Prevalence of musculoskeletal disorders in children´s foot: preliminary study

A la edad escolar ya se tiene la marcha, la funcionalidad y la morfología del pie característica del adulto pero aún no está completada la madurez esquelética. Esto hace que sea una edad propicia para realizar una adecuada prevención y un diagnóstico precoz de las alteraciones musculoesqueléticas de los pies y miembros inferiores. Hemos realizado un estudio transversal de prevalencia para conocer el estado de salud de los pies de los escolares. Se han evaluado 116 niños mediante una observación clínica y un estudio de la marcha con una plataforma de presiones. Los resultados más llamativos fueron que al 93% nunca se les había realizado una exploración similar, el 95% tenía alterado el reparto de presiones de la huella, un 75% presentaba alguna alteración en la dinámica (la más frecuente excesiva pronación en la fase de propulsión) y el mismo porcentaje de niños llevaban el calzado de talla pequeña. Más de la mitad tenía una huella anormal y el pie excesivamente pronado. Un 40% presentaba dolor, el 35% tenía pie cavo y un 10% pie plano. El 32% tenía alguna patología de antepie. El resto de alteraciones fueron menos frecuentes. Hemos encontrado una alta prevalencia de alteraciones, por lo que se evidencia una vez más la necesidad de hacer controles periódicos a estas edades e incluirlos dentro de los programas de educación para la salud y prevenir futuras complicaciones.At school age, children already have the functionality and foot morphology of adult but have not yet completed skeletal maturity. This makes it a proper age for appropriate prevention and early diagnosis of musculoskeletal disorders of the feet and lower limbs. We conducted a cross-sectional study of prevalence for the health of the feet of the schoolaged children. 116 children have been assessed by clinical observation and a study of gait with a pressure platform. The most striking results were that 93% never had made a similar exploration, 95% had altered pressure distribution footprint, 75% showed some alteration in the dynamics (the most frequent excessive pronation phase propulsion) and the same percentage of children wearing shoes small size. More than half had an abnormal trace excessively pronated foot. Meanwhile, 40% had pain, 35% had pes cavus and flatfoot 10%. Finally, 32% had one forefoot pathology. The remaining changes were less frequent. We found a high prevalence of alterations so it is further evidence of the need for regular checks at this age to prevent complications and implement programs of health education

Mitochondrial phosphoenolpyruvate carboxykinase (PEPCK-M) is a pro-survival, endoplasmic reticulum (ER) stress response gene involved in tumor cell adaptation to nutrient availability

Mitochondrial phosphoenolpyruvate carboxykinase (PEPCK-M), encoded by the nuclear PCK2 gene, links TCA cycle intermediates and glycolytic pools through the conversion of mitochondrial oxaloacetate into phosphoenolpyruvate. In the liver PEPCK-M adjoins its profusely studied cytosolic isoform (PEPCK-C) potentiating gluconeogenesis and TCA flux. However, PEPCK-M is present in a variety of non-gluconeogenic tissues, including tumors of several origins. Despite its potential relevance to cancer metabolism, the mechanisms responsible for PCK2 gene regulation have not been elucidated. The present study demonstrates PEPCK-M overexpression in tumorigenic cells as well as the mechanism for the modulation of PCK2 abundance under several stress conditions. Amino acid limitation and ER stress inducers, conditions that activate the amino acid response (AAR) and the unfolded protein response (UPR), stimulate PCK2 gene transcription. Both the AAR and UPR lead to increased synthesis of ATF4, which mediates PCK2 transcriptional up-regulation through its binding to a putative ATF/CRE composite site within the PCK2 promoter functioning as an amino acid response element. In addition, activation of the GCN2-eIF2α-ATF4 and PERK-eIF2α-ATF4 signaling pathways are responsible for increased PEPCK-M levels. Finally, PEPCK-M knockdown using either siRNA or shRNA were sufficient to reduce MCF7 mammary carcinoma cell growth and increase cell death under glutamine deprivation or ER stress conditions. Our data demonstrate that this enzyme has a critical role in the survival program initiated upon stress and shed light on an unexpected and important role of mitochondrial PEPCK in cancer metabolism

Long-Term Use of Temozolomide as Safe and Effective Therapy for an Aggressive Corticotroph Adenoma in a Very Old Patient

Background: Temozolomide (TMZ) is safe and effective in the treatment of aggressive pituitary adenomas (PAs). However, the optimal duration of TMZ therapy is still unknown. Moreover, data about administration of TMZ in elderly (≥65 years) people to treat aggressive PAs are scarce. We report the case of the oldest female patient undergoing the longest TMZ protocol described so far to treat an aggressive, initially silent corticotroph PA. Case report: The patient initially underwent partial surgical removal of the PA. Subsequent treatment with cabergoline was applied, but it was unsuccessful in controlling the growth of the residual tumor. Pasireotide and external radiation also showed to be ineffective; therefore, treatment with TMZ was started at the standard dose of 200 mg/m2/day for 5 days every 4 weeks for a total of 47 cycles. At the time of treatment's beginning, the patient was 83 years old. Radiological follow-up documented a progressive, remarkable reduction of the adenoma and the last imaging, after 39 cycles of TMZ, showed an intrasellar lesion with large areas of cystic degeneration. The patient also developed adrenal deficiency managed with glucocorticoid replacement. No major side effects were observed throughout the treatment, with exception of nausea, well controlled with anti-emetic medication. TMZ therapy was discontinued after 47 cycles; hormonal and imaging follow-up investigations documented sustained functional and dimensional response. Conclusions: Our case supports the long-term use of TMZ, confirming its safety and efficacy also for elderly patients

Restoration of the Brigadier López’s House: Santa Fe, Argentina

En la acción intersectorial entre el estado provincial, la universidad pública y la empresa privada, se consolida un “triángulo virtuoso”, en el que se complementan las especificidades de cada una de las partes. El objetivo de esta unión, en lo referido al presente artículo, fue realizar el mejor y más cuidadoso restauro de una emblemática construcción de adobe. Durante el proceso, la universidad brindó sus conocimientos para determinar la salud de su estructura, el estado redactó un pliego de contratación que contempló tanto la consolidación estructural del bien como su puesta en valor, y luego, durante la obra y en diálogo con la empresa ejecutora, se analizó la mejor forma de operar en función de la verificación de la materialidad. Se realizaron ensayos de la tierra existente en la construcción y de la materia prima que se incorporó, y se corroboró que existiera una similitud entre la ejecución original y la nueva; atendiendo a las dosificaciones y resistencias adecuadas según la técnica utilizada. Dada la poca experiencia local documentada en intervenciones de este tipo, se tuvo como resultado un antecedente importante, del cual se puede ir acumulando experiencia para obras similares, y replicar de este modo los conocimientos generados.In the intersectoral action between the provincial state, the public university and the private company a “virtuous triangle” is consolidated, in which specificities of each of the parties are complemented. The purpose of this union, as referred in this article, is to perform the best and most careful restoration of an emblematic adobe construction. During said process, the university provided its knowledge to determine the structural integrity of the house, the state drew up a contract sheet which included both the structural consolidation of the building and its put in value, and then during the work -in dialogue with the executing company- the best way to operate was analysed based on the materials’ verification. Tests were carried out to the existent earth in the building and to the raw material being incorporated, and a corroboration of existing similarity between the original and new executions were made, attending to suitable dosages and resistances according to the used techniques. Given the little documented local experience in this type of interventions, an important antecedent was set, from which experience can be accumulated in order to replicate the generated knowledge in further works.Fil: Losa, Nicolás Rodolfo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Centro de Investigaciones en Métodos Computacionales. Universidad Nacional del Litoral. Centro de Investigaciones en Métodos Computacionales; ArgentinaFil: Spina, María Laura. Universidad Tecnológica Nacional. Facultad Regional Santa Fe. Departamento de Ingeniería Civil; ArgentinaFil: Cabrera, Santiago Pedro. Universidad Tecnológica Nacional. Facultad Regional Santa Fe. Departamento de Ingeniería Civil; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

La percepción subjetiva de la crisis: una aproximación alternativa a procesos de empobrecimiento y amenaza de desclasamiento

Muchos son los trabajos que han rastreado los efectos socioeconómicos de la crisis, apoyándose en indicadores objetivos de renta, gasto o situación laboral. En este artículo se explora cómo ha afectado la crisis a estados subjetivos de las personas en función de su ubicación objetiva en esquemas de clase. Con este fin, se examinan evolutivamente indicadores extraídos de distintas encuestas realizadas en España durante ese período

Pseudomonas aeruginosa is capable of natural transformation in biofilms

Natural transformation is a mechanism that enables competent bacteria to acquire naked, exogenous DNA from the environment. It is a key process that facilitates the dissemination of antibiotic resistance and virulence determinants throughout bacterial populations. Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen that produces large quantities of extracellular DNA (eDNA) that is required for biofilm formation. P. aeruginosa has a remarkable level of genome plasticity and diversity that suggests a high degree of horizontal gene transfer and recombination but is thought to be incapable of natural transformation. Here we show that P. aeruginosa possesses homologues of all proteins known to be involved in natural transformation in other bacterial species. We found that P. aeruginosa in biofilms is competent for natural transformation of both genomic and plasmid DNA. Furthermore, we demonstrate that type-IV pili (T4P) facilitate but are not absolutely essential for natural transformation in P. aeruginosa

Effectiveness of surgical hand antisepsis using chlorhexidine digluconate and parachlorometaxylenol hand scrub

[Abstract] Background: Chlorhexidine and parachlorometaxylenol (PCMX) are antiseptics recommended for surgical hand antisepsis. To our knowledge, PCMX has not been evaluated for bactericidal efficacy “in vivo. Methods: We conducted a randomized, double-blind, controlled crossover trial to compare the bacterial loads on fingertips and fingernails under laboratory conditions after use of antiseptic test products, including chlorhexidine digluconate 4%, PCMX 3%, and a reference solution of propan-1-ol 60% (P-1). We assessed bacterial load after a prewash with soft soap, immediately after application of an antiseptic, and 3 hours after application and wearing of sterile, powder-free gloves. Our procedures followed those specified by European Norm (EN) 12791 for evaluating surgical hand antiseptics and using cotton swab for fingertips and fingernails. Results: Chlorhexidine digluconate 4% and PCMX 3% did not decrease bacterial load on the hands. The bactericidal performances of chlorhexidine digluconate 4% and PCMX 3% did not differ significantly. Chlorhexidine digluconate 4% and PCMX 3% increased bacterial load on the fingertips after participants had worn gloves for 3 hours. Fingernails had greater bacterial loads than skin on the fingertips. Conclusions: Chlorhexidine digluconate 4% and PCMX 3% had similar bactericidal efficacy, but they failed to meet the EN 12791 efficacy standard. Fingernails should be a particular focus of antisepsis in preparation for surgery. The trial was registered at ClinicalTrials.gov (ID: NCT02500758)

The patient with Austrian syndrome: regarding a case

En la actualidad, la endocarditis infecciosa es una enfermedad poco frecuente, con una incidencia estimada entre 3,1 y 3,7 episodios cada 100.000 habitantes/año. Pese a los progresos en el tratamiento médico-quirúrgico, la mortalidad hospitalaria de los pacientes con endocarditis es alta. La endocarditis infecciosa es un proceso que se debe a una infección microbiana localizada en el endocardio. La zona afectada con más frecuencia es la superficie de las válvulas y, en la mayor parte de los casos, es de origen bacteriano. Un tipo de endocarditis es el denominado síndrome de Austrian, esta afección tiene un mecanismo diferente a otros tipos de endocarditis y destaca por la agresividad con la que se destruye la región valvular izquierda del corazón. El nombre que da título al caso se debe al médico que publicó la triada de neumonía, endocarditis y meningitis neumocócica. Se presenta el caso clínico de una mujer de 68 años diagnosticada de síndrome de Austrian que ingresó en una Unidad de Cuidados Críticos Cardiológicos con gran inestabilidad hemodinámica, sedoanalgesiada y en tratamiento con ventilación mecánica por una insuficiencia respiratoria. Dada la gravedad del caso está justificado establecer un plan de cuidados basado en el modelo bifocal de Carpenito para resolver las necesidades de salud reales y potenciales en un paciente diagnosticado de síndrome de Austrian, apoyándonos en la taxonomía North American Nursing Diagnosis Association, así como en la Nursing Outcomes Classification y Nursing Interventions Classification para delimitar objetivos e intervenciones enfermeras, respectivamente.Infective endocarditis is currently an uncommon disease, with an estimated incidence of between 3.1 and 3.7 episodes per 100,000 inhabitants/year. Despite the progress in medical-surgical treatment, hospital mortality of patients with endocarditis is high. Infective endocarditis is a process that is due to a microbial infection localized in the endocardium. The area most often affected is the surface of the valves and in most cases it has a bacterial origin. A type of endocarditis is the so-called Austrian syndrome; this condition has a different mechanism from other types of endocarditis and stands out for the aggressiveness with which the left valvular region of the heart is destroyed. The name that entitles the case is due to the doctor who published the triad of pneumonia, endocarditis and pneumococcal meningitis. We present the case of a 68-year-old woman, diagnosed with Austrian syndrome, who was admitted into a Cardiac Intensive Care Unit with a serious hemodynamic instability, under sedation and analgesia and on treatment with mechanical ventilation due to respiratory failure. Considering the seriousness of the case, there is a justification for establishing a care plan based on Carpenito?s bifocal model so as to meet the real and potential health needs in a patient diagnosed with Austrian Syndrome, relying on the North American Nursing Diagnosis Association taxonomy, as well as on the Nursing Outcomes Classification and the Nursing Interventions Classification, in order to define objectives and nursing interventions, respectively

Spatial Immunology in Liver Metastases from Colorectal Carcinoma according to the Histologic Growth Pattern

In the era of immunotherapy, the tumor microenvironment (TME) has attracted special interest. However, colorectal liver metastases (CRC-LM) present histological peculiarities that could affect the interaction of immune and tumor cells such as fibrotic encapsulation and dense intratumoral stroma. We explored the spatial distribution of lymphocytic infiltrates in CRC-LM in the context of the histologic growth patterns using multispectral digital pathology providing data on three different scenarios, tumor periphery, invasive margin, and central tumoral areas. Our results illustrate a similar poor cell density of CD8(+) cells between different metastases subtypes in intratumoral regions. However, in encapsulated metastases, cytotoxic cells reach the tumor cells while remaining retained in stromal areas in non-encapsulating metastases. Some aspects are still unresolved, such as understanding the reason why most lymphocytes are largely retained in the capsule. Colorectal cancer liver metastases (CRC-LM) present differential histologic growth patterns (HGP) that determine the interaction between immune and tumor cells. We explored the spatial distribution of lymphocytic infiltrates in CRC-LM in the context of the HGP using multispectral digital pathology. We did not find statistically significant differences of immune cell densities in the central regions of desmoplastic ((d)HGP) and non-desmoplastic ((nd)HGP) metastases. The spatial evaluation reported that (d)HGP-metastases displayed higher infiltration by CD8(+) and CD20(+) cells in peripheral regions as well as CD4(+) and CD45RO(+) cells in (nd)HGP-metastases. However, the reactive stroma regions at the invasive margin (IM) of (nd)HGP-metastases displayed higher density of CD4(+), CD20(+), and CD45RO(+) cells. The antitumor status of the TIL infiltrates measured as CD8/CD4 reported higher values in the IM of encapsulated metastases up to 400 mu m towards the tumor center (p < 0.05). Remarkably, the IM of (d)HGP-metastases was characterized by higher infiltration of CD8(+) cells in the epithelial compartment parameter assessed with the ratio CD8(epithelial)/CD8(stromal), suggesting anti-tumoral activity in the encapsulating lesions. Taking together, the amount of CD8(+) cells is comparable in the IM of both HGP metastases types. However, in (d)HGP-metastases some cytotoxic cells reach the tumor nests while remaining retained in the stromal areas in (nd)HGP-metastases

Familias que acogen. Un análisis de las relaciones familiares en hogares que participan en un programa de acogimiento familiar no preadoptivo

La institución familiar está cambiando a una velocidad inusitada. En últimos años están proliferando nuevas formas familiares atípicas. Las familias monoparentales, las familias reconstituidas, las familias homoparentales, las familias que adoptan, son algunas de las expresiones más conocidas y estudiadas de ese cambio. El objetivo del estudio es acercarnos a una modalidad familiar que ha merecido menor atención, las familias "que acogen" familias en el marco de un programa de acogimiento familiar no pre­adoptivo. Muchas de estas familias establecen relaciones duraderas e intensas con los menores  que tienen (o han tenido) acogidos de manera transitoria o permanente. Nuestro objetivo en este trabajo es analizar las características de las relaciones intergeneracionales dentro de estos grupos de convivencia, contrastándolas con la evidencia que existe sobre estas relaciones en otro tipo de familias. En particular, estamos interesados el ejercicio de la "maternidad" y la “paternidad” (sucedánea) en este tipo de familias, y como se expresa en los usos del tiempo compartido, la gestión de afectos y reproches, el seguimiento de las actividades del menor, y en definitiva la construcción de significados atribuidos a esas relaciones