Experiencia en el uso de fibrina rica en plaquetas en pacientes con pie diabético / Experience in the use of platelet-rich fibrin in patients with diabetic foot

Resumen Objetivos: Describir las características clínicas y de laboratorio de los pacientes diabéticos tipo 2 (DM2) en tratamiento con fibrina rica en plaquetas (FRP) en el Hospital Clínico Herminda Martín entre los años 2014 y 2016. Materiales y Método: Se revisaron las fichas clínicas de todos los pacientes tratados con FRP en el policlínico de biomateriales en busca de los valores de HbA1c y glicemia, además de otras variables clínicas y de laboratorio que pudieren estar relacionadas con la evolución de las heridas de pie diabético. Se estableció tres grupos de comparación según el tiempo de cicatrización en cicatrización rápida (tiempo percentil 75). Resultados: De un universo de 147 pacientes con DM2 se reportan resultados de 85 (58%). El promedio de edad fue de 61 años, con una glicemia promedio de 243 g/dL y HbA1c de 9,4%. Presentaron un contaje plaquetario dentro de los parámetros normales (promedio 279 plaquetas/mm3). Se encontraron diferencias estadísticas en la escala de valoración de heridas, específicamente en la valoración del puntaje total, así como los parámetros como extensión, profundidad, y dolor entre los grupos de cicatrización rápida y lenta. No se evidenciaron diferencias en el nivel de HbA1c o glicemia en los grupos de cicatrización rápida o lenta, como tampoco en otras variables como edad, creatinina, recuento de plaquetas. Conclusión: No se encontró una asociación entre la velocidad de cicatrización y el nivel de HbA1c en individuos tratados con FRP.

Aims: To describe the clinical and laboratory characteristics of type 2 diabetic patients (DM2) treated with Platelet Rich Fibrin (FRP) at Hospital Clínico Herminda Martín between 2014 and 2016. Materials and Method: Analytical study that includes information from a secondary database. The clinical records of all patients treated with FRP at the Biomaterials Polyclinic were reviewed to search the HbA1c and glycemia values, as well as other clinical and laboratory variables that could be related to the evolution of diabetic foot wounds. Three comparison groups were established according to the healing time in rapid (time 75th percentile). Results: From a universe of 147 patients with DM2, results of 85 (58%) are reported. The average age in the included patients was 61 years. They had an average glycaemia of 243 g/dL, and HbA1c of 9.4%. They presented a platelet count within normal range (average 279 platelets/mm3). Statistical differences between the fast and slow healing groups were found in the wound assessment scale, specifically in the assessment of the total score, extension, depth, and pain. There were no differences in the HbA1c or glycemia level in the fast or slow healing groups, nor in other variables such as age, creatinine, and platelet count. Conclusion: No association was found between healing speed and HbA1c level in individuals treated with FRP.

Osteoartritis (artrosis) de la articulación temporomandibular

Resumen La osteoartritis de la articulación temporomandibular (ATM) es un desorden degenerativo de etiología multifactorial, que requiere un manejo interdisciplinario. Se presenta entre el 8% al 16% de la población y está asociada al exceso de carga articular, trauma, factores genéticos, parafunciones y desarreglos internos de la articulación, también se reconoce una alta frecuencia de otalgia refleja y tinnitus en pacientes con desorden degenerativo de la ATM. El uso combinado de tomografía computarizada y resonancia magnética permite observar las variaciones morfológicas en los tejidos duros y blandos de la estructura articular. El tratamiento no invasivo incluye la indicación de férulas de reposicionamiento mandibular, además del uso de antiinflamatorios y preferencia por inhibidores selectivos de la ciclooxigenasa-2 (COX-2). La inyección intraarticular de corticoides disminuye a largo plazo la inflamación de los tejidos articulares y mejora la movilidad, mientras que el ácido hialurónico parece disminuir la fricción en los espacios articulares. Los procedimientos quirúrgicos como artroscopia, condilectomía, artroplastia, reemplazo autógeno de disco o reemplazo total de la articulación deben ser reservados para los casos en donde la intervención no invasiva no muestra mejoría clínica.

Abstract Osteoarthritis of the temporomandibular joint (TMJ) is a degenerative disorder of multifactorial etiology, which requires interdisciplinary management. It occurs between 8% to 16% of the population and is associated with excess joint load, trauma, genetic factors, parafunctions and internal disorders of the joint, a high frequency of reflex otalgia and tinnitus is also recognized in patients with degenerative TMJ disorder. The combined use of computed tomography and magnetic resonance allows to observe the morphological variations in the hard and soft tissues of the joint structure. Non-invasive treatment includes the indication of mandibular repositioning splints, in addition to the use of anti-inflammatory drugs and preference for selective cyclooxygenase-2 inhibitors (COX-2). Intra-articular injection of corticosteroids reduces inflammation of the articular tissues and improves mobility in the long term, while hyaluronic acid seems to decrease friction in the articular spaces. Surgical procedures such as arthroscopy, condylectomy, arthroplasty, autogenous disc replacement, or total joint replacement should be reserved for cases where non-invasive intervention shows no clinical improvement.

Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome.

BACKGROUND AND OBJECTIVE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.

Spanish guidelines for diagnosis, management, treatment, and prevention of DRESS syndrome

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. OBJECTIVE: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided

ANTECEDENTES: El síndrome DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) es una reacción cutánea grave inducida por hipersensibilidad a fármacos, compleja y multisistémica. Su diagnóstico y manejo es difícil e implica a diferentes especialistas. Es muy importante una correcta identificación del fármaco responsable para que el paciente disponga de opciones terapéuticas seguras en el futuro. No hay guías ni documentos de consenso españoles previos sobre el síndrome DRESS. OBJETIVO: Realizar una revisión y guía sobre el diagnóstico clínico y alergológico, manejo, tratamiento y prevención del DRESS según la evidencia científica disponible y la experiencia de expertos de diferentes especialidades médicas. MÉTODOS: Esta guía ha sido elaborada por un grupo de alergólogos del Comité de Alergia a Fármacos de la SEAIC, junto a otros especialistas involucrados en el manejo del DRESS e investigadores del Consorcio PIELenRed. Se realizó una búsqueda de publicaciones científicas sobre DRESS y el grupo de expertos evaluó la evidencia científica de la literatura y aportaron grados de recomendación. Cuando no existía evidencia se alcanzó un consenso entre expertos. RESULTADOS: Se publica la guía española sobre DRESS. Incluye aspectos prácticos importantes sobre el diagnóstico clínico, la identificación de fármacos causales a través del algoritmo del Sistema Español de Farmacovigilancia y guía para el diagnóstico alergológico. Se realizan recomendaciones sobre el manejo, tratamiento y prevención del DRESS. Se aportan algoritmos sobre el manejo en la fase aguda y en la de recuperación. Se ha elaborado una guía terapéutica escalonada consensuada por expertos especialistas implicados en el tratamiento del DRESS

Efecto nefroprotector del Camu Camu (Myrciaria dubia) en un modelo de nefrotoxicidad inducida por gentamicina en ratas / Nephroprotective effect of Camu Camu (Myrciaria dubia) in a model of nephrotoxicity induced by Gentamicin in rats

RESUMEN El objetivo del estudio fue determinar el efecto nefroprotector del extracto de camu camu en un modelo de nefrotoxicidad inducida por la gentamicina. Estudio de tipo experimental formado por 50 ratas Sprague Dawley que se dividieron aleatoriamente en cinco grupos de estudio: Al grupo control se le administró la solución salina, al grupo gentamicina se le indujo la nefrotoxicidad y a los grupos experimentales 1, 2 y 3 se les protegió con el extracto alcohólico de camu camu a diferentes dosis. La actividad nefroprotectora se evaluó por la cuantificación de la creatinina sérica, el peso y análisis histopatológico de los riñones. Los resultados evidenciaron una disminución significativa del nivel de creatinina en los grupos protegidos con el extracto alcohólico de camu camu con respecto al grupo gentamicina (p<0,05). Los grupos que recibieron camu camu presentaron un aumento gradual del peso de los riñones en una relación directa a la dosis del extracto (p<0,05). El análisis histológico evidenció pérdida epitelial, infiltrado inflamatorio intenso y congestión vascular en el grupo gentamicina, mientras que los grupos que recibieron camu camu con el extracto disminuyeron la gravedad del daño. Se concluye que el extracto de camu camu presentó una actividad nefroprotectora significativa en un modelo de nefrotoxicidad inducida por gentamicina.

ABSTRACT The aim of the study was to determine the nephroprotective effect of camu camu extract on a gentamicin-induced nephrotoxicity model. The study design was experimental using 50 Sprague Dawley rats randomly allocated into 1 of 5 five groups: a control group that was administered a saline solution, a gentamicin group in which nephrotoxicity was induced and experimental groups 1, 2 and 3 that were provided different doses of Camu Camu alcoholic extract. Nephroprotective activity was evaluated via quantification of seric creatinine, histopathological analysis and weighing of the kidneys. Results showed a significant decrease in creatinine levels between the group administered camu camu alcoholic extract and the gentamicin group (p<0.05). Groups who received camu camu presented a gradual increase in kidneys weight which corresponded directly to the extract dose (p<0.05). The histopathological analysis showed epithelial loss, intense inflammatory infiltrate and vascular congestion in the gentamicin group, while the groups who received the extract had a lower level of damage. Camu Camu extract provided a significant nephroprotective activity on a gentamicin-induced nephrotoxicity model.

Lactancia materna. Una revisión de la evolución de esta práctica a través del tiempo. El caso de algunas comunidades indígenas en Colombia / Breastfeeding: a review of its evolution through time. The case of some indigenous communities in Colombia

La lactancia materna es una función innata de todo mamífero y el hombre como tal no es la excepción; el presente artículo se basa en una revisión de fuentes secundarias relacionadas con la evolución histórica de la práctica de la lactancia materna en diferentes contextos y momentos históricos. Realiza una aproximación a la información de tipo histórico que existe sobre dicha práctica, desde la civilización egipcia y en la Europa antes de Cristo, hasta el siglo XX, haciendo mención a las evidencias sobre los conocimientos y creencias en torno a la lactancia materna. Posteriormente se presenta un panorama del contexto colombiano desde la preconquista, la Colonia y la Independencia, hasta nuestros días; no obstante, es preciso y de gran importancia resaltar la continuidad de esta práctica bajo la influencia de la cultura indígena colombiana, motivo por el cual al final del mismo se señalan las características de las prácticas de la alimentación al seno y alimentación complementaria en algunas comunidades indígenas colombianas. Se parte del hecho de que la alimentación al pecho ha sido durante centenares de años una práctica eminentemente biocultural porque, además de ser un proceso biológico, es un comportamiento determinado por la cultura el cual sido transmitido de madres a hijas a través de generaciones.

[Thiopurine S-methyltransferase gene polymorphism in Chilean blood donors]. / Polimorfismo del gen de la tiopurina S-metiltransferasa en donantes de sangre de un hospital universitario.

BACKGROUND: Thiopurine S-methyltransferase (TPMT) is a cytosolic enzyme that catalyzes the S-methylation of 6-mercaptopurine and azathioprine. Low-activity phenotypes are correlated with polymorphism in the TPMT gene. Patients with low or undetectable TMPT activity could develop severe myelosuppression when they are treated with standard doses of thiopurine drugs. Since ethnic differences in the TPMT gen polymorphism have been demonstrated worldwide, its assessment in the Chilean population is worthwhile. AIM: To investigate the TMPT gene polymorphism in a Chilean blood donor individuals. SUBJECTS AND METHODS: The frequency of four allelic variants of the TPMT gene, *2 (G238C), *3A (G460A and A719G), *3B (G460A) and *3C (A719G) were analyzed in 210 Chilean blood donors, using polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP) and allele-specific PCR-based assays. RESULTS: TPMT variants associated to low enzymatic activity, were detected in 16 subjects (8%), who had a heterozygous genotype (*3A in 12; *3C in three and *2 in one subject). No TPMT*3B allelic variant was found. The normal allele (wild-type) was found in 92% of studied individuals. CONCLUSIONS: The allele TPMT*3A, is the most prevalent in this group of Chilean blood donors, as in Caucasian populations.

Polimorfismo del gen de la tiopurina S-metiltransferasa en donantes de sangre de un hospital universitario / Thiopurine S-methyltransferase gene polymorphism in Chilean blood donors

Background: Thiopurine S- methyltransferase (TPMT) is a cytosolic enzyme that catalyzes the S-methylation of 6-mercaptopurine and azathioprine. Lowactivity phenotypes are correlated with polymorphism in the TPMT gene. Patients with low or undetectable TMPT activity could develop severe myelosuppression when they are treated with standard doses of thiopurine drugs. Since ethnic differences in the TPMT gen polymorphism have been demonstrated worldwide, its assessment in the Chilean population is worthwhile. Aim: To investigate the TMPT gene polymorphism in a Chilean blood donor individuals. Subjects and Methods: The frequency of four allelic variants of the TPMT gene, *2 (G238C), *3A (G460A and A719G), *3B (G460A) and *3C (A719G) were analyzed in 210 Chilean blood donors, using polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP) and allele-specific PCR-based assays. Results: TPMT variants associated to low enzymatic activity, were detected in 16 subjects (8%), who had a heterozygous genotype (*3A in 12; *3C in three and *2 in one subject). No TPMT*3B allelic variant was found. The normal allele (wild-type) was found in 92% of studied individuals. Conclusions: The allele TPMT*3A, is the most prevalent in this group of Chilean blood donors, as in Caucasian populations.

Perfil de temperamento y carácter de pesonas con intento suicida / Temperament and character profile of persons with suicide attempt

Introducción. El objetivo del presente trabajo fue determinar el perfil de temperamento y carácter relacionado con el intento suicida. Método. Los pacientes consecutivos (hombres y mujeres), entre 18 y 65 años de edad, con intento suicida, hospitalizados en el Servicio de Psiquiatría del Antiguo Hospital Civil de Guadalajara, Jalisco (México), fueron evaluados con base en el Inventario de Temperamento y Carácter (ITC) de Cloninger y comparados con los datos normativos mexicanos. Resultados. Del total de 63 pacientes con edad promedio de 28,25 +/- 9,28 años, el 54 % son mujeres. El perfil de personalidad de las personas con intento suicida, a diferencia de la población normal, se caracterizó por: a) elevación de "búsqueda de la novedad" (22,9 +/- 6,0 frente a 20,2 +/- 5,1; t = 3,30, gl = 83, p = 0,01), "evitación del daño" (19,0 +/- 4,8 frente a 12,6 + 7,1; t = 8,54, gl = 132, p (0,0001) y "autotrascendencia" (19,1 +/- 5,6 frente a 16,4 +/- 6,2; t = 3,41, gl = 100, p= 0,0009), y b) disminución de "autodirección" (26,8 +/- 6,2 frente a 29,9 +/- 10,8; t = -3,02, gl = 161, p = 0,002) y "cooperatividad" (26,0 +/- 4,5 frente a 28,2 +/- 9,9; t = -2,59, gl = 214, p = 0,01). Finalmente, los hombres con intento suicida mostraron un mayor índice de evitación del daño en comparación con las mujeres (20,37 +/- 5,3 frente a 17,82 +/- 4,1; t = -2,14, gl = 61, p = 0,036). Conclusiones. Los factores temperamentales relacionados con el intento suicida están vinculados con la desregulación serotoninérgica y noradrenérgica relacionada previamente con este fenómeno, y la suma de rasgos de carácter dan cuenta de la compleja interacción entre pautas heredadas y aprendidas del comportamiento suicida

Introduction. The aim of this study was to establish the association between temperament and character personality traits with attempted suicide patients. Method. Consecutive male and female adults subjects, between 18-65 years old, presenting a suicide attempt and hospitalized in the Psychiatric Service of Civil Hospital of Guadalajara, Jalisco (Mexico), were evaluated based on Cloninger's Temperament and Character Inventory (TCI) and compared with the Mexican normative data. Results. A total 63 subjects, with a mean age of 28.25 +/- 9.28 years old, 54 % of whom were women, were enrolled. Personality traits associated with suicide attempt in comparison with general population included: temperament: elevation in "novelty seeking" (22.9 +/- 6.0 vs 20.2 +/- 5.1; t = 3.30, df = 83, p = 0.01), "harm avoidance" (19.0 +/- 4.8 vs 12.6 +/- 7.1; t = 8.54, df = 132, p < 0.001), and "self-transcendence" (19.1 +/- 5.6 vs 16.4 +/- 6.2; t = 3.41, df = 100, p = 0.0009); and character: decrease in «self-directedness » (26.8 +/- 6.2 vs 29.9 +/- 10.8; t = -3.02, df = 161, p=0.002), and "cooperativeness" (26.0 +/- 4.5 vs 28.2 +/- 9.9; t = -2.59, df = 214, p = 0.01). Finally, males with suicide attempt showed higher "harm avoidance" than females (20.37 +/- 5.3 vs 17.82 +/- 4.1; t = -2.14, df = 61, p = 0.036). Conclusions. Temperament traits associated with suicide attempt in the present study are related with serotoninergic and noradrenergic deregulation previously involved in the phenomena, and the sum of the character personality dimensions explains the complex relationship between biological and learned factors of suicide behavior

[Temperament and character profile of persons with suicide attempt]. / Perfil de temperamento y carácter de personas con intento suicida.

INTRODUCTION: The aim of this study was to establish the association between temperament and character personality traits with attempted suicide patients. METHOD: Consecutive male and female adults subjects, between 18-65 years old, presenting a suicide attempt and hospitalized in the Psychiatric Service of Civil Hospital of Guadalajara, Jalisco (Mexico), were evaluated based on Cloninger's Temperament and Character Inventory (TCI) and compared with the Mexican normative data. RESULTS: A total 63 subjects, with a mean age of 28.25 +/- 9.28 years old, 54 % of whom were women, were enrolled. Personality traits associated with suicide attempt in comparison with general population included: temperament: elevation in "novelty seeking" (22.9 +/- 6.0 vs 20.2 +/- 5.1; t = 3.30, df = 83, p = 0.01), "harm avoidance" (19.0 +/- 4.8 vs 12.6 +/- 7.1; t = 8.54, df = 132, p < 0.001), and "self-transcendence" (19.1 +/- 5.6 vs 16.4 +/- 6.2; t = 3.41, df = 100, p = 0.0009); and character: decrease in "self-directedness" (26.8 +/- 6.2 vs 29.9 +/- 10.8; t = -3.02, df = 161, p = 0.002), and "cooperativeness" (26.0 +/- 4.5 vs 28.2 +/- 9.9; t = -2.59, df = 214, p = 0.01). Finally, males with suicide attempt showed higher "harm avoidance" than females (20.37 +/- 5.3 vs 17.82 +/- 4.1; t = -2.14, df = 61, p = 0.036). CONCLUSIONS: Temperament traits associated with suicide attempt in the present study are related with serotoninergic and noradrenergic deregulation previously involved in the phenomena, and the sum of the character personality dimensions explains the complex relationship between biological and learned factors of suicide behavior.

Formoterol vs. albuterol administered via Turbuhaler system in the emergency treatment of acute asthma in children.

BACKGROUND: Formoterol is a new beta 2 agonist with a duration of 8-12 hours. Albuterol is a beta 2-agonist with rapid onset of action and a duration of approximately 6 hours. OBJECTIVE: The aim of the present study was to compare the onset of action between formoterol and albuterol, both administered through a Turbohaler. MATERIAL AND METHOD: In a double-blind, parallel-group study design 36 patients were randomly allocated to receive either formoterol 12 microg or salbutamol 200 microg. The two drugs were administered through a Turbohaler system. Response (% forced expiratory volume in one second [FEV1]) was evaluated 3, 30 and 60 minutes after drug administration. RESULTS: The %FEV1 values at 3, 30 and 60 minutes were similar in both groups: 82 15.0 for formoterol and 82 14.4 for albuterol at 60 minutes (p > 0.05). CONCLUSIONS: Formoterol 12 microg has a similar onset of action and potency to albuterol 200 microg when administered via a Turbuhaler in children with a mild acute asthma crisis.

Formoterol vs. Albuterol administered via Turbuhaler System in the emergency treatment of acute asthma in children

Background: Formoterol is a new β2-agonist with a duration of 8-12 hours. Albuterol is a β2-agonist with rapid onset of action and a duration of approximately 6 hours.Objective: The aim of the present study was to compare the onset of action between formoterol and albuterol, both administered through a Turbohaler®. Material and method: In a double-blind, parallel-group study design 36 patients were randomly allocated to receive either formoterol 12 μg or salbutamol 200 μg. The two drugs were administered through a Turbohaler® system. Response (% forced expiratory volume in one second [FEV1]) was evaluated 3, 30 and 60 minutes after drug administration. Results: The %FEV1 values at 3, 30 and 60 minutes were similar in both groups: 82 ± 15.0 for formoterol and 82 ± 14.4 for albuterol at 60 minutes (p > 0.05). Conclusions: Formoterol 12 μg has a similar onset of action and potency to albuterol 200 μg when administered via a Turbuhaler® in children with a mild acute asthma crisis (AU)

Información básica: Formoterol es un nuevo Beta2-agonista con un efecto de 8-12 horas. Salbutamol es un Beta2-agonista con una acción de comienzo rápido que dura aproximadamente 6 horas. Objetivo: El objetivo del presente estudio era comparar el inicio de la acción entre formoterol y salbutamol, ambos administrados mediante Turbohaler. Material y método: En un estudio doble ciego y de grupos paralelos se distribuyó aleatoriamente a 36 pacientes para recibir formoterol 12 mg o salbutamol 200mg. Los dos fármacos se administraron por medio de un sistema Turbohaler. Se evaluó la respuesta ( por cientoFEV1) 3, 30 y 60 minutos después de la administración del fármaco. Resultados: Los valores de por cientoFEV1 a los 3, 30 y 60 minutos fueron semejantes entre los grupos (p > 0,05), p. ej., 82 ñ 15,0 con formoterol y 82 ñ 14,4 con salbutamol a los 60 min. Conclusiones: Formoterol 12mg tuvo un inicio de acción y una potencia similares a las de salbutamol 200mg cuando se administraron a través de Turbuhaler a niños con crisis asmáticas agudas leves (AU)

Bacterial expression of the catalytic domain of 3-hydroxy-3-methylglutaryl-CoA reductase (isoform HMGR1) from Arabidopsis thaliana, and its inactivation by phosphorylation at Ser577 by Brassica oleracea 3-hydroxy-3-methylglutaryl-CoA reductase kinase.

The catalytic domain of 3-hydroxy-3-methylglutaryl-CoA reductase isoform 1 (HMGR1cd) from Arabidopsis thaliana has been expressed in Escherichia coli in a catalytically active form and purified. The high efficiency of the bacterial expression system together with the simplicity of the purification procedure used in this study resulted in the attainment of large quantities of pure enzyme (about 5 mg/l culture) with a final specific activity of up to 17 U/mg. This specific activity is higher than that reported to date for any 3-hydroxy-3-methylglutaryl-CoA reductase (HMGR) purified from a plant source. HMGR1cd activity was completely blocked by the HMGR inhibitor mevinolin (IC50 = 12.5 nM). No significant differences were observed between the Km values of HMGR1cd for NADPH (71 +/- 7 microM) and (S)-3-hydroxy-3-methylglutaryl-CoA (8.3 +/- 1.5 microM) and those of pure HMGR preparations obtained from different plant sources. The purified HMGR1cd was reversibly inactivated by phosphorylation at a single site by Brassica oleracea HMGR kinase A, which is functionally related to the mammalian AMP-activated protein kinase. The site of phosphorylation is Ser577 in the complete sequence of A. thaliana HMGR1. The results in this paper represent the first evidence that a higher plant HMGR is regulated by direct phosphorylation, at least in a cell-free system. Our results also reinforce the view that the AMP-activated protein kinase/SNF1 family is an ancient and highly conserved protein kinase system.