Dengue perinatal

Dengue is currently the most important viral disease transmitted by arthropods and which is hyperendemic in the Americas. An increase in the number of cases is related to dengue during pregnancy and the neonatal period. According to the gestational age in which infection occurs, there could be different manifestations in the fetus including abortion, malformations or neonatal dengue in newborns.This article presents a review regarding some cases reported worldwide, especially in the Americas,and some pathophysiologic issues related to perinatal dengue. doi: http://dx.doi.org/10.7705/biomedica.v33i0.1449El dengue es en la actualidad la enfermedad viral más relevante de transmisión vectorial hiperendémica en las Américas. El incremento en el número de casos se ha relacionado con la aparición de dengue durante la gestación y en el periodo neonatal. De acuerdo con la edad de gestación en la que ocurra la infección, podrían presentarse manifestaciones en el feto, como aborto, y en los pacientes a término,dengue neonatal.En este artículo se presenta una reseña de los casos reportados a nivel mundial, y especialmente en las Américas, así como aspectos fisiopatogénicos de la enfermedad. doi: http://dx.doi.org/10.7705/biomedica.v33i0.1449

Linfohistiocitosis hemofagocítica

Hemophagocytic syndrome is a rare clinical entity whose early diagnose is difficult to establish. It has a multifactorial etiology and its presentation is that of a severe and highly fatal disease. This is a 26-month child case report, with prolonged fever associated with pancytopenia and organomegaly rapidly growing during the patient’s progress. Several hemoderivatives transfusions were performed without improvement. Infectious diseases such as toxoplasmosis, cytomegalovirus, HIV, hepatitis B and syphilis, as well as myelo or lymphoproliferative diseases were discarded. Diagnosis from secondary hemophagocytic lymphohistiocytosis to infection by Epstein-Barr virus was established and treated with intravenous immunoglobulin and steroids with satisfactory outcome. Hemophagocytic lymphohistiocytosis secondary to common agents in our environment like infection by the Epstein-Barr virus needs to be considered among the causes of prolonged fever.El síndrome hemofagocítico, considerado como una entidad poco frecuente, de etiología multifactorial, y cuya presentación es la de un cuadro grave y de alta letalidad, ofrece dificultades en la aproximación diagnostica temprana. Se presenta el caso de un niño de 26 meses de edad, con síndrome febril prolongado asociado a pancitopenia y visceromegalias (hepatoesplenomegalia) rápidamente crecientes en el curso de la evolución. Durante la hospitalización requiere varias transfusiones de hemoderivados sin mejoría. Se descartan enfermedades infecciosas como toxoplasmosis, citomegalovirus, SIDA, hepatitis B y sífilis, al igual que etiología linfo y mieloproliferativa. Se usan herramientas de laboratorio que orientan el diagnóstico a linfohistiocitosis hemofagocitica secundaría a infección por Virus Epstein-Barr, y recibe tratamiento con Inmunoglobulina y esteroides con evolución satisfactoria. Es importante considerar dentro de las causas de síndrome febril prolongado, patologías como la linfohistiocitosis hemofagocítica, secundaria a agentes comunes en nuestro medio como el Epstein Barr virus

Proposta de um protocolo de reabilitação pulmonar em pacientes sobreviventes da COVID-19

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 virus is a new disease characterized by generating lung damage and compromising multiple tissues and organs throughout the body. Some of the patients with the infection should need intrahospital management with O2 support and additional measures that may include prolonged ICU immobilization. Patients who have moderate or severe conditions and survive the disease, could experience long-term impairment and dysfunction, including pulmonary fibrosis, cardiomyopathy, renal, hepatic and peripheral nerve injury, and all complications arising from hospitalizations in the ICU. It is considered that intervention in pulmonary rehabilitation is particularly important, especially at the recovery stage, and should be performed mainly with the objectives of improving: dyspnea, severe muscle weakness and fatigue, in order to promote functional independence and increase quality of life, so that anxiety and depression are diminished.La enfermedad por coronavirus 2019 (COVID-19) causada por el virus SARS-CoV-2 es una nueva enfermedad caracterizada por generar daño pulmonar y compromiso de múltiples tejidos y órganos de todo el cuerpo. Algunos de los pacientes que presentan la infección ameritan manejo intrahospitalario con soporte de O2 y medidas adicionales que pueden incluir inmovilización prolongada en UCI. Los pacientes que presentan cuadros moderados o severos y sobreviven a la enfermedad pueden presentar deterioro y disfunciones a largo plazo, incluyendo fibrosis pulmonar, miocardiopatía, lesión renal, hepática, de nervio periférico y todas las complicaciones derivadas de hospitalizaciones en UCI. Se considera que la intervención en rehabilitación pulmonar reviste gran importancia, especialmente en la etapa de recuperación, y debe realizarse, principalmente, con los objetivos de mejorar la disnea, la debilidad muscular severa y la fatiga, a fin de promover la independencia funcional y aumentar la calidad de vida, de manera que se disminuye así la ansiedad y la depresión.Doença por coronavírus (COVID-19), causada pelo vírus SARS-CoV-2, é uma nova doença caracterizada por gerar dano pulmonar e comprometimento de múltiplos tecidos e órgãos de todo o corpo. Alguns dos pacientes que apresentam a infecção merecem atendimento intra-hospitalar com suporte de O2 e medidas extraordinárias que podem incluir imobilização prolongada na UTI. Os pacientes que apresentam quadros moderados ou graves e sobrevivem à doença podem apresentar deterioração e disfunções em longo prazo, incluindo fibrose pulmonar, miocardiopatia, lesão renal, hepática, de nervo periférico e todas as complicações derivadas de internações em UTI. Considera-se que a intervenção em reabilitação pulmonar ganha grande importância, especialmente na etapa de recuperação, e deve realizar-se principalmente com o objetivo de melhorar a dispneia, a debilidade muscular grave e a fatiga, a fim de promover a independência funcional e aumentar a qualidade de vida, para que assim a ansiedade e a depressão diminuam

Evaluación de la seguridad de productos cosméticos

ilustracionesLa Organización de las Naciones Unidas para el Desarrollo Industrial (onudi), a través del programa Safe+, coordinó varias estrategias de cooperación internacional para apoyar el crecimiento de la industria cosmética colombiana, entre ellas la capacitación en evaluación de la seguridad de productos cosméticos. En este contexto, en 2018, una de las acciones que emprendió la Universidad Nacional de Colombia, fue ofertar el Curso de Formación de Consultores en Evaluación de Seguridad de Productos Cosméticos, a través del Departamento de Farmacia de la Facultad de Ciencias, con la asesoría y el diseño del consultor internacional Dr. Philippe Masson. En 2022, esta capacitación fue ampliada en número de horas impartidas, lo que permitió realizar el Diplomado en Evaluación de la Seguridad de Productos Cosméticos (Safety Assessor Training), en la modalidad telepresencial, el cual contó con la participación de más de 30 expertos. Este documento presenta los resúmenes de 53 conferencias, que hicieron parte de seis módulos: 1) contexto regulatorio de las materias primas y cosméticos; 2) aspectos de seguridad relacionados con ingredientes y productos cosméticos; 3) fundamentos de fisiología, inmunología y toxicología; 4) herramientas de evaluación toxicológica; 5) gestión del riesgo y gestión documental en la evaluación de seguridad de cosméticos; y 6) asuntos de interés en la actualidad. Esperamos con este diplomado contribuir con los fines misionales de la Universidad Nacional de Colombia, a través de la educación continua y permanente con carácter científico y tecnológico dirigida a profesionales de la industria cosmética. (Texto tomado de la fuente)Introducción -- Importancia de la formación en evaluación de seguridad para el sector cosmético -- Evaluación de calidad de productos cosméticos: introducción -- Bibliografía recomendadaMódulo 1. Contexto regulatorio de las materias primas y cosméticos -- Situación normativa en Latinoamérica con relación a la seguridad de cosméticos -- Legislación de cosméticos en la Comunidad Andina de Naciones (can) y su influencia en Colombia -- Referencias regulatorias con relación a la seguridad de cosméticos: Unión Europea y Estados Unidos -- Referencias regulatorias con relación a la seguridad de cosméticos: Asia -- Normas técnicas internacionales en seguridad de productos cosméticos -- Bibliografía recomendadaMódulo 2: aspectos de seguridad relacionados con ingredientes y productos cosméticos -- Seguridad de productos cosméticos – Quality by Design -- Origen de los ingredientes cosméticos -- Ingredientes cosméticos obtenidos por síntesis química -- Ingredientes cosméticos de origen natural -- Ingredientes cosméticos de origen biológico y biotecnológico -- Disposiciones particulares relativas a las fragancias -- Clasificación de ingredientes cosméticos y restricciones -- Estabilidad a lo largo del ciclo de vida del producto -- Estabilidad fisicoquímica -- Estabilidad microbiológica -- Envase seguro: ingeniería de envases -- Envase seguro: extractables y lixiviados de envases -- Bibliografía recomendadaMódulo 3. Fundamentos de fisiología, inmunología y toxicología -- Fundamentos: sistema inmune y piel -- Fundamentos: piel y mucosas, organización y funciones -- Evolución de la piel con la edad -- Irritación cutánea, ocular y mucosas -- Alergenicidad y sensibilización cutánea -- Fotosensibilidad cutánea y fotoirritación -- Conceptos generales en toxicología: evaluación del riesgo toxicológico -- Penetración y absorción percutánea -- Toxicidad general por vía oral y tópica -- Toxicidad de la reproducción -- Genotoxicidad, mutagenicidad y cáncer -- Bibliografía recomendadaMódulo 4. Herramientas de evaluación toxicológica -- Métodos experimentales in vivo y sus límites -- Metodologías in vitro para la evaluación de seguridad de ingredientes cosméticos -- Métodos in vitro. Experiencias en el laboratorio -- Evaluación de la penetración cutánea -- Métodos in silico como fuentes adicionales de información -- Estudios clínicos para la evaluación de cosméticos -- Cálculo del margen de seguridad -- Umbral de preocupación toxicológica (ttc) -- Bibliografía recomendadaMódulo 5. Gestión del riesgo y gestión documental en la evaluación de la seguridad de cosméticos -- Buenas prácticas de laboratorio -- Calidad de los datos experimentales -- Dossier, pif o expediente de información de producto -- Gestión del riesgo -- Caracterización y gestión del riesgo -- Acceso a los datos de ingredientes cosméticos a través de los comités científicos sccs, cir -- Claims / proclamas -- Claims vs. Soportes -- Bibliografía recomendadaMódulo 6. Asuntos de interés en la actualidad -- Uso de nanomateriales en productos cosméticos: ¿es un riesgo? -- Disrupción endocrina -- Impacto de los cosméticos en el ambiente – Cosmetovigilancia -- Pieles sensibles: consideraciones generales y aspectos reglamentarios -- Ética y estudios de seguridad -- Nuevas aproximaciones metodológicas (nam) -- Bibliografía recomendad

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Analysis of Costs Associated with the Use of Personalized Automated Dosing Systems versus Manual Preparation in a Residential Center for the Elderly in Extremadura

Introduction: During the SARS-CoV-2 pandemic, there has been a decrease in the supervision of the medication of subjects with chronic diseases. Customized automated dosing systems (SPDA) are devices that allow medication to be dispensed and administered, which have proven to be safe and effective for the patient and cost-effective for the healthcare system. Methods: an intervention study was carried out on patients from January to December 2019 in a residential centre for the elderly with more than 100 beds. The economic costs derived from manual dosing were compared with those of an automated preparation (Robotik Technology®). Results: Of the 198 patients included, 195 (97.47%) of them were polymedicated. Of the total of 276 active substances of registered medicinal products, it was possible to include them in the process of automating the preparation of the SPDA 105 active pharmaceutical ingredients. A cost reduction of EUR 5062.39 per year was found using SPDA. Taking into account the active ingredients of emblistable and non-emblistable medicines, the use of SPDA resulted in savings of EUR 6120.40 per year. The system contributed to the detection of cases of therapeutic duplication and reduced the time to prepare the medication. Conclusions: the use of SPDA is a useful and economically profitable strategy for its use in residential centres for the elderly

Analysis of Costs Associated with the Use of Personalized Automated Dosing Systems versus Manual Preparation in a Residential Center for the Elderly in Extremadura

Introduction: During the SARS-CoV-2 pandemic, there has been a decrease in the supervision of the medication of subjects with chronic diseases. Customized automated dosing systems (SPDA) are devices that allow medication to be dispensed and administered, which have proven to be safe and effective for the patient and cost-effective for the healthcare system. Methods: an intervention study was carried out on patients from January to December 2019 in a residential centre for the elderly with more than 100 beds. The economic costs derived from manual dosing were compared with those of an automated preparation (Robotik Technology®). Results: Of the 198 patients included, 195 (97.47%) of them were polymedicated. Of the total of 276 active substances of registered medicinal products, it was possible to include them in the process of automating the preparation of the SPDA 105 active pharmaceutical ingredients. A cost reduction of EUR 5062.39 per year was found using SPDA. Taking into account the active ingredients of emblistable and non-emblistable medicines, the use of SPDA resulted in savings of EUR 6120.40 per year. The system contributed to the detection of cases of therapeutic duplication and reduced the time to prepare the medication. Conclusions: the use of SPDA is a useful and economically profitable strategy for its use in residential centres for the elderly.Depto. de Farmacología, Farmacognosia y BotánicaFac. de FarmaciaTRUEpu

Propuesta de un protocolo de rehabilitación pulmonar en paciente supervivientes de COVID-19

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 virus is a new disease characterized by generating lung damage and compromising multiple tissues and organs throughout the body. Some of the patients with the infection should need intrahospital management with O2 support and additional measures that may include prolonged ICU immobilization. Patients who have moderate or severe conditions and survive the disease, could experience long-term impairment and dysfunction, including pulmonary fibrosis, cardiomyopathy, renal, hepatic and peripheral nerve injury, and all complications arising from hospitalizations in the ICU. It is considered that intervention in pulmonary rehabilitation is particularly important, especially at the recovery stage, and should be performed mainly with the objectives of improving: dyspnea, severe muscle weakness and fatigue, in order to promote functional independence and increase quality of life, so that anxiety and depression are diminished.Doença por coronavírus (COVID-19), causada pelo vírus SARS-CoV-2, é uma nova doença caracterizada por gerar dano pulmonar e comprometimento de múltiplos tecidos e órgãos de todo o corpo. Alguns dos pacientes que apresentam a infecção merecem atendimento intra-hospitalar com suporte de O2 e medidas extraordinárias que podem incluir imobilização prolongada na UTI. Os pacientes que apresentam quadros moderados ou graves e sobrevivem à doença podem apresentar deterioração e disfunções em longo prazo, incluindo fibrose pulmonar, miocardiopatia, lesão renal, hepática, de nervo periférico e todas as complicações derivadas de internações em UTI. Considera-se que a intervenção em reabilitação pulmonar ganha grande importância, especialmente na etapa de recuperação, e deve realizar-se principalmente com o objetivo de melhorar a dispneia, a debilidade muscular grave e a fatiga, a fim de promover a independência funcional e aumentar a qualidade de vida, para que assim a ansiedade e a depressão diminuam.La enfermedad por coronavirus 2019 (COVID-19) causada por el virus SARS-CoV-2 es una nueva enfermedad caracterizada por generar daño pulmonar y compromiso de múltiples tejidos y órganos de todo el cuerpo. Algunos de los pacientes que presentan la infección ameritan manejo intrahospitalario con soporte de O2 y medidas adicionales que pueden incluir inmovilización prolongada en UCI. Los pacientes que presentan cuadros moderados o severos y sobreviven a la enfermedad pueden presentar deterioro y disfunciones a largo plazo, incluyendo fibrosis pulmonar, miocardiopatía, lesión renal, hepática, de nervio periférico y todas las complicaciones derivadas de hospitalizaciones en UCI. Se considera que la intervención en rehabilitación pulmonar reviste gran importancia, especialmente en la etapa de recuperación, y debe realizarse, principalmente, con los objetivos de mejorar la disnea, la debilidad muscular severa y la fatiga, a fin de promover la independencia funcional y aumentar la calidad de vida, de manera que se disminuye así la ansiedad y la depresión