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BACKGROUND: Refractory venous leg ulcers (VLUs) often require extended time to heal, and they carry a high risk of recurrence. This case study describes our experiences with a patient with a VLU refractory to multiple treatment strategies who was successfully treated with Manuka honey. CASE: Mr S. was a 76-year-old man with multiple comorbid conditions and hypersensitivity to silver-based compounds, who developed 3 VLUs of his right lower extremity. He experienced 90 days of unsuccessful treatments using an iodized cadexomer ointment, hydrodetersive fiber dressings, hydrocolloid meshes, compression therapy, and antibiotic treatment without progression toward wound healing. We then initiated treatment with Manuka honey and continued compression therapy. His primary VLU was completely epithelialized within 38 days, and an adjacent VLU also showed progression toward healing. Mr S. reported clinically relevant improvement in wound-related pain at 17 days. CONCLUSION: The use of Manuka honey proved effective in this patient with a VLU refractory to other treatment strategies.

Gastric cancer is one of the most common cancers worldwide, with a bad prognosis associated with late-stage diagnosis, significantly decreasing the overall survival. This highlights the importance of early detection to improve the clinical course of these patients. Although screening programs, based on endoscopic or radiologic approaches, have been useful in countries with high incidence, they are not cost-effective in low-incidence populations as a massive screening strategy. Additionally, current biomarkers used in daily routine are not specific and sensitive enough, and most of them are obtained invasively. Thus, it is imperative to discover new noninvasive biomarkers able to diagnose early-stage gastric cancer. In this context, liquid biopsy is a promising strategy. In this review, we briefly discuss some of the potential biomarkers for gastric cancer screening and diagnosis identified in blood, saliva, urine, stool, and gastric juice.

Introducción: El recambio plasmático terapéutico es una técnica extracorpórea de depuración sanguínea. El recambio plasmático terapéutico mediante el método de centrifugación (plasmacentrifugación) requiere flujos de 50 ml/min lo que permite realizar el intercambio con accesos vasculares periféricos. El principal objetivo de este estudio fué el de analizar el uso y las complicaciones del acceso vascular periférico en las sesiones de plasmacentrifugación. Material y Método: Estudio observacional descriptivo longitudinal sobre el análisis de complicaciones del acceso vascular periférico de las sesiones de plasmacentrifugación realizadas entre enero de 2017 y marzo de 2018. Resultados: Inclusión de un total de 93 sesiones de plasmacentrifugación, estas sesiones fueron llevadas a cabo en 9 pacientes con una mediana de 7 [P25:6; P75:10,5] sesiones por paciente. El 66,66% (n=6) fueron mujeres. En el 89,24% (n=83) de las sesiones se usó la centrifugación y en el 10,75% (n=10) la fotoaféresis. La etiología de enfermedad para estos pacientes fue: renal en el 55,55% (n=5) de los casos, neurológica en el 33,33% (n=3) de los casos y dermatológica en el 11,11% (n=1). De las 93 sesiones totales hubo problemas relacionados con la canalización de un acceso vascular periférico en el 52,69% de las sesiones (n=49). Conclusiones: Debido a que en más de la mitad de las sesiones se presentaron complicaciones en el abordaje del acceso vascular periférico, se concluye que es necesario el estudio vascular ambulatorio del paciente antes de la primera sesión, pudiendo ser útil el uso de la punción ecoguiada.

Simple Summary Gastric cancer is one of the most common cancers worldwide, showing high mortality rates. A small portion of gastric cancer patients, known as early onset gastric cancer (EOGC) patients, develop the disease before age 50, and their characteristics are poorly described. Thus, our main objective was to describe the clinical, molecular, and genetic characteristics of EOGC in a large multicenter cohort of patients. We were able to identify that most EOGC cases have similar characteristics: diagnosed at advanced stage, diffuse type, and infrequent DNA mismatch repair somatic deficiency. Although familial aggregation of gastric cancer was uncommon, a germline genetic mutation was identified in 25% of the patients tested. Our results show that EOGC has a marked genetic heterogeneity. Thus, it is essential to consider familial history of tumors, not only GC, in order to select adequate patients to perform a suitable genetic counseling and enhance the emerging use of multigene panels. Abstract Gastric adenocarcinoma (GC) is a common tumor with high morbidity and mortality. Only 7% of patients with GC are diagnosed before age 50 (early onset gastric cancer (EOGC)), and their characteristics have been poorly described. We aimed to describe clinical, molecular, and genetic characteristics of EOGC. A total of 309 patients with EOGC were retrospectively studied in four Spanish centers. Personal information, family history, and tumor information were registered. Germinal genetic analysis was performed in patients who met current criteria of a hereditary syndrome at the time of diagnosis. The median age at diagnosis was 44 years. The majority (73.3%) of tumors were diffuse, and 78.3% were diagnosed in an advanced stage. Familial aggregation of GC was present in 18/117 (15.4%) cases, and 5/117 (4.3%) met criteria for familial GC. MMR-IHC was performed in 126/309 (40.7%) tumors: 4/126 (3.1%) had loss of expression in MLH1/PMS2, without an associated germline mutation. Sixteen germline genetic analyses were performed, detecting a pathogenic variant in four (25%) cases: one in BRCA2, one in TP53, and two in CDH1. Most EOGC are diffuse and diagnosed in an advanced stage. In these patients, DNA MMR system deficiency is uncommon. Although familial aggregation was observed in only 15% of cases, a germline mutation was found in 25% of patients tested with clinical criteria. This demonstrates that EOGC has a marked genetic heterogeneity, reinforcing the importance of an accurate genetic counseling and enhancing the emerging use of multigene panels.

There is an urgent need to strengthen the implementation of the 3Rs principle (Replacement, Reduction and Refinement) in the use of experimental animals in toxinological research and in the assessment of the neutralizing efficacy of snake antivenoms. This is a challenging task owing to the inherent complexity of snake venoms. The state of the art on this topic is hereby reviewed, with emphasis on the studies in which a correlation has been observed between in vivo toxicity tests and in vitro surrogate assays, particularly in the study of lethal activity of venoms and its neutralization. Correlations have been described with some venoms-antivenoms when using: (a) enzyme immunoassays, (b) hemagglutination, (c) enzyme assays (proteinase, phospholipase A2), (d) in vitro coagulant effect on plasma, (e) cell culture assays for cytotoxicity, (f) functional assays for assessing neurotoxicity in vitro, (g) use of hens’ eggs, and (h) antivenomics. Additionally, the routine introduction of analgesia in these assays and the design of more ‘humane’ protocols for the lethality test are being pursued. It is expected that the next years will witness a growing awareness of the relevance of the 3Rs principles in antivenom testing, and that new in vitro alternatives and more ‘humane’ experimental designs will emerge in this field.

The identification of high-risk groups of gastric (GC) and pancreatic adenocarcinoma (PC) due to a hereditary basis could imply a benefit in the affected families by establishing personalized preventive strategies. We aimed at assessing the diagnostic yield of GC/PC hereditary syndromes in individuals evaluated based on specific clinical criteria. In total, 77 unrelated individuals (45 from GC group/32 from PC group) were recruited: 51 (66.2%) cancer diagnosis &lt, 60 years, 3 (4%) with personal history of GC/PC and other cancer and 23 (29.8%) due to family history. Immunohistochemical analysis of DNA mismatch repair proteins was performed in 38 (49.3%) available tumors, being pathological in one (2%) GC. A genetic analysis was performed if clinical criteria of hereditary syndrome were fulfilled, identifying a mutation in 10/22 (45.5%) families [7/16 (43.7%) with GC and 3/6 (50%) with PC] and 19 (24.7%) fulfilled criteria of familial cancer. Diagnosis of cancer &lt, 40 years and personal history of other cancers were independent risk factors of a hereditary syndrome [OR:11.3 (95%IC 1.9&ndash, 67), p = 0.007 and OR:17.4 (95% IC 2.5&ndash, 119.9), p = 0.004, respectively]. The selection of patients based on clinical criteria leads to high diagnostic yield, detecting a causative germline mutation in almost half of the cases, therefore, both meticulous genetic counseling and use of multi-gen panels is crucial.

Colorectal cancer (CRC) is one of the most frequent neoplasia in developed countries and the second leading cause of cancer death in Spain. It develops through the accumulation of genetic and epigenetic alterations in the normal mucosa, producing advanced adenomas and invasive cancers. This multistep process makes CRC highly traceable, making it a good candidate for the implementation of preventive measures such as screening programs. Although there are different strategies, none of them meet all the criteria for CRC screening purposes. In this context, many molecular alterations involved in CRC carcinogenesis could contribute to the generation of new non-invasive methods with a high sensitivity and specificity. In this review, some of the most promising diagnostic non-invasive biomarkers for CRC will be briefly discussed.

Background: Knowledge of traditional and complementary medicine (TCM) and its use by patients are essential for patient safety. Aims: To examine knowledge of TCM among practitioners in a nephrology unit and their advice to patients. Methods: This was a descriptive, observational, cross-sectional study. Sociodemographic data were collected and an ad hoc closed response survey was used. Findings: This study included 62 practitioners, of whom: 32.26% had been trained in TCM, with no significant differences between professional groups; 41.93% used TCM and 67.74% recommended TCM to patients, with no significant difference between personal use and training received. The majority (62.90%) approved of TCM being included in clinical practice, 77.42% were in favour of it being included in formal health teaching programmes, 27.42% said patients had requested information on TCM and 50% knew it could interact with conventional treatment. Conclusion: Although the majority of practitioners had not been trained in TCM, they were interested in including such treatments in clinical practice. They recommended TCM to patients, but neither training nor personal experience were significant factors in relation to these recommendations. Training in TCM is required to ensure advice is safe.

IntroductionIn the USA, transgender women are among the most vulnerable to HIV. In particular, transgender women of colour face high rates of infection and low uptake of important HIV prevention tools, including pre-exposure prophylaxis (PrEP). This paper describes the design, sampling methods, data collection and analyses of the TURNNT (‘Trying to Understand Relationships, Networks and Neighbourhoods among Transgender women of colour’) study. In collaboration with communities of transgender women of colour, TURNNT aims to explore the complex social and environmental (ie, neighbourhood) structures that affect HIV prevention and other aspects of health in order to identify avenues for intervention.Methods and analysesTURNNT is a prospective cohort study, which will recruit 300 transgender women of colour (150 Black/African American, 100 Latina and 50 Asian/Pacific Islander participants) in New York City. There will be three waves of data collection separated by 6 months. At each wave, participants will provide information on their relationships, social and sexual networks, and neighbourhoods. Global position system technology will be used to generate individual daily path areas in order to estimate neighbourhood-level exposures. Multivariate analyses will be conducted to assess cross-sectional and longitudinal, independent and synergistic associations of personal relationships (notably individual social capital), social and sexual networks, and neighbourhood factors (notably neighbourhood-level social cohesion) with PrEP uptake and discontinuation.Ethics and disseminationThe TURNNT protocol was approved by the Columbia University Institutional Review Board (reference no. AAAS8164). This study will provide novel insights into the relationship, network and neighbourhood factors that influence HIV prevention behaviours among transgender women of colour and facilitate exploration of this population’s health and well-being more broadly. Through community-based dissemination events and consultation with policy makers, this foundational work will be used to guide the development and implementation of future interventions with and for transgender women of colour.

Introduction: Plastic cannulas (PC) have shown efficacy in haemodialysis (HD) and are presented as a positive innovation for patients and vascular access survival. Objective: To analyse Spanish HD nurses' experience of using PC. Design: Cross-sectional observational study. Methods: An ad hoc questionnaire was administered on nurses' experience of PC use. Results: A total of 163 Spanish HD nurses were surveyed, of whom 42.3% had PC in their workplace and 50.9% had used them. In all, 55.8% had received training and 77.9% wished to receive more training. These needles were significantly more available in public institutions than in private centres (p < 0.001). There was no significant difference between years of experience and having received training (p = 0.915). There was a moderate-strong correlation (ρ = 0.659) between greater professional satisfaction with the product and greater patient satisfaction (p < 0.001). The nurses would make a median of two [P25 , 1; P75 , 3] modifications in the product design. The characteristics of the PC were rated positively by 55.8% and negatively by 10.3%. Conclusions: A substantial proportion of the nurses surveyed did not use PC and had not received training in their use. Respondents reported that PC could be improved and a small percentage perceived them negatively.Implications for practice: Based on the evidence presented and available, if we manage to integrate this knowledge and work on the continuum of achieving excellence, we will continue to grow as a profession and provide higher quality care.

Introducción. Los trastornos de sueño tienen una alta prevalencia en los pacientes con Enfermedad Renal Crónica en Hemodiálisis. Un descanso insuficiente o de mala calidad influye negativamente en la actividad cotidiana siendo causa o consecuencia de estados depresivos o ansiosos. Objetivo. Evaluar la calidad del sueño en pacientes en hemodiálisis y su relación con los niveles de depresión y ansiedad. Material y Método. Estudio observacional descriptivo con inclusión de 28 pacientes en hemodiálisis durante febrero de 2017. Se recogieron datos sociodemográficos, se administró el test Pittsburg de Calidad del Sueño, y se valoró el estado cognitivo con el examen Minimental y la depresión y ansiedad con la Hospital Anxiety and Depression Scale (HADS). Resultados. El 82,14% (n=23) presentó insomnio según el test de Pittsburg. Los resultados obtenidos con el HADS fueron positivos para ansiedad en un 21% (n=6) y positivos para depresión en un 35% (n=10). Los resultados en el test Pittsburg se correlacionaron positivamente con los niveles de ansiedad (p=0,004) y depresión (p=0,049). El grado de depresión se correlacionó negativamente con ausencia de deterioro cognitivo (p=0,010). Conclusiones. La calidad del sueño en los pacientes examinados es mala y se pueden relacionar con los resultados de depresión y ansiedad encontrados. Según estos resultados, incluiremos información sobre hábitos de sueño saludables en el proceso de educación a pacientes en hemodiálisis, así como pretendemos mejorar la detección y tratamiento especializado de la ansiedad y depresión.

Snakebite envenoming by viperid species, and by some elapids, is characterized by a complex pattern of tissue damage at the anatomical site of venom injection. In severe cases, tissue destruction may be so extensive as to lead to permanent sequelae, with serious pathophysiological, social and psychological consequences. Significant advances have been performed in the study of venom-induced tissue damage, including identification and characterization of the toxins involved, insights into the mechanisms of action of venoms and toxins, and study of tissue responses to venom-induced injury. Nevertheless, much remains to be known and understood on the pathogenesis of these alterations. This review focuses on some of the pending issues in the topic of snake venom-induced local tissue damage. The traditional ‘reductionist’ approach, which has predominated in the study of snake venoms and their actions, needs to be complemented by more integrative and holistic perspectives aimed at capturing the complexity of these pathological alterations. Future advances in the study of these topics will certainly pave the way for innovative therapeutic interventions, with the goal of reducing the impact of this aspect of snakebite envenoming. UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto Clodomiro Picado (ICP) UCR::Vicerrectoría de Docencia::Salud::Facultad de Microbiología UCR::Vicerrectoría de Docencia::Salud::Facultad de Farmacia

espanolLos pacientes con enfermedad renal cronica estadio 5 tratados en dialisis presentan alteraciones cardiovasculares, musculoesqueleticas y psicosociales que afectan su capacidad fisica y funcional. La falta de actividad contribuye a un aumento de la mortalidad y al desarrollo de enfermedades cronicas. La calidad de vida relacionada con la salud es la evaluacion que realiza el individuo respecto a su salud. El objetivo del estudio fue valorar y analizar la percepcion de salud, la capacidad funcional, el estado nutricional y psicologico de los pacientes de hemodialisis (HD) y dialisis peritoneal (DP). Realizamos un estudio descriptivo que incluyo todos los pacientes que realizaban dialisis en nuestro centro. Disenamos una base de datos y analizamos las variables mediante el estadistico SPSS 21. El tamano total de la muestra fue de 42 pacientes (21 HD- 21 DP). Los resultados mostraron un grupo homogeneo en la media de edad, con indice de Barthel y niveles de albumina bajos similares, como describen otras series. Los resultados estadisticos muestran que los pacientes en HD son mas sedentarios (p EnglishPatients with stage 5 chronic kidney disease on dialysis have cardiovascular, musculoskeletal and psychosocial disorders that affect their physical and functional capacity. The lack of activity contributes to an increase in mortality and the development of chronic diseases. Quality of life is the subjective evaluation in a multidimensional concept of one's own health. The aim of this study is to evaluate and to analyse the health perceptions, functional capacity, nutritional and psychological status of patients in haemodialysis (HD) and peritoneal dialysis (PD). This is a descriptive study which included all dialysis patients in our centre. We designed a database and the data collected were analysed using SPSS 21.The sample size was 42 patients (21 HD-21 DP). The results show a homogeneous group in terms of average age, Barthel index and low albumin levels. Furthermore, HD patients are more sedentary (p

Made available in DSpace on 2019-10-05T16:54:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-04-01 IRCCS Istituto Giannina Gaslini Background To our knowledge, the characteristics and burden of childhood arthritis have never been studied on a worldwide basis. We aimed to investigate, with a cross-sectional study, the prevalence of disease categories, treatment methods, and disease status in patients from across different geographical areas and from countries with diverse wealth status. Methods In this multinational, cross-sectional, observational cohort study, we asked international paediatric rheumatologists from specialised centres to enrol children with a diagnosis of juvenile idiopathic arthritis, according to International League of Associations for Rheumatology criteria, who were seen consecutively for a period of 6 months. Each patient underwent retrospective and cross-sectional assessments, including measures of disease activity and damage and questionnaires on the wellbeing and quality of life of the children. We qualitatively compared the collected data across eight geographical areas, and we explored an association between disease activity and damage and a country's gross domestic product (GDP) with a multiple logistic regression analysis. Findings Between April 4, 2011, and Nov 21, 2016, 9081 patients were enrolled at 130 centres in 49 countries, grouped into eight geographical areas. Systemic arthritis (125 [33.0%] of 379 patients) and enthesitis-related arthritis (113 [29.8%] of 379) were more common in southeast Asia, whereas oligoarthritis was more prevalent in southern Europe (1360 [56.7%] of 2400) and rheumatoid factor-negative polyarthritis was more frequent in North America (165 [31.5%] of 523) than in the other areas. Prevalence of uveitis was highest in northern Europe (161 [19.1%] of 845 patients) and southern Europe (450 [18.8%] of 2400) and lowest in Latin America (54 [6.4%] of 849), Africa and Middle East (71 [5.9%] of 1209), and southeast Asia (19 [5.0%] of 379). Median age at disease onset was lower in southern Europe (3.5 years, IQR 1.9-7.3) than in other regions. Biological, disease-modifying antirheumatic drugs were prescribed more frequently in northern Europe and North America than in other geographical settings. Patients living in countries with lower GDP had greater disease activity and damage than those living in wealthier countries. Damage was associated with referral delay. Interpretation Our study documents a variability in prevalence of disease phenotypes and disparities in therapeutic choices and outcomes across geographical areas and wealth status of countries. The greater disease burden in lowerresource settings highlights the need for public health efforts aimed at improving equity in access to effective treatments and care for juvenile idiopathic arthritis. Copyright (C) 2019 Elsevier Ltd. All rights reserved. Univ Genoa, Ist Giannina Gaslini, IRCCS, Clin Paediat & Rheumatol, Genoa, Italy Univ Genoa, Ist Giannina Gaslini, IRCCS, Epidemiol & Biostat Serv, Genoa, Italy Univ Genoa, Ist Giannina Gaslini, IRCCS, Sci Directory, Genoa, Italy Univ Genoa, PRINTO, IRCCS, Ist Giannina Gaslini, Genoa, Italy Univ Genoa, Dept Neurosci Rehabil Ophthalmol Genet & Maternal, Genoa, Italy Wilhelmina Childrens Hosp, Dept Pediat Immunol & Rheumatol, Utrecht, Netherlands Sanjay Gandhi Postgrad Inst Med Sci, Lucknow, Uttar Pradesh, India Univ Hosp 12 Octubre, Dept Pediat Rheumatol, Madrid, Spain Alfaisal Univ, Dept Pediat Rheumatol, King Faisal Specialist Hosp, Riyadh, Saudi Arabia Alfaisal Univ, Res Ctr, Riyadh, Saudi Arabia Western Univ Childrens Hosp, Hlth Sci Ctr, London, ON, Canada Oslo Univ Hosp, Dept Rheumatol, Oslo, Norway Oslo Univ Hosp, Med Fac, Oslo, Norway Univ Oslo, Oslo, Norway Oslo Univ Hosp, Norwegian Natl Advisory Unit Rheumat Dis Children, Oslo, Norway Univ Hosp Munster, Dept Pediat Rheumatol & Immunol, Munster, Germany Hosp Sor Maria Ludovica, Rheumatol Serv, La Plata, Buenos Aires, Argentina Bucharest Emergency Hosp, Cluj Napoca, Romania Childrens Emergency Hosp, Cluj Napoca, Romania Cincinnati Childrens Hosp Med Ctr, Div Rheumatol, Cincinnati, OH 45229 USA Alberta Childrens Prov Gen Hosp, Div Pediat Rheumatol, Dept Pediat, Calgary, AB, Canada Sofiamed, Pediat Dept, Sofia, Bulgaria Rigshosp, Juliane Marie Ctr, Paediat Rheumatol Unit, Copenhagen, Denmark Natl Inst Rheumatism & Physiotherapy, Clin Immunol Adult & Paediat Rheumatol Dept, Budapest, Hungary Univ Latvia, Pediat Dept, Riga, Latvia Univ Latvia, Univ Childrens Hosp, Riga, Latvia Univ Estadual Paulista, Botucatu Fac Med, Botucatu, SP, Brazil Shariati Hosp, Rheumatol Res Ctr, Dept Pediat & Rheumatol, Tehran, Iran Inst Rheumatol Belgrade, Div Pediat Rheumatol, Belgrade, Serbia Thessaloniki Univ, Dept Pediat 1, Hippokrat Gen Hosp, Sch Med, Thessaloniki, Greece Univ Estadual Paulista, Botucatu Fac Med, Botucatu, SP, Brazil

Routine laboratory animal tests necessary to assess the toxicity of snake venoms and the preclinical neutralizing ability of antivenoms and other inhibitory substances induce significant pain and distress. This has prompted initiatives to introduce the routine use of analgesia. In this study, the analgesic effect of morphine and tramadol was assessed in tests assessing the lethal, hemorrhagic, myotoxic and edema-forming activities of the venom of the viperid snake Bothrops asper. The Mouse Grimace Scale (MGS) and mouse-exploration activity were used to assess pain and its inhibition by the analgesics. Results demonstrate that tests assessing lethality and myotoxicity induce higher levels of pain than assays quantifying hemorrhagic and edema-forming activities. Our observations also indicate that pretreatment of mice with both analgesics, at the doses used, were similarly effective in reducing the MGS magnitude and increase mouse-exploration activity after the administration of B. asper venom. Moreover, the analgesic effect of both drugs was more evident in the myotoxic and lethality assays. Combined with previous observations showing that these analgesics do not alter the extent of toxic effects induced by B. asper venom, our results strongly indicate that the use of analgesia (using either morphine or tramadol) should be considered in the routine assessment of venom toxicity and antivenom efficacy.

Resumen Introducción: Los pacientes en hemodiálisis deben someterse a tratamientos no curativos y altamente invasivos, implicando importantes cambios en el estilo, hábitos y calidad de vida. Objetivo: Conocer el estado psíquico y físico de los pacientes en programa crónico de hemodiálisis y su opinión acerca de su experiencia personal en las sesiones de hemodiálisis. Material y Método: Estudio observacional descriptivo de corte transversal. Se utilizaron diferentes escalas de valoración para conocer en profundidad el estado psico-físico de la muestra seleccionada. Resultado: Inclusión de 35 pacientes, con una media de 67,43±14,82 años y estancia mediana en hemodiálisis de 20 meses (P25 4; P75 62,5). El 71,43% presentaba algún grado de dependencia para las actividades básicas (Barthel) y el 85,71% para las actividades instrumentales (Lawton-Brody). El 71,43% presentaba algún grado de ansiedad (Hamilton) y el 77,14% la probabilidad de padecer depresión (Escala Goldberg). El 54,29% presentaba algún grado de deterioro cognitivo (Examen Minimental). El 88,57% percibe afectación en su calidad de vida en el aspecto físico y el 51,43% a nivel mental (SF-12). La experiencia en hemodiálisis fue valorada por el grupo como Regular, Mala o Muy Mala por el 51,43%, un 62,86% afirmó no hace nada durante las sesiones y un 57,14% se siente atraído por la idea de participar en un Programa de Actividades Recreativas (según cuestionario de elaboración propia). Discusión y Conclusiones: La mediana de los resultados en depresión, ansiedad, dependencia, deterioro cognitivo, percepción de calidad de vida y percepción del tratamiento está gravemente alterada. Según la bibliografía consultada, favorecer la realización de actividades lúdico-terapéuticas durante la hemodiálisis puede mejorar la actitud de los pacientes, ayudar a mantener un adecuado nivel de salud tanto físico como mental y mejorar la percepción del tratamiento. Abstract Introduction: Hemodialysis patients should undergo non-curative and highly invasive treatments, involving significant changes in style, habits and quality of life. Objective: To know the psychic and physical state of patients in a chronic hemodialysis program and their opinion about their personal experience in hemodialysis sessions. Material and Method: A cross-sectional observational descriptive study was carried out. Different rating scales were used to know in depth the psycho-physical state of the selected sample. Results: Thirty-five patients were included, with an average age of 67.43±14.82 years and a median hemodialysis time of 20 months (P25 4; P75 62.5). 71.43% had some degree of dependency for basic activities (Barthel) and 85.71% for instrumental activities (Lawton-Brody). 71.43% presented some degree of anxiety (Hamilton) and 77.14% the probability of suffering depression (Goldberg Scale). 54.29% had some degree of cognitive deterioration (Minimental Exam). 88.57% perceive impairment in their quality of life in the physical aspect and 51.43% in the mental level (SF-12). The experience in hemodialysis was rated by the group as ‘Regular’, ‘Bad’ or ‘Very Bad’ by 51.43%. A 62.86% reported doing nothing during the sessions and 57.14% are attracted by the idea of participating in a recreational program (according to a self-created questionnaire). Discussion and Conclusions: The median of the results in depression, anxiety, dependence, cognitive deterioration, perception of quality of life and perception of the treatment is seriously altered. According to the consulted bibliography, favoring the performance of ludic-therapeutic activities during hemodialysis can improve the attitude of patients, helping maintain an adequate level of both physical and mental health and improving the perception of treatment.

This article examines the 2012 young adult novel, Summer of the Mariposas , by Chicana writer Guadalupe Garcia McCall, a leading voice in Chicana and Latina children’s and young adult literature. I argue that the novel be read as a Chicana feminist text in its encouragement of strong bonds of Chicana sisterhood (“las cinco hermanitas”) specifically through a rejection and rewriting of the Mexican folkloric myth of La Llorona.

Witheringia solanacea is a small shrub that belongs to the Solanaceae family. The plant is used as an antidiabetic in Costa Rican herbal medicine. The aim of this study was to evaluate the hypoglycemic and antihyperglycemic activity of the aqueous extract of W. solanacea leaves in rodent models. About the materials and methods, a crude extract of W. solanacea leaves was prepared in boiling water and the aqueous filtrate was lyophilized. A single oral dose of 250, 500 and 1000 mg/kg of the extract was evaluated for hypoglycemic activity in a glucose tolerance test in normal rats and for antihyperglycemic activity in alloxan-induced (140 mg/kg) diabetic rats. The blood glucose level was determined at different times by the glucose oxidase method. It Result in a Dosage of 500 and 1000 mg/kg of the extract significantly decreased (p < 0.05) blood glucose levels in the glucose tolerance test in normal rats after 1 h, there was no significant difference observed at 250 mg/kg. Dose of 500 mg/kg of the extract significantly reduced (p < 0.05) blood glucose levels in alloxan induced hyperglycemic rats at 4 and 5 h. In Conclusion, in the present study, the hypoglycemic and antihyperglycemic potential of the W. solanacea was demonstrated in rats. These results give support to the traditional use of W. solanacea as antidiabetic herbal medicine. Witheringia solanacea es un pequeño arbusto que pertenece a la familia de las solanáceas. La planta se utiliza como antidiabético en la medicina herbal costarricense. El objetivo de este estudio fue evaluar la actividad hipoglucémica y antihiperglucémica del extracto acuoso de las hojas de W. solanacea en modelos de roedores. En cuanto a los materiales y métodos, se preparó un extracto crudo de hojas de W. solanacea en agua hirviendo y se liofilizó el filtrado acuoso. Se evaluó la actividad hipoglucémica de una dosis oral única de 250, 500 y 1000 mg/kg del extracto en una prueba de tolerancia a la glucosa en ratas normales y la actividad antihiperglucémica en ratas diabéticas inducidas por aloxano (140 mg/kg). El nivel de glucosa en sangre se determinó en diferentes momentos por el método de la glucosa oxidasa. Resultó que las dosis de 500 y 1000 mg/kg del extracto disminuyeron significativamente (p < 0,05) los niveles de glucosa en sangre en la prueba de tolerancia a la glucosa en ratas normales después de 1 hora, no observándose diferencias significativas con 250 mg/kg. La dosis de 500 mg/kg del extracto redujo significativamente (p < 0,05) los niveles de glucosa en sangre en ratas hiperglucémicas inducidas por alloxan a las 4 y 5 h. En conclusión, en el presente estudio se demostró el potencial hipoglucémico y antihiperglucémico de la W. solanacea en ratas. Estos resultados apoyan el uso tradicional de W. solanacea como medicina herbal antidiabética. Universidad Nacional, Costa Rica. Escuela de Ciencias Ambientales

Históricamente las construcciones de género han encauzado las sexualidades de las mujeres a vivir un proceso de discriminación y violencia a partir de la heteronormatividad, condicionando las experiencias de salud sexual y limitando un ejercicio de sus derechos. El presente artículo tiene como objetivo explorar los discursos y las prácticas heteronormativas que atraviesan la experiencia de la salud sexual en mujeres que asumen diversas identidades eróticas-amorosas, y comprender cómo a partir de esto se desprenden distintas formas de resistencia. Como resultado se encontró una construcción de dispositivos que sostienen y reproducen el heterosexismo, dando lugar a la invisibilización de las necesidades de las mujeres que se salen del marco heteronormativo, así como un conjunto de resistencias que se han creado desde la experiencia colectiva.

The goal in this article is to examine social problems associated with highly active antiretroviral therapy (HAART) adherence in Mexico and the related challenges for Mexican persons living with HIV/AIDS (PLWHAs). The study was conducted from the perspective of infected and affected individuals. The authors completed 64 in-depth interviews with heterosexual male and female PLWHAs, as well as with some key individuals from their social network. Following the principles of grounded theory, they carried out inductive analysis to create codes and organize central themes. The authors identified problems related to accessing HAART and found that conditions for implementing recommendations made in the international literature to improve adherence are poor. The findings highlight the importance of social factors, such as health care system irregularities, ineffective physician—patient communication, and availability of family and other sources of social support such as self-help groups for PLWHAs' access and adherence to antiretroviral therapy in Mexico.

CPT-11 is a potent inhibitor of topoisomerase I and has shown antitumor activity in brain xenografts and in clinical trials in recurrent/progressive malignant glioma. VM-26 and VP-16 are topoisomerase II inhibitors and have also shown activity in phase II trials. We performed a phase II trial of intravenous CPT-11 (125 mg/m2) followed 24 h later by VM-26 (125 mg/m2). VP-16 (125 mg/m2) was later substituted for VM-26 due to drug shortage. For patients on anticonvulsants, the starting dose for all drugs was 150 mg/m2. Drugs were given weekly for 3 weeks followed by 1-week rest. Twenty-five patients were entered into the study. Three patients (12%) had improvement in CAT/MRI brain scans (95% confidence interval 3-31%). Fatigue and myelosuppression, mainly leukopenia, were the main toxicities. This combination of the topoisomerase I inhibitor CPT-11 followed by the topoisomerase II inhibitor, VM-26 or VP-16, has shown modest antitumor activity comparable to that reported for each drug singly. Myelosuppression is the main toxicity when topoisomerase I and II inhibitors are combined together.

Analgesics tramadol and morphine were used in mice injected with Bothrops asper venom. Analgesics did not alter the acute toxicity of B. asper venom in mice. Precautionary (prophylactic) analgesia should be introduced routinely in Toxinology. UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto Clodomiro Picado (ICP)

Snakebite envenoming by Bothrops caribbaeus, an endemic viperid from the Lesser Antillean island of Saint Lucia, is clinically characterized by local tissue damage and systemic thrombosis that can lead to cerebral, myocardial or pulmonary infarctions and venous thromboses. Systemic effects (lethality, pulmonary hemorrhage, thrombocytopenia and coagulopathy) induced by intravenous (i.v.) administration of B. caribbaeus venom were studied in mice. The role of snake venom metalloproteinases (SVMPs) in these systemic alterations was assessed by inhibition with the chelating agent calcium disodium ethylenediaminetetraacetic acid (CaNa2EDTA). A snake C-type lectin-like (snaclec) and a type P-III hemorrhagic SVMP were isolated and characterized from this venom, and the effect of venom and the isolated snaclec on human platelet aggregation was studied in vitro. Results indicate that SVMPs play an important role in the overall toxicity of B. caribbaeus venom, being responsible for systemic hemorrhage and lethality, but not thrombocytopenia, whereas the isolated snaclec is involved in the thrombocytopenic effect. Both venom and snaclec induce platelet aggregation/agglutination. Moreover, the snaclec binds directly to glycoprotein Ib (GPIb) and induces agglutination in washed fixed platelets. On the other hand, B. caribbaeus venom hydrolyzed fibrinogen in vitro and induced a partial drop of fibrinogen levels with an increase in fibrin/fibrinogen degradation products (FDP) levels in vivo. The negative result for D-dimer (DD) in plasma is consistent with the lack of microscopic evidence of pulmonary thrombosis and endothelial cell damage. Likewise, no increments in plasma sE-selectin levels were detected. The absence of thrombosis in this murine model suggests that this effect may be species-specific. Universidad de Costa Rica/[741-B0-606]/UCR/Costa Rica UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto Clodomiro Picado (ICP)

OBJETIVO: Analizar la experiencia del aval ciudadano en el sistema de salud mexicano en la mejora de los servicios de salud. METODOS: Estudio de corte cualitativo en ocho estados de México en 2008. Se evaluaron diferentes aspectos del programa nacional para mejorar la calidad de los servicios de salud. Se compara la estrategia de México con otras experiencias en América Latina. RESULTADOS: Se exponen los avances y problemas del funcionamiento del aval ciudadano, figura que promueve la participación social en salud de la población. CONCLUSIONES: El aval ciudadano es una figura con gran potencial para representar a los usuarios en los servicios de salud y transmitir sus demandas de mejora de la calidad de la atención médica. OBJECTIVE: This article describes the experience of the aval ciudadano "Citizens' Representative" (CR) in improving the Mexican health care system. METHODS: This is a qualitative study which took place in eight Mexican states in 2008. It evaluates different aspects of a nationwide program to increase the quality of health care services (National Crusade for Quality in Health Services). The Mexican strategy is compared with experiences in other Latin American countries. RESULTS: In this paper, there is the description of achievements and problems encountered by the CR in promoting social participation in the health of the population. CONCLUSIONS: The CR has great influence when representing health service users and passing on their demands for improvements to health care quality. OBJETIVO: Analisar a experiência do aval ciudadano (reforço cidadão) no sistema de saúde mexicano na melhora dos serviços de saúde. MÉTODOS: Estudo de coorte qualitativo em oito estados mexicanos, em 2008. Foram avaliados diferentes aspectos do programa nacional para melhora de qualidade nos serviços de saúde. Compara-se a estratégia no México com outras experiências na América Latina. RESULTADOS: Foram expostos os avanços e problemas de funcionamento do aval ciudadano (reforço cidadão), figura que promove a participação social na saúde da população. CONCLUSÕES: O aval ciudadano (reforço cidadão) é uma figura com grande potencial para representar os usuários dos serviços de saúde e transmitir suas exigências de melhorias na qualidade da atenção médica.

Objective. To increase the knowledge of health care pro- vidersunderstanding of and practices on domestic violence, in order to improve care. Materials and Methods. This study was conducted between May and November 2003, In Quintana Roo, Coahuila, and Mexico City, three Mexican states with a high prevalence of domestic violence. Sixty in- depth interviews with health care providers in public health institutions and key informants of health service provision were completed. Results. Health care providers were cat- egorized based on the extent to which they reproduced four "discourses about violence". These discourses influence their daily practice and are related to the informants' gen- der values and social positions. Most informants expressed their willingness to address the issue of domestic violence. Conclusions. Attention to and care for domestic violence is insufficient in health services; this may be due more closely related to a predominant discourse tolerating domestic vi- olence among decision-makers, than to the attitudes of health care providers; the latter demonstrated greater awareness of women's rights.