Palabras claves: toxina Shiga, SUH, diarrea, insuficiencia renal, daño cerebral
Abstract RoleoftheShigatoxinintheHemolyticUremicSyndrome. Inthe last years, infection associa-
ted with Shigatoxin-producing Escherichia coli (STEC) and subsequent Hemolitic-UremicSyndrome (HUS) became relevant as a public health since it was considered as one ofthe most important emergent patogen present inthe food contaminated by cattle feces. STEC infection may be asymptomatic or begins with a watery diarrhea that may or may not progress to bloody diarrhea (hemorrhagic colitis) and HUS. In Argentina, HUS is the most common pediatric cause of acute renal insufficiency and the second cause of chronic renal failure. Up to now, STEC infection lacks of known effective treatment strategies that diminish risk of progression to HUS. The mechanisms by which Shigatoxin (Stx) induce HUS may help to find strategies to prevent or ameliorate HUS. In this article, recent progress that has contributed to understanding the disease pathogenesis of STEC is reviewed. New strategies to prevent further uptake ofShiga from the gut, either during the diarrheal phase or once HUS has developed are discussed.
Hemolyticuremicsyndrome (HUS) is defined by the triad ofhemolytic anemia microangiopathic, throm- bocytopenia and acute renal failure. In Argentina it constitutes the first cause of acute renal failure in Pediatrics. Approximately 2-4% of patients die during the acute phase ofthe disease, and only a third ofthe remaining 96% survive with renal sequelae, such as the persistence of proteinuria.
Abstract Shigatoxin-producing Escherichia coli (STEC) is a foodborne pathogen that can cause watery diarrhea, bloody diarrhea (BD), and hemolyticuremicsyndrome (HUS). The objective of this study was to determine the phenotypic and genotypic proﬁles of STEC strains isolated from children with BD and HUS treated at a pediatric hospital inthe city of La Plata inthe period 2006-2012, and to establish the clonal relationship of O157:H7 isolates by pulsed ﬁeld electrophoresis. The percentage of positive samples was 4.9% and 39.2% in patients with BD and HUS, respectively. Seventy-seven STEC strains from 10 different serotypes were isolated, with 100% colony recovery, O157:H7 being the most frequent (71.4%) serotype, followed by O145:NM (15.6%). An average of 98.2% of O157:H7 isolates belonged to biotype C and were sensitive to all the antibiotics tested. All of them (100%) carried genotype stx 2 , eae, ﬂiC H7 , ehxA, iha, efa, toxB, lpfA1-3 and lpfA2-2. When the clonal relationship ofthe O157:H7 strains was studied, a total of 42 patterns with at least 88% similarity were identiﬁed, and 6 clusters with identical proﬁles were established. The eae-negative isolates belonged to serotypes O59:H19, O102:H6, O174:NM and O174:H21. The strains O59:H19 and O174:H21 were positive for the aggR gene. This study shows that STEC of different serotypes and genotypes circulate inthe city of La Plata and surroundings. Despite the genetic diversity observed between the O157:H7 isolates, some were indistinguishable by the subtyping techniques used.
Palabras claves: respuesta innata, inflamación, anticuerpos, leucocitos, quimioquinas.
Abstract Activation of innate and specific immune responses inhemolyticuremicsyndrome (HUS)- patients. The central roleofthe immune system is the preservation ofthe health against several pathogenic microbes and injury agents. However, on special conditions defensive mechanisms triggered towards the foreign agent can damage the host. Clinical and experimental evidence indicate that inflammatory reaction triggered by the main components ofShigatoxin (Stx)- producing Escherichia coli (STEC), participate inthe evolution to the complete form of HUS. When children are diagnosed of HUS, they present evidence that have suffered a very strong and early inflammatory response. These features include: the presence of a marked neu- trophilia, the polymorfonuclear leucocytes (PMN) are “deactivated or exhausted” and the monocytes are differ- entiated towards an inflammatory phenotype (CD14-reduced and CD16-enhanced membrane expression). In addition, HUS-patients show a marked reduction inthe absolute and relative number of leucocytes carrying the receptor (CX 3 CR1) for the chemokine “Fractalkine” (FKN, CX 3 CL1), which are the classic monocytes and Natu- ral Killer cells (NK). All these cells express a high cytotoxic potencial. The chemokine FKN is expressed in en- dothelial and epithelial renal cells, and is involved inthe pathogenic mechanism of different nephropathies. Note- worthy, we found a significant correlation between the severity ofthe renal damage (as days of anuria) and the alterations described above. Finally, the protective roleof specific immune response, mainly through the anti- body production with Stx-neutralizing capacity, is discussed.
El SHUa es una patología de diagnóstico clínico. Dentro de los múltiples parámetros estudiados, el método más preciso para el diagnóstico se basa en la exclusión de otras MAT y se deben tener en cuenta, más allá de los síntomas comunes de compromiso de órganos por la microangiopatía, valores de laborato- rio compatibles con la presencia de hemólisis intra- vascular no inmunológica, como es la elevación de la LDH secundario a fragmentación de glóbulos rojos, presencia de esquistocitos en el extendido de sangre periférica, Coombs negativo, valores de hemoglobi- na bajos o niveles de haptoglobina no detectables; cabe destacar la tríada clásica caracterizada por:1) hemólisis microangiopática, 2) trombocitopenia, y 3) daño a órganos, con mayor frecuencia la lesión re- nal aguda (hematuria, proteinuria o disminución de la función renal). Condición que es potencialmente mortal y requiere tratamiento inmediato para evitar el daño irreversible de los órganos o la muerte. Las causas más comunes de MAT son la Púrpura Trombótica Trombocitopénica (PTT), el Síndrome Urémico Hemolítico (SUH), el cual, a su vez, se di- vide en SHU STEC (causado por la Shiga toxina de la E. coli entero invasiva) y SHUa (enfermedad cró- nica, genética por desregulación del sistema de com- plemento). A diferencia del SHU que se describió previamente, la trombosis intravascular en la PTT es consecuencia de una deficiencia severa de la activi- dad de la metaloproteasa ADAMST13, una enzima plasmática encargada de fragmentar los multímeros ultra largos de factor von Willebrand 15 . Actualmen-
Atypical hemolyticuremicsyndrome (aHUS) is a rare thrombotic microan- giopathy, characterized by microangiopathic hemolytic anemia, thrombocyto- penia and renal involvement. It causes end stage renal disease requiring dialysis in most affected patients. It mainly affects young adults (contrary to what was thought years ago). When aHUS is primary, the cause is a genetic mutation inthe alternative complement pathway. Instead, secondary aHUS is caused by external factors that trigger the disease by themselves or in combination with a genetic vulnerability. The type of mutation determines the severity ofthe disease, prognosis, response to therapy and renal transplantation. Advances inthe understanding of renal diseases associated with complement defects and the development of specific biologic therapies changed the course of this disease. Eculizumab is internationally approved for the treatment of primary aHUS. Its inhibitory action on the complement cascade leads to hematologic remission and restoration of renal function. We present a review of aHUS detailing its etiology, pathogenesis, clinical presentation, diagnosis and treatment.
The economic growth, that took place in Spain from the nineties till 2008, brought along huge economic and redistributive consequences. Always linked to a real estate risk and to the removal of capital from the lowest income families, this growth became into a mechanism of accumulation-dispossession suffered by the most disadvantaged social classes. Several studies, in which the socio-spatial segregation was analysed through the evolution of housing prices (as a proxy index for income), demonstrated the progressive and ongoing gentrification of certain areas ofthe city in contrast to the constant exclusion ofthe most vulnerable districts (1).
Taking all of this into account, the powers at work seem to have finally accepted that it is better to have a secular dictator in power than jihadists and Islamic fundamentalists roaming around. Ultimately, a choice to determine which is the lesser evil. Inthe case of Syria, the civil war hasn’t led to change considering that the regime seems to have achieved a victory through exhaustion. As ofthe Syrian situation in 2018, the course of things seems to be going back to step one in 2011. The massive loss of human life, millions of displaced refugees, and entire cities completely destroyed have been in vain. Inthe meantime, the world has seen the Assad regime use chemical weapons on civilian population and the rise and fall ofthe Islamic State, the most successful terrorist organization in history in terms of financial achievements and territorial conquest. Even the conservative Islamist forces found inthe Saudis, Qataris, and Turks, with their vested interest in backing the Free Syrian Army and the Islamic Front, have accepted that their mission has failed. Long story short, there simply isn’t another way forward inthe Middle East. It seems that for now, the best the region can hope for is to maintain the old order and hope that stability will triumph over chaos. Removing the Secular authoritarian regimes means chaos and we have come to accept it. Inthe case of Syria, without Bashar al Assad’s regime, the elevator only goes down.
Spontaneous speech from teachers and children -from Nursery to Year 2- was collected at the British Council School of Madrid during one school year. This bilingual school takes students from 3 to 18 years of age and most of them native speakers of Spanish (98%). The learners’ age ofthe research ranged between 3 and 7 years and the instructional focus ofthe classes was on subject matter, not only on language forms. This piece of research is a continuation of a previous longitudinal and cross-sectional studies carried out inthe same instructional environment (Fleta, 1999).
Due to the nature ofthe data available for analysis, there are a number of potentially problematic points that need to be addressed: the data used will rely heavily on the 2011 Census, with most data distributed across race and not religion. This can be a problem when trying to extrapolate data to Muslim communities since neither race nor ethnicity denote affiliation to a particular religious group. This is why we have chosen to focus on Bangladeshi and Pakistani Muslims, as they represent a majority group that can be used as a paradigm ofthe British Muslim experience. Both ethnicities are often grouped together in official statistics and surveys, and both communities are more than 90% Muslim (Office for National Statistics, 2011). Furthermore, together they represent more than half ofthe UK Muslim population (Office for National Statistics, 2011). Regarding geographical area, this dissertation will focus on England and Wales, as there is more data available and the British Muslim population is concentrated in those two countries, although certain figures for Northern Ireland and Scotland will be mentioned on occasion. Even if discrepancies in data parameters and results are thus possible, it is our belief that the data provided will be sufficient to extrapolate the situation ofthe median British Muslim, and explore theroleofthe British government in promoting Islamophobia
A number of studies have looked at how innovation would be affect- ed by a reform ofthe patent system (or, more generally, of IPRs). The results obtained cast some doubt on whether stronger patent protec- tion increases the rate of innovation. Helpman  showed that strong pat- ent protection will increase the rate of innovation only inthe short term as it raises profitability; inthe long term it lowers the innovation rate as the producers tend to produce the older products. Other studies [9, 10, 11] seem to agree with this idea. For industries where innovation is se- quential and complementary (as in software, semiconductors and com- puters), Bessen and Maskin  conclude that stronger protection
However, an industrialization movement occurred with the efforts ofthe state inthe 19th century despite the Ottoman State’s statist structure regarding the economy and its underdeveloped private sector. Quatert (1994) suggests that wars, religion and population density can be recognized as the primary reasons for the lack of capital- intensive industrialization inthe Ottoman State. During the Tanzimat era, the Ottoman State aimed to merge with the profit-based understanding ofthe West. During the 1840s, two hundred students were sent to France to receive business administration education in Les Ecoles de Haute Commerce in Paris (Duran, 2012). Upon their return, they attempted to modernize the administration infrastructure by translating the two books of Napoleon’s Code de Commerce (1807) and published it under the title Kanunname-i Ticaret (Code of Commerce) in 1850. This legal action pioneered a way for a westernized accounting understanding and trade law. Today, this influence continued to evolve with the commercial codes of 1926, 1957 and 2011. Kanunname-i Ticaret (1850) introduced two reforms towards modernization. The first one was the principles regarding the establishment of modern commercial companies. However, the existence ofthe Sharia law restrained local entrepreneurs from adopting western companies’ business approaches. Only the enterprises with foreign capital utilized the new commercial code.
2013). Of particular interest, behavioral studies show that people who take faster (and presumably more intuitive) decisions tend to be more cooperative, while people who make slower (and presumably more reflective) decisions tend to be more selfish (Rand et al., 2012, studies 1-5 and 10). However, the sole use of decision times to infer whether we are intuitively cooperative or selfish is misleading (Krajbich, Bartling, Hare, & Fehr, 2015). In fact, Evans, Dillon and Rand (2015) show that reaction times are driven by decision conflict –rather than intuition or reflection- and, therefore, “should not be interpreted as a direct proxy for the use of intuitive or reflective processes” (p. 951). Nonetheless, by directly manipulating cognitive processes one can avoid this pitfall. Accordingly, studies that induce intuitive processes show that making subjects respond under time pressure (Rand et al., 2012, studies 6-7; Cone & Rand, 2014; Rand et al., 2014a; Rand, Newman, & Wurzbacher, 2014b; Rand & Kraft-Todd, 2014c; Evans et at., 2015), priming intuitive processes (Rand et al., 2012, studies 8-9; Lotz, 2014; Evans et al., 2015) and lowering impulse control (De Dreu, Dussel, & Ten Welden, 2015) increases cooperation. In addition, there is evidence of intuitive prosociality in other social preference domains such as altruism (Cornelissen, Dewitte, & Warlop, 2011; Schulz, Fischbacher, Thöni, & Utikal, 2012) and fairness (Cappelletti, Güth, & Ploner, 2011). The cumulative behavioral evidence showing a relationship between intuition and cooperation has given rise to a labeled intuitive-cooperation effect.
Descriptores: Construcción Social del Riesgo, Gestión Integral de Riesgos, Cultura Preventiva.
The risk insocio-natural disasters is the result ofthe closerelation between the latent danger of a natural phenomenon, as external, fixed and unalterable factor, and the vulnerability determined by the local conditions to confront the threat, together with the degree of acceptance and preventive formation ofthe population. The above mentioned reality could be transformed if deepchanges were achieved. Those changes will allow the assimilation ofthe prevention component as part ofthe culture. The present test arises from the interest to think about the importance ofthe education so a new prevention culture may be reached according to this vision, only by means ofthe educational action, seem as a goal more than an aim. Collective changes will be able to be achieved and will redound towards an integral management of risks to the perspective ofthe sustainable development.
I have followed a sampling illustratively strategy (Mann and Stewart 2000: 126). It means as well that the sampling done tries to find ―an example‖ of how bloggers interact, but the result ofthe research is not an absolute truth that can be generalized to all blogosphere. Following the overview for the planning and preparation procedure for qualitative interviews by Jenifer Mason (2002: 75), written interviews of ten big questions plus several sub questions were sent to the personal emails ofthe bloggers selected, in Spanish for the bloggers of this language, and in English for the bloggers of that language 4 . Furthermore, the questions gave enough room to the participants to add more information requested inthe case they would like to comment something was not included inthe interview. I started the indexing, codification and categorization ofthe available data, using the methodology
the various stimuli for trained immunity include mi- crobes, nutrients, and other stimulating agents that are able to induce a metabolic shift from oxidative phosphorylation to aerobic glycolysis (the Warburg effect). This happens via the activation of mammalian target of rapamycin (mTOR) and its effector, hypoxia- inducible factor (HIF)-1α. So, the mTOR- and HIF-1α- induced metabolic shift play a major rolein epigenetic reprogramming of monocytes, leading to the trained innate immunity phenotype of macrophages 72 . Sum-
11 RodrigoBRAICOVICH qxd Maqueta qxd EL SOLIPSISMO Y EL PAPEL DE LA DIVINIDAD EN LAS REFLEXIONES DE EPICTETO RODRIGO SEBASTIÁN BRAICOVICH Universidad Nacional de Rosario, CONICET (Argentina) RESUMEN E[.]
ZX, Hu ZX, Lin J, Xiao JZ, Cao HB, Liu PA, Jiang XG, Jiang YY, Wang JP, Zheng H, Zhang H, Bennett PH, Howard BV. Effects of diet and ex- ercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 20(4):537-44, 1997