Real-world evidence of nivolumab for non-small-cell lung cancer in a developing country.

Nivolumab is a human programmed death receptor-1 blocking antibody, used as treatment option in patients with advanced non-small-cell lung cancer (NSCLC). We assessed the nivolumab efficacy in terms of survival and response to treatment as second-line (2L) or third-line (3L) therapy in patients with advanced NSCLC. This is a multicentric observational study. Data of patients with advanced NSCLC who received nivolumab as 2L or 3L treatment were analyzed retrospectively. Information regarding patient demographics and clinical backgrounds, treatment patterns from diagnosis to post-nivolumab treatment, effectiveness, and safety of nivolumab treatment were collected. The outcomes evaluated were overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) to treatment. OS and PFS were estimated with the Kaplan-Meier method and the differences were evaluated through the log-rank test. Data of 178 patients were included. The median follow-up was 26.8 months (interquartile range (IQR): 20.3-40.4). Nivolumab was commonly used as a 2L treatment (77.5%). The outcomes in this setting (2L) were as follows: ORR was 21.0%, and the median PFS and OS were 5.5 months (95% confidence interval (CI): 4.5-6.5) and 12.4 months (95% CI: 10.8-14.0), respectively. In 3L, the ORR with nivolumab was 15.0%, the median PFS and OS were 4.1 months (95% CI: 3.1-5.1) and 10.1 months (95% CI: 9.4-10.6), respectively. Three patients (1.7%) required discontinuation due to toxicity. Nivolumab effectiveness and safety in this scenario was consistent with that reported by previous trials and other real-world data.

Effects of Type of Concentrate and Timing of Supplementation on Feed Intake, Nitrogen Use, and Performance in Lactating Dairy Cows Grazing an Alfalfa-Ryegrass Sward.

The aim was to analyze the effects of two cereal grains differing in nutritional composition and starch degradation characteristics and the timing of their supplementation on feed intake, rumen microbial protein synthesis (MPS), performance, and nitrogen use of lactating dairy cows grazing an alfalfa-ryegrass sward. Four dietary treatments were tested in 24 lactating Brown Swiss cows in an incomplete 4 × 3 Latin square design. Cows were supplemented with 3.5 kg/d (as-fed basis) of a corn-based or an oat-based concentrate mixture (CM), of which either the majority (2.5 vs. 1.0 kg/d) was offered before or after grazing. Feed intake was similar across diets, but the interaction between type of CM and timing of supplementation affected eating time (p = 0.010), milk protein (p = 0.013) and energy-corrected milk yields (p = 0.025), efficiency of rumen MPS (p = 0.094), and nitrogen use efficiency (p = 0.081). Most of these variables were greater when the majority of the corn-based CM was offered after grazing and the oat-based CM before grazing. Supplementing slowly degradable starch sources after and rapidly degradable starch sources before grazing may improve the efficiency of rumen MPS, milk performance, and nitrogen use efficiency in dairy cows grazing alfalfa-ryegrass swards.

The kidnapping of mitochondrial function associated with the SARS-CoV-2 infection.

Infection by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) leads to multi-organ failure associated with a cytokine storm and septic shock. The virus evades the mitochondrial production of interferons through its N protein and, from that moment on, it hijacks the functions of these organelles. The aim of this study was to show how the virus kidnaps the mitochondrial machinery for its benefit and survival, leading to alterations of serum parameters and to nitrosative stress (NSS). In a prospective cohort of 15 postmortem patients who died from COVID-19, six markers of mitochondrial function (COX II, COX IV, MnSOD, nitrotyrosine, Bcl-2 and caspase-9) were analyzed by the immune colloidal gold technique in samples from the lung, heart, and liver. Biometric laboratory results from these patients showed alterations in hemoglobin, platelets, creatinine, urea nitrogen, glucose, C-reactive protein, albumin, D-dimer, ferritin, fibrinogen, Ca²âº, K⁺, lactate and troponin. These changes were associated with alterations in the mitochondrial structure and function. The multi-organ dysfunction present in COVID-19 patients may be caused, in part, by damage to the mitochondria that results in an inflammatory state that contributes to NSS, which activates the sepsis cascade and results in increased mortality in COVID-19 patients.

Association between Postmortem Kidney Biopsy Findings and Acute Kidney Injury from Patients with SARS-CoV-2 (COVID-19).

BACKGROUND AND OBJECTIVES: AKI in coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality. The objective of this study was to identify the kidney histopathologic characteristics of deceased patients with diagnosis of COVID-19 and evaluate the association between biopsy findings and clinical variables, including AKI severity. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our multicenter, observational study of deceased patients with COVID-19 in three third-level centers in Mexico City evaluated postmortem kidney biopsy by light and electron microscopy analysis in all cases. Descriptive and association statistics were performed between the clinical and histologic variables. RESULTS: A total of 85 patients were included. Median age was 57 (49-66) years, 69% were men, body mass index was 29 (26-35) kg/m2, 51% had history of diabetes, 46% had history of hypertension, 98% received anticoagulation, 66% were on steroids, and 35% received at least one potential nephrotoxic medication. Severe AKI was present in 54% of patients. Biopsy findings included FSGS in 29%, diabetic nephropathy in 27%, and arteriosclerosis in 81%. Acute tubular injury grades 2-3 were observed in 49%. Histopathologic characteristics were not associated with severe AKI; however, pigment casts on the biopsy were associated with significantly lower probability of kidney function recovery (odds ratio, 0.07; 95% confidence interval, 0.01 to 0.77). The use of aminoglycosides/colistin, levels of C-reactive protein and serum albumin, previous use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, antivirals, nonsteroid anti-inflammatory drugs, and anticoagulants were associated with specific histopathologic findings. CONCLUSIONS: A high prevalence of chronic comorbidities was found on kidney biopsies. Nonrecovery from severe AKI was associated with the presence of pigmented casts. Inflammatory markers and medications were associated with specific histopathologic findings in patients dying from COVID-19.

Factores psicosociales y familiares que influyen en la deserción en estudiantes universitarios en el contexto de los países en desarrollo / Psycho-social and familial factors influencing drop-out rates among university students in the context of developing countries / Fatores psicossociais e familiares que influenciam na deserção em estudantes universitários no contexto dos países em desenvolvimento

Resumen Introducción. La deserción universitaria es un problema de gran interés para diferentes agentes del sistema educativo, pues su ocurrencia en las sociedades es un indicador de ineficiencia, que genera considerables costos para los Estados, las universidades, los estudiantes y sus familias. Objetivo. Examinar los factores que influyen en la decisión de desertar de los estudiantes universitarios de la ciudad de Medellín (Colombia) para el año 2018. Materiales y métodos. Se llevó a cabo un estudio con enfoque cuantitativo, a partir de un diseño exploratorio-descriptivo de campo, de carácter transversal, en el que participaron 3026 estudiantes mediante la aplicación de un cuestionario autoadministrado. Resultados. Además de los factores económicos, que tradicionalmente son evaluados en este tipo de literatura, las condiciones sociales, familiares y afectivas se convierten en incidentes clave al momento de abordar la deserción escolar como un fenómeno estructural. Conclusiones. La articulación entre directivos, administrativos docentes y estudiantes se consolida como un elemento clave en los procesos de retención académica, como una estrategia para combatir el fenómeno de deserción universitaria.

Abstract Introduction: University dropout is a problem of great interest to different agents of the education system, since its presence in societies is an indicator of inefficiency, which generates considerable costs for states, universities, students and their families. Objective: Examine the factors that influence students' decision to drop out of university in the city of Medellin (Colombia) for the year 2018. Methods and instruments: A quantitative study was carried out, based on a cross-cutting exploratory-descriptive field design, in which 3026 students participated through the application of a self-administered questionnaire. Results: In addition to economic factors, which are traditionally evaluated in this type of literature, social, family and affective conditions become key incidents when dealing with school dropout as a structural phenomenon. Conclusions: The articulation between directors, administrators, teachers and students is consolidated as a key element in academic retention processes, as a strategy to combat the phenomenon of university dropout.

Resumo Introdução. A deserção universitária é um problema de grande interesse para os diferentes agentes do sistema educativo, pois sua ocorrência nas sociedades é um indicador de ineficiência, que gera consideráveis custos para os Estados, as universidades, os estudantes e suas famílias. Objetivo. Examinar os fatores que influenciam na decisão de desertar dos estudantes universitários da cidade de Medellín (Colômbia) para o ano 2018. Materiais e métodos. Foi realizado um estudo com foco no quantitativo, a partir de um desenho exploratório-descritivo do campo, de caráter transversal, onde participaram 3026 estudantes mediante a aplicação de um questionário autoadministrado. Resultados. Além dos fatores económicos, que tradicionalmente são avaliados neste tipo de literatura, as condições sociais, familiares e afetivas se convertem em incidentes chave no momento de abordar a deserção escolar como um fenômeno estrutural. Conclusões. A articulação entre diretivos, administrativos docentes e estudantes se consolida como um elemento chave nos processos de retenção académica, como uma estratégia para combater o fenômeno de deserção universitária.

Scaling of stem diameter and height allometry in 14 neotropical palm species of different forest strata.

Tropical palms reach tree-like heights without a vascular cambium through sustained cell expansion and lignification of primary tissues, but only a fraction of palms have been explored in their allometric relationships. Here, our main question was to determine how palms depart from the traditional mechanical models developed for trees and how they approach the theoretical buckling limit. We analyzed the stem allometry of 1603 palms of 14 species from different strata at 10 sites in Costa Rica and Peru. We measured their fit to the stress, elastic, and geometric similarity models, and their position relative to the maximum theoretical buckling limit calculated for trees. We evaluated the slope of the linear and logarithmic regressions between stem diameter and height using logarithmic least squares, and standardized major axis regression (SMA), expecting segregation according to canopy position and geographic location. Seventeen out of 19 statistically significant models had SMA slopes > 1, and 11 had SMA slopes ≥ 2, departing from traditional mechanical models developed for trees. Many species varied their allometry relative to geographic location. Canopy palms showed the highest regression fit but had less steep slopes than understory and subcanopy species. Subcanopy and understory species were more underbuilt than canopy palms, increasing height faster than diameter. Some of the tallest canopy palms surpassed the maximum buckling limit whereas subcanopy and understory species were consistently below the buckling limit of record-size trees. Palm stem allometry changed in response to environmental conditions.

Proteinuria asociada al dengue

Objetivos: describir el grado de proteinuria y albuminemia en pacientes con dengue, correlacionar la proteinuria con la fuga capilar medida por el nivel de hemoconcentración de la hemoglobina y hematocrito. Metodología: diseño observacional, descriptivo, prospectivo, de corte transversal. Población de estudio: varones y mujeres, mayores de edad, portadores de dengue, internados en el Dpto. de Medicina Interna entre diciembre 2012 y mayo 2013. Criterios de inclusión: dengue grave con signos de alarma, confirmado por antígeno NS1 y/o IgM positivo, en periodo crítico o postfebril. Criterios de exclusión: portadores de afecciones renales conocidas. Muestreo no probabilístico de casos consecutivos. Variables: datos demográficos, hemograma, proteinuria de 24 hs, albuminemia. Resultados: ingresaron al estudio 26 varones con edad media 42±21 años y 28 mujeres con edad media 41±21 años. Se detectó proteinuria en 43 sujetos (79,6%). La misma se hallaba en rango nefrótico (media 3184±916 mg/24 hs) en 8 casos (14,8%) y dentro de valores elevados (media 669±494 mg/24 hs) en 35 casos (64,8%). La albuminemia en los sujetos con rango nefrótico fue 3±0,7 mg/dL, en los que tenían valores elevados de proteinuria fue 2,9±0,4 mg/dL y en los sujetos sin proteinuria fue 2,6±0,4 mg/dL (p 0,09 prueba ANOVA). La correlación entre proteinuria y grado de hemoconcentración de hemoglobina fue -0,01 y con el grado de hemoconcentración del hematocrito fue -0,04. Conclusiones: el dengue produjo proteinuria en 79,6% de los pacientes, llegando a rango nefrótico en 14,8%. La proteinuria no se asoció con el grado de hemoconcentración de la hemoglobina ni del hematocrito, parámetros utilizados como indicadores de gravedad de la fuga capilar. Se recomienda agregar el dosaje de proteínas en orina de 24 hs al protocolo de tratamiento del dengue y el seguimiento prospectivo de los afectados con rango nefrótico.

Objectives: To describe the degree of proteinuria and serum albumin in patients with dengue and correlate the proteinuria with the capillary leakage measured by the level of hemoglobin and hematocrit hemoconcentration. Methods: This was a cross-sectional, prospective, descriptive and observational study. Study population: adult men and women, dengue carriers and admitted in the Department of Internal Medicine between December 2012 and May 2013. Inclusion criteria: severe dengue with warning signs, confirmed by positive NS1 antigen and/or IgM in post-febrile or critical period. Exclusion criteria: known kidney disease carriers. Non-probabilistic sampling of consecutive cases. Variables: demographic data, hemogram, 24-hour proteinuria, serum albumin. Results: Twenty six men with a mean age of 42 ± 21 years and 28 women with a mean age of 41±21 years were included in the study. Proteinuria was detected in 43 subjects (79.6%). The proteinuria was in nephrotic range (mean 3,184±916 mg/24 h) in 8 cases (14.8%) and in high values (mean 669±494 mg/24 h) in 35 cases (64.8%). The serum albumin was 3±0.7 mg/dL in patients with nephrotic range, 2.9±0.4 mg/dL in those with high levels of proteinuria and 2.6±0.4 mg/dL (p=0.09 ANOVA test) in subjects without proteinuria. The correlation between the proteinuria and degree of hemoglobin hemoconcentration was -0.01 while the correlation between the proteinuria and degree of hematocrit hemoconcentration was -0.04. Conclusions: Proteinuria associated with dengue was observed in 79.6% of the patients reaching the nephrotic range in 14.8%. The proteinuria was not associated with the degree of hemoglobin or hematocrit hemoconcentration, the parameters commonly used as indicators of the severity of the capillary leakage. It is recommended to add protein dosage in 24-hour urine in the treatment protocol of dengue as well as the prospective follow-up of those patients with nephrotic range.

Effect of water velocity on intermediary metabolism of juvenile matrinxã fish (Brycon amazonicus) / Efecto de la velocidad del agua en el metabolismo intermediario de juveniles del pez Yamú (Brycon amazonicus) / Efeito da velocidade da água no metabolismo intermediário de juvenis do peixe Matrinxa (Brycon amazonicus)

Background: determination of water velocity for optimum fish growth is fundamental since its duration and intensity can interfere with the metabolic preference for some biochemical paths, resulting in the use of specific substrates for fish growth. Objective: the purpose of this study was to assess the metabolic adjustments of juvenile matrinxã (Brycon amazonicus) reared under various sustained swimming conditions (SS). Methods: fish were subjected to SS for 90 days at five swimming speeds: 0.0 (control), 1.0, 1.5, 2.0, and 2.5 Body Length per second (BL/s). At the end of the experimental period, fish were euthanized; samples of blood, liver, white-muscle, red-muscle and ventral muscle were collected and metabolite concentrations were evaluated. Results: fish reared between 1.0-1.5 BL/s increased the hepatosomatic index (HSI) while those swimming at velocities higher than 1.5 BL/s showed diminished HSI and visceral fat. Fish under moderate swimming utilized visceral fat to supply energy for red muscle contractions while white muscle of fish swimming at higher speeds used carbon backbones from amino acids plus visceral fat. Conclusion: sustained swimming between 1.0-1.5 BL/s enhanced the intermediary metabolism of B. amazonicus, improving fish performance. Future studies linking macronutrient dietary levels and SS should allow adjusting rearing conditions under SS to optimize growth versus metabolic performance.

Antecedentes: la determinación de la velocidad del agua para óptimo crecimiento de los peces es importante porque dependiendo de la intensidad y duración, puede interferir sobre la activación de las vías metabólicas, indicando mayor o menor utilización de un determinado substrato energético para el crecimiento. Objetivo: la finalidad de este trabajo fue estudiar los efectos del ejercicio de natación sobre el metabolismo de juveniles de matrinxa (Brycon amazonicus). Métodos: juveniles de B. amazonicus fueron cultivados y condicionados a nadar bajo diferentes velocidades de natación 0,0 (control), 1,0, 1,5, 2,0 y 2,5 longitud total por segundo (LT s-1). Al final del período experimental (90 días), se realizó la eutanasia de los peces y se recolectaron muestras de sangre, tejido hepático, músculo blanco, músculo rojo y músculo ventral para determinar los intermediarios metabólicos. Resultados: peces cultivados en velocidades de natación entre 1,0 y 1,5 LT s-1 presentaron aumento del índice hepasomático (HSI), mientras que los peces que nadaron en velocidades superiores a 1,5 LT s-1 mostraron disminución de los índices HSI y grasa visceral (IGVS). Los peces condicionados a nadar en velocidades moderadas utilizaron lípidos viscerales como fuente de energía para sostener la contracción muscular del músculo rojo. Mientras que los peces que nadaron en las mayores velocidades, el músculo blanco fue más demandado, empleando como combustible, esqueletos de carbono provenientes de los aminoácidos y significativa movilización de grasa visceral. Conclusión: la natación sostenida entre 1,0 - 1,5 LT s-1 mejoró el metabolismo intermediario de B. amazonicus y el desempeño de los peces. Futuros trabajos asociando niveles de macro nutrientes y protocolos de natación moderada pueden permitir ajustes más refinados en la mejoría de las condiciones de cultivo, en la optimización del crecimiento, en la eficiencia alimenticia y en el aumento de la resistencia orgánica a las prácticas de manejo en las pisciculturas.

Antecedentes: a determinação da velocidade da água para o ótimo crescimento dos peixes é importante porque dependendo da intensidade e duração, pode interferir sobre a predominância na ativação de uma ou de outra via metabólica, indicando maior ou menor utilização de um determinado substrato energético e agir no crescimento. Objetivo: o propósito deste trabalho foi estudar os efeitos que o exercício de natação tem sobre o metabolismo de juvenis do peixe Matrinxa, Brycon amazonicus. Métodos: juvenis de B. amazonicus foram criados e condicionados a nadar durante 90 dias em cinco velocidades de natação: 0,0 (controle); 1,0; 1,5; 2,0 e 2,5 comprimentos corporais por segundo (CC s-1). Após termino do período experimental, os peixes foram sacrificados, o sangue, fígado, músculos branco, vermelho e ventral foram coletados para avaliar o perfil metabólico. Resultados: velocidades moderadas de natação entre 1,0 a 1,5 CC s-1 aumentaram o índice hepatosomático (HSI), enquanto que, o condicionamento dos peixes a maiores velocidades diminuiu significativamente o índice HSI e a gordura visceral (IGVS) em relação ao controle. Com respeito às respostas metabólicas, o condicionamento dos peixes em velocidades moderadas mostrou que o fornecimento de energia para sustentar a contração muscular dependeu primariamente dos triglicerídeos provenientes principalmente dos lipídios viscerais, ao passo que, em velocidades maiores, a via gliconeogênica foi a responsável pela manutenção na produção de energia para os músculos locomotivos, a qual aumentou progressivamente em função do catabolismo dos aminoácidos dos músculos locomotivos. Conclusão: a natação sustentada entre 1,0 - 1,5 CC s-1 melhorou o metabolismo intermediário do B. amazonicus o que resultou em melhor desempenho dos peixes. Estudos futuros associando níveis dietéticos de nutrientes com a natação moderada, pode permitir aos peixes ajustes mais refinados na melhoria das condições de criação, na otimização do crescimento, na eficiência alimentar e no aumento da resistência orgânica as praticas de manejo nas pisciculturas.

Percepción de docentes de la escuela de medicina sede Aragua de la Universidad de Carabobo sobre la atención en salud a población sexo-genero-diversa / Perception of teachers from the medicine school Dr. Witremundo torrealba, Carabobo university on health care to population sex-gender diverse

En Venezuela el tema sexo-género-diversidad ha sido tabú, aún más en nuestros centros de estudios profesionales, teniendo como consecuencia desconocimiento, estigmatización y rechazo para dicha población, e innegables impactos negativos en su situación de salud y calidad de vida. El objetivo de esta investigación es determinar la Percepción de los docentes de la Escuela de Medicina Dr. Witremundo Torrealba, Universidad de Carabobo, sobre la atención en salud a la población sexo-género-diversa. Se realizó un estudio de corte transversal, donde participaron 136 docentes de todos los años de la carrera de Medicina, a través de una encuesta anónima con preguntas cerradas. Se logró evidenciar que en los y las docentes de nuestra Escuela de Medicina se mantiene un rechazo hacia la población sexo-género-diversa; los docentes están de acuerdo en que la escasa formación del personal de salud está íntimamente ligada a discriminación y maltrato a la población sexogénero-diversa. Paradójicamente, aunque los/las docentes mantienen una posición de rechazo hacia la población sexo género diversa, homolesbotransfobia; se evidencian posibilidades para la aceptación de cambios en la formación de nuevos profesionales de salud, y así disminuir la estigmatización y el maltrato de la población sexo-génerodiversa en nuestros centros de salud.

In Venezuela the sex gender diversity issue has been taboo, even more in our professional training centers, with the consequence of ignorance, stigmatization and rejection for this population, and our medical school Dr. Witremundo Torrealba does not escape that. The objective of this research is to determine the perception of teachers of medical school UCSA, on health care to sex gender diverse population. This is a cross-sectional study of field, participants were 136 teachers from all years of the medical career, and data were collected with a anonymous survey with closed questions. It was possible to show that the teachers in our school of medicine remains a rejection diverse population gender sex, teachers estànde agree that the lack of training of health is closely linked to discrimination and abuse in our health centers. Paradoxically, the teachers maintain a position of rejection of sex gender diverse population, but, in other way, open possibilities for acceptance of changes in training new health professionals, and to reduce stigma and mistreatment of the population sex-gender diverse in our health centers.

Intermittent sustained swimming in 'matrinxã' Brycon amazonicus (Bryconidae: Bryconinae): hematological and metabolic responses

In fish, studies on a wide variety of physiological effects of exercise have been reported since a long time. It has been attributed special attention to some types of exercise, however, its application as a healthful practice in the rearing and welfare of farming fish is rising in last few years. In this particular, long-term intermittent sustained swimming (ISS) has been not yet explored. In this work, the freshwater fish Brycon amazonicus was submitted to (ISS) for 30 days at velocity of 1.0 body-length sec-1 for 12h interspaced by 12h under still water. Hematology and metabolism were evaluated. Exercised fish decreased 30% the erythrocyte number and hemoglobin was unvaried. The stores of liver glycogen and muscular triacylglycerol (TAG) were increased and the metabolic profile was typically aerobic. The slight decrease of liver (TAG) plus the full metabolic and hematic trait allow investing in this kind of exercise a beneficial practice in the rearing of fish species.

Há muito tempo, tem sido relatada uma ampla variedade de efeitos fisiológicos em peixes sob exercício. Tem sido dada especial atenção a alguns tipos de exercício, mas, sua aplicação como prática salutar na criação e para o bem estar dos peixes vem crescendo nos últimos anos. Neste caso, a natação sustentada intermitente (ISS) por longos períodos ainda não foi explorada. Neste trabalho, o peixe de água doce Brycon amazonicus foi submetido a (ISS) por 30 dias à velocidade de 1,0 comprimento corporal s-1 por 12h intervalado de 12h sob regime de água sem movimento. A hematologia e o metabolismo foram avaliados. Os peixes exercitados diminuíram 30% a contagem de eritrócitos e o teor de hemoglobina permaneceu constante. Os estoques de glicogênio hepático, o teor de triacil glycerol muscular (TAG) aumentou e o perfil metabólico foi tipicamente aeróbico. O discreto aumento de TAG hepático, além das características hematológicas e do metabolismo como um todo, instiga-nos investigar este tipo de exercício como uma prática benéfica na criação de peixes.

Precise control of intramolecular charge-transport: the interplay of distance and conformational effects.

A new series of donor-bridge-acceptor (D-B-A) compounds consisting of π-conjugated oligofluorene (oFL) bridges between a ferrocene (Fc) electron-donor and a fullerene (C60 ) electron-acceptor have been synthesized. In addition to varying the length of the bridge (i.e., mono- and bi-fluorene derivatives), four different ways of linking ferrocene to the bridge have been examined. The Fc moiety is linked to oFL: 1) directly without any spacer, 2) by an ethynyl linkage, 3) by a vinylene linkage, and 4) by a p-phenylene unit. The electronic interactions between the electroactive species have been characterized by cyclic voltammetry, absorption, fluorescence, and transient absorption spectroscopy in combination with quantum chemical calculations. The calculations reveal exceptionally close energy-matching between the Fc and the oFL units, which results in strong electronic-coupling. Hence, intramolecular charge-transfer may easily occur upon exciting either the oFLs or Fcs. Photoexcitation of Fc-oFL-C60 conjugates results in transient radical-ion-pair states. The mode of linkage of the Fc and FL bridge has a profound effect on the photophysical properties. Whereas intramolecular charge-separation is found to occur rather independently of the distance, the linker between Fc and oFL acts (at least in oFL) as a bottleneck and significantly impacts the intramolecular charge-separation rates, resulting in beta values between ßCS 0.08 and 0.19 Å(-1). In contrast, charge recombination depends strongly on the electron-donor-acceptor distance, but not at all on the linker. A value of ßCR (0.35±0.01 Å(-1)) was found for all the systems studied. Oligofluorenes prove, therefore, to be excellent bridges for probing how small structural variations affect charge transport in D-B-A systems.

Síndrome de Guillain Barré asociado al dengue. Reporte de dos casos / Guillain Barré syndrome associated with dengue. Report of two case

Se presentan dos pacientes con parálisis aguda, fláccida y arrefléctica iniciada en las siguientes semanas a dengue confirmado por serología. La electromiografía confirmó síndrome de Guillain Barré. Ambos tuvieron notable recuperación tras el tratamiento con inmunoglobulina humana.

We report two patients with acute flaccyd and arreflexic paralysis, innitiated weeks after serologically confirmed dengue. Electromyography confirmed Guillain Barré syndrome. Both had remarkable recovery after treatment with human immunoglobulin

El ultrasonido como método diagnóstico de patología mamaria oculta en mujeres con mama densa: serie clínica / Ultrasound as a Diagnostic Method of Hidden Breast Pathology in Women with Dense Breasts (case series)

Objetivo: Determinar la importancia y utilidad del ultrasonido mamario como método de imagen complementario en pacientes con mamas densas, ACR 3 y 4. Materiales y métodos: Estudio observacional longitudinal de tipo prospectivo. Se evaluaron 483 pacientes femeninas que asistieron a la Clínica de Mamas (San Cristóbal, Estado Táchira) durante el periodo de febrero de 2010 a febrero de 2011 con mamas densas en mamografía, sin hallazgo clínico ni radiológico, con evaluación ultrasonográfica complementaria y posterior estudio histopatológico según grado de sospecha de lesión por categorización BI-RADS. Resultados: La edad promedio de las pacientes fue de 45,15 años, menarquía a los 12,57 años y mamas densas ACR 3, la mayoría sin antecedentes de cáncer de mama ni uso de terapia de reemplazo hormonal. Se diagnosticaron 304 lesiones ocultas, el 10,8% con características ultrasonográficas de sospecha y el 2,2% con hallazgos histopatológicos de malignidad. Conclusiones: Se demuestra la importancia del ultrasonido como método complementario de rastreo en pacientes con mama densa.

Objective: To determine the importance and usefulness of breast ultrasounds as supplementary imaging method in patients with dense breasts, ACR 3 and 4. Materials and methods: Prospective observational longitudinal type study. We evaluated 483 female patients in the Clínica de Mama (San Cristobal, Tachira Ste.) from February 2010 to February 2011 with dense breasts in mammography without clinical or radiological findings, with additional ultrasonographic evaluation and a histopathological study according to the degree of lesion suspicion by BIRADS categorization. Results: The average age of the patients was 45.15 years, The menarche age was 12.57 years and ACR 3 breasts. Most patients did not have a background of breast cancer, nor did they use hormone replacement therapy. 304 hidden lesions were diagnosed, 10.8% with suspicious ultrasonographic features and 2.2% with histopathological malignancy findings. Conclusions: The importance of the ultrasound as a complementary screening method is proven in patients with dense breasts.

Correlación mamográfica e histológica de lesiones sospechosas de malignidad no palpables / Mammographic and Histological Correlation of non-Palpable Malignant Suspected Lesions

Objetivo: Correlacionar hallazgos mamográficos de lesiones sospechosas de malignidad no palpables con resultados histopatológicos, en mujeres asistentes a la Clínica de Mama, de San Cristóbal-Estado Táchira, durante el periodo comprendido entre octubre de 2009 y marzo de 2010. Materiales y métodos: Estudio clínico epidemiológico observacional, prospectivo, de corte transversal, de tamizaje en serie, en el que se evaluaron 36 pacientes femeninas que asistieron a Clínica de Mamas durante el periodo comprendido entre octubre de 2009 y marzo de 2010, que ameritaron biopsia guiada por estereotaxia, debido a lesiones sospechosas de malignidad demostradas por mamografía. La muestra es de tipo secuencial no probabilística. Resultados: La edad promedio de las pacientes estudiadas fue de 52,2 años. Las lesiones malignas se presentaron con mayor frecuencia en edades comprendidas entre los 40 y 49 años. El hallazgo mamográfico fue en su mayoría microcalcificaciones (97%). La lesión maligna más frecuente fue el carcinoma ductal in situ (50%), seguido del carcinoma ductal infiltrante (33%). La mayoría de las lesiones histopatológicamente reportadas como benignas fueron de tipo fibrosis-adenosis (67%). Conclusiones: El cáncer de mama se presentó principalmente en mujeres con edades comprendidas entre 40 y 49 años, el hallazgo mamográfico predominante fueron microcalcificaciones. La correlación mamográfica e histológica estimó que la mamografía respecto a la histopatología presentó una sensibilidad del 100%, especificidad del 43% y valor predictivo positivo del 26%.

Objective: To correlate the mammographic findings of non-palpable lesions with suspicion of malignancy with histopathological results, in female patients who attend the Clínica de Mama, San Cristóbal-Táchira state, from October 2009-March 2010. Materials and methods: Epidemiological clinical study, which is observational, prospective, cross-sectional, of sequential screening. In this study, 36 female patients who attended the Clínica de Mamas (San Cristóbal, Edo. Táchira) were evaluated, from October 2009-March 2010. These patients required stereotactic biopsy due to lesions, with suspicion of malignancy, as shown by the mammography. The sample is non-probabilistic sequential type. Results: The average age of the evaluated patients was 52.2 years. Malignant lesions were more frequently found in the 40-49 age group; most of the mammographic findings were micro calcifications (97%). The most frequent malignant pathologic finding was in situ ductal carcinoma (50%) followed by ductal infiltrating carcinoma (33%). Most of lesions that were histopathologically reported as benign were fibrosing adenosis type lesions (67%). Conclusions: Breast cancer was mainly present in women between the ages of 40-49. The predominant mammographic finding was micro calcifications. The mammographic and histological correlation estimated that the mammography showed a 100% sensibility, 43% specificity and 26% positive predictive value, in relation to the histopathology.

Manifestaciones sistémicas del dengue / Systemic manifestations of dengue

Introducción: el dengue es una infección que puede afectar múltiples órganos.Objetivo: determinar la afectación multisistémica por dengue. Metodología: estudio observacional, descriptivo, prospectivo realizado en sujetos adultos con dengue grave con signos de alarma internados en el Hospital Nacional entre diciembre 2012 y mayo 2013. La infección debía estar confirmada con antígeno NS1 y/o serología IgM (+). Resultados: se encontró 10,1% de hepatitis, 85,6% de transaminitis, 48% con relación CPKmb/CPK total >5%, 22,5% de alteraciones electrocardiográficas, 70,4% con proteinuria de 24 hs elevada y 9,3% con proteinuria en rango nefrótico. Conclusiones: la afectación multisistémica es frecuente, generalmente pasa desapercibida y en general es autolimitada aunque se requieren más estudios para evaluar la evolución a largo plazo en estos casos.

Introduction: dengue is an infection that could affect multiple organs. Objective: to determine the multisystem involvement of dengue. Methodology: observational, descriptive, prospective study conducted in adult subjects with severe and warning signs of dengue admitted to the National Hospital between December 2012 and May 2013. Infection should be confirmed with NS1 antigen and / or IgM serology (+). Results: we found 10.1% of hepatitis, 85.6% of transaminitis the relation CPKmb / total CPK > 5% in 48%, electrocardiographic alterations in 22.5%, elevated proteinuria in 70.4% and nephrotic proteinuria in 9.3%. Conclusions: multisystemic involvement is frecuent, usually asymptomatic and generally self-limited although more studies are needed to evaluate the long-term outcome in these cases.

Pioderma gangrenoso de rápida evolución / Pyoderma gangrenosum rapidly evolving

Se presenta caso de mujer adulta con múltiples lesiones ampollosas de 1 semana de evolución, acompañada de fiebre. Presentaba antecedentes de rectorragias ocasionales desde hace varios años. La colonoscopía detectó la presencia de Enfermedad inflamatoria intestinal, que se confirmó con la anatomía patológica. La biopsia de piel fue compatible con pioderma gangrenoso. La paciente mejoró con prednisona y aziatropina.

A case report of adult female with multiple bullous lesions of 1 week duration, accompanied by fever. She had a history of occasional rectal bleeding for several years. The colonoscopy detected the presence of inflammatory bowel disease, which was confirmed by pathology. Skin biopsy was consistent with pyoderma gangrenosum. The patient improved with prednisone and aziatropina.

Activating multistep charge-transfer processes in fullerene-subphthalocyanine-ferrocene molecular hybrids as a function of π-π orbital overlap.

We have synthesized two different fullerene-subphthalocyanine-ferrocene conjugates. The molecules were designed so that the ferrocene unit is linked at the subphthalocyanine axial position through a phenoxy spacer while the C(60) is rigidly held close to the concave face of the macrocycle via a 3-fold C(3)-symmetrical anchoring. The Bingel trisaddition reaction leading to the final products proceeded with very high regioselectivities and full diastereoselectivity. The only difference between both systems is the length of the triple tether employed, which finely regulates the regioselectivity of the trisaddition reaction and the distance between the subphthalocyanine and the C(60) complementary π-π surfaces. Thus, when the tether is connected to the subphthalocyanine through a direct C-C bond, a short π-π distance of 3.25-3.30 Å was calculated. In contrast, when it is connected through a slightly longer C-O-C bond, the distance increases to 3.5-3.6 Å. This π-π distance has a strong influence on the ground-state electronic interactions between the subphthalocyanine and the C(60), as determined from electronic absorption and cyclic voltammetry measurements. In addition, fluorescence and time-resolved transient absorption experiments demonstrated that different mechanisms operate in the two systems after photoexcitation. Despite the similar HOMO-LUMO gaps, only when the two complementary π-π surfaces of the subphthalocyanine and the C(60) are held at a close distance, therefore showing a high degree of orbital overlap, is a multistep electron transfer process triggered, ultimately leading to the long-lived, spatially separated C(60) radical anion and ferrocenium radical cation pair. A full account of the synthesis, characterization, and studies of the ground- and excited-state electronic interactions occurring in these conjugates, as well as in their reference C(60)-subphthalocyanine and subphthalocyanine-ferrocene dyads, is presented in this article.

Control over charge transfer through molecular wires by temperature and chemical structure modifications.

A series of electron donor-acceptor arrays containing π-conjugated oligofluorenes (oFL) of variable length between a zinc porphyrin (ZnP) as electron donor and fullerene (C(60)) as electron acceptor have been prepared by following a convergent synthesis. The electronic interactions between the electroactive species were determined by cyclic voltammetry, UV-visible, fluorescence, and femto/nanosecond transient absorption spectroscopy. Our studies clearly confirm that, although the C(60) units are connected to the ZnP donor through π-conjugated oFL frameworks, no significant electronic interactions prevail in the ground state. Theoretical calculations predict that a long-range electron transfer occurs primarily due to a maximized π-conjugated pathway from the donor to the acceptor. Photoexcitation of ZnP-oFL(n)-C(60) results in transient absorption maxima at 715 and 1010 nm, which are unambiguously attributed to the photolytically generated radical ion pair state, [ZnP(•+)-oFL(n)-C(60)(•-)], with lifetimes in the microsecond time regime. Temperature-dependent photophysical experiments have shown that the charge-transfer mechanism is controllable by temperature. Both charge separation and charge recombination processes give rise to a molecular wire behavior of the oFL moiety with an attenuation factor (ß) of 0.097 Å(-1). The correlation ß to the connection pattern between the ZnP donor and the oFL linker revealed that even small alterations of the linker π-electron system break the homogeneous π-conjugation pattern, leading to higher values of ß.

Electron donor-acceptor interactions in regioselectively synthesized exTTF(2)-C(70)(CF(3))(10) dyads.

The decakis(trifluoromethyl)fullerene C(1)-C(70)(CF(3))(10), in which the CF(3) groups are arranged on a para(7)-meta-para ribbon of C(6)(CF(3))(2) edge-sharing hexagons, and which has now been prepared in quantities of hundreds of milligrams, was reacted under standard Bingel-Hirsch conditions with a bis-pi-extended tetrathiafulvalene (exTTF) malonate derivative to afford a single exTTF(2)-C(70)(CF(3))(10) regioisomer in 80 % yield based on consumed starting material. The highly soluble hybrid was thoroughly characterized by using 1D (1)H, (13)C, and (19)F NMR, 2D NMR, and UV/Vis spectroscopy; matrix-assisted laser desorption ionization (MALDI) mass spectrometry; and electrochemistry. The cyclic voltammogram of the exTTF(2)-C(70)(CF(3))(10) dyad revealed an irreversible second reduction process, which is indicative of a typical retro-Bingel reaction; whereas the usual phenomenon of exTTF inverted potentials (E1ox>E2ox), resulting in a single, two-electron oxidation process, was also observed. Steady-state and time-resolved photolytic techniques demonstrated that the C(1)-C(70)(CF(3))(10) singlet excited state is subject to a rapid electron-transfer quenching. The resulting charge-separated states were identified by transient absorption spectroscopy, and radical pair lifetimes of the order of 300 ps in toluene were determined. The exTTF(2)-C(70)(CF(3))(10) dyad represents the first example of exploitation of the highly soluble trifluoromethylated fullerenes for the construction of systems able to mimic the photosynthetic process, and is therefore of interest in the search for new materials for photovoltaic applications.

Novel semiautomated method for assessing in vitro cellular antioxidant activity using the light-scattering properties of human erythrocytes.

The novel method developed for screening cellular antioxidant activity relies on differences in light-scattering properties (turbidity) between intact and lysed human erythrocytes. AAPH, a peroxyl radical generator, was used to enhance lipid peroxidation. The consequent hemolysis triggered a loss of the light-scattering ability in the lysed erythrocytes. When an antioxidant was added, the area under the absorbance decay curve (AUC) was linearly proportional to the concentration of antioxidant compound. This erythrocyte cellular antioxidant activity (ERYCA) method was found to be relatively fast, sensitive, accurate, and repeatable, even when using erythrocytes from different donors and for different storage times. The method was used to assess the antioxidant capacity of pure phenolic compounds, fruit juices, stimulant beverages, and blood plasma and compared with ORAC values. The values resulting from the two methods did not correlate as the mechanisms involved were different.