Abstract Background: Myasthenia gravis (MG) is a post-synaptic autoimmune disease of the neuromuscular junction, whose cardinal manifestations are weakness and fatigue. Objective: The objective of the study was to report a cohort of patients with a diagnosis of MG in a West Mexican hospital and compare the clinical profile, diagnostic, and therapeutic approach and prognosis against a previously published cohort of the same hospital. Materials and methods: Consecutive patients included in two cohorts: the first one already published from 1999 to 2007 and the second one reported here from 2008 to 2018. Results: The most recent cohort included 39 patients, 23 women (59%), with an average age of 50 years, and superior to the previous cohort (43 years). Hypertension (39%) and diabetes (18%) were observed with a marked increase in the current cohort. The distribution in the Osserman staging was very similar. The positivity of acetylcholine receptor antibodies (ACRA) increased from 37% to 88%. In both cohorts, most patients received pyridostigmine and in two-thirds steroids. The previous cohort recorded 4% of patients treated with a steroid-sparing immunosuppressant, contrasting with 90% (azathioprine 85%, and mycophenolate 5%) of the current cohort. Thymectomy was a less frequent practice in 12%. Mortality showed a significant decrease from 16% to 0%. Conclusion: Differences were observed among the cohorts, highlighting in the most recent one a higher age, the appearance of chronic-degenerative diseases, greater positivity to ACRA, optimization of pharmacological management, less thymectomy, and no mortality. Replicas of this work in other hospital settings are pertinent.

Resumen Antecedentes: La miastenia gravis (MG) es una enfermedad autoinmune postsináptica de la unión neuromuscular, cuyas manifestaciones cardinales son debilidad y fatiga. Objetivo: Reportar una cohorte de pacientes con diagnóstico de MG en un hospital del occidente de México y comparar el perfil clínico, el enfoque diagnóstico y terapéutico, y el pronóstico frente a una cohorte publicada previamente del mismo hospital. Material y métodos: Pacientes consecutivos incluidos en dos cohortes; la primera ya publicada (de 1999 al 2007) y la reportada aquí (del 2008 al 2018). Resultados: En la cohorte más reciente se incluyeron 39 pacientes, 23 mujeres (59%), con edad promedio de 50 años, superior a la cohorte previa (43 años). Hipertensión arterial (39%) y diabetes (18%) se observan con marcado incremento en la cohorte actual. La distribución en la estadificación de Osserman fue similar. La positividad de los anticuerpos contra el receptor de acetilcolina (ACRA) aumentó del 37 al 88%. En ambas cohortes la mayoría de los pacientes recibieron piridostigmina y dos terceras partes esteroides. La cohorte previa registró un 4% de pacientes tratados con inmunosupresores ahorradores de esteroides, contrastando con el 90% (azatioprina 85%, micofenolato 5%) de la cohorte actual. La timectomía fue una práctica menos frecuente, en el 12%. La mortalidad presentó un importante decremento, del 16% al 0%. Conclusión: Se observan diferencias entre las cohortes, destacando en la más reciente una mayor edad de presentación, aparición de enfermedades cronicodegenerativas, mayor positividad a ACRA, optimización del manejo farmacológico, menos timectomía y nula mortalidad. Son pertinentes réplicas de este trabajo.

Abstract Respiratory syncytial virus (RSV) is the agent that causes more hospitalizations and deaths due to lower acute respiratory infection. Its distribution is widespread, and almost every child has been infected by the age of two years. Different risk populations have been identified: preterm newborns (NB), children with congenital heart disease, bronchopulmonary dysplasia, Down syndrome, cystic fibrosis, asthmatics, neuromuscular diseases, among others. However, preterm NBs, children with congenital heart disease or bronchopulmonary dysplasia show higher rates of hospitalization and death from RSV. In the late 90s, monoclonal antibodies against RSV were developed, with demonstrated efficacy and safety for the prevention of RSV hospitalizations in these populations. Currently, the American Academy of Pediatrics recommends this therapy for the prevention of severe infection in the population at higher risk. Economic evaluations have been conducted to determine the effectiveness of immunization, resulting favorable for palivizumab. Immunization in Mexico has resulted cost-effective in NBs under 32 gestation weeks. Mexican authorities should discuss the inclusion of palivizumab in their clinical guidelines.

Resumen El virus sincicial respiratorio (VSR) es el agente que ocasiona más hospitalizaciones y muertes por infección aguda de vías respiratorias bajas. La mayoría de los niños ya han sido infectados a los 2 años de edad. Se han identificado diferentes poblaciones de riesgo: recién nacidos pretérmino y niños con cardiopatía congénita, displasia broncopulmonar, síndrome de Down, fibrosis quística, asma y enfermedades neuromusculares, entre otras. Sin embargo, las tasas de hospitalización y de muerte por VSR son más altas en los recién nacidos pretérmino y en los niños con cardiopatía congénita o displasia broncopulmonar. A finales de los años 90 se desarrollaron anticuerpos monoclonales contra el VSR, los cuales demostraron ser eficaces y seguros en la prevención de hospitalizaciones por VSR en estas poblaciones. Actualmente, la American Academy of Pediatrics los recomienda para la prevención de la infección grave en la población de mayor riesgo. Se ha recurrido a evaluaciones económicas para determinar la efectividad de la inmunización, las cuales han sido favorables para el palivizumab. En México se ha demostrado que la inmunización es costo-efectiva en los recién nacidos menores de 32 semanas de gestación. Las autoridades mexicanas deben discutir la inclusión del palivizumab en sus guías de práctica clínica.

ABSTRACT The effects of reducing feeding rate and molasses on water quality, growth, and gene expression of Litopenaeus vannamei were evaluated in a super intensive system with zero water exchange. A bioassay of 35 days (0,75 ± 0,22 g, 36 shrimp tank-1, 450 shrimp m-3) with treatments in triplicate was performed: I) 100% commercial feed (control group) with water exchange; II) 100% commercial feed without water exchange; III) 100% commercial feed + Bacillus licheniformis BCR 4-3 + molasses without water exchange; IV) 90% commercial feed + B. licheniformis BCR 4-3 + molasses without water exchange, and V) 80% commercial feed + B. licheniformis BCR 4-3 + molasses without water exchange. Shrimp survival, weight, nitrogenous wastes, settleable solids (SS), and the relative expression (RT-qPCR) of stress and digestive genes were determined. Shrimp survival was 100% in all treatments. The reduced diet, bioflocs, and bacilli did not affect shrimp growth. The culture conditions reduced nitrogenous wastes and modulated mRNA expression of trypsin, chymotrypsin, and heat shock protein 70. Reduced feed ration can help to maintain water quality and lower costs in intensive shrimp cultures with bioflocs.

The population fluctuation of Diaphorina citri Kuwayama and its parasitoid Tamarixia radiata Waterston was determined in urban areas of the municipality of Playa, Havana City, Cuba. The study was carried out from February 15, 2007, to April 15, 2009. The populations of both insects on plants of Murraya paniculata L. (Jack) and Citrus spp. growing in private and public gardens were evaluated every ten days. In order to understand the interactions between the target pest and its parasitoid, logistic regressions,working with a nonlinear model, were used, and the generalized relationship between the samplings were used to determine the density in which a control treatment was necessary. The population of both insects on M. paniculata plants was higher in 2009; in the case of the natural enemy, the population doubled that observed in 2007. The lowest percentages of parasitoidism were found in the citrus plants. The maximum increase rate (K) of D. citri was 147, which exceeded the rate found during the samplings, with a mean population (ì) of 110.9 individuals and a net instantaneous growth rd = 0.06 ; for the parasitoid (K) was 98.25 individuals, a value higher than that observed for the samples, with a population mean (ì) of 53.4 individuals. With these results, it was estimated that, when a total of 49 individuals was present per each five sampled buds, it would be necessary the application of some measure to avoid the quick increment of D. citri.

Se determinó la fluctuación poblacional de Diaphorina citri Kuwayama y su parasitoide Tamarixia radiata Waterston en zonas urbanas del municipio Playa, La Habana, Cuba. La evaluación de las poblaciones de ambos insectos se realizó cada diez días, en plantas de Murraya paniculata L. (Jack) y Citrus spp., ubicadas en jardines de viviendas privadas e instalaciones públicas. Para conocer el comportamiento de las interacciones que se establecen entre este fitófago y su plaga diana se realizaron regresiones logísticas, según un modelo no lineal, y se determinó la densidad de D. citri, para la cual se hace necesario un tratamiento control. Se observó que las poblaciones de ambos insectos fueron mayores en el año 2009 en plantas de M. paniculata; se duplicó en el caso del enemigo natural, con relación a las encontradas en el año 2007. El parasitoidismo mostró los porcentajes más bajos en los cítricos. La capacidad máxima de incremento (K) de D. citri fue de 147, la cual supera a la encontrada durante los muestreos, con una media poblacional (µ) de 110,9 individuos con una tasa neta de crecimiento instantánea r d=0,06; mientras que para el parasitoide fue de 98,25 individuos, valor que se encuentra por encima de lo observado durante los muestreos, con una media poblacional (µ) de 53,4 individuos. A partir de estos resultados se estimó que, de existir 49 individuos totales por cada 5 brotes muestreados, resultará necesaria la aplicación de alguna medida que evite el incremento acelerado de D. citri.

The effectiveness of Amblyseius largoensis (Muma) (Acari: Phytoseiidae) for regulating Polyphagotarsonemus latus (Banks) (Acari: Tarsonemidae) populations in pepper crops was evaluated in a greenhouse, protected microplots and a tunnel system. A. largoensis were released at the densities of 2, 4 and 8 predators per plant in the greenhouse. In the microplot and tunnel systems, only four predators per plant were released. Broad mite population densities were evaluated weekly by sampling young leaves from the top of the plants. All three released rates of A. largoensis significantly (p < 0.05) controlled broad mite populations in the greenhouse; however, the control effect was delayed when only two predatory mites were released. On the other hand, releasing A. largoensis in the microplots and tunnel was also effective in controlling broad mites. These results demonstrated the effectiveness of A. largoensis to control broad mites in the pepper crop.

En el presente estudio se evaluó la efectividad de Amblyseius largoensis (Muma) (Acari: Phytoseiidae) para regular las poblaciones de Polyphagotarsonemus latus (Banks) (Acari: Tarsonemidae) sobre pimiento en casas de malla, canaleta y túnel de cultivo protegido. En casas de malla se usaron tres tasas de liberación, 2, 4 y 8 A. largoensis por plantas, mientras que en canaleta y túnel solo se liberaron 4 depredadores por planta. La población del ácaro blanco se evaluó a través de muestreos semanales de hojas jóvenes de la parte superior de las plantas. Las tres tasas de liberación de A. largoensis redujeron significativamente (P < 0,05) las poblaciones del ácaro blanco en casa de malla; pero cuando solo se liberaron dos depredadores por plantas, el efecto de control se retardó. En canaleta y túnel la liberación de A. largoensis también fue eficaz en el control del ácaro blanco. Los resultados obtenidos demostraron que A. largoensis es un agente de control biológico efectivo del ácaro blanco en pimiento.

The broad mites, Polyphagotarsonemus latus (Banks) (Acari: Tarsonemidae) is a cosmopolitan pest of many important crops as potatoes, beans, peppers, and citrus which lives in tropical, subtropical regions and greenhouses worldwide. Acording to its biological and ethological characteristics its control is complex by traditional methods of plant protection. For this reason, the use of the predatory mites of the Phytoseiidae family is an adequate and efficient management alternative. The present paper comprises the characterization of the potentiality of Amblyseius largoensis (Muma)(Acari: Phtyoseiidae) as biological control agent of P. latus integrating, for the first time, the predator's biological characteristics; feeding behavior and the numeric and functional responses; development of methodologies for mass rearing of the biological agent and parameters for quality control processes; the study of pest behavior in the protected production of Cuban hybrids of pepper, adapting the sampling methodology and determining the thresholds to estimate the population levels in these conditions. The compatibility of this predator with the principal chemicals and biological products used in the protected production and their effectiveness as biological control agent of P. latus in different conditions were evaluated. The results obtained demonstrated that A. largoensis is a new biological alternative for the management of broad mite populations in the protected production of peppers, which could be used in other agroecosystems; those that P. latus constitutes a problem, prior validation.

Dois métodos de manejo de irrigação, por tensiometria e pelo balanço hídrico climatológico simplificado baseado no tanque "Classe A", foram aplicados e avaliados os resultados no balanço de água no solo, na evapotranspiração e na produtividade de grãos da cultura do feijoeiro, cultivar IAC-Carioca, conduzida na estação seca com irrigação por pivô central, após uma cultura de milho (estação úmida), no primeiro ano de cultivo, nos sistemas de plantio direto e convencional em uma área de Latossolo Vermelho. Concluiu-se que ambos os métodos são possíveis de serem adotados por irrigantes ou técnicos com níveis médios de tecnologia e conhecimento, embora com a tensiometria seja possível um melhor entendimento das reais condições hídricas do solo na região do sistema radicular da cultura. Não foram verificadas diferenças importantes de armazenamento de água no solo e de produtividade de grãos entre os sistemas de plantio nesse primeiro ano; o manejo por tensiometria resultou em maiores variações na água disponível consumida do que o do balanço hídrico climatológico simplificado e resultou, em relação a esse, economia de 15% na água de irrigação aplicada, sem afetar a produtividade de grãos.

Two methods of irrigation management, tensiometry and simplified climatological water balance with Class A pan, were applied in a bean crop, IAC-Carioca cultivar, growing in a Oxisol, irrigated by center pivot under conventional and no tillage systems. The soil water balance, evapotranspiration and bean yield were evaluated. The results showed that, both irrigation management methods are possible to be adopted for farmers or technicians with average level of technology and knowledge. However, the tensiometry offers a better understanding of the real soil water conditions at plant root system. Differences of soil water storage and grain yield between tillage systems were not verified. The tensiometry management method resulted in a higher variations of plant available water when compared to the simplified climatological water balance. The tensiometry management method made possible reduction of 15% of the irrigation water, when compared to the simplified water balance, without affecting the grain yield.

A review is made on the clinical aspect of angina pectoris, making emphasis on the typical pain that occurs on effort and stress. This pain is oppressive, retrosternal, diffuse and radiates into the neck, jaw, shoulders and left arm. It relieves by rest and/or nitroglycerine. The most significant results of the electrocardiogram, the echocardiogram and the ergometric test are shown. The usefulness of coronary angiography in these cases is also mentioned. Finally, it is explained the conduct to be followed from the family physician's office in relation to the general and pharmacological treatment by using nitrates, beta blockers, calcium antagonists and new drugs

Se realiza una revisión sobre los aspectos clínicos de la angina de pecho haciendo énfasis en el dolor típico que se presenta con los esfuerzos y estrés, con características de ser opresivo, retroesternal, difuso, con irradiación al cuello, mandíbula, hombros y brazo izquierdo, y que se alivia con el reposo y/o la nitroglicerina. Se enuncian los resultados más relevantes del electrocardiograma, el ecocardiograma, la prueba ergométrica y se menciona la utilidad de la angiografía coronaria en estos casos. Por último se brinda la conducta a seguir desde el consultorio del Médico de Familia, referente al tratamiento general y farmacológico, empleando los nitratos, bloqueadores beta, los anticálcicos y los nuevos medicamentos utilizados

It is described a study of the 2,3-dihydro-6-methoxybenzo-furan-2-carboxylic acid (1) resolution by enzymatic hydrolysis of its methyl ester 2, through the biotransformation with the enzymes present in the liver of bovine, pig, chicken, rat, and rabbit. Moreover, the parameters studied were temperature, pH, solvents, reaction time and the enzymatic source on its natural support.

Se describe el estudio de la resolución del ácido 2,3-dihidro-6-metoxibenzofuran-2-carboxílico (1) mediante la hidrólisis enzimática de su éster metílico 2, utilizando en la biotransformación las hidrolasas presentes en el hígado de bovino, cerdo, pollo, rata y conejo. Se variaron en la biocatálisis los parámetros de temperatura, pH, co-disolventes, tiempo de reacción y el concentrado enzimático en su soporte natural.