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Abstract Nutrient inputs and ultraviolet radiation (UVR) are global factors affecting the structure and functioning of aquatic ecosystems, particularly clear-water ecosystems. We performed experiments in two model lakes highly exposed to UVR fluxes in order to test the effect that future increases in mineral nutrients transported by dust aerosol might exert on primary producers depending on the likelihood of atmospheric inputs. Lake La Caldera (Northern Hemisphere) has been receiving recurrent dust inputs from the Sahara Desert while lake Los Cántaros (Southern Hemisphere) has been less affected by dust aerosol. UVR × Nutrient synergistically stimulated primary production (PP), chlorophyll a (Chl a), with a smaller increase in phytoplanktonic biomass in La Caldera, but not in Los Cántaros, where nutrient addition unmasked the UVR inhibitory effect on phytoplankton. The proportional decrease of mixotrophic nanoflagellates (MNFs) after the nutrient pulse (in Los Cántaros) and the long-term decline of MNFs in La Caldera associated with the increase in aerosol-dust intrusions from the Sahara during the last 40 years suggest that a future scenario of intensified aerosol events from desert and desertified areas would not only reduce functional diversity with the decline of MNFs, but would ultimately alter the C flux towards the grazing chain in oligotrophic ecosystems.

Abstract The internal iliac artery arises as a terminal extension of the common iliac artery and supplies blood to the pelvic region. This study aims to identify the anatomic variations of the internal iliac artery (IIA) in a Mexican population sample. This is a retrospective cross-sectional observational study. A total of 81 angiographies via the femoral artery approach performed on patients undergoing various medical procedures were included. Variations in the IIA branching patterns were identified by evaluating the angiographic images and grouped according to Adachi’s classification into five types (I–V). A total of 139 hemipelvises were analyzed (78 right and 61 left). The frequencies of each type of variation were as follows: Type I (71.2%), Type II (10.79%), Type III (0 cases), Type IV (0.7%), Type V (12.94%), and unclassified (4.31%). The most frequent anatomical variants of the IIA in the western Mexican population sample were Type I, followed by Types V and II. Even though Type V is rare in most populations, it was the second most frequent variant in this study. Understanding the variants of the IIA branching pattern is necessary for performing invasive procedures in the pelvic region with precision and minimizing complications.

Abstract Introduction To date, there are no sufficient studies aimed to determine a correlation between personal, academic, and psychological variables with academic achievement, measured with the grade point average (GPA) and intelligence in university students according to each sex. Study aim To determine the correlation between studying strategies, personal and psychological factors with GPA and intelligence in a sample of health sciences university students. Methods Health Sciences university students, were invited to participate, those who accepted were cited in a computer room where they signed an informed consent and filled an electronic questionnaire with sociodemographic, behavioral, psychological variables and studying strategies (from the MLSQ instrument) afterwards they performed a verbal and non-verbal intelligence test (Shipley-2). Results A total of 439 students were included, from which 297 (67.7%) were women. The mean of age was 20.34 ± 2.61 years old. We found that no differences in GPA where observed between sexes. We detected a higher correlation between combined intelligence and GPA in women than in men. In addition, most studying strategies showed a higher correlation with GPA than intelligence scores in men´s sample. All these findings coincide with the fact that preparatory GPA was the most correlated variable with university GPA in both sexes. Finally, women showed higher levels of the sum of diseases, somatization, anxiety, depression and academic stress than men, and all these variables showed low significant correlations with the combined intelligence score only in women´s sample. Conclusion Verbal and non-verbal intelligence scores show a lower association to GPA in men than in women, while studying strategies showed a higher association with GPA in men than in women.

Resumen: La disfagia lusoria es una causa rara de disfagia cuyo diagnóstico y protocolo de manejo requieren un alto índice de sospecha, así como de la comprensión de los mecanismos fisiopatológicos y embriológicos subyacentes para una correcta planificación quirúrgica necesaria para el manejo definitivo de la misma. Si bien existe moderada experiencia con el manejo de disfagia lusoria en su variante más habitual, correspondiente a la originada por a una arteria subclavia derecha aberrante, existen muy pocos casos de disfagia lusoria por arteria subclavia izquierda aberrante. A continuación se describe el caso de un paciente masculino de 45 años con presentación tardía de sintomatología por compresión en quien se encontró como causa subyacente disfagia lusoria por arteria subclavia izquierda aberrante. Abstract: Dysphagia lusoria is a rare cause of dysphagia that requires a high suspicion index to make a diagnosis and management protocol as well an understanding of the underlying physiopathological and embryological mechanisms to plan an adequate surgery for a definitive treatment. Even though there is moderate experience with the management of dysphagia lusoria in its most common variant, corresponding to that arising from an aberrant right subclavian artery, there are only a few cases of dysphagia lusoria due to an aberrant left subclavian artery. Next, we describe the case of a 45-year-old male with late onset presentation of symptoms in whom we found dysphagia lusoria with aberrant left subclavian artery.

Introducción: La pérdida de un ser querido se construye como una experiencia humana inevitable, que genera una vivencia emocional que impacta tanto al individuo que experimenta la pérdida como a su entorno. Objetivo: Investigar la relación entre los procesos de duelo anticipado y las alteraciones en la participación ocupacional de quienes fueron cuidadoras principales informales de personas con enfermedad terminal en la Región Metropolitana de Chile. Método: Enfoque cualitativo con 7 entrevistas semiestructuradas individuales a cuidadoras adultas en el sur y poniente de la región. Resultados: Fueron categorizadas experiencias y subjetividades que expresan la importancia que las mujeres atribuyen al cuidado de sus familiares, con una escasa demostración emocional durante esta etapa. Además, emergen categorías como rutinas y roles, donde muchas mujeres priorizan el cuidado; redes de apoyo, con relatos frecuentes sobre la falta de ayuda y herramientas más allá de lo económico; y áreas de ocupación afectadas, predominantemente el descanso y sueño, aunque también se menciona el autocuidado y la participación social. Conclusión: Si bien el proceso de duelo anticipado genera dolor y desgaste propio, es el cuidado informal lo que genera cambios en la participación y calidad de vida de las mujeres cuidadoras.

Abstract: This study aimed to estimate the population-based Parkinson disease prevalence, and to explore potentially associated factors and conditions. A population-based survey was conducted in Northern Peru. Symptoms compatible with Parkinson’s were defined using a validated Spanish questionnaire (≥ 42 points suggest Parkinson’s). Potential factors (e.g., age, sex, etc.) and clinical conditions (e.g., depressive symptoms, perceived stress, etc.) associated with Parkinson’s were assessed. In total, 1,609 subjects were included, mean age of participants was 48.2 (SD: 10.6), and 810 (50.3%) were women. Parkinson’s prevalence was 1.6% (95%CI: 1.0; 2.4). Those aged ≥ 55 years, and those who reported using wood as fuel for household cooking had a Parkinson’s prevalence from 3.5 to 4 times greater than those who did not. The presence of depressive symptoms, anxiety symptoms, perceived stress, poor sleep quality, and cognitive impairment was more common among those with Parkinson’s, and quality of life in these participants was lower than those without Parkinson’s. In conclusion, 1.6% of the population shows symptoms compatible with Parkinson’s. Age and use of wood for household cooking were factors associated with Parkinson’s. Several mental health conditions and lower quality of life were more frequent among those with Parkinson’s. Appropriate strategies are required to detect, prevent, and manage Parkinson’s cases.

BackgroundHealth care workers (HCWs) are often impacted by distressing situations during patient care and can experience the second victim phenomenon (SVP). Addressing an adequate response, training, and increasing awareness of the SVP can increase HCWs’ well-being and ultimately improve the quality of care and patient safety. ObjectiveThis study aims to describe and evaluate a multimodal training organized by the European Researchers’ Network Working on Second Victims to increase knowledge and overall awareness of SVP and second victim programs. MethodsWe implemented a multimodal training program, following an iterative approach based on a continuous quality improvement process, to enhance the methodology and materials of the training program over the duration of 2 years. We conducted web-based surveys and group interviews to evaluate the scope and design of the training, self-directed learning materials, and face-to-face activities. ResultsOut of 42 accepted candidates, 38 (90%) participants attended the 2 editions of the Training School program. In the second edition, the level of participants’ satisfaction increased, particularly when adjusting the allocated time for the case studies’ discussion (P

Antecedentes: Las hemorroides son dilataciones de los plexos vasculares arteriovenosos hemorroidarios superior e inferior, suelen estar ubicadas de forma expuesta e interna en el conducto anal y en el recto. Cuando estas estructuras presentan dilatación e ingurgitación ocasionan un cuadro sintomático que produce la enfermedad hemorroidal y afecta a la calidad de vida de quienes la padecen. Objetivo: Determinar la validez y la consistencia de la nueva escala para evaluar la calidad de vida en pacientes con enfermedad hemorroidal. Método: Estudio comparativo, de proceso, de escrutinio, homodémico, longitudinal, prolectivo y prospectivo. Tiempo de estudio: de marzo a septiembre 2023. El estudio se dividió en dos fases, la primera fue de elaboración de la nueva escala y la segunda en verificar su validez y consistencia. Se seleccionaron a 224 pacientes, con diagnóstico de enfermedad hemorroidal. Se elaboró un cuestionario único de 21 ítems y su validación fue sujeta a juicio por un grupo de expertos en coloproctología, cirugía general y clinimetría. Para evaluar consistencia interna se utilizó el alfa de Cronbach, consistencia externa kappa ponderada y validez convergente con rho de Spearman. Resultados: Se incluyeron 224 pacientes, de los cuales 10 formaron parte de un grupo piloto, el cual arrojó un alfa de Cronbach de 0.994, kappa ponderada de 0.001 y un valor de rho de Spearman p ≤ 0.001. Conclusión: La nueva escala de calidad de vida en pacientes con enfermedad hemorroidal tiene una consistencia interna alta, una gran consistencia externa y comprobó satisfactoriamente su validez de constructo.

La miasis es una ectoparasitosis que se produce por la infestación de los tejidos y cavidades de seres humanos, así como de algunos animales domésticos y silvestres, por larvas de dípteros, generalmente moscas. Esta condición es más frecuente en áreas tropicales, aunque también puede presentarse en lugares con condiciones sanitarias deficientes. Presentamos el caso de un paciente procedente de una zona tropical, agricultor, con antecedentes de exposición a animales muertos, animales silvestres y moscas, a quien se le diagnosticó miasis cutánea de tipo forunculoide en la región escrotal sobreinfectada. El paciente recibió tratamiento con antibióticos endovenosos, una dosis única de Ivermectina oral y, a nivel local, se realizó la oclusión de los orificios con albahaca, seguida de la extracción con pinzas de 20 larvas en dos sesiones. La evolución del paciente fue satisfactoria. Consideramos que este caso constituye una contribución original, dado que la infestación genital por larvas de mosca se reporta infrecuentemente, incluso en zonas endémicas. En la literatura nacional, existen dos casos de miasis genital: uno en una mujer joven y otro en una anciana. Sin embargo, hasta donde tenemos conocimiento, no se ha reportado la presencia de miasis escrotal en el Perú.

Optic nerve sheath meningocele is an enlargement of the sheath itself, consisting of a collection of cerebrospinal fluid along the perineural space. It should be considered primary if it is not associated with orbital–cerebral neoplasm or with cranio-orbital junction malformations. We report three cases of bilateral primary idiopathic optic nerve sheath meningocele, two of them with gradual vision loss. The first case presented a history of monocular blurred vision of the right eye and headache. It was initially treated with acetazolamide without any improvement, after which optic nerve sheath fenestration was required. The second case showed intermittent binocular diplopia with central 24-2 perimetry defects in the left eye. The third case was first presented as a subacute bilateral conjunctivitis with a suspected orbital pseudotumor. An incidental bilateral optic nerve sheath meningocele was found in the orbital imaging, being totally asymptomatic. In all the cases, orbital and cranial magnetic resonance with contrast and fat suppression was crucial in the diagnosis.

Abstract Chagas disease affects approximately 7 million people worldwide in Latin America and is a neglected tropical disease. Twenty to thirty percent of chronically infected patients develop chronic Chagas cardiomyopathy decades after acute infection. Identifying biomarkers of Chagas disease progression is necessary to develop better therapeutic and preventive strategies. Circulating microRNAs are increasingly reliable biomarkers of disease and therapeutic targets. To identify new circulating microRNAs for Chagas disease, we performed exploratory small RNA sequencing from the plasma of patients and performed de novo miRNA prediction, identifying potential new microRNAs. The levels of the new microRNAs temporarily named miR-Contig-1519 and miR-Contig-3244 and microRNAs that are biomarkers for nonchagasic cardiomyopathies, such as miR-148a-3p and miR-224-5p, were validated by quantitative reverse transcription. We found a specific circulating microRNA signature defined by low miR-Contig-3244, miR-Contig-1519, and miR-148a-3 levels but high miR-224-5p levels for patients with chronic Chagas disease. Finally, we predicted in silico that these altered circulating microRNAs could affect the expression of target genes involved in different cellular pathways and biological processes, which we will explore in the future.

In this work, the leaves of K. tomentosa were macerated with hexane, chloroform, and methanol, respectively. The phytochemical profiles of hexane and chloroform extracts were unveiled using GC/MS, whereas the chemical composition of the methanol extract was analyzed using UPLC/MS/MS. The antibacterial activity of extracts was determined against gram-positive and gram-negative strains through the minimal inhibitory concentration assay, and in silico studies were implemented to analyze the interaction of phytoconstituents with bacterial peptides. The antioxidant property of extracts was assessed by evaluating their capacity to scavenge DPPH, ABTS, and H2O2 radicals. The toxicity of the extracts was recorded against Artemia salina nauplii and Caenorhabditis elegans nematodes. Results demonstrate that the hexane and chloroform extracts contain phytosterols, triterpenes, and fatty acids, whereas the methanol extract possesses glycosidic derivatives of quercetin and kaempferol together with sesquiterpene lactones. The antibacterial performance of extracts against the cultured strains was appraised as weak due to their MIC90 values (>500 μg/mL). As antioxidants, treatment with extracts executed high and moderate antioxidant activities within the range of 50–300 μg/mL. Extracts did not decrease the viability of A. salina, but they exerted a high toxic effect against C. elegans during exposure to treatment. Through in silico modeling, it was recorded that the flavonoids contained in the methanol extract can hamper the interaction of the NAM/NAG peptide, which is of great interest since it determines the formation of the peptide wall of gram-positive bacteria. This study reports for the first time the biological activities and phytochemical content of extracts from K. tomentosa and proposes a possible antibacterial mechanism of glycosidic derivatives of flavonoids against gram-positive bacteria.

Introduction: Plasmodium falciparum is responsible for more than 90 % of malaria worldwide. Objective: characterization of Clinical-epidemiological aspects of severe malaria in patients treated at the Municipal Hospital of Cuimba, Zaire, Angola. Method: an observational, descriptive, cross-sectional and retrospective study was conducted, during the period January - June 2023, in patients reported with severe malaria. The study involved a total of 452 patients with positive malaria but only 97 of them, who presented a complication of severe malaria, were selected as sample. The variables used were as follow: severe anemia, convulsions, hyperparasitemia, among others. Results: male sex was predominant, with an average age of 14.8% and 43.3% of patients under five years of age. Plasmodium falciparum was found in 59 patients (60.8%) with a high parasitaemia prevalence. Manifestations of cerebral dysfunction in association with severe anemia were found in the clinical picture of 31% of patients. The 40.2% of patients had no complications in admission period. Acute Respiratory Distress Syndrome was the most frequent complication (18.6%), and it was the leading cause of death in 12.4% of patients. Artesunate was used in 77.3% of patients. Conclusions: malaria is a health problem in Municipal Hospital of Cuimba, with a higher incidence in children under five years of age; Plasmodium falciparum infection prevailed in patients with severe anemia.

Multiple sclerosis (MS) is a chronic inflammatory autoimmune neurological disease characterized by the recurrent appearance of demyelinating lesions and progressive disability. Currently, there are multiple disease-modifying treatments, however, there is a significant need to develop new therapeutic targets, especially for the progressive forms of the disease. This review article provides an overview of the most recent studies aimed at understanding the inflammatory processes that are activated in response to the accumulation of kynurenine pathway (KP) metabolites, which exacerbate an imbalance between immune system cells (e.g., Th1, Th2, and T reg) and promote the release of pro-inflammatory interleukins that modulate different mechanisms: membrane-receptors function; nuclear factors expression; and cellular signals. Together, these alterations trigger cell death mechanisms in brain cells and promote neuron loss and axon demyelination. This hypothesis could represent a remarkable approach for disease-modifying therapies for MS. Here, we also provide a perspective on the repositioning of some already approved drugs involved in other signaling pathways, which could represent new therapeutic strategies for MS treatment.

In this registered report, we propose to stress-test existing models for predicting the ideology-prejudice association, which varies in size and direction across target groups. Previous models of this relationship use the perceived ideology, status, and choice in group membership of target groups to predict the ideology-prejudice association across target groups. These analyses show that models using only the perceived ideology of the target group are more accurate and parsimonious in predicting the ideology-prejudice association than models using perceived status, choice, and all of the characteristics in a single model. Here, we stress-test the original models by testing the models' predictive utility with new measures of explicit prejudice, a comparative operationalization of prejudice, the Implicit Association Test, and additional target groups. In Study 1, we propose to directly test the previous models using an absolute measure of prejudice that closely resembles the measure used in the original study. This will tell us if the models replicate with distinct, yet conceptually similar measures of prejudice. In Study 2, we propose to develop new ideology-prejudice models for a comparative operationalization of prejudice using both explicit measures and the Implicit Association Test. We will then test these new models using data from the Ideology 2.0 project collected by Project Implicit. We do not have full access to this data yet, but upon acceptance of our Stage 1 registered report, we will gain access to the complete dataset. Currently, we have access to an exploratory subset of the data that we use to demonstrate the feasibility of the study, but its limited number of target groups prevents conclusions from being made.

Introdução: Face aos desafios sociais e de saúde de uma população em envelhecimento, é necessário a atualização das políticas sociais e de saúde na Europa (WHO, 2020; Rudnicka, 2020). O paradigma do Envelhecimento Saudável (HA) sublinha a necessidade de inovação nos sectores educativo, de saúde e social e a devida formação dos profissionais implicados. Objectivos: O projecto Strategic Innovative Educational Network for Healthy Ageing (SIENHA) - www.sienha.eu, visa desenvolver educação a nível superior e o desenvolvimento de competências em estudantes e profissionais dos sectores de saúde e social na Europa. Este projeto envolveu uma cooperação académica multilateral ao longo de 36 meses entre sete Instituições de Ensino Superior (IES) europeias, e foi financiado pelo programa ERASMUS+. Material e Métodos: Foram estabelecidos quatro principais resultados intelectuais: 1) Identificação de um quadro de competências profissionais em HA; 2) Desenvolvimento de um currículo de ensino superior; 3) Criação de um kit de ferramentas para inovação e investigação em HA; e 4) Produção de uma ferramenta de disseminação, um Manual em Envelhecimento Saudável. Com base numa revisão exploratória, foram estabelecidas listas de competências fundamentais e desenvolvido as estratégias de avaliação e o programa de estudos. Foi também elaborado um kit de ferramentas com vista à aplicação de investigação de implementação e estratégias pedagógicas inovadoras. Resultados: O projeto culminou na identificação de competências relevantes, na conceção de um kit de ferramentas baseado nas melhores práticas e na criação de um currículo educacional centrado no envelhecimento saudável ao longo da vida. Este currículo foi concebido para melhor preparar os profissionais de saúde e sociais, incluindo fisioterapeutas, promovendo a saúde e bem-estar ao longo da vida. Conclusões: O projeto SIENHA proporciona uma abordagem integrada e estratégica para enfrentar os desafios do envelhecimento saudável na Europa, trazendo inovações na formação e prática profissional. Esta colaboração pode representar um avanço significativo para a melhoria da formação e preparação de profissionais nos sectores de saúde e social na Europa.

As imaging techniques rapidly evolve to probe nanoscale genome organization at higher resolution, it is critical to consider how the reagents and procedures involved in sample preparation affect chromatin at the relevant length scales. Here, we investigate the effects of fluorescent labeling of DNA sequences within chromatin using the gold standard technique of three-dimensional fluorescence in situ hybridization (3D FISH). The chemical reagents involved in the 3D FISH protocol, specifically formamide, cause significant alterations to the sub-200 nm (sub-Mbp) chromatin structure. Alternatively, two labeling methods that do not rely on formamide denaturation, resolution after single-strand exonuclease resection (RASER)-FISH and clustered regularly interspaced short palindromic repeats (CRISPR)-Sirius, had minimal impact on the three-dimensional organization of chromatin. We present a polymer physics-based analysis of these protocols with guidelines for their interpretation when assessing chromatin structure using currently available techniques.

Actualmente el médico especialista tiene como parte del perfil de egreso la búsqueda, análisis y discusión de la información. La comprensión lectora se genera tras la relación del texto con el lector y se encarga de construir un conocimiento al relacionar lo leído y lo aprendido. Nos propusimos evaluar el nivel de competencia de lectura crítica en médicos residentes de medicina familiar (MF) de la Unidad de Medicina Familiar No. 24 (U.M.F. No.24), del Instituto Mexicano del Seguro Social (IMSS); para evaluar si cuentan con la competencia de lectura crítica se aplicó el instrumento de evaluación de lectura crítica (Campos A y cols. 2016). El 63% de los residentes de MF presento un nivel de comprensión lectora medio. No se encontró significancia estadística al correlacionar las variables comprensión lectora y sexo, y al correlacionar comprensión lectora y edad. Concluimos que la competencia de lectura crítica encontrada en los médicos residentes de la U.M.F. No. 24 es de nivel medio, siendo mayor que el nivel encontrado en otros estudios bajo condiciones similares. Es necesario establecer estrategias educativas que mejoren las capacidades de lectura crítica de artículos médicos.

Abstract This study analyzed the frequency and intensity of acute stress among health professionals caring for COVID-19 patients in four Latin American Spanish-speaking countries during the outbreak. A cross-sectional study involved a non-probability sample of healthcare professionals in four Latin American countries. Participants from each country were invited using a platform and mobile application designed for this study. Hospital and primary care workers from different services caring for COVID-19 patients were included. The EASE Scale (SARS-CoV-2 Emotional Overload Scale, in Spanish named Escala Auto-aplicada de Sobrecarga Emocional) was a previously validated measure of acute stress. EASE scores were described overall by age, sex, work area, and experience of being ill with COVID-19. Using the Mann–Whitney U test, the EASE scores were compared according to the most critical moments of the pandemic. Univariate and multivariate analysis was performed to investigate associations between these factors and the outcome ‘acute stress’. Finally, the Kruskal–Wallis was used to compare EASE scores and the experience of being ill. A total of 1372 professionals responded to all the items in the EASE scale: 375 (27.3%) Argentines, 365 (26.6%) Colombians, 345 (25.1%) Chileans, 209 (15.2%) Ecuadorians, and 78 (5.7%) from other countries. 27% of providers suffered middle-higher acute stress due to the outbreak. Worse results were observed in moments of peak incidence of cases (14.3 ± 5.3 vs. 6.9 ± 1.7, p

Abstract Climate change is expected to enhance weather conditions prone to wildfires. Climate regionalized projections for the Canary Islands were performed, using as boundary conditions some of the results provided by the Coupled Model Intercomparison Project (CMIP5) initiative, and covering the recent past (1980–2009) and future (2070–2099) periods, under two Representative Concentration Pathways, 4.5 and 8.5. All fire risk indicators derived from the Canadian Forest Fire Weather Index (FWI) are foreseen to worsen by the end of the century. The fire season could increase its length up to 75 days per year, being more noticeable as altitude increases. The extreme risk days (FWI > 60) show an average increase of 58%, reaching 12 days a year, and the area with high risk could increase by 44%. Analyzing the contribution of the different meteorological variables, it is observed that the main parameter in the fire danger index result is the temperature (currently weights 46%). However, in the future, the importance of precipitation will increase, since the rainfall reduction in some areas could reach 41%. The high dependence of the expected changes on land height, and the small size of the islands, demonstrates the necessity of using high-resolution climate regionalizations.

Abstract Background Mitochondrial diseases represent one of the most common groups of genetic diseases. With a prevalence greater than 1 in 5000 adults, such diseases still lack effective treatment. Current therapies are purely palliative and, in most cases, insufficient. Novel approaches to compensate and, if possible, revert mitochondrial dysfunction must be developed. Results In this study, we tackled the issue using as a model fibroblasts from a patient bearing a mutation in the GFM1 gene, which is involved in mitochondrial protein synthesis. Mutant GFM1 fibroblasts could not survive in galactose restrictive medium for more than 3 days, making them the perfect screening platform to test several compounds. Tetracycline enabled mutant GFM1 fibroblasts survival under nutritional stress. Here we demonstrate that tetracycline upregulates the mitochondrial Unfolded Protein Response (UPRmt), a compensatory pathway regulating mitochondrial proteostasis. We additionally report that activation of UPRmt improves mutant GFM1 cellular bioenergetics and partially restores mitochondrial protein expression. Conclusions Overall, we provide compelling evidence to propose the activation of intrinsic cellular compensatory mechanisms as promising therapeutic strategy for mitochondrial diseases.

Introduction Health organisations should support healthcare workers who are physically and psychologically affected by patient safety incidents (second victims). There is a growing body of evidence which focuses on second victim support interventions. However, there is still limited research on the elements necessary to effectively implement and ensure the sustainability of these types of interventions. In this study, we propose to map and frame the key factors which underlie an effective implementation of healthcare worker support interventions in healthcare organisations when healthcare workers are physically and/or emotionally affected by patient safety incidents.Methods and analysis This scoping review will be guided by the established methodological Arksey and O’Malley framework, Levac and Joanna Briggs Institute (JBI) recommendations. We will follow the JBI three-step process: (1) a preliminary search conducted on two databases; (2) the definition of clear inclusion criteria and the creation of a list of search terms to be used in the subsequent running of the search on a larger number of databases; and (3) additional searches (cross-checking/cross-referencing of reference lists of eligible studies, hand-searching in target journals relevant to the topic, conference proceedings, institutional/organisational websites and networks repositories). We will undertake a comprehensive search strategy in relevant bibliographic databases (PubMed/MEDLINE, Embase, CINHAL, Web of Science, Scopus, PsycInfo, Epistemonikos, Scielo, Cochrane Library and Open Grey). We will use the Mixed Methods Appraisal Tool V.2018 for quality assessment of the eligible studies. Our scoping review will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews.Ethics and dissemination This study will not require ethical approval. Results of the scoping review will be published in a peer-review journal, and findings will be presented in scientific conferences as well as in international forums and other relevant dissemination channels.Trial registration number 10.17605/OSF.IO/RQAT6.Preprint from medRxiv available: doi: https://doi.org/10.1101/2022.01.25.22269846.

Objective To analyse the cost-effectiveness of multicomponent interventions designed to improve outcomes in type 2 diabetes mellitus (T2DM) in primary care in the Canary Islands, Spain, within the INDICA randomised clinical trial, from the public health system perspective.Design An economic evaluation was conducted for the within-trial period (2 years) comparing the four arms of the INDICA study.Setting Primary care in the Canary Islands, Spain.Participants 2334 patients with T2DM without complications were included.Interventions Interventions for patients (PTI), for primary care professionals (PFI), for both (combined intervention arm for patients and professionals, CBI) and usual care (UC) as a control group.Outcomes The main outcome was the incremental cost per quality-adjusted life-years (QALY). Only the intervention and the healthcare costs were included.Analysis Multilevel models were used to estimate results, and to measure the size and significance of incremental changes. Missed values were treated by means of multiple imputations procedure.Results There were no differences between arms in terms of costs (p=0.093), while some differences were observed in terms of QALYs after 2 years of follow-up (p=0.028). PFI and CBI arms were dominated by the other two arms, PTI and UC. The differences between the PTI and the UC arms were very small in terms of QALYs, but significant in terms of healthcare costs (p=0.045). The total cost of the PTI arm (€2571, 95% CI €2317 to €2826) was lower than the cost in the UC arm (€2750, 95% CI €2506 to €2995), but this difference did not reach statistical significance. Base case estimates of the incremental cost per QALY indicate that the PTI strategy was the cost-effective option.Conclusions The INDICA intervention designed for patients with T2DM and families is likely to be cost-effective from the public healthcare perspective. A cost-effectiveness model should explore this in the long term.Trial registration number NCT01657227.

Introduction With a growing number of people with hypertension, the limited number of physicians could not provide treatment to all patients. We quantified the gap between medical appointments available and needed for hypertension care, overall and in relation to hypertension treatment cascade metrics.Methods Ecological descriptive analysis. We combined country-year-specific data on hypertension prevalence, awareness, treatment and control (from Non-Communicable Disease Risk Factor Collaboration) and number of physicians (from WHO). We estimated from 1 to 12 medical appointments per year for patients with hypertension. We assumed that physicians could see 25 patients per day, work 200 days/year and dedicate 10% of their time to hypertension care.Results We studied 191 countries. Forty-one countries would not have enough physicians to provide at least one medical appointment per year to all the population with hypertension; these countries were low/lower middle income and in sub-Saharan Africa or East Asia and Pacific. Regardless of the world region, ≥50% of countries would not have enough physicians to provide ≥8 medical appointments to their population with hypertension. Countries where the demand exceeded the offer of medical appointments for hypertension care had worse hypertension diagnosis, treatment and control rates than countries where the demand did not exceed the offer. There were positive correlations between the physician density and hypertension diagnosis (r=0.70, p

BackgroundSimplified blood pressure (BP) screening approaches have been proposed. However, evidence is limited to a few countries and has not documented the cardiovascular risk amongst missed hypertension cases, limiting the uptake of these simplified approaches. We quantified the proportion of missed, over-diagnosed, and consistently identified hypertension cases and the 10-year cardiovascular risk in these groups.Methods and findingsWe used 60 WHO STEPS surveys (cross-sectional and nationally representative; n = 145,174) conducted in 60 countries in 6 world regions between 2004 and 2019. Nine simplified approaches were compared against the standard (average of the last 2 of 3 BP measurements). The 10-year cardiovascular risk was computed with the 2019 World Health Organization Cardiovascular Risk Charts. We used t tests to compare the cardiovascular risk between the missed and over-diagnosed cases and the consistent hypertension cases. We used Poisson multilevel regressions to identify risk factors for missed cases (adjusted for age, sex, body mass index, and 10-year cardiovascular risk). Across all countries, compared to the standard approach, the simplified approach that missed the fewest cases was using the second BP reading if the first BP reading was 130-145/80-95 mm Hg (5.62%); using only the second BP reading missed 5.82%. The simplified approach with the smallest over-diagnosis proportion was using the second BP reading if the first BP measurement was ≥140/90 mm Hg (3.03%). In many countries, cardiovascular risk was not significantly different between the missed and consistent hypertension groups, yet the mean was slightly lower amongst missed cases. Cardiovascular risk was positively associated with missed hypertension depending on the simplified approach. The main limitation of the work is the cross-sectional design.ConclusionsSimplified BP screening approaches seem to have low misdiagnosis rates, and cardiovascular risk could be lower amongst missed cases than amongst consistent hypertension cases. Simplified BP screening approaches could be included in large screening programmes and busy clinics.

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration number NCT04323644

Esta investigación tiene como objetivo verificar el comportamiento de determinadas funciones ejecutivas (FE) en padres cuyos hijos presentan TEA y comparar este funcionamiento neurocognitivo con padres cuyos hijos no presentan la condición. Este análisis se realizó por medio de un diseño de estudio no experimental, de tipo descriptivo correlacional.Del análisis de estos resultados, se desprenden una tendencia a la baja a nivel de las FE de Memoria de Trabajo y Flexibilidad Cognitiva en el grupo experimental, sin alcanzar niveles de significancia, mientras que se identificó una tendencia al alza en las FE de Velocidad de Procesamiento e Inhibición en el mismo grupo. Los puntajes más altos podrían explicarse por una mejora a nivel de estas funciones, secundario al entrenamiento que implica atender a los desafíos de la crianza de niños con TEA. No obstante, se requiere un mayor tamaño muestral para confirmar si hay particularidades significativas en el funcionamiento cognitivo de los padres de niños con TEA que confirmen la presencia de un fenotipo ampliado.

Objetivo: Determinar el vínculo afectivo entre las gestantes adolescentes con depresión y sus recién nacidos en establecimientos de salud de Huánuco. Material y métodos: Estudio descriptivo de corte transversal. La muestra fueron 19 gestantes adolescentes atendidas entre mayo a octubre de 2013 en establecimientos de salud de Huánuco con diagnóstico de depresión. Los datos se recolectaron a través de un test adaptado por las investigadoras para realizar un descarte rápido de depresión basado en la escala de depresión perinatal de Edimburgo y un cuestionario que evalúo la vinculación afectiva prenatal mediante la técnica de entrevista. Resultados: El porcentaje de depresión durante el tercer trimestre fue 17,7%, de ellas 78,9% presentó depresión leve. Respecto a los datos sociodemográficos la mayoría de las adolescentes presentaron estudios incompletos, solteras, ocupación estudiante o ama de casa, viven con padres y dependen económicamente de ellos. Durante el puerperio el 57,9% mostró cariño por el recién nacido, en el 47,4% son otras personas las que se encargan del cuidado del neonato, el 78,9% de adolescentes se cataloga como madre poco responsable; el 52,6% da de lactar a su bebé solo porque existe la necesidad de alimentarlo. La depresión se asoció con el vínculo afectivo prenatal (p=0,02). Conclusiones: Las gestantes adolescentes con depresión, constituyen una población vulnerable, cuyo vínculo afectivo con sus recién nacidos es alta con 63,1%. La depresión en el tercer trimestre del embarazo se relaciona con el vínculo afectivo entre la madre y su recién nacido.

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Lung herniation (LH) is a rare clinical entity involving the protrusion of lung outside the thoracic cage. It has a variety of etiologies and clinical presentations, making diagnosis difficult. We present a case of a 20-year-old male who reported pleuritic pain after falling from a skateboard. Evaluation through computed tomography (CT) scanning of the chest revealed an anterior lung hernia associated with rib fractures. This case emphasizes the need for clinicians to include lung herniation in the differential diagnosis of patients with trauma and inexplicable or persistent pulmonary issues.

BackgroundXenotropic murine leukemia virus-related virus (XMRV) was generated after a recombination event between two endogenous murine leukemia viruses during the production of a prostate cancer cell line. Although the associations of the XMRV infection with human diseases appear unlikely, the XMRV is a retrovirus of undefined pathogenic potential, able to replicate in human cells in vitro. Since recent studies using animal models for infection have yielded conflicting results, we set out an ex vivo model for XMRV infection of human tonsillar tissue to determine whether XMRV produced by 22Rv1 cells is able to replicate in human lymphoid organs. Tonsil blocks were infected and infection kinetics and its pathogenic effects were monitoredResultsXMRV, though restricted by APOBEC, enters and integrates into the tissue cells. The infection did not result in changes of T or B-cells, immune activation, nor inflammatory chemokines. Infectious viruses could be recovered from supernatants of infected tonsils by reinfecting DERSE XMRV indicator cell line, although these supernatants could not establish a new infection in fresh tonsil culture, indicating that in our model, the viral replication is controlled by innate antiviral restriction factors.ConclusionsOverall, the replication-competent retrovirus XMRV, present in a high number of laboratories, is able to infect human lymphoid tissue and produce infectious viruses, even though they were unable to establish a new infection in fresh tonsillar tissue. Hereby, laboratories working with cell lines producing XMRV should have knowledge and understanding of the potential biological biohazardous risks of this virus.

A 42-year-old African male was brought by the police to the emergency department under suspicion of drug smuggling by body-packing. Plain abdominal radiograph showed multiple foreign bodies within the gastrointestinal tract. Contrast-enhanced abdominal CT confirmed the findings, and the patient admitted to have swallowed “balls” of hashish. Body-packing is a recognized method of smuggling drugs across international borders. Body packers may present to the emergency department because of drug toxicity, intestinal obstruction, or more commonly, requested by law-enforcement officers for medical confirmation or exclusion of suspected body packing.

Copyright of Anuario de Estudios Americanos is the property of Consejo Superior de Investigaciones Cientificas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)