Evidence of epigenetic landscape shifts in mucopolysaccharidosis IIIB and IVA.

Lysosomal storage diseases (LSDs) are a group of monogenic diseases characterized by mutations in genes coding for proteins associated with the lysosomal function. Despite the monogenic nature, LSDs patients exhibit variable and heterogeneous clinical manifestations, prompting investigations into epigenetic factors underlying this phenotypic diversity. In this study, we focused on the potential role of epigenetic mechanisms in the pathogenesis of mucopolysaccharidosis IIIB (MPS IIIB) and mucopolysaccharidosis IVA (MPS IVA). We analyzed DNA methylation (5mC) and histone modifications (H3K14 acetylation and H3K9 trimethylation) in MPS IIIB and MPS IVA patients' fibroblasts and healthy controls. The findings revealed that global DNA hypomethylation is present in cell lines for both diseases. At the same time, histone acetylation was increased in MPS IIIB and MPS IVA cells in a donor-dependent way, further indicating a shift towards relaxed open chromatin in these MPS. Finally, the constitutive heterochromatin marker, histone H3K9 trimethylation, only showed reduced clustering in MPS IIIB cells, suggesting limited alterations in heterochromatin organization. These findings collectively emphasize the significance of epigenetic mechanisms in modulating the phenotypic variations observed in LSDs. While global DNA hypomethylation could contribute to the MPS pathogenesis, the study also highlights individual-specific epigenetic responses that might contribute to phenotypic heterogeneity. Further research into the specific genes and pathways affected by these epigenetic changes could provide insights into potential therapeutic interventions for these MPS and other LSDs.

Complications and Revision Surgery of Forearm Fractures.

Nonunion or malunion of forearm fractures may result in restricted range of motion or persistent pain, leading to limitations in activities of daily living. Complications may also present in the form of ectopic bone growth or persistent infections. A systematic method to evaluate complications resulting from forearm fractures is helpful to both determine the cause for the failure and plan for adequate reconstruction.

Bias in Care: Impact of Ethnicity on Time to Emergent Surgery Varies Between Subspecialties.

INTRODUCTION: Disparity in access to emergency care among minority groups continues to exist despite growing awareness of the effect of implicit bias on public health. In this study, we evaluated ethnicity-based differences in time between admission and surgery for patients undergoing emergent procedures at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. METHODS: We conducted a retrospective review of 249,296 National Surgical Quality Improvement Program cases from 2006 to 2018 involving general, orthopaedic, and vascular surgeries. Analysis of variance was used to compare "time to operating room" (OR) between ethnic groups. RESULTS: Notable differences in time to OR were noted among general and vascular surgeries but not orthopaedic surgery. Post hoc comparison identified notable variation in general surgery between White and Black/African Americans. In vascular surgery, notable variations were identified between White and Black/African Americans and White and Native Hawaiian/Pacific Islanders. DISCUSSION: These findings suggest that certain surgical subspecialties continue to exhibit disparities in care that may manifest as surgical delay, most notably between White and Black/African Americans. Interestingly, variation in time to OR for patients treated by orthopaedic surgery was not notable. Overall, these results highlight the need for additional research into the role of implicit bias in emergent surgical care in the United States.

Corncob structures in dental plaque reveal microhabitat taxon specificity.

BACKGROUND: The human mouth is a natural laboratory for studying how bacterial communities differ across habitats. Different bacteria colonize different surfaces in the mouth-teeth, tongue dorsum, and keratinized and non-keratinized epithelia-despite the short physical distance between these habitats and their connection through saliva. We sought to determine whether more tightly defined microhabitats might have more tightly defined sets of resident bacteria. A microhabitat may be characterized, for example, as the space adjacent to a particular species of bacterium. Corncob structures of dental plaque, consisting of coccoid bacteria bound to filaments of Corynebacterium cells, present an opportunity to analyze the community structure of one such well-defined microhabitat within a complex natural biofilm. Here, we investigate by fluorescence in situ hybridization and spectral imaging the composition of the cocci decorating the filaments. RESULTS: The range of taxa observed in corncobs was limited to a small subset of the taxa present in dental plaque. Among four major groups of dental plaque streptococci, two were the major constituents of corncobs, including one that was the most abundant Streptococcus species in corncobs despite being relatively rare in dental plaque overall. Images showed both Streptococcus types in corncobs in all individual donors, suggesting that the taxa have different ecological roles or that mechanisms exist for stabilizing the persistence of functionally redundant taxa in the population. Direct taxon-taxon interactions were observed not only between the Streptococcus cells and the central corncob filament but also between Streptococcus cells and the limited subset of other plaque bacteria detected in the corncobs, indicating species ensembles involving these taxa as well. CONCLUSIONS: The spatial organization we observed in corncobs suggests that each of the microbial participants can interact with multiple, albeit limited, potential partners, a feature that may encourage the long-term stability of the community. Additionally, our results suggest the general principle that a precisely defined microhabitat will be inhabited by a small and well-defined set of microbial taxa. Thus, our results are important for understanding the structure and organizing principles of natural biofilms and lay the groundwork for future work to modulate and control biofilms for human health. Video Abstract.

Factors Influencing Graduating Medical Students in Puerto Rico to Pursue a Primary Care Residency in the Continental United States.

BACKGROUND AND OBJECTIVES: Primary care physician shortage represents a challenge for many countries and territories, including Puerto Rico (PR), where a significant proportion of the graduating medical students preferred the continental United States (C-US) to complete their training and even as the definitive setting for their practice. We surveyed medical students who graduated from medical schools in PR and have been accepted in a residency program to evaluate the influence of a set of demographics, academic, and personal factors in their decision to pursue a primary care residency program in the C-US. METHODS: A 19-item questionnaire was distributed by institutional email to those medical students who graduated from one of the four Liaison Committee on Medical Education fully accredited medical schools in PR in 2019. We summarized our data by frequency and percentages. We performed data analysis with statistical significance considered for P values <.05. RESULTS: The questionnaire had a response rate of 51% (138/273), where 49% (67/138) were accepted in a primary care residency. Sixty percent (40/67) matched in a primary care program in the C-US. Among the evaluated factors, a prior degree in C-US (65%) and first-degree relatives living in the C-US (70%) were associated with students who matched in the mainland. First-degree relatives living in PR (96%) were associated with students who remained on the island for training. CONCLUSIONS: The results provide insight into the influence that personal factors have on the decision of medical students in PR to pursue primary care training in the C-US.

Preoperative Planning for Anatomic Total Shoulder Arthroplasty.

The success of total shoulder arthroplasty is dependent on both proper patient selection and restoration of the native anatomy. After proper patient selection, preoperative planning is essential to select implants that will allow the surgeon to properly restore soft-tissue tension and correct for deformity. Although it is possible to template implants with plain radiographs, these do not allow accurate measurements of the complex three-dimensional anatomy of the glenohumeral joint. CT can be used to further examine version of the glenoid and humerus, as well as humeral head subluxation. Three-dimensional reconstructions also allow for virtual implantation, resulting in a more reliable prediction of implant appearance. Commercial software is available that calculates parameters such as version; however, these have been shown to have variability when compared with measurements obtained by surgeons. Patient-specific instrumentation can also be obtained based on preoperative measurements; however, although it allowed for improved measurements when compared with two-dimensional imaging, there has been no difference in version error, inclination error, or positional offset of the glenoid implant when comparing patient-specific instrumentation with standard instrumentation. Intraoperative navigation can also be used to give real-time feedback on implant positioning; however, additional studies are needed to fully evaluate its benefit.

A simple surgical mask modification to pass N95 respirator-equivalent fit testing standards during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has infected hundreds of millions of people resulting in millions of deaths worldwide. While N95 respirators remain the gold standard as personal protective equipment, they are resource-intensive to produce and obtain. Surgical masks, easier to produce and obtain, filter ≥95% submicron particles but are less protective due to a lack of seal around a user's face. This study tested the ability of a simple surgical mask modification using rubber bands to create a seal against particle exposure that would pass N95 standards. METHODS AND FINDINGS: Forty healthcare workers underwent TSI PortaCount mask fit testing using an ASTM Level 1 surgical mask modified with rubber bands. Fit Factor was determined after testing four standard OSHA N95 fit testing scenarios. Performance of the properly-modified surgical mask was compared to that of a poorly-modified surgical mask, an unmodified standard surgical mask, and an N95 respirator. Thirty-one of forty (78%) healthcare workers passed Fit Factor testing using a properly-modified mask. The Fit Factor success rate significantly improved by subsequent test date (p = 0.043), but was not associated with any other participant characteristics. The average Fit Factor score for the properly-modified mask was 151 (SD 65.2), a significantly better fit than the unmodified mask score of 3.8 (SD 3.1, p<0.001) and the poorly-modified mask score of 24.6 (SD 48.4, p<0.001) but significantly lower than a properly fitted N95 score of 199 (SD 4.5, p<0.001).do. CONCLUSIONS: Rubber bands, a low-cost and easily-accessible modification, can improve the seal and protective ability of a standard surgical mask to the level of an N95 respirator. This could mitigate N95 respirator shortages worldwide and provide individuals in under-resourced regions a practical means for increased personal respiratory protection.

Does a 2-Stage Debridement Result in Higher Rates of Implant Retention Compared With Single Debridement Alone?

BACKGROUND/METHODS: We retrospectively reviewed 89 patients with acute prosthetic joint infection treated with debridement, antibiotics, and implant retention (DAIR) or 2-DAIR. Patients had <3 weeks of symptoms and met Musculoskeletal Infection Society criteria for infection. Sixty-three patients were treated with DAIR, whereas 26 patients were managed using a 2-DAIR protocol where patients underwent initial debridement, antibiotic bead placement, and subsequent return to the operating room at an average of 16.3 days for repeat debridement and modular component exchange. Patients received a 6-week course of intravenous antibiotics and 3 months of oral antibiotics for suppression. Demographics, comorbidities, implant retention rates, and complications were compared between the groups. The McPherson host type and infection type classification system were used to categorize patients in both the DAIR and 2-DAIR groups. Regression analysis was performed to control postoperative vs acute hematogenous infection, procedure, and comorbidities. The McPherson host types and infection types were not different between DAIR and 2-DAIR patients, P = .728 and P = .061, respectively. RESULTS: There was no difference in the overall implant retention rate between DAIR and 2-DAIR (63.49% vs 69.23%, P = .605). The average days to reinfection was significantly longer for the 2-DAIR cohort compared with DAIR (271.3 vs 165.3, P = .024) in patients who failed treatment. However, when controlling for infection, microorganism, index procedure, and comorbidities, there was no difference in days to reinfection (P = .679). There were no differences in complications, 90-day readmission, or revision rates between the groups. CONCLUSIONS: A staged debridement for acute prosthetic joint infection did not improve the rates of infection control. Randomized trials are needed to define indications and potential benefits of 2-DAIR.

Enfermedades periodontales en puérperas con partos pretérmino y bajo peso al nacer / Periodontal diseases in puerperal women with preterm deliveries and low birth weight

RESUMEN Introducción: La frecuencia y gravedad de las enfermedades periodontales en puérperas son afectadas por los cambios hormonales propios del período y se estima que el riesgo de partos pretérmino y bajo peso puede asociarse a la presencia de las mismas. Objetivo: Determinar el estado periodontal y otros factores obstétricos asociados a puérperas y su posible relación causal con partos pretérmino y bebés bajo peso, en Santiago de Cuba. Material y Método: Se realizó un estudio analítico observacional caso control, en puérperas de los tres hospitales maternos provinciales de Santiago de Cuba, durante 2017 a 2019. Los casos fueron 250 puérperas con partos pretérmino bajo peso y los controles por 453 con partos a término y normopeso. Las variables independientes fueron las enfermedades periodontales y otros factores gineco-obstétricos asociados. Se aplicó el test no paramétrico de X2 de independencia con p≤ 0,05 y el coeficiente de correlación Rho de Spearman. La asociación causal se determinó por OR con sus intervalos de confianza y un modelo de regresión logística binaria. Resultados: El 37,4 % de las puérperas presentó enfermedad periodontal, con predominio de gingivitis (16 %) y periodontitis leve (15 %), el parto pretérmino y bajo peso al nacer afectó a 35,6 % del total, asociado a la enfermedad periodontal con OR=21,7 en conjunto con otros factores predisponentes. Conclusiones: Existe una alta frecuencia de enfermedades periodontales en asociación significativa con la aparición de partos pretérmino y bajo peso al nacer en conjunto con otros factores predisponentes presentes en las puérperas estudiadas.

ABSTRACT Introduction: The frequency and severity of periodontal diseases in puerperal women are affected by the hormonal changes typical of the period, and it is estimated that the risk of preterm deliveries and low birth weight can be associated with the presence of them. Objective: To determine the periodontal status and other obstetric factors associated with puerperal women, and their possible causal relationship with preterm deliveries and low-weight babies in Santiago de Cuba. Material and Methods: An analytical observational case control study was carried out in puerperal women at the three provincial maternity hospitals in Santiago de Cuba during 2017 - 2019. The cases included 250 puerperal women with preterm low birth weight deliveries and the controls involved 453 women with term normal birth weight births. The independent variables were periodontal diseases and other associated obstetric-gynecological factors. The non-parametric X2 test of independence (p≤0.05), and Spearman's Rho correlation coefficient were applied. The causal association was determined by OR with its confidence intervals and a binary logistic regression model. Results: The results show that 37,4 % of the puerperal women had periodontal disease, with a predominance of gingivitis (16 %) and mild periodontitis (15 %); preterm delivery and low birth weight affected 35,6 % of the total, which was also associated with periodontal disease (OR= 21,7) along with other predisposing factors. Conclusions: There is a high frequency of periodontal diseases that are significantly associated with preterm deliveries and low birth weight in conjunction with other predisposing factors present in the studied puerperal women.

Estado actual y metaanálisis de la relación entre nacimientos prematuros, bajo peso y enfermedades periodontales / Current state and metaanalysis of the relationship between premature births, low weight and periodontal diseases

Introducción: La enfermedad periodontal como factor de riesgo de partos pretérmino y bajo peso al nacer, así como la existencia de modelos matemáticos multifactoriales eficientes para predecir la intensidad de dicho riesgo, abren nuevas perspectivas de prevención para ambas entidades. Objetivo: Determinar el estado actual y metaanálisis de la relación de riesgo entre la enfermedad periodontal, los partos pretérmino y el bajo peso al nacer. Métodos: Se realizó una revisión bibliográfica y un metaanálisis con búsqueda en las bases de datos MEDLINE, PUBMED, SciELO, LILACS, BBO y Cochrane de estudios desde 1996 hasta el 2020, en humanos, en idiomas inglés y/o español. Resultados: Se encontraron 2 323 artículos; fueron excluidos 1 429 por estar duplicados y en otros idiomas, 742 no se correspondían con la temática de la acción de riesgo, 105 pertenecían a otros tipos de estudios, 32 no reunían los criterios de evaluación CASPe y de Newcastle - Otawa y solo 15 conformaron la muestra del metaanálisis. Más de 50 % de dichos artículos muestran asociación de riesgo entre la enfermedad periodontal y los resultados adversos del embarazo, pero en ninguno se realiza predicción del riesgo. Existe gran heterogeneidad en los estudios respecto a las limitaciones metodológicas y la forma de medir la enfermedad periodontal, el resultado del embarazo estudiado y la evaluación de la edad gestacional. Conclusiones: Se evidencia la relación de causalidad entre enfermedades periodontales y partos pretérmino con bajo peso al nacer.

Introduction: The periodontal disease as risk factor of preterm births and low birth weight, as well as the existence of efficient multifactorial mathematical models to predict the intensity of this risk, open new perspectives of prevention for both entities. Objective: To determine the current state and metaanalysis of the risk relationship between the periodontal disease, preterm births and low birth weight. Methods: A literature review and a metaanalysis were carried out with search in databases MEDLINE, PUBMED, SciELO, LILACS, BBO and Cochrane of studies from 1996 to 2020, in humans, in English and/or Spanish languages. Results: Two thousand 323 articles were found; 1 429 were excluded because they were duplicated and in other languages, 742 had nothing to do with the thematic of risk action, 105 belonged to other types of studies, 32 did not meet CASPe and Newcastle - Otawa evaluation criteria and just 15 conformed the sample of metaanalysis. More than 50 % of these articles show risk association between the periodontal disease and the adverse results of pregnancy, but risk prediction is not carried out in none of them. There is a great heterogeneity in the studies regarding methodological limitations and form of measuring the periodontal disease, result of the studied pregnancy and evaluation of the gestational age. Conclusions: The relationship of causality between periodontal diseases and preterm births with low birth weight is evidenced.

Atraumatic Index Finger Flexor Tendon Rupture as a Presenting Sign of Capitate Osteonecrosis: A Report of 2 Cases.

CASE: We present 2 cases of spontaneous index finger (IF) flexor tendon ruptures because of previously undiagnosed osteonecrosis (OA) of the capitate. Imaging revealed fragmentation of the capitate, and patients were treated with excision or fixation of the bony fragments with tendon repair. At the final follow-up, both patients had functional digital range of motion. CONCLUSIONS: OA of the capitate is relatively rare and may present as atraumatic (IF) flexor tendon ruptures because of attritional wear when associated with bony fragmentation.

Mechanisms underlying interactions between two abundant oral commensal bacteria.

Complex polymicrobial biofilm communities are abundant in nature particularly in the human oral cavity where their composition and fitness can affect health. While the study of these communities during disease is essential and prevalent, little is known about interactions within the healthy plaque community. Here we describe interactions between two of the most abundant species in this healthy microbiome, Haemophilus parainfluenzae and Streptococcus mitis. We discovered that H. parainfluenzae typically exists adjacent to mitis group streptococci in vivo with which it is also positively correlated based on microbiome data. By comparing in vitro coculture data to ex vivo microscopy we revealed that this co-occurrence is density dependent and further influenced by H2O2 production. We discovered that H. parainfluenzae utilizes a more redundant, multifactorial response to H2O2 than related microorganisms and that this system's integrity enhances streptococcal fitness. Our results indicate that mitis group streptococci are likely the in vivo source of NAD for H. parainfluenzae and also evoke patterns of carbon utilization in vitro for H. parainfluenzae similar to those observed in vivo. Our findings describe mechanistic interactions between two of the most abundant and prevalent members of healthy supragingival plaque that contribute to their in vivo survival.

Excision and Reconstruction of Alveolar Rhabdomyosarcoma Involving the Achilles Tendon in a Pediatric Patient: A Case Report.

CASE: We describe a case of a 9-year-old boy who presented with a left calf mass consistent with alveolar rhabdomyosarcoma involving the Achilles tendon. The patient underwent radical resection of the Achilles tendon and Achilles tendon allograft reconstruction. At 2.5-year follow-up, the child had full ankle range of motion and strength and no signs of disease. CONCLUSIONS: Radical resection of Achilles tendon in the setting of malignancy and reconstruction with allograft is a rare procedure that has not been previously described in the pediatric population. Orthopaedic oncologists can consider this option for the rare malignancies involving the Achilles tendon.

Complete Genome Sequence of Strain SS-5, a Magnetotactic Gammaproteobacterium Isolated from the Salton Sea, a Shallow, Saline, Endorheic Rift Lake Located on the San Andreas Fault in California.

We report the 3.7-Mb genome sequence of strain SS-5, a magnetotactic, sulfur-oxidizing rod and member of the family Chromatiaceae of the class Gammaproteobacteria, which biomineralizes membrane-bound, elongated, prismatic octahedral, magnetite nanocrystals. This genome sequence brings further diversity for understanding the origin and evolution of magnetotaxis and magnetosome biomineralization.

Dynamic Thumb Circumduction Measured With a Wearable Motion Sensor: A Prospective Comparison of Patients With Basal Joint Arthritis to Controls.

Purpose: The purpose of this study was to compare the active range of motion in patients with thumb carpometacarpal (CMC) arthritis to healthy controls. A secondary objective of this study was to examine the feasibility of using wearable motion sensors in a clinical setting. Methods: Asymptomatic controls and patients with radiographic and clinical evidence of thumb CMC joint arthritis were recruited. The experimental setup allowed participants to rest their forearm in neutral pronosupination with immobilization of the second through fifth CMC joints. An electromagnetic motion sensor was embedded into a thumb interphalangeal joint immobilizer, and participants were asked to complete continuous thumb circumduction movements. Data were continuously recorded, and circumduction curves were created based on degrees of motion. Peak thumb abduction and extension angles were also extracted from the data. Results: A total of 29 extremities with thumb CMC arthritis and 18 asymptomatic extremities were analyzed. Bilateral disease was present in 64% of patients. Patient age range was 35-83 years, and the control group age range was 26-83 years. The most affected extremities had Eaton stage 3 disease (38%, N = 11). The average maximum thumb abduction was 53.9° ± 19.6° in affected extremities and 70.8° ± 10.1° for controls. Average maximum thumb extension was 50.0° ± 15.2° in affected extremities and 58.4° ± 9.1° for controls. When comparing patients with Eaton stage 3 and 4 disease to controls, average maximum abduction and extension decreased with increasing disease stage (42.3°, 46.1°, and 70.8° for abduction, respectively, and 58.4°, 43.3°, and 41.3° for extension, respectively). Conclusions: We observed more severe motion limitations with increasing Eaton stage, and statistically significant differences were seen with stage 3 and 4 disease. A wearable motion sensor using a portable experimental setup was used to obtain measurements in a clinical setting. Type of study/level of evidence: Diagnostic II.

TRP Channels Role in Pain Associated With Neurodegenerative Diseases.

Transient receptor potential (TRP) are cation channels expressed in both non-excitable and excitable cells from diverse tissues, including heart, lung, and brain. The TRP channel family includes 28 isoforms activated by physical and chemical stimuli, such as temperature, pH, osmotic pressure, and noxious stimuli. Recently, it has been shown that TRP channels are also directly or indirectly activated by reactive oxygen species. Oxidative stress plays an essential role in neurodegenerative disorders, such as Alzheimer's and Parkinson's diseases, and TRP channels are involved in the progression of those diseases by mechanisms involving changes in the crosstalk between Ca2+ regulation, oxidative stress, and production of inflammatory mediators. TRP channels involved in nociception include members of the TRPV, TRPM, TRPA, and TRPC subfamilies that transduce physical and chemical noxious stimuli. It has also been reported that pain is a complex issue in patients with Alzheimer's and Parkinson's diseases, and adequate management of pain in those conditions is still in discussion. TRPV1 has a role in neuroinflammation, a critical mechanism involved in neurodegeneration. Therefore, some studies have considered TRPV1 as a target for both pain treatment and neurodegenerative disorders. Thus, this review aimed to describe the TRP-dependent mechanism that can mediate pain sensation in neurodegenerative diseases and the therapeutic approach available to palliate pain and neurodegenerative symptoms throughout the regulation of these channels.

Análisis comparativo de machismo sexual en estudiantes universitarios peruanos y chilenos / Comparative analysis of sexual machismo in Peruvian and Chilean university students

Resumen Introducción: El machismo sexual es una forma de sexismo que denigra a la mujer y que se asocia a diversos factores de riesgo de la salud mental. Objetivo: En el presente estudio se comparan los niveles de machismo en estudiantes universitarios de Perú y Chile en función de su nacionalidad y de otras variables sociodemográficas. Método: La muestra estuvo conformada por 303 estudiantes varones de dos universidades privadas de una ciudad de provincia de ambos países. Se aplicó la Escala de Machismo Sexual de Díaz et al. (2010) que consta de 12 ítems y fue construida y validada previamente para ambas muestras. Resultados: 28% de los estudiantes evaluados presenta altos niveles de machismo, y que los estudiantes peruanos tienen niveles mayores de machismo que los estudiantes chilenos. Además, los estudiantes que consumen alcohol, tabaco y drogas ilegales, de manera frecuente obtuvieron mayores puntajes de machismo sexual. Conclusiones: Se concluye que los estudiantes peruanos son más machistas que sus pares chilenos y que, el machismo sexual está asociado al consumo de sustancias psicoactivas.

Introduction: The sexual machismo is a sort of sexism that denigrate the women and it is associated with several risk factors for mental health. Objective: In the present study we compare the levels of machismo among university students from Peru and Chile according to their nationality and other sociodemographic variables. Method: 303 male students from two private universities located in both countries formed the sample. They were assessment by the 12 items Sexual Machismo Scale designed by Díaz et al. (2010) that was previously validated for both samples. Results: 28% of the students assessment presents high levels of machismo, and Peruvian students have higher levels of machismo comparing to the Chilean students. Moreover, the students who use to frequently consume alcohol, tobacco and illegal drugs, obtained higher punctuations on sexual machismo. Conclusions: We conclude that Peruvian students are more chauvinist than their Chilean counterparts, and sexual machismo is associated to de consumption of psychoactive substances.

Lacosamide intake during pregnancy increases the incidence of foetal malformations and symptoms associated with schizophrenia in the offspring of mice.

The use of first and second generation antiepileptic drugs during pregnancy doubles the risk of major congenital malformations and other teratogenic defects. Lacosamide (LCM) is a third-generation antiepileptic drug that interacts with collapsing response mediator protein 2, a protein that has been associated with neurodevelopmental diseases like schizophrenia. The aim of this study was to test the potential teratogenic effects of LCM on developing embryos and its effects on behavioural/histological alterations in adult mice. We administered LCM to pregnant mice, assessing its presence, and that of related compounds, in the mothers' serum and in embryonic tissues using liquid chromatography coupled to quadrupole/time of flight mass spectrometry detection. Embryo morphology was evaluated, and immunohistochemistry was performed on adult offspring. Behavioural studies were carried out during the first two postnatal weeks and on adult mice. We found a high incidence of embryonic lethality and malformations in mice exposed to LCM during embryonic development. Neonatal mice born to dams treated with LCM during gestation displayed clear psychomotor delay and behavioural and morphological alterations in the prefrontal cortex, hippocampus and amygdala that were associated with behaviours associated with schizophrenia spectrum disorders in adulthood. We conclude that LCM and its metabolites may have teratogenic effects on the developing embryos, reflected in embryonic lethality and malformations, as well as behavioural and histological alterations in adult mice that resemble those presented by patients with schizophrenia.

Mejorando la salud de la comunidad entre todos: relato de experiencia del trabajo de un CAPS con la participación de su comunidad / Improving the health of the community among all: a CAPS work experience report with the participation of its community

Como equipo de salud (ES) nos proponemos describir nuestra experiencia de trabajo en un Centro de Atención Primaria de la Salud (CAPS) de Buenos Aires, en los años 2018-2019, donde apuntamos a un cambio en las prácticas de salud en búsqueda de una mejor calidad de vida y mayor participación de la comunidad, fortaleciendo la estrategia de atención primaria. Desde este marco trabajamos en cuatro etapas: 1. División del Área Programática (AP) - Implementación de la Historia Clínica Familiar (HCF) orientada a problemas. 2. Análisis situacional: determinantes sociales y problemas prevalentes por zona. 3. Formación general de Promotores de Salud (PS). 4. Formación de Promotores de Salud (PS) en problemas prevalentes por zona - acciones de promoción de salud y prevención de enfermedades. Encontramos una importante variación entre la situación inicial y la final. No solo por los resultados obtenidos (sectorizamos el AP) en diez zonas; implementamos 950 HCF, capacitamos a diez PS, con los cuales, realizamos actividades: mapeo del barrio, encuestas domiciliarias, charlas de prevención en temas prevalentes, implementación de postas sanitarias en cinco zonas del AP gestionadas por los PS), sino también porque logramos afianzar el ES y el de los PS, permitiéndonos un mayor acercamiento con la comunidad (AU)

As a health team (HT) we propose to describe our work experience in a Primary Care Health Center (PCHC) in Buenos Aires, during 2018-19, where we aim look for a change in health practices in search of a better quality of life and greater community participation, by strengthening the primary care strategy. Based in this framework we work in four stages: 1. Division of the program area (PA) - Implementation of family-oriented medical record (FOMH). 2. Situational analysis: social determinants and prevalent problems by zone. 3. General training of health promoters (HP). 4. Training of HP in prevalent problems by zone - health promotion and disease prevention actions. We found an important variation between the initial and the final situation. Not only because of the results obtained (we sectorized the PA in ten zones) we implemented 950 HCF; we trained ten HPs, And we carried out a number of activities with them: neighborhood mapping, household surveys, prevention talks on prevalent issues, implementation of health posts in five areas of the PA (managed by the HP), but also because we managed to strengthen the HT and the HP, allowing us to get closer to the community (AU)