Epidemiology of ANCA vasculitis in Northern Spain.

OBJECTIVES: The incidence of anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) shows disparate results due to variable classification criteria and heterogeneous-population series. We aimed to estimate the incidence of AAV in a well-defined population with standardized classification criteria. METHODS: Population-based study of AAV patients diagnosed from January 2000 to December 2023 in Cantabria, Northern Spain. Patients were classified according to ACR/EULAR 2022 into granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), or unclassified vasculitis if the criteria were not met. Eosinophilic granulomatosis with polyangiitis (EGPA) patients were not included. The annual incidence rates were estimated by cases over 1,000 000 (106) (95% CI) including overall AVV, type of AAV, sex, and year of diagnosis. A literature review was also performed. RESULTS: We included 152 (80/72 men; mean age; 70.6 ± 13.18 years) patients. They were classified as MPA (67; 44%), GPA (64; 42.2%), and unclassified vasculitis (21; 13.8%). Annual incidence was 13.4 (10-16.8)/106 [male 14.5 (10.5-18.5); female 12.1 (8.7-15.6)]. The Annual incidence of MPA was 5.9 (4-7.8)/106 and GPA 5.6 (3.9-7.3)/106. The mean Annual incidence increased from 6.1 (4.5-7.7)/106-16.5 (5.6-27.4)/106 in the last three years, particularly, in GPA from 2.3 (0.3-4.9)/106-8.2 (2-14.5)/106. The prevalence of AAV was 184.7 (181-188)/106. CONCLUSION: During a 20-year period we found that the incidence of AAV (GPA and MPA) in Northern Spain is higher than Southern Spain, but lower than Northern European countries. An increase in the incidence was observed in the last years.

Carcinoma Cuniculatum, a Rare Variant of Oral Squamous Cell Carcinoma: Presentation of Five Clinical Cases and Review of the Literature.

Background: Oral carcinoma cuniculatum (CC) is a rare variant of squamous cell carcinoma. It exhibits a locally aggressive behaviour, and its histopathology poses a diagnostic challenge, as it can be mistaken for other conditions. We present five cases of oral CC treated at our institution and conduct a comprehensive review of the current literature. Case Series: Five patients (two women and three men) were treated in our institution with a final diagnosis of oral CC. Ages ranged from 9 to 85 years at the time of diagnosis. Four patients had mandibular involvement requiring mandibulectomy and reconstruction using an osseous free flap. The diagnosis of oral CC was straightforward in the most recent cases. However, for the first two cases, the diagnosis of oral CC was established after thorough discussions between the surgeons and the pathologist regarding the similarities with recent cases. Consequently, the pathological specimens had to be retrospectively re-evaluated to confirm these diagnoses. Conclusions: Oral CC is a locally aggressive tumour that can present a challenge for pathologists, often leading to misdiagnosis. According to the existing literature, surgical resection with clear margins is the preferred treatment approach.

The histamine H3 receptor inverse agonist SAR-152954 reverses deficits in long-term potentiation associated with moderate prenatal alcohol exposure.

Prenatal alcohol exposure can have persistent effects on learning, memory, and synaptic plasticity. Previous work from our group demonstrated deficits in long-term potentiation (LTP) of excitatory synapses on dentate gyrus granule cells in adult offspring of rat dams that consumed moderate levels of alcohol during pregnancy. At present, there are no pharmacotherapeutic agents approved for these deficits. Prior work established that systemic administration of the histaminergic H3R inverse agonist ABT-239 reversed deficits in LTP observed following moderate PAE. The present study examines the effect of a second H3R inverse agonist, SAR-152954, on LTP deficits following moderate PAE. We demonstrate that systemic administration of 1 mg/kg of SAR-152954 reverses deficits in potentiation of field excitatory post-synaptic potentials (fEPSPs) in adult male rats exposed to moderate PAE. Time-frequency analyses of evoked responses revealed PAE-related reductions in power during the fEPSP, and increased power during later components of evoked responses which are associated with feedback circuitry that are typically not assessed with traditional amplitude-based measures. Both effects were reversed by SAR-152954. These findings provide further evidence that H3R inverse agonism is a potential therapeutic strategy to address deficits in synaptic plasticity associated with PAE.

The Prominence of Action Sequences and Behavioral Similarity in the Morris Water Task.

The question of What is learned when navigating to a place is reinforced has been the subject of considerable debate. Prevailing views emphasize cognitive structures (e.g., maps) or associative learning, which has shaped measurement in spatial navigation tasks (e.g., the Morris water task [MWT]) toward selection of coarse measures that do not capture precise behaviors of individual animals. We analyzed the navigation paths of 15 rats (60 trials each) in the MWT at high temporal resolution (30Hz) and utilized dynamic time warping to quantify the similarity of paths within and between animals. Paths were largely direct, yet suboptimal, and included changes in speed and trajectory that were established early in training and unique to each animal. Individual rats executed similar paths from the same release point from trial to trial, which were distinct from paths executed by other rats as well as paths performed by the same rat from other release points. These observations suggest that rats learn to execute similar path sequences from trial to trial for each release point in the MWT. Occasional spontaneous deviations from the established, unique behavioral sequence, resulted in profound disruption in navigation accuracy. We discuss the potential implications of sequence navigation behaviors for understanding relations between behavior and spatial neural signals such as place cells, grid cells, and head direction cells. Supplementary Information: The online version contains supplementary material available at 10.1007/s40614-024-00402-8.

Doubling the life of Cu/ZnO methanol synthesis catalysts via use of Si as a structural promoter to inhibit sintering.

Cu/ZnO/Al2O3 catalysts used to synthesize methanol undergo extensive deactivation during use, mainly due to sintering. Here, we report on formulations wherein deactivation has been substantially reduced by the targeted use of a small quantity of a Si-based promoter, resulting in accrued activity benefits that can exceed a factor of 1.8 versus unpromoted catalysts. This enhanced stability also provides longer lifetimes, up to double that of prior generation catalysts. Detailed characterization of a library of aged catalysts has allowed the most important deactivation mechanisms to be established and the chemical state of the silicon promoter to be identified. We show that silicon is incorporated within the ZnO lattice, providing a pronounced improvement in the hydrothermal stability of this component. These findings have important implications for sustainable methanol production from H2 and CO2.

Organic solvent-free benznidazole nanosuspension as an approach to a novel pediatric formulation for Chagas disease.

Aim: Benznidazole (BNZ), a class-II drug, is the primary treatment for Chagas disease, but its low aqueous solubility presents challenges in formulation and efficacy. Nanosuspensions (NS) could potentially address these issues. Methods: BNZ-NS were prepared using a simple, organic solvents-free nano-milling approach. Physicochemical characterizations were conducted on both NS and lyophilized solid-state BNZ-nanocrystals (NC). Results: BNZ-NS exhibited particle size <500 nm, an acceptable polydispersity index (0.23), high Z-potential, and physical stability for at least 90 days. BNZ-NC showed tenfold higher solubility than pure BNZ. Dissolution assays revealed rapid BNZ-NS dissolution. BNZ-NC demonstrated biocompatibility on an eukaryotic cell and enhanced BNZ efficacy against trypomastigotes of Trypanosoma cruzi. Conclusion: BNZ-NS offers a promising alternative, overcoming limitations associated with BNZ for optimized pharmacotherapy.

[Box: see text].

Synthesis of Silver Nanoparticles Using Extracts from Different Parts of the Paullinia cupana Kunth Plant: Characterization and In Vitro Antimicrobial Activity.

The green synthesis of silver nanoparticles (AgNPs) can be developed using safe and environmentally friendly routes, can replace potentially toxic chemical methods, and can increase the scale of production. This study aimed to synthesize AgNPs from aqueous extracts of guarana (Paullinia cupana) leaves and flowers, collected in different seasons of the year, as a source of active biomolecules capable of reducing silver ions (Ag+) and promoting the stabilization of colloidal silver (Ag0). The plant aqueous extracts were characterized regarding their metabolic composition by liquid chromatography coupled to high-resolution mass spectrometry (UHPLC-HRMS/MS), phenolic compound content, and antioxidant potential against free radicals. The synthesized AgNPs were characterized by UV/Vis spectrophotometry, dynamic light scattering (DLS), nanoparticle tracking analysis (NTA), transmission electron microscopy (TEM), and scanning electron microscopy coupled to energy-dispersive X-ray spectrometry (EDX). The results demonstrated that the chemical characterization indicated the presence of secondary metabolites of many classes of compounds in the studied aqueous extracts studied, but alkaloids and flavonoids were predominant, which are widely recognized for their antioxidant capabilities. It was possible to notice subtle changes in the properties of the nanostructures depending on parameters such as seasonality and the part of the plant used, with the AgNPs showing surface plasmon resonance bands between 410 and 420 nm using the leaf extract and between 440 and 460 nm when prepared using the flower extract. Overall, the average hydrodynamic diameters of the AgNPs were similar among the samples (61.98 to 101.6 nm). Polydispersity index remained in the range of 0.2 to 0.4, indicating that colloidal stability did not change with storage time. Zeta potential was above -30 mV after one month of analysis, which is adequate for biological applications. TEM images showed AgNPs with diameters between 40.72 to 48.85 nm and particles of different morphologies. EDX indicated silver content by weight between 24.06 and 28.81%. The synthesized AgNPs exhibited antimicrobial efficacy against various pathogenic microorganisms of clinical and environmental interest, with MIC values between 2.12 and 21.25 µg/mL, which is close to those described for MBC values. Therefore, our results revealed the potential use of a native species of plant from Brazilian biodiversity combined with nanotechnology to produce antimicrobial agents.

Low-risk delisting strategy in highly sensitized patients without donor offers included in exchange donation programs. One single-center experience.

Donor exchange programs were designed to allocate organs for highly sensitized (HS) patients. The allocation algorithm differs slightly among countries and includes different strategies to improve access to transplants in HS patients. However, many HS patients with a calculated panel reactive of antibodies (cPRA) of 100 % remain on the waiting list for a long time. Some allocation algorithms assume immunological risk, including Imlifidase treatment, to increase the chance of transplantation in very HS patients. Here, we describe our unicenter experience of low-risk delisting strategy in 15 HS patients included in the Spanish donor exchange program without donor offers. After delisting, 7 out of 15 HS patients reduced the cPRA below 99.95 % and impacted the reduction of time on the waiting list (p = 0.01), where 5 out of 7 achieved transplantation. Within those HS that remained above 99.95 %, 1 out of 8 was transplanted. All the HS were transplanted with delisted DSA, and only one with DSA level rebounded early after transplantation. All HS transplanted after delisting maintain graft function. The transplant immunology laboratories are challenged to search intermediate risk assessment methods for delisting high HS patients.

Tuberculosis among children visiting friends & relatives.

BACKGROUND: Most paediatric tuberculosis (TB) cases in low-TB-incidence countries involve children born to migrant families. This may be partially explained by trips to their countries of origin for visiting friends and relatives (VFR). We aimed to estimate the risk of latent TB infection (LTBI) and TB in children VFR. METHODS: We conducted a prospective multicentric observational study in Catalonia (Spain) from June 2017 to December 2019. We enrolled children aged < 15 years with a negative tuberculin skin test (TST) at baseline and at least one parent from a high-TB-incidence country, and who had travelled to their parent's birth country for ≥21 days. TST and QuantiFERON-TB Gold Plus (QFT-Plus) were performed within 8-12 weeks post-return. LTBI was defined as a TST ≥5 mm and/or a positive QFT-Plus. RESULTS: Five hundred children completed the study, equivalent to 78.2 person-years of follow-up (PYFU). Thirteen children (2.6%) were diagnosed with LTBI (16.6/per100 PYFU, 95%CI = 8.8-28.5), including two cases (0.4%) of TB (2.5/per100 PYFU, 95%CI = 0.3-9.3). LTBI incidence rates remained high after excluding BCG-vaccinated children (9.7/per100 PYFU, 95%CI = 3.9-20.0). Household tobacco smoke exposure was associated with LTBI (aOR = 3.9, 95%CI = 1.1-13.3). CONCLUSIONS: The risk of LTBI in children VFR in high-TB-incidence countries may equal, or perhaps even exceed, the infection risk of the native population. The primary associated risk factor was the presence of smokers in the household. Furthermore, the incidence rate of active TB largely surpassed that of the countries visited. Children VFR in high-TB-incidence countries should be targeted for diagnostic and preventive interventions.

Vein of Galen Aneurysmal Malformation: A Case Report and Literature Review.

The vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation caused by the maldevelopment of its embryonic precursor, the median pros encephalic vein of Markowski. Although most of the VGAM cases are diagnosed in the neonatal period, sometimes it can also present during early childhood. It is very crucial to intervene immediately following the diagnosis because if left untreated, morbidity and mortality are imminent. The most common causes of morbidity and mortality are high-output congestive heart failure (most common neonatal presentation), hydrocephalus (most common presentation in infants), headache, and seizures.  We are presenting the case of a two-year-old male with global developmental delay, failure to thrive, and macrocephaly who presented with recurrent generalized tonic-clonic seizures. MRI/magnetic resonance venography (MRV)/magnetic resonance angiography (MRA) brain showed an enlarged vein of Galen with venous hypertension and aqueduct stenosis.  Treatment intervention included trans-arterial embolization of the right pericallosal, right/left lateral posterior, and medial posterior choroidal feeders with coils. The patient has had significant improvement in his neurocognitive functions including significant improvement in his speech/language development with outpatient therapies in between embolization.

Unraveling the complex relationship between prenatal alcohol exposure, hippocampal LTP, and learning and memory.

Prenatal alcohol exposure (PAE) has been extensively studied for its profound impact on neurodevelopment, synaptic plasticity, and cognitive outcomes. While PAE, particularly at moderate levels, has long-lasting cognitive implications for the exposed individuals, there remains a substantial gap in our understanding of the precise mechanisms underlying these deficits. This review provides a framework for comprehending the neurobiological basis of learning and memory processes that are negatively impacted by PAE. Sex differences, diverse PAE protocols, and the timing of exposure are explored as potential variables influencing the diverse outcomes of PAE on long-term potentiation (LTP). Additionally, potential interventions, both pharmacological and non-pharmacological, are reviewed, offering promising avenues for mitigating the detrimental effects of PAE on cognitive processes. While significant progress has been made, further research is required to enhance our understanding of how prenatal alcohol exposure affects neural plasticity and cognitive functions and to develop effective therapeutic interventions for those impacted. Ultimately, this work aims to advance the comprehension of the consequences of PAE on the brain and cognitive functions.

Impaired Cellular and Antibody immunity after COVID-19 in Chronically Immunosuppressed Transplant Recipients.

Assessment of cellular immunity to the SARS-CoV-2 coronavirus is of great interest in chronically immunosuppressed transplant recipients (Tr), who are predisposed to infections and vaccination failures. We evaluated CD154-expressing T-cells induced by spike (S) antigenic peptides in 204 subjects-103 COVID-19 patients and 101 healthy unexposed subjects. S-reactive CD154+T-cell frequencies were a) higher in 42 healthy unexposed Tr who were sampled pre-pandemic, compared with healthy NT (p=0.02), b) lower in Tr COVID-19 patients compared with healthy Tr (p<0.0001) and were accompanied by lower S-reactive B-cell frequencies (p<0.05), c) lower in Tr with severe COVID-19 (p<0.0001), or COVID-19 requiring hospitalization (p<0.05), compared with healthy Tr. Among Tr with COVID-19, cytomegalovirus co-infection occurred in 34%; further, incidence of anti-receptor-binding-domain IgG (p=0.011) was lower compared with NT COVID-19 patients. Healthy unexposed Tr exhibit pre-existing T-cell immunity to SARS-CoV-2. COVID-19 impairs anti-S T-cell and antibody and predisposes to CMV co-infection in transplant recipients.

Perspectives of health practitioners on the challenges to accessing sexual and reproductive health care services for Venezuelan migrant women during the COVID-19 pandemic in Quito, Ecuador / Perspectivas de los prestadores de atención de salud sobre las dificultades de acceso a los servicios de salud sexual y reproductiva de las mujeres migrantes venezolanas durante la pandemia de COVID-19 en Quito (Ecuador) / Perspectivas dos profissionais de saúde sobre as dificuldades de acesso aos serviços de saúde sexual e reprodutiva das mulheres migrantes venezuelanas durante a pandemia de COVID-19 em Quito, Equador

ABSTRACT Objectives. To describe the perspectives of health practitioners on the barriers, gaps, and opportunities that Venezuelan migrant women experienced to accessing sexual and reproductive health (SRH) services during the COVID-19 pandemic and how SRH services were affected in Quito, Ecuador. Methods. Health practitioners involved in SRH services at nine public health care facilities in three zones of Quito were surveyed. The Minimum Initial Service Package readiness assessment tool survey, available from the Inter-Agency Working Group on Reproductive Health in Crisis, was adapted for use and data collection in Ecuador. Results. Of 297 respondents, 227 were included in the analysis. Only 16% of the health practitioners agreed that discrimination against migrant Venezuelans women occurred in the health care system. Of those, only 2.3% described specific conditions associated with discrimination, including requiring identification documents (7.5%) and lack of empathy or responsiveness (6.6%). Most (65.2%) respondents reported that the COVID-19 pandemic affected the use of SRH services by women in the general population and by Venezuelan migrant women more so (56.3%) because of more limited access to SRH services, poverty, and vulnerability. There were no differences between perceptions by levels of health care facility, except with regard to the lack of supplies, awareness of discrimination, and the belief that Venezuelan migrant women were affected more negatively than the local population. Conclusion. The perception among health practitioners in Quito was that discrimination occurred infrequently during the COVID-19 pandemic despite affecting the health care system. However, some level of discrimination toward migrant Venezuelan migrant women seeking SRH services was acknowledged and may be underrepresented.

RESUMEN Objetivos. Describir las perspectivas de los prestadores de atención de salud sobre los obstáculos, las brechas y las oportunidades que registraron las mujeres migrantes venezolanas para acceder a los servicios de salud sexual y reproductiva (SSR) durante la pandemia de COVID-19 y cómo se vieron afectados estos servicios en Quito (Ecuador). Métodos. Se encuestó a prestadores de atención de salud que trabajan en servicios de SSR en nueve centros de salud pública de tres zonas de Quito. Se utilizó una adaptación de la encuesta sobre el instrumento de evaluación de la disposición operativa del paquete de servicios iniciales mínimos, disponible en el Grupo de Trabajo Interinstitucional sobre Salud Reproductiva en Situaciones de Crisis, para la recopilación de datos en Ecuador. Resultados. De las 297 personas encuestadas, 227 quedaron incluidas en el análisis. Solo el 16% de los prestadores de atención de salud estaba de acuerdo en que en el sistema de salud había discriminación contra las mujeres migrantes venezolanas. De estos, solo el 2,3% describió circunstancias específicas asociadas a la discriminación, como la exigencia de documentos de identidad (7,5%) y la falta de empatía o capacidad de respuesta (6,6%). La mayoría (65,2%) de las personas encuestadas manifestó que la pandemia de COVID-19 había impactado en el uso de los servicios de SSR por parte de las mujeres de la población general y, en mayor medida, por parte de las mujeres migrantes venezolanas (56,3%) debido a sus limitaciones para acceder a los servicios de SSR, su pobreza y su vulnerabilidad. No hubo diferencias en las percepciones según el nivel de los centros de salud, excepto con respecto a la falta de insumos, la concientización sobre la discriminación y la creencia de que estas mujeres se vieron más afectadas que la población local. Conclusión. La percepción en los prestadores de atención de salud en Quito fue que, pese a ser un fenómeno que afectaba al sistema de atención de salud, la discriminación había sido poco frecuente durante la pandemia de COVID-19. Sin embargo, se reconoció cierto nivel de discriminación hacia las mujeres migrantes venezolanas que solicitaban servicios de SSR y que este fenómeno podría estar subrepresentado.

RESUMO Objetivos. Descrever as perspectivas dos profissionais de saúde sobre as barreiras, lacunas e oportunidades que as mulheres migrantes venezuelanas encontraram para acessar serviços de saúde sexual e reprodutiva (SSR) durante a pandemia de COVID-19 e como esses serviços foram afetados em Quito, Equador. Métodos. Foram entrevistados profissionais de saúde envolvidos nos serviços de SSR de nove unidades públicas de saúde de três zonas de Quito. Adaptou-se o questionário de avaliação da prontidão para oferecer o pacote de serviço inicial mínimo, disponibilizado pelo grupo de trabalho interagencial sobre saúde reprodutiva em situações de crise, a fim de realizar a coleta de dados no Equador. Resultados. Dos 297 respondentes, 227 foram incluídos na análise. Apenas 16% dos profissionais de saúde concordaram que havia discriminação contra mulheres migrantes venezuelanas no sistema de saúde. Desses, apenas 2,3% descreveram condições específicas associadas à discriminação, como cobrança de documentos de identificação (7,5%) e falta de empatia ou responsividade (6,6%). A maioria (65,2%) dos respondentes relatou que a pandemia de COVID-19 afetou o uso dos serviços de SSR por mulheres na população de modo geral. As mulheres migrantes venezuelanas foram mais afetadas (56,3%) devido ao acesso limitado a serviços de SSR e à pobreza e vulnerabilidade. Não houve diferenças de percepção entre diferentes níveis de atenção à saúde, exceto no que diz respeito à falta de insumos, sensibilização para a discriminação e crença de que as mulheres migrantes venezuelanas foram afetadas de forma mais negativa que a população local. Conclusão. Para os profissionais de saúde em Quito, a discriminação foi pouco frequente durante a pandemia de COVID-19, embora a pandemia tenha afetado o sistema de saúde. Entretanto, os profissionais reconheceram certo nível de discriminação contra as mulheres migrantes venezuelanas que procuram serviços de SSR, que pode estar sub-representado.

Efectividad de las sesiones demostrativas para mejorar el conocimiento en la prevención de la anemia en gestantes, madres lactantes De niños menores de 3 años. Centro de salud Aparicio Pomares. Huánuco ­ perú / Effectiveness of demonstration sessions to improve knowledge in the prevention of anemia in pregnant women, nursing mothers of children under 3 years. Aparicio pomares health center. Huánuco ­ Peru

El problema de la anemia está muy relacionado a los índices de pobreza, falta de cuidado de la salud y educación de la población, pero principalmente a la falta de conocimientos sobre alimentación y nutrición infantil por parte de las madres. Objetivo: Determinar la efectividad de las sesiones demostrativas para mejorar el conocimiento en la prevención de la anemia en gestantes, madres lactantes de niños menores de 3 años. Materiales y Métodos: El estudio fue de tipo experimental, descriptivo y de nivel observacional, explicativo y analítico. La población de estudio estuvo conformada por 200 gestantes, obteniendo una muestra de 30 gestantes y 20 madres lactantes de niños menores de 3 años, haciendo un total de 50 pacientes, se utilizó el cuestionario para la recolección de datos, aplicado en dos momentos; antes y después de las sesiones demostrativas, con la finalidad de comparar los resultados. Resultados: El nivel de conocimiento teórico de las madres, luego de la aplicación de las sesiones demostrativas se incrementó su nivel a un conocimiento alto. Respecto a los conocimientos prácticos luego de la aplicación de las sesiones, se logró un conocimiento alto. Conclusiones: La técnica de sesiones demostrativas en el incremento de conocimientos es efectiva(AU)

The problem of anemia is closely related to the rates of poverty, lack of care of the health and education of the population, but mainly to the lack of knowledge about food and infant nutrition by mothers. Objective: To determine the effectiveness of the demonstration sessions to improve knowledge in the prevention of anemia in pregnant women, nursing mothers of minor children 3 years old Materials and methods: The study was of type, experimental, descriptive and observational level, explanatory and analytical. The study population consisted of 200 pregnant women, obtaining a sample of 30 pregnant women and 20 lactating mothers of children under 3 years of age, making a total of 50 patients, the questionnaire was used for data collection, applied in two moments; before and after demonstration sessions, in order to compare the results. Results: The level of theoretical knowledge of the mothers, after the application of the demonstrative sessions their level to high knowledge. Regarding the practical knowledge after the application of the sessions, high knowledge was achieved. Conclusions: The technique of demonstrative sessions in the increase of knowledge is effective(AU)

Terapia biológica en artritis reumatoidea: una revisión de reacciones adversas / Biological therapy in rheumatoid arthritis: A review of adverse reactions

RESUMEN Introducción: La relación entre eventos adversos y aplicación de medicamentos biológicos en pacientes con diagnóstico de artritis reumatoide ha sido documentada a escala mundial, pero con escasa evidencia en Colombia. Si se asume que los eventos adversos o reacciones medicamentosas con hallazgos clínicos relevantes en la salud, como consecuencia de este tratamiento terapéutico, recaen sobre la calidad de vida del paciente e influyen en los indicadores de salud a escala nacional y en los recursos del sistema, se hace importante evaluar su impacto. Objetivos: Determinar la frecuencia de eventos adversos o reacciones adversas relacionados con el uso de medicamentos biológicos en una cohorte de pacientes con diagnóstico de artritis reumatoide de una aseguradora nacional, en el periodo comprendido entre los arios 2000 y 2019. Metodología: Se realizó un estudio descriptivo, transversal y retrospectivo, con alcance analítico, en pacientes diagnosticados de artritis reumatoide, con terapia biológica, en una aseguradora a escala nacional, con registros en historias clínicas del año 2000 al 2019. Resultados: Se analizaron 252 registros clínicos de usuarios con diagnóstico de artritis reumatoide y terapia biológica. El 62,7% presentó al menos una reacción adversa y se evaluaron 9 fármacos: tocilizumab, etanercept, adalimumab, abatacept, certolizumab, golimumab, infliximab, rituximab y tofacitinib. Este último es un fármaco incluido en este estudio por solicitud de la aseguradora fuente de la información. Conclusiones: En la terapia biológica de pacientes con artritis reumatoide las reacciones adversas son frecuentes, y en un 27,3% resultan severas, lo cual describe una situación previamente desconocida en Colombia.

ABSTRACT Introduction: The relationship between adverse events and the application of biological drugs in patients with a diagnosis of rheumatoid arthritis has been documented worldwide, but with little evidence of the situation in Colombia. If adverse events and / or drug reactions with relevant clinical findings in health because of this therapeutic treatment affect the patient's quality of life and influence health indicators at the national level and system resources, it is important to assess their impact. Objectives: To determine the frequency of adverse events and / or adverse reactions related to the use of biological drugs in a cohort of patients diagnosed with rheumatoid arthritis from a national insurer, in the period from 2000 to 2019. Methodology: A descriptive, cross-sectional, and retrospective study with analytical scope was carried out in patients diagnosed with rheumatoid arthritis, on biological therapy, under a nationwide insurer, with records in their medical records from 2000 to 2019. Results: 252 clinical records of users with a rheumatoid arthritis diagnosis and biological therapy were analysed; 62.7% had at least one adverse reaction; nine drugs were evaluated in this study: Tocilizumab, Etanercept, Adalimumab, Abatacept, Certolizumab, Golimumab, Infliximab, Rituximab, and Tofacitinib. Tofacitinib was included in this study at the request of the insurer providing the information. Conclusions: Adverse reactions with biological therapy in patients with rheumatoid arthritis are frequent and were severe in 27.3%. This is a situation previously unknown in Colombia.

Vigilancia epidemiológicade los defectos congénitos en la provincia Cienfuegos / Epidemiological Surveillance of Congenital Defects in the Cienfuegos Province

RESUMEN Fundamento: los defectos congénitos se ubican entre las primeras causas de muerte en menores de un año. Constituyen un problema para el individuo, la familia, y la sociedad. En Cuba constituyenlaprimera causa de muerte en menores de un año y en Cienfuegos ocupaneltercer lugar. Objetivo: describir los defectos congénitos más frecuentes presentados en la provincia Cienfuegos entre los años 2011 y 2018 y determinar la prevalencia al nacer, frecuencia ajustada yla tendencia. Métodos: se realizó un estudio descriptivo, de corte transversal de los defectos congénitos más frecuentes en la provincia Cienfuegos, en el período 2011- 2018. El universo quedó constituido por330 niños nacidos vivos con diagnóstico de defectos congénitos y 286 terminaciones voluntarias de la gestación. Los resultados se presentaron en tablas o gráficos según fue más factible mostrar la información. Las variables analizadas fueron: prevalencia al nacer por año de la ocurrencia de defectos congénitos, frecuencia ajustada y anomalías mayores más frecuentes en la provincia.El análisis de los datos se realizó mediante la recogida de información en una base de datos para lo que se utilizó el modelo del Registro Cubano de Malformaciones Congénitas y el Registro Cubano Prenatal de Malformaciones Congénitas. Se determinó la prevalencia al nacer y la frecuencia ajustada, así como la tendencia en la ocurrencia de algunos defectos congénitos en la provincia. Los resultados se presentaron en gráficos y tablassegún fuera más factible mostrar la información Resultados: el síndrome de Down, la hidrocefalia y los defectos de abiertos de pared anterior fueron los que con más frecuencia se presentaron en la población cienfueguera, con una tendencia al decrecimiento en la aparición de anomalías como: atresia esofágica, transposición de grandes vasos,entre otros. Conclusiones: el síndrome de Down, la hidrocefalia y los defectos de abiertos de pared anterior fueron los defectos congénitos que con más frecuencia se presentaron en la población pediátrica en Cienfuegos.

ABSTRACT Background: congenital defects are among the leading causes of death in children under one year of age. They constitute a problem for the individual, the family, and society. In Cuba they are the leading cause of death in children under one year of age and in Cienfuegos they rank third. Objective: to describe the most frequent congenital defects presented in the Cienfuegos province between the years 2011 and 2018 and to determine the prevalence at birth, adjusted frequency and trend. Methods: a descriptive, cross-sectional study of the most frequent congenital defects in the Cienfuegos province was carried out, in the period 2011-2018. The universe of 330 live-born children with congenital defects diagnosis and 286 voluntary terminations of pregnancy. The results were presented in data tables or graphs as it was more feasible to display the information. The variables analyzed were: prevalence at birth per year of the occurrence of congenital defects, adjusted frequency, and the most frequent major anomalies in the province. Data analysis was carried out by collecting information in a database for which the model of the congenital malformations Cuban registry and the Cuban congenital malformations prenatal registry was used. The prevalence at birth and the adjusted frequency were determined, as well as the trend in the occurrence of some congenital defects in the province. The results were presented in graphs and data tables as it was more feasible to show the information. Results: down syndrome, hydrocephalus and open anterior wall defects were the ones that most frequently occurred in the Cienfuegos population, with a decreasing trend in the appearance of anomalies such as: esophageal atresia, transposition of the great vessels, among others. Conclusions: down syndrome, hydrocephalus and open anterior wall defects were the congenital defects that most frequently occurred in the pediatric population in Cienfuegos.

Estudio Descriptivo: Colposcopia en el diagnóstico de lesiones de cuello uterino en el Hospital de Especialidades José Carrasco Arteaga, Cuenca ­ Ecuador. 2015-2019 / Descriptive Study: Colposcopy as a diagnostic method for cervix lesions in Hospital de Especialidades Jose Carrasco Arteaga, Cuenca-Ecuador. 2015-2019

INTRODUCCIÓN: El cáncer de cuello uterino es un problema de salud pública, siendo una de las principales causas de morbilidad y mortalidad en países en vía de desarrollo. Para el screening y diagnóstico de las lesiones del cuello uterino se realiza citología cervical (Papanicolaou). Ante un reporte de citología sospechosa, la colposcopia es un procedimiento imprescindible en la evaluación del tracto genital inferior para detectar lesiones tempranas y cáncer. El objetivo de la presente investigación fue caracterizar los procedimientos colposcópicos realizados, como método diagnóstico y terapéutico, en las pacientes con resultados anormales del Papanicolaou. MATERIALES Y MÉTODOS: El presente es un estudio observacional, descriptivo de corte transversal, cuyo universo lo conformaron todas las pacientes con diagnóstico citológico anormal en Papanicolaou, que se realizaron un procedimiento colposcópico entre el año 2015 hasta el año 2019 en el Hospital José Carrasco Arteaga, con un total de 1 628 pacientes. RESULTADOS: Se incluyen 1 628 procedimientos colposcópicos. El 55.46% de la población estuvieron entre los 27 a 46 años de edad. El estado civil predominante fue casada (75%). El 63.45% de las mujeres iniciaron vida sexual entre los 21 a 30 años. El 95.20% de las pacientes tuvieron entre 1 y 3 parejas sexuales. Los resultados de Papanicolaou anormales representan; el 37.28% a LIE-BG, seguido de 35.81% con ASC-US y 14.18% como LIE-AG. El 67.32% de colposcopías fueron satisfactorias. Se realizó biopsia en el 71% de las pacientes, seguido de la toma de muestra de cono con ASA-LEEP (13.69%), legrado endocervical en el 11.05%. Los resultados de anatomía patológica reportaron LIE-AG en 46.56% de los casos, seguido de 22.23 % como LIE-BG y cervicitis crónica en el 16.27%, 12.28% de los resultados fueron negativos. CONCLUSIÓN: Tres cuartas partes de las colposcopias se realizaron en mujeres entre los 27 y 56 años de edad. Los resultados anormales más frecuentemente encontrados en el Papanicolaou fueron: LIE-BG, seguido de ASC-US. 67% de las colposcopias realizadas fueron satisfactorias. Tras la colposcopia, en la mayoría de pacientes se realizó biopsia, en un menor porcentaje y en orden de frecuencia: conización electro quirúrgica con asa (ASA-LEEP), legrado endocervical e histerectomía diagnóstica. Los resultados de anatomía patológica reportaron LIE-AG en el 46.56%, LIE-BG en el 22.23 % como y cervicitis crónica en el 16.27%; 12.28% de estudios fueron negativos.(au)

BACKGROUND: Cervical cancer is a public health issue, being one of the main causes of morbidity and mortality in developing countries. Cervical cytology (Papanicolaou) is performed for screening and diagnosis of cervical lesions. In case of a suspicious cytology report, colposcopy is an essential procedure for evaluation of the lower genital tract, to detect early lesions and cancer. The aim of this study was to characterize the colposcopy procedures performed, as a diagnostic and therapeutic method, in patients with abnormal Papanicolaou results. METHODS: This is an observational, descriptive cross-sectional study, whose universe were all the patients with abnormal cytological diagnosis in pap smear, who underwent a colposcopy procedure between 2015 and 2019 at Hospital José Carrasco Arteaga, with a total of 1 628 patients. RESULTS: 1 628 colposcopic procedures were included. 55.46% of the population were between 27 to 46 years of age. The predominant marital status was married status (75%). 63.45% of women had their first sexual experience between 21 and 30 years of age. 95.20% of the patients had between 1 and 3 sexual partners. Abnormal pap smear results represent; 37.28% to LSIL, followed by ASC-US (35.81%), and HSIL (14.18%). 67.32% of colposcopies were classified as satisfactory. Biopsy was performed in 71% of the patients, followed by loop electrosurgical excision procedure (LEEP) (13.69%), endocervical curettage in 11.05%. The pathology results reported HSIL in 46.56% of the cases, followed by 22.23% as LSIL and chronic cervicitis in 16.27%, 12.28% of the results were negative. CONCLUSION: Three-quarters of all colposcopies were performed on women between 27 and 56 years of age. The most frequently abnormal Pap smear results were: LSIL, followed ASC-US. 67% of the colposcopies were satisfactory. After colposcopy, biopsy was performed in most of the patients, in lower percentage: loop electrosurgical excision procedure (LEEP), endocervical curettage and diagnostic hysterectomy. Pathology results reported HSIL in 46.56%, LSIL IN 22.23% and chronic cervicitis in 16.27%; 12.28% of studies were negative.(au)

Effectiveness of triple therapy with dapagliflozin add-on to dual therapy over 52 weeks in patients with uncontrolled type 2 diabetes mellitus in a centre of high complexity, Cali-Colombia

ABSTRACT Objectives: To evaluate the effectiveness of adding dapagliflozin as an intensification strategy for the treatment of patients with uncontrolled type 2 diabetes mellitus (T2DM). Materials and methods: A historical cohort study was conducted in 123 adult patients over 18 years old who were diagnosed with uncontrolled T2DM, who received dapagliflozin add-on to their dual base treatment: metformin plus glibenclamide (n = 32), metformin plus saxagliptin (n = 29), metformin plus exenatide (n = 28), or metformin plus insulin (n = 34). The endpoints were evaluated using analysis of variance. Results: All the patients completed a 52-week follow-up. Overall, 52.85% of patients were female, the Hispanic population represented the largest proportion of patients in all groups (60.98%), and the mean ± SD patient age and body weight were 55.05 ± 7.58 years and 83.55 ± 9.65 kg, respectively. The mean ± SD duration of T2DM, glycated hemoglobin (HbA1c), and fasting plasma glucose (FPG) were 5.93 ± 2.98 years, 8.1 ± 0.53%, and 166.03 ± 26.80 mg/dL, respectively. The grand mean changes of HbA1c, FPG, body weight and blood pressure showed a decreasing trend during the study period and it was statistically significant in all groups (p-value = <0.001). The proportion of patients achieving HbA1c target (<7%) was highest in the group that used a dapagliflozin add-on to metformin plus saxagliptin. Conclusion: The addition of dapagliflozin as an alternative for intensification of dual therapy consistently improved, not only FPG and HbA1c, but also body weight and blood pressure, with statistically significant results.

La historiografía de la fiebre amarilla en América Latina desde 1980: los límites del presentismo / The historiography of yellow fever in Latin America since 1980: the limits of presentism

Resumen Este artículo presenta un análisis historiográfico sobre la fiebre amarilla en América Latina. Se muestra que las narrativas dominantes abordan la fiebre a partir de la dicotomía naturaleza-cultura, ya sea que la fiebre sea considerada como un actor histórico o que su historia aparezca vinculada a relaciones de poder. Se exploran algunas historias que asocian la enfermedad con la racialización del discurso de salud pública, la relación entre centros y periferias en la producción de ciencia y la salud pública norteamericana. Se argumenta que esta historiografía fija la naturaleza de la fiebre según el conocimiento médico contemporáneo (presentismo) y se sugiere que nuevos temas y perspectivas podrían emerger de un diálogo con la historia y la sociología de la ciencia.

Abstract This article provides a historiographical analysis of yellow fever in Latin America. It shows that the dominant narratives approach the fever using the nature-culture dichotomy, either treating the fever as an historical actor or linking its history to power relations. This study explores some histories that associate the disease with the racialization of public health discourse, the relationship between centers and peripheries in the production of science, and US public health. It argues that this historiography fixes the nature of the fever according to contemporary medical knowledge (presentism), and suggests that new themes and perspectives might emerge from a dialogue with the history and sociology of science.

Ventilación jet durante microcirugía de múltiples mixomas laríngeos en paciente con vía respiratoria anatómicamente difícil / Jet ventilation during microsurgery of multiple laryngeal myxomas in a patient with anatomically difficult respiratory airway

Introducción: La microcirugía de laringe incluye el dilema de un campo quirúrgico que coincide espacialmente con el del acceso a la vía respiratoria del paciente. Los mixomas, sobre todo numerosos y supra-infraglóticos, representan un reto terapéutico. Si aunado a este hecho, el paciente presenta una vía respiratoria anatómicamente difícil, la fórmula de la catástrofe sólo precisa mezclarlos con un plan de ventilación convencional. En este caso, la ventilación jet puede ser la alternativa para evitar una situación de desastre. Objetivo: Describir la secuencia de hechos y los resultados al aplicar por primera vez en el país la ventilación jet vía transcricotiroidea. Caso clínico: Ante el fracaso previo de una intervención mediante un método tradicional de ventilación, en una segunda intención para exéresis de múltiples mixomas laríngeos en una paciente con vía respiratoria anatómicamente difícil, después de obtener su consentimiento informado, se procedió a anestesiar y obtener un acceso transcricotiroideo a la vía respiratoria, para ventilar con flujos jet a través de un trocar 16G. La intervención, pensada para 15 min, se extendió durante 90 sin complicaciones ventilatorias o de oxigenación. La paciente fue dada de alta sin secuelas. Conclusiones: Aplicar ventilación jet vía transcricotiroidea fue oportuno, seguro y efectivo. Las complicaciones cardiovasculares menores fueron fácilmente controlables. Se usó por primera vez la ventilación jet transcricotiroidea en el país. Este resultado estimula la asimilación de las tecnologías de ventilación jet en contextos electivos o emergentes, como el desafío de una vía respiratoria anatómicamente difícil(AU)

Introduction: The larynx microsurgery involves the dilemma of a surgical field that coincides spatially with that of access to the patient's airway. Myxomas, especially numerous and supra/subglottic, represent a therapeutic challenge. If together with this fact, the patient presents an anatomically difficult airway, the formula for the catastrophe just needs to mix both with a conventional ventilation plan. In this case, jet ventilation can be the choice to avoid a disaster situation. Objective: To describe the sequence of events and the outcomes when transcricotyroid jet ventilation was applied for the first time in the country. Clinical case: In the face of previous failure of an intervention using a traditional method of ventilation, in a second intention for exeresis of multiple laryngeal myxomas in a patient with anatomically difficult airway, after obtaining her informed consent, we proceeded to anesthetize to obtain a transcricothyroid access to the respiratory tract, to ventilate with jet flows through a 16G trocar. The intervention, planned for 15 min, was extended for 90 minutes without ventilatory or oxygenation complications. The patient was discharged without sequelae. Conclusions: Transcricotyroid jet ventilation was timely, safe and effective. Minor cardiovascular complications were easily controllable. Transcricotyroid jet ventilation was used for the first time in the country. This outcome stimulates the assimilation of jet ventilation technologies in elective or emerging contexts, such as the challenge of an anatomically difficult airway(AU)