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The corrosion rates of carbon steel and galvanized steel according to the ISO 9223 standard, the effect of pollutant contamination and atmospheric aggressiveness under high rainfall conditions in the Chocó department were studied. Carbon and galvanized steel samples, chloride, and sulfur collectors were exposed in three atmospheric stations in three strategic positions covering the Colombian Pacific: Quibdó, Andagoya and Bahía Solano, for different exposure periods (up to 18 months). The structural-micro characterization of corrosion products was evaluated via X-ray diffraction (XRD), Raman spectroscopy and scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy SEM-EDS. The results indicate that all study regions obtained the highest time of wetness category ( τ 5 ). The sulfur-containing pollution (SO 2 ) was categorized as P 0 (rural atmosphere) with average values of P d  ≤ 4 mg/m 2 - day. Bahia Solano station showed the highest chloride deposition rate, reporting an average of 8.3 mg/m 2 -day (categorized as δ 1 ), according to ISO 9223. Due to the extremely high rainfall in the department of Chocó, the results initially suggested hematite formation on carbon steel. After several months, there was a phase transition to lepidocrocite (γ-FeOOH). The formation of γ-FeOOH induces active corrosion on the iron substrate. The zincite phase (ZnO) was observed in the galvanized steel corrosion products. The corrosion rates of carbon and galvanized steel in the location of Quibdó-Colombia were higher than in previous reports. Data analysis reveals that the precipitation variable, which governs the TOW and pollution contaminants, significantly influences the corrosion of these exposed metals., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

The concept of mental symptom is constructed considering not only the biological signal that determines it, but the multilayered causative factors related to intersubjective experience. However, specific brain damage might produce a set of symptoms expressed in a recognizable gestalt that helps to differentiate organic of psychogenic causation. The legacy of the theory of mental symptoms developed by German Berrios and the seminal work of Hughlings Jackson and Kurt Goldstein can contribute to this difficult task., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Calderón and Toro.)

Objective: The objective of this study was to determine the incidence and evolution of patients with acute fatty liver of pregnancy (AFLP) over a period of 18 years in the city of Toluca, Mexico., Methods: This was a descriptive and retrospective study of eighteen years. All women with AFLP confirmed by biopsy were included and the incidence, laboratory test values and complications were registered., Results: AFLP incidence was of 1 case for every 8,451 deliveries. The main complications were bleeding, infections and neurological compromise. The mortality was of 33.33%., Conclusion: It can be concluded that AFLP has a slightly lower incidence in Mexico than that reported in other countries but with a higher survival. This condition deserves a multidisciplinary team to improve the survival rate.

Transport intoxication in the form of body stuffing, a dangerous practice involving the ingestion or insertion of psychoactive substances into the body to evade detection during drug trafficking, represents a major medical problem that requires immediate attention in the emergency department. Unlike body packing, where substances are encapsulated and swallowed for later extraction, body stuffing involves direct ingestion without wrapping, which greatly increases the risk of serious intoxication and even death. Benzodiazepines, due to their high demand on the black market, are among the most common drugs used in body stuffing. The management of this type of poisoning in the emergency department presents a significant clinical challenge due to the variability in clinical presentation, which can range from drowsiness and confusion to respiratory depression and coma.Rapid and accurate assessment is critical for effective management.The initial focus is on patient stabilization and life support as needed, which may include administration of naloxone to reverse opioid effects, mechanical ventilation for respiratory depression, and management of seizures if they occur.An appropriate approach in the emergency department is crucial to improve the prognosis and quality of life of patients affected by this type of poisoning. Timely intervention and expert management can prevent serious complications and even death. We present the case of a patient with benzodiazepine intoxication with an atypical presentation due to clonazepam transport with bradycardia and its management in an institution in Bogotá-Colombia., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Introduction: The genus Bartonella includes species and subspecies of fastidious, facultative intracellular Gram-negative bacilli that infect a wide variety of mammalian reservoirs including cats and humans. In 2022, the Ecuadorian Ministry of Health reported an outbreak of cat scratch disease caused by B. henselae in the city of Guayaquil. Therefore, we aimed to characterize the presence of Bartonella spp. in domestic and stray cats from the area of Guayaquil where the outbreak happened in 2022., Methods: Whole blood samples of 100 domestic and stray cats were collected. Riboflavin synthase (ribC) and 16S rRNA genes detection was performed by PCR using Bartonella spp. specific primers, followed by Sanger sequencing and phylogenetic analysis., Results: 14 cats were positive for Bartonella spp. carriage. Phylogenetic analysis confirmed the presence of 12 cats infected with B. henselae and 2 cats with B. clarridgeiae., Conclusions: There is a high prevalence of Bartonella spp. carriage in cats in the city of Guayaquil within the area where a recent cat scratch disease outbreak happened. Considering the high presence of cats and other domestic and stray animals in the city of Guayaquil, a One Health approach for surveillance and prevention of zoonotic diseases like cat scratch disease is needed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Objective:  Surgical intervention in pediatric patients can cause variable degrees of psychological stress with potential consequences in the perioperative period and even in the long term, after hospital discharge in the form of behavioral changes days and months later. The aim of our study was to determine which preoperative preparation strategy reduces postoperative maladaptive behavioral changes in children undergoing ambulatory pediatric surgery., Materials and Methods:  This prospective observational study included 638 pediatric American Society of Anesthesiologists physical status I or II patients who underwent ambulatory pediatric surgery. They were grouped into four preoperative preparation groups: not premedicated (NADA), premedicated with midazolam (MDZ), parental presence during induction of anesthesia (PPIA), and parental presence during induction of anesthesia and premedicated with midazolam (PPIA + MDZ). All patients included in the study were contacted by telephone during 1 year posthospital discharge to assess the postoperative maladaptive behavioral changes using the Posthospitalization Behavior Questionnaire (PHBQ). We performed a multivariate analysis to evaluate the influence of type of preparation and behavioral changes., Results:  Patients in the PPIA and PPIA + MDZ preparation groups presented less postoperative maladaptive behavioral changes compared to patients in the NADA and MDZ groups (odds ratio [OR]: 1.8 [1.1-2.8] and OR 2.2 [1.03-4.49]) during the first week and first month. The intensity of emergence delirium measured by the Pediatric Anesthesia Emergence Delirium (PAED) scale increases the probability of postoperative maladaptive behavioral changes (OR: 1.05 [1.006-1.103])., Conclusion:  The presence of parents during induction of anesthesia (PPIA and PPIA + MDZ) is a very effective strategy in reducing postoperative behavioral changes. These benefits are more significant in children under 5 years of age., Competing Interests: None declared., (Thieme. All rights reserved.)

Objectives: Information is scarce on clinical experiences with non-neutropenic patients with invasive fungal infection (IFI) receiving isavuconazole. We aimed to report the safety and effectiveness of this drug as a first-line treatment or rescue in real life., Methods: A retrospective, observational multicentric study of non-neutropenic patients who received isavuconazole as an IFI treatment at 12 different university hospitals (January 2018-2022). All patients met criteria for proven, probable or possible IFI according to EORTC-MSG., Results: A total of 238 IFIs were treated with isavuconazole during the study period. Combination therapy was administered in 27.7% of cases. The primary IFI was aspergillosis (217, 91.2%). Other IFIs treated with isavuconazole were candidemia (n = 10), mucormycosis (n = 8), histoplasmosis (n = 2), cryptococcosis (n = 2), and others (n = 4). Median time of isavuconazole treatment was 29 days. Only 5.9% (n = 14) of cases developed toxicity, mainly hepatic-related (10 patients, 4.2%). Nine patients (3.8%) had treatment withdrawn. Successful clinical response at 12 weeks was documented in 50.5% of patients., Conclusion: Isavuconazole is an adequate treatment for non-neutropenic patients with IFIs. Toxicity rates were low and its effectiveness was comparable to other antifungal therapies previously reported., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Acne is a chronic inflammatory disorder of the pilosebaceous unit that is associated with a negative impact on quality of life, causing anxiety, depression, and poor self-esteem. The treatment of acne is not simple and presents some new challenges. This article addresses important issues faced by dermatologists on their daily, some of them specific for Latin America., Objective: To discuss daily practice recommendations when managing acne patients., Methods: A literature review was conducted by a group of eight experts with extensive experience in the field of acne. The results of the data review were presented at an initial kick-off meeting to align the consensus topics. Two e-surveys using the Delphi methodology and an interim group webinar meeting were held., Results: The expert panel reached a consensus on all proposed key statements, providing scientific support to help dermatologists and healthcare providers make acne management decisions on topics that can be challenging in the everyday practice of dermatology, such as the characteristics of Generation Z or the importance of the maintenance phase of adult acne treatment., Conclusion: This article provides current recommendations for managing acne patients. The high level of agreement achieved based on the latest evidence supports the best acne therapeutic choices in both established topics and new important issues that have emerged in recent years, such as the impact of social media, Generation Z characteristics, and transgender male patient specifics., (Copyright © 2024 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Twenty 2-(4-alkyloxyphenyl)-imidazolines and 2-(4-alkyloxyphenyl)-imidazoles were synthesized, with the former being synthesized in two steps by using MW and ultrasonication energy, resulting in good to excellent yields. Imidazoles were obtained in moderate yields by oxidizing imidazolines with MnO 2 and MW energy. In response to the urgent need to treat neglected tropical diseases, a set of 2-(4-alkyloxyphenyl)- imidazolines and imidazoles was tested in vitro on Leishmania mexicana and Trypanosoma cruzi . The leishmanicidal activity of ten compounds was evaluated, showing an IC 50 < 10 µg/mL. Among these compounds, 27 - 31 were the most active, with IC 50 values < 1 µg/mL (similar to the reference drugs). In the evaluation on epimastigotes of T. cruzi , only 30 and 36 reached an IC 50 < 1 µg/mL, showing better inhibition than both reference drugs. However, compounds 29 , 33 , and 35 also demonstrated attractive trypanocidal activities, with IC 50 values < 10 µg/mL, similar to the values for benznidazole and nifurtimox.

Biocomposites were fabricated utilizing polylactic acid (PLA) combined with native starch sourced from mountain's yam ( Dioscorea remotiflora Knuth), an underexplored tuber variety. Different starch compositions (7.5, 15.0, 22.5, and 30.0 wt.%) were blended with PLA in a batch mixer at 160 °C to produce PLA/starch biocomposites. The biocomposites were characterized by analyzing their morphology, particle size distribution, thermal, X-ray diffraction (XDR), mechanical, and dynamic mechanical (DMA) properties, water absorption behavior, and color. The results showed that the amylose content of Dioscorea remotiflora starch was 48.43 ± 1.4%, which corresponds to a high-amylose starch (>30% of amylose). Particle size analysis showed large z-average particle diameters ( D z0 ) of the starch granules (30.59 ± 3.44 μm). Scanning electron microscopy (SEM) images showed oval-shaped granules evenly distributed throughout the structure of the biocomposite, without observable agglomeration or damage to its structure. XDR and DMA analyses revealed an increase in the crystallinity of the biocomposites as the proportion of the starch increased. The tensile modulus (E) underwent a reduction, whereas the flexural modulus (E flex ) increased with the amount of starch incorporated. The biocomposites with the highest E flex were those with a starch content of 22.5 wt.%, which increased by 8.7% compared to the neat PLA. The water absorption of the biocomposites demonstrated a higher uptake capacity as the starch content increased. The rate of water absorption in the biocomposites followed the principles of Fick's Law. The novelty of this work lies in its offering an alternative for the use of high-amylose mountain's yam starch to produce low-cost bioplastics for different applications.

Introduction: Cancer needs perfusion for its growth and metastasis. Cancer cell-derived extracellular vesicles (CA-EVs) alter the tumor microenvironment (TME), potentially promoting angiogenesis. We hypothesize that conditions in the tumor, e.g., hypoxia, and in the target cells of the TME, e.g., nutrient deprivation or extracellular matrix, can affect the angiogenic potential of CA-EVs, which would contribute to explaining the regulation of tumor vascularization and its influence on cancer growth and metastasis., Methods: CA-EVs were isolated and characterized from cervical carcinoma cell lines HeLa and SiHa cultured under normoxia and hypoxia, and their angiogenic potential was evaluated in vitro in three endothelial cells (ECs) lines and aortic rings, cultured in basal (growth factor-reduced) or complete medium., Results: Hypoxia increased EV production 10-100 times and protein content 2-4 times compared to normoxic CA-EVs. HeLa-EVs contained six times more RNA than SiHa-EVs, and this concentration was not affected by hypoxia. Treatment with CA-EVs increased tube formation and sprouting in ECs and aortic rings cultured in basal medium and long-term stabilized the stablished vascular networks formed by ECs cultured in complete medium., Conclusion: Hypoxia differentially affects CA-EVs in a cell line-dependent manner. The cellular environment (nutrient availability and extracellular matrix scaffold) influences the effect of CA-EV on the angiogenic potential of ECs., Competing Interests: Declaration of competing interest The authors declare no conflict of interest. The funders had no role in the study's design, in the collection, analyses, interpretation of data, or the writing of the manuscript., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To relate the topical use of cannabis as an analgesic therapeutic alternative in patients with some inflammatory diseases in Salud Social I.P.S during May to July 2023., Methods: An analytical, retrospective study was carried out. The population from which the sample was obtained corresponds to patients diagnosed with Arthrosis, Unspecified, Non-Toxic Multinodular Goiter, Epilepsy, Unspecified Type Venous Insufficiency (Chronic) (Peripheral), Unspecified Lumbago, Secondary Gonarthrosis, Rotator Cuff Syndrome, Carpal Tunnel Syndrome, in Salud Social I.P.S of Barranquilla, Atlántico. A sample of 23 patients diagnosed with these pathologies was obtained by non-probabilistic convenience sampling., Results: All patients showed pain relief after two months of follow-up, two experienced adverse effects. Some studies suggest that cannabinoids present in cannabis, such as CBD and THC, may have analgesic and anti-inflammatory properties that could alleviate pain and inflammation associated with these conditions. This is consistent with the present study., Conclusion: Topical cannabis is presented as a therapeutic alternative in inflammatory diseases, however, it is important to highlight that research on the use of cannabis in these diseases is limited and more studies are needed to fully understand its effects and potential benefits.

Introduction: Tyrosinemia type 1 is a rare disease with autosomal recessive inheritance, featuring various clinical manifestations. These may encompass acute neonatal liver failure, neonatal cholestatic syndrome, chronic hepatitis, cirrhosis, hepatocellular carcinoma, and, alternatively, kidney disorders like renal tubular acidosis, Fanconi syndrome, hypophosphatemic rickets, among other alterations. Diagnosis relies on detecting toxic metabolites in the blood and urine, ideally confirmed through molecular testing., Method: A consensus was reached with experts in the field of inborn errors of metabolism (EIM), including eight pediatric gastroenterologists, two EIM specialists, two geneticists, three pediatric nutritionists specialized in EIM, and a pediatric surgeon specializing in transplants. Six working groups were tasked with formulating statements and justifications, and 32 statements were anonymously voted on using the Likert scale and the Delphi method. The first virtual vote achieved an 80% consensus, with the remaining 20% determined in person., Results: The statements were categorized into epidemiology, clinical presentation, diagnosis, nutritional and medical treatment, and genetic counseling., Conclusions: This consensus serves as a valuable tool for primary care physicians, pediatricians, and pediatric gastroenterologists, aiding in the prompt diagnosis and treatment of this disease. Its impact on the morbidity and mortality of patients with tyrosinemia type 1 is substantial., (Copyright: © 2024 Permanyer.)

Acute-on chronic liver failure (ACLF) has been an intensively debated topic mainly due to the lack of a unified definition and diagnostic criteria. The growing number of publications describing the mechanisms of ACLF development, the progression of the disease, outcomes and treatment has contributed to a better understanding of the disease, however, it has also sparked the debate about this condition. As an attempt to provide medical professionals with a more uniform definition that could be applied to our population, the first Mexican consensus was performed by a panel of experts in the area of hepatology in Mexico. We used the most relevant and impactful publications along with the clinical and research experience of the consensus participants. The consensus was led by 4 coordinators who provided the most relevant bibliography by doing an exhaustive search on the topic. The entire bibliography was made available to the members of the consensus for consultation at any time during the process and six working groups were formed to develop the following sections: 1.- Generalities, definitions, and criteria, 2.- Pathophysiology of cirrhosis, 3.- Genetics in ACLF, 4.- Clinical manifestations, 5.- Liver transplantation in ACLF, 6.- Other treatments., Competing Interests: Declaration of interests None., (Published by Elsevier España, S.L.U.)

Objective. To present an innovative approach for the design of a 3D mammographic phantom for medical equipment quality assessment, estimation of the glandular tissue percentage in the patient's breast, and emulation of microcalcification ( μ C) breast lesions. Approach. Contrast-to noise ratio (CNR) measurements, as well as spatial resolution and intensity-to-glandularity calibrations under mammography conditions were performed to assess the effectiveness of the phantom. CNR measurements were applied to different groups of calcium hydroxyapatite (HA) and aluminum oxide (AO) μ Cs ranging from 200 to 600 μ m. Spatial resolution was characterized using an aluminum plate contained in the phantom and standard linear figures of merit, such as the line spread function and modulation transfer function (MTF). The intensity-to-glandularity calibration was developed using an x-ray attenuation matrix within the phantom to estimate the glandular tissue percentage in a breast with a compressed thickness of 4 cm. Main results. For the prototype studied, the minimum confidence level for detecting HA μ Cs is 95.4%, while for AO μ Cs is above 68.3%. It was also possible to determine that the MTF of the commercial mammography machine used for this study at the Nyquist frequency is 41%. Additionally, a one-to-one intensity-to-glandularity calibration was obtained and verified with Monte-Carlo simulation results. Significance. The phantom provides traditional arrangements presented in accreditation phantoms, which makes it competitive with available devices, but excelling in regarding affordability, modularity, and inlays distribution. Moreover, its design allows to be positioned in close proximity to the patient's breast during a medical screening for a simultaneous x-ray imaging, such that the features of the phantom can be used as reference values to specify characteristics of the real breast tissue, such as proportion of glandular/adipose composition and/or μ C type and size lesions., (© 2023 Institute of Physics and Engineering in Medicine.)

Acute pancreatitis (AP) and recurrent acute pancreatitis (RAP) are conditions, whose incidence is apparently on the rise. Despite the ever-increasing evidence regarding the management of AP in children and adults, therapeutic actions that could potentially affect having a poor prognosis in those patients, especially in the pediatric population, continue to be carried out. Therefore, the Asociación Mexicana de Gastroenterología convened a group of 24 expert pediatric gastroenterologists from different institutions and areas of Mexico, as well as 2 pediatric nutritionists and 2 specialists in pediatric surgery, to discuss different aspects of the epidemiology, diagnosis, and treatment of AP and RAP in the pediatric population. The aim of this document is to present the consensus results. Different AP topics were addressed by 6 working groups, each of which reviewed the information and formulated statements considered pertinent for each module, on themes involving recommendations and points of debate, concerning diagnostic or therapeutic approaches. All the statements were presented and discussed. They were then evaluated through a Delphi process, with electronic and anonymous voting, to determine the level of agreement on the statements. A total of 29 statements were formulated, all of which reached above 75% agreement in the first round of voting., (Copyright © 2023 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Context: Graphene has been used as reinforcement of polymeric nanocomposites to increase mechanical and electrical properties. Recently, graphene suspensions have been used for the development of nanofluids in automotive applications, where improvements in convection heat transfer coefficients and pressure drops have been reported. However, dispersions of graphene sheets in a polymeric matrix as well as in a solvent medium are difficult to achieve; that is because Van der Waals, [Formula: see text] and Coulombic interactions cause agglomerations. Surface chemical modifications have been considered as viable options to improve the graphene integration. In this work, we studied the colloidal stability of aqueous solutions of graphene sheets functionalized with (i) carboxylic groups, (ii) 3-amino-propyl tri-ethoxy silane (amphiphilic behavior), (iii) graphene oxide, and (iv) pristine graphene. Results show that the lower sedimentation velocity corresponds to the graphene functionalized with carboxylic groups, which presents the higher colloidal stability. However, the amphiphilic group enhances the interaction energy between graphene and the solvent; we believe that there is a threshold percentage of functionalization that improves the colloidal stability of graphene., Method: Transport properties of graphene solutions were estimated by using Non-Equilibrium Molecular Dynamics simulations to generate Poiseuille flow in an NVT ensemble. Simulations were developed in the LAMMPS code. The COMPASS Force Field was used for the graphene systems and the TIP3P for the water molecules. Bonds and angles of hydrogen atoms were kept rigid by using the shake algorithm. The molecular models were built through MedeA and visualized with the Ovito software., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Vascularization is a multifactorial and spatiotemporally regulated process, essential for cell and tissue survival. Vascular alterations have repercussions on the development and progression of diseases such as cancer, cardiovascular diseases, and diabetes, which are the leading causes of death worldwide. Additionally, vascularization continues to be a challenge for tissue engineering and regenerative medicine. Hence, vascularization is the center of interest for physiology, pathophysiology, and therapeutic processes. Within vascularization, phosphatase and tensin homolog deleted on chromosome 10 (PTEN) and Hippo signaling have pivotal roles in the development and homeostasis of the vascular system. Their suppression is related to several pathologies, including developmental defects and cancer. Non-coding RNAs (ncRNAs) are among the regulators of PTEN and/or Hippo pathways during development and disease. The purpose of this paper is to review and discuss the mechanisms by which exosome-derived ncRNAs modulate endothelial cell plasticity during physiological and pathological angiogenesis, through the regulation of PTEN and Hippo pathways, aiming to establish new perspectives on cellular communication during tumoral and regenerative vascularization., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest. The funders had no role in the design of the study, in the collection, analyses, interpretation of data, or in the writing of the manuscript., (Copyright © 2023. Published by Elsevier Inc.)

Purpose: To identify prognostic factors of failure in patients undergoing perineal urethrostomy (PU) with Blandy technique, with inverted U-shaped perineal flap., Methods: This is a retrospective study of PU of non-oncological causes (2001-2017). Data of age, BMI, history of diabetes mellitus, etiology of urethral stricture, type of stricture, previous surgeries, dilatation and suprapubic catheter were collected. Failure was defined as the need for any instrumentation after surgery. Variables were analyzed by Cox regression and Kaplan-Meier curves were used for survival analysis., Results: A total of 115 PU were performed. Median age was 61 years (IQR 53-68) and BMI 27.9 (IQR 25-30.9). The most frequent etiologies were: lichen sclerosus (30.4%), iatrogenic (27%), and idiopathic (25.7%). 62.6% had panurethral stricture. There were no complications in 73%. Clavien I complications occurred in 25.2%, Clavien II in 0.9% and Clavien IVa in 0.9%. The overall success rate was 51.3% with a median follow-up of 71 months. In the last 8 years, it was 75%. In the multivariate analysis, we found that age (p = 0.01), BMI (p = 0.01), date of surgery (p = 0.01), and suprapubic catheter (p = 0.003) were predictive variables. The voiding satisfaction rate was 88.7%., Conclusions: PU with Blandy technique is a surgery with low morbidity. During the entire study period, it had a failure rate of 48.7% but the failure rate decreased to 25% over the last 8 years. Age, BMI, date of surgery and suprapubic catheter are the most important prognostic factor of failure., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To synthesize evidence from systematic reviews on the effects of qigong, tai chi, and yoga in people with neurological diseases., Methods: A systematic search was conducted in PubMed, PsycINFO, Embase, CINAHL and Cochrane Library until September 2022. Methodological quality was assessed using the AMSTAR 2 tool. A qualitative synthesis of included reviews and meta-analyses was performed. Citation matrices and the corrected covered area were used to explore the overlap of randomized controlled trials among reviews., Results: Nineteen systematic reviews (containing 74 trials and 80 meta-analyses) in people with Parkinson's disease (PD) or stroke were included. The critical domains of the AMSTAR 2 were not satisfied in more than half of the reviews, and only 4 evaluated the certainty of the evidence. The overlap was very high (21.7%) and high (11%) for tai chi studies in PD and stroke, respectively. In people with PD, qigong, yoga, and tai chi can improve balance, with tai chi being beneficial to increase functional mobility. For stroke patients, tai chi was better than controls to enhance motor function and independence, but not for health-related quality of life and quality of sleep. Findings on balance, walking ability and depression were inconclusive in stroke population., Conclusions: Qigong, tai chi, and yoga appear to be effective to improve balance performance in people with PD. Tai chi practice enhances motor function and independency in stroke patients., Competing Interests: Declaration of interest None of the authors has any financial or other interests relating to the manuscript., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Coffee is one of the most consumed beverages in the world. Coffee provides to the consumer special sensorial characteristics, can help to prevent diseases, improves physical performance and increases focus. In contrast, coffee consumption supplies a significant source of substances with carcinogenic and genotoxic potential such as furan, hydroxymethylfurfural (HMF), furfural (F), and acrylamide (AA). The present review addresses the issues around the presence of such toxic substances formed in Maillard reaction (MR) during thermal treatments in food processing, from chemical and, toxicological perspectives, occurrences in coffee and other foods processed by heating. In addition, current strategies advantages and disadvantages are presented along with application of molecular imprinting technology (MIT) and poly (ionic liquid) s (PIL) as an alternative to reduce the furan, HMF, F and AA content in coffee and other foods.

Aim of the Study: To describe perianal Crohn's disease behavior and the role of biological therapy in a sample of pediatric patients., Methods: A retrospective study of pediatric patients with Crohn's disease (CD) treated in our institution from 2017 to 2021, with a minimum follow up period of 6 months, was conducted. Patients were divided whether they had perianal disease (PD) or not. Baseline characteristics, extension of disease, growth failure rate, aggressive pattern rate, use of biological therapy and need for surgery, among other variables, were compared between both groups. Clinical and/or radiological improvement in the last 6 months of follow up was considered good control of PD., Results: Seventy eight pediatric patients with CD were included. Median age at diagnosis was 10.5 years, and median follow up time was 3.8 years. 64.1% patients were male. Of all, 15 (19.2%) had perianal disease, of which 10 had fistulizing findings and 5 had non fistulizing findings. PD was presented at diagnosis in 8 patients, and the rest developed it in a median time of 1 year from diagnosis. PD was associated with growth failure (p = 0.003), use of biological therapies (p = 0.005), and need for second line of biologics (p = 0.005). Most patients (12/15, 80%) had good control of PD with the treatment received., Conclusions: CD patients with PD seem to need a more aggressive treatment, with biological therapies playing a key role for its handling nowadays. These patients require close nutritional evaluation that ensures proper development and growth.

Background: In a previous work, an IL-2Rβγ biased mutant derived from human IL-2 and called IL-2noα, was designed and developed. Greater antitumor effects and lower toxicity were observed compared to native IL-2. Nevertheless, mutein has some disadvantages, such as a very short half-life of about 9-12 min, propensity for aggregation, and solubility problems., Objective: In this study, PEGylation was employed to improve the pharmacokinetic and antitumoral properties of the novel protein., Methods: Pegylated IL-2noα was characterized by polyacrylamide gel electrophoresis, size exclusion chromatography, in vitro cell proliferation and in vivo cell expansion bioassays, and pharmacokinetic and antitumor studies., Results: IL-2noα-conjugates with polyethylene glycol (PEG) of 1.2 kDa, 20 kDa, and 40 kDa were obtained by classical acylation. No significant changes in the secondary and tertiary structures of the modified protein were detected. A decrease in biological activity in vitro and a significant improvement in half-life were observed, especially for IL-2noα-PEG20K. PEGylation of IL-2noα with PEG20K did not affect the capacity of the mutant to induce preferential expansion of T effector cells over Treg cells. This pegylated IL-2noα exhibited a higher antimetastatic effect compared to unmodified IL-2noα in the B16F0 experimental metastases model, even when administered at lower doses and less frequently., Conclusion: PEG20K was selected as the best modification strategy, to improve the blood circulation time of the IL-2noα with a superior antimetastatic effect achieved with lower doses., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Self-perceived confidence of health professions students at one university in caring for adults with intellectual disability (ID) was examined via an electronic survey using the Therapy Confidence Scale - Intellectual Disabilities (TCS-ID). A stepwise multiple regression of data collected from 232 completed surveys revealed that prior training and prior experience were predictors of TCS-ID total score. Adults with ID experience healthcare disparities due, in part, to poor provider communication and a lack of confidence. Results from this novel study suggest that opportunities for experiential learning and training with people with ID are important considerations for health professions curricula. Further research is needed for generalizability of results., (©AAIDD.)

Objectives: To determine the clinical performance of light-cured calcium silicate-based cement for direct or indirect pulp capping. The research question was as follows: in teeth with deep caries lesions, does the use of resin-modified calcium silicate-containing composites improve the radiological success and prevent irreversible pulpitis and pulpal necrosis compared with other pulp-capping agents?, Materials and Methods: The following databases were screened until September 2021: PubMed, Web of Science, Scielo, Scopus, Embase, and The Cochrane Library. Randomized clinical trials reporting the clinical evaluation of a resin-modified calcium silicate material as an agent for pulp therapy were included. Meta-analysis was performed using the Rev Manager v5.4.1 software. The risk difference and 95% confidence interval of the dichotomous outcome (restoration failure or success) were calculated for comparison., Results: Ten studies were considered for qualitative analysis and meta-analysis. Studies evaluating the performance of light-cured calcium silicate-based cement from 1 month to a maximum follow-up period of 36 months and comparing it with the performance of CaOH, mineral trioxide aggregate, or Biodentine were included. In the global analysis for direct pulp capping at 6-month follow-up, no statistical differences were observed between the experimental group using the light-cured calcium silicate-based cement and control group (P = .28). However, at 12-month follow-up, global analysis favored the control group (P < .001). For indirect pulp capping, at 6- and 24-month follow-ups, no statistically significant differences were observed between the experimental and control groups (P = .88; P = .21)., Conclusions: Light-cured calcium silicate-based cement showed a limited clinical performance as a direct pulp capping agent, especially when evaluated in the long term. However, using it as an indirect pulp capping agent may be a reliable and easy-to-use option for restoring teeth with deep caries., Clinical Significance: This systematic review provides evidence that supports the use of light-cured calcium silicate-based cement as an indirect pulp capping agent., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The Asociación Mexicana de Hepatología A.C. carried out the Consensus on the Management of Complications of Cirrhosis of the Liver in Pediatrics to provide physicians with useful information for treating said complications. A group of pediatric gastroenterologists and experts in nutrition, nephrology, and infectious diseases participated and reviewed the medical literature. The Delphi method was applied to obtain the level of agreement on the statements that were formulated. The statements were sent to the participants to be analyzed and voted upon, after which they were discussed in virtual sessions, and the final versions were produced. The aim of the consensus results was to issue indications for the management of pediatric patients with liver cirrhosis, to prevent or control complications., (Copyright © 2022 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Purpose: The correct risk categorization and staging of upper tract urothelial cancer (UTUC) is key for disease management. Computerized tomography urography and urinary cytology have limited accuracy for risk stratification of UTUC. Ureteroscopy may increase the risk of bladder cancer recurrence. Recently, Bladder EpiCheck TM (EpiCheck) showed a high accuracy in the detection of bladder cancer. The aim of the study is to investigate the diagnostic accuracy of EpiCheck in the clinical management of UTUC and to compare it with urinary cytology., Materials and Methods: In this single-arm, blinded, prospective, single-center study (February 2019-December 2020), all patients who were candidates for ureteroscopy for suspicion of UTUC were included. Bladder and upper urinary tract (UUT) samples were collected before ureteroscopy to test for cytology and Epicheck. EpiCheck accuracy was calculated in bladder and UUT samples and compared to cytology., Results: EpiCheck resulted diagnostic in 83/86 (97%) and 73/75 (97%) of UUT and bladder samples. Histology was positive in 47/83 (57%) and 42/73 (58%) cases, respectively. In UUT samples, EpiCheck yielded a sensitivity/specificity/ negative predictive value (NPV)/positive predictive value of 83%/79%/77%/84% vs 59%/88%/61%/87% of cytology. The sensitivity/NPV for high-grade tumors was 96%/97% for EpiCheck vs 71%/86% for cytology. EpiCheck indicated ureteroscopy in 45/80 (56%) patients, missing 17%/4% of all/high-grade UTUC with 9% of unnecessary ureteroscopy. In bladder samples, the sensitivity/NPV for high-grade tumors was 71%/88% for EpiCheck and 59%/87% for cytology., Conclusions: Epicheck may be an important tool to decrease the number of unnecessary ureteroscopy. The clinical implementation of EpiCheck in UTUC warrants further investigation in multicentric prospective randomized trials.

The starch extracted from avocado ( Persea americana L. cv. Hass) seeds was characterized and used in the preparation of an edible coating to reduce the oil uptake and acrylamide content in French fries. Starch characterization was carried out using Differential Scanning Calorimetry, Fourier transform infrared spectrophotometry, gelatinization, and scanning electron microscopy. Uncoated (UFF) and coated (CFF) French fries were compared and evaluated for moisture, water activity (Aw), fat, color, firmness, acrylamide content, and sensorial analysis. The extracted starch presented a high crystalline structure and good stability to mechanical work and heat treatments. The CFF French fries showed significantly higher Aw, color parameter a* , but lower luminosity and acrylamide content than UFF samples. Similarly, the CFF samples tended to decrease the fat content, although without statistical differences. Avocado seed starch can be an economical and technically feasible alternative to the food industry as an effective coating to reduce acrylamide content in French fries., Competing Interests: Conflict of interestThe authors declare no conflict of interest., (© The Author(s) 2022.)

The sealing and bonding characteristics of luting cements may be affected by the application of desensitizers containing ingredients that induce chemical interaction with dentin organic matrix. This study evaluated the effect of different desensitizers on the immediate and long-term shear bond strength (SBS) of a self-adhesive resin cement (SARC) to dentin. Healthy bovine dentin specimens were used for the study. Gluma® Desensitizer, Desensibilize Nano P®, and Soothe® desensitizer were used in study groups, while the control group did not receive any treatment. Next, SARC (RelyXTM U200) in cylindrical mold was applied to the sample surface. All specimens were stored at 37 °C for 24 h or six months and tested for SBS. Additionally, water contact angle was measured using an optical tensiometer. Results were analyzed by analysis of variance and Student-t tests (p ˂ 0.05). Application of the different types of desensitizers had no significant influence on immediate or long-term SBS of SARC to dentin (p > 0.05). Differences for water contact angle were not statistically significant among the tested groups (p = 0.450). Within the limitations of the present study, it can be concluded that the application of the different types of desensitizers had no significant influence on the SBS of a SARC to dentin.

Introduction:  Preoperative stress and anxiety in pediatric patients are associated with poor compliance during induction of anesthesia and a higher incidence of postoperative maladaptive behaviors. The aim of our study was to determine which preoperative preparation strategy improves compliance of the child during induction and decreases the incidence and intensity of emergence delirium (ED) in children undergoing ambulatory pediatric surgery., Materials and Methods:  This prospective observational study included 638 pediatric American Society of Anesthesiologists I-II patients who underwent ambulatory pediatric surgery, grouped into four preoperative preparation groups: NADA (not premedicated), MDZ (premedicated with midazolam), PPIA (parental presence during induction of anesthesia), and PPIA + MDZ. The results were subsequently analyzed in four age subgroups: Group 1 (0-12 months), Group 2 (13-60 months), Group 3 (61-96 months), and Group 4 (> 96 months). Preoperative anxiety (modified Yale Preoperative Anxiety Scale [m-YPAS]), compliance of the child during induction (Induction Compliance Checklist [: ICC]), and ED (Pediatric Anesthesia Emergence Delirium scale) were analyzed in each group., Results:  Eighty-one percent of patients in the PPIA + MDZ preparation group presented a perfect compliance during the induction of anesthesia (ICC = 0), less preoperative anxiety (mean score m-YPAS = 26), less probability of ED (odds ratio: 10, 5 [3-37.5]; p  < 0.05), and less ED intensity compared with the NADA group (1.2 vs. 5.8; p  = 0.001)., Conclusion:  PPIA associated with midazolam premedication improves compliance during induction and decreases the incidence and intensity of ED., Competing Interests: None declared., (Thieme. All rights reserved.)

Ejaculate quality can be regarded as multifactorial, with nutrition being a factor that could directly influence sperm parameters. The present study aimed to evaluate seminal quality associated with seasonal fat-soluble vitamin supplementation of boars. Seven sexually mature boars were randomly allotted to one of the three groups, and fed one of the three supplementary diets for 32 weeks: (1) control treatment (COD), without supplementation of fat-soluble vitamins, (2) treatment containing 100% fat-soluble vitamin supplementation administered intramuscularly, which was based on fat soluble vitamin supplementation (A, D3, E) (FVD1), and (3) treatment containing 50% of fat-soluble vitamin supplementation (FVD 1 2 ). Semen was collected at 7-day intervals. Semen samples were analyzed to assess several sperm parameters using the Computer-Assisted Semen Analysis (CASA) ISAS ® v1 system. Results showed that groups receiving FVD1 and FVD 1 2 supplementation had an increased semen volume. The percentages of motile and progressively motile sperm were increased by FVD1 treatment. A statistically significant interaction between treatment and season was found in the percentage of motility and progressive motility ( p < 0.05). Sperm concentrations showed significant differences ( p < 0.05) between treatments. Velocity variables (VSL, VCL, and VAP) were higher ( p < 0.05) in boars that received fat-soluble vitamin supplementation in comparison to controls receiving no supplementation. The FVD1 treatment presented spermatozoa with greater head size and more elongated heads ( p < 0.05). Overall, the utilization of dietary fat-soluble vitamin supplementation significantly improved the semen quality of boar ejaculates. This highlights the importance of fat-soluble vitamin supplementation in sexually active boars., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Calderón-Calderón, Sevilla, Roldan, Barquero and Valverde.)

Combined treatments against SARS-CoV-2 are emerging and some have taken into account the post-COVID-19 fibrosis. The aim of this survey was to report the experience of treating COVID-19 patients with pirfenidone, nitazoxanide (NTZ) and colchicine. It was a case series report of COVID-19 patients treated from December 2020 to March 2021, in a rural health center located in the State of Mexico, Mexico. 23 patients were included (mean age 44.5 ± 17.1 years), 12 women (mean age 45.9 ± 17.9 years) and 11 men (mean age 43 ± 16.9 years) with four deaths (17.39%). The evolution time was of 17.3 ± 6.7 days being the main symptoms fever (82.6%), myalgia (69.6%) and cough (65.2%). The main comorbidities were overweight/obesity 18 (78.26%), type 2 diabetes mellitus (T2DM) 4 (17.39%), Chronic obstructive pulmonary disease (COPD) 5 (21.73%) and systemic hypertension 2 (8.69%). Two patients were intubated and both died; in these cases, they refused to take NTZ until after three days the medical doctor had prescribed it for the first time. It can be concluded that implementing a mixed treatment with pirfenidone, NTZ and colchicine could improve the survival rate in ambulatory patients of low socioeconomic status.

The surface of Tecoflex SG-80A Polyurethane (PU) films was modified by grafting polyethylene glycol (PEG) chains at three different molar amounts (0.05, 0.10, and 0.15 mmol). The resulting substrata were characterized by FTIR-ATR, TGA, AFM, SEM and contact angle to assess the surface modifications occurred during the grafting reactions. Osteoblasts and fibroblasts were cultured with PU extracts for 24 h, and their cell viability and morphology were evaluated by CellTiterBlue assay, Crystal Violet staining and Live/Dead assay. FTIR and TGA results indicated that PEG chains were successfully grafted onto PU surfaces, specifically in the hard segment of PU forming allophanate groups as the PEG grafting density increased. SEM and AFM images suggest that PU substrata were partially covered by PEG, increasing the dispersive and basic components of the PU surface energy. It was found that extracts from PEG-grafted polyurethanes increased the osteoblast viability, although fibroblasts viability remained constant regardless PEG grafting density; in spite of this both cells presented a more spread morphology at the lower PEG grafting density. Our results showed that surface energy of PU substrata can be tuned by PEG grafting density; also, the PEG leached tends to increase the pH of culture medium which leads to a higher viability of osteoblasts; nevertheless, PEG grafting density should be optimized to promote a healthy cell morphology as alterations in its morphology were detected at higher concentrations. Graphical abstract., (© 2022. The Author(s).)

Objective: To assess whether bacillus Calmette-Guérin (BCG) responsiveness after initiation of an adequate BCG treatment (at least five of six instillations of induction and at least two of three instillations of maintenance) impacts oncological outcomes in patients with carcinoma in situ (CIS) of the bladder treated with BCG immunotherapy., Patients and Methods: Data were available for 193 patients with bladder CIS with or without associated cTa/cT1 disease who received an adequate BCG treatment between 2008 and 2015. Bladder biopsies were taken at 6 months and patients were then stratified as either BCG responsive (negative biopsies) or BCG unresponsive (positive biopsies). Inverse probability weighting (IPW)-adjusted Kaplan-Meier and IPW-adjusted Cox regression were performed to compare progression-free survival (PFS), radical cystectomy-free survival (RCFS), overall survival OS, and cancer-specific survival (CSS) in the two groups., Results and Limitations: Comparing the BCG-responsive and BCG-unresponsive groups, IPW-adjusted Kaplan-Meier analysis revealed, respectively, a median (interquartile range) of PFS of 9 (5-15) vs 48.5 (28-77) months (P = 0.001), a RCFS of 11 (9-15) vs 49 (24-76) months (P < 0.001), and a CSS of 25 (13-60) vs 109 (78-307) months (P = 0.004). On IPW-adjusted Cox regression analysis, BCG-unresponsive patients had a worse PFS (hazard ratio [HR] 3.40, 95% confidence interval [CI] 1.59-7.27), RCFS (HR 3.52, 95% CI 1.77-7), and CSS (HR 4.42, 95% CI 1.95-10.01). We found no significant differences for OS., Conclusion: Using an IPW method we found that lack of response after initiation of an adequate BCG treatment has prognostic implications beyond identification of complete response in patients with CIS. BCG-unresponsive patients, satisfying the novel definition of BCG unresponsive, showed a poor PFS, RCFS, and CSS. In this setting, the patients should be counselled regarding RC as a first option or enrolled in a clinical trial if they refuse RC or are unfit for surgery., (© 2021 The Authors BJU International © 2021 BJU International.)

Background: The COVID-19 pandemic increased the incidence of neuropsychiatric diseases. Proactive models of consultation-liaison psychiatry (CLP-p) could play a key role in the prevention and management of these diseases in a general hospital., Aim: To develop a protocol for implementing screening tools for neuropsychiatric symptoms in routine clinical practice., Material and Methods: Elements of the Plan-Do-Study-Act (PDSA) model were used to modify the Neuropsychiatric Surveillance protocol implemented at a clinical hospital during the COVID-19 pandemic by members of the hospital's CLP team., Results: A flowchart for active follow-up of neuropsychiatric symptoms during hospitalization is presented, with sequential management and referral flows, accompanied by suggestions for pre-discharge evaluation to define continuity of care actions. The COSMOS tool is also presented, designed for the detection of risk factors and actions for the prevention of neuropsychiatric diseases in general hospitals., Conclusions: The neuropsychiatric surveillance protocol facilitates early and timely interventions and establishes criteria for the continuity of post-discharge care. These changes could improve the quality of care in general hospitals and reduce the gap between mental and physical health.

The properties of biological-chemical chitosan (BCh) films from marine-industrial waste and a non-conventional Ramon starch (RS) ( Brosimum alicastrum ) were investigated. Blended films of BCh/RS were prepared to a volume ratio of 4:1 and 1:4, named (BChRS-80+q, biological-chemical chitosan 80% v / v and Ramon starch, BChRS-20+q, biological-chemical chitosan 20% v / v and Ramon starch, both with quercetin), Films from commercial chitosan (CCh) and corn starch (CS), alone or blended (CChCS-80+q, commercial chitosan 80% v / v and corn starch, CChCS-20+q commercial chitosan 20% v / v and corn starch, both with quercetin) were also prepared for comparison purposes. Films were investigated for their physicochemical characteristics such as thickness, moisture, swelling, water-vapor permeability, and water solubility. In addition, their mechanical and structural properties were studied using Fourier Transform Infrared Spectroscopy (FTIR), Thermogravimetric analysis (TGA) and Scanning Electron Microscopy (SEM) techniques. Antioxidant activity was evaluated as radical scavenging, and antimicrobial effect was also determined. The BCh and RS films presented similar tensile strength values compared with commercial biopolymers. Only films with chitosan presented antioxidant and antimicrobial activity. The FTIR spectra confirmed the interactions between functional groups of the biopolymers. Although, BChRS-80+q and BChRS-20+q films exhibited poor mechanical performance compared to their commercial counterparts, they showed good thermal stability, and improved antioxidant and antimicrobial activity in the presence of quercetin. BChRS-80+q and BChRS-20+q films have promising applications due to their biological activity and mechanical properties, based on a novel material that has been underutilized (Ramon starch) that does not compete with materials for human feeding and may be used as a coating for food products.

In the present work, LaNi 0.5 Ti 0.5 O 3 and La 2 NiTiO 6 nanoparticles were synthesized by the modified Pechini method. LaNi 0.5 Ti 0.5 O 3 was calcined at 1073 K for 17 h or 100 h, while La 2 NiTiO 6 was calcined at 1273 K for 135 h. The double perovskite calcined at 1073 K for 17 h presented orthorhombic symmetry with Pbnm space group, mean particle size was 31.9 ± 1 nm, random ordering of Ni 2+ and Ti 4+ cations, Néel temperature close to 15 K, and magnetic moment of 1.29 μB. By increasing the calcination time, this material showed the same symmetry and space group, a mean particle size of 50.7 ± 2 nm, short-range ordering of Ni 2+ and Ti 4+ cations, Néel temperature around 12 K, and magnetic moment of 0.96 μB. La 2 NiTiO 6 presented a monoclinic crystal structure, with P 2 1 / n space group, mean particle size of 80.0 ± 5 nm, rock salt ordering of Ni 2+ and Ti 4+ , Néel temperature of approximately 23 K, and magnetic moment of 2.75 μB.

Aortic pathology is always a challenge for the clinician, and must be diagnosed and treated by a multidisciplinary team due to the technical and technological complexity of the resources used. Ongoing efforts to implement a systematic, protocolized approach involving "Aortic teams" made up of cardiologists, cardiac surgeons, vascular surgeons, anaesthesiologists and radiologists, among others are now leading to improved outcomes. The aim of this consensus document drawn up by the Aortic working groups of the Spanish Society of Anaesthesiology, Resuscitation and Pain Therapy (SEDAR) and the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) is to disseminate a set of working protocols. The latest consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) define the concept of "AORTIC TEAM"(1). The aortic team should be closely involved from diagnosis to treatment and finally follow-up, and should be formed of cardiac and vascular surgeons working together with anaesthesiologists, cardiologists, radiologists and geneticists. Treatment of aortic pathologies should be centralised in large centres, because this is the only way to effectively understand the natural course of the disease, provide the entire range of treatment options under one umbrella and treat potential complications. A streamlined emergent care pathway (24/7 availability), adequate transportation and transfer capabilities, as well as rapid activation of the multidisciplinary team must be available. In light of the complexity and constant evolution of therapeutic options, we present this first version of the Anaesthesiology and surgical guidelines for surgery of the ascending aorta and aortic arch. Some questions will no doubt remain unanswered, and future versions will include new techniques that, though implemented in some centres, are still not widely recommended., (Copyright © 2021 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Neuropsychiatric symptoms can be part of the clinical spectrum of COVID-19 infections., Aim: To devise an evidence based clinical algorithm as a guide for clinicians, to identify and treat underlying clinical syndromes of psychomotor agitation, such as delirium, catatonia or substance withdrawal in patients who are hospitalized and infected with SARS-CoV-2., Material and Methods: A review of the literature about the pharmacological management of neuropsychiatric manifestations of COVID-19 at the general hospital, to develop a clinical protocol based on a consensus from an interdisciplinary expert panel at a Clinical Hospital., Results: A consensual clinical algorithm for the management of delirium, catatonia, and substance withdrawal, manifested as psychomotor agitation in patients hospitalized with COVID-19, was developed as a clinical proposal for physicians at different levels of complexity in health services., Conclusions: Cooperation among different clinical units in the general hospital facilitated the implementation of a clinical algorithm for clinicians for the management of psychomotor agitation in COVID-19 patients.

Background: Anaplastic thyroid carcinoma is a rare, rapidly progressive, and highly aggressive tumor. It has a global annual incidence of 1-2 per million people. It mostly affects older adults and women. The median survival duration after diagnosis does not exceed 6-8 months., Case Presentation: A 60-year-old female patient of mixed race (Honduran) presented to the local medical service with dysphonia that had started approximately 2 months earlier, accompanied by orthopnea that had started 1 month earlier. On physical examination, a soft mass was palpated within the anterior neck region; it was approximately 4 cm in diameter, painless, and mobile on swallowing, and had irregular margins. Ultrasound and computed tomography of the neck were performed. Subsequently, fine needle aspiration biopsy was performed. The histological diagnosis was anaplastic thyroid carcinoma (stage IVB). She underwent total thyroidectomy and chemotherapy. She is currently in her fifth year of remission after diagnosis and remains under oncologic surveillance., Discussion: Anaplastic thyroid carcinoma demonstrates a lethal behavior. Approximately 18% survive for more than a year after diagnosis, and 0-10% survive for 5 years. Different pretherapeutic prognostic factors may affect survival, including age < 70 years, the absence of distant metastases, and complete local resection., Conclusion: Conventional treatment improves the quality of life of the patient, but the results are not encouraging for the medium and long term. Only a few patients manage to exceed the average life expectancy of 3-6 months, despite undergoing the currently available therapeutic regimen., (© 2022. The Author(s).)

Objective: Some attempts have previously been made to stratify patients with CIS for the purpose of risk-adapted clinical management and clinical trial design. In particular, two classification systems have been proposed: clinical classification, comprising primary (P-CIS), concomitant (C-CIS), and secondary (S-CIS) disease, and pathological classification, comprising P-CIS, cTa-CIS, and cT1-CIS. The aim of the present study was to assess the impact of both classifications on BCG response, recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS)., Patients and Methods: We performed a retrospective analysis of 386 patients with bladder CIS, with or without associated cTa/cT1 disease, treated with BCG instillations between 2008 and 2015. Patients were stratified according to the two classification systems. Cox multivariate regression models were used to assess the impact of these subtypes on BCG response, RFS, PFS, OS, and CSS. We also performed a cumulative meta-analysis according to PRISMA guidelines., Results: The median follow-up was 70.5 months. According to the clinical classification, 34 (8.8%) patients had P-CIS, 81 (21%) S-CIS, and 271 (70.2%) C-CIS. The pathological classification showed 34 (8.8%) patients to have P-CIS, 190 (49.2%) cTa-CIS, and 162 (42%) cT1-CIS. In the overall cohort, BCG response was reported in 296 (76.7%); 159 (41.2%) had recurrence, 55 (14.2%) had progression, and 67 (17.4%) underwent radical cystectomy. Death from any cause was recorded in 135 (35%) and death from urothelial carcinoma in 38 (9.9%). Cox multivariate regression analysis showed that neither clinical classification nor pathological classification is an independent predictive factor for BCG response, RFS, PFS, OS, or CSS after adjusting for confounders. In the pooled meta-analysis, two studies and the present series were included for evidence synthesis, recruiting a total of 941 patients. We found no statistically significant difference across the groups for both classifications with respect to BCG response, RFS, PFS, and CSS., Conclusions: Currently, the supporting evidence for an impact of clinical classification and pathological classification on oncological outcomes of CIS of the bladder is insufficient to justify their use to guide clinical management or follow-up., (Copyright © 2021. Published by Elsevier Inc.)

The term cholestasis refers to bile acid retention, whether within the hepatocyte or in the bile ducts of any caliber. Biochemically, it is defined by a level of alkaline phosphatase that is 1.67-times higher than the upper limit of normal. Cholestatic diseases can be associated with an inflammatory process of the liver that destroys hepatocytes (hepatitis), withjaundice (yellowing of the skin and mucus membranes, associated with elevated serum bilirubin levels), or with both, albeit the three concepts should not be considered synonymous. Cholestatic diseases can be classified as intrahepatic or extrahepatic, depending on their etiology. Knowing the cause of the condition is important for choosing the adequate diagnostic studies and appropriate treatment in each case. A complete medical history, together with a thorough physical examination and basic initial studies, such as liver ultrasound and liver function tests, aid the clinician in deciding which path to follow, when managing the patient with cholestasis. In a joint effort, the Asociación Mexicana de Hepatología (AMH), the Asociación Mexicana de Gastroenterología (AMG) and the Asociación Mexicana de Endoscopia Gastrointestinal (AMEG) developed the first Mexican scientific position statement on said theme., (Copyright © 2021. Published by Masson Doyma México S.A.)

Currently, myocardial injury has been reported in patients hospitalized with coronavirus disease 2019 (COVID-19). The studies also show a correlation between cardiac events and severe forms of the disease. COVID-19 begins with an early infection phase in which the virus infiltrates the lung parenchyma and proliferates. It then progresses to the pulmonary phase, where the initial inflammatory process, characterized by vasodilation, vascular permeability, and leukocyte recruitment, leads to lung damage, hypoxemia, and cardiovascular stress. The renin angiotensin aldosterone system is important in the pathophysiology of severe acute respiratory syndrome coronavirus 2 infection and in the propagation of systemic inflammation. Within this system, the pathway mediated by angiotensin-converting enzyme 2 (ACE2) produces vasodilation, cardioprotection, anti-oxidation, and anti-inflammation. Furthermore, the free form of ECA2 prevents binding of the virus to host cells and reduces its damage to the lung.

A biocomposite system was developed and tested for the removal of the azo dye Reactive Red (RR195) from wastewater. The biocomposite was synthesized using ceramic particles containing 75% alumina which were coated using chitosan cross-linked with oxalic acid. The biocomposite showed high performance at low pH (maximum adsorption capacity = 345.3mg.g -1 at pH=2.0). The physicochemical and structure characteristics of the matrix were evaluated by Z-potential, FTIR-ATR, SEM-EDS, XRD, and porosity. Langmuir sorption isotherm and pseudosecond-order model gave the best fit. The electrostatic interaction between RR195 (due to the sulfonate groups) and the free amino groups of chitosan, enabled successive desorption/regeneration cycles. The maximum removal percentage (>80%) occurred at pH=2.0 due to the cross-linking effect. Experiments at different temperatures allowed the calculation of thermodynamic parameters (ΔG, ΔS, ΔH); adsorption was spontaneous, exothermic, and enthalpy controlled. The presence of inorganic ions ([Formula: see text] ) was analyzed during the adsorption process. This novel biocomposite can be applied as a cost-effective and environmentally friendly adsorbent for anionic azo dye removal from wastewater. The application of chitosan cross-linked with oxalic acid as a coating of the ceramic support enhanced the adsorption capacity and enabled its use under acidic conditions without solubilization., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Obesity promotes cellular immunometabolism changes that trigger the activation of macrophages and lymphocytes, leading to systemic inflammation. Activated leukocytes undergo metabolic reprogramming, increasing glycolytic activity., Objective: To examine whether the reduction in the inflammatory state associated with bariatric surgery is associated with decreased glycolytic activity in leukocytes. Setting Single-center, prospective observational study., Methods: This study involved 18 patients with obesity undergoing bariatric surgery. All measurements were performed preoperatively and six months postoperatively. Peripheral blood mononuclear cells and plasma were obtained to determine the glycolytic rate and mitochondrial membrane potential as surrogates of the metabolic switching and high-sensitivity C-reactive protein, adipokines, and CD69 expression as inflammatory and activation markers., Results: Glycolytic activity engaged by CD3/CD28 activation was reduced six months after bariatric surgery, associated with decreased levels of T helper (Th) 1 and Th17 signature cytokines. An overall reduction in inflammatory markers was observed, which correlated with a higher adiponectin/leptin ratio., Conclusions: Metabolic and bariatric surgery-induced weight loss leads to reprogramming in T cells' metabolic machinery, resulting in reduced stimulation of glycolysis after activation, which may explain the decrease in systemic inflammation mediated by cytokines such as interferon-γ and interleukin-17A., (© 2021. Italian Society of Endocrinology (SIE).)