Evaluation of temocillin efficacy against KPC-2-producing Klebsiella pneumoniae isolates in a hollow-fibre infection model.

BACKGROUND: Temocillin is an old antimicrobial that is resistant to hydrolysis by ESBLs but has variable activity against carbapenemase-producing Enterobacteriaceae. The current EUCAST susceptibility breakpoints for Enterobacterales are set at ≤16 mg/L (susceptible with increased exposure) based on a dose of 2 g q8h, but there is limited information on the efficacy of this dose against temocillin-susceptible carbapenemase-producing Klebsiella pneumoniae isolates. OBJECTIVES: To evaluate the efficacy of this dose using a hollow-fibre infection model (HFIM) against six KPC-2-producing clinical isolates of K. pneumoniae. METHODS: The isolates were characterized by WGS and temocillin susceptibility was determined using standard and high inoculum temocillin. Mutant frequencies were estimated and temocillin activity was tested in time-kill assays and in the HFIM. At standard conditions, three of the isolates were classified as susceptible (MIC ≤ 16 mg/L) and three as resistant (MIC > 16 mg/L). The HFIM was performed over 3 days to mimic human-like pharmacokinetics of 2 g q8h. Bacterial counts were performed by plating on Mueller-Hinton agar (MHA) and MHA containing 64 mg/L temocillin to detect resistant subpopulations. RESULTS: All isolates showed a reduction in bacterial population of at least 3 log cfu/mL within the first 8 h of simulated treatment in the hollow-fibre assay. Regrowth was observed for the three resistant isolates and one of the susceptible ones. The MIC value for these isolates was higher by at least two dilutions compared with their initial values. CONCLUSIONS: These data suggest that an optimized pharmacokinetic regimen may be of clinical interest for the treatment of KPC-2-producing K. pneumoniae susceptible to temocillin. These data showed activity of temocillin against KPC-2-producing K. pneumoniae susceptible to temocillin; however, a dose of 2g q8h administered over 30 min may be inadequate to prevent the emergence of resistant variants.

Implications of two-component systems EnvZ/OmpR and BaeS/BaeR in in vitro temocillin resistance in Escherichia coli.

BACKGROUND: BaeS/BaeR is a two-component system of Escherichia coli that controls the expression of porins and efflux pumps. Its role in beta-lactam resistance is limited. OBJECTIVES: To study the role of baeS/baeR two-component system in temocillin resistance in E. coli. METHODS: E. coli strain BW25113 and single-gene deletion mutants related to two-component systems were collected from the KEIO collection. Double-gen deletion mutants were generated. Temocillin-resistant mutant frequencies were determined at 32 mg/L. E. coli BW25113 mutants were selected by selective pressure from serial passages. Biological costs were analysed by growth curves. Genomes of the generated mutants were sequenced. The expression level of the mdtA, mdtB, mdtC, acrD and tolC in the ΔbaeS mutant was determined by RT-PCR (with/without temocillin exposure). RESULTS: The frequency of temocillin mutants ranged from 2.12 × 10-8 to 4.51 × 10-8 in single-porin mutants. No mutants were recovered from E. coli BW25113 (>10-9). Selection of temocillin-resistant variants by serial passage yielded mutants up to 128 mg/L. Mutations were found in the baeS gene. Temocillin MICs ranged from 4 to 32 mg/L (highest MICs for ΔbaeS and ΔompR). The efflux pumps mdtA, mdtB, mdtC and acrD pumps were overexpressed 3-10-fold in the presence of temocillin in ΔbaeS compared to control. CONCLUSIONS: Mutations in the sensor histidine kinase, baeS, may be involved in temocillin resistance through the expression of the efflux pumps mdtABC and acrD. In addition, the low mutation rate may be a good predictor of temocillin activity.

Open Hardware Implementation of Real-Time Phase and Amplitude Estimation for Neurophysiologic Signals.

Adaptive deep brain stimulation (aDBS) is a promising concept in the field of DBS that consists of delivering electrical stimulation in response to specific events. Dynamic adaptivity arises when stimulation targets dynamically changing states, which often calls for a reliable and fast causal estimation of the phase and amplitude of the signals. Here, we present an open-hardware implementation that exploits the concepts of resonators and Hilbert filters embedded in an open-hardware platform. To emulate real-world scenarios, we built a hardware setup that included a system to replay and process different types of physiological signals and test the accuracy of the instantaneous phase and amplitude estimates. The results show that the system can provide a precise and reliable estimation of the phase even in the challenging scenario of dealing with high-frequency oscillations (~250 Hz) in real-time. The framework might be adopted in neuromodulation studies to quickly test biomarkers in clinical and preclinical settings, supporting the advancement of aDBS.

Musculoskeletal pain and muscular weakness as the main symptoms of adult hypophosphatasia in a Spanish cohort: clinical characterization and identification of a new ALPL gene variant.

INTRODUCTION: Hypophosphatasia (HPP) is a rare inherited disorder, caused by mutations in the alkaline phosphatase (ALPL) gene, which encodes for the tissue non-specific alkaline phosphatase (TNSALP) isoform of alkaline phosphatase (ALP). Adult HPP is one of the mild forms that presents with unspecific signs such as osteopenia, osteomalacia and muscle involvement. Our purpose was to identify and characterize possibly misdiagnosed adult HPP patients at a clinical and biochemical level. MATERIAL AND METHODS: At the laboratory of Miguel Servet University Hospital we retrospectively reviewed serum ALP levels in adults over a 48-month period. The clinical records of individuals with consistently low ALP levels were reviewed to exclude secondary causes. Those with persistent hypophosphatasemia were screened for symptoms of HPP. The study participants were evaluated at biochemical and genetic levels. RESULTS: We identified 705 ALP determinations (out of 384,000 processed) in 589 patients below the reference range (30 U/l). Only 21 patients with clinical signs and symptoms of HPP were selected for genetic testing. Finally, only 12 patients participated in the study, 83.3% of whom (10/12) harbored a pathogenic or likely pathogenic variant in a heterozygous state. The major symptoms of our cohort were the presence of musculoskeletal pain (100% of patients) and muscular weakness (83.3% patients). CONCLUSION: Mild HPP patients presenting with diffuse symptoms such as musculoskeletal pain may be undiagnosed or misdiagnosed as osteoporosis patients by routine diagnosis. It is important to identify these individuals, to avoid inappropriate treatment with antiresorptive drugs.

Ventilation of the deep Gulf of Mexico and potential insights to the Atlantic Meridional Overturning Circulation.

Ventilation in the deep Gulf of Mexico (GoM), its connection to the North Atlantic, and its susceptibility to changes of the Atlantic Meridional Overturning Circulation are investigated by combining observations of radiocarbon and volume transport with a Coupled Model Intercomparison Project phase 6 (CMIP6) General Circulation Model (GCM) ensemble output. Radiocarbon data and multiannual volume transport through the Yucatan Channel suggest deep water residence times ~100 years for the GoM. Comparisons to previous radiocarbon observations suggest that the deep GoM has aged in the recent past, consistent with observed raising temperatures and the CMIP6 GCM simulations. The distribution of radiocarbon indicates a time frame of ~160 years between North Atlantic convection and complete ventilation of the deep GoM. This suggests that aging and warming of GoM deep waters were initiated in the North Atlantic before ~1890 consistent with reported rapid and persistent AMOC weakening since the Little Ice Age.

Glutamatergic and GABAergic Receptor Modulation Present Unique Electrophysiological Fingerprints in a Concentration-Dependent and Region-Specific Manner.

Brain function depends on complex circuit interactions between excitatory and inhibitory neurons embedded in local and long-range networks. Systemic GABAA-receptor (GABAAR) or NMDA-receptor (NMDAR) modulation alters the excitatory-inhibitory balance (EIB), measurable with electroencephalography (EEG). However, EEG signatures are complex in localization and spectral composition. We developed and applied analytical tools to investigate the effects of two EIB modulators, MK801 (NMDAR antagonist) and diazepam (GABAAR modulator), on periodic and aperiodic EEG features in freely-moving male Sprague Dawley rats. We investigated how, across three brain regions, EEG features are correlated with EIB modulation. We found that the periodic component was composed of seven frequency bands that presented region-dependent and compound-dependent changes. The aperiodic component was also different between compounds and brain regions. Importantly, the parametrization into periodic and aperiodic components unveiled correlations between quantitative EEG and plasma concentrations of pharmacological compounds. MK-801 exposures were positively correlated with the slope of the aperiodic component. Concerning the periodic component, MK-801 exposures correlated negatively with the peak frequency of low-γ oscillations but positively with those of high-γ and high-frequency oscillations (HFOs). As for the power, θ and low-γ oscillations correlated negatively with MK-801, whereas mid-γ correlated positively. Diazepam correlated negatively with the knee of the aperiodic component, positively to ß and negatively to low-γ oscillatory power, and positively to the modal frequency of θ, low-γ, mid-γ, and high-γ. In conclusion, correlations between exposures and pharmacodynamic effects can be better-understood thanks to the parametrization of EEG into periodic and aperiodic components. Such parametrization could be key in functional biomarker discovery.

Parental Satisfaction from Telemedicine in the Follow-up of Children Operated for Craniosynostosis during COVID-19 Pandemic.

OBJECTIVE: The current study aimed to evaluate the satisfaction level of parents from telemedicine use in the long-term follow-up of children operated for craniosynostosis during the COVID-19 pandemic. DESIGN: A cross-sectional 9-question survey analysis using Qualtrics survey software. SETTING: An institutional study carried out at a national, tertiary level academic center in the Slovak Republic. PATIENTS: All patients operated for non-syndromic and syndromic craniosynostosis in our department, who participated in the virtual postoperative follow-up consultations from March 23, 2020, through July 2, 2021, were included in our series. They were enrolled 498 patients, with the parents of 256 children being responding to the survey. INTERVENTIONS: The survey remained open until July 16, 2021, two weeks after the last virtual consultations. It was delivered to the parents by e-mail to generate closed 5-point Likert scale responses. RESULTS: Overall, 72.3% of parents were satisfied with the telemedicine program, and 67.2% found it convenient. Collectively, 89.1% reported that the received instructions were helpful to them. However, only 18.7% of them answered that they would prefer telemedicine consultations in the future. CONCLUSION: The results of this study showed a high satisfaction from the parents during the virtual follow-up of children operated for craniosynostosis. However, despite their positive experience with telemedicine, the vast majority of parents stated that they would prefer in-person visits in the future.

Manifestaciones craneofaciales en pacientes con osteodistrofia renal / Craneofacial manifestaciones in patients with renal osteodystrophy

Introducción: La osteodistrofia renal es una osteopatía metabólica difusa, relacionada con la insuficiencia renal crónica, que incluye diversas patologías en el sistema musculoesquelético. Se produce en respuesta a trastornos metabólicos generados por cambios electrolíticos, la inflamación crónica y la alteración hormonal. Estas variaciones modifican el proceso de remodelación ósea. Las manifestaciones clínicas incluyen alteración en el parénquima y estroma óseo, y van desde lesiones expansivas, produciendo deformidad, hasta fracturas patológicas del hueso. Objetivo: Relacionar las manifestaciones clínicas, imagenológicas e histológicas en el componente óseo cráneo facial para el diagnóstico de la osteodistrofia renal. Presentación de caso: Se presentan dos casos clínicos de pacientes con enfermedad renal crónica e hiperparatiroidismo secundario de base, con múltiples masas en maxilares que causan asimetría facial y alteración funcional. Las imágenes tomográficas revelan alteración en la morfología ósea cortical y trabecular. Ambos individuos evidenciaron alteraciones en niveles de hormona paratiroidea, fosfatasa alcalina, fósforo y calcio sérico. La histopatología comprobó tejido fibroóseo con hueso neoformado y gran vascularización, con células multinucleadas tipo osteoclastos sin presencia de hemosiderina. Pacientes manejados de forma interdisciplinaria entre medicina interna, endocrinología y cirugía maxilofacial. Conclusiones: Los pacientes con enfermedad renal crónica avanzada presentan alteración de la estructura y del metabolismo óseo y mineral. Tal situación puede comprometer el complejo óseo craneofacial. Los casos graves de osteodistrofia renal se caracterizan por una marcada expansión de los maxilares, que genera asimetría y rasgos de leontiasis. Las imágenes tomográficas asociadas a osteodistrofia renal presentan óseos trabeculares con expansión de cortical, que evidencia el recambio óseo inmaduro presente. La histopatología no es específica y puede ser similar a los casos de displasia ósea craneofacial. Ante lo anteriormente planteado es fundamental relacionar estos hallazgos con la clínica para definir un diagnóstico adecuado(AU)

(AU)Introduction: Renal osteodystrophy is a diffuse metabolic osteopathy, related to chronic renal failure, which includes various pathologies in the musculoskeletal system. It occurs in response to metabolic disorders generated by electrolyte changes, chronic inflammation and hormonal alteration. These variations modify the process of bone remodeling. Clinical manifestations include alteration in the parenchyma and bone stroma, and range from expansive lesions, producing deformity, to pathological fractures of the bone. Objective: Relate the clinical, imaging and histological manifestations in the skull-facial bone component for the diagnosis of renal osteodystrophy. Case Presentation: Two clinical cases of patients with chronic kidney disease and secondary underlying hyperparathyroidism are presented, with multiple masses in the jaws that cause facial asymmetry and functional alteration. Tomographic images reveal alteration in cortical and trabecular bone morphology. Both individuals showed alterations in levels of parathyroid hormone, alkaline phosphatase, phosphorus and serum calcium. Histopathology verified fibro-bone tissue with neoformed bone and great vascularization, with multinucleated osteoclast-like cells without the presence of hemosiderin. Patients were attended in an interdisciplinary way between internal medicine, endocrinology and maxillofacial surgery. Conclusions: Patients with advanced chronic kidney disease present alteration of the structure and bone and mineral metabolism. Such a situation can compromise the craniofacial bone complex. Severe cases of renal osteodystrophy are characterized by a marked expansion of the jaws, which generates asymmetry and traits of leonthiasis. The tomographic images associated with renal osteodystrophy present trabecular bones with cortical expansion, which evidences the immature bone turnover present. Histopathology is not specific and may be similar to cases of craniofacial bone dysplasia. Given the above, it is essential to relate these findings to the clinic to define an adequate diagnosis(AU)

Clitoromegaly due to an epidermal inclusion cyst: A case report.

Background: Clitoromegaly is often a sign of androgen excess; however, non-hormonal causes must be ruled out. We report the case of an adolescent with isolated clitoromegaly without clinical or biochemical evidence of hyperandrogenism. Case: A 16-year-old female was referred due to a clitoromegaly of 12 months of evolution. Examination of the pubic region revealed normal female genitalia with an enlarged clitoris, 4 cm long and 2.5 cm wide. The clitoris was painless, soft on palpation, and mobile over deeper layers. There were no signs of virilization, and the patient did not report dysuria or difficulties with sexual intercourse. Her medical record was also unremarkable, with no female circumcision, family history of birth defects, or genital abnormalities. Hormone profile blood tests were normal. Pelvic ultrasound examination was normal, but a high-resolution scan with a linear transducer confirmed the presence of a cyst, lying anterior to the clitoral body and glans. The cyst was surgically removed with special care to preserve the clitoral neurovasculature. The pathological report disclosed an epidermoid clitoral cyst. The patient described emotional well-being, satisfactory sexual function, and no discomfort after a year of follow-up. Conclusion: Epidermal clitoral cysts represent an unusual cause of clitoromegaly. These cysts should be ruled out as a differential diagnosis after an exhaustive semiological and endocrinological examination.

Global transcriptomic response of Escherichia coli to p-coumaric acid.

The aromatic compound p-coumaric acid (p-CA) is a secondary metabolite produced by plants. This aromatic acid and derived compounds have positive effects on human health, so there is interest in producing them in biotechnological processes with recombinant Escherichia coli strains. To determine the physiologic response of E. coli W3110 to p-CA, dynamic expression analysis of selected genes fused to a fluorescent protein reporter as well as RNA-seq and RT-qPCR were performed. The observed transcriptional profile revealed the induction of genes involved in functions related to p-CA active export, synthesis of cell wall and membrane components, synthesis of amino acids, detoxification of formaldehyde, phosphate limitation, acid stress, protein folding and degradation. Downregulation of genes encoding proteins involved in energy production, carbohydrate import and metabolism, as well as several outer and plasma membrane proteins was detected. This response is indicative of cell envelope damage causing the leakage of intracellular components including amino acids and phosphate-containing compounds. The cellular functions responding to p-CA that were identified in this study will help in defining targets for production strains improvement.

Integration of qualitative and quantitative methods for land-use-change modeling in a deforestation frontier.

Development and implementation of effective protected area management to reduce deforestation depend in part on identifying factors contributing to forest loss and areas at risk of conversion, but standard land-use-change modeling may not fully capture contextual factors that are not easily quantified. To better understand deforestation and agricultural expansion in Amazonian protected areas, we combined quantitative land-use-change modeling with qualitative discourse analysis in a case study of Brazil's Jamanxim National Forest. We modeled land-use change from 2008 to 2018 and projected deforestation through 2028. We used variables identified in a review of studies that modeled land-use change in the Amazon (e.g., variables related to agricultural suitability and economic accessibility) and from a critical discourse analysis that examined documents produced by different actors (e.g., government agencies and conservation nonprofit organizations) at various spatial scales. As measured by analysis of variance, McFadden's adjusted pseudo R2 , and quantity and allocation disagreement, we found that including variables in the model identified as important to deforestation dynamics through the qualitative discourse analysis (e.g., the proportion of unallocated public land, distance to proposed infrastructure developments, and density of recent fires) alongside more traditional variables (e.g., elevation, distance to roads, and protection status) improved the predictive ability of these models. Models that included discourse analysis variables and traditional variables explained up to 19.3% more of the observed variation in deforestation probability than a model that included only traditional variables and 4.1% more variation than a model with only discourse analysis variables. Our approach of integrating qualitative and quantitative methods in land-use-change modeling provides a framework for future interdisciplinary work in land-use change.

El desarrollo y la implementación de la gestión efectiva de las áreas protegidas para reducir la deforestación dependen parcialmente de la identificación de los factores que contribuyen a la pérdida del bosque y de las áreas en riesgo de ser convertidas, pero el modelado estándar del cambio de uso de suelo puede no capturar completamente los factores contextuales que no se cuantifican fácilmente. Combinamos el modelado cuantitativo del cambio de uso de suelo con el análisis cualitativo del discurso en un estudio de caso del Bosque Nacional Jamanxim de Brasil para entender de mejor manera la deforestación y la expansión agrícola en las áreas protegidas del Amazonas. Modelamos el cambio de uso de suelo entre 2008 y 2018 y lo proyectamos hasta 2028. Usamos las variables identificadas en una revisión de estudios que modelaron el cambio de uso de suelo en el Amazonas (p. ej.: variables relacionadas con la idoneidad agrícola y la accesibilidad económica) y en el análisis crítico del discurso que examinó documentos producidos por diferentes actores (p. ej.: agencias gubernamentales y organizaciones sin fines de lucro para la conservación) a varias escalas espaciales. Conforme a las medidas del análisis de varianza, la pseudo-R2 ajustada de McFadden y el desacuerdo en la cantidad y la asignación, descubrimos que la inclusión dentro del modelo de las variables identificadas como importantes para las dinámicas de deforestación mediante el análisis cualitativo del discurso (p. ej.: la proporción de terrenos públicos sin asignar, la distancia hacia los desarrollos propuestos de infraestructura y la densidad de incendios recientes) junto con variables más tradicionales (p. ej.: elevación, distancia a las carreteras y estado de protección) mejoró la habilidad predictiva de dichos modelos. Los modelos que incluyeron la mezcla de variables explicaron hasta 19.3% más de la variación observada en la probabilidad de deforestación que un modelo que solamente incluyó las variables tradicionales y 4.1% más variación que un modelo con las variables del análisis del discurso. Nuestra estrategia de integrar los métodos cualitativos y cuantitativos dentro del modelado del cambio de uso de suelo proporciona un marco para futuros trabajos interdisciplinarios sobre el cambio de uso de suelo.

Prenatal diagnosis of Aicardi syndrome based on a suggestive imaging pattern: A multicenter case-series.

OBJECTIVES: To characterize a suggestive prenatal imaging pattern of Aicardi syndrome using ultrasound and MR imaging. METHODS: Based on a retrospective international series of Aicardi syndrome cases from tertiary centers encountered over a 20-year period (2000-2020), we investigated the frequencies of the imaging features in order to characterize an imaging pattern highly suggestive of the diagnosis. RESULTS: Among 20 cases included, arachnoid cysts associated with a distortion of the interhemispheric fissure were constantly encountered associated with complete or partial agenesis of the corpus callosum (19/20, 95%). This triad in the presence of other CNS disorganization, such as polymicrogyria (16/17, 94%), heterotopias (15/17, 88%), ventriculomegaly (14/20, 70%), cerebral asymmetry [14/20, 70%]) and less frequently extra-CNS anomaly (ocular anomalies [7/11, 64%], costal/vertebral segmentation defect [4/20, 20%]) represent a highly suggestive pattern of Aicardi syndrome in a female patient. CONCLUSION: Despite absence of genetic test to confirm prenatal diagnosis of AS, this combination of CNS and extra-CNS fetal findings allows delineation of a characteristic imaging pattern of AS, especially when facing dysgenesis of the corpus callosum.

Giant Right Ventricular Fibroma: Prenatal Diagnosis and Partial Resection in Early Infancy.

Congenital cardiac fibromas are very rare and prenatal diagnosis has been reported in just a few cases. We describe a four-month-old infant presenting a symptomatic giant right ventricular fibroma discovered during prenatal scanning at 33 weeks of gestation, which was confirmed after delivery on echocardiogram and cardiac magnetic resonance imaging. Due to progressive hemodynamic deterioration, partial surgical resection was performed and the patient recovered uneventfully. We report the successful management during early infancy of a giant cardiac fibroma prenatally diagnosed.

[Cardiac progression of systemic light chain amyloidosis]. / Progresión cardiaca de amiloidosis sistémica de cadera ligera.

Systemic light chain amyloidosis is a disease characterized by the accumulation of amyloid protein in multiple organs and systems. We present the case of a 52-year-old male patient with a diagnosis of systemic light chain amyloidosis associated with cardiac and renal involvement. A renal biopsy showed the presence of renal amyloidosis associated with proteinuria, and the patient was referred for cardiovascular evaluation. The baseline electrocardiogram showed micro voltage in frontal leads that were discordant with the left ventricular hypertrophy evidenced in the transthoracic echocardiogram (TTE). Cardiac magnetic resonance imaging (CMR) confirmed the presence of cardiac amyloid infiltration with a pattern of extensive ventricular late-gadolinium enhancement. Despite being referred and receiving specific systemic chemotherapy treatment, the evolution was not favorable after four months of follow-up with worsening cardiac infiltration, increasing values of biomarkers, and progression of dyspnea. The TTE was useful in revealing the unfavorable evolution and worsening of diastolic function parameters and increased wall thickness in the context of infiltration. The electrocardiogram and echocardiogram were easily accessible tools that allowed the monitoring of the response to treatment.

Tackling equitable coverage and quality of care for neonates in hospitals: a pre-post assessment on asphyxia interventions in Mesoamerica.

BACKGROUND: Intrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica. Multidimensional care for asphyxia must be implemented to ensure timely and effective care of newborns. Salud Mesoamérica Initiative (SMI) is a performance-based program seeking to improve maternal and child health for low-income areas of Central America. Our objective was to assess the impact of SMI on neonatal asphyxia care in health centers and hospitals in the region. METHODS: A pre-post design. Two hundred forty-eight cases of asphyxia were randomly selected from medical records at baseline (2011-2013) and at second-phase follow-up (2017-2018) in Mexico (state of Chiapas), Honduras, Nicaragua, and Guatemala as part of the SMI Initiative evaluation. A facility survey was conducted to assess quality of health care and the management of asphyxia. The primary outcome was coverage of multidimensional care for the management of asphyxia, consisting of a skilled provider presence at birth, immediate assessment, initial stabilization, and appropriate resuscitation measures of the newborn. Data were analyzed using multivariable logistic regression. RESULTS: Management of asphyxia improved significantly after SMI. Proper care of asphyxia in intervention areas was better (OR = 2.4; 95% CI = 1.3-4.6) compared to baseline. Additionally, multidimensional care was significantly higher in Honduras (OR = 4.0; 95% CI = 1.4-12.0) than in Mexico. Of the four multidimensional care components, resuscitation showed the greatest progress by follow-up (65.7%) compared to baseline (38.7%). CONCLUSION: SMI improved the care for neonatal asphyxia management across all levels of health care in all countries. Our findings show that proper training and adequate supplies can improve health outcomes in low-income communities. SMI provides a model for improving health care in other settings.

Assisted dorso-lumbar instrumentation with O-arm neuronavegation and minimally invasive surgery: clinical-surgical outcome.

OBJECTIVE: To evaluate the clinical-surgical outcomes after dorso-lumbar instrumentation using O-arm assisted neuronavigation and minimally invasive surgery. METHOD: In this retrospective cohort, 104 patients who underwent dorso-lumbar instrumentation with the use of O-arm from September 2013 to May 2020 were studied. Variables investigated included: symptoms, number of screws, levels approached, bleeding, surgical time, hospital stay, complications and clinical improvement after the surgical procedure. RESULTS: The most frequent symptoms were: unilateral or bilateral radiculopathy of the pelvic extremities, paresthesia, mechanical low back pain and progressive decrease in strength. A total of 542 screws were placed, with the lumbar spine being the site with the highest prevalence. The average bleeding, surgical time, and hospital stay was: 50 ml, 160 minutes, and 24 hours, respectively. The most frequent complications were: Residual neuropathy, dura mater tear and surgical site infection. Clinical improvement at 24 hours, 4 weeks and 6 months was achieved in: 77.3%, 86.5% y 94.8% of the patients, respectively. CONCLUSIONS: Neuronavigation with the use of O-arm along with mini-open surgery approach results in good clinical-surgical outcomes in the correction of complex disorders of the dorso-lumbar spine.

OBJETIVO: Evaluar los resultados clínico-quirúrgicos de la instrumentación dorso-lumbar mediante neuronavegación asistida con O-arm y cirugía mínimamente invasiva. MÉTODO: En esta cohorte retrospectiva se estudiaron 104 pacientes sometidos a instrumentación dorso-lumbar con uso de O-arm, operados entre septiembre de 2013 y mayo de 2020. Las variables investigadas fueron sintomatología, cantidad de tornillos, niveles abordados, sangrado, tiempo quirúrgico, estancia hospitalaria, complicaciones y mejoría clínica posterior al procedimiento quirúrgico. RESULTADOS: La sintomatología más frecuente fue radiculopatía unilateral o bilateral de extremidades pélvicas, parestesias, lumbalgia mecánica y disminución progresiva de la fuerza. Se utilizaron en total 542 tornillos, siendo la columna lumbar el sitio de mayor prevalencia. Los promedios de sangrado, tiempo quirúrgico y estancia hospitalaria fueron de 50 ml, 160 minutos y 24 horas, respectivamente. Las complicaciones más frecuentes fueron neuropatía residual, rasgadura de la duramadre e infección del sitio quirúrgico. La mejoría clínica a las 24 horas, 4 semanas y 6 meses se logró en el 77.3%, el 86.5% y el 94.8% de los pacientes, respectivamente. CONCLUSIONES: La neuronavegación con O-arm junto con el abordaje quirúrgico de tipo mini-open permite buenos resultados clínico-quirúrgicos en la corrección de los trastornos complejos de la columna dorso-lumbar.

Profiles of Depressive Symptoms Among Men Who Have Sex With Men and Transgender Women During the COVID-19 Outbreak in Mexico: A Latent Class Analysis.

The impact of the COVID-19 outbreak on mental health among HIV high-risk populations is not known. We assess the prevalence of depressive symptoms (DS) and explore the association with characteristics related to the COVID-19 pandemic. We conducted an online survey among 881 men who have sex with men (MSM) and transgender women (TGW) assessing the presence of DS using the Center for Epidemiological Studies Depression Scale (CESD-10); results were compared with previously self-reported DS and national data. We applied latent class analysis (LCA) to identify classes of participants with similar COVID-19 related characteristics. The overall prevalence of significant DS was 53.3%. By LCA posterior probabilities we identified three classes: (1) minimal impact of COVID-19 (54.1%), (2) objective risk for COVID-19 (41.5%), and (3) anxiety and economic stress caused by COVID-19 (4.4%). Multivariate logistic regression showed that compared with those in class one, the odds to have significant DS were almost five times higher for those in class three. Our findings suggest high levels of depression among MSM and TGW in Mexico during the COVID-19 pandemic and highlight the need for the provision of targeted psychological interventions to minimize the impacts of COVID-19 on the mental health.

Variabilidad genética del ADN mitocondrial de Vultur gryphus (cóndor andino) en Cusco y Apurímac a partir de plumas de muda / Genetic variability of mitochondrial DNA of Vultur gryphus (Andean Condor) in Cusco and Apurimac from molting feathers

Resumen La variabilidad genética intrapoblacional de Vultur gryphus (cóndores andinos) de las regiones de Cusco y Apurímac fue evaluada mediante amplificación y secuenciación del ADN mitocondrial correspondientes a la región control y subunidad ribosomal 12S (D-Loop-ARNr12S), y a los genes Citocromo Oxidasa subunidad I (COI) y NADH deshidrogenasa subunidad II (ND2). El ADN se extrajo a partir de cálamos de plumas de muda de ejemplares en cautiverio y silvestres. Se analizaron los principales índices de diversidad genética como son: la diversidad haplotípica, la diversidad nucleotídica, el número promedio de diferencias nucleotídicas y el número de sitios polimórficos. La tasa de éxito de amplificación mediante PCR fue de 100% para las tres regiones de ADN analizadas. Se secuenció 600 pb de la región D-Loop-ARNr12S caracterizándose cuatro haplotipos, 704 pb del gen COI caracterizándose seis haplotipos y 1090 pb del gen ND2 caracterizándose cinco haplotipos. El gen COI presentó el mayor valor de diversidad haplotípica (Hd = 0.468), la región del gen D-Loop-ARNr12S presentó el mayor índice de diversidad nucleotídica (π = 0.00086), mientras que el gen COI presentó el mayor número promedio de diferencias nucleotídicas (K = 0.52615). Los resultados muestran bajos niveles de variabilidad genética en los genes mitocondriales de los cóndores andinos de la zona de estudio, que indicarían una población con estructura genética homogénea.

Abstract The intrapopulation genetic variability of Vultur gryphus (Andean condors) from Cusco and Apurimac regions was evaluated by amplification and sequencing of mitochondrial DNA corresponding to the control region and 12S ribosomal subunit (D-Loop-RNAr12S), Cytochrome Oxidase subunit I (COI) genes and NADH dehydrogenase subunit II (ND2) gene. DNA was extracted from the calamus of feathers recollected from captive and wild specimens. The main indices of genetic diversity such as the haplotype diversity, the nucleotide diversity, the average number of nucleotide differences and the number of polymorphic sites were analyzed. The PCR amplification success rate was 100% for the three mitochondrial amplified sequences. Four haplotypes were identified from the 600 bp sequenced of D-Loop-RNAr12S region; six haplotypes from the 704 bp sequenced of the COI gene; five haplotypes from the 1090 bp sequenced of the ND2 gene. The COI gene presented the highest haplotype diversity (Hd = 0.468), the D-Loop-RNAr12S region presented the highest index of nucleotide diversity (π = 0.00086), while the COI gene presented the highest average number of nucleotide differences (K = 0.52615). The results show low levels of genetic variability in the mitochondrial genes of the Andean Condor in the study area, indicating a population with a homogeneous genetic structure.

Quinoa in Ecuador: Recent Advances under Global Expansion.

Quinoa is a highly diverse crop domesticated in the Andean region of South America with broad adaptation to a wide range of marginal environments. Quinoa has garnered interest worldwide due to its nutritional and health benefits. Over the last decade, quinoa production has expanded outside of the Andean region, prompting multiple studies investigating the potential for quinoa cultivation in novel environments. Currently, quinoa is grown in countries spanning five continents, including North America, Europe, Asia, Africa, and Oceania. Here, we update the advances of quinoa research in Ecuador across different topics, including (a) current quinoa production situation with a focus on breeding progress, (b) traditional seed production, and (c) the impact of the work of the nongovernment organization "European Committee for Training and Agriculture" with quinoa farmers in Chimborazo province. Additionally, we discuss genetic diversity, primary pests and diseases, actions for adapting quinoa to tropical areas, and recent innovations in quinoa processing in Ecuador. Finally, we report a case study describing a participatory breeding project between Washington State University and the Association of Andean Seed and Nutritional Food Producers Mushuk Yuyay in the province of Cañar.