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OBJECTIVE To evaluate survival outcomes of fetuses with right sided congenital diaphragmatic hernia (CDH) treated in Latin American centres and to assess the utility of left lung area to predict neonatal survival. METHODS A retrospective cohort including isolated right sided CDH cases managed expectantly during pregnancy in six tertiary centers from five Latin American countries. The utility of the observed/expected lung-to-head ratio (O/E-LHR) in predicting neonatal survival was assessed, and the best cut-off to predict prognosis was automatically selected by decision tree analysis. RESULTS A total of 99 right sided CDH cases were recruited, 58 isolated fetuses were selected at a median gestational age of 26.2 weeks, showing an overall survival rate of 26.2%. A linear trend was observed between survival and the O/E-LHR, showing that at higher O/E-LHR, the greater probability of survival (r = 0.56, p

Resumen: Las características anatómicas e histológicas excepcionales de la arteria mamaria interna (AMI) la convierten en el hemoducto ideal para la cirugía de revascularización miocárdica. La técnica para su disección esqueletizada solo con clips y tijeras, permite la construcción de un injerto con más flujo y la conservación de una mayor circulación colateral residual al esternón, con la consiguiente mejor protección ante futuros eventos isquémicos o infecciosos.Sin embargo, ese método de disección es el menos practicado por ser más lento y no estar exento de lesiones de ramas laterales de la arteria. En las últimas décadas se han introducido varios adelantos tecnológicos en el procedimiento de disección de la AMI, pero las técnicas actuales no aprovechan sus especiales características morfofisiológicas para potenciar la obtención de un hemoducto con más flujo y con menos riesgo de lesión vascular y sangrado.En esta revisión se comentan las particularidades de la anatomía quirúrgica de la AMI, y se proponen modificaciones a la técnica clásica de disección esqueletizada con clips y tijeras para obtener un hemoducto de mayor calidad. Abstract: The exceptional anatomical and histological characteristics of the internal mammary artery make it the ideal graft for myocardial revascularization surgery. The technique for its skeletonized harvesting with only clips and scissors, allows the construction of a graft with more flow and the conservation of a greater residual collateral circulation to the sternum, with the consequent better protection against future ischemic or infectious events.However, this harvesting method is the least practiced because it is slower and is not exempt from injuries to the lateral branches of the artery. In recent decades, several technological advances have been introduced in the internal mammary artery harvesting procedure, but current techniques do not take advantage of its special morphophysiological characteristics to enhance obtaining a hemoduct with more flow and with less risk of vascular injury and bleeding.In this review, the peculiarities of the internal mammary artery surgical anatomy are discussed, and modifications of the classic skeletonized harvesting technique with only clips and scissors are proposed to obtain a higher quality graft.

In COVID-19, a percentage of patients develop severe disease, with high mortality, since has been necessary to study its characteristics to stop the progression of the disease. A retrospective study was carried out in a cohort of 150 adult patients attended at Manuel Fajardo Hospital in Villa Clara, Cuba, from March to June 2020. Demographic, clinical, laboratory, gasometric and radiological variables measured at hospital admission were analyzed, defining two groups of patients according to clinical evolution: severe and non-severe. For the comparison of the groups a bivariate analysis was performed, with the objective of determining those variables with a significant association to severity. Of the total number of patients, 26 (17.3%) evolved to severity and 124 (83.7%) evolved satisfactorily. Severe patients were characterized by advanced age (mean: 83 years) and comorbidities; the most significant being hypertension, diabetes mellitus, heart disease, chronic kidney disease and cancer (p< 0.0001). Polypnea and diarrhea were the clinical manifestations with the highest association with severity (p

Endothelial cells (ECs) are an important component of the blood coagulation system because it maintains blood fluid. Because in patients with venous thromboembolic disease (VTD) a thrombophilic condition is not found sometimes, we investigated if endothelial colony-forming cells (ECFCs) from these patients have biological and functional abnormalities.Human mononuclear cells (MNCs) were obtained from peripheral blood from patients with VTD and controls to obtain ECFCs. These cells were assayed for their immunophenotype and electron microscopy characteristics and their ability to form capillary-like structures and to produce pro-inflammatory and pro-angiogenic cytokines and reactive oxygen species (ROS).ECFCs appeared at 7 and 21 days of culture in VTD patients and controls, respectively. ECFCs increased 8-fold in patients and emerged 1 week earlier. No differences in the size of the colonies of ECFCs were found. Numbers and time of appearance of ECFCs was different between groups. ECFC-derived ECs (ECFC-ECs) of both groups expressed CD31, CD34, CD146, and CD-309 but none expressed CD45, CD14, or CD90. Interest CD34 was highly expressed in ECFC-ECs from patients. In both groups, ECFC-ECs showed similar capacity to form capillary-like structures but ECFC-ECs from patients had significant abnormalities in the mitochondrial membrane. We found a significant increase in ROS production in ECFC-ECs from patients. There were significant differences in cytokine profiles between VTD patients and controls.We found a dysfunctional state in ECFC from VTD patients resembling some characteristics of dysfunctional ECs. These findings may help to understand some pathophysiological aspects of VTD.

Objective To describe changes in fetal Doppler parameters during a novel approach for open fetal surgery for myelomeningocele (MMC) repair. Methods Forty-four fetuses undergoing open fetal surgery for MMC repair characterized by a mini-hysterotomy (15mm), reduced fetal manipulation, and maintenance of a constant volume of amniotic fluid were evaluated. Doppler velocimetry of the umbilical artery (UA), middle cerebral artery (MCA), cerebroplacental ratio (CPR) and ductus venosus (DV) were registered at specific time points during fetal surgery and considered as abnormal with UA pulsatility index (PI) or DV-PI above the 95th centile, and MCA-PI or CPR values below the 5th centile. Results Median gestational age (GA) at procedure was 25.4 weeks (range, 22.9-27.9). Doppler recordings were successfully obtained during all time periods throughout surgery. As compared to Doppler values before surgery, there was a significant increase in the prevalence of brain vasodilation (15.9% (7/44) vs. 65.9% (29/44); p=0.001), abnormal DV-PI (0% vs. 22.7% (10/44); p=0.02), and a non-significant increase in the rate of abnormal UA-PI (0% vs. 11.4% (5/44); p=0.2). No absent or reversed end diastolic or atrial velocities in the UA or in the DV, respectively were seen in any fetus at any time. All abnormal Doppler parameters returned to normal values after surgery. Conclusions A small hysterotomy in conjunction with reduced fetal manipulation and maintenance of a normal amniotic fluid volume during open fetal surgery for MMC, seem not to significantly affect fetal Doppler parameters. The observed mild Doppler changes can be a manifestation of fetal adaptation to a stressful condition given by fetal surgery. This article is protected by copyright. All rights reserved.

Background The biodeterioration of food commodities by microbial pathogens remains a major public health concern. Worldwide, investigations have been carried out to develop harmless natural food preservatives based on essential oils (EOs) to protect food commodities, and advances have been made to meet users’ acceptance as a substitute for synthetic preservatives. Scope and approach In recent years, antimicrobial and antioxidant potential of the EOs from Thymus species have been documented with increasing demands from legislation changes, adaptation to the consumer trends, search for alternatives to solve rising food microbial pathogen resistance, and substitution of synthetic preservatives associated with adverse health effects. Hence, the present review paper emphasizes on the antimicrobial and antioxidant applications of EOs from different species of the genus Thymus and discloses the gaps where investigations are required. In addition, progress in the using Thymus EOs (TEOs) based nanoemulsions in food preservation, and their challenges in the application in food systems have also been discussed. Key findings and conclusions TEOs are rich in pharmacologically active constituents that confirm their industrial and health applications. In addition, TEOs and their nanoemulsions not only provide themselves to exploit in the food industry, but are also put under GRAS (Generally Recognized As Safe) category, and have shown potential inhibitory activity against a broad range of pathogens in food commodities. Thus, TEOs can be a source for the development of natural preservatives that meet the needs of the food industry to satisfy both its requirements and those of the consumers. However, despite the potential for EOs, more studies are required to assess their probable side effects and safety levels before considering their deployment for food purposes.

High generation of food waste poses potentially serious pollution issues and high handling costs. However, food processing wastes rich in nutrients are attractive substrates for the bioconversion for valuable bioproducts such as enzymes, pigments, biofuels, oligosaccharides, growth-promoting substrates, polysaccharides, proteins, bioplastics, biosurfactants, and bioactive compounds. Microbiological and enzymatic methods have been described as a sustainable solution for obtaining of these bioproducts from food wastes. Progress has currently been made in optimizing processes at the laboratory level, but studies need to be based on the scale-up of bioprocesses. In view of the increasing interest in this topic, this short review aims to highlight recent studies on microbiological and enzymatic processes for converting food waste to useful bioproducts.

Objective: The objective of this study was to describe the feasibility of single percutaneous uterine access for bilateral pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax by using an internal rotational maneuver and to compare perinatal outcomes between successful and failed procedures. Methods: A prospective cohort of 25 fetuses with isolated bilateral hydrothorax and hydrops were referred to our fetal surgery center in Queretaro, Mexico during an 8-year period. Bilateral PAS was first attempted through a percutaneous single uterine access by internal rotation of the fetus, which was achieved by using the blunt tip of the same cannula, and in case of a failed procedure, a second uterine port was used to place the second shunt. The perinatal outcomes between successful (single uterine port) and failed (2 uterine ports) fetal procedures were compared. Results: Placing of bilateral shunts through a percutaneous single uterine access was feasible in 15/25 (60%) cases. Overall, median GA at delivery was 35.2 weeks with a survival rate of 64.0% (16/25). Three cases were excluded due to shunt dislodgement, leaving a final population of 22 fetuses; 13/22 (59.1%) and 9/22 (40.9%) managed using 1 and 2 uterine ports, respectively. The group with bilateral PAS placement through a successful single uterine port showed a significantly higher GA at birth (36.5 vs. 32.8 weeks, p = 0.001), lower surgical time (11.0 vs. 19.0 min, p = 0.01), longer interval between fetal intervention and delivery (5.7 vs. 2.7 weeks, p = 0.01), lower risk of preterm delivery (46.2 vs. 100%, p < 0.01), and lower rate of perinatal death (15.4 vs. 55.6%, p < 0.05) than the failed procedures requiring 2 uterine ports. Conclusion: In fetuses with severe bilateral hydrothorax and hydrops, bilateral pleuroamniotic shunting through a successful single percutaneous uterine access is feasible in up to 60% of cases and is associated with better perinatal outcomes.

Essential oils, extracts and chemical components from aromatic plants are widely used as flavors and fragrances by the food and cosmetics industries because they act highly effective against plant pathogens and pests. According to recent research studies, some botanicals derived from higher plants are efficient insecticides against particular pests, and fungicidal against necrotrophic and biotrophic plant pathogens, in addition to their use in food production. Towards substituting synthetic insecticides/fungicides with natural substitutes, which do not carry negative health effects, the essential oils, extracts and chemical components of Curcuma species have been examined against various plant pathogens and insect pests that harm food crops. The present review discusses the efficacy of essential oils, extracts and few main components derived from a wide range of Curcuma plants against a wide variety of pests and pathogens of food crops. In addition, their mechanism of action against insects and plant pathogens as well as their potential impact on crops (i.e. the allelopathic nature) are discussed. Finally, the commercialization of Curcuma-based pesticides is reviewed and challenges and knowledge gaps are highlighted.

Objective: The objective of this study was to assess the predictive performance of preoperative cervical length (CL) for delivery within 1 week after pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax. Methods: A prospective cohort of fetuses with severe hydrothorax referred to our fetal surgery center in Querétaro, Mexico from January 2012 to July 2020. Severe fetal hydrothorax was diagnosed as an accumulation of fluid within the fetal pleural space accompanied with severe bilateral lung compression, mediastinal shift, polyhydramnios, and/or hydrops. Transvaginal CL was measured immediately before PAS, and a short cervix was defined as that Results: Thirty-five pregnancies with severe fetal hydrothorax treated with PAS were evaluated. Median gestational age at PAS was (weeks + days) 31+2 (range, 26+0–36+1). Two (5.7%) and 7 (20.0%) cases delivered within the first 24 h and 1 week after PAS, respectively. Ten (28.6%) women had a short cervix before PAS, while 25 (71.4%) had normal preoperative CL. Women with a short cervix showed lower mean interval between fetal intervention and delivery (2.4 vs. 5.5 weeks, p = 0.01), and higher prevalence of PPROM (50 vs. 12%, p = 0.01), as compared to women with a nonshort cervix. Preoperative short cervix was associated with significantly higher risk of delivery within the first 24 h (20.0 vs. 0%, respectively, p < 0.05) and 1 week after PAS (50.0 vs. 8.0%, respectively, p < 0.01) compared with pregnancies with normal preoperative CL. Conclusion: In pregnancies with severe fetal hydrothorax candidates for pleuroamniotic shunt, identification of a short cervix before fetal intervention can predict delivery within 1 week after the surgical procedure.

Objective: Several P-wave parameters reflect atrial conduction characteristics and have been used to predict atrial fibrillation (AF). The aim of this study was to determine the relationship between maximum P-wave duration (PMax) and new P-wave parameters, with atrial conduction times (CT), and to assess their predictive value of AF during electrophysiological studies (AF-EPS). Subjects and Methods: This was a cross-sectional study in 153 randomly selected patients aged 18–70 years, undergoing EPS. The patients were divided into 2 groups designated as no AF-EPS and AF-EPS, depending on whether AF occurred during EPS or not. Different P-wave parameters and atrial CT were compared for both study groups. Subsequently, the predictive value of the P-wave parameters and the atrial CT for AF-EPS was evaluated. Results: The values of CT, PMax, and maximum Ppeak-Pend interval (Pp-eMax) were significantly higher in patients with AF-EPS. Almost all P-wave parameters were correlated with the left CT. PMax, Pp-eMax, and CT were univariate and multivariate predictors of AF-EPS. The largest ROC area was presented by interatrial CT (0.852; p < 0.001; cutoff value: ≥82.5 ms; sensitivity: 91.1%; specificity: 81.1%). Pp-eMax showed greater sensitivity (79.5%) to discriminate AF-EPS than PMax (72.7%), but the latter had better specificity (60.4% vs. 41.5%). Conclusions: Left atrial CT were directly and significantly correlated with PMax and almost all the parameters of the second half of the P-wave. CT, PMax, and Pp-eMax (new parameter) were good predictors of AF-EPS, although CT did more robustly.

Background COVID-19 counts 46 million people infected and killed more than 1.2 million. Hypoxaemia is one of the main clinical manifestations, especially in severe cases. HIF1α is a master transcription factor involved in the cellular response to oxygen levels. The immunopathogenesis of this severe form of COVID-19 is poorly understood. Methods We performed scRNAseq from leukocytes from five critically ill COVID-19 patients and characterized the expression of hypoxia-inducible factor1α and its transcriptionally regulated genes. Also performed metanalysis from the publicly available RNAseq data from COVID-19 bronchoalveolar cells. Results Critically-ill COVID-19 patients show a shift towards an immature myeloid profile in peripheral blood cells, including band neutrophils, immature monocytes, metamyelocytes, monocyte-macrophages, monocytoid precursors, and promyelocytes-myelocytes, together with mature monocytes and segmented neutrophils. May be the result of a physiological response known as emergency myelopoiesis. These cellular subsets and bronchoalveolar cells express HIF1α and their transcriptional targets related to inflammation (CXCL8, CXCR1, CXCR2, and CXCR4); virus sensing, (TLR2 and TLR4); and metabolism (SLC2A3, PFKFB3, PGK1, GAPDH and SOD2). Conclusions The up-regulation and participation of HIF1α in events such as inflammation, immunometabolism, and TLR make it a potential molecular marker for COVID-19 severity and, interestingly, could represent a potential target for molecular therapy.Key messagesCritically ill COVID-19 patients show emergency myelopoiesis.HIF1α and its transcriptionally regulated genes are expressed in immature myeloid cells which could serve as molecular targets.HIF1α and its transcriptionally regulated genes is also expressed in lung cells from critically ill COVID-19 patients which may partially explain the hypoxia related events.

Sorghum is the fifth cereal most produced in the world after wheat, rice, maize, and barley. In some regions, this crop is replacing maize, due to its high yield, resistance to drought and heat. There are several varieties of sorghum, whose coloration varies from cream, lemon-yellow, red, and even black. Pigmented sorghum grain is a rich source of antioxidants like polyphenols, mainly tannins, which have multiple benefits on human health such as, antiproliferative properties associated with the prevention of certain cancers, antioxidant activities related to the prevention of associated diseases to oxidative stress, antimicrobial and anti-inflammatory effects, it also improves glucose metabolism. Despite having these types of compounds, it is not possible to assimilate them, their use in the food industry has been limited, since sorghum is considered a food of low nutritional value, due to the presence of anti-nutritional factors such as strong tannins which form complexes with proteins and iron, thus reducing their digestibility. Based on these restrictions that this product has had as food for humans, the analysis of this review emphasizes the valorization of sorghum as a source of bioactive substances and the importance they confer on human health because of the biological potential it has.

One of the relevant problems in today's agriculture is related to phytopathogenic microorganisms that cause between 30–40% of crop losses. Synthetic chemical pesticides and antibiotics have brought human and environmental health problems and microbial resistance to these treatments. So, the search for natural alternatives is necessary. The genus Streptomyces have broad biotechnological potential, being a promising candidate for the biocontrol of phytopathogenic microorganisms. The efficacy of some species of this genus in plant protection and their continued presence in the intensely competitive rhizosphere is due to its great potential to produce a wide variety of soluble bioactive secondary metabolites and volatile organic compounds. However, more attention is still needed to develop novel formulations that could increase the shelf life of streptomycetes, ensuring their efficacy as a microbial pesticide. In this sense, encapsulation offers an advantageous and environmentally friendly option. The present review aims to describe some phytopathogenic microorganisms with economic importance that require biological control. In addition, it focuses mainly on the Streptomyces genus as a great producer of secondary metabolites that act on other microorganisms and plants, exercising its role as biological control. The review also covers some strategies and products based on Streptomyces and the problems of its application in the field.

To describe the brain Doppler changes in fetuses with isolated open spina bifida (OSB).Doppler ultrasound measurements including the umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, and their combination into the cerebroplacental ratio (CPR) and umbilicocerebral ratio (UCR) were performed in a cohort of fetuses with OSB. Included patients were individually matched to a control group without structural anomalies and similar gestational ages. MCA-PI and/or CPR values below the 5th centile were considered abnormal and indicative of cerebral blood redistribution, while UCR and UA-PI above the 95th centile were considered abnormal.During the study period, 266 fetuses were recruited, 133 normally grown fetuses with OSB and 133 matched controls. Doppler recordings were successfully obtained in all fetuses at a median gestational age of 30.9 weeks. All cases showed UA-PI within normal ranges, but fetuses with OSB showed significantly higher frequency of cerebral blood redistribution (15.0 vs. 3.0%,A proportion of fetuses with isolated open spina bifida showed cerebral blood redistribution.

An entirely unknown species of coronavirus (COVID-19) outbreak occurred in December 2019. COVID-19 has already affected more than 180 million people causing ~3.91 million deaths globally till the end of June 2021. During this emergency, the food nutraceuticals can be a potential therapeutic candidate. Curcumin is the natural and safe bioactive compound of the turmeric (Curcuma longaL.) plant and is known to possess potent anti-microbial and immuno-modulatory properties. This review paper covers the various extraction and quantification techniques of curcumin and its usage to produce functional food. The potential of curcumin in boosting the immune system has also been explored. The review will help develop insight and new knowledge about curcumin's role as an immune-booster and therapeutic agent against COVID-19. The manuscript will also encourage and assist the scientists and researchers who have an association with drug development, pharmacology, functional foods, and nutraceuticals to develop curcumin-based formulations.

Since the second half of the 20th century, our knowledge about the biology of cancer has made extraordinary progress. Today, we understand cancer at the genomic and epigenomic levels, and we have identified the cell that starts neoplastic transformation and characterized the mechanisms for the invasion of other tissues. This knowledge has allowed novel drugs to be designed that act on specific molecular targets, the immune system to be trained and manipulated to increase its efficiency, and ever more effective therapeutic strategies to be developed. Nevertheless, we are still far from winning the war against cancer, and thus biomedical research in oncology must continue to be a global priority. Likewise, there is a need to reduce unequal access to medical services and improve prevention programs, especially in countries with a low human development index.

Fetal hydrothorax is a congenital anomaly primary due to leakage of lymphatic fluid into the pleural space. Cases with massive pleural effusions associated with hydrops are at a higher risk of perinatal death. For those at-risk cases, pleuroamniotic shunt (PAS) placement has demonstrated to be an effective fetal therapy to improve survival. However, such intervention is associated with risks of preterm rupture of membranes (PPROM) and preterm birth, which leads to a detrimental effect on neonatal survival1, 2 . In a recent study, preoperative cervical length (CL) was positively correlated with the interval time between PAS and delivery3 . Pregnancies with short cervix (

BACKGROUND To describe the perinatal outcomes of fetoscopic urethral meatotomy (FUM) in fetuses with lower urinary tract obstruction (LUTO) by congenital megalourethra. STUDY DESIGN Between 2012 and 2020, 226 cases with LUTO were referred to our fetal surgery center in Queretaro, Mexico. We report the perinatal outcome of cases with LUTO by congenital megalourethra that were selected for FUM in an attempt to release the penile urethral obstruction. RESULTS Congenital megalourethra was diagnosed in 10 cases (4.4%) but only 3 cases (30%) with obstructive megalourethra and megacystis were selected for fetal surgery. Fetoscopic urethral metatotomy was successfully performed in all three cases at a median gestational age (GA) of 21.4 (18.0-26.7) weeks and with a median surgical time of 27 (12-43) min. A resolution of urethral dilatation and subsequent reduction of the penile length and normalization of both the bladder size and amniotic fluid were observed in all cases. The median GA at delivery was 35.2 (range: 30.6-38.0) weeks. There were no fetal deaths but one neonatal death (33%) secondary to renal failure and preterm delivery. CONCLUSION In fetuses with LUTO by congenital obstructive megalourethra, FUM is feasible and is associated with good perinatal outcomes.

En la ciudad de Sao Paulo, el día 21 de Agosto de 2014, bajo la coordinación del Prof. Fabián Calixto Fraiz, se inició la exposición de los programas de Odontología Materno Infantil de siete países de América Latina: Argentina, Chile, Méjico, Paraguay, Perú, Uruguay y Venezuela. A partir de los relatos de los representantes de cada asociación quedó evidente que las experiencias de atención en salud bucal materno infantil en América Latina presentan gran diversidad de estrategias, protocolos y actividades. Esas especificidades responden a las distintas coyunturas sociales, económicas, culturales, políticas y administrativas de cada pais. Se por un lado reconocer esa rica diversidad permitirá la formulación de propuestas que atiendan las demandas locales con mayor eficiencia y eficacia, por otro lado, identificar los desafíos semejantes y encontrar los puntos de confluencia en nuestra practica permitirá la formulación de propuestas integradoras. Las experiencias relatadas indican que las estrategias de atención materno-infantil exigen avances conceptuales, los cuales emergieran de la profunda y constante reflexión sobre el papel de la odontología en el campo de la promoción y educación en salud, asistencia y formación de recursos humanos para el abordaje transdisciplinar para ese grupo poblacional.

The impact of increasing human population, rising food demand, and adverse effects of climate change, viz., changing rainfall pattern, rising temperature, biotic-abiotic stresses, etc., has tremendously affected global food security. In addition, increased anthropogenic inputs from urbanization, industrialization, as well as outrageous use of chemical fertilizers and pesticides have posed a severe threat to the sustainability of the agroecosystems. For many decades, the use of chemical pesticides against insect and microbial pests has become an integrative part of agriculture and contributed significantly to the crop improvement. But, their long-term persistence, cytotoxicity, and microbial resistance have resulted negative impact on the biosphere, thus creating pollution of diverse ecosystems, land degradation, and biodiversity losses. For the last two decades, alternate pest management strategies have become the new avenues for controlling pest and diseases in a greener, safer, and eco-friendly manner. The use of biological control agents (termed as biocides) such as both microbe- and plant-based formulations has been known to be the major emerging tool in crop disease/pest management and appealing alternative to the chemical pesticide in sustainable agriculture. Biopesticides employ the use of naturally occurring substances, i.e., living organisms (natural enemies) or their products (phytochemicals, microbial products) or by-products (semiochemicals) that control pests by nontoxic mechanisms, with high targeted activity against causal agents (insects, fungi, weeds, viruses, nematodes, etc.), and nonpersistence in the environment. The use of biopesticide alone or in combination with agrochemicals has become the new tool in crop protection as a part of biointensive integrated pest management (IPM) strategies. Although biopesticides are slowly substituting the chemical pesticides with great promise, its use to the desired extent is lacking; hence insight on such biological agents is a prerequisite. In this chapter, we have summarized the sources of biopesticides, their plant protective mechanisms (mode of action), availability, and status in India, as well as some critical pros and cons of its use.

INTRODUCTION The scales available to predict death and complica-tions after acute coronary syndrome include angiographic studies and serum biomarkers that are not within reach of services with limited resources. Such services need specifi c and sensitive instruments to evaluate risk using accessible resources and information. OBJECTIVE Develop a scale to estimate and stratify the risk of intra-hospital death in patients with acute ST-segment elevation myocardial infarction. METHODS An analytical observational study was conducted in a universe of 769 patients with acute ST-segment elevation myocardial infarction who were admitted consecutively to the Camilo Cienfuegos Provincial Hospital in Sancti Spiritus Province, Cuba, from January 2013 to March 2018. The fi nal study cohort included 667 patients, ex-cluding 102 due to branch blocks, atrial fi brillation, drugs that prolong the QT interval, low life expectancy or history of myocardial infarction. The demographic variables of age, sex, skin color, classic cardiovas-cular risk factors, blood pressure, heart rate, blood glucose level, in addition to duration and dispersion of the QT interval with and without correction, left ventricular ejection fraction, and glomerular fi ltration rate were included in the analysis. Patients were categorized according to the Killip-Kimball Classifi cation for degree of heart failure. A risk scale was constructed, the predictive ability of which was evaluated using the detectability index associated with an receiver-operator curve.RESULTS Seventy-seven patients died (11.5%). Mean blood glucose levels were higher among the deceased, while their systolic and dia-stolic blood pressure, left ventricular ejection fraction, and glomerular fi ltration rate were lower than those participants discharged alive. Rel-evant variables included in the scale were systolic blood pressure, Killip-Kimball class, cardiorespiratory arrest, glomerular fi ltration rate, corrected QT interval dispersion, left ventricular ejection fraction, and blood glucose levels. The variable with the best predictive ability was cardiorespiratory arrest, followed by a blood glucose level higher than 11.1 mmol/L. The scale demonstrated a great predictive ability with a detectability index of 0.92. CONCLUSIONS The numeric scale we designed estimates and strati-fi es risk of death during hospitalization for patients with ST-segment elevation myocardial infarction and has good metric properties for predictive ability and calibration. KEYWORDS ST-segment elevation myocardial infarction, mortality, risk assessment, Cuba.

Background P‐wave dispersion (PWD) is believed to be caused by inhomogeneous atrial conduction. This statement, however, is based on limited little solid evidence. The aim of this study was to determine the relationship between atrial conduction and PWD by means of invasive electrophysiological studies. Methods Cross‐sectional study in 153 patients with accessory pathways and atrioventricular node reentry tachycardia (AVNRT) undergoing an electrophysiological study. Different atrial conduction times were measured and correlated with PWD. Results Only the interatrial (P‐DCS) and left intra‐atrial conduction times (ΔDCS‐PCS) showed a significant correlation with PWD, but this correlation was weak. Multivariate linear regression analysis determined that both P‐DCS (β = 0.242; P = .008) and ΔDCS‐PCS (β = 0.295; P, P‐wave dispersion (PWD) is considered by many to be an electrocardiographic parameter originating from regional differences in atrial conduction. The aim of this study was to determine the relationship between atrial conduction and PWD by means of invasive electrophysiological studies. Interatrial and intra left atrial conduction times were directly and significantly correlated with PWD, but weakly, and were independent predictors of PWD.

One of the industrial sectors with the highest production in the world is agriculture, and therefore it is also one of the sectors that generate the greatest amount of waste. This waste is not used in its entirety and the remnants are disposed of in the correct way generating serious environmental problems. Agro-industrial waste includes a wide range of products of heterogeneous nature, which include seeds, husks, roots, stems, among others. These residues are characterized by a high content of proteins, carbohydrates or minerals so they could be used for the design of new human and animal foods, however, the content of toxic compounds limits their use. These 288residues are mostly characterized by having a high content of saponins, phytates, oxalates, alkaloids, among others, which have a negative effect on health. Therefore, it is necessary to apply treatments to be able to use these products. Biotechnological processes are a viable alternative to take advantage of these residues, given that during these toxic compounds are hydrolyzed and compounds are generated with biological activities such as antioxidants, antimicrobials, anticancer, antihypertensive, among others, which could have application in other industries such as pharmaceuticals. Nowadays, research to obtain biocompounds with these characteristics is growing since the beneficial effects of their consumption have been demonstrated. Therefore, fermentation processes are a profitable strategy to obtain high value-added biocompounds from agro-industrial residues. The objective of this chapter is to know the main toxic compounds present in agro-industrial waste and the biocompounds that can be generated from such waste according to the microorganism (bacteria, yeasts, fungi) used for fermentation.

Objectives: The aim of the study was to describe the feasibility of open fetal microneurosurgery for intrauterine spina bifida (SB) repair and to compare perinatal outcomes with cases managed using the classic open fetal surgery technique. Methods: In this study, we selected a cohort of consecutive fetuses with isolated open SB referred to our fetal surgery center in Queretaro, Mexico, during a 3.5-year period (2016–2020). SB repair was performed by either classic open surgery (6- to 8-cm hysterotomy with leakage of amniotic fluid, which was replaced before uterine closure) or open microneurosurgery, which is a novel technique characterized by a 15- to 20-mm hysterotomy diameter, reduced fetal manipulation by fixing the fetal back, and maintenance of normal amniotic fluid and uterine volume during the whole surgery. Perinatal outcomes of cases operated with the classic open fetal surgery technique and open microneurosurgery were compared. Results: Intrauterine SB repair with a complete 3-layer correction was successfully performed in 60 cases either by classic open fetal surgery (n = 13) or open microneurosurgery (n = 47). No significant differences were observed in gestational age (GA) at fetal intervention (25.4 vs. 25.1 weeks, p = 0.38) or surgical times (107 vs. 120 min, p = 0.15) between both groups. The group with open microneurosurgery showed a significantly lower rate of oligohydramnios (0 vs. 15.4%, p = 0.01), preterm rupture of the membranes (19.0 vs. 53.8%, p = 0.01), higher GA at birth (35.1 vs. 32.7 weeks, p = 0.03), lower rate of preterm delivery p = 0.01), and lower rate of perinatal death (4.8 vs. 23.1%, p = 0.04) than the group with classic open surgery. During infant follow-up, the rate of hydrocephalus requiring ventriculoperitoneal shunting was similar between both groups (7.5 vs. 20%, p = 0.24). All patients showed an intact hysterotomy site at delivery. Conclusion: Intrauterine spina repair by open fetal microneurosurgery is feasible and was associated with better perinatal outcomes than classic open fetal surgery.

Biopesticide production has become a topic of intense research because of the application and use of this kind of bioactive agents to replace some traditional pesticides that are synthesized chemically, which are applied to food commodities. Worldwide, the market of biopesticides grows annually at a rate of 45% in North America, 25% in Europe and Oceania, 15% in Latin and South American countries, and 7% in Asia. Trends in the modern agriculture reflect an increment of the use of fungal and bacterial biopesticides for which the design of efficient bioprocesses and strategies to improve the productivity and stability of these bioactive agents is a necessity. In this chapter, biological control is described in detail, with particular focus on the significant advances in the production of biopesticides. Also, biocontrol is focused as an alternative to some synthetic chemical treatments that cause environmental, human health, and food quality risks. Recent data about the state of the art of production of biopesticides by solid-state bioprocessing of agroindustrial wastes is discussed, and finally we describe some strategies for high-density bio-inoculant cultivation, describing the influence of water stress as one the best conditions for the production of fungal spores, which is an inexpensive biotechnologic option for modern agriculture in developing countries.

Humanity has been used microbial biomass for food production and now; for biofuels, drugs, and other useful compounds. Different microorganisms are employed in the production of biomass ranging from bacteria, yeast, fungi, and algae which are used to produce food, bioactive compounds, enzymes, hydrolysates, among others. Due to the accelerated population growth in the world and the need to meet its nutritional requirements, the search for alternatives that help to solve this social problem is one of the most pressing tasks.

Resumen: Introducción: Independientemente de la modalidad de estimulación (VVI o DDD), el mayor porcentaje de estimulación ventricular derecha deteriora la función contráctil izquierda. Por ello se han estudiado diferentes sitios de estimulación. Objetivo: Describir las diferencias electrocardiográficas y ecocardiográficas entre la estimulación en la región apical y la región septal del ventrículo derecho (VD)0. Métodos: Se estudió a 24 pacientes, 2 mujeres y 22 hombres, con fracción de eyección deprimida (≤ 35%) secundaria a estimulación en punta de VD. Se realizó electrocardiograma durante estimulación en ápex de VD y en seguimiento de estimulación septal. También ecocardiografía en ambos momentos. Resultados: La fracción de eyección se incrementó desde 31 ± 3.1% hasta 45 ± 12% (p = 0.0041) con estimulación septal; esta mostró mejor grado de sincronía mecánica. Conclusiones: La estimulación septal puede constituir un sitio de elección en pacientes con disfunción sistólica de ventrículo izquierdo secundaria a estimulación en ápex de VD, los cuales presenten QRS estrecho en su conducción intrínseca, pues en la muestra estudiada produce una mejoría en la sincronía electromecánica, demostrándose incrementos significativos en la fracción de eyección. Abstract: Introduction: Regardless of the type of electrical stimulation (VVI or DDD) the highest percentage of right ventricular apical pacing can cause left ventricular failure. For this reason, studies have been performed in different sites on right ventricle pacing. Objective: To describe differences between electrocardiography and echocardiography variables during right ventricular apical pacing and septal pacing. Methods: A total of 24 patients were studied, 2 women and 22 men, with heart failure due to conventional pacing on right ventricular (ejection fraction ≤ 35%). An electrocardiogram as well as an echocardiogram, was performed during right ventricular apical pacing and when patients were paced on septal area. Results: The ejection fraction increased from 31 ± 3.1% to 45 ± 12% (P=.0041) on septal pacing, showing higher degree of mechanic synchronisation. Conclusions: Pacing on septal area could be a good site for those patients that suffer heart failure due to right ventricular apical pacing. These must show narrow QRS on their intrinsic electrocardiographic conduction. This kind of pacing can produce an improvement in electromechanical synchronisation, as well as show an increased left ventricular ejection fraction. Palabras clave: Marcapasos, Insuficiencia cardíaca, Sincronía electromecánica, Estimulación septal, Cuba, Keywords: Pacemaker, Heart failure, Electromechanical synchronisation, Septal pacing, Cuba

Chronic myeloid leukemia (CML) is a myeloproliferative disease that results from the BCR-ABL gene-induced transformation of a primitive hematopoietic cell. This disease has been extensively studied, and, as a result, a very effective therapy has been developed: the tyrosine kinase inhibitors. Although, there is a significant knowledge about the intrinsic biology of CML cells, alterations in their bone marrow microenvironment are not yet completely understood. In this concise review, we summarized recent findings on the composition and function of the bone marrow microenvironment in CML, and their importance in the progression of the disease and treatment resistance.

Prognostic markers derived from standard ECG have always been seductive. Increased dispersion of durations of the P wave, of the QRS complex, or of the QT interval has been associated with the risk of atrial fibrillation, ventricular arrhythmias, sudden cardiac death, as well as with a general negative prognosis in various settings. However, these markers have intrinsic and methodological issues that question their utility. This paper presents data supporting the utility of QRS dispersion in clinical practice. Our investigation shows that QRS dispersion is a simple electrocardiographic marker with potential value in the assessment of patients in a variety of clinical settings: ischemic heart disease, heart failure, and cardiomyopathies. More studies are needed to validate QRS clinical utility for predicting the risk for ventricular arrhythmias and sudden cardiac death, and for the evaluation of the response to cardiac resynchronization therapy.

Objective To determine the relationship between QRS duration and dispersion and the occurrence of ventricular arrhythmias in early stages of acute myocardial infarction (AMI). Design A retrospective, longitudinal descriptive study was carried out. Setting Hospital General Universitario “Camilo Cienfuegos”, Sancti Spiritus, Cuba. Secondary health care. Patients or participants A total of 209 patients diagnosed with ST-segment elevation AMI from January 2012 to June 2014. Main variables of interest The duration and dispersion of the QT interval, corrected QT interval, and QRS complex were measured in the first electrocardiogram performed at the hospital. The presence of ventricular tachycardia/fibrillation was assessed during follow-up (length of hospital stay). Results Arrhythmias were found in 46 patients (22%); in 25 of them (15.9%), arrhythmias originated in ventricles, and were more common in those subjects with extensive anterior wall AMI, which was responsible for 81.8% of the ventricular fibrillations and more than half (57.1%) of the ventricular tachycardias. The widest QRS complexes (77.3 ± 13.3 vs. 71.5 ± 6.4 ms; p = 0.029) and their greatest dispersion (24.1 ± 16.2 vs. 16.5 ± 4.8 ms; p = 0.019) were found on those leads that explore the regions affected by ischaemia. The highest values of all measurements were found in extensive anterior wall AMI, with significant differences: QRS 92.3 ± 18.8 ms, QRS dispersion 37.9 ± 23.9 ms, corrected QT 518.5 ± 72.2 ms, and corrected QT interval dispersion 94.9 ± 26.8 ms. Patients with higher QRS dispersion values were more likely to have ventricular arrhythmias, with cutoff points at 23.5 ms and 24.5 ms for tachycardia and ventricular fibrillation, respectively. Conclusions Increased QRS duration and dispersion implied a greater likelihood of ventricular arrhythmias in early stages of AMI than increased duration and dispersion of the corrected QT interval.

Resumen Objetivo Determinar la relacion entre duracion y dispersion del QRS con la aparicion de arritmias ventriculares en las fases iniciales del infarto agudo de miocardio (IAM). Diseno Estudio descriptivo retrospectivo longitudinal. Ambito Hospital General Universitario «Camilo Cienfuegos» de Sancti Spiritus, Cuba. Atencion secundaria. Pacientes o participantes Doscientos nueve pacientes con diagnostico de IAM con elevacion del segmento ST entre enero de 2012 y junio de 2014. Variables principales de interes Se midieron la duracion y dispersion del QT, QTc y QRS del primer electrocardiograma hospitalario y se determino la presencia de taquicardia/fibrilacion ventricular en el seguimiento (estancia hospitalaria). Resultados Se detectaron arritmias en 46 pacientes (22%), en 25 (15,9%) estas fueron ventriculares; mas frecuentes en el IAM anterior extenso, que fue responsable del 81,8% de las fibrilaciones ventriculares y mas de la mitad (57,1%) de las taquicardias ventriculares. La duracion del QRS (77,3 ± 13,3 vs. 71,5 ± 6,4 ms; p = 0,029) y su dispersion (24,1 ± 16,2 vs. 16,5 ± 4,8 ms; p = 0,019) fue superior en las derivaciones afectadas por la isquemia. Los mayores valores de todas las mediciones se presentaron, con diferencia significativa, en el IAM anterior extenso: QRS 92,3 ± 18,8 ms, dQRS 37,9 ± 23,9 ms, QTc 518,5 ± 72,2 ms y dQTc 94,9 ± 26,8 ms. Los pacientes con mayores valores de dispersion del QRS tuvieron mas probabilidad de presentar arritmias ventriculares, con puntos de corte de 23,5 ms para la taquicardia y de 24,5 ms para la fibrilacion ventricular. Conclusiones El incremento de la duracion y dispersion del QRS mostro mayor probabilidad de aparicion de arritmias ventriculares en las fases iniciales del IAM que los incrementos del intervalo QTc y su dispersion.

The aim of this study is to determine the various types of violence that occur between students and teachers from five public higher education institutions belonging to the area of health in Monterrey, NL, to portray the practices that prevent the proper development of scientific and academic productivity and thus jeopardize the timely attainment of the training goals established in each of their preparatory, technical or professional programs. According to the methodology the study was quantitative, transversal, analytical and comparative. This allowed the analysis of the presence or absence of violence between the actors already mentioned, according to the opinion of students in a specific area of vocational training. A random, probabilistic, systematic and stratified sampling of 545 students was conducted. It is believed that violence decreases as the education level increases, which may be partially true, but the general and initial results of this study clearly show that such violence exists. In scientific literature there are few reports of intimidation, harassment and violence at universities, thus ignoring the implications that these practices throughout the training process have on the victim.

Aim: To characterize the Tpeak-Tend, the Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables. Methods: Cross-sectional study in 126 children between 9 and 12 years of the Camilo Cienfuegos School in Santa Clara, Cuba. Clinical and anthropometric variables were obtained to determine their relationship with electrocardiographic parameters: Tpeak-Tend V5, Tpeak-Tend dispersion and Tpeak-Tend/QT ratio V5. In addition, laboratory tests were conducted. Results: Age and systolic blood pressure are associated with an increased probability of having values of Tpeak-Tend/QT V5 ≥75 percentile for both sexes (OR: 1.72, CI 95%: 1.02-2.91; p= 0.043), (OR: 1.08, CI 95%: 1.01-1.16; p= 0.017) respectively. The body mass index and systolic blood pressure are linearly and significantly correlated with the Tpeak-Tend/QT V5 (r= 0.224; p= 0.012) and (r= 0.220; p= 0.014) respectively. Conclusions: The age of the patients and the systolic blood pressure figures are factors that increase the probability of having values of the Tpeak-Tend/QT V5 ≥75 percentile. There was a significant linear correlation between the Tpeak-Tend/QT V5 with the body mass index and the systolic blood pressure. Resumen Objetivo: Caracterizar el Tpico-Tfinal, la dispersión del Tpico-Tfinal y el Tpico-Tfinal/QT en niños y su relación con variables clínicas. Métodos: Estudio transversal en 126 niños entre 9 y 12 años de la escuela Camilo Cienfuegos en Santa Clara, Cuba. Se obtuvieron variables clínicas y antropométricas para determinar su relación con los parámetros electrocardiográficos: el Tpico-Tfinal V5, la dispersión del Tpico-Tfinal y el Tpico-Tfinal/QT V5. Además, se realizaron pruebas de laboratorio. Resultados: La edad y la presión arterial sistólica se asocian con una mayor probabilidad de tener valores del Tpico-Tfinal/QT V5 ≥75 percentil para ambos sexos (OR: 1.72, IC 95%: 1.02-2.91; p= 0.043), (OR: 1.08, IC 95%: 1.01-1.16; p= 0.017) respectivamente. El índice de masa corporal y la presión arterial sistólica están correlacionados de manera lineal y significativa con el Tpico-Tfinal/QT V5 (r= 0.224; p= 0.012) y (r= 0.220; p= 0.014) respectivamente. Conclusiones: La edad de los pacientes y las cifras de presión arterial sistólica son factores que aumentan la probabilidad de tener valores del percentil Tpico-Tfinal/QT V5 ≥75. Existe correlación lineal significativa entre el Tpico-Tfinal/QT V5 con el índice de masa corporal y la presión arterial sistólica.

Undoubtedly, the food industry is undergoing a dynamic process of transformation in its continual development in order to meet the requirements and solve the great problems represented by a constantly growing global population and food claimant in both quantity and quality. In this sense, it is necessary to evaluate the technological trends and advances that will change the landscape of the food processing industry, highlighting the latest requirements for equipment functionality. In particular, it is crucial to evaluate the influence of sustainable green biotechnology-based technologies to consolidate the food industry of the future, today, and it must be done by analyzing the mega-consumption trends that shape the future of industry, which range from local sourcing to on-the-go food, to an increase in organic foods and clean labels (understanding ingredients on food labels). While these things may seem alien to food manufacturing, they have a considerable influence on the way products are manufactured. This paper reviews in detail the conditions of the food industry, and particularly analyzes the application of emerging technologies in food preservation, extraction of bioactive compounds, bioengineering tools and other bio-based strategies for the development of the food industry., Graphical Abstract