in dietary salt available at retail outlets in Gran San Salvador de Jujuy, Argentina (May 2022)

El objetivo de este trabajo fue determinar la calidad de yodación de la sal alimentaria a nivel de puestos de venta en los barrios del Gran San Salvador de Jujuy (GSSJ). Para esto se llevó a cabo un estudio descriptivo y transversal. Se adquirió a nivel comercial un envase de sal en cada una de las 47 urbanizaciones del GSSJ, durante el mes de mayo del 2022. El yodo en sal se determinó por titulación con tiosulfato de sodio, con valor referencial establecido por la Ley 17.259/69 (toda sal debe estar yodada en un rango de una parte de yodo en 30.000 de sal ± 25 % = 24,7­41,2 ppm). Los resultados mostraron que el nivel de yodo en las sales fue de 24,5 ± 9,4 ppm (promedio ± desvío estándar), 26,1 ppm de mediana, 0 a 42,5 ppm (rango) y IC 95 % de 21,8­27,2 ppm. Solo el 53,2 % de las muestras estaban correctamente yodadas, el 40,4 % contenían yodo, pero de manera insuficiente, el 4,3 % estaban sin yodar y el 2,1 % en exceso marginal, con similar distribución en todas las categorías del NBI/urbanización (p=NS). Solo el 45,0 % de las sales envasadas regionales cumplían con el nivel de yodo adecuado, diferencia altamente significativa respecto a las no regionales (p=0,0077). En conclusión, en el expendio del mercado minorista del GSSJ casi la mitad de los productos necesitan optimizar el nivel de yodación, por lo que se hace necesario aunar los esfuerzos de todos los actores participantes ante la imperiosa necesidad de cumplir no solo con las normativas y parámetros referenciales, sino fundamentalmente con el aporte del nutriente clave para cubrir los requerimientos diarios de la población.

This study aimed to determine the iodization quality of food-grade salt available at retail outlets in neighborhoods of Gran San Salvador de Jujuy (GSSJ). To do so, a descriptive and cross-sectional study was conducted, involving the acquisition of salt samples from 47 urban areas within the GSSJ during May 2022. The iodine in salt was determined by titration with sodium thiosulfate, following the reference value established by Law 17,259/69 (all salt must be iodized within a range of one part iodine per 30,000 parts of salt ± 25 % = 24.7­41.2 ppm). The results showed that the iodine level in the salt samples were 24.5 ± 9.4 ppm (mean ± standard deviation), median 26.1 ppm, 0 to 42.5 ppm (range), and 95 % CI of 21.8­27.2 ppm. Only 53.2 % of the samples were correctly iodinated, 40.4 % contained iodine, but insufficiently, 4.3 % were not iodinated, and 2.1 % were in marginal excess, with similar distribution across all categories of UBN/urbanization (p=NS). Only 45.0 % of the regional packaged salts met the adequate iodine level, a highly significant difference compared to the non-regional ones (p=0.0077). In conclusion, in the GSSJ retail market, almost half of the products need to optimize their level of iodization, which is why it is necessary to combine the efforts of all relevant actors in the face of the imperative need to comply not only with the regulations and reference parameters but, fundamentally, with the contribution of this key nutrient to cover the daily requirements of the population.

Identification and validation of novel Blastocystis subtype ST41 in a Colombian patient undergoing colorectal cancer screening.

Blastocystis sp. is among the most frequent intestinal protists identified in humans globally. However, characterization of Blastocystis subtype diversity in humans is ongoing. We report here the identification of novel Blastocystis subtype ST41 in a Colombian patient undergoing colorectal cancer screening involving colonoscopy and fecal testing (microscopy, culture, PCR). The full-length ssu rRNA gene sequence of the protist was generated using MinION long-read sequencing technology. The validity of the novel subtype was confirmed via phylogenetic and pairwise distance analyses of the full-length ST41 sequence and all other valid subtypes. The study provides reference material essential for conducting subsequent experimental studies.

EVALUACIÓN DEL CONTENIDO DE YODO EN SAL ALIMENTARIA A NIVEL DE PUESTOS DE VENTA EN LA CIUDAD DE SALTA EN EL CONTEXTO DE LA PANDEMIA COVID-19 / Assessment of iodine content in dietary salt at market stall level in the city of Salta amidst the covid-19 pandemic

El objetivo del presente trabajo fue evaluar el efecto de la pandemia COVID-19 sobre la disponibilidad y accesibilidad de sal yodada en la ciudad de Salta a nivel del mercado minorista previo a y en el nuevo contexto. Para llevar a cabo este estudio se realizó un estudio multietápico, descriptivo y comparativo con una muestra estadísticamente representativa y sistemática de los 321 barrios de Salta capital. Se realizó la compra del envase de sal alimentaria en febrero/2020, enero/2021, abril/2022, estos dos últimos bajo protocolos de prevención. Se determinó el yodo por titulación con tiosulfato de sodio, considerando valores referenciales internacionales que la presencia de ">95 % de las sales de grado alimentario deben estar yodadas en el rango establecido por legislación, a nivel de producción y en el mercado" . Los resultados mostraron que las sales regionales son las de mayor oferta en los tres monitoreos. La totalidad de etiquetado presenta la leyenda "Sal enriquecida con yodo según Ley 17259/69" y sus registros normativos con gran variabilidad en la fecha del vencimiento. En el 2020, 2021 y 2022 el nivel de yodo varió tanto en las sales nacionales como regionales, las sales aptas fueron del 59,3 %, 29,2 % (p=0,0003234) y 41,9 % respectivamente. Sin yodo: 5,5 %, 4,2 % y 3,2 %. En 2021 todos los barrios ofrecieron sales no aptas. Una marca regional ocupa mayoritariamente el mercado minorista. En el contexto sanitario COVID-19, los contenidos de yodo en la sal para el consumidor descendieron marcadamente respecto a la situación pre pandémica, indicador de alerta por los efectos para la salud de la población y futuras generaciones.

The aim of this study was to evaluate the effect of the COVID-19 pandemic on the availability and accessibility of iodized salt in the city of Salta at retail market level prior to and in the new context. To conduct this research, a multistage, descriptive and comparative study was carried out with a statistically representative and systematic sample of the 321 neighbourhoods of the city of Salta. The purchase of food salt containers was made in said neighbourhoods in February/2020, January/2021, and April/2022, the two last ones under prevention protocols. Iodine was determined by sodium thiosulfate titration, under international reference values indicating that the presence of ">95 % of food grade salt must be iodized within the range established by legislation, at the production level and in the market." The results showed that regional salts are the ones with the highest supply in the three monitoring. All the labeling showed the legend "Salt enriched with iodine according to Law 17259/69" as well as its regulatory records with great variability in the expiration date. In 2020, 2021 and 2022 the level of iodine varied in both national and regional salts, the suitable salts were 59.3 %, 29.2 % (p=0.0003234) and 41.9 % respectively. Without iodine: 5.5 %, 4.2 % and 3.2 %. In 2021 all the neighbourhoods offered unsuitable salts. One regional brand takes up the majority of the retail market. In the COVID-19 health context, the iodine content in salt for human consumption decreased significantly compared to the pre-pandemic situation, a warning indicator because of the effects on the health of the population and future generations.

Estudio de parámetros salivales y su relación con caries temprana de la infancia en niños preescolares / Study of salivary parameters and their relationship with early childhood caries in preschool children

Objetivo: El presente estudio tuvo como objetivo evaluar y comparar algunos parámetros salivales en niños preescolares e investigar su relación con caries temprana de la infancia. Materiales y métodos: Un total de 77 niños preescolares de 36 a 71 meses de edad (38 con caries y 39 sin caries) fueron seleccionados para participar en este estudio. Muestras de saliva completa no estimulada fueron recolectadas de cada niño, para evaluar el pH salival, la capacidad buffer, la velocidad de flujo salival y las concentraciones de fluoruro y fosfato. Los datos obtenidos fueron tabulados y sometidos a análisis estadístico. Resultados: En la evaluación de los diferentes parámetros salivales, se encontró que en relación a las propiedades salivales, el pH en los niños con caries fue levemente menor que en los niños sin caries. La comparación de las diferentes características salivales entre niños con y sin caries temprana de la infancia, no mostró diferencias estadísticas significativas para todos los componentes salivales evaluados (p> 0.05). Conclusión: Los parámetros salivales analizados en este estudio, no tuvieron relación con el desarrollo de caries temprana de la infancia. Los resultados obtenidos no difieren de manera significativa entre los dos grupos de niños preescolares estudiados.

Objective: The present study aims to evaluate and compare some salivary parameters in preschool children and to investigate their relationship with early childhood caries. Materials and Methods: A total of 77 preschool children aged 36 to 71 months (38 with caries and 39 without caries) were selected to participate in this study. Unstimulated whole saliva samples were collected from every child to evaluate the salivary pH, buffering capacity, salivary flow rate and fluoride and phosphate concentrations. The data obtained was tabulated and subjected to statistical analysis. Results: the evaluation of the different salivary parameters showed that in relation to salivary properties, the pH in children with early childhood caries was slightly lower than in children without caries. Comparing the different salivary characteristics between children with and without early childhood caries, the results did not show significant statistical differences for all the salivary components evaluated (p> 0.05). Conclusion: The salivary parameters analyzed in this study were not related to the development of early childhood caries. The results obtained do not differ significantly between the two groups of preschool children studied.

Heavy Metals in Unprocessed or Minimally Processed Foods Consumed by Humans Worldwide: A Scoping Review.

Heavy metals (HM) can be accumulated along the food chain; their presence in food is a global concern for human health because some of them are toxic even at low concentrations. Unprocessed or minimally processed foods are good sources of different nutrients, so their safety and quality composition should be guaranteed in the most natural form that is obtained for human consumption. The objective of this scoping review (ScR) is to summarize the existing evidence about the presence of HM content (arsenic (As), lead (Pb), cadmium (Cd), mercury (Hg), methylmercury (MeHg), and aluminum (Al)) in unprocessed or minimally processed foods for human consumption worldwide during the period of 2011-2020. As a second objective, we identified reported HM values in food with respect to Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) International Food Standards for Maximum Limits (MLs) for contaminants in food. This ScR was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and PRISMA Extension for Scoping Reviews (PRISMA-ScR); advance searches were performed in PubMed, ScienceDirect and FAO AGRIS (Agricultural Science and Technology Information) databases by two reviewers who independently performed literature searches with specific eligibility criteria. We classified individual foods in food groups and subgroups according to the Global Individual Information Food Consumption Data Tool (FAO/WHO GIFT). We homologated all the reported HM units to parts per million (ppm) to determine the weighted mean HM concentration per country and food group/subgroup of the articles included. Then, we compared HM concentration findings with FAO/WHO MLs. Finally, we used a Geographic Information System (GIS) to present our findings. Using our search strategy, we included 152 articles. Asia was the continent with the highest number of publications (n = 79, 51.3%), with China being the country with the largest number of studies (n = 34). Fish and shellfish (n = 58), followed by vegetables (n = 39) and cereals (n = 38), were the food groups studied the most. Fish (n = 42), rice (n = 33), and leafy (n = 28) and fruiting vegetables (n = 29) were the most studied food subgroups. With respect to the HM of interest, Cd was the most analyzed, followed by Pb, As, Hg and Al. Finally, we found that many of the HM concentrations reported exceeded the FAO/OMS MLs established for Cd, Pb and As globally in all food groups, mainly in vegetables, followed by the roots and tubers, and cereals food groups. Our study highlights the presence of HM in the most natural forms of food around the world, in concentrations that, in fact, exceed the MLs, which affects food safety and could represent a human health risk. In countries with regulations on these topics, a monitoring system is recommended to evaluate and monitor compliance with national standards. For countries without a regulation system, it is recommended to adopt international guidelines, such as those of FAO, and implement a monitoring system that supervises national compliance. In both cases, the information must be disseminated to the population to create social awareness. This is especially important to protect the population from the consumption of internal production and for the international markets of the globalized world.

Reproducibility and validity of a food frequency questionnaire to assess cardiovascular health-related food intake among Mexican adolescents.

There is a lack of region-adapted tools to evaluate diet as a risk factor for cardiovascular disease (CVD) in adolescents. The study aim was to evaluate the reproducibility and validity of a paper-based and region-adapted food frequency questionnaire (FFQ) designed to assess CVD-related food and nutrient intakes of adolescents from Northwest México. The study design was cross-sectional. The FFQ was developed in a two-step process: prototype designing and a pilot test, with re-tested in a 3-month period, along with two administrations of 24 h-recall (24 hR). Pearson's and intra-class correlation coefficients (PCC and ICC) were assessed. Bland-Altman plots, limits of agreement and quintile classifications were carried out. Participants (n 221) were 53·8 % male, 18·5 ± 0·4 years old. Reproducibility had a median PCC = 0·66 for processed meats, ranging from 0·40 (saturated fat) to 0·74 (fish & shellfish), P = 0·001. ICC ranged from 0·53 (saturated fat) to 0·80 (sodium; and nuts, seeds and legumes), P = 0·001. Validity comparing FFQ1 v. 24 hR mean, PCCs ranged from 0·12 (P = 0·06) to 0·95 (P = 0·001), and ICC from 0·20 (P = 0·048) to 0·88 (P = 0·001); comparing FFQ2 v. 24 hR mean, PCCs ranged from 0·07 (P = 0·25) to 0·46 (P = 0·001), and ICC from 0·15 (P = 0·106) to 0·58 (P = 0·001). The FFQ overestimated the intake of all food groups and nutrients (P < 0·05), while Cohen's κ showed coefficients lower than 0·20. The proposed FFQ represents a moderately validated tool to estimate CVD-related food and nutrient intakes as a risk factor, which can be used in combination with multiple administrations of 24 hRs, as a critical mean in future interventions intended to reduce cardiometabolic risk in adolescents.

Feasibility of an mobile application as a tool for multidrug-resistant tuberculosis contact monitoring in Peru. / Factibilidad de una aplicación móvil para el monitoreo de contactos de tuberculosis multidrogorresistente en Perú.

This study aimed to validate an ODK digital mobile application (ODK-DMA) in contacts exposed to multidrug-resistant tuberculosis (MDR-TB) in Lima, Peru. Using a questionnaire in an application on a mobile device, we registered 129 household contacts of 29 index cases of MDR-TB under treatment in 10 health facilities in South Lima in August 2018. The mean time of registration per contact was found to be 4 minutes. The prevalence of active TB symptoms among MDR-TB contacts was 3.1%. An acceptability questionnaire was completed by 31 respondents; all reported feeling comfortable or very comfortable with recording their data in the ODK-DMA, although 10% expressed concerns about confidentiality. We concluded that the ODK-DMA was a feasible and acceptable tool for registering household contacts exposed to cases with MDR-TB. Future studies should consider the use of mobile platforms for the monitoring of MDR-TB contacts.

El presente estudio tuvo como objetivo realizar una validación de un aplicativo móvil Open Data Kit (AM-ODK) en contactos expuestos a tuberculosis multidrogorresistente (TB-MDR) en Lima. Utilizando un cuestionario en una aplicación en un dispositivo móvil Android, se registraron 129 contactos intradomiciliarios de 29 casos índice de TB-MDR en tratamiento, en diez establecimientos de salud de Lima Sur en agosto de 2018. Se encontró un tiempo medio de registro por contacto de cuatro minutos. La frecuencia de síntomas de TB activa entre los contactos de TB-MDR fue 3,1%. Treinta y un encuestados completaron un cuestionario de aceptabilidad; todos manifestaron sentirse cómodos o muy cómodos con el registro de sus datos en AM-ODK, aunque 10% expresó inquietudes sobre la confidencialidad. Se concluye que el AM-ODK fue una herramienta viable y aceptable para registrar contactos intradomiciliarios expuestos a casos con TB-MDR. Estudios futuros deberían considerar el uso de plataformas móviles para el monitoreo de contactos de TB-MDR.

Can Human Oral Mucosa Stem Cells Differentiate to Corneal Epithelia?

Human oral mucosa stem cells (hOMSCs) arise from the neural crest, they can self-renew, proliferate, and differentiate to several cell lines and could represent a good source for application in tissue engineering. Because of their anatomical location, hOMSCs are easy to isolate, have multilineage differentiation capacity and express embryonic stem cells markers such as-Sox2, Oct3/4 and Nanog. We have used SHEM (supplemented hormonal epithelial medium) media and cultured hOMSCs over human amniotic membrane and determined the cell's capacity to differentiate to an epithelial-like phenotype and to express corneal specific epithelial markers-CK3, CK12, CK19, Pan-cadherin and E-cadherin. Our results showed that hOMSCs possess the capacity to attach to the amniotic membrane and express CK3, CK19, Pan-Cadherin and E-Cadherin without induction with SHEM media and expressed CK12 or changed the expression pattern of E-Cadherin to a punctual-like feature when treated with SHEM media. The results observed in this study show that hOMSCs possess the potential to differentiate toward epithelial cells. In conclusion, our results revealed that hOMSCs readily express markers for corneal determination and could provide the ophthalmology field with a therapeutic alternative for tissue engineering to achieve corneal replacement when compared with other techniques. Nevertheless, further studies are needed to develop a predictable therapeutic alternative for cornea replacement.

Inmunización feto materna contra antígenos de HLA en mujeres de una población paraguaya / Fetomaternal immunization against HLA antigens in women from a Paraguayan population

El embarazo es la única causa natural de inmunización contra el sistema de Antígenos Leucocitarios Humano (HLA). Durante la gestación hay paso de leucocitos fetales a través de la placenta, lo que puede desencadenar en la madre una respuesta inmunológica contra los antígenos HLA fetales de origen paterno, con la consecuente producción de anticuerpos. El objetivo del estudio fue conocer la prevalencia de sensibilización a antígenos HLA inducida por embarazos en mujeres paraguayas y estudiar las características y especificidades de los anticuerpos encontrados. Realizamos un estudio descriptivo, prospectivo, de corte transversal de 319 mujeres paraguayas, que acudieron al Laboratorio Central de Salud Pública entre abril de 2017 y abril de 2018 utilizando la tecnología LUMINEX para la detección de anticuerpos anti- HLA. Se encontraron anticuerpos anti-HLA en 46% de las mujeres multíparas. Se detectaron anticuerpos contra todos los antígenos testados. La gran mayoría de los sueros resultaron ser poliespecíficos. Concluimos que al aumentar el número de gestas no solo aumenta la probabilidad de una mujer de desarrollar anticuerpos anti- HLA, sino que también parece aumentar la cantidad de especificidades desarrolladas y el título de los anticuerpos

Pregnancy is the only natural cause of immunization against the Human Leukocyte Antigen (HLA) system. During pregnancy, fetal leukocytes pass through the placenta, which can trigger an immunological response in the mother against the fetus paternal HLA antigens, with the consequent production of antibodies. The objective of this study was to determine the prevalence of pregnancy-induced HLA antigen sensitization in Paraguayan women and to study the characteristics and specificities of the antibodies found. We conducted a descriptive, prospective, cross-sectional study of 319 Paraguayan women, who attended the Central Laboratory of Public Health between April 2017 and April 2018 using LUMINEX technology to detect anti-HLA antibodies. We found anti-HLA antibodies in 46% of multiparous women. Antibodies against all tested antigens were detected. The vast majority of the sera exhibited multiple specificities. We conclude that increasing the number of gestations not only increases a woman's likelihood of developing anti-HLA antibodies, but it also appears to increase the number of developed specificities and titers of antibodies

Screening diabetes mellitus patients for pulmonary tuberculosis: a multisite study in Indonesia, Peru, Romania and South Africa.

BACKGROUND: Diabetes mellitus (DM) patients are three times more likely to develop tuberculosis (TB) than the general population. Active TB screening in people with DM is part of a bidirectional approach. The aim of this study was to conduct pragmatic active TB screening among DM patients in four countries to inform policy. METHODS: DM patients were recruited in Indonesia (n=809), Peru (n=600), Romania (n=603) and South Africa (n=51). TB cases were diagnosed using an algorithm including clinical symptoms and chest X-ray. Presumptive TB patients were examined with sputum smear and culture. RESULTS: A total of 171 (8.3%) individuals reported ever having had TB (South Africa, 26%; Indonesia, 12%; Peru, 7%; Romania, 4%), 15 of whom were already on TB treatment. Overall, 14 (0.73% [95% confidence interval 0.40 to 1.23]) TB cases were identified from screening. Poor glucose control, smoking, lower body mass index, education and socio-economic status were associated with newly diagnosed/current TB. Thirteen of the 14 TB cases diagnosed from this screening would have been found using a symptom-based approach. CONCLUSIONS: These data support the World Health Organization recommendation for routine symptom-based screening for TB in known DM patients in high TB-burden countries. DM patients with any symptoms consistent with TB should be investigated and diagnostic tools should be easily accessible.

Factibilidad de una aplicación móvil para el monitoreo de contactos de tuberculosis multidrogorresistente en Perú / Feasibility of an mobile application as a tool for multidrug-resistant tuberculosis contact monitoring in Peru

El presente estudio tuvo como objetivo realizar una validación de un aplicativo móvil Open Data Kit (AM-ODK) en contactos expuestos a tuberculosis multidrogorresistente (TB-MDR) en Lima. Utilizando un cuestionario en una aplicación en un dispositivo móvil Android, se registraron 129 contactos intradomiciliarios de 29 casos índice de TB-MDR en tratamiento, en diez establecimientos de salud de Lima Sur en agosto de 2018. Se encontró un tiempo medio de registro por contacto de cuatro minutos. La frecuencia de síntomas de TB activa entre los contactos de TB-MDR fue 3,1%. Treinta y un encuestados completaron un cuestionario de aceptabilidad; todos manifestaron sentirse cómodos o muy cómodos con el registro de sus datos en AM-ODK, aunque 10% expresó inquietudes sobre la confidencialidad. Se concluye que el AM-ODK fue una herramienta viable y aceptable para registrar contactos intradomiciliarios expuestos a casos con TB-MDR. Estudios futuros deberían considerar el uso de plataformas móviles para el monitoreo de contactos de TB-MDR.

This study aimed to validate an ODK digital mobile application (ODK-DMA) in contacts exposed to multidrug-resistant tuberculosis (MDR-TB) in Lima, Peru. Using a questionnaire in an application on a mobile device, we registered 129 household contacts of 29 index cases of MDR-TB under treatment in 10 health facilities in South Lima in August 2018. The mean time of registration per contact was found to be 4 minutes. The prevalence of active TB symptoms among MDR-TB contacts was 3.1%. An acceptability questionnaire was completed by 31 respondents; all reported feeling comfortable or very comfortable with recording their data in the ODK-DMA, although 10% expressed concerns about confidentiality. We concluded that the ODK-DMA was a feasible and acceptable tool for registering household contacts exposed to cases with MDR-TB. Future studies should consider the use of mobile platforms for the monitoring of MDR-TB contacts.

Toward ethical cognitive architectures for the development of artificial moral agents.

New technologies based on artificial agents promise to change the next generation of autonomous systems and therefore our interaction with them. Systems based on artificial agents such as self-driving cars and social robots are examples of this technology that is seeking to improve the quality of people's life. Cognitive architectures aim to create some of the most challenging artificial agents commonly known as bio-inspired cognitive agents. This type of artificial agent seeks to embody human-like intelligence in order to operate and solve problems in the real world as humans do. Moreover, some cognitive architectures such as Soar, LIDA, ACT-R, and iCub try to be fundamental architectures for the Artificial General Intelligence model of human cognition. Therefore, researchers in the machine ethics field face ethical questions related to what mechanisms an artificial agent must have for making moral decisions in order to ensure that their actions are always ethically right. This paper aims to identify some challenges that researchers need to solve in order to create ethical cognitive architectures. These cognitive architectures are characterized by the capacity to endow artificial agents with appropriate mechanisms to exhibit explicit ethical behavior. Additionally, we offer some reasons to develop ethical cognitive architectures. We hope that this study can be useful to guide future research on ethical cognitive architectures.