Experiences of COVID-19-Recovered Healthcare Workers in a Tertiary Hospital in the Philippines: A Mixed-Method Inquiry.

COVID-19 pandemic affected the mental health of the global population. Among the most vulnerable are the healthcare workers (HCWs) who got infected but returned to the frontline after recovery. Currently, there is a dearth of information and understanding on the psychological status and actual lived experience of the recovered HCWs in the Philippines. The present study investigated the psychological status and experiences of 93 COVID-19-recovered HCWs from a tertiary hospital in the Philippines using a mixed-method approach, particularly the explanatory-sequential design. Participants completed the Impact of Event Scale-Revised, and the Depression, Anxiety, and Stress Scale-21 in the quantitative phase. Selected participants took part in focus group discussions in the qualitative phase. Integrated results showed that our participants experienced significant COVID-19-related distress (mean IES-R score = 25.5; partial impact), anxiety (mean subscale score = 7.4; mild), and depression (mean subscale score = 8.1; mild). Certain sociodemographic and professional characteristics and the length of quarantine days appear to affect the psychometric scores. The quantitative results are supported by the participant's description of recovery experiences as living in uncertainty, distress, fatigue, dissociation, and valuation of life. In summary, adequate psychological support and intervention program should be prioritized and provided by hospital management for recovered HCWs to prevent the development of more serious mental health concerns that may significantly affect their tasks in caring for patients and in-hospital management.

Direct maxillary irrigation therapy in non-operated chronic sinusitis: a prospective randomised controlled trial.

OBJECTIVE: This study aimed to compare the effectiveness of pharmacological therapy with and without direct maxillary sinus saline irrigation for the management of chronic rhinosinusitis without polyps. METHODS: In this prospective randomised controlled trial, 39 non-operated patients were randomly assigned to be treated with direct maxillary sinus saline irrigation in conjunction with systemic antibiotics and topical sprays (n = 24) or with pharmacological therapy alone (n = 15). Endoscopy, Sino-Nasal Outcome Test and Lund-MacKay computed tomography scores were obtained before, six weeks after and one to two years after treatment. RESULTS: Post-treatment Lund-Mackay computed tomography scores were significantly improved in both cohorts, with no inter-cohort difference identified. Post-treatment nasal endoscopy scores were significantly improved in the study group but were similar to those measured in the control group. The Sino-Nasal Outcome Test-20 results showed improvement in both cohorts, with no difference between treatment arms. CONCLUSION: Maxillary sinus puncture and irrigation with saline, combined with pharmacological treatment improves endoscopic findings in patients with chronic rhinosinusitis without polyps, but has no beneficial effect on symptoms and imaging findings over conservative treatment alone.

Estimates of pedestrian exposure to atmospheric pollution using high-resolution modelling in a real traffic hot-spot.

Atmospheric pollution is a very relevant risk for the human health, in particular in urban environments, where most people lives and high levels of pollution are found. Population exposure is traditionally estimated through concentration recorded at air quality monitoring stations (AQMS) or modelled at a spatial resolution of the order of 1 km2. However, these methodologies have limitations in urban areas where strong gradients of concentration, even in the same street, exist. In addition, the movements of pedestrians make difficult to compute reliable estimates of pollutant concentration to which people are exposed to. In this context, the main objective of this study is to estimate the exposure of pedestrians to ambient nitrogen oxides (NOx) concentrations with high spatial resolution in a real urban traffic hot-spot under different methodologies. To achieve this objective, a novel methodology which combines high-resolution NOx concentrations from computational fluid dynamic (CFD) simulations with the pedestrian flows obtained by pedestrian mobility microsimulations is applied to an urban area of Madrid, Spain. High-resolution maps show pedestrian exposure peaks, at bus stops and crosswalks, that cannot be captured by the simpler methods based on spatial average concentration (SAC) or concentration measured in an AQMS. Total daily exposure obtained is 1.19 · 109 person s µg m-3, while SAC and AQMS concentration methods yielded 9-23% and 30-40% lower values. In conclusion, the proposed methodology allows to determine the areas with higher exposure in order to design local strategies to reduce the impact on human health. In addition, from a more general point of view, the total exposure in the studied area is better estimated by using spatial average concentration than through concentration recorded by AQMS. The assessment of the spatial representative of AQMS becomes necessary to use AQMS concentration to evaluate air quality and population exposure of an urban area.

Attenuation of carrageenan-induced hind paw edema and plasma TNF-α level by Philippine stingless bee (Tetragonula biroi Friese) propolis.

Despite decades-long existence of the Philippine stingless bee industry, the biological activity of propolis from this native bee species (Tetragonula biroi Friese) remains poorly understood and sparingly investigated. Herein, we examined the potential anti-inflammatory efficacy of Philippine stingless bee propolis using the lambda (λ)-carrageenan-induced mice model of hind paw edema. Thirty (30), six-week-old, male ICR mice were randomly assigned into three treatment groups (n=10/group) as follows: distilled water group, diclofenac sodium group (10 mg/kg), and propolis group (100 mg/kg). All treatment were administered an hour prior to the injection of the phlogistic agent. As observed at 3 h post-injection, λ-carrageenan remarkably evoked the classical signs of hind paw edema exemplified grossly by swelling and hyperemia. The ameliorative effect of propolis became apparent at the onset of 6 h post-injection with a statistically significant finding evident at the 24-h period. This gross attenuation histologically correlated to a considerable and specific reduction of the dermal edema, which mirrored those of the diclofenac sodium group. Furthermore, both propolis and diclofenac sodium significantly attenuated the λ-carrageenan-induced increase in the protein expression levels of the pro-inflammatory cytokine tumor necrosis factor-α (TNF-α) depicting more than two-fold decrement relative to the distilled water group. Altogether, these suggest that Philippine stingless bee propolis also exhibited a promising in vivo anti-inflammatory property, which can be partly mediated through the inhibition of TNF-α.

Incidence and characteristics of nosocomial influenza in a country with low vaccine coverage.

BACKGROUND: Influenza vaccination coverage is low in France, in at-risk patients and in healthcare workers. AIM: We aimed to estimate the incidence of nosocomial influenza, its characteristics and outcome. METHODS: During one influenza season, we retrospectively evaluated all cases of documented influenza. Inpatients with symptoms onset ≥48 h after admission were enrolled. Data were collected on a standardized questionnaire. RESULTS: From November 2017 to April 2018, 860 patients tested positive for influenza by polymerase chain reaction analysis on a respiratory sample. Among them, 204 (23.7%) were diagnosed ≥48 h after admission, of whom 57 (6.6% of all influenza cases) fulfilled inclusion criteria for nosocomial influenza: 26 women and 31 men, median age 82 years (interquartile range, 72.2-86.9). Twenty patients (38.6%) had recently (<6 months) received the seasonal influenza vaccine. Median time between admission and symptoms onset, and between symptoms onset and diagnosis were, respectively, 11 days (7-19.5) and 29 h (15.5-48). Influenza was mostly acquired in a double-bedded room (N = 39, 68.4%), with documented exposure in 14 cases. Influenza B virus was more common in nosocomial (46/57, 80.7%), than in community-acquired cases (359/803, 44.6%), P<0.001. Mortality rate at three months was 15.8% (N = 9). Incidence of nosocomial influenza was estimated at 0.22 per 1000 hospital-days during the study period. CONCLUSION: Nosocomial influenza is not rare in elderly inpatients, and may have severe consequences. Influenza B virus was over-represented, which suggests higher transmissibility and/or transmission clusters.

Systematic genetics and single-cell imaging reveal widespread morphological pleiotropy and cell-to-cell variability.

Our ability to understand the genotype-to-phenotype relationship is hindered by the lack of detailed understanding of phenotypes at a single-cell level. To systematically assess cell-to-cell phenotypic variability, we combined automated yeast genetics, high-content screening and neural network-based image analysis of single cells, focussing on genes that influence the architecture of four subcellular compartments of the endocytic pathway as a model system. Our unbiased assessment of the morphology of these compartments-endocytic patch, actin patch, late endosome and vacuole-identified 17 distinct mutant phenotypes associated with ~1,600 genes (~30% of all yeast genes). Approximately half of these mutants exhibited multiple phenotypes, highlighting the extent of morphological pleiotropy. Quantitative analysis also revealed that incomplete penetrance was prevalent, with the majority of mutants exhibiting substantial variability in phenotype at the single-cell level. Our single-cell analysis enabled exploration of factors that contribute to incomplete penetrance and cellular heterogeneity, including replicative age, organelle inheritance and response to stress.

Unexpected increase in the oxidation capacity of the urban atmosphere of Madrid, Spain.

Atmospheric oxidants such as ozone (O3), hydroxyl and nitrate radicals (OH and NO3) determine the ability of the urban atmosphere to process organic and inorganic pollutants, which have an impact on air quality, environmental health and climate. Madrid city has experienced an increase of 30-40% in ambient air O3 levels, along with a decrease of 20-40% in NO2, from 2007 to 2014. Using air pollution observations and a high-resolution air quality model, we find a large concentration increase of up to 70% and 90% in OH and NO3, respectively, in downtown Madrid (domain-wide average increase of 10% and 32% for OH and NO3, respectively). The results also show an 11% reduction in the nitric acid concentrations, leading to a remarkable denoxification of this urban atmosphere with implications for lower PM2.5 levels and nitrogen input into ecosystems. This study suggests that projected worldwide NOx emission reductions, following air quality standards, will lead to important changes in the oxidizing capacity of the atmosphere in and around large cities.

Evaluation of a CFD-based approach to estimate pollutant distribution within a real urban canopy by means of passive samplers.

The distribution of pollutants is spatially heterogeneous within urban streets making difficult to build a realistic concentration map. In this paper, a methodology based on computational fluid dynamic modeling with Reynolds-averaged Navier-Stokes approach is used to compute maps of concentration for a period of several weeks. The methodology is evaluated by comparing simulation results against experimental data from two different campaigns where a large number of passive samplers deployed in an area with heavy vehicular traffic in Madrid (Spain). The evaluation shows that the methodology is able to reproduce the general pattern of several-week averaged pollutant distribution in an urban area with heavy vehicular traffic, resolving the spatial variability up to a resolution of 1-2m. In addition, the model results fit satisfactorily the time evolution of the pollutant concentration measured at an air quality station deployed in the studied area. However, problems were detected close to zones with complex emissions patterns (tunnels, street forks, etc.), where the model compared poorly against passive sampler measurements. A preliminary assessment of the uncertainties induced in the numerical methodology due to consider NO2 as non-reactive pollutant under winter conditions indicates that it would be an acceptable approach for this particular case study. Overall, our analysis contributes to raise the confidence in that approached similar to the one presented in this study can be adopted for dealing with several aspects of the air quality management such as air quality assessment, optimization of the location of measurement stations, and the evaluation of air pollution reduction strategies.

Circulating Cd34+ cell count differentiates primary myelofibrosis from other Philadelphia-negative myeloproliferative neoplasms: a pragmatic study.

A high number of circulating CD34+ cells has been advocated to distinguish primary myelofibrosis from other Philadelphia-negative myeloproliferative neoplasms. We re-evaluated the diagnostic interest of measuring circulating CD34+ cells in 26 healthy volunteers and 256 consecutive patients at diagnosis for whom a myeloproliferative neoplasm was suspected. The ROC curve analysis showed that a number of CD34+ <10/µl excludes the diagnosis of primary myelofibrosis with a sensitivity of 97 % and a specificity of 90 % (area under the curve: 0.93 [0.89-0.98]; p < 0.001). Patients with PMF harboring a CALR mutation had more circulating CD34+ cells than patients with either a JAK 2 or MPL mutation (p = 0.02 and p < 0.01, respectively). These results suggest that this fast, simple, non-invasive, and standardized test is of particular interest to exclude the diagnosis of primary myelofibrosis.

Nonperfect mixing affects synchronization on a large number of chemical oscillators immersed in a chemically active time-dependent chaotic flow.

The problem of synchronization of finite-size chemical oscillators described by active inertial particles is addressed for situations in which they are immersed in a reacting nonstationary chaotic flow. Active substances in the fluid will be modeled by Lagrangian particles closely following the fluid streamlines. Their interaction with the active inertial particles as well as the properties of the fluid dynamics will result in modifying the synchronization state of the chemical oscillators. This behavior is studied in terms of the exchange rate between the Lagrangian and inertial particles, and the finite-time Lyapunov exponents characterizing the flow. The coherence of the population of oscillators is determined by means of the order parameter introduced by Kuramoto. The different dynamics observed for the inertial particles (chemical oscillators) and Lagrangian particles (describing chemicals in the flow) lead to nonlinear interactions and patches of synchronized regions within the domain.

Neural regeneration dynamics of Xenopus laevis olfactory epithelium after zinc sulfate-induced damage.

Neural stem cells (NSCs) of the olfactory epithelium (OE) are responsible for tissue maintenance and the neural regeneration after severe damage of the tissue. In the normal OE, NSCs are located in the basal layer, olfactory receptor neurons (ORNs) mainly in the middle layer, and sustentacular (SUS) cells in the most apical olfactory layer. In this work, we induced severe damage of the OE through treatment with a zinc sulfate (ZnSO4) solution directly in the medium, which resulted in the loss of ORNs and SUS cells, but retention of the basal layer. During recovery following injury, the OE exhibited increased proliferation of NSCs and rapid neural regeneration. After 24h of recovery, new ORNs and SUS cells were observed. Normal morphology and olfactory function were reached after 168h (7 days) of recovery after ZnSO4 treatment. Taken together, these data support the hypothesis that NSCs in the basal layer activate after OE injury and that these are sufficient for complete neural regeneration and olfactory function restoration. Our analysis provides histological and functional insights into the dynamics between olfactory neurogenesis and the neuronal integration into the neuronal circuitry of the olfactory bulb that restores the function of the olfactory system.

Obesity induced by cafeteria diet disrupts fertility in the rat by affecting multiple ovarian targets.

Obesity constitutes a health problem of increasing worldwide prevalence. Among the health detriments caused by obesity, reproduction is disrupted. However, the mechanisms involved in this disruption are not fully understood. Animals fed a cafeteria diet constitute the model for the study of obesity that most closely reflects Western diet habits. The aims of this study were to evaluate whether a cafeteria diet affects ovarian function and to contribute to the understanding of the mechanisms involved. For that purpose, 22-day-old female Wistar rats were fed ad libitum with a standard diet (control group; n = 20) or cafeteria diet (CAF group; n = 20). The cafeteria diet induced obesity and hyperglycaemia, without altering serum triglycerides, cholesterol or C-reactive protein concentrations. This diet also altered ovarian function: the rats showed prolonged dioestrous phases, decreased serum oestradiol concentrations and increased number of antral atretic follicles. Moreover, follicular cysts were detected in the CAF group, concomitantly with a decrease in the number of anti-Müllerian hormone immunoreactive pre-antral follicles and COX-2-positive antral and pre-ovulatory follicles. The authors conclude that a cafeteria diet reduces ovarian reserve, induces the presence of follicular cysts and disturbs the ovulatory process, leading to the delayed pregnancy observed in these animals.

The Use of Donation After Cardiac Death Allografts Does Not Increase Recurrence of Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) recurrence in patients undergoing liver transplantation (LT) with donation after brain death (DBD) and donation after cardiac death (DCD) allografts has not previously been investigated. Rates and patterns of HCC recurrences were investigated in patients undergoing DBD (N = 1633) and DCD (N = 243) LT between 2003 and 2012. LT for HCC was identified in 397 patients (340 DBD and 57 DCD). No difference in tumor number (p = 0.26), tumor volume (p = 0.34) and serum alphafetoprotein (AFP) (p = 0.47) was seen between the groups. HCC recurrence was identified in 41 (12.1%) patients in the DBD group and 7 (12.3%) patients in the DCD group. There was no difference in recurrence-free survival (p = 0.29) or cumulative incidence of HCC recurrence (p = 0.91) between the groups. Liver allograft was the first site of recurrence in 22 (65%) patients in the DBD group and two (37%) patients in the DCD group (p = 0.39). LT for HCC with DBD and DCD allografts demonstrate no difference in the rate of HCC recurrence. Previously published differences in survival demonstrated between recipients with HCC receiving DBD and DCD allografts despite statistical adjustment can likely be explained by practice patterns not captured by variables contained in the SRTR database.

Curcumin ameliorates autoimmune diabetes. Evidence in accelerated murine models of type 1 diabetes.

Type 1 diabetes (T1DM) is a T cell-mediated autoimmune disease that selectively destroys pancreatic ß cells. The only possible cure for T1DM is to control autoimmunity against ß cell-specific antigens. We explored whether the natural compound curcumin, with anti-oxidant and anti-inflammatory activities, might down-regulate the T cell response that destroys pancreatic ß cells to improve disease outcome in autoimmune diabetes. We employed two accelerated autoimmune diabetes models: (i) cyclophosphamide (CYP) administration to non-obese diabetic (NOD) mice and (ii) adoptive transfer of diabetogenic splenocytes into NODscid mice. Curcumin treatment led to significant delay of disease onset, and in some instances prevented autoimmune diabetes by inhibiting pancreatic leucocyte infiltration and preserving insulin-expressing cells. To investigate the mechanisms of protection we studied the effect of curcumin on key immune cell populations involved in the pathogenesis of the disease. Curcumin modulates the T lymphocyte response impairing proliferation and interferon (IFN)-γ production through modulation of T-box expressed in T cells (T-bet), a key transcription factor for proinflammatory T helper type 1 (Th1) lymphocyte differentiation, both at the transcriptional and translational levels. Also, curcumin reduces nuclear factor (NF)-κB activation in T cell receptor (TCR)-stimulated NOD lymphocytes. In addition, curcumin impairs the T cell stimulatory function of dendritic cells with reduced secretion of proinflammatory cytokines and nitric oxide (NO) and low surface expression of co-stimulatory molecules, leading to an overall diminished antigen-presenting cell activity. These in-vitro effects correlated with ex-vivo analysis of cells obtained from curcumin-treated mice during the course of autoimmune diabetes. These findings reveal an effective therapeutic effect of curcumin in autoimmune diabetes by its actions on key immune cells responsible for ß cell death.

[Classification of urinary calculi in a pediatric population from Brittany]. / Proposition de "profils types" des calculs urinaires dans une population pédiatrique bretonne.

INTRODUCTION: Urinary lithiasis in children is relatively seldom in France as in industrialized countries. The determination of their etiology based on their composition may lead to a better treatment. METHOD: One hundred and eight urinary calculi from 6 months through 18-year-old children were analyzed by using spectrophotometry, in order to specify their structure. Six groups were evidenced through a multidimensional analysis based on the presence of components weighing at least 5% of the total. RESULTS: The youngest children affected were mostly boys, and the sex ratio switched after 12.5 years. Above 14 years of age, the number of calculi significantly raised. Their composition varied with the gender, and their localization with the age. Finally a correlation between infection and composition of the calculus was shown in our study. CONCLUSION: The classification of calculi among six groups according to their composition, along with clinical informations and morphologic studies, has proven its value in determining the etiology of the lithiasis. These data help to better understand the kind of lithiasis that may be observed and the physiopathology of the mechanism explaining it from the gender and age.

Distribution pattern of neuropeptide Y in the brain, pituitary and olfactory system during the larval development of the toad Rhinella arenarum (Amphibia: Anura).

The first NPY-immunoreactivity (ir) in the central nervous system of Rhinella arenarum was obtained just after hatching in the pre-optic area, ventral thalamus and rostral rhombencephalon. During pre-metamorphosis, new NPY-ir cells were observed in other brain areas such as pallium, septum and striatum, infundibulum and pars intermedia of the pituitary. Further maturation continued through pro-metamorphosis with the appearance of cell groups in the diagonal band, amygdala, pre-optic nucleus, dorsal nucleus of the habenula, anterior ventral and dorsal thalamus, suprachiasmatic nucleus, tuberculum posterior, tectum, torus semicircularis, inter-peduncular nucleus and median eminence. During the metamorphic climax and soon after, the relative abundance of NPY-ir fibres decreased in all hypothalamic areas and the staining intensity and number of NPY-ir cells in the pallium also decreased, whereas no cells were found in the striatum, dorsal nucleus of the habenula and tectum. In the olfactory epithelium, nerve or bulb, neither cells nor NPY-ir fibres were found during the stages of development analysed. The ontogeny pattern of the NPY-ir neuronal system in the brain of Rh. arenarum is more similar to the spatiotemporal appearance reported for Rana esculenta than to that reported for Xenopus laevis. Many NPY-ir fibres were found in the median eminence and in the pars intermedia of the pituitary, supporting the idea that this neuropeptide may play a role in the modulation of hypophyseal secretion during development.

Dehydroepiandrosterone and metformin modulate progesterone-induced blocking factor (PIBF), cyclooxygenase 2 (COX2) and cytokines in early pregnant mice.

The present study examined the mechanism by which metformin (N,N'-dimethylbiguanide) prevents embryonic resorption induced in mice by dehydroepiandrosterone (DHEA). Treatment with DHEA (60mg/kg, s.c. 24 and 48h post-implantation) induces embryo resorption of early pregnant BALB/c mice while simultaneous treatment with metformin (240mg/kg, oral 24 and 48h post-implantation) prevents it. During pregnancy progesterone-induced blocking factor (PIBF) modulates prostaglandins (PGs) and cytokine production. These findings prompted us to investigate the effect of DHEA and metformin on both PIBF and cyclooxygenase 2 (COX2) expressions at the implantation sites, as well as cytokine production. PIBF and COX2 expression were detected by immunohistochemistry from DHEA and DHEA+ metformin treated 8 days-pregnant mice and serum cytokine levels of these animals were determined by ELISA. DHEA treatment both abolished PIBF expression and increased COX2 expression. Embryo resorption correlates with the lack of PIBF expression, diminished IL-6 levels and increased IL-2 concentration while metformin was able to reverse the effect of DHEA on both PIBF and COX2 expression and IL-6 levels. We concluded that hyperandrogenization induces embryo resorption in early pregnancy diminishing PIBF in implantation sites, having a pro-inflammatory effect. Metformin is able to prevent such effects.

Galanin: presence and distribution in the brain and pituitary of Rhinella arenarum (Amphibia: Anura) during development.

The immunohistochemical distribution of galanin (Gal) in the brain and pituitary of Rhinella arenarum was studied during development. Gal-immunoreactivity was first observed in the brain just after hatching in anterior preoptic area, infundibular area, median eminence and pars distalis of the pituitary as well as in the olfactory epithelium. At the beginning of prometamorphosis new Gal-immunoreactive (ir) cells were observed in the olfactory nerve and bulb. Later in prometamorphosis new Gal-ir cells were observed in the telencephalon, suprachiasmatic nucleus, rostral rhombencephalon and in the pars nervosa of the pituitary. The most numerous accumulations of Gal-ir neurons throughout the larval development were observed in the ventral hyphothalamus where numerous Gal-ir cells of cerebrospinal fluid-contacting type were found. During metamorphic climax and soon after we did not detect Gal-ir neurons in the pallium, medial or pretectal dorsal thalamus. In the median eminence and pars distalis of the pituitary many Gal-ir fibers were found during development indicating that Gal may play a role in the modulation of hypophyseal secretion. Furthermore, the distribution of Gal-ir elements observed throughout larvae development indicates that galaninergic system maturation continues until sexual maturity.

Relative Concentrations of Placental Lactogen II and PRL-Like Protein-A in Stressed Rats Placenta / Concentraciones del Lactógeno Placentario II y la Proteína A Ligada a Prolactina en Placentas de Ratas Estresadas

The chronic stress induces functional adaptations in the hypothalamo-pituitary- adrenocortical (HPA) and in the sympathetic-medullary-adrenal axis (SAM). Both axis are considered vital regulators of the homeostasis in vertebrates (Seyle, 1936; Ostrandrer et al, 2006. On the other hand, the placenta provides highly specialized functions during gestation that are critical for the normal development of the embryo/fetus (Soares et al., 1991). We hypothesized that the chronic immobilization (IMO) stress in pregnancy rats produces alterations in prolactin concentrations in placental tissue and also changes in the response of SAM axis. Chronic stress by IMO was applied on days 12, 17 and 21 of pregnancy rats. Relative concentrations and localization of placental lactogen-II (PL-II) and the PRL- like protein A (PLP-A) in chorioalantoic placenta were estimated by Immunoblotting and Immunocytochemical analysis. The levels of catecholamines metabolite, acid 3-metoxi 4-hidroximandélico (VMA), were analyzed in stressed rats urines on 6,12,17,21 days of pregnancy, by HPLC, in order to determine the response of SAM axis. During the days of the pregnancy studied, chronic stress did not induce any changes neither in the localization nor in placental concentrations of PL-II and PLP-A. The VMA values in stressed mothers urines increased on the day 6 respecting the control ones at the same time of pregnancy. VMA values in stressed rats at 21 days of pregnancy are smaller than the respective controls. We conclude that the chronic stressed mothers activated the SAM axis at the beginning of pregnancy and then they diminished the metabolites catecholamines that were interpreted as a stress adaptation coincident with normal concentrations of both placentary prolactines at this stage of the pregnancy.

El estrés crónico induce adaptaciones funcionales en los ejes hipotálamo-pituitario-adrenal (UPA) y en el simpático médulo adrenal (SAM). Ambos ejes son considerados reguladores vitales de la homeostasis en los vertebrados (Seyle, 1936; Ostrandrereí al., 2006). Por otro lado, el desarrollo y crecimiento fetal de los mamíferos dependen en gran medida del buen funcionamiento de la placenta (Soares, 1991). Nosotros hipotetizamos que el estrés crónico por inmovilización (IMO) aplicado a las ratas gestantes produce alteraciones en las concentraciones de las prolactinas en el tejido placentario y cambios en la respuesta del eje SAM. Se le aplicó estrés crónico por IMO a las hembras en los días 12, 17 y 21 de la preñez y se analizó por inmunocitoquímica e inmunoblotting la localización y concentraciones del lactógeno placentario dos (PL-II) y la proteína A ligada a la prolactina (PLP-A) en la placenta. Se analizaron por HPLC, en las orinas de ratas preñadas (6,12,17,21 días), los niveles del metabolito de las catecolaminas, (ácido 3-metoxi 4-hidroximandélico) (VMA), a fin de determinar la respuesta del eje SAM al tratamiento. El estrés crónico no indujo cambios tanto en la localización como en las concentraciones de PL-II y PLP-A en las placentas en los días de la preñez estudiados. Los valores de VMA en las orinas de las madres estresadas se incrementaron en el día 6 con respecto al control del mismo tiempo de preñez. Mientras que a los 21 días los valores de VMA de las ratas estresadas son menores que los controles respectivos. Concluimos que en las madres estresadas crónicamente, no se alteraron las concentraciones de ambas prolactinas placentarias. En cambio se activó el eje SAM al comienzo de la preñez ante el primer estímulo estresante y luego una reducción de la respuesta del eje ante el estrés crónico, a medida que avanza la preñez.

Capsule endoscopy: improving transit time and image view.

AIM: To evaluate the effect of various methods of small bowel preparation on the transit time and the quality of visualization of the entire small bowel mucosa. METHODS: Ninety-five patients underwent capsule endoscopy (CE) by easily swallowing the capsule. They were divided into three study groups according to the preparation used: group A (n = 26) by polyethylene glycol (PEG) liter or with sodium phosphate (SP) 12 h prior to the CE study; group B (n = 29) by erythromycin 1 h prior to the CE study; and group C (n = 40) without any preparation. Visualization ranged from good to satisfactory to poor. RESULTS: The gastric emptying time in the group prepared with erythromycin was shorter but without statistical significance and the small bowel transit time was unaffected. In elderly subjects prepared by PEG or SP, the gastric emptying time was significantly longer (163.7 min, P = 0.05). The transit times of the three sub-groups were not affected by gender or pathology. The grade of cleaning of the entire study group was 3.27+/-1.1. The erythromycin group presented significantly the worst quality of images (P = 0.05) compared to the other sub-groups. Age, gender, and pathology had no effect on the quality of the cleaning of the small bowel in the sub-groups. One (1.05%) case had no natural excretion. CONCLUSION: Erythromycin markedly reduces gastric emptying time, but has a negative effect on the quality of the image in the small bowel. The preparation of elderly subjects with PEG or SP has a negative effect on the small bowel transit time.