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Abstract Background Gaining a comprehensive understanding of the genetic mechanisms underlying insecticide resistance in malaria vectors is crucial for optimising the effectiveness of insecticide-based vector control methods and developing diagnostic tools for resistance management. Considering the heterogeneity of metabolic resistance in major malaria vectors, the implementation of tailored resistance management strategies is essential for successful vector control. Here, we provide evidence demonstrating that two highly selected mutations in CYP6P4a and CYP6P4b are driving pyrethroid insecticide resistance in the major malaria vector Anopheles funestus, in West Africa. Results Continent-wide polymorphism survey revealed escalated signatures of directional selection of both genes between 2014 and 2021. In vitro insecticide metabolism assays with recombinant enzymes from both genes showed that mutant alleles under selection exhibit higher metabolic efficiency than their wild-type counterparts. Using the GAL4-UAS expression system, transgenic Drosophila flies overexpressing mutant alleles exhibited increased resistance to pyrethroids. These findings were consistent with in silico predictions which highlighted changes in enzyme active site architecture that enhance the affinity of mutant alleles for type I and II pyrethroids. Furthermore, we designed two DNA-based assays for the detection of CYP6P4a-M220I and CYP6P4b-D284E mutations, showing their current confinement to West Africa. Genotype/phenotype correlation analyses revealed that these markers are strongly associated with resistance to types I and II pyrethroids and combine to drastically reduce killing effects of pyrethroid bed nets. Conclusions Overall, this study demonstrated that CYP6P4a and CYP6P4b contribute to pyrethroid resistance in An. funestus and provided two additional insecticide resistance molecular diagnostic tools that would contribute to monitoring and better management of resistance.

Abstract Insecticide resistance escalation is decreasing the efficacy of vector control tools. Monitoring vector resistance is paramount in order to understand its evolution and devise effective counter-solutions. In this study, we monitored insecticide resistance patterns, vector population bionomics and genetic variants associated with resistance over 3 years from 2021 to 2023 in Uganda. Anopheles funestus s.s was the predominant species in Mayuge but with evidence of hybridization with other species of the An. funestus group. Sporozoite infection rates were relatively very high with a peak of 20.41% in March 2022. Intense pyrethroid resistance was seen against pyrethroids up to 10-times the diagnostic concentration but partial recovery of susceptibility in PBO synergistic assays. Among bednets, only PBO-based nets (PermaNet 3.0 Top and Olyset Plus) and chlorfenapyr-based net (Interceptor G2) had high mortality rates. Mosquitoes were fully susceptible to chlorfenapyr and organophosphates, moderately resistant to clothianidin and resistant to carbamates. The allele frequency of key P450, CYP9K1, resistance marker was constantly very high but that for CYP6P9A/b were very low. Interestingly, we report the first detection of resistance alleles for Ace1 gene (RS = ~ 13%) and Rdl gene (RS = ~ 21%, RR = ~ 4%) in Uganda. The qRT-PCR revealed that Cytochrome P450s CYP9K1, CYP6P9A, CYP6P9b, CYP6P5 and CYP6M7 were consistently upregulated while a glutathione-S-transferase gene (GSTE2) showed low expression. Our study shows the complexity of insecticide resistance patterns and underlying mechanisms, hence constant and consistent spatial and temporal monitoring is crucial to rapidly detect changing resistance profiles which is key in informing deployment of counter interventions.

Abstract Background The World Health Organization (WHO) encourages all member states to adopt and implement a package of essential evidence-based interventions called the Best Buys to reduce the burden of non-communicable diseases (NCDs). To date, little is known about the implementation of national policies and interventions for NCD control in the WHO member states in sub-Saharan Africa. Our study aimed to evaluate the implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana. Methods This was explanatory mixed methods research which started with a document review of Ghana’s WHO Best Buys scores from the 2015, 2017, 2018, 2020 and 2022 WHO NCD Progress Monitor Reports. Thereafter, we conducted 25 key informant interviews and one focus group discussion (11 participants) with key policymakers and stakeholders in the NCD landscape in Ghana to understand the implementation of the NCD policies and interventions, and the policy implementation gaps and challenges faced. Data from the NCD Progress reports were presented using mean scores whilst the qualitative data was analysed thematically. Results Ghana has shown some advancements in the implementation of the WHO Best Buys measures. Ghana’s implementation scores for 2015, 2017, 2020 and 2022 were 5.0, 9.0, 5.0 and 5.5 respectively, against the mean implementation scores of 7.6/19 for lower-middle-income countries and 9.5/19 for upper-middle-income countries. Efforts to decrease major risk factors such as excessive alcohol consumption and unhealthy diet have been progressing slowly. The most common challenges were related to a) the role of socio-cultural factors, b) stakeholder engagement, c) enforcement and implementation of public health policies, d) implementation guidelines, e) public awareness and education on NCDs, f) financing of NCD prevention and control, g) curative-centered health systems, and h) over-centralization of NCD care. Conclusion Ghana has made progress in adopting the WHO Best Buys targeting risk factors of NCDs. However, the country faces contextual barriers to effective implementation. With the retrogression of some measures over time despite making progress in some earlier years, further investigation is needed to identify facilitators for sustained implementation of the WHO Best Buys interventions.

Abstract The One Health approach, recognizing the interconnectedness of human, animal, and environmental health, has gained significance amid emerging zoonotic diseases and antibiotic resistance concerns. This paper aims to demonstrate the utility of a collaborative tool, the SIEGA, for monitoring infectious diseases across domains, fostering a comprehensive understanding of disease dynamics and risk factors, highlighting the pivotal role of One Health surveillance systems. Raw whole-genome sequencing is processed through different species-specific open software that additionally reports the presence of genes associated to anti-microbial resistances and virulence. The SIEGA application is a Laboratory Information Management System, that allows customizing reports, detect transmission chains, and promptly alert on alarming genetic similarities. The SIEGA initiative has successfully accumulated a comprehensive collection of more than 1900 bacterial genomes, including Salmonella enterica, Listeria monocytogenes, Campylobacter jejuni, Escherichia coli, Yersinia enterocolitica and Legionella pneumophila, showcasing its potential in monitoring pathogen transmission, resistance patterns, and virulence factors. SIEGA enables customizable reports and prompt detection of transmission chains, highlighting its contribution to enhancing vigilance and response capabilities. Here we show the potential of genomics in One Health surveillance when supported by an appropriate bioinformatic tool. By facilitating precise disease control strategies and antimicrobial resistance management, SIEGA enhances global health security and reduces the burden of infectious diseases. The integration of health data from humans, animals, and the environment, coupled with advanced genomics, underscores the importance of a holistic One Health approach in mitigating health threats.

Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.

Abstract This work aimed to develop suitable predictive models for ammonium, nitrate, total nitrogen, total organic carbon and soil humic fractions, for Ferralsols, using Vis-NIR-SWIR, MIR and X-ray fluorescence spectroscopic techniques in conjunction with machine learning algorithms, Cubist, PLSR, Random Forest and Support Vector Machine. Chemical analyzes were carried out to determine nitrate, total nitrogen, total organic carbon and chemical fractionation of soil organic matter, as well as spectral analyzes using Vis-NIR-SWIR spectroscopy, MIR and X-ray fluorescence. The spectroscopy results were processed using RStudio v. 4.1.3, applying Cusbist, PLSR, Random Forest and Support Vector Machine machine learning algorithms to create predictive models and describe spectral curves and Pearson correlation. Of the prediction models developed for nitrogen, total organic carbon and humic fractions, the PLSR and Support Vector Machine algorithms presented the best predictive performances. The descriptive analysis of the spectra identified the main absorption bands and the location of the bands sensitive to the attributes of interest. The correlation analysis proposed that the use of Vis-NIR-SWIR, MIR and XRF spectroscopic techniques were effective in predicting the contents of nitrogen, total organic carbon and humic fractions in soil with a medium sandy texture. However, it is important to highlight that each technique has its characteristic mechanism of action, Vis-NIR-SWIR and MIR detect the element based on overtones and fundamental tones, while XRF is based on the atomic number of the elements or elemental association.

Bayesian networks (BNs) are probabilistic graphical models that leverage Bayes’ theorem to portray dependencies and cause-and-effect relationships between variables. These networks have gained prominence in the field of health sciences, particularly in diagnostic processes, by allowing the integration of medical knowledge into models and addressing uncertainty in a probabilistic manner. Objectives: This review aims to provide an exhaustive overview of the current state of Bayesian networks in disease diagnosis and prognosis. Additionally, it seeks to introduce readers to the fundamental methodology of BNs, emphasising their versatility and applicability across varied medical domains. Employing a meticulous search strategy with MeSH descriptors in diverse scientific databases, we identified 190 relevant references. These were subjected to a rigorous analysis, resulting in the retention of 60 papers for in-depth review. The robustness of our approach minimised the risk of selection bias. Results: The selected studies encompass a wide range of medical areas, providing insights into the statistical methodology, implementation feasibility, and predictive accuracy of BNs, as evidenced by an average area under the curve (AUC) exceeding 75%. The comprehensive analysis underscores the adaptability and efficacy of Bayesian networks in diverse clinical scenarios. The majority of the examined studies demonstrate the potential of BNs as reliable adjuncts to clinical decision-making. The findings of this review affirm the role of Bayesian networks as accessible and versatile artificial intelligence tools in healthcare. They offer a viable solution to address complex medical challenges, facilitating timely and informed decision-making under conditions of uncertainty. The extensive exploration of Bayesian networks presented in this review highlights their significance and growing impact in the realm of disease diagnosis and prognosis. It underscores the need for further research and development to optimise their capabilities and broaden their applicability in addressing diverse and intricate healthcare challenges.

ABSTRACT Campylobacter jejuni is the main cause of bacterial gastroenteritis and a public health problem worldwide. Little information is available on the genotypic characteristics of human C. jejuni in Spain. This study is based on an analysis of the resistome, virulome, and phylogenetic relationship, antibiogram prediction, and antimicrobial susceptibility of 114 human isolates of C. jejuni from a tertiary hospital in southern Spain from October 2020 to June 2023. The isolates were sequenced using Illumina technology, and a bioinformatic analysis was subsequently performed. The susceptibility of C. jejuni isolates to ciprofloxacin, tetracycline, and erythromycin was also tested. The resistance rates for each antibiotic were 90.3% for ciprofloxacin, 66.7% for tetracycline, and 0.88% for erythromycin. The fluoroquinolone resistance rate obtained is well above the European average (69.1%). CC-21 (n = 23), ST-572 (n = 13), and ST-6532 (n = 13) were the most prevalent clonal complexes (CCs) and sequence types (STs). In the virulome, the cadF, ciaB, and cdtABC genes were detected in all the isolates. A prevalence of 20.1% was obtained for the genes wlaN and cstIII, which are related to the pathogenesis of Guillain-Barré syndrome (GBS). The prevalence of the main antimicrobial resistance markers detected were CmeABC (92.1%), RE-cmeABC (7.9%), the T86I substitution in gyrA (88.9%), blaOXA-61 (72.6%), tet(O) (65.8%), and ant (6)-Ia (17.1%). High antibiogram prediction rates (>97%) were obtained, except for in the case of the erythromycin-resistant phenotype. This study contributes significantly to the knowledge of C. jejuni genomics for the prevention, treatment, and control of infections caused by this pathogen.IMPORTANCEDespite being the pathogen with the greatest number of gastroenteritis cases worldwide, Campylobacter jejuni remains a poorly studied microorganism. A sustained increase in fluoroquinolone resistance in human isolates is a problem when treating Campylobacter infections. The development of whole genome sequencing (WGS) techniques has allowed us to better understand the genotypic characteristics of this pathogen and relate them to antibiotic resistance phenotypes. These techniques complement the data obtained from the phenotypic analysis of C. jejuni isolates. The zoonotic transmission of C. jejuni through the consumption of contaminated poultry supports approaching the study of this pathogen through “One Health” approach. In addition, due to the limited information on the genomic characteristics of C. jejuni in Spain, this study provides important data and allows us to compare the results with those obtained in other countries.

Se describe el caso clínico de una mujer que tuvo un papiloma invertido en el seno esfenoidal. El esfenoides fue muy neumatizado y el papiloma invertido se extendió a un receso lateral del seno, más allá de la arteria carótida interna paraclival, que fue procidente. Se hizo un abordaje endonasal unilateral, combinando una esfenoidotomía bilateral con septectomía posterior con un abordaje transpterigoideo, para exponer el receso lateral neumatizado del esfenoides localizado detrás de la pared posterior del maxilar. El papiloma invertido fue resecado en forma completa, sin evidencia de recurrencias.

Key Clinical Message Posterior Reversible Encephalopathy Syndrome, typically characterized by parieto‐occipital vasogenic edema, can present atypically, as a bilateral symmetrical vasogenic edema in the basal ganglia, featuring the called “lentiform fork sign.” Prompt recognition of such variations is crucial for accurate diagnosis and tailored management, highlighting the complexity of this syndrome's manifestations. Abstract Posterior Reversible Encephalopathy Syndrome (PRES) manifests as transient neurological symptoms and cerebral edema, commonly associated with immunosuppressive drugs (ISDs) in transplant recipients. ISDs can lead to endothelial dysfunction and compromise the blood–brain barrier. Typically, PRES exhibits identifiable MRI patterns, often demonstrating vasogenic edema in the bilateral parieto‐occipital white matter. Identifying unique presentations, such as the recently observed “lentiform fork sign,” commonly seen in uremic encephalopathy, emphasizes this syndrome's broad spectrum manifestations. A 19‐year‐old male, who underwent bilateral lung and liver transplantation, experienced a bilateral tonic–clonic seizure of unknown onset 47 days post‐surgery. MRI findings revealed an unconventional PRES pattern, featuring the “lentiform fork sign” as bilateral symmetrical vasogenic edema in the basal ganglia, surrounded by a hyperintense rim outlining the lentiform nucleus bilaterally. Subsequent management, including ISD modification and magnesium supplementation, resulted in clinical and neuroimaging resolution. An almost complete clinical and radiological resolution was achieved after 14 days. The occurrence of PRES in transplant recipients highlights the intricate interplay among ISDs, physiological factors, and cerebrovascular dynamics, potentially involving direct neurovascular endothelial toxicity and disruption of the blood–brain barrier. Neuroimaging plays a pivotal role in diagnosis. The distinctive “lentiform fork sign” was observed in this patient despite the absence of typical metabolic disturbances. Management strategies usually involve reducing hypertension, discontinuing ISDs, correcting electrolyte imbalances, and initiating antiseizure drugs if necessary. Identifying the presence of the “lentiform fork sign” alongside typical PRES edema in a patient lacking renal failure emphasizes that this manifestation is not solely indicative of uremic encephalopathy. Instead, it might represent the final common pathway resulting from alterations in the blood–brain barrier integrity within the deep white matter. Understanding such atypical imaging manifestations could significantly aid earlier and more precise diagnosis, influencing appropriate management decisions.

Introduction: The diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) and, despite all the progress in this field, central nervous system infiltration (CNSi) still occurs at an incidence of 2–10%. The objective of the present study was to evaluate the Central Nervous System International Prognostic Index (CNS-IPI) score in daily practice regarding the reproducibility in a heterogeneous cohort apart from a clinical trial. Methods: Primary DLBCL patients were eligible for this study, between January 2007 and January 2017. All patients were treated with rituximab-based chemotherapy, mostly R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). The CNSi was diagnosed by liquor (positive cytology and/or immunophenotype), computerized tomography, magnetic resonance image and/or fluorodeoxy-glucose-positron emission tomography, requested only in symptomatic patients when the CNSi was clinically suspected. The CNS-IPI was assessed by graphical comparison and calibration. Results: After applying the inclusion/exclusion criteria, 322 patients were available for the analysis. The median follow-up was 60 months and the median age was 58 years. Seven patients experienced CNSi, characterizing an incidence of 2.17% (7/322). Comparing groups of patients with and without CNSi, we observed that the lactate dehydrogenase (LDH), number of extranodal sites, IPI, kidney/adrenal and absence of complete response were statistically different. The CNS-IPI model stratified patients in a three-risk group model as low-, intermediate- and high-risk. In our cohort, using the same stratification, we obtained an equivalent the 2-year rate of CNS relapse of 0.0%, 0.8% and 13.8%, respectively. Conclusion: Our study reinforces the reproducibility of the CNS-IPI, specifically apart from clinical trials, and suggests the CNS-IPI score as a tool to guide therapy.

Abstract Small and nutritionally at‐risk infants aged under 6 months (

Abstract Background Even though the use of nerve monitoring during parotid gland surgery is not the gold standard to prevent damage to the nerve, it surely offers some advantages over the traditional approach. Different from thyroid surgery, where a series of steps in intraoperative nerve monitoring have been described to confirm not only the integrity but—most importantly—the function of the recurrent laryngeal nerve, in parotid gland surgery, a formal guideline to follow while dissecting the facial nerve has yet to be described. Methods A five‐year retrospective study was done reviewing the intraoperative records of patients who underwent parotid gland surgery under neural monitoring. The operative findings regarding the neuromonitoring process, particularly in regard to the amplitude of two main branches, were revised. A literature search was done to search for guidelines to follow when a facial nerve loss of signal is encountered. Results Fifty‐five patients were operated on using the Nim 3 Nerve Monitoring System (Medtronic); 31 were female patients, and 47 patients had benign lesions. Minimum changes were observed in the amplitude records after a comparison was made between the first and the last stimulation. There were only three articles discussing the term loss of signal during parotid gland surgery. Conclusion Today, no sufficient attention has been given to the facial nerve monitoring process during parotidectomy. This study proposes a formal guideline to follow during this procedure as well as an instruction to consider when a loss of signal is observed to develop a uniform technique of facial nerve stimulation

The objective was to verify the performance of spectral techniques as well as validation models in the prediction of nitrogen, total organic carbon, and humic fractions under different cultivation conditions. Chemical analyses for the determination of nitrate, total nitrogen, total organic carbon, and the chemical fractionation of soil organic matter were performed, as well as spectral analyses by Vis-NIR-SWIR and X-ray fluorescence. The results of the spectroscopy were processed using RStudio v. 4.1.3, and PLSR and support vector machine learning algorithms were applied to validate the models. The Vis-NIR-SWIR and XRF spectroscopic techniques showed high performance and are indicated for the prediction of nitrogen, total organic carbon, and humic fractions in Ferralsols of medium sandy texture. However, it is important to highlight that each technique has its own characteristic mechanism of action: Vis-NIR-SWIR detects the element based on harmonic tones, while XRF is based on the atomic number of the element or elemental association. The PLSR and SVM models showed excellent validation results, allowing them to fit the experimental data, emphasizing that they are different statistical methods.

Resumo Este trabalho teve como objetivo avaliar o efeito do sulfito de sódio sobre o rendimento gravimétrico em taninos, extraídos da casca de Anadenanthera peregrina. A extração ocorreu em autoclave de laboratório a 100°C durante 3 horas, usando uma relação licor/casca de 20:1; contendo 0%, 1,5%, 3%, 4,5% e 6% de sulfito de sódio sobre a massa seca de casca. A adição de até 3% de sulfito de sódio na extração, aumentou significativamente o rendimento em taninos. Para valores acima de 3%, o rendimento em sólidos totais continuou aumentando porém o índice de Stiasny diminuiu.

Abstract The Developmental Origins of Health and Disease (DOHaD) concept has provided the framework to assess how early life experiences can shape health and disease throughout the life course. While maternal malnutrition has been proposed as a risk factor for the developmental programming of prostate cancer (PCa), the molecular mechanisms remain poorly understood. Using RNA-seq data, we demonstrated deregulation of miR-206-Plasminogen (PLG) network in the ventral prostate (VP) of young maternally malnourished offspring. RT-qPCR confirmed the deregulation of the miR-206-PLG network in the VP of young and old offspring rats. Considering the key role of estrogenic signaling pathways in prostate carcinogenesis, in vitro miRNA mimic studies also revealed a negative correlation between miR-206 and estrogen receptor α (ESR1) expression in PNT2 cells. Together, we demonstrate that early life estrogenization associated with the deregulation of miR-206 networks can contribute to the developmental origins of PCa in maternally malnourished offspring. Understanding the molecular mechanisms by which early life malnutrition affects offspring health can encourage the adoption of a governmental policy for the prevention of non-communicable chronic diseases related to the DOHaD concept.

Resumen: Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es la tercera causa de muerte a nivel global y en Argentina tiene una prevalencia de 14,5%, pero se desconoce el manejo de los pacientes en la vida real. Los objetivos del trabajo fueron: a) conocer las opiniones de los neumólogos de Argentina que manejan pacientes con EPOC en la práctica diaria. b) Comparar nuestros hallazgos con los especialistas de España y c) considerar nuestros resultados para planificar futuras directrices en el manejo de la EPOC en nuestro país. Material y métodos: Participaron de un consenso Delphi 89 neumólogos de Argentina, expertos en EPOC, quienes respondieron una encuesta con cinco dominios: a) adhesión al tratamiento, b) control de la EPOC, c) rasgos tratables, d) dispositivos de inhalación y e) accesibilidad a los recursos terapéuticos. Resultados: Tras dos rondas, se alcanzó el consenso en 77,6% del total de las afirmaciones y discriminando por dominio los resultados fueron: adhesión al tratamiento: 5/9 (55,5%). Control de la EPOC: 10/14 (71,4%). Rasgos tratables: 6/6 (100%). Dispositivos de inhalación: 10/14 (71,4%) y accesibilidad al tratamiento: 6/6 (100%). En la mayoría de las afirmaciones los resultados fueron similares a los obtenidos por los neumólogos españoles. Conclusiones: Los neumólogos argentinos manejamos a los pacientes con EPOC de manera similar y con mínimas diferencias con nuestros colegas españoles. Se evidenció que, en la práctica diaria, existen factores que impactan negativamente en el acceso a los tratamientos indicados. Nuestro trabajo podría servir como punto de partida para mejorar esta situación. Abstract: Introduction: COPD is the third cause of death globally and in Argentina COPD has a prevalence of 14.5%, but the management of patients in real life is unknown. The objectives of this work were: a) To know the opinions of pulmonologists in Argentina who manage patients with COPD in different aspects of daily practice. b) Compare our findings with specialists from Spain and c) Consider our results to plan future directives in the management of COPD in our country. Material and methods: 89 pulmonologists from Argentina, experts in COPD, participated in a Delphi consensus, who responded to a survey with five domains. a) Adherence to treatment, b) Control of COPD, c) Treatable features, d) Inhalation devices and e) Accessibility to therapeutic resources. Results: After two rounds of questions, total consensus was achieved in 77.6% of the statements and discriminating by domain: Treatment adherence: 5/9 (55.5%). COPD control: 10/14 (71.4%). Treatable traits: 6/6 (100%). Inhalation devices: 10/14 (71.4%) and Accessibility to treatment: 6/6 (100%). In most of the affirmations, the results were similar to those obtained by Spanish pulmonologists. Conclusions: Pulmonologists from Argentina manage COPD patients in a similar way and with minimal differences with our Spanish colleagues. It became evident that, in daily practice, there are factors that negatively impact access to the indicated treatments. Our work could serve as a starting point to improve this situation.

Objetivo. Desarrollar un Análisis de Ciclo de Vida (ACV), en granjas ganaderas con manejo rotacional del pastizal según composición botánica. Materiales y métodos: Se compararon granjas lecheras de Cotopaxi, a 2800- 3590 msnm. Granja 1: carga de 1 y 1,2 UA/ha, con 50% de Llantén (Plantago lanceolata), 50% de Trébol blanco (Trifolium repens). Granja 2: Carga de 1 y 1,2 UA/ha, 85 % de Ryegrass (Lolium perenne)-15% Trébol blanco (Trifolium repens). Granja 3: Carga de 1 y 2,1 UA/ha, 33 % de Ryegrass-33% Llantén-34% de Trébol blanco. Se usó fertilización, balanceado y animales Holstein tipos mestizo, neozelandés y norteamericano y reposo del pasto. Resultados: Hubo diferencias en uso de la tierra, coincidente en granjas 1 y 3, en mano de obra familiar. En la Granja 1, el reposo fue 15 a 28 días y FDN de 47,38 a 28,03 y 1,96 a 2,45 Mcal de energía y en 3, valores de Energía Metabolizable de 1,99 a 40 día y 2,11 a 35 días, menos leche/vaca que 3 y superior a 1. En producción de leche/ha, las granjas 1 y 3 superiores con 24 kg vs 19 kg. Esto fue positivo en ACV en esas granjas. Existió potencial para convertir más energía del sistema a productos. Conclusión: En el ACV, se encontró coincidencia con indicadores de sistemas especializados en producción de leche, balances de nitrógeno, energía y sus relaciones con el ambiente y emisiones, aunque se puede recuperar eficiencia con mejoras al manejo y sin insumos extras a la granja.

Abstract Background and Aim Until the May 2022 Monkeypox (MPXV) outbreak, which spread rapidly to many non‐endemic countries, the virus was considered a viral zoonosis limited to some African countries. The Andalusian circuit of genomic surveillance was rapidly applied to characterize the MPXV outbreak in the South of Spain. Methods Whole genome sequencing was used to obtain the genomic profiles of samples collected across the south of Spain, representative of all the provinces of Andalusia. Phylogenetic analysis was used to study the relationship of the isolates and the available sequences of the 2022 outbreak. Results Whole genome sequencing of a total of 160 MPXV viruses from the different provinces that reported cases were obtained. Interestingly, we report the sequences of MPXV viruses obtained from two patients who died. While one of the isolates bore no noteworthy mutations that explain a potential heightened virulence, in another patient the second consecutive genome sequence, performed after the administration of tecovirimat, uncovered a mutation within the A0A7H0DN30 gene, known to be a prime target for tecovirimat in its Vaccinia counterpart. In general, a low number of mutations were observed in the sequences reported, which were very similar to the reference of the 2022 outbreak (OX044336), as expected from a DNA virus. The samples likely correspond to several introductions of the circulating MPXV viruses from the last outbreak. The virus sequenced from one of the two patients that died presented a mutation in a gene that bears potential connections to drug resistance. This mutation was absent in the initial sequencing before treatment.

Introduction and Objectives: Prevalence of patients with decompensated cirrhosis with requirement of liver transplantation (LT) has increased in our country. A significant percentage of patients with this condition belongs to a geriatric population, which could contraindicate LT, although trends in other countries indicate that the results of LT in geriatric patients are excellent.To assess one-year survival of LT patients over 60 years Materials and Patients: Retrospective, observational, and analytical study of patients over 60 years who underwent LT, evaluating survival, cold ischemia time (CIT), hot ischemia time (HIT), and donor age (DA), compared with a group of patients under 60 years who underwent LT.We evaluated survival over time in months with a follow-up at one year of recipients under 60 years and older than 60 using the Kaplan-Meier curve and the log-rank test, with a significant alpha level

La hemorragia producida por lesión de la arteria lingual en la base de la lengua por cirugías o por tumores es infrecuente. La mayor frecuencia en la indicación de abordajes transorales para tratar diferentes patologías que afectan la orofaringe requiere que el equipo quirúrgico tenga experiencia en el manejo de esta complicación. La ligadura de la arteria lingual en el cuello es una técnica quirúrgica muy eficaz para solucionar la hemorragia, pero es importante conocer las posibles variantes anatómicas que puede tener la arteria en su trayecto cervical. Debido a su baja incidencia se propone como objetivo describir dos casos clínicos de pacientes que tuvieron hemorragias graves por lesión de la arteria lingual en la base de la lengua, producidas por daño quirúrgico y por erosión por tumor.

Se realizó un estudio exploratorio a través de una encuesta a Comités de Ética en países de América Latina y el Caribe de habla hispana, con el fin de relevar su situación frente a emergencias sanitarias y consultar los dilemas éticos enfrentados en las investigaciones para COVID-19. Se obtuvieron respuestas de 106 comités, pertenecientes a 14 países. Solamente el 24% respondió que existía una red de comunicación eficiente y efectiva entre comités, previa a la pandemia. El 45% respondió que no existían en su región comités específicos para evaluar proyectos vinculados a emergencias sanitarias con anterioridad a la pandemia. El porcentaje de CEI que disponía de procedimientos previos para evaluar investigaciones en situaciones de emergencias sanitarias, fue sólo de 7%, si bien el 52% estaba en proceso de elaboración a raíz de la pandemia. El porcentaje de CEI que consideró razonable un tiempo inferior a 5 días para la evaluación de proyectos de investigación, varió en virtud del diseño: 32% para los estudios observacionales y 12% para los ensayos clínicos con drogas o con vacunas. Los tres problemas éticos principales identificados en los estudios para COVID estuvieron relacionados con el consentimiento informado, los aspectos metodológicos y la poca información previa o falta de evidencia para los productos de investigación. Consideramos que debemos reformular la manera de pensar los problemas éticos de las emergencias hacia un abordaje global, con un enfoque preventivo, donde las redes de colaboración entre los CEI deberían convertirse en regla.

En Panamá, los territorios boscosos y los ecosistemas de manglar son muy susceptibles al daño causado por los insectos, debido al aumento de especies exóticas. El objetivo de este estudio fue determinar la abundancia relativa de escarabajos xilófagos en los bosques de manglar del área protegida Refugio de Vida Silvestre RAMSAR, humedal Bahía de Panamá. La investigación se realizó en los bosques de manglar ubicados en las zonas de El Embarcadero, Costa Sur y Don Bosco, donde se encontraron 5033 individuos, correspondientes a 6 familias (Kalotermitidae, Termitidae, Cerambycidae, Curculionidae, Elateridae y Scarabaeidae), asociados al bosque de manglar. El Embarcadero fue el sitio con mayor número de insectos xilófagos capturados, con 3.803 individuos. De las tres áreas muestreadas, las áreas más cercanas a la costa (Zona 1) El Embarcadero y Costa Sur presentaron la mayor cantidad de insectos xilófagos, mientras que Don Bosco presentó la menor cantidad. La familia de escarabajos Curculionidae fue la familia más comúnmente observada, siendo las subfamilias Scolitinae y Platypodinae las más importantes. El 91% de todos los insectos xilófagos capturados pertenecían a la subfamilia Scolytinae, mientras que el 6% pertenecía a la subfamilia Platypodinae; Se demostró que una especie en particular, Euplatypus parallelus, afectó en gran cantidad a individuo del mangle Avicennia germinans. Las familias de escarabajos xilófagos que presentaron menor abundancia fueron: Elateridae con 45 individuos, Scarabaeidae con 5 individuos y Cerambycidae con 2 individuos. Se observaron dos familias de termitas, Kalotermitidae con 50 nidos y Termitidae con 5 nidos. Las termitas en los ecosistemas de manglar son importantes debido a su capacidad de modificar las propiedades del suelo al descomponer la materia orgánica, principalmente la madera de los árboles de mangle que ya están muy viejos o muertos. También, contribuye a proteger los nutrientes, factores clave para mantener la estabilidad de los ecosistemas tropicales.

Background: We assessed the effects of exercise-based training programs (EBTP) in patients with chronic Chagas cardiomyopathy (CCC) through a systematic review and meta-analysis. Methods: We conducted a search in Pubmed/Medline, Embase, Scopus, Web of Science, Cochrane Library, Virtual Health Library, and SciELO until January 2023. Randomized controlled trials (RCTs) and non-randomized intervention studies (NRIS) investigating the effects of EBTP in CCC patients were included. The primary outcomes were all-cause mortality, cardiovascular mortality, and health-related quality of life (HRQoL), and the secondary outcomes were exercise capacity by peak VO2, heart failure-related hospital admissions (HFRHA), and left ventricular ejection fraction (LVEF). Results: The search strategy yielded 3617 studies. After removing duplicates and screening, eight studies (3 RCTs and 5 NRIS) involving 222 patients were included. Seven studies were conducted in Brazil. The age range was from 30 to 71 years, and 47.1% were male. Data on mortality, HRQoL, LVEF, and HFRHA were scarcely reported. The meta-analysis pooling four studies showed that the peak VO2 was significantly higher (mean difference 4.45, 95% confidence interval 3.50 to 5.39 mL/kg/min, I2 = 0%) in the EBTP group compared to the control group. Conclusion: The evidence available was limited and heterogeneous. While EBTP has shown to improve HRQoL and exercise capacity, there is no conclusive information about the other proposed outcomes. These positive effects present an opportunity to provide treatment to CCC patients in low- and middle-income countries. Further studies are needed to ascertain the effects of EBTP on hard outcomes in this population.Registration number: CRD42022334060.

Background: The objective of this study was to estimate the prevalence of adolescent pregnancy among sexually active adolescents, and identify the factors associated with this problem. Methods: A population-based analytical cross-sectional study was conducted using pooled data from the Demographic and Family Health Surveys of Peru, 2015-2019. A total sample of 8850 adolescent girls aged 12 to 19 years who reported a history of sexual intercourse were included. To identify factors related to adolescent pregnancy, the study employed adjusted prevalence ratios (aPR) with 95% confidence intervals (95% CI). The aPR were obtained from a multivariable logistic regression model. Results: The prevalence of adolescent pregnancy among sexually active adolescents in Peru was 30.9% (95%CI: 29.4–32.4%). In the multivariable analysis; being 17-19 years (aPR: 1.48; 95%CI :1.33–1.64), being married or cohabitant (aPR: 4.01; 95%CI: 3.48–4.61) and belonging to the Quechua ethnicity group (aPR: 1.16; 95%CI: 1.07–1.25), were associated with a higher prevalence. Conversely, the following factors were associated with a lower prevalence of pregnancy: being employed (aPR: 0.81; 95%CI: 0.76–0.86), being currently studying (aPR: 0.43; 95%CI: 0.38–0.49), belonging to the second (aPR: 0.91; 95%CI: 0.85–0.97), third (aPR: 0.81; 95%CI: 0.74–0.89), fourth (aPR: 0.79; 95%CI: 0.69–0.91) and fifth (aPR: 0.59; 95%CI: 0.47–0.75) wealth quintile, initiating sexual relations in middle adolescente (aPR: 0.76; 95%CI: 0.69–0.83) or late adolescence (aPR: 0.40; 95%CI: 0.35–0.46), perceiving a future pregnancy as a problem (aPR: 0.77; 95%CI: 0.72–0.83) and having knowledge of the moment in the cycle when pregnancy can occur (aPR: 0.84; 95%CI: 0.77–0.92) Conclusions: Approximately three out of ten adolescents who initiated a sexual life had at least one pregnancy. Age, marital status, employment, education, wealth, ethnicity, age at first intercourse, knowledge of when in the cycle she may become pregnant, and perception of future pregnancy were associated with adolescent pregnancy

CD40 induces pro-inflammatory responses in endothelial and Müller cells and is required for the development of diabetic retinopathy (DR). CD40 is upregulated in these cells in patients with DR. CD40 upregulation is a central feature of CD40-driven inflammatory disorders. What drives CD40 upregulation in the diabetic retina remains unknown. We examined the role of advanced glycation end products (AGEs) in CD40 upregulation in endothelial cells and Müller cells. Human endothelial cells and Müller cells were incubated with unmodified or methylglyoxal (MGO)-modified fibronectin. CD40 expression was assessed by flow cytometry. The expression of ICAM-1 and CCL2 was examined by flow cytometry or ELISA after stimulation with CD154 (CD40 ligand). The expression of carboxymethyl lysine (CML), fibronectin, and laminin as well as CD40 in endothelial and Müller cells from patients with DR was examined by confocal microscopy. Fibronectin modified by MGO upregulated CD40 in endothelial and Müller cells. CD40 upregulation was functionally relevant. MGO-modified fibronectin enhanced CD154-driven upregulation of ICAM-1 and CCL2 in endothelial and Müller cells. Increased CD40 expression in endothelial and Müller cells from patients with DR was associated with increased CML expression in fibronectin and laminin. These findings identify AGEs as inducers of CD40 upregulation in endothelial and Müller cells and enhancers of CD40-dependent pro-inflammatory responses. CD40 upregulation in these cells is associated with higher CML expression in fibronectin and laminin in patients with DR. This study revealed that CD40 and AGEs, two important drivers of DR, are interconnected.

ObjectivesClinical ethical decision-making models are largely geared toward individual clinician choices and individual patient outcomes, not necessarily accounting for larger systemic issues that affect optimal patient outcomes. The purpose of this paper is to provide an ethical decision-making model, drawing upon systems orientation and ethical theory, specifically incorporating and aiding in the mitigation of social and structural determinants of health.MethodsThis paper presents a systems-oriented ethical decision-making framework derived from the analysis and critique of the Four-Box Method for Ethical Decision-Making by Jonsen, Siegler, and Winslade. Drawing upon both deontological and utilitarian ethical theory, the developed framework will assist providers, organizations, and health system leaders in navigating the increasingly complex ethical dimensions of care delivery for underserved patient populations, who are largely impacted by social and structural determinants of health.ResultsThe needs of underserved patients are inextricably linked to various social and structural determinants of health that, if left unaddressed, result in even poorer health outcomes, exacerbating existing health disparities. A systems-oriented ethical decision-making framework, centered on obligation, duty, and a utilitarian view of the optimal good, will aid providers, organizations, health system leaders, and community stakeholders in navigating the increasingly complex ethical dimensions of care delivery for underserved patient populations.ConclusionSocioeconomic and political contexts have a significant impact on the way society is organized, how people are positioned in society, and how they will fare in terms of their health. Healthcare providers, including dentists, are largely unaware of and insensitive to the social issues that underlie the biological or psychological concerns that patients from socially disadvantaged backgrounds face. A systems-oriented ethical decision-making model will aid in mitigating social and structural determinants of health and the dental profession's obligations to the underserved.

Clinical case of a patient with a Pseudomonas aeruginosa multidrug-resistant prosthetic vascular graft infection which was treated with a cocktail of phages (PT07, 14/01, and PNM) in combination with ceftazidime-avibactam (CZA). After the application of the phage treatment and in absence of antimicrobial therapy, a new P. aeruginosa bloodstream infection (BSI) with a septic residual limb metastasis occurred, now involving a wild-type strain being susceptible to ß-lactams and quinolones. Clinical strains were analyzed by microbiology and whole genome sequencing techniques. In relation with phage administration, the clinical isolates of P. aeruginosa before phage therapy (HE2011471) and post phage therapy (HE2105886) showed a clonal relationship but with important genomic changes which could be involved in the resistance to this therapy. Finally, phenotypic studies showed a decrease in Minimum Inhibitory Concentration (MIC) to ß-lactams and quinolones as well as an increase of the biofilm production and phage resistant mutants in the clinical isolate of P. aeruginosa post phage therapy.

ABSTRACT Objective: The purpose of these guidelines is to provide specific recommendations for the surgical treatment of neck metastases in patients with papillary, follicular, and medullary thyroid carcinomas. Materials and methods: Recommendations were developed based on research of scientific articles (preferentially meta-analyses) and guidelines issued by international medical specialty societies. The American College of Physicians’ Guideline Grading System was used to determine the levels of evidence and grades of recommendations. The following questions were answered: A) Is elective neck dissection indicated in the treatment of papillary, follicular, and medullary thyroid carcinoma? B) When should central, lateral, and modified radical neck dissection be performed? C) Could molecular tests guide the extent of the neck dissection? Results/conclusion: Recommendation 1: Elective central neck dissection is not indicated in patients with cN0 well-differentiated thyroid carcinoma or in those with noninvasive T1 and T2 tumors but may be considered in T3-T4 tumors or in the presence of metastases in the lateral neck compartments. Recommendation 2: Elective central neck dissection is recommended in medullary thyroid carcinoma. Recommendation 3: Selective neck dissection of levels II–V should be indicated to treat neck metastases in papillary thyroid cancer, an approach that decreases the risk of recurrence and mortality. Recommendation 4: Compartmental neck dissection is indicated in the treatment of lymph node recurrence after elective or therapeutic neck dissection; “berry node picking” is not recommended. Recommendation 5: There are currently no recommendations regarding the use of molecular tests in guiding the extent of neck dissection in thyroid cancer.

Abstract Growing industrial crops on marginal lands has been proposed as a strategy to minimize competition for arable land and food production. In the present study, eight experimental sites in three different climatic zones in Europe (Mediterranean, Atlantic and Continental), seven advanced industrial crop species [giant reed (two clones), miscanthus (M. × giganteus and two new seed‐based hybrids), saccharum (one clones), switchgrass (one variety), tall wheatgrass (one variety), industrial hemp (three varieties) and willow (eleven clones)], and six marginality factors alone or in combination (dryness, unfavorable texture, stoniness, shallow soil, topsoil acidity, heavy metal and metalloid contamination) were investigated. At each site, biophysical constraints and low‐input management practices were combined with prevailing climatic conditions. The relative yield of a site‐specific low‐input system compared with the site‐specific control was from small to large (i.e. from −99% in industrial hemp in the Mediterranean to +210% in willow in the Continental zone), due to the genotype‐by‐management interaction along with climatic variation between growing seasons. Genotype selection and improved knowledge on crop response to changing environmental, site‐specific biophysical constraint and input application has been detected as key to profitably grow industrial crops on marginal areas. This study may act to provide hints on how to scale up investigated cropping systems, through low‐input practices, under similar environmental and soil conditions tested at each site. However, further attention to detail on the agronomy of early plant development and management in larger multi‐year and multi‐location field studies with commercially scalable agronomies are needed to validate yield performances, and thereby to inform on the best industrial crop options.

The aim of this study was to investigate the features of partial anomalous left pulmonary artery (PALPA) and differences between cases with posterior versus anterior a nomalous vessels in relation to the tracheobronchial tree. We hypothesized that statistical significance was dependent on the course of the anomalous vessel due to airway compression in the posterior type. This study included cases obtained from the literature (n = 33) and an institution teaching file (n = 2). Information collected: age, sex, medical history, additional anomalies, anomalous vessel course, and respiratory symptoms. Data were analyzed with independent samples t-test and Fisher’s exact test. PALPAs were more commonly anterior than posterior. Mean age: 5.3 years (SD = 12.4) for anterior and 6.8 years (SD = 18.5) for posterior (p = 0.77). Respiratory symptoms: 20% of anterior and 60% of posterior cases (p = 0.032). Tracheobronchial anomalies: 35% of anterior and 60% of posterior cases (p = 0.182). Non-cardiac and non-tracheobronchial anomalies: 30% of anterior and 47% of posterior cases (p = 0.511). Kabuki syndrome: 25% of anterior and 6.7% of posterior cases (p = 0.207). In conclusion, respiratory symptoms were the only significant difference between anterior and posterior PALPA types.

Metastatic CTC clusters remain relatively unexplored due to the lack of optimized and practical technologies for their detection. Here the authors report Cluster-Wells to isolate CTC clusters in whole blood; they show this allows viable cluster retrieval for further molecular and functional analysis.

We expect luminous ( M _1450 ≲ −26.5) high-redshift quasars to trace the highest-density peaks in the early Universe. Here, we present observations of four z ≳ 6 quasar fields using JWST/NIRCam in the imaging and wide-field slitless spectroscopy mode and report a wide range in the number of detected [O iii ]-emitting galaxies in the quasars’ environments, ranging between a density enhancement of δ ≈ 65 within a 2 cMpc radius—one of the largest protoclusters during the Epoch of Reionization discovered to date—to a density contrast consistent with zero, indicating the presence of a UV-luminous quasar in a region comparable to the average density of the Universe. By measuring the two-point cross-correlation function of quasars and their surrounding galaxies, as well as the galaxy autocorrelation function, we infer a correlation length of quasars at 〈 z 〉 = 6.25 of ${r}_{0}^{\mathrm{QQ}}={22.0}_{-2.9}^{+3.0}\,\mathrm{cMpc}\,{h}^{-1}$ , while we obtain a correlation length of the [O iii ]-emitting galaxies of ${r}_{0}^{\mathrm{GG}}=4.1\,\pm 0.3\,\mathrm{cMpc}\,{h}^{-1}$ . By comparing the correlation functions to dark-matter-only simulations we estimate the minimum mass of the quasars’ host dark matter halos to be ${\mathrm{log}}_{10}({M}_{\mathrm{halo},\min }/{M}_{\odot })={12.43}_{-0.15}^{+0.13}$ (and ${\mathrm{log}}_{10}({M}_{\mathrm{halo},\min }^{[\mathrm{OIII}]}/{M}_{\odot })\,={10.56}_{-0.03}^{+0.05}$ for the [O iii ] emitters), indicating that (a) luminous quasars do not necessarily reside within the most overdense regions in the early Universe, and that (b) the UV-luminous duty cycle of quasar activity at these redshifts is f _duty ≪ 1. Such short quasar activity timescales challenge our understanding of early supermassive black hole growth and provide evidence for highly dust-obscured growth phases or episodic, radiatively inefficient accretion rates.

The dark matter subhalos orbiting in a galactic halo perturb the orbits of stars in thin stellar streams. Over time, the random velocities in the streams develop non-Gaussian wings. The rate of velocity increase is approximately a random walk at a rate proportional to the number of subhalos, primarily those in the mass range ≈10 ^6−7 M _⊙ . The distribution of random velocities in long streams is measured in simulated Milky Way–like halos that develop in representative warm dark matter (WDM) and cold dark matter (CDM) cosmologies. The radial velocity distributions are well modeled as the sum of a Gaussian and an exponential. The resulting Markov Chain Monte Carlo fits find Gaussian cores of 1−2 km s ^−1 and exponential wings that increase from 3 km s ^−1 for 5.5 keV WDM, 4 km s ^−1 for 7 keV WDM, to 6 km s ^−1 for a CDM halo. The observational prospects to use stream measurements to constrain the nature of galactic dark matter are discussed.

Abstract The aim of this work is to evaluate the performance of a novel algorithm that combines dynamic wavefront aberrometry data and descriptors of the retinal image quality from objective autorefractor measurements to predict subjective refraction. We conducted a retrospective study of the prediction accuracy and precision of the novel algorithm compared to standard search-based retinal image quality optimization algorithms. Dynamic measurements from 34 adult patients were taken with a handheld wavefront autorefractor and static data was obtained with a high-end desktop wavefront aberrometer. The search-based algorithms did not significantly improve the results of the desktop system, while the dynamic approach was able to simultaneously reduce the standard deviation (up to a 15% for reduction of spherical equivalent power) and the mean bias error of the predictions (up to 80% reduction of spherical equivalent power) for the handheld aberrometer. These results suggest that dynamic retinal image analysis can substantially improve the accuracy and precision of the portable wavefront autorefractor relative to subjective refraction.

The purpose of this study was to compare the immediate effects of a plyometric warm-up protocol (PWU) and a sprint warm-up protocol (SWU) on jumping performance in female volleyball players aged 14-16 years. Through a cross-over experimental design, 18 female players were randomly divided into two groups, each receiving both warm-up protocols (PWU and SWU). Before and after each protocol, height and jumping power were evaluated in squat jump (SJ), countermovement jump (CMJ), and Abalakov (ABK) tests using the DM jump® contact mat. Both warm-up protocols significantly improved SJ, CMJ, and ABK performance (p.05), although the greatest percentage increase in jump height and power was obtained with the SWU. The ANOVA showed significant differences in group 1 (initially assigned to PWU) for all tests except for CMJ and ABK power. In group 2 (initially assigned to SWU), the ANOVA also showed significant differences, except for SJ and CMJ power. It is concluded that both warm-up protocols improve jump height and power; however, SWU shows a more favorable trend than PWU. From a practical perspective, the preliminary findings of this pilot study can provide useful guidelines for the warm-up process; however, further randomized controlled studies with adequate statistical power are required for more robust conclusions. Keywords: warm-up exercise, volleyball, muscle strength, athletic performance, adolescent

Introducción: La lesión medular (LM) es un problema médico contemporáneo caracterizado por datos insuficientes sobre prevalencia y debilidad de modelización en metodología. Objetivo: Establecer las interrelaciones del estado nutricional y la condición neurológica-funcional con signos clínicos: tiempo y tipo de lesión, nivel de lesión y severidad del trauma raquimedular dorso lumbar. Material y Métodos: Estudio descriptivo transversal de 102 pacientes con trauma raquimedular al ingreso, 85 hombres y 17 mujeres (febrero 2016 - enero de 2020, CIREN) La Habana, Cuba. Se realizó evaluación nutricional, neurológica (nivel, grado y severidad de lesión) mediante escalas ASIA, Independencia SCIM-III e índice de Barthel. Se obtienen medias, desviación estándar, error estándar y análisis de varianza para distribuciones normales. Se utilizó SPSS versión 26. Resultados: La edad promedio fue 29,7 ± 8,1 años. La antigüedad del trauma fue 3,1 ± 1,4 años. La lesión raquimedular ocurrió en 50,6 % del segmento T7– L3 en pacientes con lesión completa. Hubo deficiencia energética crónica (4,9 %), según Índice de Masa Corporal; el 50,6 % fueron ≥ 22 kg/m2, según criterio de riesgo de Nash. El 73,5 % clasificaban en escala A de ASIA. La correlación entre Catz y Barthel demostró asociación significativa (p

Abstract Gut microbiome is gaining interest because of its links with several diseases, including colorectal cancer (CRC), as well as the possibility of being used to obtain non-intrusive predictive disease biomarkers. Here we performed a meta-analysis of 1042 fecal metagenomic samples from seven publicly available studies. We used an interpretable machine learning approach based on functional profiles, instead of the conventional taxonomic profiles, to produce a highly accurate predictor of CRC with better precision than those of previous proposals. Moreover, this approach is also able to discriminate samples with adenoma, which makes this approach very promising for CRC prevention by detecting early stages in which intervention is easier and more effective. In addition, interpretable machine learning methods allow extracting features relevant for the classification, which reveals basic molecular mechanisms accounting for the changes undergone by the microbiome functional landscape in the transition from healthy gut to adenoma and CRC conditions. Functional profiles have demonstrated superior accuracy in predicting CRC and adenoma conditions than taxonomic profiles and additionally, in a context of explainable machine learning, provide useful hints on the molecular mechanisms operating in the microbiota behind these conditions.

Abstract Nutritional vulnerability under the age of 6 months is prevalent in low‐ and middle‐income countries with 20.1% infants underweight, 21.3% wasted and 17.6% stunted in a recent review. A novel Care Pathway for improved management of small and nutritionally at‐risk infants under 6 months and their mothers (MAMI) has recently been developed to provide outpatient care at large coverage. We aimed to investigate stakeholders’ views on the feasibility of its implementation and to identify barriers and enablers. This was an early stage formative mixed‐methods study: an online survey plus in‐depth interviews with country‐level stakeholders in nutrition and child health from different geographical regions and stakeholder groups. 189 stakeholders from 42 countries responded to the online survey and 14 remote interviews were conducted. Participants expressed an urgent need for improved detection and care for small and nutritionally at‐risk infants under 6 months. Whilst they considered the MAMI Care Pathway feasible and relevant, they noted it was largely unknown in their country. The most mentioned implementation barriers were: community‐specific needs and health care seeking barriers, health workers’ lack of competence in breastfeeding counselling and the absence of a validated anthropometric screening method. Possible enablers for its implementation were: patients’ preference for outpatient care, integrating the MAMI care pathway into existing maternal and child health programmes and the possibility of a local pilot project. Adaptation to the local context was considered crucial in further scale‐up.

Background Community health participation is an essential tool in health research and management where community members, researchers and other relevant stakeholders contribute to the decision-making processes. Though community participation processes can be complex and challenging, evidence from previous studies have reported significant value of engaging with community in community health projects. Objective To identify the nature and extent of community involvement in community health participatory research (CHPR) projects in Ghana and draw lessons for participatory design of a new project on diabetes intervention in Accra called the Contextual Awareness Response and Evaluation (CARE) diabetes project. Methods A scoping review of relevant publications on CHPR projects in Ghana which had a participatory component was undertaken. PubMed, PsycINFO, African Journal Online, Health Source: Nursing/Academic Edition, Humanities International Complete and Google Scholar were searched for articles published between January 1950 and October 2021. Levac et al.’s (2010) methodological framework for scoping reviews was used to select, collate and characterise the data. Results Fifteen studies were included in this review of CHPR projects from multiple disciplines. Participants included community health workers, patients, caregivers, policymakers, community groups, service users and providers. Based on Pretty’s participation typology, several themes were identified in relation to the involvement of participants in the identified studies. The highest levels of participation were found in two studies in the diagnosis, four in the development, five in the implementation and three in the evaluation phases of projects. Community participation across all studies was assessed as low overall. Conclusion This review showed that community participation is essential in the acceptability and feasibility of research projects in Ghana and highlighted community participation’s role in the diagnosis, development, implementation and evaluation stages of projects. Lessons from this review will be considered in the development, implementation, and future evaluation of the CARE diabetes project.

El estesioneuroblastoma es una neoplasia maligna que se origina del epitelio olfatorio. El tratamiento se establece de acuerdo con su extensión y el grado histológico de atipia y puede incluir cirugía, cirugía más radioterapia o más radioquimioterapia. Se han utilizado diferentes abordajes quirúrgicos que incluyeron incisiones faciales y craneotomía pero, con la mayor experiencia adquirida en cirugía endoscópica de senos paranasales y el trabajo en equipo con el neurocirujano, se han desarrollado técnicas endonasales que posibilitan realizar resecciones oncológicas en pacientes seleccionados, con menos morbilidad, internación breve y sin comprometer el control local de la enfermedad. Describimos el caso clínico de una paciente con un estesioneuroblastoma con invasión intracraneal, que fue tratada con éxito mediante una hemicraniectomía endonasal preservando el bulbo olfatorio contralateral.

ObjectiveThis paper describes the impact that the different COVID-19 related restrictions have had on the mental health and wellbeing of 57 Central American and Caribbean immigrants stranded in Mexico due to the pandemic.MethodsEthnographic data was obtained through the application of in-depth interviews centered on topics such as migration history, personal experience with COVID-19 and beliefs about the pandemic. This information was further analyzed through a narrative approach and Atlas Ti.Main findingsUS Title 42 and the Migrant Protection Protocols (MPP) have stranded thousands of individuals in the US-Mexico border region, a situation that has overcrowded the available shelters in the area and forced many of the immigrants to live on the streets and in improvised encampments. Thus, exposing them to a higher risk of contagion. Furthermore, the majority of the interviewed Central American and Caribbean immigrants consider that Mexico is more lenient when it comes to the enforcement of sanitary measures, especially when compared to their countries of origin. Finally, vaccination hesitancy was low among the interviewees, mainly due to the operative aspects of the vaccination effort in Mexico and the fear of ruining their chances to attain asylum in the US. These findings are backed up by the discovery of five recurring narratives among the interviewees regarding: (1) The pandemic's psychological impact. (2) The uncertainty of being stranded in Mexico and the long wait. (3) Their fear of violence over the fear of contagion. (4) The perceived leniency of Mexico with the pandemic when compared to their countries of origin, and (5) their beliefs about the pandemic and vaccines.Key findingThe mental health of stranded Central American and Caribbean immigrants in Mexico during the COVID-19 pandemic is mostly affected by their inability to make it across the US-Mexico border using legal means.

Rhodoliths occur extensively around the shores of Fuerteventura Island in the Canary Archipelago, with Lithothamnion cf. corallioides being the most prominent species. A large number of rhodoliths end up washed onshore, the debris from which contributes to the formation of sediments constituting modern beaches. In a previous study by one of the co-authors (MEJ), the northern coast of Fuerteventura was shown to comprise various types of rhodolith deposits such as beach, platform overwash, tidal pools, coastal dunes, and others. An extraordinary example of stranded rhodoliths is located near Caleta del Bajo de Mejillones, approximately 3 km west of Corralejo, on the north coast of the island. The deposit forms a supratidal beach 120 m long and 10 m wide that sits above the landward termination of an extensive wave-cut platform eroded in basalt and exposed at low tide to a width of 130 m perpendicular to shore. Here, rhodoliths are very small (

Abstract Objective To evaluate the taxonomic composition of the gut microbiome in gout patients with and without tophi formation, and predict bacterial functions that might have an impact on urate metabolism. Methods Hypervariable V3–V4 regions of the bacterial 16S rRNA gene from fecal samples of gout patients with and without tophi (n = 33 and n = 25, respectively) were sequenced and compared to fecal samples from 53 healthy controls. We explored predictive functional profiles using bioinformatics in order to identify differences in taxonomy and metabolic pathways. Results We identified a microbiome characterized by the lowest richness and a higher abundance of Phascolarctobacterium, Bacteroides, Akkermansia, and Ruminococcus_gnavus_group genera in patients with gout without tophi when compared to controls. The Proteobacteria phylum and the Escherichia-Shigella genus were more abundant in patients with tophaceous gout than in controls. Fold change analysis detected nine genera enriched in healthy controls compared to gout groups (Bifidobacterium, Butyricicoccus, Oscillobacter, Ruminococcaceae_UCG_010, Lachnospiraceae_ND2007_group, Haemophilus, Ruminococcus_1, Clostridium_sensu_stricto_1, and Ruminococcaceae_UGC_013). We found that the core microbiota of both gout groups shared Bacteroides caccae, Bacteroides stercoris ATCC 43183, and Bacteroides coprocola DSM 17136. These bacteria might perform functions linked to one-carbon metabolism, nucleotide binding, amino acid biosynthesis, and purine biosynthesis. Finally, we observed differences in key bacterial enzymes involved in urate synthesis, degradation, and elimination. Conclusion Our findings revealed that taxonomic variations in the gut microbiome of gout patients with and without tophi might have a functional impact on urate metabolism.

Chagas disease (CD) is one of the main neglected tropical diseases that promote relevant socioeconomic impacts in several countries. The therapeutic options for the treatment of CD are limited, and parasite resistance has been reported. Piplartine is a phenylpropanoid imide that has diverse biological activities, including trypanocidal action. Thus, the objective of the present work was to prepare a collection of thirteen esters analogous to piplartine (1–13) and evaluate their trypanocidal activity against Trypanosoma cruzi. Of the tested analogues, compound 11 ((E)-furan-2-ylmethyl 3-(3,4,5-trimethoxyphenyl)acrylate) showed good activity with IC50 values = 28.21 ± 5.34 μM and 47.02 ± 8.70 μM, against the epimastigote and trypomastigote forms, respectively. In addition, it showed a high rate of selectivity to the parasite. The trypanocidal mechanism of action occurs through the induction of oxidative stress and mitochondrial damage. In addition, scanning electron microscopy showed the formation of pores and leakage of cytoplasmic content. Molecular docking indicated that 11 probably produces a trypanocidal effect through a multi-target mechanism, including affinity with proteins CRK1, MPK13, GSK3B, AKR, UCE-1, and UCE-2, which are important for the survival of the parasite. Therefore, the results suggest chemical characteristics that can serve for the development of new trypanocidal prototypes for researching drugs against Chagas disease.

Abstract Background Analysis of lymphocyte cell lines revealed substantial differences in the expression of mRNA and microRNA (miRNA) among human populations. The extent of such population-associated differences in actual human tissues remains largely unexplored. The placenta is one of the few solid human tissues that can be collected in substantial numbers in a controlled manner, enabling quantitative analysis of transient biomolecules such as RNA transcripts. Here, we analyzed microRNA (miRNA) expression in human placental samples derived from 36 individuals representing four genetically distinct human populations: African Americans, European Americans, South Asians, and East Asians. All samples were collected at the same hospital following a unified protocol, thus minimizing potential biases that might influence the results. Results Sequence analysis of the miRNA fraction yielded 938 annotated and 70 novel miRNA transcripts expressed in the placenta. Of them, 82 (9%) of annotated and 11 (16%) of novel miRNAs displayed quantitative expression differences among populations, generally reflecting reported genetic and mRNA-expression-based distances. Several co-expressed miRNA clusters stood out from the rest of the population-associated differences in terms of miRNA evolutionary age, tissue-specificity, and disease-association characteristics. Among three non-environmental influenced demographic parameters, the second largest contributor to miRNA expression variation after population was the sex of the newborn, with 32 miRNAs (3% of detected) exhibiting significant expression differences depending on whether the newborn was male or female. Male-associated miRNAs were evolutionarily younger and correlated inversely with the expression of target mRNA involved in neuron-related functions. In contrast, both male and female-associated miRNAs appeared to mediate different types of hormonal responses. Demographic factors further affected reported imprinted expression of 66 placental miRNAs: the imprinting strength correlated with the mother’s weight, but not height. Conclusions Our results showed that among 12 assessed demographic variables, population affiliation and fetal sex had a substantial influence on miRNA expression variation among human placental samples. The effect of newborn-sex-associated miRNA differences further led to expression inhibition of the target genes clustering in specific functional pathways. By contrast, population-driven miRNA differences might mainly represent neutral changes with minimal functional impacts.

Abstract Background A therapeutic approach for the treatment of glucocorticoid‐induced skeletal muscle atrophy should be based on the knowledge of the molecular mechanisms determining the unbalance between anabolic and catabolic processes and how to re‐establish this balance. Here, we investigated whether the obestatin/GPR39 system, an autocrine signalling system acting on myogenesis and with anabolic effects on the skeletal muscle, could protect against chronic glucocorticoid‐induced muscle atrophy. Methods In this study, we used an in vivo model of muscle atrophy induced by the synthetic glucocorticoid dexamethasone to examine the liaison molecules that define the interaction between the glucocorticoid receptor and the obestatin/GPR39 systems. The findings were extended to in vitro effects on human atrophy using human KM155C25 myotubes. Results KLF15 and FoxO transcription factors were identified as direct targets of obestatin signalling in the control of proteostasis in skeletal muscle. The KLF15‐triggered gene expression program, including atrogenes and FoxOs, was regulated via KLF15 ubiquitination by the E3 ubiquitin ligase NEDD4. Additionally, a specific pattern of FoxO post‐translational modification, including FoxO4 phosphorylation by Akt pathway, was critical in the regulation of the ubiquitin–proteasome system. The functional cooperativity between Akt and NEDD4 in the regulation of FoxO and KLF15 provides integrated cues to counteract muscle proteostasis and re‐establish protein synthesis. Conclusions The effective control of FoxO activity in response to glucocorticoid is critical to counteract muscle‐related pathologies. These results highlight the potential of the obestatin/GPR39 system to fine‐tune the effects of glucocorticoids on skeletal muscle wasting.