Robotically Aided Method to Characterise the Soft Tissue Interaction with Wearable Robots.

Wearable robots are widely used to enhance, support or assist humans in different tasks. To accomplish this scope, the interaction between the human body and the device should be comfortable, smooth, high-efficient to transfer forces, and safe for the user. Nevertheless, the pressure and shear stress related to these goals have been overlooked or partially analysed. In this sense, it is crucial to understand the soft tissue response through the in-vivo characterisation of multiple areas of the human body. In fact, soft tissue characterisation plays an essential role in calculating the pressure distribution and shear stress. However, current approaches to estimating soft tissue properties are unsuitable for deployment with multiple human body areas. Hence, this work presents a novel methodology to ease the characterisation of soft tissues using a robotic arm and a 3D superficial scanner. First, the robotic arm is validated by comparing the tensile and compression tests to the indentation tests done by the robot, estimating a 10,4% error. The preliminary experimental tests present the hyperelastic model which fit two adjacent zones of the forearm. This analysis can be extended in several ways, such as: calculating the shear stress, the energy losses or deformations caused by the interaction, and investigating the pressure distribution of different types of physical interfaces.

A methodology to implement a closed-loop feedback-feedforward level control in a laboratory-scale flotation bank using peristaltic pumps.

This paper describes the implementation of a level control strategy in a laboratory-scale flotation system. The laboratory-scale system consists of a bank of three flotation tanks connected in series, which mimics a flotation system found in mineral processing plants. Besides the classical feedback control strategy, we have also included a feedforward strategy to better account for process disturbances. Results revealed that the level control performance significantly improves when a feedforward strategy is considered. This methodology uses peristaltic pumps for level control, which has not been extensively documented even though: (1) peristaltic pumps are commonly used in laboratory-scale systems, and (2) the control implementation is not as straightforward as those control strategies that use valves. Therefore, we believe that this paper, which describes a proven methodology that has been validated in an experimental system, can be a useful reference for many researchers in the field.•Preparation of reagents to ensure that the froth stability of the froth layer is representative of an industrial flotation froth.•Calibration of instruments - convert the electrical signal from PLCs to engineering units.•Tuning PI parameters using SIMC rules by performing step-changes in each flotation cell.

Biomechanical Effects of Adding an Ankle Soft Actuation in a Unilateral Exoskeleton.

Stroke disease leads to a partial or complete disability affecting muscle strength and functional mobility. Early rehabilitation sessions might induce neuroplasticity and restore the affected function or structure of the patients. Robotic rehabilitation minimizes the burden on therapists by providing repetitive and regularly monitored therapies. Commercial exoskeletons have been found to assist hip and knee motion. For instance, unilateral exoskeletons have the potential to become an effective training system for patients with hemiparesis. However, these robotic devices leave the ankle joint unassisted, essential in gait for body propulsion and weight-bearing. This article evaluates the effects of the robotic ankle orthosis T-FLEX during cooperative assistance with the AGoRA unilateral lower-limb exoskeleton (hip and knee actuation). This study involves nine subjects, measuring muscle activity and gait parameters such as stance and swing times. The results showed a reduction in muscle activity in the Biceps Femoris of 50%, Lateral Gastrocnemius of 59% and Tibialis Anterior of 35% when adding T-FLEX to the AGoRA unilateral lower-limb exoskeleton. No differences were found in gait parameters. Nevertheless, stability is preserved when comparing the two legs. Future works should focus on evaluating the devices in ground tests in healthy subjects and pathological patients.

Determinantes sociales de salud percibida y calidad de vida en mayores de dieciséis años de edad, Honduras / Social determinants of perceived health and quality of life in people over sixteen years old, in Honduras

Introducción: Los determinantes sociales son el reflejo de las políticas adoptadas por los gobiernos y la distribución de las riquezas en todo el mundo. Estos influyen en las inequidades sanitarias y calidad de vida de la población. Objetivo: Establecer la relación entre determinantes sociales de salud percibida y calidad de vida en tres cabeceras departamentales de Honduras. Métodos: Estudio descriptivo-correlacional en 2017. El universo lo constituyeron los habitantes de San Pedro Sula, Tegucigalpa y Santa Bárbara. Muestreo estratificado por lugar/género. Se incluyeron 824 participantes mayores de 16 años, voluntarios. Se aplicó un cuestionario sobre determinantes sociales de salud y el instrumento de calidad de vida WHOQOL-BREF. Los datos se procesaron en IBM SPSS versión 26. Se realizó análisis correlacional. Se calcularon las pruebas U de Mann Whitney y Kruskal Wallis. Resultados: El 53,3 por ciento (439) eran del género femenino, edades entre 16-80 años. El 29,5 por ciento (242) estaba desempleado, el 74 por ciento (610) tenían ingresos familiares mensuales menor que un salario mínimo mensual, el 85,2 por ciento (703) pertenecía a estrato social medio. El 26 por ciento (214) tenían acceso a la salud por medios privados. Se encontró relación estadísticamente significativa entre nivel educativo, ingresos mensuales, estrato social, acceso a la salud y estado de salud, con los cuatro dominios de calidad de vida. Conclusiones: Es importante mejorar la equidad social de los hondureños, para que la población en general tenga mejores oportunidades para suplir sus necesidades como lo es la vivienda, el acceso a la salud, educación y de esa manera podrán tener mejor calidad de vida(AU)

Introduction: Social determinants are the reflection of the policies adopted by governments and the distribution of wealth around the world. These influence the health inequities and quality of life of the population. Objective: To establish the relationship between social determinants of perceived health and quality of life in three departmental capitals of Honduras. Methods: Descriptive-correlational study in 2017. The universe was constituted by the inhabitants of San Pedro Sula, Tegucigalpa and Santa Barbara. Stratified sampling by place/gender. 824 participants over 16 years old, volunteers were included. A questionnaire on social determinants of health and the WHOQOL-BREF quality of life tool were applied. The data was processed in IBM SPSS version 26. Correlational analysis was performed. Mann Whitney and Kruskal Wallis U-tests were calculated. Results: 53.3 percent (439) were female, aged between 16-80 years. 29.5percent (242) were unemployed, 74percent (610) had a monthly family income lower than a minimum monthly wage, 85.2percent (703) belonged to the middle social stratum. 26percent (214) had access to health by private means. A statistically significant relationship was found between educational level, monthly income, social stratum, access to health and health status, with the four domains of quality of life. Conclusions: It is important to improve the social equity of Hondurans, so that the general population has better opportunities to meet their needs such as housing, access to health, education and thus be able to have a better quality of life(AU)

Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica.

ANTECEDENTES: Las enfermedades cardiovasculares son la principal causa mundial de mortalidad y México no es la excepción. Los datos epidemiológicos obtenidos en 1990 mostraron que los padecimientos cardiovasculares representaron el 19.8% de todas las causas de muerte en nuestro país; esta cifra se incrementó de manera significativa a un 25.5% para 2015. Diversas encuestas nacionales sugieren que más del 60% de la población adulta tiene al menos un factor de riesgo para padecer enfermedades cardiovasculares (obesidad o sobrepeso, hipertensión, tabaquismo, diabetes, dislipidemias). Por otro lado, datos de la Organización Panamericana de la Salud han relacionado el proceso de aterosclerosis como la primer causa de muerte prematura, reduciendo la expectativa de vida de manera sensible, lo que tiene una enorme repercusión social. OBJETIVO: Este documento constituye la guía de práctica clínica (GPC) elaborada por iniciativa de la Sociedad Mexicana de Cardiología en colaboración con la Sociedad Mexicana de Nutrición y Endocrinología, A.C., Asociación Nacional de Cardiólogos de México, A.C., Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, A.C., Comité Normativo Nacional de Medicina General, A.C., Colegio Nacional de Medicina Geriátrica, A.C., Colegio de Medicina Interna de México, A.C., Sociedad Mexicana de Angiología y Cirugía Vascular y Endovenosa, A.C., Instituto Mexicano de Investigaciones Nefrológicas, A.C. y la Academia Mexicana de Neurología, A.C.; con el apoyo metodológico de la Agencia Iberoamericana de Desarrollo y Evaluación de Tecnologías en Salud, con la finalidad de establecer recomendaciones basadas en la mejor evidencia disponible y consensuadas por un grupo interdisciplinario de expertos. El objetivo de este documento es el de brindar recomendaciones basadas en evidencia para ayudar a los tomadores de decisión en el diagnóstico y tratamiento de las dislipidemias en nuestro país. MATERIAL Y MÉTODOS: Este documento cumple con estándares internacionales de calidad, como los descritos por el Instituto de Medicina de EE.UU., el Instituto de Excelencia Clínica de Gran Bretaña, la Red Colegiada para el Desarrollo de Guías de Escocia y la Red Internacional de Guías de Práctica Clínica. Se integró un grupo multidisciplinario de expertos clínicos y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. Se consensuó un documento de alcances, se establecieron las preguntas clínicas relevantes, se identificó de manera exhaustiva la mejor evidencia disponible evaluada críticamente en revisiones sistemáticas de la literatura y se desarrollaron las recomendaciones clínicas. Se utilizó la metodología de Panel Delphi modificado para lograr un nivel de consenso adecuado en cada una de las recomendaciones contenidas en esta GPC. RESULTADOS: Se consensuaron 23 preguntas clínicas que dieron origen a sus respectivas recomendaciones clínicas. CONCLUSIONES: Esperamos que este documento contribuya a la mejor toma de decisiones clínicas y se convierta en un punto de referencia para los clínicos y pacientes en el manejo de las dislipidemias y esto contribuya a disminuir la morbilidad y mortalidad derivada de los eventos cardiovasculares ateroscleróticos en nuestro país. BACKGROUND: Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. OBJECTIVE: This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. MATERIAL AND METHODS: This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. RESULTS: 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. CONCLUSIONS: We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.

Development of a 3D Relative Motion Method for Human-Robot Interaction Assessment.

Exoskeletons have been assessed by qualitative and quantitative features known as performance indicators. Within these, the ergonomic indicators have been isolated, creating a lack of methodologies to analyze and assess physical interfaces. In this sense, this work presents a three-dimensional relative motion assessment method. This method quantifies the difference of orientation between the user's limb and the exoskeleton link, providing a deeper understanding of the Human-Robot interaction. To this end, the AGoRA exoskeleton was configured in a resistive mode and assessed using an optoelectronic system. The interaction quantified a difference of orientation considerably at a maximum value of 41.1 degrees along the sagittal plane. It extended the understanding of the Human-Robot Interaction throughout the three principal human planes. Furthermore, the proposed method establishes a performance indicator of the physical interfaces of an exoskeleton.

Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica / Mexican clinical practice guideline for the diagnosis and treatment of dyslipidemias and atherosclerotic cardiovascular disease

resumen está disponible en el texto completo

Abstract Background: Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. Objective: This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. Material and methods: This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. Results: 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. Conclusions: We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.

Caracterización epidemiológica y clínica de pacientes adultos con dengue en la costa Atlántica de Honduras / Epidemiological and clinical characterization of adults in the atlantic coast of Honduras

Antecedentes: El dengue es una enfermedad infecciosa causada por el virus del dengue, uno de los cuatro serotipos del virus (DENV). Actualmente es uno de los mayores problemas en salud pública a nivel nacional y en la región de las Américas. Objetivo: Determinar las características epidemiológicas y clínicas de pacientes adultos con dengue, Hospital Tela, enero-diciembre 2019. Métodos: estudio retrospectivo, descriptivo, se registró información de expedientes clínicos de los pacientes adultos con diagnóstico epidemiológico y clínico de dengue atendidos en el Hospital Tela, Atlántida durante el 2019. Resultados: Se evaluaron 276 casos. La edad media fue 37 años, femenino 57.3% (158). De acuerdo con la clasificación por gravedad de la Organización Panamericana de la Salud (OPS), 58.3% (161) fueron clasificados como dengue con signos de alarma. Los signos y síntomas más frecuentes fueron fiebre 100% (276), artralgias 90.2% (249), mialgias 89.9% (248), cefalea 79.4% (219). El 92% (254) presentó leucopenia desde el segundo día y trombocitopenia 92.8% (267) desde el primer día de enfermedad. Solamente 6.9% (19) contó con resultados de pruebas de laboratorio y de éstas fueron positivas 0.7% (2) RT-PCR, serología IgM 1.8% (5) e IgG 1.4% (4). Discusión: La presentación clínica epidemiológica más común fue en mujeres jóvenes sin antecedentes personales patológicos, clasificada como dengue con signos de alarma. Los pacientes presentaron trombocitopenia desde el primer día de enfermedad. La caracterización se vio limitada por la ausencia de confirmación por laboratorio. Se requiere correlacionar con estudios multicéntricos en el futuro...(AU)

The Actuation System of the Ankle Exoskeleton T-FLEX: First Use Experimental Validation in People with Stroke.

Robotic devices can provide physical assistance to people who have suffered neurological impairments such as stroke. Neurological disorders related to this condition induce abnormal gait patterns, which impede the independence to execute different Activities of Daily Living (ADLs). From the fundamental role of the ankle in walking, Powered Ankle-Foot Orthoses (PAFOs) have been developed to enhance the users' gait patterns, and hence their quality of life. Ten patients who suffered a stroke used the actuation system of the T-FLEX exoskeleton triggered by an inertial sensor on the foot tip. The VICONmotion capture system recorded the users' kinematics for unassisted and assisted gait modalities. Biomechanical analysis and usability assessment measured the performance of the system actuation for the participants in overground walking. The biomechanical assessment exhibited changes in the lower joints' range of motion for 70% of the subjects. Moreover, the ankle kinematics showed a correlation with the variation of other movements analyzed. This variation had positive effects on 70% of the participants in at least one joint. The Gait Deviation Index (GDI) presented significant changes for 30% of the paretic limbs and 40% of the non-paretic, where the tendency was to decrease. The spatiotemporal parameters did not show significant variations between modalities, although users' cadence had a decrease of 70% of the volunteers. Lastly, the satisfaction with the device was positive, the comfort being the most user-selected aspect. This article presents the assessment of the T-FLEX actuation system in people who suffered a stroke. Biomechanical results show improvement in the ankle kinematics and variations in the other joints. In general terms, GDI does not exhibit significant increases, and the Movement Analysis Profile (MAP) registers alterations for the assisted gait with the device. Future works should focus on assessing the full T-FLEX orthosis in a larger sample of patients, including a stage of training.

Experimental model for removal of snake venom via hemoperfusion in rats.

OBJECTIVE: To examine the efficiency of hemoperfusion in removing South American rattlesnake (Crotalus durissus terrificus) venom from rats compared with neutralization by antivenom. DESIGN: An exploratory experimental investigation in rats involving the injection of snake venom with or without subsequent hemoperfusion or antivenom administration. SETTING: Basic animal research laboratory in a private university. ANIMALS: Normal, healthy male Wistar rats (0.29-0.40 kg, 3-6 months old) from a commercial breeder. INTERVENTIONS: Four experimental groups of randomly allocated rats (n = 3/group) were studied: Group 1: rats were injected with a single dose of venom (5 mg/kg, IM, in the right thigh) with no other treatment; blood samples were collected minutes before death to determine leukocyte, platelet, and erythrocyte counts; Group 2 (Control): rats underwent hemoperfusion alone for 60 min using a hemoperfusion cartridge designed for protein adsorption (by granulated charcoal) and protein precipitation (by tannic acid); Group 3 (Venom + antivenom): rats were injected with venom (5 mg/kg, IM) and, 10 min later, were treated with antivenom at the venom:antivenom ratio recommended by the manufacturer; Group 4 (Venom + hemoperfusion): Rats were injected with venom (5 mg/kg, IM) and, 10 min later, were hemoperfused for 60 min. In groups 2-4, blood samples were collected for leukocyte, platelet, and erythrocyte counts 24 h after venom. MEASUREMENTS AND MAIN RESULTS: Rats injected with venom alone (Group 1) developed signs of neurotoxicity and ataxia and died in 9.0 ± 0.43 h but showed no changes in leukocyte or erythrocyte counts. In contrast, there were no deaths in groups 2-4. The lack of deaths in Groups 3 and 4 indicated that antivenom and hemoperfusion, respectively, protected against the lethal effects of the venom. CONCLUSIONS: Hemoperfusion with a double-action hemoperfusion cartridge capable of protein adsorption and precipitation protected rats against C. d. terrificus venom.

Experimental model for removal of snake venom via hemoperfusion in rats

OBJECTIVE: To examine the efficiency of hemoperfusion in removing South American rattlesnake (Crotalus durissus terrificus) venom from rats compared with neutralization by antivenom. DESIGN: An exploratory experimental investigation in rats involving the injection of snake venom with or without subsequent hemoperfusion or antivenom administration. SETTING: Basic animal research laboratory in a private university. ANIMALS: Normal, healthy male Wistar rats (0.29-0.40 kg, 3-6 months old) from a commercial breeder. INTERVENTIONS: Four experimental groups of randomly allocated rats (n = 3/group) were studied: Group 1: rats were injected with a single dose of venom (5 mg/kg, IM, in the right thigh) with no other treatment; blood samples were collected minutes before death to determine leukocyte, platelet, and erythrocyte counts; Group 2 (Control): rats underwent hemoperfusion alone for 60 min using a hemoperfusion cartridge designed for protein adsorption (by granulated charcoal) and protein precipitation (by tannic acid); Group 3 (Venom + antivenom): rats were injected with venom (5 mg/kg, IM) and, 10 min later, were treated with antivenom at the venom:antivenom ratio recommended by the manufacturer; Group 4 (Venom + hemoperfusion): Rats were injected with venom (5 mg/kg, IM) and, 10 min later, were hemoperfused for 60 min. In groups 2-4, blood samples were collected for leukocyte, platelet, and erythrocyte counts 24 h after venom. MEASUREMENTS AND MAIN RESULTS: Rats injected with venom alone (Group 1) developed signs of neurotoxicity and ataxia and died in 9.0 ± 0.43 h but showed no changes in leukocyte or erythrocyte counts. In contrast, there were no deaths in groups 2-4. The lack of deaths in Groups 3 and 4 indicated that antivenom and hemoperfusion, respectively, protected against the lethal effects of the venom. ONCLUSIONS: Hemoperfusion with a double-action hemoperfusion cartridge capable of protein adsorption and precipitation protected rats against C. d. terrificus venom. (AU)

Conocimientos, y prácticas de pacientes hipertensos en San José de Boquerón, julio 2018 / Knowledge, attitudes and practices of hypertensive patientsin San José de Boquerón, julio 2018

La hipertensión es una causa mayor de discapacidad y muerte a nivel mundial. El conocimiento de los pacientes es un factor importante para modificar conceptos erró-neos y el riesgo que constituye la hiperten-sión como condicionante de daño cardiovas-cular. Objetivo: Describir los conocimientos, actitudes y prácticas de pacientes hiperten-sos de la comunidad de San José de Boque-rón, San Pedro Sula, julio del 2018. Pacien-tes y Métodos: Estudio descriptivo de corte transversal cuantitativo. La muestra fue de 30 pacientes con hipertensión arterial, seleccionados a través de muestreo no probabilístico por conveniencia. La recolec-ción de datos se realizó mediante una encuesta aplicada a pacientes hipertensos que cumplían con criterios de inclusión y contaban con un consentimiento informado. Los datos se tabularon mediante Microsoft Excel 2016. Resultados: 76.7% de los pacientes eran mujeres y 64% tenía más de 60 años. El 50% de los pacientes conocía sobre hipertensión arterial, 56.7% refieren que los tratamientos caseros superan a los medicamentos. Un 10% considera que el consumo de sal era mayor del requerimiento diario. El 36.7% no sigue ninguna dieta y 60% no realiza al menos 30 minutos de ejer-cicio diario. Conclusión: El conocimiento en la población de la comunidad de San José de Boquerón fue adecuado, sin embargo, el conocimiento sobre la hipertensión arterial y los parámetros normales de presión arterial sigue siendo insatisfactorios. Hay una acti-tud positiva de los pacientes sobre asistir a consulta con un médico y mayor confianza en la medicina alternativa que en los farma-cos. El mayor déficit fue encontrado en las prácticas de dieta y ejercicio...(AU)

New pharmacological insights of Galactia glaucescens.

Galactia glaucescens leaves are popularly used against snakebites in Brazil. The hydroethanolic extract from aerial parts of G. glaucescens (HEGg) was assayed against the neurotoxicity and myotoxicity induced by Bothrops jararacussu venom. A traditional myographic technique was applied for neurotoxicity and the resulting muscles were treated routinely by light microscopy analysis for myotoxicity. Additionally, the antimicrobial potential of HEGg was evaluated against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa strains, as well as Rutin was isolated for the first time in this specie using chromatographic and spectroscopic methods and its antiophidian property was assessed. HEGg totally prevents the neurotoxicity and myotoxicity effects caused by B. jararacussu, but did not show any antimicrobial effect. Concluding, HEGg and Rutin were able to counteract the toxic effects of the venom and confirmed the antiophidian potential, but not antimicrobial, of G. glaucescens as an alternative for neutralization of B. jararacussu venom.

Fenómenos vasculares retinianos en esclerosis múltiple. Reporte de caso y revisión narrativa de la literatura / Retinal vascular phenomena in multiple sclerosis. Case report and narrative review of the literatura

Introducción: La esclerosis múltiple (EM) es la enfermedad inflamatoria desmielinizante del sistema nervioso central (SNC) más prevalente en el mundo. Puede presentar afectación a nivel ocular a través del compromiso inflamatorio de distinto tejidos. Objetivo: Dar a conocer la importancia del enfoque temprano de la esclerosis múltiple por parte del médico oftalmólogo. Diseño del estudio: Reporte de caso y revisión narrativa de la literatura. Resumen del caso: Se reporta el caso de una paciente joven con signos de vasculitis retiniana (VR) asociada a neuritis óptica bilateral y uveítis anterior como debut de inusual de la EM. Para la revisión narrativa se llevó a cabo la búsqueda avanzada en tres bases de datos electrónicas: PUBMED, LILACS y OVID. Por medio del gestor de referencias Zotero se realizó la eliminación de duplicados y lectura crítica de título y resumen de 162 artículos por parte de dos investigadores. Conclusión: La EM es una enfermedad crónica inflamatoria del SNC. Puede afectar las estructuras oculares de distintas maneras, una de ellas es la VR, que aunque se caracteriza por el compromiso de vasos venosos, hay que tener en cuenta presentaciones atípicas como hemorragias periarteriolares, aneurismas de grandes vasos, cierre capilar periférico, oclusión de arterial central de la retina, neovascularización del nervio óptico o aparición en etapas tempranas de la enfermedad. La fuerte asociación entre la VR y la actividad de la EM destaca la importancia del reconocimiento de patrones atípicos de una enfermedad que requiere del manejo y seguimiento oportuno por parte de neurología y oftalmología.

Background: Multiple sclerosis (MS) is the most prevalent infl ammatory demyelinating disease of the central nervous system (CNS) in the world. It may present involvement at the ocular level through the inflammatory compromise of different tissues. Objective: To provide knowledge on the importance of the early approach of multiple sclerosis by the ophthalmologist. Study design: Case report and narrative review of the literature. Case summary: We report the case of a young patient with signs of retinal vasculitis (RV) associated with bilateral optic neuritis and anterior uveitis as an unusual debut of MS. For the narrative review, the advanced search was carried out in three electronic databases: PUBMED, LILACS and OVID. Through the Zotero reference manager, the elimination of duplicates and critical reading of the title and summary of 162 articles by two researchers was carried out. Conclusion: MS is a chronic inflammatory disease of the CNS. It can affect the ocular structures in different ways, one of them is RV, which although it is characterized by the involvement of venous vessels, we must take into account atypical presentations such as periarteriolar hemorrhages, large vessel aneurysms,peripheral capillary closure, retinal artery occlusion, neovascularization of the optic nerve or appearance in the early stages of the disease. The strong association between RV and MS activity highlights the importance of recognizing atypical patterns of a disease that requires early management and follow-up by neurology and ophthalmology.

Histología: desde su orígen hasta la actualidad / Histology: from its origin to actuality

Histología, es la rama de la anatomía que estudia los tejidos de animales y plantas. Aunque el término anatomía microscópica no es sinónimo, se utilizan indistintamente para referirse al estudio de la estructura microscópica de células, tejidos y órganos o sistemas. Para ello, ha sido indispensable el invento del microscopio que sucedió a partir del descubrimiento de vidrios, cristales y lentes que llevaron a inventar los microscopios simples luego los compuestos, evolucionando en el siglo pasado a la invención del microscopio electrónico con mayor poder de resolución de 250 ºångström (A). Para observar un tejido al microscopio es fundamental el uso de técnicas histológicas y colorantes. Han sido muchos los personajes de la historia de la medicina que han participado en describir histológicamente el cuerpo humano, es por ello que diferentes estructuras histológicas llevan epónimos o términos constituidos por los nombres propios de sus descubridores, ejemplo los "corpúsculo de Malphigie." El Comité Internacional Federativo de Terminología Anatómica (FICAT) bajo los auspicios de la Federación Internacional de Asociaciones de Anatomistas (IFAA), recibió el encargo de unificar la terminología morfológica internacional, publicando dicha terminología histológica el año 2008. La Asociación Panamericana de Anatomía (APA), fue fundada en 1966 en la ciudad de México y desde el año 2009 se realizan los Simposios Iberolatinoamericanos de terminología Anatómica, Embriológica e Histológica, (SILAT) con el objetivo de traducir al castellano la TERMINOLOGÍA MORFOLÓGICA INTERNACIONAL, para que las instituciones educativas de medicina y de otras áreas de la salud, de habla hispana y portuguesa, la empleen cotidianamente...(AU)

Three deaf mice: mouse models for TECTA-based human hereditary deafness reveal domain-specific structural phenotypes in the tectorial membrane.

Tecta is a modular, non-collagenous protein of the tectorial membrane (TM), an extracellular matrix of the cochlea essential for normal hearing. Missense mutations in Tecta cause dominant forms of non-syndromic deafness and a genotype-phenotype correlation has been reported in humans, with mutations in different Tecta domains causing mid- or high-frequency hearing impairments that are either stable or progressive. Three mutant mice were created as models for human Tecta mutations; the Tecta(L1820F,G1824D/+) mouse for zona pellucida (ZP) domain mutations causing stable mid-frequency hearing loss in a Belgian family, the Tecta(C1837G/+) mouse for a ZP-domain mutation underlying progressive mid-frequency hearing loss in a Spanish family and the Tecta(C1619S/+) mouse for a zonadhesin-like (ZA) domain mutation responsible for progressive, high-frequency hearing loss in a French family. Mutations in the ZP and ZA domains generate distinctly different changes in the structure of the TM. Auditory brainstem response thresholds in the 8-40 kHz range are elevated by 30-40 dB in the ZP-domain mutants, whilst those in the ZA-domain mutant are elevated by 20-30 dB. The phenotypes are stable and no evidence has been found for a progressive deterioration in TM structure or auditory function. Despite elevated auditory thresholds, the Tecta mutant mice all exhibit an enhanced tendency to have audiogenic seizures in response to white noise stimuli at low sound pressure levels (≤84 dB SPL), revealing a previously unrecognised consequence of Tecta mutations. These results, together with those from previous studies, establish an allelic series for Tecta unequivocally demonstrating an association between genotype and phenotype.

A novel splice-site mutation in the GJB2 gene causing mild postlingual hearing impairment.

The DFNB1 subtype of autosomal recessive, nonsyndromic hearing impairment, caused by mutations affecting the GJB2 (connexin-26) [corrected] gene, is highly prevalent in most populations worldwide. DFNB1 hearing impairment is mostly severe or profound and usually appears before the acquisition of speech (prelingual onset), though a small number of hypomorphic missense mutations result in mild or moderate deafness of postlingual onset. We identified a novel GJB2 splice-site mutation, c. -22-2A>C, in three siblings with mild postlingual hearing impairment that were compound heterozygous for c. -22-2A>C and c.35delG. Reverse transcriptase-PCR experiments performed on total RNA extracted from saliva samples from one of these siblings confirmed that c. -22-2A>C abolished the acceptor splice site of the single GJB2 intron, resulting in the absence of normally processed transcripts from this allele. However, we did isolate transcripts from the c. -22-2A>C allele that keep an intact GJB2 coding region and that were generated by use of an alternative acceptor splice site previously unknown. The residual expression of wild-type connexin-26 [corrected] encoded by these transcripts probably underlies the mild severity and late onset of the hearing impairment of these subjects.

Mutations of the gene encoding otogelin are a cause of autosomal-recessive nonsyndromic moderate hearing impairment.

Already 40 genes have been identified for autosomal-recessive nonsyndromic hearing impairment (arNSHI); however, many more genes are still to be identified. In a Dutch family segregating arNSHI, homozygosity mapping revealed a 2.4 Mb homozygous region on chromosome 11 in p15.1-15.2, which partially overlapped with the previously described DFNB18 locus. However, no putative pathogenic variants were found in USH1C, the gene mutated in DFNB18 hearing impairment. The homozygous region contained 12 additional annotated genes including OTOG, the gene encoding otogelin, a component of the tectorial membrane. It is thought that otogelin contributes to the stability and strength of this membrane through interaction or stabilization of its constituent fibers. The murine orthologous gene was already known to cause hearing loss when defective. Analysis of OTOG in the Dutch family revealed a homozygous 1 bp deletion, c.5508delC, which leads to a shift in the reading frame and a premature stop codon, p.Ala1838ProfsX31. Further screening of 60 unrelated probands from Spanish arNSHI families detected compound heterozygous OTOG mutations in one family, c.6347C>T (p.Pro2116Leu) and c. 6559C>T (p.Arg2187X). The missense mutation p.Pro2116Leu affects a highly conserved residue in the fourth von Willebrand factor type D domain of otogelin. The subjects with OTOG mutations have a moderate hearing impairment, which can be associated with vestibular dysfunction. The flat to shallow "U" or slightly downsloping shaped audiograms closely resembled audiograms of individuals with recessive mutations in the gene encoding α-tectorin, another component of the tectorial membrane. This distinctive phenotype may represent a clue to orientate the molecular diagnosis.

Segregation of a new mutation in SLC26A4 and p.E47X mutation in GJB2 within a consanguineous Tunisian family affected with Pendred syndrome.

OBJECTIVE: Recessive mutations of the SLC26A4 (PDS) gene on chromosome 7q31 can cause sensorineural hearing loss with goiter (Pendred syndrome) or non-syndromic autosomal recessive hearing loss (DFNB4). Furthermore, mutations in the GJB2 gene results in autosomal recessive (DFNB1) and dominant (DFNA3) non-syndromic hearing loss. The aim of the present study was to characterize a family with Pendred syndrome affected by severe to profound HL and presenting goiter. METHODS: Affected members underwent detailed audiologic examination and characterization. DNA samples from family members were genotyped with polymorphic microsatellite markers and sequencing of the SLC26A4 and GJB2 genes was performed. A total of 25 families with non-syndromic hearing loss were screened for the common p.E47X mutation in the GJB2 gene by direct dideoxy sequencing. RESULTS: Genetic microsatellite analysis showed linkage to the 7q22-q31 chromosomal region and mutation analysis revealed a novel frameshift mutation (c.451delG) in the SLC26A4 gene. Screening of the GJB2 gene in one patient, displayed a homozygous p.E47X mutation, together with a heterozygous c.451delG mutation. Screening of 25 families with HL showed frequent segregation of the p.E47X mutation, which was homozygous in five of these families. Haplotype analysis using microsatellite markers and single nucleotide polymorphisms (SNPs) closely flanking the GJB2 gene, revealed the presence of two disease-associated-haplotypes suggesting the presence of at least, two founder effects carrying the p.E47X non-sense mutation in the Tunisian population. CONCLUSIONS: The segregation of both SLC26A4 and GJB2 mutations in the family illustrates once again the unexpected intra-familial genetic heterogeneity in consanguineous families and highlights the difficulty of genetic counselling in such families. In addition, our results disclose the existence of founder effects in the Tunisian population.

Nonsense mutations in SMPX, encoding a protein responsive to physical force, result in X-chromosomal hearing loss.

The fact that hereditary hearing loss is the most common sensory disorder in humans is reflected by, among other things, an extraordinary allelic and nonallelic genetic heterogeneity. X-chromosomal hearing impairment represents only a minor fraction of all cases. In a study of a Spanish family the locus for one of the X-chromosomal forms was assigned to Xp22 (DFNX4). We mapped the disease locus in the same chromosomal region in a large German pedigree with X-chromosomal nonsyndromic hearing impairment by using genome-wide linkage analysis. Males presented with postlingual hearing loss and onset at ages 3-7, whereas onset in female carriers was in the second to third decades. Targeted DNA capture with high-throughput sequencing detected a nonsense mutation in the small muscle protein, X-linked (SMPX) of affected individuals. We identified another nonsense mutation in SMPX in patients from the Spanish family who were previously analyzed to map DFNX4. SMPX encodes an 88 amino acid, cytoskeleton-associated protein that is responsive to mechanical stress. The presence of Smpx in hair cells and supporting cells of the murine cochlea indicates its role in the inner ear. The nonsense mutations detected in the two families suggest a loss-of-function mechanism underlying this form of hearing impairment. Results obtained after heterologous overexpression of SMPX proteins were compatible with this assumption. Because responsivity to physical force is a characteristic feature of the protein, we propose that long-term maintenance of mechanically stressed inner-ear cells critically depends on SMPX function.