Atención plena para disminuir la sintomatología de TDAH en escolares de Perú / Mindfulness to reduce ADHD symptoms in schoolchildren in Peru / Plena Atenção para reduzir os sintomas de TDAH em crianças em idade escolar no Peru

El Trastorno por Déficit de Atención e Hiperactividad se caracteriza por presentar síntomas de inatención, impulsividad e hiperactividad. La estrategia de atención plena puede ser una poderosa herramienta para contrarrestarlo al mejorar la capacidad de atención, concentración y autorregulación emocional. Objetivo. Determinar la efectividad de la atención plena como estrategia para disminuir la sintomatología de TDAH en escolares entre 6 a 12 años de Tacna, Perú. Material y método. Estudio cuantitativo de tipo experimental y corte longitudinal. Se llevó a cabo en el año 2023. La muestra estuvo constituida por 613 escolares pertenecientes a instituciones educativas de la ciudad de Tacna de Cono Norte y Sur. Se recolectó la información mediante la técnica de la encuesta y como instrumento un cuestionario sobre TDAH y uno sobre atención plena, este último usado como pre y post test. Se realizó la prueba de Wilcoxon, con una significancia del 95% y un valor p<0,05 como estadísticamente significativo. Resultados. Tienen nivel alto de inatención el 9,6 %, de impulsividad el 3,1 % y de hiperactividad el 2,3 %. Luego de ejecutarse 10 sesiones basadas en la atención plena, se logró mejor el nivel de satisfacción de un 51,4% (que había en el pre-test) a un 73,6% (en el post-test). Conclusiones. La aplicación de la estrategia de atención plena tuvo un efecto positivo y consistente en la disminución de la sintomatología de TDAH. Estos hallazgos respaldan la implementación de este tipo de intervenciones en el ámbito escolar para beneficiar a los estudiantes con esta condición

Attention Deficit Hyperactivity Disorder is characterized by symptoms of inattention, impulsivity, and hyperactivity. Mindfulness-based strategies can be a powerful tool to counteract ADHD by improving attention, concentration, and emotional self-regulation. Objective. To determine the effectiveness of mindfulness as a strategy to reduce ADHD symptoms in schoolchildren aged 6 to 12 years in Tacna, Peru. Materials and Methods. Quantitative experimental study with a longitudinal design, conducted in 2023. The sample consisted of 613 schoolchildren from educational institutions in the North and South Cone of Tacna. Information was collected using a survey technique and questionnaires on ADHD and mindfulness, the latter used as a pre- and post-test. The Wilcoxon test was applied, with a 95% significance and a p-value < 0.05 considered statistically significant. Results. 9.6% of the students had a high level of inattention, 3.1% had a high level of impulsivity, and 2.3% had a high level of hyperactivity. After 10 mindfulness-based sessions, the level of satisfaction improved from 51.4% (pre-test) to 73.6% (post-test). Conclusions. The application of the mindfulness-based strategy had a positive and consistent effect on the reduction of ADHD symptoms. These findings support the implementation of this type of intervention in the school setting to benefit students with this condition

O Transtorno de Déficit de Atenção e Hiperatividade é caracterizado por sintomas de desatenção, impulsividade e hiperatividade. Estratégias baseadas em atenção plena podem ser uma ferramenta poderosa para combater o TDAH, melhorando a atenção, a concentração e a autorregulação emocional. Objetivo. Determinar a eficácia da atenção plena como estratégia para reduzir os sintomas de TDAH em escolares de 6 a 12 anos em Tacna, Peru. Materiais e Métodos. Estudo quantitativo experimental com delineamento longitudinal, realizado em 2023. A amostra foi composta por 613 escolares de instituições educacionais do Cone Norte e Sul de Tacna. As informações foram coletadas usando a técnica de pesquisa e questionários sobre TDAH e atenção plena, este último usado como pré e pós-teste. O teste de Wilcoxon foi aplicado, com 95% de significância e valor de p < 0,05 considerado estatisticamente significativo. Resultados. 9,6% dos alunos apresentaram alto nível de desatenção, 3,1% alto nível de impulsividade e 2,3% alto nível de hiperatividade. Após 10 sessões baseadas em atenção plena, o nível de satisfação melhorou de 51,4% (pré-teste) para 73,6% (pós-teste). Conclusões. A aplicação da estratégia baseada em atenção plena teve um efeito positivo e consistente na redução dos sintomas de TDAH. Esses achados apoiam a implementação desse tipo de intervenção no ambiente escolar para beneficiar os alunos com essa condição

Atención plena para disminuir la sintomatología de TDAH en escolares de Perú

El Trastorno por Déficit de Atención e Hiperactividad se caracteriza por presentar síntomas de inatención, impulsividad e hiperactividad. La estrategia de atención plena puede ser una poderosa herramienta para contrarrestarlo al mejorar la capacidad de atención, concentración y autorregulación emocional. Objetivo. Determinar la efectividad de la atención plena como estrategia para disminuir la sintomatología de TDAH en escolares entre 6 a 12 años de Tacna, Perú. Material y método. Estudio cuantitativo de tipo experimental y corte longitudinal. Se llevó a cabo en el año 2023. La muestra estuvo constituida por 613 escolares pertenecientes a instituciones educativas de la ciudad de Tacna de Cono Norte y Sur. Se recolectó la información mediante la técnica de la encuesta y como instrumento un cuestionario sobre TDAH y uno sobre atención plena, este último usado como pre y post test. Se realizó la prueba de Wilcoxon, con una significancia del 95% y un valor p<0,05 como estadísticamente significativo. Resultados. Tienen nivel alto de inatención el 9,6 %, de impulsividad el 3,1 % y de hiperactividad el 2,3 %. Luego de ejecutarse 10 sesiones basadas en la atención plena, se logró mejor el nivel de satisfacción de un 51,4% (que había en el pre-test) a un 73,6% (en el post-test). Conclusiones. La aplicación de la estrategia de atención plena tuvo un efecto positivo y consistente en la disminución de la sintomatología de TDAH. Estos hallazgos respaldan la implementación de este tipo de intervenciones en el ámbito escolar para beneficiar a los estudiantes con esta condición.

Attention Deficit Hyperactivity Disorder is characterized by symptoms of inattention, impulsivity, and hyperactivity. Mindfulness-based strategies can be a powerful tool to counteract ADHD by improving attention, concentration, and emotional self-regulation. Objective. To determine the effectiveness of mindfulness as a strategy to reduce ADHD symptoms in schoolchildren aged 6 to 12 years in Tacna, Peru. Materials and Methods. Quantitative experimental study with a longitudinal design, conducted in 2023. The sample consisted of 613 schoolchildren from educational institutions in the North and South Cone of Tacna. Information was collected using a survey technique and questionnaires on ADHD and mindfulness, the latter used as a pre- and post-test. The Wilcoxon test was applied, with a 95% significance and a p-value < 0.05 considered statistically significant. Results. 9.6% of the students had a high level of inattention, 3.1% had a high level of impulsivity, and 2.3% had a high level of hyperactivity. After 10 mindfulness-based sessions, the level of satisfaction improved from 51.4% (pre-test) to 73.6% (post-test). Conclusions. The application of the mindfulness-based strategy had a positive and consistent effect on the reduction of ADHD symptoms. These findings support the implementation of this type of intervention in the school setting to benefit students with this condition.

O Transtorno de Déficit de Atenção e Hiperatividade é caracterizado por sintomas de desatenção, impulsividade e hiperatividade. Estratégias baseadas em atenção plena podem ser uma ferramenta poderosa para combater o TDAH, melhorando a atenção, a concentração e a autorregulação emocional. Objetivo. Determinar a eficácia da atenção plena como estratégia para reduzir os sintomas de TDAH em escolares de 6 a 12 anos em Tacna, Peru. Materiais e Métodos. Estudo quantitativo experimental com delineamento longitudinal, realizado em 2023. A amostra foi composta por 613 escolares de instituições educacionais do Cone Norte e Sul de Tacna. As informações foram coletadas usando a técnica de pesquisa e questionários sobre TDAH e atenção plena, este último usado como pré e pós-teste. O teste de Wilcoxon foi aplicado, com 95% de significância e valor de p < 0,05 considerado estatisticamente significativo. Resultados. 9,6% dos alunos apresentaram alto nível de desatenção, 3,1% alto nível de impulsividade e 2,3% alto nível de hiperatividade. Após 10 sessões baseadas em atenção plena, o nível de satisfação melhorou de 51,4% (pré-teste) para 73,6% (pós-teste). Conclusões. A aplicação da estratégia baseada em atenção plena teve um efeito positivo e consistente na redução dos sintomas de TDAH. Esses achados apoiam a implementação desse tipo de intervenção no ambiente escolar para beneficiar os alunos com essa condição.

Genética del TDAH en la práctica clínica / Genetics of ADHD in clinical practice

Resumen El trastorno por déficit de atención/hiperactividad (TDAH) es un trastorno del neurodesarrollo complejo y heterogéneo desde una perspectiva causal, clínica y pro nóstica. La investigación refleja su carácter multifactorial con un papel destacado de los factores genéticos. Los estudios poblacionales han señalado históricamente la implicación de numerosas variantes genéticas de escaso tamaño de efecto, las cuales por sí mismas apenas incre mentan el riesgo de TDAH y difícilmente justifican su ele vada heredabilidad. Muchas de ellas están presentes en más del 60% de la población general, lo que sugiere su pa pel modulador más que causal. No obstante, gracias a la irrupción de nuevas técnicas genéticas en los últimos 15 años, se están identificando un mayor número de casos con trastornos genéticos (muchos de ellos monogénicos), cuyas variantes genéticas explican por sí mismas la presencia del TDAH. El estudio detallado de los antecedentes personales y familiares, así como una exploración física completa, puede ayudar a identificar algunos de ellos. La identificación de la causa en este conjunto de casos tiene un valor crucial en el asesoramiento clínico, el consejo genético-familiar y la anticipación pronóstica, así como en la realización o evitación de estudios complementarios y en el diseño del plan terapéutico.

Abstract Attention-deficit/hyperactivity disorder (ADHD) is a complex and heterogeneous neurodevelopmental disor der from a causal, clinical and prognostic perspective. Research reflects its multifactorial nature with a promi nent role of genetic factors. Population studies have historically pointed to the involvement of numerous genetic variants of small effect size, which hardly by themselves increase the risk of presenting the disorder and hardly justify its high heritability. Many of them are present in more than 60% of the general population, suggesting their modulatory rather than causal role. However, after the irruption of new genetic techniques in the last 15 years, a greater number of cases are be ing identified with genetic disorders (many of them monogenic), whose genetic variants alone explain the presence of ADHD. A detailed study of the personal and family history, as well as a complete physical examination, can help to identify some of them. The identification of the cause in this group of cases has a crucial value in clinical counseling, genetic-familial counseling and prognostic anticipation, as well as in the performance or avoidance of complementary stud ies and in the design of the intervention plan.

[Genetics of ADHD in clinical practice]. / Genética del TDAH en la práctica clínica.

Attention-deficit/hyperactivity disorder (ADHD) is a complex and heterogeneous neurodevelopmental disorder from a causal, clinical and prognostic perspective. Research reflects its multifactorial nature with a prominent role of genetic factors. Population studies have historically pointed to the involvement of numerous genetic variants of small effect size, which hardly by themselves increase the risk of presenting the disorder and hardly justify its high heritability. Many of them are present in more than 60% of the general population, suggesting their modulatory rather than causal role. However, after the irruption of new genetic techniques in the last 15 years, a greater number of cases are being identified with genetic disorders (many of them monogenic), whose genetic variants alone explain the presence of ADHD. A detailed study of the personal and family history, as well as a complete physical examination, can help to identify some of them. The identification of the cause in this group of cases has a crucial value in clinical counseling, genetic-familial counseling and prognostic anticipation, as well as in the performance or avoidance of complementary studies and in the design of the intervention plan.

El trastorno por déficit de atención/hiperactividad (TDAH) es un trastorno del neurodesarrollo complejo y heterogéneo desde una perspectiva causal, clínica y pronóstica. La investigación refleja su carácter multifactorial con un papel destacado de los factores genéticos. Los estudios poblacionales han señalado históricamente la implicación de numerosas variantes genéticas de escaso tamaño de efecto, las cuales por sí mismas apenas incrementan el riesgo de TDAH y difícilmente justifican su elevada heredabilidad. Muchas de ellas están presentes en más del 60% de la población general, lo que sugiere su papel modulador más que causal. No obstante, gracias a la irrupción de nuevas técnicas genéticas en los últimos 15 años, se están identificando un mayor número de casos con trastornos genéticos (muchos de ellos monogénicos), cuyas variantes genéticas explican por sí mismas la presencia del TDAH. El estudio detallado de los antecedentes personales y familiares, así como una exploración física completa, puede ayudar a identificar algunos de ellos. La identificación de la causa en este conjunto de casos tiene un valor crucial en el asesoramiento clínico, el consejo genético-familiar y la anticipación pronóstica, así como en la realización o evitación de estudios complementarios y en el diseño del plan terapéutico.

Underlying and proximate drivers of biodiversity changes in Mesoamerican biosphere reserves.

Protected areas are of paramount relevance to conserving wildlife and ecosystem contributions to people. Yet, their conservation success is increasingly threatened by human activities including habitat loss, climate change, pollution, and species overexploitation. Thus, understanding the underlying and proximate drivers of anthropogenic threats is urgently needed to improve protected areas' effectiveness, especially in the biodiversity-rich tropics. We addressed this issue by analyzing expert-provided data on long-term biodiversity change (last three decades) over 14 biosphere reserves from the Mesoamerican Biodiversity Hotspot. Using multivariate analyses and structural equation modeling, we tested the influence of major socioeconomic drivers (demographic, economic, and political factors), spatial indicators of human activities (agriculture expansion and road extension), and forest landscape modifications (forest loss and isolation) as drivers of biodiversity change. We uncovered a significant proliferation of disturbance-tolerant guilds and the loss or decline of disturbance-sensitive guilds within reserves causing a "winner and loser" species replacement over time. Guild change was directly related to forest spatial changes promoted by the expansion of agriculture and roads within reserves. High human population density and low nonfarming occupation were identified as the main underlying drivers of biodiversity change. Our findings suggest that to mitigate anthropogenic threats to biodiversity within biosphere reserves, fostering human population well-being via sustainable, nonfarming livelihood opportunities around reserves is imperative.

Pain sensitization and atrophy of deep cervical muscles in patients with chronic tension-type headache.

OBJECTIVE: The aim of this study was to compare the pressure pain threshold and the thickness of the cervical muscles in patients with tension-type headache versus healthy participants. METHODS: An observational, retrospective, cross-sectional study was conducted at the Universidad Europea de Madrid between May and June 2022. Adults aged 18-65 years with tension-type headache diagnosed for more than 6 months were compared to healthy controls. B-mode ultrasound imaging was employed to measure the thickness of the neck stabilizing muscles, longus colli, and multifidus at the C5 and C6 levels, respectively. pressure pain threshold measurements were assessed bilaterally in the following regions: upper trapezius, masseter, temporalis, anterior tibialis, and median nerve. RESULTS: A total of 40 participants (90% females; 36.3±12.9 years, BMI 24.2±3.7 kg/m2) participated in the study. Compared with the control group (n=20), participants in the tension-type headache group (n=20) presented statistically significant lower values in all pressure pain threshold measures. Additionally, the tension-type headache group presented statistically significant lower values in the thickness of the following muscles: right multifidus at rest (1.0±0.2 cm versus 1.3±0.2 cm; p<0.001), left multifidus at rest (1.1±0.1 cm versus 1.3±0.1 cm; p<0.001) and during contraction (1.2±0.1 cm versus 1.5±0.2 cm; p<0.001), left longus colli at rest (1.0±0.2 cm versus 1.2±0.1 cm; p=0.01) and during contraction (1.2±0.2 cm versus 1.4±0.1 cm; p<0.001), and right longus colli during contraction (1.2±0.2 cm versus 1.4±0.2 cm; p=0.02). CONCLUSION: This study concluded that patients with tension-type headache showed lower thickness and lower pressure pain threshold of cervical muscles compared to healthy controls.

El impacto del TDAH sobre la lectura / The impact of ADHD on reading

Resumen Más allá de la frecuente coexistencia del trastorno por déficit de atención con hiperactividad (TDAH) y el trastorno específico del aprendizaje de la lectura, la presente revisión pretende examinar la evidencia empírica disponible sobre cómo el TDAH impacta negativamente sobre el aprendizaje de la lectura. Los datos existentes apuntan a que la presencia del trastorno (especialmente los síntomas de falta de atención), puede afectar a i) la correcta adquisición de lectura, ya sea de manera directa o a través de su influencia sobre los precursores de la lectura; ii) las propias habilidades de decodificación (precisión y fluidez lectora), tanto de manera directa como indirecta a través de su influencia sobre procesos cognitivos como la distracción o las funciones ejecutivas; y ii) la comprensión lectora, probablemente de manera indirecta por las dificultades eje cutivas y en la memoria de trabajo verbal características del TDAH. Estas conclusiones presentan importantes implicaciones para caracterizar e intervenir mejor sobre las dificultades lectoras en el TDAH, ya sean clínicas o subclínicas.

Abstract Beyond the frequent coexistence of attention deficit hyperactivity disorder (ADHD) and reading dis order (dyslexia), the present review aims to examine the available empirical evidence on how ADHD negatively impacts on learning to read. Existing data suggest that the presence of the disorder (especially inattention symp toms), may affect i) the correct acquisition of reading, either directly or through its influence on the precursors to reading; ii) decoding skills themselves (reading accuracy and fluency), both directly and indirectly through its influence on cognitive processes such as distractibility or executive functions; and iii) reading comprehension, probably indirectly through the executive and verbal memory difficulties characteristic of ADHD. These findings have important implications for better characterizing and intervening on reading difficulties in ADHD, whether clinical or subclinical.

[The impact of ADHD on reading]. / El impacto del TDAH sobre la lectura.

Beyond the frequent coexistence of attention deficit hyperactivity disorder (ADHD) and reading disorder (dyslexia), the present review aims to examine the available empirical evidence on how ADHD negatively impacts on learning to read. Existing data suggest that the presence of the disorder (especially inattention symptoms), may affect i) the correct acquisition of reading, either directly or through its influence on the precursors to reading; ii) decoding skills themselves (reading accuracy and fluency), both directly and indirectly through its influence on cognitive processes such as distractibility or executive functions; and iii) reading comprehension, probably indirectly through the executive and verbal memory difficulties characteristic of ADHD. These findings have important implications for better characterizing and intervening on reading difficulties in ADHD, whether clinical or subclinical.

Más allá de la frecuente coexistencia del trastorno por déficit de atención con hiperactividad (TDAH) y el trastorno específico del aprendizaje de la lectura, la presente revisión pretende examinar la evidencia empírica disponible sobre cómo el TDAH impacta negativamente sobre el aprendizaje de la lectura. Los datos existentes apuntan a que la presencia del trastorno (especialmente los síntomas de falta de atención), puede afectar a i) la correcta adquisición de lectura, ya sea de manera directa o a través de su influencia sobre los precursores de la lectura; ii) las propias habilidades de decodificación (precisión y fluidez lectora), tanto de manera directa como indirecta a través de su influencia sobre procesos cognitivos como la distracción o las funciones ejecutivas; y ii) la comprensión lectora, probablemente de manera indirecta por las dificultades ejecutivas y en la memoria de trabajo verbal características del TDAH. Estas conclusiones presentan importantes implicaciones para caracterizar e intervenir mejor sobre las dificultades lectoras en el TDAH, ya sean clínicas o subclínicas.

Pain sensitization and atrophy of deep cervical muscles in patients with chronic tension-type headache

SUMMARY OBJECTIVE: The aim of this study was to compare the pressure pain threshold and the thickness of the cervical muscles in patients with tension-type headache versus healthy participants. METHODS: An observational, retrospective, cross-sectional study was conducted at the Universidad Europea de Madrid between May and June 2022. Adults aged 18-65 years with tension-type headache diagnosed for more than 6 months were compared to healthy controls. B-mode ultrasound imaging was employed to measure the thickness of the neck stabilizing muscles, longus colli, and multifidus at the C5 and C6 levels, respectively. pressure pain threshold measurements were assessed bilaterally in the following regions: upper trapezius, masseter, temporalis, anterior tibialis, and median nerve. RESULTS: A total of 40 participants (90% females; 36.3±12.9 years, BMI 24.2±3.7 kg/m2) participated in the study. Compared with the control group (n=20), participants in the tension-type headache group (n=20) presented statistically significant lower values in all pressure pain threshold measures. Additionally, the tension-type headache group presented statistically significant lower values in the thickness of the following muscles: right multifidus at rest (1.0±0.2 cm versus 1.3±0.2 cm; p<0.001), left multifidus at rest (1.1±0.1 cm versus 1.3±0.1 cm; p<0.001) and during contraction (1.2±0.1 cm versus 1.5±0.2 cm; p<0.001), left longus colli at rest (1.0±0.2 cm versus 1.2±0.1 cm; p=0.01) and during contraction (1.2±0.2 cm versus 1.4±0.1 cm; p<0.001), and right longus colli during contraction (1.2±0.2 cm versus 1.4±0.2 cm; p=0.02). CONCLUSION: This study concluded that patients with tension-type headache showed lower thickness and lower pressure pain threshold of cervical muscles compared to healthy controls.

Regulatory T cells in acute and chronic human Chikungunya infection.

Chikungunya virus (CHIKV) infection generates strong immune responses that are associated with the disease pathophysiology. Regulatory T cells (Treg-cluster of differentiation (CD)-4+CD25highforkhead box P3 (FOXP3+)) are essential for the induction and maintenance of peripheral tolerance. Thus, they play key roles in determining the patient prognosis by preventing excessive immune responses via different suppression immune mechanisms. However, the regulatory mechanisms involved in human CHIKV infection are still poorly understood. Here, we characterize for the first time the Treg cell molecule-associated-mechanism during acute and chronic human Chikungunya disease. Here, we assessed the Treg cell population and molecule-associated mechanism in the peripheral blood samples of acute and chronic patients with Chikungunya. Our results indicate that CHIKV infection is associated with reduced frequency of Tregs, along with the impaired expression and production of Treg functional markers, including CD39, CD73, perforin, granzyme, programmed death 1 (PD-1), cytotoxic T lymphocyte antigen (CTLA)-4, and transforming growth factor (TGF)-ß. This observation suggests that Treg cells possess the poor regulatory capacity in both acute and chronic phases of the disease. Taken together, these data provide significant evidence that the imbalanced response of Treg cells plays an essential role in establishing the pathogenesis of Chikungunya.

Graft versus host disease-related eosinophilic fasciitis: cohort description and literature review

Abstract Background: Chronic graft versus host disease (cGVHD) simulating eosinophilic fasciitis (EF) is an underdiagnosed and challenging complication due to the lack of knowledge about its pathogenesis, refractoriness to traditional immunosuppressive agents and their negative impact on the physical function and quality of life. The aim of this study is to describe the clinical-biological characteristics and response to treatment of a case series and to provide a comprehensive literature review on cGVHD related EF involvement. Methods: Prospective observational study to describe the clinical and diagnostic evaluation characteristics of patients with EF-like follow-up as part of our multidisciplinary cGVHD consultations. In addition, the literature on joint and/or fascial musculoskeletal manifestations due to cGVHD was comprehensively reviewed. Results: 118 patients were evaluated in multidisciplinary cGVHD consultations, 39 of whom (33%) developed fasciitis. Notably, 11 patients had isolated joint contractures without sclerotic skin. After a median of three lines of treatment, the vast majority of patients achieved some degree of response. 94 potentially eligible articles were identified by the search strategy, with 17 of them, the majority isolated case reports, making the final selection. The validated staging scales used for the assessment were the Joint and Fascial Score and the Photographic Range of Motion. Conclusion: Fascial/articular involvement needs to be recognized and evaluated early. To our knowledge, our cohort is the second largest series to have been reported. Literature addressing fascial/joints complications related to cGVHD is scarce. The search for new biomarkers, the use of advanced imaging techniques and multidisciplinary approach may help improve the prognosis of patients with cGVHD.

Systemic lupus erythematosus, a disease conditioned by the environment / Lupus eritematoso sistémico, una enfermedad condicionada por el medio ambiente

ABSTRACT Systemic lupus erythematosus is an autoimmune disease that involves several systems, affects mainly young adult women, and causes a significant deterioration in quality of life. Different environmental aspects are known to facilitate the development of lupus in predisposed individuals. For several years it has been known that factors such as exposure to UV rays are related to the development of lupus; however, due to factors inherent to globalization, life-style changes, improved knowledge of cell signaling pathways as well as a better understanding of metabolomics, proteomics an genomics, it has been possible to better understand the relationship between cells and their environment. This study based on a narrative review, compiles the existing evidence on different risk factors and the development of lupus, including aspects typical of the Colombian population.

RESUMEN El lupus eritematoso sistémico es una enfermedad autoinmune que compromete diferentes sistemas, afecta principalmente a mujeres adultas jóvenes y genera un deterioro significativo de la calidad de vida. Es bien conocido que diferentes aspectos relacionados con la calidad de vida facilitan el desarrollo del lupus en individuos predispuestos. Desde hace varios años se sabe que factores tales como la exposición a los rayos ultravioleta se relacionan con el desarrollo de lupus; sin embargo, debido a factores inherentes a la globalización, a los cambios en los hábitos, a un mayor conocimiento de las vías de señalización celular, así como a una mayor comprensión de la metabolómica, la proteómica y la genómica, ha sido posible entender mejor la relación entre las células y su medio ambiente. En el presente estudio reunimos, a través de una revisión narrativa, la evidencia actual sobre diferentes factores de riesgo y el desarrollo del lupus, incluyendo aspectos típicos de la población colombiana.

Phenotypical characterization of regulatory T cells in acute Zika infection.

Zika virus (ZIKV), alongside Dengue virus (DENV), Chikungunya virus (CHIKV), and Yellow Fever Virus (YFV) are prevalent arboviruses in the Americas. Each of these infections is associated with the development of associated disease immunopathology. Immunopathological processes are an outcome of counter-balancing impacts between effector and regulatory immune mechanisms. In this context, regulatory T cells (Tregs) are key in modulating the immune response and, therefore, in tissue damage control. However, to date, Treg phenotypes and mechanisms during acute infection of the ZIKV in humans have not been fully investigated. The main aim of this work was to characterize Tregs and their immunological profile related to cytokine production and molecules that are capable of controlling the exacerbated inflammatory profile in acute Zika infected patients. Using whole blood analyses of infected patients, an ex vivo phenotypical characterization of Tregs, circulating during acute Zika virus infection, was conducted by flow cytometry. We found that though there are no differences in absolute Treg frequency between infected and healthy control groups. However, pro-inflammatory cytokine up-regulation such as IFN-γ and LAP was observed in the acute disease. Furthermore, acute ZIKV patients expressed increased levels of CD39/CD73, perforin/granzyme B, PD-1, and CTLA-4, all markers involved in mechanisms used by Tregs to attempt to control strong inflammatory responses. Thus, the data indicates a potential contribution of Tregs during the inflammatory ZIKV infection response.

Palmo-plantar hyperkeratosis associated with HTLV-1 infection: a case report.

BACKGROUND: Palmoplantar hyperkeratosis is a cutaneous manifestation that had not been clearly associated with infection by the human T-cell lymphotropic virus, which is a retrovirus that in most cases does not develop clinical pathologies and its symptoms may be undetected. The skin is one of the most affected organs, however until now only seborrheic dermatitis, xerosis/ichthyosis and infective dermatitis associated with HTLV-1 have been described as cutaneous clinical manifestations of this disease. CASE PRESENTATION: We present the case of a 36-year-old male patient with serologically documented HTLV-1 infection, who presented symptoms of diarrhea, malabsorption due to Strongyloides stercoralis, and in whom a physical examination revealed an association with generalized xerosis and palmoplantar keratoderma confirmed by skin biopsy. Other infectious etiologies and malignancy were ruled out. This clinical manifestation was managed with dermal hydration, and skin care which improved the thickened skin and make it less noticeable. CONCLUSIONS: According to our experience, this is the first reported case of palmoplantar keratoderma associated with a human lymphotropic virus infection. This is a skin manifestation that has not been confirmed in conjunction with HTLV-I before. This implies that palmoplantar keratoderma is a new clinical manifestation of this infection, that should be considered in the initial approach of patients in endemic areas with these dermatological characteristics.

Alcohol consumption and cause-specific mortality in Cuba: prospective study of 120 623 adults.

BACKGROUND: The associations of cause-specific mortality with alcohol consumption have been studied mainly in higher-income countries. We relate alcohol consumption to mortality in Cuba. METHODS: In 1996-2002, 146 556 adults were recruited into a prospective study from the general population in five areas of Cuba. Participants were interviewed, measured and followed up by electronic linkage to national death registries until January 1, 2017. After excluding all with missing data or chronic disease at recruitment, Cox regression (adjusted for age, sex, province, education, and smoking) was used to relate mortality rate ratios (RRs) at ages 35-79 years to alcohol consumption. RRs were corrected for long-term variability in alcohol consumption using repeat measures among 20 593 participants resurveyed in 2006-08. FINDINGS: After exclusions, there were 120 623 participants aged 35-79 years (mean age 52 [SD 12]; 67 694 [56%] women). At recruitment, 22 670 (43%) men and 9490 (14%) women were current alcohol drinkers, with 15 433 (29%) men and 3054 (5%) women drinking at least weekly; most alcohol consumption was from rum. All-cause mortality was positively and continuously associated with weekly alcohol consumption: each additional 35cl bottle of rum per week (110g of pure alcohol) was associated with ∼10% higher risk of all-cause mortality (RR 1.08 [95%CI 1.05-1.11]). The major causes of excess mortality in weekly drinkers were cancer, vascular disease, and external causes. Non-drinkers had ∼10% higher risk (RR 1.11 [1.09-1.14]) of all-cause mortality than those in the lowest category of weekly alcohol consumption (<1 bottle/week), but this association was almost completely attenuated on exclusion of early follow-up. INTERPRETATION: In this large prospective study in Cuba, weekly alcohol consumption was continuously related to premature mortality. Reverse causality is likely to account for much of the apparent excess risk among non-drinkers. The findings support limits to alcohol consumption that are lower than present recommendations in Cuba. FUNDING: Medical Research Council, British Heart Foundation, Cancer Research UK, CDC Foundation (with support from Amgen).

Tercer caso de vasculitis leucocitoclástica cutánea secundaria al uso de oxacilina: reporte de caso / Third case in the literature of cutaneous leukocytoclastic vasculitis secondary to oxacilin use

Resumen La vasculitis leucocitoclastica es una patologìa que compromete los vasos pequeños y cuya causa predominantemente se ha descrito como idiopatica. Se presenta el caso de una mujer de 78 años hipertensa, diabética y con enfermedad renal crónica en estadio 5, que presentó lesiones limitadas a la piel posterior a la administración de oxacilina para manejo de bacteremia por SAMS. La presentación clínica se basó en purpuras palpables predominantemente en miembros inferiores y lesiones dolorosas coalescentes que formaban ampollas de contenido hemorrágico. Estas lesiones resolvieron gradualmente después del cambio de la terapia mencionada anteriormente. La biopsia fue compatible con vasculitis leucocitoclástica, con paraclínicos que descartaron causas infecciosas y autoinmunes.

Abstract Leukocytoclastic vasculitis is a pathology that involves small vessels and whose cause has been predominantly described as idiopathic. The clinical case of a 78-year-old woman with hypertension, diabetic and chronic stage 5 kidney disease, who presented limited skin lesions after administration of oxacillin for management of bacteremia by MSSA. The clinical presentation consisted on palpable purpura predominantly in the lower limbs and painful coalescent lesions that formed blisters of hemorrhagic content. Lesions gradually resolved after the change of the therapy mentioned above. The biopsy was compatible with leukocytocastic vasculitis, with paraclinics who ruled out infectious and autoimmune causes.

Criptococosis y linfocitopenia T CD4 idiopática: Reporte de un caso / Cryptococcosis and idiopathic CD4 T lymphocytopenia: A case report

Resumen La linfocitopenia T CD4 idiopática (LCI) es un síndrome clínico inusual que se caracteriza por un déficit de células T CD4+ circulantes en ausencia de infección por VIH u otra condición de inmunosupresión. Los pacientes con dicha enfermedad pueden presentarse asintomáticos o con infecciones oportunistas, las más frecuentes son por criptococo, micobacterias o virales como herpes zoster. Presentamos el caso de un hombre de 32 años, sin antecedentes, en quien se descartó infección por retrovirus, con recuento de linfocitos T CD4+ menor a 300 células/m3; se diagnosticó LCI posterior al diagnóstico de criptococomas cerebrales mediante hallazgos imagenológicos los cuales fueron congruentes con estudios microbiológicos.

Summary Idiopathic CD4 T lymphocytopenia (ICL) is an unusual clinical syndrome characterized by a deficit of circulating CD4 + T cells in the absence of HIV infection or another immunosuppression condition. Patients with this disease may present asymptomatic or with opportunistic infections, the most frequent are cryptococcus, mycobacteria or viral such as herpes zoster. We present a case of a 32-year-old man with no prior disease, in whom retrovirus infection was discarded, with CD4 + T lymphocyte count less than 300 cells/m3; ICL was diagnosed after the diagnosis of brain cryptococomas by imaging findings which were consistent with microbiological studies.

Mortality in civilian trauma patients and massive blood transfusion treated with high vs low plasma: red blood cell ratio. Systematic review and meta-analysis / Mortalidad en pacientes con trauma civil y transfusion masiva tratados con una relación alta de plasma: globulos rojos versus una relacion baja. Revision sistemática y metaanálisis

Abstract Introduction: Massive bleeding in civilian trauma patients leads to dilutional coagulopathy. Transfusion with high plasma:red blood cell (RBC) ratio has been effective in reducing mortality in war trauma patients. However, in civilian trauma the evidence is controversial. Objective: To assess the impact on mortality of high vs low plasma:RBC ratio transfusion, in civilian trauma patients with massive bleeding. Methods: A systematic review and meta-analysis, including observational studies and clinical trials, was conducted. Data bases were systemically searched for relevant studies between January 2007 and June 2019. The main outcome was early (24-hours) and late (30-day) mortality. Fixed and random effects models were used. Results: Out of 1295 studies identified, 33 were selected: 2 clinical trials and 31 observational studies. The analysis of observational trials showed both decreased early mortality (odds ratio [OR] 0.67; 95% confidence interval [CI], 0.60-0.75) and late mortality (OR 0.79; 95% CI, 0.71-0.87) with the use of high plasma:RBC ratio transfusion, but there were no differences when clinical trials were evaluated (OR 0.89; 95% CI, 0.64-1.26). The exclusion of patients who died within the first 24 hours was a source of heterogeneity. The Injury Severity Score (ISS) altered the association between high plasma:RBC ratio and mortality, with a reduced protective effect when the ISS was high. Conclusion: The use of high vs low plasma: RBC ratio transfusion, in patients with massive bleeding due to civil trauma, has a protective effect on early and late mortality in observational studies. The exclusion of patients who died within the first 24 hours was a source of heterogeneity.

Resumen Introducción: El sangrado masivo en los pacientes con trauma civil propicia el desarrollo de coagulopatía dilucional. La transfusión de plasma y glóbulos rojos con una relación alta ha sido efectiva para disminuir la mortalidad en pacientes con trauma de guerra; sin embargo, su evidencia en trauma civil es controversial. Objetivo: Evaluar el efecto sobre la mortalidad de la transfusión de plasma: glóbulos rojos con relación alta (TPGR-RA) versus baja, en pacientes con sangrado masivo por trauma civil. Métodos: Se realizó una revisión sistemática y metaanálisis de estudios observacionales y experimentos clínicos publicados en el periodo de enero de 2007 a junio de 2019. El desenlace principal fue mortalidad temprana (24 horas) y tardía (30 días), utilizando el modelo de efectos fijos y aleatorios. Resultados: De 1.295 estudios identificados se incluyeron 33: dos experimentos clínicos y 31 estudios observacionales. El uso de TPGR-RA mostró una disminución de la mortalidad temprana (OR 0,67; IC 95 %, 0,60-0,75) y tardía (OR 0,79; IC 95 %, 0,71-0,87) cuando se analizaron los estudios observacionales, pero no hubo diferencias cuando se evaluaron los experimentos clínicos (OR 0,89; IC 95 %, 0,64-1,26). La exclusión de pacientes que fallecieron en las primeras 24 horas fue una fuente de heterogeneidad. La gravedad del trauma, ISS (por las iniciales en inglés de injury severity score)modificó la asociación entre la TPGR-RA y mortalidad, siendo menor el efecto protector cuando el ISS era alto. Conclusiones: El uso de TPGR-RA en pacientes con trauma civil y transfusión masiva (TM) tiene efecto protector sobre la mortalidad en los estudios observacionales. La exclusión de pacientes fallecidos en las primeras 24 horas fue causa de heterogeneidad.

Análisis de pacientes en diálisis peritoneal: factores clínico-epidemiológicos y tipo de transporte peritoneal con recambio hipertónico / Analysis of patients in peritoneal dialysis: clinical-epidemiologic factors and peritoneal transport type with

Resumen Introducción: la diálisis peritoneal ha sido una terapia efectiva para los pacientes con falla renal terminal. Objetivo: determinar las características de la población y el tipo de transporte peritoneal (utilizando una solución dializante hipertónica). Materiales y métodos: estudio descriptivo transversal en pacientes del Servicio de Nefrología del Hospital Escuela Universitario de Tegucigalpa, durante el período comprendido entre el 1 de octubre al 15 de noviembre de 2016. Resultados: la nefropatía diabética fue identificada como la causa de nefropatía crónica en 18 (42.9 %) pacientes; seguida de la nefropatía hipertensiva, con 14 (33.3 %), y la nefropatía mesoamericana, con 8 (19.0 %). El tipo de transporte peritoneal más frecuente fue el promedio alto, en 21 (50.0 %) de los pacientes; seguido del promedio bajo, con 12 (28.6 %); el transporte bajo, con 7 (16.7 %); y el transporte alto, con 2 (4.8 %). Discusión: en Centroamérica, durante los últimos años, ha habido un aumento de incidencia de la enfermedad renal en trabajadores provenientes de la costa pacífica, especialmente varones agricultores sin factores de riesgo. Esto constituye una epidemia de la nefropatía mesoamericana. Existe una relación entre el aumento de la transferencia de solutos y la disminución de la ultrafiltración con el paso del tiempo. Conclusiones: la nefropatía mesoamericana es una causa emergente de enfermedad en la región. No se encontró relación entre el tiempo prolongado de diálisis peritoneal, o el antecedente de peritonitis, y un transporte peritoneal bajo.

Abstract Introduction: Peritoneal dialysis has been an effective therapy in the management of patients with end-stage renal failure. Objective: To determine the characteristics of the population and the type of peritoneal transport using hypertonic dialyzing solution. Methods and Materials: Prospective and cross-sectional study in patients of the Nephrology Service of the Hospital Escuela Universitario of Tegucigalpa during the period from October 1 to November 15, 2016. Results: Diabetic nephropathy was associated as the cause of chronic kidney disease in 18 (42.9%) patients, followed by nephropathy hypertensive disease with 14 (33.3%) and Mesoamerican nephropathy with 8 (19.0%). The most frequent type of peritoneal transport was the high average in 21 (50.0%) of the patients, followed by the low average with 12 (28.6%), low transport with 7 (16.7%) and high transport with 2 (4.8%). Discussion: In Central America during the last years there has been an increase in the incidence of kidney disease in workers from the Pacific coast, especially male farmers with no risk factors, thus constituting the epidemic of Mesoamerican nephropathy. There is a relationship between the increase in solutes transfer and the decrease of the ultrafiltration with the passage of time. Conclusions: Mesoamerican nephropathy is an emerging cause of disease in the region. No relationship was found between prolonged peritoneal dialysis time or the history of peritonitis with low peritoneal transport.

Ferropenia sin anemia, más que un hallazgo de laboratorio / Ferropenia without anemia, more than a laboratory finding

El déficit de hierro sin anemia se encuentra presente en diversas patologías de la práctica clínica; sin embargo, se conoce poco sobre la importancia, las complicaciones y los beneficios de su tratamiento. Este artículo describe la evidencia actual sobre distintas vías fisiopatológicas, abordaje y tratamiento de las principales patologías relacionadas con la ferropenia sin anemia. Para ello se realizó una búsqueda completa y actualizada de la literatura científica en Medline, OVID, Lilacs, SciELO y EMBASE utilizando una estrategia definida con términos MeSH y no MeSH, limitado a español e inglés.

The deficit of iron without anemia is present in frequent pathologies of clinical practice, however, little is known about the importance, complications and benefits of the treatment. In this article, we describe an uptodate of the physiopathological pathways, the approach and treatment of the main pathologies related to iron deficiency without anemia. Methods; A complete and updated search of the scientific literature was made, in Medline, OVID, Lilacs, SciELO, EMBASE using a strategy defined with MeSH terms and not MeSH, limited to Spanish and English.