Infección congénita por citomegalovirus, hipoacusia y tamizaje neonatal. Una actualización / Congenital cytomegalovirus infection, hearing loss and newborn screening. An update

El citomegalovirus congénito (CMVc) es la infección congénita más común y la principal causa no genética de hipoacusia congénita. Gran parte de los recién nacidos (RN) con CMVc sintomático desarrolla secuelas graves permanentes, donde la hipoacusia es la más frecuente. Sin embargo, el 90% de los casos se presenta en forma asintomática, pudiendo desarrollar secuelas auditivas tardías. El diagnóstico precoz de CMVc requiere un alto índice de sospecha. Actualmente, técnicas eficientes para su detección están disponibles, lo que facilita el diagnóstico en las primeras 3 semanas de vida. La terapia antiviral es la primera línea de tratamiento para el CMVc sintomático, logrando buenos resultados auditivos. A pesar de los avances en los métodos de detección y beneficios del tratamiento, los RN no son tamizados para CMVc. El tamizaje selectivo de CMVc en pacientes que no pasan el screening auditivo facilita la intervención precoz en los casos identificados, pero no permite detectar el número significativo de niños que presenta hipoacusia de aparición tardía. El tamizaje universal permite hacer seguimiento auditivo a los pacientes en riesgo de desarrollar hipoacusia sensorioneural (HSN) por CMVc, identificando así los casos de hipoacusia de aparición tardía, pero la costo-efectividad es aún controversial. Es necesario avanzar en una estrategia local para el tamizaje de CMVc, buscando reducir su impacto a nivel nacional.

Congenital cytomegalovirus (cCMV) is the most common congenital infection and the main non-genetic cause of congenital hearing loss. A significant number of newborns (NB) with symptomatic cCMV will develop permanent serious sequelae, being hearing loss the most frequent. However, 90% of the cases are asymptomatic and may develop late auditory sequelae. Early diagnosis of cCMV requires a high index of suspicion. Currently, efficient detection techniques for its detection are available, which facilitates diagnosis within the first 3 weeks of life. Antiviral therapy is the first line of treatment for symptomatic cCMV, achieving good hearing results. Despite advances in detection methods and the benefits of antiviral therapy, NB are not routinely screened for cCMV. Selective screening for cCMV in patients who fail newborn hearing screening facilitates early intervention in identified cases but fails to detect a significant number of children with late onset hearing loss. Universal screening allows hearing follow up in patients at risk of developing sensorineural hearing loss (SNHL) due to cCMV, thus identifying late-onset hearing loss cases, but cost-effectiveness is still controversial. It is necessary to advance in a local strategy for cCMV screening, aiming to reduce its national impact.

Presence of Cryptosporidium spp. in calves from dairy herds in Northern Antioquia, Colombia / [Ocorrência de Cryptosporidium spp. em bezerros de rebanhos leiteiros do norte de Antioquia, Colômbia]

ABSTRACT Cryptosporidium spp. are important enteropathogen protozoan parasites that infect humans and other animals throughout the world. Cryptosporidiosis in cattle industry leads to considerable economic losses due to diarrhea, dehydration, growth retardation, weight loss, and possibly death, however, data on the occurrence ofCryptosporidiumspp. in cattle in Colombia are limited. Therefore, this study aimed to investigate the occurrence and possible factors associated to the excretion of Cryptosporidium spp. oocyst in pre-weaned calves from dairy farms in Northern Antioquia, Colombia. In addition, Sheather's sugar floatation (SSF), and Modified Ziehl-Neelsen staining (MZN) methods were compared. A total of 41 fecal samples were collected from calves between 1 and 92 days of age of which 23 were positive (56.1%). Crossbreed calves were nine times less susceptible than purebred dairy cattle to excretion of Cryptosporidium spp. oocysts (OR=0.10). MZN was the best technique for the detection of oocysts in fecal samples, however, the mean number of days to detect cryptosporidial oocysts was lower for the SSF method. Cryptosporidium is widespread among calves under 2 months of age in dairy herds of Northern Antioquia, although further investigations considering a greater number of farms and animals are necessary.

RESUMO Cryptosporidium spp. são importantes protozoários parasitas enteropatógenos que infectam humanos e outros animais em todo o mundo. A criptosporidiose na pecuária leiteira leva a perdas econômicas consideráveis devido à diarreia, à desidratação, ao retardo de crescimento, à perda de peso e possivelmente à morte, no entanto dados sobre a ocorrência de criptosporidiose em bovinos na Colômbia são limitados. Portanto, este estudo tem como objetivo investigar a ocorrência e possíveis fatores associados à excreção de oocistos de Cryptosporidium spp. em bezerros pré-desmamados de fazendas leiteiras no norte de Antioquia, Colômbia. Além disso, os métodos de flutuação de açúcar de Sheather (SSF) e de coloração de Ziehl-Neelsen modificado (MZN) foram comparados. Foram coletadas 41 amostras fecais de bezerros entre um e 92 dias de idade, das quais 23 foram positivas (56,1%). Bezerros mestiços foram nove vezes menos suscetíveis que bovinos leiteiros puros à excreção de oocistos de Cryptosporidium spp. (OR=0,10). MZN foi a melhor técnica para a detecção de oocistos em amostras fecais, entretanto o número médio de dias para detecção de oocistos foi menor para o método SSF. Cryptosporidium é amplamente difundido entre bezerros com menos de dois meses de idade em rebanhos leiteiros do norte de Antioquia, embora sejam necessárias mais investigações, considerando-se um maior número de fazendas e animais.

Central nervous system activity of a Tabernaemontana arborea alkaloid extract involves serotonergic and opioidergic neurotransmission in murine models.

Tabernaemontana arborea (Apocynaceae) is a Mexican tree species known to contain ibogan type alkaloids. This study aimed at determining central nervous system-related activities of an alkaloid extract obtained from the root bark of T. arborea. A gas chromatography-mass spectrometry (GC-MS) analysis was performed to describe the alkaloid profile of the extract. A wide dosing range (0.1 to 56.2 mg/kg) of this extract was evaluated in different murine models. Electrical brain activity was examined by electroencephalography (EEG). The extract's effects on motor coordination, ambulatory activity, and memory were analyzed based on the rotarod, open field (OFT), and object recognition tests (ORT), respectively. Antidepressant and antinociceptive activities were determined using the forced swimming test (FST) and the formalin assay, respectively. In order to elucidate the underlying mechanisms of action, the 5-HT1A receptor antagonist WAY100635 (1 mg/kg) or the opioid receptor antagonist naloxone (1 mg/kg) was included in the latter experiments. GC-MS analysis (µg/mg extract) confirmed the presence of the monoterpenoid indole alkaloids (MIAs) voacangine (207.00), ibogaine (106.33), vobasine (72.81), coronaridine (30.72), and ibogamine (24.2) as principal constituents of the extract, which exhibited dose- and receptor-dependent antidepressant (0.1 to 1 mg/kg; 5-HT1A) and antinociceptive (30 and 56.2 mg/kg; opioid) effects, without altering motor coordination, ambulatory activity, and memory. EEG indicated CNS depressant activity at high doses (30 and 56.2 mg/kg). The root bark of T. arborea contains a mixture of alkaloids that may hold therapeutic value in pain relief and the treatment of psychiatric diseases without causing neurotoxic activity at effective doses.

Tamizaje auditivo universal neonatal en Hospital Clínico La Florida Dra. Eloísa Díaz Insunza: Experiencia 2015-2021 / Universal newborn hearing screening at Hospital Clínico La Florida Dra. Eloísa Díaz Insunza: Experience 2015-2021

Introducción: La hipoacusia congénita es una patología frecuente entre los recién nacidos con gran impacto en su calidad de vida si no es diagnosticada y tratada precozmente. Para su pesquisa, se recomienda, internacionalmente, el tamizaje auditivo universal neonatal (TAUN), que desde 2014 se aplica en el Hospital Clínico La Florida Dra. Eloísa Díaz Insunza (HLF). Objetivo: Describir la experiencia del programa de TAUN del Servicio de Otorrinolaringología HLF. Material y Método: Estudio descriptivo, retrospectivo. Se incluyó a todos los recién nacidos vivos (RNV) del establecimiento entre 2015 y 2021, evaluados de acuerdo con el protocolo del programa. Resultados: Fueron evaluados 17.804 RNV. Se obtuvo una cobertura de 97,1% y tasa de referencia de 0,98%. Se confirmaron a 21 pacientes con hipoacusia sensorioneural (HSN), obteniéndose una tasa de HSN de 1,5 cada 1.000 RNV. Conclusión: La tasa de incidencia de HSN congénita fue similar a la estimada a nivel mundial. El programa de TAUN HLF cumple con estándares internacionales en cuanto a cobertura, tiempo de evaluación del tamizaje y tasa de referencia. El trabajo multidisciplinario, mejoría de tecnología y registro adecuado de pacientes, son las principales fortalezas. La dificultad de seguimiento durante horario inhábil y presencia de sólo un profesional con dedicación exclusiva, son aspectos a perfeccionar.

Introduction: Congenital hearing loss is a frequent pathology among newborns with great impact on their quality of life if it is not diagnosed and treated early. The Joint Committee on Infant Hearing recommends universal newborn hearing screening (UNHS) and has been applied at the Hospital Clínico La Florida Dra. Eloísa Díaz Insunza (HLF) since 2014. Aim: To describe the experience of UNHS program at the Otolaryngology Service of the HLF. Material and Method: Descriptive, retrospective study, including all newborns of the HLF between 2015 and 2021. They were evaluated according to the protocol proposed in the program. Results: 17804 newborns were evaluated. Coverage of 97,1% and a referral rate of 0,98% were obtained. Twenty-one patients with sensorineural hearing loss (SNHL) were confirmed, obtaining a SNHL rate of 1.5 per 1000 live births. Conclusion: The incidence rate of congenital SNHL is similar to that estimated worldwide. The UNHS program in HLF complies with international standards in terms of coverage, timing and referral rates. Multidisciplinary work, improved technology and adequate patient registration are the main strengths of the program. The difficulty of follow-ups during the weekends and the presence of only one full-time professional are aspects that can be improved.

[Psychometric evaluation of breastfeeding self efficiency scale in chilean sample]. / Evaluación psicométrica de la escala de autoeficacia de la lactancia materna, en una muestra chilena.

Breastfeeding self-efficacy is one of the indicators associated with the mental health of puerperal women and the maintenance of exclusive breastfeeding. OBJECTIVE: To evaluate the psychometric properties of an instrument to measure self-efficacy to breastfeed on the second postpartum day in the Chilean population. SUBJECTS AND METHOD: A convenience sample of 320 puerperal women who volunteered to participate in an interview on their second postpartum day was evaluated. Reliability was evaluated using the coefficient Cronbach's alpha. To assess its factorial structure, an exploratory factor analysis was performed. RESULTS: The results indicate that the final instrument, which has the factors "Intrapersonal Thoughts", composed of six items and "Breastfeeding Techniques", composed of eight items, presented an internal consistency by factor and total scale of F1 = 0.90, F2 = 0.91, and Total = 0.94, respectively. CONCLUSION: The breastfeeding self-efficacy scale showed good psychome tric characteristics during the second postpartum day among Chilean puerperal women.

Evaluación del proceso de atención urológica de pacientes pediátricos con mielomeningocele / Evaluation of the urological care process of pediatric patients with myelomeningocele

Introducción: El mielomeningocele (MMC) es una de las malformaciones congénitas más severas compatible con la vida. El 90% de los pacientes presenta vejiga neurogénica que debe ser evaluada y tratada precozmente. Objetivos: Describir la evaluación y tratamiento nefrourológico recibido por pacientes con MMC hasta el momento de la primera consulta en el Hospital Garrahan (periodo pre-ingreso). Describir la evaluación realizada y el tratamiento urológico implementado a partir del ingreso al hospital Garrahan (periodo post-ingreso). Evaluar la prevalencia de Enfermedad Renal Crónica (ERC). Población y Métodos: Se realizó un estudio con diseño clínico analítico, retrospectivo, longitudinal sobre pacientes con MMC de 1 mes a 18 años derivados al Hospital Garrahan para atención ambulatoria en los años 2011 y 2012. Resultados: Se incluyeron115 pacientes. Al momento de la derivación al hospital ("pre-ingreso") 7% de los pacientes habían logrado completar evaluación nefrourológica, (ecografía vesicorenal, urodinamia, Cistouretrografía, Centellograma renal y Creatininemia). Tratamiento: 33% vaciaban vejiga por CIL o vesicostomía y 21% recibían Oxibutinina. A partir del ingreso al seguimiento en el Garrahan 83% lograron completar la evaluación, y en función del resultado de la misma se indicó CIL en 87% y Oxibutinina en el 66% de los pacientes. La prevalencia de ERC al ingreso fue de 43%; la mayoría en estadio I. Conclusiones: La mayoría de los pacientes con MMC fueron derivados al hospital de tercer nivel con evaluaciones urológicas incompletas y sin el tratamiento adecuado de la vejiga neurogénica. El inicio del seguimiento interdisciplinario en un hospital de alta complejidad facilitó la realización de las evaluaciones necesarias y la implementación del tratamiento adecuado (AU)

Introduction: Myelomeningocele (MMC) is one of the most severe congenital malformations compatible with life. Of all the patients, 90% presents with a neurogenic bladder requiring early evaluation and treatment. Objectives: To describe the uronephrological evaluation and treatment received by patients with MMC up to the first consultation at Garrahan Hospital (pre-follow-up period). To describe the urological evaluation and treatment implemented from referral to Garrahan Hospital (follow-up period). To evaluate the prevalence of chronic kidney disease (CKD). Population and Methods: A retrospective, longitudinal study with a clinical, analytical design was conducted in patients with MMC between 1 months and 18 years of age referred to Garrahan Hospital for outpatient care in 2011 and 2012. Results: 115 patients were included. At the time of referral to the hospital ("pre-follow-up") 7% of the patients had undergone complete uronephrological evaluation (kidney-bladder ultrasonography, urodynamic studies, cystourethrography, renal scintigraphy, and creatininemia levels). Treatment: 33% emptied their bladder by CIC or vesicostomy and 21% received oxybutynin. From follow-up initiation at Garrahan Hospital, 83% underwent complete evaluation, and based on the results CIC was indicated in 87% and oxybutynin in 66% of the patients. On admission, prevalence of CKD was 43%; with stage I in the majority of the patients. Conclusions: The majority of the patients with MMC were referred to a third-level hospital with incomplete urological studies and without adequate treatment of the neurogenic bladder. Initiation of interdisciplinary follow-up at a tertiary hospital allowed for the necessary studies and implementation of adequate treatment (AU)

Medical education from the point of view of medical students: Results from four participatory Delphi panels in Quito, Ecuador.

BACKGROUND: Medical curricula have historically been designed in a top-down approach, usually excluding students. While Delphi panels have been used as a tool for medical education curricula design, none have been conducted in Ecuador. In addition, no such approach has ever included students both as panelists and researchers. MATERIAL AND METHODS: Four Delphi panels were developed and conducted using a participatory approach that allowed medical students to take part both as expert panelists and researchers: specifically, students developed the questionnaire and conducted a qualitative synthesis. Questionnaire responses were anonymized and dispatched online to panelists. The information was organized and collected to develop the qualitative syntheses and prepare the final statements. RESULTS: Thirty-two medical students participated between February and May 2018. A total of 32 questions were developed, corresponding to five different categories. For some questions, consensus was reached; for other questions, general statements were obtained.Discussion and conclusion: Developing the questionnaire, responding to it and analyzing the answers allowed students to raise significant concerns regarding medical education topics proposing relevant policy and curricula change. Participatory Delphi panels can be an efficient tool to obtain organized feedback, improve student class involvement, and promote research skills.

Tratamiento multidisciplinar del leimiosarcoma de vena cava inferior / Multidisciplinary treatment of leiomyosarcoma of inferior cava

Resumen Introducción Los leiomiosarcomas de la vena cava inferior son tumores raros, sólo hay 300 casos descritos en la literatura. Su incidencia es mayor en mujeres, suelen aparecer entre los 50-60 años, y presentan una progresión lenta y mal pronóstico. Los síntomas son inespecíficos haciendo que el diagnóstico se realice de forma tardía, éste se realiza mediante pruebas de imagen y biopsia guiada. Caso clínico Se presenta el caso de un varón de 73 años con diagnóstico de leiomiosarcoma de la vena cava inferior, como hallazgo incidental en TC de control, tratado mediante radioterapia neoadyuvante, cirugía y radioterapia intraoperatoria. Discusión El único tratamiento que ha descrito modificaciones en la supervivencia es la cirugía. El papel de la adyuvancia y neoadyuvancia en estos tumores es muy controvertido. La elección de la actitud terapéutica dependerá de la localización del tumor, tamaño, la relación con estructuras adyacentes y la presencia de circulación colateral.

Introduction Leiomyosarcomas of the inferior vena cava are rare tumors, with fewer than 300 cases reported. Its incidence is higher in females, usually appear in the sixth decade and they have a slow-growing and poor prognosis. Symptoms are generally non-specific. Diagnosis is made with imaging studies and guided biopsy. Clinical Case We report a case of a 73-year-old male patient with leimyosarcoma of the inferior vena cava treated by neoadjuvant radiotherapy, surgery and intraoperative radiotherapy. Discussion Surgery is the only treatment that can improve the survival. The role of the adjuvancy and neoadjuvancy is very controversial. Surgical management is determined by the location of the tumour, the relationship with adjacent structures and the presence of collateral veins.

Envejecimiento y salud mental en contextos migratorios / Ageing and mental health in the context of migration / Envelhecimento e saúde mental em contextos migratórios

Introducción: La investigación en vejez y envejecimiento se ha vuelto prioritaria ante los procesos de transformación demográfica a nivel mundial, con la inversión de la pirámide y las consecuencias que ello conlleva, en contextos sociales cada vez más complejos; uno de estos escenarios es el contexto migratorio, el cual plantea retos y desafíos en su vida cotidiana que permiten la construcción de ciertas estrategias de vida, durante el proceso de envejecimiento. El objetivo Se enmarca en presentar una revisión narrativa sobre el estado de discusión actual acerca del envejecimiento y la salud mental en contextos migratorios, desde lo generado por distintas disciplinas que contribuyen al desarrollo del conocimiento de la disciplina enfermera. Desarrollo: La lógica de presentación de esta revisión, parte de la diferenciación entre vejez y envejecimiento, los enfoques a partir de los cuales se ha analizado éste último y cómo se entrelaza el envejecimiento con dinámicas sociales como la migración, para finalmente presentar la discusión acerca de los abordajes de la salud mental, muy relevante en este tipo de situaciones. Conclusión: Esta revisión buscó despertar el interés de la disciplina enfermera por la comprensión de la forma de vida de las personas mayores en diferentes situaciones contextuales, como la migración, que permitan generar un acercamiento a la generación de estrategias de cuidado cultural y socialmente competentes.

Introduction: Considering the current inverted population pyramid and its related consequences, researching on aging and the old age has become a priority in the analysis of the demographic transformation processes worldwide, particularly in the evermore complex social contexts we live in. One on these scenarios is the migration context, which bears additional challenges to the pursuit of life strategies to coping with the aging process. Objective: This is a narrative review on the current state of discussion about aging and mental health and framed within the migration context while considering the diverse disciplines which contribute to the knowledge of nursing. Development The focusses on the differentiation and analysis between the old age and the aging process and how these are intertwined with social dynamics such as migration, are first addressed to finally present a discussion on the approaches to the related mental health issues. Conclusion: This review contributes to the understanding on the coping life strategies of old people in different contexts, such as migration, so that the corresponding culturally and socially competent care plans can be developed.

Introdução: A pesquisa em idosos e idosos tem se tornado uma prioridade nos processos de transformação demográfica mundial, com a inversão da pirâmide e as conseqüências que isso acarreta, em contextos sociais cada vez mais complexos; Um desses cenários é o contexto migratório, que coloca desafios e desafios em seu cotidiano que permitem a construção de determinadas estratégias de vida durante o processo de envelhecimento. O objetivo: Enquadra-se em apresentar uma revisão narrativa sobre o estado da discussão atual sobre envelhecimento e saúde mental em contextos migratórios, a partir do gerado por diferentes disciplinas que contribuem para o desenvolvimento do conhecimento da disciplina de enfermagem. Desenvolvimento A lógica de apresentação desta revisão, parte da diferenciação entre velhice e envelhecimento, as abordagens a partir das quais esta última tem sido analisada e como o envelhecimento está ligado a dinâmicas sociais como a migração, para finalmente apresentar a discussão sobre de abordagens de saúde mental, muito relevante neste tipo de situação. Conclusão: Esta revisão buscou despertar o interesse da disciplina de enfermagem para a compreensão do modo de vida dos idosos em diferentes situações contextuais, como a migração, que permitem gerar uma abordagem para a geração de estratégias de cuidado cultural e socialmente competentes.

Evaluation of the impact of live pig trade network, vaccination coverage and socio-economic factors in the classical swine fever eradication program in Peru.

Classical swine fever (CSF) is a viral infectious disease of swine with significant economic impact in the affected countries due to the limitation of trade, culling of infected animals and production losses. In Latin America, CSF is endemic in several countries including Ecuador, Bolivia, Brazil and Peru. Since 2010, the National Veterinary Services of Peru have been working to better control and eradicate the disease with an intensive vaccination program. The aim of this study was to evaluate the effectiveness of the vaccination program and determine which factors are still contributing to the persistence of the disease in certain regions of Peru. We integrated the data from the vaccination campaign, the live pig movement network and other socioeconomic indicators into a multilevel logistic regression model to evaluate their association with CSF occurrence at district level. The results revealed that high vaccination coverage significantly reduces the risk of CSF occurrence (OR = 0.07), supporting the effectiveness of the vaccination program. Districts belonging to large and medium pig trade network communities (as identified with walktrap algorithm) had higher probability to CSF occurrence (OR = 2.83 and OR = 5.83, respectively). The human development index (HDI) and the presence of a slaughterhouse in the district was also significantly associated with an increased likelihood of CSF occurrence (OR = 1.52 and OR = 3.25, respectively). Districts receiving a high proportion of the movements from districts that were infected in the previous year were also at higher risk of CSF occurrence (OR = 3.30). These results should be useful to guide the prioritization of vaccination strategies and may help to design other intervention strategies (e.g., target education, movement restrictions, etc.) in high-risk areas to more rapidly advance in the eradication of CSF in Peru.

Behaviour of Quercus pollen in the air, determination of its sources and transport through the atmosphere of Mexico City and conurbated areas.

Pollen allergies have a remarkable clinical impact all over world. Quercus pollen is the main allergen in many parts of world. Due to the health impacts caused by exposure to oak pollen, the objectives of this study are to characterise the aerobiological behaviour of Quercus pollen and to determine its potential sources as well as their transport through the atmosphere of Mexico City and surrounding areas between January 2012 and June 2015. Airborne Quercus pollen monitoring was carried out simultaneously in five zones of Mexico City. The percentage of Quercus pollen of the total pollen collected from the air showed that the highest concentration was recorded in 2014, followed by 2012. The annual seasonal variation indicated that flowering and pollen emission into the atmosphere began between February and March. The maximum concentration of Quercus pollen was reached at Cuajimalpa. In 2012, the amount of pollen grains was distributed in March and April uniformly, whilst in 2014, the largest amount of pollen was concentrated in March. In 2012 and 2014 (years with the highest pollen concentrations), corresponding intraday variations were quite similar, with a low relative maximum in the morning and the highest concentrations in the evening. The largest values were recorded in 2014, and two processes can explain these. In the afternoon, pollen from secondary forest is carried by southwesterly converging winds, increasing the pollen concentration in Cuajimalpa. In the evening, there is an additional pollen contribution from primary forest via transport by NW winds.

Estudio observacional para analizar las pautas de tratamiento de la disnea irruptiva en pacientes con cáncer en la práctica clínica / Observational study to analyze patterns of treatment of breakthrough dyspnea in cancer patients in clinical practice

INTRODUCCIÓN: Siendo la disnea irruptiva un síntoma muy frecuente en los pacientes oncológicos, no existen recomendaciones precisas para su tratamiento. El objetivo principal del estudio fue analizar qué tratamientos se utilizan en la práctica clínica diaria para el manejo de la disnea irruptiva en pacientes con cáncer en España. Los objetivos secundarios fueron describir las características de los pacientes oncológicos con disnea irruptiva y los atributos de esta alteración. MÉTODOS: Pacientes oncológicos mayores de 18 años, con disnea irruptiva y estado funcional Karnofsky mayor o igual a 30, atendidos en servicios de oncología. Se recogió el historial de tratamientos para la disnea irruptiva y las características de esta patología, variables antropométricas, índice de disnea de Mahler, escala de Borg, escala Edmonton Symptoms Assessment Scale, satisfacción del paciente con el tratamiento actual de la disnea irruptiva. RESULTADOS: La edad media de los 149 pacientes incluidos fue de 66 años (intervalo de confianza 95%: 64,3 a 67,9), siendo mujeres el 35,6% (53). La intensidad media de la disnea irruptiva fue de 5,85 (intervalo de confianza 95%: 5,48 a 6,22 Borg). El 55,1% de los tratamientos de primera opción fueron los opioides, seguidos del oxígeno (17,3%). El 79,9% de los pacientes (119) fueron tratados en monoterapia. En los casos que presentaban disnea basal se administró oxígeno en mayor proporción 21,1% versus 7,4% (p = 0,07). Si la disnea era predecible se administró en mayor proporción opioides, 70,9% versus 44,4% (p = 0,01). CONCLUSIONES: Los opioides constituyen el tratamiento de primera línea de la disnea irruptiva en la práctica clínica habitual; sin embargo, el grado de evidencia científica que justifique su uso es escasa. Se necesita más información procedente de ensayos clínicos controlados en los que se evalúe la eficacia comparativa de diferentes tratamientos.

INTRODUCTION: Although breakthrough dyspnea is very frequent in cancer patients, there are no precise recommendations for treating it. The main objective of this study was to analyze what treatments are used in clinical practice for the management of breakthrough dyspnea in cancer patients in Spain and the secondary objectives were to describe the characteristics of cancer patients with breakthrough dyspnea and the attributes of the disorder. METHODS: Cancer patients over 18 years of age, with breakthrough dyspnea and a Karnofsky performance score of ≥30, who were treated at departments of oncology in institutes across Spain were included in this cross-sectional observational study. The characteristics of breakthrough dyspnea, history of treatment, anthropometric variables, Mahler dyspnea index, Borg scale, Edmonton Symptoms Assessment Scale, and patient satisfaction with current breakthrough dyspnea treatment were assessed. RESULTS: The mean age of the 149 included patients was 66 years (95% confidence interval: 64.3 to 67.9), and 53 were females (35.6%). The mean breakthrough dyspnea intensity was 5.85 (95% confidence interval 5.48 to 6.22, Borg scale). A total of 55.1% of the first-choice treatments consisted of opioids, followed by oxygen (17.3%). A total of 119 patients (79.9%) received monotherapy for breakthrough dyspnea. Patients presenting with basal dyspnea received oxygen in a greater proportion of cases (21.1% vs 7.4%; p = 0.07). Patients with predictable dyspnea received a greater proportion of opioids (70.9% vs 44.4%; p = 0.01). CONCLUSIONS: Opioids constitute first-line therapy for breakthrough dyspnea in routine clinical practice, though the scientific evidence supporting their use is scarce. Further information derived from controlled clinical trials is needed regarding the comparative efficacy of the different treatments in order to justify their use.

Brassica aphid (Hemiptera: Aphididae) populations are conditioned by climatic variables and parasitism level: a study case of Triângulo Mineiro, Brazil.

Cosmopolitan pests such as Brevicoryne brassicae, Lipaphis pseudobrassicae, and Myzus persicae (Aphididae) cause significant damage to Brassicaceae crops. Assessment of the important biotic and abiotic factors that regulate these pests is an essential step in the development of effective Integrated Pest Management programs for these aphids. This study evaluated the influence of leaf position, precipitation, temperature, and parasitism on populations of L. pseudobrassicae, M. persicae, and B. brassicae in collard greens fields in the Triângulo Mineiro region (Minas Gerais state), Brazil. Similar numbers of B. brassicae were found on all parts of the collard green plants, whereas M. persicae and L. pseudobrassicae were found in greatest numbers on the middle and lower parts of the plant. While temperature and precipitation were positively related to aphid population size, their effects were not accumulative, as indicated by a negative interaction term. Although Diaeretiella rapae was the main parasitoid of these aphids, hyperparasitism was dominant; the main hyperparasitoid species recovered from plant samples was Alloxysta fuscicornis. Parasitoids seem to have similar distributions on plants as their hosts. These results may help predict aphid outbreaks and gives clues for specific intra-plant locations when searching for and monitoring aphid populations.

Artepillin C and phenolic compounds responsible for antimicrobial and antioxidant activity of green propolis and Baccharis dracunculifolia DC.

AIMS: This study investigates the antimicrobial activity in Staphylococcus aureus isolates (methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA)) and antioxidant activity of green propolis, Baccharis dracunculifolia DC extracts and Artepillin C™. METHODS AND RESULTS: The amount of Artepillin C in different extracts was determined by high performance liquid chromatography analysis. Minimum inhibitory concentration 90 (MIC90) was determined using 40 isolates of S. aureus inoculated in Müeller-Hinton agar culture medium containing the green propolis and B. dracunculifolia DC extracts. PVEE (green propolis ethanolic extract) and BDEH (B. dracunculifolia hexanic extract) showed the greatest antimicrobial activity with MIC90 values of 246·3 and 295·5 µg ml-1 respectively. Green propolis ethanolic and hexanic extracts (PVEE and PVEH respectively) showed the greatest antioxidant activity assessed by DPPH (1,1-diphenyl-2-picryl hydrazyl radical) with IC50 values of 13·09 and 95·86 µg ml-1 respectively. CONCLUSIONS: Green propolis ethanolic displays better antimicrobial and antioxidant activities compared to other extracts. These activities may be related to the presence of Artepillin C in synergism with the other constituents of the extracts. SIGNIFICANCE AND IMPACT OF THE STUDY: In this study, the antimicrobial activity of the extracts of green propolis and B. dracunculifolia DC demonstrated in MRSA and MSSA clinical isolates indicated that they can be important tools to treat infections caused by these bacteria.

Mycobacterium tuberculosis multi-drug-resistant strain M induces IL-17+ IFNγ- CD4+ T cell expansion through an IL-23 and TGF-ß-dependent mechanism in patients with MDR-TB tuberculosis.

We have reported previously that T cells from patients with multi-drug-resistant tuberculosis (MDR-TB) express high levels of interleukin (IL)-17 in response to the MDR strain M (Haarlem family) of Mycobacterium tuberculosis (M. tuberculosis). Herein, we explore the pathways involved in the induction of Th17 cells in MDR-TB patients and healthy tuberculin reactors [purified protein derivative healthy donors (PPD+ HD)] by the M strain and the laboratory strain H37Rv. Our results show that IL-1ß and IL-6 are crucial for the H37Rv and M-induced expansion of IL-17+ interferon (IFN)-γ- and IL-17+ IFN-γ+ in CD4+ T cells from MDR-TB and PPD+ HD. IL-23 plays an ambiguous role in T helper type 1 (Th1) and Th17 profiles: alone, IL-23 is responsible for M. tuberculosis-induced IL-17 and IFN-γ expression in CD4+ T cells from PPD+ HD whereas, together with transforming growth factor (TGF-ß), it promotes IL-17+ IFN-γ- expansion in MDR-TB. In fact, spontaneous and M. tuberculosis-induced TGF-ß secretion is increased in cells from MDR-TB, the M strain being the highest inducer. Interestingly, Toll-like receptor (TLR)-2 signalling mediates the expansion of IL-17+ IFN-γ- cells and the enhancement of latency-associated protein (LAP) expression in CD14+ and CD4+ T cells from MDR-TB, which suggests that the M strain promotes IL-17+ IFN-γ- T cells through a strong TLR-2-dependent TGF-ß production by antigen-presenting cells and CD4+ T cells. Finally, CD4+ T cells from MDR-TB patients infected with MDR Haarlem strains show higher IL-17+ IFN-γ- and lower IL-17+ IFN-γ+ levels than LAM-infected patients. The present findings deepen our understanding of the role of IL-17 in MDR-TB and highlight the influence of the genetic background of the infecting M. tuberculosis strain on the ex-vivo Th17 response.

Spatial Epidemiology and Risk Factor Analysis of White Spot Disease in the Shrimp Farming Industry of Sinaloa, Mexico, from 2005 to 2011.

White spot disease (WSD), caused by the white spot syndrome virus, is currently one of the primary causes of mortality and economic losses in the shrimp farming industry worldwide. In Mexico, shrimp production is one of the most important primary activities generating an annual income of USD 711 million. However, WSD introduction in 1999 had a devastating impact for the Mexican shrimp industry. The aim of this study was to characterize the WSD spatio-temporal patterns and to identify the primary risk factors contributing to WSD occurrence from 2005 to 2011 in Sinaloa, Mexico. We used data collected by the 'Comité Estatal de Sanidad Acuícola de Sinaloa' from 2005 to 2011 regarding WSD outbreaks as well as environmental, production and husbandry factors at farm level. The spatio-temporal patterns of WSD were described using space-time scan statistics. The effect of 52 variables on the time to WSD outbreak occurrence was assessed using a multivariable Cox proportional hazards model. Results reveal that WSD risk and survival time were not homogeneously distributed as suggested by the significant clusters obtained using the space-time permutation model and the space-time exponential model, respectively. The Cox model revealed that the first production cycle [hazard ratio (HR) = 11.31], changes from 1 to 1.4°C of temperature oscillation caused by 'El Niño'/'La Niña' events (HR = 1.44) and high average daily growths (HR = 1.26) were significantly associated with lower survival (i.e. shorter time to WSD outbreak) on farm. Conversely, shrimp weight at the moment of the outbreak (HR = 0.159), changes from -0.9 to -0.5°C of temperature oscillation caused by 'El Niño'/'La Niña' events (HR = 0.540), high superficial water temperature during the pound stocking (HR = 0.823) and high (>100) number of days of culture (HR = 0.830) were factors associated with higher survival. Results are expected to inform the design of risk-based, intervention strategies to minimize the impact of WSD in Mexico.

Combined approach to the identification of clinically infrequent non-tuberculous mycobacteria in Argentina.

SETTING: Over 150 potentially pathogenic non-tuberculous mycobacteria (NTM) species have been described, posing an onerous challenge for clinical laboratory diagnosis. OBJECTIVE: To evaluate different approaches for the identification of 40 clinically relevant NTM isolates whose species were not reliably identified using our routine diagnostic workflow comprising phenotypic tests and hsp65 polymerase chain reaction restriction analysis. DESIGN: We used 1) sequencing analysis of four conserved gene targets: 16S rRNA, rpoB, hsp65 and sodA; 2) two commercial reverse hybridisation assays; and 3) protein analysis using matrix-assisted laser desorption/ionisation time of flight mass spectrometry (MALDI-TOF MS). RESULTS: Combined, but not individual, sequence analysis allowed reliable species identification for 30/40 (75%) isolates, including species previously unknown to be circulating in Argentina. Commercial kits outperformed our routine identification in only 5/35 isolates, and misclassified many more. MALDI-TOF MS accurately identified species in 22/36 (61%) isolates and did not misidentify any. CONCLUSIONS: Commercial kits did not resolve the problem of species of NTM isolates that elude identification. Combined DNA sequence analysis was the approach of choice. MALDI-TOF MS shows promise as a powerful, rapid and accessible tool for the rapid identification of clinically relevant NTM in the diagnostic laboratory, and its accuracy can be maximised by building up a customised NTM spectrum database.

Calidad del sueño y consumo de inhibidores del sueño en estudiantes de medicina / Sleep quality and sleep inhibitors consumption in medical students

Introducción: Los desórdenes del sueño son un problema creciente en las sociedades occi-dentales afectando el rendimiento diurno, tanto en el ámbito académico como laboral. Ade-más en los últimos años, el consumo de inhibidores del sueño por estudiantes universita-rios ha ido en aumento. El objetivo de este estudio es conocer la calidad del sueño en los estudiantes de medicina de Universidad San Sebastián, junto con determinar la prevalencia de trastornos del sueño y consumo de psicoestimulantes en esta población. Material y Métodos: Estudio de corte transversal en 65 estudiantes de medicina de tercer año durante el año 2012. Se midió el índice de calidad del sueño de Pittsburgh, junto con las horas de sueño y la frecuencia consumo de sustancias psicoactivas en el último mes. Resultados: Un 83% de los sujetos fueron definidos como malos dormidores, con disfunción leve del sueño. Un 53,8% de los estudiantes duermen menos de 6 horas diarias en promedio. Se consignó que un 41,5% consumió fármacos psicoestimulantes y/o bebidas energéticas en el último mes y su prevalencia de consumo fue mayor en malos dormidores. Un 64,6% consumió al menos una taza de café diaria, este consumo prevalece más en los malos dormidores que en los buenos dormidores. Un 27,7% de los sujetos refirió consumir al menos un cigarrillo al día. Discusión: Se observó una alta prevalencia de mala calidad del sueño y también en el consumo de psicoestimulantes que podrían afectar el buen dormir, teniendo consecuencias para el desempeño diario y la salud de estos estudiantes.

Introduction: Sleep disorders are an increasing health problem in occidental societies, affecting daytime functioning both the academic area such as labor. The consumption of Sleep inhibitors by university students has increased. The objective is to know about sleep quality in medical students of San Sebastian's University and determine the prevalence of sleep disorders and psychostimulant use in this population. Material and method: Cross-sectional study. Study group: 65 third year medical students 2012 of San Sebastian's University. It was measured Pittsburgh ́s Sleep Quality Index, sleeping hours, psychoactive substances consumption in the last month. Results: 83% of the subjects were defined as poor sleepers, with mild sleep dysfunction. 53.8% of the students sleep less than 6 hours per day on average. 41.5% consumed psychostimulants and/or energy drinks and the consumption prevalence was higher in poor sleepers. 64.6% consumed at least one cup of coffee a day, consumption is more prevalent in poor sleepers than in good sleepers. 27.7% of subjects reported consuming at least one cigarette a day. Discussion: A very high prevalence of poor sleep quality and consumption of psychoestimulants was observed, this could affect the sleep quality, having consequences for daily performance and health of these students.

Differential effect of the 17ß-aminoestrogens prolame, butolame and pentolame in anxiety and depression models in rats.

Estrogens of clinical use produce consistent antidepressant- and anxiolytic-like effects in animal models of menopause. Regulation of the hypothalamic-pituitary-adrenal (HPA) or stress axis, has been proposed as a pathway through which estrogens improve affective-like behaviors. Anticoagulant 17ß-aminoestrogens (17ß-AEs) butolame and pentolame mimic some effects of estradiol (E2), i.e., on female rodent sexual behavior, with opposite actions on coagulation. However, their psychoactive actions have not been explored. On the basis of similitude with E2's effects, we hypothesized that these 17ß-AEs would induce anxiolytic- and antidepressant-like effects, which would be reflected in a reduction of activity in the HPA axis. In ovariectomized female rats, chronic treatment with prolame (60 µg/kg), butolame (65 µg/kg) and pentolame (70 µg/kg) reduced anxiety-like behavior in the elevated plus maze (evidenced by an increase in time in open arms, E2 (40 µg/kg) +176%; prolame +201%; butolame, +237%; and pentolame +295%, in comparison to the control vehicle group 100%). Pentolame also decreased significantly anxiety-like behavior in the burying behavior test. Prolame and E2 produced a significantly antidepressant-like action, which was not induced by butolame and pentolame. Behavioral effects of 17ß-AEs (and E2) on anxiety and depression did not follow the same pattern than corticosterone or E2 levels; they also were associated to changes in locomotor activity, evaluated by the open field test. These results constitute the first evidence of specific and selective actions of butolame and pentolame as anxiolytics for females with a hypoestrogenic condition. Results also confirm the potential of prolame as an antidepressant steroid with equivalent actions to E2. Psychoactive properties of 17ß-AEs in combinations with reduced adverse effects on coagulation, suggest that 17ß-AEs may be a good alternative replacement therapy for women with symptoms associated with menopause.

Correlación genotipo-fenotipo cardiovascular de la dopamina B- hidroxilasa (DBH) / Cardiovascular correlation genotype-phenotype of dopamine B-hydroxylase (DBH)

Introducción. Al convertir dopamina en norepinefrina la dopamina β-hidroxilasa (DβH) regula el tono dopaminérgico y adrenérgico. Los alelos rs1989787, rs1611115 y rs1108580 del gen DβH se asocian con actividad deficiente de la enzima y por eso evaluamos sus influencias sobre variables cardiovasculares clínicas, bioquímicas y farmacológicas. Métodos: A 44 voluntarios sanos con los haplotipos triple homocigoto nativo (CC/CC/AA), triple heterocigoto (CT/CT/AG), doble homocigoto mutado (TT/CC/GG) y homocigoto mutado para el rs1611115 (CC/TT/AA) les medimos presión arterial sistólica (PAS), presión arterial diastólica (PAD) y frecuencia cardíaca (FC) en posición decúbito, sentado, de pie, bajo estímulo de frío, con la maniobra de Valsalva y post ingestión de clonidina; adicionalmente medimos actividad enzimática por espectrofotometría y concentraciones séricas de dopamina y norepinefrina por ELISA. Resultados: Edad promedio 21,6±3,5 años, 54,5 porciento mujeres. No hubo diferencias de PAS, PAD y FC obtenidas bajo diferentes condiciones; sólo encontramos cambios significativos en los descensos de la PAS y la PAD postingestión de clonidina. No hubo relación de las variables clínicas, bioquímicas y farmacológicas mencionadas con los alelos rs1989787 y rs1108580, pero los portadores del alelo mutado T del rs1611115 sí tenían frecuencias cardíacas estadísticamente inferiores a los portadores del alelo nativo C. La actividad enzimática y las concentraciones de dopamina y norepinefrina no se correlacionaron con las variables cardiovasculares, pero se encontró correlación directa entre la actividad de la enzima y las concentraciones de norepinefrina. Conclusión: El polimorfismo -970C>T del gen DβH es el único asociado con menores frecuencias cardíacas en portadores del alelo mutado T.

Introduction. To the converting dopamine in norepinephrine the enzymedopamine β-hydroxylase (DβH) regulates dopaminergic and adrenergictone. The alleles rs1989787, rs1611115 and rs1108580 of the gene DβH areassociated with deficient activity of the enzyme and thus the influence ofthese SNPs in clinical, biochemical and pharmacological variables relatedwith the cardiovascular system was evaluated. Methods: 44 healthy volunteerswith homozygous triple native (CC/CC/AA), triple heterozygous (CT/CT/AG), double mutated homozygous (TT/CC/GG) and mutated homozygoushaplotypes for the rs1611115 (CC/TT/AA) were subjected to measurementsof systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate(HR) in the positions prone, sitting, standing, under cold stimulus, with theValsalva maneuver and after clonidine ingestion; additionally the enzymaticactivity of the DβH and the concentrations of dopamine and norepinephrinewere determined by spectrophotometry and ELISA, respectivelly. Results: Theaverage age of the group was 21.6±3.5 years, and 54.5% were women. Therewere no differences in SBP, DBP and HR obtained under different conditions;we only found significant changes in SBP and DBP decrease after clonidineingestion. There were no associations between clinical, biochemical andpharmacological variables with the rs1989787 and rs1108580 alleles, however,carriers of the mutant allele T of the rs1611115 had heart rates statisticallylower than the native C allele carriers. Neither enzymatic activity nor dopamineand norepinephrine levels were correlated with cardiovascular variables, but adirect correlation between enzyme activity and norepinephrine concentrationswas found. Conclusion: The-970C>T polymorphism of DβH gene is the onlyone associated with lower heart rates in carriers of the mutated allele T.