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After ejaculation, mammalian sperm undergo a series of molecular events conducive to the acquisition of fertilizing competence. These events are collectively known as capacitation and involve acrosomal responsiveness and a vigorous sperm motility called hyperactivation. When mimicked in the laboratory, capacitating bovine sperm medium contains bicarbonate, calcium, albumin and heparin, among other components. In this study, we aimed at establishing a new capacitation protocol for bovine sperm, using calcium ionophore. Similar to our findings using mouse sperm, bovine sperm treated with Ca2+ ionophore A23187 were quickly immobilized. However, these sperm initiated capacitation after ionophore removal in fresh medium without heparin, and independent of the Protein Kinase A. When A23187-treated sperm were used on in vitro fertilization (IVF) procedures without heparin, eggs showed cleavage rates similar to standardized IVF protocols using heparin containg synthetic oviduct fluid (IVF-SOF). However, when A23187 pre-treated sperm were further used for inseminating eggs in complete IVF-SOF-heparin, a significantly higher percentage of embryo development was observed, suggesting a synergism between two different signaling pathways during bovine sperm capacitation. These results have the potential to improve current protocols for bovine IVF that could also be applied in other species of commercial interest.
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Calcimicina , Ionóforos de Calcio , Criopreservación , Fertilización In Vitro , Preservación de Semen , Capacitación Espermática , Espermatozoides , Animales , Bovinos , Masculino , Ionóforos de Calcio/farmacología , Criopreservación/veterinaria , Criopreservación/métodos , Fertilización In Vitro/veterinaria , Fertilización In Vitro/métodos , Calcimicina/farmacología , Espermatozoides/efectos de los fármacos , Espermatozoides/fisiología , Capacitación Espermática/efectos de los fármacos , Preservación de Semen/veterinaria , Preservación de Semen/métodos , Femenino , Técnicas de Cultivo de Embriones/veterinaria , Desarrollo Embrionario/efectos de los fármacosAsunto(s)
Melanoma , Estadificación de Neoplasias , Biopsia del Ganglio Linfático Centinela , Ganglio Linfático Centinela , Neoplasias Cutáneas , Humanos , Melanoma/patología , Neoplasias Cutáneas/patología , Ganglio Linfático Centinela/patología , Biopsia del Ganglio Linfático Centinela/métodos , Metástasis Linfática/patología , Melanoma Cutáneo MalignoRESUMEN
Two novel species of Psalmopoeus Pocock, 1895 are described from the north-western and central-western slopes of the Cordillera Occidental of the Andes mountain range in Ecuador. The new species are easily differentiated from other congeners of Psalmopoeus by spermathecae and male palpal bulb morphology and a comparatively distant distribution to the type localities of the geographically nearest known congeners. The diagnosis of P.ecclesiasticus Pocock, 1093 is revised and updated, considering the novel species and observations on spermatheca of this species. Likewise, an evaluation is provided for the new species in terms of conservation due to the various threats impacting ecosystems and ecosystem services of their type localities. Finally, the importance of theraphosid spiders in Ecuador and South America and their possible conservation requirements are discussed and assessed.
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El cuidado de niños y adolescentes con trastornos del neurodesarrollo implica altas demandas físicas, financieras y emocionales y puede asociarse con el surgimiento de sobrecarga parental. Como consecuencia, aumenta la frecuencia de empeoramiento conductual del menor y de trastornos depresivos y de ansiedad en el adulto responsable. Se describen los casos de tres madres de pacientes con trastornos del desarrollo que presentaron sobrecarga parental para aumentar la visibilización de esta problemática en ámbitos pediátricos. Todos los hijos estaban recibiendo plan psicofarmacológico por la presencia de alteraciones conductuales y solo uno tenía acompañante terapéutico. La detección temprana y derivación de los padres con sobrecarga es imprescindible para mejorar la calidad de vida de los niños y los adolescentes con trastornos del neurodesarrollo y sus familias
Introduction: The care of children and adolescents with neurodevelopmental disorders involves high physical, financial and emotional demands, and it may be associated with the emergence of parenting stress. As a result, there is an increase in the frequency of minor behavioral worsening and depressive and anxiety disorders in the responsible adult. The cases of three mothers of patients with developmental disorders are described in order the visibility of this problem in pediatric settings. All the children were receiving psychotropics for the presence of behavioral alterations and only one had a therapeutic companion. Conclusion: Early detection and referral of parenting stress is essential to improve the quality of life of children and adolescents with neurodevelopmental disorders and their families. Objectives: to describe the initial clinical findings of patients with CVID diagnosed at Hospital de Niños Sor Maria Ludovica, between 1981 and 2019. 19 patients were included, 14 were male (74%). All Patients Had a history of recurrent infections, most frequently pneumonia (74%) and acute otitis media (42%). 9 patients suffered from chronic diarrhea (47%), with associated malabsorption in 6 of them. Thirty-two presented with severe malnutrition and 1 patient with gastric metaplasia. One Patient Had Splenomegaly and 1 had Evans´ syndrome. Bronchiectasis were found in 42% of patients at the time of diagnosis. Early suspicion of CVID from pediatricians is essential in order to arrive at a proper diagnosis
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Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Trastornos del Neurodesarrollo/psicología , Carga del Cuidador/psicología , Madres/psicología , Ansiedad/psicología , Encuestas y Cuestionarios , Depresión/psicología , Calidad del Sueño , Relaciones Madre-Hijo/psicologíaRESUMEN
Frente a los significativos y rápidos cambios en los conocimientos relacionados con la fisiopatología de la diabetes mellitus (DM) y los mecanismos involucrados en el desarrollo de las enfermedades cardiovasculares (ECV) por un lado y, por otro, frente al desarrollo de diferentes fármacos con inesperados efectos a nivel cardiovascular, nos propusimos desarrollar un consenso actualizado entre la Sociedad Argentina de Cardiología y la Sociedad Argentina de Diabetes, dos sociedades con reconocida trayectoria en la confección de guías y consensos que, en última instancia, tienen el objetivo de brindar un material actualizado y práctico para el manejo de los pacientes que presentan DM y ECV. Si bien nuestra tarea conjunta había comenzado hace tiempo atrás, este Consenso sale a la luz en medio de una de las peores crisis sanitarias a nivel mundial con el surgimiento del SARS-CoV2 y su manifestación clínica, la COVID-19.
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Humanos , Consenso , Enfermedades Cardiovasculares , Diabetes MellitusRESUMEN
INTRODUCCIÓN: La pandemia por SARS-COV-2 ha generado mortalidad por exceso, aun así, se deben revisar la mortalidad atribuida a otras enfermedades. El siguiente trabajo pretende identificar la tendencia de mortalidad no relacionada con COVID-19 en la región del Bio-bio, periodo 2016-2020. Material y Método: Estudio descriptivo, ecológico, longitudinal. Se estudió la población de la región del Biobío, periodo 2016-2020. Los datos se obtuvieron del departamento de estadística e información en Salud. Se estudió: Distribución etaria, sexo, tasa de mortalidad general y específica, y promedio anual del número de muertos en el periodo 2016-2019; excluyendo la causa de muerte por enfermedad COVID-19 o sospechosa de COVID-19. Se realizó un análisis descriptivo. Se utilizó el programa Microsoft Excel 365® para análisis. Resultados: 2016-2019 fallecieron más hombres (n=19.110; 53,00%), siendo el principal grupo etario de 75-79 años (n=2.433; 12,73%), en el caso de las mujeres fue el grupo de 90-99 años (n=2.832; 16,71%). En 2020, fallecieron más hombres que mujeres, de los mismos grupos etarios respectivamente. Tasa de mortalidad general 2020 fue 544,39 x100.000 hbts., inferior a la de otros años, excepto en 2016. Sin embargo, el periodo Enero-abril 2020, la tasa de mortalidad es mayor comparado con los años anteriores. El promedio de muertes 2016-2019 fue 9.016,0 ±186,5, siendo el total en 2020 n=9.057. Discusión: La pandemia ha afectado a pacientes con patologías que han presentado una atención poco efectiva u inoportuna, falleciendo por el SARS-COV-2 o por sus comorbilidades, camuflándose sus registros. Lo cual dificultará interpretar dichos valores.
INTRODUCTION: The SARS-COV-2 pandemic has generated excess mortality, even so, the mortality attributed to other diseases should be reviewed. The study objective was to identify the mortality trend unrelated to COVID-19 in the Bio-bio Region between 2016-2020. Material and Method: Descriptive, ecological, longitudinal study. The population of the Biobío region was studied between the years 2016-2020. Data were obtained from the Department of Statistics and Health Information, DEIS. It was studied: Age distribution, sex, general and specific mortality rate, annual average of the number of deaths between 2016-2020, excluding mortality from (or suspected) COVID-19 disease. A descriptive analysis was performed. Microsoft Excel 365® software was used for the analysis. Results: 2016-2019 mortality rate was higher for men (n=19,110; 53.00%), with the highest rates in the 75-79 years group (n=2,433; 12.73%); women 90- 99 years (n=2,832; 16.71%) presented the highest mortality rates. In 2020 more men than women continued to die in the same age groups, respectively. The general mortality rate 2020 was 544,39 x 100,000 inhabitants, which is lower than that of any other year, except for 2016. However, from January to April 2020, the mortality rate was higher when compared to the previous years. The average of deaths 2016-2019 was 9,016.0 ± 186.5, meanwhile in the same period in 2020 was 9,057. Discussion: The pandemic has affected patients with pathologies who have presented ineffective or untimely care, dying from SARS-COV-2 or its comorbidities, then their records get camouflaged, which will make it difficult to interpret these values.
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedad , Mortalidad/tendencias , Causas de Muerte/tendencias , COVID-19 , Chile/epidemiología , Epidemiología Descriptiva , Tasa de Supervivencia , Modelos Estadísticos , PandemiasRESUMEN
Las herramientas para evaluar el grado de control glucémico se modificaron últimamente. La emoglobina glicosilada (HbA1c), parámetro de referencia (gold standard), refleja el control glucémico de los últimos tres meses de manera retrospectiva, sin expresar la variabilidad glucémica. El automonitoreo glucémico capilar (AGC) brinda información inmediata y prospectiva, pero dispone de pocos datos glucémicos para generar promedios y desviaciones estándares representativas. No detecta tendencias y tiene limitaciones para obtener datos nocturnos o durante la actividad física. Es invasivo y muchas veces rechazado. Contrariamente, el monitoreo continuo de glucosa (MCG) mide la glucosa instantáneamente, y muestra sus tendencias y su variabilidad en forma continua, incorporando nuevas métricas de control. Mediante el perfil ambulatorio de glucosa (PAG) se analizan los patrones del control glucémico durante el sueño, los ayunos prolongados, la actividad física y las intercurrencias, expresándolos como curvas con sus desviaciones estándar durante períodos de horas (8 a 24 horas) o días (7, 14, 30 y 90 días). El PAG contiene las siguientes métricas: porcentaje de tiempo en rango TIR (del inglés, time in range), porcentaje de tiempo por encima del rango TAR (del inglés, time above range), porcentaje de tiempo por debajo del rango o hipoglucemia TBR (del inglés, time below range) y coeficiente de variabilidad (%CV). La información continua permite tomar decisiones inmediatas, ya sea con la ingesta de carbohidratos o con la aplicación de insulina. El MCG con terapéuticas insulínicas inyectables (TII) o bomba portable de insulina (BPI) es una herramienta muy útil y complementaria para el tratamiento de la diabetes mellitus tipo 1 (DM1) y la DM2 en la insulinoterapia. Su utilización se asoció con descensos significativos en la HbA1c, disminución de la variabilidad glucémica, reducción de las hipoglucemias totales y nocturnas, y mejoría de la calidad de vida en estos pacientes. Nuestro propósito como grupo de expertos es generar una guía práctica para regular la implementación del MCG.
The tools to assess the degree of glycemic control were modified lately. Glycosylated hemoglobin (HbA1c), the gold standard, reflects the glycemic control of the last 3 months retrospectively, without expressing glycemic variability. Selfblood glucose monitoring (SBGM) provides immediate and prospective information, but has little glycemic data to generate representative averages and standard deviations. It does not detect trends and has limitations to obtain nocturnal data or during physical activity. It is invasive and often rejected. On the contrary, continuous glucose monitoring (CGM), allows to measure glucose instantly, shows your trends and variability continuously, incorporating new control metrics. The ambulatory glucose profile (AGP) analyzes the patterns of glycemic control during sleep, prolonged fasting, physical activity and intercurrences, expressing them as curves with their standard deviations during periods of hours (8 to 24 hours) or days (7, 14, 30 and 90 days). The AGP contains the following metrics: percentage time in range (TIR), percentage time above range mg/dl (TAR), percentage time below range or hypoglycemia (TBR) and coefficient of variation (%CV). CGM with IIT or continuous subcutaneous insulin infusion (CSII), is a very useful and complementary tool for the treatment of DM1 and DM2 in insulin therapy. Its use was associated with significant decreases in HbA1c, decreased glycemic variability, reduction of total and nocturnal hypoglycemia and improvement of the quality of life in these patients. Our aim as a group of experts is to generate a practical guide to regulate the implementation of the CGM.
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Humanos , Diabetes Mellitus Tipo 1 , Ejercicio Físico , Glucosa , Hipoglucemia , Insulina , Actividad MotoraRESUMEN
Fertigation management of banana plantations at a plot scale is expanding rapidly in Brazil. To guide nutrient management at such a small scale, genetic, environmental and managerial features should be well understood. Machine learning and compositional data analysis (CoDa) methods can measure the effects of feature combinations on banana yield and rank nutrients in the order of their limitation. Our objectives are to review ML and CoDa models for application at regional and local scales, and to customize nutrient diagnoses of fertigated banana at the plot scale. We documented 940 "Prata" and "Cavendish" plot units for tissue and soil tests, environmental and managerial features, and fruit yield. A Neural Network informed by soil tests, tissue tests and other features was the most proficient learner (AUC up to 0.827). Tissue nutrients were shown to have the greatest impact on model accuracy. Regional nutrient standards were elaborated as centered log ratio means and standard deviations of high-yield and nutritionally balanced specimens. Plot-scale diagnosis was customized using the closest successful factor-specific tissue compositions identified by the smallest Euclidean distance from the diagnosed composition using centered or isometric log ratios. Nutrient imbalance differed between regional and plot-scale diagnoses, indicating the profound influence of local factors on plant nutrition. However, plot-scale diagnoses require large, reliable datasets to customize nutrient management using ML and CoDa models.
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Mammalian ejaculated spermatozoa must undergo a series of changes in the female reproductive tract, collectively called capacitation, in order to fertilize the oocyte. We reported that fibronectin (Fn), a glycoprotein from the extracellular matrix, and anandamide (AEA), one of the major members of the endocannabinoid family, are present in the bovine oviductal fluid and regulate bull sperm function. Also, AEA induces bovine sperm capacitation, through CB1 and TRPV1 receptors. In this work, we investigated if Fn induces bovine sperm capacitation thought the activation of the endocannabinoid system in this process. We incubated sperm with Fn (100 µg/ml) and/or capsazepine, a TRPV1 antagonist (0.1 µM) and some events related to sperm capacitation such as LPC-induced acrosome reaction, sperm-release from the oviduct, induction of PKA phosphorylated substrates (pPKAs) and protein tyrosine phosphorylation (pY) and nitric oxide (NO) production were assessed. Also, we studied the activity of fatty acid amide hydrolase (FAAH), the enzyme that degrades AEA. We found that Fn, via α5ß1 integrin, induced capacitation-associated events. Also, Fn stimulated signaling pathways associated to capacitation as cAMP/PKA and NO/NO synthase. Moreover, Fn decreased the FAAH activity and this correlated with sperm capacitation. Capsazepine reversed fibronectin-induced capacitation, and pPKAs and NO levels. The incubation of spermatozoa with R-methanandamide (1.4 nM), a stable analogue of AEA, increased cAMP and pPKAs levels. The presence of H89 (50 µM) or KT5720 (100 nM) (PKA inhibitors) prevented AEA-induced capacitation. In addition, R-methanandamide and capsaicin (0.01 µM), a TRPV1 agonist, increased NO production via the PKA pathway. These results indicate that Fn, through α5ß1, supports capacitation in bovine spermatozoa. This effect is dependent on the activation of TRPV1 through cAMP/PKA and NO signaling pathways. We propose that Fn could be considered as a new agent that promotes sperm capacitation in bull sperm. Our findings contribute to better understand the significance of Fn signaling in the capacitating events that lead to successful fertilization and embryo development in mammals including humans.
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Bovinos , Endocannabinoides/metabolismo , Fibronectinas/farmacología , Preservación de Semen/veterinaria , Capacitación Espermática/efectos de los fármacos , Animales , Criopreservación/veterinaria , Proteínas Quinasas Dependientes de AMP Cíclico/genética , Proteínas Quinasas Dependientes de AMP Cíclico/metabolismo , Endocannabinoides/genética , Integrina alfa5beta1/genética , Integrina alfa5beta1/metabolismo , Masculino , Óxido Nítrico , Motilidad EspermáticaRESUMEN
INTRODUCTION/OBJECTIVES: To evaluate the clinical relevance of high-resolution hand and wrist ultrasound (US) findings and their possible associations with anti-citrullinated peptide antibodies in primary Sjögren's syndrome (pSS). METHODS: Ninety-seven consecutive pSS patients (American-European Consensus Group, 2002) without meeting the American College of Rheumatology (ACR) criteria (1987) for rheumatoid arthritis (RA); 20 RA patients (ACR/European League Against Rheumatism (EULAR) criteria, 2010); and 80 healthy individuals with comparable age, gender, and ethnicity were enrolled in a case-control study. Disease activity was assessed by EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI). US was performed by one expert blinded to anti-CCP, anti-MCV, and IgM rheumatoid factor tested by ELISA. RESULTS: Frequencies of grade 3 synovitis (9.3 vs. 0%, p = 0.004), tenosynovitis (36.1 vs. 3.8%, p < 0.001), and erosions (27.8 vs. 7.5%, p = 0.001) on US were higher in pSS patients than in healthy controls. ESSDAI presented a moderate correlation with the synovitis number (p = 0.001) and tenosynovitis (p < 0.001). Most pSS patients with erosions on US (81.5%) had negative anti-CCP. Nevertheless, anti-CCP ≥ 3× cut-off value was associated with the presence of erosions in pSS (p = 0.026). Erosions in pSS were mainly small size contrasting with moderate/large size in RA (p < 0.001), and positive power Doppler synovitis predominated in RA (p < 0.001). CONCLUSIONS: US identified significant frequencies of grade 3 synovitis, tenosynovitis, and erosions in pSS. Synovitis and tenosynovitis numbers were correlated with ESSDAI. Association between erosions on US and anti-CCP (high titers) in pSS possibly identifies a subgroup with severe arthritis. These findings suggest that US is a useful method for assessing joint involvement in pSS.Key Points⢠US identified significant frequencies of grade 3 synovitis, tenosynovitis, and erosions in pSS patients in comparison with age- and race-healthy individuals.⢠Numbers of synovitis and tenosynovitis on US were correlated with ESSDAI values.⢠Most pSS patients with erosions on US were negative for anti-CCP, but anti-CCP ≥ 3× cut-off value was associated with the presence of erosions in this disease.⢠Erosions in pSS were mainly small size contrasting with moderate/large size in RA, and positive power Doppler synovitis predominated in RA.
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Mano/diagnóstico por imagen , Síndrome de Sjögren/diagnóstico por imagen , Sinovitis/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagen , Muñeca/diagnóstico por imagen , Adulto , Autoanticuerpos/inmunología , Estudios de Casos y Controles , Femenino , Mano/patología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Análisis de Regresión , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/patología , Sinovitis/complicaciones , Sinovitis/patología , Tenosinovitis/complicaciones , Tenosinovitis/patología , Ultrasonografía Doppler , Muñeca/patologíaRESUMEN
The COVID-19 pandemic has changed in a significant way the lifestyle in the world and in Mexico. Medicine is not an exception, therefore, modifications in how the assessment and treatment of our patients is done, is mandatory to assure the safeness of the patient, the medical team, the hospital staff, the medical facility, and the community. In this paper, the Mexican Association of Spine Surgery (AMCICO) make recommendations based in the information available at the moment, to help decide when and how to perform a spine surgery in the coronavirus pandemic. Objective: To provide the spine surgeon with the tools required and a decision path to postpone or perform a spine surgery in the COVID-19 pandemic.
La pandemia de COVID-19 ha afectado de forma significativa la forma de vida en el mundo y en México. El área de la medicina no es la excepción, ya que se requiere hacer cambios en la forma en la que valoramos y tratamos a nuestros pacientes para tratar de garantizar su seguridad, la del equipo médico y el personal de salud, las instituciones de salud y la comunidad. En este artículo exponemos las recomendaciones de la Asociación Mexicana de Cirujanos de Columna (AMCICO) para realizar una cirugía de columna durante la pandemia del nuevo coronavirus COVID-19. Objetivo: Proveer al cirujano de columna los elementos necesarios para seguir una ruta en la toma de decisiones para posponer o realizar una cirugía de columna durante la pandemia del nuevo coronavirus COVID-19.
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COVID-19 , Pandemias , Toma de Decisiones , Humanos , México/epidemiología , SARS-CoV-2RESUMEN
In the 2015 Paris Agreement, nations worldwide pledged emissions reductions (Nationally Determined Contributions-NDCs) to avert the threat of climate change, and agreed to periodically review these pledges to strengthen their level of ambition. Previous studies have analyzed NDCs largely in terms of their implied contribution to limit global warming, their implications on the energy sector or on mitigation costs. Nevertheless, a gap in the literature exists regarding the understanding of implications of the NDCs on countries' Energy-Water-Land nexus resource systems. The present paper explores this angle within the regional context of Latin America by employing the Global Change Assessment Model, a state-of-the-art integrated assessment model capable of representing key system-wide interactions among nexus sectors and mitigation policies. By focusing on Brazil, Mexico, Argentina and Colombia, we stress potential implications on national-level water demands depending on countries' strategies to enforce energy-related emissions reductions and their interplays with the land sector. Despite the differential implications of the Paris pledges on each country, increased water demands for crop and biomass irrigation and for electricity generation stand out as potential trade-offs that may emerge under the NDC policy. Hence, this study underscores the need of considering a nexus resource planning framework (known as "Nexus Approach") in the forthcoming NDCs updating cycles as a mean to contribute toward sustainable development.
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Política Ambiental , Calentamiento Global , Efecto Invernadero , Recursos Hídricos , Argentina , Brasil , Colombia , Gases de Efecto Invernadero , América Latina , MéxicoRESUMEN
BACKGROUND: Recent epidemics of Zika virus (ZIKV) in the Pacific and the Americas have highlighted its potential as an emerging pathogen of global importance. Both Aedes (Ae.) aegypti and Ae. albopictus are known to transmit ZIKV but variable vector competence has been observed between mosquito populations from different geographical regions and different virus strains. Since Australia remains at risk of ZIKV introduction, we evaluated the vector competence of local Ae. aegypti and Ae. albopictus for a Brazilian epidemic ZIKV strain. In addition, we evaluated the impact of daily temperature fluctuations around a mean of 28°C on ZIKV transmission and extrinsic incubation period. METHODOLOGY/PRINCIPAL FINDINGS: Mosquitoes were orally challenged with a Brazilian ZIKV strain (8.8 log CCID50/ml) and maintained at either 28°C constant or fluctuating temperature conditions. At 3, 7 and 14 days post-infection (dpi), ZIKV RNA copies were quantified in mosquito bodies, as well as wings and legs, using qRT-PCR, while virus antigen in saliva (a proxy for transmission) was detected using a cell culture ELISA. Despite high body and disseminated infection rates in both vectors, the transmission rates of ZIKV in saliva of Ae. aegypti (50-60%) were significantly higher than in Ae. albopictus (10%) at 14 dpi. Both species supported a high viral load in bodies, with no significant differences between constant and fluctuating temperature conditions. However, a significant difference in viral load in wings and legs between species was observed, with higher titres in Ae. aegypti maintained at constant temperature conditions. For ZIKV transmission to occur in Ae. aegypti, a disseminated virus load threshold of 7.59 log10 copies had to be reached. CONCLUSIONS/SIGNIFICANCE: Australian Ae. aegypti are better able to transmit a Brazilian ZIKV strain than Ae. albopictus. The results are in agreement with the global consensus that Ae. aegypti is the major vector of ZIKV.
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Aedes/virología , Mosquitos Vectores/virología , Infección por el Virus Zika/transmisión , Animales , Australia/epidemiología , Brasil , ARN Viral/análisis , Saliva/virología , Temperatura , Carga Viral , Alas de Animales/virología , Virus Zika/genética , Virus Zika/patogenicidadRESUMEN
Un adecuado control glucémico evita o retarda la aparición y/o evolución de las complicaciones crónicas en pacientes con diabetes mellitus (DM). Para lograrlo es necesario adecuar las dosis de insulina en personas con DM tipo 1 o tipo 2 en insulinoterapia, por el tradicional automonitoreo de glucosa capilar (AGC) que presenta aún limitaciones para generar un registro adecuado de datos, es invasivo y tiene baja adherencia. En contraposición, los nuevos sistemas de monitoreo continuo de glucosa (MCG) brindan una información más completa, más dinámica y con mejor tolerancia. Están constituidos por un sensor subcutáneo que informa ininterrumpidamente los niveles de glucosa del tejido celular subcutáneo y un módulo receptor que permite su lectura y almacenamiento. Los modelos de tiempo real (MCG-RT) permiten observar continuamente los datos, mientras que los sistemas intermitentes (MCG-Flash/EI) los muestran siempre y cuando se acerque el receptor al módulo sensor, generando una lectura voluntaria e intermitente, aunque almacenan todo en la memoria. El MCG informa además las tendencias glucémicas, indicando si están en ascenso o descenso y a qué velocidad cambian. El uso del MCG vs. AGC reduce la hemoglobina glicosilada (A1c) entre 0.53 y 1.0% con disminución significativa (38%) del tiempo de exposición a hipoglucemias. Presenta además, mayor adherencia. Los objetivos de esta revisión son: describir la homeostasis glucémica, evaluar la precisión del MCG, interpretar los datos adecuadamente y finalmente, sugerir en forma práctica los cambios para incorporar a la insulinoterapia tradicional, basados en la información que aportan estos novedosos sistemas de monitoreo.
An adequate glycemic control prevents and/or delays the development and/or progression of chronic complications in patients with diabetes mellitus (DM). To achieve this control, it is necessary to adjust insulin doses, in type 1 or insulinized type 2 DM persons, based on traditional capillary glucose self-monitoring, which has limitations to generate an adequate data record, is invasive and has low adherence. In contrast, new continuous glucose monitoring (CGM) systems provide more complete and dynamic information, and better compliance. In these systems, a subcutaneous sensor continuously sends glucose values which are captured and stocked by a receptor module. Real-time models (CGM-RT) allow continuous and real-time readings of interstitial glucose, whereas CGM-Flash/EI systems require lector approach to sensor module performing intermittent scanning. CGM shows if glycemic levels are increasing or decreasing and how fast it is happening (tendency). CGM decreases glycosylated hemoglobin between 0.53% and 1.0%, as well as time in hypoglycemia by 38%, increasing the time in range of glucose levels, in patients with high adherence. The objectives of this review are to describe the glycemic homeostasis, to evaluate the accuracy of the CGM to interpret the data adequately and finally, based on the information provided by these novel monitoring systems, to suggest a practical way to be added to the traditional intensive insulin therapy.
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Humanos , Glucemia/análisis , Automonitorización de la Glucosa Sanguínea/métodos , Factores de Tiempo , Sistemas de Computación , Automonitorización de la Glucosa Sanguínea/instrumentación , Diabetes Mellitus/prevención & controlRESUMEN
An adequate glycemic control prevents and/or delays the development and/or progression of chronic complications in patients with diabetes mellitus (DM). To achieve this control, it is necessary to adjust insulin doses, in type 1 or insulinized type 2 DM persons, based on traditional capillary glucose self-monitoring, which has limitations to generate an adequate data record, is invasive and has low adherence. In contrast, new continuous glucose monitoring (CGM) systems provide more complete and dynamic information, and better compliance. In these systems, a subcutaneous sensor continuously sends glucose values which are captured and stocked by a receptor module. Real-time models (CGMRT) allow continuous and real-time readings of interstitial glucose, whereas CGM-Flash/EI systems require lector approach to sensor module performing intermittent scanning. CGM shows if glycemic levels are increasing or decreasing and how fast it is happening (tendency). CGM decreases glycosylated hemoglobin between 0.53% and 1.0%, as well as time in hypoglycemia by 38%, increasing the time in range of glucose levels, in patients with high adherence. The objectives of this review are to describe the glycemic homeostasis, to evaluate the accuracy of the CGM to interpret the data adequately and finally, based on the information provided by these novel monitoring systems, to suggest a practical way to be added to the traditional intensive insulin therapy.
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Automonitorización de la Glucosa Sanguínea/métodos , Glucemia/análisis , Automonitorización de la Glucosa Sanguínea/instrumentación , Sistemas de Computación , Diabetes Mellitus/prevención & control , Humanos , Factores de TiempoRESUMEN
OBJECTIVE: Our purpose was to assess the effectiveness of hyaluronic acid infiltrations for chronic shoulder pain as an alternative to the non-surgical and surgical treatments that are currently available. MATERIAL AND METHODS: This is a prospective study of 80 consecutive patients suffering from chronic shoulder pain followed for twelve months. Five subacromial hyaluronic acid injections on five consecutive weeks were administrated to all patients. RESULTS: A significant improvement within the whole group after six months was observed. Constant score improved by 7.7 points, DASH questionnaire decreased by 5 points and Visual Analog Scale for pain decreased by 1.6 points. Patients with history of less than 24 months of pain responded better to treatment. Females responded better. Patients with decreased subacromial space or cuff tear in the MRI improved but patients diagnosed by the MRI of acromioclavicular osteoarthritis worsened in all scales assessed. DISCUSSION: Subacromial hyaluronic acid injections are specially effective in patients with history of less than 24 months of pain, a decreased subacromial space or partial or total cuff tear but, in our experience, its result is not good in patients with acromioclavicular osteoarthritis.
OBJETIVO: Nuestro objetivo fue evaluar la efectividad de las infiltraciones subacromiales de ácido hialurónico en el tratamiento del dolor crónico de hombro como alternativa a los tratamientos quirúrgicos y no quirúrgicos actualmente disponibles. MATERIAL Y MÉTODOS: Estudio prospectivo de 80 pacientes consecutivos con dolor crónico de hombro seguidos durante 12 meses. Se realizaron cinco infiltraciones subacromiales con ácido hialurónico durante cinco semanas consecutivas y se analizaron los resultados clínicos obtenidos. RESULTADOS: La puntuación en la escala de Constant mejoró en 7.7 puntos, el cuestionario DASH disminuyó en cinco puntos y la puntuación en la escala visual analógica para el dolor disminuyó 1.6 puntos por término medio. Los pacientes que presentaban dolor de menos de 24 meses de evolución respondieron mejor al tratamiento. Las mujeres respondieron mejor. Los pacientes con disminución del espacio subacromial o lesión del manguito rotador según la resonancia magnética mejoraron, pero los pacientes que mostraron signos de artrosis acromioclavicular en la resonancia empeoraron en todas las escalas evaluadas. DISCUSIÓN: Las infiltraciones subacromiales de ácido hialurónico son especialmente efectivas en el tratamiento del dolor crónico de hombro de menos de 24 meses de evolución, con disminución del espacio subacromial o lesión parcial o total del manguito rotador, pero en nuestra experiencia, su resultado no es bueno en pacientes con artrosis acromioclavicular.
Asunto(s)
Ácido Hialurónico , Dolor de Hombro , Viscosuplementos , Femenino , Humanos , Ácido Hialurónico/administración & dosificación , Inyecciones , Masculino , Estudios Prospectivos , Dolor de Hombro/tratamiento farmacológico , Resultado del Tratamiento , Viscosuplementos/administración & dosificaciónRESUMEN
Diabetes mellitus is a true pandemic; type 2 diabetes in particular, with its progressive nature, constitutes a serious health problem. Despite advances and innovations in treatment, it continues to generate high morbidity and mortality. Many patients do not achieve their metabolic control objectives, due to clinical inertia, fear of hypoglycaemia, weight gain, the complexity of the treatment and the lack of adherence to it. Recently, the clinical results of the combined use of basal insulin and agonist receptor of the glucagon-like peptide type 1 (AR-GLP1) have been successfully evaluated. Therefore, the combined use of a basal insulin (insulin degludec) with an AR-GLP1 (liraglutide), in a single device (IdegLira), is proposed as an effective and safe therapeutic alternative for the treatment intensification in people with type 2 diabetes. IdegLira has shown greater reductions in HbA1c compared to its individual components, with a low risk of hypoglycaemia and weight loss, both in insulin naïve patients and in those previously insulinized. In this review we describe the pharmacology, the rational of the combination and the most relevant clinical evidence on IdegLira safety and efficacy.
Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Insulina de Acción Prolongada/administración & dosificación , Liraglutida/administración & dosificación , Ensayos Clínicos como Asunto , Combinación de Medicamentos , Quimioterapia Combinada , HumanosRESUMEN
La diabetes mellitus es una verdadera pandemia; la diabetes tipo 2 en particular, con su carácter progresivo, constituye un grave problema de salud. A pesar de los avances e innovaciones en el tratamiento, continúa generando una alta morbimortalidad, debido a que muchos pacientes no logran los objetivos de control metabólicos, entre otras causas por la inercia clínica, el temor a la hipoglucemia, el aumento de peso, la complejidad del tratamiento y la falta de adherencia al mismo. En el último tiempo, se ha evaluado con éxito los resultados clínicos del uso combinado de insulina basal y agonistas del receptor del péptido similar al glucagón tipo 1 (AR-GLP1). Se propone, por lo tanto, el uso combinado de una insulina basal (insulina degludec) con un AR-GLP1 (liraglutida), en un único dispositivo (IdegLira), como una alternativa terapéutica eficaz y segura para la intensificación del tratamiento de las personas con diabetes tipo 2. IdegLira ha demostrado mayores reducciones de HbA1c comparado con sus componentes individuales, con un bajo riesgo de hipoglucemia y pérdida de peso, tanto en pacientes naive de insulina como en aquellos previamente insulinizados. En esta revisión se describe la farmacología, el racional de la combinación y la evidencia clínica relevante de la seguridad y eficacia de IdegLira.
Diabetes mellitus is a true pandemic; type 2 diabetes in particular, with its progressive nature, constitutes a serious health problem. Despite advances and innovations in treatment, it continues to generate high morbidity and mortality.Many patients do not achieve their metabolic control objectives, due to clinical inertia, fear of hypoglycaemia, weight gain, the complexity of the treatment and the lack of adherence to it. Recently, the clinical results of the combined use of basal insulin and agonist receptor of the glucagon-like peptide type 1 (AR-GLP1) have been successfully evaluated. Therefore, the combined use of a basal insulin (insulin degludec) with an AR-GLP1 (liraglutide), in a single device (IdegLira), is proposed as an effective and safe therapeutic alternative for the treatment intensification in people with type 2 diabetes. IdegLira has shown greater reductions in HbA1c compared to its individual components, with a low risk of hypoglycaemia and weight loss, both in insulin naïve patients and in those previously insulinized. In this review we describe the pharmacology, the rational of the combination and the most relevant clinical evidence on IdegLira safety and efficacy.