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BackgroundRheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by rheumatologists to mitigate their effects and improve the patient’s quality of life. Often, delays in outpatient consultations or the patient’s difficulties in keeping appointments make such close follow-up challenging. For this reason, it is very important to have open communication between patients and health professionals. In this context, implementing telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients self-manage certain aspects of their disease. This could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of issues that would otherwise go unnoticed. ObjectiveThe main objective of this study is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and determine whether its implementation improves clinical outcomes compared to conventional follow-up. MethodsThis is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) from 5 Spanish hospitals. The patients will be followed up by the MAM protocol, which is a care model that incorporates a digital tool consisting of a mobile app that patients can use at home and professionals can review asynchronously to detect incidents and follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analog scale for pain, and electronic patient-reported outcome (ePRO) reports will be collected for all participants. In the MAM group, these items will be self-assessed via both the mobile app and during face-to-face visits with the rheumatologist, who will do the same for patients included in the traditional care model. The patients will be able to report any incidence related to their disease or treatment through the mobile app. ResultsParticipant recruitment began in March 2024 and will continue until December 2024. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025. ConclusionsThis paper aims to provide a detailed description of the development and implementation of a digital solution, specifically an MAM. The goal is to achieve significant economic and psychosocial impact within our health care system by enhancing control over RMDs. Trial RegistrationClinicalTrials.gov NCT06273306; https://clinicaltrials.gov/ct2/show/NCT06273306 International Registered Report Identifier (IRRID)PRR1-10.2196/55829

During this century, a number of reports have described the potential roles of thermophiles in the upper soil layers during high-temperature periods. This study evaluates the capabilities of these microorganisms and proposes some potential consequences and risks associated with the activity of soil thermophiles. They are active in organic matter mineralization, releasing inorganic nutrients (C, S, N, P) that otherwise remain trapped in the organic complexity of soil. To process complex organic compounds in soils, these thermophiles require extracellular enzymes to break down large polymers into simple compounds, which can be incorporated into the cells and processed. Soil thermophiles are able to adapt their extracellular enzyme activities to environmental conditions. These enzymes can present optimum activity under high temperatures and reduced water content. Consequently, these microorganisms have been shown to actively process and decompose substances (including pollutants) under extreme conditions (i.e., desiccation and heat) in soils. While nutrient cycling is a highly beneficial process to maintain soil service quality, progressive warming can lead to excessive activity of soil thermophiles and their extracellular enzymes. If this activity is too high, it may lead to reduction in soil organic matter, nutrient impoverishment and to an increased risk of aridity. This is a clear example of a potential effect of future predicted climate warming directly caused by soil microorganisms with major consequences for our understanding of ecosystem functioning, soil health and the risk of soil aridity.

Abstract Microorganisms govern soil carbon cycling with critical effects at local and global scales. The activity of microbial extracellular enzymes is generally the limiting step for soil organic matter mineralization. Nevertheless, the influence of soil characteristics and climate parameters on microbial extracellular enzyme activity (EEA) performance at different water availabilities and temperatures remains to be detailed. Different soils from the Iberian Peninsula presenting distinctive climatic scenarios were sampled for these analyses. Results showed that microbial EEA in the mesophilic temperature range presents optimal rates under wet conditions (high water availability) while activity at the thermophilic temperature range (60°C) could present maximum EEA rates under dry conditions if the soil is frequently exposed to high temperatures. Optimum water availability conditions for maximum soil microbial EEA were influenced mainly by soil texture. Soil properties and climatic parameters are major environmental components ruling soil water availability and temperature which were decisive factors regulating soil microbial EEA. This study contributes decisively to the understanding of environmental factors on the microbial EEA in soils, specifically on the decisive influence of water availability and temperature on EEA. Unlike previous belief, optimum EEA in high temperature exposed soil upper layers can occur at low water availability (i.e., dryness) and high temperatures. This study shows the potential for a significant response by soil microbial EEA under conditions of high temperature and dryness due to a progressive environmental warming which will influence organic carbon decomposition at local and global scenarios.

Although the total number of ureteroscopy interventions during the past years has significantly increased, current flexible ureteroscopy procedures still present some limitations to urologic surgeons. However, nowadays different robotic systems have been developed in order to reduce those limitations. Flexible ureteroscopy robots provide a technological alternative which combines the benefits that this type of procedures offers to the patients, and solutions to the problems encountered from the surgeons perspective. In this paper, a virtual reality training platform for robot-assisted flexible ureterorenoscopy interventions is presented. A position based model for the virtual flexible endoscope is detailed and a standard user interface for the training platform is designed. Moreover, a comparative analysis of the performance of the training platform in different scenarios, including the navigation through a three-dimensional ureterorenal model, is presented. The obtained results determine that the training platform presents different computational rates depending on the complexity of the implemented environment and on the number of collisions and constraints that have to be handled. Nevertheless, the virtual model is visually plausible, effective for real-time user interaction and suitable for training.

Soils are highly heterogeneous and support highly diverse microbial communities. Microbial extracellular enzymes breakdown complex polymers into small assimilable molecules representing the limiting step of soil organic matter mineralization. This process occurs on to soil particles although currently it is typically estimated in laboratory aqueous solutions. Herein, estimates of microbial extracellular enzyme activity were obtained over a broad range of temperatures and water availabilities frequently observed at soil upper layers. A Pseudomonas strain presented optimum extracellular enzyme activities at high water activity whereas a desiccation resistant bacterium (Deinococcus) and a soil thermophilic isolate (Parageobacillus) showed optimum extracellular enzyme activity under dried (i.e., water activities ranging 0.5–0.8) rather that wet conditions. Different unamended soils presented a distinctive response of extracellular enzyme activity as a function of temperature and water availability. This study presents a procedure to obtain realistic estimates of microbial extracellular enzyme activity under natural soil conditions of extreme water availability and temperature. Improving estimates of microbial extracellular enzyme activity contribute to better understand the role of microorganisms in soils.

Introducción: La infección por el virus de la hepatitis B constituye uno de los principales problemas de salud a nivel mundial, su espectro clínico es variable. Objetivo: Identificar infección oculta y coinfección viral en pacientes con hepatopatía crónica por virus B. Material y Métodos: Se realizó un estudio observacional descriptivo transversal en pacientes con hepatitis B crónica con carga viral detectable, atendidos durante el último trimestre de 2014 en el Instituto de Gastroenterología. Se estimó la seroprevalencia de anti HVC y anti HIV así como la frecuencia de AgHBs, y Anti S, las asociaciones fueron evaluadas mediante el estadígrafo x2. Resultados: Existió un predominio de las cargas virales bajas para 81.3%. El 28.7% de las muestras fueron AgHBs negativas, sugestivas de infección por virus oculto. Se detectaron niveles de protección frente al antígeno S en 20 % de los pacientes con carga viral baja. La coinfección a hepatitis C fue frecuente para 8.4 %.Conclusiones: La infección oculta al virus de hepatitis B fue frecuente en las muestras procesadas en el Instituto de Gastroenterología, con asociación a coinfección al virus de hepatitis C.Palabras clave: Hepatitis B, virus, coinfección viral, infección oculta, antígeno de superficie, carga viral, VIH.ABSTRACT Introduction: Infection with the hepatitis B virus is one of the major health problems worldwide, clinical spectrum is variable. Objective: To identify occult viral infection and co-infection in patients with chronic liver disease for virus B. Material and Methods: A cross-sectional observational study was conducted in patients with chronic hepatitis B with detectable viral load seen during the last quarter of 2014 in the Institute of Gastroenterology. The seroprevalence of anti HCV and anti HIV and the frequency of HBsAg and Anti S was estimated associations were evaluated using the x2 statistic. Results:There is a predominance of low viral loadsto81.3%. 28.7% of samples were HBsAg negative, suggestive of occult virus infection. Protective levels against the antigen S were detected in 20% of patients with low viral load.Hepatitis C coinfection was frequent for 8.4%. Conclusions: The occult infection hepatitis B virus is common in samples processed at the Institute of Gastroenterology with associated coinfection virus hepatitis C.Keywords: Occult hepatitis B, hepatitis B virus, viral coinfection, occult infection, surface antigen, viral load, HIV.

We carried out an admixture analysis of a sample comprising 1,019 individuals from all the provinces of Cuba. We used a panel of 128 autosomal Ancestry Informative Markers (AIMs) to estimate the admixture proportions. We also characterized a number of haplogroup diagnostic markers in the mtDNA and Y-chromosome in order to evaluate admixture using uniparental markers. Finally, we analyzed the association of 16 single nucleotide polymorphisms (SNPs) with quantitative estimates of skin pigmentation. In the total sample, the average European, African and Native American contributions as estimated from autosomal AIMs were 72%, 20% and 8%, respectively. The Eastern provinces of Cuba showed relatively higher African and Native American contributions than the Western provinces. In particular, the highest proportion of African ancestry was observed in the provinces of Guantánamo (40%) and Santiago de Cuba (39%), and the highest proportion of Native American ancestry in Granma (15%), Holguín (12%) and Las Tunas (12%). We found evidence of substantial population stratification in the current Cuban population, emphasizing the need to control for the effects of population stratification in association studies including individuals from Cuba. The results of the analyses of uniparental markers were concordant with those observed in the autosomes. These geographic patterns in admixture proportions are fully consistent with historical and archaeological information. Additionally, we identified a sex-biased pattern in the process of gene flow, with a substantially higher European contribution from the paternal side, and higher Native American and African contributions from the maternal side. This sex-biased contribution was particularly evident for Native American ancestry. Finally, we observed that SNPs located in the genes SLC24A5 and SLC45A2 are strongly associated with melanin levels in the sample.

BackgroundAntiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals.MethodologyWe developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out.FindingsOf the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels >90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care.ConclusionsVirtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection.Trial registrationClinical-Trials.gov: NCT01117675.

La enfermedad celíaca (EC) es una de las enfermedades autoinmunes gastrointestinales que con más frecuencia se asocia a inmunodeficiencias primarias (IDP) como el déficit selectivo de IgA y la inmunodeficiencia variable común (IDVC). A propósito del vínculo entre IDP y celiaquía, se presentan dos pacientes femeninas diagnosticadas como celíacas con formas de presentación diferentes y compromiso inmunonutricional variable. Las bajas concentraciones de inmunoglobulina G (IgG) y la ausencia de IgA fueron los principales hallazgos humorales registrados, no se evidenció compromiso de células B y T, de acuerdo a la cuantificación de subpoblaciones linfoides por citometria de flujo. La intervención nutricional e inmunológica permitió la remisión de las manifestaciones clínicas y la evolución satisfactoria en ambos casos.

Introducción: la diarrea crónica inespecífica (DCI) en la infancia constituye motivo frecuente de consulta, no se ha podido determinar aún el origen de este padecimiento, se invocan varias teorías que tratan de explicar su fisiopatología sobre la base de trastornos inmunológicos asociados. Objetivo: caracterizar el estado inmunológico de niños con DCI. Materiales y Método: se realizó un estudio descriptivo transversal a 36 niños menores de 6 años con diagnóstico de diarrea crónica inespecífica, atendidos en el Instituto de Gastroenterología en el período comprendido de marzo a diciembre del 2012. A todos se les realizó determinación de hemoglobina, hierro sérico, dosificación de inmunoglobulinas totales y ultrasonido de timo. Para el análisis estadístico se emplearon pruebas paramétricas y las diferencias se consideraron significativas con p < 0,05. Resultados: el abandono de la lactancia materna exclusiva antes de los 6 meses y los niveles séricos bajos de Inmunoglobulina A (IgA) tuvieron una elevada frecuencia. No se demostró asociación entre duración de la lactancia materna exclusiva recibida, área tímica y niveles séricos de IgA. Conclusiones: la mayoría de los niños con diarrea crónica inespecífica tienen compromiso de su estado inmunológico. Los principales trastornos inmunológicos presentes son la hipoplasia tímica y los niveles séricos bajos de IgA.