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It has been suggested that parasitic infections, common in Latin American populations, may amplify the inflammatory response of the airways. There are several reports of atopic and asthmatic patients but few reports of parasitic infection in COPD patients. This study aimed to determine the prevalence of parasitic infections in COPD patients compared with atopic and asthmatic patients attending the Institute of Immunology outpatient clinics and the pneumology service of the University hospital. A case-control study was conducted compising 100 patients with bronchial asthma, 100 patients with COPD, 100 individuals with atopy without respiratory symptoms, and 100 healthy individuals. Serum-specific IgG antibodies against the parasites Ascaris lumbricoides (Al), Strongyloides stercolaris (Ss), and Toxocara canis (Tc) were measured by ELISA. IgE levels were used as an indirect indicator of atopy. Positive IgG for Al was observed in all groups, predominantly in the atopic cohort; Ss positiveness was recorded only in four COPD patients, and Tc positiveness was observed in all groups except in controls. Significant correlations exist between the values of Al and IgE in controls, atopic, and asthmatic patients without COPD. No correlation was found for Tc. IgE levels and the forced expiratory volume in 1 s (FEV1) correlate only in atopic and asthmatic patients. Parasitic infections are common in atopic patients and moderate and severe asthmatic and COPD patients. Anti-inflammatory treatment may be responsible for the increased frequency of infection in moderate and severe asthmatic and COPD patients.

BackgroundThe COVID-19 pandemic has not only caused tremendous loss of life and health but has also greatly disrupted the world economy. The impact of this disruption has been especially harsh in urban settings of developing countries. We estimated the impact of the pandemic on the occurrence of food insecurity in a cohort of women living in Mexico City, and the socioeconomic characteristics associated with food insecurity severity.MethodsWe analyzed data longitudinally from 685 women in the Mexico City-based ELEMENT cohort. Food insecurity at the household level was gathered using the Latin American and Caribbean Food Security Scale and measured in-person during 2015 to 2019 before the pandemic and by telephone during 2020-2021, in the midst of the pandemic. Fluctuations in the average of food insecurity as a function of calendar time were modeled using kernel-weighted local polynomial regression. Fixed and random-effects ordinal logistic regression models of food insecurity were fitted, with timing of data collection (pre-pandemic vs. during pandemic) as the main predictor.ResultsFood insecurity (at any level) increased from 41.6% during the pre-pandemic period to 53.8% in the pandemic stage. This increase was higher in the combined severe-moderate food insecurity levels: from 1.6% pre-pandemic to 16.8% during the pandemic. The odds of severe food insecurity were 3.4 times higher during the pandemic relative to pre-pandemic levels (pConclusionsFood insecurity increased in Mexico City households in the ELEMENT cohort as a result of the COVID-19 pandemic. These results contribute to the body of evidence suggesting that governments should implement well-designed, focalized programs in the context of economic crisis such as the one caused by COVID-19 to prevent families from the expected adverse health and well-being consequences associated to food insecurity, especially for the most vulnerable.

Abstract Background Genomic copy number alterations commonly occur in prostate cancer and are one measure of genomic instability. The clinical implication of copy number change in advanced prostate cancer, which defines a wide spectrum of disease from high-risk localised to metastatic, is unknown. Methods We performed copy number profiling on 688 tumour regions from 300 patients, who presented with advanced prostate cancer prior to the start of long-term androgen deprivation therapy (ADT), in the control arm of the prospective randomised STAMPEDE trial. Patients were categorised into metastatic states as follows; high-risk non-metastatic with or without local lymph node involvement, or metastatic low/high volume. We followed up patients for a median of 7 years. Univariable and multivariable Cox survival models were fitted to estimate the association between the burden of copy number alteration as a continuous variable and the hazard of death or disease progression. Results The burden of copy number alterations positively associated with radiologically evident distant metastases at diagnosis (P=0.00006) and showed a non-linear relationship with clinical outcome on univariable and multivariable analysis, characterised by a sharp increase in the relative risk of progression (P=0.003) and death (P=0.045) for each unit increase, stabilising into more modest increases with higher copy number burdens. This association between copy number burden and outcome was similar in each metastatic state. Copy number loss occurred significantly more frequently than gain at the lowest copy number burden quartile (q=4.1 × 10−6). Loss of segments in chromosome 5q21-22 and gains at 8q21-24, respectively including CHD1 and cMYC occurred more frequently in cases with higher copy number alteration (for either region: Kolmogorov–Smirnov distance, 0.5; adjusted P

Introduction Adipokines may play a role in the early stages of rheumatoid arthritis. This study evaluated the performance of adipokines in a Colombian population with early rheumatoid arthritis and its relationship with disease activity. Material and methods A cross-sectional study evaluated serum adipokine levels (adiponectin, resistin, adipsin, vaspin, and leptin) in patients with early rheumatoid arthritis (eRA), evaluating demographic and clinical variables, along with a control group matched by age and gender. A factorial analysis was performed using principal components analysis (PCA), and a Spearman correlation analysis was performed. Similarly, a cut-off point for serum levels is proposed based on the receiver operating characteristic (ROC) curve between eRA and controls and sensitivity analysis. Results Fifty-one eRA subjects were included; there were 41 women. The body mass index (BMI) was 25.12 ±3.8. A statistically significant correlation was identified between adipsin, BMI, and RAPID3. Vaspin and leptin were correlated with BMI. Resistin levels were higher in patients with RAPID3 near remission (p = 0.041), and adiponectin, vaspin, and leptin levels were lower in patients with DAS28 ESR in remission (p = 0.033, p = 0.012, and p = 0.017, respectively). Principal components analysis in component 1 adipokines as adipsin and leptin with BMI and RAPID3 as disease activity index are grouped. Moreover, component 2 had a strong relation between ESR and CRP with an inverse correlation with cholesterol levels and vaspin. A cut-off point was established for each adipokine, thus identifying the best performance for leptin levels greater than 0.58 ng/ml with a sensitivity of 76.5% and specificity of 74.5%. Conclusions Adipokine levels are relevant in eRA, especially with disease activity indexes. Resistin levels were higher in patients with an activity index near remission. Otherwise, adiponectin, vaspin, and leptin levels were lower in patients with low activity indexes. RAPID3 correlated with adipsin. It is complementary to the previously published analysis of adipokines.

Abstract. Background:. Endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric emptying and accommodation. As these tools gain traction in obesity therapy, their physiologic underpinnings require exploration, which may enhance efficacy, tolerance, and patient-tailored care. Methods:. We prospectively assessed consecutive subjects with fluid-filled intragastric balloons (IGBs) (n = 18) placed between October 2016 and June 2017 or underwent endoscopic sleeve gastroplasty (ESG) (n = 23) from March 2018 to June 2018. Patients underwent physiologic appraisal at 3 months with 13C-spirulina-based gastric emptying breath test to determine time to half emptying (T50), as well as maximum tolerated volume (MTV) of a standard nutrient drink test. Changes in T50 and MTV at 3 months were compared with percent total body weight loss (%TBWL) at 3 and 6 months using best-fit linear regression. Results:. The change in T50 at 3 months correlated with %TBWL at 3 months for IGB (P = 0.01) and ESG (P = 0.01) but with greater impact on %TBWL in IGB compared to ESG (R2 = 0.42 vs. 0.26). Change in T50 at 3 months was predictive of weight loss at 6 months for IGB (P = 0.01) but not ESG (P = 0.11). ESG was associated with greater decrease in MTV compared to IGB (340.25 ± 297.97 mL vs. 183.00 ± 217.13 mL, P = 0.08), indicting an enhanced effect on satiation through decreased gastric accommodation. Changes in MTV at 3 months did not correlate with %TBWL for either IGB (P = 0.26) or ESG (P = 0.49) but trended toward significance for predicting %TBWL at 6 months for ESG (P = 0.06) but not IGB (P = 0.19). Conclusion:. IGB and ESG both induce weight loss but likely through distinct gastric motor function phenotypes, and gastric emptying may predict future weight loss in patients with IGB.

Objetivos. Evaluar y comparar la distribución de macronutrientes de las canastas alimentarias entregadas por las municipalidades peruanas durante la pandemia de COVID-19 según dominio geográfico y nivel de presupuesto asignado. Materiales y métodos. Análisis secundario de la base de datos «Consulta de adquisición y distribución de bienes de primera necesidad de la canasta básica familiar» de la Contraloría General de la República. Se realizó un muestreo probabilístico estratificado. Se calculó la distribución del aporte calórico según macronutrientes y se comparó con los intervalos aceptables de distribución de macronutrientes (IADM) del Instituto de Nutrición de Centro América y Panamá (INCAP) y del Instituto Nacional de Defensa Civil (INDECI). Resultados. A nivel nacional la mediana del aporte calórico de las proteínas fue 7,7%; carbohidratos 62,5%, y grasas 28,1%. La proporción de municipalidades con canastas con déficit de proteínas fue de 84%. Las municipalidades con canastas con exceso de carbohidratos variaron de 16,5% (según INCAP) a 35,9% (según INDECI) y con exceso de grasas fue 61,6 % (según INCAP) y 20,2% (según INDECI). Según INDECI, a nivel nacional solo el 9,2% de municipalidades entregaron canastas con distribución adecuada de macronutrientes, aquí destaca Lima Metropolitana con las proporciones más altas; mientras que en la selva este porcentaje fue menor del 5%. Conclusiones. La mayoría de las canastas entregadas no tuvieron distribución adecuada de macronutrientes, en especial las canastas de municipalidades fuera de Lima Metropolitana o las que contaban con menor presupuesto. Los carbohidratos y las grasas fueron los nutrientes que se incluyeron en exceso, mientras que las proteínas tuvieron déficit.

NK cells have usually been defined as cells of the innate immune system, although they are also involved in adaptative responses. These cells belong to the innate lymphocyte cells (ILC) family. They remove unwanted cells, tumoral cells and pathogens. NK cells are essential for viral infection clearance and are involved in tolerogenic responses depending on the dynamic balance of the repertoire of activating and inhibitory receptors. NK plasticity is crucial for tissue function and vigilant immune responses. They directly eliminate virus-infected cells by recognising viral protein antigens using a non-MHC dependent mechanism, recognising viral glycan structures and antigens by NCR family receptors, inducing apoptosis by Fas-Fas ligand interaction, and killing cells by antibody-dependent cell cytotoxicity via the FcγIII receptor. Activating receptors are responsible for the clearance of virally infected cells, while inhibitory KIR receptor activation impairs NK responses and facilitates virus escape. Effective NK memory cells have been described and characterised by a low NKG2A and high NKG2C or NKG2D expression. NK cells have also been used in cell therapy. In SARS-CoV-2 infection, several contradicting reports about the role of NK cells have been published. A careful analysis of the current data and possible implications will be discussed.

The objective of this study is to describe the frequency and the clinical, paraclinical, and treatment profile of patients with lupus psychosis in a Colombian cohort of patients with systemic lupus erythematosus (SLE). This retrospective cohort study evaluated epidemiological and clinical characteristics, results of neuroimaging, analysis of the cerebrospinal fluid, treatment, and disease evolution in patients with lupus psychosis. Among 2,479 patients with SLE, six female patients aged between 20 and 50 years with a diagnosis of lupus psychosis were identified. In two patients, psychosis was present at disease onset and in the other four, SLE was already present, although the majority of them were diagnosed less than two years prior to the onset of psychosis. The entire cohort had high disease activity as measured by SLEDAI-2K. We found concomitant cutaneous, joint, and hematological alterations. Cerebrospinal fluid data were obtained in half of the patients and were normal. We performed brain tomography on most of our patients, which was almost always described as normal. In 5 out of 6 patients, the induction therapy to treat psychosis was based on steroids, and in the majority of them, a resolution of psychiatric symptoms was observed after initiating treatment. Lupus psychosis is a rare event that usually occurs early in the course of the disease and is associated with other manifestations of SLE. This investigation mainly found concomitant cutaneous, joint, and hematological manifestations, with a favorable outcome after treatment, as described in the literature.

The niche comprises the set of abiotic and biotic environmental conditions in which a species can live. Consequently, those species that present broader niches are expected to be more tolerant to changes in climatic variations than those species that present reduced niches. In this study, we estimate the amplitude of the climatic niche of fourteen species of rattlesnakes of the genus Crotalus to evaluate whether those species that present broader niches are less susceptible to the loss of climatically suitable zones due to the projected climate change for the time period 2021–2040. Our results suggest that for the species under study, the breadth of the niche is not a factor that determines their vulnerability to climatic variations. However, 71.4% of the species will experience increasingly inadequate habitat conditions, mainly due to the increase in temperature and the contribution that this variable has in the creation of climatically suitable zones for most of these species.

The opioid epidemic has emerged as a major health and social problem over the last few decades. An increasing number of patients with opioid use disorder are presenting for perioperative management. These patients are either on buprenorphine or methadone for the maintenance and treatment of opioid addiction or chronic pain. In the settings of acute pain, the optimal management of patients with opioid use disorder is challenging, and recovery can be jeopardized secondary to the unique pharmacology of these agents. The purpose of this narrative review is to summarize the existing studies on the perioperative management of patients who are using buprenorphine and methadone and provide guidance for the management of patients with opioid use disorder during the perioperative period.

Introduction: Discarded vehicle tires represent a serious threat both to the environment and to public health as they have the potential to harbor important mosquito (Diptera: Culicidae) vectors. Objective: To assess the importance of used vehicle tires as larval habitats for mosquito fauna that colonize these artificial reservoirs in Jarabacoa, Dominican Republic. Materials and methods: Used tires were sampled with pipettes at specialized tire fitting shops and scattered stockpiles of tires between June and August, 2018. Results: We sampled 396 tires; 57 (Container Index=14.4%) were positive for immature stages and contained 2,400 specimens, 11 species, and four genera (Anopheles, Aedes, Culex, and Toxorhynchites). The most abundant species was Aedes albopictus (42.3%) followed by Aedes aegypti (34.3%), and Culex quinquefasciatus (14.0%) while other species (9.4%) were less abundant. The container index varied significantly among the different tire sizes (χ2=13.4; p≤0.05). The highest infestation levels were found in the largest tires. A low positive correlation (r=0.38, n=396; p≤0.001) between the tire size and the prevalence of immature stages was recorded. The presence of organic matter had an overall positive effect on the infestation levels (U=11,430.0; p≤0.001). Conclusions: These rubber residues, usually located nearby human populations, represent suitable breeding sites for arboviruses vectors such as dengue, chikungunya, Zika, and West Nile.

Objectives: To evaluate the predictive capacity of gestational weight gain recommendations regarding low birth weight (LBW) and neonatal macrosomia, proposed by the Institute of Medicine (IOM) and the Latin American Center of Perinatology (CLAP). Materials and methods: The bibliographic search was performed in PubMed, Embase (via Ovid), Cochrane Library, EBSCOhost, Scopus, LILACS and SciELO. Methodological quality was evaluated using QUADAS 2. Results: A total of 1,192 articles were identified, only 5 articles met the inclusion criteria, no study evluated the CLAP recomendations. Sensitivity and specificity to predict LBW and macrosomia varied widely depending on which country the study took place. In the Latin American cohorts, the sensitivity for predicting LBW ranged from 62.8% to 74% and the specificity from 61.7% to 68%, while the sensitivity for predicting macrosomia was 28.8% and the specificity 43.8%. In most studies the positive predictive value was less than 25%, and the negative predictive value was more than 90%. Most studies had high risk of bias and applicability problems in patient selection. Conclusions: The limited methodological quality and representativeness of the studied cohorts, probable unadjusted confounding factors and modest values of sensitivity and specificity suggest the need to develop studies aimed at providing recommendations that fit the epidemiological characteristics of the Peruvian population.

Resumen: Introducción-objetivos: Vivimos tiempos excepcionales inmersos en la pandemia causada por el nuevo coronavirus SARS-CoV-2. Aunque tanto la afectación clínica pediátrica como de pacientes con cardiopatías congénitas son infrecuentes, la atención prioritaria de los adultos COVID-19 prácticamente ha colapsado nuestro sistema sanitario. En consecuencia, toda actividad habitual se ha minimizado durante este período. En este trabajo analizamos la reducción de nuestra cirugía de CC durante estos 2 meses de estado de alerta sanitaria y proponemos estrategias de vuelta a la normalidad. Métodos: Desde el grupo de trabajo de cardiopatías congénitas de nuestra Sociedad se realizó una encuesta en los servicios de congénitas de nuestro país para conocer la disminución de actividad causada por la pandemia COVID-19 en el período temporal del 13 de marzo hasta el 13 de mayo de 2020. Resultados: Durante la pandemia se ha disminuido parcialmente la cirugía de congénitas, interviniéndose los casos más urgentes y reduciéndose al mínimo la actividad programada. Respecto al mismo período del año anterior, se ha operado un 51% menos cirugía mayor y 54% menos extracorpóreas. La colaboración en la atención directa de adultos COVID-19 ha sido del 15%, con el 7% de nuestros cirujanos de baja. Antes de operar a cualquier paciente solicitamos PCR para descartar infección por SARS-CoV-2, y si esta es positiva solo consideramos intervención en los casos urgentes/emergentes. Conclusiones: La pandemia del SARS-CoV-2 ha obligado a todos los servicios de congénitas del país a reestructurarse para apoyar a los compañeros con tratamiento directo del COVID-19, sin mermar la atención de nuestros propios pacientes cuya cirugía no podía demorarse. Abstract: Introduction-objectives: We live in exceptional times caused by the new SARS-CoV-2 coronavirus pandemic. Although clinical involvement of children and patients with congenital heart disease are not frequent, the emergency care of adults with COVID-19 has almost collapsed our healthcare system. Consequently, the whole standard activity has been minimized during this period. In this manuscript we analyse the reduction of our congenital heart surgery over these 2 months of state of alarm, and we propose strategies to return to normal. Methods: From our Society congenital heart disease working group, a survey was carried out in Spanish congenital heart disease surgery hospitals, in order to find out the decrease in activity caused by the COVID-19 pandemic during the time period from March-13 to May-13, 2020. Results: During the pandemic, congenital heart disease surgery was partially reduced, stepping with the most urgent cases and minimizing the scheduled activity. Compared to the same period in 2019, 51% less major surgery and 54% less extracorporeal surgery were performed. Collaboration in adults COVID-19 front line care has been 15%, having 7% of our specialists on quarantine. Before operating on any patient, the PCR is asked to rule out SARS-CoV-2 infection and, if positive, we only consider intervention in urgent / emergency cases. Conclusions: The SARS-CoV-2 pandemic has forced all the congenital heart disease services nationwide to restructure, aiming to support colleagues with direct treatment of COVID-19, without sacrificing the healthcare of our own patients whose surgery could not be delayed.

Arterial dissections are uncommon in neonates. Complications include thrombosis, bleeding, dissection, aneurysm and pseudoaneurysm. We report an unusual case of multisite pathology (dissection and pseudoaneurysm) following common vascular interventions. A term neonate with antenatal diagnosis of congenital heart block secondary to maternal lupus deteriorated clinically at 5 days of life. He was found to have an abdominal aortic thrombus secondary to abdominal aortic dissection, following umbilical arterial catheter placement. Attempted percutaneous treatment was complicated by dissection of the left common carotid artery and formation of a large pseudoaneurysm. Neonatal lupus is associated with weakened vessel wall which may be vulnerable to injury from line placement and endovascular interventions. Various options are available to manage arterial dissection, thrombus, and pseudoaneurysm, but consequences of these options need to be carefully weighed to minimize further complications.

During 2016–2018, we conducted surveillance for Japanese encephalitis virus (JEV) in mosquitoes and pigs in Japan, Thailand, the Philippines, and Indonesia. Phylogenetic analyses demonstrated that our isolates (genotypes Ia, Ib, III, IV) were related to JEV isolates obtained from the same regions many years ago. Indigenous JEV strains persist in Asia.

Cold temperature is prevalent across the biosphere and slows the rates of chemical reactions. Increased catalysis has been predicted to be a dominant adaptive trait of enzymes to reduced temperature, and this expectation has informed physical models for enzyme catalysis and influenced bioprospecting strategies. To systematically test rate enhancement as an adaptive trait to cold, we paired kinetic constants of 2223 enzyme reactions with their organism’s optimal growth temperature (TGrowth) and analyzed trends of rate constants as a function of TGrowth. These data do not support a general increase in rate enhancement in cold adaptation. In the model enzyme ketosteroid isomerase (KSI), there is prior evidence for temperature adaptation from a change in an active site residue that results in a tradeoff between activity and stability. Nevertheless, we found that little of the rate constant variation for 20 KSI variants was accounted for by TGrowth. In contrast, and consistent with prior expectations, we observed a correlation between stability and TGrowth across 433 proteins. These results suggest that temperature exerts a weaker selection pressure on enzyme rate constants than stability and that evolutionary forces other than temperature are responsible for the majority of enzymatic rate constant variation.

The wavelength-dependent photo-reactivity of polyanthracene was explored upon UV-C and VIS light irradiation. The material was prepared via one-pot chemical oxidation route using FeCl3 as oxidizing agent. A decrease in surface hydrophobicity of a polyanthracene-coated poly(methylmethacrylate) substrate from 109.11° to 60.82° was observed upon UV-C exposure for 48 hrs which was attributed to increase in oxygen content at the surface, as validated by energy dispersive X-ray spectroscopy. Upon exposure to ultraviolet-visible LEDs, photo-dimerization of polyanthracene in solution occurred and was monitored using UV-VIS spectroscopy. The photo-dimer product formation decreased from 381 nm to 468 nm and was found to be higher for the polyanthracene material compared to the monomer anthracene. At 381 nm, photo-dimerization of the material was found to be approx. 4x more efficient than the non-substituted monomer counterpart. Results obtained show that photo-dimerization of polyanthracene will proceed upon exposure with visible light LEDs with reduction in efficiency at longer wavelengths. To compensate, irradiation power of the light source and irradiation time were increased.

Exosomes are cell-derived vesicles that present attractive characteristics such as nano size and unique structure for their use as drug delivery systems for drug therapy, biomarkers for prognostic, diagnostic and personalized treatments. So far, one of the major challenges for therapeutic applications of exosomes is the development of optimized isolation methods. In this context, aqueous two-phase systems (ATPS) have been used as an alternative method to isolate biological molecules and particles with promising expectations for exosomes. In this work, fractionation of exosomes obtained from CaCo2 cell line and culture media contaminants were individually performed in 20 polymer-polymer ATPS. The effect of design parameters such as polymer composition, molecular weight, and tie-line length (TLL) on polyethylene glycol (PEG)-Dextran, Dextran-Ficoll and PEG-Ficoll systems was studied. After partition analysis, 4 of the 20 systems presented the best exosome fractionation from contaminants under initial conditions, which were optimized via salt addition (NaCl) to a final concentration of 25 mM, to improve collection efficiency. The PEG 10,000 gmol-1 -Dextran 10,000 gmol-1 system at TLL 25% w/w with NaCl, showed the best potential isolation efficiency. Following this proposed strategy, an exosome purification factor of 2 in the top PEG-rich phase can be expected furtherly demonstrating that ATPS have the potential for the selective recovery of these promising nanovesicles.

Varón de 53 años, obeso y exfumador de 20 cig./día, sin otros antecedentes de interés. Acude en numerosas ocasiones a nuestro Servicio de Urgencias por disnea, que comienza con los esfuerzos y se intensifica progresivamente hasta hacerse de reposo. Como único hallazgo, aparece en su estudio un patrón intersticial bilateral de predominio periférico que plantea diversas dudas diagnósticas. Finalmente, un mes después de llegar al diagnóstico definitivo, adenocarcinoma de pulmón con linfagitis carcinomatosa, el paciente falleció.

Varón de 67 años que consulta en Urgencias por disnea, tos seca y astenia de un mes de duración. Sin antecedentes personales, salvo tratamiento crónico con Apixaban y Amiodarona (200 mg/día) por fibrilación auricular desde hace un año. Tras historia clínica, hallazgos radiológicos y otras pruebas complementarias, se sospecha neumonía por toxicidad secundaria a Amiodarona. Se inició corticoterapia y se retiró el fármaco, con importante mejoría clínico-radiológica, así como en las pruebas funcionales respiratorias.

Mujer de 72 años en seguimiento por esclerosis sistémica. Evolución favorable hasta que comienza con clínica de disnea de rápida progresión, descartándose evolución de hipertensión pulmonar y otras comorbilidades como cardiopatías, infecciones o EPID. El análisis de la evolución funcional espirométrica resulta clave para la sospecha de patología obstructiva intratorácica. Se diagnostica de estenosis subglótica mediante broncoscopia, precisando cirugía a nivel traqueal con importante mejoría clínica.

Resumen: La Sociedad Española de Cirugía Torácica-Cardiovascular presenta los resultados de nuestra actividad en pacientes con cardiopatía congénita correspondientes al período 2012-2018 basado en un registro voluntario y anónimo de los centros españoles. Este artículo es complementario al registro general del año 2018 y se publican ambos conjuntamente. Se analizan datos de los últimos 7 años, que muestran una impresión más real de nuestra actividad en estas patologías relativamente infrecuentes. Un total de 15.049 cirugías de cardiopatías congénitas se hicieron en este período, que supone un 9,87% de la cirugía mayor (congénita + adquirida) realizada en nuestro país durante ese tiempo. De estas 15.049 cirugías, 80% se hicieron con circulación extracorpórea y 20% sin ella. Destacamos las intervenciones en neonatos y en adultos por su elevada complejidad, que supusieron respectivamente un 18% y 21% de la actividad total. Las cardiopatías congénitas operadas más prevalentes continúan siendo los defectos septales en los casos que requieren circulación extracorpórea, y los ductus en pacientes operados sin circulación extracorpórea. Presentamos los datos ajustados a la escala Aristóteles básico de riesgo quirúrgico preoperatorio. La mortalidad observada en cirugías con circulación extracorpórea fue 3,12% (Aristóteles-6,72), y en cirugías sin circulación extracorpórea 2,43% (Aristóteles-4,83). Este registro muestra con precisión datos de nuestra actividad quirúrgica en cardiopatías congénitas, y permite comparaciones tanto a nivel nacional como internacional, para establecer estrategias de mejora de nuestros resultados. Abstract: The Spanish Society of Thoracic-Cardiovascular Surgery presents the 2012-2018 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving the majority of Spanish centres. This article is complementary to the 2018 cardiovascular surgery annual report, and they are published together. We included data from the previous 7 years, in order to obtain real information related to our activity in these relatively scarce pathologies. In the last seven years, a total of 15049 congenital heart defect surgeries were performed, accounting for 9.87% of major surgery (congenital + acquired) performed in Spain during that period. Of these 15049 surgeries, 80% of them required extracorporeal circulation and 20% not. Due to its high complexity, we highlight the interventions in neonates and adult patients, which represent respectively 18% and 21% of the whole activity. The most prevalent congenital heart pathologies operated on were septal defects in cases requiring extracorporeal circulation, and ductus in patients not requiring extracorporeal circulation. The data are presented adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.12% (Aristotle-6.72), and without cardiopulmonary bypass 2.43% (Aristotle-4.83). This data analysis shows accurate and reliable information about our surgery for congenital heart disease and allows us to compare ourselves within an international framework, and to organize strategies directed to improve our results. Palabras clave: Cirugía cardiovascular, Cardiopatías congénitas, Registro, España, Keywords: Cardiovascular surgery, Congenital heart disease, Registry, Spain

El diagnóstico oportuno de malaria es una estrategia propuesta por la Organización Mundial de la Salud para reducir la morbimortalidad por esta enfermedad. Se realizó un estudio con el objetivo de evaluar el desempeño en el diagnóstico microscópico de malaria en la red de laboratorios pertenecientes al Laboratorio de Referencia Nacional de Malaria del Instituto Nacional de Salud entre 2012 y 2017. En los años de estudio, los laboratorios tuvieron la calificación de aceptable en el diagnóstico de Plasmodium en un 38,4%, 43,7%, 60,0%, 83,3%, 90,9% y 95,8%, respectivamente; en la evaluación de especie en un 0%, 6,2%, 15,0%, 50,0%, 40,9% y 54,1%, respectivamente; en la evaluación de estadio en un 23,0%, 25,0%, 35,0%, 83,3%, 54,5% y 79,1%, respectivamente; y en la evaluación de densidad parasitaria en un 0%, 6,2%, 10,0%, 33,3%, 0% y 12,5%, respectivamente. Concluimos que en el periodo evaluado se incrementó el porcentaje de laboratorios que diagnosticaron, reconocieron la especie y estadio, mas no el reconocimiento de densidad parasitaria.

Resumen: La realización exitosa de una cirugía combinada de reparación de una cardiopatía congénita y trasplante pulmonar ha sido descrita raramente. Presentamos el caso de un paciente pediátrico con hipertensión pulmonar grave y cardiopatía congénita al que se le realizó un trasplante pulmonar bilateral combinado con corrección de su cardiopatía. Un año tras la cirugía el paciente se encuentra asintomático y en excelente clase funcional. Específicamente nos centramos en describir el protocolo y la técnica quirúrgica empleados en el procedimiento. Hasta donde sabemos, este podría ser el primer caso de estas características realizado con éxito en nuestro medio. Abstract: Successful completion of the combined repair of congenital heart disease and lung transplant has been rarely reported. The case is presented of a paediatric patient with severe pulmonary hypertension and congenital heart disease, who had a bilateral lung transplant combined with repair of his congenital heart defect. One year after surgery, the patient is asymptomatic and in excellent functional class. Specifically, focus was made on the surgical protocol and technique used to undertake the procedure. As far as we know, this could be the first case of its kind successfully carried out in our country. Palabras clave: Trasplante pulmonar, Hipertensión pulmonar grave, Cardiopatía congénita, Keywords: Lung transplant, Severe pulmonary hypertension, Congenital heart disease

Abstract Background Little is known about the effects of chemotherapeutic drugs on DNA methylation status of leukocytes, which may be predictive of treatment benefits and toxicities. Based on a prospective national study, we characterize the changes in leukocyte DNA methylome from pre- to post-chemotherapy (approximately 4 months apart) in 93 patients treated for early stage breast cancer and 48 matched non-cancer controls. We further examined significant methylation changes with perceived cognitive impairment, a clinically significant problem related to cancer and chemotherapy. Results Approximately 4.2% of the CpG sites measured using the Illumina 450K methylation array underwent significant changes after chemotherapy (p

Resumen: La cirugía cardiovascular es la especialidad médica que se ocupa de la prevención, diagnóstico y tratamiento quirúrgico de los trastornos y enfermedades del sistema cardiocirculatorio. Los continuos y rápidos avances en el diagnóstico y tratamiento de las enfermedades cardiovasculares justifican la necesidad de llevar a cabo una actualización de los principales aspectos definitorios y organizativos de la especialidad, relacionados con la profesión (de la práctica, calidad asistencial), con el programa docente de la especialidad, la formación continuada de los cirujanos, los procesos de acreditación desde la Sociedad Española de Cirugía Torácica-Cardiovascular, entre otros.Este documento, elaborado por expertos de la cirugía cardiovascular, representa la opinión de la Sociedad Española de Cirugía Torácica-Cardiovascular y actualiza los principales aspectos de la especialidad en nuestro país. Abstract: Cardiovascular surgery is the medical specialty that deals with the prevention, diagnosis, and surgical treatment of disorders and diseases of the circulatory system. The continuous and rapid advances in the diagnosis and treatment of cardiovascular diseases justify the need to update the main, defining, and organisational aspects of the specialty, related to the profession (its practice, quality care), aspects on the teaching program of the specialty, the continuing education program of the surgeons, the processes of accreditation from the Spanish Society of Thoracic-Cardiovascular Surgery, etc.This document, prepared by experts in cardiovascular surgery, represents the opinion of the Spanish Society of Thoracic-Cardiovascular surgery and updates the main aspects of the specialty in our country. Palabras clave: Cirugía cardiovascular, Cirugía cardíaca, Cirugía torácica, Cirugía vascular, Recomendaciones, Keywords: Cardiovascular surgery, Cardiac surgery, Thoracic surgery, Vascular surgery, Recommendations

Introducción. El consumo de sustancias psicoactivas (SPA) es una problemática que afecta a estudiantes desde edades tempranas. Objetivo. Describir las etapas de cambio de comportamiento frente al consumo de SPA en escolares de Bogotá D.C., Colombia. Materiales y métodos. Estudio transversal en 6 965 escolares de Bogotá D.C. El cambio de comportamiento se evaluó por autoreporte a través de un cuestionario estructurado a partir del Modelo Transteórico en las etapas de precontemplación, contemplación, preparación y acción/mantenimiento. Resultados. 58.4% fueron mujeres con edad promedio de 12.7±2.3 años. Frente al consumo de drogas alucinógenas, 6% de los escolares se ubicaron en la categoría de precontemplación, 44% en contemplación, 30% en preparación y 20% en acción/mantenimiento. Respecto al consumo de alcohol, 5% se encontraban en precontemplación, 36% en contemplación, 12% en preparación y 46% en acción/mantenimiento. El tabaquismo mostró prevalencias de 4% para precontemplación, 33% para contemplación, 12% para preparación y 51% para acción/mantenimiento. Conclusiones. El consumo de SPA es una problemática que se presenta cada vez con mayor frecuencia en población escolar. La mayoría de entrevistados se ubican en etapa de mantenimiento en el consumo de tabaco y alcohol y en la etapa de contemplación de consumo de drogas alucinógenas. Se requieren esfuerzos gubernamentales que fomenten programas preventivos de consumo de SPA en el ámbito escolar.

Abstract Interpretation of variants of unknown significance (VUS) in genetic tests is complicated in ethnically diverse populations, given the lack of information regarding the common spectrum of genetic variation in clinically relevant genes. Public availability of data obtained from high-throughput genotyping and/or exome massive parallel sequencing (MPS)-based projects from several thousands of outbred samples might become useful tools to evaluate the pathogenicity of a VUS, based on its frequency in different populations. In the case of the Mexican and other Latino populations, several thousands of samples have been genotyped or sequenced during the last few years as part of different efforts to identify common variants associated to common diseases. In this report, we analyzed Mexican population data from a sample of 3985 outbred individuals, and additional 66 hereditary breast cancer patients were analyzed in order to better define the spectrum of common genomic variation of the BRCA1 and BRCA2 genes. Our analyses identified the most common genetic variants in these clinically relevant genes as well as the presence and frequency of specific pathogenic mutations present in the Mexican population. Analysis of the 3985 population samples by MPS identified three pathogenic mutations in BRCA1, only one population sample showed a BRCA1 exon 16–17 deletion by MLPA. This resulted in a basal prevalence of deleterious mutations of 0.10% (1:996) for BRCA1 and 11 pathogenic mutations in BRCA2, resulting in a basal prevalence of deleterious mutations of 0.276% (1:362) for BRCA2, combined of 0.376% (1:265). Separate analysis of the breast cancer patients identified the presence of pathogenic mutations in 18% (12 pathogenic mutations in 66 patients) of the samples by MPS and 13 additional alterations by MLPA. These results will support a better interpretation of clinical studies focused on the detection of BRCA mutations in Mexican and Latino populations and will help to define the general prevalence of deleterious mutations within these populations.

(1) Background: Although the evidence is consistent that vaccines for COVID-19 effectively prevent severe illness or death, the rapid development of vaccines has led to increased beliefs about possible negative consequences and conspiracy theories about the vaccine. Several factors influence whether or not people decide to be vaccinated. Some studies suggest that our perception of what significant others do and think influences our behavior. (2) Methods: This study evaluates the predictive role of beliefs about negative consequences of the COVID-19 vaccine, conspiracy beliefs about this vaccine, and social influence on the intention to vaccinate against COVID-19 in three Latin American and Caribbean countries: Chile, Mexico, and Colombia. Using convenience sampling, 2075 adults from Chile (48.3%), Mexico (27.6%), and Colombia (24.6%) participated by answering an online questionnaire with variables of interest. (3) Results: Despite the differences between countries, the results showed that the proposed model is invariant and explains between 56–66% of the COVID-19 vaccination intent. Specifically, controlling for age, socioeconomic status, political orientation, and educational level, we found that beliefs about the negative consequences of the COVID-19 vaccine were the main predictor followed by social influence. Beliefs in conspiracy theories did not predict vaccination intention (4) Conclusions: Considering these variables in campaigns to boost vaccination intention is discussed.

Patients with pacemakers need regular follow-ups which are demanding. Telemonitoring for pacemaker can provide a new opportunity to avoid follow-up visits. On the other hand, in-person visits could help patients with pacemakers to cope better with the anxiety linked to their condition and maintain better communication with their doctors than simple remote control of their device status. Therefore, our objective was to analyze the experiences and communication comparing telemonitoring (TM) versus conventional monitoring (CM) of patients with pacemakers. A single-center, controlled, non-randomized, non-blinded clinical trial was designed. Data were collected five years after implantation in a cohort of 89 consecutive patients assigned to two different groups: TM and CM. The 'Generic Short Patient Experiences Questionnaire' (GS-PEQ) was used to assess patients' experiences, and the Healthcare Communication Questionnaire (HCCQ) was used to measure the communication of patients with healthcare professionals. Additionally, an ad-hoc survey including items from the 'Telehealth Patient Satisfaction Survey' and a 'costs survey' was used. After five years, 55 patients completed the study (TM = 21; CM = 34). Participants' mean (±SD) age was 81 (±6.47), and 31% were females. No differences in baseline characteristics between groups were found. The comparative analyses TM versus CM showed some significant differences. According to GS-PEQ, TM users received adequate information about their diagnosis or afflictions (p = .035) and the treatment was better adapted to their situation (p = .009). Both groups reported negative experiences regarding their involvement in their treatment decisions, the waiting time before admission, and perceived a low-benefit. According to HCCQ, the TM group experienced poorer consultation management by the healthcare provider (p = .041). Participants reported positive overall communication experiences. The study provides insights into the experiences and communication in PM monitoring services as well as specific areas where users reported negative experiences such as the consultation management by clinicians. Trial registration: ClinicalTrials.gov NCT02234245.

IntroductionImplementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare.Materials and methodsQuasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status.Results550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained.ConclusionsTraining using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.

Objective The COVID-19 pandemic has set unprecedented demand on the healthcare workforce around the world. The UK has been one of the most affected countries in Europe. The aim of this study was to explore the perceptions and experiences of healthcare workers (HCWs) in relation to COVID-19 and care delivery models implemented to deal with the pandemic in the UK.Methods The study was designed as a rapid appraisal combining: (1) a review of UK healthcare policies (n=35 policies), (2) mass media and social media analysis of front-line staff experiences and perceptions (n=101 newspaper articles, n=1 46 000 posts) and (3) in-depth (telephone) interviews with front-line staff (n=30 interviews). The findings from all streams were analysed using framework analysis.Results Limited personal protective equipment (PPE) and lack of routine testing created anxiety and distress and had a tangible impact on the workforce. When PPE was available, incorrect size and overheating complicated routine work. Lack of training for redeployed staff and the failure to consider the skills of redeployed staff for new areas were identified as problems. Positive aspects of daily work reported by HCWs included solidarity between colleagues, the establishment of well-being support structures and feeling valued by society.Conclusion Our study highlighted the importance of taking into consideration the experiences and concerns of front-line staff during a pandemic. Staff working in the UK during the COVID-19 pandemic advocated clear and consistent guidelines, streamlined testing of HCWs, administration of PPE and acknowledgement of the effects of PPE on routine practice.

Advances in DNA sequencing have revolutionized our ability to read genomes. However, even in the most well-studied of organisms, the bacterium Escherichia coli, for ≈65% of promoters we remain ignorant of their regulation. Until we crack this regulatory Rosetta Stone, efforts to read and write genomes will remain haphazard. We introduce a new method, Reg-Seq, that links massively parallel reporter assays with mass spectrometry to produce a base pair resolution dissection of more than a E. coli promoters in 12 growth conditions. We demonstrate that the method recapitulates known regulatory information. Then, we examine regulatory architectures for more than 80 promoters which previously had no known regulatory information. In many cases, we also identify which transcription factors mediate their regulation. This method clears a path for highly multiplexed investigations of the regulatory genome of model organisms, with the potential of moving to an array of microbes of ecological and medical relevance.

Introduction The social issue in Chile stems from an accumulation of social problems resulting from the migratory movements of the countryside-city and mining areas. The cities did not have the hygienic conditions necessary to receive migrants, which caused housing and health problems within the population. Objective To analyze the problems of housing, hygiene, and health in Chile between 1880-1920. Method We conduct a qualitative, analytical, and interpretive study using primary sources for the categories of analysis around housing, hygiene, and health of the following cities in Chile: Santiago, Valparaíso, Concepción and Chillán. Results The economic modernization led to the development of public works in the main cities of Chile, which also experienced a demographic phenomenon known as field-city migration, with urban growth never before seen. In the cities, there were problems of housing, hygiene, and health for the popular urban sectors. Conclusion The State passed laws to regulate the conditions of the conventillos and public spaces to mitigate diseases and vices of the population.

Genomic surveillance is an important aspect of contemporary disease management but has yet to be used routinely to monitor endemic disease transmission and control in low- and middle-income countries. Rabies is an almost invariably fatal viral disease that causes a large public health and economic burden in Asia and Africa, despite being entirely vaccine preventable. With policy efforts now directed towards achieving a global goal of zero dog-mediated human rabies deaths by 2030, establishing effective surveillance tools is critical. Genomic data can provide important and unique insights into rabies spread and persistence that can direct control efforts. However, capacity for genomic research in low- and middle-income countries is held back by limited laboratory infrastructure, cost, supply chains and other logistical challenges. Here we present and validate an end-to-end workflow to facilitate affordable whole genome sequencing for rabies surveillance utilising nanopore technology. We used this workflow in Kenya, Tanzania and the Philippines to generate rabies virus genomes in two to three days, reducing costs to approximately £60 per genome. This is over half the cost of metagenomic sequencing previously conducted for Tanzanian samples, which involved exporting samples to the UK and a three- to six-month lag time. Ongoing optimization of workflows are likely to reduce these costs further. We also present tools to support routine whole genome sequencing and interpretation for genomic surveillance. Moreover, combined with training workshops to empower scientists in-country, we show that local sequencing capacity can be readily established and sustainable, negating the common misperception that cutting-edge genomic research can only be conducted in high resource laboratories. More generally, we argue that the capacity to harness genomic data is a game-changer for endemic disease surveillance and should precipitate a new wave of researchers from low- and middle-income countries.

Genomic surveillance is an important aspect of contemporary disease management but has yet to be used routinely to monitor endemic disease transmission and control in low- and middle-income countries. Rabies is an almost invariably fatal viral disease that causes a large public health and economic burden in Asia and Africa, despite being entirely vaccine preventable. With policy efforts now directed towards achieving a global goal of zero dog-mediated human rabies deaths by 2030, establishing effective surveillance tools is critical. Genomic data can provide important and unique insights into rabies spread and persistence that can direct control efforts. However, capacity for genomic research in low- and middle-income countries is held back by limited laboratory infrastructure, cost, supply chains and other logistical challenges. Here we present and validate an end-to-end workflow to facilitate affordable whole genome sequencing for rabies surveillance utilising nanopore technology. We used this workflow in Kenya, Tanzania and the Philippines to generate rabies virus genomes in two to three days, reducing costs to approximately £60 per genome. This is over half the cost of metagenomic sequencing previously conducted for Tanzanian samples, which involved exporting samples to the UK and a three- to six-month lag time. Ongoing optimization of workflows are likely to reduce these costs further. We also present tools to support routine whole genome sequencing and interpretation for genomic surveillance. Moreover, combined with training workshops to empower scientists in-country, we show that local sequencing capacity can be readily established and sustainable, negating the common misperception that cutting-edge genomic research can only be conducted in high resource laboratories. More generally, we argue that the capacity to harness genomic data is a game-changer for endemic disease surveillance and should precipitate a new wave of researchers from low- and middle-income countries.

In spite of the widespread use of electronic cigarettes, also known as e-cigarettes, and the proposed adverse cardiac effects of nicotine, the detrimental effects of e-cigarettes on the heart are not well known. This study examines the detrimental effects of e-cigarettes with nicotine at doses that yield circulating nicotine and cotinine in the ranges similar to the levels found in habitual smokers, and a high fat diet (HFD) on cardiac structure and function in a commonly used model of diet-induced obesity (DIO). C57BL/6J mice on an HFD were exposed to e-cigarette in the presence (2.4% nicotine) or absence (0% nicotine) of nicotine and saline aerosol for 12 weeks. Echocardiographic data demonstrated a decrease in left ventricular (LV) fractional shortening, LV ejection fraction, and velocity of circumferential fiber shortening (VCF) in mice treated with e-cigarette (2.4% nicotine) compared to e-cigarette (0% nicotine) or saline exposed mice. Cardiomyocytes (CMs) of mice treated with e-cigarette (2.4% nicotine) exhibited LV abnormalities, including lipid accumulation (ventricular steatosis), myofibrillar derangement and destruction, and mitochondrial hypertrophy, as revealed by transmission electron microscopy. The detrimental effects of e-cigarettes (2.4% nicotine) on cardiac structure and function was accompanied by increased oxidative stress, plasma free fatty acid levels, CM apoptosis, and inactivation of AMP-activated protein kinase and activation of its downstream target, acetyl-CoA-carboxylase. Our results indicate profound adverse effects of e-cigarettes (2.4% nicotine) on the heart in obese mice and raise questions about the safety of the nicotine e-cigarettes use.

The vaccines designed against the SARS-CoV-2 coronavirus are based on the spike (S) protein. Processing of the S protein by antigen-presenting cells (APC) and its subsequent presentation to T cells is an essential part of the development of a humoral response. HLA-class II alleles are considered immune response genes because their codified molecules, expressed on the surface of APCs (macrophages, dendritic, and B cells) present antigenic peptides to T cell via their T cell receptor (TCR). The HLA-class II genes are highly polymorphic, regulating what specific peptides induce follicular helper T cells (TFH) and promote B lymphocyte differentiation into plasma or memory B cells. This work hypothesizes that the presence of certain HLA-class II alleles could be associated with the intensity of the humoral response (amount, length) to the SARS-CoV2 mRNA 1273 vaccine. We have studied the relationship between the HLA-class II typing of 87 health workers and the level of antibodies produced 30 days after vaccination. We show a possible association between the HLA-DRB1* 07:01 allele and the HLA-DRB1*07:01~DQA1*02:01~DQB1*02:02 haplotype to a higher production of antibodies 30 days after the administration of the second dose of mRNA-1273.

Climate change is causing detrimental changes in living organisms, including pathogens. This review aimed to determine how climate change has impacted livestock system management, and consequently, what factors influenced the gastrointestinal nematodes epidemiology in small ruminants under tropical conditions. The latter is orientated to find out the possible solutions responding to climate change adverse effects. Climate factors that affect the patterns of transmission of gastrointestinal parasites of domesticated ruminants are reviewed. Climate change has modified the behavior of several animal species, including parasites. For this reason, new control methods are required for controlling parasitic infections in livestock animals. After a pertinent literature analysis, conclusions and perspectives of control are given.

Upon publication of the original article [1], the authors noticed that the Figs. 1, 2 and 3 were incorrectly given.

Abstract Triple-negative breast cancer (TNBC) has been clinically difficult to manage because of tumor aggressiveness, cellular and histological heterogeneity, and molecular mechanisms’ complexity. All this in turn leads us to evaluate that tumor biological behavior is not yet fully understood. Additionally, the heterogeneity of tumor cells represents a great biomedicine challenge in terms of the complex molecular—genetical-transcriptional and epigenetical—mechanisms, which have not been fully elucidated on human solid tumors. Recently, human breast cancer, but specifically TNBC is under basic and clinical-oncology research in the discovery of new molecular biomarkers and/or therapeutic targets to improve treatment responses, as well as for seeking algorithms for patient stratification, seeking a positive impact in clinical-oncology outcomes and life quality on breast cancer patients. In this sense, important knowledge is emerging regarding several cancer molecular aberrations, including higher genetic mutational rates, LOH, CNV, chromosomal, and epigenetic alterations, as well as transcriptome aberrations in terms of the total gene-coding ribonucleic acids (RNAs), known as mRNAs, as well as non-coding RNA (ncRNA) sequences. In this regard, novel investigation fields have included microRNAs (miRNAs), as well as long ncRNAs (lncRNAs), which have been importantly related and are likely involved in the induction, promotion, progression, and/or clinical therapeutic response trackers of TNBC. Based on this, in general terms according with the five functional archetype classification, the lncRNAs may be involved in the regulation of several molecular mechanisms which include genetic expression, epigenetic, transcriptional, and/or post-transcriptional mechanisms, which are nowadays not totally understood. Here, we have reviewed the main dis-regulated and functionally non- and well-characterized lncRNAs and their likely involvement, from a molecular enrichment and mechanistic point of view, as tumor biomarkers for breast cancer and its specific histological subtype, TNBC. In reference to the abovementioned, it has been described that some lncRNA expression profiles correspond or are associated with the TNBC histological subtype, potentially granting their use for TNBC malignant progression, diagnosis, tumor clinical stage, and likely therapy. Based on this, lncRNAs have been proposed as potential biomarkers which might represent potential predictive tools in the differentiated breast carcinomas versus TNBC malignant disease. Finally, elucidation of the specific or multi-functional archetypal of lncRNAs in breast cancer and TNBC could be fundamental, as these molecular intermediary-regulator “lncRNAs” are widely involved in the genome expression, epigenome regulation, and transcriptional and post-transcriptional tumor biology, which in turn will probably represent a new prospect in clinical and/or therapeutic molecular targets for the oncological management of breast carcinomas in general and also for TNBC patients.

En el presente estudio se buscó determinar la actitud de la enfermera ante la muerte de la persona en la unidad de cuidados intensivos. Se realizó un estudio descriptivo no probabilístico, con un muestreo a conveniencia en el que participaron 30 profesionales de enfermería adscritos a una institución de segundo nivel en el estado de Durango, México. Se utilizó el Cuestionario de Actitudes ante la Muerte (CAM), elaborado a partir de la revisión del Death Attitudes and Self-Reported Health – Relevant Behaviors, en una versión cubana. Este incluye 33 reactivos, agrupados para su interpretación en seis sub-escalas: evitación, aceptación, temor, pasaje, salida y perspectiva profesional. Los hallazgos permitieron concluir que el profesional de enfermería está preparado para cuidar la vida, considerando que, a nivel general, acepta la muerte como un hecho inevitable. No obstante, desde la perspectiva profesional del personal de enfermería, la muerte es considerada como un alivio, al ver la carga que evidencian los familiares del paciente en su proceso final.

Se presenta el caso de un paciente masculino de 27 años de edad, con abdomen abierto, diagnóstico de sepsis abdominal severa y falla multiorgánica asociada a una pancreatitis aguda recurrente. Con presencia de dolor abdominal agudo, distensión abdominal, obesidad, taquipnea, xantomas en piel, signos de secuestro de líquidos. Triglicéridos 3450 mg/dL, amilasa 1212 U/L. Tomografía abdominal mostró proceso inflamatorio pancreático con índice de severidad estadio E (4 puntos), necrosis y derrames laminares en páncreas. Se realizó manejo en Unidad de Cuidados Intensivos Adulto. Se realizó laparotomía exploratoria y descomprensión abdominal por síndrome compartimental con el fin de efectuar lavado peritoneal terapéutico y necrosectomía. Se colocó bolsa de Bogotá durante el manejo. Por aplicación de criterios, se inició cierre por segunda intención con utilización del método de curación avanzada con productos de alta tecnología, un tratamiento complejo que mostró un resultado favorable en la recuperación del paciente.

Objetivo: Comprender las percepciones comunitarias vinculadas a la salud en la región Caribe colombiana, a fin de comprender las diversas problemáticas que afectan la paz en los entornos educativos.Materiales y métodos: Estudio descriptivo de tipo cualitativo desarrollado en 13 instituciones educativas de la región Caribe colombiana. Se realizaron 35 entrevistas utilizando el método en bola de nieve y 7 grupos focales. Para el análisis de los datos se empleó la técnica de análisis de contenido y fueron sistematizados y procesados con el "software" NVivo.Resultados: Se centran en las percepciones de los tres tipos de violencias vinculadas con la salud: a) violencia directa: negligencias y violencias en las familias: Cuidado de los niños y del colectivo, consumo de drogas; convivencia escolar, falta de salud, conflictos comunitarios; b) violencia estructural: la necesidad del derecho a la salud como justicia social, la precariedad en la promoción y la prevención de la enfermedad, perturbación de la paz, y c) violencia cultural: centradas en la capacidad simbólica del sujeto, exigencias por reconsideración de sus elementos culturales en beneficio de la construcción de paz.Conclusión: La población estudiada se encuentra en contexto de vulneración, destacándose una necesidad de ejercer derecho a la salud y a la paz. Es necesario un enfoque de intervención desde la política pública para generar la coparticipación de la comunidad a partir del reconocimiento de su propia cultura.

Objetivo: Evaluar el componente de mercadotecnia del programa "Chécate, Mídete, Muévete" en las comunidades rurales de Tabasco, México.Métodos: Investigación de diseño mixto, dividida en dos fases: análisis documental y trabajo de campo mediante la aplicación de listas de verificación, guías de observación, cuestionarios y grupos focales.Resultados: Las unidades médicas ("lugar") presentaron deficiencias en infraestructura (67%) y en equipamiento (33%), el 65% de las enfermeras y promotoras desconocían el Programa. En cuanto a la "promoción", el 73% de los usuarios reconoció la imagen publicitaria, resultando comprensible (33%), atractiva (46%), identificable (57%) y motivadora (43%). La televisión fue el canal de difusión con mayor impacto. En relación con el "producto" esperado en el bloque "Chécate", el 53% de los usuarios se refirió a un chequeo médico; En el bloque "Mídete", el 32% dijo que cuidaba su dieta, y en el bloque "Muévete", el 45% dijo que no practicaba actividad física. Con base en el grupo focal, se notó la existencia de motivación para el cuidado de su salud y con esto, evitando enfermedades asociadas a la obesidad. El principal cambio que la población intenta hacer para mejorar su salud es equilibrar su dieta, pero con poca inclusión de actividades físicas en su rutina diaria.Conclusiones: La imagen publicitaria de la campaña tiene las características correctas de difusión y transmisión del mensaje; sin embargo, para lograr el impacto esperado, es fundamental que las acciones de atención por parte del personal de salud de las unidades médicas sean permanentes y se ejecuten correctamente.