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Lipschütz ulcer is a non-sexually transmitted genital lesion of unknown etiology, which presents as a painful vulvar ulcer. Lipschütz ulcers have been described in most continents. This is the first case reported in Peru and South America. We present the case of a 33-year-old female patient with a Lipschütz ulcer after being vaccinated with the second dose of the AstraZeneca COVID-19 vaccine. She reported having had only one sexual partner in her lifetime. Laboratory results were negative for herpes simplex 2, Cytomegalovirus, Toxoplasma gondii, Epstein-Barr virus, and syphilis. The patient received symptomatic treatment. Ten days after the onset, the patient was significantly better during follow-up. This case report displays a potential adverse effect of the AstraZeneca COVID-19 vaccine as a Lipschütz ulcer triggered by the host humoral immune response. However, further research is needed to establish the causal relationship between these two.

In Mexico, pasture degradation is associated with extensive pastures; additionally, under these conditions, livestock activities contribute considerably to greenhouse gas (GHG) emissions. Among the options to improve grazing systems and reduce GHG emissions, silvopastoral systems (SPS) have been recommended. The objectives of this work were to quantify the N outflow in a soil–plant–animal interface, as well as the CH4 emissions and milk production in an SPS with woody legumes (Leucaena leucocephala) that is associated with stargrass (Cynodon nlemfuensis). This was then compared with stargrass in a monoculture system (MS) in the seasons (dry and rainy period) over a two-year period. Dung was collected from the animals of each of the grazing systems and applied fresh to the land plots. Fresh dung and urine were collected from the cows of each grazing system and were applied to the experimental plots. In addition, the soil CH4 and N2O contents were measured to quantify the emissions. Average milk yield by seasons was similar: MS (7.1 kg per animal unit (AU)/day−1) and SPS (6.31 kg per AU/day−1). Cows in the MS had a mean N intake of 171.9 g/UA day−1 without seasonal variation, while the SPS animals’ mean N intake was 215.7 g/UA day−1 for both seasons. For the urine applied to soil, the N2O outflow was higher in the MS (peak value = 1623.9 μg N-N2O m−2 h−1). The peak value for the SPS was 755.9 μg of N-N2O m−2 h−1. The N2O emissions were higher in the rainy season (which promotes denitrification). The values for the feces treatment were 0.05% (MS) and 0.01% (SPS). The urine treatment values were 0.52% (MS) and 0.17% (SPS). The emissions of CH4 showed that the feces of the SPS systems resulted in a higher accumulation of gas in the rainy season (29.8 g C ha−1), followed by the feces of the MS system in the dry season (26.0 g C ha−1). Legumes in the SPS helped to maintain milk production, and the N2O emissions were lower than those produced by the MS (where the pastures were fertilized with N).

Assessments of the efficiency of grazing systems, in terms of productivity and ecological sustainability, are necessary in view of the increased demand for animal protein. In this study, the methane (CH4) emissions (sniffer methodology), dry matter (DM) yield, paddock chemical composition (AOAC and Van Soest methods), nutrient intake (dry matter, DMI; crude protein, CPI; metabolizable energy, MEI), daily milk yield (DMY), body condition score (BCS), and body weight (BW) of cattle, in intensive silvopastoral systems (ISPSs) and monoculture systems (MSs), in the tropics of Mexico were evaluated. In the ISPS, CH4 emissions (18% less) and DMY were lower than in the MS. Cows from MSs tend to disperse across higher values of CH4 emissions per kg of DMI, as well as higher milk production, while cows from the ISPS were dispersed over a higher intake (DMI, CPI, and MEI) and lower CH4 emissions. There were no differences between systems in paddock DM yield, chemical composition, cows’ BCS, and BW, regardless of whether it was the dry (April to May) and rainy (September to October) season. Based on the results obtained in this study, ISPSs contribute to the mitigation of methane emissions in cattle; forage and animal production variables in both systems were similar, with a lower use of imported inputs in the ISPS.

Background The accelerated increase in the use of e-cigarette by university students in recent years has incremented nicotine use in addition to tobacco, but it is not known whether the use of cannabis is related to these alternatives. This study analyzes the association between the use of electronic cigarettes and/or tobacco and the use of cannabis in the last 12 months. An analytical cross-sectional study conducted based on the III Andean epidemiological study on drug consumption among university students in 2016. A multivariate analysis performed using a generalized linear family model and the log Poisson link option. The results were shown as Prevalence Ratios (PR) in raw (PRc) and adjusted (PRa) models, and the analysis also employed 95% confidence intervals (95% CI) for the percentages. Setting Ten Peruvian universities. Participants University students’ lifetime. Exposure Participants’ e-cigarette and/or tobacco consumption, based on questions about consumption of tobacco and e-cigarettes. Participants were categorized into those consuming: only e-cigarettes, only tobacco, both, or neither. Outcome The use of cannabis by participants in the last 12 months. Among the university students who met the inclusion criteria (n = 3981), the prevalence of using both e-cigarettes and tobacco (dual) throughout life was 11.6% (95% CI: 10.1 to 13.3), and only e-cigarettes was 1.2% (95% CI: 0.7 to 1.8). The use of cannabis in the last 12 months was 5.2% (95% CI: 4.1 to 6.5). Results of this study found a sequential probability gradient of cannabis use, where those with dual use had 58.5 times more probability of having used cannabis in the last 12 months (PRa 58.5, 95% CI: 20.9 to 163.7, p

Introduction: Due to the high incidence of mpox in Peru and the poor knowledge about this disease among healthcare workers in non-endemic countries, it is crucial to determine the knowledge status of Peruvian physicians. Methodology: We conducted an analytical cross-sectional study based on an online survey from August to September 2022. Physicians who had a medical license and lived and practiced medicine in Peru were included. To evaluate the factors associated with a higher level of knowledge, we used crude (cPR) and adjusted (aPR) prevalence ratios with 95% confidence intervals (95% CI) using Poisson regression. Results: We included 463 physicians. The mean age was 36.6 (SD: 10.3) years, and most were male (58.1%). Regarding knowledge, the median knowledge score was 14 [IQR: 13 to 15] out of 17 points. In terms of knowledge gaps, only 60.7% of the participants knew that there was an FDA-approved vaccine for mpox, 49.0% of participants knew about mpox proctitis and 33.3% acknowledged that it could be transmitted by the bite of an infected rodent. We found that taking care of patients with mpox (aPR: 1.39; 95% CI: 1.13 to 1.72) was associated with higher knowledge (>p50), while living in the eastern macro-region (aPR: 0.62; 95% CI: 0.42 to 0.93) was associated with lower knowledge (≤p50). Conclusions: Our study showed a high level of knowledge about mpox among Peruvian physicians. However, educational campaigns may be necessary, especially for physicians from the eastern region and those who do not have clinical experience with mpox.

Introduction: Acquired brain injury (ABI) during childhood typically causes behavior problems in the child and high levels of stress in the family. The aims of this study are: (1) to investigate the effectiveness and feasibility of a parenting intervention in improving behavior and self-regulation in Mexican children with ABI compared to telephone support; (2) to investigate the effectiveness and feasibility of a parenting intervention in improving parenting skills, parent self-efficacy and decreasing parental stress in parents of children with ABI compared to telephone support. Our secondary aims are (1) to explore the impact that parent characteristics have on the intervention outcomes; (2) to investigate if changes are maintained 3 months after the intervention. Methods: The research design is a blind randomized controlled trial (RCT). Eligible participants include children with a diagnosis of ABI, between 6 and 12 years of age, and their parents. Sixty-six children and their parents will be randomly allocated to either a parenting program group or telephone support group. The parenting program involves six face-to-face weekly group sessions of 2.5 h each. Participants in the control group receive an information sheet with behavioral strategies, and six weekly phone calls, in which strategies to improve academic skills are provided. Children and their parents are evaluated by blind assessors before the intervention, immediately after the intervention and 3-months post-intervention. Discussion: This study will be the first to evaluate the efficacy and feasibility of a parenting program for Mexican parents of children with ABI. Trial identifier: ACTRN12617000360314. Keywords: Brain injury, Children, Intervention, Rehabilitation, Behavior problems and self-regulation

The objective was to evaluate milk production, N2-fixation and N transfer, forage yield and composition (under two cutting intervals) in a silvopastoral system (SPS) with Leucaena leucocephala-Megathyrsus maximus and M. maximus-monoculture (MMM) with crossbred cows in a completely randomized design. Forage yield in the SPS was 6490 and 6907 kg DM ha−1 for cutting intervals (CI) of 35 and 50 days. Forage yield for the MMM was 7284 and 10,843 kg DM ha−1, and forage crude protein (CP) was 29.0% and 26.1% for L. leucocephala, harvested at 35 and 50 days, respectively. CP for the associated M. maximus was 9.9% and 7.8% for CI 35 and 50 days, respectively, and for MMM was 7.4% and 8.4%, harvested at 35 and 50 days. Milk production was 4.7 kg cow−1 day−1 for cows grazing MMM and 7.4 kg cow−1 day−1 under SPS. Nitrogen fixation in L. leucocephala (%Ndfa) was estimated to be 89% and 95%, at 35 and 50 days, with an N2 transfer to the associated grass of 34.3% and 52.9%. SPS has the potential to fix and transfer important amounts of N2 to the associated grass, and increase forage CP content and milk production.

Clostridioides difficile is a pathogen often associated with hospital-acquired infection or antimicrobial-induced disease; however, increasing evidence indicates infections can result from community or environmental sources. Most genomic sequencing of C. difficile has focused on clinical strains, although evidence is growing that C. difficile spores are widespread in soil and water in the environment. In this study, we sequenced 38 genomes collected from soil and water isolates in Flagstaff (AZ, USA) and Slovenia in an effort targeted towards environmental surveillance of C. difficile . At the average nucleotide identity (ANI) level, the genomes were divergent to C. difficile at a threshold consistent with different species. A phylogenetic analysis of these divergent genomes together with Clostridioides genomes available in public repositories confirmed the presence of three previously described, cryptic Clostridioide s species and added two additional clades. One of the cryptic species (C-III) was almost entirely composed of Arizona and Slovenia genomes, and contained distinct sub-groups from each region (evidenced by SNP and gene-content differences). A comparative genomics analysis identified multiple unique coding sequences per clade, which can serve as markers for subsequent environmental surveys of these cryptic species. Homologues to the C. difficile toxin genes, tcdA and tcdB , were found in cryptic species genomes, although they were not part of the typical pathogenicity locus observed in C. difficile , and in silico PCR suggested that some would not amplify with widely used PCR diagnostic tests. We also identified gene homologues in the binary toxin cluster, including some present on phage and, for what is believed to be the first time, on a plasmid. All isolates were obtained from environmental samples, so the function and disease potential of these toxin homologues is currently unknown. Enzymatic profiles of a subset of cryptic isolates ( n =5) demonstrated differences, suggesting that these isolates contain substantial metabolic diversity. Antimicrobial resistance (AMR) was observed across a subset of isolates ( n =4), suggesting that AMR mechanisms are intrinsic to the genus, perhaps originating from a shared environmental origin. This study greatly expands our understanding of the genomic diversity of Clostridioides . These results have implications for C. difficile One Health research, for more sensitive C. difficile diagnostics, as well as for understanding the evolutionary history of C. difficile and the development of pathogenesis.

Purpose: Megavoltage radiotherapy to irregular superficial targets is challenging due to the skin sparing effect. We developed a three-dimensional bolus (3DB) program to assess the clinical impact on dosimetric and patient outcomes., Materials and Methods: Planar commercial bolus (PCB) and 3DB density, clarity, and net bolus effect were rigorously evaluated prior to clinical implementation. After IRB approval, patients with cutaneous or locally advanced malignancies deemed to require bolus for radiotherapy treatment were treated with custom 3DB., Results: The mean density of 3DB and PCB was of 1.07 g/cm 3 and 1.12 g/cm3, respectively. 3DB optic clarity was superior versus PCB at any material thickness. Phantom measurements of superficial dose with 3DB and PCB showed excellent bolus effect for both materials. 3DB reduced air gaps compared with PCB - particularly in irregular areas such as the ear, nose, and orbit. A dosimetric comparison of 3DB and PCB plans showed equivalent superficial homogeneity for 3DB and PCB (3DB median HI 1.249, range 1.111-1.300 and PCB median HI 1.165, range 1.094-1.279), but better conformity with 3DB (3DB median CI 0.993, range 0.962-0.993) versus PCB (PCB median CI 0.977, range 0.601-0.991). Patient dose measurements using 3DB confirm the delivered superficial dose was within 1% of the intended prescription (95% CI 97-102%; P = 0.11)., Conclusions: 3DB improves radiotherapy plan conformity, reduces air gap volume in irregular superficial areas which could affect superficial dose delivery, and provides excellent dose coverage to irregular superficial targets., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

Purpose: Deformable lung phantoms have been proposed to investigate four-dimensional (4D) imaging and radiotherapy delivery techniques. However, most phantoms mimic only the lung and tumor without pulmonary airways. The purpose of this study was to develop a reproducible, deformable lung phantom with three-dimensional (3D)-printed airways., Methods: The phantom consists of: (a) 3D-printed flexible airways, (b) flexible polyurethane foam infused with iodinated contrast agents, and (c) a motion platform. The airways were simulated using publicly available breath-hold computed tomography (CT) image datasets of a human lung through airway segmentation, computer-aided design modeling, and 3D printing with a rubber-like material. The lung was simulated by pouring liquid expanding foam into a mold with the 3D-printed airways attached. Iodinated contrast agents were infused into the lung phantom to emulate the density of the human lung. The lung/airways phantom was integrated into our previously developed motion platform, which allows for compression and decompression of the phantom in the superior-inferior direction. We quantified the reproducibility of the density (lung), motion/deformation (lung and airways), and position (airways) using breath-hold CT scans (with the phantom compressed and decompressed) repeated every two weeks over a 2-month period as well as 4D CT scans (with the phantom continuously compressed and decompressed) repeated twice over four weeks. The density reproducibility was quantified with a difference image (created by subtracting the rigidly registered baseline and the repeated images) in each of the compressed and decompressed states. Reproducibility of the motion/deformation was evaluated by comparing the baseline displacement vector fields (DVFs) derived from deformable image registration (DIR) between the compressed and decompressed phantom CT images with those of repeated scans and calculating the difference in the displacement vectors. Reproducibility of the airway position was quantified based on DIR between the baseline and repeated images., Results: For the breath-hold CT scans, the mean difference in lung density between baseline and week 8 was -1.3 (standard deviation 33.5) Hounsfield unit (HU) in the compressed state and 0.4 (36.8) HU in the decompressed state, while large local differences were observed around the high-contrast structures (caused by small misalignments). By visual inspection, the DVFs (between the compressed and decompressed states) at baseline and last time point (week 8 for the breath-hold CT scans) demonstrated a similar pattern. The mean lengths of displacement vector differences between baseline and week 8 were 0.5 (0.4) mm for the lung and 0.3 (0.2) mm for the airways. The mean airway displacements between baseline and week 8 were 0.6 (0.5) mm in the compressed state and 0.6 (0.4) mm in the decompressed state. We also observed similar results for the 4D CT scans (week 0 vs week 4) as well as for the breath-hold CT scans at other time points (week 0 vs weeks 2, 4, and 6)., Conclusions: We have developed a deformable lung phantom with 3D-printed airways based on a human lung CT image. Our findings indicate reproducible density, motion/deformation, and position. This phantom is based on widely available materials and technology, which represents advantages over other deformable phantoms., (© 2019 American Association of Physicists in Medicine.)

Traditionally, head fixation devices and recording cylinders have been implanted in nonhuman primates (NHP) using dental acrylic despite several shortcomings associated with acrylic. The use of more biocompatible materials such as titanium and PEEK is becoming more prevalent in NHP research. We describe a cost-effective set of procedures that maximizes the integration of headposts and recording cylinders with the animal's tissues while reducing surgery time. Nine rhesus monkeys were implanted with titanium headposts, and one of these was also implanted with a recording chamber. In each case, a three-dimensional printed replica of the skull was created based on computerized tomography scans. The titanium feet of the headposts were shaped, and the skull thickness was measured preoperatively, reducing surgery time by up to 70%. The recording cylinder was manufactured to conform tightly to the skull, which was fastened to the skull with four screws and remained watertight for 8.5 mo. We quantified the amount of regression of the skin edge at the headpost. We found a large degree of variability in the timing and extent of skin regression that could not be explained by any single recorded factor. However, there was not a single case of bone exposure; although skin retracted from the titanium, skin also remained adhered to the skull adjacent to those regions. The headposts remained fully functional and free of complications for the experimental life of each animal, several of which are still participating in experiments more than 4 yr after implant. NEW & NOTEWORTHY Cranial implants are often necessary for performing neurophysiology research with nonhuman primates. We present methods for using three-dimensional printed monkey skulls to form and fabricate acrylic-free implants preoperatively to decrease surgery times and the risk of complications and increase the functional life of the implant. We focused on reducing costs, creating a feasible timeline, and ensuring compatibility with existing laboratory systems. We discuss the importance of using more biocompatible materials and enhancing osseointegration., (Copyright © 2017 the American Physiological Society.)

Roots play a role in maintaining foliar water balance in subalpine conifer saplings during winter. We used deuterium-labeled water to demonstrate that roots of Engelmann spruce (Picea engelmannii Parry) take up water during the late-winter-early spring period. Based on a root severing experiment, we conclude that small, snow-covered saplings were largely dependent on root water uptake to meet winter transpiration needs, whereas larger saplings relied more on water stored in stem sapwood. Both water uptake and water stored in roots appeared to be critical for the survival of saplings exposed above the snowpack during the late-winter-early spring period, when sap reserves were insufficient to meet increasing transpirational demands.