Abscesos cerebrales por Dermacoccus nishinomiyaensis como primera manifestación de enfermedad granulomatosa crónica / Dermacoccus nishinomiyaensis brain abscesses as the first manifestation of chronic granulomatous disease

La enfermedad granulomatosa crónica es una inmunodeficiencia primaria poco frecuente, que secaracteriza por defectos en alguna de las subunidades del complejo enzimático nicotinamida adeninadinucleótido fosfato oxidasa, que ocasiona un déficit en la generación de anión superóxido por losfagocitos. Dentro de este grupo, la forma ligada al X es la más frecuente. Se reporta el caso de una paciente de sexo femenino de 2 años con enfermedad granulomatosa crónica autosómica recesiva, con mutación en gen CYBA, quien presentó manifestación inicial de la enfermedad con abscesos cerebrales ocasionados por un germen oportunista (Dermacoccus nishinomiyaensis). Esta infección permitió la sospecha diagnóstica temprana, por lo que recibió el tratamiento y la profilaxis en forma oportuna. Actualmente, se encuentra libre de infecciones, a la espera del trasplante de células progenitoras hematopoyéticas.

Chronic granulomatous disease is a rare primary immunodeficiency characterized by defects in one of the subunits of the nicotinamide adenine dinucleotide phosphate oxidase enzyme complex, which causes a deficiency in the capacity of phagocytes to generate superoxide anion. Within this group, the X-linked form is the most frequent. Here we report the case of a 2-year-old female patient with autosomal recessive chronic granulomatous disease, with a mutation in the CYBA gene, whose initial manifestation was brain abscesses caused by an opportunistic microorganism (Dermacoccus nishinomiyaensis). The infection led to an early diagnostic suspicion, so treatment and prophylaxis were administered in a timely manner. Currently, she is infectionfree, awaiting hematopoietic progenitor cell transplantation.

Dermacoccus nishinomiyaensis brain abscesses as the first manifestation of chronic granulomatous disease. / Abscesos cerebrales por Dermacoccus nishinomiyaensis como primera manifestación de enfermedad granulomatosa crónica.

Chronic granulomatous disease is a rare primary immunodeficiency characterized by defects in one of the subunits of the nicotinamide adenine dinucleotide phosphate oxidase enzyme complex, which causes a deficiency in the capacity of phagocytes to generate superoxide anion. Within this group, the X-linked form is the most frequent. Here we report the case of a 2-year-old female patient with autosomal recessive chronic granulomatous disease, with a mutation in the CYBA gene, whose initial manifestation was brain abscesses caused by an opportunistic microorganism (Dermacoccus nishinomiyaensis). The infection led to an early diagnostic suspicion, so treatment and prophylaxis were administered in a timely manner. Currently, she is infectionfree, awaiting hematopoietic progenitor cell transplantation. .

La enfermedad granulomatosa crónica es una inmunodeficiencia primaria poco frecuente, que secaracteriza por defectos en alguna de las subunidades del complejo enzimático nicotinamida adeninadinucleótido fosfato oxidasa, que ocasiona un déficit en la generación de anión superóxido por los fagocitos. Dentro de este grupo, la forma ligada al X es la más frecuente. Se reporta el caso de una paciente de sexo femenino de 2 años con enfermedad granulomatosa crónica autosómica recesiva, con mutación en gen CYBA, quien presentó manifestación inicial de la enfermedad con abscesos cerebrales ocasionados por un germen oportunista (Dermacoccus nishinomiyaensis). Esta infección permitió la sospecha diagnóstica temprana, por lo que recibió el tratamiento y la profilaxis en forma oportuna. Actualmente, se encuentra libre de infecciones, a la espera del trasplante de células progenitoras hematopoyéticas.

Brachiocephalic artery aneurysm plaque rupture, stroke & repair.

A 70 year old left-handed man presented to his general practitioner with abnormal left arm movements, left hemianopia and loss of balance. He was found to have an isolated brachiocephalic artery aneurysm, measuring 3.5 cm, with associated plaque rupture, contributing to recurrent episodes of transient ischemic attack. He was discussed extensively by a multidisciplinary team. e concurrently had complete occlusion of the right internal carotid artery with distal reconstitution in its supraclinoid segment from collaterals. Stenting of the region would necessitate inappropriately covering the right vertebral artery which would further compromise intracerebral blood. Surgical intervention was deemed the only safe option and he was thus accepted for cardiothoracic surgery. Standard workup revealed left anterior descending artery stenosis. He underwent coronary artery bypass grafting, left atrial appendectomy and brachiocephalic artery resection with replacement with a interposition graft with 10 mm polytetrafluoroethylene graft. He recovered well. This case demonstrates the multi-disciplinary decision making in a rare cause of embolic stroke.

Producción intelectual de los egresados de posgrados clínico-quirúrgicos de la Universidad Surcolombiana desde 1999 hasta 2016 / Intellectual production of physicians graduated from clinical-surgical specialisations of the Universidad Surcolombiana from 1999 to 2016

INTRODUCCIÓN: El proceso de la investigación en un pilar fundamental dentro de la formación de posgrado en el área de la medicina, ya que conlleva a que el médico residente desarrolle competencias que le permitan aplicar la medicina basada en la evidencia, incrementar la investigación en ciencias básicas y clínicas y generar nuevo conocimiento. MATERIALES Y MÉTODOS: Se presenta un estudio de tipo descriptivo con corte transversal en el que se evaluó la producción científica de los egresados de los posgrados clínico-quirúrgicos de la Universidad Surcolombiana. Se realizó análisis descriptivo de tipo univariado además de un análisis bivariado mediante cálculo de la razón de prevalencias y usando chi cuadrado y prueba exacta de Fisher. RESULTADOS: El total de publicaciones fue de 161, Cirugía general es la especialidad con el mayor número de publicaciones (n=79), el artículo en revista es el tipo de publicación con mayor frecuencia (86%). La media de publicación por egresado es de 0,76 y se observó una asociación entre la vinculación docente y las publicaciones (p = 0,0024). CONCLUSIONES: La producción científica de los egresados de los posgrados clínico-quirúrgicos de la Facultad de Salud de la Universidad Surcolombiana tiene un comportamiento diverso entre los diferentes programas. Con base en los resultados se evidencia la necesidad del fortalecimiento, fomento de la investigación y el apoyo para la publicación en los posgrados clínico-quirúrgicos

BACKGROUND: Research is fundamental in the post-graduate areas of medicine, since it helps the resident doctors to develop aptitudes that will allow them to use evidence based medicine, as well as to increase research in basic and clinics sciences, and to generate new knowledge. METHODS: A descriptive, cross-sectional study was carried out to assess the scientific production of graduated physicians from clinical-surgical specialisations of the Universidad Surcolombiana. A univariate descriptive analysis and bivariate analysis was performed, as well as the calculation of the prevalence ratio, using Chi-squared and the Fisher exact test. RESULTS: The total number of publications was 161, with general surgery being the specialisation with the highest number of publications (n = 79), with an article being the most frequent type of publication (86%). The mean of publication by graduated physicians was 0.76, and a relationship was observed between teaching links and publication (p = .0024). CONCLUSIONS: Scientific production by graduate physicians from clinical-surgical specialisations of the health faculty of the Universidad Surcolombiana varies between different courses. Based on the results obtained, there is evidence for the need of strengthening and promoting research, as well as support to publish in the clinical-surgical specialisations

Serine Phosphorylation of L-Selectin Regulates ERM Binding, Clustering, and Monocyte Protrusion in Transendothelial Migration.

The migration of circulating leukocytes toward damaged tissue is absolutely fundamental to the inflammatory response, and transendothelial migration (TEM) describes the first cellular barrier that is breached in this process. Human CD14+ inflammatory monocytes express L-selectin, bestowing a non-canonical role in invasion during TEM. In vivo evidence supports a role for L-selectin in regulating TEM and chemotaxis, but the intracellular mechanism is poorly understood. The ezrin-radixin-moesin (ERM) proteins anchor transmembrane proteins to the cortical actin-based cytoskeleton and additionally act as signaling adaptors. During TEM, the L-selectin tail within transmigrating pseudopods interacts first with ezrin to transduce signals for protrusion, followed by moesin to drive ectodomain shedding of L-selectin to limit protrusion. Collectively, interaction of L-selectin with ezrin and moesin fine-tunes monocyte protrusive behavior in TEM. Using FLIM/FRET approaches, we show that ERM binding is absolutely required for outside-in L-selectin clustering. The cytoplasmic tail of human L-selectin contains two serine (S) residues at positions 364 and 367, and here we show that they play divergent roles in regulating ERM binding. Phospho-S364 blocks direct interaction with ERM, whereas molecular modeling suggests phospho-S367 likely drives desorption of the L-selectin tail from the inner leaflet of the plasma membrane to potentiate ERM binding. Serine-to-alanine mutagenesis of S367, but not S364, significantly reduced monocyte protrusive behavior in TEM under flow conditions. Our data propose a model whereby L-selectin tail desorption from the inner leaflet of the plasma membrane and ERM binding are two separable steps that collectively regulate protrusive behavior in TEM.

[Mortality in Colombia traffic accidents. Comparative study with other countries]. / Mortalidad por accidentes de tráfico en Colombia. Estudio comparativo con otros países.

OBJECTIVE: Traffic accidents (TA) are a global problem with mortality of 1.25 million each year. The objective of this study was to compare adjusted mortality rates (AMR) by AT of Colombia, with Spain and the United States (US). The selection is justified because Colombia is a country with less development in road safety, Spain a nation that has adhered to European guidelines and US for having little adherence to international guidelines. METHODS: A descriptive cross-sectional study was carried out for five-year periods, by calculating the AMRs by the direct method of standardization according to sex and age groups, as well as the adjustment of the motorization index. The mean values, the 95% confidence interval for each country and the relative change between the periods studied were calculated. RESULTS: The AMR of periods P1 and P2 in all countries decreased significantly (p <0.005). In periods P2 and P3 also decreased significantly in Spain, by 52.0% (p = 0.010), and in the US, by 23.6% p = 0.001), while in Colombia the difference of 4.0% it was not significant (p = 0.724). Spain stood out for the reduction in mortality (P1-P3), by 69.0%. CONCLUSIONS: Colombia presented a less favorable evolution of mortality due to AT than Spain and the US. Men aged 15 to 44, motorcyclists and cyclists were the most committed. The TAs are a public health problem that Colombia has raised and must adapt to its reality those successful measures in other countries.

OBJETIVO: Los accidentes de tráfico (AT) son un problema mundial con mortalidad de 1,25 millones cada año. El objetivo de este estudio fue comparar tasas ajustadas de mortalidad (TAM) por AT de Colombia, con España y Estados Unidos (EEUU). La selección se justifica por ser Colombia un país con menor desarrollo en seguridad vial, España una nación que se ha adherido a directrices Europeas y EEUU por tener poca adherencia a directrices internacionales. METODOS: Se realizó un estudio descriptivo de corte trans- versal por quinquenios, mediante el cálculo de las TAM por el método directo de estandarización según sexo y grupos de edad, así como el ajuste del índice de motorización. Se calcularon los valores medios, el intervalo de confianza al 95% por cada país y el cambio relativo entre los períodos estudiados. RESULTADOS: Las TAM de los períodos P1 y P2 en todos los países disminuyeron significativamente (p <0.005). En los períodos P2 y P3 también disminuyeron significativamente en España, en un 52,0% (p=0,010), y en EU, en un 23,6% p=0,001), mientras que en Colombia la diferencia de 4,0% no fue significativa (p=0,724). Destacó España por la reducción de su mortalidad (P1-P3), en un 69.0%. CONCLUSIONES: Colombia presentó una evolución menos favorable de mortalidad por AT que España y EEUU. Los hombres de 15 a 44 años, motociclistas y ciclistas fueron los más comprometidos. Los AT son un problema de salud pública que tiene planteado Colombia y debe adaptar a su realidad aquellas medidas exitosas en otros países.

Sequential binding of ezrin and moesin to L-selectin regulates monocyte protrusive behaviour during transendothelial migration.

Leukocyte transendothelial migration (TEM) is absolutely fundamental to the inflammatory response, and involves initial pseudopod protrusion and subsequent polarised migration across inflamed endothelium. Ezrin/radixin/moesin (ERM) proteins are expressed in leukocytes and mediate cell shape changes and polarity. The spatio-temporal organisation of ERM proteins with their targets, and their individual contribution to protrusion during TEM, has never been explored. Here, we show that blocking binding of moesin to phosphatidylinositol 4,5-bisphosphate (PIP2) reduces its C-terminal phosphorylation during monocyte TEM, and that on-off cycling of ERM activity is essential for pseudopod protrusion into the subendothelial space. Reactivation of ERM proteins within transmigrated pseudopods re-establishes their binding to targets, such as L-selectin. Knockdown of ezrin, but not moesin, severely impaired the recruitment of monocytes to activated endothelial monolayers under flow, suggesting that this protein plays a unique role in the early recruitment process. Ezrin binds preferentially to L-selectin in resting cells and during early TEM. The moesin-L-selectin interaction increases within transmigrated pseudopods as TEM proceeds, facilitating localised L-selectin ectodomain shedding. In contrast, a non-cleavable L-selectin mutant binds selectively to ezrin, driving multi-pseudopodial extensions. Taken together, these results show that ezrin and moesin play mutually exclusive roles in modulating L-selectin signalling and shedding to control protrusion dynamics and polarity during monocyte TEM.

Mortalidad por accidentes de tráfico en Colombia. Estudio comparativo con otros países / Mortality caused by traffic accidents in Colombia. Comparison with other countries

Fundamentos: Los accidentes de tráfico (AT) son un problema mundial con mortalidad de 1,25 millones cada año. El objetivo de este estudio fue comparar tasas ajustadas de mortalidad (TAM) por AT de Colombia, con España y Estados Unidos (EEUU). La selección se justifica por ser Colombia un país con menor desarrollo en seguridad vial, España una nación que se ha adherido a directrices Europeas y EEUU por tener poca adherencia a directrices internacionales. Métodos: Se realizó un estudio descriptivo de corte transversal por quinquenios, mediante el cálculo de las TAM por el método directo de estandarización según sexo y grupos de edad, así como el ajuste del índice de motorización. Se calcularon los valores medios, el intervalo de confianza al 95% por cada país y el cambio relativo entre los períodos estudiados. Resultados: Las TAM de los períodos P1 y P2 en todos los países disminuyeron significativamente (p<0.005). En los períodos P2 y P3 también disminuyeron significativamente en España, en un 52,0% (p=0,010), y en EU, en un 23,6% p=0,001), mientras que en Colombia la diferencia de 4,0% no fue significativa (p=0,724). Destacó España por la reducción de su mortalidad (P1-P3), en un 69.0%. Conclusiones: Colombia presentó una evolución menos favorable de mortalidad por AT que España y EEUU. Los hombres de 15 a 44 años, motociclistas y ciclistas fueron los más comprometidos. Los AT son un problema de salud pública que tiene planteado Colombia y debe adaptar a su realidad aquellas medidas exitosas en otros países

Background: Traffic accidents (TA) are a global problem with mortality of 1.25 million each year. The objective of this study was to compare adjusted mortality rates (AMR) by AT of Colombia, with Spain and the United States (US). The selection is justified because Colombia is a country with less development in road safety, Spain a nation that has adhered to European guidelines and US for having little adherence to international guidelines. Methods: A descriptive cross-sectional study was carried out for five-year periods, by calculating the AMRs by the direct method of standardization according to sex and age groups, as well as the adjustment of the motorization index. The mean values, the 95% confidence interval for each country and the relative change between the periods studied were calculated. Results: The AMR of periods P1 and P2 in all countries decreased significantly (p <0.005). In periods P2 and P3 also decreased significantly in Spain, by 52.0% (p = 0.010), and in the US, by 23.6% p = 0.001), while in Colombia the difference of 4.0% it was not significant (p = 0.724). Spain stood out for the reduction in mortality (P1-P3), by 69.0%. Conclusions: Colombia presented a less favorable evolution of mortality due to AT than Spain and the US. Men aged 15 to 44, motorcyclists and cyclists were the most committed. The TAs are a public health problem that Colombia has raised and must adapt to its reality those successful measures in other countries

Resultados de un programa de rehabilitación neurocognitiva en pacientes con secuelas de trauma craneoencefálico / Results from a neurocognitive rehab program on patients with sequelae of traumatic brain injury

Introducción: Los procesos de rehabilitación neurocognitiva se ven afectados por la ineficiencia en el seguimiento posterior a la hospitalización, desde una perspectiva de intervención multidisciplinar en la rehabilitación se considera la mejoría de las secuelas que afectan las condiciones cognitivas, emocionales, conductuales, sociales y vocacionales del paciente. Objetivo: Evaluar el efecto de un programa de rehabilitación neurocognitiva en los procesos de atención, memoria y función ejecutiva en pacientes con secuelas por TEC. Métodos: El programa de rehabilitación neurocognitiva se clasificó de acuerdo al proceso cognitivo objeto de intervención: (orientación, atención, memoria, funciones ejecutivas, lenguaje, aspectos comportamentales y emocionales) y se desarrolló en 60 sesiones individuales y 10 grupales durante un período de 5 meses. Resultados: En función de las puntuaciones del Neuropsi los pacientes del grupo estudio mostraron mejor desempeño, observándose diferencias significativas entre ambos grupos en los procesos de memoria (p = 0,018) y atención y funciones ejecutivas (p = 0,028). Conclusiones: Dada las características preliminares del estudio se precisa que los cambios observados en la cognición, especialmente en el proceso atencional de los pacientes podrían estar relacionados a la implementación del programa neurocognitivo.

Introduction: Neurocognitive rehabilitation have been affected by careless monitoring provided after hospitalization. Following a multidisciplinary intervention during rehab, some improvement is expected with regards complications affecting a patient’s cognitive, emotional, behavioral, social and vocational circumstances. Objective: To assess the effect of a rehabilitation program neurocognitive processes attention, memory and executive function in patients with traumatic brain injury (TBI). Methods: This would be measure through a neurocognitive rehabilitation program demonstrated with results based on the memory function and attention span. This neurocognitive rehabilitation program is design to highlight the cognitive process that act as an object ofintervention: (guidance/orientation, attention, memory, executive functions, languages, behavioral manners and affective) and it was developed through 60 individual sessions and 10 collective sessions over 5 months. Results: In the results provided by the NEUROPSI test, patients from the study group showed a better performance, and significant differences were observed in memory process, attention span (p = 0,0018) and executive function (p = 0,028). Conclusions: Given thepreliminaryfindings from the study, we suggest that changes in cognition during a patient’s attention span could be linked to the implementation of this neurocognitive program.

L-selectin shedding is activated specifically within transmigrating pseudopods of monocytes to regulate cell polarity in vitro.

L-selectin is a cell adhesion molecule that tethers free-flowing leukocytes from the blood to luminal vessel walls, facilitating the initial stages of their emigration from the circulation toward an extravascular inflammatory insult. Following shear-resistant adhesion to the vessel wall, L-selectin has frequently been reported to be rapidly cleaved from the plasma membrane (known as ectodomain shedding), with little knowledge of the timing or functional consequence of this event. Using advanced imaging techniques, we observe L-selectin shedding occurring exclusively as primary human monocytes actively engage in transendothelial migration (TEM). Moreover, the shedding was localized to transmigrating pseudopods within the subendothelial space. By capturing monocytes in midtransmigration, we could monitor the subcellular distribution of L-selectin and better understand how ectodomain shedding might contribute to TEM. Mechanistically, L-selectin loses association with calmodulin (CaM; a negative regulator of shedding) specifically within transmigrating pseudopods. In contrast, L-selectin/CaM interaction remained intact in nontransmigrated regions of monocytes. We show phosphorylation of L-selectin at Ser 364 is critical for CaM dissociation, which is also restricted to the transmigrating pseudopod. Pharmacological or genetic inhibition of L-selectin shedding significantly increased pseudopodial extensions in transmigrating monocytes, which potentiated invasive behavior during TEM and prevented the establishment of front/back polarity for directional migration persistence once TEM was complete. We conclude that L-selectin shedding directly regulates polarity in transmigrated monocytes, which affirms an active role for this molecule in driving later stages of the multistep adhesion cascade.

Estimulación del potencial de aprendizaje en niños y niñas con discapacidad intelectual / No disponible

Una de las alternativas para medir la inteligencia no influenciada por el lenguaje, la cultura y las necesidades especiales es la evaluación del potencial de aprendizaje a través del aprendizaje mediado. Esta investigación busca evidencias del efecto de la estimulación en la mejora en el potencial de aprendizaje de niños con discapacidad intelectual. Se llevó a cabo un estudio cuasi-experimental con diseño pretest-postest-postest1mes, con un grupo único compuesto por 21 niños con Síndrome de Down que asisten al Programa de Inclusión Educativa para las Necesidades Educativas Especiales. Los resultados muestran evidencias de mejora en el potencial de aprendizaje

One way to measure intelligence beyond language, culture or special needs influences is the Dynamic Assessment through Mediated Learning. In this study we try to promote learning in a group of children with intellectual disability (Down Syndrome) by the EPA. It is a study: Quasi-experimental pretest Postest- Postest1mes, with only group. Population: 21 children with Down Syndrome (DS) attending the Program for Educational Inclusion Special Educational Needs (SEN). Results show evidences of positive gain in Learning Potential

Hacer realidad un derecho: una experiencia de inclusión de alumnado con discapacidad cognitiva en una institución educativa / No disponible

La inclusión del alumnado con algún tipo de discapacidad es uno de los retos pendientes en el ámbito escolar. El presente estudio tiene como objetivo comprender las experiencias subjetivas de los estudiantes con discapacidad cognitiva leve, padres de familia, pares y docentes, frente al proceso de inclusión escolar en una institución educativa de la ciudad de Neiva. Es un estudio cualitativo-etnográfico que utilizó la observación participante y el dibujo libre en 27 personas distribuidas en 6 grupos (entidades gubernamentales, grupo de apoyo, profesores, padres de familia, estudiantes con discapacidad e iguales). Los resultados evidencian que son las entidades gubernamentales las encargadas de garantizar el derecho a la educación y a la inclusión escolar desde la normatividad reconociendo que existen dificultades en la implementación de estos programas. Las demás personas involucradas en el proceso requieren tener mucho compromiso para que la inclusión pueda realizarse en un ambiente de igualdad que permita la construcción del proyecto de vida. Los estudiantes con discapacidad cognitiva se sienten bien ya que tienen la oportunidad de iniciar un proceso de socialización con los pares los cuales los han aceptado, acogido y establecido un trato con igualdad

Inclusion in schools has been a topic of great interest because the statistics demonstrate a low level of educational inclusion. Therefore, this study aims to understand the subjective experiences of students with Mild Cognitive Disability, parents, peers and teachers to the process of school inclusion in the Educational Institution from the city of Neiva. It is a qualitative ethnographic study, used participant observation and the free drawing in 27 people in 6 groups (government agencies, support groups, teachers, parents, students with disabilities and peers). The results demonstrate that Governmental Entities are responsible for ensuring the right to education and school inclusion from the normativity recognizing that there are difficulties in implementing these programs. The other people involved in the process need to be very commitment to inclusion that can be carried out in an environment of equality that allows the construction of life project. Students with Cognitive Disabilities are feeling good because they have the opportunity to start a process of socialization with peers which have accepted them, welcomed and established equality treatment

Prevalence of dementia in Colombian populations / Prevalência de demência em populações Colombianas

With the gradual increase in the life expectancy of the population due to scientific progress and public health at the service of society, the prevalence of dementia has been increasing at different rates worldwide. Currently, the prevalence rates range between 5% and 7% (6.4% in the U.S. and up to 8.5 % in Latin America) in subjects older than 60 years. Thelowest prevalence rate (2.1%) has been reported from sub-Saharan Africa, probably due to selective mortality under 60 years of age. By contrast, a very high prevalence of dementia (23.6% dementia in individuals 60 years) was observed in the city of Neiva, Southern Colombia. We believe that this high rate could be explained by the presence of several risk factors such as very low schooling, low socio-economic strata, chronic diseases, the inclusion of geriatric homes among others, and additional unknown factors.

Com o aumento gradual da expectativa de vida das pessoas, devido aos progressos científico e de saúde pública a serviço da sociedade, a prevalência de demência tem aumentado a taxas bastante divergentes em todo o mundo. Atualmente, as taxas de prevalência variam entre 5% e 7% (6,4% em os EUA até 8,5% na América Latina) em indivíduos com idade superior a 60 anos. Prevalência mais baixa (2,1%) foi relatada na África sub-saariana, provavelmente devido a mortalidade seletiva abaixo dos 60 anos de idade. Ao contrário, uma alta prevalência de demência (23,6% de demência em pessoas ?60 anos) foi observada na cidade de Neiva, no sul da Colômbia. Acreditamos que essa taxa alta pode ser explicada pela presença de vários fatores de risco, como: baixa escolaridade, níveis socio-económicos mais baixos, doenças crônicas, inclusão de instituições geriátricas, entre outros, e outros possíveis fatores desconhecidos.

Prevalence of dementia in Colombian populations.

With the gradual increase in the life expectancy of the population due to scientific progress and public health at the service of society, the prevalence of dementia has been increasing at different rates worldwide. Currently, the prevalence rates range between 5% and 7% (6.4% in the U.S. and up to 8.5 % in Latin America) in subjects older than 60 years. The lowest prevalence rate (2.1%) has been reported from sub-Saharan Africa, probably due to selective mortality under 60 years of age. By contrast, a very high prevalence of dementia (23.6% dementia in individuals >60 years) was observed in the city of Neiva, Southern Colombia. We believe that this high rate could be explained by the presence of several risk factors such as very low schooling, low socio-economic strata, chronic diseases, the inclusion of geriatric homes among others, and additional unknown factors.

Com o aumento gradual da expectativa de vida das pessoas, devido aos progressos científico e de saúde pública a serviço da sociedade, a prevalência de demência tem aumentado a taxas bastante divergentes em todo o mundo. Atualmente, as taxas de prevalência variam entre 5% e 7% (6,4% em os EUA até 8,5% na América Latina) em indivíduos com idade superior a 60 anos. Prevalência mais baixa (2,1%) foi relatada na África sub-saariana, provavelmente devido a mortalidade seletiva abaixo dos 60 anos de idade. Ao contrário, uma alta prevalência de demência (23,6% de demência em pessoas >60 anos) foi observada na cidade de Neiva, no sul da Colômbia. Acreditamos que essa taxa alta pode ser explicada pela presença de vários fatores de risco, como: baixa escolaridade, níveis socio-económicos mais baixos, doenças crônicas, inclusão de instituições geriátricas, entre outros, e outros possíveis fatores desconhecidos.

Caracterización de la población con intento de suicidio en el Hospital Universitario del Valle, Cali (1994-2010) / Characterization of the population with suicide attempts in the Hospital Universitario del Valle, Cali (1994-2010)

Introducción: Se describe a los pacientes atendidos por intento de suicidio en la Unidad de Salud Mental (USM) del Hospital Universitario del Valle (HUV) en Cali (Colombia) entre 1994 y 2010. Métodos: Estudio descriptivo observacional retrospectivo, según las variables edad, estrato socioeconómico, procedencia, ocupación, diagnóstico psiquiátrico asociado, causa del intento, modalidad, intencionalidad, presencia de intentos previos, día de la semana y es del año de ocurrencia. Resultados: El 22,7% de los 8852 pacientes atendidos en la USM corresponde a un intento de suicidio. Hay un incremento por esta causa en grupos de menores de 35 años de edad, solteros, de estratos socioeconómicos más bajos, provenientes en su mayoría de Cali, con un trastorno psiquiátrico asociado (casi la mitad corresponde a un trastorno depresivo), alrededor del 80% por ingestión de sustancias, un tercio de los casos corresponde a un reintento suicida. En general, el intento suicida ocurre martes y domingo, y en los meses de junio y diciembre. Discusión: Los hallazgos coinciden con series de casos similares descritos en Colombia y el mundo. Conclusiones: Es necesario mejorar el instrumento con el que se recoge la información y realizar nuevas investigaciones que permitan comprender mejor la asociación entre intento de suicidio y algunas variables, como el estado civil soltero y de unión libre, los factores psicológicos específicos causales, las características propias de las personas jóvenes, determinadas ocupaciones, etcétera...

Introduction: A description of the patients with attempted suicide seen at the Mental Health Unit (MHU) of the Hospital Universitario del Valle (HUV) in Cali, Colombia between the years of 1994 and 2010 is provided. Methods: Descriptive observational retrospective study, according to the variables age, socioeconomic stratum, origin, occupation, associated psychiatric diagnosis, causes of the attempt, modality, intentionality, presence of previous attempts, day of the week and month of the year of occurrence. Results: 22.7% of the 8852 patients seen at the MHU had a suicide attempt. This was more common in the groups of single 35 year-olds or younger, from the lower socioeconomic strata, residing in Cali, with an associated psychiatric disorder (almost half had a depressive disorder), 80% ingested substances, one third of the cases corresponded to a repeated attempt. In general, the suicide attempt occurred between Tuesday and Sunday and in the months of June and December. Discussion: The findings coincide with series of similar cases described in Colombia and the world. Conclusions: The instrument used to collect the information must be enhanced and new research must be carried out that will allow us to better understand the association between attempted suicide and variables such as being single or in a non-marital union, specific causal psychological factors, characteristics inherent to young people, certain occupations, etcetera...

Polysialic acid is required for neuropilin-2a/b-mediated control of CCL21-driven chemotaxis of mature dendritic cells and for their migration in vivo.

Migration of mature dendritic cells (mDCs) to secondary lymphoid organs is required for the development of immunity. Recently, we reported that polysialic acid (PSA) and the transmembrane glycoprotein neuropilin-2 (NRP2) control mDC chemotaxis to CCL21 and that this process is dependent on the C-terminal basic region of the chemokine. Herein, we provide further insight into the molecular components controlling PSA regulated chemotaxis in mDCs. In the present study, we demonstrate that human mDCs express the NRP2 isoforms NRP2a and NRP2b, that both of them are susceptible to polysialylation and that polysialylation is required to specifically enhance chemotaxis toward CCL21 in mDCs. The results presented suggest that PSA attached to NRP2 isoforms acts as a binding module for the CCL21 chemokine, thereby facilitating its presentation to the chemokine receptor CCR7. To investigate the relevance of polysialylation on mDC migration, a xenograft mouse model was used and the migration of human DCs to mouse lymph nodes analyzed. Here, we demonstrate that the depletion of PSA from mDCs results in a drastic reduction in the migration of the cells to draining popliteal lymph nodes. With this finding, we provide first evidence that PSA is a crucial factor for in vivo migration of mDCs to lymph nodes.

Polysialylated neuropilin-2 enhances human dendritic cell migration through the basic C-terminal region of CCL21.

Dendritic cell (DC) migration to secondary lymphoid organs is a critical step to properly exert its role in immunity and predominantly depends on the interaction of the chemokine receptor CCR7 with its ligands CCL21 and CCL19. Polysialic acid (PSA) has been recently reported to control CCL21-directed migration of mature DCs. Here, we first demonstrate that PSA present on human mature monocyte-derived dendritic cells did not enhance chemotactic responses to CCL19. We have also explored the molecular mechanisms underlying the selective enhancing effect of PSA on CCL21-driven chemotaxis of DCs. In this regard, we found out that prevention of DC polysialylation decreased CCL21 activation of JNK and Akt signaling pathways, both associated with CCR7-mediated chemotaxis. We also report that the enhanced PSA-mediated effect on DC migration towards CCL21 relied on the highly basic C-terminal region of this chemokine and depended on the PSA acceptor molecule neuropilin-2 (NRP2) and on the polysialyltransferase ST8SiaIV. Altogether, our data indicate that the CCR7/CCL21/NRP2/ST8SiaIV functional axis constitutes an important guidance clue for DC targeting to lymphoid organs.

The incidence of type 2 diabetes mellitus in the Philippines: a 9-year cohort study.

AIMS: Currently, there are no available data on the incidence of type 2 diabetes mellitus (T2DM) in the Philippines. A cohort derived from a national study population (FNRI-NNS, 1998) was revisited after 9 years to yield valuable data on glucose homeostasis among Filipinos. METHODS: Six out of 13 national regions were included in the cohort. There were 1749 out of 2122 respondents (82.4%). 1386 (95.9%) consented to a fasting blood glucose (FBG) test, and 1275 (88.2%) completed the 2h post-glucose (2HPG) load determination using whole blood capillary samples. RESULTS: We observed a significant increase of mean FBGs (91.5mg/dL to 103.3mg/dL) from 1998 to 2007. The 9-year incidence of T2DM was 16.3%. The prevalence of T2DM was 28.0%. The prevalence of pre-diabetes, i.e., combined impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) was 31.3%; IFG was 17.5% and IGT was 23.9%. CONCLUSIONS: The study shows the alarming growth of diabetes, IFG, and IGT in our country that warrants early aggressive intervention for prevention and management. We encourage the use of 2h post-glucose load aside from FBG in screening for true diabetics, IFGs, and IGTs.

Prevalencia de las demencias en el municipio de Neiva 2003-2005 / Dementia prevalence in Neiva (Colombia) 2003-2005

Introducción. El aumento de la población de la tercera edad en el mundo y la consecuente proliferación de enfermedades de aparición tardía en especial los diferentes tipos de demencia, crean una necesidad de atención que obliga a los investigadores a realizar estudios epidemiológicos en los diferentes contextos para proporcionar a los organismos gubernamentales y de salud las herramientas que permitan planificar los recursos y los medios de atención a quienes ya ofrecieron al país una vida de trabajo. Objetivos. Describir y cuantificar las características sociodemográficas y clínicas de los adultos mayores de 60 años de Neiva, encontrar el índice de prevalencia de las demencias en esta población y los factores asociados que pudieran considerarse como posibles factores de riesgo.Métodos. Se trató de un estudio cuantitativo descriptivo de corte transversal y diseño muestral realizado en dos fases consecutivas por un grupo multidisciplinar, aplicando en cada una de ellas los criterios y pruebas más utilizadas en el mundo para estos casos. La población total de adultos mayores en Neiva según proyección hecha para el 2005 fue de 25.142 y la muestra para el estudio fue de 643 tomados en muestreo aleatorio.Resultados. En una muestra significativa de adultos mayores de 60 años seleccionados al azar y proporcionalmente por estrato socioeconómico, se encontró una prevalencia global de demencia de 23.6 por ciento y varios factores de riesgo asociados siendo los principales el bajo nivel de escolaridad (más del 80 por ciento); difíciles condiciones de vida (se agruparon en los estratos más bajos: 92 por ciento); y algunas comorbilidades

Bruton tyrosine kinase gene mutations in Argentina.

The block in differentiation from pro-B to pre-B cells results in a selective defect in the humoral immune response characteristic of human X-linked agammaglobulinemia (XLA). Mutations of Bruton tyrosine kinase (BTK) gene have been identified as the cause of XLA. Mutation detection is the most reliable method for making a definitive diagnosis, except when clinical and laboratory findings are distinctive and coupled with history of X-linked inheritance. To provide a definitive diagnosis to 40 families incorporated in the Argentinian Primary Immunodeficiencies Registry we analysed the BTK gene by SSCP analysis as screening method for XLA, followed by direct sequencing. The molecular defect was localized in 45 patients from 34 unrelated families. From the 34 independent mutations identified, 16 were previously undescribed, 31 were unique mutations, 22 were exonic single nucleotide changes (16 missense and 6 nonsense) and four intronic mutations. Because five families had clinical, immunological and inheritance data sufficient for a definitive diagnosis, our study allowed 37 patients from 29 families previously categorized probable/ possible XLA, have now definitive diagnosis leading to appropriate genetic counseling.