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PURPOSE: The effect of the sodium-glucose 2 (SGLT-2) inhibitors on microvascular complications remains uncertain. We performed a systematic review to determine the efficacy of the SGLT-2 inhibitors on microvascular outcomes in patients with type 2 diabetes. METHODS: A comprehensive search was performed using Ovid, MEDLINE, EMBASE, Web of Science, and Scopus from inception to May 2019. Randomized trials comparing SGLT-2 inhibitors with placebo or other medication for type 2 diabetes for ≥ 4 weeks were included. Diabetes-related microvascular complications such as nephropathy, retinopathy, neuropathy, and peripheral vascular disease were evaluated. A random-effect model using mean differences for continuous outcomes and risk ratio for dichotomous outcomes was used to synthesize data. PROSPERO (CRD 42017076460). RESULTS: A total of 40 RCTs with overall moderate quality of evidence were included. SGLT-2 inhibitors reduced the risk of renal-replacement therapy (0.65; 95% CI 0.54-0.79), renal death (0.57; 95% CI 0.49-0.65), and progression of albuminuria (0.69; 95% CI 0.66-0.73). Conversely, they appeared ineffective in maintaining eGFR (0.33; 95% CI - 0.74 to 1.41) or reducing serum creatinine (- 0.07; 95% CI - 0.26 to 0.11), whereas urine albumin-creatinine ratio (- 23.4; 95% CI - 44.6 to - 2.2) was reduced. Risk of amputation was non-significant (1.30; 95% CI 0.93-1.83). No available data were found regarding neuropathy and retinopathy to perform a quantitative analysis. CONCLUSION: SGLT-2 inhibitors may reduce the risk of renal patient-important outcomes but fail to improve surrogate outcomes. Apparently, no increased risk of amputations was observed with these medications. No data were available regarding other microvascular complications.

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Submerged electric arc discharge in liquids has shown to be a promising method for synthesizing a wide variety of nanomaterials. However, it requires an accurate current stability control to ensure the desired purity and structure of the products. The discharge stability control through light emission has been previously studied, but still requires further investigation to clarify the influence of some parameters. The present work has studied the solution's transmittance variation over time, the correlation between the arc light emission and the arc current, and the feasibility of controlling the arc current by using a specific wavelength of the arc light spectrum. Several limitations of the optoelectronic control were found at low currents (I < 50 A).

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BACKGROUND: Allergies have been described as protective factors against the development of childhood acute leukaemia (AL). Our objective was to investigate the associations between allergy history and the development of AL and acute lymphoblastic leukaemia (ALL) in children with Down syndrome (DS). METHODS: A case-control study was performed in Mexico City. The cases (n=97) were diagnosed at nine public hospitals, and the controls (n=222) were recruited at institutions for children with DS. Odds ratios (OR) were calculated. RESULTS: Asthma was positively associated with AL development (OR=4.18; 95% confidence interval (CI): 1.47-11.87), whereas skin allergies were negatively associated (OR=0.42; 95% CI: 0.20-0.91). CONCLUSION: Our findings suggest that allergies and AL in children with DS share biological and immune mechanisms. To our knowledge, this is the first study reporting associations between allergies and AL in children with DS.

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OBJECTIVE: Different approaches to the skull base have been developed through the sphenoidal sinus. Traditional boundaries of the trans-sphenoidal approach can be extended in antero-posterior and lateral planes. We review our experience with the extended endoscopic endonasal approach in the first 12 cases. METHODS: We used the extended endoscopic endonasal approach in 12 patients with different lesions of the skull base. This study specifically focuses on the type of lesions, surgical approach, outcome and surgical complications. RESULTS: The extended endoscopic endonasal approach was used in 12 patients with the following lesions: 4 invasive adenomas to the cavernous sinus, 2 clival chordomas, 2 craniopharyngiomas, 1 hypothalamic astrocytoma and 3 pituitary adenomas extended upon the tuberculum. Gross total resection was achieved in 8 cases (66.7%) subtotal resection in 3 and just a biopsy could be accomplished in the case of astrocytoma. This last patient developed meningo-encephalitis and died two weeks later. CONCLUSIONS: The extended endoscopic endonasal approach is a promising minimally invasive alternative for selected cases with sellar, parasellar or clivus lesions. As techniques and technology advance, this approach may become the procedure of choice for most lesions and should be considered an option in the management of the patients with these complex pathologies by skull base surgeons.

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A newly designed sticky ovitrap was used to determine the dispersal flight of the dengue vector Aedes aegypti in northeastern Mexico. Unfed marked females were released in the field where 100 sticky ovitraps had been positioned within a circular area 300 m in diameter. Success of this method was represented by a 7.7% (31 of 401) recapture rate during a 19-day sampling period. The maximum dispersal distance was 120 m with a mean of 30.5 m +/- 4.5 SD. Drastic hot and dry climatic conditions at the study site may have restricted mosquito dispersal. As expected, mostly gravid female mosquitoes were captured in the ovitraps. The method of sticky ovitraps proved to be useful and inexpensive for Ae. aegypti dispersal studies in Latin American countries. In addition to the marked mosquito populations, unmarked Ae. aegypti, Culex sp., roaches, and even small vertebrates such as lizards and sparrows were found glued to the sticky ovitraps. Based on these studies, the use of sticky ovitraps is recommended for Ae. aegypti dispersal studies, specially for dengue control programs in developing countries.

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The aim of this study was to generate standard curves for normal spinal and femoral neck bone mineral density (BMD) in Mexican women using dual-energy X-ray absorptiometry (DXA), to analyze geographic differences and to compare these with 'Hispanic' reference data to determine its applicability. This was a cross-sectional study of 4460 urban, clinically normal, Mexican women, aged 20-90 years, from 10 different cities in Mexico (5 in the north, 4 in the center and 1 in the southeast) with densitometry centers. Women with suspected medical conditions or who had used drugs affecting bone metabolism, were excluded. Lumbar spine BMD was significantly higher (1.089 +/- 0.18 g/cm2) in women from the northern part of Mexico, with intermediate values in the center (1.065 +/- 0.17 g/cm2) and lower values (1.013 +/- 0.19 g/cm2) in the southeast (p < 0.0001). Similarly, femoral neck BMD was significantly higher in women from the north (0.895 +/- 0.14 g/cm2), intermediate in the center (0.864 +/- 0.14 g/cm2) and lower (0.844 +/- 0.14 g/cm ) in the southeast part of Mexico (p < 0.0001). Northern Mexican women tend to be taller and heavier than women from the center and, even more, than those from the southeast of Mexico (p < 0.0001). However, these differences in BMD remained significant after adjustment for weight (p < 0.0001). A significant loss (p < 0.0001) in BMD was observed from 40 to 69 years of age at the lumbar spine and up to the eighth decade at the femoral neck. Higher and lower lumbar spine values, as compared with the 'Hispanic' population, were observed in Mexican mestizo women from the northern and southeastern regions, respectively. In conclusion, there are geographic differences in weight and height of Mexican women, and in BMD despite adjustment for weight.

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In Mexico, no effort has been made to estimate a nationwide prevalence rate of asthma. However, in the last 10 years several local studies have been carried out that analyze the same age cohort that have similar methodological features, enabling us to have a reference from which to look at childhood asthma prevalence in Mexico. Applying statistical analysis to all the surveys, we obtained a prevalence rate of childhood asthma of 11.85% with a confidence interval of 11.32% and 12.38%. We have data that let us know that the prevalence of asthma in México is increasing as in other countries. The comportment of asthma medication is changing very slowly, at least in the commercial market.

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The functional status of the sympathetic nervous system in Chagas' heart disease is still the subject of intense controversy. To determine the nature of the abnormalities of the sympathetic nervous system, we measured the plasma norepinephrine concentration of chagasic patients with varying degrees of myocardial damage. Thirty-six patients with positive serology for Chagas' disease were studied. Twenty patients were in Functional Class I (New York Heart Association), 10 were in Functional Class II and six were in Functional Classes III-IV. Cardiac catheterization was performed in 24 patients. The asymptomatic patients had a plasma norepinephrine concentration (121 +/- 37 pg/ml, mean +/- S.D.) not different from normal controls (103 +/- 59 pg/ml). The symptomatic patients, however, had a significantly elevated plasma norepinephrine concentration (665 +/- 354 pg/ml, P < 0.001). The baseline heart rate of the asymptomatic and symptomatic patients directly correlated with the plasma norepinephrine concentration (r = 0.69, P < 0.0001). The symptomatic patients had larger ventricular volumes, higher left ventricular end-diastolic pressures and lower ejection fractions than the asymptomatic patients and normal controls. The plasma norepinephrine concentration correlated linearly with the left ventricular end-diastolic volume (r = 0.77, P < 0.0001), and non-linearly with the ejection fraction (r = -0.70, P < 0.0001) and the left ventricular end-diastolic pressure (r = 0.53, P < 0.007). These results indicate that, in Chagas' heart disease as in most other cardiac diseases, sympathetic nervous system activation is a late and compensatory phenomenon. In other words, sympathetic activation is very likely related to the progressive impairment of left ventricular function.

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PURPOSE: Autopsy studies have shown that pregnancy results in physiologic pituitary enlargement. We used magnetic resonance imaging (MRI) to corroborate those findings in vivo. PATIENTS AND METHODS: Based on gestational age, 32 normal primigravid patients were divided into three groups: Group I (n = 10), less than 12 gestational weeks; Group II (n = 11), 13 to 26 gestational weeks; and Group III (n = 11), 27 gestational weeks or more. The pituitary dimensions and volumes in these groups were compared with those in 20 healthy nulliparous women (control group). RESULTS: MRI measurements showed a significant increase in pituitary volume in Groups I, II, and III when compared with the control group (p less than 0.001). Furthermore, there was an increase in pituitary volume between Groups I and II and between Groups II and III, although the former was not statistically significant (p greater than 0.05). At the end of pregnancy, the hypophysis had increased 2.6 mm in vertical, anteroposterior, and transversal dimensions, with an overall increase of 136 percent when compared with that of the control group. CONCLUSION: Baseline measurements of the normal enlargement of the pituitary gland that occurs during pregnancy could prove useful when evaluating pregnant patients with suspected pituitary tumors or lymphocytic hypophysitis.

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Se revisaron las historias clinicas de 53 enfermos entre 16 y 40 anos de edad con infarto cerebrales. Se distribuyeron en 5 grupos atendiendo a la causa en 20 pacientes (37,7%) no se pudo precisar causa alguna. La mortalidad en estos pacientes es elevada comparada con la de los enfermos mayores de 40 anos con infartos cerebrales Los elementos clinicos mas importantes para establecer el pronostico en la fase aguda son la presencia de: alteraciones de la conciencia, convulsiones, disturbios respiratorios y arritmias o isquemias cardiacas

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In the high Amazonian basin a plant named chuchuasha, (or chuchuaso) is used in traditional medicine for several purposes in the form of an alcoholic extract. This plant, a Maytenus species, most probably Maytenus laevis, grows in the subandean region of the Amazonian basin (Peru, Ecuador, Colombia). Antitumor and anti-inflammatory properties were recently attributed to the extracts of the root bark of the plant. The composition of the extract of M. laevis from the Putumayo area of Colombia was studied in order to establish the active principle responsible for these activities. The presence of phenoldienones (tingenone, 22-hydroxytingenone), a catechin (4'-methyl-(-)-epigallocatechin) and proanthocyanidins (Ouratea-proanthocyanidins A and B) was established. The biological activities of these compounds confirm the properties of the extracts of the plant claimed by traditional medicine.

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