Overview of the participation of community health workers in primary health care in 6 Latin American countries and a proposal for their integration into the health system: a qualitative study.

BACKGROUND: According to some health programmes, implementing primary health care through community health workers (CHWs) facilitates the connection between community and health services in Latin America. However, these are isolated processes that face different obstacles and would benefit from an overview of the corresponding health policies and programmes. OBJECTIVE: To provide an overview of CHW participation in 6 Latin American countries. METHODS: This exploratory qualitative study was based on 3 sources of information: a literature review, a review of public health policy documents, and interviews with experts who have led CHW programmes in 6 Latin American countries. RESULTS: The role of CHWs in Latin America and some advances in public health policies in the region were evidenced. However, limitations arising from variable implementation of the WHO guidelines on health programmes with CHWs were also apparent. CONCLUSIONS: CHWs contribute to the primary healthcare processes in the 6 Latin American countries studied in versatile and comprehensive ways. However, they constitute an underutilized human resource because they must provide various services that are not always relevant in different work contexts. Therefore, we propose a classification of the CHW profile, using the level of access to healthcare services of the population they serve as the main differentiator. This way, CHWs will not have to provide a wide range of services but only those most relevant to the specific needs of each community.

Nutrition care as a health policy in the 21st century: A phenomenological study.

BACKGROUND: Addressing the high prevalence of disease-related malnutrition (DRM) requires political will. The aim of this study is to define DRM as a health public policy issue from the point of view of the stakeholders. METHODS: We conducted a qualitative phenomenological study consisting of grey data search and individual semi-structured in-depth interviews with stakeholders (policy-makers, academics, and civil society organization representatives) from 17 Latin American countries. The analyzed themes reflected ideas repeatedly found across the interviews. RESULTS: 26 respondents were interviewed (5 policy-makers, 18 academics, 3 civil society organizations representatives). The grey data research and interviews showed that Brazil and Costa Rica were the only countries in the Region that had developed a specific public health policy addressing DRM and nutrition care issues. The rest of the Latin American countries had a nutrition policy which neither addressed DRM specifically nor included nutrition care, with important heterogeneity existing in terms of national regulation of selected nutritional care categories. Stakeholder opinions allowed to identify heterogeneity in the understanding of the nature and causes of DRM, confusing DRM with malnutrition caused by food insecurity and lack of food availability. Policy in the field of clinical nutrition can be addresses from two approaches: interdisciplinarity and a human rights-based approach. CONCLUSION: DRM is an unaddressed problem by health policy. Due to internal and external factor related to the health systems DRM has not been able to become a public policy issue. The study highlights the need for the development of public policy in clinical nutrition aimed at improving access to nutrition care.

Identification of the iduronate-2-sulfatase proteome in wild-type mouse brain.

Iduronate-2-sulfatase (IDS) is a lysosomal enzyme involved in the metabolism of the glycosaminoglycans heparan (HS) and dermatan (DS) sulfate. Mutations on IDS gene produce mucopolysaccharidosis II (MPS II), characterized by the lysosomal accumulation of HS and DS, leading to severe damage of the central nervous system (CNS) and other tissues. In this study, we used a neurochemistry and proteomic approaches to identify the brain distribution of IDS and its interacting proteins on wild-type mouse brain. IDS immunoreactivity showed a robust staining throughout the entire brain, suggesting an intracellular reactivity in nerve cells and astrocytes. By using affinity purification and mass spectrometry we identified 187 putative IDS partners-proteins, mainly hydrolases, cytoskeletal proteins, transporters, transferases, oxidoreductases, nucleic acid binding proteins, membrane traffic proteins, chaperons and enzyme modulators, among others. The interactions with some of these proteins were predicted by using bioinformatics tools and confirmed by co-immunoprecipitation analysis and Blue Native PAGE. In addition, we identified cytosolic IDS-complexes containing proteins from predicted highly connected nodes (hubs), with molecular functions including catalytic activity, redox balance, binding, transport, receptor activity and structural molecule activity. The proteins identified in this study would provide new insights about IDS physiological role into the CNS and its potential role in the brain-specific protein networks.

Specific IgY anti-group 1 dust mite allergens induced by unglycosylated synthetic oligopeptides

Introduction: The use of specific antibodies capable of detecting allergens of the group 1 of house dust mites represents a potential strategy to reduce exposure and clinical symptomatology associated with asthma and allergic rhinitis. Objective: To produce and purify chicken antibodies specific for the dust mites Dermatophagoides sp. and B. tropicalis using the IgY technology. Materials and methods: We designed and synthesized oligopeptides showing immunogenic epitopes of Der p1, Der f1, and Blo t1. These were used to produce IgY antibodies in Hy Line Brown chickens. IgY were extracted from egg yolk using thiophilic chromatography. The immunogenicity and specificity were assayed by indirect ELISA and Dot Blot. Results: We obtained high reactivity of IgY antibodies against epitopes of allergens present in whole body mites extracts of D. farinae, D. pteronyssinus, and B. tropicalis. The highest IgY levels were registered between days 32 and 40 after immunization. The antibodies showed high immunoreactivity and specificity towards D. farinae proteins with detection limits above 0.03 µg of mite proteins under the experimental conditions used. Purified IgY did not show significant reactivity when binding to Periplaneta americana extract. Conclusion: The IgY technology allowed the production of specific antibodies against house dust mites group 1 allergens using non-glycosylated synthetic peptides. To our knowledge, this is the first time that this immunochemicals are used in the detection of mites of medical relevance.

IgY antialérgenos específicos del grupo 1 de ácaros del polvo doméstico inducidos por oligopéptidos sintéticos no glicosilados / Specific IgY anti-group 1 dust mite allergens induced by unglycosylated synthetic oligopeptides

Resumen Introducción. La obtención de anticuerpos específicos capaces de detectar alérgenos del grupo 1 de ácaros del polvo doméstico representa una estrategia potencial de salud pública para reducir la exposición y la sintomatología clínica asociada con el asma y la rinitis alérgica. Objetivo. Producir y purificar anticuerpos aviares antialérgenos específicos del grupo 1 de los ácaros Dermatophagoides sp.y Blomia tropicalis utilizando la tecnología IgY. Materiales y métodos. Se diseñaron y sintetizaron oligopéptidos que evidenciaran epítopes inmunogénicos de los alérgenos Der p1, Der f1 y Blo t1 empleados posteriormente para producir anticuerpos IgY policlonales en gallinas Hy Line Brown. Las IgY presentes en las yemas de los huevos se purificaron mediante cromatografía tiofílica. Su inmunorreactividad y especificidad se determinaron mediante un inmunoensayo ELISA indirecto y Dot Blot. Resultados. Se obtuvo una reactividad elevada de las IgY contra epítopes de alérgenos presentes en extractos de cuerpo entero de D. farinae, D. pteronyssinus y B. tropicalis. Los niveles más altos de IgY se produjeron entre los días 32 y 40 de inmunización. Los anticuerpos mostraron mayor inmunorreactividad y especificidad en el reconocimiento de proteínas de D. farinae, con un límite de detección mayor de 0,03 µg de proteína total delcaroajo las condiciones experimentales analizadas. Las IgY purificadas no mostraron reactividad significativa frente al extracto de Periplaneta americana. Conclusión. La tecnología IgY permitió la producción de anticuerpos específicos contra alérgenos del grupo 1 de los ácaros del polvo al utilizar oligopéptidos sintéticos no glicosilados. Hasta donde se sabe, esta es la primera vez que se usan estos reactivos inmunológicos para la detección de ácaros de importancia médica.

Abstract Introduction: The use of specific antibodies capable of detecting allergens of the group 1 of house dust mites represents a potential strategy to reduce exposure and clinical symptomatology associated with asthma and allergic rhinitis. Objective: To produce and purify chicken antibodies specific for the dust mites Dermatophagoides sp. and B. tropicalis using the IgY technology. Materials and methods: We designed and synthesized oligopeptides showing immunogenic epitopes of Der p1, Der f1, and Blo t1. These were used to produce IgY antibodies in Hy Line Brown chickens. IgY were extracted from egg yolk using thiophilic chromatography. The immunogenicity and specificity were assayed by indirect ELISA and Dot Blot. Results: We obtained high reactivity of IgY antibodies against epitopes of allergens present in whole body mites extracts of D. farinae, D. pteronyssinus, and B. tropicalis. The highest IgY levels were registered between days 32 and 40 after immunization. The antibodies showed high immunoreactivity and specificity towards D. farinae proteins with detection limits above 0.03 µg of mite proteins under the experimental conditions used. Purified IgY did not show significant reactivity when binding to Periplaneta americana extract. Conclusion: The IgY technology allowed the production of specific antibodies against house dust mites group 1 allergens using non-glycosylated synthetic peptides. To our knowledge, this is the first time that this immunochemicals are used in the detection of mites of medical relevance.

Desarrollo de medicamentos biotecnológicos. Del laboratorio al paciente / Development of biotechnological's medicines. From the laboratory to the patient

El advenimiento de la biotecnología moderna originó grandes expectativas sobre su posibilidad para ayudar a cerrar las brecha tecnológica entre países desarrollados y en vía de desarrollo. La generación de productos biotecnológicos en nuestro país y en otros en vía de desarrollo no ha prosperado como pudiera haber sido posible, en parte por el atraso tecnológico y en parte porque la investigación que se hace en las universidades es lenta, no hay capital de riesgo para invertir en desarrollo de esos medicamentos que usualmente son muy costosos y toman muchos años entre su descubrimiento y su aprobación para mercadearlos. En nuestro país solo recientemente unas pocas universidades están preparando profesionales con suficientes competencias, mentalidad y entrenamiento suficiente para diseñar y producir medicamentos biotecnológicos que cumplan los estándares de las agencias regulatorias tanto de Estados Unidos como de Europa. Los biosimilares crearon una nueva ventana de oportunidad para disminuir precios y generar industria propia, pero garantizar la eficacia y seguridad de los medicamentos debe primar sobre cualquier otro interés de tipo económico o comercial y se requieren procesos rigurosos de evaluación de la composición, seguridad y efectividad del candidato a biosimilar frente al producto de referencia. Las universidades en los países en vías de desarrollo tienen un importante rol que desempeñar en la preparación de profesionales competentes, que tengan sensibilidad social para el desarrollo de nuevos y mejores medicamentos y métodos de diagnóstico accesibles, basados en la biotecnología, para los pacientes especialmente en materia de medicamentos huérfanos.

The advent of modern biotechnology raised great expectations about its possibilities to close the technological gap between developed and developing countries. Production of biotechnological medicines in Colombia and other developing countries as well, has not prospered as expected;,partly due to scarce availability of advanced technology, limited research facilities, slow administrative processes in the universities and lack of investors interested in risking capital to develop those very expensive products in the universities As a rule, medicines, face a lengthy process between discovery, approval and further launching to the market. Only recently, a few Colombian universities are forming professionals with skills, mental attitude and enough training to design and produce biotechnological medicines that meet the standards of regulatory agencies, both in the United States and Europe. Biosimilar products are a new window of opportunity to reduce prices and generate their own industry, providing that efficacy and safety prevail over financial interests. As mentioned earlier, a goal of our educational institutions should be , preparing skillful and socially sensible professionals competent enough to develop new and better medicines ­ hopefully orphan drugs- using affordable diagnostic biotechniques.

Computational analysis of human N-acetylgalactosamine-6-sulfate sulfatase enzyme: an update in genotype-phenotype correlation for Morquio A.

Mucopolysaccharidosis IV A (MPS IV A) is a lysosomal storage disease produced by the deficiency of N-acetylgalactosamine-6-sulfate sulfatase (GALNS) enzyme. Although genotype-phenotype correlations have been reported, these approaches have not enabled to establish a complete genotype-phenotype correlation, and they have not considered a ligand-enzyme interaction. In this study, we expanded the in silico evaluation of GALNS mutations by using several bioinformatics tools. Tertiary GALNS structure was modeled and used for molecular docking against galactose-6-sulfate, N-acetylgalactosamine-6-sulfate, keratan sulfate, chondroitin-6-sulfate, and the artificial substrate 4-methylumbelliferyl-ß-D-galactopyranoside-6-sulfate. Furthermore, we considered the evolutionary residue conservation, change conservativeness, position within GALNS structure, and the impact of amino acid substitution on the structure and function of GALNS. Molecular docking showed that amino acids involved in ligand interaction correlated with those observed in other human sulfatases, and mutations within the active cavity reduced affinity of all evaluated ligands. Combination of several bioinformatics approaches allowed to explaine 90% of the missense mutations affecting GALNS, and the prediction of the phenotype for another 21 missense mutations. In summary, we have shown for the first time a docking evaluation of natural and artificial ligands for human GALNS, and proposed an update in genotype-phenotype correlation for Morquio A, based on the use of multiple parameters to predict the disease severity.

Semi-automatic grading system in histologic and immunohistochemistry analysis to evaluate in vitro chondrogenesis / Establecimiento de un sistema de puntaje semi-automático para ensayos histoquímicos e inmunohistoquímicos con el fin de evaluar diferenciación condrogénica in vitro / Estabelecimento de um sistema de pontuação semi-automático para ensaios histoquímicos e imuno-histoquímicos para avaliar diferenciação condrogênica in vitro

Durante el desarrollo embriológico las extremidades surgen de la condensaciónde células mesenquimales y su diferenciación a condrocitos en un proceso llamado condrogénesis. Estos condrocitos sintetizanglicosaminoglicanos, jugando un papel importante durante este proceso. Existe un sistema de condrogénesis in vitro utilizandocélulas mesenquimales generalmente evaluado mediante histoquímica. Objetivo. Establecer un sistema de puntaje semi-automáticopara ensayos histoquímicos e inmunohistoquímicos. Materiales y métodos. Para condrogénesis las células fueron cultivadas conmedio inductor en agregados por tres semanas. Los glicosaminoglicanos totales fueron determinados mediante azul de dimetileno.Para el análisis histológico los agregados fueron teñidos con azul de alcian e inmunohistoquímica para detección de agrecán. Lapuntuación semi-automática fue obtenida utilizando el programa ImageJ. Resultados. Las células mesenquimales cultivadas enmedio de diferenciación condrogénica tuvieron una concentración de proteína comparable durante las tres semanas de cultivo,sugiriendo una celularidad similar. La concentración de glicosaminoglicanos fue superior para los agregados cultivados en mediocondrogénico. La misma tendencia fue observada para la tinción de azul de alcian mediante puntajes del observador ciego y análisiscon ImageJ. Finalmente, los resultados de inmunohistoquímica de puntajes asignados por el observador y los del análisis porImageJ revelaron una tendencia decreciente con el tiempo para agregados en medio condrogénico. Conclusión. Desarrollamos un sistema funcional para generación de puntaje semi-automático para diferenciación condrogénica. Corroboramos estos resultadosmediante análisis bioquímico con resultados comparables. En nuestro saber este es el primer reporte en evaluar esta metodología,la cual puede ser útil para otras aplicaciones en el campo biológico o médico...

During embryological limb formation mesenchymal cells condense and differentiate into chondrocytes, in a process known aschondrogenesis. These chondrocytes synthesize glycosaminoglycans (GAGs), thus playing an important role in this process.A simplified system in vitro chondrogenesis, using adult mesenchymal stromal cells (MSCs) has been demonstrated. Thisdifferentiation potential is usually assessed by histological staining. Objective. Establishment of a semi-automatic grading systemfor histochemistry stains and immunohistochemistry assays. Materials and methods. For chondrogenesis cells were culturedfor three weeks in aggregates with inducing media. Total GAGs were measured using dimethylmethylene blue (DMB) method.For histological analyses aggregates were stained with Alcian blue for total GAGs detection and immunohistochemistry (IHC)for aggrecan was performed. Semi-automatic grading for all slides was obtained after ImageJ analysis. Results. MSCs culturedas aggregates in chondrogenic differentiation media had similar protein concentrations for all time points, suggesting cellularityremained homogenous during culture. Total GAGs was higher for aggregates cultured in chondrogenic compared to complete media.The same trend was observed for Alcian blue stain grades by blinded observer and analysis using ImageJ software. Aggrecan’s IHCanalysis had a decreasing tendency with time for aggregates in chondrogenic media for blinded observer and ImageJ evaluation.Conclusion. We developed a functional system for semi-automatic slide grading. We corroborated these results by biochemicalanalysis with comparable results. To our knowledge, for in vitro chondrogenesis, this is the first report to evaluate stains usingthis methodology. This procedure might be useful for other applications in the field of Biology and Medical Sciences...

Durante o desenvolvimento embrionário os membros emergem a partir da condensação decélulas mesenquimais e sua diferenciação em condrócitos em um processo chamado condrogênese. Estes condrócitos sintetizamglicosaminoglicanos, desempenhando um papel importante neste processo. Existe um sistema de condrogénese in vitro utilizandocélulas mesenquimatosas, geralmente avaliado por histoquímica. Objetivo. Estabelecer um sistema de pontuação semi-automáticopara ensaios histoquímicos e imuno-histoquímicos. Materiais e métodos. Na condrogênese as células foram cultivadas commeio indutor em agregados, durante três semanas. Os glicosaminoglicanos totais foram determinados pelo azul de dimetileno.Para a análise histológica os agregados foram corados com Azul Alciano e imuno-histoquímica para detecção de agrecan. Apontuação semi-automática foi obtida utilizando o programa ImageJ. Resultados. As células mesenquimais cultivadas em meiode diferenciação condrogênica tiveram uma concentração de proteína comparável durante as três semanas de cultura, o que sugereuma celularidade similar. A concentração de glicosaminoglicanos foi maior para os agregados cultivados em meio condrogênico.A mesma tendência foi observada para a coloração com Azul Alciano segundo as pontuações do observador cego e a análisecom ImageJ. Finalmente, os resultados de imuno-histoquímica de pontuações dados pelo observador e aqueles dados pela análiseImageJ revelaram uma tendência decrescente ao longo do tempo para os agregados em meio condrogênico. Conclusão. Nósrealizamos um sistema funcional para gerar pontuação semi-automática para diferenciação condrogênica. Nós corroboramos essesresultados por análise bioquímica com resultados comparáveis. Segundo nosso conhecimento, este é o primeiro estudo a avaliaresta metodologia, que pode ser útil para outras aplicações no campo biológico ou médico...

Development of a sandwich enzyme linked immunosorbent assay (ELISA) for the quantification of iduronate-2-sulfate sulfatase.

Iduronate-2-sulfate sulfatase (IDS; EC 3.1.6.13) is an enzyme that belongs to human sulfatases. IDS deficiency causes the Hunter syndrome or mucopolysaccharidosis type II (MPS II; OMIM 309900). We have been developing an expression system for human recombinant IDS (hrIDS) in Pichia pastoris, therefore a method was required for its detection during production and purification processes, which could be used also to measure the enzyme in human fluids. In this study, an immunoquantification assay for human and recombinant IDS was developed with the combination of two antibodies. Rabbit IgG and chicken IgY were used as IDS capture and detection antibodies, respectively. Chicken IgY antibodies were developed against specific amino acid sequences present in IDS but absent in other human sulfatases. hrIDS produced in P. pastoris, commercial hrIDS, and normal human plasma samples were used as antigens and immunoquantification results were compared to enzyme activity. The technique was linear over the range 8 to 500 ng mL(-1) using commercial hrIDS. The concentration range detected for IDS in normal human plasma was 14.43 to 287.88 ng mL(-1). The hrIDS was detected in P. pastoris cultures even when the enzyme was inactive, which is convenient for monitoring the production of recombinant proteins. These results show that chicken site-specific antibodies provide a good alternative, as a substitute of monoclonal antibodies, for the detection of human proteins. This is the first report on the development of an ELISA system to detect and quantify IDS with IgY antibodies.

Genotype frequencies of C/T-13910 and G/A-22018 polymorphisms in a Colombian Caribbean population do not correspond with lactase persistence prevalence reported in the region / Las frecuencias genotípicas de los polimorfismos C/T-13910 and G/A-22018 en una población caribeña colombiana no corresponden con la prevalencia de lactasa persistencia que se informó en la región

Introduction: The C/T-13910 and G/A-22018 polymorphisms located upstream of the lactase gene are reliable predictors of lactase persistence in Caucasian-derived populations. Assessing the presence and distribution of these polymorphisms in other populations is central to developing genotyping assays and understanding the evolutionary mechanism behind this trait in several human populations. Objective: Genotyping the C/T-13910 and G/A-22018 polymorphisms in a sample of Colombian Caribbean individuals. Materials and methods: The polymorphisms were identified through Polymerase Chain Reaction/Restriction Fragment Length Polymorphism. Amplified fragments were digested using Hinf I and Hha I. Arlequin v. 3.1 was used to determine allelic and genotypic frequencies, Hardy Weinberg equilibrium, and linkage disequilibrium. Results: Genotypic frequencies were CC (81.4%), CT (18.6%), and TT (0%) for the C/T-13910 polymorphism. Frequencies were AA (55.5%), GA (45.5%), and GG (0%) for the G/A-22018 polymorphism. No linkage disequilibrium was found between the two loci. Only the locus containing the C/T-13910 polymorphism was found in Hardy Weinberg equilibrium. Conclusion: The allelic and genotypic distributions observed in this first genotyping study in a Colombian Caribbean population indicate a distribution pattern different from the one of the North European Caucasians and do not correspond to the lactase persistence prevalence reported for Caribbean populations.

Introducción: Los polimorfismos C/T-13910 y G/A-22018, que se localizan corriente arriba del gen de la lactasa son predictores confiables de la persistencia de lactasa en poblaciones derivadas de caucásicos. Conocer la presencia y distribución de esos polimorfismos en otras poblaciones es fundamental para el desarrollo de métodos de diagnóstico de lactasa persistencia y para comprender los mecanismos evolutivos de este fenotipo en seres humanos. Objetivo: Genotipificar los polimorfismos C/T-13910 y G/A-22018 en una muestra de sujetos caribeños colombianos. Materiales y métodos: Los polimorfismos se identificaron mediante la digestión de productos amplificados, que se hizo con Hinf I y Hha I. Se usó el programa Arlequín versión 3.1 para determinar las frecuencias alélicas y genotípicas, el equilibrio de Hardy-Weinberg y el desequilibrio de ligamiento. Resultados: Para el polimorfismo C/T-13910 las frecuencias genotípicas fueron CC (81.4%), CT (18.6%) y TT (0%), mientras que para el polimorfismo G/A-22018 fueron AA (55.5%), GA (45.5%) y GG (0%). No se encontró desequilibrio de ligamiento entre los loci que contienen los polimorfismos y sólo el polimorfismo C/T-13910 está en equilibrio de Hardy-Weinberg en comparación con G/A-22018. Conclusión: Las distribuciones alélicas y genotípicas observadas en este primer estudio de genotipificación en una muestra de la población caribeña colombiana muestra un patrón de distribución diferente del encontrado en poblaciones caucásicas del norte de Europa y no corresponden con la prevalencia de lactasa persistencia que se ha informado en caribeños.

Las proteínas alergénicas: un novedoso blanco para el desarrollo de estudios en proteomica funcional / The allergenic proteins: a novel target for the studies' development in functional proteomica

En la patogénesis de las enfermedades alérgicas están involucrados el ambiente, la carga genética y la inmunocompetencia del individuo. Continuamente nuestro sistema inmune está expuesto a numerosas proteínas, sin embargo, solo unas pocas inducen una respuesta inmune alérgica. El potencial intrínsico de una proteína alergénica para inducir sensibilización solo se manifiesta en individuos susceptibles, genéticamente condicionados a presentar respuestas atópicas. Muchas de estas proteínas alergénicas comparten alguna homología en su secuencia de aminoácidos. Estos alérgenos poseen un amplio rango de características moleculares, ninguna de las cuales es única solo para estas proteínas alergénicas. A pesar de esto, algunas de estas características son más comunes entre algunos alérgenos que con otras proteínas. Se ha demostrado que algunas proteínas con actividad enzimática inducen reacciones alérgicas y que esta propiedad biológica está asociada con su actividad catalítica. En la presente revisión se describen las principales características moleculares de las proteínas alergénicas, y se hace énfasis en la cistein proteasas de los ácaros intradomiciliarios, en razón a que ellas son un factor de riesgo en el desarrollo de una respuesta inmune alérgica en individuos susceptibles y se constituyen en factores desencadenantes de respuestas inflamatorias en la fisiopatología de las enfermedades alérgicas respiratorias...

The components involved in the pathogenesis of disorder allergic include the environment, the genetics and the immune competence. Continuously we are exposed to thousands of different proteins, but a single few of them induce an allergic immune response. The unique potential of an allergic protein to induce sensitization, only produce a response in susceptible individuals. Many of those allergic proteins share some homology in their sequence of amino acids, nevertheless, allergens have an ample rank of characteristic, no of which is unique for allergenic proteins. In spite of this, some characteristics are more common between allergens than in other proteins. It has been demonstrated that some proteins with enzymatic activity have a predisposition to induce allergic reactions and that its biological characteristics is associated with its catalytic activity. Those characteristic could be contribute directly to the allergenicity of this protein. In the present review we presented/displayed the main intrinsic characteristics of allergenic proteins associated with an allergic immune response, making emphasis in their Properties as activity cystein protease how and this biological faculty determining a factor in the development of the inflammatory cascade as an allergic immune response in susceptible individuals...

Enfermedad de orina en jarabe de arce: mejoría clínica asociada a detección precoz y manejo oportuno. Reporte de caso y revisión de literature / Doença de urina em xarope de arce: melhoria clínica relacionada á detecção precoce e manejo oportuno. Reporte de caso e revisão de literatura / Maple syrup urinary disease: clinical improvement associated with early detection and management. Case report and literature review

La enfermedad de orina en jarabe de arce es un error innato del metabolismo de los cetoácidos de cadena ramificada, cuya acumulación produce una encefalopatía neonatal grave y que de no ser diagnosticada y tratada de forma precoz y oportuna, lleva invariablemente a la aparición de secuelas neurológicas permanentes y a un posterior desenlace letal. El presente artículo busca, mediante la descripción de un caso clínico sucedido en el Hospital Militar Central de Bogotá, hacer una revisión de la literatura acerca de la enfermedad, resaltando los mecanismos fisiopatológicos, la detección por diferentes pruebas de laboratorio, así como las estrategias de manejo, demostrando que gracias a los progresos realizados en su comprensión y enfoque, actualmente se puede hablar de evitar la mortalidad, alcanzando en muchos casos, una sobrevida a largo plazo sin mayores secuelas neurológicas, todo ello con un manejo interdisciplinario que logre un control metabólico adecuado...

Maple syrup urine disease is an inborn error of the metabolism of branched chain keto-acids whose accumulation produces a serious neonatal encephalopathy, which if not diagnosed and treated in a precocious and opportune way, will invariably lead to the appearance of permanent neurological impairments and an ulterior lethal outcome. The present article intends, by means of the description of a clinical case which occurred at the Hospital Militar Central, to perform a review of the existent literature on this disease, to revise its fisiopathological mechanisms as well as its detection using different laboratory tests and the different care strategies, to demonstrate that, thanks to the progress achieved in its understanding and focus, at the present moment we can speak of avoiding mortality, accomplishing in many cases long term survival without important neurological consequences, all by means of an interdisciplinary approach that achieves an appropriate metabolic control...

A doença de urina em xarope de arce é um erro inato do metabolismo dos cetoácidos de corrente ramificada, cuja acumulação produz uma encefalopatia neonatal grave e que de não ser diagnosticada e tratada de forma precoce e oportuna, leva invariavelmente à aparição de seqüelas neurológicas permanentes e a um posterior desenlace letal. O presente artigo procura, mediante a descrição de um caso clínico sucedido no Hospital Militar Central de Bogotá, fazer uma revisão da literatura a respeito da doença, ressaltando os mecanismos fisiopatológicos, a detecção por diferentes provas de laboratório, bem como as estratégias de tratamento, demonstrando que graças aos progressos realizados em seu entendimento e enfoque, atualmente se pode falar de evitar a mortalidade, atingindo em muitos casos, uma sobrevida em longo prazo sem maiores seqüelas neurológicas, tudo isso com um manejo interdisciplinares que consiga um controle metabólico adequado...

[Colombian haplotypes of the Gaucher disease-causing N370S mutation may originate from a possible common ancestral haplotype]. / Los haplotipos colombianos de la mutación N370S causante de la enfermedad de Gaucher pueden provenir de un haplotipo ancestral común.

INTRODUCTION: Gaucher disease is a pan-ethnic condition characterised by glucosylceramide accumulation in macrophages due to glucocerebrosidase deficiency. Its gene, GBA, has been mapped to 1q21 and mutation N370S is the main cause of the disease in western populations, including Colombia. OBJECTIVE: To asses the degree of association between N370S mutation and the alleles of five microsatellites near the mutation site in the GBA locus in nine Colombian Gaucher patients, from the Cundinamarca-Boyacá region. MATERIALS AND METHODS: DNA from patients bearing the N370S mutation, their closest relatives, and 30 controls was taken to PCR-amplify the markers: D1S305, D1S2624, DIS2777, ITG6.6.2 and 5GC3.2. Allele frequencies were calculated, haplotypes inferred and linkage disequilibrium levels between marker alleles and N370S were also estimated. RESULTS: Eleven N370S chromosomes were obtained. A consensus N370S haplotype consisting of the alleles: 222-314-260-301-172 (base pairs) was identified. Each allele corresponding to markers 5GC3.2, ITG6.6.2, D1S277, D1S2624 and D1S305, respectively. There was statistically significant linkage disequilibrium between the alleles of 222, 314, 260, 301 base pairs and the N370S mutation. CONCLUSION: A conserved fraction of the haplotypes suggests that N370S may be present among patients and stem from a single ancestral chromosome for which the ethnic origin is still unclear.

Los haplotipos colombianos de la mutación N370S causante de a enfermedad de Gaucher pueden provenir de un haplotipo ancestral común / Colombian haplotypes of the Gaucher disease-causing N370S mutation may originate from a possible common ancestral haplotype

Introducción. La enfermedad de Gaucher es una condición panétnica, caracterizada por la acumulación de glucosilceramida en los macrófagos. La causa principal de esta enfermedad en algunos países occidentales, incluido Colombia, es la mutación N370S, en el gen de la glucocerebrosidasa localizado en 1q21. Objetivo. Determinar el grado de asociación entre la mutación N370S y los alelos de cinco microsatélites cercanos al sitio de la mutación en nueve pacientes colombianos Gaucher tipo 1, procedentes del altiplano cundiboyacense. Materiales y métodos. A partir del ADN de los pacientes, sus familiares cercanos y 30 individuos control, los loci: D1S305, D1S2624, D1S2777, ITG6.6.2 y 5GC3.2 fueron amplificados mediante reacción en cadena de la polimerasa. Las frecuencias alélicas por microsatélite fueron calculadas en pacientes y controles y 11 haplotipos N370S fueron inferidos y se determinó el grado de desequilibrio de ligamiento entre los alelos de cada haplotipo con la mutación N370S. Resultados. Se encontró un haplotipo consenso N370S compuesto por los alelos 222-314- 260-301-172 (pares de bases) que corresponden a los microsatélites: 5GC3.2 ITG6.6.2, D1S2777 D1S2624 y D1S305 respectivamente. Hubo desequilibrio de ligamiento significativo entre los alelos de 222, 314, 260 y 301 pares de bases y la mutación N370S. Conclusión. Una fracción conservada del haplotipo pudo haber estado asociada la mutación en un cromosoma ancestral al grupo de pacientes, cuya procedencia étnica es aún desconocida.

Introduction. Gaucher disease is a pan-ethnic condition characterised by glucosylceramide accumulation in macrophages due to glucocerebrosidase deficiency. Its gene, GBA, has been mapped to 1q21 and mutation N370S is the main cause of the disease in western populations, including Colombia. Objective. To asses the degree of association between N370S mutation and the alleles of five microsatellites near the mutation site in the GBA locus in nine Colombian Gaucher patients, from the Cundinamarca-Boyacá region. Materials and methods. DNA from patients bearing the N370S mutation, their closest relatives, and 30 controls was taken to PCR-amplify the markers: D1S305, D1S2624, D1S2777, ITG6.6.2 and 5GC3.2. Allele frequencies were calculated, haplotypes inferred and linkage disequilibrium levels between marker alleles and N370S were also estimated Results. Eleven N370S chromosomes were obtained. A consensus N370S haplotype consisting of the alleles: 222-314-260-301-172 (base pairs) was identified. Each allele corresponding to markers 5GC3.2, ITG6.6.2, D1S277, D1S2624 and D1S305, respectively. There was statistically significant linkage disequilibrium between the alleles of 222, 314, 260, 301 base pairs and the N370S mutation.Conclusion. A conserved fraction of the haplotypes suggests that N370S may be present among patients and stem from a single ancestral chromosome for which the ethnic origin is still unclear.

Terapia génica con vectores virales para el tratamiento de mucopolisacaridosis y otras enfermedades genéticas / Genetic therapy with viral vectors vis-à-vis the treatment of mucopolysaccharidosis and other genetic ailments

La terapia génica consiste en la inserción de DNA in vivo o ex vivo, en las células de una persona con fines terapéuticos. Inicialmente se propuso para el tratamiento de desórdenes monogénicos, pero posteriormente se extendió su uso para el tratamiento del cáncer y otras enfermedades infecciosas como el sida. La eficacia y riesgos de la terapia génica dependen de los vehículos o vectores que se usan para introducir el material genético en las células que se quieren tratar. En este artículo se revisa el estado actual del uso de los vectores construidos usando virus, sus riesgos, ventajas y limitaciones para el tratamiento de uno de los grupos de enfermedades en que más se ha avanzado en la terapia génica, las mucopolisacaridosis (MPS), enfermedades de depósito lisosomal para las cuales no hay una terapia que prevenga la aparición de los síntomas o detenga el curso de la enfermedad y cuyo manejo es simplemente sintomático.

Valoración de la utilización de servicios como parámetro para el ajuste del POS-UPC / Valuation of the use of services as parameter for the adjustment SOP-CPU

El Consejo Nacional de Seguridad Social en Salud es el máximo organismo de dirección del sistema. Fue creado mediante el artículo 171 de la Ley 100 del 93 como ente adscrito al Ministerio de Salud, el monto de las cotizaciones, el valor de la UPC, los mecanismos incluidos en el POS (Plan Obligatorio de Salud), los créditos de selección de beneficiarios del régimen subsidiado y administrar el Fondo de Solidaridad y Garantía