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Mosquitoes are one of the main vectors of many important diseases and their degree of resistance to chemical insecticides has increased. Nowadays, it has become crucial to identify novel plant larvicides with an eco-friendly impact. The components of essential oils from Croton linearis Jacq. (EO-Cl), Lantana involucrata L. (EO-Li), Ocimum sanctum var. cubensis M. Gómez. (EO-Os), and Zanthoxylum pistaciifolium Griseb. (syn. Zanthoxylum flavum subsp. pistaciifolium (Griseb.) Reynel (EO-Zp) were determined using gas chromatography-mass spectrometry (GC-MS) analysis. Larvicidal and adulticidal bioassays against Aedes aegypti, Anopheles albitarsis and Culex quinquefasciatus, were performed according to the World Health Organization standard methods. A high diversity of compounds was identified in the four oils, with a total of 152 compounds (33-70 components). EO-Cl, EO-Li, and EO-Os were classified as active against both insect forms, larvae and adults. Lantana involucrata showed the best results, with LC50 values from 33.8 to 41.7 mg/L. In most of the cases, it was not possible to associate the main compounds with the measured activity, supporting the hypothesis about probable synergistic interactions among major and minor compounds. The results indicate EO-Cl, EO-Os, and EO-Li as good eco-friendly insecticides with potential.

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Croton linearis Jacq. is an aromatic shrub that has been utilized in traditional medicine in the Bahamas, Jamaica, and Cuba. Recent studies have revealed the antiprotozoal potential of its leaves. The present work is aimed to identify the volatile constituents of essential oil from the stems of C. linearis (CLS-EO) and evaluate its in vitro antileishmanial activity. In addition, an in silico study of the molecular interactions was performed using molecular docking. A gas chromatographic-mass spectrometric analysis of CLS-EO identified 1,8-cineole (27.8%), α-pinene (11.1%), cis-sabinene (8.1%), p-cymene (5.7%), α-terpineol (4.4%), epi-γ-eudesmol (4.2%), linalool (3.9%), and terpinen-4-ol (2.6%) as major constituents. The evaluation of antileishmanial activity showed that CLS-EO has good activity on both parasite forms (IC50Promastigote = 21.4 ± 0.1 µg/mL; IC50Amastigote = 18.9 ± 0.3 µg/mL), with a CC50 of 49.0 ± 5.0 µg/mL on peritoneal macrophages from BALB/c mice (selectivity index = 2 and 3 using the promastigote and amastigote results). Molecular docking showed good binding of epi-γ-eudesmol with different target enzymes of Leishmania. This study is the first report of the chemical composition and anti-Leishmania evaluation of CLS-EO. These findings provide support for further studies of the antileishmanial effect of this product.

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Oxidative stress is an important component of many diseases including cancer, along with inflammatory and neurodegenerative processes. Natural antioxidants have emerged as promising substances to protect the human body against reactive oxygen and nitrogen species. The present study evaluates the inhibition of nitric oxide (NO) production in LPS-stimulated RAW 264.7 murine macrophages and the free radical scavenging activity of Croton linearis Jacq. leaves. UPLC-QTOF-MS analysis identified 18 compounds: nine alkaloids with a morphinane, benzylisoquinoline or aporphine nucleus, and nine O-glycosylated-flavonoids with quercetin, kaempferol and isorhamnetin as the aglycones. The crude extract (IC50 21.59 µg/mL) and the n-hexane fraction (IC50 4.88 µg/mL) significantly reduced the NO production in LPS-stimulated macrophages but with relatively high cytotoxicity (CC50 75.30 and CC50 70.12 µg/mL, respectively), while the ethyl acetate fraction also showed good activity (IC50 40.03 µg/mL) without affecting the RAW 264.7 cell viability. On the other hand, the crude extract, as well as the dichloromethane and ethyl acetate fractions, showed better DPPH and ABTS free radical scavenging activities. Considering the chemical composition and the activity observed for Croton linearis leaves, they may be considered a good source of antioxidants to combat oxidative damage-related diseases.

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ABSTRACT Microscopic polyangiitis is a rare autoimmune disease of unknown etiology, characterized by inflammation and necrosis of blood vessels. It forms a part of the antineutrophil cytoplasmic antibody-associated vasculitides-a heterogeneous group of disorders characterized by vasculitis. It is a systemic disease affecting multiple organs. The patients may present with a wide variety of symptoms. Ocular manifestations may present as its initial clinical symptoms, necessitating a multidisciplinary approach for reducing the morbidity and mortality. Early diagnosis aids in the formulation of appropriate treatment and prevention of further complications. Aggressive treatment, including surgery, is often necessary to limit structural damage and preserve visual function. We present the case of an 82-year-old woman who initially presented with peripheral ulcerative keratitis that led to the diagnosis of microscopic polyangiitis.

RESUMO A poliangeíte microscópica é uma doença autoimune rara de etiologia desconhecida, caracterizada por inflamação e necrose dos vasos sanguíneos. Faz parte das vasculites associadas a anticorpos citoplasmáticos antineutrófilos - um grupo heterogêneo de doenças caracterizadas por vasculite. É uma doença sistêmica que afeta vários órgãos. Os pacientes podem apresentar uma grande variedade de sintomas. As manifestações oculares podem apresentar-se como seus sintomas clínicos iniciais, necessitando de abordagem multidisciplinar para redução da morbimortalidade. O diagnóstico precoce ajuda na formulação do tratamento adequado e na prevenção de complicações futuras. O tratamento agressivo, incluindo cirurgia, muitas vezes é necessário para limitar o dano estrutural e preservar a função visual. Apresentamos o caso de uma mulher de 82 anos que inicialmente apresentou ceratite ulcerativa periférica que levou ao diagnóstico de poliangite microscópica.

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Microscopic polyangiitis is a rare autoimmune disease of unknown etiology, characterized by inflammation and necrosis of blood vessels. It forms a part of the antineutrophil cytoplasmic antibody-associated vasculitides-a heterogeneous group of disorders characterized by vasculitis. It is a systemic disease affecting multiple organs. The patients may present with a wide variety of symptoms. Ocular manifestations may present as its initial clinical symptoms, necessitating a multidisciplinary approach for reducing the morbidity and mortality. Early diagnosis aids in the formulation of appropriate treatment and prevention of further complications. Aggressive treatment, including surgery, is often necessary to limit structural damage and preserve visual function. We present the case of an 82-year-old woman who initially presented with peripheral ulcerative keratitis that led to the diagnosis of microscopic polyangiitis.

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OBJECTIVES: To translate, cross-culturally adapt and validate a comprehensive evidence- and theoretically-based CR education intervention in Latin America. METHODS: First, best practices in translation and cross-cultural adaptation were applied through 6 steps. Then, the Spanish version was delivered to CR participants from programs in Colombia, Costa Rica and Peru for validation, such that the evaluation was pre-post, uncontrolled, pragmatic, observational, and prospective in design. Participants completed surveys assessing knowledge, health literacy, self-efficacy, and health behaviours. All outcomes were assessed pre-, and post-CR, as well as 6 months after CR completion. RESULTS: After translation of the patient guide from English to Spanish, 5 of the 9 booklets were culturally adapted. Two-hundred and forty-nine patients consented to participate, of which 184 (74 %) completed post-CR, and 121 (48 %) completed final assessments. There was a significant improvement in disease-related knowledge pre- to post-CR, as well as in health literacy, self-efficacy, and health behaviours (all p < 0.05). These gains were sustained 6 months post-program. With adjustment, CR attendance (i.e., exposure to the education) was associated with greater post-CR knowledge (ß = 0.026; p = 0.01). CONCLUSION: A patient education intervention for CR patients in Latin America has been validated, and wider implementation is warranted. PRACTICE IMPLICATIONS: Application of this first-ever validated CR education program for Spanish-speaking settings may result in secondary prevention.

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The present study was aimed to archive the etnhnomedicinal knowledge of plants used by inhabitants of seven villages of Holguín, Eastern region, Cuba. The ethnomedicinal information was collected through interviews. The collected data were analyzed through use value (UV), informant consensus factor (Fic) and fidelity level (FL). A total of 195 species of plants distributed in 166 genera belonging to 70 families were identified for the treatment of 17 ailment categories. The most treated conditions were digestive and liver disorders. The most important species according to their use value were Lippia alba (Mill.) N.E. Br. ex Britton & P. Wilson (0.236) and Annona muricata L. (0.194). Cancer and tumors had the Fic value of 0.94. A total of 19 species has a highest FL of 100 percent. This was the first ethnobotanical survey conducted in Holguín region, which will contribute to preserve valuable information of medicinal plants that may otherwise be lost to future generations.

El presente estudio tuvo como objetivo registrar el conocimiento etnomedicinal de las plantas usadas por los pobladores en 7 comunidades de Holguín, Región Oriental, Cuba. La información fue recogida a través de entrevistas y analizada cuantitativamente mediante indicadores etnobotánicos: valor de uso (UV), factor del consenso de los informantes (Fic) e índice de fidelidad (FL). Fueron reportadas un total de 195 especies de plantas, distribuidas en 166 géneros y 70 familias, para el tratamiento de 17 categorías de usos. Las indicaciones más frecuentes fueron los problemas digestivos y del hígado. Las especies medicinales con mayor UV fueron Lippia alba (Mill.) N.E. Br. ex Britton & P. Wilson (0.236) y Annona muricata L. (0.194). Cáncer y tumores tuvieron el valor más alto de Fic (0.94). Solo 19 especies presentaron un valor de FL de 100 %. Este primer estudio contribuirá a preservar la información de las plantas medicinales y que esta no se pierda en las futuras generaciones.

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A partir del análisis de una experiencia de investigación realizada con mujeres migrantes, este texto se orienta a poner a de manifiesto una serie de cuestiones de carácter ético que acontecieron en el proceso de investigación y en la posterior difusión de sus resultados. En concreto se abordarán las implicaciones que tiene para la investigación la "reificación" de los sujetos migrantes y su conceptualización como "objetos" de estudio, así como el uso de determinadas categorías para su representación. Igualmente se considerarán toda una serie de cuestiones epistemológicas que en los estudios sobre migraciones redundan en una violencia simbólica fruto de la relación asimétrica entre investigadores y sujetos etnificados. A modo de reflexión final, se expondrá la necesidad de disponer de un corpus de principios éticos que pueda dar respuesta a las particularidades de la investigación desarrollada en el ámbito de los estudios migratorios.(AU)

Based on the analysis of a research experience with migrant women, this text aims at revealing a series of ethical issues that occurred while the research process and the subsequent dissemination of its results. Specifically, I will examine the implications that reification of migrant subjects and their conceptualization as "objects" of study, as well as the use of certain categories for their representation. I will also consider a whole series of epistemological issues that in migration studies may finish as a symbolic violence resulting from the asymmetric relationship between researchers and ethnicized subjects. As a final reflection, I will expose the need to set out a corpus of ethical principles that may be able to respond to the particularities of the research carried out in the field of migration studies.(AU)

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BACKGROUND: Cardiac rehabilitation (CR) programs can address the cardiovascular disease epidemic in South America. However, there are factors limiting CR access at the patient, provider, and system levels. The latter 2 have not been extensively studied. The objective of this study was to investigate cardiology administrator's awareness and knowledge of CR and perceptions regarding resources for CR. METHODS: This study was cross-sectional and observational in design. Cardiology administrators from South American and Caribbean countries were invited to participate by members of a professional association. Participants completed a questionnaire online. Descriptive analysis was performed and differences in CR knowledge, awareness, perception, and attitudes regarding CR were described overall, by institution funding source (private vs public) and presence of within-institution CR (yes vs no). RESULTS: Most of the 55 respondents from 8 countries perceived CR as important for outpatient care (mean ± SD = 4.83 ± 0.38 out of 5; higher scores indicating more positive perceptions), with benefits including reduced hospital readmissions (4.31 ± 0.48) and length of stay (4.64 ± 0.71 days), not only for cardiac patients but for those with other vascular conditions (4.34 ± 0.68 days). Those working in public institutions (50.9%) and in institutions without a CR program (25.0%) were not as aware of, and less likely to value, CR services (P < .05). Only 13.2% of programs had dedicated funding. CONCLUSIONS: Similar to findings from high-income settings, cardiology administrators and cardiologists in South America value CR as part of cardiac patient care, but funding and availability of programs restrict capacity to deliver these services.

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Introducción: La disfunción eréctil (DE) afecta a millones de personas en el mundo. Se caracteriza por daño endotelial vascular y actualmente es considerado un marcador de riesgo de enfermedad cardiovascular. Sin embargo, no es evaluada normalmente por el personal médico y los pacientes se rehúsan a discutirlo. El objetivo de este trabajo es determinar la prevalencia de DE y sus factores asociados en pacientes con indicación de rehabilitación cardíaca. Material y Método: Estudio descriptivo, transversal, incluyó 225 pacientes con indicación de rehabilitación cardíaca de 6 países de Latinoamérica: Chile (CH), Brasil (BR), Perú (PE), Colombia (CO), Argentina (AR) y Paraguay (PY) en el período de marzo-agosto 2014. Se obtuvo datos demográficos y se utilizó el cuestiona-rio Índice Internacional de Función Eréctil (CIIFE) auto administrado. Las variables fueron procedencia, edad, peso, talla, IMC, obesidad, hipertensión arterial (HTA), diabetes mellitus (DM), infarto agudo del miocardio (IAM), tabaquismo y uso de fármacos. Resultados: Se evaluó a 225 hombres. De acuerdo al CIIFE, 80,1% tuvo algun tipo de DE; 8,9% severa; 10,7% moderada; 26,2% media a moderada y 35,6% media. Los factores asociados significativamente fueron el país de procedencia, la DM, la edad y el tabaquismo. Conclusión: La prevalencia de Disfunción Eréctil en pacientes con indicación de rehabilitación cardíaca de Chile, Brasil, Perú, Colombia, Argentina y Paraguay fue 80,1% y sus factores asociados son edad, obesidad, IAM, DM, HTA y tabaquismo.

Background: Erectile dysfunction (ED) affects millions of males around the world. It is characterized by endothelial dysfunction and is currently considered to be a marker of cardiovascular disease. However, it is seldom evaluated by medical personnel and patients frequently refuse to discuss the subject. The aim of this investigation was to determine incidence and prevalence of ED and associated factors in patients referred for cardiac rehabilitation. Method: A descriptive, cross sectional study was performed in 225 patients referred for cardiac rehabilitation in 6 Latin American countries: Chile (CH), Brazil (BR), Perú (PE), Colombia (CO), Argentina (AR) and Paraguay (PY), from March to August 2014. Demographic data were collected and the self-administered International ED questionnaire was applied to evaluate ED. Variables included age, weight, height, BMI, obesity, hypertension (HT), diabetes mellitus (DM), acute myocardial infarction, smoking habit and use of different medications Results: 80.1% of subjects had some type of ED: it was severe in 8.9%, moderate in 10.7%. moderate to intermediate in 26.2% and intermediate in 35.6%. Factors associated to the presence of ED were country of origin, DM, age, and smoking habit Conclusion: ED was present in a mean of 80.1% of patients referred for cardiac rehabilitation in Chile, Brazil, Perú, Colombia, Argentina, and Paraguay. ED was associated to age, obesity, myocardial infarction, DM, HT, and smoking habit.

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En las salas de Emergencias Pediátricas la gravedad o el riesgo de fallecer es un hecho de especial importancia. La gravedad de una enfermedad es difícil de definir, para esto, se han desarrollado escalas de riesgo de muerte. Para optimizar la preparación del departamento de emergencia en el manejo de niños con enfermedades graves necesitamos conocer las características del paciente y su enfermedad. Objetivo: Evaluar relación entre síndrome de respuesta inflamatoria sistémica y disfunción orgánica en niños Metodología: Cohorte prospectiva. Niños con enfermedad aguda grave, admitidos en forma consecutiva al departamento de urgencias, evaluación de variables clínicas y fisiológicas. Análisis del efecto de variables sobre el riesgo de disfunción orgánica múltiple o mortalidad Resultados: Riesgo de enfermedad aguda grave, 70/105 niños <12 años; edad mediana 0,9 (0,3-3,9) años; síndrome de disfunción orgánica múltiple, 14 (24,1%) de 58; tasa de mortalidad observada 6,9%. Riesgo de muerte en niños con disfunción multiorgánica 3/14 (21,4%) contra 1(2,3%) de 44 niños sin disfunción multiorgánica (RR 9,4; χ2 6,1; p 0,04) Conclusión: En niños con enfermedad aguda grave el riesgo de muerte esta positivamente asociado con el riesgo de disfunción orgánica múltiple.

In pediatric emergency rooms, the risk of dying is a fact of particular importance. The severity of a disease is difficult to define, for this reason, risk of death scales have been developed. To optimize the preparation of emergency departments in the management of children with serious diseases we need to know the characteristics of the patient and his illness. Goal: To assess the relationship between systemic inflammatory response syndrome and organ dysfunction in children Methodology: Prospective cohort. Children with serious acute illness, admitted consecutively to the Emergency Department, evaluation of clinical and physiological variables. Analysis of the effect of variables on the risk of mortality and multiple organ dysfunction Results: Serious risk of acute illness, 70/105 children < 12 years; age median 0.9 (0, 3-3, 9) years; multiple organ dysfunction syndrome, 14 (24.1%) 58; rate 6.9% observed mortality. Risk of death in children with dysfunction multi-organ 3/14 (21.4%) against 1(2,3%) of 44 children without multiple organ dysfunction (RR 9.4; ) χ2 ( 6.1; p 0.04) Conclusion: In children with acute and severe illnesses, the risk of death is positively associated with the risk of multiple organ dysfunction.

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PURPOSE: Cardiac rehabilitation (CR) programs decrease morbidity and mortality rates in patients with coronary artery disease, the leading cause of death in Latin America. This study was carried out to assess the characteristics and current level of CR program implementation in South America. METHODS: We carried out a survey of CR programs that were identified using the directory of the South American Society of Cardiology and through an exhaustive search by the investigators. RESULTS: We identified 160 CR programs in 9 of the 10 countries represented in the South American Society of Cardiology and 116 of those responded to our survey. On the basis of survey results from the responding programs, we estimate that the availability of CR programs in South America is extremely low, approximately 1 CR program for every 2 319 312 inhabitants. These CR programs provided services to a median of 180 patients per year (interquartile range, 60-400) and were most commonly led by cardiologists (84%) and physical therapists (72%). Phases I, II, III, and IV CR were offered in 49%, 91%, 89%, and 56% of the centers, respectively. The most commonly perceived barrier to participation in a CR program was lack of referral from the cardiologist or primary care physician, as reported by 70% of the CR program directors. CONCLUSIONS: The number of CR programs in South America appears to be insufficient for a population with a high and growing burden of cardiovascular disease. In addition, there appears to be a significant need for standardization of CR program components and services in the region.

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Las escalas PIM (Índice de Mortalidad Pediátrica) y PELOD (Índice Pediátrico de Disfunción Orgánica) son sistemas de evaluación que permiten la estimación de la severidad de la enfermedad y el ajuste del riesgo de mortalidad en grupos heterogéneos de pacientes. El objetivo del presente trabajo fue el de validar las escalas PIM y PELOD en una Unidad de Cuidados Intensivos pediátrica (UCIP). Metodología. Fueron incluidos 97 niños con edad menor o igual a 12 años; las variables estudiadas fueron la mortalidad o sobrevida durante la estancia en UCI. PIM incluye 7 variables medidas durante la primera hora de admisión a UCI; PELOD incluye disfunción de seis sistemas orgánicos en 12 variables. Para estimar discriminación, se utilizó el área bajo la curva de rendimiento diagnóstico, y para evaluar calibración, la bondad de ajuste de Hosmer-Lemeshow. Resultados. Edad media 4,0 años (rango intercuartil 1,0-8,1); estancia 6,0 días; (rango 3,0 a 17,0); las principales causas de ingreso a UCIP fueron accidentes 30, sepsis 19, neurológicas 14. Desarrollaron disfunción orgánica múltiple 58 (59,8%) de 97. La mortalidad observada fue de 17,5%. La predicción de riesgo de mortalidad por PIM fue significativamente más alta en no sobrevivientes (0,48±0,35) que sobrevivientes (0,18±0,23; t test 3,40 p<0,003); calibración (p=0,025) y discriminación (área bajo la curva = 0,79 ± 0,057; p<0,001) de PIM fue buena. Conclusión: PIM es una medida válida de predicción de riesgo de mortalidad en UCIP en nuestro medio

The Pediatric Index of Mortality (PIM) and Pediatric Logistic Organ Dysfunction (PLOD) scale are scoring systems that allow assessment of the severity of illness and mortality risk adjustment in heterogeneous groups of patients. The aim of this study was to validate the accuracy and reliability of PIM and PELOD scoring in a pediatric Intensive Care Unit (ICU) Methods: 97 children under 12 years of age were included. Survival and mortality during the stay in the ICU were studied. PIM scale includes 7 parameters measured during the first hour of admission to the ICU; PELOD includes dysfunction of 6 organs and systems in 12 variables. The area under the curve was used to assess discrimination and calibration was assessed with the Hosmer-Lemeshow goodness of fit test. Results: The median patient age was 4,0 years (inter-quartile range 1,0-8,1), median length of stay was 6 days (range 3-17). Main causes for admission to the ICU were accidents 30, sepsis 19, neurological 14. Fifty eight patients (59,8%) developed multiple organic dysfunction. Observed mortality was 17,5%. Prediction of risk of mortality with PIM was significantly higher in non survivors (0,48 ± 0,35) than in survivors (0,18 ± 0,23); t test 3,40 p<0,003; calibration (p=0,025) and discrimination (area under the curve = 0,79±0,057; p<0,001) for PIM was good. Conclusions: PIM is a valid prediction index for mortality risk in pediatric ICU in our hospitals

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Antecedentes: la recuperación o mejoramiento de la función cardiaca en pacientes con infarto de miocardio antiguo se limita al manejo farmacológico y de rehabilitación. La terapia de células madre podría incrementar la función cardiaca en estos pacientes. Objetivos: determinar el grado de efectividad para recuperar la función cardiaca mediante el transplante de células madre en pacientes con infarto de miocardio antiguo. Método: ensayo clínico sin grupo de control en pacientes con infarto de miocardio antiguo de la menos cinco meses, a quienes se realiza un transplante de células madres por vía transcoronaria. Resultados: todos los pacientes mejoraron su función cardiaca y otros parámetros cardíacos; la Fracción de Eyección (FE) se incremento en un 30 por ciento en promedio en los pacientes entre el valor basal y los 06 meses; también se observó mejora en la Pureba de esfuerxo graduada (PEG) del 10 por ciento y en el consumo de METS en 20 por ciento. Conclusiones: La terapia con células madre CD34+ mejora la función cardiaca y la capacidad funcional.

Background: recovery or improvement of cardiac function in patients with old myocardial infarction is limited to medication management and rehabilitation. The stem cell therapy could improve cardiac function in these patients. Objectives: To determinate the degree of effectiveness to restore heart function by transplanting stem cells in patients with old myocardial infarction. Method: A clinical trial without control group in patients with old myocardial infarction at least five months, who underwent a transplant of stem cells through transcoronaria. Results: All patients improved their cardiac function and other parameters Cardiac Ejection Fraction (EF) was increased by 30 per cent on average in patients between baseline and 06 months, there was also improvement in the stress test graduated (PEG) 10 per cent and METS consumption by 20 per cent. Conclusions: Therapy with CD34+ stem cells improves cardiac function and functional capacity.

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