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This study delves into how motivational sessions and brief interventions impact students’ alcohol consumption, highlighting the vital role of nurses in fostering positive behavioural changes. The study aims to discern the effects of these interventions, starting with a pre-and post-intervention setup involving 62 students from a private school in northern Portugal. The intervention comprised a session delivered by school and mental health nurses, utilizing the motivational intervention and FRAMES method and a poster offering feedback on alcohol consumption scores. The results indicated that females tended to drink for fewer days and engage in less binge drinking than males. Furthermore, the intervention hinted at a reduction in the number of heavy drinking days. This study underscores the importance of including healthcare professionals, particularly nurses, in delivering brief interventions within school settings. The findings carry weight for crafting evidence-based interventions to cultivate healthier adolescent behaviours and enhance overall well-being.

IntroductionSleep-wake cycle disruption caused by shift work may lead to cardiovascular stress, which is observed as an alteration in the behavior of heart rate variability (HRV). In particular, HRV exhibits complex patterns over different time scales that help to understand the regulatory mechanisms of the autonomic nervous system, and changes in the fractality of HRV may be associated with pathological conditions, including cardiovascular disease, diabetes, or even psychological stress. The main purpose of this study is to evaluate the multifractal-multiscale structure of HRV during sleep in healthy shift and non-shift workers to identify conditions of cardiovascular stress that may be associated with shift work.MethodsThe whole-sleep HRV signal was analyzed from female participants: eleven healthy shift workers and seven non-shift workers. The HRV signal was decomposed into intrinsic mode functions (IMFs) using the empirical mode decomposition method, and then the IMFs were analyzed using the multiscale-multifractal detrended fluctuation analysis (MMF-DFA) method. The MMF-DFA was applied to estimate the self-similarity coefficients, α(q, τ), considering moment orders (q) between –5 and +5 and scales (τ) between 8 and 2,048 s. Additionally, to describe the multifractality at each τ in a simple way, a multifractal index, MFI(τ), was computed.ResultsCompared to non-shift workers, shift workers presented an increase in the scaling exponent, α(q, τ), at short scales (τ < 64 s) with q < 0 in the high-frequency component (IMF1, 0.15–0.4 Hz) and low-frequency components (IMF2–IMF3, 0.04–0.15 Hz), and with q> 0 in the very low frequencies (IMF4, < 0.04 Hz). In addition, at large scales (τ> 1,024 s), a decrease in α(q, τ) was observed in IMF3, suggesting an alteration in the multifractal dynamic. MFI(τ) showed an increase at small scales and a decrease at large scales in IMFs of shift workers.ConclusionThis study helps to recognize the multifractality of HRV during sleep, beyond simply looking at indices based on means and variances. This analysis helps to identify that shift workers show alterations in fractal properties, mainly on short scales. These findings suggest a disturbance in the autonomic nervous system induced by the cardiovascular stress of shift work.

This paper introduces a comprehensive framework for generating obstacle-free flight paths for unmanned aerial vehicles (UAVs) in intricate 3D environments. The system leverages the Rapidly Exploring Random Tree (RRT) algorithm to design trajectories that effectively avoid collisions with structures of diverse shapes and sizes. Discussion revolves around the challenges encountered during development and the successful achievement of generating collision-free routes. While the system represents an initial iteration, it serves as a foundation for future projects aiming to refine and expand upon its capabilities. Future work includes simulation testing and integration into UAV missions for image acquisition and structure scanning. Additionally, considerations for swarm deployment and 3D reconstruction using various sensor combinations are outlined. This research contributes to the advancement of autonomous UAV navigation in real-world scenarios.

Air traffic complexity is an indicator that allows air traffic controllers to understand the airspace situation. Controllers need support tools to reduce their workload. For this reason, complexity is a parameter that is being studied more and more, as it makes it possible to know a large amount of information about air traffic. In this article, we perform a bibliometric analysis in the field of air traffic complexity. Through Web of Science (WoS), a collection of complexity-related articles from 2001 to 2022 is compiled. Subsequently, the bibliometric analysis itself is performed. Then, a summary of five main contributions is presented, identifying the strengths and weaknesses of the contributions, and thus the topic. The results of the bibliometric analysis show that future air traffic complexity indicators should consider aircraft trajectories but also take into account other aspects, such as regulations. In addition, future complexity indicators should introduce artificial intelligence predictions to foresee areas of conflict in airspace but taking into account the main limitations, such as uncertainty of the air traffic trajectories. This study helps in the study of complexity due to being able to know previous studies in a summarised form and being able to draw conclusions on future lines.

Objetivos. Caracterizar los eventos adversos (EA) asociados a hidroxicloroquina (HQ), azitromicina (AZI), tocilizumab (TOB) e ivermectina (IVM) prescritos como «fuera de etiqueta» en el tratamiento de pacientes hospitalizados por la COVID-19. Materiales y métodos. Se realizó un análisis secundario transversal de la base de datos del sistema de farmacovigilancia del Seguro Social de Salud del Perú (EsSalud) de las notificaciones de EA a HQ, AZI, TOB e IVM provenientes del Hospital Nacional Edgardo Rebagliati Martins de abril a octubre del 2020. Se revisaron las historias clínicas digitales, se estimaron las tasas de reporte de EA y se evaluaron sus características por tipo de fármaco, tiempo de aparición, tipo por órgano-sistema afectado, gravedad y causalidad. Resultados. Se identificaron 154 notificaciones que describen un total de 183 EA posiblemente relacionados con HQ, AZI, TOB e IVM, siendo 8% la tasa de reporte de EA. La mediana de tiempo de aparición de EA fue de 3 días (RIC: 2–5). La mayoría fueron cardiovasculares, destacándose la prolongación del intervalo QT. Se observaron EA hepatobiliares principalmente asociados a TOB. La mayoría de los casos fueron moderados, no obstante, el 10,4% fue grave. Conclusiones. Se identificaron EA potencialmente asociados al uso de HQ, AZI, TOB e IVM contra la COVID-19, siendo los más frecuentes los de tipo cardiovasculares. A pesar de que la AZI, HQ e IVM poseen perfiles conocidos de seguridad, su empleo en la COVID-19 podría incrementar la aparición de EA por los factores de riesgo propios de esta infección. Se sugiere reforzar la vigilancia, especialmente, de TOB.

The use of electroencephalography (EEG) techniques has many advantages in the study of human performance in air traffic control (ATC). At present, these are non-intrusive techniques that allow large volumes of data to be recorded on a continuous basis using wireless equipment. To achieve the most with these techniques, it is essential to establish appropriate EEG parameters with a clear understanding of the process followed to obtain them and their practical application. This study explains, step by step, the approach adopted to obtain six EEG parameters: excitement, stress, boredom, relaxation, engagement, and attention. It then explains all the steps involved in analysing the relationship between these parameters and two other parameters that characterise the state of the air traffic control sector during the development of real-time simulations (RTS): taskload and number of simultaneous aircraft. For this case study, the results showed the highest relationships for the engagement and attention parameters. In general, the results confirmed the potential of using these EEG parameters.

El estudio tuvo como objetivo evaluar el conocimiento, las actitudes y prácticas de un grupo de profesionales de la salud sobre la farmacovigilancia en el contexto de la COVID-19 en el Seguro Social de Salud del Perú (EsSalud). Se realizó un análisis secundario descriptivo de una base de datos que incluía las respuestas de una encuesta en línea realizada por el Centro de Referencia Institucional de Farmacovigilancia y Tecnovigilancia de EsSalud. De 144 participantes, el 66% mostró alto nivel de conocimiento y el 81,2%, actitud positiva; sin embargo, el 71,5% tuvo un inadecuado nivel de práctica de farmacovigilancia. Si bien los profesionales de EsSalud demostraron tener alto conocimiento y actitud positiva para implementar farmacovigilancia, esto no se ve reflejado en la práctica de esta actividad en la época de pandemia por el SARS-CoV-2. Se deben emplear estrategias para integrar a la farmacovigilancia en las actividades asistenciales en beneficio de la seguridad del paciente.

IntroductionWe aimed to determine whether the degree of collateral circulation is associated with blood pressure at admission in acute ischemic stroke patients treated with endovascular treatment and to determine its prognostic value.MethodsWe evaluated patients with anterior large vessel occlusion treated with endovascular treatment in a single-center prospective registry. We collected clinical and radiological data. Automated and validated software (Brainomix Ltd., Oxford, UK) was used to generate the collateral score (CS) from the baseline single-phase CT angiography: 0, filling of ≤10% of the occluded MCA territory; 1, 11–50%; 2, 51–90%; 3, >90%. When dichotomized, we considered that CS was good (CS = 2–3), or poor (CS = 0–1). We performed bivariate and multivariable ordinal logistic regression analysis to predict CS categories in our population. The secondary outcome was to determine the influence of automated CS on functional outcome at 3 months. We defined favorable functional outcomes as mRS 0–2 at 3 months.ResultsWe included 101 patients with a mean age of 72.1 ± 13.1 years and 57 (56.4%) of them were women. We classified patients into 4 groups according to the CS: 7 patients (6.9%) as CS = 0, 15 (14.9%) as CS = 1, 43 (42.6%) as CS = 2 and 36 (35.6%) as CS = 3. Admission systolic blood pressure [aOR per 10 mmHg increase 0.79 (95% CI 0.68–0.92)] and higher baseline NIHSS [aOR 0.90 (95% CI, 0.84–0.96)] were associated with a worse CS. The OR of improving 1 point on the 3-month mRS was 1.63 (95% CI, 1.10–2.44) favoring a better CS (p = 0.016).ConclusionIn acute ischemic stroke patients with anterior large vessel occlusion treated with endovascular treatment, admission systolic blood pressure was inversely associated with the automated scoring of CS on baseline CT angiography. Moreover, a good CS was associated with a favorable outcome.

BackgroundOccult atrial fibrillation (AF) is one of the major causes of embolic stroke of undetermined source (ESUS). Knowing the underlying etiology of an ESUS will reduce stroke recurrence and/or unnecessary use of anticoagulants. Understanding cardioembolic strokes (CES), whose main cause is AF, will provide tools to select patients who would benefit from anticoagulants among those with ESUS or AF. We aimed to discover novel loci associated with CES and create a polygenetic risk score (PRS) for a more efficient CES risk stratification.MethodsMultitrait analysis of GWAS (MTAG) was performed with MEGASTROKE-CES cohort (n = 362,661) and AF cohort (n = 1,030,836). We considered significant variants and replicated those variants with MTAG p-value < 5 × 10−8 influencing both traits (GWAS-pairwise) with a p-value < 0.05 in the original GWAS and in an independent cohort (n = 9,105). The PRS was created with PRSice-2 and evaluated in the independent cohort.ResultsWe found and replicated eleven loci associated with CES. Eight were novel loci. Seven of them had been previously associated with AF, namely, CAV1, ESR2, GORAB, IGF1R, NEURL1, WIPF1, and ZEB2. KIAA1755 locus had never been associated with CES/AF, leading its index variant to a missense change (R1045W). The PRS generated has been significantly associated with CES improving discrimination and patient reclassification of a model with age, sex, and hypertension.ConclusionThe loci found significantly associated with CES in the MTAG, together with the creation of a PRS that improves the predictive clinical models of CES, might help guide future clinical trials of anticoagulant therapy in patients with ESUS or AF.

Abstract Background The cortical microvascular cerebral blood flow response (CBF) to different changes in head-of-bed (HOB) position has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS) technique. However, the relationship between these relative ΔCBF changes and associated systemic blood pressure changes has not been studied, even though blood pressure is a major driver of cerebral blood flow. Methods Transcranial DCS data from four studies measuring bilateral frontal microvascular cerebral blood flow in healthy controls (n = 15), patients with asymptomatic severe internal carotid artery stenosis (ICA, n = 27), and patients with acute ischemic stroke (AIS, n = 72) were aggregated. DCS-measured CBF was measured in response to a short head-of-bed (HOB) position manipulation protocol (supine/elevated/supine, 5 min at each position). In a sub-group (AIS, n = 26; ICA, n = 14; control, n = 15), mean arterial pressure (MAP) was measured dynamically during the protocol. Results After elevated positioning, DCS CBF returned to baseline supine values in controls (p = 0.890) but not in patients with AIS (9.6% [6.0,13.3], mean 95% CI, p

Abstract Introduction Glycemic variability (GV) represents the amplitude of oscillations in glucose levels over time and is associated with higher mortality in critically ill patients. Our aim is to evaluate the impact of GV on acute ischemic stroke (IS) outcomes in humans and explore the impact of two different insulin administration routes on GV in an animal model. Methods This translational study consists of two studies conducted in parallel: The first study is an observational, multicenter, prospective clinical study in which 340 patients with acute IS will be subcutaneously implanted a sensor to continuously monitor blood glucose levels for 96 h. The second study is a basic experimental study using an animal model (rats) with permanent occlusion of the middle cerebral artery and induced hyperglycemia (through an intraperitoneal injection of nicotinamide and streptozotocin). The animal study will include the following 6 groups (10 animals per group): sham; hyperglycemia without IS; IS without hyperglycemia; IS and hyperglycemia without treatment; IS and hyperglycemia and intravenous insulin; and IS and hyperglycemia and subcutaneous insulin. The endpoint for the first study is mortality at 3 months, while the endpoints for the animal model study are GV, functional recovery and biomarkers. Discussion The GLIAS-III study will be the first translational approach analyzing the prognostic influence of GV, evaluated by the use of subcutaneous glucose monitors, in acute stroke. Trial registration https://www.clinicaltrials.gov (NCT04001049)

The Air Traffic Control (ATC) system suffers from an ever-increasing demand for aircraft, leading to capacity issues. For this reason, airspace is regulated by limiting the entry of aircraft into the airspace. Knowledge of these regulations before they occur would allow the ATC system to be aware of conflicting areas of the airspace, and to manage both its human and technological resources to lessen the effect of the expected regulations. Therefore, this paper develops a methodology in which the final result is a machine learning model that allows predicting capacity regulations. Predictions shall be based mainly on historical data, but also on the traffic situation at the time of the prediction. The results of tests of the model in a sector of Spanish airspace are satisfactory. In addition to testing the model results, special emphasis is placed on the explainability of the model. This explainability will help to understand the basis of the predictions and validate them from an operational point of view. The main conclusion after testing the model is that this model works well. Therefore, it is possible to predict when an ATC sector will be regulated or not based mainly on historical data.

The study of human factors in aviation makes an important contribution to safety. Within this discipline, real-time simulations (RTS) are a very powerful tool. The use of simulators allows for exercises with controlled air traffic control (ATC) events to be designed so that their influence on the performance of air traffic controllers (ATCOs) can be studied. The CRITERIA (atC event-dRiven capacITy modEls foR aIr nAvigation) project aims to establish capacity models and determine the influence of a series of ATC events on the workload of ATCOs. To establish a correlation between these ATC events and neurophysiological variables, a previous step is needed: a methodology for defining the taskload faced by the ATCO during the development of each simulation. This paper presents the development of this methodology and a series of recommendations for extrapolating the lessons learnt from this line of research to similar experiments. This methodology starts from a taskload design, and after RTS and through the use of data related to the subjective evaluation of workload as an intermediate tool it allows the taskload profile experienced by the ATCO in each simulation to be defined. Six ATCO students participated in this experiment. They performed four exercises using the SkySim simulator. As an example, a case study of the analysis of one of the participants is presented.

Today, aircraft demand is exceeding the capacity of the Air Traffic Control (ATC) system. As a result, airspace is becoming a very complex environment to control. The complexity of airspace is thus closely related to the workload of controllers and is a topic of great interest. The major concern is that variables that are related to complexity are currently recognised, but there is still a debate about how to define complexity. This paper attempts to define which variables determine airspace complexity. To do so, a novel methodology based on the use of machine learning models is used. In this way, it tries to overcome one of the main disadvantages of the current complexity models: the subjectivity of the models based on expert opinion. This study has determined that the main indicator that defines complexity is the number of aircraft in the sector, together with the occupancy of the traffic flows and the vertical distribution of aircraft. This research can help numerous studies on both air traffic complexity assessment and Air Traffic Controller (ATCO) workload studies. This model can also help to study the behaviour of air traffic and to verify that there is symmetry in structure and the origin of the complexity in the different ATC sectors. This would have a great benefit on ATM, as it would allow progress to be made in solving the existing capacity problem.

Marfan Syndrome (MFS) is a pleiotropic and autosomal dominant condition caused by pathogenic variants in FBN1. Although fully penetrant, clinical variability is frequently observed among patients and there are only few genotype-phenotype correlations described so far. Here, we describe the generation and characterization of hiPSC lines derived from two unrelated MFS patients harboring heterozygous variants in FBN1. Human iPSCs were obtained from erythroblasts reprogrammed with episomal vectors carrying the reprogramming factors OCT4, SOX2, KLF4, c-MYC and LIN-28, and characterized according to established criteria. Differentiated cells demonstrated different patterns of fibrillin-1 expression suggesting different molecular mechanisms between the two patients.

Marfan Syndrome (MFS) is an autosomal dominant connective tissue disorder caused by mutations in the FBN1 gene. To investigate the molecular mechanisms of pathogenesis for the syndrome, we genetically modified the FBN1 gene in a line of induced pluripotent stem cells (hiPSCs) derived from a healthy donor using the CRISPR/Cas9 gene editing technology. The sublines described here were characterized according to established criteria and were shown to maintain pluripotency, three germ layer differentiation potential and genomic integrity. These clones can now be used to better understand the pathogenesis of MFS in different cell types.

This study aimed to examine the literature on the skill sets of autistic individuals and determine how these skills align with current and projected future labour market needs. Based on a literature review, researchers identified the following skill categories common to autistic individuals: visual skills, attention to detail and systemizing composite skills. Researchers then gathered aggregated data on occupations and industries from over 90 state and federal sources in the United States. Next, they collected data on the most in-demand jobs, their industries and relevant skills by analysing hundreds of millions of online job postings. The results indicate the most viable occupations aligned with each skill category. There is minimal available research using labour market data to generate special education goals and transition plans for autistic students. By providing educators and practitioners with critical information regarding viable employment pathways, all stakeholders can more effectively and equitably prepare autistic individuals for the 21st-century workforce.

The main goal of this article is to analyse the probability of detecting potential conflicts by the Air Traffic Controller (ATCo). The ATCo ensures the safety of aircraft and one of its main functions is collision avoidance. Collision avoidance is known as separation provision and this term means assuring the safe distance between each aircraft by sides, vertical and longitudinal minimums of separation. The air traffic controller must ensure a high level of airspace capacity. The work performance is related to high demands on individual characteristics, knowledge, skills and, of course, air traffic characteristics. In addition to analysing the probability of detecting potential conflicts, the study of the most influential factors on this safety event is considered of special relevance since the ATCo represents the last executive section of the air traffic control system and failure to detect potential conflicts could lead to a possible infringement of the minimum separation distances between aircraft or even a collision. In order to carry out this approach, Bayesian Networks will be used due to their high predictive capacity. In addition, a dual approach based on knowledge and real operational data provided by an ANSP will be used. These data are one of the great advantages of this study compared to those included in the current literature.

The vasculature ensures optimal delivery of nutrients and oxygen throughout the body, and to achieve this function it must continually adapt to varying tissue demands. Newly formed vascular plexuses during development are immature and require dynamic remodeling to generate well-patterned functional networks. This is achieved by remodeling of the capillaries preserving those which are functional and eliminating other ones. A balanced and dynamically regulated capillary remodeling will therefore ensure optimal distribution of blood and nutrients to the tissues. This is particularly important in pathological contexts in which deficient or excessive vascular remodeling may worsen tissue perfusion and hamper tissue repair. Blood flow is a major determinant of microvascular reshaping since capillaries are pruned when relatively less perfused and they split when exposed to high flow in order to shape the microvascular network for optimal tissue perfusion and oxygenation. The molecular machinery underlying blood flow sensing by endothelial cells is being deciphered, but much less is known about how this translates into endothelial cell responses as alignment, polarization and directed migration to drive capillary remodeling, particularly in vivo. Part of this knowledge is theoretical from computational models since blood flow hemodynamics are not easily recapitulated by in vitro or ex vivo approaches. Moreover, these events are difficult to visualize in vivo due to their infrequency and briefness. Studies had been limited to postnatal mouse retina and vascular beds in zebrafish but new tools as advanced microscopy and image analysis are strengthening our understanding of capillary remodeling. In this review we introduce the concept of remodeling of the microvasculature and its relevance in physiology and pathology. We summarize the current knowledge on the mechanisms contributing to capillary regression and to capillary splitting highlighting the key role of blood flow to orchestrate these processes. Finally, we comment the potential and possibilities that microfluidics offers to this field. Since capillary remodeling mechanisms are often reactivated in prevalent pathologies as cancer and cardiovascular disease, all this knowledge could be eventually used to improve the functionality of capillary networks in diseased tissues and promote their repair.

Objective: To determine the frequency, risk factors, and impact on the outcome of dehydration after stroke.Methods: In this cross-sectional observational study, we included prospectively and consecutively patients with ischemic and hemorrhagic stroke. The serum Urea/Creatinine ratio (U/C) was calculated at admission and 3 days after the stroke. Dehydration was defined as U/C>80. Patients were treated in accordance with the standard local hydration protocol. Demographic and clinical data were collected. Neurological severity was evaluated at admission according to the NIHSS score; functional outcome was assessed with the modified Rankin scale score (mRS) at discharge and 3 months after the stroke. Unfavorable outcome was defined as mRS > 2.Results: We evaluated 203 patients; 78.8% presented an ischemic stroke and 21.2% a hemorrhagic stroke. The mean age was 73.4 years ±12.9; 51.7% were men. Dehydration was detected in 18 patients (8.9%), nine patients at admission (4.5%), and nine patients (4.5%) at 3 days after the stroke. Female sex (OR 3.62, 95%CI 1.13–11.58, p = 0.03) and older age (OR 1.05, 95%CI 1–1.11, p = 0.048) were associated with a higher risk of dehydration. Dehydration was significantly associated with an unfavorable outcome at discharge (OR 5.16, 95%CI 1.45–18.25, p = 0.011), but the association was not significant at 3 months (OR 2.95, 95%CI 0.83–10.48, p = 0.095).Conclusion: Dehydration is a treatable risk factor of a poor functional outcome after stroke that is present in 9% of patients. Females and elders present a higher risk of dehydration.

Current neuroanatomical evidence showed the anatomical relationship between the temporomandibular joint innervation with the vestibular system. However, there is no clear evidence regarding if temporomandibular disorders are associated with balance impairments. Therefore, the aims of this study were to assess the clinical relevance of stabilometric features in populations with temporomandibular disorders and to analyze the influence of the mandibular position and visual afference in the balance scores in both healthy and clinical populations. This observational study was conducted in one sample of healthy controls and one sample with temporomandibular disorders. Sociodemographic data (age, gender, height, weight, body mass index, and foot size), clinical data (presence or absence of temporomandibular disorders) and stabilometric data under six different conditions were collected. Sixty-nine subjects (43.5% male; 36.2% patients) were assessed. No differences between Temporomandibular disorders and healthy groups were found in any stabilometric outcomes, unlike oscillation area with closed eyes and medium interscuspidal position (p < 0.01). Although visual feedback showed to be relevant (p < 0.0001), mandibular position produced no differences in any stabilometric measurement (p > 0.05). This study found that healthy subjects and patients with temporomandibular disorders showed no balance differences in the stabilometric outcomes assessed. Although visual input played an important role in the balance, mandibular position seems to be irrelevant.

Remote parenchymal haemorrhage (rPH) after intravenous thrombolysis is defined as hemorrhages that appear in brain regions without visible ischemic damage, remote from the area of ischemia causing the initial stroke symptom. The pathophysiology of rPH is not clear and may be explained by different underlying mechanisms. We hypothesized that rPH may have different risk factors according to the bleeding location. We report the variables that we found associated with deep and lobar rPH after intravenous thrombolysis.This is a descriptive study of patients with ischemic stroke who were treated with intravenous thrombolysis. These patients were included in a multicenter prospective registry. We collected demographic, clinical and radiological data. We evaluated the number and distribution of cerebral microbleeds (CMB) from Magnetic Resonance Imaging. We excluded patients treated endovascularly, patients with parenchymal hemorrhage without concomitant rPH and stroke mimics. We compared the variables from patients with deep or lobar rPH with those with no intracranial hemorrhage.We studied 934 patients (mean age 73.9±12.6 years) and 52.8% were men. We observed rPH in 34 patients (3.6%); 9 (0.9%) were deep and 25 (2.7%) lobar. No hemorrhage was observed in 900 (96.6%) patients. Deep rPH were associated with hypertensive episodes within first 24 hours after intravenous thrombolysis (77.7% vs 23.3%, p1) CMB (30.7% vs 4.4%, p = 0.003), lobar CMB (53.8% vs 3.0%, p

There are no generally accepted criteria for the etiologic classification of intracerebral hemorrhage (ICH). For this reason, we have developed a set of etiologic criteria and have applied them to a large number of patients to determine their utility.The H-ATOMIC classification includes 7 etiologic categories: Hypertension, cerebral Amyloid angiopathy, Tumour, Oral anticoagulants, vascular Malformation, Infrequent causes and Cryptogenic. For each category, the etiology is scored with three degrees of certainty: Possible(3), Probable(2) and Definite(1). Our aim was to perform a basic study consisting of neuroimaging, blood tests, and CT-angio when a numerical score (SICH) suggested an underlying structural abnormality. Combinations of >1 etiologic category for an individual patient were acceptable. The criteria were evaluated in a multicenter and prospective study of consecutive patients with spontaneous ICH.Our study included 439 patients (age 70.8 ± 14.5 years; 61.3% were men). A definite etiology was achieved in 176 (40.1% of the patients: Hypertension 28.2%, cerebral Amyloid angiopathy 0.2%, Tumour 0.2%, Oral anticoagulants 2.2%, vascular Malformation 4.5%, Infrequent causes 4.5%). A total of 7 patients (1.6%) were cryptogenic. In the remaining 58.3% of the patients, ICH was attributable to a single (n = 56, 12.7%) or the combination of ≥2 (n = 200, 45.5%) possible/probable etiologies. The most frequent combinations of etiologies involved possible hypertension with possible CAA (H3A3, n = 38) or with probable CAA (H3A2, n = 29), and probable hypertension with probable OA (H2O2, n = 27). The most frequent category with any degree of certainty was hypertension (H1+2+3 = 80.6%) followed by cerebral amyloid angiopathy (A1+2+3 = 30.9%).According to our etiologic criteria, only about 40% patients received a definite diagnosis, while in the remaining patients ICH was attributable to a single possible/probable etiology or to more than one possible/probable etiology. The use of these criteria would likely help in the management of patients with ICH.

Los melanomas uveales son los tumores intraoculares primarios más frecuentes, con una incidencia de 8/1 000 000 al año en la raza blanca. Específicamente el melanoma de iris representa entre 5 y 7 % de los melanomas malignos de la úvea. Estos tumores pueden ser amelánicos o pigmentados y por lo general muy vascularizados. Se presenta un paciente de 18 años con antecedentes de salud, que fue atendido en el cuerpo de guardia de oftalmología refiriendo dolor ocular y disminución brusca de la visión del ojo derecho. En el examen físico se constató hipertensión ocular marcada, hifema de 2 mm, y edema corneal. Este cuadro cedió con tratamiento y permitió observar una tumoración del iris que invadía el ángulo iridocorneal, muy vascularizada. Por esto se realizaron exámenes en busca de tumores a otros niveles, y finalmente una biopsia por aspiración con aguja fina. Se concluye el caso con el diagnóstico de un melanoma de iris con invasión a cuerpo ciliar. El paciente se remite para tratamiento quirúrgico al Instituto Nacional de Oncología y Radiobiología.Uveal melanomas are the most frequent primary uveal tumors, having an incidence of 8/1 000 000 a year in Caucasian people. Specifically, iris Melanoma represents 5 to 7 % of the uveal malignant melanomas and they may be amelanic or pigmented, generally very vascularized. An eighteen years old male patient with a history of health problems was presented, who had been seen at the Ophthalmological Emergency Service because of eye pain and sudden visual reduction in his right eye. In the physical exam, a marked ocular hypertension was confirmed as well as a 2 mm hyphema and corneal edema. These conditions were overcome with treatment and afterwards, there was observed iris tumoration invading the iridocorneal angle. Some complementary studies were carried out to search further tumors at other levels and finally a fine needle aspiration biopsy was performed. The diagnosis was amelanic Iris Melanoma invading the ciliary body. The patient was referred for surgical treatment at the National Institute of Oncology and Radiology.

We evaluated the hypothesis that the number of circulating EPC could be associated with the risk of stroke recurrence (SR) or vascular events (VE) after an ischemic stroke.We studied prospectively consecutive patients with cerebral infarction within the first 48 hours after the onset. We recorded demographic factors, vascular risk factors, previous Rankin scale (RS) score, and etiology. We analyzed EPC counts by flow cytometry in blood collected at day 7 and defined EPC as CD34+/CD133+/KDR+ cells. Mean follow-up was 29.3 ± 16 months. We evaluated SR as well as VE. Patients were classified as to the presence or absence of EPC in the circulation (either EPC+ or EPC-). Bivariate analyses, Kaplan-Meier survival curves and Cox regression models were used.We included 121 patients (mean age 70.1±12.6 years; 65% were men). The percentage of EPC+ patients was 47.1%. SR occurred in 12 (9.9%) and VE in 18 (14.9%) patients. SR was associated significantly with a worse prior RS score, previous stroke and etiology, but not with EPC count. VE were associated significantly with EPC-, worse prior RS score, previous stroke, high age, peripheral artery disease and etiology. Cox regression model showed that EPC- (HR 7.07, p=0.003), age (HR 1.08, p=0.004) and a worse prior RS score (HR 5.8, p=0.004) were associated significantly with an increased risk of VE.The absence of circulating EPC is not associated with the risk of stroke recurrence, but is associated with an increased risk of future vascular events.

Se analiza la actividad de camaronicultura en el Pacífico Sur de Nicaragua. Se describen los principales sistemas de producción usados, el impacto de algunas patologías y las medidas que se están tomando para contrarrestarlas, la organización cooperativa de los cultivadores, el desarrollo de las industrias anexas y las medidas promocionales del gobierno para el sector. Se describe asimismo la situación que afronta la pesca artesanal en el Pacífico nicaragüense y la importancia de proyectos internacionales de cooperación para la modernización y el desarrollo de esta actividad.

RESUMEN La presencia de la escleritis necrotizante es rara; necesita de un diagnóstico y de un tratamiento oportuno, ya que su curso es rápido, severo y destructivo de la integridad del globo ocular. Se presenta una paciente de 43 años de edad, quien requirió atención oftalmológica al presentar el ojo derecho rojo con intenso dolor. Se le encontraron 3 nódulos en la región antero-inferior escleral. Se le realizó punción-aspiración con aguja fina en los nódulos esclerales y se obtuvo un fragmento de uno de ellos para el corte histológico. En ambas muestras se observó infiltrado inflamatorio de linfocitos y neutrófilos con algunas células plasmáticas. Se le impuso tratamiento con prednisona oral (0,5 mg/kg/día), prednisolona colirio y azatioprina a dosis de 1,5 mg/kg/día. La evolución al mes fue satisfactoria con mejoría gradual de las lesiones. El tratamiento se mantuvo por 3 meses con chequeos hematológicos reiterados. Se disminuyeron posteriormente las dosis medicamentosas hasta su eliminación a los 6 meses. La curación de las lesiones fue total. No se encontró enfermedad sistémica en el chequeo clínico efectuado.