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Objectives: Host responses to infection are a major determinant of outcome. However, the existence of different response profiles in patients with endocarditis has not been addressed. Our objective was to apply transcriptomics to identify endotypes in patients with infective endocarditis. Methods: A total of 32 patients with infective endocarditis were studied. Clinical data and blood samples were collected at diagnosis and RNA sequenced. Gene expression was used to identify two clusters (endocarditis endotype 1 [EE1] and endocarditis endotype 2 [EE2]). RNA sequencing was repeated after surgery. Transcriptionally active cell populations were identified by deconvolution. Differences between endotypes in clinical data, survival, gene expression, and molecular pathways involved were assessed. The identified endotypes were recapitulated in a cohort of COVID-19 patients. Results: A total of 18 and 14 patients were assigned to EE1 and EE2, respectively, with no differences in clinical data. Patients assigned to EE2 showed an enrichment in genes related to T-cell maturation and a decrease in the activation of the signal transducer and activator of transcription protein family pathway, with higher counts of active T cells and lower counts of neutrophils. A total of 14 patients (nine in EE1 and five in EE2) were submitted to surgery. Surgery in EE2 patients shifted gene expression toward a EE1-like profile. In-hospital mortality was higher in EE1 (56% vs 14%, P = 0.027), with an adjusted hazard ratio of 12.987 (95% confidence interval 3.356-50). Translation of these endotypes to COVID-19 and non–COVID-19 septic patients yielded similar results in cell populations and outcome. Conclusions: Gene expression reveals two endotypes in patients with acute endocarditis, with different underlying pathogenetic mechanisms, responses to surgery, and outcomes.

The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using an innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS), comprehensive pathogen screening using molecular methods, clinical record abstraction and verbal autopsy. Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.

The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using an innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS), comprehensive pathogen screening using molecular methods, clinical record abstraction and verbal autopsy. Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.

Abstract Staphylococcus aureus is a frequent agent of bacteraemia. This bacterium has a variety of virulence traits that allow the establishment and maintenance of infection. This study explored the virulence profile of S. aureus strains causing paediatric bacteraemia (SAB) in Manhiça district, Mozambique. We analysed 336 S. aureus strains isolated from blood cultures of children younger than 5 years admitted to the Manhiça District Hospital between 2001 and 2019, previously characterized for antibiotic susceptibility and clonality. The strains virulence potential was evaluated by PCR detection of the Panton-Valentine leucocidin (PVL) encoding genes, lukS-PV/lukF-PV, assessment of the capacity for biofilm formation and pathogenicity assays in Galleria mellonella. The overall carriage of PVL-encoding genes was over 40%, although reaching ~ 70 to 100% in the last years (2014 to 2019), potentially linked to the emergence of CC152 lineage. Strong biofilm production was a frequent trait of CC152 strains. Representative CC152 and CC121 strains showed higher virulence potential in the G. mellonella model when compared to reference strains, with variations within and between CCs. Our results highlight the importance of monitoring the emergent CC152-MSSA-PVL+ and other lineages, as they display important virulence traits that may negatively impact the management of SAB paediatric patients in Manhiça district, Mozambique.

Este artigo trata de uma análise semiótica das capas da revista Vogue Brasil, lançadas no primeiro ano da pandemia da Covid-19. Objetiva-se, neste caminho, analisar os sentidos produzidos pelas capas da referida revista de moda em 2020, recorte temporal em que o mundo testemunhou os efeitos mais nocivos da pandemia. Para realizar a análise semiótica das capas recorreu-se aos suportes digitais online. A partir das fontes encontradas, procedeu-se com uma análise semiótica das capas, estabelecendo relações entre os sentidos produzidos por elas e sua ligação com o “espírito dos tempos”, isto é, com o contexto histórico em que foram produzidas. Como fundamentação teórica, as análises semióticas respaldam-se nos estudos de Lúcia Santaella (1983; 2010) sobre Semiótica; em estudos de Joly (2012) e Kossoy (2019) sobre imagem e produção de sentidos, além de outras pesquisas que tomaram as capas de revistas como objetos de análise, como o trabalho de Holanda (2017). Os resultados da pesquisa apontam para uma postura discreta e sutil da Vogue Brasil ao tratar da pandemia da Covid-19, ao mobilizar elementos semióticos em suas capas que fazem referência direta a essa questão de saúde pública mundial, ainda que o foco da referida revista não seja assuntos dessa natureza.

Enteric viruses are the leading cause of diarrhoea in children p = 0.006) and LSD (25/268, 9.3% vs. 9/430, 2.1%, p < 0.001); adenovirus 40/41 in MSD (7.2% vs. 1.8%, p < 0.001); astrovirus in LSD (7.5% vs. 2.6%, p = 0.002); and sapovirus in MSD (7.1% vs. 1.4%, p = 0.047) and controls (21/475, 4.4% vs. 51/2380, 2.1%, p = 0.004). Norovirus GII, adenovirus 40/41, astrovirus, and sapovirus detection increased in MSD and LSD cases after rotavirus vaccine introduction, supporting the need for continued molecular surveillance for the implementation of appropriate control and prevention measures.

A micro-machined fiber alignment device known as the capture and locking alignment spring positioner (CLASP) aligns arrays of single-mode fibers for hermetic photonic packaging. A micro-machined metal spring in the device captures and holds a vertical fiber for attachment, with an accuracy of about two micrometers. The metal used for the spring is electroplated nickel about 80 micrometers thick. The use of polyimide masking material causes variations in alignment.

Current agrochemicals used in crop farming mainly consist of synthetic compounds with harmful effects on the environment and human health. Crop-associated fungal endophytes, which play many ecological roles including defense against pathogens, represent a promising source for bioactive and ecologically safer molecules in agrochemical discovery. The methanolic extract of the endophyte Menisporopsis sp. LCM 1078 was evaluated in vitro against the plant pathogens Boeremia exigua, Calonectria variabilis, Colletotrichum theobromicola, Colletotrichum tropicale, and Mycena cytricolor. Bioassay-guided isolation using chromatographic techniques followed by detailed chemical characterization by NMR and mass spectrometry led to the identification of menisporopsin A, which showed inhibitory activity in a dose-dependent manner against the five fungal pathogens including an endophytic strain (Colletotrichum tropicale), with MIC values in the range of 0.63–10.0 μg/mL showing a potency equivalent to the broadly employed agrochemical mancozeb.

Background: Up to 30% of differentiated thyroid cancer (DTC) will develop advanced-stage disease (aDTC) with reduced overall survival (OS). Objective: The aim of this study is to characterize initial diagnosis of aDTC, its therapeutic management, and prognosis in Spain and Portugal. Methods: A multicentre, longitudinal, retrospective study of adult patients diagnosed with aDTC in the Iberian Peninsula was conducted between January 2007 and December 2012. Analyses of baseline characteristics and results of initial treatments, relapse- or progression-free survival ((RP)FS) from first DTC diagnosis, OS, and prognostic factors impacting the evolution of advanced disease were evaluated. Results: Two hundred and thirteen patients (median age: 63 years; 57% female) were eligible from 23 hospitals. Advanced disease presented at first diagnosis (de novo aDTC) included 54% of patients, while 46% had relapsed from early disease (recurrent/progressive eDTC). At initial stage, most patients received surgery (98%) and/or radioiodine (RAI) (89%), with no differences seen between median OS (95% CI) (10.4 (7.3–15.3) years) and median disease-specific-survival (95% CI) (11.1 (8.7–16.2) years; log-rank test P = 0.4737). Age at diagnosis being

BackgroundStaphylococcus aureus is one of the main causes of bacteraemia, associated with high mortality, mainly due to the occurrence of multidrug resistant (MDR) strains. Data on antibiotic susceptibility and genetic lineages of bacteraemic S. aureus are still scarce in Mozambique. The study aims to describe the antibiotic susceptibility and clonality of S. aureus isolated from blood cultures of children admitted to the Manhiça District Hospital over two decades (2001–2019).MethodsA total of 336 S. aureus isolates detected in blood cultures of children aged

Mozambique introduced the rotavirus vaccine (Rotarix®; GlaxoSmithKline Biologicals, Rixensart, Belgium) in 2015, and since then, the Centro de Investigação em Saúde de Manhiça has been monitoring its impact on rotavirus-associated diarrhea and the trend of circulating strains, where G3P[8] was reported as the predominant strain after the vaccine introduction. Genotype G3 is among the most commonly detected Rotavirus strains in humans and animals, and herein, we report on the whole genome constellation of G3P[8] detected in two children (aged 18 months old) hospitalized with moderate-to-severe diarrhea at the Manhiça District Hospital. The two strains had a typical Wa-like genome constellation (I1-R1-C1-M1-A1-N1-T1-E1-H1) and shared 100% nucleotide (nt) and amino acid (aa) identities in 10 gene segments, except for VP6. Phylogenetic analysis demonstrated that genome segments encoding VP7, VP6, VP1, NSP3, and NSP4 of the two strains clustered most closely with porcine, bovine, and equine strains with identities ranging from 86.9–99.9% nt and 97.2–100% aa. Moreover, they consistently formed distinct clusters with some G1P[8], G3P[8], G9P[8], G12P[6], and G12P[8] strains circulating from 2012 to 2019 in Africa (Mozambique, Kenya, Rwanda, and Malawi) and Asia (Japan, China, and India) in genome segments encoding six proteins (VP2, VP3, NSP1-NSP2, NSP5/6). The identification of segments exhibiting the closest relationships with animal strains shows significant diversity of rotavirus and suggests the possible occurrence of reassortment events between human and animal strains. This demonstrates the importance of applying next-generation sequencing to monitor and understand the evolutionary changes of strains and evaluate the impact of vaccines on strain diversity.

Amphibians are widely known as a prolific source of bioactive metabolites. In this work, we isolated and characterized compounds with antiparasitic activity from the oocytes of the toad Rhinella alata collected in Panama. Bio-guided isolation and structural elucidation were carried out using chromatographic and spectroscopic techniques, respectively. The organic extract was subjected to solid phase extraction followed by HPLC purification of the fraction with in vitro activity against Trypanosoma cruzi trypomastigotes. Seven steroids (1–7) of the bufadienolide family were isolated, and their structures were determined using NMR and MS analyses; of these 19-formyl-dyscinobufotalin, (3) is reported as a new natural product. Compounds 1 and 3–7 resulted in a good anti-trypanosomal activity profile. Among these, 16β-hydroxyl-hellebrigenin (1) and bufalin (7) showed significant selectivity values of >5 and 2.69, respectively, while the positive control benznidazole showed a selectivity of 18.81. Furthermore, molecular docking analysis showed compounds 1, 3 and 7 interact through H-bonds with the amino acid residues GLN-19, ASP-158, HIS-159 and TRP-177 from cruzipain at the catalytic site. Given the lack of therapeutic options to treat American trypanosomiasis, this work can serve as the basis for further studies that aim for the development of bufadienolides or their derivatives as drugs against Chagas disease.

The role of Eichhornia crassipes for removing pollutants from low strength sewage was evaluated in three pilot-scale constructed wetlands (CW): CW 1, planted with E. crassipes in a filter media; CW 2, unplanted, composed by filter media; and CW 3, composed by E. crassipes floating on the sewage. The operation was divided into three stages by varying the nominal hydraulic retention time into: (I) 24 h; (II) 48 h; (III) 72 h. Temporal sampling profiles were carried out with collection of the influent and effluent samples to determine temperature, pH, chemical oxygen demand (COD), TKN and TP. Contents of TP and TN were analyzed in the plant tissue of the macrophyte. The best removal efficiency rates for phosphorus (38%) and TKN (47%) were obtained in CW 3 for 72 h. The highest COD removal was observed in the CW 2 (80%) for 48 h. The macrophyte E. crassipes contributed to the absorption process with uptake rate percentages of 8.3% (CW 1) and 9.0% (CW 3) for TN and 0.78% (CW 1) and 1.56% (CW 3) for TP on the dry matter of the plant. The chosen species planted in the systems contributed to the achievement of higher nutrient removal. [ABSTRACT FROM AUTHOR]

The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using, among other tools, the innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS). Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.

Objetivo. Caracterizar nutritivamente in vitro e in situ ensilados con 75% de papaya de desecho y 25% de pasto pangola como base y 3% de melaza de caña como aditivo. Materiales y métodos. Los silos en bolsa (50 kg) se fermentaron por 21 d para medir características de calidad (pH, nitrógeno amoniacal, materia seca (MS), ácido láctico y ácidos grasos volátiles (AGV)) y químicas (proteína cruda (PC), cenizas (Ce), fibra detergente neutro (FDN), fibra detergente ácido (FDA)). En la prueba in vitro se midió producción parcial a las 24, 48 y 72 h y acumulada a 72 h de biogás y metano, degradación de MS, FDN y FDA a las 72 h. La digestibilidad in situ se determinó a 3, 6, 9, 12, 24, 36, 72 y 96 h, así como la cinética de digestibilidad de los nutrientes (MS, PC, FDN, FDA y MO). Resultados. Las características de calidad se encuentran dentro de los rangos establecidos para considerar un buen ensilado. En el contenido químico sobresale 5.1% de PC y 70.0% de FDN. En las primeras 24 h, se produjo 72.3% de biogás y 70.5% de metano. Las degradaciones fueron de 64% para MS, 51% en FDN y 55% en FDA. La digestibilidad in situ a las 72 h mostró degradaciones de 63% para MS, 82% para PC, 49% para FDN y 47% para FDA. Conclusiones. La elaboración de ensilado con papaya de desecho y pasto pangola es una alternativa no convencional para la alimentación de rumiantes.

RESUMEN Introducción: Diferentes estudios señalan una gran variación en las tasas de persistencia identitaria en niños, niñas y adolescentes con incongruencia de género. Objetivo: Describir el porcentaje de persistencia y de desistencia identitaria de niñas, niños y púberes atendidos/as, por manifestación de expresiones y sentimientos de género no congruente en la Unidad de Identidad de Género (UIG). Material y Métodos: Estudio transversal en una cohorte de niñas, niños y púberes que han sido atendidos entre los años 2012 y 2020, con edades comprendidas entre 3 y los 11 años. La recogida de datos se hizo mediante la información registrada en las historias clínicas y se completó con entrevistas telefónicas a menores y progenitores que no habían sido atendidos en los últimos seis meses. Resultados: La muestra final fue de 71 sujetos, 15 (21,1%) chicos trans, 45 (63,4%) chicas trans y 11 (15,5%) no binarios/variantes de género. Vinieron 39 (54,9%) en la primera infancia (0-6 años) y 32 (45,1%) en la segunda infancia-pubertad (7-11 años). El tiempo medio de seguimiento entre la primera visita a la última fue de 2,55 años. En 65 casos (91,5%) se mantuvo persistente la incongruencia de género y en seis (8,5%) hubo desistencia. 22 (30,9%) casos habían manifestado disforia corporal, 12 (16,9%) habían comenzado tratamiento hormonal para bloquear la pubertad y de estos, la mitad, habían iniciado tratamiento hormonal cruzado. Conclusiones: La persistencia de la incongruencia de género en el grupo de infancia-pubertad es mayoritaria (91,5%). La ratio sexo-género va a favor de las niñas trans (niño a niña) y hay un incremento de sujetos no binarios/variantes de género. Breve descripción del contenido: Hay estudios que señalan una gran variación en las tasas de persistencia identitaria en niños, niñas y adolescentes con incongruencia de género; es por ello que hemos analizado el porcentaje de persistencia y de desistencia identitaria de niñas, niños y púberes atendidos/as, por manifestación de expresiones y sentimientos de género no congruente en nuestra Unidad de Identidad de Género (UIG).

Reflejo del pensamiento colectivo sobre nuestra relación con las tecnologías, las inteligencias artificiales, presentes en muchos aspectos de la cotidianidad, están lejos de ser autónomas. La labor de la creatividad artística en relación con las inteligencias artificiales debe consistir en analizar y proyectar los aspectos más fundamenta-les de la mediación de estas tecnologías en la sociedad y no centrarse tanto en sus características estéticas. Las obras aquí seleccionadas son un ejemplo de cómo el arte es capaz de cuestionar el grado de autonomía de las máquinas en la actualidad y su capacidad creativa real, y de evidenciar sus relaciones con aspectos sociales como el poder, el control de información y otras facetas de trascendencia política, así como su capacidad para proyectar futuras problemáticas. Artificial intelligence, being a reflection of collective thinking about our relationship with technologies, is present in many aspects of everyday life, although it is far from being autonomous. The work of artistic creativity concerning AI should endeavor to analyze and project the most fundamental aspects of the mediation of these technologies in society, and devote less attention to their aesthetic characteristics. The works selected here are an example of how art is capable of questioning the degree of autonomy of machines today and their real creative capacity, and of highlighting their relationships with social concerns such as power, information control, and other politically relevant issues, as well as their ability to project future problems. Reflexão do pensamento coletivo sobre a nossa relação com as tecnologias, as inteligências artificiais, presentes em muitos aspetos da quotidianidade, estão longe de ser autónomas. A tarefa da criatividade artística em relação com as inteligências artificiais tem de analisar e projetar os aspetos fundamentais da mediação da tecnologia na sociedade, e não se centrar nas suas características estéticas. As obras selecionadas neste artigo são um exemplo de como a arte é apta para questionar a autonomia das máquinas na atualidade e a sua capacidade criativa real. Mesmo, evidenciar suas relações com aspetos sociais como o poder, o controle da informação e outras questões de transcendência política, e sua capacidade para prever problemáticas futuras.

Abstract Background Klebsiella spp. are important pathogens associated with bacteremia among admitted children and is among the leading cause of death in children

Resumen: Algunas personas, también las menores de edad, tienen una identidad de género que no se corresponde con el sexo asignado al nacer. Se les conoce como personas trans*, que es el término paraguas que engloba transgénero, transexual y otras identidades no conformes con el género asignado. Las unidades de asistencia sanitaria a menores trans* requieren un trabajo multidisciplinario, realizado por personal experto en identidad de género, que permita, cuando así lo soliciten, intervenciones para el menor y su entorno sociofamiliar, de forma individualizada y flexible durante el camino de afirmación de género. Este modelo de servicio también incluye tratamientos hormonales adaptados en la medida de lo posible a las necesidades del individuo, más allá de los objetivos dicotómicos de un modelo binario tradicional. Esta guía aborda los aspectos generales de la atención profesional de menores trans* y presenta el protocolo actual basado en evidencia de tratamientos hormonales para adolescentes trans* y no binarios. Además, detalla aspectos clave relacionados con los cambios corporales esperados y sus posibles efectos secundarios, así como el asesoramiento previo sobre preservación de la fertilidad. Abstract: Some people, including minors, have a gender identity that does not correspond to the sex assigned at birth. They are known as trans* people, which is an umbrella term that encompasses transgender, transsexual, and other identities not conforming to the assigned gender. Healthcare units for trans* minors require multidisciplinary working, undertaken by personnel expert in gender identity, enabling, when requested, interventions for the minor and their social–familial environment, in an individualized and flexible way during the gender affirmation path. This service model also includes hormonal treatments tailored as much as possible to the individual's needs, beyond the dichotomic goals of a traditional binary model. This guide addresses the general aspects of professional care of trans* minors and presents the current evidence-based protocol of hormonal treatments for trans* and non-binary adolescents. In addition, it details key aspects related to expected body changes and their possible side effects, as well as prior counselling about fertility preservation.

Some people, including minors, have a gender identity that does not correspond to the sex assigned at birth. They are known as trans* people, which is an umbrella term that encompasses transgender, transsexual, and other identities not conforming to the assigned gender. Healthcare units for trans* minors require multidisciplinary working, undertaken by personnel expert in gender identity, enabling, when requested, interventions for the minor and their social–familial environment, in an individualized and flexible way during the gender affirmation path. This service model also includes hormonal treatments tailored as much as possible to the individual's needs, beyond the dichotomic goals of a traditional binary model. This guide addresses the general aspects of professional care of trans* minors and presents the current evidence-based protocol of hormonal treatments for trans* and non-binary adolescents. In addition, it details key aspects related to expected body changes and their possible side effects, as well as prior counselling about fertility preservation. Resumen: Algunas personas, también las menores de edad, tienen una identidad de género que no se corresponde con el sexo asignado al nacer. Se les conoce como personas trans*, que es el término paraguas que engloba transgénero, transexual y otras identidades no conformes con el género asignado. Las unidades de asistencia sanitaria a menores trans* requieren un trabajo multidisciplinario, realizado por personal experto en identidad de género, que permita, cuando así lo soliciten, intervenciones para el menor y su entorno sociofamiliar, de forma individualizada y flexible durante el camino de afirmación de género. Este modelo de servicio también incluye tratamientos hormonales adaptados en la medida de lo posible a las necesidades del individuo, más allá de los objetivos dicotómicos de un modelo binario tradicional. Esta guía aborda los aspectos generales de la atención profesional de menores trans* y presenta el protocolo actual basado en evidencia de tratamientos hormonales para adolescentes trans* y no binarios. Además, detalla aspectos clave relacionados con los cambios corporales esperados y sus posibles efectos secundarios, así como el asesoramiento previo sobre preservación de la fertilidad.

Due to their frequency and magnitude, urban floods affect different regions of the world. For this reason, several methodologies integrate information on hazard (H) and vulnerability (V) using a «Classic» Risk (R) model for risk analysis. However, this combination of variables generally overestimates the risk in places where the frequency of flooding is low. In this work we propose a model that we call «Adjusted Risk» (AR) that integrates values ​​of urban proximity (p) to bodies of water, as a tool to assess the risk of floods. The comparison between the R and AR models showed a higher efficiency of AR to reproduce the frequency of floods for 210 cities in Veracruz, while R overestimated the level of risk in cities with low frequency of floods. The correlation values ​​associated with the frequency of flood events for a period of 45 years (1970-2015), allow to establish the utility of the AR model to evaluate the risk of urban floods when using different scales of analysis.

Abstract Background Diarrheagenic Escherichia coli (DEC) are among the leading pathogens associated with endemic diarrhea in low income countries. Yet, few epidemiological studies have focused the contribution of enterohemorrhagic E. coli (EHEC), enteroinvasive E. coli (EIEC) and diffusely adherent E. coli (DAEC). Methods We assessed the contribution of EHEC, EIEC and DAEC isolated from stool samples from a case-control study conducted in children aged

We hypothesized that fetal exposure to the oxidative stress induced by the combined challenge of preeclampsia (PE) and high altitude would induce a significant impairment in the development of pulmonary circulation. We conducted a prospective study in La Paz (Bolivia, mean altitude 3625 m) in which newborns from singleton pregnancies with and without PE were compared (PE group n = 69, control n = 70). We conducted an echocardiographic study in these infants at the median age of two days. The percentage of cesarean deliveries and small for gestational age (SGA) infants was significantly higher in the PE group. Heart rate, respiratory rate, and oxygen saturation did not vary significantly between groups. Estimated pulmonary arterial pressure and pulmonary vascular resistance were 30% higher in newborns exposed to PE and high altitude compared with those exposed only to high altitude. We also detected signs of right ventricular hypertrophy in infants subjected to both exposures. In conclusion, this study provides evidence that the combination of PE and pregnancy at high altitude induces subclinical alterations in the pulmonary circulation of the newborn. Follow-up of this cohort may provide us with valuable information on the potential increased susceptibility to developing pulmonary hypertension or other pulmonary and cardiovascular disorders.