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Resumen Introduccion El uso de anestesia general en ninos pequenos conlleva riesgos, a corto y largo plazo. El objetivo de este estudio fue evaluar la eficacia de la tecnica de resonancia magnetica (RM) cerebral sin anestesia mediante fijacion con colchon en ninos menores de 3 meses. Pacientes y metodos Estudio prospectivo de casos y controles realizado en el ano 2019. Los casos fueron pacientes menores de 3 meses con indicacion de RM craneal, estables y sin soporte ventilatorio; las resonancias se realizaron usando la tecnica de dar de comer y dormir y un colchon inmovilizador. Los controles fueron pacientes de la misma edad y sexo, inestables clinicamente, derivados para realizar RM craneal con anestesia general. Tres radiologos pediatricos evaluaron el exito de la RM (si respondia a la pregunta clinica), si era necesario repetirla y calificaron la presencia de artefactos de movimiento en una escala del 1 al 4. Resultados 47 casos fueron incluidos en este estudio (28 ninos, 19 ninas; media: 31 dias de vida), de los cuales (89%) 42 RM fueron llevadas a cabo de manera exitosa. Los estudios realizados de manera ambulatoria se asociaron a mayor posibilidad de fallo de la tecnica que los realizados a ingresados (valor de p 0,02). El 60% de las RM de los casos realizados tuvieron calidad optima y el 30%, suboptima (artefacto de movimiento en una o dos secuencias). No se detectaron problemas de seguridad con esta tecnica. La media de duracion de los estudios fue de 16,6 minutos (rango 6-30 minutos). El 100% de las RM de los controles bajo anestesia general se llevaron a cabo con exito, con una calidad optima en el 89% y suboptima en el 11% restante. En el primer ano de experiencia con esta tecnica, de 47 RM realizadas, se evito el uso de anestesia general a 42 recien nacidos. Conclusion La tecnica de dar de comer y dormir y fijacion con colchon neumatico para realizar RM sin anestesia puede realizarse de forma eficaz y segura en ninos menores de 3 meses.

Local Governments around the world have taken advantage of social media during the past ten years to improve transparency and to provide public services. Challenges related to information management and citizen participation have emerged, namely at the local level where the diffusion of social media has been slower compared to initiatives launched at the national level. This paper analyzes how the use of social media can reflect a change in the discursive exchanges established between local governments in Canada and Mexico and citizens. To achieve this goal, the use of YouTube by the municipalities of Quebec and Morelia was examined by using digital methods and content analysis. The author proposes the emergence of new conditions between government and users, which are changing the discourse, identity, and communication purposes of the municipalities. However, the development of more dialogic communication processes supported by social media is still a promise, at least on YouTube.

Background: Cystic echinococcosis is a parasitic disease that develops in endemic areas due to the transmission of Echinococcus granulosus. The liver is the organ most affected. The most frequent s...

Background Benzodiazepines (BZDs) and Z-drugs (BZDRs) are among the most prescribed medications for anxiety and insomnia, especially among older adults. Our objective was to investigate the association between the use of BZDRs and the risk of dementia. Methods A community-based retrospective cohort study was conducted based on the data available from 2002 to 2015 in Catalan Health Service. This cohort included all BZDR users (N = 83 138) and nonusers (N = 84 652) older than 45 years. A minimum 5-year lag window and an adjustment for psychiatric problems were applied for the data analysis. Results The hazard ratio (HR) for the risk of incident dementia among BZDR users was 1.22 (95% CI = 1.15 to 1.31). This risk was not significant after adjusting the data confounding factors (HR = 1.01; 95% CI = 0.94 to 1.08). We observed a higher risk with short-to-intermediate half-life BZDs (HR = 1.11; 95% CI = 1.04 to 1.20) and Z-drugs (HR = 1.20; 95% CI = 1.07 to 1.33) than for intermediate-to-long half-life BZDs (HR = 1.01; 95% CI = 0.94 to 1.08). We demonstrated a higher risk of incident dementia (HR = 1.23; 95% CI = 1.07 to 1.41 and odds ratio = 1.38; 95% CI = 1.27 to 1.50, respectively) in patients who received 91 to 180 defined daily doses (DDDs) and >180 DDDs compared with patients who received Conclusion We found that the incidence of dementia was not higher among all BZDR users. Short half-life BZDs and Z-drugs increased the risk of dementia at the highest doses, especially in female patients, showing a dose-response relationship.

Parasympathetic nervous system activity can downregulate inflammation, but it remains unclear how parasympathetic nervous system activity relates to antiviral activity. The present study examined associations between parasympathetic nervous system activity and cellular antiviral gene regulation in 90 adolescents (Mage= 16.3,SD= 0.7; 51.1% female) who provided blood samples and measures of cardiac respiratory sinus arrhythmia (RSA), twice, five weeks apart. Using a multilevel analytic framework, we found that higher RSA (an indicator of higher parasympathetic nervous system activity)—both at rest and during paced breathing—was associated with higher expression of Type I interferon (IFN) response genes in circulating leukocytes, even after adjusting for demographic and biological covariates. RSA was not associated with a parallel measure of inflammatory gene expression. These results identify a previously unrecognized immunoregulatory aspect of autonomic nervous system function and highlight a potential biological pathway by which parasympathetic nervous system activity may relate to health.

Breast cancer; Predictive markers; Translational research Cáncer de mama; Maradores predictivos; Investigación traslacional Càncer de mama; Marcadors predictius; Recerca translacional Eribulin prolongs overall survival in patients with pre-treated advanced breast cancer. However, no biomarker exists to prospectively select patients who will benefit the most from this drug. SOLTI-1007-NeoEribulin is a phase II, open-label, two-cohort, exploratory pharmacogenomic study in patients with clinical stage I–II HER2-negative breast cancer receiving neoadjuvant eribulin monotherapy treatment. Primary objective was to explore the association of baseline tumor gene expression with pathological complete response in the breast (pCRB) at surgery. Key secondary objectives were pCRB rates in all patients and according to HR status, gene expression changes during treatment and safety. One-hundred one hormonal receptor-positive (HR + ) and seventy-three triple-negative breast cancer (TNBC) patients were recruited. The pCRB rates were 6.4% in all patients, 4.9% in HR + disease and 8.2% in TNBC. The TNBC cohort was interrupted due to a progression disease rate of 30.1%. The pCRB rates differed according to intrinsic subtypes: 28.6% in HER2-enriched, 11.1% in Normal-like, 7.9% in Luminal B, 5.9% in Basal-like and 0% in Luminal A (HER2-enriched vs. others odds ratio = 7.05, 95% CI 1.80–42.14; p-value = 0.032). Intrinsic subtype changes at surgery occurred in 33.3% of cases, mostly (49.0%) Luminal B converting to Luminal A or Basal-like converting to Normal-like. Baseline tumor-infiltrating lymphocytes (TILs) were significantly associated with pCR. Eribulin showed a good safety profile with a low response and pCRB rates. Patients with HER2-negative disease with a HER2-enriched profile may benefit the most from eribulin. In addition, significant biological activity of eribulin is observed in Luminal B and Basal-like subtypes.

Resumen Introduccion y objetivos Se presentan las caracteristicas clinicas y los resultados de los trasplantes cardiacos realizados en Espana con la actualizacion correspondiente a 2019. Metodos Se describen las caracteristicas clinicas y los resultados de los trasplantes cardiacos realizados en 2019, asi como las tendencias de estos en el periodo 2010-2018. Resultados En 2019 se realizaron 300 trasplantes (8.794 desde 1984; 2.745 entre 2010 y 2019). Respecto a anos previos, los cambios mas llamativos son el descenso hasta el 38% de los trasplantes realizados en codigo urgente, y la consolidacion en el cambio de asistencia circulatoria pretrasplante, con la practica desaparicion del balon de contrapulsacion (0,7%), la estabilizacion del uso del oxigenador extracorporeo de membrana (9,6%) y el aumento de los dispositivos de asistencia ventricular (29%). La supervivencia en el trienio 2016-2018 es similar a la del trienio 2013-2015 (p = 0,34), y ambas mejores que la del trienio 2010-2012 (p = 0,002 y p = 0,01 respectivamente). Conclusiones Se mantienen estables tanto la actividad del trasplante cardiaco en Espana como los resultados en supervivencia en los ultimos 2 trienios. Hay una tendencia a realizar menos trasplantes urgentes, la mayoria con dispositivos de asistencia ventricular.

Teaching short-circuit analysis is conducted primarily through case studies; however, there are not many validated short-circuit studies available on the subject, especially when considering off-nominal turns ratio transformers. In order to improve the teaching of short-circuit analysis, a three phase short-circuit study in an industrial system according to ANSI/IEEE standards by means of Zmatrix method is presented; two case studies are considered: the industrial system with nominal and offnominal turns ratio transformers, in both cases the step by step solution is given in an explicit manner and the analytical results are validated through software simulation.

Type 2 diabetes (T2D) is a growing cause of poor health, psychosocial burden, and economic costs worldwide. The pancreatic β-cell is a cornerstone of metabolic physiology. Insulin deficiency leads to hyperglycemia, which was fatal before the availability of therapeutic insulins; even partial deficiency of insulin leads to diabetes in the context of insulin resistance. Comprising only an estimated 1 g or

Fine‐scale movement patterns are driven by both biotic (hunting, physiological needs) and abiotic (environmental conditions) factors. The energy balance governs all movement‐related strategic decisions.Marine environments can be better understood by considering the vertical component. From 24 acoustic trackings of 10 white sharks in Guadalupe Island, this study linked, for the first time, horizontal and vertical movement data and inferred six different behavioral states along with movement states, through the use of hidden Markov models, which allowed to draw a comprehensive picture of white shark behavior.Traveling was the most frequent state of behavior for white sharks, carried out mainly at night and twilight. In contrast, area‐restricted searching was the least used, occurring primarily in daylight hours.Time of day, distance to shore, total shark length, and, to a lesser extent, tide phase affected behavioral states. Chumming activity reversed, in the short term and in a nonpermanent way, the behavioral pattern to a general diel vertical pattern., This study linked horizontal and vertical movements of white sharks from active tracking data and obtained six different behavioral states through the use of hidden Markov models.

HIV infection is still a public health problem worldwide and co-infections with other infectious agents including intestinal parasites are of particular concern, mainly in developing countries like Colombia.To conduct a cross-sectional study in patients attending an HIV care program in Antioquia given that there have been few intestinal parasites prevalence studies among the HIV population in the country.We evaluated stool samples from 192 patients by direct wet mount and concentration, modified Ziehl Neelsen staining, and agar plate culture. Univariate and correlation analyses were done to explore the association between socio-demographic and clinical characteristics and parasitological data.The overall prevalence of intestinal parasites in HIV-positive subjects was 29.2% (56/192; 95% CI: 22.8% - 35.6%). Entamoeba histolytica/dispar/moshkosvkii with 13.0% (25/192; 95% CI: 8.2% - 17.8%) and Blastocystis with 12.0% (23/192; 95% CI: 7.4% - 16.6%) were the most frequent. Opportunistic parasites like Cryptosporidium spp. and Cystoisospora belli were less prevalent, each one with 0.5% of positive samples (1/192; 95% CI: 0.1% - 1.5%). Commensal protozoa were also detected with a prevalence of 18.8% (36/192; 95% CI: 13.3% - 24.3%). Most of the individuals in the study had a controlled viral load and an LTCD4 count greater than 200 cel/μL. A small percentage (9.3%) had diarrhea. Bivariate analysis and multivariate logistic regression showed that only age and having pets had a significant association with intestinal parasites in this cohort.Our results confirmed that the evaluated population is at high risk of intestinal parasite infection, which highlights the need for routine screening of gastrointestinal parasites to provide prompt treatment and reduce possible complications.Introducción. La infección por HIV y las coinfecciones con otros agentes infecciosos, incluidos los parásitos intestinales, son motivo de especial preocupación en países en desarrollo como Colombia. Objetivo. Hacer un estudio transversal en pacientes que asisten a un programa de atención de HIV en el departamento de Antioquia, dado que los estudios de prevalencia de parásitos intestinales en la población con HIV son escasos en el país. Materiales y métodos. Se evaluaron 192 muestras de materia fecal mediante examen coprológico directo y por concentración, tinción de Ziehl-Neelsen modificada, y aislamiento en agar. Se hicieron análisis univariados y de correlación, para explorar la asociación entre las características sociodemográficas y clínicas, y los datos parasitológicos. Resultados. La prevalencia global de parásitos intestinales en pacientes positivos para VIH fue del 29.2 % (56/192; IC95% 22.8-35.6 %), siendo Entamoeba histolytica/dispar/moshkosvkii, con 13.0 % (25/192; IC95% 8.2-17.8 %), y Blastocystis, con 12.0 % (23/192; IC95% 7.4-16.6 %), los mas frecuentes. Los parásitos oportunistas Cryptosporidium spp. y Cystoisospora belli fueron menos prevalentes, cada uno con 0.5 % (1/192; IC95% 0.1-1.5 %) de muestras positivas. También, se detectaron protozoos comensales, con una prevalencia del 18,8 % (36/192; IC95% 13,3-24,3 %). La mayoría de los individuos tenía una carga viral controlada y un recuento de linfocitos T CD4 superior a 200 células/μl. Un pequeño porcentaje (9,3 %) presentó diarrea. La edad y el tener mascotas mostraron una asociación significativa con la presencia de parásitos intestinales. Conclusión. Se confirmó que la población evaluada tiene un alto riesgo de infección por parásitos intestinales, lo que resalta la necesidad de un protocolo de diagnóstico para el cribado de dichos agentes, con el fin de brindar un tratamiento rápido y reducir las posibles complicaciones.

Introduction: Socioeconomic level is a determinant factor of exposure to health risks. Little is known about the relationship between non-communicable diseases in low-middle-income countries. Marginalization index and socioeconomic level are associated with COVID-19 lethality. Objective: Know if marginalization index and socioeconomic level are associated with risk factors for non-communicable diseases. Material and method: A cross-sectional study with 409 participants between 10 to 20 years’ old who live in municipalities with high and very low marginalization index. Weight, height, blood pressure, fasting glucose, and lipidic profile were measured. In addition, the AMAI questionnaire was applied. Results: Insulin resistance, elevated systolic blood pressure, and overweight, and obesity were the variables more prevalent. Differences between comorbidities, socioeconomic level, and marginalization index were found. At a higher socioeconomic level, higher values of fasting glucose. At a greater marginalization index, better levels of lipidic profile and lower fasting glucose levels were found. Conclusion: There is an elevated incidence of these risk factors, highlighting the need for interventions to monitor and manage these diseases. The population in more vulnerable situations had better health conditions than those with higher socioeconomic level; these findings were consistent with middle- and low-income countries.

Purpose The purpose of this study was to understand how the family system plays a role in knowledge sharing (KS) within family firms. The authors argue that the family’s influence can occur through two routes. An external route in which the family affects the culture of the organization and through an internal route in which family leadership within the firm affects the practices and behaviors within the business. Design/methodology/approach Data for this project came from the survey responses of 93 Spanish family firms. Findings The findings expand previous understanding about KS in family firms by outlining the two routes through which the family can have positive effect on KS within family firms. Results show that family system characteristics (i.e. next-generation commitment, family trust and intergenerational relationships) affect KS through their impact on the participative culture of a family firm. Additionally, when a family has been in control of the business for more generations, they place higher importance on family legacy and continuity, which is likely to strengthen the relationship between participative culture and KS in family firms. Originality/value Given the important role that the family system plays within the family business, this paper explored how family characteristics can influence KS in family firms. The authors contribute to the literature by highlighting the importance that the owning family can have in creating an environment that can facilitate KS in family firms.

It is estimated that chemotherapy-induced alopecia (CIA) occurs in 65% of chemotherapeutic patients. Forty-seven percent of cancer patients consider hair loss to be the most traumatic aspect of therapy. CIA can be anticipated, depending on the regimen used, and doctors should be aware of the treatments that can minimize it. Careful evaluation before chemotherapy treatment should be performed, and trichoscopy may be useful. Dermatologists do not generally evaluate postchemotherapy alopecia. However, there is an increasing number of reports of permanent chemotherapy-induced alopecia, and these patients require treatment.

In the area of recognition and classification of children activities, numerous works have been proposed that make use of different data sources. In most of them, sensors embedded in children’s garments are used. In this work, the use of environmental sound data is proposed to generate a recognition and classification of children activities model through automatic learning techniques, optimized for application on mobile devices. Initially, the use of a genetic algorithm for a feature selection is presented, reducing the original size of the dataset used, an important aspect when working with the limited resources of a mobile device. For the evaluation of this process, five different classification methods are applied, k-nearest neighbor (k-NN), nearest centroid (NC), artificial neural networks (ANNs), random forest (RF), and recursive partitioning trees (Rpart). Finally, a comparison of the models obtained, based on the accuracy, is performed, in order to identify the classification method that presents the best performance in the development of a model that allows the identification of children activity based on audio signals. According to the results, the best performance is presented by the five-feature model developed through RF, obtaining an accuracy of 0.92, which allows to conclude that it is possible to automatically classify children activity based on a reduced set of features with significant accuracy.

Flavonoids are a broad group of bioactive compounds with anticarcinogenic effects on the prostate that have been scarcely evaluated in Latin American populations. Our objective was to evaluate the association between dietary patterns of flavonoid intake and prostate cancer (PC) in a population-based case–control study carried out in Mexico City. Based on a semi-quantitative FFQ with a frame reference of 3 years before diagnosis or interview, we used an updated database for estimating the daily intake (mg/d) of flavones, flavonols and flavanols for 395 confirmed incident PC cases and 797 population controls matched by age (± 5 years). Histological PC differentiation was evaluated using the Gleason score at diagnosis. Flavonoid dietary intake patterns (FDIP) were determined through principal component analysis, and their association with PC was estimated using logistic regression models. Three FDIP were identified: gallate pattern (GP) characterised by (–)-epicatechin-3-O-gallate, (–)-epigallocatechin-3-O-gallate and (+)-gallocatechin; luteolin pattern (LP) characterised by luteolin and (–)-epigallocatechin-3-O-gallate; and a mixed pattern (MP) that included (+)-catechin, (–)-epicatechin and quercetin. A higher GP (ORT3 v.T1 = 0·47; 95 % CI 0·33, 0·66) and LP intake (ORT3 v. T1 = 0·39; 95 % CI 0·27, 0·59) were associated with a decreased PC likelihood. In contrast, a higher MP intake (ORT3 v. T1 = 2·32; 95 % CI 1·67, 3·23) increased PC likelihood. The possible differential and synergistic anticarcinogenic role of flavonoid compounds in PC deserves further study.

This essay investigates the origins and development of the influence of Borges on J.M. Coetzee, focusing particularly on the formative period of Coetzee in the United States (1965–1971) and on the ...

Coil prolapse or migration is a rare but potentially serious complication that may occur during aneurysm embolization, with no standard management currently described. Here we describe our experience with the Embolus Retriever with Interlinked Cages (ERIC) device® (Microvention, Aliso Viejo, CA, USA) for the retrieval of prolapsed or migrated coils in a case series and Flow-Model analysis. First, a retrospective review was performed using our institution database for patients in which coil prolapse or migration occurred during aneurysm embolization, and data was collected and analyzed. Second, an in vitro Flow-Model analysis was performed comparing the ERIC device® with other stent retrievers for coil retrieval. In 2 cases, the ERIC device® successfully retrieved the displaced coil from intracranial circulation in 1 pass, after failure with other devices. In the Flow-Model, again the ERIC device® achieved success for retrieving a detached coil, whereas 2 other different stent retrievers failed to capture the coil after 2 attempts. The ERIC device® appears to be a safe and effective tool for retrieving a prolapsed or migrated coil from the intracranial circulation.

Objectives Given the scarcity of data regarding prevalence of various infectious diseases in Latin-American countries, our study aims to assess the burden of T. cruzi, S. stercoralis, HIV and viral hepatitis in Latin-American migrants, with a focus on Bolivian migrants. Methods We performed a retrospective observational study of 565 screening evaluations in adults (≥18 years) carried out at our International Healthcare referral service in Barcelona. We reviewed structured clinical records and microbiological results of patients attended between February 2012 and April 2015. Results The median age was 35 years and 74% were women. Of the population screened, 87% were of Bolivian origin. We found a 48% prevalence of T. cruzi, 16% of S. stercoralis, 0.2% of HIV, 0.2% HBV and 0.2% HCV. Conclusions These results support the relevance of screening for T. cruzi and S. stercoralis in Bolivian migrants but challenge the pertinence of systematic screening for HBV in this population.

Mexico is the fifth country that collects the least in Latin America as a proportion of gross domestic product (GDP) and also the one with the lowest income from the value added tax, has highlighted the Organization for Economic Cooperation and Development (OECD) in the year 2020, (OCDE, 2020) derived from this, the Federal Executive proposed a series of reforms that allow increasing collection, among which the most notable is the Decree that reforms, adds and repeals various provisions of the Tax Law on the Income, the Law of Value Added Tax and the Fiscal Code of the Federation which has a direct effect on the so-called Authorized Grantees, this based on the fact that cases have been detected in which the income of the Authorized Grantees is not found. related to the activity authorized by the Law and carry out simulated operations. The objective of this work is to analyze the effects that this reform will have and try to foresee its immediate success.

The present study aims to carry out a projection of student burnout risk detection in young university students using Machine Learning technics (Neuronal Networks, KNN, SVM, Random Forest). A descriptive method was proposed, with a cross-sectional and stratified design in which a sample of 791 students from 4 different universities. This study opens up an innovative field of research by integrating resources from psychological evaluation and virtual resources, in addition, it would allow the generation of preventive actions to treat various implications of Burnout in school dropout and low academic performance through the analysis of information and the generation of algorithms that allow the projection of burnout risk. Due to the combination of experience of professionals in psychology, education and engineering, as well as the contribution to the projection of a syndrome that affects students, makes this article an innovative proposal.

Introducción: El plasma rico en plaquetas (PRP) es un biomaterial con alta concentración de plaquetas y factores de crecimiento que favorecen la regeneración de tejidos tras su aplicación en intervenciones quirúrgicas como la exodoncia del tercer molar. Material y métodos: El estudio se realizó con 20 pacientes con necesidad de exodoncia del tercer molar inferior bilateral. Las exodoncias se realizaron en un mismo tiempo quirúrgico y en uno de ellos, escogido aleatoriamente, se aplicó el gel de PRP y el otro tomado como grupo control. La evaluación posoperatoria se llevó acabo posterior a los tres meses; los parámetros evaluados fueron: dolor posoperatorio, curación de herida y densidad ósea mediante tomografía computarizada Cone Beam. Resultados: El dolor posoperatorio durante el tercer día, primera y segunda semana presentó menor grado en los sitios de aplicación de PRP que el grupo control (p

BackgroundCOVID-19 has overloaded national health services worldwide. Thus, early identification of patients at risk of poor outcomes is critical. Our objective was to analyse SARS-CoV-2 RNA detection in serum as a severity biomarker in COVID-19.Methods and FindingsRetrospective observational study including 193 patients admitted for COVID-19. Detection of SARS-CoV-2 RNA in serum (CoVemia) was performed with samples collected at 48-72 hours of admission by two techniques from Roche and Thermo Fischer Scientific (TFS). Main outcome variables were mortality and need for ICU admission during hospitalization for COVID-19.CoVemia was detected in 50-60% of patients depending on technique. The correlation of Ct in serum between both techniques was good (intraclass correlation coefficient: 0.612; p < 0.001). Patients with CoVemia were older (p = 0.006), had poorer baseline oxygenation (PaO2/FiO2; p < 0.001), more severe lymphopenia (p < 0.001) and higher LDH (p < 0.001), IL-6 (p = 0.021), C-reactive protein (CRP; p = 0.022) and procalcitonin (p = 0.002) serum levels.We defined “relevant CoVemia” when detection Ct was < 34 with Roche and < 31 for TFS. These thresholds had 95% sensitivity and 35 % specificity. Relevant CoVemia predicted death during hospitalization (OR 9.2 [3.8 − 22.6] for Roche, OR 10.3 [3.6 − 29.3] for TFS; p < 0.001). Cox regression models, adjusted by age, sex and Charlson index, identified increased LDH serum levels and relevant CoVemia (HR = 9.87 [4.13-23.57] for TFS viremia and HR = 7.09 [3.3-14.82] for Roche viremia) as the best markers to predict mortality.ConclusionsCoVemia assessment at admission is the most useful biomarker for predicting mortality in COVID-19 patients. CoVemia is highly reproducible with two different techniques (TFS and Roche), has a good consistency with other severity biomarkers for COVID-19 and better predictive accuracy.AUTHOR SUMMARYCOVID-19 shows a very heterogeneous clinical picture. In addition, it has overloaded national health services worldwide. Therefore, early identification of patients with poor prognosis is critical to improve the use of limited health resources. In this work, we evaluated whether baseline SARS-CoV2 RNA detection in blood (CoVemia) is associated with worse outcomes. We studied almost 200 patients admitted to our hospital and about 50-60% of them showed positive CoVemia. Patients with positive CoVemia were older and had more severe disease; CoVemia was also more frequent in patients requiring admission to the ICU. Moreover, we defined “relevant CoVemia”, as the amount of viral load that better predicted mortality obtaining 95% sensitivity and 35% specificity. In addition, relevant CoVemia was a better predictor than other biomarkers such as LDH, lymphocyte count, interleukin-6, and indexes used in ICU such as qSOFA and CURB65.In summary, detection of CoVemia is the best biomarker to predict death in COVID-19 patients. Furthermore, it is easy to be implemented and is reproducible with two techniques (Roche and Thermo Fisher Scientific) that are currently used for diagnosis in nasopharyngeal swabs samples.

Resumen Antecedentes y objetivo En Espana no existen estudios que hayan evaluado la prevalencia de la miocardiopatia hipertrofica en la poblacion general. El objetivo de este trabajo fue evaluar la prevalencia de la miocardiopatia hipertrofica en una muestra amplia de la poblacion laboral espanola. Materiales y metodos Se incluyo a 13.179 trabajadores (73% varones, con una edad media de 40 anos) de 5 regiones espanolas a los que, entre mayo de 2008 y noviembre de 2010, se les realizo un reconocimiento medico con un electrocardiograma. Se derivo a los trabajadores con alteraciones sugestivas en el electrocardiograma o con antecedentes medicos predisponentes (sincope de esfuerzo o muerte subita en familiar menor de 50 anos) para una evaluacion ecocardiografica. Se definio miocardiopatia hipertrofica a la presencia de un grosor parietal igual o mayor a 13 mm en cualquier segmento del ventriculo izquierdo. Se estimo la prevalencia de la miocardiopatia hipertrofica en toda la muestra y en los trabajadores no hipertensos. Resultados Se selecciono a 1.008 trabajadores para el ecocardiograma, aunque solo 496 (49,2% de los seleccionados) acudieron a la prueba. Tras el ecocardiograma se detectaron 16 casos de miocardiopatia hipertrofica y se estimo una prevalencia del 0,24% en el total de la muestra. En el subgrupo de trabajadores no hipertensos se objetivaron 10 casos de miocardiopatia hipertrofica, que se corresponden con una prevalencia estimada del 0,19%. Conclusiones En nuestra muestra de la poblacion laboral espanola la prevalencia estimada de miocardiopatia hipertrofica fue del 0,24%. En el subgrupo de pacientes no hipertensos la prevalencia estimada fue del 0,19%.

Cystoisospora belli is an intestinal Apicomplexan parasite associated with diarrheal illness and disseminated infections in humans, mainly immunocompromised individuals such as those living with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). An irregular administration of highly active antiretroviral therapy (HAART) in HIV patients may increase the risk of opportunistic infections like cystoisosporiasis. We describe here a case of C. belli infection in a Colombian HIV patient with chronic gastrointestinal syndrome and poor adherence to HAART. His clinical and parasitological cure was achieved with trimethoprim-sulfamethoxazole treatment. Although a reduction in the number of C. belli cases has been observed since the use of HAART, this parasite still has to be considered as a differential diagnosis of diarrheal disease in HIV/AIDS patients. Effective interventions enhancing adherence to HAART should be included in HIV patient care programs.Cystoisospora belli es un parásito intestinal del filo Apicomplexa asociado con enfermedades diarreicas e infecciones diseminadas en humanos, principalmente en individuos inmunocomprometidos, como aquellos infectados con el virus de la inmunodeficiencia humana (HIV) o el síndrome de inmunodeficiencia adquirida (sida). El cumplimiento inadecuado de la terapia antirretroviral de gran actividad (TARGA) puede aumentar el riego de infecciones oportunistas, incluida la cistoisosporiasis. Se describe el caso de infección por C. belli en un paciente colombiano con HIV, que presentó un síndrome gastrointestinal crónico e incumplía el tratamiento con la TARGA. Después del diagnóstico parasitológico, el paciente fue tratado con trimetoprimsulfametoxazol, lográndose la recuperación clínica y la cura parasitológica. Aunque se ha observado una reducción en el número de casos de C. belli desde la implementación de la TARGA, este parásito aún debe considerarse en el diagnóstico diferencial de las enfermedades diarreicas en pacientes con HIV/sida. Los programas de atención deben incluir intervenciones efectivas que potencien el cumplimiento de la TARGA en estos pacientes.

Evaluate the long-term efficacy of the Shouldice technique performed by non-specialized surgeons and also to reflex on the quality parameters necessary to safely assess hernia recurrence rates. During 3 years, a prospective study was conducted in 243 adult men who underwent surgery for primary inguinal hernias by 13 junior surgeons with an interest in hernia surgery. Using local anesthesia, a classic 4 step Shouldice repair, with polypropylene or polyester, was performed. All patients were followed for 18 years. The follow-up met the nine quality criteria proposed by the authors. At 18 years, 80.2% of patients were followed and only 6.5% were lost. There were 7 recurrences in the first 10 years, 5 of them secondary to a direct hernia, and the same after 18 years. The recurrence rate was 2.88%. Tolerance of the local anesthesia was excellent in 91.4%of patients and, after 3 years, the pain was considered moderate or severe in 4 patients (1.8%). It is necessary to incorporate more demanding criteria in the assessment of recurrence, to give more valid results. The Shouldice technique remains a useful technique today not only in patients under 30 years of age, and in the absence of risk factors, but also in cases of intolerance, patient rejection or absence of mesh. In addition, it provides the clinical and economic advantages of being possible to perform it under local anesthesia.

The need to publish is a pressure that academics face regardless of discipline. Counselor educators are subject to professional expectations including academic writing and mentorship. Structured wr...

Infrared thermography is a technique that can detect anomalies in temperature patterns which can indicate some breast pathologies including breast cancer. One limitation of the method is the absenc...

Triple-negative breast cancer (TNBC) is a subtype of breast cancer with unmet medical needs. Several studies have proved that high levels of tumor infiltrating lymphocytes (TILs) at diagnosis of TNBC confer better prognosis and patients respond better to specific chemotherapies. Nonetheless, current evidence suggests that only 15% of TNBC patients have very high levels of TILs, and another 15% lacks TILs. One possible reason to explain why patients have low TILs at diagnosis is that lymphocytes might be deactivated by an immune checkpoint in local lymph nodes, provoking their retention in there as they are unresponsive to other immune stimuli. We have identified 15 high TILs (≥50%) and 20 low TILs (≤5%) TNBC patients with localised tumour (T1c-T2N0M0) and compared the protein expression of five immune checkpoints in lymph nodes. We have also performed a customised 50-immune gene NanoString expression panel, the NanoString 360 Breast Cancer panel, and whole exome sequencing for mutation and neoantigen load analyses. In low TILs, we observed higher expression of CTLA-4 in local lymph nodes, which could explain why lymphocytes get retained in there and do not migrate to tumour. These patients have also higher neoantigen load and higher expression of B7.H3 and B7.H4 in the tumour. In high TILs, we observed more PD-L1+ tumour cells and more expanded humoral response. These results could provide a strategy to revert low tumour immune infiltration at diagnosis of TNBC, improving their prognosis. This project was supported by a grant from INTHEOS Foundation, thanks to the donation received from Pompadour, and from FERO Foundation. Peer Reviewed "Article signat per 18 autors/es: Ángela Quintana, Vicente Peg, Aleix Prat, Teresa Moliné, Guillermo Villacampa, Laia Paré, Patricia Galván, Rodrigo Dientsmann, Peter Schmid, Giuseppe Curigliano, Eva Muñoz-Couselo, José Perez-Garcia, Merce Marti, Juan Blanco-Heredia, Carla dos Anjos, Miguel Vazquez, Leticia De Mattos-Arruda, Javier Cortés"

Worldwide, motor vehicle accidents are one of the leading causes of death, with alcohol-related accidents playing a significant role, particularly in child death. Aiming to aid in the prevention of this type of accidents, a novel non-invasive method capable of detecting the presence of alcohol inside a motor vehicle is presented. The proposed methodology uses a series of low-cost alcohol MQ3 sensors located inside the vehicle, whose signals are stored, standardized, time-adjusted, and transformed into 5 s window samples. Statistical features are extracted from each sample and a feature selection strategy is carried out using a genetic algorithm, and a forward selection and backwards elimination methodology. The four features derived from this process were used to construct an SVM classification model that detects presence of alcohol. The experiments yielded 7200 samples, 80% of which were used to train the model. The rest were used to evaluate the performance of the model, which obtained an area under the ROC curve of 0.98 and a sensitivity of 0.979. These results suggest that the proposed methodology can be used to detect the presence of alcohol and enforce prevention actions.

espanolEn este trabajo abordamos la articulacion entre politica, diplomacia cultural y cine, en relacion a los vinculos de la Argentina con la Alemania nazi en el periodo previo a la declaracion de la Segunda Guerra Mundial. En primer lugar, caracterizamos las relaciones culturales entre Alemania y Argentina, atendiendo al despliegue de la diplomacia cultural alemana en el pais y a los vinculos que establecio con la comunidad local, en particular en el ambito del cine. En la segunda seccion, describimos la circulacion de cine aleman en Buenos Aires en el periodo que va desde 1935 hasta 1939, con el estallido de la guerra. Alli, analizamos el rol de las principales distribuidoras de cine aleman, sus contactos con las productoras alemanas y con cierto circuito de salas. Nos ocupamos especialmente de los titulos que fueron posteriormente censurados por considerase “propaganda nazi” en cuanto a su permanencia en cartelera y la recepcion critica. EnglishIn this work, we address the articulation between politics, cultural diplomacy and cinema, in relation to Argentina’s ties with Nazi Germany in the period prior to the declaration of World War II. First, we characterize the cultural relations between Germany and Argentina, taking into account the deployment of German cultural diplomacy in the country and the links it established with the local community, particularly in the field of cinema. In the second section, we describe the circulation of German cinema in Buenos Aires in the period from 1935 to 1939, with the outbreak of war. There, we analyzed the role of the main German cinema distributors, their contacts with German producers and with a certain theater circuit. We deal especially with the titles that were later censored for being considered «nazi propaganda» in terms of their permanence in theaters and critical reception.

Background While Balloon Guide Catheters (BGC) have been shown to increase the rate of reperfusion during mechanical thrombectomy (MT), its implementation with transfemoral approach is at times limited due to unfavorable vascular anatomy. Objective to determine safety, feasibility and performance of the transradial use of 8 F BGC Flowgate 2 during mechanical thrombectomy procedures in patients with unfavorable vascular anatomies (type 3 or bovine arch) Material/Methods: We performed a retrospective cohort study of consecutive transradial mechanical thrombectomies performed with BGC Flowgate 2 between January and December 2019. Patient demographics, procedural and radiographic metrics, and clinical data were analyzed. Results 20 (8.7%) out of 230 overall thrombectomy procedures underwent transradial approach using an 8 F BGC Flowgate. 2 Successful approach was achieved in 17/20 cases, and in 3 cases radial was switched to femoral, after failure. TICI 2 C/3 was achieved in 18 cases (90%), followed by TICI 2 b and 2a in 1 (5%) case respectively. The average number of passes was 1.8. The average radial puncture-to-first pass time was 22 min. Radial vasospasm was observed in 3/20 cases. The Flowgate 2 was found kinked in 4/20 cases (20%), all of them during right internal carotid procedures. There were no postprocedural complications at puncture site, as hematoma, pseudoaneurysm or local ischemic events Conclusion The use of 8 F Balloon Guide Catheter during MT via transradial approach might represent an alternative in selected cases with unfavorable vascular anatomies. Its use in right ICA catheterizations was associated with a high rate of catheter kinking.

Software process standards and models are used in large- and medium-sized organizations to reach the Iron Triangle. In contrast, small and very small entities either ignore them or cannot apply them because these standards and models are technically and economically not affordable. Consequently, agile software development practices are usually used by small and very small organizations. The ISO/IEC 29110 series of standards and guides are now available for very small organizations, but their utilization with agile practices represents an agility-rigor reconciliation problem. In this research, we report the experimental evaluation of Scrum + EPG (a reconciled agile-rigorous software Project Management process from Scrum, and the Project Management process of the ISO/IEC 29110 series-Entry profile, documented in an Electronic Process Guide). Scrum + EPG was compared to Scrum EPG (a non-modified Scrum process also documented in an Electronic Process Guide). Thirty-two international academicians and practitioners, including experts and novices on agile practices, from Latin America, North America, and Asia–Pacific regions, evaluated six metrics of usability. A within-subjects design and Wilcoxon matched-pairs signed-rank tests were applied for collecting and analyzing the experimental data. The statistical results support the claim that the Scrum + EPG was considered a high-quality conciliated agile-rigorous software Project Management process for the Entry profile. Given the scarcity of similar studies and the need for reconciling agile-rigorous software development practices, this study contributes to a plausible solution for very small organizations. Finally, further empirical research is encouraged to confirm, update, and extend the results reported in this investigation.

Health concerns have motivated salt reduction on diverse foods. Salt in processed meat usually reach high levels, and its reduction is not an easy task, due to its preservative action and expected sensory characteristics in them. Meat industry is looking for alternative solutions for both salt reduction and replacement. The curing time needed to reach the required salt content in meat products can be reduced by the application of ultrasound. Ultrasound technology has been applied for brining, marinating, tumbling, and cooking, with promising results as a useful strategy to reduce the salt content in meat products, such as dry-cured ham, bacon and chicken breast. However, ultrasound parameters should be optimized for each meat product, because structure and composition are diverse among products and the US effects be different. The purpose of this review is to highlight and summarize recent studies on ultrasound application to obtain low salt meat products.

Objetivo: El objetivo del presente trabajo es hacer una revisión de los casos reportados por ultrasonido de microlitiasis testicular y hacer una revisión de la literatura. Diseño: Se realizó una revisión de los ultrasonidos testiculares en los que se reportó microlitiasis testicular en el periodo comprendido del 2011 a 2018 en el Hospital “Dr. Manuel Gea González”, las variables que se analizaron fueron: edad, motivo del estudio, lado afectado y otros hallazgos. Resultados: Fueron 21 ultrasonidos con microlitiasis testicular con rango de edad de 6 a 24 años con promedio de 16 años. En el 81% afecto a ambos testículos, y en el 29% afecto el lado izquierdo. En el motivo del estudio el dolor testicular se encontró en el 33 % (7 casos), 14 % por tumor testicular (3 casos), torsión testicular 10% (2 casos), otras causas fueron varicocele, absceso y trauma testiculares. Limitaciones del estudio: Al tratarse de un estudio observacional retrospectivo, las conclusiones obtenidas son relativas. Originalidad: La microlitiasis tiene una prevalencia informada entre el 2.4% y el 3.8% en niños, se asocia a neoplasias testiculares y puede causar infertilidad. Se considera como posible etiología algunas nanobacterias que inducen las calcificaciones testiculares por lo tanto el estudio de esta patología podría modificar su tratamiento y prevenir su aparición. Conclusiones: La microlitiasis testicular es una patología rara y poco conocida que puede estar asociada a cáncer e infertilidad y al parecer su etiología puede ser infecciosa ocasionada por nanobacterias. Es una patología abierta a la investigación.

PurposeThe purpose of this paper is to analyse the important role of training (specifically, training relevance and training transfer) in enhancing franchisor-franchisee relationship satisfaction, and its influence upon customer performance (e.g., customer satisfaction, quality service), all driven by an internal marketing (IM) culture.Design/methodology/approachAn empirical study consisting of a questionnaire was conducted on a final sample of 157 individuals who are members of the franchise system. Structural equation modelling (SEM) was used to test the research hypotheses.FindingsThe results reveal that IM culture has a direct influence on training relevance; likewise, training relevance provides a positive and significant effect on training transfer, which does directly affect franchisor-franchisee relationship satisfaction and at least also impacts indirectly on customer performance.Practical implicationsIn order to ensure the success of the franchise system and customer satisfaction, all franchise parties should take a proactive role in the configuration of the training programmes. This proactive role should be conformed based on an IM culture developed properly by the franchise to strengthen a successful long-term relationship.Originality/valueThis paper provides an innovative approach to strengthen the franchisor-franchisee relationship through training based on the IM culture. This exploratory study integrates different theoretical frameworks that, to our knowledge, have not been linked, such as IM culture and franchise literature, considering the franchisee as an internal customer who has an influence on external customer satisfaction, with training and training transfer as essential key factors.

Vaccines against the severe acute respiratory coronavirus 2, which are the first to be used in humans against any coronavirus, were developed and produced in record time. Dermatologic adverse effects appeared during clinical trials and have also been described in the population since approval. Just as descriptions and categorization of skin manifestations of the coronavirus disease 2019 proved important for understanding the disease itself, characterizing the effects of vaccines may also further that goal. This paper reviews the properties of the different types of vaccines currently available and under development and describes how they interact with the immune system and the clinical signs they may cause. We focus on dermatologic adverse effects reported to date and recommendations for managing them.Las vacunas contra el SARS-CoV-2 son las primeras vacunas que han sido usadas en humanos contra coronavirus y su desarrollo se ha producido en un tiempo récord. En los análisis de seguridad de los ensayos clínicos previos a su aprobación y en la fase postautorización en la población, se han descrito efectos secundarios dermatológicos. La descripción y categorización de las manifestaciones cutáneas de la COVID-19 fueron importantes para el conocimiento de la enfermedad y de la misma forma pueden serlo las generadas por las vacunas. En este artículo hacemos un repaso a las características de los diferentes tipos de vacunas disponibles y en desarrollo, su modo de interacción con el sistema inmune, las consecuentes manifestaciones clínicas que pueden generar, con especial interés en los efectos secundarios dermatológicos hasta el momento descritos, y las actitudes terapéuticas recomendadas ante cada una de estas reacciones.

Objetivo. Resumir la evidencia científica sobre las altera­ciones renales asociadas con la infección por SARS-CoV-2. Material y métodos. Se realizó una revisión rápida con la metodología Cochrane. Resultados. La enfermedad renal crónica (ERC) preexistente en pacientes con SARS-CoV-2 varió de 1 a 38% y la lesión renal aguda (LRA), de 2.9 a 86.4%. El pronóstico de la infección fue peor en pacientes con ERC y en aquellos con reserva renal remanente (RRR) intacta que desarrollaron LRA. El riesgo de muerte fue mayor (riesgo relativo combinado = 1.49; IC95%: 1.09-2.04) en pacientes infectados por SARS-CoV-2 con ERC preexistente. Los mar­cadores de RRR mostraron alteraciones en pacientes con SARS-CoV-2 graves y fatales; el marcador más utilizado fue la creatinina sérica. Conclusiones. La evidencia científica muestra la relevancia de la evaluación y monitoreo perma­nente de la RRR en pacientes hospitalizados por SARS-CoV-2 para mejorar el pronóstico de aquellos con ERC preexistente, así como de aquellos sin ERC que desarrollan LRA.