Moral structuring of children during the process of obtaining informed consent in clinical and research settings

Background: Informed consent is an important factor in a child’s moral structure from which different types of doctor–patient relationships arise. Children’s autonomy is currently under discussion in terms of their decent treatment, beyond what doctors and researchers perceive. To describe the influential practices that exist among clinicians and researchers toward children with chronic diseases during the process of obtaining informed consent. Methods: This was a cross-sectional, qualitative study via a subjective and interpretivist approach. The study was performed by conducting semi-structured interviews of 21 clinicians and researchers. Data analysis was performed using the SPSS version 21® and Atlas Ti version 7.0® programs. Results: The deliberative and paternalistic models were influential practices in the physician–patient relationship. In the deliberative model, the child is expected to have a moral awareness of their care. The paternalistic model determined that submission was a way of structuring the child because he or she is considered to be a subject of extreme care. Conclusions: The differentiated objectification [educational] process recognizes the internal and external elements of the child. Informed consent proved to be an appropriate means for strengthening moral and structuring the child

Epidemiology and Toxicology of Ciguatera Poisoning in the Colombian Caribbean

Ciguatera is a food intoxication caused by the consumption of primarily coral fish; these species exist in large numbers in the seas that surround the Colombian territory. The underreported diagnosis of this clinical entity has been widely highlighted due to multiple factors, such as, among others, ignorance by the primary care practitioner consulted for this condition as well as clinical similarity to secondary gastroenteric symptoms and common food poisonings of bacterial, parasitic or viral etiology. Eventually, it was found that people a ected by ciguatoxins had trips to coastal areas hours before the onset of symptoms. Thanks to multiple studies over the years, it has been possible to identify the relation between toxigenic dinoflagellates and seagrasses, as well as its incorporation into the food chain, starting by fish primarily inhabiting reef ecosystems and culminating in the intake of these by humans. Identifying the epidemiological link, its cardinal symptoms and a ected systems, such as gastrointestinal, the peripheral nervous system and, fortunately with a low frequency, the cardiovascular system, leads to a purely clinical diagnostic impression without necessitating further complementary studies; in addition, what would also help fight ciguatera poisoning is performing an adequate treatment of the symptoms right from the start, without underestimating or overlooking any associated complications

Cell Signaling in Neuronal Stem Cells

The defining characteristic of neural stem cells (NSCs) is their ability to multiply through symmetric divisions and proliferation, and differentiation by asymmetric divisions, thus giving rise to different types of cells of the central nervous system (CNS). A strict temporal space control of the NSC differentiation is necessary, because its alterations are associated with neurological dysfunctions and, in some cases, death. This work reviews the current state of the molecular mechanisms that regulate the transcription in NSCs, organized according to whether the origin of the stimulus that triggers the molecular cascade in the CNS is internal (intrinsic factors) or whether it is the result of the microenvironment that surrounds the CNS (extrinsic factors)

INVO Procedure: Minimally Invasive IVF as an Alternative Treatment Option for Infertile Couples

Intravaginal culture (IVC), also called INVO (intravaginal culture of oocytes), is an assisted reproduction procedure where oocyte fertilization and early embryo development are carried out within a gas permeable air-free plastic device, placed into the maternal vaginal cavity for incubation. In the present study we assessed the outcome of the INVO procedure, using the recently designed INVOcell device, in combination with a mild ovarian stimulation protocol. A total of 125 cycles were performed. On average 6.5 oocytes per cycle were retrieved, and a mean of 4.2 were placed per INVOcell device. The cleavage rate obtained after the INVO culture was 63%. The procedure yielded 40%, 31.2%, and 24% of clinical pregnancy, live birth, and single live birth rates per cycle, respectively. Our results suggest that the INVO procedure is an effective alternative treatment option in assisted reproduction that shows comparable results to those reported for existing IVF techniques

Neurogénesis en Cerebro Adulto

La generación de nuevas neuronas en el cerebro en etapas posteriores al desarrollo embrionario es conocida como neurogénesis adulta. Este proceso sirve para mantener un grupo de neuronas con propiedades únicas, presentes durante un tiempo limitado después de su nacimiento, permitiendo tipos específicos de procesamiento neural. La neurogénesis del adulto es importante para la separación de patrones en la formación de la memoria, entre otras funciones. Enfermedades neurodegenerativas como Huntington, Parkinson, Alzheimer, así como accidentes cerebrovasculares, lesiones cerebrales de cualquier etiología incluyendo las lesiones traumáticas, suponen trastornos irreversibles en la función cognitiva, el sistema motor, somato sensorial e incluso alteraciones personalidad como consecuencia de la perdida progresiva de neuronas. Este tipo de lesiones carecen de tratamientos curativos eficaces, siendo la búsqueda de opciones terapéuticas uno de los campos de investigación más activos en la neurociencia actual. En este sentido, el descubrimiento de la reposición neuronal a partir de células madre neurales (NSC) en el sistema nervioso central (SNC) adulto ha supuesto un nuevo enfoque en el desarrollo de terapias para este tipo de lesiones cerebrales. El descubrimiento de células madre neurales (NSC) en el cerebro adulto ha abierto la posibilidad de desarrollo de nuevas terapias neurorregenerativas basadas en la reposición neuronal a partir de células madre neurales (neurogénesis). En condiciones fisiológicas, existe neurogénesis a partir de NSC únicamente en dos zonas del cerebro adulto, el hipocampo y la zona subventricular (SVZ), mientras que en el resto del cerebro adulto no existe neurogenesis o es escasa. Sin embargo, cuando se produce una lesión cerebral, estas NSC son reclutadas en el perímetro de la lesión y pueden verse células con características de precursores neurales (NPC) que proliferan. En la publicación se hace una revisión exhaustiva de los conocimientos actuales sobre la neurogenesis en cerebro adulto

Cell Signaling in Neuronal Stem Cells

The defining characteristic of neural stem cells (NSCs) is their ability to multiply through symmetric divisions and proliferation, and differentiation by asymmetric divisions, thus giving rise to different types of cells of the central nervous system (CNS). A strict temporal space control of the NSC differentiation is necessary, because its alterations are associated with neurological dysfunctions and, in some cases, death. This work reviews the current state of the molecular mechanisms that regulate the transcription in NSCs, organized according to whether the origin of the stimulus that triggers the molecular cascade in the CNS is internal (intrinsic factors) or whether it is the result of the microenvironment that surrounds the CNS (extrinsic factors)

The Role of Microglia in Glioblastoma

Glioblastoma (GB), the most aggressive malignant glioma, is made up of a large percentage of glioma-associated microglia/macrophages (GAM), suggesting that immune cells play an important role in the pathophysiology of GB. Under physiological conditions, microglia, the phagocytes of the central nervous system (CNS), are involved in various processes such as neurogenesis or axonal growth, and the progression of different conditions such as Alzheimer's disease. Through immunohistochemical studies, markers that enhance GB invasiveness have been shown to be expressed in the peritumoral area of the brain, such as Transforming Growth Factor alpha (TGF-alpha), Stromal Sell-Derived Factor 1 (SDF1/CXCL12), Sphingosine-1-Phosphate (S1P) and Neurotrophic Factor Derived from the Glial cell line (GDNF), contributing to the increase in tumor mass. Similarly, it has also been described 17 biomarkers that are present in hypoxic periarteriolar HSC niches in bone marrow and in hypoxic periarteriolar GSC niches in glioblastoma. Interestingly, microglia plays an important role in the microenvironment that supports GB progression, being one of the most important focal points in the study of therapeutic targets for the development of new drugs. In this review, we describe the altered signaling pathways in microglia in the context of GB. We also show how microglia interact with glioblastoma cells and the epigenetic mechanisms involved. Regarding the interactions between microglia and neurogenic niches, some authors indicate that glioblastoma stem cells (GSC) are similar to neural stem cells (NSC), common stem cells in the subventricular zone (SVZ), suggesting that this could be the origin of GB. Understanding the similarities between SVZ and the tumor microenvironment could be important to clarify some mechanisms involved in GB malignancy and to support the discovering of new therapeutic targets for the development of more effective glioblastoma treatments

Inmunogenética e inmunopatología de la diabetes insulinodependiente tipo I

Resumen La diabetes insulinodependiente tipo I (T1D) es una enfermedad crónica y autoinmune que altera la calidad de vida en niños desde muy temprana edad. Esta patología genera un alto costo para la salud pública y produce trastornos psicoafectivos en el núcleo familiar disminuye los años de vida productiva y los años de vida saludable. La diabetes mellitus tipo I o insulinodependiente tiene una prevalencia muchísimo menor que la diabetes tipo 2 o no dependiente de insulina. Sin embargo, sus secuelas crónicas debido a la microangiopatía, macroangiopatía y neuropatías producen una elevada morbimortalidad en los pacientes que la padecen. El análisis molecular revela que los loci DQA1 y DQB1 se encuentran fuertemente asociados con susceptibilidad y resistencia a la expresión de T1D. La asociación con susceptibilidad más documentada ha sido con los haplotipos DQB1*O3O2 – DQA1* 0301 y DQB1*0201 – DQA1*0501, ambos asociados a los antígenos DR4 y DR3 respectivamente. Un estudio realizado en poblaciones de Ciudad de México, Caracas y Medellín concluyó que existe significancia estadística para considerar a los alelos DQA1 como marcadores de susceptibilidad para el desarrollo de T1D. En otro estudio realizado en pacientes norteamericanos de origen mexicano se encontró que los alelos DQB1*0302 DQB1*0201 se encontraban en un 91% de los pacientes comparados con el 67% de los controles, y los alelos DQA1*0501 y DQA1*0301 en el 100% de los pacientes comparado con el 74% de los controles. En estudios previos realizados por nuestro grupo informamos la caracterización molecular de genes HLA clase II por medio de la técnica PCR-SSP en una población de pacientes mestizos en el litoral caribe de Colombia. Analizamos los loci: HLA DRB1 y HLA DQB1. Los alelos con mayor expresión en controles sanos en el locus DQB1 fueron: HLA-DQB1*0301, conun 23.8%, DQB1*0302 (13.8%), DQB1*0201(15.4%), DQB1*0501(12.3%) y DQB1*0602 (12.3%). En el locus DRB1, los alelos más expresados en este grupo fueron HLA – DRB1*0401 (18%), DRB1*0402 (19%), DRB1*0404 (19%) y DRB1*0405 (21%). En el grupo conformado por pacientes con T1D, los alelos más representativos fueron DRB1*0302 y DQB1*0602. Con estos datos se describe que en esta población la susceptibilidad al desarrollo a esta enfer- medad se encuentra asociada a combinaciones alélicas DRB1 y DQB1 en particular. Palabras claves: HLA, diabetes mellitus tipo I, susceptibilidad. Abstract T1D is a chronic autoimmune disease that can greatly alter the quality of life of children at a young age. This condition can also generate high public health costs and produce psycho-affec- tive disorders in the family. It can significantly reduce the years of productive and healthy life. Diabetes Mellitus Type I, or insulin dependent, has a lower prevalence than Type II, or non- insulin dependent. Diabetes nevertheless, complications like microangiopthy, macroangiopathy and neuropathy can lead to elevated mortality and morbidity. Molecular analysis show that loci DQA1 and DQB1 are strongly associated with susceptibility and resistance to T1D. HLA DQB1*O3O2 – DQA1* 0301 are the most strongest alelles associated with susceptibility and DQB1*O2O1 – DQA1* 0501 are linked to DR4 and DR3 respectively. A study performed in Mexico City, Caracas and Medellin reported that there is statistical significance to consider the DQA1 alleles as markers for susceptibility to develop T1D. Another study that looked at North Americans with Mexican origin concluded that the alleles DQB1*0302 and DQB1*0201 are found in 91% of patients, compared with 74% of controls. In previous studies, our group informed the molecular characterization of HLA Class II genes using PCR-SSP in a mestizo patient population in the Colombian Caribbean. We analyzed the loci HLA DRB1 and HLA DQB1, finding that the alleles with higher expression in healthy control subjects were HLA-DQB1*0301 with 23.8%, DQB1*0302 (13.8%), DQB1*0201(15.4%), DQB1*0501(12.3%), and DQB1*0602 (12.3%). In the DRB1 locus, the alleles mostly expressed were HLA – DRB1*0401 (18%), DRB1*0402 (19%), DRB1*0404 (19%) and DRB1*0405 (21%). In the group consisting of IDDM patients, the alleles most frequently expressed were DRB1*0302 y DQB1*0602. This data describes that in this population, the susceptibility to develop this disease is associ- ated with particular allelic combinations of DRB1 and DQB1.Key words: HLA, type 1 diabetes, susceptibility

Las proteínas alergénicas: un novedoso blanco para el desarrollo de estudios en proteomica funcional

Resumen En la patogénesis de las enfermedades alérgicas están involucrados el ambiente, la carga genética y la inmunocompetencia del individuo. Continuamente nuestro sistema inmune está expuesto a numerosas proteínas, sin embargo, solo unas pocas inducen una respuesta inmune alérgica. El potencial intrínsico de una proteína alergénica para inducir sensibilización solo se manifiesta en individuos susceptibles, genéticamente condicionados a presentar respuestas atópicas. Muchas de estas proteínas alergénicas comparten alguna homología en su secuencia de aminoácidos. Estos alérgenos poseen un amplio rango de características moleculares, ninguna de las cuales es única solo para estas proteínas alergénicas. A pesar de esto, algunas de estas características son más comunes entre algunos alérgenos que con otras proteínas. Se ha demostrado que algunas proteínas con actividad enzimática inducen reacciones alérgicas y que esta propiedad biológica está asociada con su actividad catalítica. En la presente revisión se describen las principales características moleculares de las proteínas alergénicas, y se hace énfasis en la cistein proteasas de los ácaros intradomiciliarios, en razón a que ellas son un factor de riesgo en el desarrollo de una respuesta inmune alérgica en individuos susceptibles y se constituyen en factores desencadenantes de respuestas inflamatorias en la fisiopatología de las enfermedades alérgicas respiratorias. Palabras claves: Ácaros, alérgenos cistein proteasas, inflamación, biología computacional. Abstract The components involved in the pathogenesis of disorder allergic include the environment, the genetics and the immune competence. Continuously we are exposed to thousands of different proteins, but a single few of them induce an allergic immune response. The unique potential of an allergic protein to induce sensitization, only produce a response in susceptible individuals. Many of those allergic proteins share some homology in their sequence of amino acids, nevertheless, allergens have an ample rank of characteristic, no of which is unique for allergenic proteins. In spite of this, some characteristics are more common between allergens than in other proteins. It has been demonstrated that some proteins with enzymatic activity have a predisposition to induce allergic reactions and that its biological characteristics is associated with its catalytic activity. Those characteristic could be contribute directly to the allergenicity of this protein. In the present review we presented/displayed the main intrinsic characteristics of allergenic proteins associated with an allergic immune response, making emphasis in their Properties as activity cystein protease how and this biological faculty determining a factor in the development of the inflammatory cascade as an allergic immune response in susceptible individuals. Key words: House dust mite, allergens, cystein protease, inflammation, computational biology

Empathy in the Curriculum for Patient Care

Introduction: Empathy on nursing education is an important element in therapeutic communication and in the type of humanized care provided, due the strengthening of the nurse-patient relationship depends on this. Objective: To evaluate the levels of empathy on nursing students of a Higher Education Institution. Cartagena de Indias/Colombia. Material and Methods: Cross-sectional exploratory study. A sample of 320 nursing students from first to fourth year of training, to whom the Jefferson Medical Empathy Scale (JMES) was applied in the Spanish version. Results: Levels of empathy are reflected more in women than in men in general. However, some values vary with respect to the average at 3.14 levels in relation to the first year of schooling. Conclusion: The need for a curricular redesign and favoring empathic actions by professors worthy of being imitated by students as a way of encouraging empathy when caring for patients