Resumen Objetivos: Evaluar el impacto de la suplementación con colecalciferol (D₃) mediante variables clínicas y para clínicas en pacientes con RA e insuficiencia y deficiencia de vitamina D. Métodos: Estudio aleatorio, doble ciego, placebo controlado, en el que se incluyeron pacientes de 5 a 40 años, con diagnóstico de RA e insuficiencia y deficiencia de vitamina D. Fueron suplementados con 4000 o 5000 UI,dependiendo de la edad, durante 8 semanas. Mensualmente se midió la puntuación total síntomas nasales (TNSS) y las concentraciones de 25(OH)D₃ al inicio y al final del estudio. Resultados: Se incluyeron 31 pacientes, con una edad promedio de 18.19 años. En el grupo activo existió una mejoría significativa en la sintomatología respecto a la puntación de TNSS y un incremento en los niveles séricos de vitamina D (p < 0.01). No se presentaron reacciones adversas con la ingesta de colecalciferol o placebo. Conclusiones: Suplementar a los pacientes con vitamina D₃ , a la dosis evaluada, junto con el tratamiento convencional para la rinitis alergica resulta en una mejoría sintomática y en la calidad de vida de los pacientes con esta enfermedad.

Abstract Objectives: To evaluate the impact of cholecalciferol (D₃ ) supplementation using clinical and paraclinical variables in patients with RA and vitamin D insufficiency and deficiency. Methods: A randomized, double-blind, placebo-controlled study included patients from 5 to 40 years with a diagnosis of RA and vitamin D insufficiency and deficiency. They were supplemented for 8 weeks with 4000 or levels at baseline and at the end of the study. Results: A total of 31 patients were included, with a mean age of 18.19 years. In the active group, there was a significant improvement in symptomatology with respect to the TNSS score and an increase in serum vitamin D levels (p < 0.01). There were no adverse reactions with cholecalciferol or placebo. Conclusions: Supplementing patients with vitamin D₃ , at the evaluated dose, together with conventional treatment for allergic rhinitis results in symptoms and quality of life improvement in patients with this disease.

RESUMO Objetivos: o principal objetivo deste estudo foi descrever pacientes com achados vasculares retinianos temporalmente relacionados à vacinação contra COVID-19. Com maior notificação de possíveis eventos adversos similares, esperamos compreender a real dimensão e relevância do que foi apresentado. Métodos: Onze pacientes com queixas visuais após vacinação contra COVID-19 foram estudados. Os dados analisados foram: idade, gênero, tipo de vacinação, tempo de aparecimento de sintomas, achados sistêmicos, antecedentes pessoais, acuidade visual com melhor correção, biomicroscopia e imagem retiniana multimodal (retinografia colorida, red-free, SD-OCT, OCTA e angiofluoresceinografia). Os critérios de inclusão foram a presença de alterações oftalmológicas ocorridas dentro de 30 dias após a primeira ou segunda dose de qualquer vacina contra COVID-19. Resultados: Onze pacientes foram incluídos: 5 com oclusão arterial (45,4%), 4 com oclusão venosa (36,4%) e 2 (18,2%) com alterações não específicas vasculares sugestivas de isquemia retiniana como exsudatos algodonosos. A idade média dos pacientes foi de 57 anos (DP=16; com intervalo de 27 a 84 anos). A média de tempo de aparecimento de sintomas após a vacinação foi de 10 dias (DP=5,4; com intervalo de 3 a 16 dias). Nove dos onze pacientes eram do sexo feminino (81,8%). Fatores de risco sistêmicos foram observados em 36,4% dos pacientes. Dois pacientes tiveram sintomas neurológicos e visuais, com oclusão arterial. 36,4% dos pacientes tiveram infecção prévia por COVID-19 no último ano. Sete pacientes (63,6%) receberam a vacina ChAdOx1 nCoV-19 (AZD1222). Conclusões: nossos dados sugerem que eventos retinianos temporalmente relacionados à vacinação contra COVID-19 são possíveis, porém raros. A relação entre estes eventos pós-vacinais exigem futura atenção antes de maiores conclusões.

ABSTRACT Purpose: The primary purpose of this study was to assess vascular retinal findings temporally related to COVID-19 vaccination. With greater information regarding all possible future adverse events, we hope to understand the real dimension and relevance of what was presented. Methods: Eleven patients with visual complaints after COVID-19 vaccination were enrolled. Data on the following were included: age, sex, vaccine, time of symptom onset, systemic findings, medical history, best-corrected visual acuity, and ocular findings by slit-lamp biomicroscopy as well as multimodal retinal imaging (color fundus, red-free photography, spectral-domain optical coherence tomography, optical coherence tomography angiography, and fluorescein-angiography). Inclusion criteria were the presence of ophthalmologic signs within 30 days after the first or second dose of any COVID-19 vaccine. Results: Of 11 patients, five had arterial occlusion (45.4%), four had venous occlusion (36.4%), and two (18.2%) had nonspecific vascular alterations suggestive of retinal ischemia such as cotton-wool spots. The mean age was 57 (SD = 16; range: 27-84) years. The mean time of symptoms onset was 10 (SD = 5.4; range: 3-16) days. Nine patients were female (81.8%). Systemic risk factors were observed in 36.4% of patients. Two patients had both neurological and visual symptoms, with arterial occlusion. Overall, 36.4% patients had COVID-19 in the previous year. Seven patients (63.6%) received ChAdOx1 nCoV-19 (AZD1222) vaccine. Conclusions: Our data suggest that retinal events temporally related to COVID-19 vaccination are possible but are very rare. The relationship of these events with post-COVID-19 vaccination warrants further attention to derive a meaningful conclusion.

Resumen Oligonychus perseae es un ácaro conocido como araña cristalina que afecta al cultivo de aguacate (Persea americana), prácticamente a nivel mundial. En países como Estados Unidos de América y España se reporta como la principal plaga que afecta el follaje del aguacatero. Los daños incluyen afectación de los tejidos celulares de las hojas debido a la alimentación del ácaro, defoliación y hasta daños por mancha de sol debido a la baja cantidad de follaje en el árbol. El umbral económico de esta plaga se reporta entre 100 y 500 ácaros por hoja. La finalidad del presente estudio fue modelizar el comportamiento de las poblaciones de araña cristalina en cuatro municipios productores de aguacate en el Estado de México. Los resultados mostraron que los municipios más afectados por esta plaga fueron Donato Guerra y Temascaltepec. Se observó que el estrato más afectado fue el bajo con 40 arañas por hoja, en el que se encontraron hasta 130 ácaros por árbol. Las poblaciones de araña cristalina se distribuyen de manera agregada en los municipios muestreados y se apegan a modelos esféricos y gaussianos principalmente. Todos los muestreos se validaron adecuadamente mediante el proceso de validación cruzada. La distribución de las poblaciones se ilustró mediante mapas de densidad que muestran la ubicación precisa de los centros de agregación en los municipios muestreados. Con base en los mapas se calculó la superficie infestada, la que supera el 57 % de la superficie de los municipios evaluados.

Summary Oligonychus perseae is a mite known as persea mite that affects avocado (Persea americana) plantations practically worldwide. It is reported as the main pest affecting avocado tree foliage in countries like the United States of America and Spain. Damages include injuries to the cell tissues of the leaves due to mite feeding, defoliation and even sunspot damages due to the low amount of foliage on the tree. The economic threshold of this pest is reported between 100 and 500 mites per leaf. The purpose of this study was to model the behavior of persea mite populations in four avocadoproducing municipalities in the State of Mexico, Mexico. Results showed that the municipalities most affected by this pest were Donato Guerra and Temascaltepec. It was observed that the most affected stratum was the lower one with 40 mites per leaf, in which up to 130 mites per tree were found. Persea mite populations are distributed in an aggregate way in the sampled municipalities and mainly correspond to spherical and Gaussian models. All samplings were properly validated through the cross-validation process. The distribution of populations was illustrated by density maps that show the precise location of aggregation centers in the sampled municipalities. Based on the maps, the infested area was calculated, it exceeds 57 % of the area of the evaluated municipalities.

Resumen Introducción: La degeneración macular relacionada con la edad (DMRE) exudativa está asociada con la expresión del factor de crecimiento vascular endotelial (VEGF). Varios polimorfismos de un solo nucleótido (SNP) en el gen VEGF están asociados con diferentes patrones de expresión de esta citocina (polimorfismos funcionales). En este estudio consideramos 4 SNP que están ubicados en la región promotora (rs699947 A/C, rs833061 C/T, rs1005230 C/T y rs1570360 A/G) y dos en la región 5’ no traducida (rs2010963 C/G y rs25648 C/T) que tienen efecto sobre la regulación de la transcripción. Objetivo: Asociar SNP funcionales con la DMRE exudativa en población mexicana. Métodos: A través de reacción en cadena de la polimerasa con ensayos de discriminación alélica con sondas Taqman®, los polimorfismos fueron genotipados. Las frecuencias genotípicas se compararon utilizando todos los modelos de herencia. Resultados: Los SNP fueron genotipados en 105 pacientes diagnosticados con DMRE exudativa (61 mujeres y 44 hombres, edad promedio 74.28 ± 8.32 años) y en 102 sujetos control sanos (61 mujeres y 41 hombres, edad promedio 67.41 ± 5.78 años). Los genotipos en ambos grupos estaban en el equilibrio de Hardy-Weinberg. En cualquiera de los SNP analizados, la frecuencia de alelos menores fue diferente entre los grupos, con significación estadística. Los genotipos no mostraron diferencias estadísticamente significativas entre la DMRE exudativa y los grupos control (p > 0.05). Conclusión: No se encontró asociación entre los SNP estudiados y la presencia de DMRE exudativa en la población mexicana analizada. Consideramos necesario un análisis adicional en muestras más grandes para confirmar estos hallazgos.

Abstract Introduction: The wet form of age-related macular degeneration (WAMD) is related to the expression of vascular endothelial growth factor (VEGF). Several single nucleotide polymorphisms (SNPs) in the VEGF gene are associated with different expression patterns of this cytokine (functional polymorphisms). In this study, we considered 4 SNPs that are located in the promoter region (rs699947 A/C, rs833061 C/T, rs1005230 C/T and rs1570360 A/G) and two in the 5’ untranslated region (rs2010963 C/G and rs25648 C/T) that have an effect on transcriptional regulation. Objective: To associate functional SNPs with WAMD in a Mexican population. Methods: Through allelic discrimination assays, consisting in polymerase chain reactions with Taqman® probes, the polymorphisms were genotyped. Genotype frequencies were compared using all inheritance models. Results: SNPs were genotyped in 105 patients diagnosed with WAMD (61 women and 44 men, mean age 74.28 ± 8.32 years), and in 102 healthy control subjects (61 women and 41 men, mean age 67.41 ± 5.78 years). Genotypes in both groups were in Hardy-Weinberg equilibrium. In all SNPs analyzed, the minor allele frequency was statistically significant different between the groups. Genotypes were not statistically significant different between the WAMD and the control groups (p > 0.05). Conclusion: No association was observed between the studied SNPs and the presence of WAMD in the analyzed Mexican population. We consider that further analysis in larger samples is necessary to confirm these findings.

RESUMEN Se presenta este Artículo de Revisión con base en la evidencia científica actual sobre medicina espacial enfocada en fisiología humana y sus contramedidas. Por lo cual se realizó una búsqueda bibliográfica no sistemática de artículos científicos y libros de investigación en inglés-español de los últimos 7 años, que detallan su aplicación en seres humanos, modelos murinos y experimentos in vitro. Se tomaron en cuenta las condiciones del ambiente espacial como microgravedad y radiación que producen considerables cambios fisiológicos en el sistema cardiovascular (redistribución de líquidos, remodelación cardiovascular, arritmias); nervioso (sensitivomotores, neurosensoriales, neurovestibulares); respiratorio (cambios de volúmenes y capacidades); renal (litiasis); musculo-esquelético (atrofia muscular, osteoporosis); hematológico (anemia); inmunológico (desregulación inmune) y digestivo (alteración de la microbiota intestinal). Además, existen procesos biológicos, moleculares y genéticos aún por explorar, para conocer y mitigar los mecanismos inciertos desencadenados en ambientes extremos y peligrosos. Por lo tanto, es una prioridad desarrollar e implementar contramedidas para reducir los efectos nocivos en la salud, con el objetivo de garantizar la adaptación, seguridad y performance del astronauta durante futuros viajes espaciales.

ABSTRACT This Review Article is presented based on current scientific evidence on space medicine focused on human physiology and its countermeasures. Therefore, a non-systematic bibliographic search of scientific articles and research books in English-Spanish of the last 7 years was carried out, detailing their application in humans, murine models and in vitro experiments. The conditions of the space environment such as microgravity and radiation that produce considerable physiological changes in the cardiovascular system (redistribution of fluids, cardiovascular remodeling, arrhythmias) were taken into account; nervous (sensorivomotor, neurosensory, neurovestibular); respiratory (volume and capacity changes); renal (lithiasis); musculoskeletal (muscular atrophy, osteoporosis); hematological (anemia); immunological (immune dysregulation) and digestive (intestinal microbiota disorder). In addition, there are biological, molecular and genetic processes still to be explored, in order to know and mitigate the uncertain mechanisms triggered in extreme and dangerous environments. Therefore, it is a priority to develop and implement countermeasures to reduce the harmful effects on health, with the aim of guaranteeing the astronaut's adaptation, safety and performance during future space flights.

Resumen Objetivo: Las células del epitelio pigmentario retiniano tienden a la apoptosis en la distrofia macular de Stargardt (STGD). Anteriormente, los polimorfismos de un solo nucleótido (SNP) del gen del receptor Toll de tipo 4 (TLR4) se habían relacionado con la apoptosis y la inflamación. Por tanto, este estudio se realizó para investigar si los SNP del TLR4 están asociados con la STGD en un estudio familiar. Métodos: Se incluyeron 4 pacientes mexicanos consanguíneos con diagnóstico clínico de STGD (4 mujeres) y 12 familiares no afectados. Se utilizaron como control 109 sujetos (40 hombres y 69 mujeres; edad, 63.28 ± 7.93 años) sin enfermedades maculares ni antecedentes familiares. Los SNP rs4986790, rs1927911, rs12377632, rs2149356 y rs11536889 del gen TLR4 fueron genotipados usando un ensayo de discriminación alélica Taqman®. Resultados: La frecuencia del alelo menor rs4986790 (G) fue significativamente mayor en pacientes con STGD en comparación con los controles (25 vs. 1%; p = 0.0012). El genotipo portador del alelo menor rs4986790 (AG) fue más frecuente en los pacientes con STGD (50%) en comparación con sus familiares y controles (8 y 2.75%, respectivamente) de manera significativa (p = 0.0048). Las frecuencias alélicas y genotípicas de los SNP restantes no fueron significativas entre pacientes con STGD y controles (p > 0.5). Los familiares no afectados mostraron frecuencias alélicas y genotípicas similares a las encontradas en los controles. Conclusión: El alelo menor del SNP rs4986790 (G) y el genotipo portador (AG) se relacionaron con la enfermedad de Stargardt clínica. Curiosamente, el rs4986790 se ha descrito como un promotor de la apoptosis. Así, pues, este polimorfismo del gen TLR4 debe considerarse como un marcador en estudios futuros.

Abstract Purpose: Retinal pigment epithelial cells exhibit a propensity for apoptosis in Stargardt macular dystrophy (STGD). Previously, single-nucleotide polymorphisms (SNPs) in the toll-like receptor 4 (TLR4) gene have been related to apoptosis and inflammatory response. Therefore, this study was undertaken to investigate whether TLR4 SNPs are associated with STGD in a family-based study. Methods: Four blood-related Mexican patients with a clinical diagnosis of STGD (4 women) and 12 of their unaffected relatives were included in the study. A total of 109 subjects (40 men and 69 women; age, 63.28 ± 7.93 years) without macular affections, family history, or inherited macular dystrophies were used as controls. SNPs rs4986790, rs1927911, rs12377632, rs2149356, and rs11536889 of the TLR4 gene were genotyped using a Taqman® Allelic Discrimination Assay. Results: The frequency of the minor allele of rs4986790 (G) was significantly higher in STGD patients compared to control subjects (25% vs. 1%, p = 0.0012). The genotype carrying the minor allele of rs4986790 (AG) was more frequent in STGD patients (50%) compared with their relatives and unrelated control subjects (8 and 2.75%, respectively), with statistical significance (p = 0.0048).The allele and genotype frequencies of the remaining SNPs were not significant between STGD patients and control subjects (p > 0.5). Unaffected relatives of STGD patients showed allele and genotype frequencies similar to those observed in control subjects. Conclusion: Minor alleles of the SNPs rs4986790 (G) and genotypes carrying it (AG) were related to clinical STGD in one family. Interestingly, rs4986790 has been described as a promoter of apoptosis. Therefore, this TLR4 gene polymorphism should be considered as a marker in future studies.

O presente documento foi preparado por um grupo de especialistas, membros das Sociedades de Cardiologia, Endocrinologia, Medicina Interna, Nefrologia e Diabetes dos países da América Latina, para que sirva de diretriz para médicos que cuidam de pacientes com diabetes, hipertensão e fatores de risco concomitantes ou complicações de ambas as condições. Embora o conceito de síndrome metabólica seja atualmente muito discutido, a alta prevalência na América Latina do conjunto de alterações metabólicas que a compõem sugere que a síndrome metabólica é uma entidade nosográfica útil no contexto da medicina latino-americana. Devido a isso, no presente documento presta-se especial atenção a essa síndrome com a finalidade de alertar aos médicos sobre uma população particularmente de alto risco, que, por ser subestimada, não é tratada de forma adequada para os fatores de risco que constituem a síndrome metabólica. As recomendações deste documento são o resultado de apresentações e debates que ocorreram durante um encontro de dois dias em Bucaramanga (Colômbia), em outubro de 2012. Todos os participantes aprovaram as decisões finais. Os autores reconhecem que a publicação e difusão das diretrizes não serão suficientes para alcançar as mudanças recomendadas tanto em estratégias diagnósticas como terapêuticas, por isso programaram intervenções que permitirão identificar as barreiras do conhecimento, as atitudes e comportamento, o que permitirá tanto aos médicos como aos pacientes uma adequada adesão às recomendações sugeridas nestas diretrizes. Arq Bras Endocrinol Metab. 2014;58(3):205-25

The present document has been prepared by a group of experts, members of cardiology, endocrinology, internal medicine, nephrology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is a useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations. Arq Bras Endocrinol Metab. 2014;58(3):205-25

En este trabajo se evaluó el rendimiento de la producción de jarabes de fructosa a partir del almidón extraído de dos especies de ñame (Dioscorea alata var. Diamante y Dioscorea rotundata var. Espino). Se estableció un diseño experimental multifactor categórico completamente al azar con dos factores: concentración de sustrato en cinco niveles: 10, 20, 30, 40, 50% p/v, y la especie de ñame en dos niveles: Dioscorea alata, var. Diamante y Dioscorea rotundata, var. Espino. Para la obtención de fructosa, inicialmente se prepararon jarabes de glucosa por medio de hidrólisis enzimática del almidón de ñame, utilizando las enzimas de Novozymes®, alfa-amilasa Termamyl 120L (etapa de licuefacción) y aminoglucosidasa (AMG) 300L (etapa de sacarificación). En esta etapa los máximos equivalentes de dextrosa (ED) obtenidos son 98,28 y 96,84, para una concentración de sustrato del 30% p/v. Posteriormente se procedió a isomerizar los jarabes de glucosa a jarabes de fructuosa, utilizando la enzima inmovilizada Sweetzyme de Novozymes®. Los mejores resultados se alcanzaron a una concentración de sustrato del 30% p/v para ambas especies de ñame, las cuales presentan concentraciones de 220,57 y 210,36 g de fructosa/L, con conversiones de glucosa a fructosa de 71,46% y 67,28% para ñame Espino y Diamante respectivamente. No se encontraron diferencias estadísticamente significativas entre las especies de ñame (D. alata var. Diamante y D. rotundata var. Espino), a un nivel de confianza del 5%, en cuanto a la producción de jarabe fructosado.

This investigation evaluated the yield of fructose syrup production from extracted starch of two yam species (Dioscorea alata, var. Diamond and Dioscorea rotundata, var. Espino). The experiment was conducted using an at random experimental design of multiple categorical factor analysis with two factors: a substrate concentration factor at five levels: 10, 20, 30, 40, 50% p/v and the yam species factor at two levels (Dioscorea alata, var Diamond and Dioscorea rotundata, var Espino). To obtain fructose, initially glucose syrups were prepared by enzymatic hydrolysis of yam starch using the enzymes of Novozymes®, alpha-amylase Termamyl 120L (liquefaction stage) and AMG 300L (saccharification stage). At this stage, dextrose maximum equivalents (ED) obtained were 98.28 and 96.84 for a substrate concentration of 30% w/v. In a later stage isomerisation from glucose syrups to fructose syrups using the immobilized enzyme Sweetzyme of Novozymes® was carried out. The best results were achieved with substrate concentrations of 30% p/v for both yam species, which showed fructose concentrations of 220.57 and 210.36 g/L with conversions of 71.46% and 67.28% in Espino and Diamond yams respectively. No statistically significant differences were observed between the yam species (D. alata var. Diamante and D. rotundata var. Espino) at a confidence level of 5%, regarding the production of fructose syrup.

Between 1974 and 1987 we have examined 50 patients with the diagnosis of myasthenia gravis. Female preponderance (2,5: 1) was found. Also, it was observed that most of the patients were aged between 20 and 49 years. Beside the clinical examination, the following tests were performed: (1) edrofonium test, (2) supramaximal repetitive nerve stimulation, (3) serum acetylcholine antibodies titers and (4) intraperitoneal passive transference of patient's sera to mice and recording of meepp's amplitude in the phrenic-diaphragm preparation in vitro. These four tests gave positive values for myasthenia in 90 to 100% of the cases. Thymus radiological examination was carried out by pneumomediastinography, which proved to correlate with the hsitological picture of the gland, and computed tomography, which disclosed some discrepances with the histology. Treatment was based on anticholinesterase drugs, corticosteroids and thymectomy, being the corticosteroids the most valuable therapeutical tool. Nine patients treated with steroids disclosed transitory worsening of their signs and symptoms at very early stages after onset of corticosteroid therapy, 6 of them had a disfavorable course in their follow-up. This observation seem to have value in the early prognosis of the disease.

Durante la observacion de 50 pacientes con Myasthenia gravis entre los anos 1974 y 1987 se encontro un predominio del sexo femenino en la proporcion de 2,5 a 1 y mayor frecuencia de presentacion en Ias 3ª y 5ª décadas de la vida. Luego de la evaluacion clínica, el diagnóstico fué confirmado mediante: (1) prueba dei edrofonio, (2) estímulo nervioso repetitivo, (3) dosaje de anticuerpos antirreceptor colinérgico y (4) transferencia pasiva del suero al raton con ulterior niedicion de la amplitud de mepp's. La positividad diagnostica vario entre el 90 y el 100%, segun el tipo de prueba empleada. El estúdio radiológico del timo fué hecho con neumomediastinografía. obteniendose excelente correlación con la descripcion histológica de la glândula, y con tomografia computada, que demostro menor eficiência diagnostica. El tratamiento fué implementado en base a anticolinesterásicos, timectomía y corticoterapia inmunosupresora, evidenciandose con esta última mejores resultados. Nueve pacientes desarrollaron peoria transitória del cuadro muscular al iniciarse el tratamiento esteroideo, 6 de ellos exhibieron posteriormente evolucion desfavorable. Esta observacion aparenta tener valor pronóstico en la evolucion de la MG.