Intra- and Interspecies Differences of Two Cecropia Species from Tabasco, Mexico, Determined through the Metabolic Analysis and 1H-NMR-Based Fingerprinting of Hydroalcoholic Extracts.

The genus Cecropia is used in the traditional medicine of Tabasco, Mexico, in diabetes and hypertension treatments, mainly without distinction of the species. This contribution aimed to carry out the metabolic analysis and Proton Nuclear Magnetic Resonance (1H-NMR) spectroscopy-based fingerprinting of the hydroalcoholic leaf extracts of Cecropia peltata (Cp) and Cecropia obtusifolia (Co) collected in five sub-regions of the State of Tabasco (Cp1, "Centro"; Cp2, "Chontalpa"; Cp3, "Pantanos"; Cp4, "Ríos" and Co5, "Sierra"). Firstly, the extracts were evaluated for their Total Phenol Content (TPC) and Total Flavonoid Content (TFC) by spectrophotometric methods. In addition, metabolic analysis was performed using High-Performance Liquid Chromatography with Diode-Array Detection HPLC-DAD, which allowed the quantification of the chemical markers: chlorogenic acid, isoorientin, and orientin, as well as a vitexin analog. Finally, metabolomic analysis was carried out based on the 1H-NMR spectra. The Cp4 extract (C. peltata from the "Ríos" sub-region) presented the highest values of TPC (155 ± 9.1 mg GAE/g E) and TFC (724 ± 22.2 mg RE/g E). The metabolic analysis was similar among the five samples; the highest concentrations of the four chemical markers were found in Cp3 (C. peltata from the "Pantanos" sub-region) for chlorogenic acid (39.8 ± 2.3 mg/g) and isoorientin (51.5 ± 2.9 mg/g), in Cp4 for orientin (49.9 ± 0.6 mg/g), and in Cp2 (C. peltata from the "Chontalpa" sub-region) for the vitexin analog (6.2 ± 0.2 mg/g). The metabolic analysis and the 1H-NMR fingerprint analysis showed intraspecies differences among the C. peltata samples and interspecies between C. peltata and C. obtusifolia, which were attributed to variations in the metabolite groups as well as in the proportion of sugars such as glucose and xylose.

[Differences by socioeconomic and school level in food acquisition of Mexican population]. / Diferencias por nivel socioeconómico y escolar en la adquisición de alimentos de la población mexicana.

Introduction: Introduction: social or school factors influence the acquisition and selection of foods to be consumed. Objective: identifying the socioeconomic or school level that has the greatest weight in the acquisition of food in Mexican households. Methods: cross-sectional, retrospective and comparative study based on the database of the 2018 National Household Expenditure-Income Survey of Mexico. We worked with the national total of 73,274 Mexican households. The variables considered were: expenditure module of food and beverages, school grade of the head of the family and socioeconomic status to which the household belongs. For the statistical analysis, the following tests were used: linear regression analysis, as well as variance analysis, Snedecor's F test, post-hoc test and Schefé's confirmatory test. Results: socioeconomic status has a greater weight (p < .001) for food acquisition. Sugary drinks were the most widely acquired in all social and school levels. The lowest social level is the one who acquires the most cereals, fats, sugars and legumes, while for high school levels animal foods and processed meats are the ones most frequently acquired. Conclusion: the socioeconomic level has a great weight in the acquisition and variety of foods, although this does not mean that foods obtained are the healthiest. Therefore, public policies are urgently required in favor of nutritional education at all school levels, which promote the purchase of healthy foods and compete with commercial advertising strategies.

Introducción: Introducción: los factores sociales o escolares influyen en la adquisición y selección de alimentos a consumir. Objetivo: identificar el nivel socioeconómico o escolar que tenga mayor peso en la adquisición de alimentos en hogares mexicanos. Métodos: estudio transversal, retrospectivo y comparativo a partir de la base de datos de la Encuesta Nacional de Ingreso-Gasto en Hogares de México de 2018. Se trabajó con el total nacional de 73.274 hogares mexicanos. Las variables consideradas fueron: módulo de gasto de alimentos y bebidas, grado escolar del jefe de familia y condición socioeconómica a la que pertenece el hogar. Para el análisis estadístico se utilizó análisis de regresión lineal, así como análisis de varianza, prueba F de Snedecor, prueba post-hoc y confirmatoria de Schefé. Resultados: el nivel socioeconómico tiene un mayor peso (p < ,001) para la adquisición de los alimentos. Las bebidas azucaradas fueron las de mayor adquisición en todos los niveles sociales y escolares. El nivel social más bajo es el que adquiere la mayor cantidad de cereales, grasas, azucares y leguminosas, mientras que en los niveles escolares altos son los alimentos de origen animal y carnes procesadas los más adquiridos. Conclusión: el nivel socioeconómico tiene mayor peso en la adquisición y variedad de los alimentos, aunque esto no quiere decir que por ello se obtengan los más saludables. Por lo tanto, se requiere urgentemente de políticas públicas en favor de una educación nutricional en todos los niveles escolares, que promueva la compra de alimentos saludables y que compita con las estrategias publicitarias comerciales.

18F-FDG PET Visualizes Systemic STING Agonist-Induced Lymphocyte Activation in Preclinical Models.

Stimulator of interferon genes (STING) is a mediator of immune recognition of cytosolic DNA, which plays important roles in cancer, cytotoxic therapies, and infections with certain pathogens. Although pharmacologic STING activation stimulates potent antitumor immune responses in animal models, clinically applicable pharmacodynamic biomarkers that inform of the magnitude, duration, and location of immune activation elicited by systemic STING agonists are yet to be described. We investigated whether systemic STING activation induces metabolic alterations in immune cells that can be visualized by PET imaging. Methods: C57BL/6 mice were treated with systemic STING agonists and imaged with 18F-FDG PET after 24 h. Splenocytes were harvested 6 h after STING agonist administration and analyzed by single-cell RNA sequencing and flow cytometry. 18F-FDG uptake in total splenocytes and immunomagnetically enriched splenic B and T lymphocytes from STING agonist-treated mice was measured by γ-counting. In mice bearing prostate or pancreas cancer tumors, the effects of STING agonist treatment on 18F-FDG uptake, T-lymphocyte activation marker levels, and tumor growth were evaluated. Results: Systemic delivery of structurally distinct STING agonists in mice significantly increased 18F-FDG uptake in the spleen. The average spleen SUVmax in control mice was 1.90 (range, 1.56-2.34), compared with 4.55 (range, 3.35-6.20) in STING agonist-treated mice (P < 0.0001). Single-cell transcriptional and flow cytometry analyses of immune cells from systemic STING agonist-treated mice revealed enrichment of a glycolytic transcriptional signature in both T and B lymphocytes that correlated with the induction of immune cell activation markers. In tumor-bearing mice, STING agonist administration significantly delayed tumor growth and increased 18F-FDG uptake in secondary lymphoid organs. Conclusion: These findings reveal hitherto unknown functional links between STING signaling and immunometabolism and suggest that 18F-FDG PET may provide a widely applicable approach toward measuring the pharmacodynamic effects of systemic STING agonists at a whole-body level and guiding their clinical development.

Efficacy and Safety of Extracorporeal Membrane Oxygenation in Patients under Mechanical Ventilation with COVID-19 and Severe Acute Respiratory Distress Syndrome: A Health Technology Assessment.

We aimed to assess the efficacy and safety of extracorporeal membrane oxygenation (ECMO) in patients under mechanical ventilation with COVID-19 and severe acute respiratory distress syndrome (ARDS). A systematic review of the literature published in PubMed, Cochrane Library and LILACS databases, was performed. A manual search was also conducted using the reference lists of the studies included in the full-text assessment, as well as a grey-literature search on Google. Additionally, websites of state institutions and organizations developing clinical practice guidelines and health technology assessments were reviewed. The ClinicalTrials.gov website was screened along with the websites of the International Clinical Trial Registry Platform and the National Registry of Health Research Projects of the Peruvian National Institute of Health. No restrictions were applied in terms of language, time, or country. A total of 13 documents were assessed, which included 7 clinical practice guidelines, 3 health technology assessments, 1 systematic review, 1 randomized clinical trial, and 1 observational study. A critical appraisal was conducted for each document. After this, we considered that the currently available evidence is insufficient for a conclusion supporting the use of ECMO in patients under mechanical ventilation with severe ARDS associated to COVID-19 in terms of mortality, safety, and quality of life.

Automedicación en pacientes con sospecha de COVID-19 en seguimiento clínico remoto en Lambayeque / Self-medication in patients with suspected COVID-19 in remote clinical follow-up in Lambayeque

Introducción: Debido a la pandemia, el Estado peruano decidió implementar cuarentena durante un periodo del 2020 la cual provocó cambios de comportamiento en la población, siendo uno de ellos elegir automedicarse. Por ello, el objetivo del presente estudio es describir las características de la automedicación en los pacientes sospechosos de COVID-19 en Lambayeque durante el 2020. Materiales y métodos: estudio de tipo observacional analítico transversal en el que se aplicó una encuesta telefónica a 462 pacientes voluntarios seleccionados aleatoriamente. Posteriormente, se realizó un análisis descriptivo y se buscaron potenciales asociaciones. Resultados: la media de edad fue de 42 años (edad mínima = 18 años, edad máxima = 90), más de la mitad fueron mujeres (58%), la mayoría contaba con educación superior (61,7%), radicaban en la zona urbana de Lambayeque (86,6%) y 64,9% estaba afiliado a EsSalud. Más de la mitad (53,9%) se automedicó durante el tiempo de pandemia, la ivermectina (35,7%; n=218) fue la más consumida. Se encontró que el considerar no clara (p<0.05) ni veraz (p=0.001) la información sobre cómo prevenir la transmisión del SARS-CoV-2, estaría asociado con automedicarse. Conclusiones: La población estudiada usó ivermectina para "prevenir" el contagio, adquirida está en farmacias gracias a la información obtenida de algún médico. También se concluye que creer que la información sobre prevención de COVID-19 brindada por los medios oficiales de comunicación del Perú no es clara o no es veraz está asociado con una mayor probabilidad de automedicación.

Background: Due to the pandemic, the Peruvian State decided to implement quarantine during a period of 2020 which caused changes in behavior, one of those: choosing to self-medicate. Therefore, the objective of this study is to describe the characteristics of self-medication in patients suspected of COVID-19 in Lambayeque during 2020. Materials and methods: cross-sectional analytical observational study in which a telephone survey was applied to 462 patients randomly selected volunteers. Subsequently, a descriptive analysis was performed and associations were searched. Results: the mean age was 42 years (minimun age = 18; maximun age = 90), more than half were women (58%), the majority had higher education (61.7%), they lived in the urban area of Lambayeque (86, 6%) and 64.9% were affiliated with EsSalud. More than half (53.9%) self-medicated during the pandemic, ivermectin (35.7%; n = 218) was the most consumed. It was found that not clear (p <0.05) nor truthful (p = 0.001) the information on how to prevent the transmission of SARS-CoV-2, was associated with self-medication. Conclusions: The studied population used ivermectin to "prevent" COVID-19, they acquired this in pharmacies thanks to the information obtained from a doctor. It is also concluded that believing that the information on COVID-19 prevention provided by the Peruvian media is not clear or is not truthful is associated with a greater probability of self-medication.

Preliminary Phytochemical Profile and Bioactivity of Inga jinicuil Schltdl & Cham. ex G. Don.

Several Mesoamerican cultures have used Inga jinicuil as traditional medicine for the treatment of gastrointestinal, inflammatory, and infectious issues. The aims of this contribution were to elucidate the phytochemical profile of the organic extracts from the bark and leaves of I. jinicuil and to assess the anti-inflammatory and antibacterial properties of these extracts. The preliminary chemical profile was determined by HPLC-PDA and GC-MS; the anti-inflammatory activity was evaluated with a mouse ear edema model, whereas the antibacterial activity was screened against several bacteria. The phytochemical profile of both organs (bark and leaves) of I. jinicuil led to the identification of 42 compounds, such as polyphenolic, flavonoids, triterpenes, prenol-type lipids, and aliphatic and non-aliphatic esters. This molecular diversity gave moderate anti-inflammatory activity (67.3 ± 2.0%, dichloromethane bark extract) and excellent antibacterial activity against Pseudomona aeruginosa and methicillin-resistant Sthaphylococcus aureus (MIC values of ˂3.12 and 50 µg/mL, respectively). These results contribute to the chemotaxonomic characterization and the rational use in traditional medicine of Inga jinicuil Schltdl & Cham. ex G. Don.

Getting Ahead: A Resident Led Quality Improvement Project to Increase Diabetic Nephropathy Screening in an Underserved Hispanic-Predominant Population.

Introduction: Diabetes is the leading cause of end-stage renal disease (ESRD) in the United States (US), with 37 million having chronic kidney disease. Despite national guidelines recommendations for diabetic nephropathy screening with urine albumin-to-creatinine ratio (UACR), less than 50% receive full screening.Our Internal Medicine residents led a quality improvement project to increase diabetic nephropathy screening rate with UACR in our resident clinic by 50% in one academic year. Methods: We conducted the resident-led quality improvement project from July 2021 to April 2022. We reviewed the electronic medical records (EMR) from our clinic pre-intervention July 2020 to June 2021 and compared this to post intervention July 2021 to March 2022 determining the nephropathy screening rates in patients with diabetes. Our interventions included resident education, pre and post surveys to test foundational knowledge, adding UACR in the affordable laboratory order form and establishing normal reference range of UACR in the EMR. Results: We collected 217 patients with diabetes, 27% were uninsured, 38% had Medicare/Medicaid and 90% identified as Hispanic. Comparing pre to post intervention, there was a significant change of 45 (20.7%) vs 71 (32.7%) patients screened for diabetic nephropathy with a UACR. The correct average score of knowledge-based questions was 82% on the pre survey, which increased to 88% in the post survey. Conclusion: Our study showed promising results on improving diabetic nephropathy screening. The comprehensive approach including resident education about diabetic nephropathy screening with UACR and more so facilitating the order set in the EMR were key to achieve this goal.

Conocimientos, actitudes, prácticas y percepción sobre Zika en mujeres en edad fértil de Amazonas, Perú / Knowledge, attitudes, practices and perceptions about Zika in women of childbearing age in Amazonas, Peru

RESUMEN Objetivos. Describir los conocimientos, actitudes, prácticas y percepciones del zika en mujeres en edad fértil (MEF) en el departamento de Amazonas, posterior a un brote de zika. Materiales y métodos. Estudio descriptivo de enfoque mixto cuanticualitativo. Se realizó un muestreo estratificado, aplicándose una encuesta a una muestra de 723 MEF de 15 a 49 años del distrito de Bagua, departamento de Amazonas y cuatro grupos focales con 35 MEF. Se aplicó una encuesta y guía de grupo focal. Se usaron frecuencias y teoría fundamentada para el análisis cuantitativo y cualitativo respectivamente. Se integró ambos enfoques en la interpretación mediante abordaje narrativo. Resultados. El 86,3% de MEF conocen que es posible enfermar con zika, 10,1% que se transmite por relaciones sexuales, 2,2% durante el embarazo y 68,5% consideran que es insuficiente la información. En la práctica; 60%(n=434) usa mosquiteros, 53,4%(n=386) tapa recipientes de agua y el 7,3%(n=4) perciben participación del gobierno local. Los datos cualitativos muestran desconfianza al control vectorial y expresan necesidad de apoyo psicológico a las gestantes y familia. Conclusiones. Existen brechas en el conocimiento y prácticas para la prevención del zika por trasmisión sexual y vertical, tienen desconfianza del control vectorial, no perciben participación del gobierno local, sugieren acompañamiento psicológico a la gestante con zika, a la madre con niño discapacitado y desean acceder a más información sobre zika.

ABSTRACT Objective. To describe the knowledge, attitudes, practices, and perceptions about Zika in women of childbearing age (WCA) in the department of Amazonas in Peru, following a Zika outbreak. Materials and methods. Descriptive study with a mixed quantitative-qualitative approach. We carried out stratified sampling, by applying a survey to a sample of 723 WCA aged 15 to 49 years in the district of Bagua, department of Amazonas, then we carried out four focus groups with 35 WCA in each group. Frequencies and the grounded theory were used for quantitative and qualitative analysis respectively. Interpretation of both methods was integrated using a narrative approach. Results. We found that 86.3% of WCA knew that it is possible to get sick with Zika, 10.1% knew that it is transmitted through sexual intercourse, 2.2% knew that it can be transmitted during pregnancy and 68.5% consider that the information is insufficient. In practice, 60% (n=434) used mosquito nets, 53.4% (n=386) covered water containers and 7.3% (n=4) perceived local government involvement. Qualitative data showed distrust of vector control and expressed the need for psychological support for pregnant women and their families. Conclusions. There are gaps in the knowledge and practices of WCA regarding the prevention of sexual and vertical transmission of Zika; WCA distrust vector control, do not perceive local government involvement, suggest psychological support should be provided to pregnant women with Zika, as well as to mothers with disabled children, and wish to access more information about Zika.

Mortalidad por COVID-19 en México y las enfermedades metabólicas durante el año crítico de la pandemia / COVID-19 mortality in Mexico and metabolic diseases during a critical pandemic year

Conocer la asociación específica de las enfermedades metabólicas en la mortalidad por COVID-19, ocurrida en México durante el año crítico de la pandemia de marzo 2020 a marzo 2021. Método. Se utilizó la base nacional de COVID-19 de la Dirección General de Epidemiología. Se analizaron los casos positivos que presentaron las enfermedades metabólicas: cardiovasculares, hipertensión, diabetes y obesidad. Se realizó un análisis descriptivo para conocer la distribución de los casos fallecidos y no fallecidos. Se empleó la prueba de ji cuadrada para la diferencia de las proporciones. Se utilizaron análisis de regresión logística para conocer la asociación entre las enfermedades metabólicas y la mortalidad por COVID-19 en personas positivas al virus SARS-CoV-2. Los datos fueron ajustados por edad y sexo. Resultados. Se observó la asociación de las enfermedades metabólicas en la mortalidad. La diabetes tuvo mayor porcentaje de letalidad 18,4%. Cuando se conjuntaron las enfermedades cardiovasculares y diabetes el porcentaje de letalidad subió a 31,5%; la conjunción de las enfermedades cardiovasculares, con hipertensión y diabetes fue la de mayor porcentaje de letalidad 38,7%. La obesidad fue la que tuvo menor incidencia. Conclusiones. Las enfermedades metabólicas en México son un problema de salud pública que afectó la mortalidad por covid-19. Es prioritario atender con políticas públicas preventivas y efectivas en favor de un modelo de consumo alimentario sano, acorde con las necesidades nutrimentales de la población(AU)

To know the specific association of metabolic disease on COVID-19 mortality, occurred during the critical year of the pandemic, from march 2020 to march 2021. Method: The Covid-19 national base of the General Directorate of Epidemiology was used. Positive cases of metabolic diseases were analyzed: cardiovascular disease, hypertension, diabetes and obesity. A descriptive analysis was carried out to find out the distribution of deceased and non-deceased cases. The chi-square test was used for the difference in proportions. Logistic regression analysis was used to understand the association between metabolic diseases and COVID 19 mortality in people who tested positive for the SARS-CoV-2 virus. The data were adjusted for age and gender. Results: The association of metabolic diseases on mortality was observed. Diabetes had a higher percentage of lethality 18,4%. When cardiovascular disease and diabetes were combined, the fatality rate rose to 31,5%; the combination of cardiovascular diseases, with hypertension and diabetes was the highest percentage of lethality 38,7%. Obesity had the least incidence. Conclusions: Metabolic diseases in México are a public health problem that affected COVID-19 mortality. It is a priority to deal with preventive and effective public policies in favor of a healthy food consumption model, in line with the nutritional needs of the population(AU)

Dosis de refuerzo con la vacuna BNT162b2 en población que recibió el esquema de vacunación completa para COVID-19 en Perú: Un análisis crítico de la evidencia actual / Booster dose with the BNT162b2 vaccine in the population that received the complete immunization schedule for COVID-19 in Peru: A critical analysis of the current evidence

Introducción: En el Perú, el programa actual de inmunización para COVID-19 comprende las vacunas BBIBP-CorV, BNT162B2 y ChAdOx1 nCoV-19. Si bien el esquema de inmunización es de dos dosis, algunos países han incluido recientemente una dosis de refuerzo a su esquema. Métodos: Se realizó una búsqueda de evidencia científica sobre la eficacia y seguridad de la vacunación de refuerzo con la vacuna BNT162b2 en población con esquema de vacunación completa para COVID-19 en Perú. Evidencia incluida: Se consideraron cuatro documentos de recomendación basados en evidencia, un estudio observacional y tres ensayos clínicos fase III en curso. Conclusión: A la fecha, no existe evidencia suficiente sobre la eficacia de agregar una dosis de refuerzo al esquema de inmunización para COVID-19. La evidencia disponible no permite justificar el uso de una dosis de refuerzo con la vacuna BNT162B2 en población que recibió previamente dos dosis de las vacunas anteriormente mencionadas.

Introduction: In Peru, the current immunization schedule for COVID-19 comprises BBIBP-CorV, BNT162B2 and ChAdOx1 nCoV-19 vaccines. Although the immunization schedule is two doses, some countries have recently included a booster dose to their schedule. Methods: A search for scientific evidence on the efficacy and safety of booster vaccination with BNT162b2 vaccine in a population with a complete vaccination schedule for COVID-19 in Peru was performed. Evidence included: Four evidence-based recommendation documents, one observational study and three ongoing phase III clinical trials were considered. Conclusion: To date, there is insufficient evidence on the efficacy of adding a booster dose to the immunization schedule for COVID-19. The available evidence does not justify the use of a booster dose of BNT162B2 vaccine in a population that previously received two doses of the aforementioned vaccines.

Risk factors for mortality in hospitalized patients with COVID-19 from three hospitals in Peru: a retrospective cohort study.

BACKGROUND: Peru was one of the countries with the highest COVID-19 mortality worldwide during the first stage of the pandemic. It is then relevant to evaluate the risk factors for mortality in patients hospitalized for COVID-19 in three hospitals in Peru in 2020, from March to May, 2020.  Methods: We carried out a retrospective cohort study. The population consisted of patients from three Peruvian hospitals hospitalized for a diagnosis of COVID-19 during the March-May 2020 period. Independent sociodemographic variables, medical history, symptoms, vital functions, laboratory parameters and medical treatment were evaluated. In-hospital mortality was assessed as the outcome. We performed Cox regression models (crude and adjusted) to evaluate risk factors for in-hospital mortality. Hazard ratios (HR) with their respective 95% confidence intervals (95% CI) were calculated.  Results: We analyzed 493 hospitalized adults; 72.8% (n=359) were male and the mean age was 63.3 ± 14.4 years. COVID-19 symptoms appeared on average 7.9 ± 4.0 days before admission to the hospital, and the mean oxygen saturation on admission was 82.6 ± 13.8. While 67.6% (n=333) required intensive care unit admission, only 3.3% (n=16) were admitted to this unit, and 60.2% (n=297) of the sample died. In the adjusted regression analysis, it was found that being 60 years old or older (HR=1.57; 95% CI: 1.14-2.15), having two or more comorbidities (HR=1.53; 95% CI: 1.10-2.14), oxygen saturation between 85-80% (HR=2.52; 95% CI: 1.58-4.02), less than 80% (HR=4.59; 95% CI: 3.01-7.00), and being in the middle (HR=1.65; 95% CI: 1.15-2.39) and higher tertile (HR=2.18; 95% CI: 1.51-3.15) of the neutrophil-to-lymphocyte ratio, increased the risk of mortality.  Conclusions: The risk factors found agree with what has been described in the literature and allow the identification of vulnerable groups in whom monitoring and early identification of symptoms should be prioritized in order to reduce mortality.

The co.LAB Generic Framework for Collaborative Design of Serious Games: Development Study.

BACKGROUND: Serious games are increasingly used at all levels of education. However, research shows that serious games do not always fulfill all the targeted pedagogical objectives. Designing efficient and engaging serious games is a difficult and multidisciplinary process that requires a collaborative approach. Many design frameworks have been described, most of which are dedicated to the development of specific types of serious games and take the collaborative dimension into account only to a limited extent. OBJECTIVE: Our aim was to create a generic serious game design framework that could be adapted to all kinds of serious games and implemented in a collaborative web platform. METHODS: We combined the results of a literature review with our experience in serious game design and development to determine the basic building blocks of a collaborative design framework. We then organized these building blocks into categories and determined the features that a generic design framework should include. Finally, based on the paradigm of complex systems and systemic modelling, we created the co.LAB generic design framework and specifications to allow its implementation in a collaborative web platform. RESULTS: Based on a total of 10 existing design methodologies or frameworks, 23 building blocks were identified and represent the foundation of the co.LAB framework. These blocks were organized into 5 categories: "context and objectives," "game design," "mechanics," "learning design," and "assessment." The arrangement by categories provides a structure that can be visualized in multiple and complementary ways. The classical view links game and learning design while other views offer project, systemic, and process visualizations. For the implementation of the co.LAB framework in a web platform, we propose to convert the building blocks into "cards." Each card would constitute a collaborative working space for the design of the corresponding block. To make the framework adaptive, cards could be added, adapted, or removed according to the kind of serious game intended. Enhancing the visualization of relationships between cards should support a systemic implementation of the framework. CONCLUSIONS: By offering a structured view of the fundamental design elements required to create serious games, the co.LAB framework can facilitate the design and development of such games by virtue of a collaborative, adaptive, and systemic approach. The different visualizations of the building blocks should allow for a shared understanding and a consistent approach throughout the design and development process. The implementation of the co.LAB framework in a collaborative web platform should now be performed and its actual usability and effectiveness tested.

Adquisición alimentaria en la crisis de 2008 y en 2016 en hogares rurales-urbanos de México / Food acquisition during the crisis of 2008 and 2016 in rural-urban households in Mexico

En 2008 México enfrentó una crisis alimentaria que impactó la adquisición de comestibles, ocho años después se acentuó la tendencia de los alimentos, que son más energéticos y menos nutritivos, ocasionando problemas en la salud de la población. Objetivo: Identificar la adquisición de alimentos y su equivalente en calorías en el 2008 y 2016 en hogares rurales y urbanos del sureste de México. Material y métodos: se realizó un estudio de tipo transversal, retrospectivo y comparativo de dos muestras independientes a partir de bases de datos de las Encuestas Nacionales de Ingreso Gasto en Hogares en México de 2008 y 2016. Se trabajó con un total de 5.840 hogares de los cuales, 3.522 fueron urbanos y 2.318 rurales. Las variables consideradas fueron: encuestas, tipos de hogares y adquisición de alimentos equivalentes en calorías. Para el análisis estadístico se utilizó la prueba paramétrica t de Student para muestras independientes, medias, desviación estándar y homogeneidad de varianzas, se tomó como significativo una p < ,05 Resultados: los alimentos de mayor adquisición calórica en ambos años y hogares fueron, cereales y productos de origen animal y los menos, verduras y frutas (p < ,001). Los hogares rurales, incrementaron significativamente (p < ,001) los cereales para el 2016, así como en los urbanos, disminuyó en aceites y carnes procesadas (p < ,001). Conclusión: después de la crisis alimentaria del 2008 se observaron cambios alimentarios en hogares rurales, atribuyéndosele más a la transición alimentaria que a la crisis, las familias adquirieron nuevos hábitos alimentarios(AU)

In 2008 México faced a food crisis that impacted the acquisition of groceries, eight years later the trend of foods, which are more energetic and less nutritious, was accentuated, causing problems in the health of the population. Objective: Identify food acquisition and its calorie equivalent in 2008 and 2016 in rural and urban households in southeastern México. Material and methods: A cross-sectional, retrospective and comparative study of two independent samples was conducted from databases of the National Household Spending and Income Surveys in Mexico in 2008 and 2016. A total of 5,840 households were worked on, of which 3,522 were urban and 2,318 rural. The variables considered were: surveys, types of households and acquisition of calorie-equivalent foods. For statistical analysis, Student's t parametric test was used for independent samples, mean, standard deviation and variance homogeneity, a p < ,05 was taken as significant. Results: The foods with the highest caloric acquisition in both years and households were cereals and products of animal origin and the least vegetables and fruits (p < ,001). Rural households significantly increased cereals for 2016 (p < ,001), as well as in urban households, decreased in oils and processed meats (p< ,001). Conclusion: After the 2008 food crisis, dietary changes were observed in rural households, with more attributed to the food transition than to the crisis, families acquired new eating habits(AU)

Estimating a normal reference range for serum B-cell maturation antigen levels for multiple myeloma patients.

The serum B-cell maturation antigen (sBCMA) has been identified as a novel serum biomarker for patients with multiple myeloma. However, no study has yet established a reference range for sBCMA levels. Its levels were determined in 196 healthy subjects and showed a right-tailed distribution with a median value of 37·51 ng/ml with a standard deviation of 22·54 ng/ml (range 18·78-180·39 ng/ml). Partitioning of subgroup reference ranges was considered but determined to be irrelevant. A non-parametric method using the median ± 2 standard deviations suggests using a universal reference interval of <82·59 ng/ml.

Normalization of serum B-cell maturation antigen levels predicts overall survival among multiple myeloma patients starting treatment.

Serum B-cell maturation antigen (sBCMA) is a novel biomarker for B-cell malignancies. A normal reference range (<82·59 ng/ml) has been recently established but the impact of achieving normal levels to outcomes for patients receiving treatment for B-cell malignancies has not been studied. We first found that among multiple myeloma (MM) patients starting a new treatment, those who begin treatment within normal sBCMA limits (<82·59 ng/ml) have improved progression-free survival (PFS; P = 0·0398) and overall survival (OS; P = 0·0217) than those who do not. Furthermore, among patients who begin treatment with elevated (≥82·59 ng/ml) sBCMA levels, we assessed the relationship of a decrease in sBCMA to the normal range to OS and found that those who normalize sBCMA demonstrated improved OS (P = 0·0078). Normalizing patients also experienced a markedly improved overall response rate (P < 0·0001). Moreover, all patients who achieved complete remission (CR) showed normalization of sBCMA, and time to normalization (median 0·9 months) was faster than time to CR (5·0 months; P = 0·0036) for these patients. These results suggest that normalization of sBCMA may be an accurate predictor of OS for MM patients during treatment and predict for a higher likelihood of response.

Caries en la tercera edad en una universidad de la ciudad de Puebla 2017-2018 / Caries in the third age in a university of the City of Puebla 2017-2018

La caries es una infección que afecta a cualquier persona sin importar edad, género o clase social. Es importante enfocar la atención odontológica a pacientes de tercera edad ya que tienden a un crecimiento anual de 3.8% de la población mexicana. Actualmente, se han realizado campañas de salud bucal para esta población; a pesar de los múltiples esfuerzos realizados para la prevención y erradicación de dicha enfermedad existe un descuido en los tratamientos para pacientes de la tercera edad, lo cual puede favorecer la pérdida de dientes. El objetivo del estudio fue determinar la prevalencia y severidad de caries en adultos mayores en la clínica de odontología de la Universidad Popular Autónoma del Estado de Puebla (UPAEP). Se realizó un estudio descriptivo, retrospectivo; se revisaron 345 expedientes de pacientes de tercera edad del 2017 al 2018, que asistieron por primera vez a consulta. Se obtiene la prevalencia y severidad a través del índice CPOD (cariados, perdidos y obturados). La prevalencia de dientes cariados fue 79%; se obtuvo un CPOD de 18.63 (alto riesgo). Se concluye el implementar medidas preventivas que impacten en mayor dimensión a la caries, para su disminución o erradicación en pacientes geriátricos (AU)

Caries is an infection that affects anyone regardless of their age, gender or social class. It is, however, important to focus dental care on elderly patients as that part of the Mexican population is growing at 3.8% annually. Currently, oral health campaigns have been carried out for this population, but despite the multiple efforts undertaken for prevention and eradication of the disease, treatment for elderly patients is often overlooked. The consequence of this lack of treatment can be the loss of teeth. The objective of this study is to determine the prevalence and severity of caries in elderly patients at the dental clinic of the Universidad Popular Autónoma del Estado de Puebla (UPAEP). A descriptive, retrospective study was carried out where the records of 345 elderly, first-time patients were reviewed for the 2017-2018 period. The prevalence and severity of caries was determined using the DMFT index (decay, missing, filled). The prevalence of carious teeth was 79% with a DMFT of 18.63 indicating high risk. We conclude that preventive measures should be implemented to impact and decrease caries in geriatric patients (AU)

JAK1/2 pathway inhibition suppresses M2 polarization and overcomes resistance of myeloma to lenalidomide by reducing TRIB1, MUC1, CD44, CXCL12, and CXCR4 expression.

Monocytes polarize into pro-inflammatory macrophage-1 (M1) or alternative macrophage-2 (M2) states with distinct phenotypes and physiological functions. M2 cells promote tumour growth and metastasis whereas M1 macrophages show anti-tumour effects. We found that M2 cells were increased whereas M1 cells were decreased in bone marrow (BM) from multiple myeloma (MM) patients with progressive disease (PD) compared to those in complete remission (CR). Gene expression of Tribbles homolog 1 (TRIB1) protein kinase, an inducer of M2 polarization, was increased in BM from MM patients with PD compared to those in CR. Ruxolitinib (RUX) is an inhibitor of the Janus kinase family of protein tyrosine kinases (JAKs) and is effective for treating patients with myeloproliferative disorders. RUX markedly reduces both M2 polarization and TRIB1 gene expression in MM both in vitro and in vivo in human MM xenografts in severe combined immunodeficient mice. RUX also downregulates the expression of CXCL12, CXCR4, MUC1, and CD44 in MM cells and monocytes co-cultured with MM tumour cells; overexpression of these genes is associated with resistance of MM cells to the immunomodulatory agent lenalidomide. These results provide the rationale for evaluation of JAK inhibitors, including MM BM in combination with lenalidomide, for the treatment of MM patients.

Serum B-Cell Maturation Antigen (BCMA) Levels Differentiate Primary Antibody Deficiencies.

BACKGROUND: Primary antibody deficiencies (PADs) are the most prevalent primary immunodeficiencies. More severe forms of PADs-common variable immunodeficiency (CVID) and X-linked agammaglobulinemia (XLA)-require immunoglobulin replacement therapy (IRT) and may have serious complications. Differentiating severe PAD from milder hypogammaglobulinemia not requiring IRT can involve prolonged evaluations and treatment discontinuation. Severe PAD is defined by plasma cell deficiency, but this requires a biopsy to establish. Serum B-cell maturation antigen (sBCMA) is elevated in multiple myeloma, but levels are reduced among patients with myeloma in remission who have hypogammaglobulinemia. OBJECTIVE: To measure the sBCMA level in 165 subjects to determine whether it differentiates severe PAD-CVID and XLA-from less severe forms not requiring IRT and those without PAD. METHODS: sBCMA, B cells, and tissue plasma cells were measured among subjects with and without PAD, and correlated to clinical and laboratory data. RESULTS: Subjects with an IgG level of less than 600 mg/dL had reduced sBCMA levels compared with subjects with PAD with IgG levels of greater than or equal to 600 mg/dL and controls without PAD. sBCMA level was lower in patients with CVID and XLA compared with patients with IgA or IgG deficiency and controls. sBCMA level correlated with gastrointestinal plasma cells. sBCMA level of less than 15 ng/mL had 97% positive predictive value for CVID or XLA, whereas 25 ng/mL or more had an 88% negative predictive value. CONCLUSIONS: sBCMA level is profoundly reduced in patients with severe PAD, including those with CVID and XLA and those with IgG levels of less than 600 mg/dL. sBCMA level measurement has potential to augment clinical evaluation of PAD. Prospective studies are needed to evaluate sBCMA for new PAD diagnosis and determine the necessity of IRT.

Method transfer of a near-infrared spectroscopic method for blend uniformity in a poorly flowing and hygroscopic blend.

The challenges in transferring and executing a near-infrared (NIR) spectroscopic method for croscarmellose (disintegrant) in binary blends for a continuous manufacturing (CM) process are presented. This work demonstrates the development of a NIR calibration model and its use to determine the blending parameters needed for binary blends at a development plant and later used to predict CM process blends. The calibration models were developed with laboratory scale powder blends ranging from 4.32%-64.77 (%w/w) of croscarmellose and evaluated using independent test blends. The selected model was then transferred to the continuous manufacturing development site to determine the croscarmellose concentration for spectra collected in real-time. A total of 18 development plant runs were monitored using an in-line NIR spectrometer, however, these spectra showed high baseline variations. The baseline variations were caused by the poor flow of the material within the system. An inconsistent bias which varied from 2.51 to 14.95 (%w/w) was observed in the predictions of croscarmellose. High baseline spectra were eliminated and the bias was significantly reduced by 42-51%. Experiments at lower flow rate speeds did not show significant changes in baseline and bias values showed more consistency. The calibration model was then transferred to two NIR spectrometers installed at-line at the commercial site, where powder samples were collected at the beginning middle and end of each CM plant run. The NIR calibration model predicted disintegrant concentration from the powder samples. Results showed the bias values for the NIR (1) varied from 0.74 to 2.21 (%w/w) and NIR (2) from 0.28 to 3.39 (%w/w). Average concentration values for both equipments were very close to the reference concentration values of 43.18 and 50.98 (%w/w). The study showed the model was able to identify flow issues, identified as baseline shifts, that could be used to alert to problems in the powder bed that may warrant diversion from a production line. These powder flow problems such as air gaps and inconsistent powder bed height affected the NIR spectra collected at the development plant and provided results with high bias. A lower bias was obtained in samples collected at line after blending.

Plasma B-Cell Maturation Antigen Levels are Elevated and Correlate with Disease Activity in Patients with Chronic Lymphocytic Leukemia.

BACKGROUND: Chronic lymphocytic leukemia (CLL) is a malignancy of late B cells. In another late B-cell malignancy (multiple myeloma), levels of solubilized B-cell maturation antigen (sBCMA) are elevated and predict outcomes. OBJECTIVE: We sought to evaluate sBCMA as a possible prognostic factor and monitoring tool for patients with CLL. PATIENTS AND METHODS: Using an enzyme-linked immunosorbent assay (ELISA), we assessed plasma (p) levels of BCMA in 171 CLL patients and compared them with levels in healthy individuals. RESULTS: pBCMA levels were significantly higher among patients with CLL than those from healthy donors (p < 0.0001). Among patients with aggressive disease, pBCMA was elevated compared with patients with indolent disease (p < 0.001). Those with an initial pBCMA level in the highest quartile had a shorter time to first treatment compared with CLL patients with pBCMA levels in the lowest three quartiles (p < 0.0001). Among those in the highest quartile (pBCMA > 110.9 ng/mL), overall survival was shorter than those in the lowest three quartiles (p = 0.0007). Finally, among those patients who underwent serial pBCMA testing, changes in these levels correlated with changes in their clinical status. CONCLUSIONS: Together, our findings show that pBCMA is a promising new prognostic and predictive indicator for patients with CLL.