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Multiple randomized controlled trials (RCTs) have examined first-line pharmacological agents such as anticholinergics and β3 agonists for the management of overactive bladder symptoms (OAB). Although earlier systematic reviews and (network) meta-analyses aimed to summarize the evidence, a substantial number of trials were not included, so a comprehensive and methodologically rigorous evaluation of the comparative effectiveness of all first-line pharmacological treatments is lacking. We aim to conduct a series of systematic reviews and network meta-analyses (NMAs) for a comprehensive assessment of the effectiveness and safety of first-line pharmacological treatments for OAB. Eligible studies will include RCTs comparing anticholinergics and β3 agonists to one another or to placebo in adults with OAB or detrusor overactivity. Pairs of reviewers with methodological training will independently evaluate candidate studies to determine eligibility and extract relevant data. We will incorporate patient-important outcomes, including urinary urgency episodes, urgency incontinence episodes, any type of incontinence episodes, urinary frequency, nocturia, and adverse events. We will conduct the NMAs using a frequentist framework and a graph theory model for each outcome. Analysis will follow rigorous methodologies, including handling of missing data and assessment of the risk of bias. We will conduct sensitivity and subgroup analyses and will apply the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to rate evidence certainty. Our approach aims to address the knowledge gap in the treatment of OAB by synthesizing evidence from RCTs worldwide. We will employ robust statistical methods, including frequentist NMA, to general clinically relevant and patient-important insights. Sensitivity and subgroup analyses will enhance the robustness and generalizability of our findings. Our reviews strive to inform evidence-based decisions in the management of OAB, to ultimate improve patient outcomes. Our study results may guide health policy decisions, such as reimbursement policies, and future studies in functional urology.The protocol for the review series is registered on PROSPERO as CRD42023266915.

Summary: Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.

Introduction: Esophageal pH-impedance monitoring is a tool for diagnosing gastroesophageal reflux in children. The position of the pH catheter is essential for a reliable reading and the current formulas for calculating catheter insertion length are not completely accurate. The aim of the present study was to develop a new formula for adequate insertion of the pH catheter. Material and methods: A cross-sectional study was conducted on children that underwent pH-impedance monitoring and later radiographic control, to calculate the correct catheter insertion length. The documented variables were age, sex, weight, height, naris to tragus distance, tragus to sternal notch distance, sternal notch to xiphoid process distance, and initial insertion length determined by the Strobel and height interval formulas. A multivariate regression analysis was carried out to predict the final insertion length. Regression ANOVA and Pearson’s adjusted R-squared tests were performed. Results: Forty-five pH-impedance studies were carried out, 53% of which were in males. The age and weight variables were not normally distributed. In the initial regression model, the variables that did not significantly correlate with the final insertion length were: sex (P 0.124), length determined by the Strobel or height interval formulas (P 0.078), naris to tragus distance (P 0.905), and tragus to sternal notch distance (P 0.404). The final equation: 5.6 + (height in cm * 0.12) + (sternal notch to xiphoid process distance * 0.57) produced an R2 of 0.93 (P 0.000). Conclusions: This formula can be considered a valid option for placement of the pH-impedance monitoring catheter in pediatrics. Resumen: Introducción: La pH-impedanciometría esofágica es una herramienta para el diagnóstico de reflujo gastroesofágico en niños, la posición del sensor de pH es crucial para una lectura confiable, las fórmulas existentes para el cálculo de la inserción del catéter no son tan precisas; el objetivo de este estudio fue desarrollar una nueva fórmula para la adecuada inserción de dicho catéter. Material y métodos: Estudio transversal, de niños a los que se realizó pH-impedanciometría y control radiográfico posterior para estimar la longitud de distancia de inserción correcta del catéter; se registraron las variables de: edad, sexo, peso, talla, distancia narina-tragus, tragus-horquilla esternal y horquilla-xifoides así como la longitud inicial de inserción determinada por fórmulas de Strobel e Intervalos de talla. Se realizó un análisis de regresión multivariada para predecir la longitud de inserción final y se obtuvieron ANOVA de la regresión y R cuadrado ajustado de Pearson. Resultados: Se realizaron 45 pH-impedanciometrías, 53% fueron masculinos. Las variables edad y peso no mostraron distribución normal. En el modelo de regresión inicial las variables sin correlación significativa con la longitud de inserción final fueron: sexo (p 0,124), longitud determinada por Strobel o intervalos de talla (p 0,078), distancia narina-tragus (p 0,905) y distancia tragus-horquilla (p 0,404). La ecuación final: 5,6 + (talla en cm * 0,12) + (distancia horquilla-xifoides * 0,57) alcanza un R2 de 0,93 (p 0,000). Conclusiones: Esta fórmula puede ser considerada como una opción válida para la colocación del catéter de pH-impedanciometría en pediatría.

Resumen: Introducción: La pH-impedanciometría esofágica es una herramienta para el diagnóstico de reflujo gastroesofágico en en nĩnos, la posición del sensor de pH es crucial para una lectura confiable, las fórmulas existentes para el cálculo de la inserción del catéter no son tan precisas; el objetivo de este estudio fue desarrollar una nueva fórmula para la adecuada inserción de dicho catéter. Material y métodos: Estudio transversal, de niños pacientes pediátricos a los que se realizó pH-impedanciometría y control radiográfico posterior para estimar la longitud de distancia de inserción correcta del catéter; se registraron las variables de: edad, sexo, peso, talla, distancia narina-tragus, tragus-horquilla esternal y horquilla-xifoides, así como la longitud inicial de inserción determinada por fórmulas de Strobel e intervalos de talla. Se realizó un análisis de regresión multivariada para predecir la longitud de inserción final y se obtuvieron ANOVA de la regresión y R cuadrado ajustado de Pearson. Resultados: Se realizaron 45 pH-impedanciometrías, el 53% fueron masculinos. Las variables edad y peso no mostraron distribución normal. En el modelo de regresión inicial las variables sin correlación significativa con la longitud de inserción final fueron: sexo (p 0.124), longitud determinada por Strobel o intervalos de talla (p 0.078), distancia narina-tragus (p 0.905) y distancia tragus-horquilla (p 0.404). La ecuación final: 5.6 + (talla en cm * 0.12) + (distancia horquilla-xifoides * 0.57) alcanza un R2 de 0.93 (p 0.000). Conclusiones: Esta fórmula puede ser considerada como una opción válida para la colocación del catéter de pH-impedanciometría en pediatría. Abstract: Introduction: Esophageal pH-impedance monitoring is a tool for diagnosing gastroesophageal reflux in children. The position of the pH catheter is essential for a reliable reading and the current formulas for calculating catheter insertion length are not completely accurate. The aim of the present study was to develop a new formula for adequate insertion of the pH catheter. Material and methods: A cross-sectional study was conducted on children that underwent pH-impedance monitoring and later radiographic control, to calculate the correct catheter insertion length. The documented variables were age, sex, weight, height, naris to tragus distance, tragus to sternal notch distance, sternal notch to xiphoid process distance, and initial insertion length determined by the Strobel and height interval formulas. A multivariate regression analysis was carried out to predict the final insertion length. Regression ANOVA and Pearson's adjusted R-squared tests were performed. Results: Forty-five pH-impedance studies were carried out, 53% of which were in males. The age and weight variables were not normally distributed. In the initial regression model, the variables that did not significantly correlate with the final insertion length were: sex (P 0.124), length determined by the Strobel or height interval formulas (P 0.078), naris to tragus distance (P 0.905), and tragus to sternal notch distance (P 0.404). The final equation: 5.6 + (height in cm * 0.12) + (sternal notch to xiphoid process distance * 0.57) produced an R2 of 0.93 (P 0.000). Conclusions: This formula can be considered a valid option for placement of the pH-impedance monitoring catheter in pediatrics.

Resumen: Antecedentes y objetivo: La endocarditis infecciosa presenta una mortalidad de 25%. La lesión renal aguda (LRA) se desarrolla en hasta 70% de los casos. El objetivo de presente estudio es determinar el impacto pronóstico de la LRA en la endocarditis y los factores asociados a la misma. Materiales y métodos: Estudio retrospectivo unicéntrico que incluyó a todos los pacientes ingresados por endocarditis entre 2015 y 2021. Basalmente se recogieron datos epidemiológicos y comorbilidades. Durante el ingreso, se recogieron datos de evolución de la función renal, variables asociadas con la propia infección y el desenlace de la misma. A través de modelos multivariables, se analizó la capacidad predictiva de la LRA en la mortalidad. Resultados: Se incluyó a 134 pacientes (63% varones, edad media 72 ± 15 años) de los que 94 (70%) presentaron una LRA (50% AKIN-1, 29% AKIN-2 y 21% AKIN-3). Los factores asociados a presentar una LRA fueron la edad, la hipertensión arterial, tener una enfermedad renal crónica, el FGe basal, padecer insuficiencia cardiaca y enfermedad vascular periférica. El único predictor independiente para presentar una LRA fue el FGe basal (OR 0,94, p = 0,001).Fallecieron 46 (34%) pacientes, de los que en 45 (98%) se desarrolló una LRA. A través de diversos modelos multivariantes ajustados, la LRA predijo independientemente la mortalidad. Asimismo, la pérdida de FGe (OR 1,054, p < 0,001) y el FGe basal (0,963, p = 0,012) se asociaron independientemente a fallecer durante la hospitalización. Conclusiones: El desarrollo de una LRA y su gravedad, es decir, la pérdida de FGe y la puntuación en la escala AKIN impactan en el pronóstico de una endocarditis infecciosa. Abstract: Introduction: Infective endocarditis presents a 25% mortality. Acute kidney injury (AKI) develops in up to 70% of the cases. The aim of this study is to evaluate the predictive value of AKI in mortality due to endocarditis and to assess its associated factors. Methods: Unicentric and retrospective study including all patients with in-hospital diagnosis of endocarditis between 2015 and 2021. Epidemiological data and comorbidities were collected at baseline. During admission, renal function parameters, infection-related variables and mortality were collected. Using adjusted multivariate models, LRA predictive value was determined. Results: One hundred and thirty-four patients (63% males, age 72±15 years) were included. Of them 94 (70%) developed AKI (50% AKIN-1, 29% AKIN-2 and 21% AKIN-3). Factors associated to AKI were age (p=0.03), hypertension (p=0.005), previous chronic kidney disease (p=0.001), heart failure (p=0.006), peripheral vascular disease (p=0.022) and glomerular filtration rate (GFR) at baseline (p

Resumen: La visión multidimensional de la enfermedad es fundamental en la atención de patologías complejas como la enfermedad renal crónica (ERC). Es oportuno definir y unificar conceptos que permitan que los diferentes profesionales encargados de la atención ofrezcan una atención multidisciplinar, alineados a las necesidades de cada persona.Debido al creciente aumento de la incidencia de ERC en el mundo y teniendo en cuenta que pueden existir diferentes trayectorias en el curso de la enfermedad, es necesario establecer abordajes integrales personalizados para cada paciente y sus familias de manera más temprana. Este planteamiento va más allá del simple control de los síntomas urémicos o de la congestión y consiste en abordar tempranamente los problemas no solo sintomáticos sino también funcionales, sociales y de afrontamiento de la enfermedad, facilitando la toma de decisiones tanto en el escenario de la ERC como en situaciones agudas, potencialmente irreversibles o en intervenciones que no mejoren el pronóstico vital.Para asegurar la excelencia en la atención es relevante evaluar indicadores para la atención paliativa y de soporte renal, como la presencia de la planificación anticipada y compartida de la atención, la inclusión de atención psicosocial, ética, espiritual y la atención al duelo. Esto permite ofrecer una atención integral, humanizada y de calidad para el paciente y sus familiares.Los cuidados paliativos y de soporte renal no se orientan únicamente a los pacientes en los últimos días de vida. Definir, unificar y evaluar los conceptos permitirá aplicarlos de manera oportuna en cada momento específico de la trayectoria de la ERC. Abstract: The multidimensional view of the disease is fundamental in the care of complex diseases such as chronic kidney disease (CKD). It is appropriate to define and unify concepts that allow the different professionals involved in care to provide multidisciplinary care tailored to the needs of each individual.Given the increasing incidence of CKD worldwide and the fact that the disease may progress at different rates, there is a need to establish personalized, comprehensive approaches for each patient and their families at an earlier stage. This approach goes beyond the simple control of uremic symptoms or congestion and consists of addressing not only symptomatic but also functional, social and coping problems at an early stage, facilitating decision making both in the CKD and in acute settings, potentially irreversible situations or interventions that do not improve life expectancy.To ensure excellence in care, it is important to assess indicators of palliative care and renal support, such as the presence of advance and shared care planning, the inclusion of psychosocial, ethical, spiritual and bereavement care. This enables the provision of comprehensive, humanized, and high-quality care for patients and their families.Palliative and renal care is not just about patients in the last days of life. Defining, unifying, and evaluating the concepts will allow them to be applied in a timely manner at each specific moment of the CKD trajectory.

Bone repair via endochondral ossification is a complex process for the critical size reparation of bone defects. Tissue engineering strategies are being developed as alternative treatments to autografts or allografts. Most approaches to bone regeneration involve the use of calcium composites. However, exploring calcium-free alternatives in endochondral bone repair has emerged as a promising way to contribute to bone healing. By analyzing researches from the last ten years, this review identifies the potential benefits of such alternatives compared to traditional calcium-based approaches. Understanding the impact of calcium-free alternatives on endochondral bone repair can have profound implications for orthopedic and regenerative medicine. This review evaluates the efficacy of calcium-free alternatives in endochondral bone repair through in vivo trials. The findings may guide future research to develop innovative strategies to improve endochondral bone repair without relying on calcium. Exploring alternative approaches may lead to the discovery of novel therapies that improve bone healing outcomes.

Entrepreneurial ecosystems (EEs) are a growing focus for policymakers and academics seeking to foster innovation and economic growth. While existing literature has analysed various aspects of EEs, limited research has examined how public policies can contribute to their development. Through a single-case study, this study addresses this gap by analysing the role of a regional government in overcoming the challenges of building an EE. We explore the creation and development of the Biscay Startup Bay (BSB) EE in Bilbao City (Bizkaia, Basque Country, Spain). We describe the unique framework that they crafted and implemented, highlighting the key attributes that generate value for all stakeholders. This single-case study of the BSB EE in Spain offers valuable insights for policymakers seeking to design and implement successful Open Innovation-driven approaches to creating and developing regional EEs.

Introdução: A Leucemia Linfoblástica Aguda (LLA) é a neoplasia hematológica mais comum na infância e adolescência, representando cerca de 25% dos casos dessa faixa etária. Caracteriza-se pela proliferação anormal de células progenitoras de linhagem B (LLA-B), em aproximadamente 80% dos casos, ou de linhagem T (LLA-T). O tratamento geralmente inclui quimioterapia, muitas vezes combinada com radioterapia e transplante de medula óssea (TMO), o que tem contribuído para o aumento significativo nas taxas de sobrevida dos pacientes. A LLA pode apresentar manifestações extramedulares, especialmente no contexto de recaída/refratariedade, mais comumente no Sistema Nervoso Central (SNC) e nos testículos. O acometimento de outros sítios extramedulares (pele, rins, intestino, pâncreas, olhos), conforme evidenciado em literatura, correlaciona-se com doença de pior prognóstico. Objetivos: Descrever o caso de um paciente pediátrico com LLA-B multiplamente refratário com recaída pós-TMO e apresentação clínica atípica. Relato de caso: Paciente, sexo masculino, 13 anos, previamente hígido, foi diagnosticado com LLA-B em 2019, apresentando infiltração testicular. Foi tratado com o protocolo BFM 2009, inicialmente com boa resposta, mas sofreu recaída no SNC em menos de 6 meses após o término do tratamento. Iniciou-se protocolo de resgate com BFM 2002 e radioterapia craniana, mas, durante a manutenção, houve nova recaída envolvendo SNC e medula óssea (MO), instaurando-se um segundo protocolo de resgate (R16). Durante esse tratamento, desenvolveu uma infecção fúngica invasiva, modificando-se o protocolo de tratamento para blinatumumab, interrompido devido a crises convulsivas. Iniciou, então, o uso de inotuzumab, com resposta completa e negativação da doença na MO e no SNC, sendo logo encaminhado para transplante alogênico de MO não aparentado HLA idêntico. No 76° dia pós-transplante, houve recaída com acometimento medular (22% de blastos na MO) e manifestações extramedulares agressivas e atípicas, incluindo infiltrações em peritônio (líquido ascítico rico em blastos linfoides), pele e apêndice cecal (evoluiu com apendicite e infiltração de doença documentada). O paciente foi encaminhado para CAR-T Cell, mas teve progressão rápida da doença e faleceu antes da realização do procedimento. Discussão: A LLA-B é a neoplasia hematológica mais comum da infância, apresentando boas respostas aos protocolos quimioterápicos pediátricos. Pacientes com doença refratária costumam ter evoluções mais agressivas da doença, podendo inclusive apresentar manifestações clínicas atípicas, com acometimento de sítios extramedulares. O caso exposto evidencia paciente jovem, multiplamente refratário e com recaída pós-TMO alogênico, evoluindo com acometimento de pele, apêndice cecal e peritônio, sítios raramente acometidos na LLA. Esse caso corrobora evidências literárias de que o acometimento de sítios extramedulares atípicos no contexto de LLA recaída/refratária prediz pior prognóstico de doença. A vigilância e detecção precoce de recaída em sítios atípicos pode contribuir para uma melhor decisão terapêutica. Conclusão: Considerando que a LLA é a malignidade mais comum na infância, é essencial manter um elevado grau de suspeição para essa condição, mesmo diante de manifestações atípicas, como o envolvimento de trato gastrointestinal, pele e peritônio. O diagnóstico precoce é fundamental para garantir um tratamento mais eficaz e melhorar o prognóstico do paciente.

Based on data from the Global Cancer Statistics 2022, lung cancer stands as the most lethal cancer worldwide, with age-adjusted incidence and mortality rates of 23.6 and 16.9 per 100,000 people, respectively. Despite significant strides in precision oncology driven by large-scale international research consortia, there remains a critical need to deepen our understanding of the genomic landscape across diverse racial and ethnic groups. To address this challenge, we performed comprehensive in silico analyses and data mining to identify pathogenic variants in genes that drive lung cancer. We subsequently calculated the allele frequencies and assessed the deleteriousness of these oncogenic variants among populations such as African, Amish, Ashkenazi Jewish, East and South Asian, Finnish and non-Finnish European, Latino, and Middle Eastern. Our analysis examined 117,707 variants within 86 lung cancer-associated genes across 75,109 human genomes, uncovering 8042 variants that are known or predicted to be pathogenic. We prioritized variants based on their allele frequencies and deleterious scores, and identified those with potential significance for response to anti-cancer therapies through in silico drug simulations, current clinical pharmacogenomic guidelines, and ongoing late-stage clinical trials targeting lung cancer-driving proteins. In conclusion, it is crucial to unite global efforts to create public health policies that emphasize prevention strategies and ensure access to clinical trials, pharmacogenomic testing, and cancer research for these groups in developed nations.

Entamoeba histolytica is a protozoan parasite that belongs to the Amoebozoa supergroup whose study related to the nucleocytoplasmic transport of proteins through the nucleus is poorly studied. In this work, we have performed in silico predictions of the potential nuclear localization signals (NLS) corresponding to the proteome of 8201 proteins from Entamoeba histolytica annotated in the AmoebaDB database. We have found the presence of monopartite nuclear localization signals (MNLSs), bipartite nuclear localization signals (BNLSs), and non-canonical monopartite NLSs with lengths exceeding 20 amino acid residues. Additionally, we detected a new type of NLS consisting of multiple juxtaposed bipartite NLSs (JNLSs) that have not been described in any eukaryotic organism. Also, we have generated consensus sequences for the nuclear import of proteins with the NLSs obtained. Docking experiments between EhImportin α and an MNLS, BNLS, and JNLS outlined the interacting residues between the Importin and cargo proteins, emphasizing their putative roles in nuclear import. By transfecting HA-tagged protein constructs, we assessed the nuclear localization of MNLS (U1A and U2AF1), JMNLS (U2AF2), and non-canonical NLS (N-terminus of Pol ll) in vivo. Our data provide the basis for understanding the nuclear transport process in E. histolytica.

Aptamers are single-stranded oligonucleotide sequences capable of binding to specific ligands with high affinity. In this manner, they are like antibodies but have advantages such as lower manufacturing costs, lower immunogenicity, fewer batch-to-batch differences, a longer shelf life, high tolerance to different molecular milieus, and a greater number of potential targets. Due to their special features, they have been used in drug delivery, biosensor technology, therapy, and diagnostics. The methodology that allowed its production was the “Systematic Evolution of Ligands by Exponential enrichment” (SELEX). Unfortunately, the traditional protocol is time-consuming and laborious. Therefore, numerous variants with considerable optimization steps have been developed, nonetheless, there are still challenges to achieving real applications in the clinical field. Among them, are control of in vivo activities, fast renal filtration, degradation by nucleases and toxicity testing. This review focuses on current technologies based on SELEX, the critical factors for successful aptamer selection, and its upcoming biomedical and biotechnological applications.

Resumen: El melanoma subungueal es un tumor poco común, con peor pronóstico comparado con los de otras localizaciones. Corresponde al 1-23% de los melanomas, según la población. El objetivo de este estudio fue describir las características clínicas e histopatológicas del melanoma subungueal en la población mexicana. Se incluyeron 57 pacientes con melanoma subungueal (19% de los 303 melanomas totales), con una mediana de edad de 71 años. La localización predominante fueron los miembros inferiores (52,6% de los melanomas subungueales) y el primer dedo (75,4% de los casos). El subtipo histológico más frecuente fue el acral lentiginoso (50,9%). La mediana de Breslow fue de 3 mm. El estadio IA fue el más frecuente (28,1%). Se encontró una tasa de recurrencia del 19,3% y de metástasis del 8,8%. Las características clínico-patológicas fueron semejantes a lo descrito en la literatura. Es importante realizar un diagnóstico y tratamiento tempranos de cara a mejorar su pronóstico. Abstract: Although subungual melanoma is uncommon, it is associated with worse outcomes than melanomas in other locations and accounts for 1% to 23% of all melanomas, depending on the population. The aim of this study was to describe the clinical and histopathologic features of subungual melanoma in a Mexican population. We identified 303 patients with melanoma, and of these, 19% (57 patients with a median age of 71 years) had subungual melanoma. The main sites affected were the lower limbs (52.6%) and the toe (75.4%). The most common histologic subtype was acral lentiginous melanoma (50.9%). Median Breslow thickness was 3 mm, and stage IA tumors were the most common (in 28.1% of patients). Recurrence and metastasis occurred in 19.3% and 8.8% of patients, respectively. The clinical and histopathologic features identified are similar to those described in the literature. Early diagnosis and treatment are crucial for improving prognosis.

Background: Tuberculosis (TB) is a major public health concern in Ecuador and Peru, both settings of high burden of drug resistance TB. Molecular epidemiology tools are important to understand the transmission dynamics of Mycobacterium tuberculosis Complex (MTBC) and to track active transmission clusters of regional importance. This study is the first to address the transmission of TB between Peru and Ecuador through the population structure of MTBC lineages circulating in the Ecuadorian border province of ''El Oro''. Methods: A total number of 56 MTBC strains from this province for years 2012–2015 were included in the study and analyzed by 24-loci MIRU-VNTR and spoligotyping. Results: Genotyping revealed a high degree of diversity for MTBC in ''El Oro'', without active transmission clusters. MTBC L4 was predominant, with less than 2% of strains belonging to MTBC L2-Beijing. Conclusions: These results may suggest that TB dynamics in this rural and semi-urban area would not be linked to highly transmitted strains like MTBC L2-Beijing from Peru, but related to TB relapse; although further studies with larger MTBC cultures collection from recent years are needed. Nevertheless, we recommend to reinforce TB surveillance programs in remote rural settings and border regions in Ecuador.

Livestock production companies come under increasing responsibility to reduce their environmental impact, and thereby, the simultaneous decision-making of inventory replenishment and emissions reduction investment has become essential for ensuring sustainable development in the livestock farming business. This study investigates, for the first time, the best investment strategy for a livestock farming business under the carbon cap (CC) environmental legislation, taking into account both the edible and non-edible parts of slaughtering mature growing items (GIs) after procuring and feeding baby GIs. By fusing economic and environmental factors, this study aims to shed light on two crucial issues: (i) figuring out the appropriate level of investment needed for the farm to adhere to the CC environmental regulation; and (ii) evaluating the effect of the investment decision on the farm's expenses and emissions levels. To deal with these insights, a thorough analytical framework integrating mathematical modeling methodology, economic evaluation, and carbon accounting approaches is employed. By analyzing the interaction between the farm's emissions reduction investments and replenishment choices, the cost-effective investment level is determined that enables the farm to satisfy the carbon cap obligation while guaranteeing maximum operational efficiency. The results of this study have important ramifications for livestock farming businesses trying to make their way through the stringent CC emission law. The results indicate that in order to keep the business feasible when the cap of the CC guideline is low, the livestock-producing farm should give priority to investing in minimizing feed emissions and using cutting-edge manure treatment methods.

Forty-five accessions of the genus Phaseolus from the orthodox seed collection of the National Center for Genetic Resources (CNRG) of the National Institute of Forestry, Agricultural, and Livestock Research (INIFAP) of Mexico were sequenced using RADseq. The species utilized were: P. acutifolius (14), P. coccineus (12), P. lunatus (8), P. dumosus (6), P. leptostachyus (2), P. filiformis (2), and P. vulgaris (1). A variant call file (VCF) was generated using GATK with the P. vulgaris reference genome GCF_000499845.1, identifying 97,103 shared SNPs among the species. These data have the potential to be used for studies of genetic diversity intra and interspecies, phylogeny, evolution, genetic resource conservation, and agricultural improvement.

Substance use disorders (SUD), also named addiction when it is severe, is a chronic brain disorder with serious impact on individual who suffer, the public health and with high burden of disease. They are multitude of mechanisms/factors involved in addiction: from individual characteristics of the person (from genetic to impacts of stress, sex, and age) to social and environmental situation (availability and accessibility of substances, cultural and legal aspects, socio-economical situation) and type of substance of use (pharmacological characteristics) Then, research on Addiction must include different, complementary, and translational perspectives. In this review, we explore the neurobiological, psychosocial, and epidemiological knowledge of substance addiction, and the main role played by pharmacology in the research in this field. In Spain, since 2002, collaborative networks have emerged for comprehensive research on addictions, with the creation of the Addictive Disorders Network (RTA), currently redefined as the Research Network for Primary Care in Addictions (RIAPAd) with the support of the Carlos III Health Institute (Instituto de Salud Carlos III). Basic (including neuropharmacology and behavioral pharmacology), clinical and epidemiological research groups stand out, combining efforts to address prevention, early detection and treatment through interdisciplinary cooperation and the subsequent dissemination of results.

Pipette tip-electrospray is a useful technique that synergically combines sample preparation and ambient ionization mass spectrometry for the rapid analysis of samples. In this work, the development of pipette tip extraction (PTE) is evaluated under two workflows that can be adapted to different analytical scenarios. Micro-handling PTE (MH-PTE) is an inherently portable technique that can be on-site applied. Centrifugal PTE (C-PTE), firstly presented here, allows a high sample throughput just requiring a benchtop centrifuge. The combination of both MH-PTE and C-PTE with pipette tip-electrospray is evaluated in this work for determining codeine and morphine, two metabolically related drugs, in urine and applied to the analysis of real samples. In the case of MH-PTE, intended to be on-site applied, the chemical stability of the analytes once extracted in the tips plays a crucial role. This stability has been studied in detail, simulating several transport/storage conditions compatible with regular postal services. The analytical features of both combinations are similar, although C-PTE provides a better sensitivity in terms of limit of detection (0.3 µg L−1 for codeine and 0.6 µg L−1 for morphine) compared to MH-PTE (0.6 µg L−1 for codeine and 1.5 µg L−1 for morphine). Moreover, the sample throughput provided by C-PTE is higher (up to 72 samples h−1) than that provided by MH-PTE (up to 12 samples h−1).

Resumen: El uso de dispositivos inteligentes como los teléfonos móviles (smpartphones) o relojes inteligentes (smartwatch) para promover la actividad física y el bienestar se ha incrementado en los últimos años entre los pacientes y los profesionales en atención primaria. Este cambio se ve impulsado por el acceso de los pacientes y de los profesionales a un gran catálogo de aplicaciones en salud, las cuales pueden complementar la prestación de servicios y promover el empoderamiento de los pacientes en su propia salud y los estilos de vida. Estas aplicaciones se están empezando a integrar con áreas como la inteligencia artificial (IA), el internet de las cosas médicas (IoMT) y el almacenamiento de datos en la nube, entre otros sistemas tecnológicos emergentes, ofreciendo un nuevo enfoque complementario a la práctica clínica conocida hasta el momento. A pesar del gran potencial, existen numerosas limitaciones y grandes desafíos para su implementación plena en la práctica clínica. Abstract: The use of smart devices such as mobile phones (smartphones) or smart watches (smartwatch) to promote physical activity and well-being has increased in recent years among patients and professionals in primary care. This change is driven by the access of patients and professionals to a large catalog of health applications, which can complement the provision of services and promote the empowerment of patients in their own health and lifestyles. These applications are beginning to be integrated with areas such as Artificial Intelligence (AI), the Internet of Medical Things (IoMT) and data storage in the cloud, among other emerging technological systems, offering a new complementary approach to clinical practice known so far. Despite the great potential, there are numerous limitations and major challenges for its full implementation in clinical practice.

In recent years micro- and nanoplastics and metal-oxide nanomaterials have been found in several environmental compartments. The Antarctic soft clam Laternula elliptica is an endemic Antarctic species having a wide distribution in the Southern Ocean. Being a filter-feeder, it could act as suitable bioindicator of pollution from nanoparticles also considering its sensitivity to various sources of stress. The present study aims to assess the impact of polystyrene nanoparticles (PS-NP) and the nanometal titanium-dioxide (n-TiO2) on genome-wide transcript expression of L. elliptica either alone and in combination and at two toxicological relevant concentrations (5 and 50 µg/L) during 96 h exposure. Transcript-target qRT-PCR was performed with the aim to identify suitable biomarkers of exposure and effects. As expected, at the highest concentration tested, the clustering was clearer between control and exposed clams. A total of 221 genes resulted differentially expressed in exposed clams and control ones, and 21 of them had functional annotation such as ribosomal proteins, antioxidant, ion transport (osmoregulation), acid-base balance, immunity, lipid metabolism, cell adhesion, cytoskeleton, apoptosis, chromatin condensation and cell signaling. At functional level, relevant transcripts were shared among some treatments and could be considered as general stress due to nanoparticle exposure. After applying transcript-target approach duplicating the number of clam samples, four ecologically relevant transcripts were revealed as biomarkers for PS-NP, n-TiO2 and their combination at 50 µg/L, that could be used for monitoring clams’ health status in different Antarctic localities.

The exploration of microbial strains for the biocontrol against Fusarium diseases in maize, from extreme environments within native ecosystems, holds significant importance. For these reasons, this study aimed to obtain bacterial strains from the soil of a Mexican oyamel-fir forest impacted by fire, with the goal of inhibiting the growth of strains of the species complexes of F. oxysporum, F. sambucinum, F. incarnatum-equiseti and F. fujikuroi, which are responsible for maize rot diseases in the country. Bacterial strains were isolated and in vitro characterized for their production of indoleacetic acid, siderophore, and hydrolytic enzymes. Additionally, they were evaluated for their ability to solubilize phosphate, and inhibit the growth of Fusarium spp. Furthermore, the strains were identified through a 16S rRNA phylogenetic analysis and in vivo evaluated for promoting maize seedling growth and inhibition of seedborne Fusarium spp. Bacillus sp. B4 and B28 inhibited the growth of the strains of the four Fusarium species complexes up to 76–98 % in dual cultures; additionally, they prevented systemic infection and reduced mycelial growth on maize seed coat by up to 50 %, caused by seedborne Fusarium strains within the F. fujikuroi species complex. Moreover, both strains were non-plant pathogenic, and demonstrated cellulases, pectinase, and siderophore production. Furthermore, B4 and B28 exhibited the ability to enhance maize seedlings length and water holding capacity. Bacillus sp. B4 and B28 are valuable native genetic resources, that could offer a sustainable alternative to replace or reduce chemical fertilizers and pesticides used in Mexican maize producing areas.

The following document details low-cost hardware and open-source available software tools that can be combined to support active teaching methodologies like Problem-Based Learning (PBL) and incorporate work-oriented technological skills in students. This proposal presents a prototype of Open Educational Resources (OER) that integrates software and hardware tools for the specific purpose of facilitating instruction in Artificial Intelligence. The hardware consists of affordable electronic devices, including an Arduino board, servo motors, sensors, a relay and a motor, all integrated into a scaled conveyor belt. On the other hand, open software was used to implement an image classification program with different features (shape, color, size, among others). The exact construction steps, circuits, and code are presented in detail and should encourage other scientists to replicate the experimental setup, especially if they are looking for experimental teaching of artificial intelligence, since the system allows object classification using the machine learning paradigm to facilitate the teaching of artificial intelligence concepts with computer vision concepts.

The transition to parenthood remains an understudied window of potential neuroplasticity in the adult brain. White matter microstructural (WMM) organization, which reflects structural connectivity in the brain, has shown plasticity across the lifespan. No studies have examined how WMM organization changes from the prenatal to postpartum period in men becoming fathers. This study investigates WMM organization in men transitioning to first-time fatherhood. We performed diffusion-weighted imaging to identify differences in WMM organization, as indexed by fractional anisotropy (FA). We also investigated whether FA changes were associated with fathers’ postpartum mental health. Associations between mental health and WMM organization have not been rarely examined in parents, who may be vulnerable to mental health problems. Fathers exhibited reduced FA at the whole-brain level, especially in the cingulum, a tract associated with emotional regulation. Fathers also displayed reduced FA in the corpus callosum, especially in the forceps minor, which is implicated in cognitive functioning. Postpartum depressive symptoms were linked with increases and decreases in FA, but FA was not correlated with perceived or parenting stress. Findings provide novel insight into fathers’ WMM organization during the transition to parenthood and suggest postpartum depression may be linked with fathers’ neuroplasticity during the transition to parenthood.

Platelets are the critical target for preventing and treating pathological thrombus formation. However, despite current antiplatelet therapy, cardiovascular mortality remains high, and cardiovascular events continue in prescribed patients. In this study, first results were obtained with ortho-carbonyl hydroquinones as antiplatelet agents; we found that linking triphenylphosphonium cation to a bicyclic ortho-carbonyl hydroquinone moiety by a short alkyl chain significantly improved their antiplatelet effect by affecting the mitochondrial functioning. The mechanism of action involves uncoupling OXPHOS, which leads to an increase in mitochondrial ROS production and a decrease in the mitochondrial membrane potential and OCR. This alteration disrupts the energy production by mitochondrial function necessary for the platelet activation process. These effects are responsive to the complete structure of the compounds and not to isolated parts of the compounds tested. The results obtained in this research can be used as the basis for developing new antiplatelet agents that target mitochondria.

Fast-paced markets require complex interactions from all supply-chain agents to satisfy customer demands and needs. The manufacturing industries face some difficulties in terms of production amounts and smooth delivery rates. Technical experts found that a warm-up period before a production run helps address those challenges and improves the workability of machine tools in the manufacturing process. The use of a warm-up process causes a reduction of faulty products (an adverse production outcome) and improves operational efficiency. Also, a shortage in the supply of commodities creates difficult conditions for inventory management decisions, posing the same production problems as mentioned above. Consideration of the warm-up process has recently been included in the scope of operations research, but it is necessary to study its interaction with the presence of shortage. This study presents a system where a manufacturing environment utilizes the warm-up process in its initial phase and shortages are allowed during the production period, in addition, the study takes into account carbon emissions during manufacturing to integrate environmental concerns. We assume that the company has the capability to trade the surplus carbon capacity it hasn't produced. This study offers a comprehensive framework that incorporates former research that addresses warm-up process, carbon emissions, shortages, and defective items. To solve the proposed non-linear programming problem with inequality constraints, we employ the Karush-Kuhn-Tucker (KKT) conditions method to determine the optimal solutions. Managerial insights are derived, and sensitivity analysis highlights the effects of the system parameters on the decision variables. The sensitivity analysis results indicate that the carbon trading cost has a significant impact on the overall cost, and subsequently, the company's profit.

Regulators’ increasingly stringent carbon rules to protect the environment are encouraging practitioners to modify their operational activities that are accountable for releasing emissions into the atmosphere. Thereby, practitioners dealing with product inventory planning are seeking proper management strategies not only to increase profits but also to reduce released carbons from operations. In addition, increasing uncertainty in supply operations has motivated suppliers to impose prepayment mechanisms in recent decades. This study examines the best prepayment installment policy for a practitioner for the first time, where the consumption behavior of consumers changes as a result of the combined effects of unit selling price and storage time. Moreover, to make the present inventory planning more realistic, the unit holding cost function is adopted as a power function of the inventory unit's storage period. The goal of this study is to provide the best combined installment for advance payment, price, and replenishment strategies for a practitioner under cap-and-price, cap-and-trade, and carbon tax environmental guidelines by ensuring maximum profit. For this purpose, an algorithm is created by combining all derived theoretical results from the analytical study, whereas the efficacy of the algorithm is assessed through the examination of five illustrative numerical instances. A plethora of noteworthy management insights for the practitioner are obtained by investigating the dynamic shifts in optimal strategies resulting from fluctuations in system parameters. The results reveal that if the demand is low in the nascent phases of the business cycle, then the prudent approach for the practitioner entails procuring a comparatively smaller lot-size using a modest number of payment frequencies and then setting a relatively small unit selling price to increase profits.

In this paper, the energy loss of the green building is optimized based on the thickness and lay-up of the Nano-insulation. As different thicknesses and lay-up of the Nano-insulation have a direct effect on energy consumption of the green building with 1590 square meters, especially with nanomaterial, the machine learning models are employed to represent a new model of the thermal conductivity of the proposed advanced insulation with the precision above 99%. The machine learning models are employed to classify and model the behavior of the heat transfer in the green building due to the complex behavior of the thermal conductivity in the green building. Therefore, 110 data for modeling 20 types of lay-up with 6 different thicknesses are prepared by the machine learning models including Support Vector Machine (SVM), Gaussian Process Regression (GPR), and decision tree. Based on the data analysis and statistical data, thermal conductivity modeling with a decision tree represents the best performance and fitted model. The multi-Disciplinary Optimizing method (MDO) under energy consumption constraint, economical consideration, and environmental effects on insulation properties is performed to enhance the energy efficiency of the green building. The calculated results with the Degree-Day approach reveal that the amount of energy saving for green buildings with Nano insulation is about 40% higher than common insulation in common types of insulations. The proposed insulation characteristics regarding the value of Present Worth Function (PWF) and economic aspects cause energy saving per unit area and decreasing in CO2 emission between 290 kg/m3 to 293 kg/m3 depending on weather conditions, insulation thickness, and lay-up.

In this paper, the energy supply of a zero-energy building with 220 square meters is considered using optimized nanocomposite solar panels with respect to maximum efficiency. An optimized hybrid machine learning method plays a key role in presenting solar panel modeling with over 0.99% accuracy. Predicting the properties of the nanomaterial solar cell in four different seasons is performed by efficient support vector machines (SVM), and k-nearest neighbors (KNN) machine learning algorithms. In addition, the KNN algorithm is optimized by the Particle Swarm Optimization (PSO) method to improve the capabilities of KNN and reveal the best performance criteria for the photovoltaic modeling characteristics. The parameters of the nanocomposite cells are optimized using the proposed novel Multidisciplinary Optimization Method (MDO) to increase the efficiency of the solar panel by up to 170%. Optimization of solar cell performance with nanocomposite material under energy consumption constraints is carried out to propose the best construction of cells with 3 layers. The presented approach as a solution and indicator for the next generation of commercial and residential buildings can increase the potential values of solar cells to at least 70%.

Resumen: La capacitación toxicológica cursa con disparidad en relación con otras áreas del conocimiento médico, lo que favorece vacíos cognitivos en los profesionales de la salud. Este documento presenta una propuesta educativa para el abordaje de «toxíndromes mayores» a través de un esquema que integra su identificación y tratamiento mediante escenarios de simulación clínica con empleo de pacientes simulados/estandarizados para el pregrado médico en el Centro Universitario del Sur de la Universidad de Guadalajara, desarrollado durante el año 2023. Abstract: Toxicological training has disparities in relation to other areas of medical knowledge, which favors cognitive gaps in health professionals. This document presents an educational proposal for the approach of “major toxidromes” through a scheme that integrates their identification and treatment through clinical simulation scenarios with the use of simulated/standardized patients for the medical undergraduate degree at the Centro Universitario del Sur of the Universidad de Guadalajara, developed during the year 2023.

Background: The respiratory tract harbors a variety of microbiota, whose composition and abundance depend on specific site factors, interaction with external factors, and disease. The aim of this study was to investigate the relationship between COVID-19 severity and the nasopharyngeal microbiome. Methods: We conducted a prospective cohort study in Mexico City, collecting nasopharyngeal swabs from 30 COVID-19 patients and 14 healthy volunteers. Microbiome profiling was performed using 16S rRNA gene analysis. Taxonomic assignment, classification, diversity analysis, core microbiome analysis, and statistical analysis were conducted using R packages. Results: The microbiome data analysis revealed taxonomic shifts within the nasopharyngeal microbiome in severe COVID-19. Particularly, we observed a significant reduction in the relative abundance of Lawsonella and Cutibacterium genera in critically ill COVID-19 patients (p

Some sensitive industries with precise specifications in their manufacturing process, such as aircraft engine parts, impose 100% inspection processes in their inventory-manufacturing system. In some cases, a lot of small dimensions are measured and compared with strict acceptable tolerances during these inspection processes, causing manufacturing process times (machine time speed) to be less than inspection times. This study is relevant to manufacturing enterprises that implement comprehensive 100% inspection protocols within their production procedures, encompassing sectors such as pharmaceuticals, aerospace, electronics, medical devices, and textiles. In this paper, such a phenomenon is investigated, as an inventory system with a strict inspection model is deployed under three conditions: a) an inventory-manufacturing system with scrapped items without shortage, b) an inventory-manufacturing system with reworked items without shortage, and c) an inventory-manufacturing system with scrapped and reworkable items with backorder. The aim is to minimize total cost by considering strict inspection during production process. These proposed models are suitable for managing systems where quality control is a bottleneck due to its speed such as high-precision manufacturing systems. The optimal solutions for each model are obtained as a closed-form expression. In models 1 and 2, where the shortage is not allowed, the closed-form expression is focused on determining the economic production quantity. However, in model 3, there are two expressions of significance. First, it addresses the economic production quantity, like models 1 and 2. Additionally, it provides an optimal value for the shortage in each cycle, as it considers a scenario where shortages are permitted within the inventory-manufacturing system. This study has included a numerical example to illustrate the practical applicability of each model. Based on the optimal solutions obtained, it is evident that Model 3 stands out as the superior choice. This outcome aligns with expectations, as Model 3 encompasses and comprehensively addresses the scenarios presented in the two other models. Finally, a sensitivity analysis is performed to investigate the effects of key parameters on the optimal solutions of each model, and the results are summarized to present a comparison between them.

Traumatic nerve injuries are nowadays a significant clinical challenge and new substitutes with adequate biological and mechanical properties are in need. In this context, fibrin-agarose hydrogels (FA) have shown the possibility to generate tubular scaffolds with promising results for nerve repair. However, to be clinically viable, these scaffolds need to possess enhanced mechanical properties. In this line, genipin (GP) crosslinking has demonstrated to improve biomechanical properties with good biological properties compared to other crosslinkers. In this study, we evaluated the impact of different GP concentrations (0.05, 0.1 and 0.2% (m/v)) and reaction times (6, 12, 24, 72 h) on bioartificial nerve substitutes (BNS) consisting of nanostructured FA scaffolds. First, crosslinked BNS were studied histologically, ultrastructurally and biomechanically and then, its biocompatibility and immunomodulatory effects were ex vivo assessed with a macrophage cell line. Results showed that GP was able to improve the biomechanical resistance of BNS, which were dependent on both the GP treatment time and concentration without altering the structure. Moreover, biocompatibility analyses on macrophages confirmed high cell viability and a minimal reduction of their metabolic activity by WST-1. In addition, GP-crosslinked BNS effectively directed macrophage polarization from a pro-inflammatory (M1) towards a pro-regenerative (M2) phenotype, which was in line with the cytokines release profile. In conclusion, this study considers time and dose-dependent effects of GP in FA substitutes which exhibited increased biomechanical properties while reducing immunogenicity and promoting pro-regenerative macrophage shift. These tubular substitutes could be useful for nerve application or even other tissue engineering applications such as urethra.

The main aim of this study was to identify the perceptions of people suffering from inflammatory bowel diseases (IBD) regarding the need for specialised nursing care, based on their opinions from their own experience. A qualitative design with an inductive approach based on constructivist grounded theory was conducted using a questionnaire. Almost 63 % of respondents felt that a nursing intervention was necessary for the patient's self-care and supported the care of the environment of the patient with IBD in need of care. Approximately 75 % of respondents felt that the initial nursing consultation following diagnosis of IBD was essential to address all aspects of the patient's daily life and environment for quality care and follow-up. More than 87 % of respondents felt it was important for nurses to recognise the need for referral to other professionals when caring for IBD patients and their environment to maximise their wellbeing. The percentage of females who answered yes to this last question was significantly higher than that of males (p = 0.025). Some 67.1 % of respondents felt that nurses should be responsible for informing the patient and those around them of the steps to be taken following diagnosis and what these consist of. More than 94 % of all respondents felt that IBD patients and their carers should have a plan and time for specific and appropriate education on this topic. More than 80 % of respondents agreed that the progression, monitoring, and management of their IBD should be supervised by a nurse in addition to their specialist doctor to achieve an optimal level of quality. In conclusion, this study shows that patients suffering from IBD consider the role of the nurse to be crucial in the diagnosis, management and treatment of their disease and highlights the need for specialised nurses in inflammatory bowel disease who can provide patients with high-quality healthcare.

Developing countries such as Ecuador carry a heavy food safety burden but reports on the microbiological quality of their foods are scarce. In this investigation, the microbial diversity of 10 high-risk and mass-consumption street-vended foods including bolones, encebollado, food dressings, ceviche, chopped fruits, fruit juices, fruit salads, cheese, raw chicken, and ground beef in Quito, Guayaquil, and Cuenca, three major population centers in Ecuador, were evaluated using 16S rRNA gene High Throughput Sequencing. In total, 1,840 amplicon sequence variants (ASVs) were classified into 23 phyla, 253 families, 645 genera, and 829 species. In the tested food samples, Proteobacteria and Firmicutes were the most abundant phyla accounting for 97.41% of relative abundance (RA). At genus level, 10 dominant genera were identified: Acinetobacter (12.61% RA), Lactococcus (12.08% RA), Vibrio (8.23% RA), Weissella (7.43% RA), Aeromonas (6.18% RA), Photobacterium (6.32% RA), Pseudomonas (3.92% RA), Leuconostoc (3.51% RA), Klebsiella (3.49% RA), and Cupriavidus (2.86% RA). The highest microbial diversity indices were found in raw chicken, encebollados, fruit salads, and fruit juices from Guayaquil and Cuenca. From sampled foods, 29 species were classified as food spoilage bacteria and 24 as opportunistic pathogenic bacteria. Two groups associated with human diseases were identified, including 11 enteric species and 26 species of fecal bacteria. The occurrence of recognized and opportunistic pathogenic bacteria, as well as enteric and fecal microorganisms, in the street-vended foods indicated extensive risks for the consumers’ health. This study demonstrated the application of culture-independent amplicon sequencing in providing a more comprehensive view of microbial safety for street-vended food, which could be a useful tool to facilitate the control of foodborne diseases.

The initial phase of the COVID-19 vaccination in Ecuador occurred between April and November 2021. Initially, it focused on priority populations, including health professionals and other front-line workers. During this period, there was limited knowledge about the vaccine's adverse effects. A non-probability, observational study was conducted among university staff in Guayaquil, Ecuador, who received the AstraZeneca vaccine (n = 423) between April and November 2021. This study aimed to compare the acute adverse reactions by doses and to report the incidence of long-term adverse reactions within the AstraZeneca group. As a result, comparing acute adverse reactions between doses, the odds ratio for local pain, headache, muscle pain, fever, and chills are statistically higher after the first dose than the second dose. Survival curves indicated these symptoms appeared mainly within the first 6 h post-vaccination. This is the first pharmacovigilance study from Ecuador that analyzes survival probabilities for the AstraZeneca vaccine's adverse effects.

Although subungual melanoma is uncommon, it is associated with worse outcomes than melanomas in other locations and accounts for 1% to 23% of all melanomas, depending on the population. The aim of this study was to describe the clinical and histopathologic features of subungual melanoma in a Mexican population. We identified 303 patients with melanoma, and of these, 19% (57 patients with a median age of 71 years) had subungual melanoma. The main sites affected were the lower limbs (52.6%) and the toe (75.4%). The most common histologic subtype was acral lentiginous melanoma (50.9%). Median Breslow thickness was 3 mm, and stage IA tumors were the most common (in 28.1% of patients). Recurrence and metastasis occurred in 19.3% and 8.8% of patients, respectively. The clinical and histopathologic features identified are similar to those described in the literature. Early diagnosis and treatment are crucial for improving prognosis. Resumen: El melanoma subungueal es un tumor poco común, con peor pronóstico comparado con los de otras localizaciones. Corresponde al 1-23% de los melanomas, según la población. El objetivo de este estudio fue describir las características clínicas e histopatológicas del melanoma subungueal en la población mexicana. Se incluyeron 57 pacientes con melanoma subungueal (19% de los 303 melanomas totales), con una mediana de edad de 71 años. La localización predominante fueron los miembros inferiores (52,6% de los melanomas subungueales) y el primer dedo (75,4% de los casos). El subtipo histológico más frecuente fue el acral lentiginoso (50,9%). La mediana de Breslow fue de 3 mm. El estadio IA fue el más frecuente (28,1%). Se encontró una tasa de recurrencia del 19,3% y de metástasis del 8,8%. Las características clínico-patológicas fueron semejantes a lo descrito en la literatura. Es importante realizar un diagnóstico y tratamiento tempranos de cara a mejorar su pronóstico.

Objective: To verify changes in facial soft tissue using the RadiANT-DICOM-viewer and Dolphin Imaging software, through linear measurements of tomographic points in a 3D reconstruction of the face and volumetric evaluation with three-dimensional measurements of the upper airways of patients with transverse maxillary discrepancy undergoing Surgically Assisted Rapid Maxillary Expansion (SARME). Methods: Retrospective, transverse, and descriptive study, through the analysis of computed tomography scans of the face of patients with transverse maxillary discrepancy, treated from July 2019 to December 2022. The sample consisted of 15 patients of both sexes, aged 21–42 years old, who underwent surgically assisted rapid maxillary expansion using the transpalatal distractor. Analysis was performed through linear, angular, and three-dimensional measurements in millimeters, in the preoperative and late four-month postoperative period, in frontal 3D tomographic images of the face, in the region of the width of the nose and alar base and also angular measurement in the lateral tomography for the angle nasolabial and upper airways of rhinopharynx, oropharynx and hypopharynx. Results: There was an increase in nasal width with an average of 1.3467 mm and an increase in the alar base with an average of 1.7333 mm. A significant difference was found in the pre- and postoperative assessments of the measurements of nasal width, alar base and nasolabial angle, as well as the upper airways in all their extension. The results favour a better understanding of the professional and the patient regarding the diagnosis and management of patients with transverse maxillary width discrepancies. Conclusion: Although our study shows an increase in soft tissues after SARME, no aesthetic changes are observed clinically, and all patients report significant respiratory improvement. SARME may therefore contribute to the improvement of professionals working in the field of oral and maxillofacial surgery and orthodontics. Level of evidence: Level 4.

Distributed ledger technologies (DLT) are increasingly considered to enhance payment systems’ and market infrastructures’ functionalities like their accessibility and interoperability. We explore DLT architecture options to enable a new tiered access in the RTGS system of Chile for new payment service providers (PSP). We find that by introducing decentralized apps (DApps) the RTGS system would become more accessible and interoperable by enabling a tiered access to new participants. Our work also suggests that central banks exploring design alternatives for retail Central Bank Digital Currencies (CBDC) could find relevant our approach as a pivot to build a far-reaching PSP network.

Biliary tract complications are an important cause of morbidity and mortality after liver transplantation (LT) occurring in 5% to 25% of patients. The most common biliary complication in LT recipients are strictures representing approximately half of these biliary adverse events. Bile duct strictures can be divided into anastomotic biliary strictures (ABS) and non-anastomotic biliary strictures (NABS) depending on their location in the biliary tree, being ABS the most encountered type. Several risk factors identified in previous studies can predispose to the development of ABS and NABS, especially those related to surgical techniques and donor characteristics. Magnetic resonance cholangiopancreatography (MRCP) is the recommended noninvasive imaging test for detecting post-LT biliary strictures, given its high sensitivity and specificity. Once the diagnosis of a biliary stricture after LT has been made, endoscopic retrograde cholangiopancreatography (ERCP) is the preferred initial therapy with good short and long-term results. Biliary sphincterotomy plus balloon dilation (BD) with placement of multiple plastic stents (MPS) has been the classic endoscopic approach for treating ABS, although fully-covered metallic stents (FCSEMS) have emerged as an alternative thanks to shorter total duration of stenting and fewer endoscopic procedures compared to MPS. In this review, we provide a practical update on the management of biliary strictures after LT, focusing our attention on the available evidence in the endoscopic therapy.

This study proposes a hypodermic needle (HN) as a sorbent holder and an electrospray (ESI) emitter, thus combining extraction and analysis in a single device. A novel nylon 6-cellulose (N6-Cel) composite sorbent is proposed to extract methadone from oral fluid samples. The cellulosic substrate provides the composite with high porosity, permitting the flow-through of the sample, while the polyamide contributes to the extraction of the analyte. The low price of the devices (considering the holder and the sorbent) contributes to the affordability of the method, and their small size allows easy transportation, opening the door to on-site extractions. Under the optimum conditions, the analyte can be determined by high-resolution ambient ionization mass spectrometry at a limit of detection (LOD) as low as 0.3 μg/L and precision (expressed as relative standard deviation, RSD) better than 9.3%. The trueness, expressed as relative recovery (RR), ranged from 90% to 109%. As high-resolution mass spectrometers are not available in many laboratories, the method was also adapted to low-resolution spectrometers. In this sense, the direct infusion of the eluates in a triple quadrupole-mass spectrometry provided an LOD of 2.2 μg/L. The RSD was better than 5.3%, and the RR ranged from 96% to 121%.

Resumen: Introducción: El estigma se define como un acto descalificador donde las actitudes y etiquetas negativas frente a un individuo generan sentimientos de vergüenza, culpa y exclusión social. En salud mental se conocen tres tipos básicos de estigma: el estigma social, el auto-estigma y el estigma por búsqueda de ayuda. En esta revisión, se plantea un acercamiento frente a la literatura sobre el auto-estigma y estigma por búsqueda de ayuda en el personal de salud; haciendo un especial énfasis en las intervenciones y proyectos existentes para la reducción del estigma. Metodología: Es una revisión narrativa realizada en bases de datos científicas: PubMed, MedLine, y PsycInfo, entre enero del 2005 y febrero del 2022, incluyendo artículos en inglés y español. Resultados: Solo el 38% de los pacientes con condiciones en salud mental solicitan atención profesional, entre los factores causales de este fenómeno se incluyen el auto-estigma y el estigma por buscar ayuda en salud mental. Dentro de esta población se incluyen pacientes que son estudiantes y profesionales de la salud. En los últimos 10 años, se han publicado diferentes intervenciones que se basan principalmente en la educación y el contacto sobre este grupo poblacional; los resultados han mostrado pequeños beneficios en la disminución del estigma, pero sin claridad sobre su duración en el tiempo. Discusión: Los profesionales del área de la salud, incluyendo los estudiantes de medicina, representan una población vulnerable a las condiciones de salud mental; lo cual podría estar explicado por la alta carga académica, asistencial y y expectativa social. Las intervenciones descritas hasta el momento logran reducir ciertos tipos de estigma en salud mental; pero para el futuro se necesitan enfoques más centrados la adaptación del currículo médico en este tema, además del desarrollo de más instrumentos estandarizados para poder hacer objetivo el impacto de dichas intervenciones. Abstract: Background: Stigma is a disqualifying act where negative attitudes and labels towards an individual generate feelings of shame, guilt, and social exclusion. In mental health, there are three basic types of stigma: social stigma, self-stigma, and help-seeking stigma. In this review, we present the literature on self-stigma and help-seeking stigma in health personnel; placing special emphasis on existing interventions and projects to reduce stigma. Methodology: Narrative review carried out in scientific databases between January 2005 and February 2022, including articles in English and Spanish. Results: Only 38% of patients with mental health conditions seek professional care, with self-stigma and help-seeking stigma being important contributors to this phenomenon. These data sets include both health professions students and health professionals. Different interventions have been published in the last 10 years mainly based on education and contact with this population group. The results have shown small benefits in reducing stigma, but it is unclear if this lasts over time. Discussion: Health professionals, including medical students, represent a population vulnerable to mental health conditions; which could be explained by their high academic, healthcare, and social burden. The interventions described so far manage to reduce certain types of stigma in mental health. Still, in the future, more focused approaches are needed to adapt the medical curriculum on this topic. In addition, the development of more standardized instruments that will permit objective measurement of the impact of these interventions is required.

Scientific evidence exists about the association between neurological diseases (i.e., Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis, depression, and memory loss) and oxidative damage. The increasing worldwide incidence of such diseases is attracting the attention of researchers to find palliative medications to reduce the symptoms and promote quality of life, in particular, in developing countries, e.g., South America and Africa. Among potential alternatives, extracts of Cannabis Sativa L. are suitable for people who have neurological disorders, spasticity, and pain, nausea, resulting from diseases such as cancer and arthritis. In this review, we discuss the latest developments in the use of Cannabis, its subtypes and constituents, extraction methods, and relevant pharmacological effects. Biomedical applications, marketed products, and prospects for the worldwide use of Cannabis Sativa L. extracts are also discussed, providing the bibliometric maps of scientific literature published in representative countries from South America (i.e., Brazil) and Africa (i.e., South Africa). A lack of evidence on the effectiveness and safety of Cannabis, besides the concerns about addiction and other adverse events, has led many countries to act with caution before changing Cannabis-related regulations. Recent findings are expected to increase the social acceptance of Cannabis, while new technologies seem to boost the global cannabis market because the benefits of (−)-trans-delta-9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) use have been proven in several studies in addition to the potential to general new employment.

Background/purpose(s): During a viral infection, the immune response is mediated by the toll-like receptors and myeloid differentiation Factor 88 (MyD88) that play an important role sensing infections such as SARS-CoV-2 which has claimed the lives of more than 6.8 million people around the world. Methods: We carried out a cross-sectional with a population of 618 SARS-CoV-2-positive unvaccinated subjects and further classified based on severity: 22% were mild, 34% were severe, 26% were critical, and 18% were deceased. Toll Like Receptor 7 (TLR7) single-nucleotide polymorphisms (rs3853839, rs179008, rs179009, and rs2302267) and MyD88 (rs7744) were genotyped using TaqMan OpenArray. The association of polymorphisms with disease outcomes was performed by logistic regression analysis adjusted by covariates. Results: A significant association of rs3853839 and rs7744 of the TLR7 and MyD88 genes, respectively, was found with COVID-19 severity. The G/G genotype of the rs3853839 TLR7 was associated with the critical outcome showing an Odd Ratio = 1.98 (95% IC = 1.04–3.77). The results highlighted an association of the G allele of MyD88 gene with severe, critical and deceased outcomes. Furthermore, in the dominant model (AG + GG vs. AA), we observed an Odd Ratio = 1.70 (95% CI = 1.02–2.86) with severe, Odd Ratio = 1.82 (95% CI = 1.04–3.21) with critical, and Odd Ratio = 2.44 (95% CI = 1.21–4.9) with deceased outcomes. Conclusion: To our knowledge this work represents an innovative report that highlights the significant association of TLR7 and MyD88 gene polymorphisms with COVID-19 outcomes and the possible implication of the MyD88 variant with D-dimer and IFN-α concentrations.

Background: HER2-low has emerged as a new predictive biomarker in metastatic breast cancer. However, its prognostic value in early-stage carcinomas needs to be revisited. We aimed to evaluate the association of HER2-low carcinomas with PAM50 risk groups combined with clinicopathological variables in early breast cancer. Methods: We conducted a retrospective analysis of 332 patients with early-stage breast cancer that underwent PAM50 signature analysis between 2015 and 2021at Hospital Universitario 12 de Octubre (Madrid, Spain). Clinical and pathological variables were collected from medical records. After adjusting for potential confounders, we estimated Odds Ratio (OR) and 95% confidence interval for high-risk PAM50 subgroup, comparing HER2-low versus HER2-zero carcinomas by multivariable logistic regression. P values below 0.05 were deemed statistically significant. Results: 192 (57%) patients were classified as HER2-low carcinomas. Median follow-up was 34 months. Adjusted OR for high-risk PAM50 when comparing HER2-low versus HER2-zero carcinomas was 1.31 (95% CI: 0.75–2.30, p = 0.33). The multivariable model detected significant associations for Ki-67% (≥20% vs.

Background: Deviations occur in the neuropsychomotor development of premature infants; early interventions minimize delay motor. This study aimed to determine the effect of an interdisciplinary hospital-home intervention addressing motor development adaptation in premature infants in Colombia in comparison with traditional interventions. Methods: This study was based on a parallel design, with two groups, namely, experimental and control. The experimental group, hospital-home intervention (HHI) performed in two settings (i.e., hospital neonatal care units and homes), and the control group, traditional intervention, (TI) performed in institutions for premature infants.The sample will be composed of 130 randomly-allocated infants, 65 in the experimental group (HHI) and 65 in the control group (TI) of moderate to late preterm infants (gestational age between 34 and 37 weeks), weighing more than or equal to 1.800 g, who are hemodynamically stable and reside in the cities of Tunja and Bogotá-Colombia recruited between 2021 and 2022.For the pre- and post-intervention assessments, the TIMPSI and the CapDMP are the instruments used to assess motor development and the degree of parents’ or caregivers’ knowledge about motor development. The HHI is composed of 10 intervention strategies based on stimulation of motor development, performed twice a day for 10 min for two months, in combination with calls to a mobile device, using software (Baby Motor Skills) and an instant messaging system (WhatsApp). Results: This hospital-home intervention program proposes an approach focused on the motor development of premature infants, based on sensory and motor stimulation strategies, in addition to follow-up performed at home with the use of a mobile application that improves the motor development of premature infants. Register Clinical Trial: NCT04563364. Conclusion: The HHI provides the opportunity to determine whether the individualized four-week from admission to follow up at home with parent training will improve the motor skills of premature infants.

Urinary epidermal growth factor (uEGF) is primarily produced by the kidney, and alterations of it have been associated with several kidney diseases. The aim of this review was to describe uEGF levels in presence or progression of kidney diseases. We conducted a systematic review of observational studies with uEGF determination, patients with acute kidney injury, chronic kidney disease, primary or secondary nephropathy, or renal cancer were included. Studies were searched in Medline, Google Scholar, Science Direct, and EBSCO up to August 2, 2021. Participants and measurements characteristics from which uEGF were determined as the specificity, sensitivity, and the area under the ROC curve, whenever available, were gathered. 53 studies were included, the most frequent kidney diseases studied were acute kidney injury, chronic kidney disease, and diabetic nephropathy. In most studies, uEGF levels were lower in cases than in controls. Studies showed that uEGF levels can predict presence or progression of acute kidney injury, chronic kidney disease, and nephropathy. Heterogeneity in the reported uEGF values can be attributed to the different techniques, sampling, and ways of reporting uEGF values.Although uEGF values are lower in patients with almost all kidney diseases and their progression, uEGF evaluation methods should be standardised to be used as a biomarker in clinical practice. Resumen: El factor de crecimiento epidérmico urinario (uEGF) es producido principalmente por el riñón, y sus alteraciones se han asociado con varias enfermedades renales. El objetivo de esta revisión fue describir los niveles de uEGF en presencia o progresión de enfermedades renales. Realizamos una revisión sistemática de estudios observacionales con determinación de uEGF en la que se incluyeron pacientes con insuficiencia renal aguda, enfermedad renal crónica, nefropatía primaria o secundaria, o cáncer renal. Se realizaron búsquedas de estudios en Medline, Google Scholar, Science Direct y EBSCO hasta el 2 de agosto de 2021. Se extrajeron las características de los participantes y de las mediciones del uEGF, así como la especificidad, la sensibilidad y el área bajo la curva ROC, siempre que estuvieran disponibles. Se incluyeron 53 estudios, y las enfermedades renales más frecuentes estudiadas fueron la insuficiencia renal aguda, la enfermedad renal crónica y la nefropatía diabética.En la mayoría de los estudios los niveles de uEGF fueron más bajos en los casos que en los controles. Los estudios demostraron que los niveles de uEGF pueden predecir la presencia o la progresión de la lesión renal aguda, la enfermedad renal crónica y la nefropatía. La heterogeneidad en los valores de uEGF informados se puede atribuir a las diferentes técnicas, muestreo y formas de informar los valores de uEGF.Aunque los valores de uEGF son más bajos en pacientes con casi todas las enfermedades renales y su progresión, los métodos de evaluación de uEGF deben estandarizarse para ser utilizados como biomarcadores en la práctica clínica.

Background: Solid-Phase Peptide Synthesis (SPPS) is a mature technique widely used in research and in production. There are different approaches that fulfill the diverse requirements, regarding the number, quantity and quality of peptides. We have implemented three laboratory protocols of synthesis that cover these needs. These protocols have been tested, and the results analyzed with two different sequences used in previous works. Results: The peptide synthesis protocols such as tea bag, microwave synthesis and manual synthesis have allowed obtaining specific yields of 8, 43 and 64% for the NBC112 peptide and specific yields of 36, 46 and 78% for the NBC759 peptide with the three protocols, respectively. Each protocol has different application contexts with advantages and disadvantages in each case. Conclusions: The three protocols allow the obtention of the two peptides with good purity and can be used according to specific needs and requirements.This article includes an interactive 360-degree video. To view it correctly, it is necessary to scroll through the screen to navigate across the laboratory where you will find 10 interactive points. For an immersive experience, a head-mounted display can be used. Please, visit this URL: http://ejbiotechnology.info/public/360view/2023/VTPCARDENAS1v1/index.html.How to cite: Guzmán F, Aróstica M, Román T, et al. Peptides, solid-phase synthesis and characterization: Tailor-made methodologies. Electron J Biotechnol 2023;64. https://doi.org/10.1016/j.ejbt.2023.01.005.

Summary: Nutrition support teams (NSTs) and clinical nutrition professionals (CNPs) have evolved over the years in response to changes in technology, healthcare environment, healthcare financing, and more. Two current challenges facing NSTs/CNPs are the recognition and management of disease-related malnutrition (DRM) and the need for world-wide access to nutrition care. The approach to both previous challenges has been clinical. In this article we explore an ethical additional dimension and propose that a required foundation can be provided by the Troubling Trichotomy (T3) composed of the three pillars which are technology, ethics, and law, adding to the NST/CNP's armamentarium. Most NSTs/CNPs are acquainted with technological advances related to artificially administered nutrition and hydration (AANH) but are not familiar with the nuances of research, publishing, and conflict of interest. The ethical pillar has traditionally focused on the principlism approach and end of life issues. The expanded view includes professional ethics and patient-centered care. Ten legal questions and answers regarding the U.S. legal system are reviewed. Additional needed legal topics such as licensure, top of license practice and the legal ramifications of conflict of interest in reporting, documenting and practice complete the recommended three pillars of the optimal ethical dimension. With the foundation discussed, NSTs/CNPs will be able to manage DRM via awareness, prevention, and management encompassing health promotion and disease prevention. Access to nutrition care as a human right is a pivotal obligation of NSTs/CNPs to provide the right nutrition care for the right individual at the right time in the right way.

This study examines people's understanding of who is a ‘true’ local and its intergroup implications. We expected to find two general understandings – one based on ascribed (i.e., ethnic) and the other on acquired (i.e. civic) characteristics – which would be differently associated with attitudes towards newcomers. In four studies conducted in Poland, we found that people consistently make an empirical distinction between these two understandings of local city belonging (Study 1, N = 148, Study 2, N = 1016, Study 3, N = 400, Study 4, N = 686). Further, stronger endorsement of an ascribed local belonging was related to a tendency to essentialize the ingroup and support for autochthony belief (Study 1), lower acceptance of both international and internal migrants, as well as established and recent migrants (Studies 2–4), higher perceived local threat from migrants, and higher intention for collective action against migrants (Study 4). In contrast, an acquired local understanding was associated with positive attitudes and behavioral intentions towards newcomers. In sum, our results suggest that the ascribed vs. acquired distinction of local belonging is relevant for the way people relate to newcomers in their local environments.

Resumen: Introducción: este estudio tuvo como objetivo identificar las necesidades de formación de los profesionales en salud (PS) sobre educación en salud a partir de su experiencia educando adultos mayores (AM) con enfermedad crónica en la región Sabana Centro en Colombia. Métodos: este es un estudio cualitativo con enfoque fenomenológico con PS que interactúan con los AM con enfermedad crónica que residen en los municipios de la región Sabana Centro, Cundinamarca, Colombia. Se incluyeron 20 PS con una media de edad de 34,3 años, el 95% de la población entrevistada fue del género femenino. Los datos fueron recolectados mediante entrevistas semiestructuradas. La recolección de datos concluyó una vez que se obtuvo la saturación teórica y los datos fueron analizados en el software Atlas.Ti 22. Resultados: el análisis de los datos permitió identificar 2 temas principales que representan las necesidades de formación de los PS: cómo aprende el adulto mayor, el cual incluye habilidades comunicativas, didácticas analógicas y tecnológicas, metodología, creencias y presaberes del AM y la familia en el proceso educativo; y conocimiento de las condiciones de salud, el cual abarca características y seguimientos de la enfermedad y autoevaluación de sus competencias en educación para la salud. Conclusión: las necesidades de formación de los PS sobre educación en salud se dirigen hacia la forma de cómo aprende el adulto mayor para mejorar las didácticas, metodologías y superar las barreras de aprendizaje, además de la actualización en evidencia que mejore la interdisciplinariedad para el abordaje integral de los AM. Abstract: Introduction: This study aimed to identify the training needs of health professionals (HP) regarding health education based on their experience educating older adults (AM) with chronic non-communicable diseases in the Sabana Centro region of Colombia. Methods: This is a qualitative study using a phenomenological approach with HP who work with AM with chronic non-communicable diseases in the Sabana Centro region of Cundinamarca, Colombia. Twenty semi-structured interviews were conducted. The participants were 20 HP with a mean age of 34.3 years; 95% of the individuals interviewed were females. Once the theoretical saturation was achieved, the data were analyzed using Atlas.Ti 22. Results: Data analysis identified two main themes representing the training needs of healthcare professionals: How the AM learn, which includes communication skills, analog or technological teaching techniques, methodologies and perceived barriers, and the inclusion of family in education, and knowledge of health conditions, in which healthcare personnel self-evaluate their competencies regarding their interprofessional knowledge and skills. Conclusion: Training needs for HP on health education are focused on improving didactics, methodologies, and eliminating learning barriers for AM. In addition, they need updated evidence that improves interdisciplinarity for the comprehensive approach to AM.