ASOCIACION DEL INDICE NEUTROFILO-LINFOCITO Y MORTALIDAD EN PACIENTES CON ENFERMEDAD RENAL CRONICA EN HEMODIALISIS DEL HOSPITAL GENERAL DE ECATEPEC DR JOSE MA RODRIGUEZ

ANTECEDENTES: La enfermedad renal crónica (ERC) es un proceso multifactorial de carácter progresivo e irreversible que frecuentemente conduce a un estado terminal, aumentando la mortalidad cardiovascular, es por ello que se han buscado diversos marcadores de inflamación (Il-6,IL-10, PCR, FNT-) siendo el índice neutrófilo-linfocito (INL) un marcador de estudio de fácil acceso y bajo costo. MATERIAL Y METODOS: se realizó un estudio descriptivo, retrospectivo, transversal, no controlado de 55 pacientes con tratamiento sustitutivo en hemodiálisis a los cuales se les tomó química sanguínea y citometría hemática realizandose cálculo de índice neutrófilo linfocito comparado con otros marcadores. RESULTADOS: las comorbilidades mayormente asociadas fueron diabetes, hipertensión y tabaquismo, se realizo el cálculo del INL, encontrandose una media de 3.4 (p=0.092) para pacientes sobrevivientes y 3.69 para pacientes que fallecieron;la albúmina (p=0.004) con significancia estadistica.CONCLUSIONES: dado que el INL no mostro significancia estadística, siendo el único marcador la albumina que se puede relacionar como predictor de inflamación y asociación con mortalida

Survival Patterns of Human Prion Diseases in Spain, 1998-2018: Clinical Phenotypes and Etiological Clues

Background: Human transmissible spongiform encephalopathies (TSEs) are a group of fatal neurodegenerative disorders of short duration. There are few studies on TSE survival. This study sought to analyze the survival and related factors of a TSE patient cohort, based on a nationwide surveillance system in Spain. Methods: Survival analyses were performed on 1,530 cases diagnosed across the period 1998–2018 in Spain. We calculated median survival times and plotted survival curves using the Kaplan–Meier method for all cases and for sporadic TSE (sTSE) and genetic TSE (gTSE). Crude and adjusted Cox proportional hazard models were used to identify variables associated with shorter survival. Findings: Median age at onset decreased from the sporadic forms to gTSE and, lastly, to acquired TSE. Overall median and interquartile range (IQR) survival time was 5.2 (IQR, 3.0–11.7) months and 4.9 (IQR, 2.8–10.8) months in sporadic cases and 9 (IQR, 4.9 to over 12) months in genetic cases, p < 0.001. Male sex, older age at onset, presence of 14-3-3 protein, typical MRI, and MM and VV polymorphisms at codon 129 were associated with shorter survival. gTSE showed higher survival in crude comparisons but not after adjustment. Interpretation: TSE survival in Spain replicates both the magnitude of that shown and the TSE entity-specific population patterns observed in Western countries but differs from features described in Asian populations, such as the Japanese. The reduction in differences in survival between gTSE and sTSE on adjusting for covariates and international patterns might support the view that gTSE and sTSE share causal and pathophysiological features.This work was basically funded by the Spain’s Ministry of Health and the Carlos III Health Institute (research grant no. PI08/0139) and Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED) networks (QLRG3-CT-2002-81223). Role of funders: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

A New Measure to Assess Psychopathic Personality in Children: The Child Problematic Traits Inventory

Understanding the development of psychopathic personality from childhood to adulthood is crucial for understanding the development and stability of severe and long-lasting conduct problems and criminal behavior. This paper describes the development of a new teacher rated instrument to assess psychopathic personality from age three to 12, the Child Problematic Traits Inventory (CPTI). The reliability and validity of the CPTI was tested in a Swedish general population sample of 2,056 3- to 5-year-olds (mean age = 3.86; SD = .86; 53 % boys). The CPTI items loaded distinctively on three theoretically proposed factors: a Grandiose-Deceitful Factor, a Callous-Unemotional factor, and an Impulsive-Need for Stimulation factor. The three CPTI factors showed reliability in internal consistency and external validity, in terms of expected correlations with theoretically relevant constructs (e.g., fearlessness). The interaction between the three CPTI factors was a stronger predictor of concurrent conduct problems than any of the three individual CPTI factors, showing that it is important to assess all three factors of the psychopathic personality construct in early childhood. In conclusion, the CPTI seems to reliably and validly assess a constellation of traits that is similar to psychopathic personality as manifested in adolescence and adulthood

Criterios de implementación ISO 14000:2015 Caso estudio sector salud.

https://drive.google.com/open?id=1puEL-CmJBu-pbP20-Yk_QqiXlRr936Kh, https://drive.google.com/open?id=1TzeTEv-JRl0fWBP4CqDjnMqcJwlPBVYF, https://drive.google.com/open?id=1fTrfAIeTNKC6mAV9t5NpNd3k4oX2FMj1, https://drive.google.com/open?id=1Aw8Ph77R9SWxxAwSNNRj6It1NzjIXJyzLa investigación se basa en la Revisión Ambiental Inicial (RAI) de una organización. El propósito es identificar el desempeño ambiental de la empresa Hospital Tercer Nivel, con el fin de facilitar la implementación de un Sistema de Gestión; esto nos permite aplicarla en el análisis y la observación de cada una de las etapas de producción, que en esta caso se basa en la prestación del servicio en salud. Con la información obtenida, conseguimos reconocer los riesgos y oportunidades de las actividades, que se realizan en el Hospital Tercer Nivel, ubicado en la ciudad cosmopolita de Bogotá, que exige altos estándares de complejidad en la prestación del servicio en salud. Muchas de las actividades requieren una gran demanda de recursos naturales, renovables, no renovables, biodegradables y no biodegradables; lo cual desencadenan aspectos e impactos ambientales de importante consideración en la implementación de un Sistema de Gestión. Mediante diferentes herramientas como lista de chequeo, diagrama de flujo; presentamos la evidencia de lo observado durante las visitas al Hospital Tercer Nivel, enfocando los procesos según el ciclo PHVA, para presentar un análisis detallado y recomendaciones generales a la producción de la empresa. La investigación, se realiza con el fin de practicar lo aprendido durante la carrera de Ingeniería Ambiental, pretendemos llegar a la comunidad estudiantil, que pueda usar el documento como referencia para la elaboración de nuevas investigaciones. El recurso humano y financiero, ha sido proporcionado por los autores, la vocación, responsabilidad y sentido de pertenencia nos llevan a cumplir este compromiso.The research is based on the Initial Environmental Review (RAI) of an organization. The purpose is to identify the environmental performance of the Hospital Tercer Nivel company, in order to facilitate the implementation of a Management System; This allows us to apply it in the analysis and observation of each of the production stages, which in this case is based on the provision of the health service. With the information obtained, we managed to recognize the risks and opportunities of the activities, which are carried out in the Hospital Tercer Nivel, located in the cosmopolitan city of Bogotá, which demands high standards of complexity in the provision of health services. Many of the activities require a great demand of natural resources, renewable, non-renewable, biodegradable and non-biodegradable; which triggers aspects and environmental impacts of important consideration in the implementation of a Management System. Through different tools such as checklist, flowchart; We present the evidence of what was observed during the visits to the Hospital Tercer Nivel, focusing the processes according to the PHVA cycle, to present a detailed analysis and general recommendations to the production of the company. The research is carried out in order to practice what we have learned during the Environmental Engineering career. We intend to reach out to the student community, which can use the document as a reference for the preparation of new research. The human and financial resource, has been provided by the authors, the vocation, responsibility and sense of belonging lead us to fulfill this commitment

Versatility of the estlander flap: upper lip, lower lip and comissure reconstruction due to a dog bite

Background: Dog bites continue to be a frequent cause for plastic and reconstructive services in the world. The grand majority of these cases affect the head and neck area; and more often than not they involve the commissure and the lips. The latter leading to an increased level of difficulty and a substantial decrease on the posibilities for a successful reconstruction. This case report focuses on the exploration of the Abbe-Estlander flap as an efficient alternative in most of these cases.Methods: We present two clinical cases involving dog bites where the affected area of both patients was estimated to be one third of the total volume of the lip. Both patients required emergency reconstructive surgery. An Estlander flap was successfully performed in both instances. The purpose of the article is to share the results and motivate the medical community to continue to use this method as a strong avenue for an effective recovery.Results: After two months of the surgery, the team followed up with both patients and they were satisfied with the results. Patient A presented adequate healing of the wound; a lack of alignment of the mucocutaneous rim and rounding of the commissure was observed. Phonation, oral continence without any leakage and complete closure of the lip were also part of the recovery assessment. Patient B presented adequate healing of the wound, phonation and medium oral continence with occasional leakage of liquids and incomplete closure.Conclusions: The Abbe-Estlander flap is still an excellent reconstructive alternative for upper and lower lip reconstruction where the affected area is up to one third of the total volume. As long as the commissure involvement represents minimum difficulty, both aesthetic and functional objectives can be successfully attained using this flap

Human prion disease surveillance in Spain, 1993-2018: an overview

In Spain, human transmissible spongiform encephalopathies (TSEs) have been undergoing continuous surveillance for over 25 years. In 1995, the system was launched as an EU Concerted Action, with EU surveillance network procedures being incorporated from 2002 onwards. The aim of this report was to describe performance and outcomes of this surveillance system across the period 1993-2018. Neurology and public health specialists from every region reported cases to a central hub at the Carlos III Health Institute, Madrid. In all, eight accidentally transmitted cases and five definite variant Creutzfeldt-Jakob disease (vCJD) patients were reported. All vCJD cases were diagnosed between 2005 and 2008. Two of these were family/dietary-related and spatially linked to a third. Yearly incidence of sporadic CJD per million was 1.25 across the period 1998-2018, and displayed a north-south gradient with the highest incidence in La Rioja, Navarre and the Basque Country. Genetic TSEs were observed to be clustered in the Basque Country, with a 4-fold incidence over the national rate. A total of 120 (5.6%) non-TSE sporadic, conformational, rapidly progressing neurodegenerative and vascular brain disorders were reported as suspect CJD. We conclude that TSEs in Spain displayed geographically uneven, stable medium incidences for the sporadic and genetic forms, a temporal and spatial family cluster for vCJD, and decreasing numbers for dura-mater-associated forms. The vCJD surveillance, framed within the EU network, might require continuing to cover all prion disorders. There is need for further strategic surveillance research focusing on case definition of rapid-course, conformational encephalopathies and surgical risk.This work was basically funded by the Spain’s Ministry of Health and the Carlos III Health Institute. Additional funding was obtained from the EU Research Commission, Concerted Actions (BIOMED2 Contract No. BMH4-CT97-2216, QLRG3-CT-2002-81223), EU Joint Program – Neurodegenerative Disease Research (JPND – DEMTEST, Spanish Health Research Fund, FIS PI11/03021 and PI12/00045), EUROCJD (funded by DG SANCO, 2003201), research grants by the Carlos III Health Institute (PI08/0139), NEUROPRION (an EU Network of Excellence funded by Framework 6 Programme, FOOD CT 2004 056579), the Spanish Centro de Investigaciones en Enfermedades Neurológicas (CIEN C03-06), and Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED) networks.S

Clinical and Laboratory Development of Echinocandin Resistance in Candida glabrata: Molecular Characterization

The pathogenic yeast Candida glabrata has become a public health issue due to the increasing number of echinocandin resistant clinical strains reported. In this study, acquisition and development of resistance to this antifungal class were studied in serial C. glabrata isolates from five patients admitted in two Spanish hospitals with a resistant profile against echinocandins associated with different mutations in hot-spot 1 of FKS2 gene. For two of these patients susceptible FKS wild-type isolates obtained prior to resistant ones were also investigated. Isolates were genotyped using multilocus sequence typing and microsatellite length polymorphism techniques, which yielded comparable results. Susceptible and resistant isolates from the same patient had the same genotype, being sequence type (ST) 3 the most prevalent among them. Isolates with different FKS mutations but the same ST were present in the same patient. MSH2 gene alterations were also studied to investigate their correlation with antifungal resistance acquisition but no association was found with antifungal resistance nor with specific genotypes. In vitro exposure to increasing concentrations of micafungin to susceptible isolates developed colonies carrying FKS mutations in agar plates containing a minimum concentration of 0.06 mg/L of micafungin after less than 48 h of exposure. We investigated the correlation between development of resistance and genotype in a set of susceptible strains after being in vitro exposed to micafungin and anidulafungin but no correlation was found. Mutant prevention concentration values and spontaneous growth frequencies after selection with both echinocandins were statistically similar, although FKS mutant colonies were more abundant after micafungin exposure (p < 0.001). Mutation S663P and F659 deletion were the most common ones found after selection with both echinocandins.This work was supported by the Fondo de Investigación Sanitaria (Grant FI14CIII/00025 to OR-M and research projects PI13/02145 and PI16CIII/00035 to AA-I), and also supported by the Plan Nacional de I+D+i 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16CIII/0004/0003) – co-financed by the European Development Regional Fund “A way to achieve Europe,” Operative Program Intelligent Growth 2014–2020.S

Immunoescape of HIV-1 in Env-EL9 CD8 + T cell response restricted by HLA-B*14:02 in a Non progressor who lost twenty-seven years of HIV-1 control

Background: Long-Term Non-Progressors (LTNPs) are untreated Human Immunodeficiency virus type 1 (HIV-1) infected individuals able to control disease progression for prolonged periods. However, the LTNPs status is temporary, as viral load increases followed by decreases in CD4 + T-cell counts. Control of HIV-1 infection in LTNPs viremic controllers, have been associated with effective immunodominant HIV-1 Gag-CD8 + T-cell responses restricted by protective HLA-B alleles. Individuals carrying HLA-B*14:02 control HIV-1 infection is related to an immunodominant Env-CD8 + T-cell response. Limited data are available on the contribution of HLA-B*14:02 CD8 + T -cells in LTNPs. Results: In this study, we performed a virological and immunological detailed analysis of an HLA-B*14:02 LNTP individual that lost viral control (LVC) 27 years after HIV-1 diagnosis. We analysed viral evolution and immune escape in HLA-B*14:02 restricted CD8 + T -cell epitopes and identified viral evolution at the Env-EL9 epitope selecting the L592R mutation. By IFN-γ ELISpot and immune phenotype, we characterized HLA- B*14:02 HIV-1 CD8 + T cell responses targeting, Gag-DA9 and Env-EL9 epitopes before and after LVC. We observed an immunodominant response against the Env-EL9 epitope and a decreased of the CD8 T + cell response over time with LVC. Loss of Env-EL9 responses was concomitant with selecting K588R + L592R mutations at Env-EL9. Finally, we evaluated the impact of Env-EL9 escape mutations on HIV-1 infectivity and Env protein structure. The K588R + L592R escape variant was directly related to HIV-1 increase replicative capacity and stability of Env at the LVC. Conclusions: These findings support the contribution of immunodominant Env-EL9 CD8 + T-cell responses and the imposition of immune escape variants with higher replicative capacity associated with LVC in this LNTP. These data highlight the importance of Env-EL9 specific-CD8 + T-cell responses restricted by the HLA-B*14:02 and brings new insights into understanding long-term HIV-1 control mediated by Env mediated CD8 + T-cell responses.Molecular Virology Laboratory was supported by grants SAF (2016-77894-R) from Ministerio de Economía y Competitividad (MINECO), ISCIII through the projects PI 13/02269, PI17/00164, PI16/0684, PI19/01127 (Co-funded by European Regional Development Fund/European Social Fund "Investing in your future"). The RIS-RETIC grants RD12/0017/0028, RD16/0025/0020 and RD16CIII/0002/0005. LTD was supported by the Instituto de Salud Carlos III (ISCIII) under grant agreement “CD20/00025” through the Sara Borrell Program. O.B.L was funded by an AGAUR-FI_B 00582 Ph.D. fellowship from the Catalan Government and the European Social Fund. M.A. was funded by grants RYC-2015-18241 and PID2019-107931GA-I00 from the Spanish Government and, ED431F 2018/08 from the “Xunta de Galicia”. ERM was supported by the Spanish National Research Council (CSIC). JGP laboratory was supported by National Health Institute Carlos III grant PI17/00164 and Redes Temáticas de Investigación en SIDA (ISCIII RETIC RD16/0025/0041). The funders had no role in study design, data collection and analysis, the decision to publish or drafting of the manuscript.S

Persistent HIV-controllers are more prone to spontaneously clear HCV: a retrospective cohort study.

HIV-controllers have the ability to spontaneously maintain viraemia at low or undetectable levels in the absence of antiretroviral treatment. Furthermore, HIV-controllers seem to have a superior capacity to spontaneously clear hepatitis C virus (HCV) compared to non HIV-controllers. Some of these subjects eventually lose HIV-controller status (transient controllers), whereas some HIV-controllers show a persistent natural HIV control (persistent controllers). We aimed to analyse whether persistent controllers have superior capacity to spontaneously clear HCV compared to transient controllers. We recruited HIV-controllers from January 1981 up to October 2016 with available antibodies to HCV (anti-HCV) data (n = 744). Factors associated with HIV spontaneous control in relation to HCV status were analysed in persistent and transient HIV-controllers with anti-HCV positive (n = 202 and n = 138 respectively) in comparison with 1700 HCV positive non HIV-controllers recruited from January 1981 up to March 2018, bivariate and multivariate analyses, following a logistic regression model, were applied. In addition, the factors related to the loss and time to lose HIV-controller status were explored (n = 744) using Log rank test and Kaplan-Meier curves, in this case the multivariate analysis consisted in a Cox regression model. A higher frequency of HCV spontaneous clearance was found in persistent HIV-controllers (25.5%) compared to non-controllers (10.2%). After adjusting for potential confounders, as sex, age, HIV transmission risk, CD4+ T-cell nadir and time of follow-up, HCV clearance was independently associated with persistent HIV spontaneous control (p = 0.002; OR (95% CI) = 2.573 (1.428 to 4.633)), but not with transient spontaneous control (p = 0.119; 1.589 (0.888 to 2.845)). Furthermore, persistent HIV-controllers were more likely to spontaneously clear the HCV in comparison with transient controllers (p = 0.027; 0.377 (0.159 to 0.893). Finally, not to lose or lengthen the time of losing this control was independently associated with HCV spontaneous clearance (p = 0.010; 0.503 (0.297 to 0.850). This study shows an association between spontaneous persistent HIV-control and HCV spontaneous clearance. The study findings support the idea of preserved immune mechanisms in persistent HIV control implicated in HCV spontaneous clearance. These results highlight persistent HIV-controllers but not transient controllers as a good model of functional HIV cure.This work was supported by the Instituto de Salud Carlos III (research contracts CPII014/00025 to E.R.‐M., and FI14/00431 to L.T.‐D. and research projects PI12/02283, PI16/00684, PI19/01127 to E.R.‐M.) and Red Temática de Investigación Cooperativa en SIDA (Projects RD12/0017/0029, RD12/0017/0031, and RD16/0025/0020 and RD16/0025/0013), which is included in the Acción Estratégica en Salud, Plan Nacional de Investigación Científica, Desarrollo e Innovación Tecnológica 2008 to 2011 and 2013 to 2016, Instituto de Salud Carlos III, Fondos FEDER. E.R.‐M. was supported by Consejería de Salud y Bienestar Social of Junta de Andalucía through the Nicolás Monardes program (C‐0032/17), N Rallón is a Miguel Servet investigator from the Spanish Carlos III Institute of Health (ISCIII), grant CP14/00198, Madrid, Spain and B.D.M. received a grant from The Spanish Ministry of Education (FPU13/02451). Work in CL‐G’s laboratory was supported by grants SAF (2010 to 17226) and (2016‐77894‐R) from MINECO (Spain) and FIS (PI 13/02269, ISCIII) and in part by the RIS‐RETIC grants RD06/006/0036 and RD12/0017/0028 funded by the ISC III‐FEDER. MP has a contract of RIS‐RETIC RD12/0017/0036.S

Insights into the mechanism of activation of the phosphorylation-independent response regulator NblR. Role of residues Cys69 and Cys96

Cyanobacteria respond to environmental stress conditions by adjusting their photosynthesis machinery. In Synechococcus sp. PCC 7942, phycobilisome degradation and other acclimation responses after nutrient or high light stress require activation by the phosphorylation-independent response regulator NblR. Structural modelling of its receiver domain suggested a role for Cys69 and Cys96 on activation of NblR. Here, we investigate this hypothesis by engineering Cys to Ala substitutions. In vivo and in vitro analyses indicated that mutations Cys69Ala and/or Cys96Ala have a minor impact on NblR function, structure, size, or oligomerization state of the protein, and that Cys69 and Cys96 do not seem to form disulphide bridges. Our results argue against the predicted involvement of Cys69 and Cys96 on NblR activation by redox sensing.This work was supported by the Spanish Ministerio de Ciencia e Innovación (grants BFU2009-07371 to A.C., BIO2009-10872 and BIO2010-15424 to A.M. and SAF2008-05742-C02-01 and CSD2008-00005 to J.L.N.) and the Generalitat Valenciana (grants ACOMP2006/083 and ACOMP2011/211 to A.C., ACOMP2010/114 and ACOMP2011/113 to J.L.N.). M.L. López-Redondo was a fellow of the Fundación Mutua Madrileña Automovilística