Cluster headache: an update on clinical features, epidemiology, pathophysiology, diagnosis, and treatment.

Cluster headache (CH) is one of the worst primary headaches that remain underdiagnosed and inappropriately treated. There are recent advances in the understanding of this disease and available treatments. This paper aims to review CH's recent clinical and pathophysiological findings, diagnosis, and treatment. We performed a narrative literature review on the socio-demographics, clinical presentations, pathophysiological findings, and diagnosis and treatment of CH. CH affects 0.1% of the population with an incidence of 2.07-9.8/100,00 person-years-habitants, a mean prevalence of 53/100,000 inhabitants (3-150/100,000 inhabitants). The male-to-female ratio remains inconclusive, as the ratio of 4.3:1 has recently been modified to 1.3-2.6, possibly due to previous misdiagnosis in women. Episodic presentation is the most frequent (80%). It is a polygenetic and multifactorial entity that involves dysfunction of the trigeminovascular system, the trigeminal autonomic reflex, and the hypothalamic networks. An MRI of the brain is mandatory to exclude secondary etiologies. There are effective and safe pharmacological treatments oxygen, sphenopalatine, and great occipital nerve block, with the heterogeneity of clinical trial designs for patients with CH divided into acute, transitional, or bridge treatment (prednisone) and preventive interventions. In conclusion, CH remains underdiagnosed, mainly due to a lack of awareness within the medical community, frequently causing a long delay in reaching a final diagnosis. Recent advances in understanding the principal risk factors and underlying pathophysiology exist. There are new therapeutic possibilities that are effective for CH. Indeed, a better understanding of this challenging pathology will continue to be a subject of research, study, and discoveries in its diagnostic and therapeutic approach.

Ejecución de una intervención educativa alimentaria en escolares, antes y durante el confinamiento por COVID-19 / Implementaton of an Educational Food Intervention in Schoolchildren, Before and During COVID-19 Confinement

Resumen Antecedentes: la pandemia y el confinamiento por COVID-19 modificaron las condiciones de vida de los escolares y sus familias. Objetivo: describir la ejecución de una intervención educativa alimentaria en escolares de la Institución Educativa Monseñor Gerardo Valencia Cano, Medellín, Colombia, antes y durante el confinamiento por COVID-19. Materiales y métodos: investigación cualitativa con apoyo de variables cuantitativas. La recolección y análisis de datos se hicieron con base en la teoría fundamentada. La población estuvo conformada por escolares y padres de familia de la Institución Educativa Monseñor Gerardo Valencia Cano. Antes de la COVID-19 se realizaron cuatro grupos focales y una encuesta semiestructurada a 416 estudiantes y sus padres de familia, y con 42 docentes se realizaron cuatro grupos focales más; estos se realizaron hasta alcanzar la saturación. Durante el confinamiento se aplicaron 237 encuestas a familias (escolares y padres). Se evaluó el estado nutricional. Resultados: el 37 % de los escolares entre tercero y séptimo grado tenía exceso de peso. Se logró identificar de manera participativa los factores de riesgo y protectores frente al exceso de peso, para definir una intervención educativa alimentaria desde y con los sujetos. Los nodos conceptuales de la intervención fueron alimentación saludable, métodos de cocción, preparación de alimentos saludables y alimentación para la prevención del exceso de peso y cáncer de colon. Conclusiones: el reconocimiento de las condiciones alimentarias antes y después del confinamiento de los escolares y sus familias, o del cambio de estas a lo largo de la intervención educativa, contribuyó a lograr coherencia entre las necesidades, objetivos educativos y metodologías implementadas. El hecho de tener reunidos en un mismo espacio (hogar) a los escolares y sus padres durante el confinamiento propició un microentorno favorecedor de conductas que motivaron una mejora de los hábitos alimentarios familiares.

Abstract: Background: The pandemic and COVID-19 confinement changed the living conditions of schoolchildren and their families. Objective: To describe the implementation of an educational food intervention in schoolchildren at the Monseñor Gerardo Valencia Cano Educational Institution, Medellín, Colombia, before and during the COVID-19confinement. Materials and Methods: Qualitative research supported by quantitative variables. Data collection and analysis were based on grounded theory. The population consisted of schoolchildren and parents of the Monseñor Gerardo Valencia Cano Educational Institution. Before COVID-19, four focus groups and a semi-structured survey were conducted with 416 students and their parents, and four more focus groups were conducted with 42 teachers; these were carried out until saturation was reached. During the confinement, 237 surveys were administered to families (students and parents). Nutritional status was evaluated. Results: 37% of the students between third and seventh grade were overweight. It was possible to identify in a participatory way the risk and protective factors against excess weight, in order to define an educational food intervention from and with the subjects. The conceptual nodes of the intervention were healthy eating, cooking methods, preparation of healthy food, and food for the prevention of excess weight and colon cancer. Conclusions: The recognition of the nutritional conditions before and after the confinement of the schoolchildren and their families, or the change of these throughout the educational intervention, helped to achieve coherence between the needs, educational objectives, and methodologies implemented. The fact of having schoolchildren and their parents gathered in the same space (home) during confinement generated a microenvironment that favored behaviors that triggered an improvement in family eating habits.

Manejo de un central deciduo retenido por trauma dental: a propósito de un caso / Management of a central deciduous tooth retained by dental trauma: A case study

Resumen Introducción: El trauma dentoalveolar es un tipo de afección muy común en niños, que en la mayoría de los casos involucra dientes, la porción alveolar del maxilar, la mandíbula y los tejidos blandos adyacentes. Pueden variar en cuanto a la extensión y gravedad llegando a afectar la funcionalidad e integridad de las estructuras orales, por lo que un diagnóstico correcto y tratamiento oportuno es necesario para evitar la generación de posibles secuelas en la dentición permanente. Objetivo: Reportar un caso de trauma dentoalveolar en un niño y su abordaje odontológico interdisciplinar. Presentación del caso: Paciente masculino de 7 años de edad, sin antecedentes relevantes, asiste a consulta con su madre por presentar persistencia de un diente temporal en sector anterosuperior, asociado a trauma dentoalveolar ocurrido a los 18 meses de vida aproximadamente. Se realiza exodoncia del diente temporal y tratamiento ortopédico para orientar la erupción del diente permanente, manifestando evolución favorable. Conclusiones: El abordaje interdisciplinario para los casos de trauma dento-alveolar constituye una buena alternativa para una adecuada rehabilitación y disminuye posibles secuelas.

Abstract Introduction: Dentoalveolar trauma is a common type of condition in children, which mostly affects the teeth, alveolar segment of the maxilla, mandibula and adjacent soft tissues. It can vary in terms of extension and severity, affecting the functionality and integrity of the oral structures. Therefore, a correct diagnosis and a timely treatment are necessary to avoid future sequelae in the permanent dentition. Objective: To report a case of dentoalveolar trauma in a child and its interdisciplinary dental approach. Case presentation: A 7-year-old male child with no relevant history attends a consultation with his mother due to the persistence of a temporary tooth in the anterosuperior sector. It is associated with dentoalveolar trauma that occurred when he was 18 months old. Exodontia and orthopedic treatment were performed on the temporary tooth to guide the eruption of the permanent tooth, showing a favorable evolution afterwards. Conclusions: An interdisciplinary approach for cases of dentoalveolar trauma constitutes an appropriate alternative for successful rehabilitation and reduces possible sequelae.

Nucleation and growth inhibition of biological minerals by cementum attachment protein-derived peptide (CAP-pi).

Biomineralization is a highly regulated process where proteins/peptides-crystal interactions contribute to the shaping, phasing and aggregation of minerals. We have identified and synthesized a cementum attachment protein-derived peptide (CAP-pi), which corresponds to amino acids 40-53 of the N-terminal CAP domain (MASSDEDGTNGGAS) and its phosphorylated variant (MASpSpDEDGTNGGASp) (CAP-pip). The peptide is composed of polar and negatively charged amino acids, which are disordered, according to in silico analysis. Our results show that CAP-pi inhibits hydroxyapatite (HA) formation and growth. However, it possesses low capacity to inhibit calcium oxalate crystal growth. CAP-pip showed a stronger inhibitory effect on the formation and growth of HA. As well as a high capacity to inhibit calcium oxalate monohydrate growth, mainly due to adsorption on specific growth faces. Small peptides have many advantages over the full-size protein, including low-cost production and modulation characteristics that allow for structural changes. Our findings suggest that CAP-pip-derived peptide could possess therapeutic potential to prevent or treat pathological calcifications such as renal stones and vascular calcification.

DNA barcoding and TLC as tools to properly identify natural populations of the Mexican medicinal species Galphimia glauca Cav.

Galphimia glauca is a plant that is endemic to Mexico and has been commonly used since pre-Hispanic times to treat various illnesses, including central nervous system disorders and inflammation. The first studies investigating a natural population of G. glauca in Mexico showed that the plant has anxiolytic and sedative activities in mice and humans. The plant's bioactive compounds were isolated and identified, and they belong to a family of nor-secofriedelanes called galphimines. The integration of DNA barcoding and thin-layer chromatography analysis was performed to clarify whether the botanical classification of the populations in the study, which were collected in different regions of Mexico, as G. glauca was correct or if the populations consist of more than one species of the genus Galphimia. We employed six DNA barcodes (matK, rbcL, rpoC1, psbA-trnH, ITS1 and ITS2) that were analyzed individually and in combination and then compared each other, to indicate differences among the studied populations. In the phylogenetic analysis, ITS1 and ITS2 markers as well as the combination of all DNA regions were the most efficient for discriminating the population studied. The thin-layer chromatography analysis exhibited four principal chemical profiles, one of which corresponded to the populations that produced galphimines. DNA barcoding was consistent and enabled us to differentiate the populations that produce galphimines from those that do not. The results of this investigation suggest that the studied populations belong to at least four different species of the genus Galphimia. The phylogenetic analysis and the thin-layer chromatography chemical profiles were convenient tools for establishing a strong relationship between the genotype and phenotype of the studied populations and could be used for quality control purposes to prepare herbal medicines from plants of the genus Galphimia.

Bovine Lactoferrin and Lactoferrin-Derived Peptides Inhibit the Growth of Vibrio cholerae and Other Vibrio species.

Vibrio is a genus of Gram-negative bacteria, some of which can cause serious infectious diseases. Vibrio infections are associated with the consumption of contaminated food and classified in Vibrio cholera infections and non-cholera Vibrio infections. In the present study, we investigate whether bovine lactoferrin (bLF) and several synthetic peptides corresponding to bLF sequences, are able to inhibit the growth or have bactericidal effect against V. cholerae and other Vibrio species. The antibacterial activity of LF and LF-peptides was assessed by kinetics of growth or determination of colony forming unit in bacteria treated with the peptides and antibiotics. To get insight in the mode of action, the interaction between bLF and bLF-peptides (coupled to FITC) and V. cholera was evaluated. The damage of effector-induced bacterial membrane permeability was measured by inclusion of the fluorescent dye propidium iodide using flow cytometry, whereas the bacterial ultrastructural damage in bacteria treated was observed by transmission electron microscopy. The results showed that bLF and LFchimera inhibited the growth of the V. cholerae strains; LFchimera permeabilized the bacteria which membranes were seriously damaged. Assays with a multidrug-resistant strain of Vibrio species indicated that combination of sub-lethal doses of LFchimera with ampicillin or tetracycline strongly reduced the concentration of the antibiotics to reach 95% growth inhibition. Furthermore, LFchimera were effective to inhibit the V. cholerae counts and damage due to this bacterium in a model mice. These data suggest that LFchimera and bLF are potential candidates to combat the V. cholerae and other multidrug resistant Vibrio species.

Tres variedades de sarcoma de Kaposi con compromiso gastrointestinal / Three varieties of Kaposi’s sarcoma with gastrointestinal involvement

Se presentan casos de 4 pacientes adultos con 3 variedades de sarcoma de Kaposi: epidémico (asociado con infección por virus de inmunodeficiencia humana), iatrogénico (en paciente con inmunosupresión crónica y en un hombre con cirrosis alcohólica) y clásico (en paciente anciana sin inmunosupresión conocida); todos ellos presentaron compromiso gastrointestinal. Se hace una breve revisión de esta enfermedad.

This article presents the cases of four adult patients with three varieties of Kaposi’s sarcoma: epidemic, associated with human immunodeficiency virus infections; iatrogenic, associated with chronic immune suppression (and in this case in a man with alcoholic cirrhosis); and classic, occurring in elderly patient without previously known immunosuppression. All four cases had gastrointestinal involvement. A brief review of the disease is included.

Perfil neuropsicológico en transexuales: efecto del tratamiento de reasignación de sexo / Neuropsychological profile in transsexuals: effect of sex reassignment treatment

Las funciones cognitivas, como el aprendizaje, la memoria y las funciones ejecutivas, son afectadas por las hormonas esteroides sexuales. El objetivo fue evaluar el perfil cognoscitivo en personas transexuales hombre a mujer (TH-M) en presencia y ausencia de tratamiento hormonal con estrógenos. Participaron un total de 54 sujetos. El grupo experimental fue de 22 pacientes TH-M, dividido en dos grupos: con tratamiento hormonal (n=9) y sin tratamiento hormonal (n=13). El grupo control fue conformado por hombres (n=16) y mujeres (n=16), pareados en edad y escolaridad. Evaluados con la batería NEUROPSI: Atención y Memoria (Ostrosky-Solís, Gómez, Matute, Roselli, Ardila & Pineda, 2003). Los grupos transexuales tuvieron mejores puntajes que los controles en atención inmediata y en formación de categorías, pero mostraron menores puntajes que los controles en codificación de material visoespacial y de caras, en memoria verbal inmediata y evocada. Se encontraron correlaciones negativas entre meses de tratamiento y la codificación visoespacial, memoria para caras y memoria verbal. Los resultados sugieren que las hormonas sexuales tienen efectos organizadores y activadores sobre la cognición.

Mental functions, including learning, executive functions and memory, are susceptible to be affected by sexual steroids hormones. The objective was to evaluate the cognitive profile of transsexual’s male to female (TM-F) in presence and absence of hormonal treatment with estrogens. A total of 54 subjects participated. The experimental group was conformed by 22 patients in condition transsexual male to female, divided in two groups: with hormonal treatment (n=9) and without hormonal treatment (n=13). The control group was conformed by heterosexual men (n=16) and women (n=16) paired in age and schooling to the experimental group. Subjects were evaluated by a comprehensive neuropsychological battery, NEUROPSI: Attention and Memory (Ostrosky-Solís, Gómez, Matute, Roselli, Ardila & Pineda, 2003). Transsexual’s groups performed better than controls in immediate attention, category formation, but worse than controls in visuospatial codification, faces, recall and immediate verbal memory. Negative correlations were founded between treatment months in visuospatial codification, faces, and verbal memory.

Colecistectomía laparoscópica en pacientes mayores de 60 años: experiencia de un hospital de tercer nivel / laparoscopic cholecystectomy in patients age 60 years or older: report of a tertiary level hospital

Introducción: se presenta la experiencia en colecistectomía laparoscópica en 61 pacientes mayores de 60 años en un periodo de cinco años.Material y método: los pacientes femeninos fueron 41 (67.2 por ciento) y 20 masculinos (32.7 por ciento), los márgenes de edad fueron 37 pacientes de 60 a 70 años y 24 pacientes mayores de 71 años, la cirugía fue electiva en 57 pacientes (93.4 por ciento) y de urgencia en cuatro pacientes (6.5 por ciento).Dentro de los antecedentes hubo 15 pacientes con Diabetes mellitus 2, 14 con hipertensión arterial y 20 con otras enfermedades. Resultados: a cuatro pacientes se les diagnosticó coledocolitiasis por colangiografía y un caso presentó ictericia a los seis meses del postoperatorio.Se presentaron en tres casos conversión a cirugía abierta (4.9 por ciento), dos por hemorragia de lecho hepático y uno por fuga biliar del cístico por mala colocación de grapa.Las complicaciones en siete pacientes (11.4 por ciento) fueron bradicardia postoperatoria, hemorragia de lecho hepático, alteración metabólica y dolor precordial.La estancia intrahospitalaria fue en promedio de 48 hrs, el regreso a las actividades cotidianas fue en promedio de siete días. Los reportes de patología fueron 45 con colesterolosis y colecistitis crónica litiásica, 10 con colecistitis aguda litiásica, tres con colecistitis purulenta, y tres con otros como pólipo vesicular e hidrocolecisto.Discusión: los pacientes mayores de 60 años presentaron mayor riesgo de complicación por la posibilidad de descompensación metabólica, sin embargo, la cirugía laparoscópica disminuyó este riesgo, por lo que se debe considerar como la vía quirúrgica de elección para patología vesicular.

Endometriosis apendicular como causa de síndrome abdominal agudo en la mujer: presentación de dos casos y revisión de la literatura / Appendices endometriosis as a cause of acute abdomen syndrome in women: presentation of two cases and review of the literature

Antecedentes: la endometriosis intestinal es una causa de síndrome abdominal agudo en la mujer, sus implantes incluyen: intestino delgado, epiplón y colon. Los sitios más frecuentes son recto y colon sigmoides 88 por ciento, y en menor frecuencia el apéndice cecal en 9 por ciento.La endometriosis dentro de su fisiopatología produce una reacción esclerosante en la pared intestinal que causa estrechez intraluminal.Objetivo: demostrar la frecuencia de endometriosis apendicular como etiología de síndrome abdominal agudo en la mujer en su manejo quirúrgico por cirujanos generales.Caso 1. Femenina de 30 años de edad, dismenorreica con cuadro de síndrome abdominal agudo localizado en fosa ilíaca derecha y con datos francos de irritación peritoneal y datos apendiculares presentes, alzas térmicas, laboratorio con leucocitosis y neutrofilia, radiografías de abdomen con asas de delgado y niveles hidroaéreos.Se realiza apendectomía con reporte histopatológico de endometriosis apendicular y tratamiento posterior con danazol.Caso 2. Femenina de 20 años de edad, eumenorréica con síndrome abdominal agudo de localización, en fosa ilíaca derecha, con datos apendiculares presentes, leucocitosis y neutrofilia. Se realiza apendectomía y salpingectomía derecha y tratamiento posoperatorio a base de danazol.Resultados: La frecuencia de endometriosis apendicular como etiología de apendicitis aguda se encuentra en sólo dos casos en un lapso de 5 años.Discusión: se recomienda realizar apendicectomía incidental en grupos de mujeres con síndrome abdominal agudo localizado en fosa iliaca derecha, dentro de sus etiologías poco frecuentes se encuentra la endometriosis intestinal.Se concluye que la endometriosis intestinal puede estar presente en dos manifestaciones clínicas, la más común como enfermedad crónica, la segunda y más rara como enfermedad quirúrgica aguda que requiere de resolución inmediata.