Integrated water quality assessment of two Rivers Basins from a semiarid region of Argentina.

The Tunuyán and Mendoza River Basins (Province of Mendoza, Argentina) have been selected as a representative semiarid region to test the applicability of an integrated water quality evaluation. To detect spatio-temporal variations of anthropic contamination, physicochemical and bacteriological parameters, as well as three ecotoxicological assays, were assessed in reference sites for 3 years. Bioassays based on the nematode Caenorhabditis elegans, the vascular plant Lactuca sativa, and the algae Pseudokirchneriella subcapitata were performed and toxicological categories were established. Our results showed that water quality, as well as water toxicity, deteriorates as both river systems run through urban areas. Interestingly, monitoring sites with good physicochemical and bacteriological qualities but with toxicity were identified, illustrating that traditional water quality studies do not predict potential toxic effects on living organisms. In addition, a multivariate statistical analysis was performed to detect clusters of monitoring sites according to the water quality status. In the context of climate change, this study provides information to support that integrated water monitoring is an essential tool to ensure sustainable water management and to guarantee economic growth, human health, food security, and environmental protection.

Negative modulation of the GABAAρ1 receptor function by histamine.

Besides its function as a local mediator of the immune response, histamine can play a role as a neurotransmitter and neuromodulator. Histamine actions are classically mediated through four different G protein-coupled receptor subtypes but non-classical actions were also described, including effects on many ligand-gated ion channels. Previous evidence indicated that histamine acts as a positive modulator on diverse GABAA receptor subtypes, such as GABAAα1ß2γ2, GABAAα2ß3γ2, GABAAα3ß3γ2, GABAAα4ß3γ2 and GABAAα5ß3γ2. Meanwhile, its effects on GABAAρ1 receptors, known to stand for tonic currents in retinal neurons, had not been examined before. The effects of histamine on the function of human homomeric GABAAρ1 receptors were studied here, using heterologous expression in Xenopus laevis oocytes followed by the electrophysiological recording of GABA-evoked Cl- currents. Histamine inhibited GABAAρ1 receptor-mediated responses. Effects were reversible, independent of the membrane potential, and strongly dependent on both histamine and GABA concentration. A rightward parallel shift in the concentration-response curve for GABA was observed in the presence of histamine, without substantial change in the maximal response or the Hill coefficient. Results were compatible with a competitive antagonism of histamine on the GABAAρ1 receptors. This is the first report of inhibitory actions exerted by histamine on an ionotropic GABA receptor.

El comité de ética y bioética (cometica) de la facultad de medicina universidad Mayor de San Andrés La Paz - Bolivia / Ethics and bioethics committee (cometica) of school of medicine, San Andres University, La Paz-Bolivia

Se presenta una revisión histórica de la fundación, organización y funcionamiento del Comité de Ética y Bioética (COMETICA) de la Facultad de Medicina, Enfermería, Nutrición y Tecnología Médica de la Universidad Mayor de San Andrés de La Paz, Bolivia. Se muestran sus objetivos generales y específicos. Se detallan las actividades realizadas del 2006 al 2009.

A historical review on foundation, organization and functioning of the Ethics and Bioethics Committee (COMETICA) of the School of Medicine, Nursing, Nutrition and Medical Technology of San Andres University, La Paz, Bolivia, is presented. General and specific objectives are shown. Activities carried out from 2006 to 2009 are detailed.

Results of a strategy based on clinical observation of newborns at risk of early-onset neonatal sepsis.

BACKGROUND: Serial clinical observation of asymptomatic newborns at risk of early-onset sepsis is an alternative option for which there is limited scientific evidence. AIMS: To evaluate the rate of protocol compliance, the impact on blood tests, percentage of hospitalizations and subsequent procedures, and course of diagnosed early-onset sepsis cases of a protocol based on serial clinical observation. METHODS: Retrospective observational study comparing an 18-month period under this protocol against a previous protocol based on laboratory tests. SUBJECTS: 6895 asymptomatic newborns with over 35 weeks of gestation. OUTCOME MEASURES: number of evaluations performed on each subject at risk, percentage of patients undergoing blood draws and hospitalization rates. RESULTS: Some of the evaluations included in the protocol were omitted in 51.6 % of the newborns undergoing the physical examinations. The implementation of this new approach was associated with a decrease in the percentage of patients undergoing blood draws from 16.8 % to 0.7 % (p < 0.001) with no differences in the progression of the five cases of sepsis studied in each period. The serial clinical observation protocol was associated with a significant increase in hospitalizations for suspected infection, although with no difference in the rate of lumbar punctures performed or antibiotic treatments administered. CONCLUSION: Compliance with the serial clinical observation protocol can be difficult. This approach often detects newborns with abnormal clinical data that are not explained by early-onset sepsis. Clinical observation is a safe option that minimizes the rate of blood draws.

Los modelos biomedico y biopsicosocial en medicina / Biomedical and biopsychosocial models in medicine

Se introduce el concepto de modelos en la ciencia y práctica médicas. Se analizan dos modelos vigentes en la medicina contemporánea: el modelo "biomédico" (MBM), actualmente predominante, y el modelo bio-psico-social (MBPS), que cuestiona el reduccionismo del primero. Se revisa la historia y contenido conceptual de ambos. Se revisa la "teoría general de sistemas" como referente de ambos modelos. Se introduce el ''modelo centrado en el paciente" como práctica dialógica.

The concept of models in medical science and practice is introduced. Two current models in contemporary medicine are analyzed: the "biomedical" model (MBM), currently predominant, and the bio-psycho-social model (MBPS), which questions the reductionism of the former. The history and conceptual content of both are reviewed. The "general systems theory" is reviewed as a reference for both models. The "patient-centered model" is introduced as a dialogic practice.

Determination of plasma uracil as a screening for dihydropyrimidine dehydrogenase deficiency: clinical application in oncological treatments.

AIMS: Treatment with dihydropyrimidines poses a significant risk of serious adverse reactions for patients with dihydropyrimidine dehydrogenase (DPD) deficiency. This study seeks to analyse the correlation between DPD deficiency and plasmatic uracil values in patients who are candidates for a fluoropyrimidine scheme. It also studies the incidence of adverse events (AEs) in patients with DPD deficiency established with plasmatic uracil determination. METHODS: This was a retrospective observational study conducted in a tertiary level establishment from September 2020 to April 2021. Patients included were diagnosed with gastrointestinal tumours, were of good status, and were initiated into a fluoropyrimidine-based regimen. The incidence and grade of AEs, according Common Terminology Criteria for Adverse Events (CTCAE), were collected and compared in patients with and without DPD deficiency. RESULTS: 119 patients diagnosed with gastrointestinal cancer met the inclusion criteria. In 92 (77%) patients there was no DPD deficiency according to plasmatic uracil thresholds. In the group of patients without deficit, dose reductions oscillated between 10-25% (mean 17.4%). In the no DPD deficiency group, 43 (46%) patients experienced AEs. Patients who had a DPD deficiency according to plasmatic uracil measurements were started on a 5-fluorouracil (5-FU) regimen with a dose reduction of 15-50% (mean 35%). In this group, 12 patients (44%) experienced some AEs. CONCLUSION: New research is needed to clarify the correlation between plasma uracil values and DPD deficiency to achieve an optimal balance between clinical benefit and toxicity.

The complexity and contradictions of the right to refuse to do hazardous work in the surgical center of a hospital.

BACKGROUND: The topic right to refuse to do hazardous work/to be exposed to serious and imminent risks is herein presented as the central and fundamental axis on issues associated with workers' health and safety. OBJECTIVE: Investigating how the topic right to refuse to do hazardous work/be exposed to serious and imminent risks may be used as condition and strategy to manage work in the Surgical Center of a hospital. METHODS: The research methodology focused on establishing dialogue among Activity-centered Ergonomics (Ergonomic Workplace Analysis -EWA), Ergology, Action-Research and Ethnography. Samples were collected from March to September 2018 and comprised 120 hours of data, in total. The Surgical Center of the investigated hospital was the place of choice to conduct the study. Assistive Nurses accounting for managing and operating the entire sector were the analyzed population. RESULTS: The concept of refusal was expanded and (re)signified beyond the workers' health and safety perspective, since it was also linked to variables such as environment, quality of products/processes and social accountability. CONCLUSIONS: Refusal does not only mean not doing what is requested, but performing the task requested by other means and paths that are always guided by one's commitment to achieve the overall proposed productive outcomes. The right to refuse is more than a management tool, it is a broad and effective work organization strategy.

La medicalización de la vida / The medicalization of life

Luego de una reflexión sobre la felicidad del ser humano y la tendencia moderna de equipararla a la salud, se hace un recuento evolutivo del concepto de salud y enfermedad. Se desarrolla la medicalización de la vida, entendida como la invasión de la medicina en aspectos de la sociedad y la vida que no son patológicos en sí mismos ni pasibles de tratamiento, en su conceptualización, proceso, protagonistas y consecuencias. Se refiere las no-enfermedades y la prevención cuaternaria, como procesos colaterales. Se concluye con una crítica literaria de la medicalización.

After a reflection on the happiness of the human being and the modern tendency to equate it to health, an evolutionary account of the concept of health and disease is made. The medicalization of life is developed, understood as the invasion of medicine in aspects of society and life that are not pathological in themselves or subject to treatment, in its conceptualization, process, protagonists and consequences. Non-diseases and quaternary prevention are referred to as collateral processes. It concludes with a literary critique of medicalization.

El paciente como persona / The patient as a person

RESUMEN: Se considera y valora el concepto de paciente como persona, tanto en el lenguaje común, en el lenguaje médico y de la persona enferma. Se exponen las visiones de la persona como paciente; la visión mecánica y las visiones humanistas: la fenomenológica, la noción de persona de Cassell, el yo y el otro de Tauber, la visión bio-psico-social de Engel y la medicina centrada en la persona. Humanizar la medicina para resolver la crisis actual de la atención médica.

ABSTRACT: The concept of the patient as a person is considered and valued, both in common language, medical language and of the sick person. The visions of the person as a patient are exposed; the mechanical vision and the humanistic visions: phenomenological, Cassell person notion, Tauber self and the other, Engel bio-psicho-social and the person centered medicine. Humanize medicine to solve the current health crisis.

La relación Médico Paciente / The doctor-patient relationship

La relación médico-paciente es el fundamento y razón de la medicina. Se expone la evolución histórica de este encuentro, desde la medicina prehistórica hasta la contemporánea. Se describen los actuales tipos o modelos de la relación médicopaciente: los centrados en el médico, los centrados en el paciente y los mutuales. Se invita a la reflexión sobre esta relación médica fundamental en el presente y en el futuro, en búsqueda de optimizar la atención médica.

Axiología médica / Medical axiology

Se revisa inicialmente la axiología filosófica: concepto, desarrollo histórico y teorías axiológicas. Se trata el tema de valores: definición, clasificación y jerarquización. Se ingresa a la axiología médica, concepto y desarrollo histórico. Se revisa el sistema de valores de la profesión médica y sus funciones: valores morales, cognitivos y culturales.

Philosophical axiology is initially reviewed: concept, historical development and axiological theories. It deals with the issue of values: definition, classification and hierarchy. We enter to medical axiology, concept and historical development. The value system and functions of the medical profession are reviewed: moral, cognitive and cultural values.

Pensamiento filosófico y medicina / Philosophical thought and medicine

Puede decirse que el pensamiento filosófico y la medicina surgieron juntos en los inicios de la civilización griega, cuna de la cultura occidental. En el presente ensayo, se hace una revisión histórica desde la filosofía Pitagórica hasta los paradigmas de Kuhn, mostrando autores y obras de la antigüedad, modernidad y época contemporánea, que ilustran la influencia recíproca entre la filosofía y la medicina.

It is possible to say that philosophical thought and medicine emerged together at the beginning of the Greek civilization, cradle of western culture. In the present trial, a historical review is made, from Pythagorean philosophy to Kuhns' paradigms, showing authors and works from antiquity, modernity and contemporary epoch, illustrating the reciprocal influence between philosophy and medicine

Medicina y filosofía / Medicina y filosofía

La filosofía de la medicina es un importante campo de estudio que se ocupa de temas y problemas filosóficamente relevantes en el estudio y práctica de la medicina. Este ensayo es una primera aproximación, ubicándola en el contexto histórico desde tiempos hipocráticos hasta la medicina contemporánea. Se exponen intentos de delimitación del campo específico, desde criterios de médicos y filósofos de la antigüedad hasta el concepto actual de la primacía de la relación médico-paciente, abarcando áreas fundamentales como ontología, epistemología y ética. Se destaca el debate desde la década de los 70, mostrando las tendencias actuales negativa, amplia y específica sobre su posibilidad como disciplina específica, culminando con la presentación de los cuatro modelos de filosofía de la medicina propuestos por Edmund Pellegrino.

Philosophy of medicine is an outstanding study field concerning philosophically relevant subjects and problems in medical study and practice. This paper is a first approach, showing the historical context since Hippocratic to present times. Delimitation attempts for specifying the field are shown, from ancient physicians and philosopher's criteria to present primacy of the physician-patient relationship, covering fundamental areas as ontology, epistemology and ethics. Present debate starting the seventies is pointed out, displaying negative, broad and specific tendencies for its consideration as a specific discipline, concluding with the four philosophy of medicine models proposed by Edmund Pellegrino.

Risk management and the complexity of the right to refuse dangerous work in the context of hospital care: Preliminary issues.

BACKGROUND: Risk management analysis at work makes it possible to find individual and collective experiences of recognition and hierarchization of risks in view of the specificities of labor situations and the complex and contradictory application of the right to refuse in health work, whose space and technique are still in a deep structural transformation. OBJECTIVE: To investigate how work organization impacts on the daily life of nursing care, in a general hospital surgical center, (un)enabling individual and collective risk management strategies in the context analyzed and how the right to refuse can be appropriate as a condition and strategy for work management. METHODS: Ergonomics (Work Ergonomic Analysis) was used to bring about the actual work activity and Ergology for epistemological deepening, whose research approach took place in a surgical center with four registered nurses. RESULTS: The results reveal that nursing work is invisible and that individual and collective strategies are used to manage the variability and constraints of the environment. The right to refuse is one of the competencies universe strategies conceived and built at work that ensure the realization of the results found. CONCLUSIONS: The right to refuse is full of meanings. Refusing does not mean "not doing", but also to do otherwise, by other means. It is beyond health and security and can be linked to other variables such as quality, environment, social responsibility.

De la ética médica tradicional a la bioética médica / From traditional medical ethics to medical bioethics

Después de una reseña introductoria de la medicina como ciencia y como arte, se muestra el desarrollo histórico de la ética médica desde los albores de la medicina, con su carácter mágico y religioso; su evolución y enriquecimiento a lo largo de la cultura griega, los cambios sucedidos en la edad media, moderna y contemporánea, con la naturalización, cientifización y tecnificación de la medicina, originando conflictos biomédicos que la ética médica tradicional es insuficiente para enfrentar. Surge entonces la bioética en la década de los años 70. Se ilustra su inicio como un área de reflexión multidisciplinaria de integración de temas medioambientales, sociales y médicos, que con el paso del tiempo llega a ser esencialmente una bioética médica. Se recuerda su origen y desarrollo inicialmente en los EE. UU. de NA, luego en Europa, Latinoamérica y el resto del mundo, hasta su evolución y situación actual, en la que surgen cuestionamientos a su teoría principialista original, aportando nuevas concepciones, como la de justicia social, generada en Sudamérica.

After an introductory review of medicine as a science and art, it is shown the historical development of medical ethics, since the down of medicine, with its magical and religious character; its evolution and enrichment through greek culture, changes occurred in medieval, modern and contemporary ages, with its medical naturalization, scientification and tecnification, originating biomedical conflicts that traditional medical ethics is insufficient to face. Bioethics then arises in the 70 decades. It is shown its origin as a multidisciplinary and integrative reflection área of environmental, social and medical topics, that with the passage of times becomes essentially a medical bioethics. It is remembered his origin and development initially in USA, then Europe, Latinamerica and the whole world, until its evolution and current situation, when questions arise to its principlist original theory, bringing new conceptions as social justice, originated in Southamerica.

Reactive Oxygen Species in the Regulation of the GABA Mediated Inhibitory Neurotransmission.

Reactive oxygen species (ROS) are best known for being involved in cellular metabolism and oxidative stress, but also play important roles in cell communication. ROS signaling has become increasingly recognized as a mechanism implicated in the regulation of synaptic neurotransmission, under both physiological and pathological conditions. Hydrogen peroxide (H2O2) and superoxide anion are the main biologically relevant endogenous ROS in the nervous system. They are predominantly produced in the mitochondria of neurons and glial cells and their levels are tightly regulated by the antioxidant cell machinery, which allows for dynamic signaling through these agents. Physicochemical and biological properties of H2O2 enable it to effectively play an important role in signaling. This review brings up some or the most significant evidence supporting ROS as signaling agents in the nervous system and summarizes data showing that ROS modulate γ-aminobutyric acid (GABA)-mediated neurotransmission by pre- and postsynaptic mechanisms. ROS induce changes on both, the activity of phasic and tonic GABAA receptors and GABA release from presynaptic terminals. Based on these facts, ROS signaling is discussed as a possible selective mechanism linking cellular metabolism to inhibitory neurotransmission through the direct or indirect modulation of the GABAA receptor function. This article is part of a Special Issue entitled: Honoring Ricardo Miledi - outstanding neuroscientist of XX-XXI centuries.

Glyphosate-based herbicides modulate oxidative stress response in the nematode Caenorhabditis elegans.

Glyphosate-based formulation is used as non-selective and post-emergent herbicides in urban and rural activities. In view of its recurring applications in agricultural producing countries, the increase of glyphosate concentration in the environment stresses the need to test the adverse effects on non-target organisms and assess the risk of its use. This paper analyzes the toxicological and oxidative stress and modulatory effects of a glyphosate commercial formulation (glyphosate F) on the nematode Caenorhabditis elegans. We detected ROS production and enhancement of oxidative stress response in glyphosate F-treated nematodes. Particularly, we found an increased ctl-1 catalase gene expression of a catalase specific activity. In addition, we showed that glyphosate F treatment activated the FOXO transcription factor DAF-16, a critical target of the insulin/IGF-1 signaling pathway, which modulates the transcription of a broad range of genes involved in stress resistance, reproductive development, dauer formation, and longevity. In summary, the exposure of glyphosate F induces an oxidative imbalance in C. elegans that leads to the DAF-16 activation and consequently to the expression of genes that boost the antioxidant defense system. In this regard, clt-1 gene and catalase activity proved to be excellent biomarkers to develop more sensitive protocols to assess the environmental risk of glyphosate use.

Molecular epidemiology of Anisakis spp. in blue whiting Micromesistius poutassou in eastern waters of Spain, western Mediterranean Sea.

The infection of blue whiting Micromesistius poutassou from the western Mediterranean Sea, off the eastern coast of Spain, with larvae of Anisakis spp. was studied. Between April 2016 and April 2017, 140 fish were analyzed. Total epidemiological data showed that the prevalence of Anisakis spp. was 29.3% and the mean intensity 1.8. Of the 74 larvae collected, 61% were type I and the remaining 39%, type II. Of the former, 91% were molecularly identified as Anisakis pegreffii (P = 19.3%; MI = 1.4), 2.2% as Anisakis simplex s.s. (P = 0.7%; MI = 1.0), while the rest (6.7%) showed a recombinant genotype between the two (P = 2.1%; MI = 1.0). All the type II larvae analyzed were molecularly identified as Anisakis physeteris (P = 10.0%; MI = 2.1). Three fish (2.1%) were found to have larvae in the muscle, while two were found with 1 larva of A. pegreffii and one with two larvae (1 A. simplex s.s. and 1 A. pegreffii). Statistical analysis showed that the prevalence of Anisakis spp. in blue whiting was higher in spring than in autumn (P < 0.001), probably due to the greater size (and age) of the fish and related to factors as diet shift, accumulation with age and higher food intake. Analysis of the data suggested that blue whiting were first infected with Anisakis type I (mean age 2.3 years) and later with Anisakis type II (mean age 2.7 years), probably due to the diet changing with age, with the incorporation of the paratenic/intermediate host species of these parasites. In any case, the public health authorities must continue to emphasize the need for suitable thermal treatment (freezing or cooking) of the fish prior to consumption.

Negative modulation of the GABAA ρ1 receptor function by l-cysteine.

l-Cysteine is an endogenous sulfur-containing amino acid with multiple and varied roles in the central nervous system, including neuroprotection and the maintenance of the redox balance. However, it was also suggested as an excitotoxic agent implicated in the pathogenesis of neurological disorders such as Parkinson's and Alzheimer's disease. l-Cysteine can modulate the activity of ionic channels, including voltage-gated calcium channels and glutamatergic NMDA receptors, whereas its effects on GABAergic neurotransmission had not been studied before. In the present work, we analyzed the effects of l-cysteine on responses mediated by homomeric GABAA ρ1 receptors, which are known for mediating tonic γ-aminobutyric acid (GABA) responses in retinal neurons. GABAA ρ1 receptors were expressed in Xenopus laevis oocytes and GABA-evoked chloride currents recorded by two-electrode voltage-clamp in the presence or absence of l-cysteine. l-Cysteine antagonized GABAA ρ1 receptor-mediated responses; inhibition was dose-dependent, reversible, voltage independent, and susceptible to GABA concentration. Concentration-response curves for GABA were shifted to the right in the presence of l-cysteine without a substantial change in the maximal response. l-Cysteine inhibition was insensitive to chemical protection of the sulfhydryl groups of the ρ1 subunits by the irreversible alkylating agent N-ethyl maleimide. Our results suggest that redox modulation is not involved during l-cysteine actions and that l-cysteine might be acting as a competitive antagonist of the GABAA ρ1 receptors.