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BACKGROUND: Asthma continues to be one of the most frequent chronic respiratory diseases in our country. New methods for diagnosis and treatment have been described; accordingly, the international guidelines were renewed. OBJECTIVE: To create a national platform for the development of updated guidelines, solidly based on evidence: Comprehensive Asthma Management (Spanish acronym: MIA). METHODS: MIA uses the ADAPTE method. The MIA development group consists of experts in pulmonology-allergology-methodology and representatives of 13 institutions and societies of specialties that manage asthma. The international reference guidelines (selected with AGREE-II): GINA 2020, GEMA 5.0, BTS/SIGN 2019 and ATS/ERS consensus document 2014-2019 on severe asthma. MIA covers suspected asthma, diagnosis, treatment, and special groups. Key clinical questions were formulated on treatment steps 1-3, biomarkers and severe asthma. RESULTS: Based on evidence, safety, cost and local reality, the core group developed responses. Through a Delphi process the broad MIA development group suggested adjustments until consensus was reached. CONCLUSION: A document was generated with multiple figures and algorithms, solidly based on evidence about asthma management, adjusted for Mexico with a broad base among different societies that participated in its development. It does not include guidelines for acute asthma.

Antecedentes: El asma sigue siendo una patología respiratoria crónica frecuente en México. Se han descrito nuevos métodos para el diagnóstico y tratamiento conforme se renuevan las guías internacionales. Objetivo: Crear la plataforma nacional Manejo Integral del Asma (MIA), para el desarrollo de lineamientos actualizados con base en evidencia. Métodos: Se utilizó el método ADAPTE. El grupo de desarrollo de MIA estuvo integrado por expertos en neumología, alergología y metodología y representantes de 13 instituciones y sociedades de especialidades que manejan asma. Las guías internacionales de referencia (seleccionadas con AGREE-II) fueron GINA 2020, GEMA 5.0, BTS/SIGN 2019 y consenso ATS/ERS 2014-2019. En MIA se aborda sospecha de asma, diagnóstico, tratamiento y grupos especiales. Se formularon preguntas clínicas clave sobre tratamiento en los pasos 1 a 3, biomarcadores y asma grave. Resultados: Con base en evidencia, seguridad, costo y realidad local, el grupo nuclear desarrolló respuestas. Mediante proceso Delphi, el grupo amplio de desarrollo sugirió ajustes hasta que se logró el consenso. Conclusión: El documento generado contiene múltiples figuras y algoritmos, está sólidamente basado en evidencia acerca del manejo del asma y fue ajustado para México con participación de diferentes sociedades para su desarrollo; no se incluyeron lineamientos para la crisis asmática.

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PURPOSE OF REVIEW: At the juncture of the COVID-19 pandemic, the world is currently in an early phase of collecting clinical data and reports of its skin manifestations, and its pathophysiology is still highly conjectural. We reviewed cutaneous manifestations associated with COVID-19 in the pediatric age group. RECENT FINDINGS: Children infected by SARS-CoV-2 usually develop milder respiratory symptoms, but cutaneous manifestations seem a little more prevalent than in adults. These skin features of infection by the coronavirus can be similar to those produced by other common viruses, but there are also reports of cases with more heterogeneous clinical pictures, which have made their classification difficult. To date, the more frequently reported skin variants featured in pediatric cases are purpuric (pseudo-chilblain, necrotic-acral ischemia, hemorrhagic macules, and/or cutaneous necrosis), morbilliform/maculopapular, erythema multiforme, urticarial, vesicular, Kawasaki-like, and miscellaneous (highly variable in both frequency and severity). Their pathophysiological mechanism is still elusive and is likely to be the result of the complex involvement of one or more mechanisms, like direct virus-induced skin damage, vasculitis-like reactions, and/or indirect injury as a consequence of a systemic inflammatory reaction. In this review, we presented and discussed clinical cases as examples of different cutaneous responses reported in some children with SARS-CoV-2 infection, differential diagnosis considerations, and a preliminary conceptual approach to some of their probable associated pathologic mechanisms.

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CRISPR-Cas9 is a method for genome editing that can be used efficiently for in vivo applications; the basic implementation of this method is used to generate genome site-directed sequence eliminations. Here we describe a protocol for genome editing using CRISPR-Cas9 in zebrafish (Danio rerio) one-cell embryos.

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Resumen OBJETIVO: Estimar la morbilidad obstétrica grave y mortalidad materna en el Hospital Juárez de México. MATERIALES Y MÉTODOS: Estudio retrospectivo y transversal efectuado para evaluar los registros de pacientes con morbilidad obstétrica grave y la mortalidad materna, de acuerdo con los criterios de la OMS, atendidas en el Hospital Juárez de México de 2010-2016. Se analizaron las variables relacionadas con el diagnóstico, insuficiencia o disfunción orgánica y las intervenciones asociadas con el tratamiento. Se calculó la tasa de morbilidad materna extrema y obstétrica grave (Near Miss/total de embarazadas). Se utilizaron medidas de tendencia central y de dispersión. RESULTADOS: Se registraron 137 casos de morbilidad obstétrica grave y 26 de muerte materna. La mortalidad promedio fue de 5.78% y el índice de mortalidad de 0.415. Las principales causas de morbilidad materna grave y mortalidad fueron: hemorragia obstétrica, hipertensión asociada con el embarazo y sepsis. Se observó un incremento en los casos de morbilidad materna grave y disminución de la mortalidad materna en el periodo estudiado. CONCLUSIÓN: Se sugiere establecer un comité de evaluación y análisis de pacientes con morbilidad obstétrica grave para mejorar la calidad de atención y tratamiento, y disminuir la tasa de mortalidad materna.

Abstract OBJECTIVE: To determine how many cases of severe obstetric morbidity and maternal mortality were presented in 2010-2016, at the Hospital Juárez de México. MATERIALS AND METHODS: A retrospective, cross-sectional, observational study was carried out in cases of severe obstetric morbidity and maternal death were included according, to WHO criteria, attended in the Hospital Juárez de México from 2010-2016,. We included variables related to the diagnosis, with the organic failure or dysfunction and the interventions related to the management. The extreme maternal morbidity rate was calculated; obstetric (Near miss / Total pregnant). Measures of central tendency and dispersion were used. RESULTS: A total of 137 cases of severe obstetric morbidity and 26 of maternal deaths were registered. The mortality rate on average was 5.78% and death rate .415. The main causes of severe maternal morbidity and mortality were obstetric haemorrhage, hypertension associated with pregnancy and sepsis. There was an increase in cases of severe maternal morbidity and decrease in maternal death in the period studied. CONCLUSION: We suggest the establishment of a committee to evaluate and analyze cases of severe obstetric morbidity to improve the quality of care and treatment for this group of pregnant women, to reduce maternal death.

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Chromatin regulation and organization are essential processes that regulate gene activity. The CCCTC-binding factor (CTCF) is a protein with different and important molecular functions related with chromatin dynamics. It is conserved since invertebrates to vertebrates, posing it as a factor with an important role in the physiology. In this work, we aimed to understand the distribution and functional relevance of CTCF during the embryonic development of the zebrafish (Danio rerio). We generated a zebrafish specific anti-Ctcf antibody, and found this protein to be ubiquitous, through different stages and tissues. We used the CRISPR-Cas9 system to induce molecular alterations in the locus. This resulted in early lethality. We delayed the lethality performing knockdown morpholino experiments, and found an aberrant embryo morphology involving malformations in structures through all the length of the embryo. These phenotypes were rescued with human CTCF mRNA injections, showing the specificity of the morpholinos and a partial functional conservation between the fish and the human proteins. Lastly, we found that the pro-apoptotic genes p53 and bbc3/PUMA are deregulated in the ctcf morpholino-injected embryos. In conclusion, CTCF is a ubiquitous factor during the zebrafish development, which regulates the correct formation of different structures of the embryo, and its deregulation impacts on essential cell survival genes. Overall, this work provides a basis to look for the particular functions of CTCF in the different developing tissues and organs of the zebrafish.

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Aedes aegypti L. (Díptera: Culicidae), es vector de los virus que provocan las enfermedades febriles Dengue, Chikungunya y Zika, que afectan a gran parte de la población en los países tropicales, por lo que la búsqueda de nuevos plaguicidas naturales constituye un recurso importante para combatir a este mosquito. En el presente estudio se evaluaron cinco aceites esenciales obtenidos de tres quimiotipos de Lippia graveolens Kunth. (timol, carvacrol y mixto) y dos de Lippia alba (Mill.) N.E.Br. ex Britton & P. Wilson (citral y carvona), como alternativa para disminuir el impacto ambiental, del uso de insecticidas químicos para el control de las larvas del mosquito. Se realizaron bioensayos para cada uno de las cuatro estadios larvarios, en un diseño experimental completamente al azar con cuatro repeticiones, empleando cuatro concentraciones de los aceites esenciales (0.4, 0.2, 0.1 y 0.05 mg/mL); la lectura de mortalidad se hizo a las 24 h de exposición y se determinó la concentración letal media (CL50). En los cuatro estadios larvarios, el aceite esencial obtenido del quimiotipo timol de L. graveolens, mostró las CL50 más bajas con las mayores mortalidades: primer estadio, 0.056 mg/mL 95% IC [0.046, 0.064]; segundo estadio 0.068 mg/mL 95% IC [0.062, 0.077]; tercer estadio, 0.088 mg/mL 95% IC [0.080, 0.096]; cuarto estadio, 0.092 mg/mL 95% IC [0.084, 0.100]. Estos resultados sugieren el potencial uso del aceite esencial quimiotipo timol, como un insecticida de origen natural, para el control de A. aegypti.

Aedes aegypti L. (Díptera: Culicidae), is a vector of the viruses that cause febrile illnesses such as Dengue, Chikungunya and Zika, which affect in large extent the population of tropical countries, thus, the search of pesticides of natural origin is an important resource to combat this mosquito. In this study five essential oils, obtained from three chemotypes of Lippia graveolens Kunth. (thymol, carvacrol and mixed) and two of Lippia alba (Mill.) N.E.Br. ex Britton & P. Wilson (citral and carvone), were evaluated as an alternative to chemical pesticides to reduce the environmental impact, in order to control the insect larvae. Bioassays were performed randomly for each of the four instars in an experimental design with four replications, using four concentrations of the essential oils (0.4, 0.2, 0.1 and 0.05 mg / mL); the mortality reading was recorded after 24 hours of exposure and the median lethal concentration (LC50) was determined.. In all larval stages, the essential oil obtained from L. graveolens thymol chemotype showed the lowest LC50 with the highest mortality rate: first instar, 0.056 mg/mL 95 % CI ([0.046, 0.064]); second instar, 0.068 mg/ mL 95 % CI [0.062, 0.077]; third instar, 0.088 mg/mL 95 % CI [0.080, 0.096]; fourth instar, 0.092 mg/mL 95 % CI [0.084, 0.100]. These results suggest the potential use of the essential oil thymol chemotype, as an insecticide of natural origin, to control A. aegypti.

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Hemophagocytic syndrome is characterized by increased proliferation and activation of antigen presenting cells (histiocytes) in bone marrow and other organs of the reticuloendothelial system as well as CD8+ T cells that threatens life of patients. The predominant clinical manifestations such as fever, cytopenia, hepatitis, coagulopathy, neurological symptoms and multiple organ failure are related to systemic inflammation. We report the case of an infant who started with jaundice, abdominal pain, vomiting and malaise, at admission, hepatomegaly, splenomegaly and biochemically with features suggestive of hepatocellular inflammation and progressive cholestasis with poor outcome, it was added persistent fever, seizures, anemia, thrombocytopenia, leukopenia, elevated ferritin and hypertriglyceridemia integrating hemophagocytic syndrome with fatal outcome despite immunosuppressive therapy.

El síndrome hemofagocítico se distingue por la proliferación y activación de células presentadoras de antígeno en la médula ósea y otros órganos del sistema retículo endotelial, así como de linfocitos T CD8+ que ponen en peligro la vida de los pacientes. Las manifestaciones clínicas predominantes, como fiebre, citopenias, hepatitis, coagulopatía, síntomas neurológicos e insuficiencia orgánica múltiple están relacionadas con inflamación sistémica. Comunicamos el caso de un lactante que inició su padecimiento con ictericia, dolor abdominal, vómito, ataque al estado general, hepatomegalia, esplenomegalia y características bioquímicas sugerentes de inflamación hepatocelular y colestasis progresiva con mala evolución clínica; al cuadro se agregó fiebre persistente, crisis convulsivas, anemia, trombocitopenia, leucopenia, ferritina y triglicéridos elevados, que integraron síndrome hemofagocítico con desenlace fatal a pesar de recibir tratamiento inmunosupresor.

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BACKGROUND: Blood pressure (BP) has a circadian rhythm, decreases at night and increases in the morning (dipper), have been observed in patients with impaired in this profile, increased at night and lower in the morning (no dipper) have increased cardiovascular risk. Preeclampsia-eclampsia complicates about 7% of pregnancies, preeclampsia is known to reverse the normal circadian cycle of the BP. OBJECTIVE: To determine the profile dipper/non-dipper in patients with severe preeclampsia, eclampsia and HELLP syndrome patients in Intensive Care and Obstetrics Hospital Juárez of México. MATERIAL AND METHODS: 15 patients were reviewed, 10 with severe preeclampsia, 4 with HELLP syndrome and 1 eclampsia, systolic, diastolic, mean and pulse PA were analyzed during the day/night and pregnancy/postpartum. Using ratios pregnancy day/night pregnancy, puerperium day/night postpartum dipper/non-dipper profile is determined RESULTS: Maternal age 30 ± 6.34 years, 7 primiparous (46%) 8 multiparous (54%), pregnancy was 31.67 ± 4.59 weeks. In all but two results in the ratio of pulse pressure during pregnancy was not the result dipper raiser and did not change during the postpartum period. CONCLUSION: in all patients during pregnancy profile was observed no dipper no change during the postpartum period. The established treatment did not modify this result. So it is appropriate to establish strategies to change this behavior and try to get the patient to regain normal circadian BP rhythm.

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