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Background: Cardiac amyloidosis (CA), following a non-invasive diagnosis, constitutes an increasingly prevalent heart failure (HF) etiology. This study aims to determine which echocardiography findings help to diagnose cardiac amyloidosis in patients with left ventricular hypertrophy (LVH) admitted for decompensated HF. M ethods: The present study is a retrospective observational study on a cohort of 85 LVH patients admitted for HF decompensation, in which 99m Tc-DPD scanning was performed to rule out transthyretin CA. The echocardiographic findings obtained were compared between CA and non-CA groups. Results: From a total number of 85 patients, 49 (57.6%) met the CA criteria and 36 (42.3%) were ruled out for the disease. Interventricular septum thickness (16 ± 3 mm vs. 14 ± 3 mm), left ventricular posterior wall thickness (14 ± 3 mm vs. 11 ± 2 mm), left ventricular mass (259 ± 76 g vs. 224 ± 53 g), left ventricular telediastolic diameter (48 ± 7 mm vs. 53 ± 6 mm), left ventricular telediastolic indexed volume (51 ± 18 cm 3 /m 2 vs. 59 ± 16 cm 3 /m 2 ), tricuspid annular plane systolic excursion (16 ± 5 mm vs. 20 ± 4 mm), right atrial area (27.4 ± 8.4 cm 2 vs. 22.2 ± 5.7 cm 2 ) and strain relative apical sparing (2.2 ± 0.9 vs. 1.03 ± 0.4; p = 0.04) were significantly associated with the diagnosis of CA. Conclusions: In patients with LVH admitted for HF decompensation, there are several echocardiographic features (LVH, reduced left ventricular cavity size, strain relative apical sparing, right atrial dilation, and altered right ventricular function) that are associated with the diagnosis of cardiac amyloidosis.

Resumen Introduccion La terapia electroconvulsiva es un procedimiento efectivo y seguro, el cual se indica principalmente a pacientes con episodios depresivos tanto unipolares como bipolares, mania y esquizofrenia, cuando no responden a otros tratamientos. Objetivo Describir las propiedades demograficas, sociales y clinicas de un grupo de pacientes tratados con terapia electroconvulsiva con anestesia y relajacion (TECAR) en la Clinica Universidad de La Sabana por un periodo de 8 anos. Metodos Se revisan las bases de datos y los registros de los procedimientos desde el 1 de enero de 2009 hasta el 31 de diciembre de 2017. Se realiza un analisis con estadistica descriptiva. Resultados En este periodo se realizaron 1.322 procedimientos a 143 pacientes, el 54,5% de ellos mujeres, y con diagnostico asociado de depresion mayor en el 57% de los pacientes. El numero de tratamientos por persona fue 9,2 y en el 3,8% se presentaron complicaciones, sin que se requiriese tratamiento invasivo en ninguna de ellas. Conclusiones La terapia electroconvulsiva se aplica con seguridad a los pacientes y con parametros diversos en cuanto a edad, sexo y diagnostico mas frecuente, en comparacion con otros paises de Latinoamerica y el mundo. Es importante sumar esfuerzos en investigacion que permitan tener un panorama mas completo de las caracteristicas de su aplicacion en el pais.

El cancer papilar de tiroides es el tipo de neoplasia mas frecuente de la glandula tiroides. Su principal via de diseminacion es la via linfatica, en concreto a los ganglios del cuello. Pese a que su incidencia se encuentra en un progresivo incremento, es considerado un tipo de tumor de buen pronostico, tanto por su bajo porcentaje de recurrencia como por su supervivencia. Sin embargo, no todas las cuestiones en relacion a su diagnostico y tratamiento estan resueltas. Por un lado nos encontramos con un alto porcentaje de adenopatias subclinicas no diagnosticadas en el estudio preoperatorio y que van a influir en dicho pronostico. Por otro lado no existe consenso sobre si se debe realizar o no la diseccion profilactica del compartimento cervical central a la hora de plantear la estrategia quirurgica, especialmente en los tumores pequenos. La biopsia selectiva del ganglio centinela (BSGC), pese a estar validado en el cancer de mama y el melanoma, no lo esta en el cancer papilar de tiroides. En nuestro estudio la hipotesis de trabajo se basa en obtener su validacion en este tipo de cancer de tiroides, lo que permitira su aplicacion clinica. De este modo proponemos que puede ayudar a resolver las cuestiones discrepantes anteriormente expuestas. Segun nuestros resultados conseguimos una detectabilidad del 96% con un porcentaje de falsos negativos del 7,5%, pudiendo considerar la tecnica validada. Ademas nos indica correctamente en el 92,5% de los casos cuando debemos realizar la diseccion ganglionar del cuello, limitandola solo a aquellas disecciones con finalidad terapeutica, evitando la profilactica y por tanto disminuyendo la morbilidad que este tipo de diseccion implica. Este hecho permite estadificar correctamente a cada paciente y por tanto estratificar el riesgo de recurrencia de forma ajustada, hecho que influye en la indicacion y dosificacion del tratamiento ablativo con 131I tras el tratamiento quirurgico.

Bariatric surgery (BS) is effective in improving chronic joint pain (CJP). However, the long-term effects on this comorbidity are poorly understood.To determine the prevalence of CJP in a sample of patients who had undergone BS with a minimum follow-up of 18 months. To determine whether or not there was any relationship between CJP and clinical or psychological outcomes after BS.Cross-sectional study. The Lattinen index (LI) was used to evaluate CJP, using the cut-off point of 10 to define significant CJP (SCJP).Of the 110 subjects assessed, 31.2% (35/110) had SCJP. The patients with SCJP were older (57.4±13 vs 47.8±11.6 years; p0.0001) and more time had elapsed since their BS (105.6±54.3 vs 78.5±39 months; p=0.023). The last BMI was higher in subjects with SCJP (35±5 vs 33.3±6.9kg/mSCJP is highly prevalent in patients who have had BS once they reach the weight plateau phase. There is an association between having SCJP and worse psychological and functional status, with potential detrimental metabolic effects.

Objective To assess concordance among criteria for inactive disease (ID) and low disease activity (LDA) in juvenile idiopathic arthritis (JIA) and to seek factors driving discordance. Methods The frequency of fulfillment of existing criteria was evaluated in information on 10,186 patients extracted from 3 cross-sectional data sets. Patients were divided up according to the functional phenotypes of oligoarthritis and polyarthritis. Concordance between criteria was examined using weighted Venn diagrams. The role of each individual component in explaining discordance between criteria was assessed by calculating the absolute number and percentage of instances in which the component was responsible for discrepancy between definitions. Results Criteria for ID were met by 28.6–41.1% of patients with oligoarthritis and by 24.0–33.4% of patients with polyarthritis. Criteria for LDA were met by 44.8–62.4% of patients with oligoarthritis and by 44.6–50.4% of patients with polyarthritis. There was a 57.9–62.3% overlap between criteria for ID and a 67.9–85% overlap between criteria for LDA. Parent and physician global assessments and acute-phase reactants were responsible for the majority of instances of discordance among criteria for ID (8.7–15.5%, 10.0–12.3%, and 10.8–17.3%, respectively). Conclusion We found fair concordance between criteria for ID and LDA in JIA, with the main drivers of discordance for ID being physician and parent global assessments and acute-phase reactants. This observation highlights the need for further studies aimed to evaluate the impact of subjective physician and parent perception of disease remission and of laboratory measures of inflammatory activity on the definition of ID.

From the first report of the respiratory disease caused by SARS-Cov-2 towards the end of 2019, in Wuhan, China, to June 8, 2020, 6,931,000 people had been affected in the world, and 113,619 in Mexico, where there is a lack of literature describing the tomographic behavior of this disease throughout its evolution and its correlation with patient clinical data.To identify, describe and classify the manifestations detected on chest computed tomography images of patients with pneumonia caused by SARS-CoV-2.Hospitalized patients with RT-PCR-confirmed SARS-CoV-2 infection and who underwent a plain chest tomography were included.The most common tomographic patterns were ground glass opacity, consolidation, cobblestone pattern and mixed pattern, with peripheral and subpleural distribution and bilateral involvement in up to 95 %. Subpleural bands that distorted the architecture were identified in up to 62 % of patients, with an average of seven days of evolution. The most common extrapulmonary finding was an increase in pulmonary artery transverse axis.Knowing the behavior of this type of pneumonia allows becoming familiarized with the characteristic tomographic patterns, in order to aid timely detection and treatment.Desde el primer reporte de la enfermedad respiratoria causada por SARS-Cov-2 a finales de 2019, en Wuhan, China, hasta el 8 de junio de 2020, habían sido afectadas 6 931 000 personas en el mundo y 113 619 en México, donde se carece de informes que describan el comportamiento tomográfico de esta enfermedad a lo largo de su evolución y su correlación con los datos clínicos del paciente.Identificar, describir y clasificar las manifestaciones en las imágenes de tomografía de tórax de pacientes con neumonía causada por SARS-CoV-2.Se incluyeron pacientes hospitalizados con infección por SARS-CoV-2 confirmada mediante PCR-TR y en quienes se realizó tomografía simple de tórax.Los patrones tomográficos más comunes fueron opacidad de vidrio despulido, consolidación, empedrado y patrón mixto, con distribución periférica, subpleural y afectación bilateral hasta en 95 %. Se identificaron bandas subpleurales que distorsionaban la arquitectura hasta en 62 % de los pacientes, con un promedio de siete días de evolución. El aumento del eje transverso de la arteria pulmonar constituyó el hallazgo extrapulmonar más frecuente.Conocer el comportamiento de este tipo de neumonía permite la familiarización con los patrones tomográficos característicos, con el fin de coadyuvar a la detección y tratamiento oportunos.

Resumen Introduccion El uso de activador tisular del plasminogeno (rt-PA) a dosis bajas fue propuesto inicialmente en paises asiaticos en atencion a particularidades raciales relacionadas con la funcionalidad del fibrinogeno y factores de coagulacion que contribuyen al riesgo de hemorragias intracerebrales, asi como a la intencion de ahorrar costos. Ante la controversia sobre el uso de rt-PA por debajo de la dosis estandar, realizamos una revision de la literatura sobre los estudios que motivaron su uso y aquellos dirigidos a comparar diferentes dosis de rt-PA. Desarrollo Se revisaron 198 resumenes relacionados con los terminos de busqueda. Se revisaron 52 publicaciones de texto completo de los ultimos 30 anos. Se incluyeron 13 ensayos clinicos aleatorizados dirigidos a determinar la eficacia y seguridad del uso de rt-PA a diferentes dosis en el ictus agudo, 14 estudios de cohorte observacionales, 5 metaanalisis y 3 revisiones sistematicas. Conclusiones No se cuenta con evidencia suficiente para catalogar la dosis baja de alteplase como superior o al menos no inferior que el tratamiento estandar en el manejo del ictus agudo en poblacion occidental. Se requieren mas ensayos clinicos para determinar, si el uso de dosis bajas es beneficioso en pacientes con contraindicaciones relativas de terapia trombolitica u otras circunstancias particulares que eleven el riesgo de hemorragias intracerebrales.

Background Aortic aneurysm and dissection are important causes of morbimortality in patients with Marfan syndrome (MFS) and other connective tissue diseases that affect the cardiovascular tissues. Timely intervention through different surgical techniques improves the prognosis. Both sparing and replacement-type interventions of the aortic valve are used, but selection depends on the condition of the patient at the time of diagnosis, the patient's emergency condition, surgeon preference and hospital resources. Previous meta-analyses have suggested an advantage with the use of sparing-type interventions, but this finding must be updated and extended to patients with other connective tissue disorders. The objetive of this study is to evaluate the outcomes of valve-sparing root replacement versus aortic root replacement procedures in patients with MFS and similar connective tissue diseases that present with aortic aneurysm or dissection. Methods A systematic review of cohort studies that evaluated sparing-type (preserving, remodeling, reimplantation, Yacoub, David or Florida Sleeve) or replacement-type (repair, Bentall, Button-Bentall, composite valve graft or Cabrol) procedures in patients with Marfan, Loeys-Dietz, Beals-Hecht or Ehlers-Danlos syndromes was done. Studies were retrieved from the SCOPUS, MEDLINE, CINAHL, EMBASE and LILACS electronic databases up to January 2020 without language restrictions. Only studies that directly compared sparing- versus replacement-type procedures were included in the meta-analysis. Results A total of 33 studies (n=1,807 subjects) reported sparing-type surgical interventions and 26 studies (n=2,218 subjects) reported replacement-type surgical interventions. Pooled rates of endocarditis, thromboembolism and aneurysm were higher in replacement-type surgical intervention studies. Sixteen studies were included in the meta-analysis. Sparing-type interventions were associated with a reduced risk of endocarditis (RR =0.13, 95% CI: 0.03-0.61); however, replacement-type interventions favored freedom from valve reoperation (RR =2.39, 95% CI: 1.24-4.60). All studies were at low risk of bias. Conclusions The choice of the best surgical technique is dependent on the type of disease (MFS or other connective tissue diseases) as well as the accompanying aortic and cardiovascular damage, since these key factors are heterogeneous. Although the results of this meta-analysis tend to show some advantages for one type of surgical intervention over the other and viceversa, the surgeon can only make the best decision during the surgical act.

Background Irritant contact dermatitis (ICD) is caused by the acute locally toxic effect of a strong irritant, or the cumulative exposure to various weaker physical and/or chemical irritants. Objectives To describe characteristics of patients with ICD in the population patch tested in the European Surveillance System on Contact Allergies (ESSCA; www.essca-dc.org) database. Methods Data collected by the ESSCA in consecutively patch tested patients from January 2009 to December 2018 were analyzed. Results Of the 68 072 patients, 8702 patients were diagnosed with ICD (without concomitant allergic contact dermatitis [ACD]). Hand and face were the most reported anatomical sites, and 45.7% of the ICD was occupational ICD (OICD). The highest proportions of OICD were found in metal turners, bakers, pastry-cooks and confectionery makers. Among patients diagnosed with ICD, 45% were found sensitized with no relevance for the current disease. Conclusions The hands were mainly involved in OICD also in the subgroup of contact dermatitis patients, in whom relevant contact sensitization had been ruled out, emphasizing the need for limiting irritant exposures. However, in difficult to treat contact dermatitis, unrecognized contact allergy, or unrecognized clinical relevance of identified allergies owing to incomplete or wrong product ingredient information must always be considered. This article is protected by copyright. All rights reserved.

There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up.A multidisciplinary consensus following the Delphi methodology.Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients.This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.

Hydroxychloroquine is an antimalarial drug with immunomodulatory, anti-inflammatory, antibacterial, and antiviral properties. It has a good safety profile, can be used in children and in pregnant and breastfeeding women, and does not suppress the immune system. Regular screening for retinopathy, one of the drug's most feared adverse effects, is necessary. Hydroxychloroquine is a widely used, essential drug in dermatology. Clinical response rates are good in lupus erythematous, where it is a first-line therapy, as well in numerous autoimmune/inflammatory diseases, including lichen planus, polymorphic light eruption, porphyria cutanea tarda, granuloma annulare, and sarcoidosis. In 2020, it was widely prescribed both to prevent and to treat COVID-19 caused by SARS-CoV-2. Its increased use led to serious supply shortages and in some cases stocks were entirely depleted. Recent meta-analyses have concluded that hydroxychloroquine is ineffective against COVID-19 and have advised against its use.

Germinal center B-cell-like diffuse large B cell lymphoma (GCB-DLBCL) at diagnosis is associated with superior long-term outcomes compared to non-GCB-DLBCL in patients treated with conventional chemo-immunotherapy. Whether cell of origin (COO) by Hans algorithm retains its prognostic significance in patients with (R/R) relapsed/refractory DLBCL undergoing autologous hematopoietic cell transplant (auto-HCT) is not well established. Three hundred and fifty-seven patients underwent auto-HCT between 2005 and 2018. The COO status was determined in 284 patients and these were included in the analysis. One hundred ninety-four patients had GCB-DLBCL while 90 had non-GCB-DLBCL. Median follow up was 1.7 (0-13) years. The GCB-DLBCL was associated with inferior 5-year overall survival at 44% (95%CI, 36-52) versus 64% (95%CI, 54-77) (P = .004) and a higher relapse incidence at 67% (95%CI, 58-74) versus 49% (95%CI, 35-60) (P = .01) in the non-GCB-DLBCL. The difference between GCB and non-GCB-DLBCL remained statistically significant in multivariate analysis. Additionally, response at the time of transplant was an independent prognostic factor. GCB-DLBCL was enriched in double-hit and triple hit phenotype based on available fluorescence in situ hybridization data. These results suggest an enrichment of high-risk genetic rearrangements in R/R GCB-DLBCL resulting in limited efficacy of auto-HCT.

Resumen Antecedentes y objetivos Uno de los potenciales efectos negativos de un confinamiento son los cambios en los patrones dieteticos y de estilo de vida, que pueden conllevar a una ganancia de peso. El objetivo fue ver los cambios sobre los habitos higienico-dieteticos y de patrones de ingesta en una situacion de confinamiento y el impacto sobre el peso. Asimismo, ver si el estar bajo tratamiento con analogos de GLP1 (aGLP1) modifico estos parametros. Material y metodos Se recluto, de forma consecutiva, a 100 pacientes con sobrepeso/obesidad que acudieron a revision al finalizar el confinamiento. Se diseno una entrevista estructurada para ver los cambios en los habitos dieteticos, rutinas y ejercicio. Resultados El 52% de los pacientes ganaron peso durante el confinamiento. El porcentaje de sujetos con historia activa de depresion o ansiedad fue superior entre el grupo de pacientes que gano peso. El porcentaje de pacientes que empeoraron su hiperfagia ansiosa fue superior en aquellos que ganaron peso (71,2% vs. 10,6%; p Conclusiones Un confinamiento es un periodo vulnerable para ganar peso, especialmente en aquellos pacientes con antecedentes psicopatologicos. Los aGLP1 consiguen controlar la ingesta emocional convirtiendolos en una opcion terapeutica valiosa.

Background Enhanced Recovery After Surgery (ERAS) protocols have been successfully instituted for pancreaticoduodenectomy (PD). This study evaluates reasons patients fail to meet length of stay (LOS) and areas for pathway improvement. Materials and Methods A multidisciplinary team developed and implemented an ERAS protocol for open PD in 2017. The study includes a medical record review of all patients who were perioperatively managed with the ERAS protocol and failed to meet LOS after PD procedures. Target LOS was defined as 7 d. Results From 2017 to 2020, 44% (93 of 213) of patients using ERAS protocol after PD procedures failed to meet target LOS. The most common reason to fail target LOS was ileus or delayed gastric emptying (47 of 93, LOS 11). Additional reasons included work-up of leukocytosis or pancreatic leak (17 of 93, LOS 14), additional “night” of observation (14 of 93, LOS 8), and orthostatic hypotension (3 of 93, LOS 10). Of these additional 46 patients, 19 patients underwent computed tomography (on or after POD 7) and only four patients received additional inpatient intervention. Conclusions The most common reason for PD pathway failure included slow return of gastrointestinal function, a known complication after PD. The remaining patients were often kept for observation without additional intervention. This group represents an actionable cohort to target for improving LOS through surgeon awareness rather than protocol modification.

This article reports the case of a 28-year-old female 31.6 weeks pregnant with twins diagnosed with SARS-CoV-2 infection, who delivered a boy and a girl. The newborns underwent RT-PCR testing for SARS-CoV-2; the male tested negative and the female newborn tested positive, in that the female placenta was SARS-CoV-2 positive and the male placenta negative. Clinical and laboratory findings evincing vertical transmission of SARS-CoV-2 were identified. Strict, multidisciplinary prenatal care is recommended for this group of patients. This case report alone does not provide statistical evidence of vertical transmission, but it is an account of a relevant matter.

Key Points Ofatumumab with glucocorticoid therapy for cGVHD resulted in 62.5% ORR at 6 months and 53% FFS at 12 months.Safety was observed with ofatumumab plus glucocorticoid for initial therapy., Visual Abstract, Standard initial therapy of chronic graft vs. host disease (cGVHD) with glucocorticoids results in suboptimal response. Safety and feasibility of therapy with ofatumumab (1000 mg IV on days 0 and 14) and prednisone (1 mg/kg/day) was previously established in our phase I trial (n = 12). We now report the mature results of the phase II expansion of the trial (n = 38). The overall NIH severity of cGVHD was moderate (63%) or severe (37%) with 74% of all patients affected by the overlap subtype of cGVHD and 82% by prior acute cGVHD. The observed 6 month clinician-reported and 2014 NIH-defined overall response rates (ORR = complete + partial response [CR/PR]) of 62.5% (1-sided lower 90% confidence interval=51.5%) were not superior to pre-specified historic benchmark of 60%. Post-hoc comparison of 6 month NIH response suggested benefit compared to more contemporaneous NIH-based benchmark of 48.6% with frontline sirolimus/prednisone (CTN 0801 trial). Baseline cGVHD features (organ involvement, severity, initial immune suppression agents) were not significantly associated with 6-month ORR. The median time to initiation of second-line therapy was 5.4 months (range 0.9-15.1 months). Failure-free survival (FFS) was 64.2% (95% CI 46.5-77.4%) at 6 months and 53.1% (95% CI 35.8-67.7%) at 12 months, whereas FFS with CR/PR at 12 months of 33.5% exceeded a benchmark of 15% in post-hoc analysis, and was associated with greater success in steroid discontinuation by 24 months (odds ratio 8 (95% CI 1.21-52.7). This single-arm phase II trial demonstrated acceptable safety and potential efficacy of the upfront use of ofatumumab in combination with prednisone in cGVHD. This trial was registered at www.clinicaltrials.gov as #NCT01680965.

Burns represent a major public health problem worldwide, accounting for thousands of deaths annually (World Health Organization). When dealing with large burns we tend to have limited resources when covering up the wound areas because of lack of skin; at that point is where other technologies come into play. Cultured Epidermal Autograft (CEA) and Autologous Spray Cell Suspension (ASCS) are both useful autologous technologies that we use to help patients with limited donor sites. However, we have not identified any published cases where both products are used in the same burn. In this case report we present the methods of treatment and outcomes for 2 cases that were treated with both CEA and ASCS.

This work presents a novel and promising approach to the clinical management of acute stroke. Using machine learning techniques, our research has succeeded in developing accurate diagnosis and prediction real-time models from hemodynamic data. These models are able to diagnose stroke subtype with 30 min of monitoring, to predict the exitus during the first 3 h of monitoring, and to predict the stroke recurrence in just 15 min of monitoring. Patients with difficult access to a CT scan and all patients that arrive at the stroke unit of a specialized hospital will benefit from these positive results. The results obtained from the real-time developed models are the following: stroke diagnosis around 98% precision (97.8% sensitivity, 99.5% specificity), exitus prediction with 99.8% precision (99.8% Sens., 99.9% Spec.), and 98% precision predicting stroke recurrence (98% Sens., 99% Spec.). Graphical abstract depicting the complete process since a patient is monitored until the data collected is used to generate models.

Introduction Maternal mortality is a potentially preventable public health issue. Maternal morbidity is increasingly of interest to aid the reduction of maternal mortality. Obstetric patients admitted to the intensive care unit (ICU) are an important part of the global burden of maternal morbidity. Social determinants influence health outcomes of pregnant women. Additionally, intimate partner violence has a great negative impact on women9s health and pregnancy outcome. However, little is known about the contextual and social aspects of obstetric patients treated in the ICU. This study aimed to conduct a systematic review of the social determinants and exposure to intimate partner violence of obstetric patients admitted to an ICU. Methods and analysis A systematic search will be conducted in MEDLINE, CINAHL, ProQuest, LILACS and SciELO from 2000 to 2016. Studies published in English and Spanish will be identified in relation to data reporting on social determinants of health and/or exposure to intimate partner violence of obstetric women, treated in the ICU during pregnancy, childbirth or within 42 days of the end of pregnancy. Two reviewers will independently screen for study eligibility and data extraction. Risk of bias and assessment of the quality of the included studies will be performed by using the Critical Appraisal Skills Programme (CASP) checklist. Data will be analysed and summarised using a narrative description of the available evidence across studies. This systematic review protocol will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. Ethics and dissemination Since this systematic review will be based on published studies, ethical approval is not required. Findings will be presented at La Trobe University, in Conferences and Congresses, and published in a peer-reviewed journal. Trial registration number CRD42016037492.

ispartof: INTENSIVE CARE MEDICINE vol:47 issue:3 pages:344-348 ispartof: location:United States status: published

The 2020 guidelines of the European Society of Cardiology (ESC) recommend a novel ESC 0/2h-algorithm as the preferred alternative to the ESC 0/1h-algorithm in the early triage for rule-out and/or rule-in of Non-ST-segment-elevation myocardial infarction (NSTEMI). The aim was to prospectively validate the performance of the ESC 0/2h-algorithm using the high-sensitivity cardiac troponin I (hs-cTnI) assay (ARCHITECT) in an international, multicenter diagnostic study enrolling patients presenting with acute chest discomfort to the emergency department.

Psoriatic arthritis is a chronic systemic inflammatory disease that affects the skin, musculoskeletal structures and other organs and systems compromising functionality, quality of life and reducing the life expectancy of patients. It is a complex disease that requires specialist and timely care and management. The alternatives for treating the manifestations of psoriatic arthritis have increased and the effect of the different agents on specific manifestations has been clarified in recent studies. Therefore, we should incorporate the available evidence to build a strategy for the treatment of these patients. The Mexican College of Rheumatology selected a committee to evaluate these different alternatives and make recommendations. Methods The study group included 16 rheumatologists and 3 certified dermatologists, selected from different health institutions and regions of the country. An executive committee was formed to coordinate the meetings and a committee of experts selected the literature search criteria, prepared the research questions, rated the quality of the evidence, and produced the recommendations in the different disease domains based on the GRADE methodology. Results 24 updated recommendations were generated for the treatment of patients with psoriatic arthritis. The recommendations establish the role of the drugs currently available in our country. The importance of adequate disease control is emphasized, individualizing the level of involvement of each patient in each of the six domains potentially affected by the disease. In addition, the sequence in the choice of treatments available for each domain is established, based on their efficacy, safety profile and accessibility. Conclusions With this consensus document, it will be possible to improve the care of patients with psoriatic arthritis. The recommendations were generated based on the best available information and in consideration of the Mexican health system.

The purpose of this study was to predict dietary supplements (DS) use among Defense Health Agency (DHA) and Veterans Affairs (VA) beneficiaries who were scheduled for surgical procedures.This was a predictive descriptive multicenter study with a convenience sample of 2,623 adult subjects. After institutional review board exemption, data collection occurred preoperatively via electronic survey. Participation was voluntary and data unidentifiable.Data were collected in preoperative anesthesia clinics during preanesthetic evaluations, or in surgery holding areas immediately prior to surgery, using a validated data collection tool. The total convenience sample size was 2,623 subjects from 6 medical centers. Data were voluntarily, anonymously, and verbally obtained from subjects using electronic survey methodology. Collected data included: gender, age, rank, beneficiary status, race, body mass index, tobacco use, marital status, and knowledge of DS side effects and drug interactions. For predictive modeling of DS use, multiple logistic regression was performed for binary outcomes via SPSS.For binary logistic regression the predictors were significant for the following outcomes: taking DS (education, sex, age, and race; P.05), knowledge of side effects (age, race, and rank; P.05), and believe they are having side effects (age; P.05).Understanding DS use is central to predict and anticipate potential negative sequelae in patient outcomes in anesthesia. College education, females, Caucasians, and increasing age are indicators for greater DS use. These results provide opportunities for perianesthesia nurses to improve preoperative assessments, design patient specific perianesthesia care, and enhance patient education. Further research is recommended.

Background and aims The clinical spectrum of the SARS-CoV-2 infection is very broad, ranging from asymptomatic infection to severe pneumonia. However, the majority of fatalities related to COVID-19 have involved old, frail and patients with comorbidities, such as obesity, groups that also have high rates of a poor nutritional status. To assess the impact on clinical outcomes of the coexistence of any degree of obesity and low albumin levels on admission among patients with COVID-19. Methods This is a sub-analysis of a former study where 75 patients admitted due to COVID-19 were evaluated cross-sectionally. In this analysis, patients were divided in two groups, according to the presence of obesity and albumin levels on admission lower than 3.5 g/dl. Results 11 out 75 patients evaluated (14.7%) had obesity and albumin levels lower than 3.5 g/dl. Patients with obesity and hypoalbuminemia were older than patients without these two conditions (65.3 ± 7.7 vs 54.2 ± 17 years; p = 0.01). CRP (141.4 ± 47.9 vs 70.1 ± 60.6 mg/l; p = 0.002), D-dimer (2677.3 ± 2358.3 vs 521.7 ± 480.3 ng/ml; p = 0.001), fibrinogen (765.9 ± 123.9 vs 613.5 ± 158gr/L; p = 0.007) ferritin levels (903.1 ± 493 vs 531.4 ± 418.9 mcg/l; p = 0.01) and procalcitonin (3.5 ± 0.6 vs 1.1 ± 0.7 ng/ml; p = 0.009) were significantly higher in the group with obesity and hypoalbuminemia. Among patients with low albumin and obesity, length of hospital was higher (21.9 ± 18.7 vs 10.5 ± 9.5 days; p = 0.004) and the proportion of subjects admitted to ICU was greater (81.8% vs 11.5%; p

Introduction International travelers have grown significantly over last years, as well as imported diseases from tropical areas. Information in pediatric population is scarce. We describe demographic and clinical characteristics of febrile children coming from the tropics. Methods Retrospective review of patients under 18 years old, presenting at a tertiary hospital and surrounding primary health care centers between July 2002 and July 2018 with a stay in a tropical region during the previous year. Patients were selected from microbiological charts of thick smears for malaria or dengue serologies. Results 188 patients were studied: 52.7% were born in Spain with a median age of 3.0 years old (IQR 1.5–8.0). Main regions of stay were Sub-Saharan Africa (54.8%) and Latin America (29.8%), mostly for visiting their friends and relatives (56.3%), followed by recent arrival migrants (32.4%). Only 34% of travelers attended pre-travel consultation. More than 80% of these febrile children attended directly the Emergency Room. The most frequent diagnoses were febrile syndrome without source (56.4%), respiratory condition (15.4%) and acute diarrhea (11.7%). Around a half (52.1%) were managed as outpatients, but 46.2% were hospitalized and 7.4% were admitted to Intensive Care Unit. No specific diagnosis was achieved in 24% of cases. However, 29.7% were diagnosed with malaria. Conclusion Children with fever coming from tropical areas were at risk of severe infectious diseases. Malaria was diagnosed in one out of four and 7% required admission in PICU. This information emphasizes the need of reinforcing training about tropical diseases among first line physicians.

In this paper a modified printed dipole is proposed for mobile terminals operating in the first band of Personal Communication System (PCS) that is ranging from 800 to 900 MHz. One of the most important features of this kind of antenna is its wide bandwidth as required in the mentioned band. The modified design of the proposed antenna allows the user to move in any direction as is usual in mobile communications. The results of this article include an analytical design, simulations that have been performed numerically using a Finite Element Method (FEM) computational tool, structure optimization in order to maximize the antenna bandwidth and experimental measurements with the aim of spatial evaluating of electromagnetic radiated fields.

Resumen Objetivo Evaluar los factores asociados a morbilidad materna y perinatal en gestantes con edad materna avanzada (EMA), atendidas en el Instituto Nacional Materno Perinatal de Peru durante el periodo de enero a diciembre 2018. Materiales y metodos Estudio observacional de corte transversal, realizado en el Instituto Nacional Materno Perinatal de Peru durante el ano 2018. Los criterios de inclusion fueron gestantes de 35 a mas anos de edad que culminaron en parto vaginal o cesarea. Las variables estudiadas fueron factores sociodemograficos, obstetricos y perinatales. Se uso el metodo de regresion logistica multivariada y analisis de curvas ROC. Resultados Participaron 325 gestantes, con edad media 38,01 ± 2,66 anos. Estado civil conviviente 70,8%; control prenatal inadecuado 47,7%; sobrepeso pregestacional 38,6%; primiparas 11,7% y grandes multiparas 18,5%. Periodo intergenesico largo 62,8% y corto 15,4%. El 56,3% presento cesarea y el 28% desgarro vaginal I°. Aplicando regresion logistica el IMC ≥ 25 kg/m2 presento un odds ratio (OR) de 1,02 para preeclampsia severa; OR: 2,35 para desgarro vaginal I°; y OR: 2,91 para macrosomia fetal. Control prenatal inadecuado representa OR: 1,31 para parto pretermino y un OR: 1,48 para preeclampsia severa. Antecedente de preeclampsia previa OR: 3,03 para parto pretermino y OR: 10,90 para preeclampsia severa. Curva ROC para el desarrollo de preeclampsia severa fue 69,74%; complicaciones en parto vaginal 85,44% y macrosomia fetal 72,78%. Conclusiones Sobrepeso pregestacional en EMA estan asociados a desarrollar preeclampsia severa, desgarro vaginal y macrosomia fetal y la preeclampsia previa, esta fuertemente asociada al desarrollo de parto pretermino y preeclampsia severa; las cuales deberian indagarse a detalle durante la atencion prenatal.

This paper reflects upon the mechanisms that enable development of curricular approaches to multidisciplinary architecture/engineering higher education. Building upon recent calls for integrated multidisciplinary building design practice, academics at UCL, industry partners and respective professional bodies embarked upon developing a new course that challenged disciplinary boundaries and defined the needs of a new design professional. Whilst there have been attempts internationally to better integrate architecture as well as engineering education, efforts have largely been focused on bolt-on solutions based on pre-existing education programmes. In addition, there has been little discussion (empirical or theoretical) on practical measures associated with developing multidisciplinary education in the built environment. Drawing on mixed data including documentary evidence, semi structured interviews and observations, the study begins to shed light on the approaches underpinning the development of a multidisciplinary built environment MEng course at UCL that integrates architecture, building services and civil engineering. The paper’s contribution is threefold. First, the findings have implications for developing multidisciplinary built environment education curricula, through revealing key mechanisms including the need for shared attitudes and expectations. Second, the paper highlights the conditions that enable the negotiation of multidisciplinary curricula including institutional support, shared values and a collective need and willingness to explore new solutions. Third, the paper reflects upon the value of design studio learning as a critical integrative component to the delivery of multidisciplinary education in the built environment and STEM more widely.

PurposeThe aim is to enable debates about the need for changes in the restaurant's management posture regarding food waste.Design/methodology/approachThis study is a teaching case about a restaurant and was prepared based on information collected from the authors' experiences in teaching, consulting, and academic research. The plot, company name, and characters are fictitious.FindingsThe results are related to the classroom application to promote discussion and knowledge of topics such as finance, costs, sustainability, food waste, and the Demonstration of Results for the Exercise.Research limitations/implicationsThe main limitation is that it is a fictitious study, but it allows applied research based on the authors' scientific knowledge and professional practice.Practical implicationsThe theme contributes to anchoring decision-making by managers in the face of day-to-day business challenges. Furthermore, in a contemporary perspective, it involves a small establishment concerning the possibilities of contributing to the Sustainable Development Goals (SDGs). Furthermore, due to the richness of details, the case constitutes an intriguing teaching tool to be applied in the classroom.Social implicationsIt impacts social actions, according to the examples found in the narrative used in the teaching case.Originality/valueIts originality is related to its interdisciplinarity and how it involves the themes of finance and sustainability applied in business practice.

BACKGROUND More than 20 million inguinal hernia repair (IHR) procedures are performed worldwide every year. The critical view of the myopectineal orifice (CV of the MPO) is a stepwise guide to the achievement and standardization of minimally invasive IHR (MI IHR). We propose a scoring system as an objective method for fulfillment of the CV of the MPO. METHODS The scoring system was employed for evaluation of the transabdominal preperitoneal (TAPP) technique in 15 video-recorded procedures. Two variants of the score were used: the simple CV of the MPO score (s-CVMPO score) and the extended CV of the MPO score (e-CVMPO score). The inter-rater agreement and internal consistency for both scores and the correlation between the two scores were assessed. RESULTS Inter-rater agreement with respect to satisfactory/unsatisfactory achievement of the CV of the MPO was high for both the s-CVMPO and e-CVMPO scores (κ = 1, p

Background We aimed to derive and validate a 0/2 h-algorithm using the new high-sensitivity cardiac troponin I (hs-cTnI)-VITROS assay (VITROS® Immunodiagnostic Products hs-Troponin I Reagent Pack, Ortho Clinical Diagnostics) for rapid rule-out/in of non-ST-segment elevation myocardial infarction (NSTEMI). Methods The final diagnosis was centrally adjudicated by 2 independent cardiologists according to the fourth universal definition of myocardial infarction (MI) among 1888 patients presenting to the emergency department with acute chest pain. hs-cTnI-VITROS concentrations were measured at presentation and at 2 h in a blinded fashion. The optimal assay-specific thresholds for the hs-cTnI-VITROS 0/2 h-algorithm were derived in a randomly selected 70% of the cohort and validated in the remaining 30%. Results NSTEMI was the final diagnosis in 216/1322 (16.3%) patients of the derivation cohort. Rule-out was defined as baseline hs-cTnI concentrations of 3 h or a baseline hs-cTnI concentration of Conclusion hs-cTnI-VITROS concentrations at presentation combined with absolute changes within the first 2 h allowed safe rule-out and accurate rule-in of NSTEMI in two-thirds of unselected patients presenting with acute chest pain to the emergency department. Trial registration www.clinicaltrials.gov: NCT0047058

Cuban immigrants constitute an important group in both the United States and Spain, with different behaviors toward organ donation having been described among the different Latin American nationalities. We analyzed the attitude toward organ donation among the Cuban populations in Cuba, Spain, and Florida. The study population was Cuban immigrants over 15 years of age residing in Cuba, Spain, and Florida, with samples randomly stratified by age and sex. A validated questionnaire on psychosocial aspects of organ donation (PCID-DTO Rios) was used. Census was used as the sampling base in all 3 countries; however, additionally, in Spain and the United States (Florida), we sought the support of immigration support associations to determine the Cuban population without legal documentation. The questionnaire was completed anonymously and self-administered. The completion rate of the study was 74% (4123/5574) among 424 surveyed in Spain, 1224 in Florida, and 2475 in Cuba. The attitude in favor of donating their own organs upon death was 60.6% of those surveyed in Spain, 37.6% in Florida, and 68.9% in Cuba, or 58% of the global sample. Multivariate analysis showed that country of residence was an independent factor associated with attitude toward organ donation (odds ratio, 1.929). Other factors associated with attitude were sex, educational level, performance of prosocial activities, knowledge of the brain death concept, religion, the couple's opinion toward donation, fear of mutilation after donation, and attitude toward manipulation of the body after death. The attitude toward organ donation among Cubans in their country of origin and immigrants in Spain was similar, being significantly different from those who emigrate to Florida, where the attitude is much less favorable.

The mechanism of vertical transmission of Trypanosoma cruzi is poorly understood. In this study, we evaluated the role of IgG subclasses in the congenital transmission of Chagas disease. We conducted a case-control study in a public maternity hospital in Santa Cruz, Bolivia, enrolling women at delivery. Thirty women who transmitted T. cruzi to their newborns (cases), and 51 women who did not (controls) were randomly selected from 676 total seropositive women. Trypanosoma cruzi–specific IgG1, IgG2, and IgG3 levels were measured by in-house ELISA. The IgG4 levels were unmeasurable as a result of low levels in all participants. Quantitative polymerase chain reaction results and demographic factors were also analyzed. One-unit increases in normalized absorbance ratio of IgG1 or IgG2 levels increased the odds of congenital T. cruzi transmission in Chagas-seropositive women by 2.0 (95% CI: 1.1–3.6) and 2.27 (95% CI: 0.9–5.7), adjusted for age and previous blood transfusion. Odds of congenital transmission were 7.0 times higher in parasitemic mothers (95% CI: 2.3–21.3, P < 0.01) compared with nonparasitemic mothers. We observed that all mothers with IgG1 ≥ 4 were transmitters (sensitivity = 20%, specificity = 100%). Additionally, no mothers with IgG2 < 1.13 were transmitters (sensitivity = 100%, specificity = 21.6%). We demonstrated that IgG subclasses and parasite presence in blood are associated with vertical transmission of T. cruzi and could identify women at increased risk for congenital transmission by measuring IgG subclasses. These measures have potential as objective screening tests to predict the congenital transmission of Chagas.

Diversity is a key driver of scientific innovation, yet fields in science, technology, engineering, and mathematics (STEM) have struggled to retain diverse communities. Research suggests that fostering a sense of belonging is critical for retaining diversity. We propose an iterative process that aims to improve sense of belonging among laboratory (lab) members through self-reflection and community collective action.

Background Systemic sclerosis (scleroderma; SSc) is a rare autoimmune connective tissue disease. We completed an initial feasibility trial of an online self-administered version of the Scleroderma Patient-centered Intervention Network Self-Management (SPIN-SELF) Program using the cohort multiple randomized controlled trial (RCT) design. Due to low intervention offer uptake, we will conduct a new feasibility trial with progression to full-scale trial, using a two-arm parallel, partially nested RCT design. The SPIN-SELF Program has also been revised to include facilitator-led videoconference group sessions in addition to online material. We will test the group-based intervention delivery format, then evaluate the effect of the SPIN-SELF Program on disease management self-efficacy (primary) and patient activation, social appearance anxiety, and functional health outcomes (secondary). Methods This study is a feasibility trial with progression to full-scale RCT, pending meeting pre-defined criteria, of the SPIN-SELF Program. Participants will be recruited from the ongoing SPIN Cohort (http://www.spinsclero.com/en/cohort) and via social media and partner patient organizations. Eligible participants must have SSc and low to moderate disease management self-efficacy (Self-Efficacy for Managing Chronic Disease (SEMCD) Scale score ≤ 7.0). Participants will be randomized (1:1 allocation) to the group-based SPIN-SELF Program or usual care for 3 months. The primary outcome in the full-scale trial will be disease management self-efficacy based on SEMCD Scale scores at 3 months post-randomization. Secondary outcomes include SEMCD scores 6 months post-randomization plus patient activation, social appearance anxiety, and functional health outcomes at 3 and 6 months post-randomization. We will include 40 participants to assess feasibility. At the end of the feasibility portion, stoppage criteria will be used to determine if the trial procedures or SPIN-SELF Program need important modifications, thereby requiring a re-set for the full-scale trial. Otherwise, the full-scale RCT will proceed, and outcome data from the feasibility portion will be utilized in the full-scale trial. In the full-scale RCT, 524 participants will be recruited. Discussion The SPIN-SELF Program may improve disease management self-efficacy, patient activation, social appearance anxiety, and functional health outcomes in people with SSc. SPIN works with partner patient organizations around the world to disseminate its programs free-of-charge. Trial registration ClinicalTrials.govNCT04246528. Registered on 27 January 2020

Introducción El tratamiento de la rizartrosis del pulgar mediante la implantación de prótesis totales está en continua expansión. La prótesis Isis® es un implante de cúpula troncocónica de anclaje roscado y semiconstreñida. Nuestro objetivo fue valorar los resultados funcionales y de supervivencia de este implante durante un mínimo de un año de evolución. Material y método Estudio prospectivo sobre 53 prótesis Isis® implantadas entre abril de 2014 y enero de 2019. Se evaluaron el test funcional de Van Cappelle, dolor, fuerza, movilidad, regreso a la actividad, variables radiológicas y colocación de la cúpula. La técnica quirúrgica se realizó siempre con aguja guía centrada en el trapecio y control de escopia. Se registraron complicaciones y se llevó a cabo un análisis estadístico. Resultados Se revisaron 51 implantes (49 pacientes) con un seguimiento medio de 2,1 años (1-5,7). El test de Van Cappelle, el dolor, la movilidad y la fuerza de puño y pinza mejoraron significativamente; también la distancia entre cabeza de metacarpiano y base de trapecio. El 96% de los pacientes regresaron en menos de 6 meses a sus actividades. Las complicaciones registradas fueron: 3 tendinopatías de De Quervain, 2 fracturas de metacarpiano y 2 de trapecio intraoperatoriamente, y un síndrome del túnel carpiano. No hubo ninguna luxación, infección ni movilización del implante en el último seguimiento. Conclusiones Los resultados funcionales de la prótesis Isis® son excelentes a corto plazo, con una supervivencia del 100% tras el primer año de evolución. Las complicaciones surgidas fueron escasas. El anclaje y colocación de la cúpula guiada por escopia parecen ser cruciales para el buen resultado. Introduction The treatment of trapeziometacarpal osteoarthritis through the implantation of total trapeziometacarpal prostheses is in continuous expansion. The Isis® prosthesis is a trunk-conical threaded anchorage prosthesis. Our objective was to assess the functional results and survival of this implant for at least one year of follow-up. Material and method Prospective study on 53 Isis® prosthesis, implanted from april 2014 to january 2019. The Van Cappelle functional test, pain, strength, mobility, return to previous activity, radiological variables and placement of the trapezial component were evaluated. The surgical technique was performed with a guide wirefocused on the trapezius and control of the scopia. Observed complications were recorded and statistical analysis was performed. Results Fifty-one implants (49 patients) were reviewed. Mean follow-up was 2.1 years (1-5.7). Van Cappelle's test, pain, mobility, and grip and clamp strength improved significantly, as did the distance between the metacarpal head and the trapezius base; 96% of the patients returned in less than 6 months to their activities. Minor complications, 3 De Quervain's tendinopathy and 2 intra-operative metacarpal and 2 trapezium fractures were recorded, and one carpal tunnel syndrome. There was no dislocation, mobilization, or implant infection. Conclusions The functional results of the Isis® prosthesis are excellent in the short term, far exceeding the first year of 100% of survival. The complications that arose were minor and few. The anchorage and placement of the trapezial component guided by scopia seem to be crucial for the good result.

Resumen Introduccion y objetivos La presion arterial (PA) ambulatoria predice el riesgo de enfermedad cardiovascular (ECV) mejor que las mediciones clinicas (MCPA). Sin embargo, los modelos actuales de estratificacion del riesgo de ECV se basan exclusivamente en las MCPA junto con otros factores tradicionales, como edad, sexo, tabaquismo, dislipemia y diabetes. Metodos Se utilizaron los datos de 19.949 participantes en el Proyecto Hygia, evaluados con monitorizacion ambulatoria de la PA (MAPA) de 48 h, para comparar la precision, la discriminacion y el rendimiento de la escala de Framingham original (RSOFG) y su version ajustada a la poblacion del Proyecto Hygia (RSAFG) con un nuevo modelo en el que la MCPA se reemplazo con parametros pronosticos derivados de la MAPA (RSABPM). Resultados Tras un seguimiento de hasta 12,7 anos, 1.854 participantes sufrieron un evento de ECV (muerte C V, infarto, revascularizacion, insuficiencia cardiaca, ictus, accidente isquemico transitorio, angina o enfermedad arterial periferica). La media de la PA sistolica (PAS) durante el sueno y la disminucion relativa de la PAS en actividad/sueno fueron los marcadores significativos del riesgo de ECV y, por ello, se utilizaron como sustitutos de la MCPA en el modelo RSABPM. Este modelo, en comparacion con la RSOFG y la RSAFG, presento calibracion, precision diagnostica, discriminacion y rendimiento significativamente mayores (p Conclusiones Los resultados documentan importantes limitaciones de la estratificacion del riesgo de ECV basada en MCPA, incluidas las del modelo de Framingham, y corroboran el valor de la MAPA para diagnosticar hipertension y estratificar el riesgo de ECV.

Since the 1990s, perinatal transmission of HIV has decreased substantially, largely as a result of improved detection secondary to routine HIV screening in pregnancy and the use of antiretroviral therapy. However, despite reductions in HIV transmission, elimination of perinatal transmission, defined as an incidence of perinatal HIV infection of1 per 100,000 live births and a transmission rate of1%, remains elusive. An estimated 80% of perinatal transmissions occur after 36 weeks' gestation, which highlights the importance of diagnosis and treatment of maternal HIV infection before the highest-risk period for perinatal transmission. With timely identification of seroconversion, intrapartum and neonatal interventions can lower the risk of perinatal transmission from 25% to 10%, substantially reducing perinatal transmission events. The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention recommend that routine HIV testing be performed in all pregnancies, as early in the prenatal course as possible. Third-trimester repeat testing is only recommended for individuals known to be at high risk of acquiring HIV (ie, those who are incarcerated; who reside in jurisdictions with elevated HIV incidence; who are receiving care in facilities that have an HIV incidence in pregnant women1 per 1000 per year; or have signs or symptoms of acute HIV). However, among reproductive-age women, heterosexual intercourse is the most common mode of HIV transmission, and the risk of HIV seroconversion is greater during pregnancy than outside of pregnancy. Furthermore, state statutes for HIV testing in pregnancy are largely lacking. In this clinical opinion, we reviewed the evidence in support of universal third-trimester repeat HIV testing in pregnancy using a successful state-mandated testing program in Illinois. In addition, we provided clinical recommendations to further reduce missed perinatal transmission cases by implementing universal third-trimester repeat testing, obtaining hospital buy-in, monitoring testing adherence, bridging communications across multidisciplinary teams, and engaging clinicians in advocacy work.

Neonicotinoids are systemic insecticides used since the 1990’s , that possess renal tubular toxicity. We conducted a field-based descriptive study in the North Central Dry-zone of Sri Lanka, where chronic kidney disease (CKD) of unknown etiology has been increasing since the 1990’s. To elucidate the relationship between renal tubular dysfunctions and urinary neonicotinoids concentrations, we collected spot urine samples from15 CKD patients, 15 family members, and 62 neighbors in 2015, analyzed two renal tubular biomarkers, Cystatin-C and L-FABP, quantified seven neonicotinoids and a metabolite N-desmethyl-acetamiprid by LC–MS/MS; and we investigated their symptoms using a questionnaire. Cystatin-C and L-FABP had a positive correlation (p N-Desmethyl-acetamiprid was detected in 92.4% of the urine samples, followed by dinotefuran (17.4%), thiamethoxam (17.4%), clothianidin (9.8%), thiacloprid and imidacloprid. Dinotefuran and thiacloprid have never been registered in Sri Lanka. In High Cystatin-C group (> 70 μg/gCre, n = 7), higher urinary concentration of dinotefuran (p = 0.009), and in Zero Cystatin-C group (N-desmethyl-acetamiprid (p = 0.013), dinotefuran (p = 0.049), and thiacloprid (p = 0.035), and more complaints of chest pains, stomachache, skin eruption and diarrhea (p

Co-infections have been widely described in COVID-19 patients. Bacterial infections being the main cause but also have been reported fungal infections in up to 20 % of the cases. Candida species are the second most common fungi identified in pulmonary mycotic infections affecting hospitalized COVID-19 patients after Aspergillus. We present a case of severe COVID-19 associated with pulmonary candidiasis.

Retinal degenerative diseases are one of the main causes of complete blindness in aged population. In this study, we compared the therapeutic potential for retinal degeneration of human mesenchymal stem cells derived from abdominal subcutaneous fat (ABASCs) or from orbital fat (OASCs) due to their accessibility and mutual embryonic origin with retinal tissue, respectively. OASCs were found to protect RPE cells from cell death and were demonstrated to increase early RPE precursor markers, while ABASCs showed a raise in retinal precursor marker expression. Subretinal transplantation of OASCs in a mouse model of retinal degeneration led to restoration of the RPE layer while transplantation of ABASCs resulted in a significant restoration of the photoreceptor layer. Taken together, we demonstrated a lineage-specific therapeutic effect for either OASCs or ABASCs in retinal regeneration.

Objetivo. El objetivo de esta revisión bibliográfica es analizar la evidencia científica existente, sobre los diferentes tratamientos regenerativos pulpares, en dientes permanentes jóvenes con necrosis pulpar, para conocer las diversas alternativas de materiales y técnicas utilizadas. Materiales y métodos Se realizó una búsqueda electrónica biomédica avanzada en base de datos PubMed, utilizando palabras clave MeSh Terms (Medical Subject Headings), para identificar la cantidad de artículos científicos disponibles, en la que se encontraron estudios sobre tratamientos de regeneración pulpar en dientes permanentes jóvenes inmaduros, con el fin de identificar los diferentes tratamientos, materiales, técnicas, y resultados obtenidos con dichas maniobras clínicas. Resultados Se encontraron 30 artículos, en los que se identificaron los diversos tratamientos en regeneración pulpar de dientes permanentes jóvenes inmaduros, investigaciones de ensayos clínicos aleatorios, utilizando 11 artículos. Conclusiones En las diversas investigaciones se encuentran diferentes tratamientos, materiales y técnicas a utilizar de para la regeneración pulpar, encontrando variaciones en soluciones irrigadoras, medicaciones intraconductos, número de citas y material de sellado coronal, sin embargo el Trióxido Mineral Agregado MTA es el utilizado con mayor frecuencia; se necesitan más investigaciones que puedan destacar un protocolo de atención.

El análisis de las diferentes amenazas y los factores de riesgo de desastres dentro de un territorio comprenden elementos fundamentales para el desarrollo en todos los ámbitos de una población, aborda la problemática desde los procesos de conocimiento y reducción del riesgo hasta la respuesta y recuperación ante un posible desastre. Este trabajo estudia las políticas públicas de gestión de riesgo en la parte norte del Páramo Cruz Verde ubicado al costado oriental de la ciudad de Bogotá. Para esto se revisan las propuestas del gobierno local en sus planes de gestión del suelo en esta zona, abarcando elementos que implementan las autoridades estatales en cuanto al ordenamiento territorial que delimitan las zonas en condición en riesgo y la presencia de eventos de amenaza en la región de estudio. Por consiguiente, es importante conocer cuáles son los entes reguladores que realizan estos estudios en Colombia y verificar sí las normativas se están realizando de manera eficiente. Como parte de los resultados, se encuentran documentos normativos desactualizados e información geográfica, en algunos casos, no disponible al público. Adicionalmente, no existe una conexión estrecha entre las entidades científicas y administrativas que logre establecer un análisis interdisciplinar en el territorio. Por lo expuesto anteriormente, se recomienda realizar un diagnóstico detallado del riesgo para evitar la ocupación en terrenos no apropiados, y como parte de una oportunidad para el desarrollo local, ya que evita costosas inversiones que de una u otra manera los municipios deben sufragar en el momento de presentarse un desastre.

Allogeneic hematopoietic cell transplantation (allo-HCT) is potentially curative for patients with malignant and benign hematologic conditions. Graft-versus-host disease (GVHD) is a known complication of allo-HCT that results in significant morbidity and mortality. A common GVHD prophylaxis strategy combines a calcineurin inhibitor with methotrexate. When mucositis and organ toxicity develop, the day +11 dose is frequently omitted to limit further organ damage. The potential impact of this practice on allo-HCT outcomes is unclear as published data show conflicting results. Thus, we performed a systematic review/meta-analysis of the available literature to assess the impact of omitting day +11 methotrexate on allo-HCT recipients. Data were extracted in relation to benefits (overall survival [OS], progression-free survival [PFS]) and harms (acute and chronic GVHD, non-relapse mortality [NRM], and relapse). Pooled OS rate favored those who received day +11 methotrexate vs. those who did not (HR = 1.21; 95% CI = 1.02-1.43; p = 0.03). There was no significant difference in pooled rates of PFS (HR = 0.96; 95% CI = 0.60-1.52; p = 0.85), acute GVHD (HR = 1.03; 95% CI = 0.35-2.98; p = 0.96), chronic GVHD (HR = 0.83; 95% CI = 0.44-1.57; p = 0.57), NRM (HR = 0.86; 95% CI = 0.67-1.11; p = 0.25), and relapse (HR = 0.97; 95% CI = 0.75-1.26; p = 0.83) between the two groups. Large prospective multicenter studies are needed to better define the significance of day +11 methotrexate omission.

Due to the acoustoelastic effect, ultrasonic guided waves have been used to estimate mechanical stress in a cheap and nondestructive fashion. Machine learning has been applied to map complex waveforms to stress estimates, though important aspects to construct and deploy real-time monitoring systems, such as accuracy and hardware consumption, to date, have not been concomitantly explored. The goal of the present paper is to propose a data modeling methodology that optimizes accuracy and computational implementation, towards devising the best practices for real-time ultrasonic-based stress estimation. We evaluate shallow and deep learning models with dimensionality reduction, which are compared to the most recent work showing overall better results for the approach presented herein both in terms of accuracy and hardware resources consumption. We generated a dataset to evaluate the models on a test rig with a plate measuring (i) ultrasonic guided waves excited by broadband signals and (ii) different stress conditions. The models are created and tested using a Monte-Carlo hold-out procedure with a repeated k-fold randomized hyperparameter search to evaluate their robustness in different stress conditions. We dramatically improve the current state of the art by proposing and evaluating a more efficient model construction procedure. Results show that by using shallow models and principal component analysis, we were able to improve the model performance in terms of predictive power and inference hardware consumption. Specifically, we obtained an accuracy improvement of about 10% and hardware consumption used for inference smaller in three orders of magnitude when compared to the state-of-the-art reported with deep neural network models. Results herein depicted impact the way practitioners may proceed for building efficient embedded predictive models for stress estimation using guided waves, enabling more precise, decentralized, and real-time nondestructive monitoring.