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In the US, the prevalence of traumatic subdural hematoma (TSDH) continues to increase. Using a nationally representative sample of discharge records of patients with TSDH, the study objectives were to estimate trend in number of TSDH cases, surgical management, inpatient cost, length of stay (LOS), mortality rate, and complication rate; and to identify the association of sociodemographic, clinical and hospital characteristics with complications and mortality.We identified patients with a primary diagnosis of TSDH from the National Inpatient Sample (NIS) database from 2010 to 2017. Quarterly and monthly trends were estimated using interrupted time series design. Multivariate logistic regressions measured association between various factors and inpatient death and complications.Number of cases, mean LOS, rate of complication increased. Proportion of patients undergoing surgery, mean inpatient cost, inpatient mortality decreased. Mean inpatient cost was $23,182.40 and LOS was 6.41 days. Odds of inpatient death and complications increased with injury severity score and comorbid conditions requiring use of anticoagulants. Odds of inpatient death were highest among those ≥85 years old and in south and northeast region.Given the increase in prevalence of TSDH in USA, additional resources should be allocated toward improving patient outcomes and lowering healthcare costs.

Lophomonas infection is an emerging parasitic disease causing respiratory infections. After China, Peru is the second country with the highest number of cases. In the bright-field microscopy evaluation of fresh samples, most of them are incorrectly estimated. Therefore, correct identification using cytological stains is to be supplemented. We report a case of a 29-year-old male with typical clinical symptoms of pneumonia, marked eosinophilia, and noninfiltrative pattern in chest X-ray, who had bronchopulmonary lophomoniasis.

Aim: This study aimed to determine the prevalence of Oestrus ovis in sheep meant for meat commercialization in the main slaughterhouse of the country. Materials and Methods: Between October 2015 and December 2015, we assessed the occurrence of Oestrus myiasis in the main slaughterhouse localized in Quito. In total, 80 sheep heads were randomly inspected and necropsied. Larvae were removed from nasal cavities and paranasal sinuses and cleaned. ANOVA (generalized linear model) was used to estimate the relationship between sex, age, and place of origin and presence or absence of parasite larvae. Results: Morphological identification confirmed that 19% (15/80) of the examined animals were positive for Oestrus ovis; from the positive cases, 21% were young animals 2500 meters above sea level (m.a.s.l.), and only one case from the coastal region at 250 m.a.s.l. with tropical environmental conditions. Conclusion: Our results showed evidence of the presence of myiasis caused by O. ovis in Andean and coastal places in Ecuador and its adaptation to different environmental conditions from that reported previously in temperate regions from Europe and Africa.

El objetivo del presente estudio fue determinar la probabilidad de riesgo asociado a la presencia de macroquistes de Sarcocystis spp. en canales de camélidos sudamericanos domésticos (CSDs) faenadas en la Empresa Pública Metropolitana de Rastro Quito (EMRAQ-EP) entre noviembre de 2017 y enero de 2018. Se utilizaron un total de 54 canales que fueron agrupadas por especie (43 de alpacas [41] y llamas [2], y 11 de híbridos), sexo (36 de machos y 18 de hembras) y edad (16 de jóvenes [menores de 5 años] y 38 de adultos [mayores de 5 años]). La prueba de Chi cuadrado de Pearson (P

The design of effective CO2 capture materials is a current challenge. Here, we report the synthesis of aminosilanes-functionalized MCM-41 and SBA-15 materials with high efficiency toward carbon dioxide adsorption. The functionalization of the mesoporous silicas involves a post-synthesis method by impregnation with 3-aminopropyltriethoxysilane. The carbon dioxide adsorption capacities for the samples were carried out under ambient pressures. The results evidenced that aminosilanes with a terminal amine were functionalized through covalent coupling of this group onto the channels' surface in the ordered mesoporous silica. It means that the amine is anchored on the surface of the largest pores of the MCM-41 and SBA-15 supports. The Lagergren kinetic model evidenced the enhanced carbon dioxide adsorption capacity and stability of the functionalized ordered mesoporous molecular sieves.

The environmental persistence of hexachlorobenzene (HCB) is a challenge that promotes studies for efficient treatment alternatives to minimize its environmental impact. Here, we evaluated the HCB removal by electrochemical, biological, and combined approaches. The electrochemical treatment of 4 μM HCB solutions was performed using a synthesized Ti/RuO

The aim of this study was to characterize carbapenem-resistant Klebsiella pneumoniae (CR-Kp) isolates recovered from adults and children with severe bacteremia in a Peruvian Hospital in June 2018. Antimicrobial susceptibility was determined by disc/gradient diffusion and broth microdilution when necessary. Antibiotic resistance mechanisms were evaluated by PCR and DNA sequencing. Clonal relatedness was assessed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Plasmid typing was performed with a PCR-based method. Thirty CR-Kp isolates were recovered in June 2018. All isolates were non-susceptible to all &beta, lactams, ciprofloxacin, gentamicin and trimethoprim-sulfamethoxazole, while mostly remaining susceptible to colistin, tigecycline, levofloxacin and amikacin. All isolates carried the blaNDM-1 gene and were extended spectrum &beta, lactamase (ESBL) producers. PFGE showed four different pulsotypes although all isolates but two belonged to the ST348 sequence type, previously reported in Portugal. blaNDM-1 was located in an IncFIB-M conjugative plasmid. To our knowledge, this is the first report of an New Delhi metallo-&beta, lactamase (NDM)-producing K. pneumoniae recovered from both children and adults in Lima, Peru, as well as the first time that the outbreak strain ST348 is reported in Peru and is associated with NDM. Studies providing epidemiological and molecular data on CR-Kp in Peru are essential to monitor their dissemination and prevent further spread.

The various industrial sectors, as well as livestock and agricultural activities, are increasing the production of inputs to meet the demand of the worldwide demographic explosion, making a challenge the clean maintenance of water, soil, and air. Therefore, the search for solutions for a pollutant-free environment without compromising economic development has become extremely important. Thereby, biotechnological studies in order to solve environmental issues have been gaining extensive attention through the coupling of technology procedures to biological systems as sustainable solutions to remediate contaminated areas. In this sense, this review covers topics such as the role of Omics era in microbial environmental biotechnology for pollution control as well as the microbial fuel cell use in energy production. Moreover, phytoremediation and the perspective of applying chemical methods are approached as environmentally friendly tools for the pollutant control to improve remediation processes., Los diversos sectores industriales, así como las actividades ganaderas y agrícolas, están aumentando la producción de insumos para satisfacer la demanda de la explosión demográfica mundial, lo cual dificulta el mantenimiento limpio del agua, el suelo y el aire. Por lo tanto, la búsqueda de soluciones para un medio ambiente libre de contaminantes sin comprometer el desarrollo económico se ha vuelto extremadamente importante. De este modo, los estudios biotecnológicos para resolver problemas ambientales han recibido una gran atención a través del acoplamiento de procedimientos tecnológicos a sistemas biológicos como soluciones sostenibles para remediar áreas contaminadas. En este sentido, esta revisión cubre temas como el papel de la era Ómica en la biotecnología ambiental microbiana para el control de la contaminación, así como el uso de celdas de combustible microbianas en la producción de energía. Además, la fitorremediación y la perspectiva de aplicar métodos químicos se abordan como herramientas ecológicas para el control de contaminantes y mejorar los procesos de remediación.

In this study, we investigated the impact of a TiO

Background: Cytological samples are cleared with xylene in two or three baths during a Pap test, however, this solvent has a high degree of toxicity, and being a controlled reagent infers high costs for its purchase and implications for environmental pollution. We estimated the impact of xylene during the Pap test in terms of the number of liters and cost of two baths of xylene, and also estimated the impact with three baths Methods: This cross-sectional study was carried out in four hospitals of EsSalud in Peru in two stages. First, the analysis of the impact due to the use of two baths of xylene was conducted during the period 2015–2019, and second, the estimates were calculated based on the assumption of three baths of xylene for the years 2020–2025. The assumption was based on the recommendations of the 2018 EsSalud cytology guideline. The monthly amount of xylene was ~10 liters per bath/month and the cost per liter was estimated at 8.13 USD (27 soles). Results: For the staining of 594,898 cytology tests, 7,848 liters of xylene were necessary, resulting in a cost of 60,861 USD (202,068 soles) during the period 2015–2019. The estimates showed a maximum assumption of 9,483 liters and 77,110 USD (256,040 soles) for the use of three baths of xylene in the four EsSalud hospitals (p = 0.0025) during the period 2020–2025. Conclusions: We determined that there was a high economic impact of using xylene with two baths from 2015 to 2019 and a dramatic increase in costs with the possible use of three baths of xylene in the Pap test for the following five years.

Electrochemical synthesis has been presented as a powerful technique to produce nanoparticles. However, it has been especially focused on noble metal particles, while few studies have been done on oxides production. On the other hand, when partially doped with trivalent cations at the barium sublattice, BaTiO₃-based ceramics are well known to exhibit semiconductive character, accompanied by a positive temperature coefficient of resistivity (PTCR). Here, we synthesized pure and La-doped BaTiO₃ nanoparticles electrochemically using a metallic titanium electrode as a Ti source. The powder synthesis was made in an electrochemical cell coupled to a thermostatic bath under mild conditions (ambient temperature and pressure) with an electrical potential up to 50 V and current of 3.2 A. In these conditions, the synthesized powders present nanometric size, confirmed by transmission electron microscopy images. The pseudo-cubic BaTiO₃ phase is confirmed by X-ray diffraction and Raman spectroscopy techniques. To check the quality, the powders were sintered at 1250 °C and the ceramics achieved a relative density of 95%. The BaTiO₃:La sintered ceramics present a PTCR jump of up to three orders of magnitude on resistivity with minimum value at room temperature of 10

Objetivo: Determinar los factores de riesgo en adultos con COVID-19 en población rural andina durante 2020. Métodos: En este estudio de cohorte retrospectivo multicéntrico, incluimos a 184 pacientes adultos (≥18 años) con pruebas serológicas y moleculares para COVID- 19 de tres hospitales de la sierra peruana (Ancash y Apurímac) incluidos con sospecha clínica entre abril y junio. Se utilizó análisis descriptivos y regresión logística univariable para explorar los factores de riesgo asociados a los pacientes con COVID-19. Resultados: Del total de pacientes, 14 (7.6%) tuvieron SARS-CoV-2. En los pacientes infectados 12 (85.7%) fueron varones con promedio de edad de 47.3±21 años. Las comorbilidades estuvieron presentes en cerca de la tercera parte de pacientes, siendo la hipertensión y diabetes las más frecuentes (ambas 14.3%), y la sintomatología más frecuentes fueron fiebre y cefalea (57.2%). La regresión univariable mostró mayores probabilidades de infección con SARS-CoV-2 en la población rural andina asociada con la edad avanzada (OR: 1.1 IC95% 0.7-1.8; p=0,019), comorbilidades previas (OR: 1.7, IC95% 0.32–9.39; p=0,006), y sintomatología previa (OR: 49.8, IC95% 5.6–436.9; p=0,0011). Conclusiones: Los posibles factores de riesgo como la edad avanzada, las comorbilidades y sintomatología previas están relacionados con el desarrollo de COVID- 19 en población rural andina de Perú.

Contexto: Se ha observado deficiencias de Selenio (Se) y otros minerales, en el suelo y los pastos de extensas áreas altoandinas destinadas al pastoreo de ovejas. No se conoce si las zonas altoandinas del Ecuador presentan estas deficiencias. Objetivo: Determinar el estatus de selenio circulante en ovejas; la materia orgánica, el pH y el perfil mineral en suelos; y la composición proximal y mineral de praderas. Diseño: Estudio observacional en diez ovejas Corriedale de tres años de edad y en suelos y praderas del sector Itulcachi, en la Provincia de Pichincha. El Selenio en suero sanguíneo se midió mediante espectrofotometría de absorción atómica. Los minerales de suelos y paraderas mediante técnica EAA y colorimetría. Resultados: El promedio de selenio sanguíneo fue de 0.249 ± 0,064 μg dl-1 , que corresponde al límite inferior de los valores de referencia. En suelos y praderas la concentración de selenio fue de

It is widely known that sulfur ligands, such as alkanethiols or phenothiols and their derivatives, are useful anchor systems for gold materials due to the high affinity of sulfur to gold surfaces. In this study we use DFT calculations and a 42-atom gold cluster model to study the interaction between selenophenol and tellurophenol-derivatives with the Au(111) surface to gain information towards potential new gold-based materials. We modulated the interaction strength by controlling the charge transfer process of a particular interaction by chemically modifying the ligands. To obtain a complete analysis, we studied the ligands in their protonated, anionic and radical states aiming to cover the three possibilities in which these may interact with the gold cluster. In order to get a deeper insight into the nature of the interaction we used several analysis techniques such as energy decomposition analysis (EDA), non-covalent interactions (NCI) and natural population analysis (NPA). Our results reveal that tellurium in the anionic state provides complexes of better thermodynamic stability by ∼12.0 kcal mol, when compared with the strongest sulfur–gold complex, also in the anionic state. Furthermore, this indicates that the anionic ligand is probably the dominant state for both selenium and tellurium as observed previously for sulfur. The extent to which the interaction strength could be controlled directly depends on the state of the anchor atom. In our case the anionic state is the most suitable for tuning the interaction. Finally, our main findings suggest that exchanging sulfur with selenium or tellurium involves an important increase of the interaction strength, thus, making these selenophenol and tellurophenol derivatives attractive for the development of new functional materials.

Introduction Sporadic Creutzfeldt-Jakob disease is a prion disease characterized by rapidly progressive dementia, ataxia and myoclonus. Atypical phenotype masquerading as stroke, movement disorders or autoimmune encephalitis have been described. Here, I report a probable case of sCJD with an atypical presentation associated with anti-Zic4 antibody and review the literature of neuronal antibodies in CJD. Case Report A 70 year-old gentleman is admitted with a 2-month history of recurrent stroke-like symptoms associated with behavioral disturbances, gait ataxia and rapidly progressive dementia. His initial examination demonstrated akinetic mutism, diffuse rigidity, dysautononia, and Cheyne-Stokes respiration. Over the following weeks his condition progressed to profound coma. A comprehensive infectious, metabolic, inflammatory and autoimmune work-up yielded negative results. Empiric immunosuppressive therapy ensued. He expired three months after symptoms onset. Autopsy was not performed. After his demise, prion tests came back abnormal for elevated 14-3-3 protein, total tau and positive RTQuIC. Later on, anti-Zic4 antibodies were found in serum. Conclusion This case underscores the importance of a high index of suspicion for CJD even in case of atypical features or the concurrence of neuronal antibodies. Further larger prospective studies on the prevalence of these neuronal antibodies in CJD and the contribution of these autoantibodies to disease pathophysiology are necessary.

To assess concordance between physician assessment and patient-reported symptoms when screening for depression in Parkinson disease (dPD).Depression in Parkinson disease is highly prevalent (∼40%) and has a significant impact on quality of life and disability, yet physician recognition and treatment remain inadequate.One thousand seventy-six patients with PD completed the Brief Symptom Inventory-18 (BSI-18), a screening questionnaire for psychiatric symptoms, which was compared to item #3 (depression) on the Unified Parkinson's Disease Rating Scale (UPDRS).The mean BSI-18 depression score was 51.4 (9.7). Of the 170 (16%) patients screening positive for dPD on the BSI-18, 104 (61%) were not recognized as depressed by neurologists on the UPDRS. Factors associated with lower neurologist recognition included male gender, better mental health quality of life, and lack of antidepressant use.More than 60% of patients screening positive for depression on self-report were not recognized by neurologists on the UPDRS. A patient-reported screening tool for depression may improve recognition and management of dPD.

El retorno a la democracia en el Ecuador (1978) permitió el fortalecimiento y trascendencia de los movimientos sociales. Uno de los elementos paradigmáticos de este proceso fue la autorización del voto a personas analfabetas, que en su gran mayoría eran indígenas, afrodescendientes y campesinos. El presente artículo, tras hacer una breve revisión histórica de la participación política de los pueblos de la diversidad cultural del país y sus actores en las últimas décadas, analiza el contexto constitucional y legal actual de los derechos políticos de los pueblos del Ecuador. Luego, a la luz del proceso electoral de febrero de 2013, analiza la posible existencia de una dinámica del voto frente a candidatos de las diversidades culturales en cinco cantones con alta autoidentificación indígena, afroecuatoriana o montubia. El trabajo muestra interesantes resultados y observaciones de gran utilidad para los tomadores de decisiones respecto de los instrumentos electorales, así como para las organizaciones de los pueblos del país e investigadores en la materia.

To report a case of sporadic Creutzfeldt-Jakob disease (CJD) with bilateral hearing loss at onset and literature review of the scarce cases of CJD with similar audiologic manifestations at presentation.A 67-yr-old man presented to the hospital for evaluation of rapid progression of behavioral decline, unsteady gait, and bilateral hearing loss. Three months before admission, he abruptly developed bilateral hypoacusis without associated tinnitus or vertigo. Shortly after, his family noted an ataxic gait and behavioral changes, for example, paranoid delusions. Initial workup, including a complete autoimmune panel and heavy metals, infectious, toxicology, and paraneoplastic panel (e.g., anti-Hu, anti-VGKC), was conducted. Electroencephalography revealed diffuse generalized slowing without periodic complexes. The presence of distortion product otoacoustic emissions bilaterally was consistent with normal cochlear function, suggesting a retrocochlear origin for symptoms of hearing loss. In the meantime, the patient developed startle myoclonus. The brain magnetic resonance imaging demonstrated asymmetric cortical ribbon along with T2 FLAIR signal hyperintensities of bilateral basal ganglia. Later on, the protein 14-3-3 in the cerebrospinal fluid came back positive, which supported the diagnosis of CJD. Only three cases of CJD with deafness at onset have been published: one sporadic, associated with symptoms suggestive of polyneuropathy; and the other two familial, with the E200K mutation. One presented with symptoms of polyneuropathy and the other with typical features.This case illustrates the phenotypic variability of presentation of CJD in a patient with hearing loss as the initial manifestation. In patients with subacute bilateral hypoacusis and signs of dementia, the differential diagnosis of CJD must be taken into consideration.

Tuberculosis continues to be a global public health problem, the extrapulmonary form being estimated to occur in 10-20% of immunocompetent individuals, increasing in patients who are carriers of the human immunodeficiency virus (HIV); its diagnosis is difficult with conventional methods due to the paucibacillary nature of samples. The Xpert® MTB/RIF test represents an important development in the molecular detection of Mycobacterium tuberculosis and has been used with a variety of non-respiratory clinical samples. To determine the effectiveness of Xpert® MTB/RIF in the detection of M. tuberculosis and sensitivity to rifampicin in patients with suspected extrapulmonary tuberculosis attending Hospital Universitario de San Vicente Fundación in Medellín in 2013-2014. This was a descriptive, cross-sectional ambispective study of 372 consecutive samples from 301 patients with suspected extrapulmonary tuberculosis, who were subjected to bacilloscopy, followed by culture in Ogawa Kudoh and the Xpert® MTB/RIF molecular test. The most frequent base diagnosis (60%) for the 182 patients was infection with HIV. Using the culture as reference, the sensitivity and general specificity of the molecular test was 94% (95% CI: 83-100) and 97% (95% CI: 95-99), respectively; for bacilloscopy it was 38.71(95% CI: 19-57) and 100% (95% CI: 99-100), respectively. Sensitivities higher than 75% were found in analyses stratified by samples. Thirty-seven of the isolates were sensitive and one resistant to rifampicin. Xpert® MTB/RIF performed well in samples from different tissues and liquids, representing a significant advance in support of extrapulmonary tuberculosis diagnosis in terms of time and percentage positivity.

A 74-year-old man presented with acute right-sided hemiparesis and epilepsia partialis continua in association with fever and confusion. Initial workup revealed possible cerebritis in the left medial frontal lobe without involvement of the temporal lobes. Cerebrospinal fluid (CSF) analysis revealed minimal lymphocytic pleocytosis but negative real-time herpes simplex virus (HSV) PCR. Acyclovir was discontinued on day 5 due to a negative infectious workup and clinical improvement. On day 9 his condition deteriorated and he was transferred to a higher level of acuity for advanced supportive care. Worsening encephalopathy and refractory status epilepticus ensued despite medical care. Repeat CSF analysis showed mild lymphocytic pleocytosis with negative real-time HSV PCR. Brain MRI revealed progression of cortical enhancement. Immunosuppressive therapy and plasma exchange were attempted without clinical response. On day 24, another lumbar puncture showed only mild lymphocytic pleocytosis. Brain MRI showed involvement of the right medial temporal lobe. Subsequently, acyclovir was resumed. The HSV-1 PCR result was positive on day 30. Unfortunately, the patient expired.

Palatal tremor (PT) is usually considered a movement disorder that presents with recurring rhythmic contractions of the soft palate. The inferior olive shows a characteristic pseudohypertrophy secondary to brainstem lesions in the triangle of Mollaret and Guillain that interrupt dentato-olivary and tegmental pathways. We report a 35-year-old man with a history of uncontrolled hypertension who presented to the emergency department with PT after a left middle cerebral artery ischemic stroke. The diagnostic work-up consisted of brain MRI, which revealed restricted diffusion over the left frontoparietal lobes without involvement of the brainstem. During hospitalization, the patient reported two brief episodes of soft palate and base-of-the-tongue high-frequency, low-amplitude and rhythmic tremor that resolved after intravenous administration of lorazepam. A 2-hour video electroencephalogram showed no abnormalities. After initiation of levetiracetam therapy, no further spells were reported by the patient. At the 2-month follow-up, the patient had had no episodes of stereotypical PT or upper limb tremors since discharge. This report provides further evidence of the central role of the cortex in the generation of PT. The cortical origin of symptomatic palatal tremor (SPT) should be considered in patients presenting after an acute ischemic insult, particularly if there is no evidence of a brainstem lesion. Potential causes of SPT of cortical origin include focal epilepsy and diaschisis.

We describe one patient and review the literature to define delayed posthypoxic leukoencephalopathy, its etiology, pathophysiology and prognosis. We present a 54-year-old man with confusion and diffuse rigidity following a morphine overdose that had required intubation three weeks previously. A brain CT scan showed bilateral globi pallidi hypodensities and diffusion-weighted brain MRI (DWI) was consistent with acute cerebral anoxia. On day 20 after the initial presentation, the patient insidiously progressed to a state of "akinetic mutism". The brain MRI showed diffuse hyperintensity of the white matter on T2-weighted fluid-attenuated inversion recovery sequences. These areas were bright on DWI and were hypointense on the apparent diffusion coefficient map. An extensive autoimmune, metabolic, toxicological, and infectious work-up included arylsulfatase A enzyme levels, which were unremarkable. Therapy with levodopa was initiated with subsequent improvement of the diffuse rigidity. At discharge, the patient continued to be lethargic with moderate rigidity but began to display signs of recovery. He eventually fully recovered with residual mild confusion. Thus, delayed hypoxic leukoencephalopathy is a rare complication of hypoxic-ischemic encephalopathy, occurring in 2.75% of victims of carbon monoxide poisoning. It typically manifests two to 40 days after apparent recovery from an obtunded state. Prognosis is variable, but recovery can be complete. This report brings to light an important syndrome that can easily be misdiagnosed. Patients who present with these clinical and radiographic features should be treated fully and given time to recover without abrupt withdrawal of care.

A series of Pt–Sn/C catalysts used as anodes during ethanol oxidation are synthesized by a deposition process using NaBH4 as the reducing agent. The order in which the precursors are added affects the electrocatalytic activity and physical-chemical characteristics of the bimetallic catalysts, where the Pt–Sn catalyst prepared by co-precipitation of both metals functions best below a potential of 0.5 V and the catalyst prepared by sequential deposition of Sn and Pt (drying after Sn addition) is most active above a potential of 0.5 V. The electrochemical behavior of catalysts during ethanol oxidation in an acidic medium are characterized and monitored in a half-cell test at room temperature by cyclic voltammetry, chronoamperometry and anode potentiostatic polarization. Catalyst structure and chemical composition are investigated by transmission electron microscopy (TEM), X-ray powder diffraction (XRD) and X-ray photoelectron spectroscopy (XPS). This behavior presented for best Pt–Sn catalyst can be attributed to the so-called bifunctional mechanism and to the electronic interaction between Pt and Sn. The authors thank the Brazilian National Council of Technological and Scientific Development-CNPq (grants: 303630/2012-4, 402243/2012-9 and 310282/2013-6) for the scholarships and financial support for this work.

The authors report a 66 year-old female with past medical history relevant for thoracic abdominal aneurysm who presented with a complaint of chest pain radiating into her neck. The physical examination was significant for the distinctive facial features of wide spaced eyes and V-shaped uvula. Thoracic CT scan revealed a type I aortic dissection which warranted immediate surgical repair. On post-op day one she was noted to be confused and was found to have acute bilateral lower extremity paraparesis with proximal predominance. Furthermore, her left radial artery line had no pulse waves and no brachial, radial, or ulnar pulses could be detected with Doppler ultrasound. Emergent head CT scan revealed bilateral postcentral gyri infarctions and the thoracic CT scan demonstrated extension of the dissection into the aortic branches, including the left brachial and the bilateral carotid arteries. Consequently, surgical brachial artery repair ensued. In the interim, a repeated head CT scan demonstrated new ischemic infarcts involving the bilateral frontal lobes. Anticoagulation was not indicated due to the high risk of bleeding at surgical site. Genetic testing confirmed the presence of a mutation in the TGFBR2 gene at exon 5. Loeys-Dietz syndrome is an autosomal dominant disease caused by heterozygous mutations in the genes encoding type I or II transforming growth factor-β (TGF-β) receptor. Loeys-Dietz syndrome manifests with aggressive vascular pathology. This case underscores the importance of recognition of this spectrum of clinical and pathologic manifestations to identify and manage Loeys-Dietz syndrome.

The electronic structure and spectroscopic properties of [Au3(μ-C(OEt) = NC6H4CH3)3]n-(C6F6)m and [Au3(μ-C(2),N(3)-bzim)3]n-(Ag(+))m were studied at the B3LYP, PBE and TPSS levels. The interaction between the [Au3] cluster and L (C6F6, Ag(+)) was analyzed. Grimme's dispersion correction is used for those functionals. Weak π-interactions (Au-C6F6) were found to be the main contribution short-range stability in the models; while in the models with Ag(+), an ionic interaction is obtained. The absorption spectra of these models at the PBE level agree with the experimental spectra.