Examining Global Crises: Extracting Insights From the COVID-19 Pandemic and Natural Disasters to Develop a Robust Emergency Diabetic Retinopathy Strategy for Puerto Rico.

In this critical analysis, we investigate the profound impact of natural disasters and pandemics on the care and adherence to treating diabetic retinopathy, a severe complication of diabetes requiring continuous monitoring and treatment to prevent vision loss. Our study also sheds light on the social and economic context of Puerto Rico, emphasizing recent emergency events that have exacerbated existing public health challenges. Through a comprehensive review of relevant literature from PubMed, Google Scholar, and the George Washington University Himmelfarb Health Sciences Library database, we identified 31 pertinent articles out of 45 evaluated, focusing on the effects of these crises on healthcare delivery, diabetic retinopathy screening, and treatment. The evidence strongly indicates that during such emergencies, barriers to healthcare escalate, leading to significant treatment delays and a reduction in diabetic retinopathy screening and diagnosis, ultimately resulting in deteriorated visual outcomes. Thus, our review underscores the urgent need for the development of effective emergency plans tailored specifically to diabetic retinopathy, particularly in Puerto Rico, where diabetes prevalence and its complications are notably higher. Such plans should not only incorporate established emergency measures but also harness emerging technological advances in the field of ophthalmology to ensure optimal preparedness for future pandemics and natural disasters.

Sleep and Perceived Stress: An Exploratory Mediation Analysis of the Role of Self-Control and Resilience among University Students.

BACKGROUND: High levels of stress are frequent in university education, and a lack of sleep has been reported to make students more vulnerable to stress. The mechanisms through which sleep harms students have not been sufficiently clarified; therefore, this study aimed to explore the mediating role of self-control and resilience in the relationship between sleep quality and duration and perceived stress. METHODS: Of 32 first-year college students, 21 (78%) were women, with a mean age of 18.47 (±0.84). They responded to a self-administered survey that included questions on stress, resilience, and sleep quality and recorded their daily sleep duration using a wristband for six days. RESULTS: Perceived stress was significantly correlated with resilience (r = -0.63), self-control (r = -0.46), sleep duration (r = -0.35), and lower sleep quality (r = 0.57). Path analysis revealed that self-control and resilience were partially mediated by sleep quality (R2 = 0.62; p < 0.01) and completely mediated by sleep duration (R2 = 0.46; p < 0.01). In both models, self-control had a direct effect on resilience and had a good-fit index. CONCLUSION: Being resilient seems to play a mediating role in the relationship between sleep and perceived stress; this ability can be favored by self-control, which is directly influenced by sleep.

[Controversies between mental health and disability standards in Mexico]. / Controversias entre los estándares de salud mental y de discapacidad en México.

There are controversies between the practice of psychiatry, current international standards and mental disorders or conditions with disabilities, framed in social care models. The objective of this work is to provide evidence and analyze the main gaps in mental health such as: the invisibility of some people with disabilities for the design of policies, legislation, or public programs; the predominance of the medical model, in which the substitution of decision-making in informed consent prevails, which violates the rights of legal personality, equality, freedom, security and respect for personal integrity, among others. This analysis highlights the importance of: a) integrating the legal provisions on health and disability to international standards, and complying with the Human Rights framework of the Political Constitution of the United States of Mexico, especially the pro personae principle and to the conforming interpretation clause; b) reform the General Health Law in matters of mental health and general health, in order to change the paradigm of asylum care to move towards that of community care with a focus on primary health care, adjacent to the services of the National System of Health; c) prohibit the institutionalization of people with mental disorders, as well as coercive measures as containment measures, and instead train and encourage verbal de-escalation techniques.

Existen controversias entre la práctica de la psiquiatría, los estándares internacionales vigentes y los trastornos o condición mental con discapacidad, enmarcados en los modelos de atención social. El objetivo de este trabajo es aportar evidencia y analizar las principales brechas en materia de salud mental como: la invisibilidad de algunas personas con discapacidad para el diseño de políticas, legislación o programas públicos; el predominio del modelo médico, en el que prevalece la sustitución de toma de decisión en el consentimiento informado, lo que viola los derechos de personalidad jurídica, igualdad, libertad, seguridad y respeto a la integridad personal, entre otros. El presente análisis resalta la importancia de: a) integrar las disposiciones legales en materia de salud y discapacidad a los estándares internacionales, y cumplir con el marco de los Derechos Humanos de la Constitución Política de los Estados Unidos Mexicanos, en especial al principio pro persona y a la cláusula interpretación conforme; b) reformar la Ley General de Salud en materia de salud mental y salubridad general, a fin de cambiar el paradigma de atención asilar para transitar hacia el de atención comunitaria con enfoque de atención primaria de la salud, adyacente a los servicios del Sistema Nacional de Salud; c) prohibir la institucionalización de las personas con trastornos mentales, así como las medidas coercitivas como medidas de contención, y en su lugar capacitar e incentivar técnicas de desescalamiento verbal.

Bilateral Acute Iris Transillumination Associated with Moxifloxacin Antibiotic Use.

PURPOSE: To describe the clinical and demographic characteristics and associated factors leading to bilateral acute iris transillumination (BAIT) syndrome. METHODS: A retrospective review of patients with BAIT syndrome was performed. RESULTS: Thirty-five patients with a diagnosis of BAIT were identified. The median age at presentation was 53 years; 80% of the patients were female. Twenty-six patients (74%) had recent histories of systemic antibiotic treatment. Of those with such a history, 24 patients (92%) had been receiving moxifloxacin. Two patients within our cohort were prescribed moxifloxacin prophylactically prior to a systemic surgical procedure and had no evidence of systemic illness or recent viral illness. CONCLUSIONS: Our data support the notion that moxifloxacin might be associated with the onset of BAIT syndrome. Notably, within our cohort, two patients received moxifloxacin as surgical prophylaxis and subsequently developed BAIT syndrome. This could suggest a potential association between moxifloxacin and the onset of BAIT, though further studies are needed to confirm this finding.

The transcription factor VAX1 in VIP neurons of the suprachiasmatic nucleus impacts circadian rhythm generation, depressive-like behavior, and the reproductive axis in a sex-specific manner in mice.

Background: The suprachiasmatic nucleus (SCN) within the hypothalamus is a key brain structure required to relay light information to the body and synchronize cell and tissue level rhythms and hormone release. Specific subpopulations of SCN neurons, defined by their peptide expression, regulate defined SCN output. Here we focus on the vasoactive intestinal peptide (VIP) expressing neurons of the SCN. SCN VIP neurons are known to regulate circadian rhythms and reproductive function. Methods: To specifically study SCN VIP neurons, we generated a novel knock out mouse line by conditionally deleting the SCN enriched transcription factor, Ventral Anterior Homeobox 1 (Vax1), in VIP neurons (Vax1Vip; Vax1fl/fl:VipCre). Results: We found that Vax1Vip females presented with lengthened estrous cycles, reduced circulating estrogen, and increased depressive-like behavior. Further, Vax1Vip males and females presented with a shortened circadian period in locomotor activity and ex vivo SCN circadian period. On a molecular level, the shortening of the SCN period was driven, at least partially, by a direct regulatory role of VAX1 on the circadian clock genes Bmal1 and Per2. Interestingly, Vax1Vip females presented with increased expression of arginine vasopressin (Avp) in the paraventricular nucleus, which resulted in increased circulating corticosterone. SCN VIP and AVP neurons regulate the reproductive gonadotropin-releasing hormone (GnRH) and kisspeptin neurons. To determine how the reproductive neuroendocrine network was impacted in Vax1Vip mice, we assessed GnRH sensitivity to a kisspeptin challenge in vivo. We found that GnRH neurons in Vax1Vip females, but not males, had an increased sensitivity to kisspeptin, leading to increased luteinizing hormone release. Interestingly, Vax1Vip males showed a small, but significant increase in total sperm and a modest delay in pubertal onset. Both male and female Vax1Vip mice were fertile and generated litters comparable in size and frequency to controls. Conclusion: Together, these data identify VAX1 in SCN VIP neurons as a neurological overlap between circadian timekeeping, female reproduction, and depressive-like symptoms in mice, and provide novel insight into the role of SCN VIP neurons.

Retinitis Pigmentosa and Polydactyly in a Patient with a Heterozygous Mutation on the BBS1 Gene.

PURPOSE: To report retinitis pigmentosa and a history of polydactyly in a Bardet-Biedl syndrome mutation carrier. OBSERVATIONS: A 25-year-old male presented to the clinic complaining of poor visual acuity since childhood, night-blindness, and progressive peripheral vision loss. The patient also had a history of polydactyly in both feet. Ophthalmic evaluation was remarkable for a best-corrected visual acuity of 20/400 in both eyes. Imaging revealed a "salt-and-pepper" appearance surrounding the macula, bone-spicule retinal pigment epithelium hyperplasia, paravenous retinal pigment epithelium hyperplasia, and arteriolar attenuation. In addition, bilateral macular autofluorescence with a surrounding granular hypoautofluorescence and an additional hyperautofluorescent zone was present. Full-field ERG results showed non-recordable scotopic ERG responses and diminished photopic ERG responses OU, consistent with progressive rod-cone dystrophy. Genetic testing was positive for a pathogenic heterozygous mutation in the BBS1 gene of the variant c.1169T>G (p.Met390Arg) and several variants of uncertain significance in other genes. CONCLUSIONS AND IMPORTANCE: Ascertainment of the inheritance patterns in BBS is an evolving discussion. Our case, a BBS carrier with retinitis pigmentosa and a history of polydactyly, could support previous research suggesting non-Mendelian genetics in this ciliopathy. Furthermore, genetic testing and analyses of additional mutations and variants of uncertain significance could potentially explain the reason for BBS-like phenotype in presumed BBS carriers.

A Genotype-Phenotype Analysis of the Bardet-Biedl Syndrome in Puerto Rico.

BACKGROUND: Bardet-Biedl syndrome is a complex heterogeneous ciliopathy caused by genetic mutations. Although establishing genotype-phenotype correlations has been challenging, some regional variations have been previously reported. Due to its relative geographic isolation, Puerto Rico has a greater prevalence of Bardet-Biedl syndrome than do other regions. We sought to characterize the most frequent genotypic variations in a local cohort of Bardet-Biedl syndrome patients and report any genotypic-phenotypic trends. METHODS: Twenty-seven patients from an ophthalmology clinic in Puerto Rico with genetically confirmed Bardet-Biedl syndrome took a questionnaire inquiring about their most common symptoms. Ophthalmological information was obtained from patient records. The frequencies of the genotypic variations and symptoms were calculated. RESULTS: In the study population, BBS1 was the most prevalent mutated gene, followed by BBS7. In the BBS1 group, we found homozygotes for c.1169T>G (p.Met390Arg) and c.1645G>T (p.Glu549*), and compound heterozygotes for c.1169T>G (p.Met390Arg) and c.1645G>T (p.Glu549*), with one patient having c.1645G>T (p.Glu549*) and c.432+1G>A (splice donor). All the BBS7 patients were homozygous for c.632C>T (p.Thr211Ile). Compared to BBS7, we found that BBS1 patients generally had a milder ocular and systemic phenotype. However, when analyzing different BBS1 variants, patients with mutations in c.1645G>T (p.Glu549*), both compound heterozygous and homozygous, had more severe systemic phenotypes, overall. CONCLUSION: Our study was the first detailed genotype-phenotype analysis of the Bardet-Biedl syndrome in Puerto Rico. Genetic mutations in BBS1 and BBS7 seem to be the most common culprits behind Bardet-Biedl syndrome in this population. Although patients diagnosed with BBS1 are likely to display milder systemic features, this was not the case with our BBS1 patients having the c.1645G>T (p.Glu549*) mutation. Further studies should focus on the c.1645G>T (p.Glu549*) mutation's impact on the BBS1 gene and protein product.

Síndrome de Guillain Barré recurrente: reporte de caso / Guillain Barré Syndrome Recurrent: Case report

El síndrome de Guillain-Barré (SGB) o poli-rradiculoneuritis aguda es una enfermedad autoinmune, desencadenada por una infec-ción viral o bacteriana, su incidencia es de 1.7/100000, únicamente el 3% puede recaer en los años subsiguientes. Es una patología poco frecuente y menos frecuente aún son los casos recurrentes, por lo que realizamos una revisión de su epidemiología, cuadro clínico, criterios diagnósticos y su manejo. Se trata de un paciente masculino de 9 años de edad, que el 13 de octubre de 2008 al primer año de edad fue ingresado durante 1 mes al Instituto Hondureño de Seguridad Social (IHSS) con cuadro de parálisis flácida ascendente progresiva (Síndrome de Guillain Barré), recibió manejo con inmunoglobulina cuya dosis y otros datos sobre su tratamiento, exámenes o estudios realizados se descono-cen. La recuperación completa se dio aproxi-madamente a los 6 meses posteriores al inicio de los síntomas. Sin embargo reingresa el 12 de noviembre de 2014 en IHSS con diagnóstico de Parálisis Flácida ascendente recurrente (segundo episodio), sin recupera-ción completa ya que presentó secuelas en miembros inferiores. Se le realizó Electromio-grafía con datos compatibles con polirradicu-lopatía motora desmielinizante simétrica. En marzo de este año (2017) se presenta con igual sintomatología por lo que se ingresa como síndrome de Guillain barré recurrente (tercer episodio)...(AU)

Effect of the dry matter intake level on the sanguine profile of glucose, insulin, urea, estrogen and progesterone and concentration of IGF-I in the follicular liquid of crossbred heifers

The aim of this work was to study effect of the dry matter intake level on the concentrations of glucose, insulin, urea, estrogen and progesterone in the blood and the level of IGF-I in the follicular liquid of heifers. Twenty seven crossbred heifers were used, in three treatments: 1.2, 1.6 and 2.6 percent of the live weight of dry matter intake (DMI) daily. The sanguine concentrations of glucose and estrogen were higher in the animals with 1.6 percent of DMI and the insulin levels were higher in the animals with 2.6 percent of DMI. There was an increase in the sanguine levels of urea with the increase of the DMI. There was no effect of the DMI on the progesterone levels in the sanguine plasma collected from the jugular. The progesterone levels in caudal vena were higher in the animals with 2.6 percent of DMI. There was no effect of the DMI on the follicular levels of IGF-I.

O objetivo deste trabalho foi estudar o efeito do nível de ingestão de matéria seca (IMS/ por cento do PV) sobre as concentrações sanguíneas de glicose, insulina, urea, estrógeno e progesterona e o nível de IGF-I no líquido folicular de novilhas. Vinte e sete novilhas cruzadas foram utilizadas, distribuídas em três tratamentos: 1,2 por cento; 1,6 por cento e 2,6 por cento do peso vivo de ingestão de matéria seca por dia. As concentrações no plasma da veia jugular de glicose e estrógeno foram maiores nos animais com 1,6 por cento de IMS e os níveis de insulina foram maiores nos animais com 2,6 por cento de IMS. Houve um aumento dos níveis plasmáticos de uréia com aumento dos níveis de IMS. Não houve efeito da IMS sobre os níveis de progesterona no plasma sangüíneo coletado da jugular. No plasma sangüíneo coletado da veia cada caudal, os níveis de progesterona foram maiores (P<0,05) nos animais com 2,6 por cento de IMS. Não houve efeito da IMS sobre os níveis foliculares de IGF-I.