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The article analyzes how the Mexican subnational governments responded the COVID 19 outbreak during the first stage of the crisis. The response of two subnational governments whose territory is part of the largest metropolitan area in the country that has been the focus of the pandemic is presented. We ask about the coordination instruments to face COVID-19 between the federal policy and programs with the subnational governments and argue that, during the first stage of the management of the COVID-19 crisis the institutional and organizational design of the Mexican political-administrative system has had a relevant impact on the government’s response, as well in the coordination policies. The article demonstrates that in a crisis, coordination instruments do not depend on political parties but consist of a blend of weak and suitable articulation of policies of the subnational governments with the federal strategy, as well as the need to improve the instruments of collaboration between the various levels of government in the context of a healthcare system in transformation.

Cerebral venous thrombosis is a less common but relevant cause of stroke in adults. The clinical manifestations are nonspecific leading frequently diagnostic delays, so imaging findings are is of vital importance. Conventional imaging modalities, namely computed tomography and magnetic resonance imaging (MRI), allow identification of the thrombus and parenchymal involvement due to venous congestion to a variable degree, but this entity may appears as a nonexpected finding in a nonvenographic study. computed tomography and MRI venographies allow noninvasive confirmation of the diagnosis and adequate characterization of the extent of the thrombus and acute complications, both of them being robust diagnostic techniques. MR venography also can be done without the use of contrast media, which is especially important in certain clinical situations. Cerebral venous thrombosis needs follow-up, and imaging plays a key role in detection of late complications of the disease, including dural arteriovenous fistulas and intracranial hypertension due to veno-occlusive disease. Knowledge of other diseases and conditions that may mimic a thrombus is needed to avoid wrong diagnosis. In this article, we conduct a pictorial comprehensive review of cerebral venous thrombosis, including also the technical aspects of different imaging modalities, diagnosis and acute complications, follow-up, late complications and potential imaging mimics.

Objective To describe a group of patients with suspected acute invasive fungal rhinosinusitis (AIFRS) diagnosis, and identify factors associated with a greater risk of presenting this disease. Design Non-concurrent cohort study. Setting A single-centre non-concurrent follow-up of patients with suspected AIFRS between August 2015 and July 2018. Participants 50 inpatients referred due to suspected AIFRS at Hospital Clinico Universidad Catolica based on the association of a predisposing factor (neutropenia/immunodeficiency/poorly controlled diabetes) with fever of unknown origin. Main outcome measure The primary outcome was AIFRS diagnosis, defined as a concordant tissue biopsy. Results Acute invasive fungal rhinosinusitis was confirmed in 18% (9/50) of the evaluated patients. AIFRS was significantly associated with a positive galactomannan (P = .04), and a paranasal sinus MRI with lack of contrast enhancement (LoCE) (P = .04) orbit compromise (P = .03) or global extrasinusal extension (P = .04). LoCE and extrasinusal extension in the paranasal sinus/brain MRI were risk factors for AIFRS (OR 16; CI 1.2-210.6 and OR 12.75; CI 1.3-128.8, respectively). Conversely, a nasal endoscopy showing healthy mucosa was identified as a protective factor for AIFRS (OR 0.06; CI 0.007-0.57). Conclusions In patients with suspected AIFRS, we identified laboratory and radiologic variables associated with the disease, which may help for a more accurate diagnostic algorithm and approach in this population.

BACKGROUND: Therapies to interrupt the progression of early coronavirus disease 2019 (Covid-19) remain elusive. Among them, convalescent plasma administered to hospitalized patients has been unsuccessful, perhaps because antibodies should be administered earlier in the course of illness. METHODS We conducted a randomized, double-blind, placebo-controlled trial of convalescent plasma with high IgG titers against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in older adult patients within 72 hours after the onset of mild Covid-19 symptoms. The primary end point was severe respiratory disease, defined as a respiratory rate of 30 breaths per minute or more, an oxygen saturation of less than 93% while the patient was breathing ambient air, or both. The trial was stopped early at 76% of its projected sample size because cases of Covid-19 in the trial region decreased considerably and steady enrollment of trial patients became virtually impossible. RESULTS A total of 160 patients underwent randomization. In the intention-to-treat population, severe respiratory disease developed in 13 of 80 patients (16%) who received convalescent plasma and 25 of 80 patients (31%) who received placebo (relative risk, 0.52; 95% confidence interval [CI], 0.29 to 0.94; P = 0.03), with a relative risk reduction of 48%. A modified intention-to-treat analysis that excluded 6 patients who had a primary end-point event before infusion of convalescent plasma or placebo showed a larger effect size (relative risk, 0.40; 95% CI, 0.20 to 0.81). No solicited adverse events were observed. CONCLUSIONS Early administration of high-titer convalescent plasma against SARS-CoV-2 to mildly ill infected older adults reduced the progression of Covid-19. (Funded by the Bill and Melinda Gates Foundation and the Fundación INFANT Pandemic Fund; Dirección de Sangre y Medicina Transfusional del Ministerio de Salud number, PAEPCC19, Plataforma de Registro Informatizado de Investigaciones en Salud number, 1421, and ClinicalTrials.gov number, NCT04479163.). Fil: Libster, Romina Paula. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Pérez Marc, Gonzalo. Hospital Militar Central, Buenos Aires; Argentina Fil: Wappner, Diego. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Coviello, Silvina Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Bianchi, Alejandra. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Braem, Virginia. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Esteban, Ignacio. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Caballero, Mauricio Tomás. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Wood, Cristian. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Berrueta, Mabel. Hospital Militar Central; Argentina Fil: Rondan, Aníbal. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Lescano, Gabriela Mariel. Hospital Dr. Carlos Bocalandro; Argentina Fil: Cruz, Pablo. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Ritou, Yvonne. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Fernández Viña, Valeria Silvina. Hospital Simplemente Evita; Argentina Fil: Álvarez Paggi, Damián Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Esperante, Sebastian. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquímicas de Buenos Aires. Fundación Instituto Leloir. Instituto de Investigaciones Bioquímicas de Buenos Aires; Argentina Fil: Ferreti, Adrián. Hospital Dr. Carlos Bocalandro; Argentina Fil: Ofman, Gaston. University of Oklahoma; Estados Unidos Fil: Ciganda, Álvaro. Gobierno de la Provincia de Buenos Aires. Hospital Interzonal Especializado de Agudos y Cronicos San Juan de Dios.; Argentina Fil: Rodriguez, Rocío. Hospital Simplemente Evita; Argentina Fil: Lantos, Jorge. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Valentini, Ricardo. No especifíca; Fil: Itcovici, Nicolás. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Hintze, Alejandra. No especifíca; Fil: Oyarvide, M. Laura. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Etchegaray, Candela. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Neira, Alejandra. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Name, Ivonne. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Alfonso, Julieta. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Swiss Medical Group; Argentina Fil: López Castelo, Rocío. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina Fil: Caruso, Gisela. Hospital Militar Central; Argentina Fil: Rapelius, Sofía. Hospital Militar Central; Argentina Fil: Alvez, Fernando. Hospital Militar Central; Argentina Fil: Etchenique, Federico. Hospital Militar Central; Argentina Fil: Dimase, Federico. Hospital Militar Central; Argentina Fil: Alvarez, Darío. Hospital Militar Central; Argentina Fil: Aranda, Sofía S.. Hospital Militar Central; Argentina Fil: Sánchez Yanotti, Clara Inés. Hospital Militar Central; Argentina Fil: De Luca, Julián. Hospital Militar Central; Argentina Fil: Jares Baglivo, Sofía. Hospital Militar Central; Argentina Fil: Laudanno, Sofía. Fundación Hematológica Sarmiento; Argentina Fil: Nowogrodzki, Florencia. Swiss Medical Group; Argentina Fil: Larrea, Ramiro. Hospital Municipal San Isidro; Argentina Fil: Silveyra, María. Hospital Militar Central; Argentina Fil: Leberzstein, Gabriel. No especifíca; Fil: Debonis, Alejandra. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Molinos, Juan. Fundación para la Investigación en Infectología Infantil; Argentina Fil: González, Miguel. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Perez, Eduardo. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Kreplak, Nicolás. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Pastor Argüello, Susana. Fundación para la Investigación en Infectología Infantil; Argentina Fil: Gibbons, Luz. Hospital Municipal de San Isidro; Argentina Fil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Bergel, Eduardo. Sanatorio Sagrado Corazón; Argentina Fil: Polack, Fernando Pedro. Provincia de Buenos Aires. Ministerio de Salud; Argentina

Pituitary abscesses (PAs) are a rare clinical entity which may arise from normal pituitary tissue or underlying lesions within the gland. Rathke’s cleft cysts (RCCs) are not commonly associated with the development of PA. Retrospective chart review of three patients with PAs within RCCs at a single university center and review of the literature. Three cases are reported. The first case presented with fever and headache and a history of prior surgery due to RCC and a recent respiratory tract infection. The second case had a history of recent skin infections and presented with sudden onset headache and hypopituitarism. In the third case, chronic visual field impairment prompted an ophthalmologic evaluation resulting in a diagnosis of an adenoma and an infected RCC. In all three cases, an endoscopic endonasal approach was performed to drain infected tissue and allowed microbiological identification of gram-positive cocci, followed by treatment with antibiotics for at least three weeks. Cases in the literature are scarce and the diagnosis is usually made intraoperatively due to non-specific manifestations and imaging. PAs arising from underlying pituitary lesions are less common than primary PAs. Differential diagnosis should include pituitary apoplexy, hypophysitis and other cystic lesions. PAs occurring in RCCs are infrequent. Clinical manifestations are commonly subacute, without septic symptoms. Imaging is usually non-specific. Preoperative diagnosis is infrequent and a broad differential diagnosis should be considered. Empirical antimicrobial therapy should be initiated and adjusted after obtaining cultures to reduce the rate of recurrence and improve clinical outcomes.

Background Mechanical Thrombectomy (MT) is the standard of care for treatment of large vessel occlusion stroke. Until the beginning of 2020 MT was not funded nor widely implemented at the public healthcare level in Chile. Objective To describe the results of a pilot program created to provide access to public MT in Santiago - Chile. Methods Analysis from a prospectively collected database of MT cases performed between September 2017 and September 2019 in one center. A stroke network was developed with a single MT capable stroke center and five primary stroke centers. The primary efficacy endpoint was the rate of functional independence (mRS 0-2) at 90 days. Successful reperfusion was defined as 2 b-3 according to the thrombolysis in cerebral infarction scale. Safety outcomes include the rates of symptomatic intracranial hemorrhage and 90-day mortality. Results A total of 100 patients were treated over the study period. Their mean age was 62.8 ± 11.8 years and median baseline National Institute of Health Stroke Scale (NIHSS) measurement was 17. Seventy-seven percent of the patients received intra venous thrombolysis. Successful reperfusion was achieved in 95% of the cases. NIHSS at 24 hours showed a median drop of 7 points from baseline (p Conclusions We demonstrated the feasibility of a publicly funded MT program in Chile, with similar results as other international randomized control trials.

Introduction This study aimed to investigate the effects of a home-based occupational therapy telerehabilitation (TR) via smartphone in enhancing functional and motor performance and fall efficacy for outpatients receiving day hospital rehabilitation after hip fracture surgery in Hong Kong. Methods This was a feasibility randomised controlled trial with two groups – an experimental group and a comparison group – and a sample of 31 older adults attending a geriatric day hospital who had undergone hip fracture surgery within 12 weeks of diagnosis. Patients were assessed at baseline, immediately after a three-week intervention and at three-week post-intervention follow-up for motor performance, activities of daily living (ADL) functioning and fall efficacy. The experimental group received a home programme using the Caspar Health e-system and a mobile app for smartphones, while the comparison group received paper-and-pencil instructions for the home programme on a weekly basis for three weeks. Results Compared to the comparison group, significant improvements in fall efficacy and instrumental ADL performance at post intervention and follow-up were found in the experimental group. However, in the comparison group, inadequate social support was a factor contributing to better muscle strength testing in both the affected and non-affected legs. There were no significant differences between the two groups in regard to the other variables. Discussion This study supports the potential use of TR via smartphone as an alternative home programme for use in occupational therapy practice with older adults after hip fracture surgery.

Hydrophilic polymer coatings on intravascular devices lower friction between the device and vasculature, thereby reducing trauma during interventional procedures. Polymer coating embolism-the detachment and downstream embolism of polymer particles-has been reported as an iatrogenic complication of coated interventional devices affecting the vasculature and various organs. The Food and Drug Administration (FDA) acknowledges this complication and continues to work with stakeholders to close gaps in performance testing and standards related to polymer coating integrity. Recent innovations within interventional technologies have led to development of new hydrophilic-coated devices with expanded indications for use. The 2018 FDA draft guidance for intravascular guidewires expands the application of particulate generation testing to most devices and recommends labeling changes to increase industry awareness. This article highlights current procedural trends where the phenomenon of polymer coating embolism may be more prevalent. It describes the mechanisms of polymer separation, reported clinical sequelae, and risk factors for relevant indications. These procedural trends and associated risk factors articulate the need for particulate testing and support the FDA's draft guidance recommendations for performance testing of applied coatings. If standardized, particulate assessments may allow characterization and comparisons of coating integrity among devices from various manufacturers, and are an important foundation for setting particulate limits. As hydrophilic coatings enable endovascular treatment for a range of patient populations, setting particulate limits or finding alternative solutions without compromise to device function may be essential. Particulate testing is relevant to physicians, regulators, and manufacturers for the purposes of product development and quality improvement of interventional devices.

The Open Innovation paradigm has spread widely since 2003, and led to the emergence of Open Innovation Platforms as software systems aiming at supporting and facilitating open innovation initiatives and projects. This software domain has matured up to a point where many functional concepts became notably common and used in these platforms. When implementing open innovation platforms, related people often struggle when defining expected functional characteristics due to the general application of the paradigm, making necessary the existence of a model that provide a set of potential functional features expected in the creation and development of this type of platform. Reference models provides a domain-specific set of clearly defined entities aiming at encouraging better communication in the domain. We propose in this paper a reference model for capturing and defining the functional features that could be implemented in outside-in oriented open innovation platforms. For building this reference model, we reviewed some of the already published reports of open innovation platforms implementations in order determine and define the potential functional features expected in this kind of platforms. We believe this knowledge base could ease software development and deployment decisions, especially at early stages where open innovation platforms adopters face development in a domain that as of this writing is still new to many people.

El objetivo del presente trabajo es realizar la valorización de una empresa televisiva en el Perú y hallar el valor fundamental de la acción al cierre del 2017 (año base). La empresa televisiva en estudio es una de las casas televisoras de señal abierta más importantes a nivel nacional. Se dedica exclusivamente a la venta de espacios publicitarios por medio de programas televisivos propios o de terceros, que son transmitidos por la programación de la empresa televisiva. Durante el periodo 2012- 2017, la empresa ha presentado un crecimiento sostenido en ventas con una tasa anual compuesta del 12,6%, pese a que el mercado nacional de telecomunicaciones, en especial el sector televisivo, mantiene un nivel de inversión bastante bajo en comparación con otros países de la región. Bajo este contexto, se han realizado entrevistas a los ejecutivos principales y al accionista mayoritario de la empresa, a partir de las que se obtuvo variables, tales como los precios promedios por espacios publicitarios, eventos especiales que mantiene la compañía de acuerdo a contratos y una serie de factores que influyen en las proyecciones financieras. Asimismo, se reveló el costo de capital de la corporación, indicador importante para la valorización dela empresa. Finalmente, luego del análisis y de dicha valorización, se concluye que los accionistas esperarían una apreciación del valor de la acción debido al potencial crecimiento del negocio, al crecimiento del sector y al posicionamiento de la compañía.

Breast cancer is one of the most frequent cancer types worldwide and the first cause of cancer-related deaths in women. Although significant therapeutic advances have been achieved with drugs such as tamoxifen and trastuzumab, breast cancer still caused 627,000 deaths in 2018. Since cancer is a multifactorial disease, it has become necessary to develop new molecular therapies that can target several relevant cellular processes at once. Ion channels are versatile regulators of several physiological- and pathophysiological-related mechanisms, including cancer-relevant processes such as tumor progression, apoptosis inhibition, proliferation, migration, invasion, and chemoresistance. Ion channels are the main regulators of cellular functions, conducting ions selectively through a pore-forming structure located in the plasma membrane, protein–protein interactions one of their main regulatory mechanisms. Among the different ion channel families, the Transient Receptor Potential (TRP) family stands out in the context of breast cancer since several members have been proposed as prognostic markers in this pathology. However, only a few approaches exist to block their specific activity during tumoral progress. In this article, we describe several TRP channels that have been involved in breast cancer progress with a particular focus on their binding partners that have also been described as drivers of breast cancer progression. Here, we propose disrupting these interactions as attractive and potential new therapeutic targets for treating this neoplastic disease.

Rapid increases of energy consumption and human dependency on fossil fuels have led to the accumulation of greenhouse gases and consequently, climate change. As such, major efforts have been taken to develop, test, and adopt clean renewable fuel alternatives. Production of bioethanol and biodiesel from crops is well developed, while other feedstock resources and processes have also shown high potential to provide efficient and cost-effective alternatives, such as landfill and plastic waste conversion, algal photosynthesis, as well as electrochemical carbon fixation. In addition, the downstream microbial fermentation can be further engineered to not only increase the product yield but also expand the chemical space of biofuels through the rational design and fine-tuning of biosynthetic pathways toward the realization of "designer fuels" and diverse future applications.

Polymer coating emboli have been affiliated with persisting brain lesions after endovascular procedures.1–6 Patient symptoms include headaches, fevers, chills (ie, constitutional symptoms), neurological presentations of focal weakness, sensory and visual deficits, and seizures. Follow-up imaging highlights distinct areas of contrast enhancement in slightly different locations, with some lesions increasing in number and size (see figure 1). Polymer particles from various coating compositions have different rates of degradation, absorption, and metabolism or excretion (DAM/E). These varied rates of DAM/E may have impacts on persisting brain lesions, recurrent patient symptoms, and adverse event outcomes. Figure 1 Characteristic MRI of patients with persisting brain lesions. T1 postcontrast images highlighting an increase in the number and size of lesions (white arrows) over a 12 month period. Also note formation of new enhancing lesions. Images used with permission by Williams and Wilkins Co. (license ID: 1100407-1). Degradation is the chemical breakdown of a polymer by hydrolysis, oxidation, or enzymatic processes. A faster degradation rate may result in less obstruction within blood vessels or reduced presence …

The association of sleep disruption with a higher vulnerability to COVID-19 infection is asubject of major clinical importance. In patients with pneumonia associated with COVID-19admitted to non-intensive care unit (NICU) several factors, like the disrupting influence ofrespiratory distress, medication, greater stress due to social isolation, and lack of appropriateexposure to environmental light can be instrumental to disrupt sleep / wake cycle. Thetherapeutic potential of melatonin to counteract the consequences of COVID-19 infection hasbeen advocated. Because of its wide-ranging effects as an antioxidant, anti-inflammatory, andimmunomodulatory compound, melatonin could be unique in impairing the consequences ofSARS-CoV-2 infection. Melatonin is also an effective chronobiotic agent to reverse the circadiandisruption of social isolation and to control delirium in severely affected patients. Properlyadministered, melatonin may restore the optimal circadian pattern of the sleep-wake cycle andimprove clinical condition in pneumonia associated with COVID-19 patients. The present reviewarticle discusses the importance of maintaining normal sleep and circadian rhythmicity in NICUpatients and provides preliminary data suggesting the efficacy of melatonin (9 mg/day) to reducelength of stay of pneumonia patients associated with COVID-19 in NICU. Fil: Brusco, Luis Ignacio. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Cruz, Pablo. No especifíca; Fil: Cangas, Alicia. No especifíca; Fil: González Rojas, Carmen. No especifíca; Fil: Vigo, Daniel Eduardo. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; Argentina Fil: Cardinali, Daniel Pedro. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; Argentina

Hypopituitarism after moderate or severe traumatic brain injury (TBI) is usually underdiagnosed and therefore undertreated. Its course can be divided in an acute phase during the first 14 days after TBI with 50 to 80% risk of hypopituitarism, and a chronic phase, beginning three months after the event, with a prevalence of hypopituitarism that ranges from 2 to 70%. Its pathophysiology has been addressed in several studies, suggesting that a vascular injury to the pituitary tissue is the most important mechanism during the acute phase, and an autoimmune one during chronic stages. In the acute phase, there are difficulties to correctly interpret pituitary axes. Hence, we propose a simple and cost-effective algorithm to detect and treat a potential hypothalamic-pituitary-adrenal axis impairment and alterations of sodium homeostasis, both of which can be life-threatening. In the chronic phase, post-concussion syndrome is the most important differential diagnosis. Given the high prevalence of hypopituitarism, we suggest that all pituitary axes should be assessed in all patients with moderate to severe TBI, between 3 to 6 months after the event, and then repeated at 12 months after trauma by a specialized team in pituitary disease.

BackgroundTherapies to interrupt progression of early COVID-19 remain elusive. Among them, convalescent plasma in hospitalized patients was unsuccessful, perhaps because antibody should be administered earlier. We advanced plasma infusions to the first 72 hours of symptoms to arrest COVID-19 progression.MethodsA randomized, double-blind, placebo-controlled trial of convalescent plasma with high IgG titers against SARS-CoV2 in elderly subjects within 72 hours of mild COVID-19 symptoms. The primary endpoint was severe respiratory disease defined as a respiratory rate ≥30 and/or an O2satResults160 patients underwent randomization. In the intention-to-treat analysis (ITT), 13/80(16.2%) patients receiving plasma vs. 25/80(31.2%) receiving placebo experienced severe respiratory disease [RR(95%CI)= 0.52(0.29,0.94); p=0.026)] with an RRR=48%.A modified ITT analysis, excluding six subjects who experienced the primary endpoint before infusion, showed a larger effect size [RR(95%CI) = 0.40(0.20, 0.81), p=0.007]. High- and low-titer donor analyses, based on a median IgG titer=1:3,200, evidenced a dose-dependent response with an RRR=73.3% for recipients of high-titer plasma (p=0.016) and a number needed to treat (NNT)=4.4. All secondary endpoints exhibited trends towards protection. No solicited adverse events were observed.ConclusionsEarly administration of high-titer convalescent plasma against SARS-CoV2 to mildly ill infected seniors reduced COVID-19 progression. This safe, inexpensive, outpatient intervention facilitates access to treatment from industrialized to LMIC, can decompress demands on hospitals, and may contribute to save lives.Funded by The Bill & Melinda Gates Foundation and The Fundación INFANT Pandemic Fund. Registered in the Dirección de Sangre y Medicina Transfusional del Ministerio de Salud (PAEPCC19), Plataforma PRIISA (1421), and clinicaltrials.gov (NCT04479163).All authors have completed the ICMJE uniform disclosure form atwww.icmje.org/coi_disclosure.pdfand declare: no support from any organization for the submitted work; RL, GPM, DW and FPP are investigators in a phase 3 SARS CoV2 trial from Pfizer; no other relationships or activities that could appear to have influenced the submitted work.

ESSENCE, the Software Engineering Method and Theory (SEMAT) extensible Kernel, allows description of software development initiatives. One of the extensions is SETMAT, the Software Engineering Teaching Method and Theory, which provides a set of new sub-alphas and activity spaces aiming at the description of software engineering teaching initiatives such as software-related university courses. Different alternatives for describing the elements of SETMAT would eventually provide more freedom for adopters by widening the representations options. In this paper we propose mapping SETMAT elements to SPEM (the Software Process Engineering Meta-model) to provide another representation alternative for SETMAT practices. We also provide an example by making use of EPF Composer and SPEM to map a previously created SETMAT practice for a Software Analysis and Design course. We also argue that by making use of a platform like EPF Composer both software engineering professors and practitioners will be able to instrument and enact the practices as concrete processes.

Research in both South America and Europe in a diachronic perspective allowed to bring together a series of examples relating to the use of a reverberatory furnace for smelting non-ferrous ores. Although the invention of this process may have occurred in multiple places, the main region of innovation is incontestably the Andes. To approach this dynamic process of innovation, we decided to study this using an experimental approach. Over 6 years and 14 tests, a total of 165 h of firings were conducted on the experimental platform at Melle, France. The tests carried out with galena (PbS) allowed us to understand the operating mode and the possible yields of this type of furnace. By analogy, this provides information for the better identification of archaeological remains.

Open innovation platforms emerged as software solutions to facilitate collaboration among diverse participants in an open innovation initiative. Implementing an open innovation platform is a challenging endeavor mainly due to the disruptive nature of the paradigm itself and to technological aspects that, if left overlooked, may have a big impact later. During our experience in implementing an open innovation platform in a Chilean university, we soon discovered the need for guidance in the implementation, and we argue that this guidance is compatible with the gap-covering structure of capability maturity models, a well-known approach to ICT process improvement. Based on this insight, we propose an initial version of a focus-area maturity model to assess an organization's readiness to implement and deploy open innovation software platforms. As befits emerging work, we also discuss and share some future lines of work.

Cognitive training (CT) for individuals with mild cognitive impairment (MCI) may not be optimal for enhancing cognitive functioning. Coupling CT with transcranial direct current stimulation (tDCS) may maximize the strength of transmission across synaptic circuits in pathways that are stimulated by CT. The synergistic effects arising from this combination could be superior to those with administration of CT alone.To investigate whether the receiving tDCS combined with CT is superior to CT alone on domain-specific and task-specific cognitive outcomes in older adults with MCI.This double-blind, sham-controlled randomized trial included 67 older adults with MCI assigned to 3 groups: 1) tDCS combined with CT (tDCS+CT), 2) sham tDCS combined with CT (sham tDCS+CT) and 3) CT alone. Nine sessions of computerized CT were administered to the 3 groups for 3 weeks. In addition, tDCS and sham tDCS was delivered to the left dorsolateral prefrontal cortex to the tDCS+CT and sham tDCS+CT groups, respectively, simultaneously with CT. Standardized cognitive assessments were performed at baseline, post-intervention, and at 6-week follow-up. Participants' performance in the CT tasks was rated every session.The 3 groups showed improvements in global cognition and everyday memory (P0.017) after the intervention and at follow-up, with larger effect sizes in the tDCS+CT than other groups (d0.94) but with no significant differences between groups. Regarding CT outcomes, the groups showed significant differences in favour of the tDCS+CT group in decreasing the completion and reaction times of working memory and attention activities (P0.017).tDCS combined with CT was not superior to sham tDCS with CT and CT alone in its effects on domain-specific cognitive outcomes, but it did provide comparatively larger effect sizes and improve the processing speed of task-specific outcomes. CLINICALTRIALS.GOV: NCT03441152.

Background Multiple sclerosis (MS) is a chronic immune mediated disease and the progressive phase appears to have significant neurodegenerative mechanisms. The classification of the course of progressive MS (PMS) has been re-organized into categories of active vs. not active inflammatory disease and the presence vs. absence of gradual disease progression. Clinical trial experience to date in PMS with anti-inflammatory medications has shown limited effect. Andrographolide is a new class of anti-inflammatory agent, that has been proposed as a potential drug for autoimmune disorders, including MS. In the present trial, we perform an exploratory pilot study on the efficacy and safety of andrographolide (AP) compared to placebo in not active PMS. Methods A pilot clinical trial using 140 mg oral AP or placebo twice daily for 24 months in patients with not active primary or secondary progressive MS was conducted. The primary efficacy endpoint was the mean percentage brain volume change (mPBVC). Secondary efficacy endpoints included 3-month confirmed disability progression (3-CDP) and mean EDSS change. Results Forty-four patients were randomized: 23 were assigned to the AP group, and 21 were assigned to the placebo group. The median baseline EDSS of both groups was 6.0. Annualized mPBVC was − 0.679% for the AP group and − 1.069% for the placebo group (mean difference: -0.39; 95% CI [− 0.836–0.055], p = 0.08, relative reduction: 36.5%). In the AP group, 30% had 3-CDP compared to 41% in the placebo group (HR: 0.596; 95% CI [0.200–1.777], p = 0.06). The mean EDSS change was − 0.025 in the AP group and + 0.352 in the placebo group (mean difference: 0.63, p = 0.042). Adverse events related to AP were mild rash and dysgeusia. Conclusions AP was well tolerated and showed a potential effect in reducing brain atrophy and disability progression, that need to be further evaluated in a larger clinical trial. Trial registration ClinicalTrials.gov NCT02273635 retrospectively registered on October 24th, 2014.

To describe hepatitis A virus (HAV) seroprevalence and associated factors in adolescents (10–19 years) and young adults (20–25 years) in different Mexican regions, using 2012 National Health and Nutrition Survey data. A random selection of 1581 serum samples was analyzed. Weighted HAV seroprevalence with 95% confidence intervals (95%CI) and its association with sociodemographic factors were estimated. Mean weighted HAV seroprevalence was 69.3% (95%CI: 64.8–73.4) overall, with 58.8% (95%CI: 53.4–64.1) in adolescents and 83.0% (95%CI: 75.3–88.7) in young adults. By age of 10, 46.7% (95%CI: 33.9–60.0) were seropositive and by age of 15, 52.8% (95%CI: 36.5–68.5), corresponding to intermediate endemicity nationally. Factors associated with HAV seropositivity (adjusted odds ratio, aOR) included: lower socioeconomic status (SES) (aOR = 4.09 for low and aOR = 2.31 for medium versus high SES), older age (aOR = 0.29 for adolescents versus young adults), living in the South (aOR = 2.12 versus Central Mexico) or in rural areas (aOR = 2.25 versus urban areas). Regional differences and increased seroprevalence of HAV in marginalized populations present an important public health issue, as a relatively large proportion of young adults are susceptible to infection. The burden of symptomatic disease must be addressed further to support specific programs of continued sanitation and education improvement, and the possibility of vaccination in more susceptible regions.

Objectives: To estimate hepatitis B virus (HBV) seroprevalence from natural infection or vaccination in 10–25-year-olds in Mexico, using the 2012 National Health and Nutrition Survey (ENSANUT). Methods: Randomly selected serum samples (1,581) from adolescents and young adults, representative of 38,924,584 Mexicans, were analyzed to detect hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs) and hepatitis B core antibody (anti-HBc). Weighted HBV seroprevalence in the Mexican population and association with sociodemographic variables were calculated. Results: Overall weighted seroprevalence from natural infection (positive for anti-HBs and anti-HBc) was 0.23% (95% confidence interval [95% CI] 0.10–0.52). No HBsAg was detected, indicating no acute or chronic infection. Vaccine-derived immunity (positive ≥ 10.0 mIU/ml for anti-HBs and negative to anti-HBc) was 44.7% (95% CI: 40.2–49.4) overall; lower in persons aged 20–25 years (40.83%) than in persons aged 10–19 years (47.7%). Among the population analyzed, 54.2% (95% CI: 49.6–58.8) were seronegative to HBV (negative for all three markers) and no sociodemographic risk factors were identified. Conclusions: HBV seroprevalence from natural infection was low. Vaccination-induced immunity was higher among Mexican adolescents than young adults, possibly due to vaccination policies since 1999.

Background Context Differentiating osteoporotic vertebral fractures (OVFs) from metastatic vertebral fractures (MVFs) is an important clinical challenge. A novel magnetic resonance imaging (MRI)-based score (the META score) was described, aiming to differentiate OVF from MVF. This score showed an almost perfect agreement by the group developing it, but an independent agreement evaluation is pending. Purpose We aimed to perform an independent inter- and intraobserver agreement evaluation of the META score and to test the score's capability of differentiating OVF from MVF. Study design This is an agreement study of the META score. Methods Sixty-four patients with confirmed OVF or MVF were assessed by six independent evaluators (three spine surgeons and three fellowship-trained radiologists) using the META score. We used the intraclass correlation coefficient (ICC) to determine the overall inter-and intraobserver agreement, and the kappa statistic (κ) to express the agreement for each individual score criterion. The score accuracy was determined by calculating the area under the receiver operating characteristic curve. Finally, we used κ to evaluate the agreement among raters to determine whether the fracture was OVF or MVF. Results The overall interobserver agreement was poor [ICC=0.10 (0.02–0.20)]; spine surgeons [ICC=0.75 (0.66–0.83)] had better agreement than radiologists did [ICC=0.05 (−0.08 to 0.21)]. The intraobserver agreement was poor [ICC=0.17 (0.01–0.32)]; both spine surgeons [ICC=0.21 (0.05–0.41)] and radiologists had a poor agreement [ICC=0.03 (−0.29 to 0.27)]. The agreement for each specific criterion varied from κ=0.24 to κ=0.60. The area under the receiver operating characteristic curve was 0.58 (0.64 for spine surgeons and 0.52 for radiologists, p Conclusions The interobserver agreement using the META score was adequate for spine surgeons but not for other potential users (radiologists); the intraobserver agreement was poor. Further studies are thus necessary before the use of this score is recommended.

Background An essential component of the “Polio Eradication and Endgame Strategic Plan 2013–2018” is the evaluation of population immunity. Mexico introduced the inactivated polio vaccine (IPV) into its routine immunization schedule in 2007 but continued to give trivalent oral polio vaccine OPV twice a year during National Health Weeks through 2016. Methods To describe the seroprevalence of poliomyelitis among children one to four years old in Mexico and analyze risk factors for susceptibility. We detected antibodies to poliovirus type 1 by microneutralization test in 966 serum samples randomly selected from the National Health and Nutrition Survey, 2012. We assessed variables associated with susceptibility using multivariable logistic regression. Results The overall weighted seroprevalence of the general population was 98.39% (95% confidence interval [CI] 96.76–99.21). We found significant differences of prevalence according to age (94.39%, 95% CI 87.56–97.58; 99.02%, 95% CI 95.68–99.79; 99.82%, 95% CI 98.77–99.98; and 100% among children 1, 2, 3, and 4 years old respectively) and number of IPV doses (96.91%, 95% CI 90.55–99.44; 100%; 97.85%, 95% CI 94.46–99.18; and 99.92%, 95% CI 99.45–99.98 for 1 2, 3, and 4 number of doses, respectively). Multivariate analyses showed that susceptibility was associated with younger age, fewer doses of IPV, and certain socioeconomic levels. Conclusions Overall seroprevalence was high. However, we found susceptible children among younger ages and children with fewer or unknown IPV doses belonging to certain socioeconomic strata. Results are relevant for countries transitioning from OPV to IPV and underline the importance of achieving high coverage with IPV.

Background We aimed to elucidate household and community-level shedding and transmission of trivalent oral polio vaccine (tOPV) in communities with inactivated polio vaccine (IPV) routine immunization after tOPV is administered during a national health week (NHW). Methods We conducted a 3-arm, randomized trial with data collected at baseline through 10 weeks post-NHW in households with at least 1 child

Background The World Health Assembly 2012 Polio Eradication and Endgame Strategic Plan calls for the eventual cessation of all oral polio vaccines (OPVs), to be replaced with inactivated polio vaccine (IPV); however, IPV induces less robust mucosal immunity than OPV. This study characterized household and community OPV shedding and transmission after OPV vaccination within primarily IPV-vaccinated communities. Methods Households in 3 IPV-vaccinated Mexican communities were randomized to receive 3 levels of OPV vaccination coverage (70%, 30%, or 10%). Ten stool samples were collected from all household members over 71 days. Analysis compared vaccinated subjects, household contacts of vaccinated subjects, and subjects in unvaccinated households. Logistic and Cox regression models were fitted to characterize transmission of OPV by coverage and household vaccination status. Results Among 148 vaccinated children, 380 household contacts, and 1124 unvaccinated community contacts, 78%, 18%, and 7%, respectively, shed OPV. Community and household contacts showed no differences in transmission (odds ratio [OR], 0.67; 95% confidence interval [CI], .37–1.20), in shedding trajectory (OR, 0.61; 95% CI, .35–1.07), or in time to shedding (hazard ratio, 0.68; 95% CI, .39–1.19). Transmission began as quickly as 1 day after vaccination and persisted as long as 71 days after vaccination. Transmission within unvaccinated households differed significantly across vaccination coverage communities, with the 70% community experiencing the most transmissions (15%), and the 10% community experiencing the least (4%). These trends persisted over time and in the time to first shedding analyses. Conclusions Transmission did not differ between household contacts of vaccinees and unvaccinated households. Understanding poliovirus transmission dynamics is important for postcertification control.

Indexación: Scopus. If Septic shock (SS) evolves to refractory SS, mortality could reach 90%, despite giving an optimal treatment. Nowadays, extracorporeal devices which adsorb inflammatory cytokines are available, reducing the systemic inflammatory response syndrome. These devices can be used with continuous renal replacement therapy or conventional hemodialysis. We report two diabetic females aged 50 and 58 years, who underwent a total colectomy and amputation of diabetic foot and who developed a SS with high requirements of vasoactive drugs (norepinephrine and adrenaline) to maintain a mean arterial pressure about 60 mmHg. Both were subjected to hemodialysis, connected to a cytokine hemadsorption device. The most important finding was the progressive reduction of vasopressor doses, effect that was observed nine hours after the beginning of the hemadsorption and lasted until its removal at 26 hours. Both patients survived. © 2018, Sociedad Medica de Santiago. All rights reserved. https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872018000600796&lng=en&nrm=iso&tlng=en

To perform a systematic review and meta-analysis to estimate the effect of endometriosis on preterm birth (PB) risk. Searches were conducted in PubMed-MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, Google Scholar, and SciELO for studies published in all languages from inception through April 2017. We included cohort studies evaluating pregnant women with and without endometriosis and conception either by spontaneous conception (SC) or with assisted reproductive technology (ART). Primary outcome was PB (

Multiple Sclerosis patients' clinical symptoms do not correlate strongly with structural assessment done with traditional magnetic resonance images. However, its diagnosis and evaluation of the disease's progression are based on a combination of this imaging analysis complemented with clinical examination. Therefore, other biomarkers are necessary to better understand the disease. In this paper, we capitalize on machine learning techniques to classify relapsing-remitting multiple sclerosis patients and healthy volunteers based on machine learning techniques, and to identify relevant brain areas and connectivity measures for characterizing patients. To this end, we acquired magnetic resonance imaging data from relapsing-remitting multiple sclerosis patients and healthy subjects. Fractional anisotropy maps, structural and functional connectivity were extracted from the scans. Each of them were used as separate input features to construct support vector machine classifiers. A fourth input feature was created by combining structural and functional connectivity. Patients were divided in two groups according to their degree of disability and, together with the control group, three group pairs were formed for comparison. Twelve separate classifiers were built from the combination of these four input features and three group pairs. The classifiers were able to distinguish between patients and healthy subjects, reaching accuracy levels as high as 89% ± 2%. In contrast, the performance was noticeably lower when comparing the two groups of patients with different levels of disability, reaching levels below 63% ± 5%. The brain regions that contributed the most to the classification were the right occipital, left frontal orbital, medial frontal cortices and lingual gyrus. The developed classifiers based on MRI data were able to distinguish multiple sclerosis patients and healthy subjects reliably. Moreover, the resulting classification models identified brain regions, and functional and structural connections relevant for better understanding of the disease. Keywords: Resting state, fMRI, DTI, SVM, Multiple sclerosis, Classification

Electromyography is a useful tool in orthodontics to evaluate and monitor muscle activity for diagnosis and during treatment Objectives: The aim of this study was to determine changes in electric muscular activity during different phases of orthodontic treatment. Material and methods: We performed a cohort study and measured bilateral electromyographic activity (EMG) for 30 seconds in maximum intercuspation. EMG activity was measured monthly for 15 months during 4 phases in orthodontic treatment: preatreatment (P0), splint wear (P1); leveling and aligning (P2); space closure (P3); and fi nishing stage (P4). EMG was measured using a digital electromyograph developed by our group (hardware and software) to determine μV every 0.002 seconds. The root mean square (RMS) value was estimated as a mean value of EGM. Patients were treated at the Orthodontics Department and the Physiology Laboratory of UNAM during 2014-2016. We performed a descriptive, bivariate analysis and a random effects linear regression model for repeated measurements adjusted by age, gender, malocclusion and extractions. Results: Our pilot study included 10 patients (6 female and 4 male); mean age was 20 years. At baseline, maximum median EMG was recorded (median 239 μV, IQR 143 μV-561 μV), Multivariate analysis showed that EMG measurements decreased at P1 (regression coeffi cient [Coef]. -180.97; 95% CI -330.37, -31.56; p = 0.018), P3 (Coef. -168; 95% CI -332.36; -3.76; p = 0.045) and P4 (Coef. -184.21; 95% CI -326.91, -41.5; p = 0.011). Conclusions: EMG changes decreased randomly during orthodontic phases and not constantly as generally believed.

Secondary paroxysmal dyskinesias (SPDs) are short, episodic, and recurrent movement disorders, classically related to multiple sclerosis (MS). Carbamazepine is effective, but with risk of adverse reactions. We identified 7 patients with SPD among 457 MS patients (1.53%). SPD occurred in face ( n = 1), leg ( n = 2), or arm +leg ( n = 4) several times during the day. Magnetic resonance imaging (MRI) showed new or enhancing lesions in thalamus ( n = 1), mesencephalic tegmentum ( n = 1), and cerebellar peduncles ( n = 5). Patients were treated with clonazepam and then acetazolamide ( n = 1), acetazolamide ( n = 5), or levetiracetam ( n = 1) with response within hours (acetazolamide) to days (levetiracetam). No recurrences or adverse events were reported after a median follow-up of 33 months.

We report the case of a 25-year-old woman who developed temporal lobe epilepsy associated with systemic lupus erythematosus (SLE). Serum and cerebrospinal fluid samples showed high titers of anti-ribosomal P (anti-P) antibodies with negative anti-NMDAR antibodies. She was receiving prednisone and azathioprine, with normalization of SLE serum markers, but without changes in titers of anti-P antibodies. No seizure control was achieved using valproic acid, levetiracetam and lamotrigine. However, she had a selective response to topiramate, an AMPAR blocker, maintained during 6 years of follow-up. We discuss the pathophysiology of this autoimmune epilepsy associated with high titer anti-P antibodies.

Background Determine the impact of poor oral health on the oral health-related quality of life (OHRQoL) in community-dwelling older adults. Methods Cross-sectional study of community-dwelling older adults in Mexico City. Sociodemographic characteristics were obtained and assessed their OHRQoL according to the Geriatric/General Oral Health Assessment Index (GOHAI). Clinical evaluation of their oral health: painful chewing, use of dentures, dry mouth, xerostomia, plaque, calculus, coronal and root caries, tooth loss and gingival bleeding. Finally, we determined the oral health of participants through Latent Class Analysis (LCA), excluding totally edentulous. The strength of association was determined (Odds Ratio [OR] and 95% confidence interval [95% CI]) through logical regression between the oral health categories (latent classes) and OHRoL in older adults, adjusted with the other variables included in the study: age, sex, marital status, living arrangements (lives alone), educational level, paid work status, comorbidity, cognitive deterioration, depression and use of medical and dental services in the previous 12 months. Results The mean (SD) GOHAI score for the 228 older adults to 46.5 (8.7), number of classes to characterize oral health through LCA was three (entropy 0.805). The GOHAI mean for Class 3 (57.0%), acceptable oral health was 50.1 (7.1); totally edentulous (9.6%), 47.9 (8.4); for Class 2 (16.7%), regular oral health, 43.8 (9.3); and for Class 1 (16.7%), poor oral health, 42.2 (9.7). Significant differences were observed among means (p

Modified (bioactive and hydrogel) coil embolization technologies were introduced to reduce aneurysm recurrence rates. The addition of bioactive polymers to bare platinum coils is designed to induce a tissue response and promote neoendothelialization. Hydrogel polymers on platinum coils swell in

Purpose To determine the capabilities of a multilayer perceptron (MLP) for calculating the power of an intraocular lens (IOL) to be implanted and in achieving a given postoperative stable refraction. Setting Cuban Institute of Ophthalmology, Havana, Cuba. Design Retrospective review. Methods The study comprised data of patients who had uneventful phacoemulsification cataract surgery with implantation of a biconvex acrylic foldable IOL (type RYCF, model Ocuflex) in the capsular bag over 6 years. Exclusion criteria were previous intraocular or refractive corneal surgery, any corneal disease, pathological or complicated cataracts, intraoperative complications, preoperative astigmatism beyond 3.0 diopters (D), postoperative corrected distance visual acuity worse than 20/40, missing postoperative refractive information, eyes with an axial length (AL) shorter than 19.36 mm, eyes with an AL longer than 27.0 mm, average corneal keratometry (K) power lower than 36.0 D or higher than 50.9 D, and refractive surprises greater than ±3.0 D. The data were used to train an MLP to predict the value of the IOL power required for attaining a given postoperative refraction. Using AL, K value, and predicted and real postoperative refraction as input data, the output of the MLP was the IOL power. Results The study comprised 15 728 eyes of 15 728 patients. The trained neural networks predicted the value of the implanted IOL with an error less than 0.5 D in more than 95% of patients, even for a case in which a surgeon was not included in the training process. Conclusions The accuracy attained by the trained MLP is high, indicating the feasibility of a prospective study leading to a new method of predicting the IOL power in refractive surgery with an error lower than the current prediction methods.

Architecture evaluation is a systematic approach to evaluate target architectures and ATAM (Architectural Trade-off Analysis Method) is one of the available methods. Migration of software systems imply many architectural decisions that should be systematically evaluated to assess concrete trade-offs and risks. This article reports on the ATAM usage at a mid-size Chilean specialty software development company to assess the migration of its 20-year old flagship product to a micro-service platform. Over three days, 10 key architectural decisions, addressing 35 scenarios, were considered. Since almost all requirements were deemed essential for legal reasons, the evaluation scheme used a modified importance dimension distinguishing among business-key (first line deal breakers), legally-mandated (second-line deal breakers), and desirable requirements. Key lessons learned include the very positive client feedback on the introduction of systematic evaluation of architectural choices using business criteria.

Fil: Lopardo, Gustavo. Hospital Municipal Dr. Bernardo Houssay; Argentina Fil: Lopardo, Gustavo. Fundación del Centro de Estudios Infectológicos; Argentina Fil: Belloso, Waldo H. Hospital Italiano de Buenos Aires. Department of Research; Argentina Fil: Nannini, Esteban. Sanatorio Británico. Departamento de Enfermedades Infecciosas; Argentina Fil: Nannini, Esteban. Consejo Nacional de Investigaciones Científicas y Tecnicas; Argentina Fil: Colonna, Mariana. Inmunova S.A; Argentina Fil: Sanguineti, Santiago. Inmunova S.A; Argentina Fil: Zylberman, Vanesa. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Zylberman, Vanesa. Inmunova S.A; Argentina Fil: Munoz, Luciana. Inmunova S.A; Argentina Fil: Dobarro, Martín. Sanatorio Sagrado Corazón; Argentina Fil: Lebersztein, Gabriel. Sanatorio Sagrado Corazón; Argentina Fil: Farina, Javier. Hospital de Alta Complejidad Cuenca Alta Néstor Kirchner; Argentina Fil: Vidiella, Gabriela. Sanatorio Agote; Argentina Fil: Bertetti, Anselmo. Sanatorio Güemes; Argentina Fil: Crudo, Favio. Hospital Municipal Emilio Zerboni; Argentina Fil: Crudo, Favio. Universidad Nacional de San Antonio de Areco; Argentina Fil: Alzogaray, María Fernanda. Instituto Medico Platense; Argentina Fil: Barcelona, Laura. Hospital Municipal Dr. Bernardo Houssay; Argentina Fil: Teijeiro, Ricardo. Hospital General de Agudos Dr. Ignacio Pirovano; Argentina Fil: Lambert, Sandra. Hospital de Alta Complejidad El Cruce Néstor Kirchner; Argentina Fil: Scublinsky, Darío. Clínica Zabala; Argentina Fil: Iacono, Marisa. Hospital Provincial Neuquén Dr. Castro Rendón; Argentina Fil: Stanek, Vanina. Hospital Italiano de Buenos Aires. Servicio de Medicina Interna. Sección de Infectología; Argentina Fil: Solari, Ruben. Hospital de Infecciosas Francisco Javier Muñiz; Argentina Fil: Cruz, Pablo. Centro Gallego de Buenos Aires; Argentina Fil: Casas, Marcelo Martín. Clínica Adventista Belgrano; Argentina Fil: Abusamra, Lorena. Hospital Municipal Dr. Diego Thompson; Argentina Fil: Luciardi, Hector Lucas. Hospital Centro de Salud Zenón J. Santillán; Argentina Fil: Cremona, Alberto. Hospital Italiano La Plata; Argentina Fil: Caruso, Diego. Hospital Español; Argentina Fil: Miguel, Bernardo de. mAbxience; España Fil: Millan, Susana. mAbxience; España Fil: Kilstein, Yael. Hospital Municipal Dr. Bernardo Houssay; Argentina Fil: Kilstein, Yael. Hospital Italiano de Buenos Aires. Department of Research; Argentina Fil: Pereiro, Ana. Hospital Municipal Dr. Bernardo Houssay; Argentina Fil: Pereiro, Ana. Sanatorio Británico. Departamento de Enfermedades Infecciosas; Argentina Fil: Sued, Omar. Hospital Municipal Dr. Bernardo Houssay; Argentina Fil: Sued, Omar. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Cahn, Pedro. Hospital Municipal Dr. Bernardo Houssay; Argentina Fil: Cahn, Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Spatz, Linus. Inmunova S.A.; Argentina Fil: Goldbaum, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones Bioquímicas de Buenos Aires; Argentina Fil: Goldbaum, Fernando. Inmunova S.A.; Argentina Fil: Goldbaum, Fernando. Fundación Instituto Leloir; Argentina Fil: Goldbaum, Fernando. Universidad Nacional de San Martín Campus Miguelete. Centro de Rediseño e Ingeniería en Proteínas; Argentina Fil: Pérez Lloret, Santiago. Consejo Nacional de Investigaciones Científicas y Tecnicas; Argentina Fil: Pérez Lloret, Santiago. Pontificia Universidad Católica Argentina. Facultad de Ciencias Médicas. Departamento de Docencia e Investigación; Argentina Fil: Pérez Lloret, Santiago. Universidad Abierta Interamericana. Centro de Altos Estudios en Ciencias Humanas y de la Salud; Argentina Abstract: Background: passive immunotherapy is a therapeutic alternative for patients with COVID-19. Equine polyclonal antibodies (EpAbs) could represent a source of scalable neutralizing antibodies against SARS-CoV-2. Methods: we conducted a double-blind, randomized, placebo-controlled trial to assess efficacy and safety of EpAbs (INM005) in hospitalized adult patients with moderate and severe COVID-19 pneumonia in 19 hospitals of Argentina. Primary endpoint was improvement in at least two categories in WHO ordinal clinical scale at day 28 or hospital discharge (ClinicalTrials.gov number NCT04494984). Findings: between August 1st and October 26th, 2020, a total of 245 patients were enrolled. Enrolled patients were assigned to receive two blinded doses of INM005 (n = 118) or placebo (n = 123). Median age was 54 years old, 65 1% were male and 61% had moderate disease at baseline. Median time from symptoms onset to study treatment was 6 days (interquartile range 5 to 8). No statistically significant difference was noted between study groups on primary endpoint (risk difference [95% IC]: 5 28% [-3 95; 14 50]; p = 0 15). Rate of improvement in at least two categories was statistically significantly higher for INM005 at days 14 and 21 of follow-up. Time to improvement in two ordinal categories or hospital discharge was 14 2 (§ 0 7) days in the INM005 group and 16 3 (§ 0 7) days in the placebo group, hazard ratio 1 31 (95% CI 1 0 to 1 74). Subgroup analyses showed a beneficial effect of INM005 over severe patients and in those with negative baseline antibodies. Overall mortality was 6 9% the INM005 group and 11 4% in the placebo group (risk difference [95% IC]: 0 57 [0 24 to 1 37]). Adverse events of special interest were mild or moderate; no anaphylaxis was reported. Interpretation: Albeit not having reached the primary endpoint, we found clinical improvement of hospitalized patients with SARS-CoV-2 pneumonia, particularly those with severe disease.

Students may adopt various approaches to academic learning. Occupational therapy students' approaches to study and the impact of cultural context have not been formally investigated to date.To examine the approaches to study adopted by undergraduate occupational therapy students from four different cultural settings.712 undergraduate occupational therapy students (n = 376 from Australia, n = 109 from Hong Kong, n = 160 from Norway and n = 67 from Singapore) completed the Approaches and Study Skills Inventory for Students (ASSIST). A one-way analysis of variance (ANOVA) was conducted to compare the ASSIST subscales for the students from the four countries.Post-hoc comparisons using the Tukey HSD test indicated that the mean scores for the strategic approach were significantly different between Australia and the other three countries. The mean scores for the surface approach were significantly different between Australia and Hong Kong, and Hong Kong and Norway. There were no significant differences between the deep approach to studying between Australia, Norway, Singapore and Hong Kong.Culture and educational context do appear to impact the approaches to study adopted by undergraduate occupational therapy students. Academic and practice educators need to be cognizant of what approaches to studying the students they work with adopt.

Background Human tuberculosis caused by Mycobacterium bovis is believed to be frequent in developing countries. Transmission is usually through ingestion of unpasteurized dairy products, although airborne contagion is possible. Disease caused by M. tuberculosis or M. bovis is clinically indistinguishable from each other. The aim of this study was to determine the factors associated with M. bovis disease. Methods Retrospective analysis of all culture-positive cases of M. bovis and M. tuberculosis from 2000 to 2015, in a Mexican tertiary-care centre. Sociodemographic, clinical, and radiographic data from medical records were compared. Disease site was classified as pulmonary, extrapulmonary, or pulmonary and extrapulmonary, based on cultures. Results We evaluated 533 cases, 372 (69.7 %) of which were caused by M. tuberculosis and 161 (30.2 %) by M. bovis. Characteristics associated with M. bovis disease were: younger age (aOR 0.97, 95 % CI 0.95–0.98), glucocorticoid use (aOR 2.27, 95 % CI 1.42–3.63), and extrapulmonary disease (aOR 1.80, 95 % CI 1.21–2.69). M. tuberculosis was associated with lower socioeconomic status (aOR 0.52, 95 % CI 0.28–0.97). When we analysed only pulmonary cases, younger age (aOR 0.97, 95 % CI 0.96–0.99), glucocorticoid use (aOR 2.41, 95 % CI 1.30–4.46), and smoking (aOR 1.94, CI 95 % 1.15–3.27) were associated with M. bovis. Both groups showed similar proportions of direct microscopy smear results (respiratory samples) and chest X-ray cavitations. Conclusions Younger age, glucocorticoid use, and extrapulmonary disease were associated with M. bovis as the causative agent of tuberculosis in a group of patients from a tertiary care centre in a country where bovine tuberculosis is endemic. Further studies must be conducted in the general population to determine pathogen-specific associated factors and outcomes.

Aim Oral health in old persons is frequently poor; non-functional prostheses are common and negatively affect quality of life. The objective of this study was to estimate the impact of oral health problems on oral health related quality of life in a sample of home dwelling Mexican elders. Methods Household survey in 655 persons 70 years old and over residing in one county in Mexico City. Variables Oral Health Related Quality of Life (Short version of the Oral Health Impact Profile validated in Mexico-OHIP-14-sp), self-perception of general and oral health, xerostomia, utilization of dental services, utilization and functionality of removable dental prostheses, dental and periodontal conditions, age, gender, marital status, schooling, depression, cognitive impairment and independence in activities of daily living (ADL). A negative binomial regression model was fitted. Results Mean age was 79.2 ± 7.1 years; 54.2% were women. Mean OHIP-14-Sp score was 6.8 ± 8.7, median was 4. The final model showed that men (RR = 1.30); persons with xerostomia (RR = 1.41); no utilization of removable prostheses (RR = 1.55); utilization of non-functional removable prostheses (RR = 1.69); fair self-perception of general health (RR = 1.34); equal (RR = 1.43) or worse (RR = 2.32) self-perception of oral health compared with persons of the same age; and being dependent for at least one ADL (RR = 1.71) increased the probability of higher scores of the OHIP-14-sp. Age, schooling, depression, cognitive impairment and periodontal conditions showed no association. Conclusions Oral rehabilitation can improve quality of life, health education and health promotion for the elder and their caregivers may reduce the risk of dental problems. Geriatr Gerontol Int 2016; ••: ••–••.

Background: Multiple Sclerosis produces changes in the functional connectivity of the brain. Resting-State fMRI is a useful tool for the study of functional changes in the human brain, and its metrics can be related to clinical findings involved in clinical decline. Social cognition has focused increasing interest because patients are exposed to experiencing social disorganization during the progression of the disease. fMRI has proved to be a useful tool for studying brain connectivity and its relation with social cognition both in resting-state and during socio-cognitive tasks. Objective. to identify functional changes during rest in Relapsing-Remitting Multiple Sclerosis patients and look for a correlation with social cognition. Methods. 45 patients with Relapsing-Remitting Multiple Sclerosis and 47 control subjects were recruited to perform a neuropsychological evaluation of the social cognition performance and to acquire resting-state fMRI. Results. Patients exhibited lower performance in social cognition tasks, mostly related to face emotion recognition. Decreased functional connectivity in patients is seen concerning the right anterior insula, middle frontal, and occipital regions while increased connectivity is mostly related to the occipital and visual areas. The connectivity of the fusiform cortex and the amygdala is related to the performance in emotion recognition and Theory of Mind tasks respectively. Conclusion. Social cognition compromise was found in this sample. Functional connectivity changes during rest were detected and correlated with social cognition changes in patients.

We report six patients with anti-LGI1 associated epilepsy. Two patients presented with new-onset generalized tonic-clonic seizures, four developed faciobrachial dystonic seizures and two piloerection. All patients had significant cognitive complaints at the time of diagnosis. All patients described seizure reduction during the first week of carbamazepine, and seizure freedom was obtained at a median of 13 days (range 7–22), sustained after the initiation of immunosuppression. Median time from symptom onset to carbamazepine initiation was 164 days (range 38–206 days). We discuss the particular seizure response to sodium channel blocking antiepileptic drugs, alone or associated with immunosuppression in this antibody mediated seizures., Graphical abstract Unlabelled Image, Highlights • Anti-LGI1 associated epilepsy may particularly respond to sodium channel blocking AED. • Immunosuppression is usually needed to achieve sustained seizure freedom (SzF). • Carbamazepine and prednisone are affordable and available in developing countries. • We report 6 patients with SzF within two weeks of carbamazepine +/− immunotherapy. • Treatment was well tolerated and seems cost-effective.

Sciatic neuropathy is rare and difficult to diagnose in pediatrics, and its long-term course has not been completely understood. Objective: To analyze the clinical presentation and evolution of a group of pediatric patients with sciatic neuropathy. Patients and Method: Retrospective analysis of the clinical characteristics of pediatric patients with sciatic neuropathy treated in two hospitals of Santiago between 2014 and 2018. Locomotor examination, muscle trophism, deep tendon reflexes, gait, sensation, and pain were assessed. Sciatic nerve conduction study and electromyography (EMG) were performed, and magnetic resonance imaging (MRI) in three patients. Results: Six patients were included with an average age of 11.8 years. The etiologies were traumatic (N = 2), by compression (N = 2), vascular (N = 1), and tumor (N = 1). All of the 6 patients presented foot drop and Achilles tendon hyporeflexia/areflexia, and 5 patients presented severe neuropathic pain. The EMG showed involvement of the sciatic nerve rami and dependent muscles. In two patients, a pelvic girdle and lower limbs MRI was performed, showing selective muscle involvement in sciatic territory. One patient underwent a lumbosacral plexus MRI, and subsequently histological study showing a benign neural tumor. Out of the three patients who were followed-up longer than one year presented motor sequelae and gait disorder. Conclusion: Sciatic neuropathy in the study group was secondary to different causes, predominantly traumatic and compressive etiologies. The three patients that were in a long-term follow-up presented significant motor sequelae. In most of the cases, neural injury was associated with preventable causes, such as accidents and positioning in unconscious children, which is crucial in the prevention of a pathology with a high sequelae degree.

Software process improvement (SPI) initiatives are based upon an appropriate assessment of the actual state or maturity of processes and a concrete model to guide engineers in the next steps to move from the actual state to an improved one. In the context of an SPI initiative at the Chilean National Customs Service, we used the SEMAT Kernel to assess software processes and to guide the implementation of practices for their improvement. We present in this paper our experience using the SEMAT Kernel. We also present a description of several lessons learned in this experience.

Background: Transcranial direct-current stimulation (tDCS) facilitates cognitive improvement in healthy and pathological populations. It has been increasingly used in cases of mild cognitive impairment (MCI) and dementia. Our research question is: Can tDCS serve as a clinical intervention for improving the cognitive functions of persons with MCI (PwMCI) and dementia (PwD)? Objective: This systematic review evaluated the evidence to determine the efficacy of tDCS in improving cognitive outcomes in PwD and PwMCI. Methods: A systematic review was conducted of studies published up to November 2017 involving tDCS in cases of MCI and dementia. Studies were ranked according to the level of evidence (Oxford Center for Evidence-Based Medicine) and assessed for methodological quality (Risk of Bias Tool in the Cochrane Handbook for Systematic Reviews of Interventions). Data was extracted on all protocol variables to establish a reference framework for clinical interventions. Different modalities, tDCS alone or combined with cognitive training, compared with sham tDCS were examined in both short and long-term effects. Four randomized control trials (RCTs) with memory outcomes were pooled using the fixed-effect model for the meta-analysis. Results: Twelve studies with 195 PwD and four with 53 PwMCI met the inclusion criteria. Eleven articles were ranked as Level 1b. The results on the meta-analysis on pooled effects of memory indicated a statistically significant medium effect size of 0.39 (p = 0.04) for immediate effects. This improvement was not maintained in the long term 0.15 (p = 0.44). Conclusion: tDCS improves memory in PwD in the short term, it also seems to have a mild positive effect on memory and language in PwMCI. However, there is no conclusive advantage in coupling tDCS with cognitive training. More rigorous evidence is needed to establish whether tDCS can serve as an evidence-based intervention for both populations.