RESUMO

Pharmacogenomics (PGx) is considered an emergent field in developing countries. Research on PGx in the Latin American and the Caribbean (LAC) region remains scarce, with limited information in some populations. Thus, extrapolations are complicated, especially in mixed populations. In this paper, we reviewed and analyzed pharmacogenomic knowledge among the LAC scientific and clinical community and examined barriers to clinical application. We performed a search for publications and clinical trials in the field worldwide and evaluated the contribution of LAC. Next, we conducted a regional structured survey that evaluated a list of 14 potential barriers to the clinical implementation of biomarkers based on their importance. In addition, a paired list of 54 genes/drugs was analyzed to determine an association between biomarkers and response to genomic medicine. This survey was compared to a previous survey performed in 2014 to assess progress in the region. The search results indicated that Latin American and Caribbean countries have contributed 3.44% of the total publications and 2.45% of the PGx-related clinical trials worldwide thus far. A total of 106 professionals from 17 countries answered the survey. Six major groups of barriers were identified. Despite the region's continuous efforts in the last decade, the primary barrier to PGx implementation in LAC remains the same, the "need for guidelines, processes, and protocols for the clinical application of pharmacogenetics/pharmacogenomics". Cost-effectiveness issues are considered critical factors in the region. Items related to the reluctance of clinicians are currently less relevant. Based on the survey results, the highest ranked (96%-99%) gene/drug pairs perceived as important were CYP2D6/tamoxifen, CYP3A5/tacrolimus, CYP2D6/opioids, DPYD/fluoropyrimidines, TMPT/thiopurines, CYP2D6/tricyclic antidepressants, CYP2C19/tricyclic antidepressants, NUDT15/thiopurines, CYP2B6/efavirenz, and CYP2C19/clopidogrel. In conclusion, although the global contribution of LAC countries remains low in the PGx field, a relevant improvement has been observed in the region. The perception of the usefulness of PGx tests in biomedical community has drastically changed, raising awareness among physicians, which suggests a promising future in the clinical applications of PGx in LAC.

RESUMO

The liver has a complex vascularization and is subjected to a high metabolic demand, making it vulnerable to hemodynamic changes. As a result, several pathologies can develop, one of which is congestive hepatopathy. This disease occurs secondary to various cardiovascular conditions that generate a persistent passive venous congestion in the liver, which in the long term can culminate in fibrosis and cirrhosis, which in turn increases the risk of developing hepatocellular carcinoma. In order to avoid this outcome, early diagnosis is crucial; however, both the clinical presentation and laboratory tests are unspecific, and they are only altered in advanced stages of the disease. One form of early detection is through imaging findings, there being various useful modalities such as Doppler ultrasonography (US), computed tomography, and magnetic resonance imaging. The purpose of this article is to detail the imaging findings of congestive hepatopathy in the different available modalities, with special emphasis on Doppler US, highlighting the role of the radiologist in the suspicion of this disease. We summarize the pathophysiologic mechanisms of congestive hepatopathy, clinical findings, and provide description of its main differential diagnoses.

Assuntos

RESUMO

BACKGROUND: Infection by Adenovirus 36 (Ad-36) has been associated with adipogenesis using cell and animal models, and a high risk of developing obesity has been reported in Ad-36-seropositive individuals. However, molecular mechanisms involved in the maintenance over the years of adipogenesis associated with Ad-36 has not been investigated in human adipose tissue. Epigenetic mechanisms, such as micro-RNAs (miRNAs) that regulate gene expression at the post-transcriptional level, have shown an important role in the development and maintenance of metabolic diseases. AIM: This study investigated the expression of miRNA associated with the adipogenic process in visceral adipose tissue from obese individuals according to Ad-36 serology. METHODS: Obese individuals were separated according to their status of Ad-36 serology in seropositive (Ad-36 (+); n = 29) and seronegative (Ad-36 (-); n = 28) groups. Additionally, a group of lean controls (n = 17) was selected to compare with obese individuals. Biopsies of visceral adipose tissue were obtained to evaluate miRNA and gene expression. The study of Ad-36 serology was carried out by ELISA. The expression of pro-adipogenic (miR-17 and miR-210) and anti-adipogenic (miR-155, miR-130 and miR-27a) miRNAs was evaluated using Taqman advanced miRNA assays by qPCR. The expression of adipogenes encoding LEP, ADIPOQ, and PPARγ was evaluated by Taqman predesigned assays through qPCR. RESULTS: The obese group had higher LEP (p < 0.001) and PPARγ (p = 0.016) expression and lower ADIPOQ expression (p = 0.017), and also had higher expression of miR-210 (p = 0.039), whereas lower expression of miR-155 (p = 0.019) and miR-27a (p = 0.028) as compared to lean controls. Higher PPARγ expression (p = 0.008), but no influence on LEP or ADIPOQ expression was observed in Ad-36 (+) group. Those seropositive individuals also had higher expression of the miR-17 (p = 0.028) and lower levels of miR-155 (p = 0.031) in adipose tissue as compared to seronegative subjects. CONCLUSIONS: Individuals with previous infection by Ad-36 had higher expression of the pro-adipogenic miR-17 and lower expression of the anti-adipogenic miR-155, which could lead to an increased adipogenic status by positively modulating PPARγ expression in adipose tissue from obese subjects.

Assuntos

RESUMO

INTRODUCCIÓN La fenitoína es usada con mucha frecuencia en nuestro medio, por lo que se requiere hacer estudios de monitorización terapéutica, que contribuya a minimizar los efectos adversos y optimizar la terapia farmacológica. En ese contexto, nuestro objetivo ha sido determinar el índice nivel/dosis de la fenitoína en pacientes epilépticos voluntarios de Mérida. MÉTODOS Se realizó un estudio descriptivo, observacional y por reclutamiento consecutivo concurrente, conformado por 30 pacientes voluntarios con diagnóstico de epilepsia. Las muestras de suero se obtuvieron en niveles mínimos de pacientes que estaban en tratamiento con fenitoína durante 1 mes. Los niveles del fármaco se cuantificaron por el método de Inmunoensayo de enzima donante clonada en el equipo Indiko Thermo Scientific. RESULTADOS El índice nivel/dosis fue de 1,4 y 1,6, la concentración plasmática de 4,8mg/l y 8,0mg/l, la capacidad metabólica de 388,4 y 462,9mg/día, respectivamente en mujeres y hombres. Mientras que el nivel de la concentración plasmática en el estado estacionario fue de 6,5mg/l y 5,5mg/l, la dosis de carga máxima de 237,3mg y de 395,6mg, respectivamente en mujeres y hombres con epilepsia de la ciudad de Mérida. CONCLUSIONES Nuestros resultados sugieren que se debe individualizar la dosis en base al índice nivel/dosis de cada paciente, ya que no se puede extrapolar para todos los pacientes con epilepsia, debido a diversos factores como al fenotipo metabólico y al uso de fármacos inductores e inhibidores enzimáticos.

INTRODUCTION Phenytoin is used very frequently in our environment, so it is necessary to do studies of therapeutic monitoring, which helps to minimize adverse drug reaction and optimize pharmacological therapy. In this context, our objective was to determine the level/dose index of phenytoin in volunteer epileptic patients from Mérida. METHODS A descriptive, observational and consecutive concurrent recruitment study was carried out, consisting of 30 volunteer patients with a diagnosis of epilepsy. The serum samples were obtained in minimum levels from patients who were in treatment with phenytoin for 1 month. The levels of the drug were quantified by the method of donor enzyme immunoassay cloned in the Indiko Thermo Scientific equipment. RESULTS The level/dose index was 1,4 and 1,6, the plasma concentration of 4,8mg/l and 8,0mg/l, the metabolic capacity of 388,4 and 462,9mg/day, respectively in women and men. While the level of plasma concentration at steady state was 6,5mg/l and 5,5mg/l, the maximum loading dose of 237,3mg and 395,6mg, respectively in women and men with epilepsy of the city of Mérida. CONCLUSIONS Our results suggest that the dose should be individualized based on the level/dose index of each patient, since it can not be extrapolated for all patients with epilepsy, due to various factors such as the metabolic phenotype and the use of enzyme-inducing drugs and inhibitors.

Assuntos

RESUMO

INTRODUCCIÓN: Desde diciembre de 2019 la neumonía por SARS-CoV-2 ha experimentado un fuerte avance presentando a la fecha más de nueve millones de casos a nivel mundial. El objetivo de esta revisión es describir las principales características de la neumonía por COVID-19 en la tomografía computada (TC) de tórax en pacientes adultos. MATERIALES Y MÉTODOS: Se buscaron en PubMed artículos que se centraran en las características de la infección por COVID-19 en la tomografía computada de tórax en adultos durante el último año, en inglés y español. Las palabras clave fueron: "COVID-19", "chest CT manifestations" "chest CT findings" y "chest CT features", excluyendo estudios en población pediátrica, cartas al editor y casos clínicos. Se examinaron títulos y resúmenes de artículos obtenidos y se descartaron estudios no atingentes al objetivo de la investigación. RESULTADOS: Se obtuvieron 21 artículos. Una gran variedad de hallazgos en la TC de tórax han sido reportados en los distintos artículos revisados, siendo los más característicos las opacidades en "vidrio esmerilado" de predominio periférico y bilateral; con o sin consolidaciones, que además pueden asociarse a engrosamiento septal interlobulillar, conformando un patrón en empedrado (crazy paving) y a engrosamiento perivascular. Menos frecuentes son el compromiso central, la presencia de nódulos, quistes y derrame pleural. CONCLUSIONES: La tomografía computada de tórax tiene un papel fundamental en la evaluación y manejo de los pacientes con COVID-19, con un evidente rol diagnóstico en ciertas situaciones. El conocimiento de sus características imagenológicas resulta de suma importancia en el contexto actual

Introduction: The new Coronavirus Disease 2019 (COVID-19) has become an unprecedented global health emergency. The World Health Organization estimates global mortality from COVID-19 at 3.4%, however it will be higher in patients with comorbidities such as Cancer (5.6%), High Blood Pressure (6.0%), Chronic respiratory disease (6.3%), Diabetes (7.3%) and Cardiovascular Disease (10.5%). These diseases are among the most prevalent in the world, for this reason we pretend to synthesize their pathophysiology and role in COVID-19, in order to identify effective measures that decrease morbidity and mortality in these high risk groups. Methodology: A review was performed using the databases MEDLINE, PubMed and Google Scholar. Original articles and bibliographic review articles were considered, prioritizing the articles published this year. Results: SARS-CoV-2 uses the enzyme ACE2 as a functional receptor, which allows its entry into the host cell. Eventually, regulates its expression downward, with Angiotensin-II prevailing with its profibrotic, prothrombotic and proinflammatory functions, leading to the deleterious effects of the disease. Chronic non-transmissible diseases (NTCD) would have baseline alteration in ACE2 levels, dysregulation of the immune system, endothelial dysfunction, and chronic inflammation, which would be associated with increased susceptibility and severity in COVID-19. Conclusion: Prevention and identification of risk patients remains the main measure against COVID-19. It is necessary to emphasize efforts in the prevention of NTCD and the promotion of healthy lifestyles. The negative effects of prolonged confinement and suspension of health care services must be considered.

Assuntos

RESUMO

El objetivo de esta investigación fue evaluar los efectos fisiológicos y neuroquímicos en 60 ratones machos cepas Naval Medical Research Institute (NMRI) en edad adulto-joven con pesos promedios de 25,45 ± 3,05 g, sometidos durante seis semanas a dosis del principio psicoactivo de la marihuana el Δ-9-tetrahidrocannabinol en concentraciones entre 4 - 20%. Se realizaron tomas de sangre retroorbital para evaluar parámetros hematológicos y bioquímicos antes, durante y post experiencia. Se monitorearon medidas tales como: peso, ingesta de agua, alimentos, actividad locomotora horizontal y vertical, entre otros. Al final de la experiencia se realizo autopsia y toma de muestras de regiones cerebrales, para medir niveles de neurotransmisores aminoacidicos y dopamina. Estos resultados permiten concluir que altas concentraciones del principio psicoactivo de la marihuana hacen más dependiente al consumidor con los consecuentes daños fisiológicos y neurológicos. Esto lleva a que cada vez se necesite más droga para producir el mismo efecto.

The objective of this research was to evaluate the physiological and neurochemical effects in 60 (Naval Medical Research Institute) NMRI male mice strains in young adult - age average weight 25.45 ± 3.05 g, underwent six weeks at doses of the psychoactive ingredient in marijuana the Δ -9-tetrahydrocannabinol in concentrations between 4-20 %. Retroorbital blood shots were conducted to evaluate hematological and biochemical parameters before, during and post experience. Weight, water intake, food, horizontal and vertical locomotors activity include: measures such as monitored. At the end of the experience autopsy was conducted and sampling of brain regions to measure levels of amino acid neurotransmitters and dopamine. These results suggest that high concentrations of the psychoactive ingredient in marijuana consumers become more dependent with consequent physiological and neurological damage. This leads to more and more drugs is needed to produce the same effect.

Assuntos

RESUMO

El Trastorno de Desatención e Hiperactividad (TDHA) esposiblemente la patología infantil que más auge ha adquiridoen las dos últimas décadas. Este trastorno es considerado,en muchos casos, una problemática social, tanto por sucada vez mayor prevalencia, como por el involucramientode distintos sectores en la misma. Ello ha llevado a queexista una fuerte presión desde la institución escolar y enalgunos casos también de la familia para que esta patologíainfantil encuentre una rápida resolución mediante el usode psicofármacos. En la actualidad, sin embargo, se hapuesto en duda los fundamentos científicos que muestranuna prevalencia elevada para este trastorno hasta alcanzar,en algunos casos, el 20% del total de población infantil.Ello conlleva a la discusión acerca de si es posible sosteneral TDHA como una entidad diagnóstica independiente, osi solo se trata de un conjunto de síntomas relativamenteindependientes entre sí

The disorder of inattention and hyperactivity is arguablythe child pathology more boom has acquired in the past twodecades, considered in many cases a real social problem, its increasing prevalence, both sectors that are involved with regard to the same. This hasled to that there is strong pressure from the school and in some cases also the family sothat this child pathology find a quick resolution through the use of psychoactive drugs.However, it should be questioned about the scientific foundations who claim a high andbelief so high prevalence for this pathology, reaching almost, in some cases, 20 per cent.Alternatively, if it is possible to hold to the TDHA as an independent diagnosed entity, orif it is only a relatively independent symptoms set with each other

Assuntos

RESUMO

El Trastorno de Desatención e Hiperactividad (TDHA) esposiblemente la patología infantil que más auge ha adquiridoen las dos últimas décadas. Este trastorno es considerado,en muchos casos, una problemática social, tanto por sucada vez mayor prevalencia, como por el involucramientode distintos sectores en la misma. Ello ha llevado a queexista una fuerte presión desde la institución escolar y enalgunos casos también de la familia para que esta patologíainfantil encuentre una rápida resolución mediante el usode psicofármacos. En la actualidad, sin embargo, se hapuesto en duda los fundamentos científicos que muestranuna prevalencia elevada para este trastorno hasta alcanzar,en algunos casos, el 20% del total de población infantil.Ello conlleva a la discusión acerca de si es posible sosteneral TDHA como una entidad diagnóstica independiente, osi solo se trata de un conjunto de síntomas relativamenteindependientes entre sí(AU)

The disorder of inattention and hyperactivity is arguablythe child pathology more boom has acquired in the past twodecades, considered in many cases a real social problem, its increasing prevalence, both sectors that are involved with regard to the same. This hasled to that there is strong pressure from the school and in some cases also the family sothat this child pathology find a quick resolution through the use of psychoactive drugs.However, it should be questioned about the scientific foundations who claim a high andbelief so high prevalence for this pathology, reaching almost, in some cases, 20 per cent.Alternatively, if it is possible to hold to the TDHA as an independent diagnosed entity, orif it is only a relatively independent symptoms set with each other(AU)

Assuntos

RESUMO

Con el fin de detectar la presencia de benzoilecgonina en orina de consumidores de té de coca, se realizó un estudio piloto analizando muestras de orina a 10 voluntarios sanos, no consumidores de cocaína, antes de ingerir la infusión de té de coca (Nasa Esh´s Coca Nasa), y las recolectadas hasta las 48 horas después de la ingestión, de una toma única de 100 mL el mismo día. El análisis se realizó por métodos de inmunoensayo, cualitativo, mediante pruebas rápidas Acu-check, y semicuantitativo AxSYM Cocaine Metabolite, basado en In munoensayo de Fluorescencia Polarizada (FPIA). Antes de la ingestión de la infusión por los métodos cualitativos y semicuantitativos las muestras recolectadas resultaron negativas, después de haber ingerido la infusión, por ambos métodos se detectó concentraciones de benzoilecgonina desde la primera hasta las 48 horas con diversas variaciones entre las muestras, observándose excelente concordancia entre los métodos para la determinación de benzoilecgonina en orina. En este estudio, se concluyó que existe la presencia de benzoilecgonina en muestras de orina de consumidores de té de coca. Los métodos utilizados sólo proporcionan resultados preliminares, se recomienda utilizar unos más específicos a fin de encontrar parámetros que permitan discriminar individuos que hayan ingerido infusión de té de coca, de aquellos que son adictos a la cocaína. Además, es importante prevenir a los consumidores de té de coca sobre el riesgo de detección de benzoilecgonina en orina dentro de las primeras 24 a 48 horas y las implicaciones que trae consigo tales hallazgos de laboratorio.

In order to detect the presence of benzoylecgonine in urine of consumers of coca tea, a pilot study was conducted by analyzing urine samples from 10 volunteers not cocaine users, be fore drinking the coca tea infusion, and collected until 48 hours after ingestión of a single shot (100 mL) the same day, The analysis was performed by immunoassay qualitative methods, using fast Acu-check tests, and semi quantitative automated equipment Abbott Axsym System, based on fluorescence polarization immunoassay (FPIA). Before ingestion of the infusion for qualitative and semiquantitative methods for samples collected were negative, and after drinking the tea, for both methods, concentrations of benzoylecgonine was detected from the first to 48 hours with several variations between samples, observed excellent agreement between the methods for the determination of benzoilecgonine in urine. In this study, we concluded that there is the presence of benzoylecgonine in urine samples from consumers of coca tea. According to the methods used provide only preliminary results, we recommend using a more specific in order to find parameters to discriminate individuals who have ingested coca tea infusions of dose that are cocaine addicts, In turn, it is important to prevent cosumers coca tea on the risk of detection of benzoylecgonine in urine within the first 24 to 48 hours and the implications it brings such laboratory findings.

Assuntos

RESUMO

La presente investigación se realizó con la población concurrente al Servicio de Salud Mental del Hospital Pediátrico del Niño Jesús de la Ciudad de Córdoba, de julio a diciembre del año 2008. Tuvo como objetivo general mostrar cual es la relevancia social del Trastorno de Desatención e Hiperactividad (TDHA), las características psicológicas de los niños afectados con esta patología y las características socio-familiares como posibles factores de riesgo del mismo. El tipo de estudio fue descriptivo retrospectivo simple. Los materiales de registro que se utilizaron fueron las entrevistas e historias clínicas realizadas por los profesionales del servicio. Se conformaron dos muestras, la primera de ellas con todos los sujetos que realizaron entrevista de admisión en el periodo comprendido por la investigación y la segunda con todos los sujetos atendidos en el servicio con el diagnóstico de TDHA. Entre los resultados obtenidos se destaca que la frecuencia de TDHA fue del 9 del total de la consulta, siendo el cuarto en orden de importancia luego de las problemáticas de tipo familiar, los trastornos de aprendizaje y la debilidad mental, y los trastornos disociales. Se observa, también altas frecuencias de comorbilidad, de antecedentes psicopatológicos en las madres de los niños con TDHA y de antecedentes familiares capaces de alterar la salud mental infantil.

Assuntos