Markers of senescence?

The specific identification of cellular senescence in clinical material has important implications for determining the role of senescence in age-related pathologies and in neoplasia in certain tumours. One suggested marker of senescence is the histochemical identification of a specific beta-galactosidase enzyme operative at pH 6.0. However, recent data indicate that this enzyme may not be specific for senescence in all tissues and probably represents the expression of endogenous lysosomal acid beta-galactosidase, which is expressed by a variety of differentiated cell types.     

Universalization of health or of social security?

This article presents an analysis of the architecture of Mexico's health system based on the main economic problem, failing to achieve a GDP growth rate to increase real wages and give workers in formal employment coverage social security. This analysis describes the relationship between social security of the population and employment status of it (either formal or informal employment) and the impact that this situation poses to our health system. Also, it ends with a reform proposal that will give all workers the same social rights, ie to grant universal social security.     

Descartes' Passions of the soul--seeds of psychiatry?

Rene Descartes (1596-1650), often called the 'father of modern philosophy', aimed at rooting all knowledge in certainty so that our understanding of the world could progress without error. To achieve this, he needed at least one sure thing on which to build. Starting with the most basic knowledge, the fact of his own existence--cogito ergo sum (I think therefore I am), he systematically proceeded to explain the world. Such systematic understanding would be accessible to anyone who applied the Cartesian method, and in turn would lead to a good life. Descartes' Passions of the Soul was written according to his method of certainty and fits in with a meticulously refined worldview. It is one of the first systematic treatises to explain a wide array of emotions, both normal and abnormal. Based on the Cartesian dualistic model of mind and body, the work helps ground a long medical tradition of separating 'rational' consciousness from emotions. For Descartes, emotions arose from two sources, the intellect and the body (Passions of the Soul and Passions of the Body). The more subtle 'Passions of the Soul' were viewed as superior to coarser and often-troublesome emotions taking root in the body. It is interesting to note the absence of clarity, however, in Descartes' division of intellectual emotions from bodily emotions, perhaps revealing an enduring weakness in the dualistic model itself. The work grapples with the multi-causal nature of psychopathology and brings out complex interactions between temperament and life experience. While modern neuroscience makes ever-tighter associations between physiology and experience, many of the basic scientific challenges we face today are outlined in this 350-year-old book.     

Prevention of mother-to-child transmission of HIV--what next?

Mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) is a global problem. HIV can be transmitted from mother-to-child at various stages of pregnancy including in utero, intrapartum and during breastfeeding. A number of interventions have, therefore, been aimed at effectively providing alternatives to breastfeeding and limiting the risk of newborn infection during delivery, by using caesarian section as the mode of delivery and administering antiretroviral (ARV) drugs prepartum and peripartum. However, these approaches are not always possible in developing countries and the use of ARV drugs, in particular nevirapine, zidovudine and zidovudine/lamivudine, have been investigated in both developing countries and developed countries. The studies have involved the administration of various ARV prophylaxis regimens to HIV-infected pregnant women perinatally, either as monotherapy or in various combinations. In some studies, infants have also received ARV prophylaxis. Although studies have enrolled different populations and utilized various ARV drugs and regimens, encouraging reductions in the MTCT rates have been reported. These interventions have raised concerns regarding the development of ARV-resistant HIV strains. Mutations that confer resistance to nevirapine have been detected in pregnant women who received this drug, but the emergence of these mutations was not associated with an increased risk of transmission of HIV-1 to their infants. Studies are ongoing to determine if the presence of these mutations has implications for the subsequent administration of nevirapine, either to prevent MTCT of HIV-1 or for the mother's own health. Effective interventions that can reduce MTCT of HIV are now available worldwide. However, a number of issues remain to be resolved, particularly methods to reduce the transmission of the virus during breastfeeding and to deliver effective treatment for the mothers' own HIV infection.     

A case of alcohol-induced ketoacidosis?

We report a case of severe ketoacidosis. Initially the patient showed metabolic acidosis, the anion gap was positive and there was neither hyperlactatemia nor intoxication with acid substances. As the rate of glycemia was high (17.8 mmol/L), the diagnosis of diabetic ketoacidosis was proposed. Under treatment with continuous IV injection of insulin, hypoglycemia (1.8 mmol/L) appeared rapidly, while urine bioreactive test was positive for ketonuria, but negative for glycosuria. We finally concluded that it was an alcoholic ketoacidosis. The history of the patient confirmed the diagnosis : chronic alcoholism with recent increased of alcohol intake which provoked vomiting and fasting. This case report shows the difficulty in distinguishing between alcoholic ketoacidosis and diabetic ketoacidosis. We discuss the diagnostic strategy and particularly biologic data in the light of pathophysiologic mechanism of alcoholic ketoacidosis.