Incidence and Risk Factors for Pneumonitis Associated With Checkpoint Inhibitors in Advanced Non-Small Cell Lung Cancer: A Single Center Experience.

INTRODUCTION: Immune checkpoint inhibitor (ICI) pneumonitis causes substantial morbidity and mortality. Estimates of real-world incidence and reported risk factors vary substantially. METHODS: We conducted a retrospective review of 419 patients with advanced non-small cell lung cancer (NSCLC) who were treated with anti-PD-(L)1 with or without anti-CTLA-4 therapy. Clinical, imaging, and microbiological data were evaluated by multidisciplinary adjudication teams. The primary outcome of interest was grade ≥2 (CTCAEv5) pneumonitis. Clinicopathologic variables, tobacco use, cancer therapies, and preexisting lung disease were assessed for univariate effects using Cox proportional hazards models. We created multivariate Cox proportional hazards models to assess risk factors for pneumonitis and mortality. Pneumonitis, pneumonia, and progression were modeled as time-dependent variables in mortality models. RESULTS: We evaluated 419 patients between 2013 and 2021. The cumulative incidence of pneumonitis was 9.5% (40/419). In a multivariate model, pneumonitis increased the risk for mortality (HR 1.6, 95% CI, 1.0-2.5), after adjustment for disease progression (HR 1.6, 95% CI, 1.4-1.8) and baseline shortness of breath (HR 1.5, 95% CI, 1.2-2.0). Incomplete resolution was more common with more severe pneumonitis. Interstitial lung disease was associated with higher risk for pneumonitis (HR 5.4, 95% CI, 1.1-26.6), particularly in never smokers (HR 26.9, 95% CI, 2.8-259.0). CONCLUSION: Pneumonitis occurred at a high rate and significantly increased mortality. Interstitial lung disease, particularly in never smokers, increased the risk for pneumonitis.

Cultural adaptation and validation of the Quality of Dying in Long-term Care (QoD-LTC and QoD-LTC-C) scales by caregivers in nursing homes.

BACKGROUND: There is a lack of tools that can evaluate quality of dying in nursing homes from the perspective of deceased patients' caregivers. The aim of this study was to adapt and validate the caregivers' versions of the Quality of Dying in Long-Term Care (QoD-LTC) and Quality of Dying in Long-Term Care Complete (QoD-LTC-C) scales in the Spanish context. METHODS: This was a cultural adaptation and validation study. The scales were translated from English to Spanish and vice versa, and 13 experts in end-of-life care participated in a two-round Delphi panel. Caregivers of 69 deceased residents from seven nursing homes in southern Spain completed both scales. Reliability, feasibility, and concurrent validity with global quality of dying perception and symptom burden (Edmonton Symptom Assessment Scale), were evaluated. RESULTS: Spanish caregivers' version of the QoD-LTC scale showed good internal consistency for the total scale (α = 0.74) and each of its three factors, and good inter-rater reliability (ICC = 0.50) and test-retest reliability (ICC = 0.81). The Spanish QoD-LTC-C scale for caregivers showed good internal consistency for the total scale (α = 0.81) and for its component factors, and good test-retest reliability (ICC = 0.89) and inter-rater reliability (ICC = 0.66). Both scales correlated with family caregivers' global perception of deceased residents' quality of dying (r = 0.39; r = 0.32), but not with the ESAS score. CONCLUSIONS: Both scales presented an adequate factorial structure, internal consistency, and reliability to assess caregivers' perception of the quality of dying in Spanish nursing homes.

[Self-management in people with multimorbility: Contributions from salutogenesis and health assets model]. / Automanejo en personas con multimorbilidad: aportes desde la salutogénesis y el modelo de activos en salud.

Different models of care in context of chronicity and multimorbidity include community, health system, clinical practice, health policies, prevention, and health promotion. Among these, the role of the health team as a facilitator of self-management is pointed out, being people the protagonists of their process. Multimorbidity approach is mostly carried out from a risk and disease focused point of view, which limits the exploration of resources of people and their environment. Incorporating a positive health approach can contribute to a greater comprehensiveness. The purpose of this article is to propose an approach from the synergy model of health, integrating salutogenesis and health assets model, to help facilitate self-management promoting people's agency capacity. Potential areas of application of these models are presented to work in the context of multimorbidity, promoting health and well-being conditions in people and their families.

Upper limb neurodynamic test 1 in patients with clinical diagnosis of carpal tunnel syndrome: A diagnostic accuracy study.

STUDY DESIGN: Diagnostic accuracy. INTRODUCTION: Upper limb neurodynamic test 1 (ULNT1) is used to evaluate the mechanical sensitivity especially in the peripheral nerves of the upper limbs. The reproduction of typical symptoms in the affected hand improves the estimation of the probability of carpal tunnel syndrome (CTS). However the test has not been evaluated sufficiently to determine its real usefulness. In the present study the diagnostic accuracy of ULNT1 as a clinical test for CTS was determined. METHODS: We used the ULNT1 as the index test and nerve conduction as the reference standard. 120 subjects, (240 hands), with a medical diagnosis of CTS were evaluated. The study population was a consecutive series of participants. Sensitivity, specificity, positive and negative predictive values, accuracy, and positive likelihood ratio were calculated. RESULTS: ULNT1 was found to have a sensitivity of 93 % and a specificity of 6.67 %. The positive likelihood ratio was 1.04 and the negative likelihood ratio was 1.00. The positive predictive value was 86.9 % and the negative predictive value was 12.5%. DISCUSSION: Acute or relatively mild CTS cases may not be accurately identified through nerve conduction tests. The findings of this study coincide with other studies in the finding that ULNT1 has a significant diagnostic and clinical screening value for CTS in people at-risk, or with upper limb symptoms. CONCLUSION(S): This research suggests the use of ULNT1 as a screening test for CTS, followed by tests that are more specific. LEVEL OF EVIDENCE: III-2.

In and out of refugia: historical patterns of diversity and demography in the North American Caesar's mushroom species complex.

Some of the effects of past climate dynamics on plant and animal diversity make-up have been relatively well studied, but to less extent in fungi. Pleistocene refugia are thought to harbour high biological diversity (i.e. phylogenetic lineages and genetic diversity), mainly as a product of increased reproductive isolation and allele conservation. In addition, high extinction rates and genetic erosion are expected in previously glaciated regions. Some of the consequences of past climate dynamics might involve changes in range and population size that can result in divergence and incipient or cryptic speciation. Many of these dynamic processes and patterns can be inferred through phylogenetic and coalescent methods. In this study, we first delimit species within a group of closely related edible ectomycorrhizal Amanita from North America (the American Caesar's mushrooms species complex) using multilocus coalescent-based approaches; and then address questions related to effects of Pleistocene climate change on the diversity and genetics of the group. Our study includes extensive geographical sampling throughout the distribution range, and DNA sequences from three nuclear protein-coding genes. Results reveal cryptic diversity and high speciation rates in refugia. Population sizes and expansions seem to be larger at midrange latitudes (Mexican highlands and SE USA). Range shifts are proportional to population size expansions, which were overall more common during the Pleistocene. This study documents responses to past climate change in fungi and also highlights the applicability of the multispecies coalescent in comparative phylogeographical analyses and diversity assessments that include ancestral species.

Pharmacokinetic drug-drug interaction study of the angiopoietin-1/angiopoietin-2-inhibiting peptibody trebananib (AMG 386) and paclitaxel in patients with advanced solid tumors.

BACKGROUND: Trebananib is an anti-angiogenic peptibody under investigation in patients with advanced cancer. This study evaluated the pharmacokinetic (PK) drug-drug interaction of paclitaxel and trebananib. PATIENTS AND METHODS: Patients with advanced solid tumors received weekly 80 mg/m(2) intravenous (IV) paclitaxel (3 weeks on/1 week off) with weekly 15 mg/kg IV trebananib starting at Week 2. Blood samples for PK analysis were collected at Week 1 (paclitaxel alone), Week 6 (paclitaxel and trebananib), and Week 8 (trebananib alone). An absence of interaction was to be concluded if the 90 % confidence intervals (CI) for the differences in paclitaxel exposure fell within the 0.80-1.25 interval. RESULTS: The primary study was conducted between 7/2012 and 10/2013. Thirty-five patients were enrolled and 34 received both treatments. Most patients were white (91 %) and female (59 %); mean age was 61 years. The most common tumor types were ovarian (32 %) and bladder (27 %), 71 % of patients had stage IV disease, and all had Eastern Cooperative Oncology Group (ECOG) scores of 0 or 1. PK parameter analysis was done on patients with evaluable PK data at both assessments (with and without concomitant therapy; n = 28). The geometric least squares mean (GLSM) ratio (90 % CI) of paclitaxel AUCinf with and without trebananib was 1.17 (1.10, 1.25). The GLSM ratio (90 % CI) of trebananib AUCtau,ss with and without paclitaxel was 0.92 (0.87, 0.97). The most common adverse events were fatigue, local edema, peripheral edema, and nausea. CONCLUSIONS: This study showed no evidence of clinically meaningful PK interaction between paclitaxel and trebananib.

Association of Preoperative Lung Function with Complications after Lobectomy Using Race-Neutral and Race-Specific Normative Equations.

Rationale: Pulmonary function testing (PFT) is performed to aid patient selection before surgical resection for non-small cell lung cancer (NSCLC). The interpretation of PFT data relies on normative equations, which vary by race, but the relative strength of association of lung function using race-specific or race-neutral normative equations with postoperative pulmonary complications is unknown. Objectives: To compare the strength of association of lung function, using race-neutral or race-specific equations, with surgical complications after lobectomy for NSCLC. Methods: We studied 3,311 patients who underwent lobectomy for NSCLC and underwent preoperative PFT from 2001 to 2021. We used Global Lung Function Initiative equations to generate race-specific and race-neutral normative equations to calculate percentage predicted forced expiratory volume in 1 second (FEV1%). The primary outcome of interest was the occurrence of postoperative pulmonary complications within 30 days of surgery. We used unadjusted and race-adjusted logistic regression models and least absolute shrinkage and selection operator analyses adjusted for relevant comorbidities to measure the association of race-specific and race-neutral FEV1% with pulmonary complications. Results: Thirty-one percent of patients who underwent surgery experienced pulmonary complications. Higher FEV1, whether measured with race-neutral (odds ratio [OR], 0.98 per 1% change in FEV1% [95% confidence interval (CI), 0.98-0.99]; P < 0.001) or race-specific (OR, 0.98 per 1% change in FEV1% [95% CI, 0.98-0.98]; P < 0.001) normative equations, was associated with fewer postoperative pulmonary complications. The area under the receiver operator curve for pulmonary complications was similar for race-adjusted race-neutral (0.60) and race-specific (0.60) models. Using least absolute shrinkage and selection operator regression, higher FEV1% was similarly associated with a lower rate of pulmonary complications in race-neutral (OR, 0.99 per 1% [95% CI, 0.98-0.99]) and race-specific (OR, 0.99 per 1%; 95% CI, 0.98-0.99) models. The marginal effect of race on pulmonary complications was attenuated in all race-specific models compared with all race-neutral models. Conclusions: The choice of race-specific or race-neutral normative PFT equations does not meaningfully affect the association of lung function with pulmonary complications after lobectomy for NSCLC, but the use of race-neutral equations unmasks additional effects of self-identified race on pulmonary complications.

[Temporomandibular manifestation in patients with Ehlers-Danlos syndrome: a systematic review]. / Manifestaciones temporomandibulares en pacientes con síndrome de Ehlers-Danlos: una revisión sistemática.

Introduction: Ehlers-Danlos Syndrome (EDS) consists of a group of diseases that imply a disorder among individuals connective tissue due to an altered collagen production. Fibrocartilaginous structures, support ligaments, disc and retrodiscal from the temporomandibular joint are composed primarily of collagen. Objective: Identify TMJ manifestations in patients with different types of EDS. Materials and Methods: a systematic review of the literature was performed on PubMed, Scopus and Web of Science databases. Observational studies and case series reports published either in spanish or panish were included up until January 2023. Results: 12 articles met the inclusion criterial. The prevalence of temporomandibular disorders varies from 26.6% to 100%, being EDSh the most reported subtype, whereas disc displacement with or without reduction and joint hypermobility were the most reported joint disorders. Conclusion: Temporomandibular pathologies are common in patients with EDS, especially in those with the EDSh subtype.

Sarcoidosis and Airway Disease After Immune Checkpoint Inhibitor Therapy: Case Study and Review of the Literature.

Pulmonary toxicity from immune checkpoint inhibitor therapy is typically a severe and potentially fatal complication, but these observations are driven by the most common toxicity, pneumonitis. Rarer pulmonary immune related adverse events, like airway disease and sarcoidosis, may have a more benign course. In this case report, we present a patient in whom therapy with the PD-1 inhibitor pembrolizumab resulted in severe eosinophilic asthma and sarcoidosis. This is the first case showing that anti-IL-5 inhibition may be safe in patients who develop eosinophilic asthma after ICI therapy. We further show that sarcoidosis does not necessarily require treatment cessation. This case highlights relevant nuances when clinicians face pulmonary toxicities other than pneumonitis.

Quality of dying among elderly people diagnosed with dementia in nursing homes: A mixed methods study.

WHAT IS KNOWN ON THE SUBJECT: Nurses working at nursing homes can play a pivotal role in mental health as a high proportion of residents diagnosed with dementia are in these facilities. Many institutionalized residents diagnosed with dementia develop clinical complications and symptoms that reduce the quality of dying. A mixed-methods approach can help nurses with the difficult task of assessing the quality of dying among these residents and identify inconsistencies that cannot be found using scales alone, but no studies were found in this topic. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Through the Quality of dying in Long-Term Care Scale (QoD-LTC), nurses described symptom management, quality of care, and end-of-life appearance as adequate and end-of-life communication as lacking. Generally speaking, the scores on the scale were consistent with the data from semi-structured interviews conducted with nurses. In the semi-structured interviews, some of the concepts on the scale, including 'dignity', 'holistic' care, 'good relationships with healthcare professionals', and 'a peaceful death', are complex and not fully incorporated into nurses' practice in nursing homes when assessing residents diagnosed with dementia. This could be improved by using the SENSES Model or person-centred care frameworks. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is evidence of shortcomings among professionals in the correct use of concepts linked to psychological wellbeing, communication, therapeutic relationship, safety and participation, preservation of dignity, decision-making, and resident autonomy, which can be addressed using specific theoretical approaches developed in the field of mental health nursing. ABSTRACT: Introduction The complex nature of end-of-life assessment of individuals diagnosed with dementia would benefit from a mixed-methods approach that simultaneously assess the perception and response of nurses to standardized tools. Aim/Question To examine nursing professionals' perceptions of the quality of dying among residents diagnosed with dementia using the Quality of Dying in Long-Term Care settings (QoD-LTC) questionnaire and to identify consistencies and inconsistencies in their narratives. Method Mixed-methods study using concurrent triangulation with data integration for results and interpretation. Nurses from eight nursing homes assessed 117 residents diagnosed with dementia who died in the previous 3 months using the QoD-LTC scale. After informed consent was obtained (nurses/caregivers), 17 semi-structured scale-based interviews were conducted. Results Symptom management, quality of care, and end-of-life appearance were found to be adequate, while end-of-life communication was deemed insufficient. The qualitative and quantitative data were consistent for most of the items on the QoD-LTC. Discussion Concepts such as dignity, holistic care, good relationships, and peaceful death are complex and not fully incorporated into professional practice. Implications for Practice The results highlight the need for greater involvement of mental health nurses as well as improved communication, training, and specific tools tailored to residents diagnosed with dementia.

The cultural role played by the ethnomycological knowledge of wild mushrooms for the peoples of highlands and lowlands in Tlaltenango, Zacatecas, Mexico.

The greatest diversity of culturally relevant fungi in Mexico has been recorded in temperate forests. Likewise, it has been proven that people who live in such environments possess greater ethnomycological knowledge, compared with people in the lowlands. In this study, we investigated whether the uses and perceptions of fungi were different between people living near forests in highlands and those living in lowlands near grasslands and subtropical scrublands. We selected seven communities from the municipality of Tlaltenango, Zacatecas, Mexico, where we conducted guided tours, 35 semistructured interviews, and free lists to 420 people. Since highlands surrounded by temperate forests give rise to high species diversity, we expected that the inhabitants, in comparison with those of the lowlands where there is less diversity, would recognize a larger number of fungi. To test this hypothesis, we employed discriminant function analysis, principal coordinate analysis, Mann-Whitney U test, and linear regression. The cultural importance of each species was calculated based on the frequency with which it was mentioned and the first principal coordinate. Although the highlanders have a deeper knowledge of mushrooms, lowlanders and highlanders had similar fungal backgrounds and preferred the same species, regardless of the fungi surrounding their territory. The lack of differences among communities was due in part to the fact that the most culturally important species were those that grew in grasslands and subtropical scrub areas. Agaricus campestris was the most culturally prevalent and only commercialized species both in the highlands and lowlands, followed by Pleurotus djamor and Volvariella bombycina. None of the mushrooms growing in the pine-oak forest had a high cultural importance value, even for the communities living in the vicinity of this forest, forcing them to travel long distances to collect Agaricus campestris. Further investigations are needed in order to assess the relevance of sociocultural factors, and their potential influence in the preference for particular mushrooms in this region.

[Clinical, obstetric and perinatal characteristics of Mexican pregnant women with COVID-19]. / Características clínicas, obstétricas y perinatales de embarazadas mexicanas con Covid-19.

Background: COVID-19 disease is the leading cause of maternal death in Mexico. The data published to date indicate that pregnancy favors severe forms of the disease. Objective: To describe the clinical, obstetric and perinatal characteristics of pregnant women with COVID-19 disease treated at the UMAE "Luis Castelazo Ayala" of the Instituto Mexicano del Seguro Social. Material and methods: Observational, cross-sectional and retrospective study of pregnant women with COVID-19 treated from March to December 2020. The epidemiological characteristics, complications and perinatal results were analyzed with descriptive and inferential statistics. Results: 133 patients included: 84.5% with mild disease, 8 % moderate and 8.5% severe and critical. Pre-existing comorbidities: obesity, diabetes and hypothyroidism. Main symptoms: cough, headache, fever, rhinorrhea and anosmia. In severe and critical cases, tachycardia, tachypnea, and hypoxemia were present. Lymphoneutropenia, hyperglycemia, and transaminasemia were seen in severe and critical forms. Fibrinogen and D dimer stayed unchanged. Preterm delivery, oligohydramnios, gestational hypertension, severe preeclampsia, and pneumonia were the main complications. 75% of the newborns without complications. Conclusions: The clinical behavior of the disease was mostly mild and even in moderate cases, and even in moderate as well as severe and complicated cases, the binomial results were favorable. There was no maternal death.

Introducción: la enfermedad COVID-19 en el embarazo es la primera causa de muerte materna en México, y se ha reportado que favorece las formas graves de la enfermedad. Objetivo: describir las características clínicas, obstétricas y perinatales de pacientes embarazadas con enfermedad COVID-19 atendidas en la UMAE "Luis Castelazo Ayala" del Instituto Mexicano del Seguro Social (IMSS). Material y métodos: estudio observacional, transversal y retrospectivo de pacientes embarazadas con COVID-19 atendidas de marzo a diciembre del 2020. Las características epidemiológicas, complicaciones y resultados perinatales se analizaron con estadística descriptiva e inferencial. Resultados: se incluyeron 133 pacientes: 84.5% presentaron enfermedad leve, 8% moderada y 8.5% severa y crítica. Las comorbilidades preexistentes fueron: obesidad, diabetes e hipotiroidismo. Los principales síntomas: tos, cefalea, fiebre, rinorrea y anosmia. En casos severos y críticos la taquicardia, taquipnea e hipoxemia estuvieron presentes. En las formas severa y crítica se observaron: linfoneutropenia, hiperglucemia y transaminasemia. El fibrinógeno y dímero D sin cambios. El parto pretérmino, el oligohidroamnios, la hipertensión gestacional, la preeclampsia severa y la neumonia fueron las principales complicaciones. El 75% de los recién nacidos no preentaron complicaciones. Conclusiones: el comportamiento clínico de la enfermedad fue, en su mayoría, leve, e incluso en los casos moderados así como en los severos y complicados los resultados del binomio fueron favorables. No hubo muerte materna ni se evidenció transmisión vertical.

Sociocultural drivers of mycological knowledge: insights from Wixarika and Mestizo groups in western Mexico.

BACKGROUND: Traditional mycological knowledge (TMK) is complex, not distributed equally among the entire population, and constantly adapting to current social situations. There are sociocultural factors that could influence the fact that some people retain a greater wealth of knowledge, for instance, cultural affiliation, migration, occupation, level of schooling, and person's age. METHODS: We analyze the distribution of the TMK based on sociocultural variables and 12 indicators to quantify the TMK based on a literature review. We chose two sites where there was a Wixarika and Mestizo population with records of use and consumption of wild mushrooms. In each site, 150 semi-structured interviews were conducted. The format of the semi-structured interviews was made up of sociocultural questions plus 12 questions corresponding to each of the indicators. With the data obtained, we performed linear regression tests and principal components analysis (PCA); furthermore, the significance of the groupings obtained by PCA was tested with a discriminant function analysis. RESULTS: We find that TMK was determined by the cultural group to which a person belongs. Contrary to what was expected, age and formal schooling did not influence people's level of knowledge. Likewise, migration and occupation were not determining factors either, although in some specific cases they did influence the differences in knowledge about mushrooms between people. The indicators that most helped to differentiate between the Wixarika people, and the Mestizos were knowledge of the nutritional contribution, propagation methods, and knowledge about toxic mushrooms. CONCLUSIONS: In general, sociocultural differences did not affect the transmission of the TMK due to the valorization of this knowledge among the young generations and the maintenance of the use of wild resources. Specifically, the Wixaritari had and preserved a greater TMK thanks to their pride in their cultural identity, which had allowed them to adapt to modernity while preserving their traditions and knowledge. On the other hand, the Mestizos increasingly disused wild resources due to urbanization. The indicators proposed here provided a good tool to quantify TMK; however, to replicate the study in other sites it is necessary to adapt the indicators to the context of the place.

The Primate Cultural Significance Index: applications with Popoluca Indigenous people at Los Tuxtlas Biosphere Reserve.

BACKGROUND: The study of the cultural significance (CS) of biodiversity provides key information to develop conservation strategies consistent with traditions and perceptions of human communities. In Los Tuxtlas Biosphere Reserve (TBR) in Mexico, the mantled howler monkeys (Alouatta palliata mexicana) and the black-handed spider monkeys (Ateles geoffroyi vellerosus) have historically coexisted with Popoluca Indigenous Peoples. This study sought to determine how the presence of a natural protected area (TBR location) and a range of sociodemographic factors (gender, age, origin, language proficiency, education level, religion) relate to the CS held by the Popoluca Indigenous People in relation to these two endangered primate species. METHODS: The first Primate Cultural Significance Index (PCSI) was designed as a composed index of 11 cultural variables (sub-indices) and was applied randomly to a representative size sample of people over 15 years old in two Popolucas communities, one within the TBR (Piedra Labrada = 81 people) and another outside (Los Mangos = 91). U Mann-Whitney tests were used to compare the PCSI between communities and Generalized Linear Models (GLM) to evaluate the sociodemographic factors of participants that influenced the sub-indices in the PCSI. RESULTS: The cultural significance of spider monkeys held by the Popolucas was higher for the community within the TBR than for the community outside, while for howler monkeys it was higher outside. For both primate species across the two communities, the most relevant sub-indices were (1) interest in conservation and (2) touristic significance of primates. Sociodemographic factors of participants influenced nine sub-indices of cultural significance out of the possible 10 sub-indices applied for each primate species. The demographic factors that most influenced each sub-index for both species were location and gender. CONCLUSIONS: The main differences found between communities may be linked to the conservation and sustainable development programs promoted by the reserve, as well as the greater persistence of Popolucan ancestral traditions within the boundaries of the reserve. We recommend that conservation efforts should focus on people less interested about primate conservation (women, non-natives and residents outside the reserve), and turn to the leadership of people more interested (native men who reside inside the reserve).

Efectos de las Técnicas de Cierre de Fisura Labio-Máxilo-Palatina sobre el Crecimiento y Desarrollo Esqueletal: Una Revisión Narrativa

Las fisuras labio-máxilo-palatinas (FLMP) son malformaciones congénitas que requieren de un manejo quirúrgico complejo para devolver un correcto funcionamiento del sistema estomatognático. Sin embargo, aún no existe un consenso sobre qué modalidad quirúrgica representa los mejores resultados y sus efectos a largo plazo en el desarrollo esqueletal y funcional de los individuos. El objetivo de este trabajo fue describir mediante la información científica disponible; el efecto de los diferentes protocolos quirúrgicos para el cierre de la FLMP sobre el crecimiento y desarrollo esqueletal de los pacientes. Se realizó una búsqueda de la literatura en bases de datos Pubmed, Cochrane y Epistemonikos, contemplando estudios desde el año 2013 hasta la actualidad. Se obtuvieron un total de 999 estudios encontrados. Una vez aplicados los criterios de inclusión y exclusión, se seleccionaron 13 estudios. El tratamiento quirúrgico de las FLMP consiste en procedimientos complejos que implican alteraciones en el desarrollo esqueletal de los individuos intervenidos a largo plazo. Las discrepancias en el desarrollo esqueletal de los pacientes empiezan a detectarse durante la dentición mixta. Es recomendable extender el seguimiento hasta la etapa de la pubertad y adultez, ya que podría demostrar diferencias significativas entre las diferentes cronologías quirúrgicas empleadas.

Cleft Lip and Palate (CLP) belong to a group of congenital anomalies that require complex surgical management, in order to restore the normal function of the stomatognathic system. However, there is no consensus that determines which surgical technique is better according to its outcomes and long- term effects on the skeletal and functional development of treated individuals. The objectives of this study are To describe, using the available scientific information, the effect of the different surgical protocols regarding CLP closure, on the skeletal and functional development patients undergoing surgery. A research of the available information was made in three different databases: PubMed, Cochrane and Epistemonikos. This research included articles released since the year 2013 onwards. A total of 999 studies were found. Once exclusion and inclusion criteria were applied, 13 studies were selected. Surgical treatment of CLP consists of complex procedures which imply long-term skeletal alterations in undergoing patients. These skeletal discrepancies are first detected during the mixed dentition phase. It is recommended to extend patient follow-up up until puberty and adulthood, as it might demonstrate significant differences among the different surgical approaches.

Manejo Quirúrgico de Fístula Bucosinusal: Reporte de Caso y Revisión de la Literatura

Las fístulas bucosinusales son complicaciones poco frecuentes originadas a partir de comunicaciones bucosinusales de larga trayectoria o no tratadas que predisponen a desarrollar cuadros patológicos tales como infecciones, sinusitis y un establecimiento crónico de la fístula si no es tratada de manera apropiada y oportuna. El tratamiento indicado es el cierre quirúrgico de esta comunicación, la cual puede ser lograda mediante múltiples técnicas; siendo el tamaño, localización y compromiso de los tejidos blandos circundantes los factores principales para considerar una técnica por sobre otra. El siguiente artículo tiene como objetivo presentar el manejo de una fístula bucosinusal de larga data en un paciente de 71 años con antecedentes médicos de radioterapia de cabeza y cuello.

Oroantral fistulae are rare complications originating from non-treated or long-term oroantral communications which can contribute to the development of certain pathological entities such as local infections, sinusitis and chronic fistula formation. The treatment modality indicated is surgical closure of the communication, which can be achieved through multiple techniques, being the size, location and nearby soft tissue the main factors for considering one technique over another. The objective of the following article is to present the management of an oroantral fistula in a 71 year old patient with a medical history of head and neck radiotherapy.

Expansión Rápida del Maxilar: Revisión actualizada de las técnicas disponibles / Rapid Maxillary Expansion: Updated Review of Available Techniques

La deficiencia transversal del maxilar es una anomalía dentomaxilar capaz de producir problemas funcionales en la oclusión, respiración y estéticos. Su presentación clínica tradicional es la mordida cruzada posterior y una alteración en la relación transversal intermaxilar, la cual impide la correcta erupción de las piezas dentarias. Su manejo corresponde a la expansión rápida del maxilar, la cual puede ser asistida mediante mini-implantes (MARPE), cirugía (SARPE) o una combinación de ambas técnicas (MISMARPE). El objetivo del presente artículo es presentar un contraste entre las técnicas empleadas en la expansión rápida del maxilar, para simplificar la toma de decisiones clínicas. Se elaboró una revisión narrativa en las bases de datos PubMed, Scopus y Epistemonikos contemplando revisiones sistemáticas, metaanálisis, ensayos clínicos aleatorizados y estudios observacionales publicados entre el año 2013 a 2023. Un total de 23 artículos fueron incluidos, los cuales cumplían con los criterios de inclusión y exclusión establecidos. El manejo clínico de la deficiencia transversal del maxilar frecuentemente requiere un abordaje interdisciplinario combinando un enfoque ortopédico y quirúrgico. Según lo encontrado en la actual revisión, tanto el MARPE, SARPE y MISMARPE reportan indicaciones y limitaciones, así como complicaciones asociadas, sin embargo, serían efectivas en la resolución de deficiencias transversales. Se recomienda al clínico considerar dicha información de acuerdo a las necesidades particulares de cada caso clínico, así como profundizar y prolongar el estudio de nuevas técnicas para analizar su estabilidad a largo plazo en comparación a las otras corrientes terapéuticas.

The transverse deficiency of the maxilla is a dentomaxillary anomaly capable of producing functional problems in occlusion, respiration and esthetics. Its traditional clinical presentation is dental crowding, which obstructs the correct eruption of the teeth. Its management corresponds to rapid maxillary expansion, which can be assisted by means of mini-implants (MARPE), surgery (SARPE) or a combination of both techniques (MISMARPE). The objective of this article is to present a contrast between the techniques used in rapid maxillary expansion to simplify clinical decision making. A narrative review was performed in PubMed, Scopus and Epistemonikos databases, including systematic reviews, meta-analyses, randomized clinical trials and observational studies published between 2013 and 2023. A total of 23 articles were included, which met the established inclusion and exclusion criteria. The clinical management of transverse deficiency of the maxilla frequently requires an interdisciplinary management, combining an orthopedic and surgical approach. As found in the current review, all techniques; MARPE, SARPE and MISMARPE, report indications and limitations, as well as associated complications. It is recommended to deepen and prolong the study of new techniques in order to analyze their long-term stability in comparison to other therapeutic currents.

Traditional knowledge, uses, and perceptions of mushrooms among the Wixaritari and mestizos of Villa Guerrero, Jalisco, Mexico.

The relationship between humans and nature is defined by culture. Accordingly, the use, conceptions, and perceptions of resources differ among cultural groups, even among those inhabiting the same region or those who come into contact with the same biota. In particular, mushrooms evoke a wide range of sentiments. During ethnobiological tours in Mexico, semi-structured interviews were carried out with 37 individuals of each community, from ten Wixarika and mestizo communities, living in the same locality and sharing similar resources, in the municipality of Villa Guerrero in northern Jalisco, Mexico. Furthermore, informal interviews with four Wixarika and five mestizo key informants were conducted. The topics treated were regarding the traditional nomenclature and classification, uses, and knowledge of mushrooms and related practices. Wixarika names of 37 mushroom species with edible, medicinal, and recreational uses were recorded. In addition, the Wixaritari were found to associate toxic mushrooms with the divine, as evidenced by one case of the use of mushrooms as a hierophanic agent. Each culture's knowledge of the phenology and ecology of mushrooms was recorded in addition to data highlighting the cultural exchange between the Wixaritari and mestizos. However, a loss in the knowledge and practices concerning mushrooms was observed as a result of social changes. Even so, both cultures prefer mushrooms to other foods, including meat, especially Volvariella bombycina and Pleurotus djamor.

Negative correlation between testosterone and TNF-α in umbilical cord serum favors a weakened immune milieu in the human male fetoplacental unit.

Clinical and epidemiological evidence supports that pregnancies carrying a male fetus are more vulnerable to infections and preterm birth, probably due to testosterone immunosuppressive properties. In human placentas, testosterone lowers the expression of CYP27B1, the vitamin D (VD)-activating enzyme, diminishing cathelicidin synthesis, a potent VD-dependent antimicrobial peptide (AMP). VD also stimulates other AMPs, including defensins. To get insights into the increased male vulnerability mechanisms, we investigated the relationship between fetal sex and the immunoendocrine milieu at the fetoplacental unit. For this, umbilical vein serum and placental samples were collected from healthy newborns. In males' serum, testosterone levels were significantly higher and negatively associated with TNF-α, a cytokine that strengthens the immune response. Males showed lower serum TNF-α and increased levels and gene expression of the immunosuppressive cytokine IL-10. Only in female samples there was a positive association (P < 0.05) between AMPs and both TNF-α and CYP27B1 and between 25-hydroxyvitamin D3 and IL-1ß serum levels. Accordingly, VD-metabolites (25-hydroxyvitamin D3, calcitriol) significantly stimulated IL-1ß gene expression in cultured trophoblasts. Interestingly, IL-1ß mRNA correlated positively with defensins (P < 0.05) in males, but not with cathelicidin expression, which was significantly diminished in comparison to females. Our data suggest that high umbilical serum testosterone and IL-10 in males could explain reduced TNF-α levels and lack of association between VD-dependent innate immunity markers and proinflammatory cytokines expression in the fetoplacental unit. Altogether, our observations imply a restricted basal immune milieu in males compared to females, which may help understand the higher male susceptibility to adverse perinatal outcomes.

Sociodemographic differences in the cultural significance of edible and toxic mushrooms among Tsotsil towns in the Highlands of Chiapas, Mexico.

BACKGROUND: Mushrooms are important forest resources, mostly as food, despite the serious health threat posed by toxic species. In the Highlands of Chiapas, numerous wild mushroom intoxications have been registered. While Chiapas has been vastly studied from an ethnomycological perspective, no certainty exists as to how nomenclature systems differentiate edible and toxic species, which species are most culturally significant, and whether sociodemographic factors relate to how well-known they are in the Highlands of Chiapas. This paper evaluates which are the most culturally significant edible and toxic wild mushroom species in seven Tsotsil communities from this region and whether differences exist in their knowledge relating to different sociodemographic subsets (gender, schooling, and occupation). The hypothesis that there is a difference in the number of species that people mention, as well as the number of times each ethno-taxon is mentioned, between people from different social groups was tested. METHODS: With consent, 133 Tsotsil people from seven communities were interviewed. Interviews focused on local systematics and free listings of edible and toxic mushrooms. Qualitative and quantitative analyses were performed, including multivariate methods and non-parametric statistics. RESULTS: Twenty-five edible and 15 toxic taxa were mentioned. Some directly correspond to Linneanean species, while others are subdifferentiated or supradifferentiated. Only 62% of the interviewees named toxic mushrooms. The most frequently mentioned edible taxa were Amanita hayalyuy and A. jacksoniii, Agaricus spp., and Armillaria mellea. The most frequently mentioned toxic species were Amanita muscaria, Suillellus luridus, and Russula emetica. Significant differences in the number of mentioned edible ethnotaxa were found only among different occupations and schooling. The models including schooling interacting with either gender or occupation are better supported. Significant differences in the number of times toxic ethnotaxa are mentioned were found only between men and women. CONCLUSIONS: The Tsotsil region of the Highlands of Chiapas is where the most average mushroom species are recognized state-wide. Schooling and occupation seem most determinant for people to know more or less species of mushrooms, while gender appears irrelevant. People with no studies and field-related occupations name more species. Identification criteria to distinguish edible from toxic species seem to rest not on detailed recognition of the second set but precise knowledge of the first.