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In this study, gold and silver were recovered through a bioleaching process conducted at room temperature over 11 days. Native bacteria and varying ratios of mineral pulp to culture medium (20/80, 37.5/62.5, and 50/50 %) from a mining operation in Zacatecas, Mexico, were evaluated. The mineral was crushed to a particle size of 0.125 inches or smaller, containing gold and silver concentrations of 0.609 g/ton and 138.89 g/ton, respectively. Four native microorganisms were identified using molecular biology techniques and a 16S rRNA gene fragment: Acidovorax citrulli, Brevundimonas albigilva, Sphingomonas korenensis, and Methylobacterium organophilum. The bioleaching system achieved metal extractions of 84.12 % and 63.93 % for gold and silver, respectively. Different microorganisms were identified at various processing times: Sphingomonas korenensis (days 1, 2, 5, 8, and 11), Methylobacterium organophilum (days 1 and 2), Paenibacillus dongdonensis (days 1 and 2), Brevundimonas albigilva (day 5), Ureibacillus manganicus (day 5), Peribacillus simplex (day 8), Niallia circulans (day 8), Massilia atriviolacea (day 11), and Bacillus licheniformis (day 11). The dominant bacterium throughout the process was Sphingomonas korenensis, which appeared at all stages of the experiment.

Over the past decade, hip-preservation strategies have gained momentum, resulting in a notable increase in the use of hip arthroscopy for diagnostic and therapeutic interventions in hip-related pathology. In this 3-part series, the authors will aim to comprehensively review the fundamentals of hip arthroscopy in the setting of femoroacetabular impingement. This Technical Note will thoroughly review the senior authors’ approach to managing the central compartment of the hip in the context of femoroacetabular impingement.

Failure of rotator cuff repairs contributes to decreased patient satisfaction and quality of life. Biologic enhancement of repairs represents a novel augmentation strategy attempting to reproduce native healing while concomitantly potentially decreasing the existing high failure rates associated with rotator cuff repairs. Scaffolds placed on top of the rotator cuff have been widely studied, yet no recreation of the native enthesis is achieved via this augmentation strategy. Several strategies involving placement of demineralized bone matrix scaffolds on an inlay configuration (between bone and tendon) have been reported demonstrating enhanced recreation of the native bone-tendon unit. This Technical Note describes the surgical technique of inlay demineralized bone fiber scaffold augmentation of rotator cuff repairs to enhance biological healing in aims of recreating the native enthesis.

Over the past decade, hip-preservation strategies have gained momentum, resulting in a notable increase in the use of hip arthroscopy for diagnostic and therapeutic interventions in hip-related pathology. In this 3-part series, the authors will aim to comprehensively review the fundamentals of hip arthroscopy in the setting of femoroacetabular impingement. While considering the advantages and disadvantages of post versus postless hip arthroscopy, this Technical Note will review the preferred patient and portal positioning approach used by the senior authors.

Over the past decade, hip preservation strategies have gained momentum, resulting in a notable increase in the use of hip arthroscopy for diagnostic and therapeutic interventions for hip-related pathology. In this 3-part series, we aim to comprehensively review the fundamentals of hip arthroscopy in the setting of femoroacetabular impingement. This Technical Note will thoroughly review the senior authors’ approach to managing the peripheral compartment of the hip in the context of femoroacetabular impingement.

Hip arthroscopy has been shown to be an effective surgical treatment with excellent outcomes and a low percentage of complications; however, there are published data regarding iatrogenic complications with hip distraction. Hip distraction is mandatory to gain access to the central compartment and to perform a reliable labral repair or labral reconstruction. Postless hip arthroscopy is very popular nowadays, and several techniques have been published. To our knowledge, no published techniques have been described that access the hip with a postless technique in reconstructing a labrum in a complete, segmental, or augmented manner. We present a modified technique for hip labral augmentation and reconstruction without a post. The described technique was obtained from the original technique for hip arthroscopic labral reconstruction by Dr. Brian J. White in the “front-to-back” technique.

ABSTRACT: Cheese is a food in which toxic concentrations of biogenic amines (BA) may be reached, mainly as a consequence of the decarboxylation of determined amino acids by certain lactic acid bacteria (LAB). To maintain the food safety of cheese, environmentally friendly strategies are needed that specifically prevent the growth of BA-producing LAB and the accumulation of BA. The bacteriocins produced by LAB are natural compounds with great potential as food biopreservatives. This work examines the antimicrobial potential of 7 bacteriocin-containing, cell-free supernatants (CFS: coagulin A-CFS, enterocin A-CFS, enterocin P-CFS, lacticin 481-CFS, nisin A-CFS, nisin Z-CFS and plantaricin A-CFS) produced by LAB against 48 strains of the LAB species largely responsible for the accumulation of the most important BA in cheese, that is, histamine, tyramine, and putrescine. Susceptibility to the different CFS was strain-dependent. The histamine-producing species with the broadest sensitivity spectrum were Lentilactobacillus parabuchneri (the species mainly responsible for the accumulation of histamine in cheese) and Pediococcus parvulus. The tyramine-producing species with the broadest sensitivity spectrum was Enterococcus faecium, and Enterococcus faecalis and Enterococcus hirae were among the most sensitive putrescine producers. Nisin A-CFS was active against 31 of the 48 BA-producing strains (the broadest antimicrobial spectrum recorded). Moreover, commercial nisin A prevented biofilm formation by 67% of the BA-producing, biofilm-forming LAB strains. These findings underscore the potential of bacteriocins in the control of BA-producing LAB and support the use of nisin A as a food-grade biopreservative for keeping BA-producing LAB in check and reducing BA accumulation in cheese.

Resumen: La falla hepática aguda es un síndrome poco común pero grave, con una incidencia de aproximadamente 2,000 a 3,000 casos por año en América del Norte. Su fisiopatología y curso clínico varían según la causa del daño hepático primario, y puede llevar a una alta morbimortalidad o necesidad de trasplante hepático, a pesar de las terapias disponibles. Este síndrome involucra una activación excesiva del sistema inmunológico con daño en otros órganos, lo que contribuye a su alta tasa de mortalidad. La definición más aceptada incluye daño hepático con encefalopatía hepática y coagulopatía en las últimas 26 semanas en un paciente sin enfermedad hepática previa. Las principales causas son intoxicación por paracetamol, hepatitis viral, lesión hepática inducida por drogas, entre otras. Es crucial identificar la causa, ya que influye en el pronóstico y tratamiento. La supervivencia ha mejorado con medidas de soporte, terapia intensiva, prevención de complicaciones y el uso de medicamentos como la N-acetilcisteína. El trasplante hepático es una opción curativa para casos no respondedores al tratamiento médico, pero la evaluación adecuada del momento para el trasplante es crucial para mejorar los resultados. Factores como la edad del paciente, la causa subyacente y la gravedad de las fallas orgánicas influyen en los resultados y la supervivencia postrasplante. Abstract: Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. Its pathophysiology and clinical course vary, depending on the cause of the primary liver injury, and can lead to high morbidity and mortality or the need for liver transplantation, despite available therapies. This syndrome involves excessive activation of the immune system, with damage in other organs, contributing to its high mortality rate. The most accepted definition includes liver injury with hepatic encephalopathy and coagulopathy within the past 26 weeks in a patient with no previous liver disease. The main causes are paracetamol poisoning, viral hepatitis, and drug-induced liver injury, among others. Identifying the cause is crucial, given that it influences prognosis and treatment. Survival has improved with supportive measures, intensive therapy, complication prevention, and the use of medications, such as N-acetylcysteine. Liver transplantation is a curative option for nonresponders to medical treatment, but adequate evaluation of transplantation timing is vital for improving results. Factors such as patient age, underlying cause, and severity of organ failure influence the post-transplant outcomes and survival.

Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. Its pathophysiology and clinical course vary, depending on the cause of the primary liver injury, and can lead to high morbidity and mortality or the need for liver transplantation, despite available therapies. This syndrome involves excessive activation of the immune system, with damage in other organs, contributing to its high mortality rate. The most accepted definition includes liver injury with hepatic encephalopathy and coagulopathy within the past 26 weeks in a patient with no previous liver disease. The main causes are paracetamol poisoning, viral hepatitis, and drug-induced liver injury, among others. Identifying the cause is crucial, given that it influences prognosis and treatment. Survival has improved with supportive measures, intensive therapy, complication prevention, and the use of medications, such as N-acetylcysteine. Liver transplantation is a curative option for nonresponders to medical treatment, but adequate evaluation of transplantation timing is vital for improving results. Factors such as patient age, underlying cause, and severity of organ failure influence the post-transplant outcomes and survival. Resumen: La falla hepática aguda es un síndrome poco común pero grave, con una incidencia de aproximadamente 2000 a 3000 casos por año en América del Norte. Su fisiopatología y curso clínico varían según la causa del daño hepático primario, y puede llevar a una alta morbimortalidad o necesidad de trasplante hepático, a pesar de las terapias disponibles. Este síndrome involucra una activación excesiva del sistema inmunológico con daño en otros órganos, lo que contribuye a su alta tasa de mortalidad. La definición más aceptada incluye daño hepático con EH y coagulopatía en las últimas 26 semanas en un paciente sin enfermedad hepática previa. Las principales causas son intoxicación por paracetamol, hepatitis viral, lesión hepática inducida por drogas, entre otras. Es crucial identificar la causa, ya que influye en el pronóstico y tratamiento. La supervivencia ha mejorado con medidas de soporte, terapia intensiva, prevención de complicaciones y el uso de medicamentos como la N-acetilcisteína. El trasplante hepático es una opción curativa para casos no respondedores al tratamiento médico, pero la evaluación adecuada del momento para el trasplante es crucial para mejorar los resultados. Factores como la edad del paciente, la causa subyacente y la gravedad de las fallas orgánicas influyen en los resultados y la supervivencia post-trasplante.

One of the most challenging robotic manipulator designs is finding an appropriate balance between the shaking force and shaking moment because this reduces vibrations. Several approaches have been introduced in the last decades; nevertheless, some assumptions must be established to make such a balance. In this paper, a dynamic balancing approach is proposed. The main novelty is the no dependence on specific trajectories to be executed by the manipulator, which allows finding a design with a similar tradeoff in the balancing under robot configuration changes. Also, the proposal incorporates mass distribution and link shape in a single design procedure. The proposal is stated as a constrained nonlinear optimization problem and applied to a hybrid serial-parallel robotic manipulator. The use of different bio-inspired algorithms and one gradient one in the solution of the balancing problem reveals that differential evolution finds the most suitable design. Besides, comparative simulation results of the obtained design with other design approaches show that the obtained design presents the most suitable tradeoff between the shaking force and the shaking moment when the manipulator executes tasks with different operating velocities.

Introduction: Cancer treatments have a detrimental impact on the quality of life (QoL) of young women with breast cancer (YWBC). Research exploring QoL trajectories has been mostly centered on postmenopausal women. Here we report longitudinal changes across all QoL domains and associated factors in YWBC. Methods: In this prospective longitudinal cohort study, women aged ≤40 with stage I-III BC completed the European Organization for the Research and Treatment of Cancer Core QoL questionnaire at diagnosis and during 4 follow-up visits over 5 years, alongside demographic and clinical data collection. Group-based multivariate trajectory modeling was used to identify patient groups based on their functional and symptom scores, finding 3 groups (best, good, and poor). Factors associated with each trajectory pattern were identified with multinomial logistic models. Results: A total of 477 women (median age: 36; IQR: 32–38) were clustered into the best (n = 259, 54 %), good (n = 79, 17 %), or poor trajectory groups (n = 139, 29 %). Throughout the disease, patients with a poor QoL experienced clinically significant impairment in emotional functioning, nausea and vomiting, and pain. They also had significant cognitive impairment, dyspnea, and diarrhea. Patients with a good QoL had clinically meaningful diarrhea for the first 7 months, while those with the best QoL had clinically important nausea and vomiting during the first 2 months since diagnosis. Noteworthy, all groups experienced significant financial difficulties throughout their follow-up. Regular alcohol consumption at diagnosis (aOR [adjusted odds ratio] 1.64; 95 % CI [confidence interval] 1.02–2.65) and HER2-positive BC (aOR 2.53; 95 % CI 1.35–4.73) were independent factors associated with classification to the poor and good groups, respectively. Conclusion: This study underscores the variability in QoL among YWBC and the importance of ongoing monitoring. Strategies to improve access to economic resources, manage treatment-related adverse effects, and support patients in discontinuing modifiable risk factors are needed.

This study evaluates the enhanced cyclic oxidation resistance of Metcoloy II coatings applied to ASTM A53 Grade B steel substrates using electric arc thermal spray, across temperatures ranging from 500 °C to 700 °C. The research identifies distinct performance differences between coated and uncoated samples under cyclic oxidation conditions. Initially, both sample types exhibited mass increases due to oxide formation. However, uncoated samples developed non-protective iron oxides, while Metcoloy II coatings formed a protective layer of chromium and nickel oxides. During 500 oxidation cycles at 500 °C, uncoated samples showed a rapid mass increase, indicative of accelerated oxidation, whereas Metcoloy II coatings experienced a controlled mass gain, reflecting effective protection by chromium and aluminum oxides. At 700 °C, the mass variation trends were similar for both types initially; however, uncoated samples suffered significant mass loss due to iron oxide volatilization, emphasizing their susceptibility. Conversely, Metcoloy II coatings exhibited a reduced but steady mass increase, indicating their resilience under high-temperature conditions. Microstructural analysis confirmed the presence of a protective oxide layer in the coated samples, which is essential for reducing substrate oxidation. Although challenges such as coating detachment and thinning were observed, particularly at higher temperatures, Metcoloy II coatings maintained their protective role. This study highlights the coating's effectiveness in extending the lifespan of steel substrates subjected to cyclic oxidation, providing valuable insights for optimizing protective coatings in demanding industrial applications and advancing material science strategies for enhanced durability.

Fire plays a critical role in nutrient cycling and species diversity but also causes severe disturbances to ecosystems. Despite remote sensing has emerged as a valuable tool to study wildfires, a lack of information regarding post-fire dynamics still remains for certain regions. This study investigated the post-fire dynamics of four burned sites in the temperate forest of Chihuahua, northern Mexico from 2009 to 2017, based on the variability of spectral indices under varied topographic conditions of aspects and slopes. The Normalized Difference Vegetation index (NDVI), Soil Adjusted Vegetation Index (SAVI), Normalized Burn Ratio (NBR), and Normalized Difference Water index (NDWI) were utilized to assess vegetation recovery on the burned sites. One-way ANOVAs and Tukey´s tests were performed to evaluate separately the effects of aspect and slope on the indices’ variability (p < 0.05). In general, the NDVI measured the highest values of the burned sites along the evaluated lapse while the NDWI indicated the lowest measures. Results indicated significant effects of aspect on NDVI and SAVI (p < 0.05), while slope significantly influenced the four evaluated indices (p < 0.05).That in turn showed northern aspects and steeper slopes to have the highest post-fire vegetation recoveries. Furthermore, aspect only affected the bi-annual variability of SAVI (p < 0.05). However, the NBR and NDWI showed higher magnitudes of change among periods than the SAVI (i. e., recovery and non-recovery). Besides registering a continuous recovery of the burned sites from the wildfire events to 2015, this study revealed the NDVI and SAVI as the most useful spectral indices for assessing post-fire vegetation dynamics in the region. Besides aspect and slope, future studies could focus on the inclusion of additional indicators to more effectively assess post-fire ecosystem dynamics in northern Mexico.

Background: Studies of adult populations in high-income countries have found an association between arthritis and myocardial infarction (MI) due to high levels of systemic inflammation. Our objectives were to examine the association between arthritis and MI among Mexican adults and to assess the mediating effect of C-reactive protein (CRP) on this association. Methods: Data came from the 2012, 2015, and 2018 observation waves of the Mexican Health and Aging Study. Our sample included 11,707 participants aged 50 and older with no prior MI before 2012. We used self-reported information for arthritis, joint pain, medication use, and limitations to daily activities in 2012. Logistic regression was used to model the association between arthritis and self-reported MI in 2015 or 2018. We used a sub-sample of 1602 participants to assess the mediating effect of CRP. Results: In the full sample, participants with arthritis that limited their daily activities had higher odds of MI than participants with no arthritis (OR = 1.40; 95 % CI = 1.04–1.88). In the sub-sample, arthritis that limited daily activities was associated with higher mean CRP (5.2 mg/dL; 95 % CI = 4.10–6.21) than arthritis with no limitations (3.5 mg/dL; 95 % CI = 2.93–4.01). However, CRP levels had a small mediating effect, and the relationship between arthritis with physical limitations and MI remained statistically significant. Conclusion: Mexican adults with arthritis that limits their daily activities are at an increased risk for MI. Continued research is needed to identify factors that contribute to this increased risk.

The 2022-23 hydrological year in the Lake Titicaca, Desaguadero River, and Lake Poopó hydrological system (TDPS) over the South American Altiplano constituted a historically dry period. This drought was particularly severe during the pre-wet season (October–December), when the TDPS and the adjacent Andean-Amazon region experienced as much as 60% reductions in rainfall. Consequently, Titicaca Lake water levels decreased by 0.05 m from December to January, which is part of the rising lake level period of normal conditions. Such conditions have not been seen since the El Niño-related drought of 1982-83. Using a set of hydroclimatic, Sea Surface Temperature (SST) and atmospheric reanalysis datasets, we find that this new historical drought was associated with enhanced southerly moisture flux anomalies, reducing the inflow of moisture-laden winds from the Amazon basin to the TDPS. Such anomalies in moisture transport were not seen since at least the 1950s. The atmospheric dynamics associated with this drought are related to La Niña SST anomalies via subtropical teleconnections associated with Rossby wave trains towards South America, further extended by subtropical Atlantic Ocean SST anomalies. This feature reduced the atmospheric moisture inflow from the Amazon and weakened the development of the Bolivian High in the upper troposphere. These results document a new atmospheric mechanism related to extreme droughts in the TDPS associated with La Niña SST anomalies during the pre-wet season. This goes beyond the traditional understanding of El Niño events, especially the strongest ones, being associated with dry conditions in the TDPS during the wet season (December–March).

Objective: The study aimed to investigate the feasibility of a remote mindfulness based self-management intervention for individuals with type 2 diabetes. It is important to further our understanding of how to improve self-management to improve health outcomes and low levels of uptake to self-management courses. Method: 29 participants with type 2 diabetes were recruited from the University Hospital Coventry and Warwickshire NHS trust. Three groups of participants engaged with a remote mindfulness based self-management intervention, which were delivered sequentially. After each intervention was complete, patient feedback was retrieved and implemented into the following intervention. The quantitative analysis comprised of descriptive statistics, independent sample t-test, paired sample t-test and multiple regression analysis. A qualitative analysis was also conducted through reflexive thematic analysis (RTA) to understand participant’s perspective on the intervention. Results: There was a total of 17 who attended the course (59 %) and a total drop out of 12 participants over the three courses (41 %). The qualitative findings reported three main themes: (1) Eating to manage my emotions rather than my diabetes (2) Implementing mindfulness has helped me manage my emotions (3) Medication rather than self-management behaviours control my diabetes. The focus group feedback included participants’ appreciation of the community aspect of the intervention and their perception that the current course was more interactive compared to previous interventions. In addition, participants highlighted the importance of offering the course at an earlier stage of diagnosis to provide further support at the beginning of their diabetes journey. No significant findings were reported for the independent sample t-test, paired sample t-test and multiple regression analysis. Conclusion: The qualitative findings suggested that the course was beneficial, especially in demonstrating how mindfulness could aid self-management for individuals living with type 2 diabetes. Further funding and trials are warranted to improve the quality of technology used and to assess impact on diabetes control and mental health.

Searching for positive selection signals across genomes has identified functional genetic variants responding to environmental change. In Native Americans of Mexico, we used the fixation index (Fst) and population branch statistic (PBS) to identify SNPs suggesting positive selection. The 103 most differentiated SNPs were tested for associations with metabolic traits, the most significant association was FADS2/rs174616 with body mass index (BMI). This variant lies within a linkage disequilibrium (LD) block independent of previously reported FADS selection signals and has not been clearly associated with metabolic phenotypes. We tested this variant in two independent cohorts with cardiometabolic data. In the Genetics of Atherosclerotic Disease (GEA) cohort, the derived allele (T) was associated with increased BMI, lower LDL-C levels and a decreased risk of subclinical atherosclerosis in women. Significant gene-diet interactions affected lipid, apolipoprotein and adiponectin levels with differences according to sex, involving mainly total and complex dietary carbohydrate%. In the Genotype-related Effects of PUFA trial, the derived allele was associated with lower Δ-6 desaturase activity and erythrocyte membrane dihomo-gamma-linolenic acid (DGLA) levels, and with increased Δ-5 desaturase activity and eicosapentaenoic acid levels. This variant interacted with dietary carbohydrate% affecting Δ-6 desaturase activity. Notably, the relationship of DGLA and other erythrocyte membrane LC-PUFA indices with HOMA-IR differed according to rs174616 genotype, which has implications regarding how these indices should be interpreted. In conclusion, this observational study identified rs174616 as a signal suggesting selection in an independent linkage disequilibrium block, was associated with cardiometabolic and erythrocyte measurements of LC-PUFA in two independent Mexican cohorts and showed significant gene-diet interactions.

This review highlights the growing concern regarding the proliferation of microplastics (MPs) in aquatic ecosystems and their potential impact on both the environment and human health. Despite current efforts, a considerable number of MPs remain untreated due to their small size. Conventional identification and treatment methods are summarized pointing to the current limitations. Emerging technologies in microfluidics and nanotechnology are presented as potential solutions for the removal of MPs from aquatic environments. These novel technologies, which are currently being used for the development of novel point of care (PoC) diagnostic devices, can take advantage of the size and density similarities between MPs and commonly separated particles in microfluidics applications such as cells, making them promising candidates for MPs separation and recovery in wastewater treatment plants.This review evaluates the limitations of current MPs separation and recovery technologies in water treatment plants and laboratories and compares them with the promising capabilities of microfluidics and nanotechnology, providing valuable insights into future strategies for combating MPs pollution.

Aim: To describe the perceptions and experiences of key stakeholders to understand the use of telehealth in community mental health centers (CMHCs) during the COVID-19 pandemic in Lima and Callao, Peru. Methods: A qualitative study was carried out in four CMHCs in Lima and Callao, Peru. Forty-nine individual semi-structured interviews were conducted between September 2021 and March 2022, considering CMHCs' users and their relatives, health and administrative workers, directors, as well as local and national policymakers. Data was analyzed using thematic analysis. Results: Regarding the transition from in-person care to telehealth, CMHCs' directors and workers identified some of the regulations issued by the Government during the pandemic, such as the continuity of care through telehealth, especially for pregnant women and for people with comorbidities related to COVID-19. Regarding benefits, workers and users indicated that it allowed better communication, such as constant follow-ups. Directors and workers recognized that Google Drive facilitated access to user information, since they did not have an electronic medical record. Additionally, workers said they used social media to share educational information on mental health, and explained that some new users began their treatment this way. Regarding difficulties, participants reported a lack of devices and poor internet connection in CMHCs. Users mentioned that scheduling an appointment was difficult because the phone lines were usually saturated, and they could not find available appointments. Conclusion: Although the pandemic forced an immediate and disruptive change towards telehealth, CMHCs were able to adapt most of their services. This study reports the adaptations made by CMHCs to move from in-person to remote care, identifying the benefits and challenges faced, information that can be used for the nationwide implementation of telehealth in CMHCs. We recommend ensuring technological equipment and internet connection and adapt the telehealth system to make it responsive to the routine practices of CMHCs.

This study conducts a Social Life Cycle Assessment (S-LCA) of Rainwater Harvesting Systems (RWHS) in Mexico City to evaluate their social performance. Given the city's pressing water scarcity, RWHS have become critical for promoting water autonomy and sustainable urban development. The research integrates quantitative data from surveys and interviews with RWHS users and organizational employees, along with qualitative analysis using the Product Social Impact Assessment (PSIA) approach. This methodology allows for a thorough examination of socio-environmental dynamics influenced by RWHS adoption. Our findings show high acceptance of RWHS among users and highlight progressive labor practices, underscoring RWHS's potential to transform urban water management. This study, the first to evaluate this ecotechnology through an S-LCA, identifies the need for a multidimensional approach to understand socio-economic and environmental intersections with water systems. It also underscores NGOs' role in facilitating technology transfer and adoption in urban communities. Recommendations include extending the S-LCA methodology to cover the entire RWHS lifecycle and incorporating broader social science theories to deepen understanding of water sustainability interventions. The results offer new insights into RWHS assessment, emphasizing the complexities of deploying decentralized water technologies in a mega-city and laying groundwork for policy recommendations that support sustainable, equitable water access.

Summary: The mouse epididymis is a long tubule connecting the testis to the vas deferens. Its primary functions are to mature spermatozoa into motile and fertile cells and to protect them from pathogens that ascend the male tract. We previously demonstrated that a functional extracellular amyloid matrix surrounds spermatozoa in the epididymal lumen and has host defense functions, properties not unlike that of an extracellular biofilm that encloses and protects a bacterial community. Here we show the epididymal amyloid matrix also structurally resembles a biofilm by containing eDNA, eRNA, and mucin-like polysaccharides. Further these structural components exhibit comparable behaviors and perform functions such as their counterparts in bacterial biofilms. Our studies suggest that nature has used the ancient building blocks of bacterial biofilms to form an analogous structure that nurtures and protects the mammalian male germline.

Introduction: Burnout syndrome (BS) is a prevalent occupational health problem in health professionals. To describe the prevalence and factors associated with BS in Peruvian health professionals. Method: A systematic review and meta-analysis were performed. The key terms “burnout” and “professional exhaustion” were used with words related to Peru. The databases consulted were LILACS/Virtual Health Library, Medline/PubMed, Science Direct, EBSCO, Scopus, SciELO, and RENATI-SUNEDU; articles published between January 2000 to December 2020 were considered for inclusion. Methodological quality was evaluated using the Newcastle–Ottawa scale. Results: Thirty studies were identified (8 scientific articles and 22 graduate theses). The median sample size was 78, with an interquartile range of 50–110. A meta-analysis was performed to calculate a dichotomic prevalence of burnout syndrome in health professionals of 25 % (95%CI: 9 %–45 %; I2 = 97.14 %; 5 studies). Also, our meta-analysis estimated the overall prevalence of mild burnout (27 %; 95%CI: 16%–41 %; I2 = 96.50 %), moderate burnout (48 %; 95%CI: 32%–65 %; I2 = 97.54 %), and severe burnout (17 %; 95%CI: 10%–24 %; I2 = 92.13 %; 18 studies). We present meta-analyses by region, profession, hospital area, and by dimension of the Maslach Burnout Inventory. Overall, the studies presented adequate levels of quality in 96.7 % of the included studies (n = 29). In addition, our narrative review of factors associated with BS and its three dimensions identified that different studies find associations with labor, socio-demographic, individual, and out-of-work factors. Conclusions: There is a higher prevalence of moderate BS in Peruvian health professionals at MINSA and EsSalud hospitals in Peru, with severity differing by region of Peru, type of profession, work area, and dimensions of BS.

Objective: Nurses inevitably encounter patients who require care aimed at limiting therapeutic effort (LTE), even though many of them are not prepared to provide support to individuals with terminal illnesses and their families. One of the contexts in which the LTE is considered is the intensive care unit (ICU). This review is to describe the competencies for the execution of a nursing professional role in the LTE in the ICU. Method: An integrative review of the literature published between the years 2010 and 2023. The search was carried out in five databases: Medline, Wiley Online Library, SciELO, ScienceDirect, and Web of Science. The Critical Appraisal Skills Programme in Spanish was used as the template for study evaluation. The methodology of the Oxford Center for Evidence-Based Medicine (CEBM) was used to assess the level of evidence and the degree of recommendation. Result: A total of 25 articles in a wide range of studies were included. The findings suggest that the competencies for LTE in the ICU are direct patient care, family-centered care, and the role of the nurse within the team. However, more high-quality studies are needed to confirm these conclusions. Three categories were identified: (a) competencies as defender agent between the patient, his family, and the interdisciplinary team; (b) competencies for decision-making in limiting the therapeutic effort; and (c) competencies for nursing therapeutic interventions at the end of life. Conclusion: The competencies of the nursing professionals who work in the adult ICU in the LTE are essential to the patient’s quality of life, dignity of their death, and comprehensive family support for coping with grief.

The genus Passiflora (Passifloraceae) comprises about 500 species. The Passiflora edulis stands out because of its economic and medicinal importance. It is widely planted in tropical and subtropical regions worldwide, especially in South America, the Caribbean, South Africa, and Asia. The aqueous extract of Passiflora edulis Sims f. edulis (Gulupa) leaves is used in traditional medicine for its soothing and tranquilizing effects on the central nervous system. Therefore, evaluating its safety for human use is a fundamental requirement to continue the development of new therapies within the framework of regulatory, preclinical, and clinical guidelines. Here, the sub-acute toxicity study was conducted following the Organization for Economic Cooperation and Development (OECD) guideline 407 for 28 days in Wistar albino rats. The study showed that 1000 mg/kg/day of the aqueous extract in 10 adult Wistar rats (five males and five females) was well tolerated. The hematological results are at normal levels. However, monocytopenia and eosinopenia were observed with a significant difference (P

Resumen: La infección por el virus de la hepatitis C (VHC) es un problema de salud pública a nivel mundial asociado a una gran morbimortalidad. En el caso del trasplante hepático, la demanda de órganos continúa siendo mayor que la oferta. Este problema ha llevado a tomar en consideración el uso de órganos de donadores con VHC positivos en receptores negativos.Gracias al advenimiento de los antivirales de acción directa (AAD), los cuales han mostrado ser altamente efectivos para la curación del virus, ha sido posible procurar y utilizar órganos de donadores con infección por el VHC para ser trasplantados. En este artículo se hace una breve revisión de la evidencia actual del uso de órganos provenientes de pacientes infectados por el VHC. Abstract: Hepatitis C virus (HCV) infection is a worldwide public health problem associated with significant morbidity and mortality. In the context of liver transplantation, the demand for organs continues to exceed the supply, prompting the consideration of using organs from HCV-positive donors in HCV-negative recipients. The introduction of direct-acting antivirals (DAAs), which have demonstrated great efficacy in eradicating the virus, has made transplantation of organs from donors with HCV infection possible. The present article provides a brief review of the current evidence on the use of organs from HCV-infected patients.

Hepatitis C virus (HCV) infection is a worldwide public health problem associated with significant morbidity and mortality. In the context of liver transplantation, the demand for organs continues to exceed the supply, prompting the consideration of using organs from HCV-positive donors in HCV-negative recipients. The introduction of direct-acting antivirals (DAAs), which have demonstrated great efficacy in eradicating the virus, has made transplantation of organs from donors with HCV infection possible. The present article provides a brief review of the current evidence on the use of organs from HCV-infected patients. Resumen: La infección por el virus de hepatitis C (VHC) es un problema de salud pública a nivel mundial asociado a una gran morbilidad y mortalidad. En el caso del trasplante hepático, la demanda de órganos continúa siendo mayor que la oferta. Este problema ha llevado a tomar en consideración el uso de órganos de donadores con VHC positivos en receptores negativos.Gracias al advenimiento de los antivirales de acción directa (AAD), los cuales han mostrado ser altamente efectivos para la curación del virus, ha sido posible procurar y utilizar órganos de donadores con infección por VHC para ser trasplantados. En este artículo se hace una breve revisión de la evidencia actual del uso de órganos provenientes de pacientes infectados por VHC.

Background: Systematic reviews suggest that animal-assisted therapy (AAT) and pet-robot interventions (PRI) achieve a reduction in mental health variables such as depressive symptoms. However, these systematic reviews include both randomised and non-randomised studies, which prevents an adequate assessment of the effect of confounding variables. Objective: This systematic review and meta-analysis aimed to evaluate the comparative effectiveness of AAT and PRI through randomized controlled trials (RCTs) in reducing depression in older adults. Methods: Our study is a systematic review. We searched three databases of scientific articles: SCOPUS, Web of Science and PubMed. We included studies that their population was older adults, aged 65 years or older, with or without a clinical condition, clinical diagnosis based on mental examination/test or documentation from medical records, accredited by the facilities' staff. We included trials in which the comparator was a passive intervention or an active intervention. We used the Cochrane risk-of-bias tool for randomised trials (RoB 2) to assess the risk of bias for each study. Our study was registered in PROSPERO (CRD42023393740). Results: Twenty-three studies were included in this systematic review. However, only 19 trials were included in the meta-analysis. At the overall risk of bias level, 78.9% of the studies were at high risk of bias (n = 15). We found that AAT (g= −0.72; 95%CI −1.13 to −0.31; p = 0.001) has a moderate and statistically significant effect as an intervention to reduce depressive symptoms in older adults. However, the PRIs do not show a significant effect on reducing depressive symptoms in older adults. In addition, a sub-analysis based on dog-assisted therapy (g= −0.65; 95%CI −1.21 to −0.08; p = 0.025), a specific type of AAT, showed a modest effect on reducing depressive symptoms. Conclusions: Our study concluded that AAT and DAT had a moderate and statistically significant effect as interventions to reduce depressive symptoms in older adults. On the other hand, PRI did not show a significant effect in reducing depressive symptoms.

Despite advances in breast cancer care, breast cancer in young women (BCYW) faces unique challenges, diagnostic delays, and limited awareness in many countries. Here, we discuss the challenges and consequences associated with the delayed diagnosis of BCYW. The consequences of delayed diagnosis in young women - which generally varies among developed, developing, or underdeveloped countries - are severe due to a faster breast tumor growth rate than tumors in older women, also contributing to advanced cancer stages and poorer outcomes. Though there are many underlying reasons for diagnostic delays due to age, the article delves explicitly deep into the diagnostic delay of BCYW, focusing on healthcare providers, potential contributing factors, its consequences, and the urgent need to start minimizing such incidences. The article suggests several strategies to address these issues, including increasing awareness, developing educational programs for healthcare providers to identify signs and symptoms in young women, developing clear diagnostic guidelines, and improving screening strategies.

Summary: The taxation of menstrual products has been identified as unfair, imposing economic burden on people who menstruate based simply on a biological difference. These taxes have been described as major contributors to menstrual poverty. Although they have been debated among governments, and a focus of political activism, academic literature has largely neglected the issue. Here I comprehensively reviewed the status of menstrual product taxes for all countries and populated territories in the Americas in 2022. Data from 57 countries and territories, and 78 states (those of the United States and Brazil) were included. Since 2012, 10 countries and territories have eliminated taxation on menstrual products—Jamaica, Canada, Saint Kitts & Nevis, Trinidad & Tobago, Guyana, Colombia, Puerto Rico, Mexico, Ecuador, and Barbados. Nevertheless, menstrual product taxes were still applied in 63.2% of locations in 2022, with an average tax rate of 11.2% (ranging from 1.0% in Costa Rica to 22.0% in Uruguay). The average woman of reproductive age in the Americas experienced a menstrual product tax rate of 5.8% in 2022. In sum, despite activism and progress, most of the region continues to employ discriminatory taxation against people who menstruate, with particularly high taxation rates concentrated in South America.

Background: During the first wave of the pandemic, a constant concern of healthcare workers, who are more vulnerable to contagion, is their personal safety. This is directly related to the availability of adequate PPE, which led to a perception of dissatisfaction and inequality with government responses. We aim t o determines whether perception of adequate PPE availability is associated with depressive, anxiety, and stress symptoms in different types of healthcare workers. Methods: Analytical cross-sectional study surveyed clinical and non-clinical healthcare workers in two third-level hospitals in Lima, Peru. An online self-survey assessed the perception of adequate PPE availability, using a Likert scale question, which was then dichotomized for the analysis. In addition, we assessed the depressive, anxiety, and stress symptoms using validated questionnaires. Results: 563 participants were included. In general, there is no association between perception of PPE availability and three mental health outcomes. However, in the subgroup analysis, physicians with better perception of PPE availability had less moderate-severe outcomes in mental health; in contrast, nurses had higher moderate-severe outcomes. The type of profession in healthcare workers may modify the effect of this association. Conclusion: The association between perception of PPE availability and mental health outcomes is complex in healthcare workers from two third-level hospitals. This association can vary according to the type of work.

Summary: Healthcare systems in Latin America are broadly heterogeneous, but all of them are burdened by a dramatic rise in liver disease. Some challenges that these countries face include an increase in patients requiring a transplant, insufficient rates of organ donation, delayed referral, and inequitable or suboptimal access to liver transplant programs and post-transplant care. This could be improved by expanding the donor pool through the implementation of education programs for citizens and referring physicians, as well as the inclusion of extended criteria donors, living donors and split liver transplantation. Addressing these shortcomings will require national shifts aimed at improving infrastructure, increasing awareness of organ donation, training medical personnel, and providing equitable access to care for all patients.

Background: Overwhelming requirements, a high degree of work, and prolonged exposure to emotionally demanding circumstances in work and life settings can lead to burnout syndrome. The purpose of the study is to assess burnout syndrome and its associated factors among medical students during the COVID-19 pandemic.Methods: A cross-sectional, prospective, descriptive study was conducted in a Mexican medical school during the last week of the spring semester of 2021 using the Maslach Burnout Inventory-Student Survey (MBI-SS) and an associated factors survey.Results: Based on the MBI-SS definition, most students (54.2%, n = 332) had burnout symptoms and high emotional exhaustion (79.6%, n = 448), high cynicism (57.3%, n = 351), and low academic effectiveness (36.4%, n = 223). After adjusting the associated factors, a significant correlation between the school year and the presence of burnout was identified (OR 1.127, 95% CI [1.023–1.241], p

Background: Knowledge on the management of kaposiform hemanigioendothelioma (KHE) with kasabach-merritt phenomenon (KMP) rely on single case reports, case series and a few retrospective studies. Case report: A 3-month old girl was admitted for a violaceous, palpable mass in the right posterior neck. Laboratory studies showed thrombocytopenia and consumptive coagulopathy with hypofibrinogenemia and raised Dimer-D values. A diagnosis of KHE with KMP was confirmed histopathologically. Treatment regimen for KMP was commenced with oral prednisone and salicylic acid, followed by oral sirolimus at 1 mg/m2/day. It led to an involution of the vascular lesion at 12-month follow-up. Conclusion: The case contributes with another example of KHE with KMP that was effectively treated with the novel mTOR inhibitor. Prospective studies for sirolimus are urged and clinical guidelines are yet to be defined.

Resumen: Introducción y objetivos: La donación en asistolia controlada se ha convertido en una de las principales estrategias para aumentar el número de donantes. Hasta el momento el corazón de este tipo de donantes no era valorado por el riesgo de lesión isquémica durante la limitación del soporte vital. En los últimos años, con los sistemas de perfusión ex situ se iniciaron programas de donación cardiaca en asistolia controlada que demostraron la viabilidad miocárdica. El uso de perfusión regional normotérmica en nuestro medio y la experiencia de otros países en la recuperación cardiaca nos lleva a elaborar un protocolo de extracción cardiaca en asistolia controlada con valoración in situ y conservación en frío. Métodos: Se conforma un equipo multidisciplinar que realiza un protocolo de extracción cardiaca con donante en asistolia controlada. Tras una fase de experimentación animal, dicho protocolo es aprobado por el Comité de Ética para la Asistencia Sanitaria y por la Organización Nacional de Trasplantes. Resultados: Se realiza un protocolo que establece los criterios de selección de donantes y receptores y que regula el procedimiento de donación con perfusión toracoabdominal tras exclusión de los troncos supraaórticos. La valoración cardiaca es in situ y la conservación estática, en frío. Este protocolo se comunica al resto de hospitales donantes, y esto nos lleva a realizar el primer trasplante cardiaco en España con asistolia controlada. Conclusiones: El trasplante cardiaco con donación en asistolia controlada es una realidad clínica que permitirá aumentar el número de potenciales donantes. Las características técnicas del procedimiento hacen que este tipo de donación se deba concentrar en centros con experiencia. Abstract: Introduction and objectives: Donation after circulatory death has become one of the main strategies to increase the number of donors. Until now, the heart of this type of donor was not evaluated due to the risk of ischaemic injury during the withdrawal of life support. In recent years, ex situ perfusion systems have initiated cardiac donation programmes after circulatory death that have demonstrated myocardial viability. The use of normothermic regional perfusion in our environment and the experience of other countries in cardiac recovery led us to develop a protocol for cardiac procurement in donation after circulatory death with in situ assessment and cold preservation. Methods: A multidisciplinary team was formed to create a cardiac extraction protocol with donation after circulatory death. After a phase of animal experimentation, the protocol was approved by the Ethics Committee for Health Care and by the National Transplant Organization. Results: A protocol was drawn up establishing the criteria for donor and recipient selection and regulating the donation procedure with thoracic-abdominal perfusion after exclusion of the supra-aortic trunks. Cardiac evaluation is in situ and static preservation in cold storage. This protocol was sent to the rest of the donor hospitals and this led us to perform the first heart transplant in Spain with this donation modality. Conclusions: Cardiac transplantation with donation after circulatory death is a clinical reality that will increase the number of potential donors. The technical characteristics of the procedure mean that this type of donation should be performed in experienced centres.