Development and validation of a predictive model for choledocholithiasis.

BACKGROUND: Gallstone-related conditions affect a significant portion of the population, with varying prevalence among different ethnic groups. Complications such as pancreatitis and cholangitis are associated with the presence of common bile duct (CBD) stones. Existing guidelines for diagnosing choledocholithiasis lack precision, leading to excessive use of invasive procedures like endoscopic retrograde cholangiopancreatography (ERCP). METHODS: A prospective study was conducted at Hospital Central "Dr. Ignacio Morones Prieto," involving 374 patients in the development cohort and 154 patients in the validation cohort. Patients meeting inclusion criteria underwent biochemical testing and ultrasonography. A predictive scoring system was developed using logistic regression and validated in an independent cohort. Clinical and laboratory variables were collected, and model performance was assessed using receiver-operator characteristic (ROC) curves. RESULTS: The predictive model incorporated variables such as age, pancreatitis, cholangitis, bilirubin levels, and CBD stone presence on ultrasound. The model demonstrated an area under the ROC curve (AUC) of 93.81% in the validation dataset. By adjusting the threshold defining high-risk probability to 40%, the model improved specificity and sensitivity compared to existing guidelines. Notably, the model reclassified patients, leading to a more accurate risk assessment. CONCLUSIONS: The developed algorithm accurately predicts choledocholithiasis non-invasively in patients with symptomatic gallstones. This tool has the potential to reduce reliance on costly or invasive procedures like magnetic resonance cholangiopancreatography and ERCP, offering a more efficient and cost-effective approach to patient management. The user-friendly calculator developed in this study could streamline diagnostic procedures, particularly in resource-limited healthcare settings, ultimately improving patient care.

The power of Posidonia oceanica meadows to retain microplastics and the consequences on associated macrofaunal benthic communities.

In the coastal environment, a large amount of microplastics (MPs) can accumulate in the sediments of seagrass beds. However, the potential impact these pollutants have on seagrasses and associated organisms is currently unknown. In this study, we investigated the differences in MPs abundance and composition (i.e., shape, colour and polymer type) in marine sediments collected at different depths (-5 m, -15 m, -20 m) at two sites characterized by the presence of Posidonia oceanica meadows and at one unvegetated site. In the vegetated sites, sediment samples were collected respectively above and below the upper and lower limits of the meadow (-5 m and -20 m), out of the P. oceanica meadow, and in the central portion of the meadow (-15 m). By focusing on the central part of the meadow, we investigated if the structural features (i.e. shoots density and leaf surface) can affect the amount of MPs retained within the underlying sediment and if these, in turn, can affect the associated benthic communities. Results showed that the number of MPs retained by P. oceanica meadows was higher than that found at the unvegetated site, showing also a different composition. In particular, at vegetated sites, we observed that MPs particles were more abundant within the meadow (at - 15 m), compared to the other depths, on unvegetated sediment, with a dominance of transparent fragments of polypropylene (PP). We observed that MPs entrapment by P. oceanica was accentuated by the higher shoots density, while the seagrass leaf surface did not appear to have any effect. Both the abundance and richness of macrofauna associated with P. oceanica rhizomes appear to be negatively influenced by the MPs abundance in the sediment. Overall, this study increases knowledge of the potential risks of MPs accumulation in important coastal habitats such as the Posidonia oceanica meadows.

Penile Fracture Secondary to Gunshot Injury: A Multidisciplinary Approach and Exceptional Surgical Management in an Uncommon Case.

Penile fractures happen when the tunica albuginea is forcefully torn during intense sexual activity or vigorous masturbation. Gunshot-induced cases are extremely rare. Diagnosis, often requiring surgical exploration, poses challenges due to the condition's rarity and severity. We report a complex case of a patient with multiple gunshot wounds, highlighting the need for a multidisciplinary approach for abdominal and genitourinary regions. A 24-year-old male presented to the emergency department with multiple gunshot wounds to the anterior thoracic and abdominal walls, inguinal region, penis, and lower extremities. Despite multiple gunshot wounds, the patient maintained hemodynamic stability during physical examination. No imaging study was performed since surgical management was decided due to the presence of hematemesis. During exploratory laparotomy, a 2 cm stomach lesion was found and repaired by the general surgery team. Urology then addressed genital trauma, identifying and fixing a 1 cm tunica albuginea defect in each corpora cavernosa, achieving bilateral penile fracture repair. The patient was discharged after eight days of hospitalization, with adequate oral intake and urinating. Fifty-two days later, he persists with mild erectile dysfunction (International Index of Erectile Function-5 score: 17 points). This unique case involving a gunshot-induced penile fracture alongside abdominal and several other injuries was successfully managed through a multidisciplinary approach. As these lesions are rare, prompt treatment with standardized surgical procedures for civilian cases is crucial for optimal outcomes.

Impact of Risk Factors on COVID-19 Outcomes in Unvaccinated People With Rheumatic Diseases: A Comparative Analysis of Pandemic Epochs Using the COVID-19 Global Rheumatology Alliance Registry.

OBJECTIVE: Approximately one third of individuals worldwide have not received a COVID-19 vaccine. Although studies have investigated risk factors linked to severe COVID-19 among unvaccinated people with rheumatic diseases (RDs), we know less about whether these factors changed as the pandemic progressed. We aimed to identify risk factors associated with severe COVID-19 in unvaccinated individuals in different pandemic epochs corresponding to major variants of concern. METHODS: Patients with RDs and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance Registry between March 2020 and June 2022. An ordinal logistic regression model (not hospitalized, hospitalized, and death) was used with date of COVID-19 diagnosis, age, sex, race and/or ethnicity, comorbidities, RD activity, medications, and the human development index (HDI) as covariates. The main analysis included all unvaccinated patients across COVID-19 pandemic epochs; subanalyses stratified patients according to RD types. RESULTS: Among 19,256 unvaccinated people with RDs and COVID-19, those who were older, male, had more comorbidities, used glucocorticoids, had higher disease activity, or lived in lower HDI regions had worse outcomes across epochs. For those with rheumatoid arthritis, sulfasalazine and B-cell-depleting therapy were associated with worse outcomes, and tumor necrosis factor inhibitors were associated with improved outcomes. In those with connective tissue disease or vasculitis, B-cell-depleting therapy was associated with worse outcomes. CONCLUSION: Risk factors for severe COVID-19 outcomes were similar throughout pandemic epochs in unvaccinated people with RDs. Ongoing efforts, including vaccination, are needed to reduce COVID-19 severity in this population, particularly in those with medical and social vulnerabilities identified in this study.

Definición de la presión arterial normal a las 11-14 semanas de gestación según riesgo / Definition of normal blood pressure at 11 to 14 weeks' gestation according to risk

Resumen Objetivo: Definir la presión arterial normal en el primer trimestre de la gestación según el desempeño para predecir preeclampsia. Método: Estudio de cohorte en embarazos de feto único, según el modelo de riesgos en competencia para preeclampsia. La presión arterial se midió de manera estandarizada entre las 11 y 14 semanas de gestación. Resultados: En 797 embarazos incluidos hubo 40 (5.0%, intervalo de confianza del 95% [IC 95%]: 3.6-6.4) partos con preeclampsia. Las presiones arteriales sistólica, diastólica y media fueron respectivamente de 101 (9), 68 (8) y 79 (8) mmHg en las embarazadas que no desarrollaron preeclampsia, frente a 109 (10), 75 (8) y 86 (8) mmHg en las que sí (p < 0.001, prueba t de Student). Las áreas bajo la curva fueron 0.707 (0.637-0.777), 0.728 (0.661-0.795) y 0.738 (0.673-0.803). A 3% de falsos positivos, los puntos de corte fueron 119, 83 y 94 mmHg con valores predictivos negativos del 95.6%. Conclusiones: Es factible definir normalidad para la presión arterial en el embarazo con base bioestadística y clínica.

Abstract Objective: To define normal blood pressure at first trimester of pregnancy by performance for pre-eclampsia prediction. Method: A cohort study in singleton pregnancies, according to the competing risks model for pre-eclampsia. Blood pressure was measured according to a standardized method at 11 to 14 weeks' gestation. Results: Among 797 pregnancies included, there were 40 (5.0%, IC95 3.6; 6.4) deliveries with pre-eclampsia. The systolic, diastolic, and mean arterial blood pressures were respectively of 101(9), 68(8) and 79(8) mmHg in pregnant women who did not develop pre-eclampsia, against 109(10), 75(8) and 86(8) in those who did (p < 0.001, t-test). The areas under the curves were 0.707 (0.637; 0.777), 0.728 (0.661; 0.795), and 0.738 (0.673; 0.803). At a 3% of false positive rate, the cut-off points were 119, 83 and 94 mmHg with predictive values of negative of 95.6%. Conclusions: It is feasible to define the normal values for blood pressure in pregnancy on biostatistic and clinical basis.

Antifungal Activity of Avocado Seed Recombinant GASA/Snakin PaSn.

The avocado fruit (Persea americana) has become a significant fruit in the human diet for its nutritional properties. However, the seed is a source of bioactive molecules and has been poorly utilized. Previously, we reported that the PaSn gene is expressed in the avocado seeds, a cysteine-rich antimicrobial peptide (GASA/Snakin), and demonstrated its antibacterial activity. In this work, we report the recombinant production of PaSn in the Escherichia coli system and evaluate its antifungal activity against plant and human pathogen fungi. The recombinant peptide showed antifungal activity at 200 µg/mL against phytopathogens Colletotrichum gloeosporioides and Fusarium oxysporum and human pathogens Candida albicans and C. glabrata. Our results demonstrate the usefulness of a prokaryotic expression system for avocado antimicrobial peptide production. In conclusion, the snakin PaSn could be helpful in the control of postharvest avocado and other fruits' fungal diseases and human fungal pathogens.

Association between subjects with newly Diagnosed rheumatoid arthritis and dental caries / Asociación entre sujetos con artritis reumatoide recientemente diagnosticada y caries dental

Abstract Alterations in saliva, temporomandibular joint disorders, dysphagia, Sjogrens syndrome, dental caries, periodontal disease, and tooth loss have been identified in patients with Rheumatoid Arthritis. The aims of this research were 1) to study the association between newly diagnosed rheumatoid arthritis and dental caries and 2) to identify most frequent teeth with caries in study groups. A descriptive pilot study was performed. A total of 620 participants were evaluated, 29 met the selection criteria. The subjects were divided into 2 groups: 13 subjects with newly diagnosed rheumatoid arthritis and 16 subjects without rheumatoid arthritis. Salivary parameters, DMFT index, care index, FS-T index and Treatment Needs Index were evaluated in all participants. The Fishers Exact test and Mann-Whitney U test we used to establish the differences between groups. Low mean in all salivary parameters and a high caries frequency were observed in subjects with newly diagnosed rheumatoid arthritis compared to a control group (p<0.01). The right maxillary second premolar (n=6, 46%, p=0.0100); right mandibular second premolar (n=7,54%, p=0.0462) and left mandibular second molar (n=10,77%, p=0.0001) were the most frequent teeth with caries. Early diagnosis and early treatment of rheumatoid arthritis can improve the prognosis in most of patients. The development of new public health policies and care based on the prevention are necessary to improve the quality of patients lives.

Resumen Alteraciones en la saliva, trastornos de la articulación temporomandibular, disfagia, síndrome de Sjogren, caries dental, enfermedad periodontal y pérdida de dientes son algunas patologías que se han identificado en pacientes con artritis reumatoide. Los objetivos de este estudio fueron (1) Asociar la artritis reumatoide recientemente diagnosticada con la caries dentales e (2) Identificar los dientes más frecuentes con caries en los grupos de estudio. Se realizó un estudio piloto descriptivo. 620 participantes fueron evaluados, 29 sujetos cumplieron con los criterios de selección. Los sujetos se dividieron en 2 grupos: 13 sujetos con artritis reumatoide recién diagnosticados y 16 sujetos sin artritis reumatoide. En todos los participantes se evaluaron parámetros salivales, el índice CPOD, el índice IC, el índice FS-T y el índice INT. La prueba exacta de Fisher y U de Mann-Whitney se utilizaron para establecer diferencias entre grupos. En los resultados se observó un bajo promedio de los parámetros salivales y una alta frecuencia de caries en sujetos con artritis reumatoide recién diagnosticados comparados con un grupo control (p<0.01). El segundo premolar superior derecho (n=6,46%, p=0,0100); el segundo premolar mandibular derecho (n=7,54%, p=0.0462) y el segundo molar mandibular izquierdo (n=10,77%, p=0.0001) fueron los dientes más frecuentes con caries dental. El diagnóstico y el tratamiento temprano de la artritis reumatoide pueden mejorar el pronóstico en la mayoría de los pacientes. El desarrollo de nuevas políticas de salud pública basadas en la prevención de la cavidad bucal son necesarias para mejorar la calidad de vida de los pacientes.

Valores de referencia personalizados para el índice de pulsatilidad medio de la arteria uterina durante el embarazo según paridad, medición transvaginal y presión arterial / Reference values for uterine artery mean pulsatility index throughout pregnancy customized by parity, transvaginal measurement and blood pressure

Resumen Introducción: Los rangos de referencia de población específica para el índice de pulsatilidad medio de la arteria uterina (IPmAUt) durante el embarazo han demostrado valor en el cuidado prenatal. Objetivo: Construir valores de referencia para el IPmAUt durante el embarazo, personalizados por características maternas, medición transvaginal y presión arterial en una población mexicana. Métodos: Estudio transversal de 2286 embarazos normales de feto único en la Ciudad de México. La presión arterial y el IPmAUt se midieron mediante metodología estandarizada. Se construyeron rangos de referencia por gestación. Los efectos de las variables independientes se probaron mediante regresión lineal múltiple. Resultados: La mediana del IPmAUt entre las 11 y 41 semanas disminuyó de 1.714 a 0.523. El percentil 95 disminuyó de 2.600 a 0.653. La paridad sin preeclampsia previa representó el principal efecto sobre el IPmAUt. La presión arterial media tuvo efecto sobre el IPmAUt por interacción con la paridad. La preeclampsia previa tuvo efecto sobre el IPmAUt por interacción con las características maternas. Se obtuvo un factor de corrección para medición transvaginal. Conclusiones: El IPmAUt disminuye normalmente según la placentación y adaptación materna al embarazo. Los efectos de la paridad sobre la presión arterial y el IPmAUt podrían reflejar remodelación cardiovascular posterior a la gestación.

Abstract Introduction: Population-specific reference ranges for uterine artery (UtA) mean pulsatility index (PI) throughout pregnancy have been shown to be of value in antenatal care. Objective: To construct reference values for UtA mean PI throughout pregnancy, customized by maternal characteristics, transvaginal measurement and blood pressure in a Mexican population. Methods: Cross-sectional study in 2286 normal singleton pregnancies in Mexico City. Blood pressure and UtA mean PI were measured using standardized methodology. Reference ranges by gestation were constructed. The effects of independent variables were tested by multiple linear regression. Results: UtA mean PI median value between 11 and 41 weeks decreased from 1.714 to 0.523. The 95th percentile decreased from 2.600 to 0.653. Previous parity without preeclampsia had the main effect on UtA mean PI. Mean blood pressure had an effect on UtA mean PI by interaction with parity. Previous preeclampsia had an effect on UtA mean PI by interaction with maternal characteristics. A correction factor was obtained for transvaginal measurement. Conclusions: UtA mean PI usually decreases according to placentation and maternal adaptation to pregnancy. The effects of parity on blood pressure and UtA mean PI might reflect cardiovascular remodeling after gestation.

Minimally invasive hysterectomy for benign indications-surgical volume matters: a retrospective cohort study comparing complications of robotic-assisted and conventional laparoscopic hysterectomies.

The objective of this study was to evaluate the incidence of perioperative complications in robotic-assisted hysterectomies performed by high-volume robotic surgeons compared to conventional laparoscopic hysterectomies performed by all gynecologic surgeons. This retrospective cohort study was performed at a single-center community based hospital and medical center. A total of 332 patients who underwent hysterectomy for benign indications were included in this study. Half of these patients (n = 166) underwent conventional laparoscopic hysterectomy and the other half underwent a robotic-assisted laparoscopic hysterectomy. The main outcome measures included composite complication rate, estimated blood loss (EBL), and hospital length of stay (LOS). Median (IQR) EBL was significantly lower for robotic hysterectomy [22.5 (30) mL] compared to laparoscopic hysterectomy [100 (150) mL, p < 0.0001]. LOS was significantly shorter for robotic hysterectomy (1.0 ± 0.2 day) compared to laparoscopic hysterectomy (1.2 ± 0.7 days, p = 0.04). Despite averaging 3.0 (IQR 1.0) concomitant procedures compared to 0 (IQR 1.0) for the conventional laparoscopic hysterectomies, the incidence of any type of complication was lower in the robotic hysterectomy group (2 vs. 6%, p = 0.05). Finally, in a logistic regression model controlling for multiple confounders, robotic-assisted hysterectomy was less likely to result in a perioperative complication compared to traditional laparoscopic hysterectomy [odds ratio (95% CI) = 0.2 (0.1, 0.90), p = 0.04]. In conclusion, robotic-assisted hysterectomy may reduce complications compared with conventional laparoscopic hysterectomy when performed by high volume surgeons, especially in the setting of other concomitant gynecologic surgeries.

An Analysis COVID-19 in Mexico: a Prediction of Severity.

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes a mild illness in most cases; forecasting COVID-19-associated mortality and the demand for hospital beds and ventilators are crucial for rationing countries' resources. OBJECTIVE: To evaluate factors associated with the severity of COVID-19 in Mexico and to develop and validate a score to predict severity in patients with COVID-19 infection in Mexico. DESIGN: Retrospective cohort. PARTICIPANTS: We included 1,435,316 patients with COVID-19 included before the first vaccine application in Mexico; 725,289 (50.5%) were men; patient's mean age (standard deviation (SD)) was 43.9 (16.9) years; 21.7% of patients were considered severe COVID-19 because they were hospitalized, died or both. MAIN MEASURES: We assessed demographic variables, smoking status, pregnancy, and comorbidities. Backward selection of variables was used to derive and validate a model to predict the severity of COVID-19. KEY RESULTS: We developed a logistic regression model with 14 main variables, splines, and interactions that may predict the probability of COVID-19 severity (area under the curve for the validation cohort = 82.4%). CONCLUSIONS: We developed a new model able to predict the severity of COVID-19 in Mexican patients. This model could be helpful in epidemiology and medical decisions.

Arboles de Decisión como Metodología para Determinar el Rendimiento Académico en Educación Superior / Decision Trees as a Methodology to Determine Academic Performance in Higher Education / Árvores de Decisão como Metodologia para Determinar o Desempenho Acadêmico no Ensino Superior

Resumen Introducción. En este artículo se presentan los resultados finales de la investigación Árboles de decisión como metodología para determinar el rendimiento académico en educación superior. Objetivo. Explicar el rendimiento académico de los alumnos que cursan asignaturas relacionadas con la programación en una institución de nivel superior ubicada en la zona urbana de Pánuco, Veracruz, México. El rendimiento académico presenta una situación que no solamente preocupa a las instituciones educativas, sino también a los estudiantes, padres de familia, profesores y directores. Puede mencionarse que este presenta también una situación mundial y que es investigado en diferentes áreas de conocimiento. Materiales y Métodos. Se aplicó un cuestionario a 341 estudiantes repartidos en el segundo, cuarto y sexto semestre. Se utilizaron dos técnicas de modelado estadístico: árbol de decisión y regresión lineal múltiple, para definir qué variables independientes están asociadas al rendimiento académico. Resultados. Se ubica que las variables de aprendizaje en el aula y las tutorías externas están relacionadas con la variable de rendimiento académico y que el 48.1 % de los alumnos necesitan algún apoyo académico o capacitación externa para el reforzamiento de la programación. Conclusiones. Se recomienda implementar estrategias de mejora para reducir la sobrecarga de trabajo de los alumnos. También realizar una sensibilización antes de aplicar la encuesta y que los cuestionarios sean aplicados en fechas de exámenes ya que los alumnos se encuentran en niveles altos de estrés. En trabajos posteriores se tiene contemplado poder evaluar los efectos sobre el rendimiento académico, económico, social y cultural.

Abstract Introduction. This article presents the results of the Decision Trees research as a methodology to determine academic performance in higher education. Objective. Explain the academic performance of students taking subjects related to programming at a higher-level institution located in the urban area of Pánuco, Veracruz, Mexico. Academic performance presents a situation that not only concerns educational institutions, but also students, parents, teachers, and principals. It can be mentioned that this also presents a world situation and that it is investigated in different areas of knowledge. Materials and methods. A questionnaire was applied to 341 students distributed in the second, fourth and sixth semester. Two statistical modeling techniques were used: decision tree and multiple linear regression, to define which independent variables are associated with academic performance. Results. It is located that the learning variables in the classroom and the external tutorials are related to the academic performance variable and that 48.1 % of the students need some academic support or external training to reinforce the programming. Conclusions. It is recommended to implement improvement strategies to reduce the work overload of the students. Also make an awareness before applying the survey and that the questionnaires are applied on test dates since the students are at high levels of stress. Future research could evaluate the effect on academic, economic and cultural performance.

Resumo Introdução. Este artigo apresenta os resultados da pesquisa Árvores de Decisão como uma metodologia para determinar o desempenho acadêmico no ensino superior. Objetivo. Explique o desempenho acadêmico dos estudantes que cursam matérias relacionadas à programação em uma instituição de nível superior localizada na área urbana de Pánuco, Veracruz, México. O desempenho acadêmico apresenta uma situação que diz respeito não apenas às instituições de ensino, mas também a estudantes, pais, professores e diretores. Pode-se mencionar que isso também apresenta uma situação mundial e é investigada em diferentes áreas do conhecimento. Materiais e métodos. Foi aplicado um questionário a 341 alunos distribuídos no segundo, quarto e sexto semestre. Foram utilizadas duas técnicas de modelagem estatística: árvore de decisão e regressão linear múltipla, para definir quais variáveis independentes estão associadas ao desempenho acadêmico. Resultados. Fica localizado que as variáveis de aprendizagem em sala de aula e os tutoriais externos estão relacionados à variável desempenho acadêmico e que 48,1 % dos alunos precisam de algum apoio acadêmico ou treinamento externo para reforçar a programação. Conclusões. Recomenda-se implementar estratégias de melhoria para reduzir a sobrecarga de trabalho dos alunos. Lembre-se também antes de aplicar a pesquisa e que os questionários sejam aplicados nas datas dos testes, uma vez que os alunos estão em altos níveis de estresse.

Presión arterial en embarazos normales de la Ciudad de México / Blood pressure in normal pregnancies from Mexico City

Resumen Objetivo: Determinar la presión arterial (PA) normal en embarazadas en la Ciudad de México. Método: Estudio transversal descriptivo de la PA en embarazos normales de feto único en la Ciudad de México. Las mediciones siguieron un método estandarizado con uso de dispositivos electrónicos automatizados. Se construyeron valores de referencia de las presiones sistólica (PS), diastólica (PD) y arterial media (PAM). Se probaron los efectos de las características maternas y de la gestación sobre la PA. Los intervalos de referencia de la PA se ajustaron para las variables significativas. Resultados: En 1,056 mujeres con edad media de 33 años y 160 cm medios de estatura se realizaron 1,915 mediciones entre las 5 y 41 semanas de edad gestacional (EG) con peso medio de 65 kg. La PA durante el embarazo fue de 102.7/67.2 ± 9.3/7.4 DE mmHg y 79.0 ± 7.4 DE mmHg la PAM. La PA tuvo una relación cuadrática con la EG, la más baja en el segundo trimestre. La PS y la PD mostraron una correlación lineal (r = 0.71). El peso materno tuvo el efecto más significativo sobre PS y PAM; la estatura sobre la PD. La edad, etnia, paridad, consumo de tabaco y antecedente familiar ejercieron efectos diferentes en cada PA. La gestación no tuvo efecto significativo en el modelo multivariado de la PS. Conclusiones: La PA se halló por debajo de la norma convencional en embarazadas. Los criterios diagnósticos para hipertensión en el embarazo deben revisarse; los valores de referencia pueden ajustarse a características maternas y gestacionales.

Abstract Objective: To determine the normal blood pressure (BP) in pregnancy, Mexico City. Methods: A cross-sectional observational study was carried out of BP on singleton normal pregnancies in Mexico City. Measurements followed a standardised methodology using automated electronic devices. Reference values of systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) were constructed. Maternal and gestation characteristics effects on BP were tested. The reference ranges of BP were adjusted for significant variables. Results: On 1,056 women of 33 years old mean age and 160.0 cm mean height, 1,915 measurements were made between 5 and 41 weeks of gestational age (GA) with 65.0 kg of mean weight. The median BP throughout pregnancy was 102.7/67.2 ± 9.3/7.4 SD mmHg, and 79.0 ± 7.4 SD mmHg the MAP. BP had a quadratic relationship with GA, being the lowest in 2nd trimester. SBP and DBP had a r = 0.71 linear correlation. Maternal weight had the most significant effect on SBP and MAP; height, on DBP. Maternal age, ethnic origin, parity, tobacco habit and family history had differential effects on BP. Gestation had no significant effect on SBP multivariate model. Conclusions: BP resulted lower than conventional standard for pregnant women. Diagnostic criteria for hypertension in pregnancy must be revised; reference values can be adjusted by maternal and gestation characteristics.

Presión arterial en embarazos normales de la Ciudad de México.

OBJECTIVE: To determine the normal blood pressure (BP) in pregnancy, Mexico City. METHODS: A cross-sectional observational study was carried out of BP on singleton normal pregnancies in Mexico City. Measurements followed a standardised methodology using automated electronic devices. Reference values of systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) were constructed. Maternal and gestation characteristics effects on BP were tested. The reference ranges of BP were adjusted for significant variables. RESULTS: On 1,056 women of 33 years old mean age and 160.0 cm mean height, 1,915 measurements were made between 5 and 41 weeks of gestational age (GA) with 65.0 kg of mean weight. The median BP throughout pregnancy was 102.7/67.2 ± 9.3/7.4 SD mmHg, and 79.0 ± 7.4 SD mmHg the MAP. BP had a quadratic relationship with GA, being the lowest in 2nd trimester. SBP and DBP had a r = 0.71 linear correlation. Maternal weight had the most significant effect on SBP and MAP; height, on DBP. Maternal age, ethnic origin, parity, tobacco habit and family history had differential effects on BP. Gestation had no significant effect on SBP multivariate model. CONCLUSIONS: BP resulted lower than conventional standard for pregnant women. Diagnostic criteria for hypertension in pregnancy must be revised; reference values can be adjusted by maternal and gestation characteristics.

OBJETIVO: Determinar la presión arterial (PA) normal en embarazadas en la Ciudad de México. MÉTODO: Estudio transversal descriptivo de la PA en embarazos normales de feto único en la Ciudad de México. Las mediciones siguieron un método estandarizado con uso de dispositivos electrónicos automatizados. Se construyeron valores de referencia de las presiones sistólica (PS), diastólica (PD) y arterial media (PAM). Se probaron los efectos de las características maternas y de la gestación sobre la PA. Los intervalos de referencia de la PA se ajustaron para las variables significativas. RESULTADOS: En 1,056 mujeres con edad media de 33 años y 160 cm medios de estatura se realizaron 1,915 mediciones entre las 5 y 41 semanas de edad gestacional (EG) con peso medio de 65 kg. La PA durante el embarazo fue de 102.7/67.2 ± 9.3/7.4 DE mmHg y 79.0 ± 7.4 DE mmHg la PAM. La PA tuvo una relación cuadrática con la EG, la más baja en el segundo trimestre. La PS y la PD mostraron una correlación lineal (r = 0.71). El peso materno tuvo el efecto más significativo sobre PS y PAM; la estatura sobre la PD. La edad, etnia, paridad, consumo de tabaco y antecedente familiar ejercieron efectos diferentes en cada PA. La gestación no tuvo efecto significativo en el modelo multivariado de la PS. CONCLUSIONES: La PA se halló por debajo de la norma convencional en embarazadas. Los criterios diagnósticos para hipertensión en el embarazo deben revisarse; los valores de referencia pueden ajustarse a características maternas y gestacionales.

A Drastic Shift in Lipid Adducts in Colon Cancer Detected by MALDI-IMS Exposes Alterations in Specific K+ Channels.

Even though colorectal cancer (CRC) is one of the most preventable cancers, it is one of the deadliest, and recent data show that the incidence in people <50 years has unexpectedly increased. While new techniques for CRC molecular classification are emerging, no molecular feature is as yet firmly associated with prognosis. Imaging mass spectrometry (IMS) lipidomic analyses have demonstrated the specificity of the lipid fingerprint in differentiating pathological from healthy tissues. During IMS lipidomic analysis, the formation of ionic adducts is common. Of particular interest is the [Na+]/[K+] adduct ratio, which already functions as a biomarker for homeostatic alterations. Herein, we show a drastic shift of the [Na+]/[K+] adduct ratio in adenomatous colon mucosa compared to healthy mucosa, suggesting a robust increase in K+ levels. Interrogating public databases, a strong association was found between poor diagnosis and voltage-gated potassium channel subunit beta-2 (KCNAB2) overexpression. We found this overexpression in three CRC molecular subtypes defined by the CRC Subtyping Consortium, making KCNAB2 an interesting pharmacological target. Consistently, its pharmacological inhibition resulted in a dramatic halt in commercial CRC cell proliferation. Identification of potential pharmacologic targets using lipid adduct information emphasizes the great potential of IMS lipidomic techniques in the clinical field.

Surgical procedure versus medical treatment for infective endocarditis associated to mortality in Mexican population.

BACKGROUND: Early surgical procedures on patients with infective endocarditis (IE) have shown a clearly benefit to reduce embolization at the central nervous system. We conducted a retrospective cohort in Mexican population to evaluate mortality and clinical outcomes in patients with IE with or without surgical intervention. OBJECTIVES: Our aim was to evaluate factors associated with mortality in patients with IE and compare both groups with and without a surgical intervention. METHODS: We evaluated a retrospective cohort of patients who had been diagnosed with IE according to the Duke's criteria at our Institution in SLP, Mexico, from January 2001 to September 2016. We compared the risk factors associated to mortality of patients with or without surgery. Our primary outcome was mortality within 6 months of follow-up after the diagnosis. RESULTS: We included 105 patients, 51 (48.6%) were men, median age 46 [Q1 30, Q3 59] years, 36 patients (34.3%) received surgical treatment (STG), and 69 (65.7%) only medical treatment (MTG) group; 41 patients (39%) died during the study period; in the surgery group eight patients died (22%); and 33 in the MT group (47%) p = 0.049. Adjusted for APACHE II, surgery, creatinine levels and the size of vegetation, the surgery group had lower mortality than patients on MTG (HR 0.36, p = 0.047). CONCLUSION: As previously described in the literature, patients who underwent surgery had lower mortality than the patients who only received medical treatment; however, the Mexican population is different to other populations group, due to higher risk of diabetes mellitus (28%) versus (10%) in global risk of DM in the world and its complications and other chronic diseases as arterial systemic hypertension. Thus, surgical treatment must be elected as goal standard treatment in patient's whit IE and presence of vegetation.

Antecedentes: Los procedimientos quirúrgicos tempranos en pacientes con endocarditis infecciosa (EI) han mostrado un beneficio claro para reducir la embolización en el sistema nervioso central. Realizamos una cohorte retrospectiva en ­población mexicana para evaluar la mortalidad y los resultados clínicos en pacientes con EI con o sin intervención quirúrgica. Objetivos: Nuestro objetivo fue evaluar los factores asociados a la mortalidad en pacientes con endocarditis infecciosa y comparar ambos grupos con y sin intervención quirúrgica. Métodos: Evaluamos una cohorte retrospectiva de pacientes que habían sido diagnosticados de EI según los criterios de Duke en nuestra Institución en SLP, México, desde enero de 2001 a septiembre de 2016. Comparamos los factores de riesgo asociados a la mortalidad de pacientes con o sin cirugía. Nuestro resultado primario fue la mortalidad dentro de los 6 meses de seguimiento después del diagnóstico. Resultados: Se incluyeron 105 pacientes, 51 (48.6%) eran hombres, mediana de edad46 [Q1 30, Q3 59] años, 36 pacientes (34.3%) recibieron tratamiento quirúrgico (STG) y 69 (65.7%) solo grupo de tratamiento médico (MTG); 41 pacientes (39%) murieron durante el período de estudio; en el grupo de cirugía fallecieron 8 pacientes (22%) y en el grupo de MT (47%) 33 p = 0.049. Ajustado por APACHE II, cirugía, niveles de creatinina y tamaño de la vegetación, el grupo de cirugía tuvo menor mortalidad que los pacientes en MTG (HR 0.36, p = 0.047). Conclusión: Como se ha descrito anteriormente en la literatura, los pacientes que se sometieron a cirugía tuvieron menor mortalidad que los pacientes que solo recibieron tratamiento médico, sin embargo, la población mexicana es diferente a otros grupos poblacionales, debido a un mayor riesgo de diabetes mellitus (28%) vs (10%) en otros países y sus complicaciones y otras enfermedades crónicas como hipertensión arterial sistémica. Por tanto, el tratamiento quirúrgico debe ser elegido como principal método de tratamiento en pacientes con endocarditis infecciosa y presencia de vegetaciones.

Validación de la calculadora de la Fundación de Medicina Fetal para tamiz de preeclampsia adaptada a población mexicana / Validation of the Fetal Medicine Foundation calculator for pre-eclampsia screening test adapted to a Mexican population

Resumen OBJETIVO: Validar el rendimiento de la calculadora de la Fundación de Medicina Fetal 4.0 adaptada a población mexicana. MATERIALES Y MÉTODOS: Estudio de cohorte efectuado en embarazos con feto único, según el modelo de riesgos en competencia para preeclampsia en un centro de medicina fetal de la Ciudad de México. El riesgo a priori se calculó de acuerdo con la historia clínica. La presión arterial media, el índice de pulsatilidad medio de la arteria uterina y la proteína plasmática A asociada al embarazo se midieron a las 11 a 14 semanas de gestación con metodología estandarizada. El valor de cada marcador se transformó en múltiplos de la mediana adaptados a la población local. Se aplicaron la distribución normal multivariante y el teorema de Bayes para obtener las probabilidades posprueba individuales, que se utilizaron como clasificadores para el área bajo la curva de característica receptor-operador. RESULTADOS: La incidencia de preeclampsia fue del 5.0% (54/1078). El área bajo la curva de característica receptor-operador fue de 0.784 (0.712; 0.856) para preeclampsia a menos de 37 semanas y de 0.807 (0.762; 0.852) para preeclampsia global. CONCLUSIONES: La calculadora FMF 4.0 adaptada a población mexicana resultó válida. Si bien tuvo menor rendimiento al esperado para preeclampsia a menos de 37 semanas, el rendimiento para preeclampsia global fue satisfactorio. Se justifica desarrollar la calculadora local.

Abstract OBJECTIVE: To validate the performance of the Fetal Medicine Foundation 4.0 calculator adapted to the Mexican population. MATERIALS AND METHODS: Cohort study performed in singleton pregnancies, according to the competing risk model for preeclampsia in a fetal medicine center in Mexico City. The a priori risk was calculated according to the clinical history. Mean arterial pressure, mean uterine artery pulsatility index and pregnancy-associated plasma protein A were measured at 11 to 14 weeks of gestation with standardized methodology. The value of each marker was transformed into multiples of the median adapted to the local population. Multivariate normal distribution and Bayes' theorem were applied to obtain individual posttest probabilities, which were used as classifiers for the area under the receiver-operator characteristic curve. RESULTS: The incidence of preeclampsia was 5.0% (54/1078). The area under the receiver-operator characteristic curve was 0.784 (0.712; 0.856) for preeclampsia at less than 37 weeks and 0.807 (0.762; 0.852) for global preeclampsia. CONCLUSIONS: The FMF 4.0 calculator adapted to Mexican population proved valid. Although it had lower performance than expected for preeclampsia at less than 37 weeks, the performance for global preeclampsia was satisfactory. The development of the local calculator is justified.

Surface engineering for efficient capture of circulating tumor cells in renal cell carcinoma: From nanoscale analysis to clinical application.

Sensitive detection of circulating tumor cells (CTCs) from patients' peripheral blood facilitates on-demand monitoring of tumor progression. However, clinically significant capture of renal cell carcinoma CTCs (RCC-CTCs) remains elusive due to their heterogenous surface receptor expression. Herein, a novel capture platform is developed to detect RCC-CTCs through integration of dendrimer-mediated multivalent binding, a mixture of antibodies, and biomimetic cell rolling. The nanoscale binding kinetics measured using atomic force microscopy reveal that dendrimer-coated surfaces exhibit an order of magnitude enhancement in off-rate kinetics compared to surface without dendrimers, which translated into cell capture improvements by ~60%. Selectin-induced cell rolling facilitates surface recruitment of cancer cells, further improving cancer cell capture by up to 1.7-fold. Lastly, an antibody cocktail targeting four RCC-CTC surface receptors, which included epithelial cell adhesion molecule (EpCAM), carbonic anhydrase IX (CA9), epidermal growth factor receptor (EGFR), and hepatocyte growth factor receptor (c-Met), improves the capture of RCC cells by up to 80%. The optimal surface configuration outperforms the conventional assay solely relying on EpCAM, as demonstrated by detecting significantly more CTCs in patients' samples (9.8 ± 5.1 vs. 1.8 ± 2.0 CTCs mL-1). These results demonstrate that the newly engineered capture platform effectively detects RCC-CTCs for their potential use as tumor biomarkers.

One-step synthesis of polyethyleneimine-coated magnetite nanoparticles and their structural, magnetic and power absorption study.

Magnetic nanoparticles (NPs) are especially interesting for several biomedical applications due to their chemical surface, especially for targeted cancer imaging and therapeutics. In order to realize these applications, it is important to know their magnetic properties among other complementary properties that help to improve the understanding of the synthesis process. In this work, we report the magnetic properties of polyethyleneimine-coated magnetite (PEI-Fe3O4) NPs synthesized by a one-step method via the co-precipitation method and using PEI as a stabilizer. Transmission electron microscopy (TEM) images revealed agglomerated magnetic nanoparticles with an average size of ∼10 nm; meanwhile, the X-ray diffraction (DRX) analysis confirmed a pure magnetite phase. The study of magnetic properties shows a superparamagnetic system with coexistence of non-interacting single NPs with a low blocking temperature (∼35 K) and interacting NPs in the aggregates with a higher blocking temperature (>150 K), in which the interparticle interactions of magnetic cores dominate over surface spin disorder. The interaction between the surface spin-disorder layer and NP core was found to be weak, related to a weak exchange bias effect. A maximum specific loss power (SLP) value of 70 W g-1 was obtained (f = 571 kHz and H = 23.87 kA m-1) indicating that the magnetic response plays a crucial role in determining the heating efficiency for future applications.

Tobacco consumption in the population of Risaralda, Colombia.

INTRODUCCIÓN: El tabaquismo tiene una alta prevalencia en todo el mundo, y genera alta mortalidad, morbilidad e inequidad social. OBJETIVO: Determinar la prevalencia e identificar las características del tabaquismo en la población del departamento de Risaralda, Colombia. MATERIAL Y MÉTODOS: Estudio de corte transversal que incluyó 2084 personas mayores de 18 años residentes en los municipios del departamento de Risaralda, en la región cafetalera de Colombia. Se les preguntó por el consumo de tabaco, el grado de dependencia del tabaco (prueba de Fagerström) y el nivel de ansiedad por el consumo (cuestionario QSU-brief). MATERIAL Y MÉTODOS: El 12% fueron fumadores activos, el 17% exfumadores y un 20-24% convivió, trabajó o estudió con alguien que fumaba. El 94% de los fumadores intentó dejar de fumar y el 67% lo logró por más de 1 año. La mediana de la escala de Fagerström fue de 4 (rango intercuartílico [RIC]: 2-5) y la del QSU-brief fue de 28 (RIC: 16-44). El consumo del cigarrillo sin llegar al filtro (p < 0.001), comprar la caja de cigarrillos entera (p < 0.001), haber intentado dejar de fumar (p < 0.001), consumir café (p < 0.001), desear dejar de fumar (p < 0.001) y fumar aunque se esté enfermo (p = 0.002) aumentaron el riesgo de ser fumador actual, mientras que pedirle el cigarrillo a un amigo o familiar (p = 0.004) y haber dejado de fumar en algún momento (p < 0.001) lo disminuyeron. CONCLUSIONES: La frecuencia de consumo fue alta, pero los niveles de dependencia y ansiedad permiten establecer que un programa de cesación de consumo de tabaco sería exitoso en esta población. Se sugiere aplicar la encuesta definida en esta investigación para identificar a los fumadores actuales e implementar estrategias de cesación de consumo de tabaco en este grupo. BACKGROUND: Smoking has a high prevalence worldwide, generates high mortality, morbidity and social inequity. OBJECTIVE: Determine the prevalence and identify the characteristics of tobacco smoking in the population of Risaralda, Colombia. MATERIAL AND METHODS: Cross-sectional study that included 2084 people over 18 years living in the municipalities of the Department of Risaralda, in the coffee region of Colombia. They were asked about tobacco consumption, level of tobacco dependence (Fagerström test) and level of consumption anxiety (QSU-brief questionnaire). MATERIAL AND METHODS: 12% were active smokers, 17% were ex-smokers and 20-24% lived, worked or studied with someone who smoked. 94% of smokers have tried to stop smoking, and 67% achieved it for more than one year. The median of the Fagerström scale was 4 (interquartile range [IQR]: 2-5) and the QSU-brief was 28 (IQR: 16-44). Consumption of the cigarette without reaching the filter (p < 0.001), buying the whole cigarette package (p < 0.001), having tried to stop smoking (p < 0.001), consuming coffee (p < 0.001), wishing to stop smoking (p < 0.001) and smoking even if sick (p = 0.002) increased the risk of being a current smoker, while asking a friend or family member for a cigarette (p = 0.004) and achieved smoking cessation at some point (p < 0.001), decreased it. CONCLUSIONS: The frequency of consumption was high, due and the levels of dependence and anxiety found, it is possible to propose that a smoking cessation program would be successful in this population. It is suggested to apply the survey defined in this research to identify the current smoker and implement tobacco cessation strategies in this group.

Impact of psychosocial comorbidities on clinical outcomes after liver transplantation: Stratification of a high-risk population.

BACKGROUND: Liver transplantation is the accepted standard of care for end-stage liver disease due to a variety of etiologies including decompensated cirrhosis, fulminant hepatic failure, and primary hepatic malignancy. There are currently over 13000 candidates on the liver transplant waiting list emphasizing the importance of rigorous patient selection. There are few studies regarding the impact of additional psychosocial barriers to liver transplant including financial hardship, lack of caregiver support, polysubstance abuse, and issues with medical non-compliance. We hypothesized that patients with certain psychosocial comorbidities experienced worse outcomes after liver transplantation. AIM: To assess the impact of certain pre-transplant psychosocial comorbidities on outcomes after liver transplantation. METHODS: A retrospective analysis was performed on all adult patients from 2012-2016. Psychosocial comorbidities including documented medical non-compliance, polysubstance abuse, financial issues, and lack of caregiver support were collected. The primary outcome assessed post-transplantation was survival. Secondary outcomes measured included graft failure, episodes of acute rejection, psychiatric decompensation, number of readmissions, presence of infection, recidivism for alcohol and other substances, and documented caregiver support failure. RESULTS: For the primary outcome, there were no differences in survival. Patients with a history of psychiatric disease had a higher incidence of psychiatric decompensation after liver transplantation (19% vs 10%, P = 0.013). Treatment of psychiatric disorders resulted in a reduction of the incidence of psychiatric decompensation (21% vs 11%, P = 0.022). Patients with a history of polysubstance abuse in the transplant evaluation had a higher incidence of substance abuse after transplantation (5.8% vs 1.2%, P = 0.05). In this cohort, 15 patients (3.8%) were found to have medical compliance issues in the transplant evaluation. Of these specific patients, 13.3% were found to have substance abuse after transplantation as opposed to 1.3% in patients without documented compliance issues (P = 0.03). CONCLUSION: Patients with certain psychosocial comorbidities had worse outcomes following liver transplantation. Further prospective and multi-center studies are warranted to properly determine guidelines for liver transplantation regarding this high-risk population.