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With the introduction of pertussis immunization for pregnant women in many countries, there has been renewed interest in the impact of whole-cell pertussis vaccine (wP) versus acellular vaccine (aP) on disease control, particularly regarding the best approach for priming. To gather evidence on this topic, we analyzed the impact of aP or wP priming on aP vaccination during pregnancy (aPpreg) in mice. Two-mother vaccination schemes were employed (wP-wP-aPpreg and aP-aP-aPpreg), and the immune response in the mothers and their offspring, as well as the protection of the offspring against Bordetella pertussis challenge, were assessed. Pertussis toxin (PTx)-specific IgG responses were detected in mothers after both the second and third doses, with higher titers after the third dose, regardless of the vaccination schedule. However, a significant reduction in PTx-IgG levels was observed after 22 weeks post aPpreg immunization in mothers with the aP-aP-aPpreg scheme but not in the wP-wP-aPpreg immunized mothers. The aP-aP-aPpreg schedule triggered a murine antibody response mainly to a Th2-profile, while wP-wP-aPpreg induced a Th1/Th2 mixed profile. Both immunization schemes administered to the mothers protected the offspring against pertussis, but the wP-wP-aPpreg vaccination conferred offspring protection in all pregnancies at least up to 20 weeks after receiving the aPpreg-dose. In contrast, the immunity induced by aP-aP-aPpreg began to decline in births that occurred 18 weeks after receiving the aPpreg dose. For the aP-aP-aPpreg scheme, pups born from gestations furthest from aPpreg (+22 weeks) had lower PTx-specific IgG levels than those born closer to the application of the dose during pregnancy. In contrast, for pups born to wP-wP-aPpreg vaccinated mothers, the PTx-specific IgG levels were maintained over time, even for those born at the longest time studied (+22 weeks). It is noteworthy that only the pups born from mothers with aP-aP-aPpreg and receiving a neonatal dose of either aP or wP were more susceptible to B. pertussis infection than mice with only maternal immunity, suggesting interference with the induced immunity (p<0.05). However, it should be noted that mice with maternal immunity, whether vaccinated or not with neonatal doses, are better protected against colonization with B. pertussis than mice without maternal immunity but vaccinated with aP or wP.
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Tos Ferina , Femenino , Humanos , Embarazo , Animales , Ratones , Tos Ferina/prevención & control , Bordetella pertussis , Inmunización , Madres , Toxina del Pertussis , Vacuna contra la Tos Ferina , Inmunidad , Inmunoglobulina GRESUMEN
There is evidence that harm to the mental health of healthcare workers has occurred during the pandemic caused by COVID-19. The burnout syndrome is a form of exhaustion that occurs in occupational settings and is a condition caused by long-term stress in the workplace. The objectives of this systematic review of observational studies were to present data from research into the prevalence of burnout syndrome in healthcare workers during the COVID-19 pandemic and observe its prevalence among frontline workers. The search was conducted on the MEDLINE, LILACS, and Embase databases from 2019 to May of 2021 and returned 538 publications, which underwent a two-stage process of selection by independent peers, resulting in selection of a sample of 29 articles. Data were then extracted and synthesized for presentation in narrative form. Cross-sectional designs were more prevalent (n = 26) than longitudinal studies (n = 3). The sample included research from 19 different countries, with one Brazilian study. A wide range of different instruments were administered by study authors to assess burnout syndrome, the most common of which was the Maslach Burnout Inventory (n = 13). The prevalence of burnout syndrome in the studies varied from 76 to 14.7%. Data on the relationship between development of burnout syndrome and working on the frontline were controversial. The lack of standardization of burnout syndrome assessment was a source of considerable difficulty, compromising comparability of the results, and should therefore be targeted for improvement by researchers. We suggest that more investigations should be conducted into prevalence and the associated factors of risk and protection.
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BACKGROUND This case series describes 5 patients with SARS-CoV-2 infection and COVID-19 in Ecuador who had been treated with hydroxychloroquine for systemic lupus erythematosus (SLE) prior to their COVID-19 illness. CASE REPORT Case #1 reports a 29-year-old woman who had been treated with 200 mg of hydroxychloroquine per day for 1 year and presented with flu-like symptoms, chest pain, fever, odynophagia, asthenia, dry cough, and chills. Case #2 was a 34-year-old woman whose treatment for SLE included 200 mg of hydroxychloroquine per day since 2017. She arrived at the clinic with a dry cough, asthenia, and myalgias. Case #3 was a 24-year-old woman who had been using 200 mg of hydroxychloroquine per day since 2010. She presented with asthenia, myalgias, headaches, hypogeusia, and anosmia. Case #4 was a 39-year-old woman taking 200 mg of hydroxychloroquine every day for SLE who presented with dyspnea, chest pain, odynophagia, hypogeusia, anosmia, diarrhea, and fever. Case #5 was a 46-year-old woman who had been taking 200 mg of hydroxychloroquine since 2019. She came to our hospital complaining of chest pain, fever, and dyspnea. In all 5 patients, SARS-CoV-2 infection was confirmed with a nasopharyngeal SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test using the Cepheid/GeneXpert system. CONCLUSIONS All 5 of our patients with SLE who were taking hydroxychloroquine presented with SARS-CoV-2 infection and symptoms of COVID-19. This case series provides support for a lack of prevention of COVID-19 by hydroxychloroquine.
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Infecciones por Coronavirus/prevención & control , Hidroxicloroquina/administración & dosificación , Lupus Eritematoso Sistémico/tratamiento farmacológico , Pandemias/prevención & control , Neumonía Viral/prevención & control , Adulto , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Disnea/diagnóstico , Disnea/etiología , Ecuador , Servicio de Urgencia en Hospital , Femenino , Fiebre/diagnóstico , Fiebre/etiología , Humanos , Persona de Mediana Edad , Pandemias/estadística & datos numéricos , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , ARN Viral/análisis , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Medición de Riesgo , Muestreo , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
Newborns and unvaccinated infants, compared to other age groups, are more susceptible to pertussis infection, manifesting severe symptoms leading to a higher mortality. The recent increase in pertussis cases demands more effective strategies to overcome this major health problem. In parallel with maternal-immunization, neonatal-immunization (NI) is a strategy needing revision. Here, using the intranasal-challenge-mouse-model we evaluated the protective capacity of NI in both naïve-mice and those with maternally acquired immunity. We tested our acellular-vaccine-candidate based on outer-membrane-vesicles derived from Bordetella pertussis (OMVP) that induces Th2-profile but also the recommended Th-profile for protection: Th1/Th17-profile and CD4 T-memory-cells that reside in the lungs. Commercial acellular-vaccine (aP) and whole cell-vaccine (wP) inducing mainly Th2-profile and Th1-profile, respectively, were also tested. Analyzing the induced immunity and protection capability of NI included in 1- or 2-dose schedules with the same or different types of vaccine, we detected that the aP-vaccine administered in either single- or 2-dose schedules protected against sublethal B. pertussis infection. Schedules consisting of doses of aP neonatally and of OMVP or wP vaccine during infancy greatly reduced bacterial lung colonization while inducing the highest levels of high-avidity anti-pertussis toxin (PTx) IgG. That OMVP or wP neonatal dose did not interfere with the protection of transferred maternal immunity was especially encouraging. Moreover, OMVP- or wP used as a neonatal dose enhanced the quality of the humoral immune response in immunized pups. Antibodies generated by OMVP-or wP-vaccinated mice born to aP-immunized mothers were of higher avidity than those from mice that harbored only maternal immunity; but when mothers and neonates were immunized with the same aP-vaccine, the humoral response in the neonates was partially suppressed through the blunting of the level of anti-PTx IgG induced by the neonatal aP dose. These results demonstrated that neonatal immunization is a possible strategy to be considered to improve the current pertussis epidemiology. For neonates without maternal-immunity, mixed-vaccination schedules that include the aP- and OMVP-vaccines appear to be the most appropriate to induce protection in the pups. For offspring from immune mothers, to avoid blunting-effect, NI should be carried out with vaccines other than those applied during pregnancy.
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Most studies on autism spectrum disorder (ASD) risk factors have been conducted in developed countries where ethnicity and environment are different than in developing countries. We compared nutritional status, immune response and microbiota composition in mestizo children with ASD with matched controls in Ecuador. Twenty-five cases and 35 controls were matched by age, sex and school location. The prevalence of under- and overweight was higher in children with ASD. Nutritional differences were accompanied by abnormal food habits and more frequent gastrointestinal symptoms in children with ASD. Also, greater serum concentrations of TGF-ß1 were observed in children with ASD. Finally, there was greater alpha diversity and abundance of Bacteroides (2 OTUs), Akkermansia, Coprococcus and different species of Ruminococcus in ASD children.
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Trastorno del Espectro Autista/inmunología , Trastorno del Espectro Autista/microbiología , Citocinas/sangre , Microbioma Gastrointestinal , Inmunidad , Estado Nutricional , Estudios de Casos y Controles , Niño , Preescolar , ADN Bacteriano , Ecuador , Femenino , Humanos , Masculino , Prevalencia , Factores de Riesgo , Análisis de Secuencia , Factor de Crecimiento Transformador beta1/sangreRESUMEN
Pertussis is a respiratory infectious disease that has been resurged during the last decades. The change from the traditional multi-antigen whole-cell pertussis (wP) vaccines to acellular pertussis (aP) vaccines that consist of a few antigens formulated with alum, appears to be a key factor in the resurgence of pertussis in many countries. Though current aP vaccines have helped to reduce the morbidity and mortality associated with pertussis, they do not provide durable immunity or adequate protection against the disease caused by the current circulating strains of Bordetella pertussis, which have evolved in the face of the selection pressure induced by the vaccines. Based on the hypothesis that a new vaccine containing multiple antigens could overcome deficiencies in the current aP vaccines, we have designed and characterized a vaccine candidate based on outer membrane vesicle (OMVs). Here we show that the OMVs vaccine, but not an aP vaccine, protected mice against lung infection with a circulating pertactin (PRN)-deficient isolate. Using isogenic bacteria that in principle only differ in PRN expression, we found that deficiency in PRN appears to be largely responsible for the failure of the aP vaccine to protect against this circulating clinical isolates. Regarding the durability of induced immunity, we have already reported that the OMV vaccine is able to induce long-lasting immune responses that effectively prevent infection with B. pertussis. Consistent with this, here we found that CD4 T cells with a tissue-resident memory (TRM) cell phenotype (CD44+CD62LlowCD69+ and/or CD103+) accumulated in the lungs of mice 14 days after immunization with 2 doses of the OMVs vaccine. CD4 TRM cells, which have previously been shown to play a critical role sustained protective immunity against B. pertussis, were also detected in mice immunized with wP vaccine, but not in the animals immunized with a commercial aP vaccine. The CD4 TRM cells secreted IFN-γ and IL-17 and were significantly expanded through local proliferation following respiratory challenge of mice with B. pertussis. Our findings that the OMVs vaccine induce respiratory CD4 TRM cells may explain the ability of this vaccine to induce long-term protection and is therefore an ideal candidate for a third generation vaccine against B. pertussis.
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Bordetella pertussis/inmunología , Linfocitos T CD4-Positivos/inmunología , Exosomas/inmunología , Memoria Inmunológica , Vacuna contra la Tos Ferina/inmunología , Tos Ferina/prevención & control , Animales , Citocinas/metabolismo , Modelos Animales de Enfermedad , Factores Inmunológicos/metabolismo , Ratones , Vacuna contra la Tos Ferina/administración & dosificación , Vacunas Acelulares/administración & dosificación , Vacunas Acelulares/inmunologíaRESUMEN
OBJECTIVE: The aim of this study is to demonstrate if routine assessment of patient index data 3 has a correlation with disease's activity as much as disease activity score 28, clinical disease activity index, and simplified disease activity index in Ecuadorian patients with rheumatoid arthritis seen in Unidad de Enfermedades Reumáticas y Autoinmunes [UNERA] from December 2016 to December 2017. METHODS: This is a retrospective study in 200 patients that fulfill the American College of Rheumatology 2010 criteria for diagnosis of rheumatoid arthritis. The patients were evaluated from December 2016 to December 2017. Descriptive analyses were carried out, also Pearson correlation was used, and, to give a better clinical significance, a chi-square test was conducted. Whenever assumptions of chi-square test were violated, a Fisher's exact test was reported. RESULTS: RAPID3 correlated best with DAS28 (r.83, p < 0.001), followed by CDAI (r.80, p < 0.001) and then SDAI (r.77, p < 0.001). CONCLUSION: RAPID3 is a questionnaire that only takes 10 seconds to calculate and correlates in a significant way with traditional clinical measures that require more time to perform, saving time in busy health facilities.
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Artritis Reumatoide/epidemiología , Índice de Severidad de la Enfermedad , Adulto , Anciano , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/terapia , Ecuador/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inducción de RemisiónRESUMEN
Bordetella parapertussis is a respiratory-disease pathogen producing symptomatology similar to that of pertussis but of underestimated incidence and with no specific vaccine existing. We recently designed a vaccine candidate from B. parapertussis outer-membrane vesicles (OMVs) that proved to be safe and protective in a murine-infection model. Based on protection recently reported for the B. parapertussis O antigen in aqueous solution, we assessed here whether the B. parapertussis O-antigen-containing lipopolysaccharide (BppLPS-O+) embedded in the membranes, as present in B. parapertussis-derived OMVs (OMVs(Bpp-LPS-O+)), was the component responsible for that previously observed protection by OMVs. By performing a comparative study with OMVs from a human strain with undetectable O antigen (OMVs(Bpp-LPS-O-)), we demonstrated that the OMVs(Bpp-LPS-O+), but not the OMVs(Bpp-LPS-O-), protected mice against sublethal B. parapertussis infections. Indeed, the B. parapertussis loads were significantly reduced in the lungs of OMVs(Bpp-LPS-O+) -vaccinated animals, with the CFUs recovered being decreased by 4 log units below those detected in the non-immunized animals or in the animals treated with the OMVs(Bpp-LPS-O-), (p < 0.001). We detected that the OMVs(Bpp-LPS-O+) induced IgG antibodies against B. parapertussis whole-cell lysates, which immunocomponents recognized, among others, the O antigen and accordingly conferred protection against B. parapertussis infection, as observed in in-vivo-passive-transfer experiments. Of interest was that the OMVs(Bpp-LPS-O+) -generated sera had opsonophagocytic and bactericidal capabilities that were not detected with the OMVs(Bpp-LPS-O-)-induced sera, suggesting that those activities were involved in the clearance of B. parapertussis. Though stimulation of cultured spleen cells from immunized mice with formulations containing the O antigen resulted in gamma interferon (IFN-γ) and interleukin-17 production, spleen cells from OMVs(Bpp-LPS-O+) -immunized mice did not significantly contribute to the observed protection against B. parapertussis infection. The protective capability of the B. parapertussis O antigen was also detected in formulations containing both the OMVs derived from B. pertussis and purified BppLPS-O+. This combined formulation protected mice against B. pertussis along with B. parapertussis.
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Vacunas Bacterianas/inmunología , Infecciones por Bordetella/inmunología , Bordetella parapertussis/fisiología , Bordetella pertussis/fisiología , Antígenos O/inmunología , Animales , Anticuerpos Antibacterianos/sangre , Proteínas de la Membrana Bacteriana Externa/metabolismo , Micropartículas Derivadas de Células/metabolismo , Resistencia a la Enfermedad , Femenino , Humanos , Inmunidad Heteróloga , Inmunización Pasiva , Interferón gamma/metabolismo , Interleucina-17/metabolismo , Activación de Linfocitos , Ratones , Ratones Endogámicos BALB C , Antígenos O/metabolismo , VacunaciónRESUMEN
BACKGROUND Sjögren's syndrome is a chronic inflammatory autoimmune disease, which is also known as sicca syndrome, due to the symptoms of dry eyes and dry mouth, and is associated with other connective tissue diseases and autoimmune diseases. Sjögren's syndrome can also be associated with renal involvement. Fanconi's syndrome is associated with impaired reabsorption in the proximal renal tubule associated with tubulointerstitial nephritis and is associated with renal tubular acidosis and hypophosphatemia. Osteomalacia is a rare association with Sjögren's syndrome, which may result from renal disease. CASE REPORT We report the case of a 34-year-old woman who presented with xerostomia, xerophthalmia, bone fractures, and osteomuscular pain. A Schirmer test showed reduced tear production, and a biopsy of a minor salivary gland of the lip, with high titers of antinuclear antibodies (ANA), and positive anti-SSA/Ro and anti-SSB/La antibodies confirmed the diagnosis of Sjögren's syndrome. Serum and urinary laboratories tests and clinical manifestations confirmed Fanconi's syndrome associated with osteomalacia. The patient was treated with potassium supplements, 25-hydroxyvitamin D (25(OH)D), hydroxychloroquine, mycophenolate mofetil, and prednisone, with a favorable response. CONCLUSIONS This case is of a rare association between Sjögren's syndrome, Fanconi's syndrome, and osteomalacia. Even though these are rare clinical associations, early detection can improve the quality of life and prevent further complications.
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Síndrome de Fanconi/complicaciones , Osteomalacia/complicaciones , Síndrome de Sjögren/etiología , Adulto , Antibióticos Antineoplásicos/uso terapéutico , Antirreumáticos/uso terapéutico , Biopsia , Quimioterapia Combinada , Síndrome de Fanconi/diagnóstico , Femenino , Glucocorticoides/uso terapéutico , Humanos , Hidroxicloroquina/uso terapéutico , Imagen por Resonancia Magnética , Ácido Micofenólico/uso terapéutico , Osteomalacia/diagnóstico , Potasio/uso terapéutico , Prednisona/uso terapéutico , Síndrome de Sjögren/diagnóstico , Síndrome de Sjögren/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Vitamina D/análogos & derivados , Vitamina D/uso terapéuticoRESUMEN
Maternal safety through pertussis vaccination and subsequent maternal-fetal-antibody transfer are well documented, but information on infant protection from pertussis by such antibodies and by subsequent vaccinations is scarce. Since mice are used extensively for maternal-vaccination studies, we adopted that model to narrow those gaps in our understanding of maternal pertussis immunization. Accordingly, we vaccinated female mice with commercial acellular pertussis (aP) vaccine and measured offspring protection against Bordetella pertussis challenge and specific-antibody levels with or without revaccination. Maternal immunization protected the offspring against pertussis, with that immune protection transferred to the offspring lasting for several weeks, as evidenced by a reduction (4-5 logs, p < 0.001) in the colony-forming-units recovered from the lungs of 16-week-old offspring. Moreover, maternal-vaccination-acquired immunity from the first pregnancy still conferred protection to offspring up to the fourth pregnancy. Under the conditions of our experimental protocol, protection to offspring from the aP-induced immunity is transferred both transplacentally and through breastfeeding. Adoptive-transfer experiments demonstrated that transferred antibodies were more responsible for the protection detected in offspring than transferred whole spleen cells. In contrast to reported findings, the protection transferred was not lost after the vaccination of infant mice with the same or other vaccine preparations, and conversely, the immunity transferred from mothers did not interfere with the protection conferred by infant vaccination with the same or different vaccines. These results indicated that aP-vaccine immunization of pregnant female mice conferred protective immunity that is transferred both transplacentally and via offspring breastfeeding without compromising the protection boostered by subsequent infant vaccination. These results-though admittedly not necessarily immediately extrapolatable to humans-nevertheless enabled us to test hypotheses under controlled conditions through detailed sampling and data collection. These findings will hopefully refine hypotheses that can then be validated in subsequent human studies.
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OBJECTIVE:: To determine the prevalence of lead (Pb) poisoning at birth in Morelos, analyze its distribution by social marginalization level, and estimate the association with the use of lead glazed ceramics (LGC). MATERIALS AND METHODS:: Blood lead level (BLL) in umbilical cord was measured in a representative sample of 300 randomly selected births at the Morelos Health Services and state IMSS. RESULTS:: The prevalence of Pb poisoning at birth (BLL> 5µg/dL) was 14.7% (95%CI: 11.1, 19.3) and 22.2% (95%CI: 14.4, 32.5) in the most socially marginalized municipalities. 57.1% (95%CI: 51.3, 62.7) of the mothers used LGC during pregnancy, and the frequency of use was significantly associated with BLL. CONCLUSION:: This is the first study to document the proportion of newborns with Pb poisoning who are at risk of experiencing the related adverse effects. It is recommended to monitor BLL at birth and take action to reduce this exposure, especially in socially marginalized populations.
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Intoxicación por Plomo/epidemiología , Estudios Transversales , Femenino , Humanos , Recién Nacido , Intoxicación por Plomo/sangre , Masculino , México/epidemiología , Marginación SocialRESUMEN
Resumen: Objetivo: Determinar la prevalencia de intoxicación por plomo (IPb) al nacimiento en Morelos, analizar su distribución por nivel de marginación y estimar la asociación con el uso de barro vidriado (BV). Material y métodos: Se midió plomo en sangre (PbS) en cordón umbilical de una muestra representativa de 300 nacimientos seleccionados aleatoriamente de aquéllos atendidos por los Servicios de Salud de Morelos e IMSS estatal. Resultados: La prevalencia de IPb al nacimiento (PbS>5µg/dL) fue 14.7% (IC95%: 11.1, 19.3), y 22.2% (IC95%: 14.4, 32.5) en los municipios más marginados. 57.1% (IC95%: 51.3, 62.7) de las madres usaron BV durante el embarazo y la frecuencia de uso se asoció significativamente con PbS. Conclusión: Este es el primer estudio que documenta la proporción de recién nacidos con IPb que están en riesgo de sufrir los consecuentes efectos adversos. Se recomienda monitorear PbS al nacimiento y emprender acciones para reducir esta exposición, especialmente en poblaciones marginadas.
Abstract: Objective: To determine the prevalence of lead (Pb) poisoning at birth in Morelos, analyze its distribution by social marginalization level, and estimate the association with the use of lead glazed ceramics (LGC). Materials and methods: Blood lead level (BLL) in umbilical cord was measured in a representative sample of 300 randomly selected births at the Morelos Health Services and state IMSS. Results: The prevalence of Pb poisoning at birth (BLL> 5μg/dL) was 14.7% (95%CI: 11.1, 19.3) and 22.2% (95%CI: 14.4, 32.5) in the most socially marginalized municipalities. 57.1% (95%CI: 51.3, 62.7) of the mothers used LGC during pregnancy, and the frequency of use was significantly associated with BLL. Conclusion: This is the first study to document the proportion of newborns with Pb poisoning who are at risk of experiencing the related adverse effects. It is recommended to monitor BLL at birth and take action to reduce this exposure, especially in socially marginalized populations.
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Humanos , Masculino , Femenino , Recién Nacido , Intoxicación por Plomo/epidemiología , Estudios Transversales , Marginación Social , Intoxicación por Plomo/sangre , México/epidemiologíaRESUMEN
OBJECTIVE: The aim of this study was to observe potential drug-drug interactions in the medication of Mexican schizophrenic patients. METHODS: We performed a retrospective and cross-sectional study that was carried out in a psychiatric clinic. Only the prescriptions of patients with schizophrenia whose diagnoses were based on the DSM-IV instrument were included in this study. The Drug Interactions Checker software ( http://www.drugs.com/drug_interactions.html ) was used in this study to analyse potential drug-drug interactions. RESULTS: In total, 86 of 126 patients were at risk of potential drug-drug interactions. Haloperidol and biperiden was the most common drug pair of 232 pairs evaluated. In our study, 13.8% of drug-drug interaction showed a major level of severity, whereas in 83.2%, the interaction was moderate. Finally, central nervous system (CNS) depression and anticholinergic effect were the main possible effects of drug-drug interaction. CONCLUSIONS: Our results revealed a high number of patients with schizophrenia receiving two or more drugs. The potential drug-drug interactions observed in the Mexican population are consistent with the concomitant use of antipsychotics, benzodiazepines, and antidepressants prescribed in schizophrenia that could cause central nervous system (CNS) depression and anticholinergic effect. Drug-drug interaction must be considered when the patient with schizophrenia is medicated.
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Antipsicóticos/uso terapéutico , Incompatibilidad de Medicamentos , Interacciones Farmacológicas , Antagonistas Muscarínicos/uso terapéutico , Esquizofrenia/tratamiento farmacológico , Adolescente , Adulto , Antipsicóticos/efectos adversos , Biperideno/efectos adversos , Biperideno/uso terapéutico , Estudios Transversales , Femenino , Haloperidol/efectos adversos , Haloperidol/uso terapéutico , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Antagonistas Muscarínicos/efectos adversos , Estudios Retrospectivos , Esquizofrenia/epidemiología , Adulto JovenRESUMEN
Epidemiological studies have reported a decrease in the prevalence of Alzheimer's disease in individuals who chronically use non-steroidal anti-inflammatory drugs (NSAIDs). Clinical trials, on the other hand, have been less positive. Nevertheless, it has been proposed that NSAIDs exert part of their effects by reducing long-term cerebral neuroinflammation, although this mechanism has not been proven. In this study, we report that ibuprofen, one of the more widely used non-steroidal anti-inflammatory drugs, was able to alter the ultrastructure of amyloid-ß peptide (Aß) and significantly decrease its association to neuronal membranes, and consequently, its synaptotoxic effect in rat primary hippocampal and cortical cultures at 24 h incubation. In agreement with these results, we found that the decrease in the frequency of calcium transients with Aß was partly recovered by addition of ibuprofen (8.0 × 10-2 Hz in control; 3.4 × 10-2 Hz in 5 µM Aß, and 5.9 × 10-2 Hz in the presence of Aß and 200 µM ibuprofen). Additionally, this effect correlated well with the increment and recovery of miniature spontaneous currents (47 ± 5% of control in 1 µM Aß alone and 104 ± 14% in the presence of Aß and ibuprofen). Our results suggest that ibuprofen could be exerting its neuroprotective effect by directly interacting with Aß and altering its toxic aggregated forms. We postulate that other ibuprofen analogs with better pharmacological properties might have a higher efficacy in AD.
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Antiinflamatorios no Esteroideos/farmacología , Ibuprofeno/farmacología , Neuronas/efectos de los fármacos , Fármacos Neuroprotectores/farmacología , Proteína Amiloide A Sérica/efectos de los fármacos , Transmisión Sináptica/efectos de los fármacos , Animales , Calcio/metabolismo , Corteza Cerebral/efectos de los fármacos , Técnicas In Vitro , Potenciales Postsinápticos Miniatura/efectos de los fármacos , Ratas , Ratas Sprague-Dawley , Proteína Amiloide A Sérica/metabolismo , Membranas Sinápticas/efectos de los fármacosRESUMEN
To present the main results of the regional situation diagnosis and intervention plan developed in 2010 as part of the planning activities of the Mesoamerican Health System by the Working Group on Maternal, Reproductive and Neonatal Health. A group of experts and representatives from countries in the region (Central America and nine southern Mexican states) conducted an exhaustive review of available data to construct a situational analysis and a review of effective practices for improving maternal, reproductive and neonatal health. Finally, the group proposed a regional action plan, defining regional goals and specific interventions. The situational diagnosis suggests that, although there has been progress in the last 10 years, maternal and neonatal mortality rates are still unnaceptably high in the region, with a substantial variability across countries. The group proposed as a regional goal the reduction of maternal and neonatal mortality in accordance with the Millenium Development Goals. The regional plan recommends specific maternal and neonatal health interventions emphasizing obstetric and neonatal emergency care, skilled birth attendance and family planning. The plan also includes a five year implementation strategy, along with training and evaluation strategies. The regional plan for maternal, neonatal and reproductive health has the potential to be successful, provided it is effectively implemented.
Asunto(s)
Promoción de la Salud/organización & administración , Bienestar del Lactante , Bienestar Materno , Salud Reproductiva , Adolescente , Adulto , América Central , Niño , Servicios de Salud del Niño/organización & administración , Servicios de Salud del Niño/provisión & distribución , Países en Desarrollo , Servicios de Planificación Familiar , Femenino , Objetivos , Implementación de Plan de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Mortalidad Infantil/tendencias , Recién Nacido , Cooperación Internacional , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/provisión & distribución , Mortalidad Materna/tendencias , México , Persona de Mediana Edad , Embarazo , Regionalización , Adulto JovenRESUMEN
Presentar los principales resultados del diagnóstico situacional y plan regional de intervenciones en salud materna, reproductiva y neonatal elaborado como parte de los trabajos del Sistema Mesoamericano de Salud por el grupo de salud materna, reproductiva y neonatal (SMRN) en 2010. Se conformó un grupo de expertos y de representantes de los países de la región (que incluye Centroamérica y nueve estados del sur de México). Se hizo una revisión documental para conformar un diagnóstico situacional, una revisión de prácticas efectivas y se conformó un plan regional de acción. El diagnóstico situacional indica que las tasas de mortalidad materna y neonatal se mantienen inaceptablemente altas en la región. Se propuso como meta regional reducir la mortalidad materna y neonatal de acuerdo a los Objetivos de Desarrollo del Milenio. Se conformó un plan regional que identifica intervenciones específicas en SMRN con énfasis en la atención adecuada a las emergencias obstétricas y neonatales, atención calificada al nacimiento, y en planificación familiar. Se sugiere asimismo un plan de implementación a cinco años y una estrategia de evaluación y de capacitación. El plan regional en SMRN puede tener éxito siempre y cuando los aspectos de implementación sean atendidos debidamente.
To present the main results of the regional situation diagnosis and intervention plan developed in 2010 as part of the planning activities of the Mesoamerican Health System by the Working Group on Maternal, Reproductive and Neonatal Health. A group of experts and representatives from countries in the region (Central America and nine southern Mexican states) conducted an exhaustive review of available data to construct a situational analysis and a review of effective practices for improving maternal, reproductive and neonatal health. Finally, the group proposed a regional action plan, defining regional goals and specific interventions. The situational diagnosis suggests that, although there has been progress in the last 10 years, maternal and neonatal mortality rates are still unnaceptably high in the region, with a substantial variability across countries. The group proposed as a regional goal the reduction of maternal and neonatal mortality in accordance with the Millenium Development Goals. The regional plan recommends specific maternal and neonatal health interventions emphasizing obstetric and neonatal emergency care, skilled birth attendance and family planning. The plan also includes a five year implementation strategy, along with training and evaluation strategies. The regional plan for maternal, neonatal and reproductive health has the potential to be successful, provided it is effectively implemented.
Asunto(s)
Adolescente , Adulto , Niño , Femenino , Humanos , Recién Nacido , Persona de Mediana Edad , Embarazo , Adulto Joven , Promoción de la Salud/organización & administración , Bienestar del Lactante , Bienestar Materno , Salud Reproductiva , América Central , Servicios de Salud del Niño/organización & administración , Servicios de Salud del Niño/provisión & distribución , Países en Desarrollo , Servicios de Planificación Familiar , Objetivos , Implementación de Plan de Salud , Necesidades y Demandas de Servicios de Salud , Mortalidad Infantil/tendencias , Cooperación Internacional , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/provisión & distribución , Mortalidad Materna/tendencias , México , RegionalizaciónRESUMEN
El método de auto-combustión fue utilizado para sintetizar una serie de óxidos tipo perovskita La1-xAxNiO3, donde el catión La³+ es sustituido parcialmente por Sr²+ y Mg²+. Los análisis de difracción de rayos X indican que el Sr ejerce un efecto notable sobre la estructura de los sólidos sintetizados, obteniéndose una fase simple de óxido tipo perovskita para un grado de sustitución x<= 0,1 y una mezcla de fases de óxidos tipo espinelas y NiO para x>= 0,2. Se observa que el estado de oxidación formal del Ni disminuye desde 3+ (x= 0) hasta 2,6+ (x= 0,4), indicando que el Sr facilita la reducción ya que promueve la capacidad de aceptación de electrones sobre la muestra. El Mg, por otra parte, no produce un sólido con estructura perovskita. Los estudios de reducción a temperatura programada (RTP) revelan que estos procesos ocurren a través de especies intermediarias hasta formar Ni0, SrO y La2O3, fases que se relacionaran con la actividad presentada durante los estudios catalíticos sobre estos sólidos precursores
Asunto(s)
Química , Incendios , VenezuelaRESUMEN
Un defecto posquirúrgico en el maxilar o paladar blando, luego de una cirugía oncológica, puede crear problemas funcionales significativos en el individuo, donde las funciones motoras orales como la masticación fonación y deglución pueden verse totalmente afectadas estableciendo barreras que impiden su normal integración al medio familiar y social. Una etapa fundamental dentro de la rehabilitación del paciente que será sometido a una cirugía oncológica de cabeza y cuello, la constituye el tratamiento protésico, el cual deberá reestablecer las funciones básicas perdidas en el paciente, permitir una estética aceptable y por ende mejorar su calidad de vida. El propósito del presente trabajo es describir uno de los tipos de prótesis utilizadas con mayor frecuencia para la rehabilitación oral del paciente oncológico, y analizar la irrelación del odontólogo protesista como parte del equipo quirúrgico, destacando su importancia en el tratamiento integral del paciente
Asunto(s)
Humanos , Calidad de Vida , Neoplasias de Cabeza y Cuello , Cirugía General , Estética Dental , Prótesis Maxilofacial , Rehabilitación , Venezuela , Oncología MédicaRESUMEN
En el presente trabajo se cuestiona la imágen de la ética como algo acabado y al margen de las condiciones sociales e históricas de la población; esto es, no se presenta una defensa del relativismo sino que más bien se incursiona en una visión "dialogada" de la ética. En este sentido, se cuestionan las figuras de autoridad para hablar de los y las adolescentes al tiempo que se señala la necesidad de recuperar la presencia ciudadana en la redefinición de la ética. Aunado a lo anterior, se hace una crítica a la visión de la salud reproductiva basada simplemente en problemas (y por lo mismo necesitada de un marco asistencial) ya que debido a ello se ignora la dimensión prositiva de la sexualidad (que es y debe ser saludable y responsable). Como complemento, en este documento se recupera el avance en la discución actual que pasa de lo demográfico (como prioridad) al ámbito de los derechos en donde se busca privilegiar la dimensión de la igualdad y equidad entre los hombres y las mujeres, pero sobre todo, se hace énfasis en el que la adolescencia debe ser considerada como una etapa crucial en los procesos de elección reproductiva