Nuevo panorama para las enfermedades reumáticas pediátricas / New landscape for pediatric rheumatic diseases

Introducción: Las enfermedades reumáticas no se limitan a la edad adulta. Afectan a personas de todas las edades, incluidos los niños, y a menudo afectan a adultos jóvenes. En consecuencia, las enfermedades reumáticas pediátricas necesitan una evaluación y un seguimiento minuciosos y cuidadoso. Pueden ser debilitantes y, si no se tratan adecuadamente, pueden poner en peligro la vida. Objetivos: En este artículo se comentará sobre avances en el diagnóstico y tratamiento de las enfermedades reumáticas pediátricas, destacando las ventajas del empleo de determinados medios diagnósticos. Desarrollo: Para ello se ha realizado una revisión bibliográfica que permite aportar elementos importantes a considerar. Conclusiones: Se ha avanzado mucho en las últimas décadas en el campo de la reumatología pediátrica, que incluyen, entre otros, la patogenia, los criterios de clasificación y las terapias. Los reumatólogos pediátricos deben mantenerse al día con el progreso para aumentar la precisión del diagnóstico y mejorar el pronóstico de los pacientes(AU)

ABSTRACT Introduction: The effective treatment of postoperative pain is today a challenge for anesthetists, rheumatologists, orthopedic surgeons, surgeons and researchers of various specialties, who constantly propose protocols based on scientific evidence. Objective: Reflect and open the debate regarding the role of anesthesia in the relief of pain of rheumatological origin. Development: In Rheumatology, it is recommended, in all patients with chronic rheumatic pain, to calculate the intensity of the pain, both for the first choice of the analgesic treatment and for the measurement of the response. And, for this, several methods of quantification have been proposed. Conclusions: Diagnostic management and multidisciplinary treatment preside when this type of case is examined, since it is the only way to identify the origin of pain and provide prudent relief. In general, patients respond to conservative treatment and only a small group will need invasive anesthetic techniques(AU)

Pileflebitis como complicación de apendicitis aguda en paciente gestante / Pylephlebitis as a Complication of Acute Appendicitis in a Pregnant Patient

Introducción: La pileflebitis, trombosis séptica del sistema portal por cuadros inflamatorios agudos abdominales, se presenta con manifestaciones clínicas variables en dependencia de la causa de origen y por rama portal afectado. El diagnóstico incluye función hepática normal o ligeramente alterada con leucocitosis, hemocultivos positivos, eco doppler o tomografía computarizada que corrobore la enfermedad. Objetivo: Describir la pileflebitis como una complicación inusual en una paciente embarazada con apendicitis aguda, desde su concepto, fisiopatología, presentación clínica, diagnóstico y medidas terapéuticas. Caso clínico: Paciente femenina de 18 años, gestante, que refirió dolor abdominal de gran intensidad, acompañado de vómito y deposiciones diarreicas y tinte ictérico. Por tales motivos fue trasladada al Hospital General Docente Ambato. Se diagnosticó sepsis de origen abdominal por apendicitis aguda perforada, peritonitis generalizada complicada con pileflebitis. Se realizó intervención quirúrgica y resolución del cuadro clínico. Conclusiones: La pileflebitis presenta una gran dificultad diagnóstica, por lo que herramientas como la ecografía doppler y la tomografía computarizada son de ayuda en estos casos. Los pilares del tratamiento incluyen control del foco séptico abdominal y tratar la pileflebitis(AU)

Introduction: Pylephlebitis, septic thrombosis of the portal system due to acute abdominal inflammatory conditions, it presents with variable clinical signs depending on the cause of origin and the affected portal branch. Diagnosis includes normal or mildly impaired liver function with leukocytosis, positive blood cultures, Doppler echocardiography, or computed tomography confirming the disease. Objective: To describe pylephlebitis as an unusual complication in a pregnant patient with acute appendicitis, referring to its concept, pathophysiology, clinical presentation, diagnosis and therapeutic measures. Clinical case report: This is the case of an 18-year-old female pregnant patient, who had severe abdominal pain, accompanied by vomiting, diarrhea and jaundiced stools. For such reasons, she was transferred to the Ambato General Teaching Hospital. Sepsis of abdominal origin was diagnosed due to acute perforated appendicitis, generalized peritonitis complicated with pylephlebitis. Surgical intervention was performed and the clinical condition was solved. Conclusions: Pylephlebitis represents a great diagnostic difficulty, hence tools such as Doppler ultrasound and computed tomography are helpful in these cases. The mainstays of treatment include control of the abdominal septic focus and treating pylephlebitis(AU)

Patogenia de la artritis reumatoide, manejo terapéutico actual y perspectivas futuras / Pathogenesis of rheumatoid arthritis, current therapeutic management and future prospects

La artritis reumatoide es una enfermedad autoinmune, sistémica, crónica, que afecta con más frecuencia a mujeres que a hombres, y se observa predominantemente en ancianos. El propósito de este trabajo es presentar el resultado de una revisión bibliográfica sobre aspectos generales relacionados con la patogenia de la artritis reumatoide y el manejo terapéutico actual, así como perspectivas futuras de nuevos enfoques terapéuticos. Existen dos subtipos principales de artritis reumatoide según la presencia o ausencia de anticuerpos antiproteína citrulinada. La citrulinación es catalizada por la enzima peptidilarginina-deiminasa dependiente de calcio, que cambia una arginina cargada positivamente a una citrulina polar, pero neutra como resultado de una modificación postraduccional. Este estudio se enfoca en el subconjunto de artritis reumatoide positivo para anticuerpos antiproteína citrulinada y se divide la progresión del proceso de artritis reumatoide en varias etapas. Cabe mencionar que estas etapas pueden ocurrir de forma secuencial o simultánea. Se requiere con urgencia una mejor comprensión de cómo los mecanismos patológicos impulsan el deterioro del progreso de la artritis reumatoide en los individuos con el fin de desarrollar terapias que tratarán eficazmente a los pacientes en cada etapa del progreso de la enfermedad(AU)

Rheumatoid arthritis is a chronic systemic autoimmune disease that arises more frequently in women than in men, and is predominantly observed in the elderly. To present the result of a bibliographic review on general aspects related to the pathogenesis of rheumatoid arthritis and current therapeutic management, as well as future perspectives of new therapeutic approaches. There are two main subtypes of rheumatoid arthritis according to the presence or absence of anti-citrullinated protein antibodies. Citrullination is catalyzed by the calcium-dependent enzyme peptidylarginine deiminase, which changes a positively charged arginine to a polar but neutral citrulline as a result of post-translational modification. This work focuses on the anti-citrullinated protein antibodies -positive rheumatoid arthritis subset and divides the progression of the rheumatoid arthritis process into several stages. It should be mentioned that these stages can occur sequentially or simultaneously. A better understanding of how pathological mechanisms drive the deterioration of rheumatoid arthritis progression in individuals is urgently required in order to develop therapies that will effectively treat patients at each stage of disease progression(AU)

Laparoscopy and intraoperative enteroscopy, a helpful tool in a rare tumor (inflammatory fibroid polyp) of the small bowel. A case report.

INTRODUCTION AND IMPORTANCE: Inflammatory fibroid polyps (IFPs) are rare, benign tumors that can arise throughout the gastrointestinal tract, they are usually asymptomatic, and clinical presentation depends on the site of involvement. Gastric and colon IFPs are traditionally identified incidentally, whereas small intestinal lesions are often encountered in the setting of intussusception or during imaging studies. Complete resection via endoscopy or surgery is recommended. CASE PRESENTATION: Patient is a 52-year-old male without past medical history; he had a five-month history of mild colicky abdominal pain. A mass was detected in the small bowel, and surgery was decided. Since the mass was small a cooperative approach with an intraoperative enteroscopy was needed to locate the mass and achieve complete resection. DISCUSSION: IFPs of the small bowel require complete resection. Surgery should be performed as early as possible to prevent complications like intussusceptions, ischemia, and necrosis. CONCLUSIONS: In these rare tumors, the collaboration between surgeons and endoscopists is indispensable to improve the patient's prognosis.

Synthesis and Solid-State Dynamics of a Crystalline Steroid Molecular Rotor without the Alkyne Axle: Steroid Dimers Based on a 1,4-Di(1,3-dioxan-2-yl)benzene Moiety.

Two diastereomeric crystalline steroid dimers were obtained by acid-catalyzed double acetalization of (20S)-5α-pregnan-3ß,16ß,20-triol 3-monoacetate with terephtalaldehyde. These compounds were characterized by NMR in solution, MS, single-crystal X-ray diffraction, and variable-temperature solid-state NMR by 13C cross-polarization magic angle spinning (CPMAS). While the phenylene rotator in the SR diastereomer remains static even at 373 K, the RR isomer shows a slow rotational process of the phenylene ring at temperatures above room temperature and thus may be considered the first crystalline steroid molecular rotor without the alkyne axle.

Calidad de vida de pacientes con enfermedad pulmonar obstructiva crónica, participantes en un programa educativo integral / Quality of life of patients with chronic obstructive pulmonary disease participating in a comprehensive educational program

Resumen Introducción: La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una enfermedad altamente prevalente que se caracteriza principalmente por la disnea, la cual genera un impacto sobre la calidad de vida del individuo. El programa de cuidado respiratorio integral ofrece una intervención esencialmente educativa, individualizada y multidisciplinaria enfocada en las necesidades del paciente y su familia, buscando mejorar la calidad de vida. Objetivo: Describir el efecto de un programa educativo de cuidado integral en la calidad de vida de pacientes con enfermedad pulmonar obstructiva crónica. Materiales y métodos: Se realizó un estudio descriptivo transversal incluyendo pacientes con diagnóstico de EPOC en quienes se aplicó el cuestionario para medición de calidad de vida Saint George al ingreso y a los seis meses de estar vinculado al programa. Se realizaron pruebas estadísticas no paramétricas debido al comportamiento no gaussiano de las variables. Resultados: Se incluyeron un total de 31 pacientes con promedio de edad 82,7 años, 43,3% tenían antecedente de tabaquismo, de las variaciones en la encuesta Saint George se observó un cambio significativo en el dominio de actividad y en el puntaje global de la encuesta al ser aplicada a los seis meses de seguimiento. Conclusiones: La implementación del programa educativo integral parece apoyar la mejoría en la calidad de vida de los participantes con diagnóstico de EPOC. Futuros estudios prospectivos podrán validar esta hipótesis.

Abstract Introduction: The Chronic Obstructive Pulmonary Disease (COPD) is a highly prevalent disease, characterized mainly by dyspnea, which has an impact on the quality of life of the person. The program of comprehensive respiratory care offers an essentially educational, individualized and multidisciplinary intervention focused on the needs of the patient and its family, seeking to improve the quality of life and associated morbidities. Objective: To describe the quality of life in a comprehensive care program for patients with chronic obstructive pulmonary disease. Methods: A cross-sectional retrospective descriptive study was carried out, including patients diagnosed with COPD, in whom the Saint George quality of life questionnaire was applied at admission and six months after being linked to the program. Student's t test was performed for the analysis by normality tests. Results: A total of 31 patients with an average age of 82.7 years were included, 43.3% had a history of smoking, variations in the Saint George survey showed a significant change in the domain of activity and in the overall score when applied to the six-month follow-up. Conclusions: The implementation of the comprehensive educational program seems to support the improvement in the quality of life of participants diagnosed with COPD. Future prospective studies may validate this hypothesis.

Kinetic Control of [AuCl4]- Photochemical Reduction and Gold Nanoparticle Size with Hydroxyl Radical Scavengers.

Laser-induced photochemical reduction of aqueous [AuCl4]- is a green synthesis approach requiring no chemical reducing agents or stabilizers; but size control over the resulting gold nanoparticles remains a challenge. Under optical breakdown conditions producing hydrated electrons (eaq-) and hydroxyl radicals (OH•) through decomposition of water, [AuCl4]- reduction kinetics follow an autocatalytic rate law, which is governed by rate constants: nucleation rate k1, dependent on eaq-; and growth rate k2, dependent on the OH• recombination product, H2O2. In this work, we add the hydroxyl radical scavengers isopropyl alcohol and sodium acetate to limit H2O2 formation. Higher scavenger concentrations both lowered k2 values and produced smaller gold nanoparticles with Gaussian size distributions and remarkably narrow mass-weighted size distributions. With sufficiently high scavenger concentrations, the mean nanoparticle size could be tuned from 3.8 to 6.1 nm with polydispersity indices below 0.08. Both the higher surface area-normalized catalytic activity of the gold nanoparticles synthesized in the presence of scavengers, and FTIR measurements, indicate no capping ligands on the nanoparticle surfaces. These results demonstrate that the size distributions of "naked" gold nanoparticles produced by photochemical [AuCl4]- reduction can be effectively tuned by controlling the reaction kinetics.

Íleo biliar / Bile ileus

Bile ileus represents 1-4% of mechanical intestinal obstructions with greater incidence in people over 65 (25%), predominantly in women (ratio 3.5: 1) (1,2), it is characterized by the impact of a Large gallstone (≥3cm) in the intestinal lumen through a fistula (1,2). This is a 77-year-old female patient with high blood pressure controlled, which comes from diffuse abdominal pain type 24 colic hours of evolution On physical examination the distended, painful abdomen at deep palpation, without peritonism, absent hydro sounds. The abdomen x-ray with uneven levels. It was initially handled by conservative way. Tests revealed leukocytosis, and ultrasound Abdominal showed an intestinal loop occupied by hyperechogenic imaging with posterior acoustic shadow (Figure 1); it is decided to perform tomography contrasted abdominal-pelvic, evidencing lobe pneumobilia left hepatic, dilated bile duct (11 mm), duodenal distention, jejunal and transition zone with 3.2cm calcified intraluminal image (Figure 2). With these findings the behavior was surgical exploration, finding jejunal mass, located 40cm from the angle of Treitz. In the enterotomy was removed large litho causing complete obstruction (Figure 3). Next, enterorrafa was performed and the procedure concluded without complications. The patient evolved favorably and She was discharged on the third day.

Baeyer-Villiger reaction of steroid sapogenins by CF3COOH-H2O2. A short cut to pregnan-3ß,16ß,20-triol 3-monoacetates.

Treatment of steroid sapogenins with H2O2 in CF3COOH for 15min followed by reflux in CH3OH/H2O afforded good yields of pregnan-3ß,16ß,20-triol 3-monoacetates. When the hydrolysis step was carried out with KOH in refluxing methanol excellent yields pregnantriols were obtained. The resulting compounds were characterized by their melting points and NMR spectral data. An X-ray diffraction analysis of compound 3a confirmed the proposed structure and provided detailed information about the bond lengths, bond angles and conformation.

Synthesis and in vitro anticancer activity of 23(23')E-benzylidenespirostanols derived from steroid sapogenins.

Benzylidenespirostanols were prepared by two-step synthesis including BF3·Et2O-catalyzed aldol condensation of several acetylated steroid sapogenins with benzaldehyde followed by saponification. The obtained compounds showed moderate cytotoxicity against three cancer cell lines (T-lymphoblastic leukemia cell line CEM, breast carcinoma cell line MCF7 and cervical carcinoma cell line HeLa) and normal human fibroblasts (BJ). The most active of the five tested substances was 3c (lowest IC50 for MCF7 cells 19.9±0.1µM) without any selectivity towards human cancer and normal cells, respectively.

Higher household income and the availability of electronic devices and transport at home are associated with higher waist circumference in Colombian children: the ACFIES study.

BACKGROUND: The current "epidemic" of childhood obesity is described as being driven by modern lifestyles with associated socioeconomic and environmental changes that modify dietary habits, discourage physical activity and encourage sedentary behaviors. OBJECTIVE: To evaluate the association between household income and the availability of electronic devices and transport at home, and the values of waist circumference (WC), as an indicator of abdominal obesity, in children and adolescents from Bucaramanga, Colombia. METHODS: Cross-sectional study of public elementary and high school population, of low-middle socioeconomic status. RESULTS: A total of 668 schoolchildren were recruited. After adjusting for potential confounders, significant positive associations between waist circumference and higher household income (p = 0.011), and waist circumference and the availability of electronic devices and transport at home (p = 0.026) were found. CONCLUSIONS: In low-middle socioeconomic status schoolchildren in a developing country, those from relatively more affluent families had greater waist circumference, an association that is opposite to that observed in developed countries. This finding could be related to higher income family's ability to purchase electronic devices and motorized transport which discourage physical activity and for their children to buy desirable and more costly western fast food.

Advancing adolescent capacity to consent to transgender-related health care in Colombia and the USA.

Many sexual and reproductive health care services, including gender reassignment treatment, facilitate reproductive autonomy and self-determination of gender identity. Individuals who are unable to refuse or consent to these services on their own behalf, such as adolescents, are at risk of violations of their rights to privacy and self-determination. This paper explores the issue of adolescent capacity to consent to transgender-related health care in Colombia and the United States (USA), focusing on the two countries' struggles to balance the rights of adolescents to make autonomous and confidential decisions with the rights of their parents. Unfortunately, many countries, including Colombia and the USA, have been slow to develop jurisprudence and legislation that explicitly protect transgender adolescents' capacity to consent to gender assignment treatment. Courts in Colombia, however, have developed jurisprudence that restricts parents' ability to make medical decisions on behalf of their infant intersex children, which lays a strong normative foundation for advancing adolescent capacity to consent to transgender-related health care. It is a strategy that may prove effective in other countries in the Americas, even those with different frameworks for adolescent medical decision-making capacity, such as the USA.

Using the multifaceted Rasch model to improve the TAT/PSE measure of need for achievement.

We used the Rasch (1980) model to develop new pictures for the Thematic Apperception Test (C. D. Morgan & Murray, 1938; McClelland, Atkinson, Clark, & Lowell, 1953) or picture story exercise to measure need for achievement (nAch). In Experiments 1 and 2, we analyzed stories to assess the difficulty level of a total of 8 pictures using the multifaceted Rasch model with picture difficulty, story probe difficulty, and participant ability as facets with a partial credit model (FACETS; Linacre, 2005). A total of 6 pictures were retained and 4 new ones added for Experiment 3 in which 201 participants wrote 6 stories to a random set of the 10 pictures. FACETS analysis revealed improved person separation reliability. In Experiment 4, 206 participants wrote 1 story to the Studying picture either before or after filling out a battery of achievement-related questionnaires. The 2 experimental groups did not differ in the amount of nAch in their stories. The coder facet was demonstrated with 2 independent coders using the revised coding system for nAch.