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Autism is a lifelong condition characterized by repetitive and restrictive behaviors and differences in social communication. The reported prevalence of autism has risen exponentially in the past years. Early identification and subsequent early intervention are key to promoting better outcomes for autistic individuals. However, there is a dearth of research focusing on understanding variables that impact the age of diagnosis of autistic children in Paraguay. We collected data from 176 caregivers of autistic individuals aged 18 years or younger who lived in Paraguay and conducted a hierarchical regression analysis to understand whether demographic and clinical variables predicted the age of autism diagnosis in Paraguayan autistic children. Our results indicated that child's age, child's age at caregivers' first concerns for their development, and child's verbal skills were significant predictors of the age of autism diagnosis in Paraguay. Educating caregivers and professionals to increase awareness of autism characteristics and atypical behaviors in social communication beyond verbal skills may support the early identification of autism and subsequent access to early intervention.

INTRODUCTION: EGFR-mutated NSCLC is minimally responsive to programmed cell death protein 1 or programmed death-ligand 1 blockade. We evaluated the safety, tolerability, and immunomodulatory effects of the EGFR tyrosine kinase inhibitor (TKI) afatinib in combination with the programmed cell death protein 1 antibody pembrolizumab in patients with EGFR-mutant NSCLC. METHODS: Patients with advanced EGFR-mutant NSCLC with progression (PD) on previous EGFR TKI(s), aged above or equal to 18 years, Eastern Cooperative Oncology Group performance status less than or equal to 1, acceptable organ function, no significant autoimmune disease, measurable disease, and controlled brain metastases were eligible. Primary end point was determination of the maximum tolerated dose and recommended phase 2 dose. Serial specimens were collected to assess for alterations in cytokines and immune cell subsets by quantitative immunofluorescence in tissue and Luminex and flow cytometry in the blood. RESULTS: A total of 11 patients were enrolled, six in dose finding and five in dose expansion. No dose-limiting toxicities were observed. The maximum tolerated dose was determined to be afatinib 40 mg orally daily and pembrolizumab 200 mg intravenously every 21 days. Four (36%) patients had immune-related adverse events (irAEs). Ten patients were assessable for response: two partial response, seven stable disease, and one PD. Peripheral natural killer and natural killer T-cells (p = 0.027, p = 0.01) increased and exhausted CD8+ T-cells decreased on treatment (p = 0.0035). Peripheral CD4/CD8 T-cells (area under the curve = 0.96, p = 0.042) and central memory T-cells (CD4/CD8) (area under the curve = 1.0, p = 0.0006) increased in patients who had disease control more than 6 months or partial response to afatinib/pembrolizumab as did CD3+ T-cells in a patient with progression-free survival more than 6 months after afatinib/pembrolizumab treatment. CONCLUSIONS: Afatinib and pembrolizumab were found to have modest activity associated with irAEs after PD on previous EGFR TKI setting. Proinflammatory changes in immune cell subsets in tissue and blood were detected and associated with antitumor activity and irAEs.

New approaches are needed to determine which ductal carcinoma in situ (DCIS) is at high risk for progression to invasive ductal carcinoma (IDC). We retrospectively studied DCIS patients who declined surgery (2002-2019), and received endocrine therapy (ET) and breast MRI. Baseline MRI and changes at 3 months and 6 months were analyzed by recursive partitioning to stratify IDC risk. Sixty-two patients (63 DCIS; 1 bilateral) with a mean follow-up of 8.5 years were included. Fifty-one percent remained on active surveillance (AS) without evidence of IDC, with a mean duration of 7.6 years. A decision tree based on MRI features of lesion distinctness and background parenchymal enhancement (BPE) at baseline and change after 3 months of ET stratified patients into low, intermediate, and high risk for progression to IDC. MRI imaging features in patients treated with ET and undergoing AS, may help determine which DCIS lesions are at low versus high risk for IDC.

Introducción. La fase pre-analítica es un componente esencial en el algoritmo de análisis clínicos, que conlleva una serie de pasos y procedimientos. Objetivo. Describir el nivel de cumplimiento de los indicadores preanalíticos en las áreas de química y hematología del laboratorio clínico del Hospital Distrital Inmaculada Concepción. Materiales y método. Se aplicó un diseño no experimental con un enfoque mixto de corte transversal y alcance descriptivo. Se incluyeron tres bioquímicos y cien pacientes mediante un muestreo por conveniencia. Los datos fueron obtenidos por observación estructurada a pacientes y entrevista semiestructurada a los funcionarios del hospital. Resultados. El nivel de desempeño de los bioquímicos con relación a los indicadores preanalíticos presenta aspectos tanto positivos como negativos, de los cuales resalta el aspecto positivo en un 61% y el 39% corresponde a aspectos considerados como deficientes. Las dificultades existentes son la identificación correcta del paciente y la comunicación entre el médico tratante y/o técnico con ellos, los cuales en su gran mayoría no tienen conocimiento de las condiciones en las cuales deben presentarse para un examen médico. Conclusión. La adecuada realización de las acciones correctas, como la calidad de las mismas, en la fase pre-analítica se relaciona de manera directa con los resultados que se obtienen, que luego serán utilizados por los profesionales solicitantes para toma de decisiones, por lo que es un eslabón inicial que afecta a todo el proceso posterior.

A large body of research has linked childhood family socioeconomic status (SES) to neurodevelopment in childhood and adolescence. However, it remains unclear to what extent childhood family SES relates to brain functioning in adulthood. To address this gap, the present study investigated the associations between retrospective accounts of objective and subjective childhood family SES and two well-established electrophysiological indices of brain functioning in adulthood-the MMN and P3b event-related potentials (ERP) components, as neural correlates of automatic change detection and cognitive control respectively. Higher objective childhood family SES, as proxied by parent educational attainment in childhood, was associated with larger (more positive) P3b amplitudes in adulthood. In contrast, there was no association between childhood parent educational attainment and the magnitude of MMN. Adult reports of subjective family SES during childhood were not related to the magnitude of MMN or P3b. These findings suggest that the links between childhood parent educational attainment and brain functioning may extend into adulthood, especially for brain functions supporting cognitive control. These results also imply that, when using retrospective accounts of childhood family SES, objective and subjective reports likely proxy different childhood experiences that have distinct links with specific neurodevelopmental outcomes, and that some of these links may not persist into adulthood. Our findings lay the groundwork for future investigations on how and why childhood family SES relates to brain functioning in adulthood.

A multiscale methodology approach was employed integrating microscopic analysis of the biomasses present in the biocomposite (lignocellulosic and fungal) to understand their macroscopic response in terms of physical and mechanical properties. Colombian native strain Ganoderma gibbosum, used for the first time in the production of biocomposites was cultivated on peach palm fruit peel flour and sugar cane bagasse wet dust, individually and as a mixture. During the solid-state fermentation were monitoring the change that occurred in substrate composition such as glucan, arabinoxylan, and lignin through biomass compositional analysis using structural carbohydrates and lignin. Moreover, fungal biomass formation was monitored via scanning electron microscopy. The resulting biocomposites underwent characterization through flexural and water absorption tests. Our findings indicated that G. gibbosum primarily degraded the polysaccharides in each of the evaluated media. However, lignin degradation to 15.06 g/g was only observed in the mixture biocomposite of peach palm fruit peel fluor and sugarcane bagasse wet dust in a ratio of 1꞉1, accompanied by a reduction in glucan and arabinoxylan weights to 26.1 and 7.72 g/g, respectively. This polymer degradation, combined with a protein-rich source in the mixture biocomposite of peach palm fruit peel fluor and sugarcane bagasse wet dust in a ratio of 1꞉1, facilitated the production of a fungal skin (biological matrix) with a high hyphal density of 65%, contributing to Young's modulus of 3.83 MPa, elongation without failure, and low water absorption rate in this biocomposite (55%). The lignocellulosic biomass in the culture media acted as a filler for mechanical interlocking with the matrix and provided attachment points for water absorption. Thus, our study establishes a connection between the microscopic scale and the macroscopic behavior of this biocomposite, assessing structural carbohydrates and lignin analysis during solid-state fermentation (SSF), laying the groundwork for a more customized design of mycelium-based biocomposites. Finally, this study demonstrates the possibility of tailoring nutrient composition by designing their culture media to obtain physical-mechanical properties according to the application requirement.

Abstract Background Chronic kidney disease patients, especially those on hemodialysis, are at increased risk of developing hepatitis B virus (HBV) infection. Guidelines suggest that all patients with chronic kidney disease patients should be vaccinated against HBV, but these guidelines are sub-optimally implemented. Notably, there is a lack of studies in Ethiopia examining the hepatitis B vaccination status among patients with end-stage renal disease. Objective To assess the vaccination status of hepatitis B and associated factors among people with end-stage renal disease who were on hemodialysis. Methods A multi-center cross-sectional observational study was conducted in six randomly selected dialysis centers in Ethiopia, from May 2023 to September 2023. Logistic regression analysis was used to evaluate factors associated with vaccination status. A person is considered to be vaccinated against hepatitis B if he/ she has taken at least one dose of HBV. Vaccination status was determined by patient’s recall and verification from medical record. Results Only 16% of patients with end-stage renal disease on hemodialysis were vaccinated against hepatitis B virus (16.6%; with CI = 12.18, 21.83), of which 30% had received one dose, 57.5% had two doses, 12.5% had three doses, and only five had a booster dose. Post-secondary education (AOR = 5.47; 95% CI = 1.41, 21.2; P

Abstract Background Entomopathogenic nematodes (EPN) are used as a biological control agent for different insect pests in agriculture. The genera Heterorhabditis and Steinernema are the most used commercially. For an EPN species to be used as a biological controller, it is necessary to know its ecological aspects, including reproductive potential, movement capacity, and mean lethal concentration (LC50). These aspects were evaluated in three EPN strains isolated in Galleria mellonella larvae collected in the Lambayeque-Peru region, to determine if they are promising as biological controllers. The strains of EPN studied are Heterorhabditis sp. (PC9 strain), H. bacteriophora Poinar (PM10 strain), and Steinernema diaprepesi Nguyen y Duncan (SV19 strain). Results Heterorhabditis sp. (PC9 strain) and H. bacteriophora (PM10 strain) had high production of infective juveniles (IJs): 217.750 and 186.800, respectively, while S. diaprepesi (SV19 strain) only reached 84.150 IJs. The movement capacity of Heterorhabditis sp. (PC9 strain) and H. bacteriophora (PM10 strain) reached a depth of 15 cm to parasitize G. mellonella larvae, while S. diaprepesi (SV19 strain) only reached 10 cm. In decreasing order, the LC50 value of S. diaprepesi (SV19 strain), Heterorhabditis sp. (PC9 strain) and H. bacteriophora (PM10 strain) were: 24.03, 13.74, and 8.19 IJs/ml, respectively. Conclusions Heterorhabditis sp. PC9 and H. bacteriophora PM10 are promising a biological control agent because they present great production of IJs, great displacement capacity, and high pathogenicity against G. mellonella. Additionally, both strains present a mixed search strategy or seeker-hunter (seeker-browser).

Este estudio examina la inclusión laboral de las mujeres en instituciones públicas de la provincia del Cañar, Ecuador, con un enfoque en la asignación equitativa de cargos directivos. Adoptando un enfoque cualitativo y cuantitativo, se emplearon métodos históricos para trazar el desarrollo de los derechos laborales de las mujeres y métodos analíticos para evaluar los datos actuales de cinco instituciones públicas seleccionadas. Los resultados indican variabilidad en la representación de género: en tres de las cinco instituciones, los hombres predominan en términos de empleo general y ocupación de cargos directivos; sin embargo, en el sector educativo y en el hospital estudiados, las mujeres no solo forman la mayoría del personal, sino que también ocupan la mayoría de los cargos directivos. Estos hallazgos sugieren que, aunque se han hecho avances hacia la equidad de género en algunos sectores, aún existen áreas significativas de desigualdad que necesitan atención dirigida y esfuerzos renovados por parte de las políticas gubernamentales. Este análisis subraya la necesidad de políticas más robustas y efectivas que promuevan una verdadera equidad de género en la administración pública, no solo para cumplir con los principios de justicia social, sino también para mejorar la eficacia administrativa y el desarrollo social. La inclusión equitativa de las mujeres en todos los niveles de la administración pública se presenta no solo como un imperativo ético, sino como una necesidad urgente para el progreso integral de la sociedad.