RESUMO
Resumen Objetivo: generar recomendaciones sobre el diagnóstico y el tratamiento de la alergia a la proteína de la leche de vaca (APLV), que sirvan de referencia y consulta para los médicos pediatras y de cuidado primario. Materiales y métodos: el presente documento de posición de expertos fue desarrollado por un grupo de médicos, especialistas en diferentes áreas terapéuticas y con experiencia en APLV. Se definieron los temas más relevantes y se realizó una revisión de la literatura científica disponible, a fin de elaborar una propuesta de recomendaciones que fue discutida por los autores. Resultados: se elaboró un documento de posición que propone un enfoque práctico sobre la definición, el diagnóstico y el tratamiento de la APLV en el paciente pediátrico. Conclusiones: el diagnóstico temprano y el manejo adecuado de la APLV pueden contribuir a una disminución de la carga de esta enfermedad y sus complicaciones.
Abstract Objective: The objective of this paper is to develop and present recommendations for diagnosis and treatment of Cow's Milk Protein Allergy (CMPA) which can serve as a reference for pediatric and primary care physicians to consult. Materials and methods: This expert position document was developed by a group of doctors who are specialists in several therapeutic areas who have experience in CMPA. The most relevant topics were defined and a review of the available scientific literature was carried out to prepare a proposal for recommendations that was then discussed by the authors. Results: A position paper was developed that proposes a practical approach to definition, diagnosis and treatment of CMPA in pediatric patients. Conclusions: Early diagnosis and proper management of CMPA can help decrease the burden of this disease and its complications.
Assuntos
Humanos , Lactente , Terapêutica , Hipersensibilidade , Diagnóstico , Substitutos do Leite Humano , PediatrasRESUMO
INTRODUCTION: The risk of falls in older adults increases because of the decrease in strength, flexibility, balance and sensory changes affecting functionality and quality of life. For this reason, an integral system of evaluation of equilibrium is necessary, for preventive purposes or for early therapeutic interventions. AIM: To present the results of the transcultural translation and adaptation process of the Balance Evaluation Systems Test (BESTest) to Spanish language. SUBJECTS AND METHODS: The original version of the BESTest was translated into Spanish, following the process of retro-traduction and cultural adaptation considering the semantic, idiomatic, conceptual and experiential equivalences. Subsequently the version was reviewed by a panel of experts qualifying clarity, coherence, relevance and sufficiency. The pilot test included 32 adults between 50 and 80 years old. RESULTS: It was possible to carry out the complete translation of the instrument, the instructions for the subject and for the evaluator. Most items of the test reached the maximum score of 4.0 (100%), nine items achieved an average score of 3.9 (99%), one item got an average score of 3.8 (95%) and two items achieved an average score of 3.7 (92.5%). CONCLUSIONS: With this study the Spanish speakers community has a pertinent sufficient, coherent and clear instrument in order to identify the control postural system altered to focus treatment and to get better functional outcomes from balance evaluation in older adults.
TITLE: Adaptacion transcultural al castellano del sistema de evaluacion del equilibrio (BESTest) en adultos mayores.Introduccion. El riesgo de caidas en adultos mayores se incrementa a consecuencia de la disminucion de la fuerza, la flexibilidad, el equilibrio y los cambios sensoriales, que afectan a la funcionalidad y la calidad de vida. Por tal razon se hace necesario un sistema integral de evaluacion del equilibrio con fines preventivos o para intervenciones terapeuticas tempranas. Objetivo. Presentar los resultados del proceso de traduccion y adaptacion transcultural del sistema de evaluacion del equilibrio (BESTest) al castellano. Sujetos y metodos. Se tradujo al castellano la version original del BESTest, siguiendo el proceso de retrotraduccion y adaptacion cultural y teniendo en cuenta las equivalencias semanticas, idiomaticas, conceptual y experiencial. Posteriormente, la version fue revisada por un panel de expertos que califico la claridad, la coherencia, la pertinencia y la suficiencia. En la prueba piloto participaron 32 adultos de 50-80 años. Resultados. Se realizo la traduccion completa del instrumento y de las instrucciones para el sujeto y para el evaluador. La mayoria de items de la prueba alcanzaron la puntuacion maxima de 4 (100%), nueve items lograron una calificacion media de 3,9 (99%); un item, una calificacion media de 3,8 (95%), y dos items, una calificacion media de 3,7 (92,5%). Conclusiones. Con este estudio, la comunidad de habla hispana cuenta con un instrumento pertinente, suficiente, coherente y claro para identificar el sistema del equilibrio afectado, enfocar el tratamiento y obtener mejores resultados funcionales a partir de la evaluacion del equilibrio en adultos mayores.
Assuntos
Características Culturais , Avaliação Geriátrica/métodos , Equilíbrio Postural , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Projetos Piloto , TraduçõesRESUMO
Cell-type determination is a complex process driven by the combinatorial effect of extrinsic signals and the expression of transcription factors and regulatory genes. MicroRNAs (miRNAs) are non-coding RNAs that, generally, inhibit the expression of target genes and have been involved, among other processes, in cell identity acquisition. To search for candidate miRNAs putatively involved in mice rod photoreceptor and Müller glia (MG) identity, we compared miRNA expression profiles between late-stage retinal progenitor cells (RPCs), CD73-immunopositive (CD73+) rods and postnatal MG. We found a close similarity between RPCs and CD73+ miRNA expression profiles but a divergence between CD73+ and MG miRNA signatures. We validated preferentially expressed miRNAs in the CD73+ subpopulation (miR-182, 183, 124a, 9(∗), 181c and 301b(∗)) or MG (miR-143, 145, 214, 199a-5p, 199b(∗), and 29a). Taking advantage of the unique capacity of MG to dedifferentiate into progenitor-like cells that can be differentiated to a rod phenotype in response to external cues, we evaluated changes of selected miRNAs in MG-derived progenitors (MGDP) during neuronal differentiation. We found decreased levels of miR-143 and 145, but increased levels of miR-29a in MGDP. In MGDPs committed to early neuronal lineages we found increased levels of miR-124a and upregulation of miR-124a, 9(∗) and 181c during MGDP acquisition of rod phenotypes. Furthermore, we demonstrated that ectopic miR-124 expression is sufficient to enhance early neuronal commitment of MGDP. Our data reveal a dynamic regulation of miRNAs in MGDP through early and late neuronal commitment and miRNAs that could be potential targets to exploit the silent neuronal differentiation capacity of MG in mammals.
Assuntos
Diferenciação Celular/fisiologia , Células Ependimogliais/metabolismo , Regulação da Expressão Gênica/fisiologia , MicroRNAs/metabolismo , Células Fotorreceptoras Retinianas Bastonetes/metabolismo , 5'-Nucleotidase/metabolismo , Animais , Animais Recém-Nascidos , Diferenciação Celular/efeitos dos fármacos , Células Cultivadas , Embrião de Mamíferos , Células Ependimogliais/efeitos dos fármacos , Proteínas do Olho/genética , Proteínas do Olho/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Regulação da Expressão Gênica no Desenvolvimento/fisiologia , Glutamato-Amônia Ligase/genética , Glutamato-Amônia Ligase/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/farmacologia , Camundongos , Análise em Microsséries , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Neurotransmissores/farmacologia , Retina/citologia , Células Fotorreceptoras Retinianas Bastonetes/efeitos dos fármacos , Células-TroncoRESUMO
Müller cells are not only the main glial cell type in the retina but also latent progenitor/stem cells, which in pathological conditions can transdifferentiate to a neuronal phenotype and regenerate the neurons lost in a mature retina. Several signal transduction pathways can induce the dedifferentiation of mature Müller cells to a progenitor-like state, including that stimulated by glutamate. However, the precise molecular mechanisms by which terminally differentiated cells are initially primed to acquire multipotency remain unclear. In the present study, we have characterized early genetic and epigenetic events that occur immediately after glutamate-induced dedifferentiation of fully differentiated Müller cells is initiated. Using Müller cell-enriched cultures from postnatal rats, we demonstrate that glutamate triggers a rapid dedifferentiation response characterized by changes in cell morphology coupled to the induction of progenitor cell marker gene expression (e.g., nestin, lin28 and sox2) within 1h. Dedifferentiation involved the activation of N-methyl-d-aspartate and type II metabotropic glutamate receptors, as well as global DNA demethylation (evident through the decrease in methyl-CpG-binding protein 2 immunoreactivity) and an increase in gadd45-ß gene expression; although, early progenitor gene expression was only partially inhibited by pharmacological impairment of DNA methylation. Importantly, the expression of Müller glia identity genes (i.e., glutamine synthetase; cellular retinaldehyde binding protein, CRALBP) is retained through the process. Dedifferentiated Müller cells held an early neuronal differentiation potential similar to that observed in retinal progenitor-enriched cultures but, contrary to the latter, dedifferentiated Müller cells failed to further differentiate into mature photoreceptor lineages. We speculate that, in spite of the initial triggering of the dedifferentiation pathways, these cells may exhibit a certain degree of epigenetic memory that precludes them from further differentiation.
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Desdiferenciação Celular/fisiologia , Células Ependimogliais/fisiologia , Epigênese Genética/fisiologia , Ácido Glutâmico/farmacologia , Fenótipo , Células Fotorreceptoras de Vertebrados/fisiologia , Animais , Desdiferenciação Celular/efeitos dos fármacos , Células Cultivadas , Células Ependimogliais/efeitos dos fármacos , Epigênese Genética/efeitos dos fármacos , Células Fotorreceptoras de Vertebrados/efeitos dos fármacos , Ratos , Ratos Long-Evans , Retina/citologia , Retina/efeitos dos fármacos , Retina/fisiologiaRESUMO
This work presents the evaluation of pulse rate variability (PRV) obtained from pulse onsets of photoplethysmographic (PPG) signals. Three published algorithms were used to determine the pulse onsets: diastolic point, maximum second derivative and tangent intersection. Temporal series of pulse onsets were obtained for each method, and several variability indices were derived from these series. Simultaneous ECG and PPG records were acquired from 37 healthy volunteers to evaluate the interchangeability between PRV indices and heart rate variability (HRV) indices by the Bland-Altman method. Furthermore, the concordance correlation coefficient was used to correlate the indices. In all the cases, PRV indices obtained through the tangent intersection method showed better accuracy and precision (Bland-Altman analysis, bias ± 1.96 standard deviation: low frequency, LF(ms)(2) = -28.06 ± 72.68; high frequency, HF(ms)(2) = -68.23 ± 192.85; high frequency in normalized units, HF(nu) =-2.02 ± 7.08; LF/HF = 0.17 ± 0.71) and higher correlation (concordance correlation coefficients: low frequency, LF(ms)(2) = 0.99; high frequency, HF(ms)(2) = 0.98; high frequency in normalized units, HF(nu) = 0.97; LF/HF = 0.90) with HRV indices than other methods, and could be used as a good surrogate of HRV.
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Algoritmos , Diagnóstico por Computador/métodos , Frequência Cardíaca/fisiologia , Fotopletismografia/métodos , Pulso Arterial/métodos , Humanos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Retinogenesis is a developmental process that involves the sequential formation of neurons and glia from retinal progenitors. Once retinogenesis is completed, Müller glial cells can be stimulated to differentiate into neuronal lineages and constitute a retina-intrinsic source of neural progenitors. The identification of the intrinsic and extrinsic factors that control proliferation and differentiation of Müller cells or retinal progenitors is needed in order to fully define their potential therapeutic use in regenerative approaches. Here we determined the response of retinal progenitors derived from Müller glia primary cell cultures to GABA-activated signal transduction cascades. Using Western blot analysis, immunocytochemistry and calcium imaging we found that GABA induces an increase of the number of progenitor cells that present spontaneous intracellular calcium transients as well as their frequency, which involve the participation of L-type voltage-gated calcium channels (VGCCs). This process correlates with the activation of transcription factor CREB through Ser33 phosphorylation and the induction of expression of the early neuronal markers NeuroD1 and ßIII-tubulin. GABA-mediated CREB phosphorylation was rapid and sustained and the pharmacological blockade of CREB activity inhibited the effect of GABA on NeuroD1 expression. Furthermore, consistent with the role of CREB as a histone acetyltransferase recruiter, we demonstrate that GABA induces the modification of histone H4 acetylation pattern in these cells suggesting that epigenetic alterations participate in the differentiation process. Our results support the notion that postnatal retinal progenitors derived from Müller glia primary cell cultures respond to GABA through the same molecular pathway previously characterized in hippocampal progenitors and developing neurons. We speculate that the induction of GABA receptor signaling could represent a novel strategy to enhance neural versus glial specification from these cells through genetic and epigenetic mechanisms.
Assuntos
Diferenciação Celular/fisiologia , Células-Tronco Neurais/citologia , Neurogênese/fisiologia , Neuroglia/citologia , Neurônios/citologia , Animais , Western Blotting , Diferenciação Celular/efeitos dos fármacos , Células Cultivadas , Imuno-Histoquímica , Ratos , Ratos Long-Evans , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transdução de Sinais/fisiologia , Ácido gama-Aminobutírico/metabolismo , Ácido gama-Aminobutírico/farmacologiaRESUMO
Objetivo: Comprobar la proliferación de células madres mesenquimales (MSCs) provenientes de tejido conjuntivo gingival humano sobre una matriz de quitosano. Método: Estudio experimental in vitro en el cual se aislaron MSCs a partir de cultivos por explante de tejido conjuntivo gingival. La presencia de MSCs, se caracterizó mediante citometría de flujo, utilizando para ello anticuerpos CD34, CD45, CD73, CD90, CD105, diferenciación hacia tres linajes celulares: adipocitos, osteoblastos y condroblastos. La diferenciación fue corroborada mediante microscopía óptica con tinciones Oil Red, Alizarin Red y Safranina O respectivamente. La matriz de quitosano fue analizada mediante microscopía óptica. Las MSCs en pasaje 5, fueron sembradas en presencia de la matriz de quitosano. La proliferación de las células madres fue analizada mediante microscopía óptica y tinción con cristal violeta. Resultados: A partir del explante de tejido gingival humano se obtuvieron MSCs, que cumplieron con los criterios de caracterización morfológica y fenotípica correspondiente a una MSC. Las MSC adoptaron una morfología fibroblastoide, adherencia al plástico, confluencia de un 80 por ciento y sobre un 90 por ciento expresaron los marcadores CD73, CD90 y CD105 y bajo un 10 por ciento fueron negativas para CD34, y CD45 por técnica de citometria de flujo. Las MSC cultivadas en presencia de quitosano proliferan, sin embargo observamos que a mayor concentración de quitosano en el cultivo disminuye la proliferación y densidad celular. La matriz de quitosano en presencia del medio de cultivo pierde sus propiedades físicas, disolviéndose y formando un gel no transportable. Conclusiones: A pesar de existir proliferación celular de MSCs de origen gingival humano en presencia de la matriz de quitosano, su utilidad como andamiaje y medio de transporte de MSC es deficiente debido a que se alteran sus propiedades físicas, disolviéndose y formando un gel no transportable en contacto con el medio de...
Aim: The purpose of this study was to assess the proliferation of mesenchymal stem cells (MSCs) from human gingival tissue on chitosan matrix. Methods: Experimental study in vitro. Gingival connective tissue samples were obtained from healthy volunteers from the maxillary tuberosity. The explants were minced and cultured on tissue culture dishes. MSC were characterized by flow cytometry using markers for CD34, CD45, CD73, CD90, CD105 and for differentiation into, adipogenic, osteogenic and chondrogenic lineages. The tissue differentiated was analyzed with light microscopy and evaluated by culture staining using Oil Red, Alizarin Red y Safranina O respectively. MSC from passage 5 were cultured with chitosan scaffold. Proliferation of MSC was analyzed with light microscopy and crystal violet staining. Results: MSCs were obtained from gingival explants, and developed the standard of the morphologic and phenotypic characterization as a stem cell. The MSC adopted a fibroblastoid morphology, adherence to plastic, confluence of 80 percent and over 90 percent were consistently positive for CD90, CD105, CD73 markers and under 10 percent were negative for hematopoietic markers CD34 and CD45 by flow cytometry analysis. The MSC cultured in presence of chitosan matrix proliferated, however complete medium, it was dissolved forming a gel structure. We also observed that at higher concentrations of chitosan, MSC has less density and growth. Chitosan matrix in presence of cell culture medium loses physical properties, dissolving and forming a non-transportable gel. Conclusions: Despite the existence of proliferation of MSCs from human gingival tissue with chitosan matrix, its ability to act as a cell carrier and scaffold is deficient, since its physical properties are altered, dissolving and forming a non-transportable gel in contact with cell culture medium.
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Humanos , Quitosana , Gengiva , Células-Tronco Mesenquimais , Proliferação de Células , Regeneração , Antígenos CD , Diferenciação Celular , Células Cultivadas , Citometria de Fluxo , Imunofenotipagem , Microscopia , PeriodontoRESUMO
Infarct-induced heart failure is usually associated with cardiac hypertrophy and decreased beta-adrenergic responsiveness. However, conflicting results have been reported concerning the density of L-type calcium current (I Ca(L)), and the mechanisms underlying the decreased beta-adrenergic inotropic response. We determined I Ca(L) density, cytoplasmic calcium ([Ca2+]i) transients, and the effects of beta-adrenergic stimulation (isoproterenol) in a model of postinfarction heart failure in rats. Left ventricular myocytes were obtained by enzymatic digestion 8-10 weeks after infarction. Electrophysiological recordings were obtained using the patch-clamp technique. [Ca2+]i transients were investigated via fura-2 fluorescence. beta-Adrenergic receptor density was determined by [ H]-dihydroalprenolol binding to left ventricle homogenates. Postinfarction myocytes showed a significant 25 percent reduction in mean I Ca(L) density (5.7 + or - 0.28 vs 7.6 + or - 0.32 pA/pF) and a 19 percent reduction in mean peak [Ca2+]i transients (0.13 + or - 0.007 vs 0.16 + or - 0.009) compared to sham myocytes. The isoproterenol-stimulated increase in I Ca(L) was significantly smaller in postinfarction myocytes (Emax: 63.6 + or - 4.3 vs 123.3 + or - 0.9 percent in sham myocytes), but EC50 was not altered. The isoproterenol-stimulated peak amplitude of [Ca2+]i transients was also blunted in postinfarction myocytes. Adenylate cyclase activation through forskolin produced similar I Ca(L) increases in both groups. beta-Adrenergic receptor density was significantly reduced in homogenates from infarcted hearts (Bmax: 93.89 + or - 20.22 vs 271.5 + or - 31.43 fmol/mg protein in sham myocytes), while Kd values were similar. We conclude that postinfarction myocytes from large infarcts display reduced I Ca(L) density and peak [Ca2+]i transients. The response to Beta-adrenergic stimulation was also reduced and was probably related to Beta-adrenergic receptor down-regulation and not to changes in adenylate cyclase activity
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Animais , Masculino , Feminino , Ratos , Agonistas Adrenérgicos beta , Canais de Cálcio Tipo L , Insuficiência Cardíaca , Isoproterenol , Infarto do Miocárdio , Receptores Adrenérgicos beta , Adenilil Ciclases , Canais de Cálcio Tipo L , Colforsina , Insuficiência Cardíaca , Hipertrofia Ventricular Esquerda , Ratos Wistar , Receptores Adrenérgicos betaRESUMO
Infarct-induced heart failure is usually associated with cardiac hypertrophy and decreased -adrenergic responsiveness. However, conflicting results have been reported concerning the density of L-type calcium current (I Ca(L)), and the mechanisms underlying the decreased -adrenergic inotropic response. We determined I Ca(L) density, cytoplasmic calcium ([Ca2+]i) transients, and the effects of -adrenergic stimulation (isoproterenol) in a model of postinfarction heart failure in rats. Left ventricular myocytes were obtained by enzymatic digestion 8-10 weeks after infarction. Electrophysiological recordings were obtained using the patch-clamp technique. [Ca2+]i transients were investigated via fura-2 fluorescence. -Adrenergic receptor density was determined by [ H]-dihydroalprenolol binding to left ventricle homogenates. Postinfarction myocytes showed a significant 25% reduction in mean I Ca(L) density (5.7 0.28 vs 7.6 0.32 pA/pF) and a 19% reduction in mean peak [Ca2+]i transients (0.13 0.007 vs 0.16 0.009) compared to sham myocytes. The isoproterenol-stimulated increase in I Ca(L) was significantly smaller in postinfarction myocytes (Emax: 63.6 4.3 vs 123.3 0.9% in sham myocytes), but EC50 was not altered. The isoproterenol-stimulated peak amplitude of [Ca2+]i transients was also blunted in postinfarction myocytes. Adenylate cyclase activation through forskolin produced similar I Ca(L) increases in both groups. -Adrenergic receptor density was significantly reduced in homogenates from infarcted hearts (Bmax: 93.89 20.22 vs 271.5 31.43 fmol/mg protein in sham myocytes), while Kd values were similar. We conclude that postinfarction myocytes from large infarcts display reduced I Ca(L) density and peak [Ca2+]i transients. The response to -adrenergic stimulation was also reduced and was probably related to -adrenergic receptor down-regulation and not to changes in adenylate cyclase activity.
Assuntos
Canais de Cálcio Tipo L/metabolismo , Insuficiência Cardíaca/metabolismo , Infarto do Miocárdio/complicações , Miócitos Cardíacos/metabolismo , Receptores Adrenérgicos beta/metabolismo , Adenilil Ciclases/efeitos dos fármacos , Agonistas Adrenérgicos beta/farmacologia , Animais , Canais de Cálcio Tipo L/efeitos dos fármacos , Colforsina/farmacologia , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Técnicas Eletrofisiológicas Cardíacas , Feminino , Insuficiência Cardíaca/etiologia , Hipertrofia Ventricular Esquerda/patologia , Isoproterenol/farmacologia , Masculino , Infarto do Miocárdio/metabolismo , Miócitos Cardíacos/efeitos dos fármacos , Ratos , Ratos Wistar , Receptores Adrenérgicos beta/efeitos dos fármacos , Fatores de TempoRESUMO
El Sida es una enfermedad epidémica que sigue extendiéndose por zonas rurales, sobre todo en las entidades que tienen flujos migratorios hacia Estados Unidos. Esta enfermedad se ha convertido en un problema de salud pública mundial pues tiene múltiples repercusiones psicológicas, sociales, éticas, económicas y políticas que rebasan el ámbito de la salud. Por esta razón es necesaria la participación de diversos sectores de la sociedad y la coordinación entre instituciones y países para poder combatirla, ya que en reportes publicados por la Dirección General de Epidemiología, el grupo de hombres entre 25 y 44 años es el más afectado. Por lo tanto, es un factor de riesgo potencial para mujeres en edad fértil, con la consecuente transmisión perinatal. Esta es una de las principales razones para continuar en forma permanente difundiendo su prevención.
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Criança , Instalações de Saúde/estatística & dados numéricos , México , Síndrome da Imunodeficiência Adquirida/epidemiologia , Doenças Transmissíveis/epidemiologia , Saúde Pública/estatística & dados numéricosRESUMO
El objetivo de este estudio fue conocer la incidencia y prevalencia del dengue hemorrágico en la población pediátrica de derechohabientes del ISSSTE en los 31 estados y D.F. Se incluyeron todos los casos confirmados por serología o por asociación epidemiológica que se notificaron al Departamento de Epidemiología a nivel central. De un total de 57 paciente, 30 (53 por ciento) correspondieron al sexo femenino y 27 (47 por ciento) al masculino. La edad promedio fue de 13 años, y el estado más afectado fue Veracruz con 31 pacientes; el mes de mayor incidencia fue octubre con 23 casos (40 por ciento). El cuadro clínico se manifestó por fiebre (100 por ciento), cefalea 40 (70 por ciento), dolor retroocular 52 (91 por ciento), escalofríos 51 (89 por ciento), conjuntivitis 52 (89 por ciento), mialgias 48 (84 por ciento) y otras. Todos los pacientes necesitaron manejo hospitalario. La mortalidad fue de 2 por ciento