Impact on Fatality Rates and Years of Life Lost During the COVID-19 Pandemic: The Experience of the Mexican Public Health Incident Management Command.

BACKGROUND: The SARS-CoV-2 pandemic challenged health systems worldwide. In Mexico, the Public Health Incident Management Command (COISS) strategy was implemented to improve health care for patients with COVID-19 who required hospitalization. AIM: To evaluate the impact of the COISS strategy on case fatality rates (CFR) and years of life lost (YLL) in hospitalized patients with COVID-19. MATERIALS AND METHODS: The COISS strategy included eight actions implemented in states with high epidemic risk (COISS states). A secondary analysis of the public database from the Mexican Ministry of Health was performed considering patients with confirmed diagnoses of SARS-CoV-2 infection. The COISS strategy effectiveness was evaluated by its impact on in-hospital CFR and YLL at the beginning (T0) and end (T1) of the third wave, and at the end of the fourth wave (T2) and compared to states without intervention (non-COISS states). RESULTS: At T0, COISS states showed a higher CFR for hospitalized patients than non-COISS states, which decreased after the strategy implementation. After correction for baseline conditions, lower relative CFR at T1 and T2, compared to T0, and a protective effect in different age groups, especially in those ≥65 years, were found in hospitalized patients in COISS states. The COISS strategy was associated with lower CFR in hospitalized patients with COVID-19 at both T1 and T2. At T0, YLLs were higher in COISS states, but there were no significant differences at T1 and T2. CONCLUSIONS: COISS interventions effectively reduced CFR in hospitalized patients with COVID-19, providing protection to vulnerable patients and reducing the YLL gap.

Rocky Mountain Spotted Fever in Mexico: A Call to Action.

Rocky Mountain spotted fever (RMSF) is an ongoing public health crisis in Mexico, particularly in states bordering the United States. The national highest incidence and mortality of RMSF occur in this region, resulting in a case-fatality rate that ranges annually between 10% and 50%, primarily affecting vulnerable groups such as children, elderly adults, and persons living in poverty. Multiple biological, environmental, and social determinants can explain its growing presence throughout the country and how it challenges the health system and society. It is necessary to integrate resources and capacities from health authorities, research centers, and society to succeed in dealing with this problem. Through a scientific symposium, a group of academicians, U.S. health officials, and Mexican health authorities met on November 8-10, 2023, in Hermosillo, Mexico, to discuss the current situation of RMSF across the country and the challenges associated with its occurrence. An urgent call for action to improve national capacity against RMSF in the aspects of epidemiological and acarological surveillance, diagnosis, medical care, case and outbreak prevention, health promotion, and research was urged by the experts. The One Health approach is a proven multidisciplinary strategy to integrate policies and interventions to mitigate and prevent the burden of cases, deaths, and suffering caused by RMSF in Mexico.

Generalized and visual anosognosia, Anosodiaphoria after bifrontal injury: symptom length and cognitive outcomes after one year from first report documented.

IMPORTANCE: GAAB Syndrome was recently discovered and coined by Rodríguez, Azariah, Ritter, et al.. (2024). It is characterized by bifrontal brain injury, visual pathway damage involving bilateral enucleation, generalized and visual anosognosia and lack of emotional processing with visual anosognosia being more prominent in the clinical presentation of the patient given the context of bilateral enucleation. The syndrome was not explained by delirium nor by amnesia, not either by multiple shunt adjustments or psychological denial. OBJECTIVE: To describe the clinical presentation and syndrome length of the patient one year after injury. Results show that most of the syndrome symptoms are resolved after nine months, with just visual anosognosia not resolving completely. The patient improved cognitively as shown by the same tests one year later.

Profiles of alcohol intoxication and their associated risks in young adults' natural settings: A multilevel latent profile analysis applied to daily transdermal alcohol concentration data.

OBJECTIVE: Transdermal alcohol concentration (TAC) sensors capture aspects of drinking events that self-reports cannot. The multidimensional nature of TAC data allows novel classification of drinking days and identification of associated behavioral and contextual risks. We used multilevel latent profile analysis (MLPA) to create day-level profiles of TAC features and test their associations with (a) daily behaviors and contexts and (b) risk for alcohol use disorders at baseline. METHOD: Two hundred twenty-two regularly heavy-drinking young adults (Mage = 22.3) completed the Alcohol Use Disorders Identification Test (AUDIT) at baseline and then responded to mobile phone surveys and wore TAC sensors for six consecutive days. MLPA identified day-level profiles using four TAC features (peak, rise rate, fall rate, and duration). TAC profiles were tested as correlates of daily drinking behaviors, contexts, and baseline AUDIT. RESULTS: Four profiles emerged: (a) high-fast (8.5% of days), (b) moderate-fast (12.8%), (c) low-slow (20.4%), and (d) little-to-no drinking days (58.2%). Profiles differed in the odds of risky drinking behaviors and contexts. The highest risk occurred on high-fast days, followed by moderate-fast, low-slow, and little-to-no drinking days. Higher baseline AUDIT predicted higher odds of high-fast and moderate-fast days. CONCLUSIONS: Days with high and fast intoxication are reflective of high-risk drinking behaviors and were most frequent among those at risk for alcohol use disorders. TAC research using MLPA may offer novel and important insights to intervention efforts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Gynecologic infection rates after ablation treatment for cervical intraepithelial neoplasia grade 2 and higher (CIN2+): Secondary analysis of a non-inferiority randomized trial.

Although concerns have been raised regarding potential infection and morbidity in women undergoing ablation treatment for cervical precancer in low- and middle-income countries (LMIC), there is extremely limited data to substantiate this claim. This is a secondary analysis of a randomized non-inferiority trial (id: NCT03084081) that compares the efficacy and safety of three ablation treatments for biopsy-confirmed cervical intraepithelial neoplasia grade 2 or higher (CIN2+): CO2 gas-based cryotherapy, non-gas cryotherapy, and thermal ablation (TA). Here, we present findings regarding the incidence of sexually transmitted infections (STI) and vaginitis post-treatment. Samples were collected at enrollment and again at 6 weeks post-treatment and assessed for STIs (Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), and Trichomonas vaginalis (TV)) and vaginitis (Bacterial vaginosis (BV) and/or Candida albicans (Candida)). This analysis reflects 864 women with baseline and 6-week follow-up data. None of the ablative treatments put women at increased risk for STIs (CT, NG, TV) or vaginitis (BV, Candida). While most women adhered to post-treatment recommendations (97%) and no difference by treatment arm was observed, the incidence of STIs at follow-up in women that did not adhere with a given recommendation was higher compared to their adherent counterparts. The incidence of gynecologic infection did not increase with any of the ablation treatments from baseline to the six-week follow-up. Non-gas cryotherapy and TA emerge as safe alternatives to gas-based cryotherapy with respect to gynecologic infection rates.

Controlled Wrinkle Patterning on Thin Films to Improve Hydrophobicity.

Controlling surface morphology is one of the main strategies used to tune surface hydrophobic and icephobic properties. Taking advantage of coating growth by initiated chemical vapor deposition, random and ordered wrinkles were induced on a thin film of polyperfluorodecyl acrylate (pPFDA) deposited on polydimethylsiloxane (PDMS) to simultaneously modify surface chemistry and morphology. A range of wrinkles of different wavelengths were studied, and how the wrinkle characteristics change with varying coating thickness. Ordered wrinkles enhanced hydrophobicity more when compared to random wrinkles, with a noticeable effect for coating thickness on the order of hundreds of nanometers. An insight into the mechanism of surface wrinkling and its effect on freezing delay is also provided, and promising results were found on ordered wrinkles, where a freezing delay was observed.

Fiddler crabs from highly disturbed beaches are more sensitive to human presence.

The presence of humans frequently modifies the behavior of animals, particularly their foraging patterns, compromising energetic demands. The fiddler crab Leptuca leptodactyla inhabits mangroves with high degrees of anthropogenic influence. Thus, we tested if populations living in highly anthropized mangroves respond differently from those living in more protected areas. We predict that individuals from touristy areas will be more tolerant to humans and will resume their activities sooner after disturbance. To do so, we conducted an experiment that consisted in the approach of an observer to the burrows, recording the response of individuals to the stimuli. The experiment took place in July 2022, in Ubatuba, São Paulo, Brazil. We analysed the duration and latency of various behaviors of a total of 80 adult males from two populations (high and low anthropogenic influence). Contrary to our predictions, individuals from the anthropized population were less tolerant, spending more time inside their burrows and taking longer to resume their activities. Therefore, fiddler crabs were not habituated to human presence. These results help us understand the learning process in invertebrates and their ability to select stimuli, contributing to understanding the impacts of human-wildlife interactions.

Boosting Effect of Sterically Protected Glucosyl Substituents in Formic Acid Dehydrogenation by Iridium(III) 2-Pyridineamidate Catalysts.

[Cp*Ir(R-pica)Cl] (Cp*=pentamethylcyclopentadienyl anion, pica=2-picolineamidate) complexes bearing carbohydrate substituents on the amide nitrogen atom (R=methyl-ß-D-gluco-pyranosid-2-yl, 1; methyl-3,4,6-tri-O-acetyl-ß-D-glucopyranosid-2-yl, 2) were tested as catalysts for formic acid dehydrogenation in water. TOFMAX values over 12000 h-1 and 50000 h-1 were achieved at 333 K for 1 and 2, respectively, with TON values over 35000 for both catalysts. Comparison with the simpler cyclohexyl-substituted analogue (3) indicated that glucosyl-based complexes are much better performing under the same experimental conditions (TOFMAX=5144 h-1, TON=5000 at pH 2.5 for 3) owing to a lower tendency to isomerize to the less active k2-N,O isomer upon protonation. The 5-fold increase in TOFMAX observed for 2 with respect to 1 is reasonably due to an optimal steric protection by the acetyl substituent, which may prevent unproductive inner-sphere reactivity. These results showcase a powerful strategy for the inhibition of the common deactivation pathways of [Cp*Ir(R-pica)X] catalysts for FA dehydrogenation, paving the way for the development of better performing hydrogen storage systems.

Predictors of mortality after craniotomy for geriatric traumatic brain injury.

BACKGROUND: With a sustained increase in the proportion of elderly trauma patients, geriatric traumatic brain injury (TBI) is a significant source of morbidity, mortality and resource utilization. The aim of our study was to assess the predictors of mortality in geriatric TBI patients who underwent craniotomy. METHODS: We performed a 4-year analysis of ACS-TQIP database (2016-2019) and included all geriatric trauma patients (≥65y) with isolated severe TBI who underwent craniotomy. We calculated 11- point modified frailty index (mFI) for patients. Our primary and secondary outcomes were mortality and unfavorable outcome, respectively. Multivariate regression analysis was performed to identify the predictors of outcomes. Patients with mFI ≥ 0.25 were defined as Frail, whereas patient with mFI of 0.08 or higher (<0.25) were identified as pre-frail; Non-frail patients were identified as mFI of <0.08. RESULTS: We analyzed data from 20,303 patients. The mortality rate was 17.7 % (3,587 patients). Having ≥ 2 concomitant types of intra-cranial hemorrhage (OR = 2.251, p < 0.001), and pre-hospital anticoagulant use (OR = 1.306, p < 0.001) increased the risks of mortality. Frailty, as a continuous variable, was not considered as a risk factor for mortality (p = 0.058) but after categorization, it was shown that compared to non-frails, patients with pre-frailty (OR = 1.946, p = 0.011) and frailty (OR = 1.786, p = 0.026) had increased risks of mortality. Higher mFI (OR = 4.841), age (OR = 1.034), ISS (OR = 1.052), having ≥ 2 concomitant types of intra-cranial hemorrhage (OR = 1.758), and use of anticoagulants (OR = 1.117) were significant risk factors for unfavorable outcomes (p < 0.001, for all). CONCLUSIONS: Having more than two types of intra-cranial hemorrhage and pre-hospital anticoagulant use were significant risk factors for mortality. The study's findings also suggest that frailty may not be a sufficient predictor of mortality after craniotomy in geriatric patients with TBI. However, frailty still affects the discharge disposition and favorable outcome. LEVEL OF EVIDENCE: Level III retrospective study.

Enzyme-catalyzed transesterification of galactomannan extracted from mesquite seed (Prosopis velutina) with vinyl carboxylate esters.

Galactomannans (GM) are hemicellulosic polysaccharides composed of D-mannopyranose chains linked by ß (1 â†’ 4) glycosidic linkages with branches of D-galactopyranose linked by α (1 â†’ 6) linkages. This polysaccharide is recognized for its hydrophilic character, as it is rich in hydroxyl groups (-OH). This chemical characteristic, combined with the absence of ionic charges, enables structural modifications such as transesterification of the fatty acid chains (FA), which provides a strategy for obtaining amphiphilic structures. The enzyme-catalyzed syntheses were carried out in DMSO with GM decanoate (GMD) and GM palmitate (GMP) at different molar ratios (0.5 and 1.0) and the resulting structures were evaluated with infrared spectroscopy (FTIR), solid-state nuclear magnetic resonance (CP/MAS 13C NMR) and differential scanning calorimetry (DSC). The FTIR spectrum confirmed the transesterification of GM with the appearance of a C[bond, double bond]O band (1730-1750 cm-1). These results were confirmed by the signals observed at 177 and 30 ppm in the CP/MAS 13C NMR spectrum, which corresponded to the C[bond, double bond]O groups of the esters and the terminal -CH3 groups of the FA chains, respectively. Finally, DSC showed glass transition temperatures (Tg) in the range 43-51 °C, while the melting temperatures (Tm) of the GM esters (59 °C) were not affected by different degrees of esterification (DE) for GMD (0.37 and 0.71) and GMP (0.47 and 0.57).

Structural Colored Based Humidity Sensor Consisting of High Resolution 3D Printed Photonic Crystal Coated with Ultrathin Responsive Hydrogels.

Today, humidity sensors have become an integral part of the daily lives. In particular, humidity sensors using an electronic measuring principle have become the standard. Although these sensors have proven to be a stable measurement method, they have some disadvantages, such as their long response time or the danger of using them in explosive environments. This work introduces photonic crystals as an alternative optical measurement approach. The novel technology of ultra-fast two-photon polymerisation printing is combined with a thin-film deposition process, namely iCVD. This allows to print large area high-precision 3D templates, which are subsequently coated with a humidity responsive hydrogel thin film (p(HEMA) of 20 nm.The limits of 2PP technology are being pushed allowing the production ofs table and periodic large-area 3D structures. The flexible customization of hydrogels for ambient conditions make them exceptionally promising for a wide range of sensing applications. Additionally, optical methods for measuring humidity seem to be an excellent alternative to overcome the limitations for current state of the art humidity sensors. The optical detection of changes in ambient air humidity is achieved by observing color changes of the printed structure within the visible wavelength range.

Cell-type specific effects of mineralocorticoid receptor gene expression suggest intercellular communication regulating fibrosis in skeletal muscle disease.

Introduction: Duchenne muscular dystrophy (DMD) is a fatal striated muscle degenerative disease. DMD is caused by loss of dystrophin protein, which results in sarcolemmal instability and cycles of myofiber degeneration and regeneration. Pathology is exacerbated by overactivation of infiltrating immune cells and fibroblasts, which leads to chronic inflammation and fibrosis. Mineralocorticoid receptors (MR), a type of nuclear steroid hormone receptors, are potential therapeutic targets for DMD. MR antagonists show clinical efficacy on DMD cardiomyopathy and preclinical efficacy on skeletal muscle in DMD models. Methods: We have previously generated myofiber and myeloid MR knockout mouse models to dissect cell-specific functions of MR within dystrophic muscles. Here, we compared skeletal muscle gene expression from both knockouts to further define cell-type specific signaling downstream from MR. Results: Myeloid MR knockout increased proinflammatory and profibrotic signaling, including numerous myofibroblast signature genes. Tenascin C was the most highly upregulated fibrotic gene in myeloid MR-knockout skeletal muscle and is a component of fibrosis in dystrophic skeletal muscle. Surprisingly, lysyl oxidase (Lox), canonically a collagen crosslinker, was increased in both MR knockouts, but did not localize to fibrotic regions of skeletal muscle. Lox localized within myofibers, including only a region of quadriceps muscles. Lysyl oxidase like 1 (Loxl1), another Lox family member, was increased only in myeloid MR knockout muscle and localized specifically to fibrotic regions. Discussion: This study suggests that MR signaling in the dystrophic muscle microenvironment involves communication between contributing cell types and modulates inflammatory and fibrotic pathways in muscle disease.

Clinical features and outcomes of mpox in people with and without HIV: a national comparative study.

BACKGROUND: People who live with HIV (PWLH) have been one of the most affected groups during the current mpox outbreak. They are hypothesized to have a more severe clinical course than people without HIV but comparative data is scarce. We aimed to compare clinical features and outcomes of mpox in people with and without HIV in Mexico. SETTING: Country-wide study in Mexico. METHODS: We performed an observational study using nation-wide epidemiological data. We included all people with confirmed mpox diagnosed between May and November 2022 in Mexico. Clinical and sociodemographic characteristics were compared between people with and without HIV. Multivariable logistic regression models were preformed to determine the association between HIV, clinical features, and outcomes and reported with odds ratios (ORs) and 95% confidence intervals (95% CI). ORs for rare outcomes were interpreted as risk ratios. RESULTS: Among 3291 people with mpox, 59% were PWLH. PWLH had an increased risk of severe mpox (OR 2.6, 2.4-2.9) and death (OR 10.8, 9.7-11.9). They also had a higher risk of otalgia, proctitis, and urethritis. Eleven individuals died, of whom ten were PWLH. All deaths were directly attributed to mpox. CONCLUSION: People with HIV have a higher risk of severe mpox and death due to mpox.

CAR-T cell therapy targeting surface expression of TYRP1 to treat cutaneous and rare melanoma subtypes.

A major limitation to developing chimeric antigen receptor (CAR)-T cell therapies for solid tumors is identifying surface proteins highly expressed in tumors but not in normal tissues. Here, we identify Tyrosinase Related Protein 1 (TYRP1) as a CAR-T cell therapy target to treat patients with cutaneous and rare melanoma subtypes unresponsive to immune checkpoint blockade. TYRP1 is primarily located intracellularly in the melanosomes, with a small fraction being trafficked to the cell surface via vesicular transport. We develop a highly sensitive CAR-T cell therapy that detects surface TYRP1 in tumor cells with high TYRP1 overexpression and presents antitumor activity in vitro and in vivo in murine and patient-derived cutaneous, acral and uveal melanoma models. Furthermore, no systemic or off-tumor severe toxicities are observed in an immunocompetent murine model. The efficacy and safety profile of the TYRP1 CAR-T cell therapy supports the ongoing preparation of a phase I clinical trial.

Outbreak of Fusarium solani Meningitis in Immunocompetent Persons Associated With Neuraxial Blockade in Durango, Mexico, 2022-2023.

Background: Fungal meningitis can be associated with epidural anesthesia procedures. Fusariosis is a rare infection typically affecting immunocompromised patients and rarely causes meningitis. During 2022-2023, public health officials responded to a large outbreak of Fusarium solani meningitis associated with epidural anesthesia in Durango, Mexico. Methods: The public health response and epidemiological and clinical features of patients affected by this outbreak were described. Coordinated actions were addressed to identify the etiological agent, determine its drug susceptibility, develop diagnostic tests, and implement clinical and epidemiological protocols. Retrospective analyses of clinical variables and outcomes were performed to determine association with better patient survival. Results: A total of 1801 persons exposed to epidural anesthesia were identified, of whom 80 developed meningitis. Fusarium solani was found in 3 brain biopsies and showed susceptibility to voriconazole and amphotericin B. After F solani polymerase chain reaction (PCR) implementation, 57 patients with meningitis were PCR-screened, and 31 (38.8%) had a positive result. Most patients were female (95%), and cesarean section was the most common surgical procedure (76.3%). The case fatality rate was 51.3% (41 patients) and the median hospitalization duration was 39.5 days (interquartile range, 18-86 days). Seventy-one patients (88.8%) received voriconazole/amphotericin B and 64 subjects (80%) additionally received steroids. Cox regression analysis showed an increased lethality risk in patients who received antifungal treatment after 5 days (hazard ratio, 2.1 [95% confidence interval, 1.01-4.48], P < .05). Conclusions: The F solani meningitis outbreak in Durango was an unprecedented medical challenge. Timely treatment and effective healthcare management were associated with better survival outcomes.

Icephobic Gradient Polymer Coatings Deposited via iCVD: A Novel Approach for Icing Control and Mitigation.

Materials against ice formation and accretion are highly desirable for different industrial applications and daily activities affected by icing. Although several concepts have been proposed, no material has so far shown wide-ranging icephobic features, enabling durability and manufacturing on large scales. Herein, we present gradient polymers made of 1,3,5,7-tetravinyl-1,3,5,7-tetramethylcyclotetrasiloxane (V4D4) and 1H,1H,2H,2H-perfluorodecyl acrylate (PFDA) deposited in one step via initiated chemical vapor deposition (iCVD) as an effective coating to mitigate ice accretion and reduce ice adhesion. The gradient structures easily overcome adhesion, stability, and durability issues of traditional fluorinated coatings. The coatings show promising icephobic performance by reducing ice adhesion, depressing the freezing point, delaying drop freezing, and inhibiting ice nucleation and frost propagation. Icephobicity correlates with surface energy discontinuities at the surface plane resulting from the random orientation of the fluorinated groups of PFDA, as confirmed by grazing-incidence X-ray diffraction measurements. The icephobicity could be further improved by tuning the surface crystallinity rather than surface wetting, as samples with random crystal orientation show the lowest ice adhesion despite high contact angle hysteresis. The iCVD-manufactured coatings show promising results, indicating the potential for ice control on larger scales and various applications.

Convergent, discriminant, and known groups validity of the Behavioral Assessment Screening Tool (BAST) in chronic traumatic brain injury.

The Behavioral Assessment Screening Tool (BAST) measures self-reported neurobehavioral symptoms commonly experienced by adults with traumatic brain injury (TBI). To assess the convergent, discriminant, and known-groups validity of the BAST among community-dwelling adults with chronic traumatic brain injury (TBI), we conducted correlation analyses and tests of group differences with previously validated symptom measures in two samples (n = 111, n = 134). Measures used for comparison were: Patient Health Questionnaire (depression), Generalized Anxiety Disorder-7 (anxiety), Positive and Negative Affect Schedule, Frontal Systems Behavior Scale (Executive Dysfunction, Apathy, Disinhibition), Modified Fatigue Impact Scale, PROMIS Fatigue, Aggression Questionnaire (anger, hostility, physical and verbal aggression), and Alcohol Use Disorders Test (alcohol misuse). BAST subscales had stronger correlations with measures of similar (|r|=.602-.828, p < .001) and related (|r|>.30, p < .001) constructs and weaker correlations (|r|<.300) with measures of dissimilar/unrelated constructs, supporting hypotheses of convergent and discriminant validity, respectively. Statistically significant group differences (p's < .001) in BAST subscales were found, with large effect sizes (Cohen's d = 1.2-1.9), for known-groups with moderate-severe depression, moderate-severe anxiety, clinically significant fatigue, problematic disinhibited and frontal-executive behaviors, and alcohol use. Conclusions: Results support the convergent and discriminant validity of the BAST subscales. The BAST was specifically developed as a self-reported measure for remote symptom reporting, supporting its incorporation into mobile health platforms to improve chronic symptom monitoring in community-dwelling adults with TBI. With further validation research, the BAST could be used for early identification of persons with TBI who could benefit from intervention.

Maternal vaccination against COVID-19 and neonatal outcomes during Omicron: INTERCOVID-2022 study.

BACKGROUND: In early 2023, when Omicron was the variant of concern, we showed that vaccinating pregnant women decreased the risk for severe COVID-19-related complications and maternal morbidity and mortality. OBJECTIVE: This study aimed to analyze the impact of COVID-19 during pregnancy on newborns and the effects of maternal COVID-19 vaccination on neonatal outcomes when Omicron was the variant of concern. STUDY DESIGN: INTERCOVID-2022 was a large, prospective, observational study, conducted in 40 hospitals across 18 countries, from November 27, 2021 (the day after the World Health Organization declared Omicron the variant of concern) to June 30, 2022, to assess the effect of COVID-19 in pregnancy on maternal and neonatal outcomes and to assess vaccine effectiveness. Women diagnosed with laboratory-confirmed COVID-19 during pregnancy were compared with 2 nondiagnosed, unmatched women recruited concomitantly and consecutively during pregnancy or at delivery. Mother-newborn dyads were followed until hospital discharge. The primary outcomes were a neonatal positive test for COVID-19, severe neonatal morbidity index, severe perinatal morbidity and mortality index, preterm birth, neonatal death, referral to neonatal intensive care unit, and diseases during the neonatal period. Vaccine effectiveness was estimated with adjustment for maternal risk profile. RESULTS: We enrolled 4707 neonates born to 1577 (33.5%) mothers diagnosed with COVID-19 and 3130 (66.5%) nondiagnosed mothers. Among the diagnosed mothers, 642 (40.7%) were not vaccinated, 147 (9.3%) were partially vaccinated, 551 (34.9%) were completely vaccinated, and 237 (15.0%) also had a booster vaccine. Neonates of booster-vaccinated mothers had less than half (relative risk, 0.46; 95% confidence interval, 0.23-0.91) the risk of being diagnosed with COVID-19 when compared with those of unvaccinated mothers; they also had the lowest rates of preterm birth, medically indicated preterm birth, respiratory distress syndrome, and number of days in the neonatal intensive care unit. Newborns of unvaccinated mothers had double the risk for neonatal death (relative risk, 2.06; 95% confidence interval, 1.06-4.00) when compared with those of nondiagnosed mothers. Vaccination was not associated with any congenital malformations. Although all vaccines provided protection against neonatal test positivity, newborns of booster-vaccinated mothers had the highest vaccine effectiveness (64%; 95% confidence interval, 10%-86%). Vaccine effectiveness was not as high for messenger RNA vaccines only. Vaccine effectiveness against moderate or severe neonatal outcomes was much lower, namely 13% in the booster-vaccinated group (all vaccines) and 25% and 28% in the completely and booster-vaccinated groups, respectively (messenger RNA vaccines only). Vaccines were fairly effective in protecting neonates when given to pregnant women ≤100 days (14 weeks) before birth; thereafter, the risk increased and was much higher after 200 days (29 weeks). Finally, none of the neonatal practices studied, including skin-to-skin contact and direct breastfeeding, increased the risk for infecting newborns. CONCLUSION: When Omicron was the variant of concern, newborns of unvaccinated mothers had an increased risk for neonatal death. Neonates of vaccinated mothers had a decreased risk for preterm birth and adverse neonatal outcomes. Because the protective effect of COVID-19 vaccination decreases with time, to ensure that newborns are maximally protected against COVID-19, mothers should receive a vaccine or booster dose no more than 14 weeks before the expected date of delivery.

Microstructural Characterization and Corrosion Behavior of Similar and Dissimilar Welded Advanced High-Strength Steels (AHSS) by Rotary Friction Welding.

Advanced high-strength steels (AHSSs) are designed for meeting strict requirements, especially in the automotive industry, as a means to directly influence the reduction in the carbon footprint. As rotary friction welding (RFW) has many important advantages over other welding technologies, it plays an important role in the automotive sector. On the above basis, in this work, combinations of the first (complex phase (CP)), second (TWIP (TW)), and third (quenched and partitioned (Q&P)) generations of similar and dissimilar high-alloyed advanced steels have been joined by the RFW process. Having a specific microstructure, rods of CP/CP, Q&P/Q&P, CP/TW, and Q&P/TW steels were welded by employing a homemade adaptation machine under fixed parameters. Microstructural characterization has allowed us to corroborate the metallic bonding of all the tested advanced steels and to identify the different zones formed after welding. Results indicate that the welding zone widens in the center of the workpiece, and under the current friction action, the intermixing region shows the redistribution of solute elements, mostly in the dissimilarly welded steels. Furthermore, because of their complex chemistry and the different mechanical properties of the used steels, dissimilarly welded steels present the most noticeable differences in hardness. The TWIP steel has the lower hardness values, whilst the CP and Q&P steels have the higher ones. As a direct effect of the viscoplastic behavior of the steels established by the thermomechanical processing, interlayers and oxidation products were identified, as well as some typical RFW defects. The electrochemical response of the welded steels has shown that the compositional and microstructural condition mostly affect the corrosion trend. This means that the dissimilarly welded steels are more susceptible to corrosion, especially at the TWIP-steel interface, which is attributed to the energy that is stored in the distorted microstructure of each steel plate as a consequence of the thermomechanical processing during RFW.

Generalized anosognosia, anosodiaphoria, and visual hallucinations with bilateral enucleation after severe bifrontal brain injury: a case report describing similarities with and differences from Anton syndrome.

Visual anosognosia, associated with confabulations and cortical blindness in the context of occipital lobe injury, is known as Anton syndrome. Patients with this syndrome strongly deny their vision loss and confabulate to compensate for both visual loss and memory impairments. In this article, we present a case of a patient with some similarities to Anton syndrome, however, with several differences in clinical presentation. Bifrontal brain injury, bilateral enucleation, affective indifference (anosodiaphoria), generalized anosognosia, and the conviction that vision will resume mark clear clinical differences with Anton syndrome. Differentiating these findings from Anton syndrome will help occupational therapists, neuropsychologists, speech-language pathologists, physical therapists, and physicians when assessing frontal lobe brain injury with total and partial visual loss. This case demonstrates that visual anosognosia and confabulations can occur without occipital lobe dysfunction or cortical blindness.