Expanding access to biotherapeutics in low-income and middle-income countries through public health non-exclusive voluntary intellectual property licensing: considerations, requirements, and opportunities.

Biotherapeutics, such as recombinant proteins and monoclonal antibodies, have become mainstays of modern medicine as shown by their increasing number in the WHO Model List of Essential Medicines. However, despite frequently offering clinical advantages over standards of care, they remain largely out of reach for populations in low-income and middle-income countries (LMICs), partly because of high costs. Accordingly, the WHO Model List of Essential Medicines Expert Committee has requested that the Medicines Patent Pool explore intellectual property licensing to address this challenge. We therefore investigated how licensing could successfully improve affordability of and timely access to biotherapeutics in LMICs, by leveraging expert consultations, literature analysis, and internal technical knowledge. The key elements identified as relevant to support access to affordable biosimilars in LMICs through licensing include: prioritising potential biotherapeutic targets according to their potential for public health impact; supporting biosimilar product and clinical development (including through technology transfer to expedite regulatory approval); and facilitating biosimilars' entry and use in LMICs (by meeting procurement, supply chain, and health system requirements).

Dose-dependent transcriptomic responses of zebrafish eleutheroembryos to Bisphenol A.

Despite the abundant literature on the adverse effects of Bisphenol A (BPA) as endocrine disruptor, its toxicity mechanisms are still poorly understood. We present here a study of its effects on the zebrafish eleutheroembryo transcriptome at concentrations ranging from 0.1 to 4 mg L-1, this latter representing the lowest observed effect concentration (LOEC) found in our study at three different macroscopical endpoints (survival, hatching and swim bladder inflation). Multivariate data analysis methods identified both monotonic and bi-phasic patterns of dose-dependent responses. Functional analyses of genes affected by BPA exposure suggest an interaction of BPA with different signaling pathways, being the estrogenic and retinoid receptors two likely targets. In addition, we identified an apparently unrelated inhibitory effect on, among others, visual function genes. We interpret our data as the result of a sum of underlying, independent molecular mechanisms occurring simultaneously at the exposed animals, well below the macroscopic LOEC, but related to at least some of the observed morphological alterations, particularly in eye size and yolk sac resorption. Our data supports the idea that the physiological effects of BPA cannot be only explained by its rather weak interaction with the estrogen receptor, and that multivariate analyses are required to analyze the effects of toxicants like BPA, which interact with different cellular targets producing complex phenotypes.

Assessment of endocrine disruptors effects on zebrafish (Danio rerio) embryos by untargeted LC-HRMS metabolomic analysis.

Bisphenol A (BPA), perfluorooctane sulfonate (PFOS), and tributyltin (TBT) are emerging endocrine disruptors (EDCs) with still poorly defined mechanisms of toxicity and metabolic effects in aquatic organisms. We used an untargeted liquid chromatography-high resolution mass spectrometry (LC-HRMS) metabolomic approach to study the effects of sub-lethal doses of these three EDCs on the metabolic profiles of zebrafish embryos exposed from 48 to 120hpf (hours post fertilization). Advanced chemometric data analysis methods were used to reveal effects on the subjacent regulatory pathways. EDC treatments induced changes in concentrations of about 50 metabolites for TBT and BPA, and of 25 metabolites for PFOS. The analysis of the corresponding metabolic changes suggested the presence of similar underlying zebrafish responses to BPA, TBT and PFOS affecting the metabolism of glycerophospholipids, amino acids, purines and 2-oxocarboxylic acids. We related the changes in glycerophospholipid metabolism to alterations in absorption of the yolk sack, the main source of nutrients (including lipids) for the developing embryo, linking the molecular markers with adverse phenotypic effects. We propose a general mode of action for all three chemical compounds, probably related to their already described interaction with the PPAR/RXR complex, combined with specific effects on different signaling pathways resulting in particular alterations in the zebrafish embryos metabolism.

Modelling of Hydrophilic Interaction Liquid Chromatography Stationary Phases Using Chemometric Approaches.

Metabolomics is a powerful and widely used approach that aims to screen endogenous small molecules (metabolites) of different families present in biological samples. The large variety of compounds to be determined and their wide diversity of physical and chemical properties have promoted the development of different types of hydrophilic interaction liquid chromatography (HILIC) stationary phases. However, the selection of the most suitable HILIC stationary phase is not straightforward. In this work, four different HILIC stationary phases have been compared to evaluate their potential application for the analysis of a complex mixture of metabolites, a situation similar to that found in non-targeted metabolomics studies. The obtained chromatographic data were analyzed by different chemometric methods to explore the behavior of the considered stationary phases. ANOVA-simultaneous component analysis (ASCA), principal component analysis (PCA) and partial least squares regression (PLS) were used to explore the experimental factors affecting the stationary phase performance, the main similarities and differences among chromatographic conditions used (stationary phase and pH) and the molecular descriptors most useful to understand the behavior of each stationary phase.

Metabolic disruption of zebrafish (Danio rerio) embryos by bisphenol A. An integrated metabolomic and transcriptomic approach.

Although bisphenol A (BPA) is commonly recognized as an endocrine disruptor, the metabolic consequences of its exposure are still poorly understood. In this study, we present a non-targeted LC-MS based metabolomic analysis in combination with a full-genome, high-throughput RNA sequencing (RNA-Seq) to reveal the metabolic effects and the subjacent regulatory pathways of exposing zebrafish embryos to BPA during the first 120 hours post-fertilization. We applied multivariate data analysis methods to extract biochemical information from the LC-MS and RNA-Seq complex datasets and to perform testable predictions of the phenotypic adverse effects. Metabolomic and transcriptomic data revealed a similar subset of altered pathways, despite the large difference in the number of identified biomarkers (around 50 metabolites and more than 1000 genes). These results suggest that even a moderate coverage of zebrafish metabolome may be representative of the global metabolic changes. These multi-omic responses indicate a specific metabolic disruption by BPA affecting different signaling pathways, such as retinoid and prostaglandin metabolism. The combination of transcriptomic and metabolomic data allowed a dynamic interpretation of the results that could not be drawn from either single dataset. These results illustrate the utility of -omic integrative analyses for characterizing the physiological effects of toxicants beyond the mere indication of the affected pathways.

Knowledge integration strategies for untargeted metabolomics based on MCR-ALS analysis of CE-MS and LC-MS data.

In this work, two knowledge integration strategies based on multivariate curve resolution alternating least squares (MCR-ALS) were used for the simultaneous analysis of data from two metabolomic platforms. The benefits and the suitability of these integration strategies were demonstrated in a comparative study of the metabolite profiles from yeast (Saccharomyces cerevisiae) samples grown in non-fermentable (acetate) and fermentable (glucose) carbon source. Untargeted metabolomics data acquired by capillary electrophoresis-mass spectrometry (CE-MS) and liquid chromatography-mass spectrometry (LC-MS) were jointly analysed. On the one hand, features obtained by independent MCR-ALS analysis of each dataset were joined to obtain a biological interpretation based on the combined metabolic network visualization. On the other hand, taking advantage of the common spectral mode, a low-level data fusion strategy was proposed merging CE-MS and LC-MS data before the MCR-ALS analysis to extract the most relevant features for further biological interpretation. Then, results obtained by the two presented methods were compared. Overall, the study highlights the ability of MCR-ALS to be used in any of both knowledge integration strategies for untargeted metabolomics. Furthermore, enhanced metabolite identification and differential carbon source response detection were achieved when considering a combination of LC-MS and CE-MS based platforms.

Structural Damage of Jailed Guidewire During the Treatment of Coronary Bifurcation Lesions: A Microscopic Randomized Trial.

OBJECTIVES: The study sought to compare the safety (resistance to damage) and efficacy (ability to cross the side branch) of polymer-coated and non-polymer-coated guidewires in the jailed wire technique used during the percutaneous treatment of bifurcation lesions. BACKGROUND: The jailed wire technique is a useful strategy in the treatment of bifurcation lesions by provisional stenting. However, these wires can be damaged or even be broken during their removal. METHODS: We performed a randomized study in patients with bifurcation lesions treated by provisional stenting. The jailed wire technique was mandatory, and the types of guidewires, polymer-coated (n = 115) and non-polymer-coated (n = 120), were randomized. After the procedures, the wires were evaluated by stereoscopic microscopy. The induced damage in the wires was classified as follows: no damage, mild, moderate, or severe. RESULTS: The clinical characteristics were similar between patients treated with polymer-coated or non-polymer-coated wires. Polymer-coated wires were significantly (p < 0.001) more resistant to retrieval damage (only 2 wires showed mild damage) than were non-polymer-coated wires. However, 63 (55%) of the non-polymer-coated wires were damaged; 37 (32%), 24 (21%), and 2 (2%) had mild, moderate, and severe damage, respectively. Additionally, the jailed length of the wire was a factor contributing to the degree of wire damage. The time of side branch wiring was shorter in the polymer-coated wire group (19 ± 40 s vs. 42 ± 72 s; p < 0.05). CONCLUSIONS: Jailed wires during interventional procedures of bifurcation lesions commonly showed microscopic damage. Polymer-coated wires were more resistant to retrieval damage and were more efficient in crossing the side branch ostium than non-polymer-coated wires. (Jailed Wire Technique in the Treatment of Coronary Bifurcations Lesions With Stent: Stereoscopic Microscopy Study; NCT02516891).

Poliposis adenomatosa familiar: a propósito de un caso / Familial adenomatous polyposis: a case report

La poliposis adenomatosa familiar (PAF) es la forma más frecuente y conocida de poliposis. Se trata de una enfermedad hereditaria autosómica dominante caracterizada por el desarrollo de múltiples pólipos adenomatosos, principalmente en el colon y recto. La prevalencia de esta enfermedad es de aproximadamente 1 de cada 10.000-20.000 individuos. La aparición de los pólipos suele iniciarse a una edad temprana, con un riesgo de casi el 100% de desarrollo de cáncer colorrectal (CCR) si el paciente no recibe tratamiento de forma precoz. Las lesiones suelen desarrollarse en la segunda y la tercera década de la vida: el 15% a los 10 años de edad, el 50% de los pacientes sobre los 15 años y un 95% a los 35 años. Este artículo tiene como objetivo presentar la evolución clínica y nutricional de una paciente de 54 años de edad diagnosticada de PAF que precisa nutrición parenteral complementaria (NPC) domiciliaria, así como evaluar los resultados clínicos de esta paciente. A través de la revisión de la historia clínica, se estudió la evolución de los datos antropométricos (peso y talla), así como los parámetros analíticos para su valoración. Paciente de 54 años de edad diagnosticada de PAF que acudió a nuestro hospital tras trasladarse temporalmente de ciudad para recibir soporte nutricional. El artículo describe la composición de la NPC recibida durante los 90 días de seguimiento. La NPC en este tipo de pacientes es importante, ya que presentan una insuficiencia del tracto gastrointestinal irreversible que les impide la absorción de nutrientes apropiados para mantener una adecuada calidad de vida (AU)

Familial adenomatous polyposis (FAP) is the most common known form of polyposis. It is an autosomal dominant inherited disease characterized by the development of multiple adenomatous polyps mainly in the colon and rectum. The prevalence of this disease is approximately about 1 in every 10,000-20,000 people. The appearance of the polyps usually starts at an early age with a 100% risk of developing colorectal cancer (CRC) if the patient does not receive early treatment. These lesions usually manifest during the second and third decades of life: 15% at the age of 10, 50% around 15 years of age and 95% at the age of 35. This article aims to present the clinical and nutritional evolution of a 54 years old patient diagnosed with FAP who requires complementary home parenteral nutrition (CPN), and the evaluation of these patient clinical outcomes. The evolution of anthropometric data (weight and height) and the results of laboratory parameters were followed and studied by review of medical records. The patient diagnosed with FAP was referred to our hospital after a temporary city transfer to receive nutritional support. This article describes the composition of the CPN received during the 90 days of follow up. CPN in these patients is important because of the irreversible gastrointestinal tract failure that prevents them from absorbing sufficient nutrients to maintain an adequate quality of life (AU)

Daño estructural de la guía encarcelada en el tratamiento de bifurcaciones coronarias. Evaluación microscópica / Structural damage to jailed guidewire during the treatment of coronary bifurcations: microscopic evaluation

Introducción y objetivos: La técnica de la guía encarcelada resulta de gran utilidad en el tratamiento de lesiones bifurcadas mediante la técnica de stent condicional. Sin embargo, esta guía puede sufrir daño e incluso fracturarse en el momento de la retirada. El objetivo de este estudio es evaluar la aparición de daño estructural en las guías encarceladas, tanto poliméricas como no poliméricas. Métodos: Entre enero de 2011 y diciembre de 2012 se realizó un estudio observacional en el que se evaluaron mediante microscopia estereoscópica 135 guías (45 no poliméricas y 90 poliméricas) utilizadas previamente en el tratamiento percutáneo de bifurcaciones y que resultaron encarceladas. El daño tras la extracción se valoró como leve, moderado o grave. Resultados: Las distribuciones de edad y sexo fueron similares en los dos grupos de pacientes tratados con guías poliméricas y no poliméricas. Sin embargo, los operadores seleccionaron las guías poliméricas con más frecuencia en bifurcaciones más complejas y en pacientes diabéticos. Se observó algún tipo de daño microscópico en 25 de las guías analizadas (18%). Paradójicamente, estas alteraciones fueron más frecuentes en el grupo de guías no poliméricas (el 53,0 frente al 1,1%; p < 0,001). Solo se produjo daño grave en 2 casos (1,5%). No se produjo ninguna rotura completa de la guía. Conclusiones: Las guías coronarias que se encarcelan durante el tratamiento de las bifurcaciones con stentcondicional presentan a menudo daño microscópico no grave. Aunque las guías poliméricas se utilizaron en bifurcaciones más complejas, paradójicamente se dañaron con menos frecuencia (AU)

Introduction and objectives: The use of the jailed guidewire technique is highly useful when treating bifurcation lesions by provisional stenting. However, at the time of withdrawal, the guidewire can suffer damage and even fracture. The aim of this study was to evaluate structural damage in both polymercoated and nonpolymer-coated jailed guidewires. Methods: Between January 2011 and December 2012, an observational study was conducted using stereoscopic microscopy to evaluate 135 jailed guidewires (45 nonpolymer-coated and 90 polymercoated) previously used in the percutaneous treatment of bifurcation lesions. Damage after withdrawal was classified as mild, moderate, or severe. Results: Age and sex distributions were similar in both groups of patients treated with polymer-coated and nonpolymer-coated guidewires. However, operators selected polymer-coated guidewires more frequently when treating more complex bifurcations and in diabetic patients. Some type of microscopic damage was observed in 25 of the guidewires analyzed (18%). Paradoxically, damage was more common in nonpolymer-coated guidewires (53.0% vs 1.1%; P < .001). None of the guidewires suffered complete fracture. Conclusions: Coronary guidewires that are jailed during the treatment of bifurcations using provisional stenting often suffer nonsevere microscopic damage. Although polymer-coated guidewires were used in more complex bifurcation lesions, paradoxically, they were damaged less frequently (AU)

Nab-Paclitaxel asociado a gemcitabina en el tratamiento del adenocarcinoma de páncreas metastásico: experiencia de uso / Nab-Paclitaxel plus gemcitabine in patients with metastatic pancreatic adenocarcinoma: experience of use

Objetivo: Describir los resultados obtenidos en el uso de nab-paclitaxel y gemcitabina en el tratamiento de pacientes con adenocarcinoma de páncreas metastático. Material y métodos: Estudio observacional retrospectivo. Se seleccionaron pacientes en tratamiento con nab-paclitaxel asociado a gemcitabina entre enero 2013 y enero 2014. Se recogieron datos demográficos y clínicos. Resultados: Se incluyeron 15 pacientes (edad media: 59,4 ± 10,3 años). Todos ellos recibieron la combinación de nab-paclitaxel y gemcitabina en primera línea para la enfermedad metastásica. Nueve recibieron tratamiento adyuvante antes de que la enfermedad fuera metastásica, siendo la media de líneas de tratamiento previamente al uso de la combinación de 1,1. La mediana de supervivencia libre de progresión fue de 5,6 meses (IC 95%: 4,44 - 8,03). Sólo dos pacientes suspendieron el tratamiento por toxicidad. Conclusiones: El tratamiento con nab-paclitaxel y gemcitabina en nuestros pacientes ha resultado en una supervivencia libre de progresión similar a la de los ensayos clínicos publicados, presentando además una buena tolerancia (AU)

Objective: To evaluate the results obtained with the combined use of nab-paclitaxel and gemcitabine in the treatment of patients with metastatic pancreatic adenocarcinoma. Materials and methods: Retrospective observational study. Patients treated with nab-paclitaxel and gemcitabine between January of 2013 and January of 2014 were selected. Demographical and clinical data were gathered. Results: 15 patients (mean age 59,4 ± 10,3 years) were included. All patients received the combination of nab-paclitaxel and gemcitabine in first-line metastatic disease. Nine received adjuvant treatment before the disease was metastatic. The median progression-free survival rate with combined nab-paclitaxel and gemcitabine was 5,6 months (95% CI: 4,44 - 8,03). In two patients the treatment was stopped due to toxicity. Conclusions: The treatment with nab-paclitaxel and gemcitabine in our patients resulted in progression-free survival rates similar to those published in clinical trials with good treatment tolerability (AU)

[Nab-Paclitaxel plus gemcitabine in patients with metastatic pancreatic adenocarcinoma: experience of use]. / Nab-Paclitaxel asociado a gemcitabina en el tratamiento del adenocarcinoma de páncreas metastásico: experiencia de uso.

OBJECTIVE: To evaluate the results obtained with the combined use of nab-paclitaxel and gemcitabine in the treatment of patients with metastatic pancreatic adenocarcinoma. MATERIALS AND METHODS: Retrospective observational study. Patients treated with nab-paclitaxel and gemcitabine between January of 2013 and January of 2014 were selected. Demographical and clinical data were gathered. RESULTS: 15 patients (mean age 59,4 ± 10,3 years) were included. All patients received the combination of nab-paclitaxel and gemcitabine in first-line metastatic disease. Nine received adjuvant treatment before the disease was metastatic. The median progression-free survival rate with combined nab-paclitaxel and gemcitabine was 5,6 months (95% CI: 4,44 - 8,03). In two patients the treatment was stopped due to toxicity. CONCLUSIONS: The treatment with nab-paclitaxel and gemcitabine in our patients resulted in progression-free survival rates similar to those published in clinical trials with good treatment tolerability.

Objetivo: Describir los resultados obtenidos en el uso de nab-paclitaxel y gemcitabina en el tratamiento de pacientes con adenocarcinoma de páncreas metastático. Material y métodos: Estudio observacional retrospectivo. Se seleccionaron pacientes en tratamiento con nab-paclitaxel asociado a gemcitabina entre enero 2013 y enero 2014. Se recogieron datos demográficos y clínicos. Resultados: Se incluyeron 15 pacientes (edad media: 59,4 ± 10,3 años). Todos ellos recibieron la combinación de nab-paclitaxel y gemcitabina en primera línea para la enfermedad metastásica. Nueve recibieron tratamiento adyuvante antes de que la enfermedad fuera metastásica, siendo la media de líneas de tratamiento previamente al uso de la combinación de 1,1. La mediana de supervivencia libre de progresión fue de 5,6 meses (IC 95%: 4,44 - 8,03). Sólo dos pacientes suspendieron el tratamiento por toxicidad. Conclusiones: El tratamiento con nab-paclitaxel y gemcitabina en nuestros pacientes ha resultado en una supervivencia libre de progresión similar a la de los ensayos clínicos publicados, presentando además una buena tolerancia.

Structural Damage to Jailed Guidewire During the Treatment of Coronary Bifurcations: Microscopic Evaluation.

INTRODUCTION AND OBJECTIVES: The use of the jailed guidewire technique is highly useful when treating bifurcation lesions by provisional stenting. However, at the time of withdrawal, the guidewire can suffer damage and even fracture. The aim of this study was to evaluate structural damage in both polymer-coated and nonpolymer-coated jailed guidewires. METHODS: Between January 2011 and December 2012, an observational study was conducted using stereoscopic microscopy to evaluate 135 jailed guidewires (45 nonpolymer-coated and 90 polymer-coated) previously used in the percutaneous treatment of bifurcation lesions. Damage after withdrawal was classified as mild, moderate, or severe. RESULTS: Age and sex distributions were similar in both groups of patients treated with polymer-coated and nonpolymer-coated guidewires. However, operators selected polymer-coated guidewires more frequently when treating more complex bifurcations and in diabetic patients. Some type of microscopic damage was observed in 25 of the guidewires analyzed (18%). Paradoxically, damage was more common in nonpolymer-coated guidewires (53.0% vs 1.1%; P<.001). None of the guidewires suffered complete fracture. CONCLUSIONS: Coronary guidewires that are jailed during the treatment of bifurcations using provisional stenting often suffer nonsevere microscopic damage. Although polymer-coated guidewires were used in more complex bifurcation lesions, paradoxically, they were damaged less frequently.

Enfermedad de Hirschsprung asociada al síndrome de Mowat-Wilson: a propósito de un caso / Hirschsprung disease associated with mowat-wilson syndrome: report of a case

Introducción: La enfermedad de Hirschsprung (EH) o megacolon agangliónico es un trastorno congénito que se caracteriza por la ausencia de células ganglionares intramurales de los plexos mioentéricos submucosos (de Auerbach y Meissner, respectivamente) en tramos distales del intestino, debido al fracaso de la migración de los precursores de estas células desde la cresta neural durante el desarrollo embrionario y asociada a otras anomalías en el 18% restante de los casos, en ocasiones formando parte de síndromes polimalformativos específicos. Objetivo: Este artículo tiene como objetivo presentar la evolución clínica y nutricional de un paciente pediátrico de 14 meses diagnosticado de EH al nacer asociado a MWS, así como evaluar los resultados clínicos de este paciente. Métodos: A través de la revisión de la historia clínica, se estudió la evolución de los datos antropométricos (peso y talla) así como los parámetros analíticos para su valoración. Adicionalmente, se evaluaron las complicaciones asociadas al soporte nutricional y la estrategia terapéutica en el contexto multidisciplinar. Resultados: Paciente de 14 meses, sexo masculino, hijo de padres sanos no consanguíneos inmigrantes de Colombia acude al servicio de urgencias de nuestro hospital por presentar distensión abdominal y vómitos con ausencia de deposiciones espontáneas. Descripción de la composición de la nutrición parenteral recibida durante los 28 días que duró su ingreso hospitalario. Conclusión: La asociación de la enfermedad de Hirschsprung y el síndrome de Mowat-Wilson puede conducir a la necesidad de nutrición parenteral de manera prolongada y presentar con mayor frecuencia desvío del estoma produciéndose un mayor número de complicaciones postoperatorias en estos pacientes, tal y como es el caso de nuestro paciente (AU)

Introduction: Hirschsprung’s disease (HD) or aganglionic megacolon is a congenital disorder characterized by the absence of ganglion intramural cells of the submucosal myenteric plexus (namely Auerbach and Meissner, respectively) in distal sections of the intestine. This is due to a failure in the migration of the precursors of these cells from the neural chalk during the embryonic development and also due to other abnormalities associated (18 % of cases), in some cases involving specific polymalformation syndromes. Objectives: The aim of the work is to present the clinical and nutritional evolution of a 14 months aged pediatric patient who was diagnosed with HD since was born associated with Mowat- Wilson syndrome (MWS). In addition, it is also targeted to evaluate the clinical results from this patient. Methods: Reviewing the medical history of the patient, the evolution of the anthropometric data (weight and height) as well as the analytical parameters for further studies were carried out. In addition, the upcoming issues associated with nutritional support and therapeutic strategies in the multidisciplinary context were evaluated. Results: A male, 14 months aged patient, son of not consanguineous healthy immigrants parents from Colombia went to the emergency department of our hospital suffering abdominal distension and vomiting with no spontaneous bowels. A detailed description of the composition of parenteral nutrition administered within the period of 28 days of hospital admission. Conclusion: As observed in this patient, the association of HD and MWS can lead to the need of prolonged parenteral nutrition and frequently present diverting stoma leading to a greater number of postoperative complications in this population (AU)

Combination of CE-MS and advanced chemometric methods for high-throughput metabolic profiling.

In this work, an untargeted approach based on capillary electrophoresis-mass spectrometry (CE-MS) in combination with multivariate data analyses is proposed as a high-throughput general methodology for metabolomic studies. First, total ion electropherograms (TIEs) were considered for exploratory and classification purposes by means of principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA). Then, multivariate curve resolution alternating least squares (MCR-ALS) was applied to the multiple full scan MS data sets. This strategy permitted the resolution of a large number of metabolites being characterized by their electrophoretic peaks and their corresponding mass spectra. The proposed approach allowed solving additional electrophoretic issues, such as background noise contributions, low signal-to-noise ratios, asymmetric peaks and migration time shifts. The usefulness of the proposed methodology is demonstrated in a comparative study of the metabolic profiles from baker's yeast (Saccharomyces cerevisiae) samples cultured at two temperatures, 30°C and 37°C. A total number of 80 metabolites were relevant to yeast samples differentiation at the two temperatures and almost 50 of them were tentatively identified based on their accurate experimental molecular mass. The results show that changes in amino acid, nucleotide and lipid metabolic pathways participated in the acclimatization of yeast cells to grow at 37°C.

Hirschsprung disease associated with Mowat-Wilson syndrome: report of a case.

INTRODUCTION: Hirschsprung's disease (HD) or aganglionicmegacolon is a congenital disorder characterized by the absence of ganglion intramural cells of the submucosal myenteric plexus (namely Auerbach and Meissner,respectively) in distal sections of the intestine. This is due to a failure in the migration of the precursors of these cells from the neural chalk during the embryonic development and also due to other abnormalities associated(18 % of cases), in some cases involving specific polymalformation syndromes. OBJECTIVES: The aim of the work is to present the clinical and nutritional evolution of a 14 months aged pediatric patient who was diagnosed with HD since was born associated with Mowat-Wilson syndrome (MWS). In addition,it is also targeted to evaluate the clinical results from this patient. METHODS: Reviewing the medical history of the patient,the evolution of the anthropometric data (weight and height) as well as the analytical parameters for further studies were carried out. In addition, the upcoming issues associated with nutritional support and therapeutic strategies in the multidisciplinary context were evaluated. RESULTS: A male, 14 months aged patient, son of not consanguineous healthy immigrants parents from Colombia went to the emergency department of our hospital suffering abdominal distension and vomiting with no spontaneous bowels. A detailed description of the composition of parenteral nutrition administered within the period of 28 days of hospital admission. CONCLUSION: As observed in this patient, the association of HD and MWS can lead to the need of prolonged parenteral nutrition and frequently present diverting stoma leading to a greater number of postoperative complications in this population.

Introducción: La enfermedad de Hirschsprung (EH) o megacolon agangliónico es un trastorno congénito que se caracteriza por la ausencia de células ganglionares intramurales de los plexos mioentéricos submucosos (de Auerbach y Meissner, respectivamente) en tramos distales del intestino, debido al fracaso de la migración de los precursores de estas células desde la cresta neural durante el desarrollo embrionario y asociada a otras anomalías en el 18% restante de los casos, en ocasiones formando parte de síndromes polimalformativos específicos. Objetivo: Este artículo tiene como objetivo presentar la evolución clínica y nutricional de un paciente pediátrico de 14 meses diagnosticado de EH al nacer asociado a MWS, así como evaluar los resultados clínicos de este paciente. Métodos: A través de la revisión de la historia clínica, se estudió la evolución de los datos antropométricos (peso y talla) así como los parámetros analíticos para su valoración. Adicionalmente, se evaluaron las complicaciones asociadas al soporte nutricional y la estrategia terapéutica en el contexto multidisciplinar. Resultados: Paciente de 16 meses, sexo masculino, hijo de padres sanos no consanguíneos inmigrantes de Colombia acude al servicio de urgencias de nuestro hospital por presentar distensión abdominal y vómitos con ausencia de deposiciones espontáneas. Descripción de la composición de la nutrición parenteral recibida durante los 28 días que duró su ingreso hospitalario. Conclusión: La asociación de la enfermedad de Hirschsprung y el síndrome de Mowat-Wilson puede conducir a la necesidad de nutrición parenteral de manera prolongada y presentar con mayor frecuencia desvío del estoma produciéndose un mayor número de complicaciones postoperatorias en estos pacientes, tal y como es el caso de nuestro paciente.

Uso de pertuzumab y desensibilización a docetaxel en paciente oncológico; a propósito de un caso / Use of pertuzumab and docetaxel desensitization in oncological patient; apropos of a case

No disponible

Uso de anakinra en un caso de fiebre mediterránea familiar / Anakinra in a case of fever familial Mediterranean

No disponible