Is older age an independent prognostic factor of survival in metastatic colorectal cancer?

INTRODUCTION: Older patients (>75 years) with advanced colorectal cancer (CRC) may have worse survival than non-older patients. We hypothesized that, rather than age alone, concurrent factors may be more relevant for real-world survival. METHODS: Patients diagnosed with CRC in a 5-year period (2014-2018) were analyzed to determine which factors influenced in overall survival (OS). Kaplan-Meier method was used to estimate OS. Univariate and multivariate analysis was conducted by Cox regression analysis. The study was approved by Ethic Committee. RESULTS: Out of 477 patients diagnosed with CRC, 231 had advanced disease. 92 patients (40%) were older than 75 years, median OS (mOS) was 17.1m (CI95% 14.3-23.3), p<0.001. In non-older patients, mOS was 26.7m (CI95% 21.9-32.6), p<0.001. We evaluated eighteen concurrent factors that included: characteristics related to the patient (age, sex, comorbidities, polypharmacy, Eastern Cooperative Oncology Group (ECOG) and nutritional status), to the tumor (stage at diagnosis, tumor side, molecular profile, tumor burden, location, and number of metastasis) and to the treatment administered (systemic treatment for advanced disease, chemotherapy schedule and number of lines, severe adverse events and dose reductions, and surgery of liver metastasis). In the univariate analysis, age at diagnosis, ECOG, nutritional status, tumor side, molecular profile, tumor burden, systemic treatment for advanced disease, and surgery of liver metastases had significant impact on survival. However, multivariate analysis revealed that only four factors (tumor burden, nutritional status, systemic treatment for advanced disease, and surgery of liver metastases) were independently associated with OS, but not older age at diagnosis. CONCLUSION: Older age is not an independent survival prognostic factor for advanced CRC. Tumor burden, nutritional status, systemic treatment for advanced disease and surgery of liver met were significant factors associated with OS. These findings suggest that older patients should not be excluded from cancer treatment based on age alone.

Confirmation of the presence of Rickettsia felis infecting Ornithodoros puertoricensis in Mexico.

Soft ticks are neglected competent vectors of a wide range of pathogenic microorganisms, among which bacteria of the genera Rickettsia and Borrelia stand out. In Mexico, previous studies have shown the presence of a member of the Ornithodoros talaje complex in the Virginia opossum (Didelphis virginiana Didelphimorphia: Didelphidae Kerr) from southeastern Mexico. However, its specific identification has not been achieved. Two D. virginiana were treated in a private clinic during the period of April-May 2022. Tick larvae were manually removed, DNA extraction was performed, and some genes from various bacterial and parasitic pathogens were amplified and sequenced. A total of 96 larvae were recovered, which were morphologically identified as Ornithodoros puertoricensis (Ixodida: Argasidae Fox); the 16 S sequences showed a similarity of 96.79%-99.51% with sequences of O. puertoricensis from Panama and Colombia. The presence of Rickettsia felis (Rickettsiales: Rickettsiaceae Bouyer et al.) was detected in 15 specimens from one host. The soft tick O. puertoricensis is recorded for the first time as an ectoparasite of the Virginia opossum in America and represents the second report for this soft tick in Mexico since 1963. This represents the most northern record of this tick species in its geographic distribution and brings a new soft tick-Rickettsia association.

Apolipoprotein L1 is increased in frontotemporal lobar degeneration post-mortem brain but not in ante-mortem cerebrospinal fluid.

AIMS: Frontotemporal Dementia (FTD) is caused by frontal-temporal lobar degeneration (FTLD), characterized mainly by brain protein aggregates of tau (FTLD-Tau) or TDP-43 (FTLD-TDP). The clinicopathological heterogeneity makes ante-mortem diagnosis of these pathological subtypes challenging. Our proteomics study showed increased Apolipoprotein L1 (APOL1) levels in CSF from FTD patients, which was prominently expressed in FTLD-Tau. We aimed to understand APOL1 expression in FTLD post-mortem brain tissue and to validate its potential as a CSF biomarker for FTD and its pathological subtypes. METHODS: APOL1 levels were analyzed in the frontal cortex of FTLD (including FTLD-Tau and FTLD-TDP) and non-demented controls by immunohistochemistry (FTLD total = 18 (12 FTLD-Tau and 6 FTLD-TDP); controls = 9), western blot (WB), and a novel prototype ELISA (FTLD total = 44 (21 FTLD-Tau and 23 FTLD-TDP); controls = 9). The association of APOL1 immunoreactivity with phosphorylated Tau (pTau) and TDP-43 (pTDP-43) immunoreactivity was assessed. CSF APOL1 was analyzed in confirmed FTD patients (n = 27, including 12 FTLD-Tau and 15 FTLD-TDP) and controls (n = 15) using the same ELISA. RESULTS: APOL1 levels were significantly increased in FTLD post-mortem tissue compared to controls as measured by immunohistochemistry, WB, and ELISA. However, no differences between the pathological subtypes were observed. APOL1 immunoreactivity was present in neuronal and glial cells but did not co-localize with pTau or pTDP-43. CSF APOL1 levels were comparable between FTD patients and controls and between pathological subtypes. CONCLUSION: APOL1 is upregulated in FTLD pathology irrespective of the subtypes, indicating a role of this novel protein in FTD pathophysiology. The APOL1 levels detected in brain tissue were not mirrored in the CSF, limiting its potential as a specific FTD biofluid-based biomarker using our current immunoassay.

Molecular detection of Coxiella-like endosymbionts and absence of Coxiella burnetii in Amblyomma mixtum from Veracruz, Mexico.

Ticks are obligate ectoparasites associated with a wide range of vertebrate hosts, including domestic animals. Moreover, ticks are capable of transmitting many pathogens such as Coxiella. To date, Coxiella burnetii, the etiological agent of coxiellosis or Q fever, is the only valid species of the genera. Nevertheless, a wide range of agents denominated Coxiella-like have been detected in recent studies, mainly associated with ticks. The pathogenicity of these Coxiella-like agents is controversial as some of them can infect both birds and humans. In Mexico, knowledge about Q fever is scarce and limited to historical serological records, and there is an overall lack of molecular proof of any agent of the genus Coxiella circulating in the country. Therefore, the aim of this study was to detect the presence of Coxiella in ticks associated with cattle in all 10 regions of Veracruz, Mexico. To accomplish this objective, first, we identified ticks collected from cattle and horses in Veracruz. Then, for Coxiella detection, DNA extraction from ticks and PCR amplification of the 16S-rDNA of Coxiella was performed. Finally, we performed a phylogenetic reconstruction to determine the Coxiella lineages detected. From the 10 regions sampled we collected 888 ticks grouped in 180 pools, and only five Amblyomma mixtum from the locality of Castán, and one from Los Angeles from Tuxpan were found positive, which represents a frequency of 20% for each locality. This study represents the first attempt at molecular detection of Coxiella in ticks associated with cattle in the state of Veracruz, the major livestock producer in the country. The findings of the present study are relevant as they establish a precedent regarding the circulation of Coxiella-like agents, as well as the absence in three municipalities of the state of Veracruz of C. burnetii, an abortive agent of livestock importance.

Antifungal Activity of Ethanol-extracted Bixa orellana (L) (Achiote) on Candida albicans, at Six Different Concentrations.

AIM: The aim of the study was to determine the antifungal activity of six different concentrations of the ethanol extract of Bixa orellana (L) (Achiote) on the strains of Candida albicans (ATCC 90028). MATERIALS AND METHODS: The ethanol extract of Bixa orellana (L) (BEE) was prepared in six different concentrations (5%, 10%, 20%, 40%, 60%, and 100%), which were confronted with the positive control group (Nystatin 100,000 UI/mL). The total sample consisted of n = 174 wells inoculated with each concentration evaluated in the Petri dishes. The cultivation procedure was carried out at a temperature of 37°C, and then the 6 mm diameter wells on which the sowing of the Candida albicans in suspension was carried out. Subsequently, the BEE (Achiote) was inoculated in all the concentrations mentioned in the same way for Nystatin; finally, the inhibition halos were evaluated by the Kirby-Bauer method at the scheduled times of 24, 48, and 72 hours. RESULTS: The highest antifungal activity was found at 24 hours and this increased directly proportional to the concentration of BEE (5%, 10%, 20%, 40%, 60%, and 100%): 11 ± 0, 11 ± 0, 13.1 ± 1.3, 17.2 ± 0.8, 19.1 ± 1.0, and 21.4 ± 1.3 mm, respectively. However, there was no statistically significant difference when compared with Nystatin, at p > 0.05 Conclusion: It was shown that 5%, 10%, 20%, 40%, 60%, and 100% BEE had an antifungal effect against Candida albicans. However, there were no statistically significant differences against the effect of Nystatin at 100,000 IU/mL, who has an inhibitory effect greater than BEE, with a significance level of p < 0.05. CLINICAL SIGNIFICANCE: This article describes the antifungal activity and the possible impact on dentistry that the use of Bixa orellana (L) may have because according to our results it had an antifungal effect against strains of Candida albicans. This opens a great line of research to potentially use this natural resource in dentistry. How to cite this article: Poma-Castillo L, Espinoza-Poma M, Mauricio F, et al. Antifungal Activity of Ethanol-extracted Bixa orellana (L) (Achiote) on Candida albicans, at Six Different Concentrations. J Contemp Dent Pract 2019;20(10):1159-1163.

Facial asymmetry and genetic ancestry in Latin American admixed populations.

Fluctuating and directional asymmetry are aspects of morphological variation widely used to infer environmental and genetic factors affecting facial phenotypes. However, the genetic basis and environmental determinants of both asymmetry types is far from being completely known. The analysis of facial asymmetries in admixed individuals can be of help to characterize the impact of a genome's heterozygosity on the developmental basis of both fluctuating and directional asymmetries. Here we characterize the association between genetic ancestry and individual asymmetry on a sample of Latin-American admixed populations. To do so, three-dimensional (3D) facial shape attributes were explored on a sample of 4,104 volunteers aged between 18 and 85 years. Individual ancestry and heterozygosity was estimated using more than 730,000 genome-wide markers. Multivariate techniques applied to geometric morphometric data were used to evaluate the magnitude and significance of directional and fluctuating asymmetry (FA), as well as correlations and multiple regressions aimed to estimate the relationship between facial FA scores and heterozygosity and a set of covariates. Results indicate that directional and FA are both significant, the former being the strongest expression of asymmetry in this sample. In addition, our analyses suggest that there are some specific patterns of facial asymmetries characterizing the different ancestry groups. Finally, we find that more heterozygous individuals exhibit lower levels of asymmetry. Our results highlight the importance of including ancestry-admixture estimators, especially when the analyses are aimed to compare levels of asymmetries on groups differing on socioeconomic levels, as a proxy to estimate developmental noise.

Unraveling the diversity of Trypanosoma species from Central Mexico: Molecular confirmation on the presence of Trypanosoma dionisii and novel Neobat linages.

Bats are one of the groups of mammals with the highest number of associated Trypanosoma taxa. There are 50 Trypanosoma species and genotypes infecting more than 75 species of bats across five continents. However, in Mexico, the inventory of species of the genus Trypanosoma associated with bats is limited to only two species (Trypanosoma vespertilionis and Trypanosoma cruzi) even though 140 species of bats inhabit this country. Specifically, 91 bat species have been recorded in the state of Veracruz, but records of trypanosomatids associated with this mammalian group are absent. Due to the complex Trypanosoma-bat relationship, the high diversity of bat species in Veracruz, as well as the lack of records of trypanosomatids associated with bats for this state, the aim of this work was to analyze the diversity of species of the genus Trypanosoma and their presence from a bat community in the central area of the state of Veracruz, Mexico. During the period of January to August 2022 in the Tequecholapa Environmental Management Unit where bats were collected using mist nets and blood samples were obtained from their thumbs. We extracted genetic material and amplified a fragment of 800 bp of the 18S ribosomal gene of the genus Trypanosoma by conventional PCR. The positive amplicons were sequenced, and phylogenetic reconstruction was performed to identify the parasite species. A total of 285 bats (149♀, 136♂) belonging to 13 species from 10 genera and a single family (Phyllostomidae) were collected. Twenty-three specimens from six species tested positive for the presence of Trypanosoma dionisii, Trypanosoma sp. Neobat 4, and a potential novelty species provisionally named as Trypanosoma sp. Neobat 6. The results of the present work increase the number of species of the genus Trypanosoma infecting bats in Mexico and in the Neotropical region.

Evaluating microevolutionary models for the early settlement of the New World: the importance of recurrent gene flow with Asia.

Different scenarios attempting to describe the initial phases of the human dispersal from Asia into the New World have been proposed during the last two decades. However, some aspects concerning the population affinities among early and modern Asians and Native Americans remain controversial. Specifically, contradictory views based mainly on partial evidence such as skull morphology or molecular genetics have led to hypotheses such as the "Two Waves/Components" and "Single Wave" or "Out of Beringia" model, respectively. Alternatively, an integrative scenario considering both morphological and molecular variation has been proposed and named as the "Recurrent Gene Flow" hypothesis. This scenario considers a single origin for all the Native Americans, and local, within-continent evolution plus the persistence of contact among Circum-Arctic groups. Here we analyze 2D geometric morphometric data to evaluate the associations between observed craniometric distance matrix and different geographic design matrices reflecting distinct scenarios for the peopling of the New World using basic and partial Mantel tests. Additionally, we calculated the rate of morphological differentiation between Early and Late American samples under the different settlement scenarios and compared our findings to the predicted morphological differentiation under neutral conditions. Also, we incorporated in our analyses some variants of the classical Single Wave and Two Waves models as well as the Recurrent Gene Flow model. Our results suggest a better explanatory performance of the Recurrent Gene Flow model, and provide additional insights concerning affinities among Asian and Native American Circum-Arctic groups.

Species diversity and blood meal sources of phlebotomine sand flies (Diptera: Psychodidae) from Los Tuxtlas, Veracruz, Mexico.

Phlebotomine sand flies can transmit several species of the genus Leishmania, that cause leishmaniasis, a serious neglected tropical disease worldwide. Although Mexico is an endemic country for the disease, studies on the biology, ecology, and the identification of blood meal sources of phlebotomine sand flies in some states remain unexplored. For this reason, this study aimed to evaluate the species diversity of sand flies, and identify their blood meal sources in the Biosphere Reserve Los Tuxtlas, Veracruz, an area with a high prevalence of Leishmania infantum. The cumulative sampling effort of sand flies covered 300 trap-nights between March 2011 and May 2013. For estimating species diversity, we calculated the species richness (q = 0), the diversity of the species (q = 1) and the dominant species (q = 2). To identify the blood meal sources, we amplified and sequenced a fragment of ≈400 bp of the vertebrate Cytb gene. A total of 951 specimens belonging to 15 species were collected. Psathyromyia aclydifera and Psychodopygus panamensis were the most abundant species. We were able to identify seven terrestrial vertebrate species, among which human beings were the most common source of the blood meal. In this study, relevant information on the structure of sand fly populations and their blood meal sources was obtained, providing basic and important information about the interactions between sand flies, hosts and Leishmania species.

The influence of masticatory loading on craniofacial morphology: A test case across technological transitions in the Ohio valley.

Masticatory loading is one of the main environmental stimuli that generate craniofacial variation among recent humans. Experimental studies on a wide variety of mammals, including those with retrognathic postcanine teeth, predict that responses to masticatory loading will be greater in the occlusal plane, the inferior rostrum, and regions associated with the attachments of the temporalis and masseter muscles. Here we test these experimentally-derived predictions on an extinct human population from the middle and upper Ohio valley that underwent a marked shift from hunting-gathering to extensive farming during the last 3,000 years and for which we have good archaeological evidence about diet and food processing technology. Geometric morphometric methods were used to detect and measure the putative effect of diet changes on cranial shape independent of size. Our results partially confirm only some of the experimental predictions. The effect of softer and/or less tough diets on craniofacial shape seem to be concentrated in the relative reduction of the temporal fossa and in a displacement of the attachment of the temporal muscle. However, there were few differences in craniofacial shape in regions closer to the occlusal plane. These results highlight the utility of exploring specific localized morphological shifts using a hierarchical model of craniofacial integration.

Bignoniaceae metabolites as semiochemicals.

Members of the family Bignoniaceae are mostly found in tropical and neo-tropical regions in America, Asia and Africa, although some of them are cultivated in other regions as ornamentals. Species belonging to this family have been extensively studied in regard to their pharmacological properties (as extracts and isolated compounds). The aim of this review is to summarize the reported scientific evidence about the chemical properties as well as that of the extracts and isolated compounds from species of this family, focusing mainly in insect-plant interactions. As it is known, this family is recognized for the presence of iridoids which are markers of oviposition and feeding preference to species which have became specialist feeders. Some herbivore species have also evolved to the point of been able to sequester iridoids and use them as defenses against their predators. However, iridoids also exhibit anti-insect properties, and therefore they may be good lead molecules to develop botanical pesticides. Other secondary metabolites, such as quinones, and whole extracts have also shown potential as anti-insect agents.

Echinoderes unispinosus (Kinorhyncha: Cyclorhagida), a new record from deep-sea sediments in the Gulf of Mexico.

Kinorhyncha is a phylum of exclusively marine, meiofaunal invertebrates (Sørensen Pardos 2008). Currently, the knowledge about the worldwide distribution of most of its species is considerably patchy, as several taxa have been reported from a single or few localities, usually within a limited geographic area (Sørensen Pardos 2008; Yamasaki et al. 2018a). This even becomes more evident for deep-sea kinorhynchs, as noticed by Sørensen et al. (2018). Given the particular value of new records from the deep-sea to increase our understanding in the distribution of meiofaunal organisms plus the observed relationship of morphological variation through the bathymetric gradient, we aim to report the first record of Echinoderes unispinosus Yamasaki, Neuhaus George, 2018 in the southern edge of the Gulf of Mexico (GoM), and contribute with new information about the morphological intraspecific variation of this species. In Mexico, studies of kinorhynch biodiversity are limited to the northern Gulf of California (50-1570m depth) (Álvarez-Castillo et al. 2015, 2018; Cepeda et al. 2019) and the Yucatán Peninsula (Sánchez Martínez 2019). The GoM is a semi-closed basin located in a transition zone with both subtropical and tropical weather. Deep-sea muddy sediment samples of the present study were collected during the expedition XIXIMI-5 (10-24 June 2016) and processed according to Cisterna-Céliz et al. (2019). Kinorhynch specimens were mounted, measured and photographed according to Cepeda et al. (2019). Two adult males were identified as E. unispinosus, one from station B11 (2298 m depth) and another from station B15 (3708m depth). Kinorhynch specimens were deposited at the Aquatic Invertebrates Collection of the Facultad de Ciencias, Universidad Nacional Autónoma de México (UNAM), Mexico, under accession numbers: KGM.001 and KGM.002.

Screening of Uruguayan plants for deterrent activity against insects.

We evaluated the anti-insectan activity of extracts from different vegetative parts of ten plant species native to Uruguay. The selected plants belong to five families: Bignoniaceae: Clytostoma callistegioides, Dolichandra cynanchoides, Macfadyena unguis-cati; Sapindaceae: Dodonaea viscosa, Allophylus edulis, Serjania meridionalis; Lamiaceae: Salvia procurrens, Salvia guaranitica; Solanaceae: Lycium cestroides; and Phytolaccaceae: Phytolacca dioica. The extracts were evaluated in independent bioassays against four insect pests and one beneficial insect. Aphid settling inhibition was evaluated with a grass specialist, Rhopalosiphum padi, and a feeding generalist, Myzus persicae (both Hemiptera: Aphididae). Antifeedant activity was tested with adults of the specialist Epilachna paenulata (Coleoptera: Coccinellidae) and larvae of the generalist Spodoptera littoralis (Lepidoptera: Noctuidae). Finally, contact toxicity was assessed with honey bees, Apis mellifera (Hymenoptera: Apidae). Strong settling inhibition (SI) activity (expressed as %SI, where 100% means complete inhibition by the extract) was found only for the twig extracts of A. edulis (Sapindaceae) against M. persicae (% SI = 77 +/- 4). Antifeedant activity (expressed as % of feeding reduction (FR), where 100% means no consumption on extract-treated diet) against E. paenulata was significant for the leaf extracts of L. cestroides (Solanaceae) (% FR = 100 +/- 0) as well as of all Bignoniaceae and Sapindaceae species. No extracts were active against S. littoralis larvae, and most of them were innocuous to honey bees, with the exception of L. cestroides and S. meridionalis leaf extracts.

Interaction Promotes the Adaptation of Referential Conventions to the Communicative Context.

Coordination between speakers in dialogue requires balancing repetition and change, the old and the new. Interlocutors tend to reuse established forms, relying on communicative precedents. Yet linguistic interaction also necessitates adaptation to changing contexts or dynamic tasks, which might favor abandoning existing precedents in favor of better communicative alternatives. We explored this tension using a maze game task in which individual participants and interacting pairs had to describe figures and their positions in one of two possible maze types: a regular maze, in which the grid-like structure of the maze is highlighted, and an irregular maze, in which specific parts of the maze are salient. Participants repeated this task several times. Both individuals and interacting pairs were affected by the different maze layouts, initially using more idiosyncratic description schemes for irregular mazes and more systematic schemes for regular mazes. Interacting pairs, but not individuals, abandoned their unsystematic initial descriptions in favor of a more systematic approach, which was better adapted for repeated interaction. Our results show communicative conventions are initially shaped by context, but interaction opens up the possibility for change if better alternatives are available.

Central sleep apnea in children with obstructive sleep apnea syndrome and improvement following adenotonsillectomy.

BACKGROUND: Although the pathogenesis of central and obstructive events seems to be different, these two entities may somehow be related. We aimed to determine whether, as reported in previous research, the number of central sleep apnea (CSA) cases in a population of children with obstructive sleep apnea syndrome (OSAS) was greater than in patients without obstructive events, and if CSA worsens with increasing OSAS severity. As a second objective, we analyzed changes in central apnea index (CAI) after adenotonsillar surgery compared to changes when no surgery has been performed. METHODS: We retrospectively reviewed nocturnal polysomnography (PSG) data from children between 1 and 14 years of age with no neurological conditions or syndromes. Patients with CAI values greater than 5 per hour were diagnosed as having CSA. Improvements of greater than 50% in CAI on repeat PSG were considered to represent a real change. RESULTS: Data were available from 1279 PSG studies, resulting in 72 children with a CAI greater than 5 per hour (5.6%). Patients with OSAS showed a higher CAI (2.16) compared with those without OSAS (1.17), and this correlation increased with higher degrees of obstructive apnea severity. When adenotonsillectomy was performed due to OSAS, the CAI decreased by 1.37. The average decrease in PSG values was only 0.38 in cases where no surgery was performed. CONCLUSION: The results of this study suggest that although CSA is perceived to be mostly associated with central nervous system ventilatory control, there may be a connection with airway obstruction and in children with CSA and OSA diagnosis adenotonsillectomy may improve both conditions.

Antifeedant and phytotoxic activity of hydroxyperezone and related molecules.

The insect antifeedant and toxic activity of hydroxyperezone (1), its derivatives 2-9, along with 3-hydroxy- (10) and 6-hydroxythymoquinone (11) were studied against Spodoptera littoralis, Leptinotarsa decemlineata, and Myzus persicae. The antifeedant tests showed that L. decemlineata was the most sensitive insect, followed by M. persicae, while S. littoralis was not deterred by compounds 1-11. Leucohydroxyperezone tetraacetate (3), oxoperezinone (6), dihydroleucoperezinone diacetate (7), 3-hydroxy- (10) and 6-hydroxythymoquinone (11) showed strong activity against L. decemlineata. 1 and 7 exhibited moderate deterrent activity against M. persicae, while 1 and dihydroleucohydroxyperezone tetraacetate (4) acted as post-ingestive antifeedants to S. littoralis. The phytotoxic activity of compounds 1-11 was also evaluated. Hydroxyperezone (1) strongly inhibited seed germination at 24 h, while the activity of 3-8 and 10 was moderate. The level of radicle growth inhibition obtained with compounds 1-5 and 8-11 was significant (< 50%).

Chewing lice (Insecta: Phthiraptera) associated with vertebrates in Mexico.

The chewing lice (Insecta: Phthiraptera: Amblycera and Ischnocera) of Mexico have been little studied and many publications include isolated records. This paper summarizes current knowledge of chewing lice recorded from Mexico resulting from an exhaustive search of the literature published from 1866 to 2017. We found 342 louse species associated with 206 bird and 28 mammal species. As a result, we provide a checklist of the chewing lice recorded from Mexico, including a host-parasite list and their geographical distribution within the country.

End of life of the cancer patient: patient, family and physician perceptions / Fin de vida del paciente oncológico: percepciones de pacientes, familiares y médicos

Abstract Chronic diseases such as cancer have imposed challenges on health systems. Colombia has worked on the construction and implementation of a legal framework for palliative care, but a comprehensive approach to the care provided to cancer patients at the end of their lives is still lacking. Such an approach should be based on understanding of the perceptions of its different actors in order to allow for adequate decision-making and improved support during this stage. Currently, the infrastructure to provide adequate oncological support is insufficient, the administrative procedures that patients and families have to go through to get authorization for treatments and medications for symptom relief are overwhelming and, many times, costs must be paid out of pocket. On the other hand, it is important to train healthcare personnel to develop communication skills to approach patients from a place of compassion, personal development and reflection, creating spaces in which patients can speak openly about their wishes, fears and worries, even if they come together with the desire to accelerate the end of life. In addition, healthcare staff should support and initiate conversations about life and the end of life between patients and their families if this communication is complicated, given its importance for healthcare, quality of life and death. This article seeks to reflect on the end of life of the cancer patient from the perceptions of the actors involved, namely, patients, caregivers and healthcare professionals.

Resumen Las enfermedades crónicas, como el cáncer, han impuesto retos a los sistemas de salud; Colombia ha trabajado en la construcción e implementación de un marco legal de los cuidados paliativos, pero la atención brindada en el fin de vida del paciente oncológico aún carece de un abordaje integral basado en la comprensión de las percepciones de sus diferentes actores, que permita una adecuada toma de decisiones y mejor acompañamiento en esta etapa. Actualmente, la infraestructura para brindar un adecuado soporte oncológico es insuficiente, los trámites que debe realizar el paciente y su familia en la autorización de tratamientos o medicamentos para el alivio de síntomas se vuelven desgastantes y en muchas ocasiones los costos deben ser asumidos por ellos mismos. Por otra parte, es importante fortalecer la formación del personal de salud en comunicación hacia el paciente y su familia, la cual debe ser compasiva, fundamentada en el desarrollo personal y la reflexión, mediante espacios en los que el paciente pueda hablar abiertamente de sus deseos, miedos y preocupaciones, incluso si estos acompañan el deseo de acelerar el fin de vida. Además, el personal de salud deberá apoyar e iniciar conversaciones sobre la vida y el fin de vida entre pacientes y sus familiares si esta comunicación es complicada, dada su importancia para la atención en salud, calidad de vida y muerte. Este artículo busca reflexionar sobre el fin de vida del paciente oncológico desde las percepciones de los actores involucrados: pacientes, cuidadores y el personal de salud.

Socioeconomic Status Is Not Related with Facial Fluctuating Asymmetry: Evidence from Latin-American Populations.

The expression of facial asymmetries has been recurrently related with poverty and/or disadvantaged socioeconomic status. Departing from the developmental instability theory, previous approaches attempted to test the statistical relationship between the stress experienced by individuals grown in poor conditions and an increase in facial and corporal asymmetry. Here we aim to further evaluate such hypothesis on a large sample of admixed Latin Americans individuals by exploring if low socioeconomic status individuals tend to exhibit greater facial fluctuating asymmetry values. To do so, we implement Procrustes analysis of variance and Hierarchical Linear Modelling (HLM) to estimate potential associations between facial fluctuating asymmetry values and socioeconomic status. We report significant relationships between facial fluctuating asymmetry values and age, sex, and genetic ancestry, while socioeconomic status failed to exhibit any strong statistical relationship with facial asymmetry. These results are persistent after the effect of heterozygosity (a proxy for genetic ancestry) is controlled in the model. Our results indicate that, at least on the studied sample, there is no relationship between socioeconomic stress (as intended as low socioeconomic status) and facial asymmetries.

Correction: Socioeconomic Status Is Not Related with Facial Fluctuating Asymmetry: Evidence from Latin-American Populations.

[This corrects the article DOI: 10.1371/journal.pone.0169287.].