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Background Calcium intake is below recommendations in several parts of the world. Improving calcium intake has benefits not only for bone health but also helps to prevent pregnancy hypertension disorders. Calcium concentration of tap water is usually low The aim of the present study was to determine the maximum amount of calcium that can be added to tap water while complying with drinking water Argentine regulations. Methods Tap water samples were collected from the Province of Buenos Aires (Argentina). Physicochemical properties and saturation index were measured. Different incremental concentrations of calcium chloride were added to the experimental aliquots. Results Baseline water had a mean calcium concentration of 22.00 ± 2.54 mg/L, water hardness of 89.9 ± 6.4 mg/L CaCO3, and a saturation index of -1.50 ± 0.11. After the addition of 0.4554 ± 0.0071 g of salt, water hard-ness reached 355.0 ± 7.1 mg/L CaCO3, a calcium concentration of 140.50 ± 2.12 mg/L, and a saturation index -0.53 ± 0.02. Conclusions This study shows that at laboratory level it is feasible to increase calcium concentration of drinking water by adding calcium chloride while complying with national standards. Calcium concentration of drinking tap water could be evaluated and minimum calcium concentration of tap water regulated so as to improve calcium intake in populations with low calcium intake.

Abstract Acute lymphoblastic leukemia (ALL) is the most prevalent cancer in children, and despite considerable progress in treatment outcomes, relapses still pose significant risks of mortality and long-term complications. To address this challenge, we employed a supervised machine learning technique, specifically random survival forests, to predict the risk of relapse and mortality using array-based DNA methylation data from a cohort of 763 pediatric ALL patients treated in Nordic countries. The relapse risk predictor (RRP) was constructed based on 16 CpG sites, demonstrating c-indexes of 0.667 and 0.677 in the training and test sets, respectively. The mortality risk predictor (MRP), comprising 53 CpG sites, exhibited c-indexes of 0.751 and 0.754 in the training and test sets, respectively. To validate the prognostic value of the predictors, we further analyzed two independent cohorts of Canadian (n = 42) and Nordic (n = 384) ALL patients. The external validation confirmed our findings, with the RRP achieving a c-index of 0.667 in the Canadian cohort, and the RRP and MRP achieving c-indexes of 0.529 and 0.621, respectively, in an independent Nordic cohort. The precision of the RRP and MRP models improved when incorporating traditional risk group data, underscoring the potential for synergistic integration of clinical prognostic factors. The MRP model also enabled the definition of a risk group with high rates of relapse and mortality. Our results demonstrate the potential of DNA methylation as a prognostic factor and a tool to refine risk stratification in pediatric ALL. This may lead to personalized treatment strategies based on epigenetic profiling.

Abstract The skeletal muscle contraction is determined by cross-bridge formation between the myosin heads and the actin active sites. When the muscle contracts, it shortens, increasing its longitudinal shear elastic modulus ( $${\mu }_{L}$$ μ L ). Structurally, skeletal muscle can be considered analogous to the molecular receptors that form receptor–ligand complexes and exhibit specific ligand-binding dynamics. In this context, this work aims to apply elastography and the ligand-binding framework to approach the possible intrinsic mechanisms behind muscle synergism. Based on the short-range stiffness principle and the acoustic–elasticity theory, we define the coefficient $$C$$ C , which is directly related to the fraction saturation of molecular receptors and links the relative longitudinal deformation of the muscle to its $${\mu }_{L}$$ μ L . We show that such a coefficient can be obtained directly from $${\mu }_{L}$$ μ L estimates, thus calculating it for the biceps brachii, brachioradialis, and brachialis muscles during isometric elbow flexion torque (τ) ramps. The resulting $$C\left(\tau \right)$$ C τ curves were analyzed by conventional characterization methods of receptor–ligand systems to study the dynamical behavior of each muscle. The results showed that, depending on muscle, $$C\left(\tau \right)$$ C τ exhibits typical ligand-binding dynamics during joint torque production. Therefore, the above indicates that these different behaviors describe the longitudinal shortening pattern of each muscle during load sharing. As a plausible interpretation, we suggested that this could be related to the binding kinetics of the cross-bridges during their synergistic action as torque increases. Likewise, it shows that elastography could be useful to assess contractile processes at different scales related to the change in the mechanical properties of skeletal muscle.

Key Clinical Message Streptococcus gordonii‐associated endocarditis is a rare occurrence, raising diagnostic challenges, and is often associated with considerable morbidity. However, vigilance can prevent devastating consequences. Abstract Streptococcus gordonii‐associated endocarditis is rarely reported but often associated with considerable morbidity. We describe three cases of infective endocarditis caused by S. gordonii during a four‐week period in 2023, and the use of whole‐genome sequencing to determine whether these isolates were genetically related. The available literature was reviewed.

Astrocytes play a pivotal role in maintaining brain homeostasis. Recent research has highlighted the significance of palmitic acid (PA) in triggering pro-inflammatory pathways contributing to neurotoxicity. Furthermore, Genomic-scale metabolic models and control theory have revealed that metabolic switches (MSs) are metabolic pathway regulators by potentially exacerbating neurotoxicity, thereby offering promising therapeutic targets. Herein, we characterized these enzymatic MSs in silico as potential therapeutic targets, employing protein–protein and drug–protein interaction networks alongside structural characterization techniques. Our findings indicate that five MSs (P00558, P04406, Q08426, P09110, and O76062) were functionally linked to nervous system drug targets and may be indirectly regulated by specific neurological drugs, some of which exhibit polypharmacological potential (e.g., Trifluperidol, Trifluoperazine, Disulfiram, and Haloperidol). Furthermore, four MSs (P00558, P04406, Q08426, and P09110) feature ligand-binding or allosteric cavities with druggable potential. Our results advocate for a focused exploration of P00558 (phosphoglycerate kinase 1), P04406 (glyceraldehyde-3-phosphate dehydrogenase), Q08426 (peroxisomal bifunctional enzyme, enoyl-CoA hydratase, and 3-hydroxyacyl CoA dehydrogenase), P09110 (peroxisomal 3-ketoacyl-CoA thiolase), and O76062 (Delta(14)-sterol reductase) as promising targets for the development or repurposing of pharmacological compounds, which could have the potential to modulate lipotoxic-altered metabolic pathways, offering new avenues for the treatment of related human diseases such as neurological diseases.

This study investigates the intricate relationship between Venezuelan migration and urban growth in Colombia from 2018 to 2021. The study employs remote sensing data and social network metrics to uncover migration patterns and their impact on urban expansion. The methodology consists of three stages. Firstly, nighttime satellite imagery is used to analyze year-over-year urban growth in Colombia. Secondly, social network data estimates Venezuelan migration, overcoming challenges of underreporting and informal border crossings. Lastly, an econometric analysis explores the quantitative link between Venezuelan migration and urban growth, integrating socioeconomic variables to address endogeneity. The findings reveal the complex interplay of Venezuelan migration, socioeconomic factors, and urban growth. The study outlines remote sensing analysis, introducing the Anthropogenic Footprint Expansion Index (AFEI) to quantify urban growth. Facebook API data estimates migration trends and explores socioeconomic impacts on urban expansion. The analysis uncovers migration, poverty, aging, and urban population proportion as key factors affecting Colombia's urban landscape. Furthermore, the research underscores how Venezuelan migration affected short-term urban expansion pre- and post-COVID-19. Migration had a notable effect before the pandemic, but this influence waned afterward. The study highlights migration's short-term nature and emphasizes age demographics' role in medium-term dynamics.

Resumen: La incidencia y el riesgo global de las infecciones de dispositivos de electroestimulación cardiaca (DEC) ha aumentado de manera exponencial en los últimos años con el incremento de implantes sobre una población más envejecida, que presenta más comorbilidades. La identificación de estas infecciones continúa siendo un reto por su amplia variabilidad de presentación clínica y complejidad del proceso diagnóstico. Hasta ahora, el uso de la ecocardiografía transesofágica (ETE) ha sido la técnica diagnóstica de elección. Sin embargo, la reciente incorporación de la tomografía por emisión de positrones/tomografía computarizada con 18F-Fluorodesoxiglucosa ([18F]FDG-PET/TC) ha supuesto un notable avance en este campo. La combinación de ambas técnicas permite incrementar considerablemente el diagnóstico de la afectación endovascular e intracardiaca y optimizar, por tanto, el posterior manejo terapéutico de estas infecciones. En esta revisión, presentamos un enfoque basado en las últimas evidencias publicadas en la literatura para el diagnóstico de la infección de DEC. Abstract: The incidence of cardiac implantable electronic device (CIED) infections has increased remarkably in recent years, with the higher implantation rate in an older population with more comorbidities. Diagnosing CIED infection is challenging due to the wide variability of clinical presentation and the complexity of the diagnostic process. To date, transesophageal echocardiography (TEE) has been the key in the diagnostic algorithm process. However, the recent introduction of 18F-Fluorodeoxyglucose positron emission tomography/computed tomography ([18F] FDG-PET/CT) has brought notable progress in this field, especially in local CIED infections. Nevertheless, combining both techniques increase the diagnosis yield on endovascular and intracardiac-lead systemic infections. In this review, we present an approach based on the latest evidence published in the literature to diagnose CIED infection.

Objetivo. Estimar la carga de enfermedad y económica atribuible al consumo de bebidas azucaradas en El Salvador. Métodos. Se utilizó un modelo de riesgos comparativos para estimar los efectos en muertes, eventos de salud, años perdidos por muerte prematura y discapacidad (AVAD), y costos médicos directos atribuibles al consumo de bebidas azucaradas. Resultados. Un total de 520 muertes (8 cada 100 000 individuos), 214 082 eventos en salud (3 220 cada 100 000 individuos) y 16 643 AVAD podrían ser atribuibles al consumo de bebidas azucaradas en El Salvador, lo que representa $69,35 millones (dólar americano) en costos médicos directos para el año 2020. En particular, los eventos de diabetes tipo 2 (DBT2) atribuibles al consumo de bebidas azucaradas podrían llegar a representar más del 20% del total de casos de DBT2 para el país. Conclusión. Un elevado número de muertes, eventos y costos podrían atribuirse al consumo de bebidas azucaradas en El Salvador

Abstract: Sugar-sweetened beverages (SSBs) are a major source of added sugar and are associated with noncommunicable diseases (NCDs) such as obesity and diabetes. This study assessed the impact of SSBs consumption on disease burden in Brazil, including deaths, disability-adjusted life years (DALYs), and healthcare costs. A 3-stage methodology was used to assess the direct effects of SSBs on diabetes, cardiovascular diseases, and body mass index (BMI), along with the influence of BMI on disease incidence. These assessments were then used to estimate the economic and health burden using population-attributable factors. Results showed that 2.7% and 11% of adult and children overweight/obesity cases were attributable to SSBs, respectively. SSBs consumption in Brazil led to 1,814,486 cases, 12,942 deaths, 362,088 DALYs, and USD 2,915.91 million in medical costs related to diabetes, cardiovascular diseases, oncological diseases, and other NCDs. Urgent implementation of public policies is crucial to address the consumption of SSBs, recognized as a key risk factor for NCDs.

Con el objetivo de priorizar políticas públicas para disminuir el consumo de bebidas azucaradas en Argentina, Brasil, El Salvador y Trinidad y Tobago e identificar las necesidades de información relacionadas con la carga de enfermedad atribuible a su consumo se realizó un diálogo de políticas en el que participaron miembros de gobierno, organizaciones de la sociedad civil, investigadores y comunicadores de países de Latinoamérica y el Caribe. Se llevaron a cabo exposiciones y talleres deliberativos utilizándose herramientas de recolección de datos semiestructuradas y discusiones grupales facilitadas. Las intervenciones priorizadas fueron el incremento de impuestos, el etiquetado frontal, la restricción de la publicidad, promoción y patrocinio y las modificaciones del entorno escolar. La principal barrera percibida fue la interferencia de la industria alimentaria. La realización de este diálogo de decisores permitió la identificación de las políticas públicas prioritarias para disminuir el consumo de bebidas azucaradas en la región.

Las crisis humanitarias pueden presentarse en sitios afectados por amenazas químicas, físicas, biológicas y sociales, sobre todo cuando estas amenazas interaccionan entre sí y causan una sindemia. A fin de evitar las crisis, en estos sitios se hace necesario introducir medidas de mitigación que hemos enmarcado bajo el término de “escenarios humanitarios”. Debido a su naturaleza, la implementación de dichas acciones de intervención requiere de la conformación de grupos operativos multidisciplinarios y de una estrategia de trabajo que permita integrarlos con la comunidad afectada. En el caso de la población infantil, el grupo operativo recibió el nombre de unidad de riesgos infantiles en sitios contaminados (RISC), es decir, en localidades impactadas por amenazas químicas, físicas o biológicas. La estrategia consta de las siguientes seis fases: i) planificación para el estudio y la visita al sitio; ii) participación de la comunidad para identificar amenazas, vulnerabilidades y rutas de exposición (el camino que deben seguir los contaminantes desde su fuente hasta la población receptora), así como para el trabajo conjunto en las siguientes fases; iii) priorización de riesgos identificados mediante el monitoreo ambiental y uso de biomarcadores de exposición y efectos; iv) prevención de riesgos a través de la creación de diversas capacidades y alternativas para la prevención ante amenazas sindémicas (CAPAS); v) promoción para implementar las CAPAS mediante la comunicación de riesgos y la capacitación local; y vi) protección con medidas que incluyen propuestas de telesalud, progreso social e innovación para mejorar la cobertura sanitaria. La estrategia ha sido aplicada en diferentes contextos, en algunos de los cuales, ha sido enriquecida con el análisis del respeto de los derechos humanos.

Resumen: La muerte fetal es un evento de gran repercusión afectiva para los padres involucrados y su entorno. Históricamente, por diferentes razones, casi en dos tercios de los casos no es posible determinar la causa, quedando el equipo de salud inhabilitado para realizar una consejería adecuada que permita brindar a los padres la tranquilidad suficiente para enfrentar un próximo embarazo. Numerosos esfuerzos se han hecho en las últimas décadas para estandarizar los sistemas de registro de muerte fetal y su causa para proponer políticas de salud efectivas en la prevención de un próximo evento. En este artículo se realiza una revisión narrativa sobre los factores de riesgo y los avances en el estudio diagnóstico de la muerte fetal in utero. Abstract: Fetal death is an event with great affective repercussions for the parents and those close to them. Historically, for different reasons, in almost two thirds of cases it is not possible to determine the cause, leaving the health team unable to carry out adequate counseling in order to give parents sufficient peace of mind to face a next pregnancy. Numerous efforts have been made in recent decades to standardize stillbirth registration systems and their cause in order to propose effective health policies to prevent a future event. In this article, a narrative review is carried out on the risk factors and the advances in the diagnostic study of in utero fetal deaths.

Abstract Mechanisms that ensure the stability of dynamical systems are of vital importance, in particular in our globalized and increasingly interconnected world. The so-called connectivity-stability dilemma denotes the theoretical finding that increased connectivity between the components of a large dynamical system drastically reduces its stability. This result has promoted controversies within ecology and other fields of biology, especially, because organisms as well as ecosystems constitute systems that are both highly connected and stable. Hence, it has been a major challenge to find ways to stabilize complex systems while preserving high connectivity at the same time. Investigating the stability of networks that exhibit small-world or scale-free topology is of particular interest, since these topologies have been found in many different types of real-world networks. Here, we use an approach to stabilize recurrent networks of small-world and scale-free topology by increasing the average self-coupling strength of the units of a network. For both topologies, we find that there is a sharp transition from instability to asymptotic stability. Then, most importantly, we find that the average self-coupling strength needed to stabilize a system increases much slower than its size. It appears that the qualitative shape of this relationship is the same for small-world and scale-free networks, while scale-free networks can require higher magnitudes of self-coupling. We further explore the stabilization of networks with Kronecker-Leskovec topology. Finally, we argue that our findings, in particular the stabilization of large recurrent networks through small increases in the unit self-regulation, are of practical importance for the stabilization of diverse types of complex systems.

Abstract The aim of this study was to analyse the differences in the A–S profile of elite football players induced by playing position and the microcycle day. Players belonged to a second division club in the Spanish La Liga competition. They were classified into five playing positions: central defenders (CD), full backs (FB), midfielders (MF), wide midfielders (WMF) and forwards (FW). Microcycle days were categorised according to the days until matchday (MD, MD-1, MD-2, MD-3, MD-4 and MD-5). Data was collected along six microcycles, including one match per microcycle. The variables analysed were: maximal theoretical acceleration (A0), maximal theoretical speed (S0), maximal acceleration (ACCmax), maximal speed (Smax) and A–S slope (ASslope). Significant differences were found within positions and microcycle day for all variables (p

Introduction: Monkeypox virus (MPXV) is an enveloped double-stranded DNA virus with a genome of approximately 197.209 bp. The current classification divides MPXV into three clades: Clade I (Central African or Congo Basin clade) and clades IIa and IIb (West African clades). Objective: To report the complete genome and phylogenetic analysis of a human monkeypox case detected in Colombia. Materials and methods: Exudate from vesicular lesions was obtained from a male patient with recent travel history to Spain. A direct genomic approach was implemented in which total DNA from the sample was purified through a column-based method, followed by sequencing on the Nanopore GridION. Reads were aligned against the MPXV reference genome using minimap2 v.2.24 and phylogenetic inference was performed using maximum likelihood estimation. Results: A total of 11.951 reads mapped directly to a reference genome with 96.8% of coverage (190.898 bp). Conclusion: Phylogenetic analysis of the MPXV circulating in Colombia demonstrated its close relationship to clade IIb responsible for the multi-country outbreak in 2022.

Introduction: The pinna, due to its anatomical situation is susceptible to a series of traumatic or pathological injuries, making its reconstruction a real challenge for the surgeon in charge of maintaining symmetry with the contralateral pinna as its complex structure. Objective: To present a patient who underwent partial reconstruction of the pinna due to blunt traumatic injury. Case Report: Patient attended in emergency with loss of the helical border, after a fight, suffered blunt trauma with avulsive injury of the pinna. Reconstruction was performed with a versatile and simple technique, which requires compliance with all the requirements of asepsis, adequate suturing and anatomical repair, to expect good postoperative results, including from the aesthetic point of view. Conclusions: Early care, aseptic and antisepsis conditions, with a surgical technique according to Weerda's classification, are important to achieve adequate aesthetic results, without complications.

Introducción: las caídas son la principal manifestación de accidente en el adulto mayor; existen varios clasificadores del riesgo de caer. Objetivo: comparar las escalas de Downton y de Tinetti en la clasificación del riesgo de caída en el adulto mayor. Métodos: se realizó una investigación analítica, transversal en el Consultorio 16-6 del Policlínico “Santa Clara”, de la Provincia Villa Clara, en el año 2017. Se seleccionaron por muestreo aleatorio simple 61 individuos del total adultos mayores dispensarizados. Se recolectaron los datos procedentes de las historias clínicas en una guía elaborada con fines investigativos. En el análisis estadístico se emplearon las pruebas de independencia de Chi cuadrado y la V de Cramer; se modificó la escala de Tinetti mediante punto de corte óptimo por curva ROC y se comparó con la escala de Downton y con la prueba de Mc Nemar y el índice de Kappa. Resultados: el riesgo a caer aumenta con la edad y es mayor en el sexo femenino. Son factores de riesgo a caer la caída previa, la deambulación dificultosa, el uso de medicamentos y el déficit sensorial. Hubo relación significativa de la edad y el sexo respecto a la clasificación a caer en ambas pruebas. La caída previa y la deambulación no normal mostraron una correlación fuerte. Ambas pruebas resultaron ser significativamente iguales, con buena concordancia e índice de Kappa de 0,704. Conclusiones: las escalas de Downton y de Tinetti son similares en la clasificación de riesgo al caer, por lo que pueden ser útiles en la atención primaria de salud.

Introducción: Las fracturas por heridas de arma de fuego son un motivo de consulta habitual en nuestro país. Existe gran variabilidad de conductas respecto a su tratamiento. El objetivo principal de este trabajo es analizar los distintos tratamientos y sus indicaciones. Materiales: Se realizó una revisión sistematizada de la literatura en las bases de datos Pubmed y Scielo. Se incluyeron artículos con fracturas por herida de arma de fuego en miembros superiores e inferiores, excluyendo la mano. Se analizó: tratamiento (ortopédico o quirúrgico), debridamiento, antibioticoterapia y complicaciones. Resultados: Se obtuvieron 19 artículos que cumplían los criterios de inclusión y exclusión. Los artículos tuvieron un Nivel de Evidencia tipo 2b, 3 y 4. Conclusiones: Los artículos analizados tienen un bajo nivel de evidencia. La fijación quirúrgica es variable y depende de la topografía ósea, la lesión de partes blandas y las lesiones asociadas. El debridamiento profundo está relacionado con mayores índices de infección. Las fracturas estables de tratamiento ortopédico no deberían debridarse ya que aumenta los índices de infección. Debería realizarse antibioticoterapia intravenosa inicial en todos los pacientes, la terapia posterior es discutida.

ObjectiveTo examine the associations of sociodemographic, socioeconomic, and behavioral factors with depression, anxiety, and self-reported health status during the COVID-19 lockdown in Ecuador. We also assessed the differences in these associations between women and men.Design, setting, and participantsWe conducted a cross-sectional survey between July to October 2020 to adults who were living in Ecuador between March to October 2020. All data were collected through an online survey. We ran descriptive and bivariate analyses and fitted sex-stratified multivariate logistic regression models to assess the association between explanatory variables and self-reported health status.Results1801 women and 1123 men completed the survey. Their median (IQR) age was 34 (27-44) years, most participants had a university education (84%) and a full-time public or private job (63%); 16% of participants had poor health self-perception. Poor self-perceived health was associated with being female, having solely public healthcare system access, perceiving housing conditions as inadequate, living with cohabitants requiring care, perceiving difficulties in coping with work or managing household chores, COVID-19 infection, chronic disease, and depression symptoms were significantly and independently associated with poor self-reported health status. For women, self-employment, having solely public healthcare system access, perceiving housing conditions as inadequate, having cohabitants requiring care, having very high difficulties to cope with household chores, having COVID-19, and having a chronic disease increased the likelihood of having poor self-reported health status. For men, poor or inadequate housing, presence of any chronic disease, and depression increased the likelihood of having poor self-reported health status.ConclusionBeing female, having solely public healthcare system access, perceiving housing conditions as inadequate, living with cohabitants requiring care, perceiving difficulties in coping with work or managing household chores, COVID-19 infection, chronic disease, and depression symptoms were significantly and independently associated with poor self-reported health status in Ecuadorian population.

BackgroundApproximately two-thirds of Argentine adults are overweight or obese, and 11% have diabetes. Over the last two decades, all population groups have increased their consumption of ultra-processed foods and sugar-sweetened beverages (SSB). We aimed to estimate the disease burden-deaths, events, and costs to the health system-attributed to SSB consumption in Argentina.MethodsWe used a comparative risk assessment framework to estimate the health and economic impacts that would be avoided in a scenario without sugar-sweetened beverage (SSB) consumption. We calculated the direct effects on diabetes, cardiovascular disease, and BMI, and then estimated the effects of BMI on disease incidence. Finally, we applied the population attributable factor to calculate the health and economic burden avoided in Argentina in 2020.ResultsOur model estimated that about 4,425 deaths, 110,000 healthy life years lost to premature death and disability, more than 520,000 cases of overweight and obesity in adults, and 774,000 in children and adolescents would be attributed to SSB Consumption in Argentina. This disease burden corresponds to 23% of type-2 diabetes cases and other significant proportions of cardiovascular disease and cancer. The overweight and obesity costs attributable to SSB totaled approximately $47 million in adults and $15 million in children and adolescents.ConclusionA significant number of disease cases, deaths, and health care costs could be attributed to SSB consumption in Argentina. Implementing measures to reduce the sugar content in beverages is a pending debt for the country and could lead to measurable improvements in population health, especially among children and adolescents.

Introduction Healthcare fragmentation, a main cause for delay in cancer diagnosis and treatment, contributes to high mortality in Latin America (LA), particularly among disadvantaged populations. This research focuses on integrated care interventions, which have been limitedly implemented in the region. The objective is to evaluate the contextual effectiveness of scaling-up an integrated care intervention to improve early diagnosis of frequent cancers in healthcare networks of Chile, Colombia and Ecuador.Methods and analysis This research is two pronged: (A) quasi-experimental design (controlled before and after) with an intervention and a control healthcare network in each LA country, using an implementation-effectiveness hybrid approach to assess the intervention process, effectiveness and costs; and (B) case study design to analyse access to diagnosis of most frequent cancers. Focusing on the most vulnerable socioeconomic population, it develops in four phases: (1) analysis of delays and barriers to early diagnosis (baseline); (2) intervention adaptation and implementation (primary care training, fast-track referral pathway and patient information); (3) intracountry evaluation of intervention and (4) cross-country analysis. Baseline and evaluation studies adopt mixed-methods qualitative (semistructured individual interviews) and quantitative (patient questionnaire survey) methods. For the latter, a sample size of 174 patients with cancer diagnosis per healthcare network and year was calculated to detect a proportions difference of 15%, before and after intervention (α=0.05; β=0.2) in a two-sided test. A participatory approach will be used to tailor the intervention to each context, led by a local steering committee (professionals, managers, policy makers, patients and researchers).Ethics and dissemination This study complies with international and national legal stipulations on ethics. It was approved by each country’s ethical committee and informed consent will be obtained from participants. Besides the coproduction of knowledge with key stakeholders, it will be disseminated through strategies such as policy briefs, workshops, e-tools and scientific papers.

Objectives To estimate the risk factors for SARS-CoV-2 transmission in close contacts of adults at high risk of infection due to occupation, participants of the CoVIDA study, in Bogotá D.C., Colombia.Setting The CoVIDA study was the largest COVID-19 intensified sentinel epidemiological surveillance study in Colombia thus far, performing over 60 000 RT-PCR tests for SARS-CoV-2 infection. The study implemented a contact tracing strategy (via telephone call) to support traditional surveillance actions performed by the local health authority.Participants Close contacts of participants from the CoVIDA study.Primary and secondary outcome measures SARS-CoV-2 testing results were obtained (RT-PCR with CoVIDA or self-reported results). The secondary attack rate (SAR) was calculated using contacts and primary cases features.Results The CoVIDA study performed 1257 contact tracing procedures on primary cases. A total of 5551 close contacts were identified and 1050 secondary cases (21.1%) were found. The highest SAR was found in close contacts: (1) who were spouses (SAR=32.7%; 95% CI 29.1% to 36.4%), (2) of informally employed or unemployed primary cases (SAR=29.1%; 95% CI 25.5% to 32.8%), (3) of symptomatic primary cases (SAR of 25.9%; 95% CI 24.0% to 27.9%) and (4) living in households with more than three people (SAR=22.2%; 95% CI 20.7% to 23.8%). The spouses (OR 3.85; 95% CI 2.60 to 5.70), relatives (OR 1.89; 95% CI 1.33 to 2.70) and close contacts of a symptomatic primary case (OR 1.48; 95% CI 1.24 to 1.77) had an increased risk of being secondary cases compared with non-relatives and close contacts of an asymptomatic index case, respectively.Conclusions Contact tracing strategies must focus on households with socioeconomic vulnerabilities to guarantee isolation and testing to stop the spread of the disease.

The decline in vaccination coverage associated with the population’s mistrust of vaccines has been defined as a global health threat. Adopting a qualitative approach centered on the social significance of vaccines, we conducted semi-structured interviews with mothers and fathers in the City of Buenos Aires between July and December 2020. We describe and analyze their knowledge and the arguments used to justify their acceptance or reluctance to vaccinate their children in the context of COVID-19. The results show that the studied population possesses knowledge about vaccines and accepts them as a preventive practice. Nonetheless, it was possible to identify a broad spectrum of attitudes towards vaccination, including more reticent positions based on concerns regarding their safety, adverse effects, and the need to apply them for eradicated diseases, proposing vaccination as an optional and complementary practice to other care practices. Arguments are organized under the assumption of individual and moral responsibility for health care, an expression of the current sociocultural and health backdrop.

Abstract To design a new subperiosteal implant structure for patients suffering from severe Maxillary Atrophy that lowers manufacturing cost, shortens surgical time and reduces patient trauma with regard to current implant structures. A 2-phase finite-element-based topology optimization process was employed with implants made from biocompatible materials via additive manufacturing. Five bite loading cases related to standard chewing, critical chewing force, and worst conditions of fastening were considered along with each specific result to establish the areas that needed to be subjected to fatigue strength optimization. The 2-phase topological optimization tested in this study performed better than the reference implant geometry in terms of both the structural integrity of the implant under tensile-compressive and fatigue strength conditions and the material constraints related to implant manufacturing conditions. It returns a nearly 28% lower volumetric geometry and avoids the need to use two upper fastening screws that are required with complex surgical procedures. The combination of topological optimization methods with the flexibility afforded by additively manufactured biocompatible materials, provides promising results in terms of cost reduction, minimizing the surgical trauma and implant installation impact on edentulous patients.

Resumen Background and objective. Due to the cosmetic and functional implications, scars in children represent a concern for patients and their parents. Currently, there are multiple lines of treatment with variable effectiveness. Adipose tissue transfer is a relatively new alternative in the treatment of different alterations including scars, because this tissue contains among other elements growth, angiogenic and antiapoptotic factors, in addition to a reserve of mesenchymal stem cells with the ability to replicate indefinitely and differentiate into several cell types that can promote the reorganization and regeneration of tissue. We show the results of the use of fat graft for treatment of pathological scars in a series of pediatric patients. We base its use on the satisfactory effects found on scars in adults to suggest this method as an alternative in the management in children, considering that this technique represents an emerging treatment for the management of this condition in this age group. Methods. Retrospective, observational, non-randomized study, carried out in pediatric patients underwent to autologous fat grafts for the management of pathological scars during the period from January 2016 to January 2018. The scars were treated with autologous fat grafts and evaluated before the procedure and 3 and 6 postoperative months, using the Vancouver scale. The data obtained were statistically analyzed using the Wilcoxon rank test. Results. Nine patients were included in the study (5 women and 4 men) with an age range of 2 to 17 years (average 8.8 years). A statistically significant reduction in the averages of the variables vascularization, elasticity and in total score of the Vancouver scale (p value

Objetivo: Determinar la prevalencia de estudios complementarios (EC) en sujetos con afecciones de columna que acuden al Servicio de Kinesiología de un hospital público de la Ciudad Autónoma de Buenos Aires. Como objetivos secundarios, nos planteamos calcular costos directos producto de los EC en sujetos con dolor lumbar (DL), dolor cervical (DC) y prevalencia de banderas rojas en DL. Materiales y método: Estudio transversal. Se incluyeron sujetos con afección de columna vertebral, mayores de 18 años y que firmaron el consentimiento informado. Resultados: La prevalencia de EC para la población general fue de 83%. El 87,5% de los sujetos con DL presentó al menos una bandera roja. El costo total de los EC fue de $210133 (US$3431) y el costo promedio por sujeto fue de $1129 (US$18) en la población general. Conclusión: La prevalencia de EC de los sujetos con afecciones de columna fue del 83%, lo que generó un costo promedio de $1129 (US$18) por sujeto. Al evaluar la presencia de banderas rojas, el 87,5% de los sujetos con DL presentó al menos una.

Dystonia is often associated with functional alterations in the cerebello-thalamic pathways, which have been proposed to contribute to the disorder by propagating pathological firing patterns to the forebrain. Here, we examined the function of the cerebello-thalamic pathways in a model of DYT25 dystonia. DYT25 (Gnal+/−) mice carry a heterozygous knockout mutation of the Gnal gene, which notably disrupts striatal function, and systemic or striatal administration of oxotremorine to these mice triggers dystonic symptoms. Our results reveal an increased cerebello-thalamic excitability in the presymptomatic state. Following the first dystonic episode, Gnal+/- mice in the asymptomatic state exhibit a further increase of the cerebello-thalamo-cortical excitability, which is maintained after θ-burst stimulations of the cerebellum. When administered in the symptomatic state induced by a cholinergic activation, these stimulations decreased the cerebello-thalamic excitability and reduced dystonic symptoms. In agreement with dystonia being a multiregional circuit disorder, our results suggest that the increased cerebello-thalamic excitability constitutes an early endophenotype, and that the cerebellum is a gateway for corrective therapies via the depression of cerebello-thalamic pathways.

Resumen: Antecedentes: La pandemia global de COVID-19 llega al continente americano en marzo del año 2020 y en menos de dos meses reúne a más de la mitad de los casos a nivel global. Objetivo: Caso clínico de una mujer embarazada con una presentación crítica de COVID-19 y embarazo a las 25 semanas de gestación, en el contexto del peak de la pandemia en Chile en el otoño del año 2020. Caso Clínico: El 20 de junio de 2020, una mujer de 34 años, con 25 semanas de embarazo, es trasladada desde Hospital de San Bernardo a Clínica Las Condes en Santiago, Chile, con un cuadro de 10 días de evolución de COVID-19, que evoluciona a una situación crítica con insuficiencia respiratoria severa. Ingresa a unidad de cuidados intensivos para ventilación mecánica. Las imágenes de radiología simple y de tomografía axial computarizada de tórax demuestran una neumopatía bilateral con imágenes características opacidades en vidrio esmerilado, asociado a engrosamiento intersticial, imágenes descritas previamente como características para COVID-19. La paciente permanece en unidad de cuidados intensivos en ventilación mecánica por siete días, con evolución favorable posterior, mejoría del cuadro séptico y alta después de 22 días de hospitalización. El parto ocurre en forma espontánea a las 38 semanas, la madre y el recién nacido evolucionan en buen estado general. El examen histopatológico placentario demuestra compromiso inflamatorio vellositario y los exámenes de anticuerpos en sangre del recién nacido demuestran la presencia de anticuerpos del tipo IgG e IgM. Se trata de uno de los pocos casos demostrados reportados de transmisión transplacentaria vía sanguínea de SARS-CoV-2 de la madre al recién nacido. Summary: Background: The global COVID-19 pandemic reaches the American continent in March 2020 and in less than two months it brings together more than half of the cases globally. Objective: The clinical case of a 25-week pregnant woman with a critical presentation of COVID-19 and pregnancy at 25 weeks of gestation, is presented in the context of the peak of the pandemic in Chile in the fall of 2020. Clinical case: On June 20, 2020, a 34-year-old woman, 25 weeks pregnant, is transferred from Hospital de San Bernardo to Clinica Las Condes in Santiago, Chile, with a ten-day evolution of a COVID-19 that evolves to critical with severe respiratory failure. She is admitted to the intensive care unit for mechanical ventilation. Chest computerized axial tomography images demonstrate bilateral pneumopathy with characteristic images of ground-glass opacities, associated with interstitial thickening, images previously described as characteristics for COVID-19. The patient remains in the intensive care unit on mechanical ventilation for seven days, with subsequent favorable evolution, improvement of the septic condition, and discharge after 22 days of hospitalization. Delivery occurs at 38 weeks, the mother and the newborn evolve in good general condition. The placental histopathological examination demonstrates villous inflammatory involvement, and the newborn's blood tests show the presence of IgG and IgM antibodies. It is one of the few reported cases of transplacental transmission of SARS-CoV-2 from the mother to the newborn.

Abstract Objective To describe the calcium concentration of tap and bottled waters from Argentina and to estimate the contribution of drinking water to calcium recommendations. Results Calcium concentrations provided by water authorities ranged from 6 to 105 mg/L. The mean calcium level of samples analysed at the Laboratorio de Ingeniería Sanitaria, National University of La Plata was 15.8 (SD ± 13.2) mg/L and at the Bone Biology Laboratory of the National University of Rosario was 13.1 (± 10.0) mg/L. Calcium values of samples from supply systems and private wells was similar. Most bottled waters had calcium levels well below 50 mg/L. The intake of one litre of drinking water from Argentina could represent in average between 1.2 and 8.0% of the calcium daily values for an adult.

Ovarian epithelial cancer (OEC) is the most lethal gynecologic malignancy. Despite current chemotherapeutic and surgical options, this high lethality can be attributed to multiple factors, including late-stage presentation. In order to optimize OEC treatment, it is important to highlight that it is composed of five main subtypes: high-grade serous ovarian carcinoma (HGSOC), low-grade serous ovarian carcinoma (LGSOC), endometrioid ovarian carcinoma (EOC), ovarian clear cell carcinoma (CCOC), and mucinous ovarian carcinoma (MOC). These subtypes differ in their precursor lesions, as well as in epidemiological, morphological, molecular and clinical features. OEC is one of the tumours in which most pathogenic germline mutations have been identified. Accordingly, up to 20% OC show alterations in BRCA1/2 genes, and also, although with a lower frequency, in other low penetrance genes associated with homologous recombination deficiency (HRD), mismatch repair genes (Lynch syndrome) and TP53. The most important prognostic factor is the 2014 FIGO staging, while older age is also associated with worse survival. HGSOC in all stages and CCC and MOC in advanced stages have the worse prognosis among histological types. Molecular markers have emerged as prognostic factors, particularly mutations in BRCA1/2, which are associated with a better outcome. Regarding treatment, whereas a proportion of HGSOC is sensible to platinum-based treatment and PARP inhibitors due to HRD, the rest of the histological types are relatively chemoresistant. New treatments based in specific molecular alterations are being tested in different histological types. In addition, immunotherapy could be an option, especially for EOC carrying mismatch repair deficiency or POLE mutations.

In March 2015, a patient in Colombia with HIV/AIDS was hospitalized for disseminated ulcers after milking cows that had vesicular lesions on their udders. Vaccinia virus was detected, and the case met criteria for progressive vaccinia acquired by zoonotic transmission. Adherence to an optimized antiretroviral regimen resulted in recovery.

Introducción: la vena porta origina clásicamente de la confluencia de las venas mesentérica superior y tronco espleno mesentérico, conformado por las venas esplénica y mesentérica inferior. Su conformación y principales afluentes no escapa de presentar variaciones anatómicas, las cuales el cirujano debe conocer y anticipar, al momento del abordaje del macizo duodeno pancreático en vistas a evitar consecuencias catastróficas. El objetivo es el estudio de la conformación, dimensiones y disposición espacial de la vena porta en su origen, y sus principales afluentes. Materiales y método: se utilizaron 50 cadáveres formolados. Se registró origen de la vena porta, calibre de la misma y sus afluentes. ángulos de abocamiento y nivel vertebral de proyección. Resultados: se distinguieron tres tipos de origen. Se registró el tipo I en el 78% de los casos, tipo II en el 18% y tipo III en el 4%. Los calibres fueron: vena porta 16,12 mm, mesentérica superior 11,77 mm, esplénica 9,34 mm, mesentérica inferior 5,03 mm y tronco esplenomesaraico de 10,44 mm. Este último, alcanzó una longitud de 20,26 mm. Los ángulos fueron: ángulo porta - tronco esplenomesenterico 124,18°, ángulo mesentérica superior - tronco esplenomesenterico 101,92° y ángulo mesentérica inferior - esplénica 75,4°. En el 75% de los casos el nivel de proyección vertebral fue el tercio superior de L2. Conclusiones: El origen mas frecuente fue el clásicamente descrito. De sus variantes, es mas constante la reunión de la vena mesentérica superior con la vena esplénica, y mas variable la desembocadura de la vena mesentérica inferior.

Objetivo: Identificar las creencias de los deportistas acerca del dolor lumbar. Como objetivo secundario, proponemos averiguar si las creencias reportadas difieren según la experiencia del dolor lumbar. Materiales y método: Estudio transversal tipo encuesta. Se invitó a atletas (recreacionales, amateurs y profesionales), mayores de 18 años con o sin dolor lumbar, a participar de una encuesta online a través de las redes sociales. Se utilizó el cuestionario Back Pain Attitudes Questionnaire (Back-PAQ) para evaluar las creencias sobre la espalda. Las opciones de las preguntas del Back-PAQ fueron clasificadas como “positivas”, “neutras” o “negativas”. Resultados: Un total de 1591 respuestas fueron incluidas en el análisis. La media del puntaje total del Back-PAQ fue 113,1 (Intervalo de Confianza 95%, 112,5 - 113,7) con un puntaje mínimo de 63 y máximo de 148. No se encontraron diferencias estadísticamente significativas entre los grupos observados (p= 0,51). Los atletas con dolor actual tuvieron creencias menos útiles que aquellos con historia de dolor lumbar: mediana de 115 (rango intercuartílico 108 - 121) versus 113 (rango intercuartílico 105 - 120); p= 0,002. Conclusión: Los atletas presentaron creencias predominantemente negativas sobre el dolor de espalda, independientemente del nivel de competencia. Prevalecieron los conceptos erróneos sobre la vulnerabilidad de la espalda y la necesidad de protegerla. Se expresaron creencias positivas sobre el pronóstico de un episodio de dolor lumbar.

Introduction Globally, medical students have demonstrated knowledge gaps in emergency care and acute stabilization. In Colombia, new graduates provide care for vulnerable populations. The World Health Organization (WHO) Basic Emergency Care (BEC) course trains frontline providers with limited resources in the management of acute illness and injury. While this course may serve medical students as adjunct to current curriculum, its utility in this learner group has not been investigated. This study performs a baseline assessment of knowledge and confidence in emergency management taught in the BEC amongst medical students in Colombia. Methods A validated, cross-sectional survey assessing knowledge and confidence of emergency care congruent with BEC content was electronically administered to graduating medical students across Colombia. Knowledge was evaluated via 15 multiple choice questions and confidence via 13 questions using 100 mm visual analog scales. Mean knowledge and confidence scores were compared across demographics, geography and prior training using Chi-Squared or one-way ANOVA analyses. Results Data were gathered from 468 graduating medical students at 36 institutions. The mean knowledge score was 59.9% ± 23% (95% CI 57.8–62.0%); the mean confidence score was 59.6 mm ±16.7 mm (95% CI 58.1–61.2). Increasing knowledge and confidence scores were associated with prior completion of emergency management training courses (pConclusion Knowledge and confidence levels of emergency care management for graduating medical students across Colombia demonstrated room for additional, specialized training. Higher scores were seen in groups that had completed emergency care courses. Implementation of the BEC as an adjunct to current curriculum may serve a valuable addition.

BackgroundGlobally, tobacco consumption continues to cause a considerable burden of preventable diseases. Although the smoking prevalence in Nigeria may be declining over the last years, the absolute number of active smokers remains one of the highest in Africa. Little is known about the disease burden and economic costs of cigarette smoking in Nigeria. Consequently, there is an evidence gap to inform the design and implementation of an effective policy for tobacco control.MethodsWe applied a microsimulation model to estimate the burden attributable to smoking in terms of morbidity, mortality, disability-adjusted life-years (DALYs), and direct medical costs and indirect costs (e.g., productivity loss costs, informal caregivers' costs). We also modeled the health and economic impact of different scenarios of tobacco price increases through taxes.ResultsWe estimated that smoking is responsible for approximately 29,000 annual deaths in Nigeria. This burden corresponds to 816,230 DALYs per year. In 2019, the total economic burden attributable to tobacco was estimated at ₦ 634 billion annually (approximately U$D 2.07 billion). If tobacco cigarettes' prices were to be raised by 50% through taxes, more than 30,000 deaths from smoking-attributable diseases would be averted in 10 years, with subsequent savings on direct and indirect costs of ₦597 billion and increased tax revenue collection of ₦369 billion.ConclusionIn Nigeria, tobacco is responsible for substantial health and economic burden. Increasing tobacco taxes could reduce this burden and produce net economic benefits.

Introducción: la equinococosis quística músculo-esque­lética es poco frecuente, pudiendo determinar retrasos diagnósticos y errores terapéuticos. Reporte de caso: presentamos el caso de un paciente con un quiste hidático primario único a nivel de la región femoral posterior derecha, infectado. Discusión: se realizó una revisión en las bases de datos PubMed y LILACS sobre el diagnóstico y manejo terapéutico de los quistes hidáticos músculo-esqueléticos primarios. Conclusiones: la equinococosis quística músculo-esquelética debe ser tenida en cuenta dentro de los diagnósticos diferenciales de tumoraciones de partes blandas en pacientes provenientes de zonas endémicas. La tomografía computada y/o resonancia magnética cumplen un rol diagnóstico y de planificación terapéutica. El tratamiento es quirúrgico, a medida del paciente y del quiste, en función de su topografía, tamaño y fundamentalmente relaciones vasculo nerviosas y musculares. Otros factores a tener en cuenta son las futuras secuelas funcionales y resultados estéticos.

Introducción: a nivel mundial, la pandemia COVID-19 determinó una disminución significativa en el volumen de cirugía electiva. Existe preocupación por parte de generaciones de residentes quirúrgicos debido a las consecuencias en su formación. Si bien la formación alcanza otros aspectos que exceden a la práctica quirúrgica, ésta no deja de ser un pilar fundamental. Objetivo: cuantificar el impacto de la pandemia COVID-19 en el volumen asistencial de los residentes de cirugía general en un servicio universitario. Método: es un estudio observacional, retrospectivo y analítico. Se comparó el volumen quirúrgico y asistencial de los residentes de cirugía general durante el período entre el 13/03/2020 y el 13/12/2020, posterior al inicio de la pandemia COVID-19, con el volumen registrado en el mismo período previo al inicio de la pandemia. Resultados: todos los residentes participaron en un menor número de cirugías. El mayor impacto fue en la participación de cirugías de coordinación, siendo menores las diferencias en la cirugía de urgencia. El mayor impacto en cuanto a volumen de pacientes operados fue para el residente de primer año. Discusión y conclusiones: a nivel mundial, la pandemia determinó una notoria disminución en el volumen de cirugías electivas. Este trabajo demostró una disminución significativa en el volumen quirúrgico asistencial del residente de cirugía general, por lo que, de prolongarse las medidas sanitarias, sería sustancial evaluar la necesidad de proyectar objetivos e instancias alternativas de aprendizaje.

Resumen: El ámbito laboral tiene un gran potencial para difundir información e implementar actividades de promoción de la salud, como la prevención y detección temprana del cáncer. Debido al desafío de implementar intervenciones sanitarias en este ámbito, se necesitan investigaciones formativas para adecuar el diseño y la implementación de las estrategias para que sean exitosas. Con el objetivo de informar el diseño e implementación de la intervención, para mejorar la tasa de adherencia al tamizaje con el test de sangre oculta en materia fecal, en un ámbito laboral en Argentina, se realizó una investigación formativa para identificar potenciales barreras y facilitadores. La investigación formativa siguió un diseño metodológico cualitativo. Se realizaron entrevistas con 10 responsables de áreas clave de la institución en que se desarrolló el estudio y 8 grupos focales con trabajadores mayores de 50 años. Se identificaron desafíos para la implementación de la intervención en el nivel institucional, como la dispersión geográfica de los trabajadores y la complejidad del organigrama de la institución, y en el nivel de la población objetivo, como el bajo conocimiento del cáncer colorrectal y de los test diagnósticos, así como la baja percepción de riesgo. Entre los facilitadores se destacaron la aceptabilidad de la intervención, además de la disponibilidad de recursos humanos y materiales para llevar adelante la intervención, como canales de comunicación institucional para la diseminación de información, así como la logística para la distribución de kits diagnósticos. La investigación formativa permitió relevar recursos e identificar potenciales barreras que informaron el diseño y la implementación de la intervención.

The development of simple, reliable, and cost-effective methods is critically important to study the spatial and temporal variation of microcystins (MCs) in the food chain. Nanobodies (Nbs), antigen binding fragments from camelid antibodies, present valuable features for analytical applications. Their small antigen binding site offers a focused recognition of small analytes, reducing spurious cross-reactivity and matrix effects. A high affinity and broad cross-reactivity anti-MCs-Nb, from a llama antibody library, was validated in enzyme linked immunosorbent assay (ELISA), and bound to magnetic particles with an internal standard for pre-concentration in quantitative-matrix-assisted laser desorption ionization-time of flight mass spectrometry (Nb-QMALDI MS). Both methods are easy and fast; ELISA provides a global result, while Nb-QMALDI MS allows for the quantification of individual congeners and showed excellent performance in the fish muscle extracts. The ELISA assay range was 1.8–29 ng/g and for Nb-QMALDI, it was 0.29–29 ng/g fish ww. Fifty-five fish from a MC-containing dam were analyzed by both methods. The correlation ELISA/sum of the MC congeners by Nb-QMALDI-MS was very high (r Spearman = 0.9645, p < 0.0001). Using ROC curves, ELISA cut-off limits were defined to accurately predict the sum of MCs by Nb-QMALDI-MS (100% sensitivity; ≥89% specificity). Both methods were shown to be simple and efficient for screening MCs in fish muscle to prioritize samples for confirmatory methods.

Dengue is a disease of high interest for public health in the affected localities. Dengue virus is transmitted by Aedes species and presents hyperendemic behaviors in tropical and subtropical regions. Colombia is one of the countries most affected by the dengue virus in the Americas. Its central-west region is a hot spot in dengue transmission, especially the Department of Antioquia, which has suffered from multiple dengue outbreaks in recent years (2015–2016 and 2019–2020). In this article, we perform a retrospective analysis of the confirmed dengue cases in Antioquia, discriminating by both subregions and dengue severity from 2015 to 2020. First, we conduct an exploratory analysis of the epidemic data, and then a statistical survival analysis is carried out using a Cox regression model. Our findings allow the identification of the hazard and socio-demographic patterns of dengue infections in the Colombian subtropical region of Antioquia from 2015 to 2020.

Abstract Acute respiratory infections, a large part being of viral origin, constitute a major public health issue. To propose alternative and/or new therapeutic approaches, it is necessary to increase our knowledge about the interactions between respiratory viruses and their primary cellular targets using the most biologically relevant experimental models. In this study, we used RNAseq to characterize and compare the transcriptomic signature of infection induced by different major respiratory viruses (Influenza viruses, hRSV and hMPV) in a model of reconstituted human airway epithelia. Our results confirm the importance of several cellular pathways commonly or specifically induced by these respiratory viruses, such as the innate immune response or antiviral defense. A very interesting common feature revealed by the global virogenomic signature shared between hRSV, hMPV and influenza viruses is the global downregulation of cilium-related gene expression, in good agreement with experimental evaluation of mucociliary clearance. Beyond providing new information about respiratory virus/host interactions, our study also underlines the interest of using biologically relevant experimental models to study human respiratory viruses.

Background: Current algorithm for Congenital Chagas Disease (cCD) diagnosis is unsatisfactory due to low sensitivity of the parasitological methods. Moreover, loss to follow-up precludes final serodiagnosis after nine months of life in many cases. A duplex TaqMan qPCR kit for Trypanosoma cruzi DNA amplification was prospectively evaluated in umbilical cord (UCB) and peripheral venous blood (PVB) of infants born to CD mothers at endemic and non-endemic sites of Argentina. Methods: We enrolled and followed-up 370 infants; qPCR was compared to gold-standard cCD diagnosis following studies of diagnostic accuracy guidelines. Findings: Fourteen infants (3·78%) had cCD. The qPCR sensitivity and specificity were higher in PVB (72·73%, 99·15% respectively) than in UCB (66·67%, 96·3%). Positive and negative predictive values were 80 and 98·73% and 50 and 98·11% for PVB and UCB, respectively. The Areas under the Curve (AUC) of ROC analysis for qPCR and micromethod (MM) were 0·81 and 0·67 in UCB and 0·86 and 0·68 in PVB, respectively. Parasitic loads ranged from 37·5 to 23,709 parasite equivalents/mL. Discrete typing Unit Tc V was identified in five cCD patients and in six other cCD cases no distinction among Tc II, Tc V or Tc VI was achieved. Interpretation: This first prospective field study demonstrated that qPCR was more sensitive than MM for early cCD detection and more accurate in PVB than in UCB. Its use, as an auxiliary diagnostic tool to MM will provide more accurate records on cCD incidence. Funding: FITS SALUD 001-CHAGAS (FONARSEC, MINCyT, Argentina) to the Public-Private Consortium (INGEBI-CONICET, INP-ANLIS MALBRAN and Wiener Laboratories); ERANET-LAC-HD 328 to AGS and PICT 2015-0074 (FONCYT, MinCyT) to AGS and FA.

El siguiente caso, se trata de una paciente de sexo femenino que acude a consulta de traumatología por dolor de rodilla y dificultad para deambular, sin antecedente de trauma. En la radiografía anteroposterior y lateral se evidencian múltiples áreas radiolúcidas y escleróticas en meseta tibial y fémur distal derecho. La biopsia reporta: Condrosarcoma indiferenciado Grado 2. Se inicia sesiones de quimioterapia profiláctica y se planifica la cirugía de salvamento, esto ante la negativa de la paciente para aceptar la cirugía de amputación. La cirugía de reconstrucción se realizó mediante la colocación de una prótesis semiconstreñida tipo Endo Model cementada. En el posoperatorio se realizó controles y curaciones semanales, con buena cicatrización de la herida, y posteriormente rehabilitación por fisioterapia. Actualmente la paciente puede deambular con apoyo y casi de manera independiente.

High-Grade Gliomas (HGG) are the most frequent brain tumor in adults. The gold standard of clinical care recommends beginning chemoradiation within 6 weeks of surgery. Disparities in access to healthcare in Argentina are notorious, often leading to treatment delays. We conducted this retrospective study to evaluate if time to chemoradiation after surgery is correlated with progression-free survival (PFS). Our study included clinical cases with a histological diagnosis of Glioblastoma (GBM), Anaplastic Astrocytoma (AA) or High-Grade Glioma (HGG) in patients over 18 years of age from 2014 to 2020. We collected data on clinical presentation, type of resection, time to surgery, time to chemoradiation, location within the Buenos Aires Metropolitan Area (BAMA) and type of health insurance. We found 63 patients that fit our inclusion criteria, including 26 (41.3%) females and 37 (58.7%) males. Their median age was 54 years old (19-86). Maximal safe resection was achieved in 49.2% (n = 31) of the patients, incomplete resection in 34.9% (n = 22) and the other 15.9% (n = 10) received a biopsy, but no resection. The type of health care insurance was almost evenly divided, with 55.6% (n = 35) of the patients having public vs. 44.4% (n = 28) having private health insurance. Median time to chemoradiation after surgery was 8 (CI 6.68-9.9) weeks for the global population. When we ordered the patients PFS by time to chemoradiation we found that there was a statistically significant effect of time to chemoradiation on patient PFS. Patients had a PFS of 10 months (p = 0.014) (CI 6.89-13.10) when they received chemoradiation 8 weeks after surgery. Also, our univariate and multivariate analysis found that temporal lobe location (p = 0.03), GMB histology (p = 0.02) and biopsy as surgical intervention (p = 0.02) all had a statistically significant effect on patient PFS. Thus, time to chemoradiation is an important factor in patient PFS. Our data show that although an increase in HGG severity contributes to a decrease in patient PFS, there is also a large effect of time to chemoradiation. Our results suggest that we can improve patient PFS by making access to healthcare in Buenos Aires more equitable by reducing the average time to chemoradiation following tumor resection.

La diabetes es una enfermedad con importante prevalencia en todo el mundo. Se calcula que cerca de 415 millones de personas la padecen en la actualidad y que para el año 2040 esta cifra aumentará poco más del 50%. Debido a esto, se estima que gran parte de los ingresos por urgencias serán de pacientes diabéticos o sujetos a los cuales esta patología se les diagnosticará en dicha hospitalización; esta situación hace necesario conocer los lineamientos y las recomendaciones de las guías para el manejo intrahospitalario de los pacientes con hiperglucemia. El pilar fundamental del manejo hospitalario de diabetes es la monitorización intensiva, junto con la educación al paciente y la administración de insulina. El control glicémico es clave debido a que disminuye complicaciones intrahospitalarias. Cabe resaltar que el control estricto puede llevar a hipoglucemias, por lo que los episodios deben ser debidamente documentados y su causa corregida de inmediato.

Introducción: la colecistectomía laparoscópica (CL) es la cirugía más frecuente del tracto digestivo. A pesar de considerarse un procedimiento seguro, la morbilidad se reporta hasta en un 10%, no existiendo registro a nivel nacional. Objetivo: describir la incidencia de complicaciones y morbimortalidad de la CL electiva en una población no seleccionada de un servicio universitario. Método: se realizó un estudio retrospectivo observacional de los pacientes intervenidos en forma electiva de CL, entre el 1/1/2010 y el 31/12/2019 en la Clínica Quirúrgica B del Hospital de Clínicas y en la Unidad Docente Asistencial de Cirugía del Hospital Español. Las variables incluidas fueron demográficas, diagnóstico operatorio, conversión, morbimortalidad, reintervenciones y readmisiones. Resultados: se reclutó un total de 1.499 CL electivas, edad promedio 49 años (15-87), 79% sexo femenino, incidencia de litiasis de vía biliar principal (LVBP) en 210 (17%) casos; 25 conversiones (1,7%). Hubo un total de 64 complicaciones (4,3%) con una incidencia significativamente mayor en pacientes con LVBP (2,8% vs 7,6%, p 0,01). Hubo dos lesiones del hepato-colédoco (0,13%) (tipo Hannover D y C), ambas detectadas y reparadas en la misma cirugía y tres lesiones viscerales (0,20%). Hubo 16 readmisiones (1,07%) y 9 reintervenciones (0,6%). Dos pacientes fallecieron (0,13%) en el posoperatorio (insuficiencia hepatocítica crónica descompensada y pancreatitis grave pos-CPRE posoperatoria). Conclusiones: la CL en la población no seleccionada del servicio universitario analizado en este trabajo demuestra ser un procedimiento seguro, con tasas de complicaciones, reintervenciones y readmisiones que en este estudio se comparan favorablemente con las reportadas en la literatura. La presencia de litiasis en la vía biliar principal se asoció a una incidencia significativamente mayor de complicaciones posoperatorias y de mayor severidad.

Thirty-six-year-old male referred to the emergency room by the general practitioner with chest pain of 1-month duration. After the initial assessment revealed the presence of diffuse T-wave flattening, normal troponin levels, and a normal echocardiogram, the patient was discharged with a diagnosis of low-risk atypical chest pain. However, due to symptom recurrence and the fact that the treadmill test triggered angina-like symptoms and the ECG showed transient T-wave abnormalities, a coronary angiography was performed that ruled out the presence of epicardial stenosis (video 1 of the supplementary data). The patient was readmitted a week later due to disabling oppressive chest pain related to low intensity exercise. Due to persistent angina without coronary stenosis, an intracoronary physiological assessment was scheduled with acetylcholine, adenosine, and simultaneous pressure and flow measurements in the left anterior descending coronary artery using a dual-sensor pressure and Doppler velocity guidewire. Acetylcholine (Ach) (200 mcg) triggered the patient’s typical symptoms, the repolarization abnormalities seen on the ECG and the 50% decrease of coronary artery flow velocity (APV) without epicardial spasm (video 2 of the supplementary data). Intracoronary nitroglycerin (NTG) solved all abnormalities (figure 1A,B). The adenosine non-endothelium-dependent assessment revealed a normal fractional flow reserve (FFR), hyperemic microcirculatory resistance (HMR), and coronary flow reserve (CFR) (figure 1C). Because of the clinical features present (acetylcholine-triggered angina with repolarization abnormalities seen on the ECG without epicardial spasm), microvascular vasospastic angina was diagnosed. Medical therapy adjustment with calcium channel blockers as first-line treatment improved the patient’s symptoms at the follow-up.

Excessive water production in mature heavy oil fields causes incremental costs, energy consumption, and inefficiency. Understanding multiphase flows near the wellbore is an alternative to improve production efficiency. Therefore, this study conducts a series of numerical experiments based on the full set of the Navier-Stokes equations in 3D to simulate multiphase flows in porous media for heavy oil production horizontal wells. The solution given by this advanced mathematical formulation led to the description of the movement of the fluids near the wellbore with unprecedented detail. A sensitivity analysis was conducted on different rock and fluid properties such as permeability and oil viscosity, assuming homogeneous porous media. The influence of these parameters on the prediction of the breakthrough time, aquifer movement, and the severity of water production was noticed. Finally, the numerical model was verified against field data using two approaches. The first one was conducting a history match assuming homogeneous rock properties. In contrast, the second one used heterogeneous rock properties measured from well logging, achieving a lower deviation than field data, about 20%. The homogeneous numerical experiments showed that the breakthrough occurs at the heel with a subsequent crestation along the horizontal well. Moreover, at adverse mobility ratios, excessive water production tends to happen in water connings at the heel with an inflow area less than 1% of the total inflow area of the completion liner. Different aquifer movement dynamics were found for the heterogeneous case, like the breakthrough through multiple locations along the horizontal well. Finally, critical hydraulic data in the well, such as the pressure and velocity profiles, were obtained, which could be used to improve production efficiency. The numerical model presented in this study is proposed as an alternative to conducting subsurface modeling and well designs.