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The objectives of this study were to evaluate parental confidence and attitudes towards immunization in urban Guatemala between private versus public health systems and their impact on vaccination timeliness in their children. A cross-sectional survey was conducted in parents 6–18-month-old children who attended well-child outpatient clinics from two health systems (public employee-based insurance and private health care) in Guatemala City from November 2017 through August 2018. Parental demographics, household characteristics, food insecurity, vaccine hesitancy using the WHO SAGE Vaccine Hesitancy Scale, and information on parental use of social media platforms and vaccine information sources were collected. Five hundred-three parents were surveyed, most of them mothers. Only 9 parents reported they had previously refused a vaccine for their child: 8 (3.2 %) from private clinics and 1 (0.4 %) from the public clinic (p = 0.02). Significantly more children attending private clinics (226, 90.4 %) were shown to have a delay in any of their vaccines scheduled for the first 2 years of life compared to those in the public clinic (169, 66.8 %; p < 0.01). Children of parents having a college degree (84.5 vs 70.1 %; p < 0.001), earning more than US$ 1,000 per month (81.5 vs 70.7 %; p < 0.001), and having a computer at home (81.4 vs 70.2; p = 0.007) were more likely to have any delays in the scheduled vaccines. Parents seeking care at private clinics were 1.14 times more at risk of delaying a vaccine compared to those at the public clinic, adjusted for other covariates (p = 0.03, 95 % CI: 1.01, 1.28). In Guatemala, children receiving immunizations at private clinics were significantly more likely than those attending public clinics to be delayed in their immunization schedule and to remain more days without the recommended protection, especially for third doses of the primary vaccine series. [ABSTRACT FROM AUTHOR]

[Display omitted] The histamine H 3 receptor (H 3 R) is a neurotransmitter receptor that is primarily found in the brain, where it controls the release and synthesis of histamine, as well as the release of other neurotransmitters (e.g. dopamine, serotonin). Notably, 20 H 3 R isoforms are differentially expressed in the human brain as a consequence of alternative gene splicing. The hH 3 R-445, -415, -365 and -329 isoforms contain the prototypical GPCR (7TM) structure, yet exhibit deletions in the third intracellular loop, a structural domain that is pivotal for G protein-coupling, signaling and regulation. To date, the physiological relevance underlying the individual and combinatorial function of hH 3 R isoforms remains poorly understood. Nevertheless, given their significant implication in physiological processes (e.g. cognition, homeostasis) and neurological disorders (e.g. Alzheimer's and Parkinson's disease, schizophrenia), widespread targeting of hH 3 R isoforms by drugs may lead to on-target side effects in brain regions that are unaffected by disease. To this end, isoform- and/or pathway-selective targeting of hH 3 R isoforms by biased agonists could be of therapeutic relevance for the development of region- and disease-specific drugs. Hence, we have evaluated ligand biased signaling at the hH 3 R-445, -415, -365 and -329 isoforms across various Gα i/o -mediated (i.e. [35S]GTPγS accumulation, cAMP inhibition, pERK1/2 activation, pAKT T308/S473 activation) and non Gα i/o -mediated (i.e. β-arrestin2 recruitment) endpoints that are relevant to neurological diseases. Our findings indicate that H 3 R agonists display significantly altered patterns in their degree of ligand bias, in a pathway- and isoform-dependent manner, underlining the significance to investigate GPCRs with multiple isoforms to improve development of selective drugs. Neuropharmacology. [ABSTRACT FROM AUTHOR]

• CdTe-based solar cell with Sb 2 S 3 HTL has been modeled by SCAPS-1D. • PV Performances of CdTe solar cells without and with HTL are investigated. • Recombination loss at back side is reduced by adding Sb 2 S 3 HTL into CdTe solar cell. • Enhanced efficiency of proposed CdTe solar cell with HTL is obtained to be 28.41%. In this work, we design a novel cadmium telluride (CdTe)-based solar structure with antimony sulfide (Sb 2 S 3) as hole transport layer (HTL). One Dimensional Solar Cell Capacitance Simulator (SCAPS-1D) program is used to perform comparison studies on the photovoltaic performances between the standard thin-film cadmium sulfide (CdS)/CdTe solar cell and the proposed Al/FTO/CdS/CdTe/Sb 2 S 3 /Ni heterojunction structure. The solar cell outputs such as open-circuit voltage (V oc), short-circuit current density (J sc), fill-factor (FF), and efficiency have been evaluated by varying impacts of thickness, electron affinity, carrier concentration, and bulk defect density of different layers. In addition, we have analyzed the effect of interface defects at both CdS/CdTe and CdTe/Sb 2 S 3 interfaces. This study reveals that the introduction of Sb 2 S 3 as HTL improves the V oc appreciably by creating appropriate band alignment with the CdTe absorber and thus remarkably enhance the efficiency of solar cell by lowering carrier recombination at back contact surface. Moreover, the impacts of working temperature, back contact metal work function, and surface recombination velocity are elucidated. The absorber thickness is optimized to be 1.0 µm with doping concentration of 2.1 × 1015 cm−3. Best efficiency of 28.41% together with other parameters such as V oc of 1.15 V, J sc of 28.74 mA/cm2, and FF of 86.03% is achieved for the optimized device. These results lead to suggest that the Sb 2 S 3 as HTL can be employed to fabricate highly efficient and inexpensive thin-film CdTe heterojunction solar devices. [ABSTRACT FROM AUTHOR]

Paragangliomas of the spine are extremely rare, and they should be considered in the differential diagnosis of spinal tumors due to its overlapping clinical and radiological features with many spinal tumors. In this article, we present a 30-year-old lady who presented with low back pain and radicular neuropathic pain at L1 dermatome which was intractable to medical surgery. Her magnetic resonance imaging (MRI) of the lumbosacral spine revealed a T1 isointense, T2 heterogeneously hyperintense intradural extramedullary lesion at the conus medullaris with strong homogenous enhancement on contrast administration. The lesion was surgically excised completely with L1 laminectomy, and the histopathological picture was suggestive of paraganglioma. The patient's complaints resolved fully postoperatively, and there was no evidence of recurrence on long-term follow-up. Due to the absence of pathognomonic clinical or radiological features of paragangliomas, they should be taken into consideration in the differential diagnosis of spinal tumors. They share similar clinical and radiological features of schwannomas, ependymomas, and hemangioblastomas. The diagnosis is usually made postoperatively based on histopathological examination. • Paragangliomas overlap the clinical and radiological features with other tumors. • Diagnosis is made postoperatively based on histopathological examination. • It should be considered in the differential diagnosis of spinal tumors. [ABSTRACT FROM AUTHOR]

Intraoperative neurophysiological monitoring (IONM) has improved the diagnosis and surgical treatment of brainstem and posterior fossa tumors. Several modalities are available for IONM such as electroencephalography, brainstem mapping (BSM), cranial nerves evoked potentials), somatosensory evoked potentials (SEP), motor evoked potentials (MEP), brainstem auditory evoked potentials (BAEPs), nerve conduction, and electromyography (EMG) signals. Though motor evoked potential (MEP) and brainstem mapping are the most common IONM modalities used for surgical management of brainstem gliomas, cranial nerve potentials can also be of great help. This article describes a 10-year-old child with diffuse intrinsic pontine glioma (DIPG) who presented with gradual progressive crossed hemiparesis. His brain images carried a range of potential differential diagnoses. Her underwent a successful brainstem biopsy via using motor evoked potential for facial nerve without injuring nearby structures. Motor evoked potential of the facial nerve can be used solely for biopsy taking in cases of DIPG. • IONM has improved the diagnosis and surgical treatment of brainstem and posterior fossa tumors. • MEP and brainstem mapping are the most common IONM modalities used for surgical management of brainstem gliomas, cranial nerve potentials. • Motor evoked potential of the facial nerve can be used solely for biopsy taking in cases of diffuse intrinsic pontine glioma (DIPG). [ABSTRACT FROM AUTHOR]

Surgical approach of aortoiliac occlusive disease (AOD) with aorto-bi-femoral graft or endarterectomy, has been the first line treatment with patency rates up to 90%. Nevertheless, this procedure has an early mortality rate of 4%. Vascular complications of aorto-bi-femoral graft have an average incidence of 5–10% and development of incisional hernia in 10% of the cases. The Covered Endovascular Reconstruction of Aortic Bifurcation or CERAB technique, as a new approach is shaping up to be a promising approach. However, there are few studies in Latin America and the Caribbean. Retrospective multicenter study. All patients treated with the CERAB technique between February 2015 and June 2021 in three hospitals. A total of 9 patients (5 male and 4 female) were treated with the CERAB technique. Only one patient died. Of the total number of patients, 41.2% had a TASC II - C classification, and 58.8% had a TASC II - D classification. Complications included dissection in only 2 patients, massive bleeding in 1 patient and hematoma in 3 patients. The average number of days in critical care was 1.2 days and 2.6 in hospitalization. Two patients required endovascular reintervention. Primary patency was present in 66.7% of the patients. The CERAB technique presents a low morbidity and mortality with an 88.9% of technical success rate. None of our patients needed Chimney CERAB procedure. Our results are similar to those reported in the literature, where they report primary patency rates between 82% and 97%. • CERAB technique for TASC II C and D patients is safe and feasible. • CERAB technique is an alternative for open surgery in Latin America. • CERAB technique has primary patency rates between 82% and 97%. [ABSTRACT FROM AUTHOR]

Congenital hernias occur 70% on the right side, 25% on the left side, and approximately 5% bilaterally. The finding of a congenital Amyand's hernia is of interest, especially in patients who do not present risk factors associated with connective tissue disorders, ascitic conditions, fetal developmental disorders or any condition that increases abdominal pressure. Male patient, 6 months old, was brought to the pediatric surgery department due to a visible mass in the bilateral inguinal region, which protruded with crying. The parents report that he was a 36-week preterm, low birth weight, monochorionic monoamniotic twin with bilateral congenital inguinal hernia. An open herniorrhaphy was performed, showing a left communicating hydrocele with an indirect left inguinal hernia and right communicating hydrocele with indirect inguinal hernia containing cecal appendix with no signs of inflammation. The most common clinical presentation is the presence of a reducible or irreducible mass, erythema and/or inguino-scrotal edema, irritability manifested by crying and recurrent pain in older infants. This condition may be associated with cryptorchidism, intrauterine structural developmental disorder, and the presence of fistulas. Appendectomy and traditional hernia reduction are the most common surgical approach. The evolution of this condition is favorable with extremely low complication rates. Amyand's hernia in the neonate is a rare presenting condition, which frequently involves nearby structures with risk of inflammation, incarceration and perforation, so repair should be performed early. • Currently there are controversies in the approach of congenital inguinal hernias. • The overall outcome in the management of congenital hernia is favorable. • Traditional hernia management for congenital Amyand's hernia has good results. [ABSTRACT FROM AUTHOR]

The Potter sequence is defined as a series of congenital defects related to severe oligohydramnios, associated with polycystic kidney disease, bilateral renal agenesis, pulmonary hypoplasia, obstructive uropathy and premature rupture of membrane, which compromises the life of the neonate sometime after birth. Within the evidence published so far, which is very little, no perforation of the gastrointestinal tract has been reported as a complication of this condition. Male neonate born preterm with prenatal diagnosis of pulmonary hypoplasia, polycystic renal dysplasia and severe oligohydramnios (Potter sequence), presented acute respiratory distress syndrome 10 min after birth, requiring mechanical ventilation and admission to the intensive care unit. During her stay in intensive care, he developed abdominal distension and presence of biliary content in the nasogastric tube. An abdominal X-ray was performed and showed signs of pneumoperitoneum, evidencing gastric perforation on exploratory laparotomy. Gastric perforation in neonates is a condition that causes high health costs, morbidity, high risk of mortality and disability, regardless of the cause. The management of gastric perforation in Potter syndrome, as well as any other complication, represents a challenge due to the prognosis of these patients. Renal failure and acute respiratory distress syndrome are disorders that compromise the function of various structures and organs such as the heart and brain. Gastric perforation is a possible complication of the Potter sequence or syndrome. In addition, there is no literature describing the benefits or disadvantages of specific surgical techniques in the resolution of perforation. • Spontaneous perinatal gastric perforation is a complication of Potter's syndrome. • Pathophysiological mechanism of gastric perforation in these cases is unknown. • There is a lack of evidence on the management of potter's syndrome. [ABSTRACT FROM AUTHOR]

In the present work, antimony selenide (Sb 2 Se 3)-based solar cell with a back surface field (BSF) layer has been designed and studied. The purpose of this research is to improve the performance of the Sb 2 Se 3 -based solar cell by introducing low-cost and widely available barium silicide (BaSi 2) material as the BSF layer into the basic Sb 2 Se 3 -based heterojunction solar structure. A comparative study on the performance of the conventional Sb 2 Se 3 solar cell structure consisting of Al/FTO/CdS/Sb 2 Se 3 /Mo and the proposed structure of Al/FTO/CdS/Sb 2 Se 3 /BaSi 2 /Mo is made. The photovoltaic parameters such as open circuit voltage, short-circuit current density, fill-factor, power conversion efficiency, and quantum efficiency of heterojunction structures are analyzed intensively by using the Solar Cell Capacitance Simulator in One Dimension (SCAPS-1D) program. To optimize the device, the thickness of Sb 2 Se 3 absorber layer is varied from 0.1 to 2 μm. In addition, the effects of acceptor ion and bulk defect densities in Sb 2 Se 3 absorber layer, interface defect density of buffer/absorber and absorber/BSF, back surface recombination velocity, operating temperature, and cell resistances on the overall performances are investigated. The thicknesses of BaSi 2 BSF and Sb 2 Se 3 absorber layers are optimized to be 0.3 μm and 1 μm, respectively. The efficiency of the proposed solar structure with a thin 1 μm Sb 2 Se 3 absorber layer is obtained to be 29.35%. The simulation results lead to suggest that the BaSi 2 material as a BSF layer would be effective to fabricate low cost and high-efficient Sb 2 Se 3 -based thin-film solar cells. • Numerical study of Sb 2 Se 3 -based solar cell with a BaSi 2 BSF layer has been performed by SCAPS-1D simulator. • A comparative study on performances between conventional and proposed Sb 2 Se 3 solar cells is made. • Significant improvement of solar cell characteristics has been achieved by introducing BaSi 2 BSF layer at back contact in conventional Sb 2 Se 3 solar cells. • Carrier recombination loss can be reduced at back contact surface of heterojunction solar structure with BSF layer. • Conversion efficiency of proposed Sb 2 Se 3 solar cell is increased from 23.99 to 29.35%. [ABSTRACT FROM AUTHOR]

• A novel heterojunction Al/FTO/WS 2 /Cu 2 Te/Ni solar cell has been designed. • Comparison of outputs between Cu 2 Te solar cells with CdS and WS 2 buffers is provided. • Cd-free WS 2 buffer with Cu 2 Te absorber enhances PV outputs by reducing carrier recombination. • Improved efficiency of 24.23 % with V oc of 0.68 V, J sc of 42.95 mA/cm2, and FF of 82.77 % is evaluated. In this work, the Cd-free tungsten disulfide (WS 2) material as the buffer layer is proposed in the copper telluride (Cu 2 Te)-based heterojunction solar structure. The Cu 2 Te thin-film photovoltaic organization of Ni/Cu 2 Te/CdS or WS 2 /SnO 2 :F(FTO)/Al has been designed and evaluated numerically by using the One Dimensional Solar Cell Capacitance Simulator. The WS 2 buffer layer provides a significant improvement in the output parameters of the Cu 2 Te solar device compared to the cell with the CdS buffer. A high efficiency of 24.23% with V oc of 0.68 V, J sc of 42.95 mA/cm2, and FF of 82.77% is obtained for the designed Cu 2 Te-based solar cell with WS 2 buffer. The 'spike-like' band structure formed at Cu 2 Te/WS 2 interface plays an important function in the enhancement of the outputs by minimizing carrier recombination. The thicknesses of 0.05 μm for buffer and 1.0 μm for absorber are optimized by considering the low fabrication cost. Moreover, the photovoltaic parameters of the Cu 2 Te solar cell are evaluated by varying the doping concentration, bulk and interface defects, operative temperature, rear contact work function, and cell resistances. The data outcomes imply that the anticipated Cu 2 Te-based photovoltaic device with a non-toxic WS 2 buffer can be an efficient substitute to the toxic CdS for cost-effective and stable thin-film solar devices. [ABSTRACT FROM AUTHOR]