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Aims We described the presence of Helicobacter pylori (HP) and estimated the prevalence of primary and secondary resistance using molecular detection in gastric biopsies of Ecuadorian patients. Methods and Results 66.7% (238/357) of the patients demonstrated the presence of HP using CerTest qPCR. Of these, 69.79% (104/149) were without previous HP eradication treatment and 64.42% (134/208) with prior HP eradication treatment. The mutation-associated resistance rate for clarithromycin was 33.64% (primary resistance) and 32.82% (secondary resistance), whereas that in levofloxacin the primary and secondary resistance was 37.38% and 42%, respectively. For tetracycline and rifabutin, primary and secondary resistance was 0%. Primary and secondary resistance for metronidazole and amoxicillin could not be evaluated by genotypic methods (PCR and sequencing). Conclusions The analysis of mutations in gyrA, 23S rRNA and 16S rRNA is useful to detect bacterial resistance as a guide for eradication therapy following failure of the first-line regimen. Significance and Impact of the Study This study carried out in an Ecuadorian population indicates that the resistance of HP to first-line antibiotics is high, which may contribute to the high rates of treatment failure, and other treatment alternatives should be considered.

The purpose of the present study is to make known the impact caused by the new tax regime for micro-enterprises and to describe the advantages or disadvantages generated by this tax collection instrument, used as a means to reduce the levels of informality and to promote tax culture. The methodology used was descriptive, the type of research was theoretical - documentary bibliographic and qualitative approach, which analyzed primary sources such as websites, theses, magazine portals, portals of governmental sites, news portals, books, in addition to the critical analysis of the authors on the main case of the company DISPROALCEX S.A. The main result shows that the new tax regime for micro-enterprises is a tax collection instrument used as a means to reduce the levels of informality and promote the tax culture. A. The main result shows that the income tax payable under the general regime was USD 6,274.84, while the income tax payable under the microenterprise regime was USD 15,922.18, showing a significant increase of USD 9,647.34, since the costs and expenses for the period 2020 could not be deducted. The reforms established by the Internal Revenue Service condition the productive process in some micro-enterprises in the sector, reducing their economic and financial liquidity.

La deserción universitaria es uno de los fenómenos que atenta al logro de la calidad educativa, este hecho se percibe en la sociedad actual y posee consecuencias no deseadas por el alto costo social, económico y personal. El objetivo del presente trabajo consiste en analizar bibliográficamente los principales factores de la deserción universitaria. Se justifica considerando la relevancia a nivel teórico y práctico, el mismo constituye una realidad: la deserción y la necesidad de contextualizar las condiciones que permiten esta situación. La metodología respondió a la revisión bibliográfica, recopilación de materiales referentes al tema, se realizó una búsqueda de artículos en las principales bases de datos disponibles, portal CICCO y en Google Académico. Se adoptó el enfoque cualitativo, con diseño analítico, descriptivo. El resultado del análisis demostró que existen factores internos y externos que convergen en la deserción universitaria por lo que amerita la implementación de múltiples transformaciones, tanto a nivel de las instituciones de educa­ción superior como así también de los organismos encargados de este nivel, que aseguren políticas de desarrollo de la calidad con el abordaje de la deserción como una de las principales líneas de acción.

El trabajo analiza la importancia del aprendizaje social y emocional en la educación superior. Se justifica considerando que la educación social y emocional permite una formación integral en las personas. El objetivo de este estudio consistió en determinar la necesidad de incorporar la educación emocional en las aulas universitarias. La metodología respondió a la revisión bibliográfica, recopilación de materiales referentes al tema, se realizó una búsqueda de artículos en las principales bases de datos disponibles (portal CICCO y en Google Académico), y en materiales proveídos en el curso de Especialización en Educación e Inteligencia Emocional. Se adoptó el enfoque cualitativo, con diseño analítico, descriptivo. El resultado del análisis demostró que el aprendizaje social y emocional puede ayudar a cambiar las actitudes o mejorar la comprensión de las emociones ante los problemas e incertidumbres propias de la actualidad, por lo que podría aportar en el nivel universitario un aprendizaje integral, adecuado a las necesidades y vicisitudes del entorno social y cultural buscando construir efectivamente una educación holística e integral del ser humano.

BACKGROUND: Recently, hoarseness affecting the supraglottic structure has been reported in Kawasaki Disease. The objective of this study was to characterize the frequency of hoarseness in acute KD patients in Latin America. METHODS: We used prospective data from the multinational REKAMLATINA Network (Red de Enfermedad de Kawasaki en America Latina) a total of 865 patients from 20 countries were enrolled during the 3-year study period. Data on hoarseness was available in 858 (99.2%) patients. The clinical and laboratory characteristics between hoarse and non-hoarse KD were compared. RESULTS: Hoarseness was documented in 100 (11.6%) patients. Hoarse patients were younger compared to KD without hoarseness (median age 18 vs. 26 months; p=0.002) and presented with a lower hemoglobin (10.7g/dL vs 11.3g/dL; p= 0.040) and hematocrit levels (32% vs 33%, p=0.048) . CONCLUSIONS: Hoarseness was found to be prevalent as a presenting sign of acute KD in younger children. Anemia may indicate the presence of active inflammation.

Introduction: Ultrasound (US) guidance increases the success rate and decreases complications during central venous catheterisation (CVC). The benefits of US guidance in arterial catheterisation are less clear. The aim of this study is to compare the outcomes of US-guided arterial catheterisation with the traditional landmark (LM) technique in critically ill children. Methods: A prospective multicentre study was carried out in 18 Paediatric Intensive Care units in Spain during a 6-months period. Ultrasound guided and landmark techniques were compared in terms of cannulation technical success and immediate mechanical complications. Results: A total of 161 procedures were performed on 128 patients (78 procedures in the US group and 83 in the LM groups).. The median (interquartile range) age and weight of the cohort was 11 months (2–52), and 10 kg (4–17) respectively. More than half (59.6%) were male. US was used mainly in high-volume-high-complexity hospitals (cardiac surgery program 76.9% vs. 25.6%, P

Surgical site infections (SSI) affect millions of individuals around the world, leading to a significant burden on perioperative morbidity and healthcare economy. Over the past decade low-income and middle-income countries (LMICs) have made substantial advancements on infection prevention strategies. However, the incidence of SSI is still increasing in many LMICs across all surgical specialties, denoting overlooked areas and ongoing challenges. This article aims to describe the role of anesthesiologists on current standards of infection prevention and sterility as well as ongoing developments in resource-limited settings, with a focus on LMICs. Recent estimates indicate a threefold increase in the incidence of SSI across LMICs over the past two decades, approaching two times the estimated SSI incidence of high-income countries. As a result, public health officials have promoted standard practices for infection prevention in the surgical arena by creating multidisciplinary teams and tailoring to the availability of equipment and resources. Anesthesiologists play a pivotal role for the implementation of infection prevention strategies such as antimicrobial prophylaxis, normothermia, intraoperative glucose control, and adequate handling of intravenous anesthetics. Unfortunately, the lack of cohesive practices and leadership structures, along with poor surveillance systems, are still common barriers. One potential method of overcoming these obstacles is investment in sustainable national infection prevention programs. Infection prevention standards should be tailored to local workflow and institutional resources. The successful implementation of programs in LMICs depends on sustainable national infection prevention programs which includes a well-trained team and an institutional climate of safety.

Objetivos: Describir el soporte nutricional que se administra en la UCI Pediátrica del Hospital Metropolitano y evaluar nuestra capacidad de alcanzar los objetivos nutricionales recomendados en guías clínicas internacionales. Métodos: Análisis retrospectivo de datos recolectados prospectivamente desde el 09/01/2018 hasta el 12/31/2019 de todos los pacientes con soporte nutricional. Resultados: Durante el periodo de estudio ingresaron a la UCIP 124 pacientes y, de éstos, 31% requirieron soporte nutricional. La edad promedio fue 40 meses, los varones fueron 63%, el diagnóstico fue médico en 63% de los casos, la estadía promedio fue de 3 días y la mortalidad de esta cohorte fue de 4,8%. Se implementó nutrición enteral (NE) en 71,8% de los niños, nutrición parenteral (NP) 15,4%, y nutrición mixta, enteral y parenteral en 12,8%. La NE se inició dentro de las primeras 48 horas en 56,4% de los casos. Al comparar el soporte administrado frente a los objetivos nutricionales, el aporte de energía alcanzó el 75% del objetivo calculado mediante la ecuación de Schofield al día 4 y el 100% al día 8. En los niños desnutridos el 75% del objetivo calórico se alcanzó al día 8. Mediante la NE, el 75% del objetivo se alcanzó al día 4 y el 100% al día 5. El objetivo proteico mínimo se alcanzó al día 7 con NE y al día 3 con NP. El aporte promedio de energía a la población estudiada fue de 42,6 kcal/kg/día y 18,5% de los pacientes recibió un promedio de 57 kcal/kg/día. El aporte promedio de proteínas a esta cohorte fue de 1,43 g/kg/día y 42% de ellos recibió un promedio de 1,5 g/kg/día. Conclusiones: Los objetivos recomendados mínimos de energía y proteínas de 57 kcal/kg/día y 1,5 g/kg/día, respectivamente, para alcanzar anabolismo y balance nitrogenado positivo, no fueron alcanzados en nuestros pacientes durante la primera semana después del ingreso.

El ingreso a la UCIP somete al niño a una serie de estímulos y procedimientos estresantes y dolorosos. El uso de analgesia y sedación es un componente central en los cuidados del niño críticamente enfermo para asegurar su confort y seguridad. Es importante durante la prescripción de analgosedación la monitorización continua de sus efectos. Este proceso debe ser vigilado por todos los integrantes del equipo de salud y su familia. Esta guía se basa en los principios propuestos por la iniciativa “Libérame de la UCI”, que consisten en un paquete (bundle) de medidas (ABCDEF) para optimizar la recuperación de los pacientes y sus desenlaces. Contiene tablas con la farmacología de los analgésicos y sedantes, con estrategias generales para el manejo de analgosedación y prevención del síndrome de abstinencia y delirium. Guía realizada por el equipo multidisciplinario para lograr una adherencia más completa.

Objective: The aim of the study was to assess the diagnostic yield of 2 different next-generation sequencing (NGS) approaches: gene panel and “solo” clinical exome sequencing (solo-CES), in fetuses with structural anomalies and normal chromosomal microarray analysis (CMA), in the absence of a known familial mutation. Methodology: Gene panels encompassing from 2 to 140 genes, were applied mainly in persistent nuchal fold/fetal hydrops and in large hyperechogenic kidneys. Solo-CES, which entails sequencing the fetus alone and only interpreting the Online Mendelian Inheritance in Man genes, was performed in multisystem or recurrent structural anomalies. Results: During the study period (2015–2020), 153 NGS studies were performed in 148 structurally abnormal fetuses with a normal CMA. The overall diagnostic yield accounted for 35% (53/153) of samples and 36% (53/148) of the fetuses. Diagnostic yield with the gene panels was 31% (15/49), similar to 37% (38/104) in solo-CES. Conclusions: A monogenic disease was established as the underlying cause in 35% of selected fetal structural anomalies by gene panels and solo-CES.

La administración de líquidos y electrolitos parenterales es una terapia fundamental de soporte en niños agudamente enfermos si la vía oral no permite la administración de la cantidad o composición requeridas de fluidos, por ejemplo en enfermedades de tipo gastrointestinal, respiratorio, neurológico, o en el período transoperatorio. Al momento de planificar la administración de líquidos y electrolitos parenterales en niños a partir del mes de edad, se debe considerar componentes relacionados con la cantidad de líquidos a infundir considerando los requerimientos secundarios a pérdidas hídricas habituales o requerimientos para reacciones metabólicas, evaluar el grado de deshidratación para la administración de líquidos que complementen el déficit, corregir las pérdidas que se han producido secundarios a una noxa externa (enfermedad, procedimiento quirúrgico, trauma, etc.) y finalmente aportar la cantidad adecuada de fluido que permita re-establecer la perfusión tisular. Es necesario conocer los cambios instaurados basados en la evidencia actual con la finalidad de incorporar a el manejo frecuente de los pacientes considerando también la toxicidad ya sean cualitativos o cuantitativos de esta terapéutica tan necesaria en el manejo del paciente pediátrico.

El megadolicocolon es una patología inusual, de etiología no bien esclarecida, tal parece ser de origen congénito, se presenta con frecuencia en recién nacidos y lactantes con vólvulos de colon. Su incidencia es variable y se encuentra entre 1,9 y 28,5 %. Este reporte de caso es excepcional debido a que se presenta con una evolución y comportamiento agresivo de la enfermedad, pues se trata de un paciente de edad avanzada, con antecedente de sigmoidopexia y cuadro clínico de 7 meses de evolución consistente en estreñimiento crónico y exacerbación difusa de dolor abdominal incapacitante, quién requirió procedimiento quirúrgico de emergencia para su manejo.

Introducción: El surgimiento de bacterias Gram negativas multirresistentes y la aparición de infecciones post quirúrgicas, ha representado un desafío en el manejo antimicrobiano. Las características estructurales de estas bacterias, la formación de biofilms en los dispositivos internos y la presencia de infecciones en órganos de difícil acceso antimicrobiano como el sistema nervioso central, ha obligado a retomar el uso de antibióticos como Colistina por vías de administración poco utilizadas. Caso clínico: Presentamos el caso clínico de un paciente de 2 años de edad con meningo-ventriculitis postquirúrgica causada por Pseudomonas aeruginosa multirresistente manejado con tratamiento combinado de Colistina intraventricular e intravenoso, resultando en éxito terapéutico para el paciente. No se reportó ninguna reacción adversa a la medicación local ni sistémica. Tampoco se reportó recaídas infecciosas posterior al alta. Conclusiones: Los aspectos claves en el manejo de este tipo de infecciones deben ser consideradas: eliminación de la derivación ventrículo peritoneal infectada, óptima cobertura antimicrobiana y elección de la vía de administración más efectiva.

STUDY QUESTION Can maternal plasma cell-free DNA (cfDNA) detect chromosomal anomalies in early pregnancy loss (EPL) and recurrent pregnancy loss (RPL)? SUMMARY ANSWER Genome-wide cfDNA testing can serve as an alternative to cytogenetic analysis in products of conception (POCs) in RPLs and can guide further management. WHAT IS KNOWN ALREADY Random chromosomal anomalies are the single most common cause for EPL and RPL. Cytogenetic analysis in POCs may be used to direct management in RPL because the detection of random chromosomal anomalies can eliminate further unwarranted testing. STUDY DESIGN, SIZE, DURATION This was a prospective diagnostic test study from March 2018 to January 2019 of 109 patients experiencing pregnancy loss before 14 weeks gestation at a tertiary-care academic medical center. PARTICIPANTS/MATERIALS, SETTING, METHODS Blood samples were drawn for genome-wide cfDNA testing prior to chorionic villous sampling for cytogenetic analysis of POCs with both short-term cultures (STCs) and long-term cultures (LTCs). Final analysis included 86 patients with non-mosaic cytogenetic results in POCs and available cfDNA results. Aneuploidy detection rates by cfDNA testing and POC cytogenetic analysis were compared. The first 50 samples served as the Training Set to establish pregnancy loss-specific log-likelihood ratio (LLR) thresholds using receiver-operator characteristic (ROC)-like analyses. These were then used for the entire cohort. MAIN RESULTS AND THE ROLE OF CHANCE Seventy-eight samples (71.5%) had results available from both STC and LTC; 12 samples (11%) had a result from STC only, and 7 samples (6.4%) had a result from LTC only. A chromosomal anomaly was detected in 55/86 (64%). The rates of chromosomal anomalies were 61, 72, 73 and 44% in patients undergoing their first, second, third and ≥4th pregnancy losses, respectively. The median cfDNA fetal fraction was 5%. With standard LLR thresholds used for noninvasive prenatal screening, the sensitivity of cfDNA in detecting aneuploidy was 55% (30/55) and with a specificity of 100% (31/31). Using pregnancy loss-specific LLR thresholds, the sensitivity of cfDNA in detecting aneuploidy was 82% (45/55), with a specificity of 90% (28/31). The positive and negative likelihood ratios were 8.46 and 0.20, respectively. Fetal sex was correctly assigned in all cases. LIMITATIONS, REASONS FOR CAUTION Cases with a false-positive result by cfDNA analysis would not receive the indicated RPL workup. Specificity could be improved by using a fetal fraction (FF) cutoff of 4%, but this would result in exclusion of more than a quarter of cases. WIDER IMPLICATIONS OF THE FINDINGS cfDNA-based testing can serve as an alternative to POC cytogenetic analysis and can guide further RPL management: if cfDNA demonstrates aneuploidy, no further action is taken and if no abnormality is detected, the recommended RPL workup is performed. STUDY FUNDING/COMPETING INTEREST(S) Cell-free DNA testing was funded by Illumina, Inc., San Diego, CA. Y.Y. is a member of Illumina’s Clinical Expert Panel and has received travel grants. A.B. has received travel grants from Illumina. All authors have no competing interest to declare.

OBJECTIVE To assess the frequency of atypical chromosomal and submicroscopic anomalies, as well as fetal structural abnormalities, observed on first-trimester ultrasound scan in fetuses with nuchal translucency (NT) thickness > 99th centile, in order to evaluate the suitability of using standard cell-free DNA (cfDNA) testing as the sole screening test in these pregnancies. METHODS This was a retrospective cohort study of 226 fetuses with NT > 99th centile at 11-14 weeks' gestation, between January 2013 and December 2017, in a clinical setting in which greater than 95% of pregnant women receive first-trimester combined screening. All patients underwent genetic testing by means of quantitative fluorescence polymerase chain reaction and chromosomal microarray analysis, mainly in chorionic villus samples. We assessed the theoretical yield of two cfDNA testing models, targeted cfDNA (chromosomes 21, 18 and 13) and extended cfDNA (chromosomes 21, 18, 13 and sex chromosomes), and compared it with that of cytogenetic testing and ultrasound assessment in the first and second or third trimesters. RESULTS In the 226 fetuses analyzed, cytogenetic testing revealed 84 (37%) anomalies, including 68 typical aneuploidies (involving chromosomes 13, 18 or 21), six sex chromosome aneuploidies (four cases of monosomy X and two of trisomy X), three clinically relevant atypical chromosomal anomalies (one trisomy 22, one trisomy 21 mosaicism and one unbalanced translocation), five submicroscopic pathogenic variants and two cases with Noonan syndrome. Targeted and extended cfDNA testing would miss at least 12% (10/84) and 19% (16/84), respectively, of genetic anomalies, accounting for 4.4% and 7.1% of the fetuses with an increased NT, respectively. Finally, of the 142 fetuses with no identified genetic anomaly, a major fetal malformation was observed in 15 (10.6%) fetuses at the early anomaly scan, and in 19 (13.4%) in the second or third trimester. CONCLUSIONS cfDNA does not appear to be the appropriate genetic test in fetuses with NT > 99th centile, given that it would miss 12-19% of genetic anomalies in this group. Additionally, first-trimester ultrasound will identify a major structural abnormality in 11% of the fetuses with NT > 99th centile and no genetic anomaly. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Congenital Zika infection has been linked with a characteristic phenotype including neurologic sequelae. However, West syndrome has not been previously well described as a consequence. We aim to show this association through a retrospective descriptive study performed in Ecuador. Among 147 infants with congenital Zika infection, 7.5% suffered from West syndrome. Vigabatrin seems to be effective to control the spasms.

Introduction. Infections caused by fast growing mycobacteria have increased markedly worldwide. They are normally associated with trauma, surgery or cosmetic interventions. Paraguay has a deficit in sanitary control including clinics, private practices, and aesthetic centres. This situation is accompanied by the easy access to drugs, which leads to the performance of exclusively medical aesthetic procedures by people without professional knowledge or training. Case report. A 26-year-old female patient comes to a medical consultation with pain and bruising in the abdominal area with more than 3 months of progression, without fever or apparent cause. Later, she confessed to the application of subcutaneous injections of ‘growth hormones’ at the gym. Excisional biopsy of the lesions was carried out for anatomopathological and microbiological studies. In addition, the use of polymerase chain reaction analysis was indicated because of the strong suspicion of an atypical mycobacterial infection. The Ziehl-Neelsen staining was negative for BAAR, and the PAS-Hematoxylin negative for fungal elements. When performing the culture, the growth of atypical mycobacteria was observed on chocolate and blood agar medium culture. Through the polymerase chain reaction study, it was possible to identify the atypical mycobacterium as ‘Mycobacterium abscessus’. Conclusion. The irresponsible application of medications by people without professional authorization or biosafety precautions can lead to the development atypical infections that are difficult to diagnose and treat. This situation could lead to serious complications and even death.

Background: At the end of 2019, a hitherto unknown coronavirus was identified in Wuhan (China) it was called SARS CoV-2 and the disease caused by it was named COVID-19. With the increase in cases an unusual manifestation for this type of virus began to appear: anosmia and dysgeusia, of uncertain etiology, which it could be an autonomic alteration, more precisely in the baroreflex. In this context, it seems likely that subclinical manifestations of baroreflex involvement occur. The regulation of the baroreflex is carried out by the vegetative nervous system through the balance between sympathetic and parasympathetic activity. The objective of this study is to verify whether patients with COVID-19 present alteration of this mechanism by means of ECG Holter recording Material and methods: the study design was cross-sectional, observational, descriptive, prospective inclusion and the sampling was non-probabilistic of convenience. Patients were included if they had a confirmed diagnosis of COVID-19 admitted to the Internal Medicine Service of JB Iturraspe Hospital in Santa Fe city, Argentina, in the period from May 10 to July 20, 2021. An ECG Holter recording was performed at rest for 5 minutes, determining the variables of the frequency domain using Fourier transform analysis through Kubios. Data are presented for frequency measures of HRV: low-frequency power (LF), and high-frequency power (HF) and normalized unit LFnu, HFnu. Were excluded patients with a diagnosis of diabetes mellitus of more than 5 years of evolution, medicated with beta-blockers or with a history of irradiation in the neck Results: 68 patients were studied. 62% were men 38% were women. The mean age was 48.9 ± 13.3 years. The median systolic blood pressure (SBP) was 120 mmHg (95 to 170) and the diastolic blood pressure (DBP) 80 mmHg (60 -110). The heart rate was 76 ± 13 beats per minute and the respiratory rate was 24 (16 to 40). Anosmia was observed in 22% (n = 15) and dysgeusia in 19% (n = 13). The variables of the analysis in the frequency domain were: LF 135.8 ms2 (13.7 - 2861.7); HF, 89.04 ms2 (4.14-5234.4), LFnu 57.57 ± 22.39, HFnu 43.18 ± 22.64. LF / HF ratio 2.1 ms2 ± 2.09. 41.2% (n = 28) of the patients had a high LF / HF ratio (> 2). Discussion: The high and low frequency components known as HF (High Frequency) representing predominantly parasympathetic function, and LF (Low Frequency) which is both sympathetic and parasympathetic activity; can be obtained through the analysis in the frequency domain. The relationship between these two elements would thus represent the sympatho-vagal balance and is expressed as the LF / HF ratio. We observed that 41.2% of the studied patients showed elevated LF / HF ratio Conclusion: The 41.2% of the patients hospitalized with COVID-19 presented with an increase in the LF / HF ratio and this result could be interpreted as an alteration in autonomic function.

El tratamiento de maxilares atróficos mediante implantes cigomáticos fue introducido de manera inicial por Branemark en 1988, a partir de entonces se han presentado varias modificaciones en cuanto a sus indicaciones, planificación prequirúrgica y técnica quirúrgica. Siendo en la actualidad una alternativa segura y predecible a largo tiempo. El objetivo del presente estudio fue analizar la presencia de problemas biológicos y biomecánicos, así como la satisfacción de los pacientes rehabilitados con implantes cigomáticos extrasinusales con carga inmediata para lo cual se revisó de manera retrospectiva 21 implantes cigomáticos instalados en 6 pacientes que presentaban tanto maxilares atróficos como maxilares con secuela de maxilectomia quienes fueron tratados en una clínica privada de la ciudad de Quito – Ecuador. Los resultados de este estudio demostraron que solo un 9,52 % de los implantes presentó complicaciones biológicas, de las cuales 1 implante presento comunicación bucosinusal (4.76 %) y 2 implantes presentaron sinusitis maxilar- (9,52 % - se repite el implante afectado con la comunicación buco-sinusal); Además todos los pacientes brindaron respuestas satisfactorias en cuanto a la satisfacción general al tratamiento. Se concluye que la técnica de implantes cigomáticos extrasinusales es una técnica confiable y reproducible que genera una alta satisfacción en los pacientes.

In human clinics, pathologies as diverse as cancer, sepsis, autoimmune diseases, among others; of different etiology and a different pathophysiological behavior, converge in a failure of gene repression that allows the phenotypic expression of the disease; The possibility of having a biological marker that shows these events to the clinician is desirable since it would allow early diagnostic and therapeutic strategies. Micro RNAs are small and non-coding RNAs that fulfill that “genetic silencing” role, however, the step from basic research to clinical applicability, that is, their translational utility is still little diffused in specialties other than oncology. The objective of this review is to explain in a more precise way.

La distrofia muscular de Duchenne (DMD) es la miopatía más común en niños, de herencia recesiva ligada al cromosoma X y causada por mutaciones en el gen DMD (Xp21.2). Se caracteriza por atrofia y debilidad muscular progresiva, con consecuentes complicaciones musculoesqueléticas, respiratorias y cardíacas, entre otras. Considerando la alta prevalenciade esta condición (prevalencia mundial 0.5 por cada 10 000 hombres) (1,2) y la importancia del manejo multidisciplinar para el diagnóstico oportuno y el manejo adecuado de los pacientes, se realiza un consenso interdisciplinario de expertos para proponer recomendaciones para el diagnóstico y seguimiento de los pacientes colombianos con DMD

Indexación: Scopus. Introduction. Percutaneous electrotherapy is a therapeutic alternative in musculoskeletal conditions. Percutaneous microelectrolysis (MEP) stands out as treatment for tendinopathies and musculoskeletal pain, such as myofascial trigger points (MTrPs), although more studies are needed to support it. The study aimed to investigate MEP effectiveness in reducing pain pressure threshold (PPT) and pain intensity (Pi) in MTrPs. Methods. A randomized controlled clinical trial was performed at Physiotherapy Laboratory of Andrés Bello University and involved 48 volunteers with MTrPs in upper trapezius muscle, randomly assigned to the experimental or control group. Both groups received baseline ultrasound treatment. in the experimental group, MEP intervention was applied with 3 reevaluation sessions (on days 1, 3, and 7). direct current was delivered with an acupuncture needle directly to MTrPs, and PPT and Pi were reevaluated before and after the application. The main outcomes were PPT and Pi differences (PPTdiff and Pidiff) between evaluation sessions. Results. TMEP implied positive changes, increasing PPT (PPTdiff11, p = 0.0000; PPTdiff21, p = 0.0000; PPTdiff31, p = 0.0000) and decreasing Pi (Pidiff11, p = 0.0001; Pidiff21, p = 0.0001; Pidiff31, p = 0.0008) in the experimental group. Significant differences were observed in PPT in the second reevaluation session compared with the control group (PPTdiff21, p = 0.0032). Conclusions. MEP is a good analgesic treatment for MTrPs compared with therapeutic ultrasound, although neither of these therapies seems to be better than the other in a long term. They improve PPT and Pi, so MEP can be considered effective alternative treatment for MTrPs pain. © University School of Physical Education in Wrocław. https://www.termedia.pl/Effectiveness-of-percutaneous-microelectrolysis-and-ultrasound-in-the-decrease-of-pain-in-myofascial-trigger-points-evaluation-through-algometry-and-visual

Colorectal cancer is one of the leading causes of cancer death worldwide. Over the last decades, several studies have shown that tumor-related genomic alterations predict tumor prognosis, drug response, and toxicity. These observations have led to the development of several therapies based on individual genomic profiles. As part of these approaches, pharmacogenomics analyses genomic alterations which may predict an efficient therapeutic response. Studying these mutations as biomarkers for predicting drug response is of a great interest to improve precision medicine. We conduct a comprehensive review of the main pharmacogenomics biomarkers and genomic alterations affecting enzyme activity, transporter capacity, channels, and receptors; and therefore the new advances in CRC precision medicine to select the best therapeutic strategy in populations worldwide, with a focus on Latin America.

Resumen La melanosis neurocutanea es un sindrome congenito no hereditario poco frecuente, caracterizado por la presencia de nevus congenitos gigantes o multiples nevus satelites asociados a celulas productoras a nivel de leptomeninges o del parenquima cerebral. Al menos uno de cada 20.000 nacimientos estan afectados con nevus congenito melanocitico gigante y solo uno de cada 500.000 corresponden a la variedad nevus congenito melanocitico gigante similar a prenda de vestir. Se presenta el caso de un escolar de 7 anos con nevus melanocitico gigante con retraso en el neurodesarrollo, crisis convulsivas repetidas y resonancia magnetica cerebral compatibles con melanosis neurocutanea.

The non-invasive collection of biological samples has proven useful to study a diverse array of research topics worldwide. Here, we present a systematic bibliographical synthesis exploring how the non-invasive collection of genetic samples has been used to study avian populations in the Neotropics. We searched international online databases for scientific publications, spanning from 2007 to 2017, to describe the trends and identify the sample types used, species studied, and research questions addressed. The analysis of 21 articles showed that shed feathers were most frequently used (66.7% of articles), followed by carcasses (14.2%), eggs (9.5%), and non-invasively obtained blood (4.8%); one study used both feces and shed feathers. Most studies addressed population genetic issues (38.1%), followed by species identification (28.6%), phylogenetic questions (14.3%), molecular sexing (9.5%), and parentage analyses (9.5%). Brazil produced almost half (47.6%) of the publications retrieved. Despite an increasing interest in using non-invasive sampling to study Neotropical avifauna, its application is still largely concentrated in the most developed countries in this region and to explore a limited number of questions. A more regular use of non-invasive sampling would help advance the knowledge of ecological, behavioral, genetic, and evolutionary aspects of Neotropical birds. Investigating the extent of human?wildlife conflict, such as impact of road-kills, illegal traffic, and collision with aerial infrastructure or unmanned vehicles, is an underexplored avenue of research in which this method could be of much help. Non-invasive genetic sampling can help tackle conservation problems and pave the way to scientifically informed conservation policies in this avian biodiversity hotspot. Fil: Baus, Isaura. Pontificia Universidad Catolica de Chile. Facultad de Ciencias Biológicas; Chile Fil: Miño, Carolina Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Universidad Nacional de Misiones. Instituto de Biología Subtropical; Argentina Fil: Monge, Otto. Universidad de Costa Rica. Escuela de Biología; Costa Rica

OBJECTIVE: To evaluate the transgenerational transmission of small-for-gestational age (SGA). METHODS: This was a cohort study of a random sample of 2043 offspring delivered between 1975 and 1993 at Hospital Sant Joan de Déu in Barcelona. Exclusion criteria were multiple pregnancy, aneuploidy or genetic syndrome, major birth defects, severe mental disease and macrosomia. Eligible individuals were contacted and those with at least one offspring were included in the study. Participants were classified according to the presence of SGA (defined as birth weight < 10(th) percentile) at birth. Multiple regression analysis was used to determine the presence of SGA or placenta-mediated disease (defined as the presence of SGA, pre-eclampsia, gestational hypertension and/or placental abruption) in the following generation. RESULTS: Of 623 individuals who agreed to participate, 152 (72 born SGA and 80 born appropriate-for-gestational age (AGA)) were reported to have at least one child. Descendants of SGA individuals presented with a lower birth-weight percentile (median, 26 (interquartile range (IQR), 7-52) vs 43 (IQR, 19-75); P < 0.001) and a higher prevalence of SGA (40.3% vs 16.3%; P = 0.001) and placenta-mediated disease (43.1% vs 17.5%; P = 0.001) than did the offspring of AGA individuals. After adjustment for confounding variables, parental SGA background was associated with an almost three-fold increased risk of subsequent SGA or any placenta-mediated disease in the following generation. This association was stronger in SGA mothers than in SGA fathers. CONCLUSIONS: Our data provide evidence suggesting a transgenerational transmission of SGA, highlighting the importance of public health strategies for preventing intrauterine growth impairment. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Talking about gender-based violence and sexual harassment at the Ecuadorian university has been considered by many as an uncomfortable subject, and for some years it has been silenced. It is only recently that this situation has become an essential topic to investigate, so that currently several universities have struggled to explore through studies the problems of gender violence, discrimination and sexual harassment in the university context. In this sense, the present study has tried to develop a review of all the investigations that have been carried out to identify cases or situations of gender violence in universities at international, national and local level, as well as to determine the role of education institutions superior in the prevention and eradication of this problem. Keywords: gender violence, sexual harassment, university. Resumen Hablar de violencia de género y acoso sexual en la universidad ecuatoriana ha sido considerado por muchos como un tema incómodo por lo que durante algunos años ha permanecido silenciado. No es sino hace poco que esta situación se ha vuelto una temática imprescindible de investigar, por lo que actualmente varias universidades se han esforzado en explorar a través de estudios los problemas de violencia de género, discriminación y acoso sexual en el contexto universitario. En este sentido, el presente estudio ha pretendido desarrollar una revisión de todas las investigaciones que se han realizado para identificar los casos o situaciones de violencia de género en universidades a nivel internacional, nacional y local, así como determinar el rol de las instituciones de educación superior en la prevención y erradicación de esta problemática. Palabras clave: violencia de género, acoso sexual, universidad.

Aim: to develop a model for regenerative endodontics using newly-weaned Wistar rats immature molars with pulp necrosis to histologically describe the evolution of apical tissues following treatment with a bi-antibiotic paste, induced bloodclot formation and MTA. Methods: Ten 25-day-old female Wistar rats were divided into an initial control group (Ci) and two experimental groups in which pulp necrosis was experimentally induced on the left mandibular first molar by exposing the pulp chamber and leaving it open to the oral environment. One of the experimental groups was left untreated (E1) while the other was submitted to a protocol of regenerative endodontics 10 days thereafter (E2). Fifteen days after placement of a bi-antibiotic paste, bleeding was induced into the root canal space and MTA was placed upon. Animals were euthanized 30 days later. Right mandibular first molars served as an 80-day-old final control group (Cf). Each hemimandible was histologically processed to analyse parameters associated with root development. Statistical analysis was carried by means of ANOVA; p values below 0.05 were considered statistically significant. Results: baseline (i.e. 25-days old) mean root length and apical diameter of the distal root canal were 1.84±0.25 and 0.38±0.02mm respectively. Following the regenerative endodontic protocol, cells lining the walls of the root canal and significant increase to both length (2.37±0.22mm) and diameter (0.32±0.03 mm) were observed. Conclusions: newly-weaned Wistar rats serve as a suitable model to evaluate regenerative endodontic protocols. However, further research is needed in order to disclose the nature of the cells and/or cell mediators involved.

We develop a simple (incumbent versus entrant) strategic deterrence model to study the economic and geopolitical interactions underlying international trade-related infrastructure projects such as the Panama Canal. We study the incentives for global geopolitical players to support allied satellite countries where these projects are or could potentially be built. We show that even if no effective competitor emerges, the appearance of a geopolitical challenger capable of credibly supporting the entrant has a pro-competition economic effect which benefits consumers all over the world.

Bothrops spp. envenomation and its relationship with ischemic stroke has complex pathogenesis. Local effects such as edema, pain, redness, necrosis, and systemic manifestations like coagulation disorders, thrombosis, renal failure, and hemorrhage have been reported. Hemorrhagic stroke is a common neurological complication but ischemic stroke is poorly understood. We present here the case of a 50-year-old male with no comorbidities referred from a rural area in southwest Colombia with a Bothrops spp. snakebite on the left hand. On admission, the patient presented with a deterioration of consciousness and required mechanical ventilation assistance. The MRI showed multiple ischemic areas in the bilateral frontaltemporal and occipital regions. Two months later, the patient had a favorable resolution, although central paresis in the III and VI cranial nerves and positive Babinski's sign persisted. As already mentioned, the pathophysiology of ischemic stroke due to snakebite is complex but the procoagulant activity of the venom components, the hypovolemic shock, the endothelial damage, and the thromboinflammation can explain it, and although it rarely occurs, it should be considered as a complication of ophidian accidents caused by Bothrops spp.La mordedura de serpientes Bothrops spp. y el ataque cerebrovascular isquémico tienen una patogenia compleja. Se reconocen efectos locales como edema, dolor, enrojecimiento y necrosis, así como manifestaciones sistémicas como trastornos de la coagulación, trombosis, insuficiencia renal y hemorragia, por lo que el accidente cerebrovascular hemorrágico es una complicación neurológica común, pero, en cambio, el accidente cerebrovascular isquémico es poco conocido. Se presenta el caso de un paciente de 50 años, sin comorbilidades, remitido de una zona rural del suroccidente de Colombia debido a la mordedura de una serpiente Bothrops spp. en su mano izquierda. En el momento del ingreso, el paciente presentaba deterioro de la conciencia y requirió asistencia respiratoria mecánica. Mediante resonancia magnética, se observaron múltiples áreas isquémicas bilaterales en la región fronto-temporal y en la occipital. Dos meses después, el paciente había evolucionado favorablemente, pero persistían la paresia en los pares craneales III y VI y el signo de Babinski. La fisiopatología del accidente cerebrovascular isquémico por mordedura de serpiente es compleja. La actividad procoagulante de los componentes del veneno, el choque hipovolémico, el daño endotelial y la tromboinflamación pueden explicar el accidente cerebrovascular isquémico que, aunque raro, debe considerarse como una complicación del accidente ofídico causado por serpientes Bothrops spp.

Resumen Objetivo: describir las características sociodemográficas e histopatológicas en pacientes con diagnóstico de adenocarcinoma gástrico en la Clínica Oncológica Aurora, durante el período 2014-2017 en la ciudad de Pasto, Colombia. Métodos: se realizó un estudio descriptivo en una cohorte de 54 pacientes con diagnóstico de cáncer gástrico sometidos a gastrectomía durante los años 2014 a 2017. La información sociodemográfica se obtuvo a través de la historia clínica. El sistema de Sydney y la clasificación de Lauren se usaron para determinar las características histopatológicas. Resultados: la mayoría de los tumores se presentó en hombres mayores de 50 años (relación hombre mujer de 2,6:1). La ubicación predominante fue la región antropilórica. El histotipo tumoral más frecuente fue el intestinal (80%). La prevalencia de Helicobacter pylori en pacientes fue del 24,07% y fue mayor en el histotipo intestinal. La metaplasia intestinal fue la lesión premaligna más prevalente en todos los histotipos tumorales. Conclusiones: en el presente estudio se encontró que la edad mayor a 50 años y el sexo masculino son condiciones asociadas con el cáncer gástrico; hallazgo ya demostrado en estudios previos. Es perentorio avanzar en el mejoramiento de las condiciones de salud pública, control de la infección por H. pylori y tamizaje temprano de lesiones premalignas, pues son factores determinantes en la carcinogénesis de pacientes con carcinomas no cardiales e histotipos intestinales ubicados en la región antrocorporal. Aunque no se encontraron diferencias significativas entre los histotipos tumorales, el adenocarcinoma de tipo intestinal ubicado en la región antropilórica fue el diagnóstico más frecuente. Abstract Objective: To describe the sociodemographic and histopathological characteristics of patients diagnosed with gastric adenocarcinoma at the Clínica Oncológica Aurora between 2014 and 2017 in the city of Pasto, Colombia. Methodology: A descriptive study was carried out in a cohort of 54 patients diagnosed with gastric cancer who underwent gastrectomy between 2014 and 2017. Sociodemographic information was taken from the medical records of the patients. The Sydney system and Lauren classification were used to determine histopathological characteristics. Results: Most tumors were found in men older than 50 years (with a male:female ratio of 2.6:1). The predominant location was the antropyloric region. The most frequent tumor histotype was intestinal (80%). The prevalence of Helicobacter pylori in patients was 24.07 % and it was most commonly found in the intestinal histotype. Intestinal metaplasia was the most prevalent premalignant lesion in all tumor histotypes. Conclusions: The present study found that the age of 50 and the male sex are conditions associated with gastric cancer. This finding has already been demonstrated in previous studies. Progress in improving public health conditions, controlling H. pylori infection, and early screening of premalignant lesions is imperative, as they are determining factors of carcinogenesis in patients with non-cardia carcinomas and intestinal histotypes located in the anthrocorporal region. Although no significant differences were found among tumor histotypes, intestinal adenocarcinoma in the antropyloric region was the most frequent diagnosis.

A 31-year-old patient presented with abdominal pain, hematemesis, and melena. Digestive endoscopy demonstrated a tumor in the lesser curvature. Computed tomography scan demonstrated an expansive, solid, and cystic mass, with central and intramural calcifications, located in the epigastrium, in close contact with the wall of the lesser curvature (Figure A). The patient developed acute anemia and underwent emergency surgery. The pathology report showed a giant gastric tumor measuring (12× 8× 5 cm). On serial sectioning, cystic and solid areas with mucinous material, adipose tissue, and scattered hairs (arrows) were identified (Figure B). Histopathology revealed several well-differentiated tissues derived from the germ layers, adipose tissue and skin with its appendages (Figure C). The Ki-67 was reactive in the basal layer of the squamous epithelium (Figure D). No malignancy was found in the tumor.

Existen diversos tipos de documentos que se desarrollan con el propósito de asistir al médico en la toma de decisiones diagnósticas y/o terapéuticas. Como ejemplos podemos citar el artículo de posicionamiento (position paper), las guías de práctica clínica (clinical practice guidelines), también llamados protocolos clínicos, y los consensos clínicos (clinical consensus statement).

BackgroundThe neutrophil-to-lymphocyte ratio (NLR) has been investigated in many autoimmune conditions as a biomarker of inflammation and/or disease activity. The role of NLR in AQP4-IgG-positive neuromyelitis optica spectrum disorders (NMOSD) is far from clear. In this study, NLR was evaluated in patients with AQP4-IgG-positive NMOSD at disease onset and its prognostic impact was subsequently assessed.MethodsIn this multicenter study, we retrospectively included all recent/newly diagnosed treatment-naïve patients with AQP4-IgG-positive NMOSD (n=90) from three different countries in Latin America (LATAM): Argentina, Ecuador, and Mexico. NLR was compared between AQP4-IgG-positive NMOSD and healthy controls (HC, n = 365). Demographic, clinical, paraclinical (including imaging), and prognostic data at 12 and 24 months were also evaluated. Multivariate regression analysis was used to describe and identify independent associations between the log-transformed NLR and clinical (relapses and EDSS) and imaging (new/enlarging and/or contrast-enhancing MRI lesions) outcomes.ResultsNLR was higher in NMOSD patients during the first attack compared with HC (2.9 ± 1.6 vs 1.8 ± 0.6; pConclusionsIn this cohort of LATAM patients with AQP4-IgG-positive NMOSD, NLR was abnormally high in attacks but also during follow-up. However, a high NLR was not an independent predictor of clinical or imaging outcomes in our models.

Progressive disseminated histoplasmosis (PDH) is thought to be on the top of the list of AIDS-defining illnesses in South America. Reported experience in children is very scarce. The aim of this study was to describe the clinical characteristics, management, and outcomes of children living with HIV presenting with PDH in Ecuador. We did a retrospective study using collected data on medical records of children living with HIV attended in Francisco Icaza Bustamante Children's Hospital (Guayaquil) between 1997 and 2019. The inclusion criteria consisted of patients under 18 years of age at admission with documented HIV infection and laboratory-confirmed diagnosis of PDH. Twenty-four children living with HIV were attended due to laboratory-confirmed PDH. Median CD4 cell count was 39 cells/mm³ (p25-p75 21-155) between 1 and 5 years and 22 cells/mm³ (p25-p75 10-57) for those aged 6 years and over. Fever (96%) was the most common clinical manifestation, followed by hepatomegaly (75%), cough (67%), weight loss (63%), diarrhea (63%), and abdominal distension (58%). Most significant laboratory findings were hypoalbuminemia (90%), hypertransaminasemia (78%), and pancytopenia (46%). Intravenous treatment with amphotericin B deoxycholate was started in all but one case in which diagnosis was postmortem. All these 23 patients were discharged after being hospitalized for a median of 68 days (p25-p75 48-90). Two children showed relapse during follow-up, one of whom died during the hospitalization of this second episode of PDH.Conclusion: Clinical manifestations and laboratory findings of PDH in children living with HIV seem similar to those seen in adults, and low CD4 cell count appears to be the most important risk factor. What is Known: • Since 1987, progressive disseminated histoplasmosis has been considered an AIDS-defining illness and, although underdiagnosis is frequent, is thought to be on the top of the list of AIDS-defining illnesses in South America. • Reported experience in children is very scarce. What is New: • Clinical manifestations and laboratory findings of progressive disseminated histoplasmosis in children living with HIV seem similar to those seen in adults. • Low CD4 cell count to be the most important risk factor.

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAM, Introducción El uso de la ecografía ha demostrado mejorar los resultados de la canalización venosa central. Sin embargo, sus beneficios en la canalización arterial en niños no han sido claramente establecidos. El objetivo de este estudio fue evaluar el uso de la ecografía en la canalización arterial en la unidad de cuidados intensivos pediátricos (UCIP). Métodos Estudio prospectivo multicéntrico en 18 UCIP en España durante un periodo de 6 meses. Se compararon los resultados de la canalización arterial ecoguiada (ECO) con la técnica tradicional basada en referencias anatómicas (REF) en cuanto a la tasa de éxito y las complicaciones inmediatas. Resultados Se incluyeron 161 procedimientos en 128 pacientes (78 procedimientos en el grupo ECO y 83 en el grupo REF). La mediana (rango intercuartil) de edad y peso de los pacientes fueron 11 meses (2-52) y 10 kg (4-17), respectivamente; el 59,6% eran varones. La ecografía se utilizó preferentemente en las UCIP de mayor tamaño (número de camas 11 [8-16] vs 6 [4-10], p < 0,001) y complejidad (cirugía cardiaca 76,9% vs 25,6%, p < 0,001), así como en pacientes más pequeños (peso 5,7 kg [3,8-13] vs 11,5 kg [4,9-22,7], p < 0,001). El 49,7% de los participantes era personal inexperto (residentes o personal con menos de 5 años de experiencia en UCIP) y solo el 24,4% de los participantes habían realizado más de 50 procedimientos de canalización ecoguiada antes del estudio. No hubo diferencias significativas entre ECO y REF en la tasa de éxito en una punción (35,8% vs 33,7%, p = 0,773), en la tasa de éxito global (75,6% vs 71,1%, p = 0,514), en el número de punciones (2 [1-4] vs 2 [1-3], p = 0,667) ni en la incidencia de complicaciones (16,6% vs 25,6%, p = 0,243). El ajuste por variables de confusión en los modelos de regresión no alteró estos resultados. En un análisis de subgrupos se mostró que la ECO mejoró la tasa de éxito global (83,7% vs 62,7%, p = 0,036) y redujo las complicaciones (10,8% vs 32,5%, p = 0,020) en las canalizaciones realizadas por operadores con menos de 5 años de experiencia en UCIP. Conclusiones En este estudio prospectivo no hemos observado que, globalmente, el uso de la ecografía mejore los resultados de la canalización arterial en la UCIP. La canalización ecoguiada podría tener ventajas para el personal con menos experiencia, Introduction: Ultrasound (US) guidance increases the success rate and decreases complications during central venous catheterisation (CVC). The benefits of US guidance in arterial catheterisation are less clear. The aim of this study is to compare the outcomes of US-guided arterial catheterisation with the traditional landmark (LM) technique in critically ill children. Methods: A prospective multicentre study was carried out in 18 Paediatric Intensive Care units in Spain during a 6-months period. Ultrasound guided and landmark techniques were compared in terms of cannulation technical success and immediate mechanical complications. Results: A total of 161 procedures were performed on 128 patients (78 procedures in the US group and 83 in the LM groups). The median (interquartile range) age and weight of the cohort was 11 months (2-52), and 10 kg (4-17), respectively. More than half (59.6%) were male. US was used mainly in big (number of beds 11 [8-16] vs 6 [4-10], p < 0,001) and high complexity intensive care units (cardiac surgery program 76.9% vs. 25.6%, P < .001) as well as in smaller children [weight 5.7 kg (3.8-13) vs 11.5 kg (4.9-22.7), P < .001]. Almost half (49.7%) of the procedures were performed by an inexperienced operator (paediatric resident, or staff with less than 5 years of clinical experience in the PICU), and only 24.4% had performed more than 50 US-guided vascular access procedures before the study. There were no significant differences between US and LM techniques in terms of first-attempt success (35.8% vs 33.7%, P = .773), overall success (75.6% vs 71.1%, P = .514), number of puncture attempts [2 (1-4) vs 2 (1-3), P = .667] and complications (16.6% vs 25.6%, P = .243). Adjustment by potential confounders using multivariate regression models did not modify these results. Subgroup analyses showed that US outperformed LM technique in terms of overall success (83.7% vs 62.7%, P = .036) and complications (10,8% vs 32.5%, P = .020) only when procedures where performed by less-experienced operators. Conclusions: In this prospective observational multicentre study, US did not improve arterial cannulation outcomes compared to the traditional LM technique in critically ill children. US-guided arterial cannulation may offer advantages when cannulation is performed by inexperienced operators

CA extern - Weitere Nicht-UDE-Autoren sind nicht genannt. Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007. © 2020 Hellenic Society of Cardiology

We develop a simple (incumbent versus entrant) strategic deterrence model to study the economic and geopolitical interactions underlying international trade-related infrastructure projects such as the Panama Canal. We study the incentives for global geopolitical players to support allied satellite countries where these projects are or could potentially be built. We show that even if no effective competitor emerges, the appearance of a geopolitical challenger capable of credibly supporting the entrant has a pro-competition economic effect which benefits consumers all over the world. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

[Abstract] Purpose. This paper aims to present and describe the main actions carried out in six different faculties and common areas such as cultural and research centres and administrative buildings in the Ferrol campus at the University of A Coruña to achieve the second green flag on a Galician University. Design/methodology/approach. A case study describing the steps for implementing a green campus programme in a medium-size, young university campus integrated into a small city. An Environmental Campus Committee was created to assess the main factors that affect environmental footprint, discuss sustainability initiatives and develop a guide to action regarding different goals related to sustainable transport options, energy, water conservation and waste reduction. The actions included several fields such as education, circular economy and healthy life and involved the on and off-campus community. Findings. The programme achieved a decrease in water consumption and electrical energy. An important change in educational values and behaviours regarding sustainability was observed in and out of the campus community. The measurements adopted mainly in waste management, mobility and education led the Ferrol campus to achieve a green campus flag on November 2019. Originality/value. This experiment can serve as a guide to establish the Green Campus philosophy in other similar university campuses. The authors of this article want to thank the finantial and institutional support of Environmental Office of University of A Coruña to develop talks, activities and to implement different actions in Ferrol Campus. The authors of this article want to thank the finantial and institutional support of Vicerrectorado del Campus de Ferrol y Responsabilidad Social of University of A Coruña to achieve the Green Flag. Ana Ares-Pernas wants to thank the financial support of Vicerrectorado de Planificación Académica e Innovación Docente of University of A Coruña obtained in the I Edition of the Prizes for Teaching Innovation Projects in Service-Learning to develop Service-Learning activities

Background Few congenital Zika syndrome (CZS) cases have been notified in Ecuador and, to our knowledge, there are no significant published studies dealing with their clinical evolution. We present a detailed clinical characterization of 21 children with congenital Zika virus (ZIKV) infection born in Ecuador who were followed up until September 2019. Methods We did a retrospective longitudinal study of children attended by the infectious disease specialists of Francisco Icaza Bustamante Children’s Hospital (Guayaquil) due to congenital ZIKV infection suspicion. The inclusion criteria consisted of laboratory confirmed diagnosis of congenital ZIKV infection. Results Sixteen of these 21 cases of congenital ZIKV infection showed clinical, neuroimaging and laboratory findings strongly suggestive of CZS and 5 children showed laboratory findings compatible with congenital ZIKV infection without congenital manifestations associated to CZS. All children with CZS showed neurodevelopmental delay, spasticity and hyperreflexia during follow-up, whereas the majority of them (14/15) experienced recurrent epileptic seizures and dysphagia (12/13). Two CZS cases died during follow-up. Visual evoked potential and hearing screening with acoustically evoked auditory brainstem response were abnormal in 50% and 37.5% of CZS cases, respectively. Congenital ZIKV infection without findings consistent with CZS at birth was not clinically relevant at 23 months of age in the five cases of our cohort. Conclusions Severe neurodevelopmental delay, severe microcephaly, epileptic seizures and dysphagia were present at 2 years of age in most CZS cases of our cohort.

Background Anaplastic astrocytoma is a rare disorder in children from 10 to 14 years of age, with an estimated 0.38 new cases per 100,000 people per year worldwide. Panel-based next-generation sequencing opens new possibilities for diagnosis and therapy of rare diseases such as this one. Because it has never been genetically studied in the Ecuadorian population, we chose to genetically characterize an Ecuadorian pediatric patient with anaplastic astrocytoma for the first time. Doing so allows us to provide new insights into anaplastic astrocytoma diagnosis and treatment. Case presentation Our patient was a 13-year-old Mestizo girl with an extensive family history of cancer who was diagnosed with anaplastic astrocytoma. According to ClinVar, SIFT, and PolyPhen, the patient harbored 354 genomic alterations in 100 genes. These variants were mostly implicated in deoxyribonucleic acid (DNA) repair. The top five most altered genes were FANCD2, NF1, FANCA, FANCI, and WRN. Even though TP53 presented only five mutations, the rs11540652 single-nucleotide polymorphism classified as pathogenic was found in the patient and her relatives; interestingly, several reports have related it to Li-Fraumeni syndrome. Furthermore, in silico analysis using the Open Targets Platform revealed two clinical trials for pediatric anaplastic astrocytoma (studying cabozantinib, ribociclib, and everolimus) and 118 drugs that target the patient’s variants, but the studies were not designed specifically to treat pediatric anaplastic astrocytoma. Conclusions Next-generation sequencing allows genomic characterization of rare diseases; for instance, this study unraveled a pathogenic single-nucleotide polymorphism related to Li-Fraumeni syndrome and identified possible new drugs that specifically target the patient’s variants. Molecular tools should be implemented in routine clinical practice for early detection and effective preemptive intervention delivery and treatment.

Background Few studies regarding MRI-defined acute optic nerve lesions (aONL) in patients with first-ever neuromyelitis optica spectrum disorder (NMOSD)-related optic neuritis (ON) have been reported worldwide and none of them was conducted in Latin America (LATAM). Therefore, we aimed to assess the frequency of aONL at disease onset using conventional brain MRI in LATAM. Methods We reviewed the medical records and brain MRIs (≤30 days from ON onset) of patients with ON as first lifetime NMOSD attack. Patients from Argentina (n=48), Ecuador (n=24), Brazil (n=22), Venezuela (n=10) and Mexico (n=8) were included, and further divided into two subgroups according to either presence (P-MRI) or absence (A-MRI) of aONL (T2 hyperintensity and/or contrast enhancement). Clinical, paraclinical, imaging and prognostic data were compared. Results A total of 112 patients were included and aONL were found in 86 (76.7%) at disease onset. Aquaporin-4 antibodies were detected in 69.6%. Non-Caucasian patients comprised 59.8% of the total cohort. In P-MRI, conventional brain MRI showed isolated or combined unilateral (54.4%, [8.5% of these aONL were associated with chiasmatic lesions]) and bilateral (46.6%, [35.9% of these aONL were associated with chiasmatic lesions]) lesions. Thus, 100% of chiasmatic lesions were associated with unilateral or bilateral lesions. No statistically significant differences were found in age, gender, ethnicity, clinical course, mean follow-up time, disability, and spinal cord MRI findings. However, rituximab use was higher in P-MRI than in A-MRI (p=0.006). Conclusions More than three quarters of LATAM patients with first-ever NMOSD-related ON have aONL detected by brain MRI. Unilateral lesions were the most common finding. Further studies including different ethnicities are needed to assess the generalizability of our results.

Background Congenital insensitivity to pain with anhidrosis (CIPA) is an extremely rare autosomal recessive disorder characterized by insensitivity to pain, inability to sweat and intellectual disability. CIPA is caused by mutations in the neurotrophic tyrosine kinase receptor type 1 gene (NTRK1) that encodes the high-affinity receptor of nerve growth factor (NGF). Case presentation Here, we present clinical and molecular findings in a 9-year-old girl with CIPA. The high-altitude indigenous Ecuadorian patient presented several health problems such as anhidrosis, bone fractures, self-mutilation, osteochondroma, intellectual disability and Riga-Fede disease. After the mutational analysis of NTRK1, the patient showed a clearly autosomal recessive inheritance pattern with the pathogenic mutation rs763758904 (Arg602*) and the second missense mutation rs80356677 (Asp674Tyr). Additionally, the genomic analysis showed 69 pathogenic and/or likely pathogenic variants in 46 genes possibly related to phenotypic heterogeneity, including the rs324420 variant in the FAAH gene. The gene ontology enrichment analysis showed 28 mutated genes involved in several biological processes. As a novel contribution, the protein-protein interaction network analysis showed that NTRK1, SPTBN2 and GRM6 interact with several proteins of the pain matrix involved in the response to stimulus and nervous system development. Conclusions This is the first study that associates clinical, genomics and networking analyses in a Native American patient with consanguinity background in order to better understand CIPA pathogenesis.

Objective: To characterize the clinical presentation and outcomes of Kawasaki disease (KD) in infants 10 days (50 vs. 7.4%, P = 0.043)]. Conclusion: Our data show that despite treatment in the first 10 days of illness, infants

Uruguay is one of the main exporters of beef and dairy products, and cattle production is one of the main economic sectors in this country. Rotavirus A (RVA) is the main pathogen associated with neonatal calf diarrhea (NCD), a syndrome that leads to significant economic losses to the livestock industry. The aims of this study are to determine the frequency of RVA infections, and to analyze the genetic diversity of RVA strains in calves in Uruguay. A total of 833 samples from dairy and beef calves were analyzed through RT-qPCR and sequencing. RVA was detected in 57.0% of the samples. The frequency of detection was significantly higher in dairy (59.5%) than beef (28.4%) calves (p &lt, 0.001), while it did not differ significantly among calves born in herds that were vaccinated (64.0%) or not vaccinated (66.7%) against NCD. The frequency of RVA detection and the viral load were significantly higher in samples from diarrheic (72.1%, 7.99 log10 genome copies/mL of feces) than non-diarrheic (59.9%, 7.35 log10 genome copies/mL of feces) calves (p &lt, 0.005 and p = 0.007, respectively). The observed G-types (VP7) were G6 (77.6%), G10 (20.7%), and G24 (1.7%), while the P-types were P[5] (28.4%), P[11] (70.7%), and P[33] (0.9%). The G-type and P-type combinations were G6P[11] (40.4%), G6P[5] (38.6%), G10P[11] (19.3%), and the uncommon genotype G24P[33] (1.8%). VP6 and NSP1-5 genotyping were performed to better characterize some strains. The phylogenetic analyses suggested interspecies transmission, including transmission between animals and humans.