Efeitos agudos da restrição, choque e treinamento no labirinto elevado em T nos sistemas de noradrenalina e serotonina no córtex pré-frontal

The prefrontal cortex (PFC) participates in cognitive functions and stress regulation. Noradrenaline (NA) and serotonin (5-HT) levels in some regions of the central nervous system are modified by acute stress. The effects depend on the type of stressor and the time elapsed between the presence of the stressor and the assessment. The aims of the present study were to assess the acute effect of different stressors on NA and 5-HT activities in the PFC and its relation with corticosterone levels. Independent groups of male Wistar rats (250-280 g) were submitted to restraint, footshock or training in the elevated T-maze (ETMT). The animals were sacrificed immediately (T0) or one hour (T1) after stress exposure. An untreated group sacrificed concurrently with treated animals was included as control. Samples of the PFC were dissected and the concentration of NA, 5-HT and their metabolites were measured by HPLC. Corticosterone levels were measured in serum. None of the treatments modified NA levels in the PFC. Animals exposed to footshock or ETMT showed significantly higher concentrations of 5-HT at T0. Restraint and footshock treatments were associated with higher corticosterone levels at T0 and T1 after the respective treatment. Taken together the results show that in the PFC, the noradrenergic and serotonergic systems, and the corticosterone levels respond in different ways to different stressors.La corteza prefrontal (CPF) participa en las funciones cognitivas y la regulación del estrés. Las concentraciones de noradrenalina (NA) y serotonina (5-HT) en algunas regiones en el sistema nervioso central son modificadas por el estrés agudo. El efecto depende del estresor y del tiempo que transcurra entre el estresor y la evaluación. El objetivo del presente estudio fue evaluar el efecto agudo de diferentes estresores en la actividad de la NA y 5-HT en la CPF y su relación con los niveles de corticosterona. Grupos independientes de ratas (250-270 g) fueron sometidos a restricción, choque o entrenamiento en el laberinto elevado en T (ELET). Los animales fueron sacrificados inmediatamente (T0) o una hora (T1) después de la exposición al estrés. Un grupo no tratado, sacrificado al mismo tiempo que los animales tratados, se incluyó como control. Las muestras de la CPF fueron disecadas y la concentración de NA, 5-HT y sus metabolitos fue detectada por la técnica de HPLC. Las concentraciones de corticosterona fueron medidas en el suero. Ninguno de los tratamientos modificó las concentraciones de NA en la CPF. Al T0 los animales expuestos a choque o al ELET mostraron concentraciones de 5-HT significativamente mayores que el control. Los tratamientos de restricción y choque estuvieron asociados con altas concentraciones de corticosterona al T0 y a T1 después del tratamiento respectivo. En conjunto, los resultados mostraron que en la CPF los sistemas noradrenérgico y serotonérgico y la concentración de corticosterona responden en forma diferente a los distintos estresores.O córtex pré-frontal (CPF) participa nas funções cognitivas e na regulação do estresse. As concentrações de noradrenalina (NA) e serotonina (5-HT) em algumas regiões do sistema nervoso central são modificadas pelo estresse agudo. O efeito depende do estressor e do tempo que transcorra entre o estressor e a avaliação. O objetivo do presente estudo foi avaliar o efeito agudo de diferentes estressores na atividade da NA e 5-HT no PFC e sua relação com os níveis de corticosterona. Grupos independentes de ratos (250-270 g) foram submetidos a restrição, choque ou treinamento no labirinto elevado em T (ELET). Os animais foram sacrificados imediatamente (T0) ou uma hora (T1) depois da exposição ao estresse. Um grupo não tratado, sacrificado ao mesmo tempo que os animais tratados, incluiu-se como controle. As mostras do PFC foram dissecadas e a concentração de NA, 5-HT e seus metabolitos foi detectada pela técnica de HPLC. As concentrações de corticosterona foram medidas no soro. Nenhum dos tratamentos modificou as concentrações de NA no PFC. Em T0 os animais expostos a choque o ao ELET mostraram concentrações de 5-HT significativamente maiores que o controle. Os tratamentos de restrição e choque estiveram associados com altas concentrações de corticosterona em T0 e em T1 depois do tratamento respectivo. Em conjunto, os resultados mostraram que no PFC os sistemas noradrenérgico e serotonérgico e a concentração de corticosterona respondem de maneira diferente aos diferentes estressores

Desarrollo y validación psicométrica de la escala de expectativas del consumo de alcohol en estudiantes hombres universitarios

El propósito de este estudio fue generar un instrumento que permita medir las expectativas del consumo de alcohol en población masculina universitaria de manera confiable y valida. Para lo cual se construyó una escala conformada por 29 reactivos con 4 opciones de respuesta; para realizar su validación psicométrica se aplicó a 189 estudiantes de licenciatura de la Ciudad de México, de entre los 18 y 24 años de edad, de los cuales todos fueron hombres estudiantes de alguna licenciatura. Se llevaron a cabo análisis para conocer el poder discriminativo de los reactivos; la confiabilidad y la estructura factorial válida para la población universitaria de la Ciudad de México. La escala final estuvo constituida por 22 reactivos, organizados en cinco factores: efectos positivos en el estado de ánimo, conducta social con otros, pasar momentos agradables con amigos, búsqueda de experiencias nuevas, reducción de la tensión.The main objective of this research was to generate a reliable and valid scale that Assessed alcohol's expectations in university's students in Mexico City. A scale was developed specifically for this purpose. The scale included 29 items with four options for answers (Totally agree, agree, disagree, and Totally disagree). The scale was applied to a sample of 189 university's students in order to obtain its psychometrical validation. The distribution of the participants was as follow: age between 18 to 24; all of them men: diverse majors and schools of university campus. A proper analysis took place in order to learn about the items discriminative power, reliability and valid factorial structure. The final scale was conformed by 22 items organized by five factors as follow: 1) positive effectts on mood, 2) social behavior with others, 3) live pleasant moments with friends, 4) looking for new experiences and 5) stress reduction, it explains 60of variance and has a reliability of Cronbach Alpha =0.89.Facultad de Humanidades y Ciencias de la Educació

DISOCIACIÓN DE LOS EFECTOS AMNÉSICOS Y ANSIOLÍTICOS EN EL LABERINTO ELEVADO EN T

La administración de benzodiazepinas produce efectos ansiolíticos y amnésicos.Los ansiolíticos no benzodiazepínicos, como la buspirona (BU), parecentener pocos efectos amnésicos, pero los resultados obtenidos varían con losprocedimientos usados para evaluar esos efectos. El laberinto elevado enT (LET) es un procedimiento que permite evaluar al mismo tiempo el efectoamnésico y el ansiolítico. En el presente estudio comparamos los efectos dela administración de escopolamina (E), un antagonista colinérgico clásico conefectos amnésicos, y de dos ansiolíticos, diazepam (DZ) y buspirona sobrela ejecución en el LET. Para ello, ratas Wistar machos (200-250 g) fueronevaluadas en el LET después de uno de los siguientes tratamientos: E (0.5,1, 3 mg/kg), DZ (2, 5 mg/kg), BU (2, 5 mg/kg) o salina (SAL). El día de entrenamientocada sujeto fue inyectado y puesto en el brazo cerrado y se midióel tiempo de permanencia en este brazo (evitación) (EV), lo cual fue seguidopor otros dos ensayos de EV. A continuación, cada sujeto fue puesto en elbrazo abierto y se midió el tiempo en que el sujeto tardó en volver al brazocerrado (latencia de escape) (ES). En la prueba de retención las latencias deEV y de ES fueron registradas a las 24 h sin la administración de los fármacos. Se observó un deterioro importante en las latencias de evitación en laadquisición y retención en los grupos tratados con E en comparación con losque recibieron salina; no se observaron cambios en las latencias de escape.Efectos similares, pero en menor grado fueron observados en las latenciasde evitación y retención en los grupos tratados con DZ; se observó un aumentoen las latencias de escape sugiriendo un efecto ansiolítico. La BU notuvo efectos en las latencias de evitación en la adquisición y en la retención;en los animales tratados con la mayor dosis de BU se observó un aumento enlas latencias de escape en el primer día, por lo que se sugiere que el fármacotuvo un efecto ansiolítico. A partir de los resultados del estudio sugerimos quela E induce efectos amnésicos pero no ansiolíticos, mientras que el DZ y laBU tienen efectos ansiolíticos; pero sólo el DZ induce amnesia anterógrada,y que estos efectos pueden ser disociados usando el LET

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

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

Mis casos clínicos de especialidades odontológicas

Libro que muestra la atención de casos clínicos particulares referente a las diferentes especialidades odontológicasLibro que muestra la atención de casos clínicos particulares referente a las diferentes especialidades odontológicasUniversidad Autónoma de Campeche Universidad Autónoma del Estado de Hidalgo Universidad Autónoma del Estado de Méxic

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Funciones ejecutivas como predictoras del consumo y la dependencia al tabaco

Among the factors related to tobacco use are problems in executive functions, which could influence the achievement of abstinence from smokers. However, the investigations have not been conclusive, since some studies have not found that association or refer to the manifestation of alterations occurs in adults over 60 years. The objective of the present investigation was to determine whether performance in executive functions predicts the pattern of tobacco consumption and the level of nicotine dependence. The sample consisted of 26 people who consume tobacco, with an average age of 42.8 years (SD = 15.0). A multiple regression analysis showed that the selective attention, mental flexibility and inhibitory control predict the total score of the level of nicotine dependence, and inhibitory control predicts the pattern of tobacco consumptionEntre os fatores relacionados ao uso do tabaco encontram-se problemas nas funções executivas, o que poderia influenciar a obtenção de abstinência de fumantes. No entanto, as investigações não têm sido conclusivas, uma vez que alguns estudos não descobriram que a associação ou referem que manifestação de alterações ocorre em adultos de mais de 60 anos. O objetivo desta pesquisa foi determinar se o desempenho nas funções executivas prevê o padrão de uso do tabaco e o nível de dependência da nicotina. A amostra foi conformada por 26 pessoas que consomem tabaco, com uma média de 42.8 anos (de= 15.0). Uma análise de regressão múltipla mostrou que a atenção seletiva, a flexibilidade mental e o controle inibitório predizem o escore total do nível de dependência da nicotina, e o controle inibitório prediz o padrão do consumo de tabaco.Entre los factores relacionados con el consumo de tabaco se encuentran problemas en las funciones ejecutivas, lo cual podría influir en el logro de la abstinencia de los fumadores. Sin embargo, las investigaciones no han sido concluyentes, ya que algunos estudios no han encontrado esa asociación o refieren que la manifestación de alteraciones ocurre en adultos de más de 60 años. El objetivo de la presente investigación fue determinar si el rendimiento en las funciones ejecutivas predice el patrón de consumo de tabaco y el nivel de dependencia a lanicotina. La muestra estuvo conformada por 26 personas que consumen tabaco, con una media de edad de 42.8 años (DE= 15.0). Un análisis de regresión múltiple mostró que la atención selectiva, la flexibilidad mental y el control inhibitorio predicen el puntaje total del nivel de dependencia a la nicotina, y el control inhibitorio predice el patrón del consumo de tabaco