Perfil de pacientes de uci neonatal con bronquiolitis en institución de cuarto nivel en Bogotá 2011

Introducción: La bronquiolitis se ha convertido en una patología de alta relevancia clínica y de salud pública, de la cual se han realizado múltiples estudios en cuanto a tratamiento y diagnóstico; Identificar el perfil de los pacientes que presentan esta patología en nuestra población justifica el profundizar en su conocimiento y contexto a nivel local. Metodología: Se realizó un estudio observacional descriptivo de serie de casos. Muestreo consecutivo o secuencial de pacientes con bronquiolitis que cumplieron los criterios de selección, durante el 2011. La información se analizó en SPSS. Se realizó un análisis descriptivo y análisis para determinar la posible asociación entre las variables. Resultados: El total de pacientes en el estudio fue 92. Se encontraron una serie de características comunes, discriminadas en dos grupos, características sociodemográficas de los pacientes y sus padres y características o manifestaciones clínicas de los pacientes, al ingreso, durante y al egreso de su hospitalización. Discusión: Las características sociodemográficas que identifican a los pacientes que presentan bronquiolitis pueden ser determinantes, como pertenecer a población vulnerable, como los pacientes recién nacidos, o lactantes menores; pertenecer a una comunidad en la cual haya presencia de niños en edad escolar. Conclusiones: Los pacientes con riesgo de presentar bronquiolitis, para este estudio, son lactantes menores y recién nacidos; hijos de padres profesionales, y bachilleres, y provenientes de la ciudad de Bogotá. A nivel socio demográfico se encontró que convivir con personas fumadoras y niños en edad escolar no mostró una diferencia en la distribución porcentual de estas variables.

Actuación de UNAMID (operación híbrida de la Unión Africana y las Naciones Unidas en Darfur) en la defensa de los Derechos Humanos de las mujeres en el conflicto en Darfur (2008 – 2012)

El interés de esta monografía es analizar los alcances y las limitaciones de la actuación de UNAMID en la defensa de los Derechos Humanos de las mujeres en el conflicto en Darfur (2008-2012). Lo anterior, para dar cuenta de que si bien UNAMID ha tenido avances significativos en el aumento de denuncias por violación sexual, en la educación y en la inclusión de la mujer en Darfur, la intervención tardía, la falta de personal cualificado y el lento despliegue ha limitado su actuación para erradicar la violencia sexual como arma de guerra. Sin embargo, la baja internalización de la norma por parte del Estado de Sudán ha sido el mayor limitante para la Misión de Paz. Este análisis se realiza mediante el concepto de Responsabilidad de proteger y el enfoque de Alexander Wendt y Nicholas Onuf.

Hallazgos radiológicos de la enfermedad pulmonar en pacientes Colombianos con esclerodermia

La esclerosis sistémica (ES) es una enfermedad autoinmune multisistémica que afecta principalmente la piel, los pulmones, el tracto gastrointestinal, el corazón y los riñones. La enfermedad pulmonar, presente en casi el 100% de los casos, es el factor con mayor influencia en la mortalidad. El propósito de este estudio es realizar un análisis detallado de la enfermedad pulmonar por tomografía computarizada de alta resolución(TCAR) en pacientes Colombianos con ES, para lo cual se realizó un estudio de prevalencia analítica en 44 pacientes con ES valorados en el Hospital Universitario Mayor Méderi en los últimos 7 años. Los resultados mostraron características demográficas y clínicas similares a las previamente descritas. La prevalencia de enfermedad pulmonar intersticial fue alta, y los hallazgos de fibrosis pulmonar como vidrio esmerilado y panal de abejas se asociaron con la presencia del autoanticuerpo antiSCL70. La medida del diámetro esofágico por TCAR fue mayor en los pacientes con disfagia, antiSCL 70 y linfopenia, los cuales son marcadores de mal pronóstico.

La evaluación de la competencia lectora : un enfoque cognitivo.

Ofrecer un modelo integrado de evaluación de la competencia lectora. Construir unas pruebas que permitan describir el tipo de estrategias que utilizan los lectores cuando se enfrentan a los textos escritos. Ofrecer un instrumento de evaluación que permita adaptar la intervención, en este campo, a las necesidades específicas de cada alumno. Participan, en los tres estudios que se presentan, 102 sujetos, alumnos de sexto y séptimo de EGB de un colegio público de la ciudad de Salamanca. Los sujetos son asignadosale atoriamente a tres tratamientos (pero teniendo en cuenta el curso). Se cuenta con dos programas de instrucción (estructura y resumen) y un grupo control (en el que sólo se aplican las pruebas de evaluación sin pasar tratamiento alguno). El programa de instrucción denominado 'estructura' está centrado en el componente dedicado a la organización textual. El programa de instrucción denominado 'resumen' está orientado a los componentes de progresión temática y aplicación de las macrorreglas. Las pruebas utilizadas son: prueba de resumen, prueba de progresión temática y la prueba denominada 'texto'. Igualmente se toman medidas del rendimiento académico, aptitudes escolares, actitudes hacia el estudio y pruebas de comprensión. En la prueba de progresión temática los alumnos debían completar un párrafo a partir de tres alternativas. Con esta prueba se pretende comprobar si el alumnos es capaz de localizar el tema específico de diferentes párrafos de un texto. En la prueba de resumen los alumnos deben generar un resumen de un párrafo. Se pretende comprobar la capacidad del alumno para aplicar las diferentes macrorreglas que genera la macroestructura textual. En la prueba texto los alumnos deben realizar tres tareas: el recuerdo libre del texto, contestar a unas preguntas del mismo y estimar el grado de importancia de una serie de frases del texto. Por otro lado, el rendimieto académico se operacionaliza a partir de las calificaciones de los alumnos en la primera evaluación del curso. Para evaluar las aptitudes escolares se aplica el SRA de Thurstone y Thurstone, adaptado al castellano con el nombre de TEA-2. Las actitudes hacia el estudio se evalúan mediante el cuestionario de actitudes escolares de Prieto. Se utilizan dos pruebas más de comprensión lectora: la prueba de comprensión lectora de Lázaro y el CTL de Suarez y Meara (procedimiento 'cloze'). Todas las pruebas, a excepción del cuestionario de actitudes escolares y el TEA-2, se aplican dos veces, antes y después de los programas de instrucción. Se utilizan varias pruebas para el análisis de los ítems (nivel de dificultad de cada ítem, análisis de correlación, análisis devarianza, fiabilidad y validez). Igualmente se utiliza la prueba de análisis de varianza de medidas repetidas, la prueba t de Student, el análisis de covarianza, análisis de correlación y análisis de regresión múltiple. El primer estudio concluye que los pruebas de resumen y recuerdo son altamente fiables para los propósitos para los que fueron construidas. El segundo estudio concluye que los alumnos entrenados en cada uno de los programas de instrucción mejoran en las pruebas que se relacionan con ellos. Los resultados de este estudio parecen corroborar la utilidad para la que se habían construido las pruebas: ser sensibles a los programas de instrucción, lo que a su vez implica que pueden diferenciar a los alumnos competentes de aquellos que no lo son. En el tercer estudio se comprueba que los resultados obtenidos por los alumnos en las pruebas elaboradas se relacionan con los resultados obtenidos en variables como el rendimiento académico, las aptitudes escolares o las actitudes hacia el estudio. Las consecuencias prácticas de los tres estudios deben ir encaminadas al planteamiento de la instrucción en comprensión de textos. Se deduce que la instrucción debe centrarse en los aspectos más relacionados con la organización textual (y no tanto en la estrategia de resumir). Igualmente se recomienda que se tengan en cuenta los avances habidos en la psicología cognitiva y de la instrucción.

Mapping the immune response to the outer domain of a human immunodeficiency virus-1 clade C gp120

The outer domain (OD) of human immunodeficiency virus (HIV)-1 gp120 represents an attractive, if difficult, target for a beneficial immune response to HIV infection. Unlike the entire gp120, the OD is structurally stable and contains the surfaces that interact with both the primary and secondary cellular receptors. The primary strain-specific neutralizing target, the V3 loop, lies within the OD, as do epitopes for two cross-reactive neutralizing monoclonal antibodies (mAbs), b12 and 2G12, and the contact sites for a number of inhibitory lectins. The OD is poorly immunogenic, at least in the context of complete gp120, but purposeful OD immunization can lead to a substantial antibody response. Here, we map the antibody generated following immunization with a clade C OD. In contrast to published data for the clade B OD, the majority of the polyclonal response to the complete clade C OD is to the V3 loop; deletion of the loop substantially reduces immunogenicity. When the loop sequence was substituted for the epitope for 2F5, a well-characterized human cross-neutralizing mAb, a polyclonal response to the epitope was generated. A panel of mAbs against the clade C OD identified two mAbs that reacted with the loop and were neutralizing for clade C but not B isolates. Other mAbs recognized both linear and conformational epitopes in the OD. We conclude that, as for complete gp120, V3 immunodominance is a property of OD immunogens, that the responses can be neutralizing and that it could be exploited for the presentation of other epitopes.

Contribution of redox status to hepatitis C virus E2 envelope protein function and antigenicity

Disulfide bonding contributes to the function and antigenicity of many viral envelope glycoproteins. We assessed here its significance for the hepatitis C virus E2 envelope protein and a counterpart deleted for hypervariable region-1 (HVR1). All 18 cysteine residues of the antigens were involved in disulfides. Chemical reduction of up to half of these disulfides was compatible with anti-E2 monoclonal antibody reaction, CD81 receptor binding, and viral entry, whereas complete reduction abrogated these properties. The addition of 5,5'-dithiobis-2-nitrobenzoic acid had no effect on viral entry. Thus, E2 function is only weakly dependent on its redox status, and cell entry does not require redox catalysts, in contrast to a number of enveloped viruses. Because E2 is a major neutralizing antibody target, we examined the effect of disulfide bonding on E2 antigenicity. We show that reduction of three disulfides, as well as deletion of HVR1, improved antibody binding for half of the patient sera tested, whereas it had no effect on the remainder. Small scale immunization of mice with reduced E2 antigens greatly improved serum reactivity with reduced forms of E2 when compared with immunization using native E2, whereas deletion of HVR1 only marginally affected the ability of the serum to bind the redox intermediates. Immunization with reduced E2 also showed an improved neutralizing antibody response, suggesting that potential epitopes are masked on the disulfide-bonded antigen and that mild reduction may increase the breadth of the antibody response. Although E2 function is surprisingly independent of its redox status, its disulfide bonds mask antigenic domains. E2 redox manipulation may contribute to improved vaccine design.

Novel single chain antibodies to the prion protein identified by phage display

A well defined structure is available for the carboxyl half of the cellular prion protein (PrPc), while the structure of the amino terminal half of the molecule remains ill defined. The unstructured nature of the polypeptide has meant that relatively few of the many antibodies generated against PrPc recognise this region. To circumvent this problem, we have used a previously characterised and well expressed fragment derived from the amino terminus of PrPc as bait for panning a single chain antibody phage (scFv-P) library. Using this approach, we identified and characterised I predominant and 3 additional scFv-Ps that contained different V-H and V-L sequences and that bound specifically to the PrPc target. Epitope mapping revealed that all scFv-Ps recognised linear epitopes between PrPc residues 76 and 156. When compared with existing monoclonal antibodies (MAb), the binding of the scFvs was significantly different in that high level binding was evident on truncated forms of PrPc that reacted poorly or not at all with several pre-existing MAbs. These data suggest that the isolated scFv-Ps bind to novel epitopes within the aminocentral region of PrPc. In addition, the binding of MAbs to known linear epitopes within PrPc depends strongly on the endpoints of the target PrPc fragment used. (c) 2006 Elsevier Inc. All rights reserved.

Agonist-dependent internalization of D2 receptors: imaging quantification by confocal microscopy

In positron emission tomography and single photon emission computed tomography studies using D2 dopamine (DA) receptor radiotracers, a decrease in radiotracer binding potential (BP) is usually interpreted in terms of increased competition with synaptic DA. However, some data suggest that this signal may also reflect agonist (DA)-induced increases in D2 receptor (D2R) internalization, a process which would presumably also decrease the population of receptors available for binding to hydrophilic radioligands. To advance interpretation of alterations in D2 radiotracer BP, direct methods of assessment of D2R internalization are required. Here, we describe a confocal microscopy-based approach for the quantification of agonist-dependent receptor internalization. The method relies upon double-labeling of the receptors with antibodies directed against intracellular as well as extracellular epitopes. Following agonist stimulation, DA D2R internalization was quantified by differentiating, in optical cell sections, the signal due to the staining of the extracellular from intracellular epitopes of D2Rs. Receptor internalization was increased in the presence of the D2 agonists DA and bromocriptine, but not the D1 agonist SKF38393. Pretreatment with either the D2 antagonist sulpiride, or inhibitors of internalization (phenylarsine oxide and high molarity sucrose), blocked D2-agonist induced receptor internalization, thus validating this method in vitro. This approach therefore provides a direct and streamlined methodology for investigating the pharmacological and mechanistic aspects of D2R internalization, and should inform the interpretation of results from in vivo receptor imaging studies.

Cleavage and serum reactivity of the severe acute respiratory syndrome coronavirus spike protein

Severe acute respiratory syndrome (SARS) coronavirus (SCoV) spike (S) protein is the major surface antigen of the virus and is responsible for receptor binding and the generation of neutralizing antibody. To investigate SCoV S protein, full-length and individual domains of S protein were expressed on the surface of insect cells and were characterized for cleavability and reactivity with serum samples obtained from patients during the convalescent phase of SARS. S protein could be cleaved by exogenous trypsin but not by coexpressed furin, suggesting that the protein is not normally processed during infection. Reactivity was evident by both flow cytometry and Western blot assays, but the pattern of reactivity varied according to assay and sequence of the antigen. The antibody response to SCoV S protein involves antibodies to both linear and conformational epitopes, with linear epitopes associated with the carboxyl domain and conformational epitopes associated with the amino terminal domain. Recombinant SCoV S protein appears to be a suitable antigen for the development of an efficient and sensitive diagnostic test for SARS, but our data suggest that assay format and choice of S antigen are important considerations.

Agonist-dependent internalization of D2 receptors: Imaging quantification by confocal microscopy

In positron emission tomography and single photon emission computed tomography studies using D2 dopamine (DA) receptor radiotracers, a decrease in radiotracer binding potential (BP) is usually interpreted in terms of increased competition with synaptic DA. However, some data suggest that this signal may also reflect agonist (DA)-induced increases in D2 receptor (D2R) internalization, a process which would presumably also decrease the population of receptors available for binding to hydrophilic radioligands. To advance interpretation of alterations in D2 radiotracer BP, direct methods of assessment of D2R internalization are required. Here, we describe a confocal microscopy-based approach for the quantification of agonist-dependent receptor internalization. The method relies upon double-labeling of the receptors with antibodies directed against intracellular as well as extracellular epitopes. Following agonist stimulation, DA D2R internalization was quantified by differentiating, in optical cell sections, the signal due to the staining of the extracellular from intracellular epitopes of D2Rs. Receptor internalization was increased in the presence of the D2 agonists DA and bromocriptine, but not the D1 agonist SKF38393. Pretreatment with either the D2 antagonist sulpiride, or inhibitors of internalization (phenylarsine oxide and high molarity sucrose), blocked D2-agonist induced receptor internalization, thus validating this method in vitro. This approach therefore provides a direct and streamlined methodology for investigating the pharmacological and mechanistic aspects of D2R internalization, and should inform the interpretation of results from in vivo receptor imaging studies.

O impacto da coqueluche no Estado do Rio de Janeiroestudo epidemiológico e percepção da Biossegurança: contribuindo para análise da re-emergência no Brasil

A coqueluche é uma doença respiratória, causada pela bactéria Bordetella pertussis. Atualmente, estima-se a ocorrência anual de 50 milhões de casos e mais de 300 mil mortes anuais em todo mundo. A transmissão ocorre, principalmente, pelo contato direto de uma pessoa doente com uma pessoa suscetível, através de gotículas de secreção da orofaringe eliminada por tosse ou espirro. O estudo realizado objetivou a caracterização da coqueluche como doença re-emergente, visando a análise epidemiológica da doença no Estado do Rio de Janeiro, valorizando também a percepção da Biossegurança pelos profissionais da área da saúde. Os resultados alcançados revelaram indicadores da ressurgência da doença no Brasil. As análises foram objeto de reflexões propostas em quatro artigos científicos, que explicitaram as metodologias utilizadas, os resultados encontrados e as discussões pertinentes à pesquisa. Os artigos intitulam-se: (1) An overview of reemerging Pertussis and evidence of ressurgence in Brazil, (2); A re-emergência da coqueluche; Da rotina dos atendimentos ao imperativo da Biossegurança (3); Fórum itinerante de ciência e saúde. Programa de capacitação para as doenças negligenciadas e re-emergentes e (4) Identification of linear B epitopes of pertactin of Bordetella pertussis induced by immunization with whole and acellular vaccine

Vaccine glycoproteins tagged with the human Fc domain as second generation vaccine candidates

Traditional vaccines such as inactivated or live attenuated vaccines, are gradually giving way to more biochemically defined vaccines that are most often based on a recombinant antigen known to possess neutralizing epitopes. Such vaccines can offer improvements in speed, safety and manufacturing process but an inevitable consequence of their high degree of purification is that immunogenicity is reduced through the lack of the innate triggering molecules present in more complex preparations. Targeting recombinant vaccines to antigen presenting cells (APCs) such as dendritic cells however can improve immunogenicity by ensuring that antigen processing is as efficient as possible. Immune complexes, one of a number of routes of APC targeting, are mimicked by a recombinant approach, crystallizable fragment (Fc) fusion proteins, in which the target immunogen is linked directly to an antibody effector domain capable of interaction with receptors, FcR, on the APC cell surface. A number of virus Fc fusion proteins have been expressed in insect cells using the baculovirus expression system and shown to be efficiently produced and purified. Their use for immunization next to non-Fc tagged equivalents shows that they are powerfully immunogenic in the absence of added adjuvant and that immune stimulation is the result of the Fc-FcR interaction.

Isolation of recombinant antibodies against EspA and intimin of Escherichia coli O157:H7

Intimin, Tir, and EspA proteins are expressed by attaching-effacing Escherichia coli, which include enteropathogenic and enterohemorrhagic E. coli pathotypes. EspA proteins are part of the type three secretion system needle complex that delivers Tir to the host epithelial cell, while surface arrayed intimin docks the bacterium to the translocated Tir. This intimate attachment leads to attaching and effacing lesions. Recombinant forms of these effector proteins from enterohemorrhagic E. coli O157:H7 were produced by using E. coli expression vectors. Binding of intimin and Tir fragments in enzyme-linked immunosorbent assay (ELISAs) demonstrated the interaction of intimin fragments containing the C-terminal 282 or 188 amino acids to a Tir fragment containing amino acid residues 258 to 361. Recombinant intimin and EspA proteins were used to elicit immune responses in rabbits and immune phage-display antibody libraries were produced. Screening of these immune libraries by conventional phage-antibody panning and colony filter screening produced a panel of antibodies with specificity for EspA or intimin. Antibodies recognizing different C-terminal epitopes on intimin bound specifically to the gamma intimin of O157:H7 and not to other classes of intimin. Antibodies recognizing EspA from E. coli O157 also recognized the protein from the eae-deficient O157 mutant DM3 and from E. coli O111. Anti-intimin antibodies were also produced as fusion proteins coupled to the reporter molecule alkaline phosphatase, allowing the one-step detection of gamma intimin. The isolated recombinant monoclonal antibodies were functional in a range of assay formats, including ELISA, Western blotting, and dot blots, thus demonstrating their diagnostic potential.

Binding properties and adhesion-mediating regions of the major sheath protein of Treponema denticola ATCC 35405

There is growing evidence that a number of oral Treponema species, in particular Treponema denticola, are associated with the progression of human periodontal disease. The major sheath (or surface) protein (Msp) of T. denticola is implicated in adhesion of bacteria to host cells and tissue proteins and is likely to be an important virulence factor. However, the binding regions of the Msp are not known. We have purified from Escherichia coli recombinant Msp (rMsp) polypeptides corresponding to the following: full-length Msp (rMsp) minus 13 N-terminal amino acid (aa) residues, an amino-terminal fragment (rN-Msp, 189 aa residues), a 57-aa residue segment from the central region (rV-Msp), and a C-terminal fragment (rC-Msp, 272 aa residues). rMsp (530 aa residues) bound to immobilized fibronectin, keratin, laminin, collagen type 1, fibrinogen, hyaluronic acid, and heparin. The N- and V-region polypeptides, but not rC-Msp, also bound to these substrates. Binding of rMsp to fibronectin was targeted to the N-terminal heparin I/fibrin I domain. Antibodies to the N-region or V-region polypeptides, but not antibodies to the rC-Msp fragment, blocked adhesion of T. denticola ATCC 35405 cells to a range of host protein molecules. These results suggest that the N-terminal half of Msp carries epitopes that are surface exposed and that are involved in mediating adhesion. Binding of rMsp onto the cell surface of low-level fibronectin-binding Treponema isolates conferred a 10-fold increase in fibronectin binding. This confirms that Msp functions autonomously as an adhesin and raises the possibility that phenotypic complementation of virulence functions might occur within mixed populations of Treponema species.

Post-endocytic sorting of calcitonin receptor-like receptor and receptor activity-modifying protein 1

Calcitonin receptor-like receptor (CLR) and the receptor activity-modifying protein 1 (RAMP1) comprise a receptor for calcitonin gene-related peptide (CGRP). Although CGRP induces endocytosis of CLR/RAMP1, little is known about post-endocytic sorting of these proteins. We observed that the duration of stimulation with CGRP markedly affected post-endocytic sorting of CLR/RAMP1. In HEK and SK-N-MC cells, transient stimulation (10(-7) M CGRP, 1 h), induced CLR/RAMP1 recycling with similar kinetics (2-6 h), demonstrated by labeling receptors in living cells with antibodies to extracellular epitopes. Recycling of CLR/RAMP1 correlated with resensitization of CGRP-induced increases in [Ca(2+)](i). Cycloheximide did not affect resensitization, but bafilomycin A(1), an inhibitor of vacuolar H(+)-ATPases, abolished resensitization. Recycling CLR and RAMP1 were detected in endosomes containing Rab4a and Rab11a, and expression of GTPase-defective Rab4aS22N and Rab11aS25N inhibited resensitization. After sustained stimulation (10(-7) M CGRP, >2 h), CLR/RAMP1 trafficked to lysosomes. RAMP1 was degraded approximately 4-fold more rapidly than CLR (RAMP1, 45% degradation, 5 h; CLR, 54% degradation, 16 h), determined by Western blotting. Inhibitors of lysosomal, but not proteasomal, proteases prevented degradation. Sustained stimulation did not induce detectable mono- or polyubiquitination of CLR or RAMP1, determined by immunoprecipitation and Western blotting. Moreover, a RAMP1 mutant lacking the only intracellular lysine (RAMP1K142R) internalized and was degraded normally. Thus, after transient stimulation with CGRP, CLR and RAMP1 traffic from endosomes to the plasma membrane, which mediates resensitization. After sustained stimulation, CLR and RAMP1 traffic from endosomes to lysosomes by ubiquitin-independent mechanisms, where they are degraded at different rates.