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This study was inspired by the literary elements of "cuentos tipicos" (culturally-relevant stories). The book "Prietita y la llorona" ("Prietita and the Ghost Woman") written by Anzaldua (1995) is a good example of a "cuento" that provides information about medicinal herbs and also includes "consejos" (advice). The plot stems from a well-known Mexican story that is traditionally told orally and passed on through generations. Reading this book validates the parents' background knowledge of medicinal herbs and provides a forum for their animated discussion, enthusiastic contributions, and elaboration of shared information. This context thus inspired a community of learners, which in turn facilitated the parents' participation and performance of the protocol-based literacy tasks the authors assigned them. The Family Institute for Early Literacy (FIELD) is housed on two university campuses in Texas. FIELD seeks to examine how multiple literacies from home and school interconnect to increase support for the literacy development of young children. In this study, Mexican-American and Mexican immigrant parents were invited to attend a weeklong workshop with their three-to-four-year-old child. FIELD primarily seeks to hear what parents' perceptions are about the type of learning that the school requires for their young child as well as to identify specific family cultural practices that could support academic learning. The results of this study indicated that parents of Mexican heritage performed and shared a range of literate behaviors in relevant and authentic ways with their young children. While the findings are limited to this specific sample of parents and young children, the results highlight the distributive effects of using culturally-relevant literature to validate parents' background knowledge. (Contains 1 figure and 2 notes.)

Travelers’ diarrhea has a high incidence rate among deployed US military personnel and can hinder operational readiness. The Global Travelers’ Diarrhea study is a US Department of Defense­–funded multisite surveillance effort to investigate the etiology and epidemiology of travelers’ diarrhea. During 2018–2023, we enrolled 512 participants at partner institutions in 6 countries: Djibouti, Georgia, Egypt, Honduras, Nepal, and Peru. Harmonized laboratory methods conducted at each partner institution identified >1 pathogens, including Escherichia coli (67%–82%), norovirus (4%–29%), and Campylobacter jejuni (2%–20%), in 403 (79%) cases. Among cases, 79.7% were single infections, 19.6% were double infections, and 0.7% were triple infections. The most common enterotoxigenic E. coli colonization factors identified were CS3 (25%) and CS21 (25%), followed by CS2 (18%) and CS6 (15%). These data can inform best treatment practices for travelers’ diarrhea and support US military health readiness.

Abstract Reduced nitric oxide (NO) bioavailability is a pathological link between obesity and Alzheimer’s disease (AD). Obesity-associated metabolic and mitochondrial bioenergetic dysfunction are key drivers of AD pathology. The hypothalamus is a critical brain region during the development of obesity and dysfunction is an area implicated in the development of AD. NO is an essential mediator of blood flow and mitochondrial bioenergetic function, but the role of NO in obesity-AD is not entirely clear. We investigated diet-induced obesity in female APPswe/PS1dE9 (APP) mouse model of AD, which we treated with two different NO donors (sodium nitrite or L-citrulline). After 26 weeks of a high-fat diet, female APP mice had higher adiposity, insulin resistance, and mitochondrial dysfunction (hypothalamus) than non-transgenic littermate (wild type) controls. Treatment with either sodium nitrite or L-citrulline did not reduce adiposity but improved whole-body energy expenditure, substrate oxidation, and insulin sensitivity. Notably, both NO donors restored hypothalamic mitochondrial respiration in APP mice. Our findings suggest that NO is an essential mediator of whole-body metabolism and hypothalamic mitochondrial function, which are severely impacted by the dual insults of obesity and AD pathology.

Abstract The KATITA-25 (Kidney AlloTransplant Immunosuppressive Therapy Adherence) Questionnaire is a multidimensional self-administered scale developed in Brazilian Portuguese that measures the predisposition for non-adherence to immunosuppressive medication in candidate patients for kidney transplantation, in the pre-transplant setting. The aim of this study was the cross-cultural validation of the Spanish version of the KATITA-25 scale. The translation/back-translation method was used, followed by cognitive interviews and a pre-test. The Spanish version of KATITA-25 was administered to 163 candidate patients for kidney transplantation from 2 kidney transplant centres and 2 dialysis centres in Catalonia, Spain. The scale was re-administered to the first 79 patients included into the study, after a 2 to 4 weeks interval. Internal consistency was assessed using Cronbach’s alpha, test–retest reliability with the intraclass correlation coefficient (ICC); construct validity with goodness of fit indices after confirmatory factor analysis using structural equation modelling. The Cronbach’s alpha of the Spanish version was 0.83, the ICC was 0.86. Confirmatory factor analysis showed adequate fit of the structural model. Overall, the analytical results closely resembled those obtained in the validation of the original scale. In conclusion, this cross-cultural validation study showed adequate reliability and construct validity of the Spanish version of the KATITA-25 questionnaire.

Intellectual disability (ID) encompasses limitations in intellectual and adaptive functions that facilitate an individual’s social, familial and occupational development. In Latin America, it is estimated that the prevalence is four times higher than the rest of the world, with figures ranging from 4% to 16%. This article presents a literature review on the prevalence, behavior, diagnosis and treatment of anxiety and depression disorders in individuals with ID, considering the psychosocial consequences and overall health implications they entail. In this population, it is crucial to understand the diversity in the manifestations of mental disorders, as their presentation may vary compared to the general population. For this reason, we use scales and clinical interviews that, along with clinical judgement, will guide medical management. Treatments aimed at patients with ID and comorbid anxious or depressive disorders do not differ from those recommended for the general population, as the use of medications is directed at treating existing comorbidity without impacting the intellectual quotient or daily functionality. However, there is a lack of specific studies in this population group.

Fort Sherman virus (FSV) was isolated in Panama in 1985 from a US soldier. We report a case of human FSV infection in a febrile patient from northern coastal Peru in 2020. FSV infections spanning ≈35 years and a distance of 2,000 km warrant diagnostics, genomic surveillance, and investigation of transmission cycles.

Resumen: Introducción: La tormenta tiroidea se caracteriza por síntomas exagerados de hipertiroidismo, pudiendo ocasionar falla multiorgánica y paro cardiorrespiratorio. Es un fenómeno poco frecuente, pero con elevada mortalidad. Caso clínico: hombre de 35 años, sin antecedentes, con cuadro de 2 semanas de palpitaciones y epigastralgia, que en 24 horas presenta exacerbación importante, agregándose náuseas y diaforesis. En el traslado a urgencias presenta paro cardiorrespiratorio por asistolia, cursando posteriormente con falla multiorgánica durante su hospitalización. En base a antecedentes otorgados por la familia de una clínica hipertiroidea reciente, se plantea posible diagnóstico de tormenta tiroidea. Se ordenan pruebas tiroideas, resultando en T4 libre mayor a 7,7 ng/dl y TSH menor a 0,005 μUI/ml. Se maneja con tiamazol, hidrocortisona y propranolol, evolucionando favorablemente. Discusión y Conclusión: Es necesario un diagnóstico oportuno, pues un manejo y detección precoz disminuye complicaciones y mortalidad. Una vez sospechada, deben iniciarse medidas de reanimación y tratamiento farmacológico que disminuya los efectos de hormonas tiroideas. Abstract: Introduction: A thyroid storm is a rare but highly lethal disease. It is characterized by exaggerated symptoms of hyperthyroidism, and it can lead to multiorgan failure and cardiopulmonary arrest. Case Report: A 35-year-old man with no prior medical history presented with a two-week history of palpitations and epigastric pain, which abruptly worsened over 24 hours, accompanied by nausea and diaphoresis. During transportation to the emergency department, he experienced cardiopulmonary arrest and multiorgan failure during his hospitalization. Family reported recent hyperthyroid symptoms led to the consideration of a thyroid storm diagnosis. Thyroid function tests revealed a free T4 level greater than 7.7 ng/dl and a TSH level less than 0.005 μIU/ml. The patient was treated with thiamazole, hydrocortisone, and propranolol, showing favorable progression. Discussion and Conclusion: Opportune diagnosis of a thyroid storm is crucial, as early management and detection reduce complications and mortality. Once suspected, resuscitation measures and pharmacological treatment should be initiated to mitigate the effects of thyroid hormones.

Abstract The extended period of coexistence between Neanderthals and Homo sapiens in Europe coincided with the emergence of regionally distinctive lithic industries, signalling the onset of the Upper Palaeolithic. The Iberian Peninsula was on the periphery of pioneering Upper Palaeolithic developments, with archaeological remains primarily found in northern territories. We report the discovery of an initial Upper Palaeolithic lithic industry at Cueva Millán in the hinterlands of Iberia. This industry, termed here Arlanzian, not only represents the earliest and southernmost evidence of such industries in Iberia but also lacks a direct counterpart. However, it exhibits chronological and technological parallels with the lithic industries associated with the earliest expansion of Homo sapiens throughout Eurasia. We interpret this as potential evidence of its intrusive nature, but not necessarily associated with a migration event, as more complex scenarios derived from inter-population connectivity must be also considered. The biological identity of the Arlanzian makers remains unknown, but they coexisted with declining Neanderthal groups from neighbouring territories.

Background: In skeletal muscle, adenosine triphosphate stores decrease during the first 3 h of ischemia. In the present study, we performed a comprehensive hemodynamic evaluation during the postoperative period after cardiac surgery and measured skeletal muscle enzyme levels and markers of muscle damage and inflammation. The aim was to determine whether these values change and, if so, whether these changes coincide with the presence of low flow and poor perfusion. Methods: We included a cohort of 280 nonconsecutive adults who were monitored in the postoperative period following cardiac surgery. We measured hemodynamic indices repeatedly in the first 24 h postoperatively, and we identified differences between the levels of skeletal muscle enzymes and muscle damage markers on admission (0 h) and 12 and 24 h postoperatively. Results: A clinically and statistically significant elevation of creatine kinase (CK) level was observed at 12 h postoperatively in patients with low macrocirculatory flow and anaerobic metabolism. Lactate dehydrogenase (LDH) level was significantly elevated in these patients at 24 h. Conclusions: In the first 24 h after cardiac surgery, a state of low macrocirculatory flow and the consequent deficit in flow at the capillary–cell interface in the presence of anaerobic metabolism was associated with clinically and statistically significant elevations of CK level at 12 h and LDH level at 24 h. These changes may be markers of skeletal muscle ischemia and may provide an additional tool in the monitoring and resuscitation of these critically ill patients. Resumen: Antecedentes: En el músculo esquelético, las reservas de trifosfato de adenosina disminuyen durante las primeras 3 h de isquemia. En el presente estudio, realizamos una evaluación hemodinámica integral durante el período postoperatorio de cirugía cardíaca, y medimos los niveles de enzimas del músculo esquelético y los marcadores de daño muscular. El objetivo fue determinar si estos valores cambian y, en caso afirmativo, coinciden con la presencia de bajo flujo y mala perfusión. Métodos: Incluimos una cohorte de 280 adultos no consecutivos que fueron monitorizados en el postoperatorio de cirugía cardíaca. Medimos los índices hemodinámicos postoperatoriamente, e identificamos diferencias entre los niveles de enzimas del músculo esquelético y los marcadores de daño muscular al ingreso (0 h) y a las 12 y 24 h, postoperatoriamente. Resultados: Se observó una elevación clínica y estadísticamente significativa del nivel de creatina cinasa (CK) a las 12 h del postoperatorio en los pacientes con bajo flujo macrocirculatorio y metabolismo anaeróbico. El nivel de lactato deshidrogenasa (LDH) estuvo significativamente elevado en estos pacientes a las 24 h. Conclusiones: En las primeras 24 h después de una cirugía cardíaca, un estado de bajo flujo macrocirculatorio y el consiguiente déficit de flujo en la interfaz capilar/célula en presencia de metabolismo anaeróbico se asoció con elevaciones clínica y estadísticamente significativas del nivel de CK a las 12 h y de la LDH a las 24 h. Estos cambios pueden ser marcadores de isquemia del músculo esquelético y pueden proporcionar una herramienta adicional en el seguimiento y en la reanimación de estos pacientes.

Abstract Background Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic. Methods This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants’ response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates. Results A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017). Conclusions This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study’s findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics. Trial registration Clinicaltrials.gov, NCT04352634.

Abstract Climate-driven changes in freshwater inputs have been shown to affect the structure and function of coastal ecosystems. We evaluated changes in the influence of river runoff on coastal systems of Northwestern Patagonia (NWP) over recent decades (1993–2021) by combined analysis of long-term streamflow time series, hydrological simulation, satellite-derived and reanalysis data on sea surface conditions (temperature, turbidity, and salinity). Significant decreases in minimum streamflow across a zone spanning six major river basins were evident at weekly, monthly, and seasonal scales. These changes have been most pronounced in mixed-regime northern basins (e.g., Puelo River) but appear to be progressing southward to rivers characterised by a nival regime. In the adjacent two-layer inner sea, reduced freshwater input corresponds with a shallower halocline and increased surface temperatures across northern Patagonia. Our results underscore the rapidly evolving influence of rivers on adjacent estuarine and coastal waters in NWP. We highlight the need for cross-ecosystem observation, forecasting, mitigation and adaptation strategies in a changing climate, together with corresponding adaptive basin management of systems that supply runoff to the coastal marine waters.

Abstract Patients recovering from COVID-19 commonly exhibit cognitive and brain alterations, yet the specific neuropathological mechanisms and risk factors underlying these alterations remain elusive. Given the significant global incidence of COVID-19, identifying factors that can distinguish individuals at risk of developing brain alterations is crucial for prioritizing follow-up care. Here, we report findings from a sample of patients consisting of 73 adults with a mild to moderate SARS-CoV-2 infection without signs of respiratory failure and 27 with infections attributed to other agents and no history of COVID-19. The participants underwent cognitive screening, a decision-making task, and MRI evaluations. We assessed for the presence of anosmia and the requirement for hospitalization. Groups did not differ in age or cognitive performance. Patients who presented with anosmia exhibited more impulsive alternative changes after a shift in probabilities (r = − 0.26, p = 0.001), while patients who required hospitalization showed more perseverative choices (r = 0.25, p = 0.003). Anosmia correlated with brain measures, including decreased functional activity during the decision-making task, thinning of cortical thickness in parietal regions, and loss of white matter integrity. Hence, anosmia could be a factor to be considered when identifying at-risk populations for follow-up.

Introducción. El parto prematuro es un problema médico, social y económico importante, causa gran mortalidad y morbilidad neonatal, tiene un impacto importante en el sistema de salud y afecta la calidad de vida de las familias. El peso de los recién nacidos de madres con enfermedad periodontal es significativamente menor en comparación con los de madres no afectadas por esta enfermedad bucal. Este resultado adverso se considera un problema de salud pública global según los datos epidemiológicos. Objetivo. Determinar la asociación entre la prevalencia de parto prematuro y la enfermedad periodontal en Bolivia, Chile y Colombia entre el 2000 y el 2020. Materiales y métodos. Este estudio ecológico consideró las poblaciones de mujeres de Bolivia, Chile y Colombia, y la prevalencia de partos prematuros y enfermedad periodontal, discriminadas por grupos de edad. El estudio abarcó el período entre el 2000 y el 2020. La estrategia de búsqueda con la herramienta de investigación del Institute for Health Metrics and Evaluation incluyó prevalencia, grupos de edad, años entre 2000 y 2020, causas de parto prematuro y enfermedad periodontal, contexto y ubicaciones, mujeres y tasas. El análisis estadístico incluyó una regresión lineal simple entre parto prematuro y enfermedad periodontal para cada grupo de edad dentro de cada país. Resultados. Las tasas de partos prematuros fueron mayores en el grupo de 15 a 19 años (Bolivia: 697.563, Chile: 844.864, Colombia: 804.126). La prevalencia de la enfermedad periodontal aumentó con la edad, particularmente en el grupo de 45 a 49 años (Bolivia: 22’077.854, Chile: 34’297.901, Colombia: 32'032,830). Según los grupos de edad, la regresión lineal fue estadísticamente significativa (p < 0,001) para todos los grupos evaluados de la población boliviana, en los grupos mayores de 30 años para las colombianas y solo en el grupo de 15 a 19 años para las mujeres chilenas. Conclusión. Se encontró asociación entre el parto prematuro y la enfermedad periodontal en todos los grupos de edad en Bolivia, solo en el grupo de 15 a 19 años en Chile, y de 30 años y más en Colombia en el período evaluado de 20 años.

La osteoradionecrosis (ORN) es una complicación ósea asociada a la irradiación de tejidos secundaria al tratamiento de una neoplasia. Los pacientes con antecedentes de irradiación de cabeza y cuello tienen un riesgo aumentado de padecer esta enfermedad al someterse a algún procedimiento dental. Existen protocolos de prevención y tratamiento de la ORN con oxígeno hiperbárico, que son seguros y presentan pocos efectos secundarios. Este estudio observacional retrospectivo de registros médicos en un hospital de referencia de la Seguridad Social de Costa Rica identificó 50 participantes, con una frecuencia promedio de 8 protocolos aplicados por año. Los pacientes presentaban una edad media de 53,6 años y predominantemente masculinos, con el cáncer de glándula salival como el más prevalente. La sepsis dental fue el diagnóstico más común y su tratamiento fue la exodoncia. La aparición de ORN fue sumamente baja, así como los eventos secundarios quirúrgicos y asociados a la OHB. La población analizada muestra un comportamiento similar a lo reportado en otras latitudes y el protocolo pareciera ser bien tolerado y podría disminuir la incidencia de ORN

Abstract Background Pompe disease, a rare autosomal recessive disorder caused by acid alpha-glucosidase deficiency, results in progressive glycogen accumulation and multisystem dysfunction. Enzyme replacement therapy with recombinant human acid alpha-glucosidase is the standard of care; however, some patients develop anti-recombinant human acid alpha-glucosidase antibodies, leading to reduced efficacy. This case report presents two infants with early-onset Pompe disease who developed IgG antibodies to enzyme replacement therapy and were subsequently treated with methotrexate, highlighting the importance of monitoring antibody development and exploring alternative therapeutic approaches. Case presentation Patient 1, a 10-month-old female from Bogota, Colombia, presented with generalized hypotonia, macroglossia, hyporeflexia, and mild left ventricular hypertrophy. Diagnostic tests confirmed early-onset Pompe disease, and enzyme replacement therapy was started at 12 months. Due to a lack of improvement and high anti-recombinant human acid alpha-glucosidase IgG antibody titers (1:1800), methotrexate was started at 18 months. After 8 months of combined therapy, antibody titers were negative and significant improvement in motor function was observed using the Gross Motor Function Measure 88. Patient 2, a 7-year-old female from Bogota, Colombia, was diagnosed with early-onset Pompe disease at 12 months and initiated enzyme replacement therapy. At 5 years of age, she experienced frequent falls and grip strength alterations. Functional tests revealed motor development delay, generalized hypotonia, and positive anti-recombinant human acid alpha-glucosidase IgG antibody titers (6400). Methotrexate was initiated, leading to a reduction in falls and antibody titers (3200) after 6 months, with no adverse events or complications. Motor function improvement was assessed using the Motor Function Measurement 32. Conclusions The presented cases highlight the importance of monitoring patients for anti-recombinant human acid alpha-glucosidase antibody development during enzyme replacement therapy and the potential benefit of methotrexate as an immunomodulatory agent in early-onset Pompe disease. Early diagnosis and timely initiation of enzyme replacement therapy, combined with prophylactic immune tolerance induction, may improve clinical outcomes and reduce the development of anti-recombinant human acid alpha-glucosidase antibodies. The cases also highlight the importance of objective motor function assessment tools, such as Gross Motor Function Measure 88 and Motor Function Measurement 32, in assessing treatment response. Further research is needed to optimize treatment regimens, monitor long-term effects, and address the current limitations of enzyme replacement therapy in Pompe disease.

Abstract Loss aversion is a psychological construct defined as a tendency to value potential losses more than gains in a situation that requires decision-making. The Loss Aversion Scale (LAS, eight items) measures an individual’s loss aversion to various situations. However, the generalization of its psychometric properties to different population groups is unknown. This study aimed to validate the LAS instrument for use among Spanish university adults. To this end, two studies were conducted: a content validity study calculating the substantive validity (N = 24) of the instrument’s translation from original English to Spanish and a study of internal structure and association (N = 766) among Spanish university men and women aged 18–35. The analyses performed for each sample indicated that the instrument had adequate validity and reliability values as a one-dimensional measure; however, items 5 and 8 had to be removed. Their scores indicated moderate-magnitude correlations with social desirability. This article debates the study’s limitations, practical implications, and future lines of research based on the results. The conclusion is that the Loss Aversion Scale instrument suits general Spanish population samples and requires probable methodological control concerning social desirability.

Objetivos: evaluar la evolución de la resistencia a los antibióticos de los microorganismos aislados de pie diabético infectado en pacientes atendidos en el Hospital Clínico Viedma, en las gestiones 2014, 2016, 2018 y 2021. Métodos: investigación observacional, descriptiva, retrospectiva, transversal con enfoque cuantitativo, 268 cultivos y antibiogramas de pacientes con diagnóstico de infección de pie diabético fue la muestra analizada con un 2,82 % de error máximo admitido. Resultados: se identificaron 312 microorganismos, con 71,5 % las bacterias Gram negativas fueron las más frecuentes, de estas la Klebsiella spp con 17,9 % y Escherichia coli con 17,6 % predominaron, cuya resistencia a la ciprofloxacina, sulfatrimetoprim y gentamicina aumentó, los bacilos Gram negativos no fermentadores más aislados fueron las Pseudomonas spp y el Acinetobacter spp cuya resistencia a las cefalosporinas, ciprofloxacina y carbapenémicos incrementó. Por otro lado, con 16,3 % el Staphylococcus aureus fue la bacteria Gram positiva más identificada, la resistencia a la meticilina de 17 % en 2014 aumentó a 25 % en 2021. Conclusiones: las enterobacterias fueron los microorganismos aislados con más frecuencia, cuya resistencia se asoció a la producción de betalactamasas de espectro extendido (BLEE).

Abstract Objetive this study was to determine the relationship between acute febrile illness and bacterial pathogens with zoonotic potential that cause emerging and re-emerging diseases in a central-eastern region of Peru. Results Out of the 279 samples analyzed, 23 (8.2%) tested positive for infection by Rickettsia spp., while a total of 15 (5.4%) tested positive for Leptospira spp. Women had a higher frequency of infection by Rickettsia spp., with 13 cases (53.3%), while men had a higher frequency of infection by Leptospira spp., with 10 cases (66.7%). The most frequently reported general symptom was headache, with 100.0% (n = 23) of patients with Rickettsia (+) and 86.7% (n = 13) of patients with Leptospira (+) experiencing it. Arthralgia was the second most frequent symptom, reported by 95.6% (n = 22) and 60% (n = 9) of patients with Rickettsia (+) and Leptospira (+), respectively. Myalgia was reported by 91.3% (n = 21) and 66.7% (n = 10) of patients with Rickettsia (+) and Leptospira (+), respectively. Retroocular pain, low back pain, and skin rash were also present, but less frequently. Among the positives, no manifestation of bleeding was recorded, although only one positive case for Leptospira spp. presented a decrease in the number of platelets.

Abstract Increasing forest structural complexity is becoming a common goal in forestry worldwide. However, the lack of empirical quantification clouds its implementation. Here we quantified the long-term effects (> 30 y) of partial harvest on stand structural complexity and net primary productivity using the east–west precipitation gradient (318–2508 mm, mean annual precipitation-MAP) of western Patagonian as a study system. In this gradient, pairs of 1-ha plots on 20 sites (20 plots harvested and 20 plots unharvested) were installed. In each plot terrestrial laser scanning was used to quantify the stand structural complexity index (SSCI), and Sentinel satellite images to obtain the Enhanced Vegetation Index (EVI: proxy of net primary productivity). Generalized linear mixed-effect models were used to relate SSCI to MAP and EVI to SSCI, with harvesting as indicator variable, and site as random variable (two plots nested to same precipitation). Results showed that harvested plots on mesic-to-humid sites (but not on dry sites) had higher SSCI and EVI values compared to unharvested plots, likely due to a greater vertical canopy packing. These results show the influence of precipitation on SSCI, which resulted in a more diversified stand structure and higher EVI. Such insights support site-specific management aimed to increase forest structural complexity.

Introduction The characteristics and clinical relevance of pleural effusion (PLEF) in acute pulmonary embolism (APE) are not fully understood.Methods A single-centre, retrospective study was performed of patients admitted with APE classified according to the subsequent development or not of PLEF. A model was built to predict PLEF and its impact on 30-day all-cause mortality was investigated.Results A total of 1602 patients with APE were included (median age, 74 (61, 82) years; 674 men (42.1%); 382 (23.8%) with PLEF). PLEF was associated with a higher number of comorbidities (p=0.015); more peripheral APE (0.001); a higher frequency of pulmonary infarctions (p

Introducción: México tiene una alta prevalencia de sobrepeso y obesidad. Los pacientes que padecen estas condiciones cuando son infectados por COVID-19 tienen un mayor riesgo de experimentar una secuencia clínica más severa. El presente estudio tuvo como objetivo evaluar la obesidad como un factor de riesgo independiente para la severidad de la enfermedad y la mortalidad en pacientes mexicanos con COVID-19. Métodos: Se analizó una base de datos construida prospectivamente. Se dividió a 1027 pacientes con infección por COVID-19 en categorías basadas en la gravedad de la obesidad. Se analizaron comparativamente entre grupos las características demográficas, las comorbilidades relacionadas con la obesidad, la gravedad de la disfunción pulmonar, las puntuaciones de gravedad, la necesidad de ingreso hospitalario, la suplementación con oxígeno/ventilación mecánica y la mortalidad. Las imágenes de TC torácica se puntuaron según el sistema de clasificación de Yang. El análisis estadístico se realizó de acuerdo con la naturaleza escalar de las variables. Resultados: La edad media ± DE de todo el grupo fue de 55.4 ± 15.3 años. No hubo diferencias estadísticamente significativas entre las categorías de índice de masa corporal (IMC) en cuanto a la presencia de complicaciones relacionadas con la obesidad. Los pacientes con un IMC más elevado presentaron puntuaciones de gravedad significativamente más altas en la TC (rho de Spearman = 0.13; p = 0.005). Los pacientes con mayor grado de obesidad requirieron hospitalización e intubación/ventilación mecánica con mayor frecuencia. Sin embargo, la mortalidad fue similar entre los grupos. Conclusiones: Los pacientes mexicanos con obesidad infectados por COVID-19 presentaron una enfermedad más agresiva.

Introducción: El cáncer infantil más frecuente es la leucemia linfoblástica aguda. Al momento del diagnóstico, un 5% de los pacientes presentan daño del sistema nervioso central (SNC). El tratamiento consiste en controlar la médula ósea y la enfermedad sistémica. La quimioterapia triple intratecal consiste en administrar tres agentes combinados (metotrexato, citarabina y un glucocorticoide), que sinergizan el efecto profiláctico y remedial en caso de afectación leucémica del SNC. Objetivo: Determinar la incidencia de efectos secundarios de la sedoanalgesia en niños que reciben quimioterapia intratecal, no descrita previamente en población pediátrica. Método: Se realizó un estudio descriptivo, retrospectivo y transversal en pacientes pediátricos que recibían quimioterapia intratecal en un hospital de tercer nivel de atención. Se evaluaron la edad, el sexo, la premedicación para náusea/vómito/dolor, la técnica anestésica empleada, el tiempo transanestésico, el tiempo de estancia en el área de recuperación y los efectos secundarios más comunes. Se utilizó estadística descriptiva. Las variables cualitativas se analizaron con el test de Fisher y las cuantitativas con la prueba t de Student, usando el programa estadístico Graphpad Prism 8. Resultados: En los 51 pacientes seleccionados, las náuseas y los vómitos fueron los principales efectos secundarios postanestésico, pero su incidencia no fue significativa, presentándose solo en 6 pacientes (18.3%) que no recibieron premedicación antihemética. El dolor se presentó en 2 pacientes (6.1%) en el sitio de abordaje debido a la multipunción dural. Conclusiones: La incidencia de efectos secundarios en pacientes pediátricos que reciben quimioterapia intratecal tuvo un porcentaje bajo y no fue significativa. Sin embargo, se tiene que prestar especial atención, ya que no fueron inexistentes y es importante vigilar que no se deriven a una complicación mayor.

The National Toxicology Center of Cuba, 39 years after its creation

Background Biological invasions are a major threat to global biodiversity, with freshwater ecosystems being among the most susceptible to the successful establishment of non-native species and their respective potential impacts. In Poland, the introduction and spreading of non-native fish has led to biodiversity loss and ecosystem homogenisation. Methods Our study applies the Dispersal-Origin-Status-Impact (DOSI) assessment scheme, which is a population-level specific assessment that integrates multiple factors, including dispersal mechanisms, origin, status, and impacts, providing a nuanced framework for assessing invasion risks at local and regional levels. We used this tool to evaluate the risks associated with non-native fish species across three major Polish rivers (Pilica, Bzura, and Skrwa Prawa) and to prioritise them for management actions. Results Using DOSI, we assessed eight non-native species identified in the three studied rivers: seven in both Pilica and Bzura and four in Skrwa Prawa. The DOSI assessment scheme identified high variability in the ecological impacts and management priorities among the identified non-native species. Notably, species such as the Ponto-Caspian gobies exhibited higher risk levels due to their rapid spread and considerable ecological effects, contrasting with other species that demonstrated lower impact levels and, hence, received a lower priority for intervention. Conclusion The adoption of the DOSI scheme in three major rivers in Poland has provided valuable insights into the complexities of managing biological invasions, suggesting that localised, detailed assessments are crucial for effective conservation strategies and highlighting the importance of managing non-native populations locally.

Freshwater crayfish are amongst the largest macroinvertebrates and play a keystone role in the ecosystems they occupy. Understanding the global distribution of these animals is often hindered due to a paucity of distributional data. Additionally, non-native crayfish introductions are becoming more frequent, which can cause severe environmental and economic impacts. Management decisions related to crayfish and their habitats require accurate, up-to-date distribution data and mapping tools. Such data are currently patchily distributed with limited accessibility and are rarely up-to-date. To address these challenges, we developed a versatile e-portal to host distributional data of freshwater crayfish and their pathogens (using Aphanomyces astaci, the causative agent of the crayfish plague, as the most prominent example). Populated with expert data and operating in near real-time, World of Crayfish™ is a living, publicly available database providing worldwide distributional data sourced by experts in the field. The database offers open access to the data through specialized standard geospatial services (Web Map Service, Web Feature Service) enabling users to view, embed, and download customizable outputs for various applications. The platform is designed to support technical enhancements in the future, with the potential to eventually incorporate various additional features. This tool serves as a step forward towards a modern era of conservation planning and management of freshwater biodiversity.

Context: DNA mismatch repair (MMR) deficiency (dMMR) testing is now recommended in endometrial cancer. Defect identification in the molecules participating in this pathway, or the presence of microsatellite instability, are commonly employed for this purpose. Novel methods are continuously evolving to report dMMR/microsatellite instability and to easily perform routine diagnoses. Objective: The main aim of this study was to compare the concordance of the Idylla microsatellite instability test for the identification of dMMR endometrial cancer samples defined by immunohistochemistry and MMR genomic status. Design: We applied the Idylla MSI test to 126 early-stage endometrial cancer cases with MMR testing by immunohistochemistry and genomic characterization (methylation in MLH1 and sequence alterations in MLH1, PMS2, MSH2 and MSH6). Individual markers and overall specific performance indicators were explored. Results: The Idylla platform achieved a higher global concordance rate with MMR genomic status than with immunohistochemistry (75 % and 66 %, respectively). Sensitivity and specificity are also higher (75 % vs 66 % and 96 % vs 90 %, respectively). Clustering analysis split the patients into 2 well-differentiated clusters, the pMMR and the dMMR group, represented by MLH1/PMS2 loss and the MLH1 methylated promoter. Overall, immunohistochemistry and MMR genomic status identified more dMMR cases than did the Idylla test, although correlations were improved with a modified Idylla test cut-off. Conclusions: Performance of the Idylla test was better correlated with MMR genomic status than MMR immunohistochemistry status, which improved with a modified test cut-off. Further studies are needed to confirm the cut-off accuracy.

Introduction: supracondylar fractures of the humerus in children are associated with acute complications such as vascular complications that endanger the viability of the affected limb. Objective: to systematize acute vascular complications in patients with supracondylar fracture of the humerus in children. Method: the search and analysis of the information was carried out over a period of 61 days (December 1, 2023 to January 31, 2024) and the following words were used: pediatric supracondylar humeral fractures AND vascular injury, pulseless hand AND pediatric supracondylar humeral fracture, complex fracture, compartment syndrome. Based on the information obtained, a bibliographic review of a total of 186 articles published in the databases was carried out. Results: reference is made to the behavior of the articles in the PubMed database in the last 10 years. The main characteristics of vascular lesions are mentioned in terms of their exploration and forms of presentation. The use of Doppler ultrasound and arteriography in these patients is discussed, as well as the procedure to follow. In relation to compartment syndrome, the incidence, forms of presentation and behavior to follow are described. Conclusions: acute vascular complications related to supracondylar fracture in pediatric patients constitute a challenge for medical personnel. Its variants are multiple with different interpretation and implementation, most of the complementary exams provide insufficient elements in the initial stages.

Las malformaciones vasculares representan un heterogéneo espectro de lesiones que suelen presentarse como un reto diagnóstico y terapéutico, por lo cual se requiere de un alto índice de sospecha clínica para llegar al diagnóstico definitivo. El síndrome Cloves es un trastorno de sobrecrecimiento poco común y de etiología genética asociada a una mutación somática activadora de PIK3CA, que forma parte de la vía de señalización intracelular PI3K-Akt-mTOR. Clínicamente, se caracteriza por un sobrecrecimiento lipomatoso congénito de cualquier parte del cuerpo (principalmente el tórax), acompañado de malformaciones vasculares y linfáticas, nevus epidermal y anomalías estructurales del sistema óseo como escoliosis y alteraciones de la columna vertebral. Actualmente el pilar terapéutico de este síndrome es la terapia con rapamicina, un inhibidor de la vía mTOR. Por su parte, el síndrome de Klippel-Trenaunay, de igual manera, es una afección vascular compleja asociada al sobrecrecimiento, resultado de mutaciones somáticas en el gen PIK3CA con presencia de traslocaciones cromosómicas y alteraciones en el gen vascular VG5Q. Como características clínicas, posee una tríada clásica compuesta por hemihipertrofia de los tejidos blandos y los huesos de una extremidad, hemangiomas cutáneos y várices en posiciones anatómicamente anormales. Las principales características distintivas de este síndrome residen en la presencia de anomalías vasculares de tipo lento, desprovistas de fístulas arteriovenosas significativas, en comparación con el síndrome Cloves. En ambos casos, la presencia de características clínicas coincidentes relacionadas con los síndromes de sobrecrecimiento con alteraciones en el gen PIK3CA pone en manifiesto el reto de un diagnóstico certero.

Objetivo: Determinar los factores asociados al ausentismo de la cita médica en pacientes de un hospital nacional peruano. Materiales y métodos: Estudio observacional, retrospectivo, analítico, de casos y controles, en pacientes que se ausentaron o no a la cita médica programada; la población de ausentes fue de 2963 y los que cumplieron fueron 12 125. La muestra fue de 126 citados para el grupo casos y 253 para el grupo control, seleccionados por muestreo sistemático, considerando criterios de selección. A partir de los registros de programación de citas y la base de datos de las atenciones médicas, en una ficha de recolección de datos se recogieron factores personales, como residencia, condición en el establecimiento, condición en el servicio, financiamiento y sexo, e institucionales, como el diferimiento de citas. Los factores asociados se analizaron con regresión logística binaria. Resultados: La proporción de ausentismo fue 19,64 %. El 81,75 % de los pacientes ausentes y el 65,22 % de los del grupo control se atienden por el Seguro Integral de Salud (SIS); por otro lado, 68,25 % de los primeros y 52,38 % de los segundos separaron su cita con siete días o más de anticipación. Los factores asociados al ausentismo fueron el financiamiento (p = 0,002; OR = 2,385; IC 95 % [1,365-4,168]) y el diferimiento de la cita (p = 0,005; OR = 1,965; IC 95 % [1,225-3,152]). Respecto a la probabilidad de ausentarse, la del beneficiario del SIS corresponde a 2,385, mientras que la de los usuarios que programan una cita con siete o más días de anticipación, 1,965. Conclusiones: Ser paciente beneficiario del SIS y el otorgamiento de una cita con un diferimiento de más de siete días ocasionan mayor probabilidad de ausentarse a la cita médica programada; se sugiere la revisión de los procesos como parte de la mejora continua.

BackgroundFederally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. ObjectiveThis study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. MethodsWe recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a “think aloud” exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website’s acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. ResultsSurvey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website’s content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. ConclusionsBased on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool’s usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs.

BackgroundDuring the pandemic in Peru, the COVIDA (Collaboration Network of Volunteer Brigade Members for the Investigation, Detection, and Primary Management of Community Cases Affected by COVID-19) project proposed an innovative way to provide telemonitoring and teleorientation to COVID-19 patients, led by health care student volunteers. However, it has not been described how this interaction is perceived from the patient’s perspective and which factors increase their engagement with this service. ObjectiveThe aim of this study is to describe the perceptions of patients about COVIDA and identify factors associated with their engagement with this service. MethodsA mixed methods study was conducted to evaluate perceptions of patients that participated in the COVIDA project. This telehealth intervention organized by the National University of San Marcos was implemented in Peru from August to December 2020. The service involved daily phone calls by volunteer students to monitor registered COVID-19 patients until the completion of the 14th day of the illness or if a warning sign was identified. The volunteers also provided teleorientation to address the patients’ needs and concerns. Quantitative analysis was performed to describe the characteristics of the patients and to assess the factors related to their engagement with the service, which was defined by the percentage of participants who completed the follow-up according to their individual schedule. Qualitative analysis through semistructured interviews evaluated the patients’ perceptions of the service regarding the aspects of communication, interaction, and technology. ResultsOf the 770 patients enrolled in COVIDA, 422 (55.7%) were female; the median age was 39 (IQR 28-52) years. During the monitoring, 380 patients (49.4%) developed symptoms, and 471 (61.2%) showed warning signs of COVID-19. The overall median for engagement was 93% (IQR 35.7%-100%). Among those patients who did not develop warning signs, engagement was associated with the presence of symptoms (OR 3.04, 95% CI 2.22-4.17), a positive COVID-19 test at the start of follow-up (OR 1.97, 95% CI 1.48-2.61), and the presence of comorbidities (OR 1.83, 95% CI 1.29-2.59). Patients reported that the volunteers provided clear and valuable information and emotional support. Communication via phone calls took place smoothly and without interruptions. ConclusionsCOVIDA represents a well-accepted and well-perceived alternative model for student volunteers to provide telemonitoring, teleorientation, and emotional support to patients with COVID-19 in the context of overwhelmed demand for health care services. The deployment of this kind of intervention should be prioritized among patients with symptoms and comorbidities, as they show more engagement with these services.

Abstract The immune effector mechanisms involved in protecting against severe COVID-19 infection in elderly nursing home residents following vaccination or natural infection are not well understood. Here, we measured SARS-CoV-2 Spike (S)-directed functional antibody responses, including neutralizing antibodies (NtAb) and antibody Fc-mediated NK cell activity (degranulation and IFNγ production), against the Wuhan-Hu-1, BA.4/5 (for NtAb), and Omicron XBB.1.5 variants in elderly nursing home residents (n = 39; median age, 91 years) before and following a third (pre- and post-3D) and a fourth (pre- and post-4D) mRNA COVID-19 vaccine dose. Both 3D and 4D boosted NtAb levels against both (sub)variants. Likewise, 3D and 4D increased the ability of sera to trigger both LAMP1- and IFNγ-producing NK cells, in particular against XBB.1.5. In contrast to NtAb titres, the frequencies of LAMP1- and IFNγ-producing NK cells activated by antibodies binding to Wuhan-Hu-1 and Omicron XBB.1.5 S were comparable at all testing times. Stronger functional antibody responses were observed in vaccine-experienced participants compared to vaccine-naïve at some testing times. These findings can contribute to identifying a reliable correlate of protection in elderly nursing home residents against severe COVID-19 and inform future vaccine strategies in this population group.

Abstract Background The measurement of the skin carotenoids using the Veggie Meter® has emerged as a rapid objective method for assessing fruit and vegetable intake, highly recommended by the Mediterranean Diet (MD), which represents one of the healthiest dietary patterns, worldwide. This study aimed to examine differences in skin carotenoid content and degree of adherence to the MD pattern between two adult populations from Southern Italy and the Dominican Republic. Methods This cross-sectional study enrolled a total of 995 adults, 601 subjects from Italy and 394 from the Dominican Republic. All participants underwent anthropometric measurements and skin carotenoid assessment by Veggie Meter®. Adherence to the MD and lifestyle were evaluated using the Mediterranean Diet Adherence Screener (MEDAS) and the Mediterranean Lifestyle Index (MEDLIFE) questionnaires. Correlations between the skin carotenoid and MEDAS score were estimated using Pearson’s correlation coefficient. Multiple linear regression models were created to determine variables that affect skin carotenoid score for both populations. Results Mean total skin carotenoids were higher in the Italian compared to the Dominican Republic population (342.4 ± 92.4 vs 282.9 ± 90.3; p

There is evidence that the quality of life and mental health of pregnant women change during pregnancy. To evaluate the impact of physical activity on the quality of life and mental health of pregnant women with obesity or overweight, a systematic review was performed using six electronic databases (PubMed, Cochrane (CENTRAL), ScienceDirect, Scielo, BVS and PEDro). In total, 205 articles were collected, and after screening in accordance with the PRISMA declaration, six randomized clinical trials were selected. Methodological quality was assessed using the Cochrane RoB2 tool and a narrative synthesis of the results was performed. Physical activity interventions did not demonstrate statistically significant results on the quality of life and mental health of pregnant women with obesity or overweight. The effects of physical activity during pregnancy for women with obesity or overweight are varied due to the diversity of interventions implemented. Nonetheless, a discernible positive association emerges between stringent adherence to the prescribed physical activity regimen and enhanced physical well-being, weight management, and heightened aerobic capacity. In order to ascertain more definitive conclusions, rigorous clinical trials are needed that take into account the heterogeneity of interventions and ensure adequate adherence to the protocol.

Abstract Divergence dating analyses in systematics provide a framework to develop and test biogeographic hypotheses regarding speciation. However, as molecular datasets grow from multilocus to genomic, sample sizes decrease due to computational burdens, and the testing of fine-scale biogeographic hypotheses becomes difficult. In this study, we use coalescent demographic models to investigate the diversification of poorly known rice paddy snakes from Southeast Asia (Homalopsidae: Hypsiscopus), which have conflicting dates of origin based on previous studies. We use coalescent modeling to test the hypothesis that Hypsiscopus diversified 2.5 mya during the Khorat Plateau uplift in Thailand. Additionally, we use ecological niche analyses to identify potential differences in the niche space of the two most widely distributed species in the past and present. Our results suggest Hypsiscopus diversified ~ 2.4 mya, supporting that the Khorat Plateau may have initiated the diversification of rice paddy snakes. We also find significant niche differentiation and shifts between species of Hypsiscopus, indicating that environmental differences may have sustained differentiation of this genus after the Khorat Plateau uplift. Our study expands on the diversification history of snakes in Southeast Asia, and highlights how results from smaller multilocus datasets can be useful in developing and testing biogeographic hypotheses alongside genomic datasets.

Abstract The abbreviated measurement of coping strategies is useful for monitoring and identifying the effects of stress. The Coping strategy indicator-Short version (CSI-S, including the dimensions of seeking support, problem solving and avoidance strategies) is a new adaptation of the full version of this indicator, and additional evidence of its validity is needed. Psychology students (n = 125) from a public university in Lima, Peru, were recruited to help provide such evidence of validity in terms of internal structure, reliability and associations with other variables (perceived stress and general efficacy in cope with difficulties), which were evaluated using nonparametric item response theory procedures. Support-seeking and problem-solving items from the Mokken scale and the avoidance scale exhibited limitations. The correlations between the scales were moderate or low and exhibited theoretical consistency, and the relationship with perceived stress highlighted the predictive capacity of avoidance and problem-solving strategies. In general, the CSI-S exhibits suitable psychometric properties; however, the avoidance score requires further examination or reconstruction of its items.

Abstract Metal-rich particles originating from non-ferrous metallurgical activities are the primary source of atmospheric metals in urban environments. These particles vary in size, morphology, and elemental compositions and they undergo weathering processes that alter their composition and affect their toxicity. This study focuses on lead (Pb)-rich particles in settled urban dust within an arid and dusty city, Torreón in North Mexico, affected by Met–Mex Peñoles complex, one of the world's largest Ag–Cd–Pb–Zn smelting and refining facilities in operating since 1901. Torreón is characterized by arid conditions, temperature fluctuations, and low humidity. Dry atmospheric particles were collected in 2015 and 2017 from Torreón's urban area within a 3 km radius of the Met–Mex Peñoles complex. We used various analytical techniques, including scanning electron microscopy (SEM), Energy Dispersive X-ray Spectroscopy (EDS), and X-ray powder diffraction (XRD) to determine the size, morphology, elemental composition and mineralogy of Pb-bearing particles. Our analysis revealed a range of Pb-bearing particle sizes and morphologies with varying Pb (0.3 to 51–87.2%) and other element contents, such as As (0.04 to 1–3.4%), Cd (0.4 to 3.3–5.1%), Cu (0.51–14.1%), Hg (ND-0.6%), and Zn (1.7 to 79–90.3%). XRD analysis confirmed the presence of Pb and Zn sulfides, Pb carbonates, Pb sulfate, and Pb oxides in urban dust, both as individual particles and agglomerates. Primary Pb minerals were linked to fugitive feed concentrates and smelter flue gas at Met–Mex Peñoles, while secondary Pb minerals, like Pb carbonates, Pb sulfate, and Pb oxides, resulted from direct emissions and weathering processes. Compared to galena, secondary Pb minerals exhibit higher chemical availability in the environment, posing greater risks to the environment and human health. As the particles analyzed are presumed to be resuspended rather than freshly emitted by Met–Mex, the presence of secondary Pb minerals in settled urban dust is predominantly linked to weathering processes. The physical and chemical transformations in Pb-rich particles contribute to increased Pb bioavailability and toxicity in urban dust, with substantial implications for environmental and human health. These findings highlight the potential consequences of weathered Pb-rich particle in urban areas, particularly in the arid and dusty city of Torreón.

Objectives: Describe the epidemiology of cuboid fracture, the mechanisms of injury and associated injuries, the progression to osteoarthritis, and propose a surgical management algorithm. Methods: A retrospective and descriptive study of patients with cuboid fractures operated on between 2009 and 2014. The variables analyzed were age, sex, mechanism of injury, classification, associated fractures, and osteoarthritis changes, among others. Results: Twenty-seven patients were included: 19 men and eight women. The mean age was 41.3 years (range 25 - 62). The mean followup was 3.3 years. The mechanisms of injury were motor vehicle accidents and falls from height. Among the patients, 44.4% had lateral column shortening, and 81.5% involved calcaneal cuboid articular surface. Cuboid locking plates were used in 15 patients, and single screw fixation was used in four patients. Three patients required a bone graft. Degenerative changes were observed in calcaneocuboid and cuboid-metatarsal joints. Conclusions: Cuboid fracture is an uncommon injury. In general, the injuries are caused by high-energy accidents. In our study, 40.7% of patients had an injury to the medial column. It is recommended the use of a cuboid locking plate for comminuted fractures, screw fixation for simple fractures, and a bridging plate or external fixation can be considered for most complex cases. Level of Evidence IV; Retrospective Case Series.

Introducción: La atención en salud involucra aspectos culturales que deben conocerse para beneficiar a las personas desde el cuidado de enfermería. Objetivo: Describir el uso de la etnoenfermería como diseño de investigación y la teoría del cuidado cultural de Madeleine Leininger en la literatura de enfermería. Metodología: Se realizó una revisión integrativa bajo las fases de Withmoore y Knalf. La búsqueda bibliográfica se llevó a cabo en Medline, Cuiden Plus, Lilacs, Scopus y ScienceDirect, con los descriptores “investigación cualitativa”, “enfermería”, “asistencia sanitaria culturalmente competente” y “enfermería transcultural” en idioma inglés, español, portugués, incluyendo artículos originales publicados entre 2013 a 2023. Resultados: Se eligieron 12 artículos que fueron codificados para el surgimiento de cuatro categorías: necesidad de formación en etnoenfermería y teoría del cuidado de la cultura; reconocimiento del contexto cultural y barreras para el cuidado culturalmente congruente; diversidad y universalidad de los cuidados culturales; y acciones para el cuidado culturalmente congruente. Conclusiones: La revisión permitió reconocer que la teoría de cuidado cultural y la etnoenfermería han sido escasamente utilizadas en la práctica científica y profesional de enfermería. Es necesario incentivar en los profesionales la importancia de valorar el respeto por las diferentes culturas en los servicios de salud.

Introduction: Management in healthcare organizations enables the competitive performance of healthcare institutions; therefore, it requires constant monitoring with valid and reliable instruments. Objective: To validate a scale to evaluate management in health care organizations, according to the perception of health care workers. Methods: Instrumental study, in which 302 health workers from hospitals and primary care centers in a health region of Peru participated. The process included content validation by expert judgment and pilot testing. construct validity was assessed by exploratory factor analysis and fit was assessed by confirmatory factor analysis, which included different estimation methods. Discriminant, predictive and reliability validity were analyzed. Results: A short version of 8 items grouped in a single general factor was obtained, which explained 55.88% of the total variance; the model has adequate goodness-of-fit indices independently of the estimation method used. The variability indexes of the items were excellent; the discriminative and predictive validity were satisfactory. The internal consistency with McDonald's omega (ω= 0.892), Cronbach's alpha (α= 0.892) and Gutmann (λ6= 0.887), revealed optimal reliability values. Conclusions: The scale for evaluating management in healthcare organizations has adequate metric properties.

Antecedentes: Las hemorroides son dilataciones de los plexos vasculares arteriovenosos hemorroidarios superior e inferior, suelen estar ubicadas de forma expuesta e interna en el conducto anal y en el recto. Cuando estas estructuras presentan dilatación e ingurgitación ocasionan un cuadro sintomático que produce la enfermedad hemorroidal y afecta a la calidad de vida de quienes la padecen. Objetivo: Determinar la validez y la consistencia de la nueva escala para evaluar la calidad de vida en pacientes con enfermedad hemorroidal. Método: Estudio comparativo, de proceso, de escrutinio, homodémico, longitudinal, prolectivo y prospectivo. Tiempo de estudio: de marzo a septiembre 2023. El estudio se dividió en dos fases, la primera fue de elaboración de la nueva escala y la segunda en verificar su validez y consistencia. Se seleccionaron a 224 pacientes, con diagnóstico de enfermedad hemorroidal. Se elaboró un cuestionario único de 21 ítems y su validación fue sujeta a juicio por un grupo de expertos en coloproctología, cirugía general y clinimetría. Para evaluar consistencia interna se utilizó el alfa de Cronbach, consistencia externa kappa ponderada y validez convergente con rho de Spearman. Resultados: Se incluyeron 224 pacientes, de los cuales 10 formaron parte de un grupo piloto, el cual arrojó un alfa de Cronbach de 0.994, kappa ponderada de 0.001 y un valor de rho de Spearman p ≤ 0.001. Conclusión: La nueva escala de calidad de vida en pacientes con enfermedad hemorroidal tiene una consistencia interna alta, una gran consistencia externa y comprobó satisfactoriamente su validez de constructo.

Introduction Brace treatment is common to address radiological dysplasia in infants with developmental dysplasia of the hip (DDH); however, it is unclear whether bracing provides significant benefit above careful observation by ultrasound. If observation alone is non-inferior to bracing for radiological dysplasia, unnecessary treatment may be avoided. Therefore, the purpose of this study is to determine whether observation is non-inferior to bracing for infants with radiological dysplasia.Methods and analysis This will be a multicentre, global, randomised, non-inferiority trial performed under the auspices of a global prospective registry for infants and children diagnosed with DDH. Patients will be included if they present with radiological dysplasia (centred hip, alpha angle 43–60°, percent femoral head coverage greater than 35% measured on ultrasound) of a clinically stable hip under 3 months old. Patients will be excluded if they present with clinical hip instability, have received prior treatment or have known/suspected neuromuscular, collagen, chromosomal or lower-extremity congenital abnormalities or syndromic-associated hip abnormalities. Patients will be enrolled and randomised to undergo observation alone or brace treatment with a Pavlik harness for a minimum of 6 weeks. Follow-up visits will occur at 6 weeks, 1 year and 2 years post-enrolment. The primary outcome will be the norm-referenced acetabular index measured on the 2-year radiograph with a 3° non-inferiority margin. A total of 514 patients will be included.The study is anticipated to start in April 2024 and end in September 2028.The primary outcome will be compared between arms with a mixed-effects model with a random intercept for study centre, and a single covariate for the treatment group. If the lower bound of the 95% CI lies within 3° of the mean, we will treat this as evidence for non-inferiority.Ethics and dissemination Ethics approval has been obtained from the lead site’s ethics board (University of British Columbia, Children’s and Women’s Research Ethics Board). Ethics approval will be obtained from the local ethics committees or institutional review boards at each institution prior to patient enrolment. It is intended that the results of this study shall be published in peer-reviewed journals and presented at suitable conferences.Trial registration number NCT05869851.

Con esta publicación iniciamos una serie de monografías en las que iremos gradualmente dando a conocer, a medida que los medios de que disponemos nos lo permitan, las especies interesantes de nuestra materia médica. Consideramos un deber abordar de una vez por todas estos estudios, tanto para justificar la utilización de muchas drogas indígenas dignas ele ser incorporadas definitivamente a la terapéutica, como para demostrar la existencia en nuestra flora médica de recursos farmacológicos de primer orden, e interesar a los poderes e instituciones públicas sobre la necesidad de facilitar estos estudios cuya realización es un deber primordial de los gobiernos. Rivadavia, cuyas visiones de estadista se agigantan en el andar del tiempo, no desconoció su importancia, tanto que en plena guerra de la independencia, en 1815, inició, por intermedio de Sarratea, entonces residente en Londres como agente de las Provincias Unidas del Río de la Plata, gestiones para decidir a Bonpland, el sabio compañero de Alejandro de Humboldt, a venir a radicarse en Buenos Aires “para fundar y dirigir un jardín botánico y estudiar las plantas útiles y medicinales del país”. (Ms. en Archivos de Aimé Bonpland). Cumplimos también así los propósitos que nos formuláramos hace 25 años al fundar este Instituto, cuya existencia consideramos entonces una necesidad a llenar dentro de la Facultad, cuya misión no debe limitarse a la formación del profesional, sino extenderse a la investigación de todo aquello que directa o indirectamente pueda relacionarse con la salud pública y el bienestar general.

Abstract We present the case of a patient with antecedent of tree nuts allergy who developed an anaphylactic reaction after ingesting a piece chocolate. An allergy study detected sensitization to cocoa in skin tests as well as cross‐reactivity with tree nuts in the SDS‐PAGE immunoblotting‐inhibition.

Introduction: Pulmonary sclerosing hemangioma, also called pneumocytoma, benign pulmonary histiocytoma or xanthomatous pseudotumor, presents as parenchymal or endobronchial lesions of the lung. The most frequent form of presentation is the asymptomatic solitary pulmonary nodule, but it can also present with multiple lesions in the lung and other organs. It is a rare disease in which surgical treatment is the most effective approach. Objective: To present a rare form of pulmonary sclerosing hemangioma. Case Report: 59-year-old patient who presented with chest pain of 4 months of evolution. Chest radiographic studies were performed, in which disseminated nodular images were observed; tomography showed metastatic lesions. He underwent videothoracoscopy in which nodular, pearly white lesions were visualized, reporting a diffuse variant of multicentric sclerosing hemangioma of the lung. Conclusions: Multiple pulmonary nodules, constitute a rare and atypical presentation of pulmonary hemangiomatosis.

Introducción: la gestión inadecuada de residuos en el sector de la salud, especialmente en odontología, conlleva riesgos para la salud y el medio ambiente. En Chile, el reglamento sobre manejo de residuos de establecimientos de atención de salud (REAS) clasifica los residuos según su riesgo. La odontología sostenible, mediante prácticas como las 3 R y un modelo ampliado de 5 R, reduce impactos ambientales y costos, atrayendo a pacientes ecoconscientes. Objetivos: identificar el impacto ambiental de residuos en odontología y, utilizando el modelo de 5R, proponer acciones ecológicas basadas en evidencia, que se puedan aplicar en Chile. Materiales y Métodos: se realizó una revisión narrativa sobre el manejo de residuos generados en servicios dentales y prácticas sustentables durante la atención. Se utilizaron 30 artículos para lograr los objetivos. Resultados: los residuos odontológicos, en especial los quirúrgicos, provocan un impacto desmesurado en el medio ambiente. La generación y gestión de estos residuos dependen directamente de los profesionales. La odontología ecológica se centra en la adopción de prácticas sustentables y diferentes tecnologías e innovaciones para reducir el consumo de energía y la generación de residuos. Se presentan alternativas basadas en las 5R (reducir, reutilizar, reciclar, reflexionar e investigar) para disminuir la huella ambiental en la odontología. Conclusión: abordar el impacto ambiental de la odontología es crucial. La odontología sostenible requiere un enfoque interdisciplinario, prácticas más ecoamigables y políticas públicas adecuadas. La educación continua, la investigación y la concienciación ambiental son esenciales para este cambio. El método de las 5R es clave para fomentar la sostenibilidad en la odontología.

Using Holland's personality theory of occupational decision making, a study examined the influence of personality/career fit on initial medical career aspirations of college freshmen, and the extent to which the fit is associated with maintaining or abandoning these aspirations. Overall, results support the theory and illustrate how personality characteristics are systematically associated with changes in career choice during college. (Author/MSE)

Abstract Despite progress towards malaria reduction in Peru, measuring exposure in low transmission areas is crucial for achieving elimination. This study focuses on two very low transmission areas in Loreto (Peruvian Amazon) and aims to determine the relationship between malaria exposure and proximity to health facilities. Individual data was collected from 38 villages in Indiana and Belen, including geo-referenced households and blood samples for microscopy, PCR and serological analysis. A segmented linear regression model identified significant changes in seropositivity trends among different age groups. Local Getis-Ord Gi* statistic revealed clusters of households with high (hotspots) or low (coldspots) seropositivity rates. Findings from 4000 individuals showed a seropositivity level of 2.5% (95%CI: 2.0%-3.0%) for P. falciparum and 7.8% (95%CI: 7.0%-8.7%) for P. vivax, indicating recent or historical exposure. The segmented regression showed exposure reductions in the 40–50 age group (β1 = 0.043, p = 0.003) for P. vivax and the 50–60 age group (β1 = 0.005, p = 0.010) for P. falciparum. Long and extreme distance villages from Regional Hospital of Loreto exhibited higher malaria exposure compared to proximate and medium distance villages (p

Abstract In the last decade, fatigue in clinical populations has been re-conceptualized, including dimensions such as perceived fatigue (trait and state fatigue) and fatigability. The aim of this study was to evaluate different expressions of fatigue in Spinal Cord Injury (SCI) and Multiple Sclerosis (MS) participants compared to able-bodied controls, during activities of daily living, especially during gait. A total of 67 participants were included in this study (23 with SCI, 23 with MS, and 21 able-bodied controls). All participants performed two functional tests (6-Minute Walk Test and 10-Meter Walk Test) and they completed the Fatigue Severity Scale (FSS). The rate of trait fatigue was different between groups, with MS participants showing the highest rate. Moreover, scores on functional tests and state fatigue were different between groups after the tests. Our results indicate that trait fatigue and state fatigue in individuals with SCI and MS are different with respect to able-bodied population. Both SCI and MS groups experienced more trait fatigue than control group in daily life. In addition, walking tasks produced similar levels of state fatigue between healthy people and patients with MS/SCI. However, these tests induced longer-lasting levels of state fatigue in the patients.